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Summary Purpose To compare two distinct surgical techniques in the management of chronic Primary Lacrimal Canaliculitis (PLC) with clinically detectable concretions. Materials and methods Inclusion criteria: Patients presenting with symptoms consistent with the diagnosis of primary lacrimal canaliculitis (PLC) with ocular involvement were gathered. Gomori-Grocott Methenamine Silver test was used for concretion staining. Two groups were identified based on the surgical technique. Group A consisted of patients who underwent a punctum sparing canalicular curettage using a chalazion curette, while the patients in Group B underwent one-snip punctoplasty with lateral canaliculotomy. Failure was defined as recurrence of the initial symptoms at any time (ocular and canalicular inflammation with purulent discharge and pouting punctum). The results were analyzed by comparisons using a Fisher's exact test. Results Ninety-six consecutive patients (96) with a confirmed diagnosis of PLC underwent surgical treatment between 1987 and 2017. Data were collected and divided based on the surgical technique discussed above (Group A and B). Group A: 51 cases with a mean follow-up time of 22 months [1–224] presented with a mean age of 51.5 [25–83] and a surgical failure rate of 19.6%. Group B: 45 patients with a mean follow-up time of 27 months [1–176], a mean age of 68 [17–87] years and a surgical failure rate of 4.4%. Statistical significance was demonstrated, with a p-value of 0.033, odds ratio (OR) of 0.1936 and Standard Deviation (SD) at a 95% confidence interval of [0.0195–0.9885]. Conclusions One-snip punctoplasty with lateral canaliculotomy is a simple, fast and effective procedure that allows better anatomical visualization intraoperatively and is thus shown to be statistically superior to punctum sparing canalicular curettage using a chalazion curette.

Summary Introduction The formation of a fistula between the lacrimal sac and the skin is a classic outcome of resistant lacrimal sac abscesses. There is currently no consensus about treatment in such cases. The goal of this study was to describe the natural history of acquired fistulas between the lacrimal sac and the skin, occurring before planned endonasal dacryocystorhinostomy (DCR) and without any treatment of the fistula. Materials and methods This prospective study was only descriptive and included patients between 1999 and 2012. The patients included were adults with a nasolacrimal duct (NLD) obstruction that was planned to be treated with endonasal DCR. A resistant lacrimal sac abscess appeared a few days before the planned surgery, and fistulized spontaneously despite medical treatment. The surgery was not delayed. The DCR was endoscopic. Nothing was done for the fistula. Its healing was spontaneous. The exclusion criteria were the following: congenital fistulas, post-traumatic and/or iatrogenic fistulas, fistulas which had regressed by the day of the surgery, postoperative follow-up less than 5 months, post-traumatic and/or iatrogenic fistulas, any history of previous DCR or any other lacrimal surgery, children. Results Twenty adults (25 cases) were included in the analysis. Mean age was 79 years old (from 41 to 90). The mean follow-up was 41 months (from 5 to 108 months). The fistula spontaneously disappeared in all cases, less than one month after it had appeared and in a permanent fashion. No unsightly scar developed. Discussion Spontaneously acquired fistulas between the lacrimal sac and the skin may occur in the natural course of abscessed acute dacryocystitis. Our study showed spontaneous healing of the fistula post-endoscopic DCR. Conclusion Fistula excision in fistulous acute dacryocystitis does not seem essential to its healing. The laisser-faire approach appears adequate for aesthetic outcomes as well as for functional outcomes of DCR.

Tearing and conjunctivitis in children are commonly due to lacrimal drainage system obstruction. Congenital nasolacrimal obstruction is a common pathology treated by probing with or without silicone stent insertion, depending upon the age of the child. The silicone stent is self-retaining and placed for at least one month. MasterkaThe medical records of two patients surgically treated with the MasterkaThe frequency self-retaining stent disappearance is estimated at 15%. Among these cases, intralacrimal migration is only reported in 0.5% of cases. To prevent intralacrimal migration, the surgical technique must follow a certain number of rules. Management, based on residual epiphora, is discussed.Prevention of intralacrimal migration of self-retaining stents involves a rigorous analysis of the relationship between the meatus and the fixation head at the time of placement. After lacrimal intubation, scheduled monitoring is necessary to screen for stent disappearance. Management is based on clinical findings, anterior rhinoscopy and even exploratory canaliculotomy.

