Evaluation of the prevalence and specificities of asymptomatic paranasal sinus aspergillosis: retrospective study of 59 cases.

STUDY OBJECTIVES: To calculate the prevalence of asymptomatic localized paranasal sinus aspergillosis (or fungus ball) in the general population and to compare asymptomatic and symptomatic fungus balls (FB) in order to determine their specificities. MATERIAL AND METHOD: Retrospective study including 59 patients operated for FB between 2006 and 2011 in a single unit. Patients were divided into two groups: asymptomatic patients (group 1, n=10), and symptomatic patients (group 2, n=49). All patients in group 1 were identified by systematic screening for a site of infection prior to cataract surgery during this period (n=6198). All patients were treated by endonasal surgery. Calculation of the prevalence of asymptomatic FB was based on standardization of the source population (normal distribution, 95% confidence interval). The two groups were then compared (clinical context, age, history of root canal treatment, topography, recurrence rate), after randomization test by Student's test and Chi(2) test. RESULTS: The prevalence rate of asymptomatic FB in our study was 1.6/1000 in the population over the age of 55 years. A statistically significant difference was demonstrated between the two groups in terms of the following parameters: more advanced age for patients of group 1, constant history of root canal treatment in group 1, constant maxillary topography in group 1, and higher recurrence rate in group 2. Mean follow-up was 18.7 months (range: 3-49 months). DISCUSSION: This study, the first to determine the prevalence of asymptomatic FB, suggests the existence of very slowly progressive, minimally symptomatic forms, raising the problem of the surgical indications in these patients. CONCLUSION: The prevalence of asymptomatic fungus balls is 1.6/1000. Prospective studies are necessary to justify conservative management in these patients.

Cleft palate associated with cervico-facial teratoma: report of two cases and review of the literature.

We report two original cases of association of cleft palate and lateral cervico-facial teratoma. We discuss the embryological explanation. The first child presented a cleft palate associated with two cervico-facial localisations of teratoma. The other had Pierre Robin sequence associated with lateropharyngeal teratoma with an extra sub maxillary localisation. Most reported cases were of midline teratomas, leading different authors to advance a mechanical origin to the cleft. Our cases are different: we could hardly find reported cases of associate lateral tumours and cleft palate, which would suggest two different embryologic mechanisms, or at least a combination of more complicated phenomenons.

[Modified butterfly cartilage tympanoplasty: retrospective study on 26 patients]. / Tympanoplastie transcanalaire type "butterfly" modifiée: etude rétrospective sur 26 patients.

OBJECTIVE: To assess the results of inlay butterfly tympanoplasty on dry perforation. STUDY DESIGN: Retrospective case study. PATIENTS: 26 patient (14 male, 12 female), mean age 38 years, ranged from 9 to 73. Mean follow up: 20 months. SURGERY: Inlay cartilage butterfly tympanoplasty performed under general or local anesthesia according to the technique originally described by Eavey, with our specific modifications (use of a dermatological punch). RESULTS: 92.3% of perforation closure was obtained; 2 residual perforations and 1 non-epithelialisation were observed. No iatrogenic cholesteatoma was observed. The mean preoperative to post operative four-tone air bone gap improved from 27.67 to 20.1 (mean gain 7.5). CONCLUSION: Inlay butterfly cartilage tympanoplasty is a safe, efficient and easy technique. This technique need more prospective evaluation, and its place among other techniques of tympanoplasty needs to be precised.

[Slide tracheoplasty in congenital tracheal stenosis]. / Hypoplasies trachéales complexes du nourrisson: extension des limites de la "Slide Tracheoplasty".

OBJECTIVES: Slide Tracheoplasty has progressively become the gold standard in the management of long-segment tracheal stenosis in children and infants. However, in certain situations this operation might become difficult and others techniques might be preferred. MATERIAL AND METHODS: Five patients, 1 to 6 month old had surgery by our team, for complex tracheal stenosis between 2001 and 2005. Tracheal hypoplasia was considered complex because it was associated to either: an acquired critical stenosis, a cricoid stenosis, a bronchial stenosis, a tracheal bronchus or associated to oesophageal atresia and severe tracheomalacia. All of them have been treated by a modified slide tracheoplasty. RESULTS: The postoperative status required an average of 15 days in ICU, including 8 days of ventilation. Two patients had laryngeal nerve injury. Medium term follow up (27 months) demonstrated no need for re-intervention, good potential growth and normal child activity. CONCLUSIONS: Slide tracheoplasty can provide good results in certain cases of severe and complex tracheal hypoplasia in infants.