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Thiel's body preservation method allows the donor body to retain color and soft tissue that are similar to those of a living individual. Since its initial description, the technique has not been developed much. Here, we propose a simpler protocol applied to the head and neck, making the technique easier, cheaper, and more accessible to a greater number of medical schools.The modified Thiel technique was applied to three heads separated from the body, followed by 6 h of perfusion and 6 weeks of fixation. This technique was compared with formalin (three heads) and freeze (three heads) preservations during academic training in head and neck surgery. Anatomical dissections included a parotid gland dissection, a submandibular gland dissection, an otologic and an endonasal dissection. Twelve surgeons blindly assessed the three types of preservations using a standardized questionnaire.The modified Thiel technique made possible better quality of dissection and tissue identification, with the exception of endonasal dissection. Concerning the endonasal dissection, the modified Thiel technique ranked best for smell, but all other criteria ranked lower than the freezing method. For the submandibular and parotid gland dissections, the modified Thiel technique was ranked best, with statistically significant differences (p 0.002) for all items. The modified Thiel technique also ranked significantly better during otologic surgery regarding the quality of the skin/eardrum, bone, and muscle, and the smell.This study demonstrated that the modified Thiel technique is an embalming technique which improves the quality of head and neck surgical anatomy education.

BACKGROUND: The objectives were to assess the prevalence, severity, and medication taken, and to look for predictive factors in order to better identify characteristics of passengers at risk of motion sickness during transport from Hobart in Tasmania to the French polar stations in Antarctica. METHODS: There were 239 passengers who were surveyed over 4 yr with 4 round trips per year using the Motion Sickness Susceptibility Questionnaire (MSSQ), Simulator Sickness Questionnaire (SSQ), state-trait anxiety test (STAI-Trait and STAI-State), and general parameters (age, gender, number of trips, jet-lag, direction of the trip), medication, calculation of the distance of each passengers cabin to the center of gravity (CoG). RESULTS: While the passengers had a low intrinsic sensitivity to motion sickness (MSSQ), 94 reported at least one SSQ symptom of motion sickness, and 38 vomited. Five associated factors were discovered: greater initial sensitivity (MSSQ), anticipation of being ill, younger age, higher level of anxiety at midtrip, and greater distance from the CoG. Of the passengers, there were 54 who took anti-motion sickness medication at different times of the trip, however, these passengers experienced more nausea. This could be due to self-selection since they were more sensitive to motion sickness. CONCLUSION: We identified three predictive factors of motion sickness (greater intrinsic susceptibility, younger age, and greater cabin distance from the CoG). For preventive purposes, two associated factors of MS (anticipation of being ill, MSSQ score) were determined to classify three groups of risk of MS to improve passenger care during the trip. Besnard S, Bois J, Hitier M, Vogt J, Laforet P, Golding JF. Motion sickness lessons from the Southern Ocean. Aerosp Med Hum Perform. 2021; 92(9):720727.

Resume La sinusotomie de type Draf III est une des chirurgies les plus complexes du sinus frontal. Elle permet de limiter les risques de restenose en reunissant les deux ostia et en resequant le plancher sinusien. Sa realisation necessite de bonnes connaissances anatomiques et une experience chirurgicale certaine pour eviter tout risque de breche meningee et limiter les risques de restenose. Pour cela, le chirurgien peut s’aider des differents foramens, sillons osseux et arteres situes a la partie anterieure de la lame criblee. Le but de cette note technique est d’en expliciter l’utilisation pour la realisation en toute securite de la sinusotomie frontale de type Draf III par voie mediale.

To compare two types of CT acquisition parameters: CT scan of the facial bone and CT scan of the sinuses, for studying the ethmoidal slit and its relationship with the frontal sinus and anterior ethmoidal artery.Retrospective study of 145 scans of the sinuses and 79 of the facial bones performed between 2012 and 2016. On each scan, the visibility of the ethmoidal slits, their length, their distance from the ethmoidal artery, and their relationship with the anterior and posterior wall of the frontal sinus were studied.The ethmoidal slit was better visualized on CT scans of the facial bone (58.2%) than on those of the sinuses (43.1%) (p = 0.02). The distance between the anterior ethmoidal artery and the anterior part of the cribriform plate was 9.3 mm for CT scans of the facial bone and 8.4 mm for CT scans of the sinuses. The theoretical risk of damaging the glabellar soft tissue and that of damaging the meninges during a frontal sinusotomy was evaluated, respectively, at 9.6% and 26.1% for CT scans of the facial bone, and at 6.2% and 21.5% for sinus scans.CT scans of the facial bone are better than CT scans of the sinuses for identifying ethmoidal slits and their distance from the canal of the anterior ethmoidal artery. The identification of these elements is relevant for the surgeon during frontal sinus surgery and makes it possible to assess the risk of damaging the glabellar soft tissue or meninges. Performing a CT scan of the facial bone seems preferable to that of a CT scan of the sinuses in certain pathological situations, such as cerebrospinal rhinorrhea or revision surgeries of the frontal sinus.

Background Despite the development of anterior skull base surgery, the anatomy of the nasal bone and anterior cribriform plate remains unclear. A recent study confirmed 2 distinct foramina in the anterior part of cribriform plate: the ethmoidal slit (ES) and the cribroethmoidal foramen (CF). The aim of this study was to specify their content, their anatomic relationship to the frontal sinus and skull base, and their potential value in skull base surgery. Methods Dissections were performed on 36 cadaver heads. Macro- and microscopic examinations were carried out. Microcomputed tomography scans contrasted with osmium were performed to identify vessels and nerves. Histology with neural, meningeal, or luteinizing hormone-releasing hormone immunomarkers was performed on the content of the foramina. Finally, endonasal surgical dissections were carried out. Results The ES and the CF were observed in all cases. They measured a mean of 4.2 and 1.6 mm, respectively. The ES contained dura mater, arachnoid tissues, lymphatics, and the terminal nerve. The CF contained the anterior ethmoidal nerve and artery. This foramen continued forward with the cribroethmoidal groove, which measured a mean of 2.5 mm. This groove was under the frontal sinus and in front of the skull base. We also described a "cribroethmoidal canal" and a "nasal bone foramen." Conclusion The clinical applications of this new anatomic description concern both cribriform plate and frontal sinus surgeries. Identifying the terminal nerve passing through the ES is a step forward in understanding pheromone recognition in humans.

