Department of ENT CHU Bretonneau 37000 Tours France
bakhos_d@med.univ-tours.fr
16/06/1977 2007: DIU Rhinologie 2007: Master 2 Sciences Chirurgicales 2008: DIU Carcinologie Cervico-Faciale 2008: Thèse de médecine: Modélisation 3D de l'os temporal
Abstract: OBJECTIVE: To assess the role of the CT-scan in the preoperative evaluation of juvenile otosclerosis and to study additional outcome data. DESIGN AND SETTING: We performed a retrospective case series study from an academic referral hospital using data from 1992 to 2005. PATIENTS AND METHODS: We selected patients younger than 18-year-old who had undergone primary stapedectomy for otosclerosis among the 10 stapedectomies performed over the study period and analyzed the patients' systematic pre- and post-operative audiograms and CT-scan findings. RESULTS: For this survey, complete data was available for 7 children, totaling 10 primary stapedectomies for otosclerosis. Their ages at diagnosis ranged from 10 to 17 years. In 4 children, CT-scan demonstrated bilateral findings typical of otosclerosis: poorly calcified foci near the fissula ante fenestram, associated with a hypodense edging surrounding the labyrinthine capsule in 2 children. The youngest patient had no CT-scan abnormalities. Stapedectomy was performed in one case and laser stapedotomy in 9 cases. Seven children were immediately improved following surgery and no postoperative facial palsy or prolonged vertigo was reported. The mean (S.D.) postoperative ABG was 6.5dB (+/-3.7). The mean closure was 19dB (+/-11.2). The mean change in high-tone bone conduction level was 1.8dB (+/-7.5). Six children had a postoperative ABG less than 10dB while in one, the ABG was inferior to 20dB. CONCLUSION: Preoperative CT-scan is useful for the preoperative diagnosis of otosclerosis in children. The images seen must be distinguished from other footplate pathologies or deformities of the ossicular chain which are often associated with poorer surgical results. This survey provides additional evidence that stapes surgery is an effective procedure for treating juvenile otosclerosis.
Abstract: BACKGROUND.: The aim of the retrospective study was to compare the indications, the postoperative outcomes, and the survival of the supracricoid laryngectomy with cricohyoidoepiglottopexy and the anterior frontal laryngectomy. METHOD.: Nineteen patients who underwent cricohyoidoepiglottopexy (group I) and 23 patients who underwent reconstructive anterior frontal laryngectomy (group II) from January 1992 and December 2004 have been reviewed. We have compared their respective indications and postoperative outcomes. RESULTS.: There were no differences for median time before decanulation. Median time for removal feeding tube, for first oral alimentation, and hospital stay period were significantly shorter in group II. Five-year survival was 85% (group I) and 95% (group II). Local tumor control was obtained in 83% in group I and in 87% in group II. CONCLUSION.: Cricohyoidoepiglottopexia (CHEP) was used more often than anterior frontal laryngectomy when there was contralateral vocal fold spread but resulted in longer postoperative outcomes. (c) 2008 Wiley Periodicals, Inc. Head Neck, 2008.
Abstract: INTRODUCTION:: In vestibular schwannoma (VS) surgery, the arachnoidal duplication, based on an epiarachnoidal origin of the tumor, is reputedly induced by medial growth of tumor and helpful in atraumatic dissection. This study was intended to verify the epiarachnoidal origin of VS. MATERIALS AND METHODS:: We studied 49 human temporal bones (TBs) specimens. Twenty-two TBs from 18 patients with VS were selected. An additional series of 27 TBs without any tumor within the internal auditory meatus were also included. We identified the location of the meninges and the position of the transition zone inside the meatus and described the lateral extension of the subarachnoid spaces. RESULTS:: In VS specimens, psammoma bodies were seen at the fundus along the arachnoidal layer. No connective tissue or protrusion of a psammoma body was observed between the nerves and the VS. High magnification failed to demonstrate any meningeal cleavage plane between the facial or cochlear nerve and the tumor. The subarachnoid space was visible within the internal auditory meatus and extended from the porus to the fundus. In every case, the transition zone, the vestibular ganglion, or the VS was located in the subarachnoid fluid space. CONCLUSION:: We were not able to identify any layer between tumor and the intrameatal contents and did not observe any conjunctive-tissue capsule surrounding the intrameatal VS, as an epiarachnoidal tumor origin would suggest. These observations are in contradiction with the descriptions concerning the epiarachnoidal origin of VS.
