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International audience; Introduction: To explore the prevalence of dysphonia in European patients with mild-to-moderate COVID-19 and the clinical features of dysphonic patients.Methods: The clinical and epidemiological data of 702 patients with mild-to-moderate COVID-19 were collected from 19 European Hospitals. The following data were extracted: age, sex, ethnicity, tobacco consumption, comorbidities, general, and otolaryngological symptoms. Dysphonia and otolaryngological symptoms were self-assessed through a 4-point scale. The prevalence of dysphonia, as part of the COVID-19 symptoms, was assessed. The outcomes were compared between dysphonic and nondysphonic patients. The association between dysphonia severity and outcomes was studied through Bayesian analysis.Results: A total of 188 patients were dysphonic, accounting for 26.8% of cases. Females developed more frequently dysphonia than males (P = 0.022). The proportion of smokers was significantly higher in the dysphonic group (P = 0.042). The prevalence of the following symptoms was higher in dysphonic patients compared with nondysphonic patients: cough, chest pain, sticky sputum, arthralgia, diarrhea, headache, fatigue, nausea, and vomiting. The severity of dyspnea, dysphagia, ear pain, face pain, throat pain, and nasal obstruction was higher in dysphonic group compared with nondysphonic group. There were significant associations between the severity of dysphonia, dysphagia, and cough.Conclusion: Dysphonia may be encountered in a quarter of patients with mild-to-moderate COVID-19 and should be considered as a symptom list of the infection. Dysphonic COVID-19 patients are more symptomatic than nondysphonic individuals. Future studies are needed to investigate the relevance of dysphonia in the COVID-19 clinical presentation.

Background The rapid spread of the coronavirus disease 2019 and the implementation of quarantine in many European countries led to a swift change in health care delivery. Telemedicine was implemented in many otolaryngological departments to ensure the continuous care. The purpose of this study is to report our experience about telemedicine in 86 patients consulting virtually in our departments. Methods A total of 86 patients benefited from telemedicine consultation from April to Mai May 2020. Patients and physicians were invited to fulfill a satisfaction survey over the 3 days after the consultation. Results Patients consulted in the following fields: laryngology, voice and swallowing (N=15; 17.4%), head and neck or plastic surgery (N=34; 39.5%), rhinology (N=31; 36.1%) and otology (N=6; 7.0%). Practitioners estimated that the clinical examination would not have changed the consultation issue in 73.2% of cases. The realization of delayed clinical examination was rapidly necessary in 9.3% of cases and useless in 33.7% of cases. Five percent of patients estimated that the consultation did not bring reliable conclusion. Although the majority of patient (87.7%) would recommend telemedicine consultation to friend/family in the context of pandemic, only 44.6% would accept to replace office- consultation by telemedicine consultation outside the pandemic. Conclusion Telemedicine appears to be an interesting alternative approach in situation of pandemic and lock-down. Because the patient motivation to further participate to telemedicine appears to be conditioned by the context, efforts are still required to understand the patient perception, satisfaction and fears in view of future implementation outside pandemic. Supplementary Information The online version contains supplementary material available at 10.1007/s00405-021-06624-9.

International audience; Objective: To investigate prevalence and epidemiological and clinical factors associated with olfactory dysfunction (OD) and gustatory dysfunction (GD) in COVID-19 patients according to the disease severity. Study design: Cross-sectional study. Methods: A total of 2579 patients with a positive diagnosis of COVID-19 were identified between March 22 and June 3, 2020 from 18 European hospitals. Epidemiological and clinical data were extracted. Otolaryngological symptoms, including OD and GD, were collected through patient-reported outcome questionnaire and Sniffin’Sticks tests were carried out in a subset of patients. Results: A total of 2579 patients were included, including 2166 mild (84.0%), 144 moderate (5.6%) and 269 severe-to-critical (10.4%) patients. Mild patients presented an otolaryngological picture of the disease with OD, GD, nasal obstruction, rhinorrhea and sore throat as the most prevalent symptoms. The prevalence of subjective OD and GD was 73.7 and 46.8%, and decreases with the severity of the disease. Females had higher prevalence of subjective OD and GD compared with males. Diabetes was associated with a higher risk to develop GD. Among the subset of patients who benefited from psychophysical olfactory evaluations, there were 75 anosmic, 43 hyposmic and 113 normosmic patients. The prevalence of anosmia significantly decreased with the severity of the disease. Anosmia or hyposmia were not associated with any nasal disorder, according to SNOT-22. Conclusion: OD and GD are more prevalent in patients with mild COVID-19 compared with individuals with moderate, severe or critical diseases. Females might have a higher risk of developing OD and GD compared with males.

