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Introduction High-intensity conflict is back after decades of asymmetric warfare. With the increase in the incidence of head, face, and neck (HFN) injuries, the French Medical Military Service has decided to deploy HFN surgeons in the new French Role 2: the Damage Control, Resuscitation, and Surgical Team (DCRST). This study aims to provide an overview of HFN French surgeons from their initial training, including the surgical skills required, to their deployment on the DCRST. Materials and Methods The DCRST is a tactical mobile medico-surgical structure with several configurations depending on the battlefield, mission, and flux of casualties. It represents the new French paradigm for the management of combat casualties, including HFN injuries. Results The HFN’s military surgeon training starts during residency with rotation in the different subspecialties. The HFN surgeon follows a training course called “The French Course for Deployment Surgery” that provides sufficient background to manage polytrauma, including HFN facilities on modern warfare. We have reviewed the main surgical procedures required for an HFN military surgeon. Conclusion The systematic deployment of HFN surgeons in Role 2 is a specificity of the French army as well as the HFN surgeon’s training. Currently, the feedback from an asymmetric conflict is encouraging. However, it will have to innovate to adapt to modern warfare.

Riassunto Il seno frontale e il seno che presenta la sfida piu seria per i chirurghi del naso e dei seni, non solo per la complessa anatomia delle sue vie di drenaggio o per la vicinanza di strutture vitali che possono rendere difficile la dissecazione a questo livello, ma anche per la difficolta a ottenere risultati funzionali regolarmente soddisfacenti a lungo termine. La diversita delle tecniche chirurgiche nel trattamento delle patologie frontali testimonia questa difficolta. Questo articolo mira a presentare le principali tecniche chirurgiche utilizzate nel trattamento delle patologie non tumorali e non traumatiche del seno frontale. Le tecniche descritte sono principalmente destinate alla patologia sinusale cronica infettiva (sinusite cronica, aspergilloma, ecc.), ritenzionale (mucocele), tumorale benigna (osteoma, papilloma invertito, ecc.) e ai meningoencefaloceli, patologie spesso legate a una patologia etmoidale anteriore o a una storia chirurgica a livello del recesso frontale. Sono state descritte due categorie principali di tecniche chirurgiche. Le prime sono chiamate “di drenaggio” e mirano a ristabilire una via di drenaggio e di ventilazione delle cavita del seno frontale. Interventi “minimamente invasivi”, le tecniche endoscopiche rappresentano, attualmente, il gold standard, ma richiedono una buona padronanza dei punti di riferimento anatomici endoscopici, un’attenta valutazione della tomografia computerizzata (TC) preoperatoria e il controllo dei lembi mucoperiostali, al fine di prevenire le stenosi postoperatorie e di evitare le complicanze. Persistono ancora indicazioni per alcune tecniche di ripermeabilizzazione per via esterna. Le tecniche di esclusione sinusale tramite riempimento devono essere riservate ai casi di fallimento o ai casi sfavorevoli legati all’anatomia o alla patologia causale. La mucosa del seno viene, poi, sradicata nella sua interezza, il seno viene riempito con del materiale biologico o sintetico ed ogni comunicazione nasofrontale viene obliterata. La cranializzazione dei seni frontali richiede una stretta collaborazione con un’equipe neurochirurgica.

Resumen El seno frontal es el seno que plantea el reto mas importante a los cirujanos nasosinusales, no solo por la anatomia compleja de sus vias de drenaje o por la proximidad de las estructuras vitales que pueden dificultar la diseccion a este nivel, sino tambien por la dificultad para obtener resultados funcionales constantemente satisfactorios a largo plazo. La diversidad de las tecnicas quirurgicas en el tratamiento de las patologias frontales refleja esta dificultad. El objetivo de este articulo es presentar las principales tecnicas quirurgicas utilizadas en el tratamiento de las patologias no tumorales y no traumaticas del seno frontal. Las tecnicas descritas se dirigen esencialmente a la patologia sinusal cronica infecciosa (sinusitis cronica, aspergiloma, etc.), de retencion (mucoceles), tumoral benigna (osteoma, papiloma invertido, etc.) y a los meningoencefaloceles, patologias a menudo relacionadas con una afectacion etmoidal anterior o con antecedentes quirurgicos del receso frontal. Se han descrito dos grandes categorias de tecnicas quirurgicas. Las primeras se denominan «de drenaje» y se dirigen a restablecer una via de drenaje y de ventilacion de las cavidades sinusales frontales. Las tecnicas endoscopicas son cirugias minimamente invasivas que representan en la actualidad el patron oro, pero requieren un buen dominio de las referencias anatomicas endoscopicas, una evaluacion minuciosa de la tomografia computarizada (TC) preoperatoria y el dominio de los colgajos mucoperiosticos para prevenir las estenosis postoperatorias y evitar las complicaciones. Siguen existiendo indicaciones para algunas tecnicas de repermeabilizacion por via externa. Las tecnicas de exclusion sinusal por llenado deben reservarse a los casos de fracaso o a los casos desfavorables relacionados con la anatomia o la patologia causal. En estos procedimientos, se reseca toda la mucosa sinusal, el seno se rellena con un material biologico o sintetico y se oblitera cualquier comunicacion nasofrontal. La cranealizacion de los senos frontales requiere una colaboracion estrecha con un equipo neuroquirurgico.