Resume La rhinoplastie, qu’elle soit par voie externe ou dissimulee se realise classiquement dans le plan sus-perichondral c’est-a-dire sous le SMAS. Depuis quelques annees ont ete decrites des voies d’abord sous-perichondrales totales et sous periostees permettant une large exposition de l’ensemble de la charpente osteo-cartilagineuse du nez. Cette dissection plus profonde necessite une adaptation de l’instrumentation pour a la fois realiser la dissection sous-perichondrale et sous-periostee, mais aussi pour la realisation des osteotomies. De nouveaux outils tels que les moteurs de rhinosculpture ou piezoelectriques trouvent alors tout leur interet. L’acquisition de cette technique de dissection, bien que necessitant une courbe d’apprentissage importante, est cependant largement recompensee par son interet dans les rhinoplasties primaires ou secondaires. Le but de cette note technique est de decrire en detail la technique operatoire ainsi que l’instrumentation necessaire a sa realisation.

Resume L’endoscope et le microscope peuvent etre utilises conjointement dans certaines localisations comme le cholesteatome de l’oreille moyenne ou pour l’exerese de tumeurs de l’angle pontocerebelleux. Dans le cas de tumeurs de l’apex petreux, celles-ci sont classiquement abordees par voie otologique laterale, ou pour les plus anterieures, par voie endonasale endoscopique. Par voie laterale l’acces est limite en bas par le golfe jugulaire ; medialement par le labyrinthe, le nerf facial et le conduit auditif interne ; en haut par la dure-mere ; et lateralement par la carotide interne. Par voie anterieure endonasale, le corridor forme par l’artere carotide interne et la meninge paraclivale limite l’acces a la partie posterieure de l’apex petreux, limitant cette approche a certains granulomes a cholesterine ou petits cholesteatomes. Aucune de ces voies n’est a elle seule suffisante en cas de lesion extensive de l’apex petreux. Le but de cette note technique est de decrire la voie microscopique/endoscopique combinant l’utilisation sequentielle du microscope puis de l’endoscope par voie laterale en cas de volumineuse lesion de l’apex petreux.

It has become well established that vestibular information is important for hippocampal function and spatial memory. However, as yet, relatively little is known about how different kinds of vestibular information are 'represented' in different parts of the hippocampus. This study used selective electrical stimulation of each of the 5 vestibular sensors (the horizontal (HC), anterior (AC) and posterior (PC) semi-circular canals, and the utricle and saccule) in the rat and recorded local field potentials (LFPs) across the hippocampus, using a 16 electrode microarray. We found that stimulation of any vestibular sensor in the left labyrinth evoked triphasic LFPs in both hippocampi, although it was clear that, in general, the amplitudes were greater for the right, contralateral side. This was particularly true for Phase 1 for the HC, AC, utricle and saccule, Phase 2 for the HC, PC, utricle and saccule, and Phase 3 for the AC, PC and saccule. Overall, our results suggest that vestibular input to the hippocampus is bilateral, preferentially contralateral, but highly stratified in that stimulation of the same vestibular sensor results in activation of different specific areas of the hippocampus, with different LFP amplitudes and latencies. This suggests the possibility that different regions of the hippocampus use different kinds of vestibular information for different purposes and that there may be a high degree of redundancy in the representation of vestibular input, perhaps ensuring that the hippocampus is more robust to the partial loss of vestibular information.

Draf III frontal sinusotomy is one of the most complex surgical procedures on the frontal sinus, designed to limit the risks of restenosis by ensuring unification of the two ostia and resection of the floor of the sinus. This procedure requires a good knowledge of anatomy and sufficient surgical expertise to avoid the risk of CSF leak and to limit the risk of restenosis. The surgeon can use various landmarks, consisting of foramina, bone grooves and arteries located on the anterior part of the cribriform plate to guide the procedure. The purpose of this technical note is to explain the use of these landmarks to ensure safe Draf III frontal sinusotomy via a medial approach.

The hippocampus is a brain structure well known for its importance to spatial learning and memory. As such it is assumed to use multisensory integration in order to generate mathematical maps of the spatial environment. Auditory inputs to the hippocampus have been described to a limited extent. Although it has been demonstrated that natural auditory stimulation can evoke local field potentials (LFPs) and single neuron responses in the hippocampus, and that noise trauma and tinnitus can cause maladaptive hippocampal plasticity, to the best of our knowledge no one has selectively, electrically stimulated the cochlea and recorded electrophysiological responses in the hippocampus. Here, we used unilateral electrical cochlear stimulation in rats while recording LFPs in the hippocampus bilaterally, with a multi-electrode array. We observed triphasic LFP responses bilaterally from unilateral stimulation, but with larger amplitudes on the contralateral side, especially for Phase 1 and 3 of the LFP, for which the latencies were also longer. The latencies under urethane anaesthesia were consistent with auditory information from the cochlea travelling across approximately 6-7 synapses. These data demonstrate that the cochlea contributes a powerful auditory input to the hippocampus, which is also lateralized, and may have implications for spatial cognition in cochlear implant patients.