Introduction La lacorhinostomie est l’intervention qui etablit une communication permanente entre la region caronculaire et la fosse nasale a l’aide d’un tube place a demeure. Les principales complications sont liees a la biotolerance de ce tube. Observation Quinze ans apres une chirurgie lacrymale, une femme presenta des inflammations recidivantes de la region canthale, associees a des epistaxis du meme cote. La rhinoscopie anterieure mit en evidence une obstruction du meat inferieur par une tumeur d’allure muqueuse saignant au contact. L’imagerie confirma l’existence d’une tumeur locale, mais sans lyse osseuse. La dacryocystorhinostomie endonasale retrouva deux corps etrangers : un tube de lacorhinostomie au sein de la tumeur et une lithiase intra-sacculaire. L’examen histologique montra qu’il s’agissait d’une actinomycose du sac lacrymal. Discussion Les actinomycoses d’autres localisations sont volontiers associees a la presence d’un corps etranger. A l’inverse, les actinomycoses lacrymales sont le plus souvent primitives. L’association dans ce cas est plus vraisemblablement une coincidence. Conclusion Une reaction inflammatoire torpide suite a une chirurgie lacrymale doit faire rechercher une reaction a un corps etranger.

Resume Les traumatismes faciaux sont frequents lors de la pratique du rugby et de gravite variable. Leur connaissance ainsi qu'une prise en charge adaptee precoce sont les seuls garants de sequelles minimales ulterieures. Le medecin de terrain doit se familiariser avec ces lesions qui justifient parfois d'un geste specifique en urgence et toujours d'un bilan specialise dans les delais les plus brefs.

A pesar de la complejidad del desarrollo de la nariz y de la region mediofacial, las anomalias congenitas nasales son infrecuentes. Los quistes y fistulas del dorso nasal, los encefaloceles y las heterotopias gliales nasales son los mas frecuentes. El riesgo consiste en ignorar una posible comunicacion con el sistema nervioso central en la fosa craneal anterior. Estas malformaciones se encuentran de forma global en alrededor de 1/40.000 nacidos vivos. Pueden aparecer con o sin obstruccion ventilatoria. Si se tiene en cuenta que los neonatos son respiradores nasales obligatorios, la obstruccion nasal suele diagnosticarse en el periodo neonatal, mientras que el diagnostico de las anomalias congenitas sin obstruccion nasal suele ser mas tardio. Este articulo incluye una descripcion embriologica de la nariz y de la region mediofacial. En el se retoman y se describen las principales hipotesis embriologicas del desarrollo de la region frontonasal, en especial la teoria del espacio prenasal de Grunwald a la luz de los recientes resultados obtenidos mediante embriologia experimental. Se describen las principales malformaciones mediofaciales, asi como sus modalidades terapeuticas.

Nonostante la complessita dello sviluppo del naso e della regione mediofacciale, le anomalie congenite del naso sono rare. Le piu frequenti sono le cisti e fistole del dorso del naso, gli encefaloceli e le eterotopie gliali nasali. Il rischio e di ignorare una comunicazione potenziale con il sistema nervoso centrale a livello del piano anteriore della base del cranio. Queste malformazioni sono complessivamente riscontrate in circa il 1/40 000 nati vivi e possono manifestarsi con o senza ostruzione ventilatoria. Tenuto conto del fatto che i neonati sono respiratori nasali obbligati, l’ostruzione nasale e generalmente diagnosticata nel periodo neonatale, mentre la diagnosi di anomalie congenite senza ostruzione nasale e in genere piu tardiva. Questo articolo comprende una descrizione embriologica del naso e della regione mediofacciale e riprende e discute le grandi ipotesi embriologiche di sviluppo della regione nasofrontale, in particolare la teoria dello spazio prenasale di Grunwald, alla luce dei recenti risultati ottenuti nell’embriologia sperimentale. Saranno descritte le principali malformazioni mediofacciali e le loro modalita di gestione.

Pour traiter les stenoses lacrymonasales symptomatiques et rebelles, nous disposons d’une meme dacryocystorhinostomie (DCR) avec ses deux voies d’abords : externe (VEX) et endonasale (VEN). L’indication de base est la meme dans tous les cas, et les chemins sont tout aussi legitimes. Les preferences de l’operateur trancheront. La VEX parait difficilement egalable en terme de rapidite operatoire, de simplicite d’enseignement, de faible cout. L’abord canthal interne est logique pour traiter en association un diverticule du sac lacrymal, une stenose irreductible du canalicule d’union ou associer une canthopexie. La VEN a acquis droit de cite. Elle semble preferable chaque fois que coexiste une pathologie naso-sinusienne a operer simultanement, dans les rares abces lacrymaux irreductibles medicalement, lorsque la crainte d’une cicatrice fait obstacle a une indication operatoire legitime, et enfin dans les reprises de DCR. Il faudra encore quelques etudes prospectives randomisees pour savoir si reellement la voie d’abord influence les resultats. Alors, le choix entre VEX et VEN deviendra limpide. Dans cette attente, l’ideal est de disposer des deux methodes pour pouvoir se determiner cas par cas sans dogmatisme.

