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Objectives: Ollier's disease is a constitutional pathology of unknown etiology. It is characterized by bone dysplasia generating numerous enchondromas. The malignant degeneration of this dysplasia is well known. The aim of this article is to study the diagnostic, therapeutic and prognostic characteristics of these lesions., Material and Methods: We report a case of parapharyngeal chondrosarcoma extended to the base of the skull in a patient with Ollier's disease. The treatment was a surgical removal by a cervicotransoral incision combined with a preauricular incision and with a mastoidectomy. It was therefore possible to control the skull base, the parapharyngeal space, the infratemporal fossa and the major neurovascular structures. The removal of the lesion was completed at the level of the clivus and sphenoid with optics (30 and 70 degrees ). We discuss this treatment and the follow up on the bases of literature data., Results: The neoplastic degeneration of enchondromas is estimated between 25 to 50% of cases. The most frequent location is the pelvic bones. Chondrosarcomas are slow growing tumors and their metastatic potential is less significant as we note it in our case report. Their diagnostic is essentially based on histological criteria's and their treatment is surgical., Conclusion: Chondrosarcomas of the ENT area occurring with Ollier's disease is rare. Their prognostic is good if the surgical treatment is well done.

Objective: An open therapeutic trial was conducted in patients with Bell's palsy. Results were compared with data in the literature., Materials and Methods: Between 1997 and 2000, 76 patients with Bell's palsy were treated with intravenous methylprednisolone (2 mg/kg/day) and acyclovir (5-10 mg/kg/8 hours) for 7 days. Treatment was initiated in all patients before the 14th day of illness. Severity of the palsy was scored on the first day of treatment and again one year later using the House and Brackman scale., Results: Grade II or III palsy were observed in 38% of the patients at initial presentation, grades IV to VI in 62%. After treatment, 92% of the patients had reverted to grades I and II (good outcome) and only 8% had sequelae at 1-year follow-up. All patients with initial grade I or II recovered completely. For patients with grade IV, V, or VI complete recovery at 1 year was observed in 94, 86 and 50% respectively., Conclusion: Data in the literature suggest that corticosteroids should improve recovery in Bell's plasy. In our study, adjunction of acyclovir did not demonstrate any clear improvement in the cure rate. Benefit could depend on early prescription.

Hemifacial spasm is characterized by intermittent involuntary contractions of one or several groups of muscles innervated by the facial nerve. The possible causal mechanisms have been the subject of numerous publications. The pre-eminent work of Moller and Jannetta implicates the compression of the facial nerve at its point of entry into the central nervous system, the Root Entry Zone, while the physiopathology is poorly understood, two principle hypotheses emerge: 1) ephaptic transmission between injured fibers; 2) hyper excitability of the facial motor nucleus. Using standard electromyographic techniques and blink reflex studies, we were able to demonstrate hyperexcitability of the facial nucleus. The cause of this hyperexcitability remains unexplained. It could be the result of a permanent antidromic stimulation from a peripheral ectopic center of excitation.

The authors have developed an animal model for the electrophysiological investigation of the blink reflex. The justification for such investigations and the experimental protocol were presented. The authors studied the blick reflex with electromyographic recordings obtained after the stimulation of the supra orbital nerve (V1) in the awake rat and in the anaesthesized rat. Two components of the reflex, R1 and R2 were observed. The early component, R1 was ipsilateral to the stimulus. It was observed whatever the degree of anaesthesia. The R2 component came later and was only observed in awake or weakly anaesthesized rats. It appeared to be isolated and unprecedented by an R1 component when the contralateral supra orbital nerve was stimulated. The R1 responses were facilitated by prior ipsilateral or contralateral stimulation of V1.

About a series of 33 patients operated in the ENT Depart. Prof. Soudant-La Pitié-Salpêtrière Hospital-Paris. Any emphasis was put on 11 cases of aspergillosis sinusitis. Most of the time, clinical signs are non specific. But X rays studies are of great help for the diagnosis. Treatment of chronic sinusitis of dental origin, particularly aspergillosis, remains surgical: caldwell-luc operation or endonasal approach. As a conclusion, the authors suggest systematic removal of all intrasinusal foreign body.

There are two types of neurofibromatosis, i.e. peripheral neurofibromatosis (type 1) and central neurofibromatosis (type 2). Neurinomas of the acoustic nerve are basically seen in central neurofibromatosis, in which case they are generally bilateral. Surgical indications for neurinoma are rare and 5 patients will be discussed: 2 of these underwent an operation on the neurinoma by the posterior route on several occasions, while 1 patient was operated by the trans-labyrinth route. Nuclear magnetic resonance remains the best means of monitoring.

