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Objective: Prospective study designed to count the number of granulocytic cells and eosinophils in nasal polyp tissue removed during ethmoidectomy and to look for anatomical correlations., Methods: Bilateral ethmoidectomy with a postoperative local steroid treatment was performed in 40 patients with nasal polyposis. Immunolabeling of the operative specimen using common leukocyte antigen (CD 45) and granulocytes associated antigen (CD 15) and quantification of the granulocyte infiltrate by image and manual counting of eosinophils with the mean of micro-reticule, were performed. The results were compared to those of 10 healthy subjects. An endoscopy of the postoperative cavities was performed one year after surgery to assess the local results., Results: The granulocyte and eosinophil infiltrates were significantly more important in the operated patients compared to the healthy population (p<10(- 4)). A "moderate" granulocytic infiltration (G -) was found in 11 patients out of 40 (27.5%). Among them, 9 patients showed less than 30% eosinophils (mean 16.2% +/- 2%). "Severe" granulocytic infiltrate (G +) was found in 29 patients out of 40 (72.5%). Among them, 25 patients showed more than 30% eosinophils (mean 48.8% +/- 2%). Most of the patients with G + type infiltrate suffered from asthma or Widal disease. One year after surgery, 17 out of 29 G + patients had no nasal polyposis recurrence, 12 out of 29 G + patients had a recurrence. However, 12 out of 15 patients with recurrent polyposis had G + type infiltrate., Conclusions: Granulocyte and eosinophil infiltration cannot be considered as a prognostic factor for recurrence at the time of surgery. A severe granulocyte and eosinophil infiltration is a typical feature of nasal polyposis, particularly in patients with asthma and/or in the aspirin triad.

The potential risk of prion contamination has led the government authorities to stop the use of dura mater allografts of human origin. The aim of this work was to determine the potential risk for implantation of allografts in otology and to review the current reglementation. Although Creutzfeldt-Jakob's disease has not been reported to be transmitted by these allografts and despite the apparently rigorous decontamination methods used by the manufacturers which meet the most severe international recommendations, it is apparently necessary to stop implantation for the time being. This decision has resulted from the lack of a precise directive from the governmental authorities and the uncertainty about prion transmission and the reel effect of inactivation procedures.

Retrolabyrinthic access was described long ago but was often found to narrow and progressively abandoned in favour of the retrosigmoid route. Certain modification in the initial technique, notably in wider dissection of the dura-mater of the sigmoid sinus and sometimes section of the endolymphatic canal provides a larger access to the ponto-cerebellous angle. A rigid 0 degree or 30 degrees endoscope can be introduced. In order to evaluate this method, we examined surgical specimens and subjects operated via retrolabyrinthic access for a neurinoma of the acoustic nerve in an attempt to preserve auditive function or for suspected vessel-nerve conflict. Our findings demonstrated that the retrolabyrinthic route allows direct access to the ponto-cerebellous angle doser to the vascular and nervous structures than the retro-sigmoid route and also provides remarkable endoscopic vision of the angle and its elements. This route is particularly interesting for surgery of acoustic neurinomas when attempting to preserve the auditive functions, for diagnosis and treatment of vessel-nerve conflicts, and to a lesser extent for vestibular neurotomy or for evaluating certain diseases difficult to diagnosis in the posterior cranial fossa.

Constant anatomic boundaries of the lateral mass of the ethnoid are described, based on data from microdissections, endoscopic examinations, computed tomography imaging and histology in 12 subjects. As with surgical progression, identification of these boundaries follows the lateral orbital and superior craniofrontal surfaces. The "starred groove formation", ethmoidal roof lamina and ethmoidosphenoidal recesses are the safety beacons for endonasal ethmoidectomy under endoscopic control.

While rhino-liquorrhea is a severe condition, its incidence is not exceptionally rare, and it raises problems, namely etiopathogenic, diagnostic and therapeutical ones, which call for the close collaboration of ENT doctors, neuroradiologists and neurosurgeons. 4 relatively recent cases are reported here, whereby the diversity of the problems encountered is made apparent. ENT specialists must be aware of those when faced with refractory aqueous rhinorrhea, often triggered by forward head motion, Valsalva's maneuver... Screening for rhinorrhea is readily achieved by biochemical tests, or simply using a Labstix-type diagnostic strip. Rhinoscopic examination should be accurate and carried out optically to check for any congenital malformation (meningocele). Most of the times, but not always, a thorough radio-neurological workup (isotopic analysis, CT-scan with contrast medium, MR imaging) will provide precise data regarding the infraction site and its possible cause, invariably warranting surgical management. Surgery should be case-adapted (CSF derivation, filling of the gap via the extra- or intracranial approach).

