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Biomedical subjects

G Roger

Publications and source records attributed to G Roger.

At least 37 records · Page 2Linked to original sources
PubMed1998

Results of tympanoplasty in children with primary ciliary dyskinesia.

OBJECTIVE: To assess the results of tympanoplasty in children with primary ciliary dyskinesia complicated by tympanic perforation or cholesteatoma with hearing loss and/or recurrent otorrhea. DESIGN: Retrospective study. Postoperative follow-up of 26.3 months in the type 1 tympanoplasty group and 46 months in the child with cholesteatoma. SETTING: Hospitalized care, referral center. PATIENTS: Seven children with primary ciliary dyskinesia, complicated in 6 children by 9 tympanic perforations (3 bilateral perforations) and in 1 child by an attical cholesteatoma. RESULTS: After 9 type 1 tympanoplasties, the grafts were intact in 9 ears, with no recurrence of otorrhea, but serous otitis media was present in 6 of the 9 ears. Auditory improvement was significant, with an average gain of 17-dB hearing level in speech frequencies. After a canal wall-down tympanoplasty with mastoidectomy for attic cholesteatoma in 1 ear, the cavity that was operated on showed no signs of otorrhea or residual cholesteatoma after a follow-up of 46 months. CONCLUSION: In children with primary ciliary dyskinesia, tympanoplasty has a high probability of graft success and auditory improvement, despite the frequent recurrence of serous otitis media.

Adolescent↗
PubMed1998

Posterior laryngeal clefts: preliminary report of a new surgical procedure using tibial periosteum as an interposition graft.

OBJECTIVE: To present the preliminary results of a new surgical procedure for posterior laryngeal cleft repair. DESIGN: Retrospective study in an academic tertiary care center. METHOD: The study included three male patients (age at surgery, 2, 13, and 14 mo). One presented with severe aspiration and cyanotic attacks, the two others with aspiration and recurrent chest infections. The types of laryngeal clefts included complete cleft of the cricoid with varying degrees of tracheal involvement but not further than the first six tracheal rings. Associated malformations included one VATER syndrome, one esophageal atresia, and one tracheoesophageal fistula. Surgery was performed under general anesthesia with nasotracheal intubation. A vertical anterior laryngofissure was performed. The mucosal margins of the clefts were incised and then repaired in two layers with polyglactin sutures. The original feature of this procedure was the interposition of a small piece of tibial periosteum between the two layers. This fascia graft is known to be strong and resistant in cleft palate surgery. MAIN OUTCOME MEASURE: Clinical and endoscopic follow-up was used for evaluation of results. RESULTS: The three patients had successful laryngeal repair at a mean follow-up of 6 months (range, 4-14 mo). CONCLUSION: The anterior laryngofissure provides a good surgical access to the cleft. The interposition of tibial periosteum allows durability of the cleft repair. A longer follow-up is needed to confirm these preliminary results. A computed tomography scan study and a study on the rabbit are planned in order to evaluate the outcome of these periosteal grafts.

Adolescent↗
PubMed1998

Management of acute otitis media caused by resistant pneumococci in infants.

OBJECTIVES: To assess the clinical outcome and risk of failure after oral vs. intravenous treatment in otitis media caused by penicillin-resistant pneumococci. To determine the possible correlations between pneumococcal minimal inhibitory concentration (MIC) to penicillin and clinical outcome. DESIGN: Retrospective study of 156 cases collected between 1993 and 1995. Mean follow-up: 5 months. Setting. Two tertiary academic medical centers in Paris, France. PATIENTS AND METHODS: Pneumococcus was isolated from 191 of 570 ear samples obtained from children with otitis media and shown to be penicillin-resistant in 156. Medical history, antibiotic therapy during the previous 3 months and day-care center attendance were reviewed. For the current episode microbiologic characteristics of the isolated strains, type of treatment, therapy efficacy and clinical outcome were analyzed. Patients were predominantly young (76.3% were <1 year old) and bacteriologic samples were taken mainly because of previous treatment failure. RESULTS: Among 156 children with pneumococcal penicillin-resistant otitis media, 72.2% attended day-care centers, 71.8% had been previously treated with aminopenicillin and 52.5% with cephalosporins. Failure of previous empirical oral therapy was noted in 84% (one-third of these had been receiving amoxicillin-clavulanate). Patients treated intravenously had had a more protracted otitis but no greater number of previous episodes of acute otitis media than those receiving oral therapy. Acute mastoiditis occurred in 4 infants resulting in mastoidectomy. Oral treatment (mainly with high dose amoxicillin,120 to 150 mg/kg/day) and intravenous therapy (cephalosporin or glycopeptide) had been used in 59 and 41%, respectively. Mean duration of therapy was 10.7 days. Three failures (1.9%) and 10 recurrences (6.4%, average 28 days) occurred. No statistical difference was found between intravenous and oral therapy with respect to risk of recurrence. A high penicillin MIC value was correlated with previous antibiotic treatment but not with clinical outcome. CONCLUSIONS: Oral therapy appears to be as effective as intravenous therapy for the treatment of penicillin-resistant pneumococcal otitis media. Intravenous treatment should not necessarily be dictated by the penicillin susceptibility value but should be considered in cases of failure to thrive, persistent otitis or other complications.