Sudden deafness is a medical emergency, for which etiopathology is ill-known and no therapeutic consensus exists. This study is aimed at demonstrating that a greater audiometric gain can be achieved if trimetazidine, a major cellular anti-ischemia agent, is associated with hemodilution, than when the treatment is based on hemodilution only. 42 patients suffering from sudden deafness were all treated with hemodilution before their 7th day of deafness, half of them being given 3 tablets of trimetazidine daily in addition and the other half placebo, during one month. The results of this double-blind trial demonstrate an additional audiometric gain of 10% in the trimetazidine group for all frequencies, as well as a higher percentage of total recovery, ie. 63% vs. 47% in the placebo group. No particular sensitivity to treatment was noted according to the shape of the audiometric curve or in the case of initial cophosis, known to be of poor prognosis. The statistic significance was not established due to the small number of cases. The association of trimetazidine and hemodilution therefore seems to be an interesting therapeutic approach for sudden deafness, owing to the clinically appreciable audiometric improvement we have noted.

We have been studying 17 cases for operated mucoceles over a period of 4 years. Usual predisposing factors are often present, however we found no underlying malignant tumor revealed by a mucocele. Surgical treatment always included exclusion and filling with bone grafts in case of frontal involvement. Small ethmoidal lesions without symptom found on the CT scan are worrying because of their potential deterioration; in such cases, our attitude has been surgical.

Post traumatic optic nerve compression gives a Clinic picture of physiological section. CT Scan is consistent with optic canal lesion when considering direct signs (bony fragments compressing the nerve) or indirect (fractures and hematoma of posterior orbital wall, of posterior ethmoid, and sphenoid). 23 patients had a surgical decompression through transethmoidosphenoidal approach. A lesion of optic canal was found in 22 out of 23 cases. Improvement of vision was noted in 12 cases.

Amylosis is characterized by an infiltration of acellular substance into the tissues. This substance is mainly made of protein molecules. This disease is primary or secondary to general disorders. Its anatomical polymorphism can well involve the ENT system. Its clinical pictures are well known by the ENT specialist. About tow amyloid tumors diagnosed because of oropharyngeous signs, the authors remind the main symptoms at the upper airway and ENT tracts; the local, regional and general treatment will be discussed.

Often difficult surgical problems are encountered during treatment of acquired stenosis of external auditory canal. Theses stenoses can be of tumoral, inflammatory or traumatic origin and are the cause of infectious complications related to epidermal retention. Even with the assistance of modern imaging procedures, preoperative investigation is not simple, precise details of lesions being obtained in greater detail during surgical exploration. Four stages are involved in surgical treatment: excision of lesion, reaming of bony canal and enlargement of auditory meatus, providing cover and maintaining graft in place. The CO2 laser can be useful for excision of lesion or possible postoperative recurrence, and adjacent pedicle flaps are best for covering site. Postoperative inflammatory episodes can be treated by infiltration of local corticoids. Whatever the result of these different techniques, long-term surveillance of these patients is essential.

This study of the Brainstem evoked Response has been done to try to find the exact location of neurologic disorders. The authors wanted to see if there were differences between normal subjects and patients with multilocular sclerosis, when the auditory stimulus in increasing from 10 pps to 50 pps. From 15 normal subjects (30 ears) the results have been compared to those obtained from 6 patients. The findings were: -- there is no adaptation phenomenon in the Brainstem (the conduction time in the Brainstem is absolutely constant). -- there is an adaptation which occurs before the first peak, happening later at 50 pps than at 10 pps. -- in the multilocular sclerosis the findings were: augmentation of the peak to peak delay no synchronisation of the peaks so that is very difficult to recognize each peaks. And the peaks are easier to recognize at 50 pps than at 10 pps which fact unexpectable. This dyssynchronisation at the compression and rarefaction click is for the authors an important factor for the multilocular sclerosis diagnosis.

Thyroglossal duct cyst, a common clinical entity, may undergo malignant change. The majority of such malignancies are capillary adenocarcinomas; squamous cell carcinomas are rare. Only 7 cases have been reported since 1950. The authors present a case of a 65 years old man who died 16 months after the tumor's discovery.

A method for conducting "brain stem early derived potentials" using an inexpensive microcomputer is described. This type of examination is, however, difficult to perform, and is not currently employed in clinical practice. The contribution offered by this data-processing system is emphasized.

The treatment of the chronic diseases of the temporomandibular joint is always difficult. At one moment or another, surgical treatment is discussed, proposed and performed. Many operations have been described to make the temporo-mandibular joint recovering its normal movements. Both joints are involved in those movements, because the joint is symmetrical. Myrhaug's technique, described in 1951, consists in the resection of all the temporal condyle. This technique which respects the meniscus and all the chondro-fibrous system of the joint creates a permanent and reducible chronic dislocation of the joint. This paper is made to show that under an experience of more than 60 operations the authors can give all the details they use, with some modifications of the original Myrhaug's technique. The authors give their own results over 60 operations: there are more than 70% of good or excellent results, without any complication. For all the cases they have operated and they present, the follow-up is more than one year and some times more than ten years. They have not seen any late complication and the results have not been modified after all that time. The main indication of this technique is the temporomandibular joint dysfunction syndrome which affects more the female population. This syndrome is made of an association of pain, cracking, abnormal movements and subdislocations, but pain is only one of the symptoms. The same operation is very efficient to treat chronic subdislocations affecting one or both joints. This Myrhaug's technique operation is very simple without any complication in the post-operative days and give very good results.(ABSTRACT TRUNCATED AT 250 WORDS)