Objectif Les auteurs presentent un cas de carcinome epidermoide developpe sur un kyste du tractus thyreoglosse chez une adulte. Les modalites de prise en charge et la necessite d’une prevention sont discutees. Patient et methode Patiente de cinquante-cinq ans suivie pour un kyste du tractus thyreoglosse en raison d’un refus parental d’une chirurgie au cours de l’enfance. Resultats Le diagnostic a ete evoque sur une augmentation de volume et des douleurs cervicales. En raison d’un envahissement carotidien et de l’axe larynge, le traitement radiochirurgical n’a pas permis de guerison bien que l’evolution locale soit controlee par une chimiotherapie palliative avec deux ans de recul. Discussion L’exerese dans l’enfance des kystes du tractus thyreoglosse (KTT) est davantage pratiquee afin de prevenir des poussees infectieuses qu’une transformation maligne. Bien que faible, le risque de developpement d’un carcinome sur kyste du tractus thyreoglosse est certainement sous-evalue en raison d’une chirurgie d’exerese preventive tres souvent realisee dans l’enfance. Conclusion L’evolution dramatique du cas presente nous amene a recommander encore une fois une chirurgie d’exerese preventive de ce type de malformation, et a discuter les modalites de prise en charge de ce type d’evolution.

But de la presentation Etudier retrospectivement des patients operes de chirurgie orthognatique (osteotomie maxillaire, mandibulaire et genioplastie)afin d’en visualiser les consequences sur l’aspect esthetiques du nez. Materiel et methodes Cinquante cas de patients operes de chirurgie orthognatique : osteotomie maxillaire (Le fort), mandibulaire (osteotomie sagittale), chirurgie bimaxillaire, genioplastie. Examen des photos face et profil pre et post-operatoire. Resultats L’osteotomie de Le Fort d’avancee maxillaire entraine une modification constante de l’aspect du nez sous forme d’un elargissement de la base de face et d’une rotation de la pointe vers la partie cephalique. Selon le type de nez ceci va avoir un impact positif ou negatif sur l’esthetique L’impaction maxillaire seule va entrainer un elargissement de la pyramide nasale sans remontee de la pointe qui peut entrainer un resultat esthetique deletere sur l’aspect du nez. L’osteotomie d’avancee mandibulaire dans les classes 2 d’Angle va diminuer de maniere subjective la projection du nez sur le profil. La genioplastie d’avancee peut egalement diminuer la projection subjective du nez. Conclusion La chirurgie des bases osseuses du massif facial modifie de maniere certaine l’esthetique nasale, soit dans un sens positif, soit dans le sens d’une deterioration esthetique. Une bonne analyse photographique pre-operatoire est imperative pour prevenir le patient de cette modification afin de le preparer a un geste esthetique nasal secondaire si necessaire.

To study the behavior of a "pushed" monocanalicular stent by means of nasal endoscopy.Four children (six affected sides) with congenital nasolacrimal duct obstruction were treated with monocanalicular intubation with an anchoring plug. The children's mean age at the time of the operation was 33 months (range, 30-37 months). The procedure began with probing in order to verify (a) dacryostenosis (simple or extensive nasolacrimal duct impatency) and (b) the metal-to-metal contact in the lower nasal meatus. The stent was similar to a Monoka(TM), but the guide (a malleable stainless steel probe) is located inside the silicone stent rather than projecting from it. The silicone's total length is 40 mm and the external diameter 0.96 mm. Simultaneously, the guide acts to catheterize the nasolacrimal duct by pushing the silicone through the upper and lower parts of the outflow system. The guide is removed via a punctal approach. This mode of intubation dispenses with the nasal recovery step. Nasal endoscopy was used to monitor (a) the position of the stent in the lower nasal meatus (free or submucosal), (b) mucosal damage and bleeding, and (c) the behavior of the silicone tube during removal of the guide.Because of the complexity of nasolacrimal ducts, two of the six sides were treated with the classical Monoka intubation method of pulling the silicone tubing out from the nasal exit of the duct (the pull technique). The pushed intubation method was used for the four simple nasolacrimal stenoses, with no problems whatsoever. In all four cases, endoscopic examination showed (a) no submucosal tunneling (false passage), (b) no noteworthy mucosal damage, and (c) no retraction (bunch-up) of the silicone tube during the metal guide removal. No particular complications were reported during the procedure or the intubation period, which lasted an average of 3 weeks. The stents were removed in the consulting room. Tearing ceased during the 1(st) week in two cases, during the intubation period. Tearing persisted throughout the intubation period in the other two cases, but ceased during the week following stent removal. The follow-up lasted 2 months.The pushed procedure simplifies monocanalicular nasal intubation. Its indications remain to be determined.