International audience; Background: The clinical presentation of European patients with mild-to-moderate COVID-19 infection is still unknown. Objective: To study the clinical presentation of COVID-19 in Europe. Methods: Patients with positive diagnosis of COVID-19 were recruited from 18 European hospitals. Epidemiological and clinical data were obtained through a standardized questionnaire. Bayesian analysis was used for analysing the relationship between outcomes. Results: A total of 1,420 patients completed the study (962 females, 30.7% of healthcare workers). The mean age of patients was 39.17 ± 12.09 years. The most common symptoms were headache (70.3%), loss of smell (70.2%), nasal obstruction (67.8%), cough (63.2%), asthenia (63.3%), myalgia (62.5%), rhinorrhea (60.1%), gustatory dysfunction (54.2%) and sore throat (52.9%). Fever was reported by 45.4%. The mean duration of COVID-19 symptoms of mild-to-moderate cured patients was 11.5 ± 5.7 days. The prevalence of symptoms significantly varied according to age and sex. Young patients more frequently had ear, nose and throat complaints, whereas elderly individuals often presented fever, fatigue and loss of appetite. Loss of smell, headache, nasal obstruction and fatigue were more prevalent in female patients. The loss of smell was a key symptom of mild-to-moderate COVID-19 patients and was not associated with nasal obstruction and rhinorrhea. Loss of smell persisted at least 7 days after the disease in 37.5% of cured patients. Conclusion: The clinical presentation of mild-to-moderate COVID-19 substantially varies according to the age and the sex characteristics of patients. Olfactory dysfunction seems to be an important underestimated symptom of mild-to-moderate COVID-19 that needs to be recognized as such by the WHO.

The surgical treatment of oropharyngeal squamous cell carcinoma (OSCC) has undergone a considerable evolution, with, among others, transoral robotic surgery (TORS). However, TORS is rarely used for the surgery of soft palate. A 73-year-old man presented a human papilloma virus OSCC of the posterior soft palate. The tumor was resected using TORS. This report describes the surgical technique step by step of the tumor resection. The resection of early stage OSCC of the posterior surface of soft palate is possible through TORS. The procedure is noninvasive, rapid, and seems to be associated with excellent functional outcomes.

International audience; We investigated safety and efficacy of transoral robotic surgery (TORS) for base of tongue (BOT) reduction in obstructive sleep apnea syndrome (OSAS) patients. PubMed, Cochrane Library, and Scopus were searched. A meta-analysis was performed. Random effects models were used. Thirty-one cohorts met our criteria (1693 patients). The analysis was based mostly on retrospective studies. The summary estimate of the reduction of Apnea–Hypoxia Index (AHI) was 24.25 abnormal events per hour (95% CI: 21.69–26.81) and reduction of Epworth Sleepiness Scale (ESS) was 7.92 (95% CI: 6.50–9.34). The summary estimate of increase in lowest O2 saturation was 6.04% (95% CI: 3.05–9.03). The success rate of TORS BOT reduction, either alone or combined with other procedures, was 69% (95% CI: 64–79). The majority of studies reported low level of evidence but suggested that TORS BOT reduction may be a safe procedure associated with improvement of AHI, ESS, and lowest O2 saturation.

• COVID-19 patients with total loss of smell have more olfactory bulb abnormalities at the magnetic resonance imaging than patients without loss of smell. • The olfactory bulb MRI abnormalities may be objectified through a signal intensity ratio measurement that is calculated between the average signals of the olfactory bulb and the frontal white matter. • The loss of smell is probably due to olfactory bulb inflammation related to virus spread.