International audience; There is substantial evidence that loss of vestibular function impairs spatial learning and memory related to hippocampal (HPC) function, as well as increasing evidence that striatal (Str) plasticity is also implicated. Since the N-methyl-d-aspartate (NMDA) subtype of glutamate receptor is considered essential to spatial memory, previous studies have investigated whether the expression of HPC NMDA receptors changes following vestibular loss; however, the results have been contradictory. Here we used a novel flow cytometric method to quantify the number of neurons expressing NMDA receptors in the HPC and Str following bilateral vestibular loss (BVL) in rats. At 7 and 30 days post-op., there was a significant increase in the number of HPC neurons expressing NMDA receptors in the BVL animals, compared to sham controls (P ≤ 0.004 and P ≤ 0.0001, respectively). By contrast, in the Str, at 7 days there was a significant reduction in the number of neurons expressing NMDA receptors in the BVL group (P ≤ 0.05); however, this difference had disappeared by 30 days post-op. These results suggest that BVL causes differential changes in the number of neurons expressing NMDA receptors in the HPC and Str, which may be related to its long-term impairment of spatial memory.

Objectif Etude descriptive de l’institut d’anatomie de Graz, Autriche, selon le point de vue d’un etudiant en medecine francais. Methode Les informations ont ete recueillies durant un stage de 6 semaines a partir de documents officiels, d’entretiens et d’observations personnelles. Resultats Fonde en 1771, l’institut d’anatomie de Graz reste dirige par des anatomistes dedies. Sans aucune activite clinique, les 5 enseignants titulaires consacrent exclusivement leur temps a la recherche et a l’enseignement de l’anatomie. Celui-ci s’adresse aux etudiants paramedicaux et biologistes, mais surtout aux etudiants de medecine avec 380 heures d’Anatomie dispensees en 2 ans. Il se base sur des cours magistraux, avec dessins a la craie ou sur papier retro-projetes, et demonstration de preparations anatomiques. Parallelement aux cours magistraux, les etudiants ont acces au musee de l’institut et peuvent etudier ces preparations anatomiques en autonomie. Dissections et travaux pratiques sur preparations anatomiques, font partie des piliers de la formation au sein de l’institut, car representent la moitie du temps de cours. L’enseignement s’appuie egalement sur un tutorat forme de 42 etudiants des annees superieures, recrutes sur entretien et remuneres. Malgre le nombre important d’etudiant (360 chaque annee), les examens sont principalement realises a l’oral. L’activite de recherche est faite par les anatomistes, avec possible collaboration de medecin ou d’etudiant, et produit une quinzaine de publication/anatomiste/an. Ces activites s’appuient sur un budget de 420 000 €/an. Conclusion L’institut d’anatomie de Graz offre un enseignement traditionnel avec une implication forte des etudiants, favorisant le dialogue et les echanges pedagogiques. Cet enseignement apparait comme une ecole d’excellence, ou l’anatomie occupe une place fondamentale dans les etudes medicales, et illustrent parfaitement les mots de l’anatomiste autrichien Werner PLATZER : « L’anatomie sans clinique est morte, la clinique sans anatomie est mortelle ».

We report the first case of a newborn presenting with a celio-mesenteric trunk variation associated with a giant omphalocele. The celio-mesenteric trunk was unexpected and unseen during the staged surgical closure. After partial reintegration of the liver, the newborn presented refractory hypovolemia with anuria, leading to redo surgery. This procedure revealed ischemia of the liver and necrosis of the entire gastrointestinal tract except the colon. Despite treatment, including liver externalization, the infant did not survive. The autopsy revealed a celio-mesenteric trunk, a rare anomaly characterized by a common origin of the celiac axis and the superior mesenteric artery from the aorta. This association may explain the dramatic consequences of the staged closure procedure. Awareness of the association of celio-mesenteric trunk and omphalocele would allow the surgeon to take extra care during this delicate surgery.

Introduction/Objectifs La zone de transition entre les cartilages alaire et triangulaire du nez est une zone capitale pour la fonction respiratoire. Ces deux cartilages s’articulent entre eux et participent a la valve interne du nez dont la dysfonction est responsable d’une obstruction nasale invalidante [1] . Preserver cette fonction lors de la rhinoplastie est donc essentielle pour eviter tout trouble fonctionnel postoperatoire. Jusqu’a present, on pensait que les deux cartilages etaient unis par une gaine perichondrale simple, voire une continuite cartilagineuse [2] , [3] . Les constations peroperatoires de Cakir et Saban pendant les rhinoplasties conservatrices vont a l’encontre de ces notions et font etat de 2 cartilages ou plus interposes entre le cartilage triangulaire et alaire. Le but de cette etude etait de verifier ces assertions par une dissection minutieuse de la region alo-triangulaire. Materiel et methodes Huit nez sur piece anatomique (16 cotes) ont ete disseques sous microscope au niveau des cartilages alaires et triangulaires par abord sous-perichondral. Au niveau de la jonction alo-triangulaire, les tissus mous etaient minutieusement disseques pour visualiser les structures cartilagineuses, les denombrer et les mesurer. Resultats La jonction alo-triangulaire comportait 4 a 12 cartilages, mesurant chacun entre 0,5 et 10 mm de long. On observe une grande variation interindividuelle et intra-individuelle entre le cote droit et gauche. Dans la majorite des cas, on remarque la presence d’un cartilage de taille plus importante en position posterieure (cartilage majeur), associe a plusieurs cartilages de plus petite taille en position plus anterieure (cartilages mineurs). Conclusion De nombreux cartilages sont presents a la jonction alo-triangulaire. Leur connaissance est essentielle pour permettre de les conserver au cours de la chirurgie, et preserver ainsi la fonction de la valve en postoperatoire.