Acute Disease↗
PubMed1997

Midline cervical cleft.

Midline cervical cleft is a rare congenital anomaly of the ventral neck and its embryological origin has not been clearly established. Less than 100 cases have been reported in the literature. We present a case of midline cervical cleft operated on at the age of 2 months in order to illustrate its clinical presentation and surgical management.

Branchial Region↗
PubMed1997

Nasal dermoid sinus cysts in children.

Thirty-six children with nasal dermoid sinus cysts were treated in the Department Pediatric Otolaryngology, Armand Trousseau's Children's Hospital (Paris, France) between 1974 and 1994. Ten of the patients presented with a midline cyst only, eight had nasal pits only, and 18 had combined cases. In six of the 36 patients, presurgical imagery indicated signs of intracranial extension of the tract, reaching the foramen caecum without intracranial mass. Three surgical techniques were used: an external rhinoplasty approach with medial crura section in 23 cases, a direct median approach in seven cases, and a paracanthal approach in six cases. Only two cases had meningeal adherences. Two superficial recurrences occurred within the 7-year follow-up period. Widening of the scar occurred in four children after verticomedian approach or nasal pit excision. The external rhinoplasty procedure with medial crura section results in a wide surgical approach, low recurrence rate, and good aesthetic results.

Adolescent↗
PubMed1997

[Inferior turbinectomy in asthmatic children].

Nineteen children with asthma underwent bilateral inferior turbinectomy from 1990 to 1995. Mean age was 11.5 years (range 8-17). All had obstructive allergic rhinitis and were resistant to long-term local corticosteroids. All operations were done under general anesthesia and endoscopic control. Mean hospital stay was 3 days. The postoperative period was uneventful and mean follow-up is 21 months (10-44). The patients described outcome as a clear improvement (n = 15), partial improvement (n = 3) and unilateral improvement (n = 1). The effect on asthma was more difficult to ascertain due to the number of cofactors. It can be noted however that asthma was not aggravated and that in 9 cases episodes decreased in frequency. Inferior turbinectomy provides considerable improvement in the comfort of patients with asthma, especially in terms of nasal ventilation.

Adolescent↗
PubMed1997

Predictive risk factors of residual cholesteatoma in children: a study of 256 cases.

OBJECTIVE: This study aimed to determine which children are at risk of having residual cholesteatoma develop after initial surgery for either cholesteatoma or severe retraction pocket. This study aimed to identify the characteristics of each patient and assessing whether predictive factors exist to propose a well-guided therapeutic approach. DESIGN: This was a retrospective study. Mean follow-up period (after the last eradication intervention) was 42 months. PATIENTS: Two hundred thirty-one children (256 ears) with either cholesteatoma (n = 157) or severe retraction pockets (n = 99), both treated surgically, composed the patient group. METHODS STATISTICAL ANALYSIS: univariate analysis of event-free survivals (using log-rank test and Kaplan-Meier estimate) and multivariate analysis (using Cox regression model) of clinical history, surgical observations, residuals occurrence (using Kaplan-Meier's statistical method) were used. RESULTS: Posterior mesotympanum involvement, ossicular chain interruption after disease excision (and moreover combination of both), relative lack of experience of the surgeon, and presumed incomplete removal were identified as independent risk factors highly correlated with residuals' development (relative risks ranging from 2.02-4.84). Disease extension, type of process (cholesteatoma vs. retraction pocket), eventual surgical history, and surgical method initially used (closed or open) showed no such correlation. CONCLUSION: The identification of any of these factors should instigate a mandatory second-look procedure regardless of other initial surgical findings and of technique used. The authors propose to advance this procedure from 12 to 9 months when all these factors are found in one child.

