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Biomedical subjects

F Chabolle

Publications and source records attributed to F Chabolle.

At least 19 recordsLinked to original sources

[Congenital neck masses. Embryonic origin and diagnosis. Report of the CIREOL].

Various congenital cervical anomalies are found in the neck region including defects of the branchial apparatus (branchial, thymic and parathyroid anomalies) and vascular anomalies. They manifest as cystic masses, sinuses, fistulas and as ectopic glands. This multicentric retrospective imaging study done in 5 different radiological centers (4 adult radiological departments and 1 pediatric radiological department) shows the result in understanding the congenital cervical anomalies and include 63 patients. The age of the patients varied between 24 days-81 years with a mean age of 23 years. This study included 27 patients having congenital branchial pouch anomalies (4 cases of anomalies of obliteration of the 4 th arch), 14 cases of cervical cystic hygromas, 11 thyroglossal tract cyst cases, 1 congenital laryngocele case, 1 case of jugular ectasia, 3 cases of capillary haemangioma. The embryologic basis of these different malformations were reviewed. Their characteristic findings and sites were illustrated together with their typical et atypical appearances. The frequency of occurrence of each branchial anomaly were plotted, the second branchial cleft cyst being by far the most common congenital cystic neck mass (70%). The study revealed the role of different imaging modalities in the diagnosis of various congenital cervical anomalies, especially in some particular complicated cases of congenital neck masses presenting in adult. Imaging study helps the clinician to anticipate any difficulties in unforeseen circumstances that may arise including infection haemorrhage, or parapharyngeal extension. Understanding the various radiologic appearances of these anomalies is greatly aided by familiarity with their embryologic origin. Moreover, considering the anatomic location and radiologic appearance, the precise embryologic origin can be accurately predicted.

Adolescent

[Analysis of results of pharyngotomy in the surgical treatment of sleep apnea syndrome. Apropos of 150 cases].

The indications and limitations of simple veloamygdalotomy as surgical cure for sleep apnoea were analyzed on the basis of results obtained in the first 150 cases treated prospectively by pharyngotomy. Clinical and polysomnographic results were analyzed as possible factors predicting success or failure. With a success rate of 80%, pharyngotomy is a simple and effective treatment for patients with minor forms of sleep apnoea (initial apnoea/hypopnoea index < 20) and no severe obesity. It appears unreasonable to propose isolated pharyngotomy if the initial index is < 30 since the success rate in the cases is only 27%. Nasal repermeation does not improve overall results significantly. The lack of patient compliance to diagnostic and therapeutic modalities is an unavoidable reality due to human, social and economic implications.

Adult

[Primary non-Hodgkin lymphoma of the nasal fossae and sinuses. Apropos of 8 cases].

The authors report their experience about 8 cases of nasal lymphomas diagnosed and treated between 1987 and 1993. Behind ordinary symptoms, a very bad forecast lymphoma may be hidden. Histological diagnosis is sometimes difficult and needs voluminous fresh fragments. During the evolution of this affection, local temporary nasal and paranasal remissions are often noted after chimiotherapy and/or radiotherapy, but rapidly appear visceras secondary localisations, suggesting an underestimation of the nasal and paranasal sinuses localisations among the treated non-Hodgkin's lymphomas population.

Aged

[A new technique of gene transposition in the surgical treatment of sleep apnea syndrome].

Pharyngotomy appears to be insufficient for the treatment of severe sleep apnea. For patients who refuse or abandon mechanical ventilatory assistance, surgery can be used to widen the retrobasilingual space adapting it to the cephalometric profile defined by cineradiography and MRI in combination with velopharyngeal plasty. For patients with no maxillomandibular or lingual malformation, the pharyngotomy can be combined with an anterior transposition of the genial insertions of the tongue without rotation. A method different from that described by Riley and Powel is proposed. The details of the surgical procedure are exposed. The operation is indicated in snorers with sleep apnoea with an Apnea Index Superior to 30 who refuse nocturnal ventilatory assistance and who do not have a hypertrophied tongue (Surface less than 30 cm2) or maxillomandibular retroposition.

Cephalometry

[Attic emptying in cholesteatoma and precholesteatoma states. Technique, indications and results].

A surgical procedure different from the open or closed technique is presented. The attic is emptied through the meatus after a retromeatal access to the antromastoidal cavities. By blocking the aditus ad antrum, the procedure produces an antrio-attic microcavity with no recessus. Results of resection of epidermal lesions are quite satisfactory with a low rate of residual pathology. Retraction pouches do not develop because the mastoid is excluded and no attic recessus is formed. Surveillance of the cavity is easy and the disadvantages of functional sequellae inherent in open techniques are avoided. The preliminary results would confirmed the quality of the procedure. In 22 cases, there were 3 residual perles on the windows and 2 retraction pouches (anterior and posterosuperior). This technique is indicated in precholesteatoma states with poor prognosis and cholesteatomas of the attic. For more advanced lesions, this technique is less reliable and the open procedure is required.

Adolescent

[Laser CO2 arytenoidectomy by endoscopic approach in bilateral laryngeal paralysis. Apropos of 45 cases].

Between 1980 and 1993, 45 patients with bilateral cord abductor paralysis were treated by carbon dioxide endoscopic laser arytenoidectomy. Thyroid surgery was the main cause of bilateral laryngeal palsy (67%). Seven patients, who were tracheotomised before treatment, were decanulated. Ninety-one percent of the patients recovered physiologic respiration. The follow up period lasted from one month to thirteen one-half years. Advantages and disadvantages of laser arytenoidectomy are compared with other techniques.

Adult

[Embolization by direct puncture of hypervascularized ORL tumors].

