Transcervical styloidectomy in Eagle's syndrome.

Eagle's syndrome is a rare disease responsible for polymorphic head and neck symptoms, often resulting in delayed diagnosis. The diagnosis of Eagle's syndrome is based on the presence of suggestive clinical signs associated with pain on palpation of the styloid process in the tonsillar fossa, a positive lidocaine test and elongation of the styloid process on 3D CT scan. The most commonly proposed curative treatment is styloidectomy, which allows complete resolution of symptoms in the great majority of cases. This procedure can be performed via a transoral approach or a transcervical approach. After briefly reviewing the embryology and anatomy of the styloid diaphragm region, the authors describe the transcervical styloidectomy technique performed in their department. This simple technique is based on anatomical imperatives designed to limit the operating time and avoid damage to neurovascular structures.

Influence of preoperative imaging on fibula free flap harvesting.

INTRODUCTION: The fibula free flap (FFF) is the gold standard for the reconstruction of large maxillofacial defects. Magnetic resonance angiography (MRA) seems to supersede digital subtraction angiography (DSA) as the reference in preoperative evaluation, being non-invasive and having equivalent diagnostic results. The aim of this study was to assess the impact of preoperative MRA versus DSA on the viability of FFF and its success rate. MATERIAL AND METHODS: A total of 216 patients, who underwent mandibular or maxillary FFF reconstruction from January 1995 to January 2011, were retrospectively included in the study. Of them, 101 patients underwent preoperative DSA and 115 underwent MRA. Recorded criteria were as follows: age, sex, tobacco consumption, defect etiology, preoperative vascular assessment, donor-site choice and flap failure. The DSA group was compared to the MRA group. RESULTS: The harvested side was switched in 15.7% of cases with preoperative MRA versus 4% with DSA. Our success rate was higher (96.1%) with MRA than with DSA (88.1%) (P<0.05). More atherosclerotic patients (P=0.004) were diagnosed through MRA. MRA and DSA showed similar results in anatomical variation detection. CONCLUSION: MRA is less invasive and more effective in atherosclerosis detection than DSA. Therefore, donor-site switching was more frequent in the MRA group, which led to a better success rate. MRA should replace DSA as the reference in preoperative assessment.

[The "left-open abdomen". Technic, indication and results]. / Das "offengelassene Abdomen". Technik, Indikation und Resultate.

Critical evaluation of 22 cases with serious diffuse purulent or fecal peritonitis treated by open abdomen following surgical intervention. Seven (32%) patients died, three because of continuing sepsis and one because of acute haemorrhagic necrotizing pancreatitis. The three other died of general complications (1 coma hepaticum, 2 massive embolisms; at autopsy their abdominal cavity was entirely cleaned. The therapeutic principle of "open abdomen" in cases of severe purulent and fecal peritonitis will be recommendable.