Adolescent↗
PubMed1996

Laryngeal dyskinesia as a cause of stridor in infants.

OBJECTIVE: To describe 9 cases of stridor attributed to the failure of the vocal cord to abduct during inspiration. DESIGN: Case series. SETTING: Pediatric otolaryngology referral center. PATIENTS: Nine hospitalized infants, aged 1 to 13 months, presented over a 3-year period for exploration of inspiratory stridor that was attributed to a condition that we have termed laryngeal dyskinesia. RESULTS: A consistent clinical presentation was noted in all cases. The laryngeal dyskinesia occurred during calm breathing, crying, or sleep and was associated with gastroesophageal reflux in 8 cases (diagnosed clinically and/or with pH monitoring). In addition, 3 infants suffered from fainting spells associated with vagal hypertonia that was confirmed by 24-hour Holter monitoring. True paralysis of the abductor muscles was ruled out in all infants because of the presence of normal glottic motion during calm breathing or induction of anesthesia. The stridor resolved between the ages of 4 and 13 months in 7 of the patients. Improvement was progressive and had no clear relationship to treatment for gastroesophageal reflux. CONCLUSION: Laryngeal dyskinesia in infants seems to be a distinct clinical entity, frequently associated with gastroesophageal reflux.

Age Factors↗
PubMed1996

[Malformations of the nasal fossa and paramedian facial clefts. New perspectives].

Since choanal atresia may be associated with other cranio-facial malformations, including various degrees of nasal fossa malformation, and be a part of paramedian facial clefts, (as described by Tessier), they can be integrated into the larger group of neurocristopathies. We identified four such cases with combined clinical elements corresponding to Tessier's paramedian facial cleft, including eyelid coloboma, mild to severe choanal and nasal fossa anomalies, ethmoidal hypoplasia and anterior skull base malformation, sometimes with proboscis lateralis. These various malformations are due to abnormality of the olfactive placode and the adjacent mesenchyme. These discoveries incited us to elaborate a conception first of all on the pertinent embryology involved, second, to propose a new classification based on anatomical and pathogenic embryological considerations. And finally, since endonasal laser therapy is particularly dangerous in such cases, to propose the use of transpalatal approach to restore choanal permeability. Pediatric ENT surgeons should pay special attention to any small stigmatism of facial cleft when dealing with children affected by choanal atresia.

Abnormalities, Multiple↗
PubMed1995

Role of modern imaging technology in the implementation of pediatric cochlear implants.

Since 1989, 40 patients have received cochlear implants in our institution. Over the past 2 years, 17 children among these patients have undergone radiographic assessment combining magnetic resonance imaging (MRI) and high-resolution computed tomography (CT) scanning. Imaging is not essential, and is only used after assessment by a multidisciplinary team. However, the imaging results influence the choice of implant, and sometimes the side to be implanted. The first study is always CT, as it detects congenital abnormalities, and for children with a history of bacterial meningitis, it can detect signs of labyrinthine ossification that contraindicates or complicates cochlear implantation. These signs are not always visible with tomodensitometry, especially when fibrosis within the canal has not yet ossified. This examination also provides for postoperative confirmation of implant position in case of failure or complication. Over the past 3 years, MRI has been combined with tomodensitometry, especially with children having a history of meningitis. This examination provides a basis for evaluating the liquid nature of the labyrinth. A GE Signa 1.5-T unit was used by the authors, employing sequences of volumetric acquisition (steady state free precision with 1.5-mm image slices and an angle of 15 degrees to 35 degrees). Hence, modern imaging plays an important role when the decision to implant has already been made, particularly in the case of profoundly deaf children. We always use MRI in combination with a CT scanner in children with a history of meningitis.

Adolescent↗
PubMed1995

Severe laryngomalacia: surgical indications and results in 115 patients.