Resumen Las infecciones especificas son patologias microbianas que se caracterizan por la presencia de lesiones granulomatosas, en cuyo interior pueden identificarse celulas especificas, sugestivas del microorganismo causal. Evolucionan de forma subaguda o cronica. Plantean el dificil problema del diagnostico diferencial con las otras patologias granulomatosas de la cara, pues la misma lesion histologica puede corresponder a un espectro etiologico amplio.

BACKGROUND: When a pilot is referred for presbycusis, his flight fitness may be questionable. The objective of this retrospective study was to describe a case series of presbycusis in a pilot population and to discuss the decisions about their flight waivers.METHODS: There were 19 pilots who were referred to the ENT-Head and Neck Surgery Department of the National Pilot Expertise Center. Their medical files were retrospectively examined.RESULTS: Of the 19 patients, 5 did not obtain flight fitness waivers. Among the 14 who received waivers, 7 had no restrictions on their flight fitness.DISCUSSION: Flight fitness was based on the maximum percentage of speech recognition and the slope of the curve for speech recognition in speech audiometry in noise and the follow-up of these findings. The results made it possible to determine a patient’s fitness to fly with a waiver, which may be associated with restrictions. In our series, only 5 pilots out of 19 did not obtain a flight fitness waiver. The few published studies on the resumption of flight for patients who had presbycusis and our experience in France with similar waivers in commercial and military aviation suggest that under certain conditions and after relevant cochlear assessment, presbycusis may allow for a safe pursuit of aviation activity.Ballivet de Régloix S, Genestier L, Maurin O, Marty S, Crambert A, Pons Y. Presbycusis and fitness to fly. Aerosp Med Hum Perform. 2020; 91(5):403–408.

Cervical congenital malformations are relatively common in children. They can also be found in adults. The embryological development of the cervical region is closely related to the branchial clefts. This must be a diagnosis made by elimination; a cervical tumor must evoke the diagnosis of cancer. A cutaneous fistula or a cervical tumor, chronic or recent appearance in an inflammatory context, are the clinical signs. The thyroglossal duct cysts and the second branchial clefts cysts are the most common causes of median and lateral cervical cysts, respectively. Imaging contributes greatly to the orientation and diagnostic evaluation of the extent of the lesions. Treatment is initially based on antibiotic therapy and then on complete surgical excision, away from an infectious episode, the sole guarantee for the absence of local recurrence.

Introduction Blast injuries in modern warfare are common, and tympanic perforation is often found. Spontaneous closures of large perforations that encompass greater than 80% of the tympanic surface are rare. Early closure of the tympanic membrane avoids the immediate infectious risk, which potentially complicates the initial management of these war-wounded patients, and allows for safe and early recovery of military activity. This study compared the outcomes of spontaneous closures and early biomembrane myringoplasty in subjects with large blast injury-induced tympanic perforation following a massive explosion. Materials and methods This is a retrospective, observational, cohort study military troops with large barotraumatic tympanic membrane perforation. The study investigates early surgical tympanoplasty versus observation for spontaneous closure. The hearing loss, tympanic perforation closure rate, and closure time were noted. Results Fourteen patients (19 ears) were referred from May 2008 to April 2017, and 6 patients (9 ears) underwent early myringoplasty. A total of 89% (n = 8) and 100% (n = 9) of the ears exhibited successful sealing of the perforation at one and 6 mo, respectively. In contrast, 60% (n = 6) of the 10 ears (8 patients) without initial myringoplasty did not heal spontaneously at 6 mo, and these ears underwent a delayed tympanoplasty procedure. Notably, patients with early myringoplasty suffered lower conductive hearing loss and fewer functional signs remotely. Conclusion Early myringoplasty using a biomembrane for blast injury-induced large tympanic perforation is a fast and minimally invasive method to achieve earlier tympanic closure and a higher closure rate for safe recovery of activity. It can be performed under general anesthesia concurrently with surgery for additional body-wide trauma. The deployment of ENT surgeons on the battlefield in the French Army has enabled early management of these patients.

Complications of sinusitis arise mostly as a result of the sinuses being separated from key organ structures only by relatively thin pieces of bone. As a result, there is always the potential for the disease to spread from the sinuses into the orbital space, and intracranially.

Dopo aver presentato i dati epidemiologici delle ferite cervicofacciali da proiettili (cifre, popolazioni e incidenza), questo articolo sviluppa la loro patogenesi precisando le nozioni di balistica utili al medico insieme alle conseguenze fisiopatologiche. Esso propone una tipologia di anatomia lesionale facciale e cervicale. Nell’analisi clinica sono esposti i mezzi clinici e i metodi di imaging e di endoscopia in uso in questa patologia. Questa analisi permette di individuare degli indici di gravita vitali, funzionali ed estetici. L’aspetto della lesione e descritto secondo le modalita di anatomia lesionale. In seguito, vengono richiamati i principi terapeutici adatti a questo tipo di patologia traumatica insieme ai metodi farmacologici, con la somministrazione di un’antibioticoterapia precoce, e ai metodi chirurgici, con i metodi meccanici di lavaggio e drenaggio. In conclusione, uno schema terapeutico descrive l’intervento e la sua organizzazione e, infine, il suo svolgimento, individuando le differenti fasi di estrema urgenza, di urgenza, di trattamento secondario e dei tempi delle sequele, facendo riferimento agli indici di gravita delle ferite cervicofacciali.

