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Epistaxis is defined as flow of blood from the nasal fossae and is a common and benign disorder in the great majority of cases which does not require medical care. It may however become a genuine medical or surgical emergency because of the amount, repeated episodes or patient's medical vulnerability (such as coronary artery disease patients). Epistaxis may be either primary or a symptom of an underlying disease. Four levels of problems need to be answered faced with epistaxis: recognizing it, and in particular not missing "epistaxis" due to swallowed blood or venous hemorrhage, which falls outside of the scope of interventional radiology; establishing the amount and its repercussions, particularly as a decompensating factor in another disease; investigating its cause and in particular never missing a tumor (male adolescents); obtaining hemostasis. Epistaxis varies not only in type and cause but must be considered in its clinical context. Arterial embolization is a treatment of choice for severe refractory epistaxis and some hemorrhages. When carried out by trained operators, it is an effective method with few risks of complications and is increasingly being used in reference centers (Brinjikji et al.). It remains, however, a method which is less widely used than surgery, particularly in the United States where in a series of 69,410 patients treated over the last 10 years for refractory epistaxis, 92.6% underwent surgical ligation, 6.4% embolization and 1% combined treatments (Brinjikji et al.). Epistaxis is occasionally catastrophic and requires extremely urgent management. In each case, close collaboration with the surgeon, the presence of an intensive care anesthetist and at least sedation are all factors which improve management and therefore the results of embolization. All patients and/or their friends/close family should have given "reliable, clear and appropriate" information., (Copyright © 2015 Éditions françaises de radiologie. Published by Elsevier Masson SAS. All rights reserved.)

Introduction: The objective of the study was to determine the preferential territories of drainage of skin areas of the face and neck. This knowledge can guide the strategies of diagnostic (search for primary tumor skin to cervical lymphadenopathy) and treatment (determination of the extent of neck dissection to achieve in case of skin tumor)., Materials and Methods: This is a retrospective study of the surgical procedures of sentinel node research between January 2003 and April 2011. The lymphoscintigraphic and intraoperative localization of the initial tumor site and sentinel lymph node were collected., Results and Discussion: One hundred and thirty-seven patients were included in the study. The parotid gland is a privileged territory of drainage of the head and neck skin. At cervical level, the submental region drains the lower and median part of the face (lips and chin). The posterior segments (IIb and V sector) were represented for the posterior locations of the head (ear, vertex), and cervical region., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

Video-assisted endonasal endoscopic surgery is used for a constantly increasing number of indications, replacing more invasive external approaches. Indications include chronic bacterial and fungal sinusitis, nasosinus polyposis, mucocele, inverted papilloma, and lacrimal duct stenosis. This microinvasive technique offers the advantage of preserving the physiological properties of the mucosa while assuring proper ventilation of the nasal and sinus cavities. We discuss the technical basis of this new surgical option used by ear-nose-throat specialists and maxillofacial surgeons. We focus on turbinai, septal, maxillary, and lacrimal surgery but do not discuss the more specific rhinology areas such as ethmoidectomy, sphenoidotomy or frontal surgery. The main procedures are described together with indications and expected results.

Antrochonal polyp is a unilateral and benign tumor of the maxillary sinus occurring in children. Its physiopathology remains unclear. Nasal presenting symptoms are unilateral obstruction and nasal discharge. In rare cases, presenting symptoms may be atypical. Radiographic examination with CT-scan and more rarely MRI helps the diagnosis. Surgery remains the mainstay of treatment and the endoscopic approach should be used in first intention. Double maxillary meatotomy by endoscopic approach procures a good exposure and permits a complete resection of the pedicle of the polyp. The insertion of the pedicule should be coagulated. In cases with recurrence or in cases of incomplete resection, an external approach (Caldwell-Luc) should be preferred.