Ethmoidal slit (ES) and cribroethmoidal foramen (CF) have been poorly studied, without any radiological description. They may ease cribriform plate's diseases. The objective was to describe the frequency, size, and computed tomography (CT) appearance of these foramina.A two-part anatomoradiological study was performed: first on dry skulls using a surgical microscope and CT, second on patients CT scans. For each, foramina were searched for, described, and measured when possible.Thirteen dry macerated skulls were studied. The orbitomeatal plane was relevant for studying ES. With microscope, ES and CF were identified in, respectively, 92% and 100% of cases. Using CT, all ES and CF were visible, with a mean length and width of, respectively, 3.9 ± 1.7 mm and 0.9 ± 0.3 mm for ES and 1.6 ± 1 mm and 0.9 ± 0.3 mm for CF. CT scans from 153 patients were reviewed. ES and CF were identified in, respectively, 80% and 91% of cases, with a mean length and width of, respectively, 3.9 ± 0.8 mm and 0.8 ± 0.2 mm for ES.Large-sized ES was found frequently, and were clearly visible in patients CT scans. CF was markedly smaller, but seen in most patient scans. ES and CF could be areas of least resistance in the anterior part of the cribriform plate. CT might be helpful in understanding their pathological implications.

International audience

Resume Les breches meningees du sinus frontal sont rares et leur prise en charge chirurgicale difficile. Jusqu’a recemment, elles necessitaient la realisation d’un abord chirurgical externe avec volet osseux de table externe. Depuis le developpement de la chirurgie endoscopique, des techniques moins invasives telles que des abords endoscopiques exclusifs sont apparues et permettent aujourd’hui des suites operatoires plus simples. Neanmoins, la realisation de ces techniques requiert une connaissance approfondie de l’anatomie du sinus frontal et de la prise en charge endoscopique des breches meningees. Cette connaissance est essentielle pour assurer a la fois la fermeture de la breche et preserver la permeabilite du sinus frontal.

International audience; Frontal sinus cerebrospinal fluid leaks are rare and their surgical management is difficult. Up until recently, they could only be treated by open surgery with an osteoplastic flap. With the development of endoscopic surgery, less invasive techniques such as an exclusive endoscopic approach can now be used, ensuring a simpler postoperative course. However, these techniques require a thorough knowledge of frontal sinus anatomy and endoscopic CSF leak repair. This knowledge is essential both to ensure closure of the CSF leak and to preserve frontal sinus patency.

Il y a plus d’un siecle, le nerf terminal (NT) etait clairement identifie comme un nerf crânien, la paire crânienne 0. Depuis il a ete decrit chez l’animal, ou il est suppose jouer un role dans la detection des pheromones. Neanmoins, chez l’Homme adulte le NT est une structure meconnue, autant sur le plan anatomique que physiologique. L’objectif de notre etude a ete de caracteriser le trajet endonasal du NT, ainsi que d’etudier les relations qu’il pourrait entretenir avec les differentes structures de la muqueuse nasale, notamment avec l’organe vomero-nasal. Nous avons pour cela inclus un total de 18 cadavres. Ceux-ci ont ete analyses selon 3 axes de recherche, une etude par dissection (9 cadavres), une etude anatomopathologique (5 cadavres) et une etude radiologique (4 cadavres). Le NT est compose d’en moyenne 3 ± 0,86 [2–5] fibres plexiformes ganglionnaires sur l’ensemble de son trajet. Le passage au niveau de la base du crane se fait exclusivement par la fente ethmoidale, ensuite les branches du NT cheminent vers le bas et l’avant de la cloison nasale pour se terminer a environ 13 mm ± 4,5 [8–24] du plancher des fosses nasales, juste en avant de l’organe vomero-nasal. Au sein de la cavite nasale ces branches ont une longueur de 40,5 mm ± 2,5 [37–45]. Sur le plan anatomopathologique, le cytosquelette du NT est compose de neurofilament lourd (SMI31), parmi ces fibres certaines contiennent de la GnRH et un neurotransmetteur de type neuropeptide Y. D’autre part, l’organe vomero-nasal semble etre le siege d’un important reseau neuronal, avec la presence de neurones olfactifs matures ainsi qu’un reseau peri-neuronal (WFA). Cette etude nous a permis d’approfondir les connaissances du nerf terminal chez l’Homme adulte, en precisant son anatomie extra-crânienne et ses caracteristiques anatomopathologiques, ainsi que d’objectiver une impregnation neuronale de l’organe vomero-nasal.

Introduction L’anatomie chirurgicale de l’os temporale est classiquement enseignee aux chirurgiens en debutant sur des os normaux issus de pieces anatomiques ou imprimes en 3D [1] , [2] . Cependant la chirurgie reelle est souvent plus complexe car les reperes anatomiques peuvent etre partiellement modifies par des pathologies, comme le cholesteatome. Nous proposons ici un modele de rocher synthetique reproduisant celui d’un patient atteint d’un cholesteatome, afin de permettre une etape intermediaire entre l’apprentissage sur rocher normal et le traitement du patient. Materiel et methode Le scanner d’un patient atteint de cholesteatome a ete segmente avec 3D Slicer en individualisant les reperes anatomiques importants : nerf facial, meninges, sinus sigmoide, osselets et canal semi-circulaire lateral. Le modele etait ensuite imprime en deux parties (imprimante 3D Objet30, Sculpteo) afin de placer a l’interieur les tissus mous colores en latex, et le cholesteatome fait d’un melange de latex et de poudre d’amande. Le modele etait opere par 4 chirurgiens hospitalo-universitaires independants et evalue en utilisant une echelle de Likert en sept points. Resultats Les enseignants d’otologie considerent le modele synthetique tres interessant pour l’enseignement chirurgical (5/7) et souhaiteraient l’acheter a un prix raisonnable dans leur centre (5,25/7). La correspondance anatomique avec le scanner est bonne pour les cellules mastoidiennes (5,25/7), le canal semi-circulaire lateral (5/7), le nerf facial (5/7), et la localisation du cholesteatome (4,75/7). La consistance des tissus mous fins reste differente de la realite pour l’aspect visuel du cholesteatome (2,75/7) et de la membrane tympanique pathologique (1,75/7). Discussion et conclusion Ce nouveau modele de rocher permet une formation a la chirurgie au plus proche de la realite clinique, avec possibilite d’analyse preoperatoire du scanner. Le modele est bon pour tous les reperes anatomiques entoures d’os, qui sont les plus importants pour l’apprenti chirurgien.

