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Studying 213 cases of epithelioma of the laryngeal margin, the authors report on a 3-part study. The first part defines, classifies and specifies the extension of marginal epitheliomas, the second part studies anterior margin epitheliomas and the third, epitheliomas of the lateral margin. This first part shows that the laryngeal margin forms a precise anatomo-clinical entity which must be subdivided into anterior lateral posterior and total margins. The anterior margin consists of the free edge, the supra-hyoid laryngeal side of the epiglottis and, for the authors, the laryngeal side of the epiglottis that belongs, for the UICC, to the oropharynx. The lateral margin consists of the aryteno-epiglottic fold and, for the authors, of the intersection of the three fold that are not mentioned in the UICC or the AJC classifications. The arytenoid cartilage forms the posterior margin. Together, tumors of the anterior margin and the lateral margin make up for 94% of marginal tumors. This first part specifies the macroscopic aspects of marginal epitheliomas with their local and lymphatic extension.

In this second part, we study 102 cases of epithelioma of the anterior margin of the larynx. The authors insist on the need for bilateral treatment of lymphatic areas on account of their frequent bilateral involvement, jumping from 9% for N0 to 80% for a fixed unilateral enlarged lymph node. Whatever the T stage, the best therapeutic results are provided by total or partial surgery of the lesion combined with surgical treatment of lymphatic areas completed by irradiation.

An 11-year-old child developed an infection of the scalp due to anaerobic germs following an acute attack of frontal sinusitis. The mechanism and therapy of this rare complication are discussed. The favorable outcome in this case suggests the need for revision of the generally poor prognosis of this complication, on the condition that adequate treatment be applied under the control of a multidisciplinary team.

The third part ends the study on epitheliomas of the laryngeal margin and concerns 8 cases of epithelioma of the lateral margin (aryteno-epiglottic fold and intersection of the three folds). The authors emphasize the considerable lymphatic tropism of these tumors. In 58% of these, enlarged lymph nodes were found, 65% of which showed histological involvement. Best results (survival and local sterilisation) are provided by surgery, partial or complete, depending on the T stage, the tumoral site, and combined with lymphadenectomy, completed by irradiation.

The two principal embryogenic theories, persistence of residual structures remaining after closure of the anterior neuropore and inclusion of epiblastic derivatives in the prenasal space, may be combined, with resulting two embryonic varieties of these malformations. Glabellar cysts, with or without fistulae extending them downwards, and which remaining at superficial level may perforate the true nasal bones. Other fistulae can develop which extend deeply and present variable dilatations with a more or less oblique path upwards depending on the level of their opening into the nose.

Organization is conserved in proboscis lateralis and in this respect it represents a half-nose and not a nasolacrymal canal. It is characterized by mainly skeletal deficiency and a paramedian lateral localization. Associated alterations involved olfactory and ocular structures, often with a disorder of closure of the colobomic slit, but overall neuroblast development is not disturbed. Effects on the subjacent facial regions are variable and remain lateral, the overall situation in relation to Tessier's fissure tending to clarify their significance. Comparison of the malformation with the different degrees of cyclopia and with the bifid nose confirms its origin from a particular form of embryogenic process. Significance of participation of the olfactory placodes and the neighboring ectomesenchyme is discussed, together with the modalities of this participation. The latent bilateral nature of the malformation must be recognized together with its embryogenic consequences.

Two patients developed cholesteatomos following conservative surgical treatment of facial palsy by antro-atticotomy of the bony framework. As the middle ear was not affected the lesions probably arose from the internal auditory meatus, and this was confirmed in one case. The association of stenosis of the external auditory meatus due to sliding and retraction of the external ear raises the question of the need for its correction to prevent this rare complication.

