Search

Sinonasal and temporal bone infections may extend to the skull, skull base, meninges, pericerebral spaces, brain parenchyma, dural sinuses, deep cerebral or cortical veins, intracranial arteries and cranial nerves either via contiguous or hematogeneous spread. The site of infection dictates the sites of potential complications: orbital with ethmoid sinusitis, cavernous sinus thrombophlebitis and oculomotor palsies with sphenoid sinusitis, transverse sinus thrombophlebitis with mastoiditis and superior sagittal sinus thrombophlebitis with frontal sinusitis. All may result in brain abscess. Congenital and acquired defects of the skull and meninges, with or without associated meningocele or meningoencephalocele, perilymphatic fistulas, and some anomalies of the inner ear may predispose to the intracranial extension of ENT infections.

The number of patients with cochlear implant increases each year. Most of these patients may undergo MR imaging up to 1.5 Tesla, based on safety recommendations from each of the manufacturers. All external components should be removed for the examination. For three manufacturers providing about 85 % of all implanted devices in Europe, the internal components may be left in place and covered by an external bandage. Strict protocol guidelines must be implemented, especially head positioning in the magnet and within 30 cm from the bore opening. A single manufacturer, providing about 15 % of implanted devices, recommends surgical removal of the internal magnet prior to MR imaging.

This study aimed at evaluating the performance of Cine-MRI to assess swallowing in patients previously treated for head and neck cancer.10 healthy control subjects and a cohort of 10 patients with 8 partial glossectomies, 1 total laryngectomy and 1 glossolaryngectomy underwent imaging from October 2005 to February 2007. The MRI examinations were performed on a 1.5 Tesla system (Siemens Avanto), with True-Fisp sequences (TR = 170 ms, TE = 1 ms, slice thickness = 10 mm) at a rate of 8 pictures per second, during dry swallowing.Results are relevant for real-time spatial resolution from lips to larynx and dynamic motions analyses of tongue, velum, posterior pharyngeal wall and larynx during dry swallowing. Oro-pharyngo-laryngeal occlusion deficiency induces aspiration in case of partial glossectomy. Total laryngectomy modifies tongue, velum and pharynx landmarks.Cine-MRI i) provides functional insight from the oral cavity to the larynx, ii) gives accurate informations about impairments due to the pathology and its treatment, iii) completes others investigations like fiberoptic endoscopy or transit time, iiii) allows a precise analysis of the muscular movements involved in the deficient swallowing mechanism, in order to optimize rehabilitative strategies and results.

To assess the value of CT for diagnosis and follow-up of AFS. Evaluation of characteristic CT features of AFS.Retrospective review of 12 cases of AFS presenting with all published diagnostic criteria (1) chronic rhinosinusitis refractory to standard management (2) CT features of chronic sinusitis (3) anatomopathologic, immunoallergologic, biochemical and mycologic criteria. CT findings were correlated with surgical findings and reviewed by one ENT and two radiologists to assess the diagnostic value of different CT features, alone or in association.AFS was isolated in 6 cases, and associated with allergic bronchopulmonary aspergillosis (ABPA) in 6 cases. CT showed pan- or polysinusitis, unilateral or bilateral, with mucosal thickening, sinus opacification frequently heterogeneous, bony changes, fluid trapping, and with pseudotumoral appearance in 3 cases.CT findings alone are not specific or pathognomonic but may suggest AFS in the correct clinical or immunoallergologic setting. It may alert the physician to the need for complementary work-up, exclude the presence of associated lung disease, and better adapt treatment and follow-up.

To identify the anterior ethmoidal artery (AEA) of a skull specimen on CT prior to transnasal endoscopic surgical management of anterior epistaxis.From a medial canthotomy approach, the AEA was located and a marker placed on 9 skull specimens (18 AEA). CT with 2D reformations was then performed. The AEA were then dissected using an endoscopic anterior ethmoidectomy approach. The presence of AEA procidence was recorded.Correlation between CT and surgical findings allowed identification of 2 criteria predictive of AEA procidence: 1) presence of an ethmoid bulla above the AEA canal 2) AEA canal located below (not within) the ethmoid roof, anterior to the bulla.High resolution CT depiction of the AEA provides information regarding its accessibility for endoscopic ligation in patients with severe anterior epistaxis as an alternative to external ligation while demonstrating the upper limit of the anterior ethmoid.

Massage of the lateral pterygoid muscle according to Cyriax's principles is an unrecognized procedure. This procedure was tried on patients presenting with temporomandibular joint dysfunction syndrome.Fifteen patients were treated. Pain, joint clicking, measurement of mouth opening, lateral excursion and propulsion were recorded. Assessment was made before and after the massage in the same consultation.Joint clicking was solved in 80% and pain in 50% of the cases. Mouth opening increased by 12.8%, propulsion by 11.6% and lateral excursion by 41.3%.Massage of the lateral pterygoid muscle according to Cyriax's principles is a simple and efficient method that can be recommended for patients presenting with temporomandibular joint dysfunction syndrome. We performed a brief anatomical and radiological MRI study supporting the feasibility of lateral pterygoid muscle palpation.