The generalized use of phosphocalcic biological assays makes the discovery of sporadic primary hyperparathyroidism increasingly common. In 1989-1990, first-intention surgery was performed in 26 female patients. In all cases, an exploratory cervicotomy under cervical peridural anesthesia allowed discovering and treating a parathyroid lesion: adenoma, asymmetric or symmetric hyperplasia, cancer. We discuss: the circumstances of the clinical diagnosis and the biological criteria, the timeliness of preoperative radiological assessment, the surgical strategy advocated. In more than 90% of all cases, a cervicotomy for the exploration of all areas of parathyroid migration should allow curing primary hyperparathyroidism.

The authors report the case of a patient who underwent the neurosurgical exeresis of an acoustic neuroma 14 years ago, and subsequently presented with a total facial palsy in spite of a spinofacial anastomosis. This patient had to be reoperated because of tumoral recurrence compressing the trigeminal nerve (V). This operation, through atranslabyrinthic that also emptied the entire internal auditory canal of its neural elements, allowed removing the neuroma. Once the facial nerve had been resected, the patient recovered some facial motricity and his masticatory function improved on the day following the operation. Since the contralateral facial nerve was not involved and the spinofacial anastomosis was absolutely not functional, only motor reinnervation from the trigeminal nerve was possible. The anatomy of the facial and trigeminal nerves in summarized, and their central connexions and peripheral anastomoses are studied. Out of the 27 cases of spontaneous motor reinnervation following the resection of the facial nerve described in the literature, only one similar case of recovery of motricity after a major nerve resection in the cerebellopontine angle is reported. Such a phenomenon can be explained only by the transformation of some sensory fibers of the 5th cranial nerve into motor fibers, which are activated by the resection of the 7th nerve and receive their nervous influx from the motor nucleus of the 5th or 7th nerve through protuberantial communications.

Although a number of authors have evoked a psychosomatic etiology for Ménière's disease, few works have dealt specifically with this subject. Forty-eight patients with authentic Ménière's disease underwent a series of psychometric self-evaluation determinations, in addition to a complete, repeated ENT examination. The first questionnaire, the SCL 90, explored the psychological profile. The second questionnaire, the QD 2 A, explored the depressive tendency. This study clearly showed that patients with Ménière's disease present a psychopathological profile which significantly differs to that of a reference population, particularly in terms of level of anxiety, depressive tendency and phobia. The latter points are of real practical importance, since they imply that improvements in Ménière's disease call for treatment of the phobic component in addition to the anxious-depressive component. Finally, there is an obvious correlation between the extent of hearing loss, in turn related to the frequency of vertigo attacks, and the severity of psychopathological disorders.

Results from pre-treatment SCC antigen assay were assessed in 106 patients with epidermoid carcinoma of the upper aerodigestive ways. The control population consisted of healthy blood donors (N = 61). Blood antigen levels ranged 1.6 ng/ml to 21.5 ng/ml in the patient population. 35 patients in 106 (i.e., 33% of cases) had levels considered pathological (greater than 2.00 ng/ml). Antigen levels were higher with increasing tumor size and when adenopathy was more marked (N+, N+R+). However, no correlation could be found with the T (stage)--N (histological) classification of tumors or with the site of lesion. Tumor immunologic response was obviously not uniform. Although the SCC antigen presents no diagnostic value, it appears to bear some prognostic significance, regardless of the tumoral stage. Antigen levels below 2.00 ng/ml correlate with (p less than 0.001) good immediate therapeutical results. On the other hand, serum levels greater than 2.00 ng/ml correlate either with non-sterilization, or with locoregional recurrence and/or rapid development of metastases. Other studies are required to confirm these data, and to demonstrate the value of long-term SCC antigen monitoring in these patients.

Nine patients with "severe" laryngeal dysplasia as shown by multiple microbiopsies during laryngoscopy were treated with a synthetic derivative of retinol (Etretinate 0.5 to 1 mg/kg/day) over one or two months. Follow up histology after 8 to 18 months surveillance showed histologic improvement with respect to dyskeratosis, atypical cells and to a lesser extent epithelial hyperplasia. The use of synthetic vitamin A derivatives for "severe" laryngeal dysplasia is discussed.

Labyrinthine trepanation was performed in the majority of 16 patients with minor agenesis of middle ear involving either stapedovestibular ankylosis or absence of fenestra vestibuli. Preoperative findings are discussed, as well as the prevention and treatment of labyrinthine geysers and the possibility of obtaining a functioning labyrinthine opening. Results were good in simple cases but poorer in more complex lesions, for which the indication for use of this procedure is debatable.