Neonatal obstruction of the distal part of the lachrymal system can lead to dilatation of the lachrymal sac if associated with a canaliculus problem. Clinical presentation is a blue tumor of the internal canthus. This external expansion of the lachrymal sac communicates with a nasal expansion under the inferior nasal turbinate. Even if this typical presentation is spectacular, spontaneous resolution occurs in 80% of cases. There are two main types of progression: an abscess of the lachrymal sac can occur (20%) or bilateral nasal respiratory obstruction in cases of bilateral obstacle because newborns are obligatory nose breathers (0.1%).

A persistent, symptomatic lacrimal duct stenosis is treated by dacryocystorhinostomy (DCR), with external (EX) or endonasal (EN) access. The basic indication is the same in all cases and either route can be used. The EX route seems better in terms of speed of surgery, learning curve and cost. It is logical to use the external route to treat the disorder when it is associated with a lacrimal sac diverticulum, an irreducible stenosis of the union canal, or a canthopexy. The EN route has been shown to be worth consideration whenever there is a nasal sinus disorder that can be repaired at the same time. Moreover, it is indicated in a rare case of lacrimal abscess that cannot be treated medically, where the risk of scarring would contraindicate standard surgery, or when DCR is recurrent. A series of prospective randomized studies is needed to determine whether the route materially influences the outcome. Until then, it is best to have both methods available for an unbiased case-by-case decision.

To present a case of squamous cell carcinoma developed on a thyroglossal duct cyst in an adult patient. Modalities of treatment and prevention are discussed.A 55-year-old woman had a thyroglossal duct cyst since childhood. Surgical resection had not been performed because of parental refusal.Diagnosis of malignant degeneration was suggested by an increase in volume associated with cervical pain. Surgery was incomplete because of carotid artery and laryngeal involvement. Postoperative radiotherapy was given. At two years follow-up, local progression was controlled by palliative chemotherapy.For most authors, the risk of recurrent infections is the main reason for surgical resection of a thyroglossal duct cyst during childhood. The risk of malignant degeneration is generally not put forward. It is rather uncommon for carcinoma to develop on a thyroglossal duct cyst. The risk is probably underestimated because surgery is generally performed early in childhood.This observation of malignant degeneration emphasizes the importance of surgical resection of thyroglossal duct cysts during childhood. We discuss treatment in the event of malignant degeneration.

Hemangiomas and superficial vascular anomalies of the head and neck form what usually calls the angiomas. Many terms exist in the literature for that reason the classification of the ISSVA, admitted by most of the doctors, helps us in naming the different anomalies. The processing of this pathology needs a multidisciplinary collaboration with doctors of different specialties. The evolution of the radiological, surgical techniques of laser, and who knows, of the research, allows to hope us to cure some of the particularly dangerous anomalies like the arteriovenous malformations. We presented here the different technics used in 2001 in the management of hemangioma and superficial vascular anomalies insisting on a multidisciplinary approach.

But de la presentation Le systeme de Rhinosculpture de la societe Bien Air a recemment beneficie d’une evolution technique permettant un travail osseux simplifie et plus rapide. Le but de la presentation est de presenter cette evolution et d’en discuter l’interet. Materiel et methodes Trente patients ont consecutivement ete opere avec une nouvelle râpe et une nouvelle lame pour realiser les osteotomies laterales. Une echelle de confort chirurgical et une mesure de la duree du temps osseux de la chirurgie a ete compare avec une etude faite precedemment. Resultats L’etude de l’echelle de confort chirurgicale montre que l’utilisation d’une râpe plus agressive apporte une nette amelioration des possibilites de rhinosculpture par rapport aux anciens instruments de râpage. Par contre cela necessite une utilisation plus precautionneuse pour eviter les encoches en « nid de poule » sur les surfaces laterales des os propres du nez. Les nouvelles scies laterales sont plus faciles d’utilisation a partir du moment mais ne reglent pas le probleme de l’effraction muqueuse interne qui reste difficilement controlable. Conclusion L’evolution des lames de Rhinosculpture permet un travail osseux plus rapide et plus efficient qui simplifie le temps osseux de la rhinoplastie mais il existe encore une marge de progression.