Otosclerosis is a primitive osteodystrophia of the labyrinthine bone. Its diagnosis must be confirmed by a CT scan in order to eliminate the other causes that may lead to conductive hearing loss with an absence of stapedial reflex: fixation of the head of the malleus to the lateral wall of the tympanic cavity, absence of the long process of the incus or stapes, gusher syndrome, primary cholesteatoma, or tympanic facial nerve neuroma blocking the stapes. Particular problems in otosclerosis must be clarified: an extension to the round window (poor postoperative results), and extension to the tympanic cavity blocking the malleus and/or the incus, the labyrinthine lumen, or the internal auditory meatus (very rare). The position of the tympanic facial nerve canal and associated abnormalities must be assessed: stapedial artery, malformations of the ossicles and/or the labyrinth, and chronic otitis media. MRI is indicated in extension to the labyrinthine lumen, the internal auditory meatus, and in postoperative complications with labyrinthitis. MRI can also evaluate the active otosclerotic focus (gadolinium enhancement).

Cogan's syndrome is defined by the combination of non syphilitic interstitial keratitis and inner ear dysfunction, similar to Meniere's disease.Cogan's syndrome was revealed by haemorrhagic glaireous diarrhoea in a 21 year-old woman whose medical history included Hirschsprung's disease. Cerebral MRI revealed viral-like bilateral neuritis of the eighth cranial nerve, never described in the literature before. The auditory and visual disorders regressed after treatment with corticosteroids.The early diagnosis of Cogan's syndrome permits the cure of the visual and auditory and notably inner ear symptoms with corticosteroid therapy.

To evaluate computed tomography quantification of injured pulmonary volume after thoracic trauma and its relevance for severity grade of patients with lung contusion.Retrospective study in a major French Level I university trauma center.Clinical and biological data including oxygenation index (PaO2/FIO2) and therapeutics modalities during the first 5 days: positive end expiratory pressure (Peep) and nitric oxide (NO), were collected on 49 patients with lung contusion resulting from thoracic trauma. Injured pulmonary volume was evaluated on initial thoracic tomodensitometry by 2 senior radiologists. The correlation between oxygenation index, therapeutics modalities and initial injured pulmonary volume was assessed for signification.Injured pulmonary volume larger than 37.75% of total lung volume is associated with both hypoxemia at the twenty-fourth hour (PaO2/FIO2300), and need for Peep6 cm H2O and /or ongoing NO administration on day 5.Injured parenchymal pulmonary volume evaluation on initial tomodensitometry seems to be an important indicator of lung contusion severity. Thoracic computed tomography provides additional prognostic information in the initial evaluation of thoracic trauma with parenchymal injury.

CT and MRI are in most of the cases associated in imaging of tumours and pseudo-tumours of the temporal bone. The tumours of the external auditory meatus particularly the malignant ones are rare. It is of a great interest to delineate a possible extension to the chorda tympani. Secondary cholesteatoma are the most frequent pseudo-tumours of the middle ear: CT and MRI evaluate very well their extension particularly in the giant forms. Others tumours like tuberculosis, histiocytosis, primitive cholesteatoma, tympanic body++ tumours may be diagnosed by imaging as well as the neuroma of the facial nerve, the meningioma or some rarer lesions as the adenoma, or the carcinoid tumour of the middle ear. The adenoma of the endolymphatic sac is the only true tumour of the membranous labyrinth whose diagnosis is nicely made by MRI. The primitive cholesteatoma, the neuroma of the facial nerve may reach the labyrinthine bone and are easily diagnosed by imaging which generally speaking is very good in evaluating the kind of pathology of each cavities, delineating the extension of the lesions and orientating the surgical procedures.

The occurrence of non-hodgkin's lymphoma is a classical complication after transplantation. The frequent localization near the graft is well established. We report 5 cases of lymphoma, arising from the renal graft, from a series of 648 transplantations (0.77%). The lesions appear as soft tissue masses, iso or hypoechoic with ultrasonography, soft tissue attenuation with CT and low attenuation after contrast medium. With MRI, we note isosignal in T1 and hyposignal in T2 weighted sequences. The involvement of renal parenchyma (n = 3) and the inclusion of the vessels in the masses (n = 2) are frequent. Excretory tract compression leading to obstruction is often associated (n = 3).

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.

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.

A case of desmoid abdominal tumor is reported. This is a rare benign tumor often found in association with Gardner's syndrome. The radiological features with ultrasonography, computed tomography and magnetic resonance imaging are presented. These explorations illustrate the infiltrating characteristics and the high potentially recurrence rate of desmoid tumor.