To investigate the feasibility and the outcomes of transoral laser CORetrospective chart review of patients treated by TLM cordectomy in a single European University Hospital for early-stage vocal fold SCCs (Tis, T1a, T1b, and T2). The following TLM outcomes were studied regarding the tumor size (Tis and T1a vs T1b and T2) and the margin status (negative vs positive/suspicious): patient position; type of laryngoscope; requirement to external counter pressure; resection of supraglottic structures (eg, ventricular band, epiglottic petiole, and suprahyoid epiglottis); pre- and postoperative complications; overall survival; disease-specific survival (DSS); and disease-free survival (DFS).A total of 148 patients were included. The TLM was realized in 95.3% of cases. External counter pressure, partial, or total vestibulectomy were necessary in 65.9%, 57.4%, and 4.2% of cases, respectively. A resection of the epiglottic petiole was required in 24.8% of cases. The realization of both epiglottis petiole resection and vestibulectomies were significantly higher in patients with T2 and T1b SCCs compared to those with T1a and Tis SCCs (The exposure of glottis is possible in 95% of cases of early-stage vocal cord SCC but requires the use of several additional surgical procedures, especially for anterior commissure SCCs. The SCC involvement of the vocal fold anterior commissure is associated with lower DSS, DFS, and laryngeal preservation rate.

Objectives: We investigated the prognostic value of pre-treatment hematological parameters in patients with p16-positive oropharyngeal squamous-cell carcinoma (OPSCC). Material and methods: Neutrophil count, lymphocyte count, neutrophil-to-lymphocyte ratio (NLR), and hemoglobin concentration measurement (Hb), were collected on day one of treatment. Endpoints were overall survival (OS) and progression-free survival (PFS). All patients were planned to receive concurrent chemoradiation. Staging were reviewed according to the recent AJCC 8th edition. Results: We included 167 patients in this study. In multivariate analyses, a smoking history > 30 packyears was associated with decreased OS (p = 0.009; HR, 3.4827) and PFS (p = 0.042; HR, 2.421); Hb < 12 g/dL was associated with impaired OS (p = 0.007; HR, 6.527) and PFS (p = 0.014; HR, 4.092); an NLR > 5 before treatment was associated with decreased OS (p = 0.042; HR, 2.945). Hemoglobin concentration and the NLR were not correlated (p = 0.577), nor anemia and an NLR > 5 (p = 0.167). Patients with an NLR > 5 had a significantly higher rate of disease recurrence (30.8% vs. 8.4%, p = 0.0299, RR = 3.922, 95% CI 1.351–11.386). Discussion: We found hemoglobin level and the NLR to be independent prognostic factors in p16-positive OPSCC patients. This approach is to be considered for further clinical investigations, and its significance in treatment decision-making should be further explored. Keywords: Oropharyngeal carcinoma, P16, Papillomavirus, Smoking, Hemoglobin, Neutrophil-to-lymphocyte ratio

Objective To evaluate the oncological, functional and voice rehabilitation outcomes of transoral robotic surgery for total laryngectomy (TORS-TL). Methods A retrospective chart review of patients treated by TORS-TL was conducted at a single academic medical center. The following outcomes were studied: indication; average robotic set-up and operative times; mean estimated blood loss; postoperative complications; re-feeding features; mean hospital stay; need of adjuvant therapy and voice rehabilitation type. Results TORS-TL was performed in 10 patients for the following indications: nonfunctional larynx (N = 2); low-grade cricoid chondrosarcoma (N = 3) and recurrent laryngeal cancer after (chemo) radiation (N = 5). Two patients were excluded because the larynx was not exposable. Average robotic set-up and operative times were 20 and 278 min, respectively. The mean estimated blood loss was 50 mL. The mean hospital stay was 13.9 days (8–28 days). There was no local recurrence in patients operated for cancer recurrence (N = 5) 5 years after the surgery. Distant metastases occurred in one patient. A patient with laryngeal chondrosarcoma experienced local failure 3 years after TORS-TL. The voice rehabilitation consisted of esophageal voice (N = 2) and tracheoesophageal prosthesis (Provox®, N = 8). The main reasons for prosthesis replacement were transprosthetic (79%) and periprosthetic leaks (21%). The median lifespan of prostheses was 81 days. Conclusion TORS-TL may be a safe and effective surgical approach for selected surgical indications. Future controlled studies are needed to determine additional indications and limitations of this procedure.

