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We analyse the most important clinical, CT, surgical, histopathological, biological, biochemical, mycological and bacteriological features of caseous sinusitis, i.e. chronic, poorly symptomatic sinusitis which are resistant to usual treatment. CT shows an opacity of the maxillary sinus with often a hyperdense foreign body (dental overfilling) but no valid predictive criteria for fungal etiology. The endoscopic or surgical procedures point out a caseous mass often called fungal mass or aspergilloma. The biochemical composition of this mass (water, proteins, lipids) is similar to that of tissues surrounding the sinus. The calcium value is variable and shows no correlation with CT imaging. The qualitative and quantitative analysis of the metals (zinc, lead, silver, copper, iron) is of relevance for exogenic origin (dental overfilling). The fungal etiology is inconstant (20 cases) after the mycological investigations. We discuss the nosologic and diagnostic features of caseous sinusitis, fungal or not, and which are often or too often called aspergillosis sinusitis.

The authors report an uncommon case of caseous dental sinusitis with infection or superinfection by mocorales and actinomycetes. The patient was healthy, without diabetes mellitus, but was treated for lymphoma 18 years before. This observation leads to a discussion of nosologic, diagnostic and therapeutic features of caseous sinusitis, dental or not, fungal or not, which are often or too often called aspergillosis sinusitis. The recovery of the patient was complete after surgery, amphotericin B and hyperbaric oxygen.

A patient with a progressive peripheral facial paralyses should be considered to have a tumor involved the facial nerve until proved otherwise. Haemangiomas of the temporal bone are uncommon and the present study discusses pathology, clinical presentation and therapeutic management of a tumor located at the geniculate ganglion. Complete surgical removal by the middle fossa approach is the treatment of choice with adequate margins and preservation of adjacent structures when it is oncologically possible. The surgeon must be familiar with all aspects of facial nerve repair.

Authors present one case of hemangiopericytoma of the infra-temporal fossa and the lateral wall of the nasopharynx. They describe the characteristics of this rare, recurrent and sometime malignant vascular tumor. The selected therapy is an aggressive and wide exeresis. The antero-inferior approach via the cervico-trans-oral route would seem to be of particular interest, offering good exposure of the anatomical features of the region avoiding the parotid bed ans dissection of the facial nerve.

The embryologic origin of the parietal bone is membranous bone. Experimentally, membranous bone grafts, maintain its original size, structure with good osteo-integration contrary to endochondral bone autografted (ilium, rib or tibia). The morbidity of skull bone grafts is much less than other donor site of bone. In our study, between 1988 and 1992, autogenous split calvarial bone grafts were used in maxillo-facial reconstruction of seventy-one patients. We observed no major complication. Patient followup has been from 2 to 6 years and results are better than endochondral grafts (iliac crest, ribs, tibia). Parietal grafts bone have been used in the following case: nasal reconstruction, rehabilitation of defects in the floor of the orbit, maxilla grafts, correction of frontal depression and mandibular reconstruction.

This retrospective study of 110 middle ear cholesteatomas, concerning children up to 15 years old which have been treated between 1982 and 1992 in the ENT department of the university hospital of Strasbourg, analyzes the particularities of this disease and the therapeutic strategy adopted. The evolution of middle ear cholesteatoma is more rapid in childhood than in adulthood, due to greater growth potential of tissue in childhood, persistence of Eustachian tube dysfunction and aggressive extension in middle ear. The surgical removal is said to be difficult with numerous postoperative recurrences. Closed technique tympanoplasty was used for 47 cholesteatomas (43%), with a postoperative recurrence rate of 54%. An open technique was used for 63% cholesteatomas (57%), with a recurrence rate of 29%. The postoperative follow up has to be continued as long as possible, whatever the technique used may be.

Secondary localisations of malignant tumors to the ENT areas are rare. One case of renal adenocarcinoma metastasis to the thyroid has been followed in our department. After a quick recall of the clinical story, we will try to point out the epidemiological and physiopathological specificities of this localisation and to emphasize its therapeutic difficulties.

15 cases of congenital cholesteatoma surgically treated from 1982 to 1992 are presented. Clinical diagnosis criteria, pathology, localisations and extensions to the middle ear are analyzed. Ossicular malformations were associated in one third of the patients of this series. These ossicular malformations underscore the congenital origin of such cholesteatoma. A review of the literature and pathogenesis of congenital cholesteatoma is discussed.

The use of osseointegrated titanium implants has improved the quality of auricle prosthesis fixation. Between december 1993 and july 1994, twenty two titanium fixtures have been surgically implanted in nine patients in the Ear Nose Throat department of the university hospital of Strasbourg. This method of auricle amputation repair achieves a good esthetic result with a low rate of postoperative complications.

Vestibular neuronitis is an acute disorder of the vestibular apparatus which manifests by sudden vertigo, without apparent cause, and without auditory or neurological symptoms. Clinically and by thermal stimulation tests, it is characterised by unilateral peripheral vestibular deficit. Evolution is favourable in several days to several weeks and prognosis is favourable, although disorders of moderate intensity may rather often persist, in the form of positional vertigo, sometimes paroxysmal, or disorders of equilibrium on abrupt movement. Careful history-taking and clinical examination, routine evaluation of the vestibular-cochlear apparatus and follow-up of the patient during the first days can eliminate the possibility of vascular cerebellar syndrome, which would require emergency imaging and possibly recuperation by surgery. The aetiology of vestibular neuronitis remains mysterious: inflammatory, viral, vascular? Sedatives acting on the vestibular system should be given for only a very limited time; they inhibit the mechanism of central compensation, which is on the contrary favoured by early vestibular function and rehabilitation.

Closure of wide palate defects is still a very complex problem and a real challenge for cervico-facial surgeons. The authors present an original technics drifted of the one D.W. Furnas describe in 1986. It allows, in a single stage, reconstruction of palatal defects. Surgical procedure of the temporal fasciosseous island flap is presented and then, advantages and inconveniences are discussed.

About one case of septic sigmoid sinus thrombosis, the authors present various clinical and paraclinical elements of this rare pathology, whose entity are generally subtle for benign but also for serious forms. Although uncomplicated dural venous thrombosis carries an excellent prognosis with proper treatment, delay in diagnosis and institution of appropriate therapy may lead to serious, or even fatal, consequences. The modern literature is reviewed and the pathology, presentation and management of lateral sinus pathology is discussed.

Extra capsular bleeding occupies a particular place within the evolutional complications of parathyroid tumors. Its rarity, the difficulty of the pre-operative diagnosis and its potential evolution towards airway obstruction by compression underline its singular character. A case is presented where an evolutive cervico-thoracic hematoma, evolving without functional symptoms, has led to the diagnosis of parathyroid hyperplasia. The diagnostic and therapeutic characteristics of this pathology are detailed and confronted to the similar cases found in the literature.

Objective pulsatile tinnitus is an unusual disease. Diagnosis, suspected by the interrogation, can be confirmed by vascular radiography. Treatments are discussed and can use surgical solution or interventional radiology. The authors describe one case of arteriovenous occipito-sinusal fistula revealed by pulsatile tinnitus and treated with success by means of embolisation.