Pathological link between teeth and maxillary sinus. Pathological relationship between the teeth and the maxillary sinus can be explained by their embryological and anatomical relationships. The floor is centered by the apex of antral teeth: premolars and first molars. Any dental disease process may have sinus consequences. Dental caries are the best example. Iatrogenic pathology, including preimplant surgery and benign or malignant tumors are also responsible for sinusitis. Therapeutic for every etiology avoids the complications and sequelae whose forensic incidence remains low.Relations pathologiques entre dents et sinus maxillaire. Les relations pathologiques entre les dents et le sinus maxillaire s’expliquent par leurs nombreux rapports, tant embryologiques qu’anatomiques. La paroi inférieure du sinus est centrée par les apex des dents dites antrales : les prémolaires et les premières molaires. Ainsi, tout processus pathologique dentaire peut avoir des conséquences sinusiennes. La pathologie carieuse en est le meilleur exemple. La pathologie iatrogène, notamment la chirurgie pré-implantaire, ainsi que les tumeurs bénignes ou malignes sont également responsables de sinusites. Une thérapeutique adaptée à chaque cause permet d’éviter les complications et les séquelles.

En este articulo se presentan los datos epidemiologicos de las heridas cervicofaciales por proyectiles (cifras, poblaciones y modo de produccion), tras lo que se describe su patogenia, precisando los conceptos de balistica utiles para el medico, asi como las consecuencias fisiopatologicas. Se propone una tipologia de la anatomia lesional facial y cervical. En el analisis clinico, se describen los metodos clinicos de imagen y de endoscopia que se utilizan en esta patologia. Este analisis permite individualizar los indices de gravedad vitales, funcionales y esteticos. Se describe el aspecto de las lesiones segun las modalidades de la anatomia lesional. A continuacion, se exponen los principios terapeuticos adaptados a este tipo de patologia traumatica, asi como los metodos medicos, con la instauracion de una antibioticoterapia precoz, y las tecnicas quirurgicas con los metodos mecanicos de lavado y de drenaje. Para concluir, se presenta un esquema terapeutico que describe la intervencion y su organizacion, desarrollandolo a continuacion, individualizando las fases de extrema urgencia, de urgencia, de tratamiento secundario y la etapa de secuelas, basandose en los indices de gravedad de las heridas cervicofaciales.

Resume Buts Le but de l’etude etait d’evaluer la courbe d’apprentissage de la septoplastie endoscopique pour un chirurgien senior deja forme a la chirurgie sinusienne endonasale. Materiel et methodes Entre novembre 2011 et septembre 2012, 100 patients ont ete inclus de maniere prospective et ranges consecutivement dans le groupe correspondant a leur ordre chirurgical (5 groupes de 20 patients). Le critere de jugement principal etait la mesure du temps operatoire. Les complications per- et postoperatoires et l’evaluation fonctionnelle etaient analysees. Resultats Le temps operatoire diminuait avec l’experience du chirurgien et devenait stable apres 60 procedures. Le gain de temps operatoire etait d’environ 10 minutes toutes les 20 procedures. Le temps operatoire moyen etait stable entre le groupe 4 (21,1 minutes ± 9,6) et le groupe 5 (19,2 minutes ± 8,2). Il y avait 2 % de conversions en technique conventionnelle pour des difficultes techniques. Le nombre d’interventions sans effraction muqueuse accidentelle augmentait et devenait stable apres 40 procedures. Il y avait 4 % de perforations residuelles postoperatoires. Le score NOSE etait ameliore en postoperatoire dans chaque groupe (p Conclusion Apres 60 procedures de septoplastie endoscopique, un chirurgien senior maitrise la technique chirurgicale avec des temps operatoires satisfaisants, tout en diminuant les complications per- et postoperatoires.

Aims The aim of the current study was to report the learning curve for endoscopic septoplasty for a senior surgeon already trained in endonasal sinus surgery. Material and methods From November 2011 to September 2012, 100 patients were prospectively included and grouped in 5 consecutive groups of 20 by date of surgery. The primary endpoint was operative time. Intra- and postoperative complications and functional assessment were also analyzed. Results Operative time decreased with the surgeon's experience and became stable after 60 procedures. Operative time saving was about 10 min per 20 procedures. Mean operative time was stable between groups 4 (21.1 ± 9.6 min) and 5 (19.2 ± 8.2 min). There was a 2% rate of conversion to conventional surgery for technical problems. The number of procedures free of accidental mucosal lesion increased and became stable after 40 procedures. There was a 4% rate of residual postoperative perforation. Nasal Obstruction and Septoplasty Effectiveness (NOSE) score improved postoperatively in each group (P Conclusion After 60 endoscopic septoplasty procedures, a senior surgeon masters the surgical technique with satisfactory operative times, and a decreasing rate of intra- and postoperative complications.

The aim of this review of literature was to compare conventional and endoscopic septoplasty in terms of operating time, functional efficacy and perioperative morbidity. A systematic review of the scientific literature was performed on the PubMed database, Google and Google Scholar, searching for randomized prospective trials comparing endoscopic and conventional septoplasty. The primary endpoint was operating time, and the secondary endpoints were intra- and postoperative complications, postoperative pain, hospital stay and functional result. Twenty-nine articles published between 1991 and 2012 compared conventional and endoscopic septoplasty, five of which were prospective randomized trials. Operating time was shorter with endoscopic surgery (P0.001), with less mucosal damage (P0.01); there was less synechia (P0.01) and residual deformity (P0.05); and postoperative pain was milder. Endoscopic septoplasty thus shortened surgery time and reduced perioperative complications, but the functional result was the same as with conventional septoplasty.