Abstract: OBJECTIVE: Describe the management of subglottic stenosis in a patient with Wegener's granulomatosis. MATERIAL AND METHOD: Case report. RESULTS: We report the case of a 26-year-old woman who presented Wegener granulomatosis and subglottic stenosis, with renal, skin, oropharyngeal, nasal, and paranasal locations. Medical treatment had cured all the locations except the subglottic stenosis. An endoscopic dilatation was performed. Two months later, the endoscopic treatment was repeated twice with intralesional corticosteroid injection. One year later, the patient was in complete functional remission. CONCLUSION: Respiratory obstruction in Wegener granulomatosis can result from subglottic stenosis. In this case, intralesional corticosteroid injection seemed to be a good adjunct to local treatment with an effective long-term result.
Abstract: OBJECTIVES: To describe surgical experience in the repair of anterior skull base defects, we studied patients with congenital or acquired defects. According to a multidisciplinary evaluation, all subjects underwent surgery performed by an ENT surgeon in order to avoid craniotomy. DESIGN: Retrospective study of patients who were treated for an anterior skull base defect between 2000 and 2005 at a tertiary referral centre. MATERIALS AND METHODS: Twelve patients had surgery to correct anterior skull base defects. Four patients had spontaneous anterior basal defect and eight had a post-traumatic cerebrospinal fluid (CSF) leakage. The diagnosis was made with imaging studies: Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) scans, possibly supplemented by a cisternography. The defects were repaired using the endoscopic endonasal approach excepted in frontal sinus location. RESULTS: CT and MRI scans demonstrated the defect in all but two cases. In one of them, MR cisternography showed the intranasal sac and in the other CT cisternography demonstrated a CSF fistula without any bone defect at the ethmoid roof. After surgery, the follow-up period was at least 16 months (mean 26 months). Success rate at first attempt was 83%. Two adults needed a second surgical repair with successful outcome in one, increasing the success rate to 92% after the second attempt. One female patient, obese with a body mass index > 30 and hydrocephaly, had a recurrence of CSF leakage despite surgical revision. Postoperative imaging studies, CT scan or MRI, showed that the defect had successfully been repaired in 11 patients. CONCLUSION: High-resolution CT scan, MRI with or without cisternography, should investigate osteo-meningeal defect. Our report confirms that endonasal surgical techniques are useful for treating meningoceles and meningo-encephaloceles. The external route is to be preferred when the lesion is located in the apex of the frontal sinus.
Abstract: OBJECTIVES: To study the circumstances of diagnosis, imaging techniques and therapeutic management of cavernous hemangioma of the nasal cavity. MATERIAL AND METHOD: We report the case of a 60-year-old woman, who presented epistaxis CT scan and nasal obstruction. RESULTS: Rhinoscopy showed a purplish, regular mass that filled the left nasal cavity. Computed tomographic and MRI images showed the tumor in contact close to the middle turbinate. An arteriography with selective embolization was performed. The lesion was completely removed by endonasal endoscopic surgery. The histological examination showed a cavernous hemangioma of the nasal cavity. CONCLUSION: Even if cavernous hemangiomas are rare, the practitioner must suggest the diagnosis if the patient has a purplish bleeding mass of the nasal cavity. CT scan, MRI, and arteriography can help make the diagnosis. Before surgical management, embolization is recommended.