Objectives: To define clinical and radiological characteristics of nasal septal schwannoma, and to propose endoscopic surgery., Patient and Methods: We report a case of an isolated schwannoma of the anterior part of the nasal septum, without involvement of any local structure. The only preoperative symptom was nasal obstruction. Imaging study included a CT scan and an MRI study., Results: Schwannoma is a sheath tumor originating from Schwann cells of peripheral nerves. It rarely occurs in nasal and paranasal sinuses and its development on the nasal septum is extremely rare. Complete removal of the tumor was performed by endoscopic sinus surgery technique. Limits of the excision were free of tumor and the histological type was Antoni type A Schwannoma. After a year of follow up, the patient is free of recurrence., Conclusion: The Schwannoma of the nasal septum is a rare tumour whose clinical and radiological diagnosis by CT scan and IRM is relatively easy. Its treatment is surgical and the endoscopic surgery can be proposed in the forms slightly extensive.

Nasosinusal polyposis in the pediatric population is uncommon and its etiology is unclear. In this eleven-year retrospective study, we describe the etiologic features and evaluate the effectiveness of endoscopic sinus surgery in 49 children. Patients were divided into three groups according to whether nasosinusal polyposis was either isolated (n = 14), or associated with either asthma (n = 5) or cystic fibrosis (n = 30). An allergy was present in 10% of patients with isolated polyposis, 80% of patients with polyposis associated with asthma, and 19% of patients with polyposis associated with cystic fibrosis. The indications for surgery were disabling symptoms, specially chronic nasal obstruction, rhinorrhea and mouth breathing, and failure to respond to medical treatment. No surgical complications were encountered. Most patients reported improvement in quality of life with reduction of nasal obstruction in 83% of cases and rhinorrhea in 61%. Minor asymptomatic recurrence (i.e. a few micropolyp localized on the roof of the ethmoid cavity) was observed in 22.7% of the cases in this series, and major recurrence with the same functional symptoms as before surgery in 13.6%. However, recurrences were higher in patients with cystic fibrosis, since minor recurrence with no clinical manifestation was observed in 28.6% of cases and major recurrence in 17.8%. Endoscopic sinus surgery must be decided in collaboration with the pediatric and pulmonary physicians, and must be performed skillfully. With a mean follow-up of 4 years, results in this series are encouraging.

Objectives: Endonasal sphenoidotomy is a high risk operation: fatal complications due to direct lesion to the internal carotid artery have been reported. We conducted a prospective analysis of carotid prolapse within the sphenoid cavity in order to draw attention to this dangerous anatomic variant., Methods: Tomodensitometry of the sinuses was performed in 150 patients (mean age 35 years; range 20-70) with inflammatory nasal symptoms of less than one year duration (mean 5.2 months). Cases with benign or malignant tumours, polyposis or a past history of sinus trauma were excluded. Transversal sections were analyzed by one radiologist and one ear-nose-throat specialist. The diagnosis of carotid prolapse was defined as an intrasphenoid protrusion of the artery at least as long as one-third of its circumference. Results of the analysis were expressed as percent for 300 sinuses., Results: Prolapse of the internal carotid was found in 20.3% of the sinuses (n = 61). In all cases a thin (> 1 mm) bony structure surrounded the artery. No prolapse was observed into the posterior ethmoid cells., Conclusions: Intrasphenoid prolapse of the internal carotid artery is a major risk factor in nasal and sinus surgery. The high incidence (1 out of 5 sinuses) indicates the need for routine preoperative imagery to reduce surgical risk.

The generalized disorders which characterize cystic fibrosis often involve the nose and paranasal sinuses and may frequently lead to the development of nasal polyps. A retrospective study of 78 patients with cystic fibrosis, 3 to 28 years old, was undertaken in order to determine the incidence of nasal involvement and to define an approach to the treatment of disabling recurrent nasal polyposis. 65% of these patients presented chronic symptoms such as rhinorrhea, nasal obstruction and disturbances of smell. Nasal polyps were found in 50% of patients and were more frequent in adults than in children. Clinical symptoms were directly related to the extent of polyp development which could be classified according to 3 groups. CT scans showed maxillary sinus involvement in almost all patients. The incidence and extent of ethmoidal sinus involvement on CT scans was correlated to the grade of polyp development. Medical treatment of polyposis failed in all cases. Polypectomy was always followed by recurrence. Intranasal ethmoidectomy seems to be an interesting alternative, since 73% of patients undergoing this procedure had clinical improvement.