Resume L’objectif de cette revue de la litterature etait de comparer la septoplastie endoscopique aux techniques conventionnelles en termes de gain de temps operatoire, d’efficacite fonctionnelle et de diminution de la morbidite operatoire. Nous avons recherche des articles sur PubMed, Google et Google Scholar. Nos criteres d’inclusion etaient les essais prospectifs randomises comparant la septoplastie endoscopique a la septoplastie conventionnelle. Le critere de jugement principal etait le gain de temps operatoire et les criteres secondaires etaient les complications per- et postoperatoires, la douleur postoperatoire, la duree d’hospitalisation et le resultat fonctionnel. Entre 1991 et 2012, nous avons retrouve 29 articles comparant la septoplastie endoscopique a la septoplastie conventionnelle ; 5 etudes etaient des essais prospectifs randomises, qui ont ete inclus a l’etude. Il existait une diminution du temps operatoire avec la technique endoscopique (p

This article is designed to provide a step-by-step description of our endoscopic septoplasty technique and discuss its difficulties and technical tips. Endoscopic septoplasty comprises 10 steps: diagnostic endoscopy, subperichondral infiltration, left mucosal incision, dissection of the left subperichondral flap, cartilage incision (0.5 centimetre posterior to the mucosal incision), dissection of the right subperichondral flap, anterior cartilage resection, perpendicular plate dissection, dissection and resection of the maxillary crest, endoscopic revision, mucosal suture and Silastic stents. A satisfactory postoperative result was observed at 3 months in 97% of cases in this series. The main contraindication to endoscopic septoplasty is anterior columellar deviation of the nasal septum requiring a conventional procedure.

Resume L’objectif de cette etude etait de decrire, etape par etape, notre technique de septoplastie endoscopique et d’en discuter ses difficultes et ses astuces. La septoplastie endoscopique comprend 10 etapes : l’endoscopie diagnostique, l’infiltration sous-perichondrale, l’incision muqueuse (a gauche), le decollement sous-perichondral gauche, l’incision cartilagineuse (un demi-centimetre en arriere de l’incision muqueuse), le decollement sous-perichondral droit, la resection cartilagineuse anterieure, l’abord septal osseux posterieur, la prise en charge du pied de cloison, l’endoscopie de controle, la fermeture et la mise en place d’attelles. Le resultat a 3 mois est satisfaisant dans 97 % des cas d’apres notre experience. La principale contre-indication de la septoplastie endoscopique est representee par la deviation anterieure, columellaire de la cloison nasale, necessitant une procedure conventionnelle.

Cervical congenital malformations are relatively common in children. They can also be found in adults. The embryological development of the cervical region is closely related to the branchial clefts. This must be a diagnosis made by elimination; a cervical tumor must evoke the diagnosis of cancer. A cutaneous fistula or a cervical tumor, chronic or recent appearance in an inflammatory context, are the clinical signs. The thyroglossal duct cysts and the second branchial clefts cysts are the most common causes of median and lateral cervical cysts, respectively. Imaging contributes greatly to the orientation and diagnostic evaluation of the extent of the lesions. Treatment is initially based on antibiotic therapy and then on complete surgical excision, away from an infectious episode, the sole guarantee for the absence of local recurrence.

Le infezioni specifiche sono delle patologie microbiche caratterizzate dalla presenza di lesioni granulomatose, all’interno delle quali si possono identificare delle cellule specifiche, indicative del microrganismo in causa. Esse evolvono in maniera subacuta o cronica; pongono il difficile problema di diagnosi differenziale con le altre patologie granulomatose del volto.

Le manifestazioni otorinolaringoiatriche (ORL) sono frequenti nel corso delle emopatie, tanto maligne che benigne. Esse possono essere rivelatrici della malattia e portare i pazienti a consultare in primo luogo il medico ORL. E opportuno, allora, alla luce della clinica e del contesto generale, riconoscere i segni che indicano un’eziologia ematologica per orientare al meglio il paziente. Un primo bilancio semplice e orientato permette di indirizzare il paziente all’ematologo avendo gia fatto progressi nell’iter diagnostico. Peraltro, nel corso del loro follow-up, non e raro che questi pazienti presentino una sintomatologia ORL o in rapporto con una localizzazione specifica della loro malattia o di ordine emorragico o infettivo. L’ematologo e, allora, portato a chiedere un consiglio al suo collega ORL per adattare la gestione terapeutica del paziente. Infine, le terapie utilizzate in ematologia, tanto la chemioterapia quanto la radioterapia o, ancora, i trattamenti associati, possono avere degli effetti collaterali che interessano la sfera ORL. La loro diagnosi precoce, il loro trattamento e il loro follow-up appaiono, allora, indispensabili per una gestione globale del paziente.