The present study represents part of a more important work relative to normal food refuse and change of weight of varied food according to different ways of cooking. The study has been realized on vegetables and some fruits of frequent utilization in the population. It was accomplished by 25 voluntary housekeepers from Paris and Marseille during a whole year according to precise instructions about the method of weighings, every vegetable having to be weighed, three times at different intervals, during the year; 3203 weighings were mode corresponding to 2 399 kg of divers types of vegetables. The results have pointed out important variations according to the kinds of vegetables and methods of cooking. At boiling, the most utilized method, the variations of weight according to the weight before cooking are very important extending from + 10 p. 100, for Brussel sprouts and fresh flageolets at--25 p. 100 and--36 p. 100 for lettuce and endive, the last of weight being the highest for fine leaves vegetables, lesser for roots and tubers, and around zero for artichokes, french beans, cauliflower, aubergines. Other methods of cooking, through concerning a more limited number of kinds of vegetables have pointed out that "sauté" brings a higher loss for the vegetables studied; Similar observations can be made for braising and stewing, frying leads to the highest loss reaching--48 p. 100 for chips. However the weight of fresh pulses varies slightly at boiling and stewing, it is the same for potatoes. As for dry beans, the increase of weight is less important than the percentage curently utilized for the calculation of surveys, the loss of weight according to cooked fruits pears and apples is not high (about 10 p. 100). These results should be taken into consideration for the exploitation of food surveys, especially norvadays when surveys are made more often at home and at the hospital and concern the individual consumption either by weighing the food consumed at table in dining-room or on the tray of the patient, and also when surveys are realized by interrogatory, the food being then, cooked, without refuse. From this point of view the last two tables present the results for a practical utilization. The first one gives the different kinds of vegetables studied with every way of cooking observed, the numbers of weighings effected the weight corresponding to 100 g raw and the weight corresponding to 100 g cooked, the other one presents the kinds of vegetables classified according to importance of the variations of weight for different ways of cooking in connection with the weight before cooking.

Postoperative course and complications were studied as a function of the type of anesthesia, and the employ of a tracheotomy tube and gauze drainage of the laryngeal cavity, following partial vertical surgery on the larynx of 238 patients. Findings demonstrated that a general anesthetic by intubation with total skin closure without tracheotomy and gauze drainage of the laryngeal cavity, reduced the incidence of local infections complications and the duration of hospitalization. Without insisting on the advantages of this type of anesthesia and the value of immediate suturing, the authors note that these simple techniques markedly reduce the hospitalization period at a time when emphasis is being placed on the economic impact of the duration of this period.

Results of therapy as a function of etiology are discussed in relation to 72 cases of acquired facial palsy in children. Spontaneous recovery occurred in 28 of the 33 cases with idiopathic facial palsy, this representing the most common form (46 p. cent of total) and appearing to have a still better prognosis than in adults. An infectious origin was determined in 19 cases (26 p. cent). Medical treatment produced complete recovery in 7 of the 8 cases with otitis, while simple mastoidectomy relieved 8 of the 11 patients with facial palsy due to mastoiditis. The indications for operative intervention should be widened in post-traumatic cases (14 in this series) with immediate onset of paralysis. Similarly, medical treatment of secondary paralysis should not delay surgery in cases with no regression after three weeks.

Cefotaxime levels were measured in the middle ears of 12 children, after operations for insertion of a transtympanic aerator for serous or relapsing otitis. Mean auricular cefotaxime levels were 4,3 and 5,1 mcg/ml on the right and left respectively. Mean serum level one hour after 25 mg/kg i.m. was 14,5 mcg/ml. In can be concluded that cefotaxime penetrates effectively into the middle ear. Its use should be reserved for difficult or menacing cases of otitis, but its bacteriological activity with regard to Haemophilus influenzae and certain enterobacteria is of value in cases where ampicillins may be ineffective due to resistance of strains.

In spite of imperfections, combined functional and plastic surgery is of value of treating major aplasias of the ear. The two operative procedures can be performed by the same surgeon or the same team when the child has reached 5 to 6 years of age. The technique involves the use of sliding pedunculated flaps, with rotation in the auricular region, and the employ of conventional otologic microsurgical methods (homograft, moulded temporal aponeurosis). Results in 48 cases demonstrated auditory improvement of more than 20 decibels in 47-5 p. cent of cases, and 30 to 40 decibels in 20.8 p. cent.