Between 1987 and 1993, 115 children were operated on for severe forms of laryngomalacia in two pediatric ear, nose, and throat (ENT) departments. The criteria used to determine the severity of the illness were selected following short hospitalization periods during which the children received both pediatric and ENT checkups. Based on clinical manifestations and/or the results of pH monitoring gastroesophageal reflux was found to be present in 68% of the children in the study. Detailed analysis and endoscopy were used to differentiate the symptoms that were related to laryngomalacia from those that were caused by other conditions, including mixed-breathing, swallowing, and sucking difficulties. Endoscopic resection of the aryepiglottic folds, with or without the use of a carbon dioxide laser, resulted in rapid improvement of both ventilation and swallowing. The success rate of this simple and effective procedure, which has no inherent morbidity, was 98% in an average follow-up period of 30 months. Only seven children required an additional similar procedure. The procedure failed in only two children, who needed to be tracheotomized. Given these excellent results, endoscopic resection can be considered an effective technique for the management of severe laryngomalacia.

Acute Disease↗
PubMed1995

Endoscopic and CT-scan evaluation of rhinosinusitis in cystic fibrosis.

In order to obtain an accurate evaluation of nasal and paranasal sinus disease in cystic fibrosis patients, 75 patients with a proven cystic fibrosis diagnosis have been investigated using the following standard techniques: questionnaire, ENT examination, endoscopical examination, sinus X-rays, and in 31% of the cases a CT scan. The analysis of results shows that nasal obstruction is the most frequent symptom (32%) and that nasal polyps are present in 43% of the cases. Endoscopic examination seems to be of great interest in giving a more accurate picture of nasal and paranasal sinus disease. Analysis of CT scan images leads the authors to describe a new and specific entity in nasal and paranasal sinus disease in cystic fibrosis patients: the pseudomucocele. In this report, the authors discuss the various aspects of pseudomucocele, attaching particular importance to the CT scan results.

Adolescent↗
PubMed1995

[Predictive factors of residual cholesteatoma in children].

The decision on the appropriate surgical technique for treating cholesteatoma in children raises a number of controversial questions, most because of personal convictions rather than because of established data. We attempted to determine which patients are at risk of residual cholesteatoma in order to propose the most rational therapeutic strategy. A retrospective study of 250 children with cholesteatoma or severe retraction underwent surgery between 1986 and 1992. During this period 69 cases of residual cholesteatoma were recorded during a second intervention. After a mean follow-up of 33 months after the final operation, the Kaplan-Meier plot shows a rate of 31% and 34% at 3 and 5 years respectively. The univariate and multivariate (Cox regression) analysis was performed to search for a correlation between residual cholesteatoma development and past history including type of process involved, peroperative findings and surgical technique. Three factors were closely and independently related (p < 0.003) to residual cholesteatoma: invasion of the posterior middle ear, presence of ossicular erosion after excision and presumption of incomplete ablation. Inversely, age, surgical history, extension and nature of the process involved as well as surgical technique had no effect on development of residual cholesteatoma. Only one comparable study has been published where only ossicular erosion was found to be significant on multivariate analysis. The presence of one or more of the three of the factors mentioned above should lead to a second intervention, perhaps after a short delay, whatever the initial technique (open or closed).

Child↗
PubMed1994

Sarcoidosis of the upper respiratory tract in children.

Sarcoidosis is a multisystemic granulomatosis of unknown etiology which mainly affects young adults. It is characterized primarily by bilateral hilar adenopathies, a pulmonary infiltrate and cutaneous and ocular lesions. It rarely occurs in children under the age of 16. Localization in the upper respiratory tract (URT) is infrequent and sarcoidosis of the URT in children is exceptional, with only 13 cases reported in the literature. In the present report we describe the clinical, diagnostic explorations, histological and therapeutic aspects of 2 new cases in children.

Adenoidectomy↗
PubMed1994

[Clinical and endoscopic aspects of laryngeal dyskinesia in the infant].

Laryngeal dyskinesia, also called function stridor or stridor by cordal dysfunction, has been described in older children and in adults as episodes of acute dyspnea sometimes induced by exertion and in a particular psychological context. We report 5 cases of infants with stridor due to defective abduction of the vocal cords and normal laryngeal opening which occurred at rest or at awakening after anaesthesia. The common point was the clinical course of the stridor comparable with stridor which occurs during rapid respiration (crying) seen at birth then disappearing during the first 18 months of life, and also clinically observed gastro-oesophageal reflux which was confirmed by oesophageal pH measurements. Two infants had malaise with vagal hyperactivity. Disappearance of the stridor had no times relationship with the initiation of anti-reflux treatment and disappeared progressively near the end of the first year of life.

Airway Obstruction↗