Las manifestaciones otorrinolaringologicas (ORL) son frecuentes en las hemopatias, tanto benignas como malignas. Pueden ser el proceso revelador de la enfermedad y motivar que el paciente consulte inicialmente con el especialista en ORL. Por tanto, basandose en la clinica y del contexto general, se deben identificar los signos que indiquen una etiologia hematologica para orientar de forma optima al paciente. Una primera evaluacion simple y dirigida permite remitir al paciente al hematologo, una vez iniciado el proceso diagnostico. Por otra parte, no es infrecuente que estos pacientes presenten durante su seguimiento una semiologia ORL que puede estar relacionada con una localizacion especifica de su enfermedad, o ser de tipo hemorragico o infeccioso. En tal caso, el hematologo debera consultar con el ORL para adaptar el tratamiento del paciente. Por ultimo, los tratamientos utilizados en hematologia (tanto la quimioterapia como la radioterapia o los tratamientos asociados) pueden tener efectos secundarios en la region ORL. Su diagnostico precoz, su tratamiento y su seguimiento son indispensables para el tratamiento global del paciente.

Las infecciones especificas son patologias microbianas que se caracterizan por la presencia de lesiones granulomatosas, en cuyo interior pueden identificarse celulas especificas, sugestivas del microorganismo causal. Evolucionan de forma subaguda o cronica. Plantean el dificil problema del diagnostico diferencial con las otras patologias granulomatosas de la cara.

The phantom sound perception mechanism by which a sound perception occurs without any external sound source is still enigmatic. According to our previous fMRI study, a small region in the parietal operculum 3 was hyperactivated as a function of tinnitus periodicity in subjects with acoustic trauma tinnitus sequelae. This region was localized in the vicinity of neural correlates of middle-ear tympano-ossicular chain movements due to pressure variations. Disturbed proprioceptors are known to trigger illusory perceptions; therefore, we hypothesized that a disturbance of middle-ear proprioceptors may originate phantom sound perceptions. We designed an fMRI study that aimed to stimulate middle-ear proprioceptors by repetitive vibrations using various rates of click trains. In this study, we report that exposure to specific rates of stimuli for a few minutes at comfortable intensity level in healthy subjects distinctly triggered transient tinnitus-like aftereffects. The fMRI neural correlates of the aftereffects were unequivocally localized in the same parietal region as in acoustic trauma tinnitus sufferers. Our results strongly suggest that a middle-ear kinesthetic/proprioceptive illusion exists at the origin of acoustic trauma tinnitus via a somatosensory pathway encompassing the trigeminal system.

Background: The objectives of this study were first to show principles of the minimally invasive video-assisted thyroidectomy (MIVAT), based on a video highlighting critical steps, and second to discuss tips and pearls to assist surgical teams that would like to start using this technique. Methods: Based on a video, we described tips and pearls of a MIVAT. Results: MIVAT includes 5 main steps: (1) skin incision and identification of the common carotid artery, (2) dissection and ligation of the upper pedicle, (3) identification of the inferior laryngeal nerve and parathyroid glands, (4) isthmectomy and lobe extraction, and (5) closure. Discussion: Coordination between the surgeon and the 2 assistants is of paramount importance for the performance of MIVAT. Appropriate material is also required. The magnification and tissue contrast emphasizes the identification of the vessels, the superior and inferior laryngeal nerves, and parathyroid glands, on a large-view screen.

The complications of sinusitis are essentially secondary to ethmoidal and frontal sinusitis, occurring in patients weakened, particularly in case of immunodeficiency or anatomical defects. The gravity is due to the risk of spreading infection in intracranial tissues and orbital cavity. The diagnosis is always to discuss any symptomatology resistant to treatment and the appearance of orbital or neurological signs. The scanner and MRI contribute greatly to the orientation and diagnostic evaluation of the extent of the lesions. Treatment is based on prolonged antibiotic therapy and surgery and requires a multidisciplinary approach involving ENT, ophthalmologist, neurosurgeon and anesthesiologist resuscitator.

La Presse Medicale - In Press.Proof corrected by the author Available online since mardi 30 septembre 2014

Resume Introduction Une sialocele du canal parotidien correspond a une cavite salivaire, developpee aux depens du canal excreteur de la parotide. De nombreux cas de sialoceles parotidiennes sont rapportes, mais tres peu concernent les sialoceles de son canal excreteur. Cas clinique Nous rapportons le cas d’une sialocele post-traumatique du canal parotidien. Le bilan lesionnel a repose sur la sialo-IRM. Nous avons effectue un catheterisme du canal parotidien par voie endo-buccale. Le drain a ete laisse en place dix jours. Il n’a pas ete note de recidive dans les suites. Discussion Les cas rapportes de sialocele du canal parotidien dans la litterature sont rares. Nous en avons recense sept. Plusieurs therapeutiques existent face a une sialocele, interessant la parotide ou son canal excreteur. On retrouve frequemment l’utilisation de toxine botulinique en injection sous-cutanee, avec de bons resultats. Le catheterisme du canal parotidien est une technique egalement rapportee, essentiellement pour les sialoceles parotidiennes. A notre connaissance, en dehors de notre cas clinique, il n’existe qu’une seule description de cette technique pour une sialocele du canal parotidien. Cette technique est peu invasive, avec une tres faible comorbidite, et presente de bons resultats.

Facial palsy can be defined as a decrease in function of the facial nerve, the primary motor nerve of the facial muscles. When the facial palsy is peripheral, it affects both the superior and inferior areas of the face as opposed to central palsies, which affect only the inferior portion. The main cause of peripheral facial palsies is Bell's palsy, which remains a diagnosis of exclusion. The prognosis is good in most cases. In cases with significant cosmetic sequelae, a variety of surgical procedures are available (such as hypoglossal-facial anastomosis, temporalis myoplasty and Tenzel external canthopexy) to rehabilitate facial aesthetics and function.