Introduction/Objectifs Les cartilages du nez sont des cartilages hyalins, composes de chondrocytes et d’une matrice extra-cellulaire (essentiellement du collagene). Ils sont entoures de perichondre, une enveloppe de tissu conjonctif qui sert pour la regeneration de son cartilage [1] , [2] , [3] . Au cours de la rhinoplastie conservatrice dont les premieres descriptions sont recentes, la voie de dissection sous-perichondrale passe en theorie entre le perichondre et le cartilage sous-jacent [4] . Le but de cette etude est de verifier en histologie la veracite de ce plan de dissection et d’etudier l’histologie du cartilage du nez pour faciliter la comprehension de la rhinoplastie conservatrice. Materiel et methodes Six nez sur piece anatomique ont ete disseques en monobloc, et un septieme d’abord disseque en sous-perichondral. Les nez ont ensuite ete fixes et inclus en paraffine. Des coupes ont ete realisees et les lames obtenues ont ete colorees en parallele avec une coloration HES-orceine et avec le trichrome de Masson. Les lames ont ete analysees au microscope optique. Resultats Nous avons mis en evidence un perichondre au niveau de toutes les structures cartilagineuses du nez et avons note une difference d’epaisseur des cartilages en fonction de leur localisation, notamment l’epaisseur plus importante du perichondre septal et de la partie haute du dorsum par rapport au perichondre alaire et triangulaire. Les colorations ont permis de montrer la presence de fibres de collagene au sein de ce perichondre, et de distinguer deux couches : une premiere couche externe fibreuse, et une seconde plus interne, cellulaire. Le plan de dissection sous-perichondral passe entre le cartilage et la couche interne. Conclusion La dissection sous-perichondrale permet d’eviter de leser des structures vasculaires ou nerveuses, et d’eviter le developpement d’une fibrose en postoperatoire. Neanmoins, detacher la couche chondrogene du cartilage sous-jacent pose la question des consequences sur ce cartilage.

European Annals of Otorhinolaryngology, Head and Neck Diseases - Vol. 135 - N° 2 - p. 143-144

International audience

A new endovascular treatment consisting of stent-assisted coil implantation is described for jugular bulb abnormalities causing symptomatic vestibular aqueduct dehiscence. Three patients presenting with vertigo associated with pulsatile tinnitus or hearing loss were treated. This technique cured the vertigo and pulsatile tinnitus in all patients and preserved normal cerebral venous drainage with no side effects.

Annales Francaises d'Oto-Rhino-Laryngologie et de pathologie cervico-faciale - Vol. 135 - N° 2 - p. 140-141

International audience

Objectif Les primates hominoides (humain, Chimpanze, Gorille, Orang-outang et Gibbons) possedent des orbites convergentes qui favorisent la vision binoculaire et stereoscopique (vision precise) mais limite le champ visuel lateral. Cependant, une etude recente montre que l’humain elargit son champ visuel de plus de 60° grâce aux mouvements oculaires (champs visuel dynamique). Nous cherchons a comprendre les bases anatomiques de cette performance et savoir si elles sont presentes chez les autres primates hominoides. Methode Les orbites de 100 humains (47 hommes/36 femmes), 30 Chimpanzes, 30 Gorilles, 30 Orangs-outangs, et 30 Gibbons ont ete analysees en mesurant leur angle de convergence et leur angle d’ouverture laterale ainsi que le rapport largeur/hauteur. Ces parametres sont compares selon les genres et modelises pour evaluer le retentissement sur le champ visuel dynamique. Resultats Le genre humain possede une orbite significativement bien plus large (largeur/hauteur = 1,19) que les autres hominoides (p Discussion La forme de l’orbite humaine se distingue des autres hominoides et permet a la fois une vision binoculaire precise et un champ visuel elargi lors des mouvements oculaires. Cette caracteristique pourrait resulter de l’evolution de l’homme dans un milieu ouvert ou la detection des predateurs est essentielle a la survie, tandis que l’orbite des hominoides arboricoles est plus fermee lateralement, protegeant mieux l’œil face aux traumatisme des branches.

The stapedial artery is an embryonic artery which disappears during the tenth week in utero, in human species. During its short life, this artery shapes the stapes and transforms the middle meningeal artery from the internal carotid artery to a branch of the external carotid system. Nevertheless, a persistent stapedial artery is seen in 0.2-4.8 per thousand of human adults. This persistence is usually asymptomatic but can sometimes cause pulsatile tinnitus or conductive hearing loss. Despite the risk of facial palsy, hearing loss and even hemiplegia argued by several authors, some surgeons have succeeded in coagulation without side effects. Reviewing the literature, we seek to enlighten the actual knowledge about the persistent stapedial artery to evaluate the risk to coagulate it. Embryologic studies explain the four types of persistent stapedial arteries: the hyoido-stapedial artery, the pharyngo-stapedial artery, the pharyngo-hyo-stapedial artery and aberrant internal carotid with persistent stapedial artery. Phylogenetic studies show that the stapedial artery persists in adulthood in many vertebrates. Its disappearance is therefore either a random effect or an adaptative convergence. This adaptation could be partially linked to the negative allometry of the stapes. Practically, the risk to coagulate a stapedial artery seems limited thanks to anastomoses, for example with the stylomastoid artery. The risk of hemiplegia reported is in fact an extrapolation of variation in rats' embryos. A persistent stapedial artery can therefore reasonably be coagulated, with special attention to the facial nerve, because the facial canal is always dehiscent where the artery penetrates.