Forty-four cases of neonatal facial paralysis have been treated in the ENT department for children in the hôpital Trousseau, paris. In nearly half of the cases the etiology was related to nervous or muscular aplasia, while in the other cases of traumatic, infective, or doubtful etiology, the severity and course of the paralysis served as a guide to choice of therapy. Surgery was indicated in only 13 cases and recovery was obtained in 4 infants, with more or less marked sequelae. Prognosis is very poor in cases treated at a late stage, especially when the nerve appears to be greatly altered or compressed by callus. Surgical exploration should therefore be undertaken reasonably early (6 weeks to 2 months) when total paralysis persists or becomes worse after initial improvement.

A case of proboscis lateralis with total absence of the corresponding half of the nose is reported. The length of the mucocutaneous cylinder enabled initial insertion of its free extremity around its bony orifice in communication with the single nasal fossa, and the creation of a functional, well situated naris. Second-stage operation several months later involved spreading of the upper part, closure of the coloboma, and treatment of the lacrimal pathways. Total liberation of the superior pedicle and final modelling is to be envisaged at a later date as a function of growth.

Extensive investigation of 41 patients highly suspected of having pontocerebellar angle tumors led to the detection of 21 surgically confirmed tumors. Precise criteria, involving numerical rating of sensitivity and specificity, were applied to compare the diagnostic reliability of multidirectional and computed tomography. An analysis of the diagnostic value of internal auditory canal anomalies demonstrated the obvious superiority of 3 mm as against 6 to 9 mm scanner sections, and the good correlation between the anomalies detected by these thin scanner sections and those obtained by tomography. Above all, however, the efficacy of thin scanner sections appears to be markedly superior to that of tomography, as 80 p.cent of tumors were visualized without false positives even when the internal auditory canal was normal. The number of cisternography examinations was thus considerably reduced. This efficacy of thin scanner sections varied as a function of the tumor size : all those of 2 cm diameter or more were detected by the scanner, 50 p.cent of those between 1 and 2 cm by both the scanner and tomography, the latter being more effective for detecting tumors less than 1 cm in diameter. The availability of the 4th generation scanner will markedly increase its effectiveness.

Tonsillar diffusion of two antibiotics was compared in 61 children, 26 receiving 100 mg/kg/d of ampicillin, and the other 35 being treated with 50 mg/kg/d of triacetyloleandomycin during the 24 hours preceding tonsillectomy. Drug levels were measured by a microbiological method. The mean ampicillin level in the tonsil was 0,84 mcg/ml for a serum level of 4,1 mcg/ml 90 minutes before sampling, concentrations being absent in the tonsil in 12 cases (45 p. cent). Mean triacetyloleandomycin levels in the tonsil were 12,16 mcg/ml for a serum level of 2,27 mcg/ml 90 minutes before sampling, concentrations being absent in the tonsil in only 4 cases (11 p. cent). Very high concentrations of triacetyloleandomycin as against low or no levels of ampicillin were therefore detected in the tonsil. This suggest that macrolides should be employed in preference to ampicillin for the treatment of recurrent sore throats, and tonsillixis, and for preventive treatment of acute rheumatic fever.

Acoustic neurinomas must be diagnosed as early as possible for the tumour to be removed while it is still small and the facial and, sometimes, auditory functions to be preserved. Since 89% of neurinomas lie on the vestibular nerve, enhancing the sensitivity of test exploring this nerve is important. Bilateral bithermal caloric stimulation is more sensitive (85%) than unilateral stimulation (71%) in detecting functional impairment. By comparing the two examinations in a series of 28 patients the authors have demonstrated that the test is more sensitive and reliable when bilateral and unilateral stimulation are practised successively. A study of correlations between these tests and the volume of the neurinoma showed that while functional impairment generally increases with the size of the tumour, it may vary from nil to 100% in small neurinomas. However, the sensitivity of the caloric test remains inferior to that of more sophisticated audiometric techniques, such as BERA-recording of stapedial reflex.