Biomedical subjects
Publications and source records attributed to D Portmann.
The authors describe the various techniques of tympanomastoidectomy that can be used to eradicate chronic disease processes. The techniques are either open or closed operations; the factors in determining the choice of technique for specific conditions are presented.
Temporo parietal fascial flap is a way of total ear reconstruction when there is not a sufficient quantity of available skin in auricular region. This flap very thin, supplied by superficial temporal vessels is located above the auricle and can cover the framework's convolutions. This technique has been well described by Burt Brent. Our experience is based upon 12 total ear reconstruction with this kind of flap. When there is an extreme skin shortage, but of good quality, we discuss the technique of skin expander.
Severe and recurrent epistaxis in cases of Rendu-Osler disease (Hereditary hemorrhagic telangiectasia) are very difficult to treat. For one case the authors propose a bilateral nasolabial flap with inferior pedicle. They describe the technique and after 15 months of follow-up there is no recurrency. This treatment is used for particular cases: old people with short expectation of life, severe anaemia involving the vital prognosis.
This is a comparative study of 622 patients undergoing either stapedectomy or stapedotomy for otosclerosis. 379 underwent stapedectomy, which in the majority of cases employed interposition of the posterior crus of the stapes into a venous graft placed over the newly created fenestra. The results of this technique are compared with 243 microwindow stapedotomies performed since 1976. For all patients a minimum of 5 years had elapsed between surgery and evaluation of outcome. In some instances, this time period was 20 years. One month post-surgery the closure of the air-bone gap was more frequently superior with stapedectomy, particularly in the low frequencies. The degree of an incidence of overclosure was comparable for both techniques. However, at 4,000 Hz, bone threshold levels deteriorated more usually following stapedectomy. The air-bone gap widened progressively over the proceeding years post-stapedectomy. This was in contrast to the effect seen during the same period after stapedotomy, namely a narrowing of the air and bone threshold levels. Additionally a progressive loss of bone thresholds was noted after the latter technique. The incidence of sudden total deafness, either immediate or delayed, was less than 1% for both procedures. Even after 15 years or more poststapedectomy, the air-bone gap (13 dB average) and bone thresholds remained stable. Revision surgery was necessary in 8% of stapedectomies and in 4% stapedotomies. However, the post-operative follow up period is much shorter for the latter.
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We present a group of 50 patients with retrocochlear pathology, divided on 41 (82 per 100) non tumoral and 9 (18 per 100) tumoral: 8 cerebello-pontine angle meningiomas and 1 intracranial cholesteatoma. The retrocochlear diagnosis of the pathology is assessed by the results of the audiovestibular explorations, specially the electrophysiology (early auditory evoked response, electrocochleography). The neuroradiologic explorations (TAC, MNR) define the tumoral or non tumoral nature of the pathology. We review some technical aspects of the common electrocochleographic practice, as actually is realised by the Bordeaux group; also, the different parameters of a retrocochlear pathologic response. In this group, the electrocochleography was necessary on 64 per 100 of the cases to obtain an electrophysiologic retrocochlear diagnostic.
The authors study the different parameters of the stapedius reflex on a 55 patients group with retrocochlear and non tumoral diagnostic is assess by electrophysiologic (BERA, Electrocochleography) and neuroradiologic explorations (TAC), Meato-cisternography, NMR). We realise an comparative study between the results of this group and the results of 2 other groups (98 acoustic neuromas and 104 endocochlear diseases). The test has a moderate sensibility and none specificity in this kind of pathology, because the high percent of false negative (30%), and the positivity on 95% of acoustic neuromas and on 74% of endocochlear diseases.