BACKGROUND We investigated the survival of patients with a p16-positive N3 oropharyngeal squamous cell carcinoma (OPSCC) and the prognostic significance of patient, tumor, and treatment characteristics. METHODS We retrospectively reviewed the data of patients treated at our Cancer Center for a p16-positive N3 OPSCC between 2003 and 2016. End points were overall survival (OS) and progression-free survival (PFS). RESULTS A total of 29 patients were included. The 5-year OS and PFS were 67.5% and 59.1%, respectively. Smoking history above 10 pack-years and the absence of human papillomavirus DNA were associated with worse OS (P = .02 and P = .03, respectively) and PFS (P = .02 and P = .02, respectively). Induction chemotherapy or radical neck dissection were not associated with different treatment outcomes. CONCLUSION Patients with an N3 p16-positive oropharyngeal cancer in our series had a 5-year OS rate of 67.5%. Smoking history and viral DNA were prognostic factors associated with survival.

Metastatic tumors result from hematogenous spread through a tumor located at a distance. All these tumors represent about 1% of malignant tumors of the oral cavity (1). The most common location is the mandible (70%), more rarely maxillary (2). The most frequently encountered tumors are carcinomas or adenocarcinomas of mammary origin, brocho-lung, prostate, kidney or another. This study reports the case of a 46 year-old man, who presented for consultation with a low left laterofacial swelling, paresthesia lip and chin straight associated with pain at the lower edge of the mandible evolving for 2 months. The patient is known to take alcohol and tobacco for 20 years. The panoramic radiograph showed radiolucent image with blurred boundaries at the lower right premolar region. Dentascan revealed an irregular osteolytic lesion with rupture of the table lingual. After surgical exploration, the pathological examination is for a well-differentiated and invasive adenocarcinoma of the mandible. Extension work-up shows the presence of a tumor right lung, a lytic lesion at the 8th costal arch, the fourth dorsal vertebra and another location in fibula. The surgical exploration of pulmonary was performed and confirmed the pulmonary primitive localization of adenocarcinoma.

Möbius syndrome is a rare congenital disease characterized by facial and abducens nerve palsy. Children are unable to smile, frown, suck, grimace, blink their eyes, and to move their eyes laterally. The aim of this study was to analyze the diagnosis and treatment of this disease. Maxillofacial examination reveals: facial diplegia, retrognathism, palatine and dental malformations. Möbius syndrome is usually associated with multiple cranial nerve involvement, limb or orofacial malformation, and Poland syndrome. Although the pathogenesis of the syndrome is unclear, a number of mechanisms have been suggested including vascular and genetic hypotheses. Symptomatic treatment is used to manage this syndrome. The diagnosis of Möbius syndrome may be difficult in some patients with atypical signs of facial diplegia and other cranial nerve palsies, it requires a multidisciplinary approach.

Cementoblastoma is a rare benign odontogenic neoplasm. Its cause is unknown. It represents less 6 % of all odontogenic tumors. The aim of our work is to present a rare case of maxillary cementoblastoma involving an included central incisor. A 32-year old man consulted for a left maxillary swelling to projection under nostril. A panoramic radiographic examination revealed an included tooth 21 with a radiopaque lesion around its root. The computed tomography revealed the included tooth 21 with a process around its root. This process is well-defined, high-dense and is surrounded by a radiolucent halo. The treatment should consist of complete removal of the lesion with the tooth 21. Histological examination concluded to the diagnosis of a cementoblastoma. The cementoblastoma occurs most frequently in young persons and predominantly among men. The mandibular premolar and molar are the more frequently reached. The maxillary localization remains rare. This tumor occurs around the roots of the posterior and lower teeth. Radiographically, the lesion is well-defined and attached to the root of the tooth, radiopaque dense and surrounded by a radiolucent halo. The cementoblastoma evolves slowly and has the tendency to blow the cortical. The prognosis is good.