Direct intratumoral embolization was used to treat five patients with vascularized tumors of the head and neck: 2 nasopharyngeal angiofibroma, 2 glomus jugulare tumors and 1 hemangiopericytoma. Embolization was performed by direct puncture and intratumoral injection of a plastic mixture under angiographic control. In 4 patients, embolization was performed preoperatively. Devascularization was induced in at least 90% of the volume of these tumors, thus facilitating subsequent surgical removal of the tumor. In 1 patient, embolization was performed with palliative intent. Good regression of symptoms was obtained.

Adolescent

[An unusual cause of dysphagia: cervical schwannoma of the prevertebral space. Radioclinical correlations].

The authors report a case of cervical schwannoma with an atypical clinical expression, site and imaging features. The anteromedian lesion lying in the prevertebral and retropharyngeal spaces accounts for its clinical expression in the form of dysphagia. The target appearance on computed tomography and on the T2-weighted MRI sequence was suggestive of a neurofibroma and was due to deposition of fibrin and haemorrhagic exudates in the center of the lesion. The presence of a prevertebral ansa cervicalis in front of the long muscles of the neck, between the longus capitis and longus colli muscles, accounts for the vertical, elongated appearance of this tumour involving the prevertebral space.

Deglutition Disorders

[Treatment of simple snoring. Surgical pharyngoplasty vs. laser CO2 pharyngotomy].

CO2 laser pharyngotomy is a newly described technique used in treatment bronchopathy without sleep apnea syndrome. Retrospective results of 70 CO2 laser pharyngotomies and 63 surgical pharyngoplasties are studied and compared. All patients were SAS free snoring patients. The results were rated satisfactory by 54% of the CO2 Laser treated patients against 78% for classical surgery. CO2 laser pharyngotomy is an easy procedure done in the office. The complication rate is very low. The predictive criteria upon which one can select the best procedure for each particular patient remain largely unknown.

Adult

[Unusual localization of an olfactory esthesioneuroma].

Olfactory neuroblastoma, a nerve tumour arising in the olfactory mucosa, is a relatively easy diagnosis in the case of a mass centered around the cribriform plate. It is more difficult to diagnose in its exceptional ectopic forms (maxillary sinus) in the absence of any cytological and histochemical arguments (fibrils, olfactory rosettes). Its local malignancy is variable with a 42% 5-year survival for stage C and metastases in 30% of cases (principally cervical nodes, bone and liver). The role of imaging is to define the criteria of a mass syndrome and to perform the preoperative staging in a case of apparently simple sinus obstruction.

Brain Neoplasms

[Total pharyngolaryngoesophagectomy. Indications and results apropos of 17 cases].

Pharyngolaryngoesophagectomy (PLO) allows one-stage treatment of synchronous tumors involving both esophagus and hypopharynx and may also be advocated when the pharyngo-esophageal junction (PEJ) is involved. Less radical surgery may be advocated in the case of hypopharyngeal malignancy sparing the pharyngoesophageal junction. The authors report the results of 17 PLO carried out in 11 cases for a tumor involving the PEJ, and in 4 cases for synchronous tumors involving esophagus and hypopharynx. In 2 instances, PLO was performed for primary hypopharyngeal malignancy requiring total circular excision (i.e. which did not involve the PEJ). Five patients had previously received chemotherapy and 6 had had an association of chemotherapy and radiation therapy as initial treatment before surgery. Reconstructive procedure used the stomach and colon in 12 and 5 cases respectively. Hospital mortality was 4 cases out of 17. There was 1 cervical fistula secondary to pharyngogastric anastomosis necrosis. One and 2 year actuarial survival rates were 73% and 37%. Tumor recurrence and a remote new tumor were noted in 6 and 4 cases respectively, despite extensive surgical procedures and the use of chemotherapy and/or radiotherapy. When esophagectomy was added to total circular excision in case of hypopharyngeal tumor sparing the PEJ, no significant benefit was noted. Good functional results obtained by means of PLO shall lead to therapeutic trials including surgery, chemotherapy and radiotherapy with the aim of improving long-term results.

Adult

[Endonasal microsurgery].

Endoscopic surgery of the sinuses is a valuable procedure for evaluating allergic or infectious chronic recurrent sinusitis. It allows assessment of the ostium and the state of the mucosa. Its complications are exceptional (rhinorrhoea, meningitis, orbital trauma), but require a detailed preoperative examination in order to reveal variations in sinus anatomy. The role of preoperative CT is therefore to analyse the type and the extent of the disease and individual anatomical variants. It is difficult to predict the depth and angle of introduction of the endoscope on the basis of the CT scan, which is performed in the coronal plane with variable angle. Ideally, only lateral scans would allow guidance of the introduction of the endoscope (hence the value of MRI or 3-D reconstructions).

Endoscopy

Mandibular nerve: MR versus CT about 10 proved unusual tumors.

10 patients with symptoms of mandibular neuralgia formed the basis of this study. They were studied by both enhanced CT and MRI. MRI, better than CT, easily permits distinction between intrinsic and extrinsic lesions and detects involvement of the cavernous sinus and meninges. Moreover, because of its multiplanar imaging capability, and ability to portray exquisite anatomic details and characteristic tissue signal intensity, MRI is helpful in the evaluation of tumor involvement for biopsy and preoperative planning for these deep tumours.

Adult

[Provoked oto-emissions. Parameters obtained in normal subjects using Kemp's equipment].

Response parameters relating to the stimulus (click or filtrated bursts), the patient's age and audition curve (physiological presbyacusis) were derived from 3158 provoked otoemission (POE) recordings obtained in normal subjects. Current limits imposed by the device used constitute a factor restricting indications for such devices to the screening of loss hearing in the young child, obviously, but also to the investigation of certain paucisymptomatic hearing disorders presenting with normal or subnormal pure tome audiograms.

Adolescent