The objective was to describe a case series of penetrating neck injuries (PNIs) and compare their management in combat versus civilian trauma.From 2012 to 2014, all soldiers and civilians referred to Percy Military Training Hospital for PNI were analyzed. The mechanism of injury, type and site of the lesion, and initial emergency management were noted.Among the 55 patients, 26 were wounded in action, and 29 were civilians. PNIs were commonly stab wounds resulting from an assault. Anatomical zone II, as well as the central neck compartment, was the most affected area. The most affected organ was the larynx. 74% of patients underwent computed tomography angiography (CTA), surgical exploration was performed for 42% of patients, and 33% of patients required intensive care unit monitoring. The differences between the two groups in terms of management were not statistically significant.The current management is based on clinical examination and CTA and is similar between soldiers and civilians. Surgical exploration is less commonly used than CTA, which is a fast and accurate method to evaluate PNI for stable patients. The classification by compartment seems more relevant than the classification by anatomical zone, particularly in absence of medical imaging.

The patient was a 28-year-old man who had been diagnosed with tinnitus. He reported having rhythmic ear clicking in his right ear. The neurological examination revealed a rhythmic jerky movement of the soft palate with an audible clicking noise outside (see online [supplementary video][1]). MRI of

Los traumatismos externos del seno frontal son menos frecuentes en la actualidad gracias al uso del cinturon de seguridad y a la prevencion individual y colectiva durante ciertos deportes de riesgo. El problema del tratamiento de las fracturas de los senos frontales es complejo: ademas de las lesiones cerebrales asociadas, debe tener en cuenta el riesgo estetico de las fracturas de la pared anterior, el riesgo funcional por la repercusion de la fractura o de la reparacion sobre la funcion de drenaje y aireacion del conducto nasofrontal (origen de complicaciones a corto y largo plazo), asi como el riesgo infeccioso vital por la afectacion de la pared posterior del seno frontal. En este articulo se describen los principios diagnosticos y terapeuticos de los traumatismos externos del seno frontal. Los traumatismos internos relacionados con la cirugia endonasal no se detallaran.

The aim of this study was to review recent management of juvenile nasopharyngeal angiofibroma (JNA) in our institution during the past 10 years and to analyze the shift in surgical paradigm based on the rate of endoscopic approach and Radkowski staging.Case series with chart review.The study was conducted from April 2000 to August 2010 in a tertiary care university hospital (Lariboisière, Paris, France).All patients referred for a JNA were included in the study. Medical files and imaging data were retrospectively analyzed. Surgical management was then evaluated for 2 different periods (group 1, n = 31, consecutive patients operated on from April 2000 to June 2005, and group 2, n = 41, from July 2005 to August 2010).Seventy-two patients were operated on, with a mean age of 16.25 years (range, 9-33 years). The rate of the endoscopic approach was significantly higher in group 2 than in group 1 (82.9% vs 45%). Rates of recurrence and complications were similar. Recurrences (ie, residual disease growing and treated by redo) were noted in 6 cases or 8.3% (group 1, n = 3; group 2, n = 3; P.05).Progress in skull base anatomy, instrumentation, cameras, and surgical strategy allows for expansion of the indications for endoscopic removal of JNA. This approach may have a better outcome in terms of blood loss, hospital stay, and local sequelae. Still, an external approach should be considered only for selected cases due to massive intracranial extension or optic nerve or internal carotid artery entrapment by the tumor.

Background Ethmoid sinus osteomas are uncommon, benign, osteogenic tumors. The purpose of this retrospective study was to describe their usual clinical presentation and to discuss their surgical management. Methods The medical records of 25 patients treated for ethmoid osteoma between March 2001 and December 2010 were retrospectively reviewed. Results The average tumor size was 18.5 ± 14 mm. Only 3 patients were asymptomatic, 14 had a history of frontal sinusitis (complicated with orbital cellulitis in 4 cases), and 4 patients presented with diplopia. An endoscopic approach was performed in 19 cases, a coronal approach in 4 cases, and a combined approach (endoscopic + coronal) in 2 cases. No recurrence was reported. Conclusion Ethmoid sinus osteoma can be asymptomatic and detected incidentally on CT scans, but often causes frontal sinusitis and orbital complications. The endoscopic approach offers the possibility of safe removal with cosmetic advantages compared to coronal approach.

When an aircrew member is referred for otosclerosis, his flight fitness may be questionable. The objective of this retrospective study was to describe a case series of otosclerosis in an aircrew population and to discuss the decisions about their flight waivers. There were 27 aircrew members who were referred to the ENT-Head and Neck Surgery Department of the National Pilot Expertise Center. Their medical files were retrospectively examined. Out of 16 patients who had surgery, 2 did not obtain a flight fitness waiver afterwards. Among the 14 who received waivers, 12 had no restrictions on their flight fitness. Among the nonoperated patients, 1 of 11 did not obtain a waiver. Seven patients were declared medically fit to fly without a waiver and three obtained a waiver. Fitness was based on auditory and balance statuses and the follow-up of these findings. A postoperative CT-scan and the operative report were used to determine the quality of stapes surgery. Professional speech audiometry in noise might be as interesting. The results made it possible to determine a patient’s fitness to fly with a waiver, which is more or less associated with restrictions. In this series, only 3 aircrew members out of 27 did not obtain a flight fitness waiver. The few published studies on the resumption of flight for patients who underwent surgery and the authors’ experience in France with similar waivers in commercial and military aviation suggest that under certain conditions and after relevant vestibulocochlear assessment, stapes surgery may allow for a safe recovery of aviation activity.