Foreign bodies in the orbit are rare. They can generate more or less serious complications depending on their nature and size. We report an exceptional case of a bulky foreign body in the orbit (the tip of a pen), which did not lead to any complication.A 13-year-old child presented with a right orbital trauma caused by a pen. He consulted 3 months later when a small palpebral swelling appeared. The CT scan showed the presence of a foreign body on the orbital floor. Wound debridement allowed extracting the tip of a pen measuring 3.5cm without any complication. There were no postoperative complications.The originality of this observation is two-fold; the singularity of the foreign body and its total harmlessness in spite of its large size. However, orbital trauma and a secondary orbital syndrome must lead to emergency imaging.

The repair of facial self-mutilation often fails if the reconstruction is not protected. The authors report a case of a lip self-mutilation treated by an orthodontic device: the "lip bumper".A four-year-old patient presented with self-mutilation of the lower lip in a context of multiple malformations. The defect concerned two third of the lower lip. The treatment combined antibiotics, local care, psychiatric management and a lip bumper. The evolution was favorable without need for secondary reconstruction.The lip bumper is a simple orthodontic device. It pushes the lower lip away from the dental arch. It is used to stop the pattern "agitation-mutilation-infection".

A 29 year-old-woman presented with a massive painless slow-growing tumor of the right cheek, with a benign aspect on clinical examination. The CT scan with injection, showed a solid-cystic mass, well defined, and partially enhanced. The mass was easily removed with a complete endobuccal excision. The histological examination and immunohistochemical study revealed a paraganglioma. There was no postoperative complication. No recurrence was noted after six months of follow-up.The paraganglioma is a rare neuroendocrine tumor and its location in the cheek has never been reported.

Congenital macrostomia, a transverse facial cleft, is a rare deformity of the mouth, which can occur alone or in association with other deformities. We report a case of congenital bilateral macrostomia. We discuss the difficulties of plastic surgery in this pathology.Congenital macrostomia in a one-year-old girl compromised feeding. The patient presented an isolated bilateral transverse facial cleft. Surgery associated a suture of the orbicularis oris muscle and a cutaneous W plasty. At twelve months, follow-up has been uneventful.Congenital macrostomia is most commonly associated with others anomalies. Many procedures are described regarding surgical correction of macrostomia. Reconstruction of the integrity of the oral sphincter associated with W plasty usually gives the best results.

Ameloblastoma is a benign odontogenic tumor which can be locally aggressive and invasive. Metastases are rare but possible and must be considered as a malignant form of the tumor.A 50-year-old woman presented a jugal metastasis of a mandibular ameloblastom which had been treated several times 28 years earlier. Six months after resection of the metastasis, the patient developed multiple cervical node metastases which were removed by radical curettage. Five months later, new metastases developed on the scalp and three months later a voluminous metastasis involving the right hemiface extended to the base of the skull. Surgical resection was only partial followed by radiotherapy. Ten months later the outcome was favorable.The absence of any histological sign of malignity in the primary tumor and in the metastases, as observed in our patient, is remarkable. Metastases generally develop in the lung (61-80% of cases). Metastases to the scalp have never been described. The time to development of a metastasis is generally very long and metastases usually remain asymptomatic. Progression is very slow, like for the primary tumor. Several factors predictive of metastasis have been described: female gender, age at onset of primary tumor (2nd to 3rd decade) and multiple local recurrences. There is no standard treatment for metastases. Chemotherapy is not effective. Radiotherapy may be effective, particularly when lesions are not accessible to surgery. Surgical resection remains the treatment of choice.

Cystic cervico-facial lymphangioma (DDFL) are relatively rare. Because of their size and site, they pose a real problem in treatment. The authors present a retrospective study about 10 cases.The mean age of this series of patients was 31 years, with a slight female preponderance. Ultrasound scanning is sufficient to establish the diagnosis. CT or MRI scan helps to show whether there is parapharyngeal or mediastinal extension.Every patient in this series underwent operation. We had one recurrence and two postoperative neurological sequelae.Although there is little difficulty in the diagnosis of this condition, it is difficult to treat because of extension which involve the face, the floor of mouth and tongue base, and also the major structures in neck. Current interest is centred on treating these lesions with sclerosis agents, either for recurrence or, according to some authors, as a first therapeutic option.

Although thyroid cancer is not the first cause of bone metastases, this diagnosis must be always entertained because when it is found to be the cause of the metastasis, the survival is good. Bone metastases can take on different appearances and thyroid cancer discovered secondarily. We report two cases of mandibular metastases revealing a thyroid cancer and we stress on diagnosis and therapeutic difficulties.