The authors report about their experience with partial lower turbinectomy. Twenty-nine cases were followed up over an average time lapse of 2 years. Anterior rhinomanometry was performed pre- and postoperatively in all patients. The results include 26 successful operations (90%) and 3 failures, one case of hemorrhage on pack removal and one of synechia. In view of the 3 failures, the authors are presently favorable to subtotal lower turbinectomy.

From 1974 to 1990, the same surgeon operated 96 cases of hyperthyroidism: 72 cases of Basedow's disease, and 24 basedoid goiters. The preliminary preparation with antithyroid agents, sedation, Lugol and beta-blockers is particularly important, as is rehydration, high-dose sedation and beta-blockers, if required, during the postoperative period. There are few complications: 1 hematoma, 1 permanent unilateral laryngeal paralysis, 1 permanent hypocalcemia, 5 transient psychical and/or cardiac disorders, 1 malignant exophthalmia. There was no thyrotoxic crisis. Long-term follow-up allows nothing 4 recurrences as well as hypothyroidism in 46% of all cases. The size of the thyroid remains left in place is closely related to hypothyroidism. One case of vesiculo-papillary carcinoma is noted among the 24 cases of basedoid goiters (4.5%), which justifies total thyroidectomy in such cases. There also was one papillary carcinoma among the 72 patients with Basedow's disease (1.3%).

Two studies were conducted consecutively on two series of post-operative acoustic neurinoma patients. The first one included 104 patients over a period spanning from January 1982 through April 1986; the second one bore on 75 cases enrolled between October 1985 and April 1988. Post-operative complications, sequelae, and findings were analyzed. As far as facial function was concerned, this was assessed on the basis of a classification worked out by J.W. House and D.E. Brackmann. For the first series (93 patients tested, 86 followed up and 7 who completed and returned a form arranged from Brackmann's questionnaire), the following results were obtained: 94% with anatomically intact nerves, including 50.0% grade I; 8.6% grade II; 10.7% grade III; 12.8% grade IV; 4.3% grade V, and 2.2% grade VI cases. 10 nerve sections pertaining to grade III and grade IV surgical repair cases including 10 hypoglossofacial anatomoses were reported. In the second series, 75 patients were followed up for at least 2 years. The facial nerve condition was recorded at the end of the operation, corresponding to the beginning of the nerve recuperation period. A very tight relationship was noted between the nerve condition and the end result as reflected by facial function; such correlation was also found to exist between facial function and tumor size. Likewise, end-point facial function was strictly dependent upon the incipient recuperation phase, whenever palsy had been complete or partial post-operatively. That is to say, if recovery started out after the third month following surgery, the affected hemiface would never retrieve its normal or subnormal function (grade I and II as per J.W. House and D.E. Brackmann). In this series, facial function was restored in 45%, 15%, 21%, 11%, 1%, and 0 cases corresponding to grade I, II, III, IV, V and VI, respectively. Five grade III and IV nerve sections were repaired via five hypoglossofacial anastomosis operations. We propose a slight modification be brought to the House-Brackmann classification. The aim of this study was to accurately assess the complications and sequelae secondary to surgical ablation of unilateral acoustic neurinoma by an otoneurosurgical team utilizing almost exclusively the broadened translabyrinthic (B.TL) and medial cerebral fossa or supra-petrous (SP) approaches Despite achievements realized since W.F. House [23] described those, the main problem encountered has been-excluding major complications which are fortunately rare, remains the preservation of normal or subnormal facial function.

Mandibular reconstruction in 6 patients was by free flap from iliac crest in pelvi-mandibulectomies. The different technics proposed for mandibular reconstruction are described with emphasis on the specificity of repair surgery in cervicofacial oncology. In this precise indication stress is placed on the limitations of conventional graft and endoprosthesis procedures and the need to transfer a vascularized bone fragment. Among the technics for transfer of vascularized bone, preference is accorded to the composite flap from iliac crest as against the osteo-musculo-cutaneous flap, and details for removal of the former are given. The osteo-musculo-cutaneous flap from iliac crest appears to be the procedure of choice for reconstruction of bone in all cases where mandibular reconstruction is necessary after loss of continuity.