Abstract: INTRODUCTION: Intrathyroid metastases are uncommon. Clinically, the distinction may be difficult with thyroid malignant tumor. CASE REPORT: A 76-year-old woman was referred to our department for an evaluation of a dysphonia. She had a past history of renal cancer 6 months ago. A multinodular goiter was noticed at the palpation. Left recurrent laryngeal nerve palsy was observed; there was no cervical lymph node. Fine-needle aspiration was not contributive. Computed tomography confirmed the multinodular goiter. Total thyroidectomy was performed and final histologic examination revealed a metastasis of a renal cancer. CONCLUSION: Even if intrathyroid metastasis are rare, the practitioner must suggest the diagnosis if the patient had a thyroid tumor and a past history of cancer. A fine-needle aspiration can help the diagnosis. The surgical management is recommended for isolated metastasis to the thyroid gland especially in renal cancer.
Abstract: Neuroendocrine adenomas are rare tumors, which can appear in the middle ear. Approximately a hundred cases have been reported in the literature. We report the case of a 58-year-old man who consulted for an abnormal sensation of fullness in the right ear. The otoscopic examination showed a retrotympanic tumefaction. The CT scan and MRI of the middle ear demonstrated a well-defined tissue mass without any osteolysis. We performed surgical exeresis by transcanal procedure with a cartilage graft tympanoplasty. Microscopic examination and immunohistochemistry revealed an endocrine adenoma of the middle ear. Neuroendocrine adenomas can develop in a number of different sites. When they appear in the middle ear they usually produce hypoacousia. The otoscopic examination shows non-specific findings with only retrotympanic swelling. Surgical exeresis enables histologic and immunohistochemically analysis of the surgical specimen. The adenoma is composed of two cellular types: neuroendocrine (which closely resemble carcinoid tumors) and glandular. Regular clinical and radiologic follow-up is necessary since recurrence is possible. The formal diagnosis of neuroendocrine adenomas of the middle ear requires histologic and immunohistochemically confirmations since the clinical symptoms are non-specific. Surgical excision with removal of the ossicular chain is the treatment of choice in order to prevent recurrence.
Abstract: INTRODUCTION: Congenital isolated tracheo-oesophageal fistulae without oesophageal atresia account for about 4% of tracheo-oesophageal malformations. An Otolaryngologist, even with a paediatric practice, is unlikely to treat a lot of cases during his career. We report 3 cases and discuss the investigations and management of the fistulae. PATIENTS AND METHODS: Three neonates with an isolated congenital tracheo-oesophageal fistula were treated between 1997 and 2002. We describe their presentation, investigation and treatment. We present radiology, endoscopic and surgical images for one case. RESULTS: The mean age at diagnosis of congenital isolated fistula was 6.7 days. In retrospect, the symptoms were usually present from birth. A barium swallow had demonstrated the tracheo-oesophageal fistula in 2 infants. In all three cases the fistula was clearly visualized by tracheoscopy. The most distal fistula was 25 millimetres below the true vocal cords. The closure of the fistula was made by cervicotomy in all cases. Our results are discussed with regards to the literature. CONCLUSION: Congenital tracheo-oesophageal fistulae are rare malformations. Diagnostic delay is common. Tracheo-oesophageal endoscopy is the investigation of choice. Good results are obtained with surgery treatment via a cervical approach. The management of such fistulae requires medical teams familiar with neonatal endoscopy and cervical surgery.
Abstract: INTRODUCTION: Extracranial aneurysm of the internal carotid artery is an exceptional finding. CASE REPORT: An 89-year-old woman consulted for a peritonsillar mass. Physical examination revealed a parapharyngeal pulsatile mass in the oropharynx. Computed tomography (CT) provided the diagnosis of extracranial internal carotid artery aneurysm. Endovascular or surgical treatment were declined. Anticoagulation medication was given. DISCUSSION: We reviewed the CT and magnetic resonance imaging findings and the clinical manifestations of extracranial internal artery aneurysm. Endovascular treatment is an alternative to open surgery.