Rare benign tumours of the larynx (RBTL) form a heterogeneous group. The clinical picture is non-specific. Based on a series of 17 cases of RBTL treated in our department, we wish to draw attention to the diagnosis, treatment and clinical course of these tumours. The mean age of the patients was 37 years, with the male sex predominating. The presenting symptom was most commonly progressive dysphonia, while 5 patients were admitted in respiratory distress. Examination and special investigations revealed 8 cases of laryngocoele, 6 cases of angioma, 2 cases of schwannoma, and one of chondroma. Treatment was surgical, by an external approach in 10 cases and endoscopically in 7. The postoperative course was satisfactory. No long-term recurrences were encountered. Conservative surgery by an external or endoscopic approach has revolutionised the functional outcome in these benign tumours.

The antrochoanal polyp is a particular pathology of nasal fossae and sinuses. Since the first description made by Killian, several pathogenic mechanisms and surgical techniques have been reported. The polyp exeresis is classically made using the Caldwell-Luc approach. The aim of our study is to lay stress on the interest of endonasal surgery compared to other surgical procedures. Between 1996 and 1998, we operated on 12 cases by endonasal approach. Diagnosis is made upon clinical, CT-scan and pathological data. In all cases, an extended middle meatotomy is performed. In 3 cases, it is associated with an inferior meatotomy. The polyp pedicle is systematically coagulated at level of its maxillary implantation area. No recurrence, nor operative complication are noted. The average follow-up is 12 months.

Fractures of the orbit floor have very disabling oculomotor after effects. The objective of this study was to report that close collaboration between the maxillo-facial specialist and ophthalmologist is necessary to avoid oculomotor after effects.Our study included 10 cases of the fracture of the orbit floor. These cases were recorded between 1992 and 1996.This pathology affected young subjects aged between 20 and 40 years in 70 % of the cases. 80 % of the subjects were males. 90 % of the patients presented a vertical diplopia as a result of a transitory oculomotor deficit. 20 % of the subjects presented a permanent oculomotor deficit at the stage of after effects. All these deficits were of a mechanical origin and, contrary to other authors, we found no deficit with nervous sensory origin.Therapeutic success is based on early diagnosis and treatment that requires close collaboration between the maxillo-facial and ophthalmology teams.

The treatment of the parotid tumors was clarified for a majority of the tumors, in spite of her histology diversity. The authors report in a retrospective study 120 cases of a parotid gland tumors during ten years over. They insist on the difficult of therapeutics, the histological diversity and the complications and sequelles of the surgery. The diagnosis was especially clinical and completed by scan and or a sialography. The superficial or total parotidectomy with preservation of facial nerve was realized in eighty-nine percent. The functional courage and the radiotherapy were associated respectively in eleven and seventeen patients. The histology was dominated by the benign tumors. The complications and sequelles were a facial paralysis definitive and a Frey's syndrome respectively in three percent cases. The ninety-seven percent patients were controlled with a mean follow up of three years. After results we must know every histologic type for to adapt his treatment. And the same complications and the sequelles were noted in all surgery type.

Fibrous dysplasia is a benign bone tumor. The cranio-facial localization concern 20% of fibrous dysplasia. A congenital etiology is evoked by all the authors. Our observations ask for the real etiology of this affection: Congenital? Familial? The diagnosis is done by anatomo-pathology, and surgery is the treatment for severe cases. Relapses are frequent.

The authors report 45 cases of tissue loss in the nose, in most cases secondary to cancer ablation, and in a few (2 cases) to trauma. The reconstructive techniques were mainly the classical ones using local flaps, usually at the same time as the tumour removal. Where the reconstruction was a total one, this involved the use of a compound extended Converse flap, which has the advantage of bringing in sufficient tissue associated with the bone graft, and also avoids the risks of thinning or exposure of the graft. The indications depend on anatomical factors, and on the extent and depth of the tissue loss. The cospetic results are very satisfactory, but it is necessary to revise the flaps in order to obtain the best final results.