Several animal models of vestibular deficits that mimic the human pathology phenotype have previously been developed to correlate the degree of vestibular injury to cognate vestibular deficits in a time-dependent manner. Sodium arsanilate is one of the most commonly used substances for chemical vestibular lesioning, but it is not well described in the literature. In the present study, we used histological and functional approaches to conduct a detailed exploration of the model of vestibular lesions induced by transtympanic injection of sodium arsanilate in rats. The arsanilate-induced damage was restricted to the vestibular sensory organs without affecting the external ear, the oropharynx, or Scarpa's ganglion. This finding strongly supports the absence of diffusion of arsanilate into the external ear or Eustachian tubes, or through the eighth cranial nerve sheath leading to the brainstem. One of the striking observations of the present study is the complete restructuring of the sensory epithelia into a non sensory epithelial monolayer observed at 3months after arsanilate application. This atrophy resembles the monolayer epithelia observed postmortem in the vestibular epithelia of patients with a history of lesioned vestibular deficits such as labyrinthectomy, antibiotic treatment, vestibular neuritis, or Ménière's disease. In cases of Ménière's disease, aminoglycosides, and platinum-based chemotherapy, vestibular hair cells are destroyed, regardless of the physiopathological process, as reproduced with the arsanilate model of vestibular lesion. These observations, together with those presented in this study of arsanilate vestibular toxicity, suggest that this atrophy process relies on a common mechanism of degeneration of the sensory epithelia.

International audience; Vestibular function after cochlear implantation is difficult to understand, as subjective vestibular symptoms seem uncorrelated with the results of objective tests. Consequently, clinicians may struggle to decide what assessments to perform for a symptomatic patient. We used a systematic review and meta-analysis approach to enlighten this point. After a study inclusion process, results were classified into four different groups for each test in each study: (1) ‘true positive’ if the test showed impairment from pre-operative to post-operative in symptomatic patients; (2) ‘false positive’ if the test showed impairment from pre-operative to post-operative in asymptomatic patients; (3) ‘true negative’ if the test showed no impairment in asymptomatic patients; and (4) ‘false negative’ if the test showed no impairment in symptomatic patients. From these groups, sensitivities and specificities of each test were calculated in a meta-analysis. After reviewing more than 3000 references, 16 studies were included, representing 957 patients. The meta-analysis revealed a sensitivity of 0.21 (CI 95 % 0.08–0.40) for the caloric tests, of 0.32 (CI 95 % 0.15–0.54) for the cervical vestibular evoked myogenic potentials (c-VEMP), and of 0.5 (CI 95 % 0.07–0.93) for the head impulse tests. The analysis of prevalence revealed that c-VEMPs were the most often impaired, and the HIT the most often conserved. Our review and meta-analysis revealed that no vestibular test is sensitive enough to be recommended as a single test. Ideally, all the five vestibular sensors should be tested. In clinical practice, we suggest a case-to-case strategy according to patient’s symptoms and their suspected origin.

Throat cancer has always struck people's imagination. This type of cancer affects some of the patient's most essential physiological functions: speaking, swallowing and breathing. At advanced stages, radical surgery is disabling. The impact of a mutilated larynx corresponds to a very real trauma that is both individual and social. Our aim is to define how a total laryngectomy (TL) is represented by both the surgeon and the patient. The history of TL makes it possible to understand the changes that were needed for the key players in the subject to impose or accept this operation. Without doubt, the implementation of the "cancer plan" in the early 2000s was a major turning point in the management of patients with neoplasia. Increased awareness among the elite, encouraged by the mobilisation of patients and their families, is the explanation for the new role played by TL in 2008. The progress made in medical and surgical techniques, modifications to the patient-carer relationship and the appearance of the concept of Quality of Life are all themes that have changed the approach to this operation and the management of patients undergoing a TL.

OBJECTIVES: The aim of this study was to evaluate psychosocial quality of life (PQoL) in patients with Hereditary Haemorrhagic Telangiectasia (HHT). STUDY DESIGN AND SETTING: A retrospective study was performed on PQoL in HHT patients presenting with epistaxis. One hundred fifteen patients were interviewed using a questionnaire designed by two sociologists and a head and neck surgeon. Changes over time were assessed according to information on psychosocial well-being, social life, family support, occupation, and medical and demographic data regarding age, gender and patient appearance. RESULTS: Analysis of Psychosocial Quality of Life (PQoL) revealed no statistical difference in relation to gender, marital status, household income or place of residence (rural or urban); however, a significant difference was observed with age. Elderly patients had a poorer PQoL than younger patients. Workers had a better PQoL than unemployed patients. Epistaxis and professional duties were correlated: workers with less than one episode of epistaxis per month were more active. Frequent episodes of epistaxis and abundant bleeding decreased PQoL. These patients felt different and often experienced a desire to withdraw compared to others. CONCLUSION: Epistaxis in hereditary haemorrhagic telangiectasia patients was associated with the impairment of many PQoL criteria, together with relationship modifications.

Souvent oublie a cote des 5 autres sens, le systeme vestibulaire est le 6e sens et joue un role fondamental bien au-dela de l’equilibre. Detecteur des mouvements de courant lors de la vie aquatique, il evolua vers la detection des mouvements de l’organisme et la stabilisation du regard a la base de l’evolution de l’occulomotricite. Precurseur de l’audition il se developpera avec la vie terrestre pour s’adapter a la gravite, et permettre l’equilibre. Le systeme vestibulaire influence egalement le systeme vegetatif, modifiant la pression arterielle, la mineralisation osseuse ou les rythmes circadiens et entrainant des nausees lors des vertiges ou du mal des transports. Si l’existence d’un cortex vestibulaire primaire reste debattue, l’influence du systeme vestibulaire sur le cortex est largement reconnue. En particulier dans la formation hippocampique, le systeme vestibulaire joue un role fondamental sur notre representation de l’espace en influencant les cellules de lieu et les cellules de direction de la tete. Le systeme vestibulaire est donc au cœur de nos cartes cognitives, mais influence egalement les performances mathematiques et la conscience de soi. Des stimulations du systeme vestibulaire chez des personnes saines sont ainsi capables de creer des sensations de sortie de son propre corps (sensation de ne plus habiter son corps) en agissant probablement a la jonction temporoparietale. Ces avancees fondamentales dans la connaissance du systeme vestibulaire nous aident egalement a mieux comprendre l’important retentissement des pathologies vestibulaires dans la vie de certains patients.