Endonasal dacryocystorhinostomy is technically more difficult than the classic method and apparently less rational. The nasal fossa is a variable and potentially dangerous anatomic region. The uncinate process "opens the door" to the middle meatus and covers, in almost all cases, the junction between the lacrymal bone and maxillary concha. A marker almost always found. Uncinate process resection is a natural way to access the lacrymal apparatus. Associated with transillumination of the lacrymal duct, uncinate process resection, is in our opinion, a reliable and, most importantly, reproducible method for an endonasal approach to the lacrymal sac. With resection, endonasal dacryocystorhinostomy becomes a simple, safe and rapid procedure.

To analyze the interest of protected drills to perform endoscopic endonasal DCR.[corrected] Fifty patients suffering from chronic epiphora were operated successively. None of those patients had had prior nasal surgery. The same surgeons (BF and ER) did the surgical procedure for all the cases. The technical steps were: endoscopic visualization of the middle meatus and evaluation of the anatomic variations of the nose; identification of the lacrymal bag with a 1 mm light in the canaliculus; unciformectomy; the maxillary bone was drilled with a 3.2 mm bit (straightshot Xomed), protected and irrigated; the lacrymal bag was opened by cissors and the flap was pushed in the ethmoid and coagulated.The suction-irrigation system was efficient to clean the surgical site, with a good endoscopic control. The protected bit didn't damage the 4-mm optics and the septal wall mucosa, even in narrow noses. The staightshot bit (Xomed) was tough enough to drill the maxillary bone in only 68 % of the surgical cases. In 28 % the drilling was unsatisfactory and in 4 % it was inefficient. The functional results at 6 month were good in 85 %. There was no difference between normal and narrow noses.The concept of protected bits perfectly matches the endoscopic endonasal DCR. The visual comfort and security of the surgical procedure are increased. Short term results are equivalent to external DCR, but are rather inefficient and expensive.

Introduction Rapporter les resultats fonctionnels et les complications a long terme d’une serie homogene de DCR endonasale. Materiels et Methodes Cent adultes presentant une stenose lacrymo-nasale chronique, isolee et idiopathique ont ete operes par DCR endonasale entre 97 et 99. L’etude etait retrospective. Il s’agissait de 81 femmes et 19 hommes. Âge moyen : 54 ans (extremes 22 et 82 ans). La technique chirurgicale etait standardisee : transillumination du canalicule commun, turbinectomie moyenne anterieure en cas de recouvrement de la gouttiere lacrymale, unciformectomie anterieure, osteotomie par forage protege ; meme equipe chirurgicale. Un nouvel examen completait les resultants rapportes initialement en 2000 puis en 2001. Il recherchait la permeabilite des voies lacrymales et les complications naso-sinusiennes. Les nouveaux echecs ont ete documentes par une tomodensitometrie avec opacification des voies lacrymales. Resultats Soixante-deux patients sont perdus de vue. 48 patients presentent un recul clinique superieur a celui de 2001. Le recul moyen est de 78 mois (extremes : 14 et 110 mois). 77 % (37/48) des voies lacrymales sont permeables. Ce taux de succes est moins bon que celui obtenu en 2000 et 2001 (respectivement 87 et 83 % de bons resultats). L’analyse tomodensitometrique des 5 echecs tardifs montre : a) la persistance d’une paroi osseuse en regard du canalicule commun (4/5) ; cette region correspond a l’insertion du cornet moyen sur la gouttiere lacrymale. b) une osteotomie « libre » ; Cet echec etant explique par une fibrose cicatricielle. Discussion Par rapport aux examens de 2000 et 2001, aucune nouvelle complication naso-sinusienne n’a ete decelee. Conclusion Ces resultats amenent a discuter 3 notions classiquement admises : 1) l’acquisition definitive du succes fonctionnel au-dela du 6 e mois post-operatoire, 2) l’absence de repousse osseuse des bords de l’osteotomie, 3) l’apparition tardive de complications sinusiennes secondaires a la voie endonasale.