The authors report their experience concerning the diagnostic and therapeutic approach of 38 cases of cysts and odontogenous bening tumors of maxillaries. They underline of following: the frequency of this pathology in young male adults (58%); the importance of standard radiology which permits a diagnostic approach in 20 cases (52.6%); the necessity of adequate treatment the type of which depends on the radiological aspect and mainly the peroperative macroscopic aspect of the lesion and the necessity of the anatomopathological examination of any surgical piece of cystic lesion in order not neglect an ameloblastoma.

The authors report ten cases of reconstruction in the mandibular interrupter substance wast after excision of the large benign tumors which dominated by ameloblastoma. The reparation is realised by free no vascularized bone graft, of ten with the iliac crest, rarely with costochondral graft. The lateral mandibular interrupter substance waste concerning the temporo-mandibular joint (type III) is frequent. The reparation often immediate, is realised by the iliac crest graft fixed to mandibular stump with miniatures plaques and intermaxillar blocking. The fonctioning and morphology results in majority is qualified to be mean with a follow-up between 14 and 24 months.

Our retrospective study has concerned 85 cases of zygomatic-orbito molar fractures, hospitalised and treated from january 1983 to december 1992. 86% of patients were men. The young adult is interested in 78% of cases. The traffic accidents are predominant in 45%. The diagnosis is especially, made by the clinic and confirmed by the radiology. The abstension is justificate in 27, 1% due to the absence of deplacement and associated disorders. The orthopedic treatment concerns the len deplaced (20% of cases) and stable molar fractures. The surgery such as reduction with osteosynthesis or reconstruction of floor is realised in 55% of patients presenting deplaced fractures with norphologic and/or fonctionel disorders. The evolution is good in general. Few sequellaes has been noted in 25% cases. The authors insist on the interest of the precocity of diagnosis and treatment and on the multidisciplinar collaboration which permit an adapted treatment with few sequellaes.

The laryngopyocele is a rare complication of laryngocele. About one case of laryngopyocele and review of literature, the authors recall the main characteristics of this affection. Its clinical picture is often alarming. The CT scan, not often made emmergenceley, give a characteristic image. The treatment is mainly surgical but also endoscopic, then facilitated by the use of laser. The fact of thinking to this diagnosis toward a laryngeal dyspnea with fever permit sometimes to avoid tracheotomy then usually made emmergencely.

The authors report 10 cases of frontal sinus osteoma. The patient group consisted of 5 men and 5 women, ranging in age from 15 to 60 years. The most common revelating symptom was headache. Treatment depends on tumor size, its course, and complications. Transfacial incision was used in 3 cases and Cairns Unterberger approach in 5 cases. Post operatively anatomic and esthetic results were good, without recurrences.

A retrospective study of 25 sinuses mucoceles over a ten year period is presented. The authors insist on epidemics and diagnostics characteristics of this pathology and discuss the various therapeutics means.

The ossifiant fibroma is an authentic scarce benign tumoral processus. According to a literature review and two recent cases taken in charge in our service, having stand diagnostical and therapeutical problems. They seem interesting to accost the subject of the ossifiant fibroma in maxillo-facial surgery and put the accent on the differential diagnosis in histological plane between ossifiant fibroma and fibrous dysplasia having given different therapeuticals indicents. The two reported cases interest the masculine young subjects in one case with mandibular localisation and in the other one maxillary.

We report in this study six cases of the inverted papillomas of the nose, that we have noticed in the ORL's department in 20 august hospital from 87 to february 1992. It's about patients aged from 12 to 60 years old, a child, a woman and four tabagic men, one of who has an allergic rhinitis. The clinical symptomatology is evocative of our patients and is especially marked by the unilateral nasal obstruction. The radiology which has an important resort permitted to lean the diagnosis and to precise the extension of the tumor. The anatomopathologic examination permittedus confirm the diagnosis with certitude. The surgical treatment is chosen for the whole of our patients. The evolution in all the cases is satisfying. We neither notice a recurrence nor a malignant transformation.