Introduction/Objectifs Le developpement de la chirurgie endoscopique de la base du crâne necessite des reperes anatomiques precis. Aussi, la lame criblee anterieure reste une region incompletement decrite. Une etude preliminaire retrouvait l’existence de deux foramens appeles « fente ethmoidale » et « trou ethmoidal », ne contenant pas de filets olfactifs et mesurant respectivement 4,1 et 1,8 mm. L’objectif de notre etude a ete de preciser le contenu de ces foramens et leurs rapports pour la chirurgie. Materiels/Patients et methodes Nous avons effectue une etude cadaverique sur 36 specimens, analyses selon quatre techniques : – etude osteologique (12 crânes) : les foramens ont ete mesures par voie endonasale et endocrânienne ; – etude histologique (12 crânes) : sur corps frais apres decalcification pour analyse en coloration standard, immunohistochimie, immunofluorescence et microscopie electronique ; – etude radiologique (2 crânes) : micro-scanner. Deux d’entre eux ont ete contrastes au tetroxyde d’osmium avec reconstruction en 3 dimensions ; – etude chirurgicale endonasale (10 crânes) : avec injection et reperage des elements vasculo-nerveux. Resultats La « fente ethmoidale » et le « trou ethmoidal » ont ete retrouves dans 100 % des cas. Leur longueur moyenne etait respectivement de 4,2 (1,9) mm et 1,6 (0,7) mm. La fente ethmoidale contenait de la dure-mere, des granulations arachnoidiennes ainsi qu’un nerf ganglionnaire amyelinique correspondant au nerf terminal. Le trou ethmoidal contenait l’artere ethmoidale anterieure et le nerf ethmoidal anterieur. Ce trou se poursuivait en avant par une gouttiere que l’on a appele « gouttiere du trou ethmoidal », mesurant en moyenne 2,5 mm de long et qui constitue un nouveau repere en chirurgie endonasale. Conclusions Cette etude confirme l’existence de la fente ethmoidale et du trou ethmoidal au niveau de la lame criblee anterieure, en precisant leur contenu et leurs rapports. Les applications cliniques de ces nouvelles donnees concernent autant la chirurgie de la lame criblee que celle du sinus frontal.

Introduction/Objectifs La methode de conservation des corps selon Walter Thiel a ete publiee en 1992. Cette technique, contrairement aux techniques classiques, permet au cadavre de garder une certaine souplesse, proche du sujet vivant. Depuis sa description initiale, cette technique s’est peu developpee, malgre des possibilites tres interessantes pour les cliniciens soucieux d’apprendre et de perfectionner leurs gestes medico-chirurgicaux. Nous souhaitons apporter une evolution pedagogique avec un souci de qualite de l’outil et un cout abordable. Materiels/patients et methodes La presente etude a compare 3 types de « conservation », chez des personnes ayant fait don de leur corps a la science. La technique developpee par Thiel adaptee a la conservation d’une tete, a ete comparee a la conservation de reference au formol et a la congelation sans fixateur. Ainsi, 3 tetes de chaque conservation ont ete preparees et comparees sur les chirurgies suivantes : parotidectomie, mastoidectomie ainsi qu’un decollement du lambeau tympano-meatal, rhinoplastie, meatotomie, ethmoidectomie, sphenoidotomie et sous-maxillectomie. Resultats Les resultats preliminaires nous montrent une nette preference des intervenants en faveur de la Thiel fixation modifiee. On obtient une odeur moins nauseabonde, ainsi qu’une meilleure qualite des tissus et de la dissection se rapprochant du vivant pour un cout de produits d’environ 30 euros. La technique primaire de conservation decrite par Thiel necessite une volumineuse installation et des moyens consequents, pour une utilisation qui reste restreinte, avec un delai de 2 a 6 mois de preparation. Notre technique permet de nous affranchir d’une telle installation et ainsi de diminuer significativement les couts et l’encombrement. Conclusions Le dogme : jamais la premiere fois sur le patient, nous montre l’importance de developper des techniques permettant un entrainement pertinent des etudiants. Cette technique de conservation reste un excellent compromis entre dissections anatomiques sur le vivant et un cout relativement faible permettant un acces a l’apprentissage du plus grand nombre.

Background/Hypothesis: The need for a neck dissection after radiochemotherapy (RCT) for patients with unresectable cancer of the head and neck remains questionable. We evaluated our strategy to perform a neck dissection in patients with a controlled primary tumor based on the response to RCT according to regional control, survival rates, and morbidity. Study Design: The French “Groupe d'Etude des Tumeurs de la Tete et du Cou” (GETTEC) group retrospectively performed a multicenter review. One hundred and three stage III (N = 7) or IV (N = 96) patients with unresectable primary tumors and node-positive disease and no distant metastases treated between 1996 and 2002. Tumors were considered unresectable or with poor surgical curability based on advanced stage, or patients were surgically unfit for medical reasons. Results: With a median follow-up of 30 months, the complete clinical and radiological nodal response rate was 61%. Among 39% (N = 40) of patients with residual neck disease, 70% (N = 28) underwent a neck dissection, whereas the remaining 30% either underwent watchful follow-up for probable scary nodes, or were deemed unresectable or medically unfit for surgery. Half of the neck dissection specimens showed pathological evidence of viable tumor. Grade 3 to 4 complications were recorded in four patients (14%) after neck dissection. Regional control was better for complete responders. Disease-free survival and overall survival were similar between patients with a complete response in the neck and no neck dissection, and patients with a neck dissection for residual neck disease. Conclusions: The strategy to avoid a neck dissection is safe in patients with a complete response in the neck, regardless of initial nodal stage. In patients with residual neck disease, postRCT neck dissection can be performed with limited morbidity. Progress is warranted to optimize the pathological response in the nodes and to better assess ambiguous nodal responses with multi-modal imaging.