Certain fixed adherent retraction pockets especially in the posterior aspect of the tympanic cavity and certain cholesteatomas are difficult to treat even after a posterior tympanotomy has been performed. Using 70 degrees and especially 30 degrees optical systems can be of great value as the lesions can be perfectly visualised and endoscopic copho-surgery itself can even be carried out. Study of 27 cases of fixed retraction pockets and 14 cholesteatomas which underwent microscopic surgery but with optical verification of the operative cavity demonstrated the value of this technique. The safety of the method even allows the exclusive use of the endaural route in cases which have up to now required a posterior approach and posterior tympanotomy.

This study involved 15 patients suffering from large volume squamous carcinomas of the base of the tongue, who were likely to benefit from curative therapy (tumours graded T3, T4, N0, N1, N2, TNM UICC 1987). In 13 patients, treatment included transmaxillary bucco-pharyngectomy (TMBP) carried out either as first intention (10 cases), or as a second stage procedure after radiotherapy (3 cases). 2 patients underwent total laryngectomy with secondary basi-glossectomy. Per-operative radiotherapy was performed on the basi-lingual resection site, delivering a boost of 15 to 20 Gy using adapted localisers. A pectoralis major musculo-cutaneous flap procedure was carried out for the TMBP. Post-operative external radiotherapy to the tumour zone for patients treated as first intention was limited to 50 Gy with a boost of 15 Gy to the cervical lymphatic clearance wound in the event of capsular rupture. The aim of this method was to deliver an elective basi-lingual boost allowing better loco-regional control, while reducing the complications of high dose external oro-pharyngeal irradiation. The technique (reliability-tolerance) and the preliminary results are presented.

A viral etiology is often advanced to explain the origin of Bell's palsy, sudden deafness and certain vertigos. Virology findings were compared in 72 patients with either chicken pox, herpes, zona or other "viral" infections, where the viral origin was not absolutely clear, and a population of healthy volunteers. Results confirmed the indefinite viral nature of these affections. However, recent studies have shown that definite viral disorders are not always associated with an increase in antibody levels, and the intervention of a virus should not be totally discounted in some of these affections, especially as several particularly demonstrative cases have provided confirmation of a virus origin, particularly the Epstein-Barr virus.

Technical aspects are described of the reconstructive laryngectomy used between 1982 and 1986 to treat 59 patients with endolaryngeal epidermoid carcinoma. Both "conservative" techniques (Tücker's laryngectomy, total endolaryngeal functional evidement) and "non-conservative" techniques (cricohyoidopexy, cricohyoidoepiglottopexy, cricobasiglossopexy) as well as their functional outcome are described. Results of surgical review of endolaryngeal spaces (paraglottic space, hyothyroepiglottic space) are analyzed for each method, and a schema for their use proposed.

Principal anatomical "targets" and physiological consequences of cervical epidural anesthesia are outlined, technic and aims of the method discussed and 53 patients (class ASA I and II) receiving major cervical surgery, mainly for cancer, reviewed. Effectiveness of cervical epidural anesthesia was rated as excellent for total pharyngo-laryngectomy, with or without flaps, total laryngectomy, lymph node curettage and thyroidectomy, moderate for reconstructive laryngectomy and only fair for transmaxillary buccopharyngectomy. Advantages of the method concern principally the postoperative period: immediate awakening (92% of cases) in the operating room whatever the duration of surgery, avoiding intensive care, and pain relief for at least 48 hours (85% of cases) by maintenance of catheter. Contraindications include hypocoagulability, local or general infection and impossibility of adjusting heart rate, and the method is not applicable for all patients in whom general anesthesia with assisted ventilation is contraindicated.

A review of 62 cases of blockage of head of malleus showed that apart from secondary lesions (post-traumatic, postoperative, postinfectious), primary blockades were a definite entity. The latter were either isolated or associated with stapedo-vestibular ankylosis. Isolated blockade of head of malleus provoties only direct transmission deafness, and is associated in nearly all cases with a cochlear lesion, often bilateral, at least in the primary forms. Instead of simple unblocking of the attic, the treatment preferred is an ablation of the incus, section of head of malleus and subsequent functional gestures that are described.

As deafness surgery is subject to the two imperatives of safety and reduction of bleeding, local anaesthesia constitutes a very satisfactory solution. The concomitant administration of Midazolam and Buprenorphine relaxes the patient and ensures analgesia and anterograde amnesia, allowing the surgeon to operate under excellent conditions. Over the last 6 months, except in one subject under the age of 16 years and one psychologically very fragile patient, all surgical operations for deafness, regardless of their importance, have been performed under local anaesthesia improved by means of diazanalgesia. It is probable that in the future, numerous cophosurgeons will adopt a similar protocol.