For several years, the authors have been using a columellar transalar incision through the medial crus along the nasal septum, reaching the vault and continued laterally by a transalar cartilaginous incision. The nasal tip is thus opened like a car-hood, leaving the alar cartilage attached to the skin and exposing the triangular cartilage and the nasal septum. This approach allows septoplasty to be performed with excellent exposure. The tip is easily revised backwards allowing anomalies to be viewed directly. The advantages of this external approach compared with the classical external Rethi's approach are multiple: simplicity and rapidity of the technique, excellent access to triangular cartilages and the triangular-septum junction; possibility of always going from an endonasal approach to an external one and excellent access to the tip. Moreover, there is no long term swelling of the tip. The indications of this external approach are asymmetry of the tip, excessive tip projection, saddle nose deformities and secondary rhinoplasties. No complication has been observed in a series of 32 patients with a follow-up of 6 to 48 months. There is no disturbance of the tip position and the skin scar is imperceptible.

A prospective investigation about the influence of the tabagism and its characters on the laryngeal cancer has been led in the department of oncology in the Hospital Center Ibnou Rochd in Casablanca from December 1990 to June 1991. The investigation concerned 58 new patients. We conclude from this investigation that the risk of cancer increases with the intensity of the tabagism (the precocious age at the beginning, long duration, high number of packets/years; black tobacco, deep inhalation of the smoke, absence of weanling). The risk increases with the association with an intense alcoholism. We don't find the professional exposition. These cancers related to tobacco have epidermoid predominance. Finally, the major interest of this study is to convince us about the ampleness of this flail and to lead us through an educative action for the preventive fight against tobacco because of the risk of laryngeal cancer.

The authors report 3 cases of authentic maxillary osteoma. Two cases concerns an exceptional osteoma with multiple localisation and the third case a giant maxilla osteoma. Topographic, diagnostic and therapeutic notions of these tumors are related.

Between 1985 and 1990, 15 ethmoid frontal mucoceles were collated. All our patients consulted us at the exteriorization stage. A CT-scan is the ideal examination, making it possible to assert the diagnosis and to individualize the bone destruction and the neighbouring tissue repression. Trans-ethmoid or trans-nasal marsupialization by an external or endonasal approach provided excellent results after a 1 to 5 year follow-up period.

The authors report a case of auricular myiasis with a review of literature. Diagnostic, therapeutic and prophylactic means established facing this parasitical disease are analysed.

The outcome of surgical of small, ptotic breasts is reported in a retrospective series of fifteen patients operated between 1983 and 1989. Seven patients underwent breast augmentation by insertion of breast implant supplemented in one case by a dermopexy while eight patients underwent cutaneous and glandular remodeling alone. Simple breast augmentation with breast implant gave good results with mild to moderate ptosis (i.e. when the distance between the inferior margin of the clavicle and the upper margin of the areola was equal to or less than 17 cm) provided that: the subareolar segment III did not exceed 5 cm, the skin had good static qualities for breast suspension, the amount of glandular, adipose and cutaneous tissue present allowed the prothesis to be covered by a sufficiently thick layer. With breast ptosis greater than 17 cm or when segment III exceeded 5 cm, cutaneous remodeling by dermopexy was associated with insertion of breast implant. In this group of patients treated, either by breast implant alone, or associated with dermopexy, results were good in 33%, and satisfactory in 50% of cases. Better results were obtained in patients with marked ptosis and breasts which, although hypotrophic, conserved a amount of adipose and glandular tissue sufficient to allow breast reconstruction by soft tissue remodeling alone (without the insertion of an implant). Patients in this group were treated by glandular and cutaneous remodeling with good to excellent results in 80% of cases.

Mucocele of the maxillary sinus is a rare affection his pathogenesis is still discussed, with a prevalence of the injury's and inflammatory's theories. The diagnosis being confirmed by computed tomography imaging ... We report in this study, 3 cases of maxillary sinus mucocele, with a review of literature.

Capsular contracture around breast prostheses still represents a challenge, in spite of the numerous papers published on this topic. The etiology and pathogenesis of this condition are perplexing resulting in considerable controversy concerning the rationale for surgical treatment. The authors report two cases of recurrent disease: one patient with recurrent contracture after breast augmentation, the other patient with recurrence after breast reconstruction. Both patients were operated according to an original technique which consists in a square-shaped incision of the pectoralis major muscle via an inframammary approach. This surgical technique allows the prosthesis to sink into deeper layers leading to a better shape of the breast and providing satisfactory skin cover of the prosthesis.