OUR ANATOMICAL STUDY DEMONSTRATES THE EXISTENCE OF BOTH FORAMINA. THE ETHMOIDAL FISSURE CLEARLY REPRESENTS AN AREA OF WEAKNESS AT THE ANTERIOR PART OF THE OLFACTORY CLEFT, WHICH COULD PREDISPOSE TO ANTERIOR SKULL BASE CSF-LEAK AND MENINGOCELES. 1Rouviere H, Precis d’anatomie et de dissection, 1911 and later editions 2Gray H, Spitzka E, Anatomy, descriptive and applied, 1913 and later editions 3Jankowski R. Endoscopic resection of the olfactory cavity. Fr ORL. 2007;93:341-6. 4-Dare AO, Balos LL, Grand W. Neural-dural transition at the medial anterior cranial base: an anatomical and histological study with clinical applications. J Neurosurg. 2003;99(2):362-365. 5Vasvari G, Reisch R, Patonay L. Surgical anatomy of the cribriform plate and adjacent areas. Minim Invasive Neurosurg. 2005;48(1):25-33. ONE HUNDRED YEARS AGO....... MATERIAL AND METHODS

Objective. Jugular bulb abnormalities can induce tinnitus, hearing loss, or vertigo. Vertigo can be very disabling and may need surgical treatments with risk of hearing loss, major bleeding or facial palsy. Hence, we have developed a new treatment for vertigo caused by jugular bulb anomalies, using an endovascular technique. Patients. Three patients presented with severe vertigos mostly induced by high venous pressure. One patient showed downbeat vertical nystagmus during the Valsalva maneuver. The temporal-bone computed tomography scan showed a high rising jugular bulb or a jugular bulb diverticulum with dehiscence and compression of the vestibular aqueduct in all cases. Intervention. We plugged the upper part of the bulb with coils, and we used a stent to maintain the coils and preserving the venous permeability. Results. After 12- to 24-month follow-up, those patients experienced no more vertigo, allowing return to work. The 3-month arteriographs showed good permeability of the sigmoid sinus and jugular bulb through the stent, with complete obstruction of the upper part of the bulb in all cases. Conclusion. Disabling vertigo induced by jugular bulb abnormalities can be effectively treated by an endovascular technique. This technique is minimally invasive with a probable greater benefit/risk ratio compare with surgery.

Aspergillus spondylodiscitis (AS) is rare in immunocompetent (IC) patients. A 65-year-old diabetic IC male subject presented with cervical AS 18 months after otomycosis. Two serological tests, mastoidectomy and biopsy of the sphenoid bone, were negative. A prevertebral biopsy identified A. flavus. The patient was successfully treated with voriconazole. Forty-three cases of AS in IC patients have been published. A predisposition was found in 84 % of cases. Fever was reported in 20 % of cases, whereas neurological defects were present in 41 %. Serology was inconsistently positive (5/7) and diagnosis was confirmed by biopsy or surgery. A. fumigatus was the most frequently isolated species (74 %). All episodes were medically treated, associated with surgery in 57 % of cases, and 73 % of patients fully recovered. AS must be discussed in IC patients presenting with risk factors, including diabetes mellitus. Biopsy is necessary to confirm diagnosis, since serology offers low sensitivity. Nevertheless, the prognosis is good.

Objectif Les fentes ethmoidales et trous ethmoidaux sont des foramens de la partie anterieure de la lame criblee de l’ethmoide. Ils n’ont, a notre connaissance, jamais ete etudies en imagerie. L’objectif etait de verifier leur visibilite en scanner, de les decrire, de trouver un plan d’examen reproductible des fentes. Methodes Etude de correlation anatomo-radiologique (scanner conventionnel, parametres d’acquisition de routine) de 13 crânes secs. Resultats Vingt-quatre cotes etaient analysables pour les fentes et pour les trous. Les fentes ethmoidales avaient une configuration « classique » (dessins de Gray [1] ) : caractere unique de chaque cote, forme ovalaire, sans cloison, dans 83 % des cas (20/24 cotes). Pour 2 cotes, une cloison separait la fente en deux parties, anterieure et posterieure. Pour 2 autres cotes, les fentes n’etaient pas identifiees. Lorsqu’elles etaient presentes, elles etaient toutes bien visibles au scanner, en particulier dans les plans orbito- et supraorbito-meataux. Elles mesuraient en moyenne 3,9 ± 1,7 mm de longueur, 0,9 ± 0,3 mm de largeur (dans le plan orbito-meatal). Les trous ethmoidaux etaient presents dans tous les cas, et toujours visibles au scanner. Ils mesuraient en moyenne 1,6 ± 1 mm de longueur, 0,9 ± 0,3 mm de largeur. De petites subdivisions des trous ethmoidaux etaient visibles au scanner dans 58 % des cas. Conclusion Fentes ethmoidales et trous ethmoidaux sont frequemment presents, et souvent bien visibles sur des scanners de crânes secs. Leurs tailles moyennes ont ete calculees, proches des valeurs retrouvees par deux etudes anterieures [2] , [3] . Leur visualisation scanographique chez des patients ainsi que leurs eventuelles implications pathologiques (rhinorrhees cerebrospinales, voies d’extensions tumorales, traumatismes chirurgicaux) restent a demontrer.