A limited number of tomodensimetrical sections, MRI or echographical according to the fundamental, frontal, sagittal or horizontal plans makes possible the exploration of the sub-renal part of the lower vena cava. The comparison of pictures with the corresponding anatomical sections makes possible a detailed analysis of all the visualized structures, around the lower vena cava.

The authors evaluate the merits of computer reconstructions in the coronal and sagittal planes to assess the anatomy of the facial structures. If the patient can be kept motionless, the coronal plane provides information similar to those obtained by a study with direct sections. The ethmoidofrontal recesses, the lamina cribrosa, the thin relief of the middle meatus, the floor of the orbit are perfectly examined. The sagittal plane provides a new approach of the anterior and posterior cortical bone, of the frontal sinus, of the nasofrontal canal, of the ethmoidal cells, of the sphenoid sinus and of the vault of the palate.

The authors present a typical case of a traumatic internal carotid aneurysm rupture appearing 40 years after a blunt head trauma and surgically treated with success. The etiopathogenic and clinical aspects are reviewed and the important place of the angiography in diagnostic and therapeutical strategy is discussed.

In this report, the authors evaluate the indications of the different imaging techniques of the face and the adjacent deep and superficial regions. Thus, CT stays the first examination of the paranasal sinuses completed by MRI especially when an inflammatory pathology is associated with a benign or malignant tumor. Traumatisms of the face must be investigated by CT with an emphasis on the frontal and sagittal reformated sections. The study of the superficial areas of the face (parotid gland) is best explored by US and MRI. MRI gives better results than CT in the exploration of the deep regions of the face. Arteriography remains obligatory in the study of certain tumours specially the nasopharyngeal angiofibroma.

The correcting action of tropatepine hydrochloride upon the extrapyramidal effects induced by neuroleptics has been studied in 32 acute psychotic states. A satisfying result has been obtained with daily doses of 10 to 20 mg in 30 cases (excellent results: 20, good results: 10 patients). The action upon dyskinetic crises is particularly good and quickly obtained, avoiding a recourse to an i.m. corrector in 7 cases out of 8. The akineto-hypertonic syndrome has been efficiently corrected in 18 cases out of 23. The hyperkinetic manifestations (akathisia, tasikinesia) reacted favourably in 8 cases out of 11, dysarthria in 7 cases out of 11. The lessening of tremor was less satisfying (8 cases out of 15); same thing for the dryness of the mouth (7 cases out of 16) and disorder of visual accomodation (6 cases out of 12). The clinical tolerance was excellent. With the used doses, we found neither inconvenient atropinic effect, nor disorder of the vigilance, nor pharmacodependence. The one daily administration of a 10 mg tablet turned out to be sufficient in 19 cases. This possibility of only one administration a day appeared to us as a great advantage.

CAT scan by thin slices offers the possibility of evaluation of the bone structures of the ear and their contents. The progressively increasing availability of the scanner should make access much more routine for study of the ear, with a concomitant reduction in tomographies, inadequate in a large number of circumstances. The 4 main indications are chronic otitis with cholesteatoma, trauma, acoustic neuromas and malformations. The respective performances of tomography and CAT scan in each of these situations are discussed and an investigation strategy is suggested.

Pinning of fractures of the clavicle is easily and safely done by introducing the pin through the medial fragment. The pointed tip is embedded into the cortex of the lateral fragment and the inner end of the pin is bent at a right angle to fix it to the bone. Insertion is made with image intensification to avoid vascular damage and to guide the passage of the pin through the medial fragment without danger. Of 25 fractures treated in this way, only two, treated at the beginning of the series, required open reduction. No other immobilisation was necessary. All the fractures united uneventfully.

Orbital fractures should be evaluated by CT in frontal and transverse planes. The significance of blow-out floor and medial wall fractures is discussed. Limitation of inferior rectus muscle mobility is thought to be a result of edema, enophthalmos, fat prolapse or scar tissue formation, rather than muscle incarceration. The consequent therapeutic attitude implies a rigorous preoperative exploration by CT or for some orbital floor fractures by MR.

After a previous analysis of African depressions in studies based on the use of D.S.M. III as a preliminary tool, the authors are now seeking to understand more directly the different ways for depressed Ivorians to express the lowering of self-esteem, as well as the various meanings of agitation observed among them. An attempt of nosographic classification, closely linked with local reality, has been extracted from this material by the authors.

Based on 5 personal cases, the authors conducted a study of sphenoid mucocele, based notably on the results of CAT-scanning. This is the key step in diagnosis. Indeed, it makes it possible to determine the origin of the mass, and its growth, and lysis or even consolidation of bone walls. Magnetic resonance should supply valuable information on the inflammatory nature of the mass, its relationship with the pituitary and chiasma, as well as the images on a sagittal section. The studies conducted to date in general show a different presentation of the tumors in comparison with mucoceles. Because of the latent character of mucoceles they are often diagnosed at a late stage on signs of local involvement.