Seventy two head and neck cancers have been treated with a combination of Cis-DDP (20 mg/m2/day) and bleomycin (6 mg/m2/day, 24 hours infusion) given for 5 days 3 courses every 3 weeks in preoperative cases and for 6 days (4 courses every 3 weeks) in non preoperative cases. Fifteen patients treated for local recurrence after irradiation experienced no significant response and their actual survival at 12 months is 22%. For the other patients the objective response rate was 78% with 10 complete responses and the projected survival at 12 months varies from 62% to 92% according to the subsequent treatment (irradiation or surgery followed by irradiation). These results are in agreement with a few reports using similar combinations; but it needs to answer new questions about possibility of surgical strategy variations in the cases of good or complete responses with such a chemotherapy.

A case of central point myelinolysis is described in a heavy beer drinker who was found to have severe water and electrolyte disturbances on admission. The patient subsequently developed quadriparesis with pseudobulbar symptoms. The authors stress the diagnostic value of brain stem auditory-evoked responses and of blink-reflex, which were restored to normal as the patient recovered.

A case of undifferentiated epithelioma of the left parotid gland occurred 2 years after the removal of a cystadenolymphoma in the right parotid gland. The relationship of these two tumours was supported by several statements: the immunohistochemical study demonstrated in the epithelial cells of the 2 neoplasms the existence of ACE, usually thought as characteristic of cystadenolymphoma. Besides, it showed a high number of plasma cells secreting IgA in the stroma of the 2 tumours, the ultrastructural study performed on the epithelioma also demonstrated some similarities between epitheliomatous cells and epithelial cells of cystadenolymphomas (outlined epidermoid or glandular differentiation, numerous mitochondria). A peculiar, perhaps immunological mechanism could induce the cancerization, according to the theories used to explain the histogenesis of cystadenolymphoma.

Diagnosis in a suspected case of laryngeal pseudo-actinomycosis was confirmed by examinations conducted in the Pasteur Institute. This capricious and misleading affection is reviewed, its treatment requiring only simple but prolonged antibiotic therapy.

Treatment of sequelae of ophthalmopathy of Basedow's disease, essentially exophthalmos, oculomotor disorders and upper eyelid retraction, is of particular importance because of the functional and esthetic problems presented. Improvement in the different symptoms can be obtained by surgical treatment, but patients must have been perfectly stable with respect to both the thyroid and ophthalmologic plan for at least 6 months. It marked exophthalmos exists this is treated initially by orbital enlargement. Oculomotor problems are then resolved and finally treatment is terminated by surgery to eyelids. Very satisfactory functional and esthetic results are obtained.

The authors have dissected a series of nasal pyramids and septum. The various a anatomical structures have been measured and their relations with surgical landmarks have been recorded. Histograms show their findings. Surgical interest was emphasized for each stage of dissection. Some important points have been noticed during this study. They could bring some explanations to certain failures encountered after a septorhinoplasty.

The authors report their experience in the Treatment of essential Trigeminal Neuralgia with controlled increments of radiofrequency heating from an electrode inserted in the Gasserian ganglion or the posterior rootlets. Assuming that the less myelinated small fibers (A delta and C) are more sensitive to the heat than the heavily myelinated A beta and A alpha fibers, graduate controlled thermo coagulation could produce a differential destruction of pain fibers. 30 patients were treated with this method since 10 months. In all cases, the patients experienced immediate relief. There was no mortality and no neurological morbidity outside the trigeminal nerve. The most serious undesired result has been the production of anesthesia or marked hypesthesia in 10% of our cases.

The ambulatory intervention in ORL surgery presents a certain amount of constraint : anaesthetic, surgical, medicolegal and socio-economic. In spite of the lack of medicolegal definition for ambulatory anaesthesia, these anaesthetic intervention may take place in conditions approaching the other anaesthetic intervention provided that some rules are respected. The authors propose a practical treaty for the ambulatory intervention ORL surgery and as an illustration to this presentation propose a sample of a hundred ambulatory interventions.

Thirty three patients have been operated with total laryngectomy (LT) or pharyngolaryngectomy (PLT) with or without Zadical neck dissection, without nasogastric feeding to be and in five cases without tracheal cannula (but connection of a large tracheostomy). The authors demonstrated that there is no increasement of pharyngeal fistua. The beginning of oral alimentation has been made between the 4th and the 6th postoperative day. Such a procedure is more comfortable for the patients and decrease the hospitalisation duration.

Confronted with nose malformations in children, surgeons experience at the same time a legitimate desire to rapidly attend to the altered anatomical structures, and a fear to aggravate the lesions existing initially by operating during a period of growth. Numerous animal experiments have not been conclusive as far as these two contradictory theses are concerned. In all cases, prudence remains mandatory, that is prudence towards the operational indications (important functional impairment), the date of the intervention (risk minimization with age), assessment of expected results (secondary malformations occurring even very late postoperatively).