Resume La surdite brusque est idiopathique. Elle s’installe en moins de 24 heures et regresse spontanement dans deux tiers des cas en 15 jours. L’imagerie participe a l’elimination des autres causes de surdite d’apparition brutale (schwannome vestibulaire, dissection des arteres vertebrales, accident vasculaire cerebral [AVC]) et permet egalement de faire une analyse morphologique de l’oreille interne. Des etudes portant sur cet aspect de l’imagerie ont fourni un substrat anatomique a un nouveau concept : « l’oreille fragile ». Les anomalies morphologiques les plus souvent rencontrees touchaient, par ordre decroissant de frequence : le canal semi-circulaire externe (hypoplasie ou dilatation), le canal semi-circulaire superieur, le canal semi-circulaire posterieur, le vestibule et la cochlee. Notons par ailleurs qu’une dilatation de l’aqueduc du vestibule est egalement frequemment rencontree.

Resume Introduction Le syndrome d’apnees du sommeil (SAOS) est un probleme de sante publique important de par sa frequence et ses consequences sur la vigilance et la sante. L’objectif de cette etude etait de tester les pratiques des medecins generalistes face a un sujet suspect de SAOS. Methodes Trois cent trente-quatre medecins travaillant pour l’armee francaise ont ete interroges par le moyen d’un questionnaire ecrit. Les resultats obtenus ont ete compares a ceux des etudes precedentes. Resultats Cent huit praticiens ont repondus. A peine plus de la moitie se sentait a l’aise avec cette pathologie. Il s’agissait plutot des jeunes praticiens. Ils connaissaient bien les signes d’appel et les facteurs de risques du SAOS mais connaissaient mal la physiopathologie et les complications potentielles liees a ce syndrome. Conclusions Les resultats obtenus dans cette etude, globalement meilleurs que les resultats precedemment publies dans la litterature, montre qu’un effort de formation a ete fait sur le SAOS. Mais cette pathologie est encore sous-diagnostiquee et l’effort de formation doit etre poursuivi.

El tercio medio facial corresponde a la porcion situada por encima de la arcada dental superior y por debajo de la linea que pasa por los bordes orbitarios superiores y la union nasofrontal. Los relieves que lo constituyen (hueso nasal, hueso cigomatico o malar) enmarcan zonas de fragilidad (orbita, cavidades sinusales maxilares). Las lesiones traumaticas del tercio medio suelen deberse a accidentes de trafico o a agresiones. Pueden ser complejas y afectar o no a la articulacion dental. Pueden comprometer las funciones esenciales oculares, respiratorias y olfatorias, debido a las lesiones asociadas. Los procedimientos de reparacion recurren en la mayoria de los casos a osteosintesis. El uso de microplacas se ha convertido en la tecnica predominante.

Introduction: When a pilot is referred for vestibular schwannoma (VS), his or her fitness to fly may be questioned. The objective of this retrospective study was to describe a series of VS cases in a pilot population and to discuss their fitness to fly options. Methods: Between September 2002 and March 2010, the ENT/Head and Neck Surgery Department of the National Pilot Expertise Center conducted nearly 120,000 expert consultations for 40,000 pilots. We examined the files of 10 pilots who were referred to our 2 national experts for VS. Results: At the time of the expert consultation, hypoacusis was present in nine cases (four with total deafness), tinnitus in one case, and vertigo in nine cases. In our series, only 2 of the 10 pilots experienced a negative impact on their fitness to fly. Discussion: Decisions on fitness to fly were based on several factors: minimally disturbed audition, i.e., less than a 35-dB hearing loss with a good speech discrimination score; good balance, i.e., no reported difficulties; no spontaneous nystagmus recorded on videonystagmography (VNG); no postural deviation; and a normal head-shaking test. The delay and the VS's evolution between diagnosis and expert consultation are important because the selection of a treatment to control VS is critical in minimizing the possible associated complications. When a pilot is referred for VS, his or her fitness to fly is determined by the size of the tumor, balance, auditory status, and the follow-up results of these findings. The complications that may arise from VS treatments must also be considered.

The aim of this retrospective study was to determine the relevance of 5 different imaging signs in the evaluation of carotid artery invasion.Between September 2001 and September 2008, 22 patients (20 men and 2 women) presented with lymph node metastasis of a head and neck squamous cell carcinoma that invaded the carotid artery. The patients received either carotid artery dissection (CAD, group 1 [n = 17]) or carotid resection (group 2 [n = 5]). Preoperative images using CT (n = 18) and/or MRI (n = 14) were analyzed.In 1 of 17 cases in group 1 and in 5 of 5 cases in group 2, encasement of more than 180 degrees of the artery was present (P.05). Segmental obliteration of the fat between the lymph node and the carotid artery was noted in 7 of 17 cases in group 1 and for all cases in group 2 (P.05). Deformation of the carotid artery was reported in no cases in group 1 and in all cases in group 2 (P.05).The combination of deformation of the carotid artery, encasement of more than 180 degrees of the carotid perimeter, and segmental obliteration of the fat between the adenopathy and the carotid artery was highly predictive of massive invasion of the carotid artery, which would require a resection en bloc. In comparison, the isolated existence of encasement of more than 180 degrees or segmental obliteration of fat could not strictly indicate massive invasion of the carotid artery; thus, CAD could be planned.

Objectives: We sought to verify the relevance and reliability of the main temporal bone anatomic landmarks commonly used for the middle fossa approach and to test the use of digital technology to perform an accurate analysis of these landmarks. Methods: Ten fresh cadaveric temporal bones (5 heads) were analyzed by both computed tomographic imaging and dissection procedures, with the help of an image guidance system (DigiPointeur). Eight landmarks, which were selected for their wide citation in the otoneurosurgical literature, were studied. Results: Of the 8 landmarks studied, we obtained results similar to previously published data for 2 (the distance between the temporal squama and the internal auditory meatus [IAM] fundus, and the distance between the top of the anterior semicircular canal [ASCC] arch and the IAM fundus), but divergent measurements for the other 6 (the distance between the temporal squama and the arcuate eminence; the distance between the top of the ASCC arch and the cochlear promontory; the IAM roof thickness; the angle formed by the ASCC arch plane orientation and the IAM axis; the angle formed by the head of the malleus, the geniculate ganglion, and the IAM fundus; and the correspondence between the arcuate eminence and the top of the ASCC arch). Conclusions: The use of an image guidance system allowed us to make sharp and precise measurements of the main anatomic landmarks used during a middle fossa approach. We found 6 measurements to be different from those reported in previously published data out of the 8 landmarks studied.

Resume Introduction Le carcinome canalaire est l’une des tumeurs parotidiennes les plus rares et les plus agressives. Les auteurs en ont rapporte deux cas. Presentation des cas Cas 1 : un patient de 78 ans etait adresse pour un carcinome canalaire de la parotide gauche. Le traitement avait ete chirurgical (parotidectomie avec dissection cervicale selective homolaterale) sans rupture capsulaire et avec des marges saines. Le patient etait en survie sans recidive apres sept ans de surveillance. Cas 2 : un patient de 41 ans etait adresse pour un carcinome canalaire de la parotide gauche. La parotidectomie avec dissection cervicale selective homolaterale laissait des marges saines mais insuffisantes ( Discussion L’âge moyen retrouve dans les cas publies dans la litterature etait de 60 ans. Le sex-ratio etait de deux hommes pour une femme. Le taux de survie sans recidive a cinq ans etait de 34 % en moyenne. Conclusion La chirurgie est le principal traitement de ce type de cancer. La radiotherapie postoperatoire est indiquee en cas d’extension tumorale extraparotidienne, si les marges de resection ne sont pas saines, en cas de metastase ganglionnaire cervicale et en cas d’emboles lymphatiques et/ou d’envahissement nerveux. La chimiotherapie est reservee en general aux formes metastasiques.

Introduction Parotid duct sialocele is a salivary cavity arising at the expense of the parotid duct. Many cases of parotid sialocele have been published, but very few cases of parotid duct sialocele have been reported. Case report We report a case of post-traumatic parotid duct sialocele that was assessed by MR sialography. The parotid duct was catheterized via the oral cavity and the catheter was left in place for ten days. No recurrence was observed. Discussion Published cases of parotid duct sialocele are rare, as only seven cases were identified in the literature. Several treatment options are available for sialocele involving the parotid gland or parotid duct. Subcutaneous injection of botulinum toxin is commonly used, with good results. Parotid duct catheterization has also been reported, mainly for parotid gland sialoceles. To the best of our knowledge, apart from the present case, the use of this technique for parotid duct sialocele has only been reported once before. This technique is minimally invasive, with very low morbidity and good results.

Background The purpose of this study was to evaluate the learning curve for minimally invasive video-assisted thyroidectomy (MIVAT). Methods Fifty consecutive patients were prospectively included in groups corresponding to their surgical order (10 patients in each group). Results The mean operation times between 2 neighboring groups were 33.9 minutes longer in group 1 than in group 2 (p = .01) and 25.8 minutes longer in group 3 than in group 4 (p = .002). The conversion rate for technical difficulties in group 1 was 6% (3 of 50). The definitive complication rate was 2% (1 of 50). Conclusions In terms of operative time, 10 patients represented the early stage of the learning curve, and 30 patients represented the number of procedures required to reach an advanced level of skill. Considering the low conversion and complication rates, improved aesthetic results and postoperative course, MIVAT should become a tool in the repertoire of high-volume thyroid surgeons. © 2012 Wiley Periodicals, Inc. Head Neck, 2013

Upper digestive and respiratory tract cancers represent, in frequency, the fourth cancer in the general population. They are responsible of non-specific symptoms. Clinical examination of this anatomical region is difficult for a layman for whom the specific material is not available to diagnose a small tumour The objective of this paper was to make more sensitive the general practictioners about these type of cancers.

SummaryIntroductionSalivary duct carcinoma is one of the rarest and most aggressive forms of parotid tumor. We report two cases.CasesCase 1: a 78-year-old man was referred for a salivary duct carcinoma of the left parotid gland. Treatment was surgical (parotidectomy with ipsilateral selective neck dissection), without capsule rupture, and with healthy margins. At seven years’ follow-up, the patient was alive and disease-free.Case 2: a 41-year-old man was referred for a salivary duct carcinoma of the left parotid gland. Parotidectomy with ipsilateral selective neck dissection left healthy but insufficient margins (