[Choanal imperforations. Therapeutic contribution of laser].
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Choanal Atresia↗
Biomedical subjects
J J Piquet
Publications and source records attributed to J J Piquet.
[Our experience of meatotomy in the treatment of paranasal sinus diseases].
Results are presented of patients treated by endonasal microsurgery in the ORL clinic of the Lille UCH between January 1986 and July 1990. The principal affections treated were: chronic sinusitis, aspergillosis and Killian's polyp. The objective of the technique employed, which has evolved progressively, was in each case to eradicate the infectious focus or its cause, and to maintain satisfactory ventilation and drainage of the maxillary sinus. The technique used is described, and results presented based on the responses received from a questionnaire sent to 164 patients.
Drainage↗
[Endonasal microsurgery of antro-choanal polyps].
Between 1986 and 1991, 33 patients were operated on by the senior author. Neither sex, nor side prevalence has been observed. In 50% of the cases, the patient was a teenager. In 18% of the cases, a cystic oedematous transformation was the cause of the polyp. Its treatment must be surgical. Five cases were operated on by gingival access, the others by median and inferior meatotomy which is recommended by the authors. They found one recurrence out of the recorded 24 cases.
Adolescent↗
Subtotal laryngectomy with crico-hyoido-epiglotto-pexy for the treatment of extended glottic carcinomas.
We first described subtotal laryngectomy with crico-hyoido-epiglotto-pexy in 1974. This procedure is a modification of Majer's operation and results in the complete resection of the intact thyroid cartilage. The epiglottic petiole, the false cords, the true cords, and one arytenoid are also excised, along with the paraglottic space. The pharynx is closed by suturing the cricoid to the epiglottis and the hyoid bone. The neoglottis is occluded during deglutition by the epiglottis and the base of tongue, which come into contact with the remaining arytenoid. Postoperative hospitalization lasts approximately 3 weeks, and patients have a strong but deep voice. Between 1972 and 1985, we treated 104 patients with stage T2 and T3 lesions of the glottis using this method. A retrospective analysis showed that the overall survival rate of patients was 86% at 3 years and 75% at 5 years. Five patients experienced local recurrence. Seven patients had recurrences in the neck, and eight developed second primaries. Thirteen patients were lost to follow-up or developed intercurrent disease. Patients with T3NO lesions were treated with unilateral prophylactic neck dissection, and positive nodes were found in 23% of cases. We believe that the high proportion of positive nodes justifies routine prophylactic neck dissection in these patients. Because our operation is associated with good local control (5% recurrence rate), we propose that, for the treatment of extended glottic cancers, it replace transcartilaginous procedures that are associated with much higher recurrence rates.
Carcinoma, Squamous Cell↗
[Use of the PVC, a laryngoscope for difficult intubation].
The PCV (Piquet-Crinquette-Vilette) laryngoscope has been designed for use in difficult endotracheal intubation in the adult. Its blade, 170 mm long, is curved, narrow (12 mm internal diameter) and semicircular in cross-section, like a closed C. An 8 mm endotracheal tube can be pushed through this blade. There is a cold light source. The use of this blade requires a teeth protector. The epiglottis will be lifted directly, and the blade will be moved into the vestibule, stopping short of the vocal cords. The endotracheal tube will then be introduced into the laryngoscope blade which guides it in between the cords. Once the tube has been checked to be within the trachea, the laryngoscope is removed by sliding the blade backwards over the tube. The PCV may be introduced into the mouth either on the right, or on the left, or behind the molar teeth, or between two teeth. It can held with the handle horizontal in case of a prominent sternum. The limits of this tool are a mouth opening of less then 20 mm, and some rare predictable difficulties which require an X-ray assessment to determine the best intubation technique to be used. Of 115 patients with a predicted difficult endotracheal intubation, fifty were intubated with the PCV without any failures. Also, twenty-five patients, out of thirty, were successfully intubated with the PCV after an attempt with a MacIntosh blade had failed. Of these five failures, one was never intubated by any technique whatsoever, two were intubated by fibroscopy and two by the ENT surgeon.
Anesthesiology↗
[Subtotal laryngectomy in the treatment of extensive tumors of the larynx].
The authors assess the possibility to perform subtotal laryngectomy for extensive tumors of the endolarynx. They describe a particular variety of T3/T4 tumor extending anteriorly to the thyroid cartilage or to the pre-epiglottic space. Such tumors do not affect the arytenoid cartilages posteriorly, which makes functional subtotal laryngectomy with CHP or CHEP possible. This surgery was performed in 28 patients from 1972 to 1985, with 20 patients still living after 5 years, ie. 72% of all cases.
Humans↗
[Liposarcoma of the infratemporal fossa. Apropos of a case].
The authors report about one female patient with a liposarcoma of the right infratemporal fossa. Such tumors are rare, making up 10 to 12% of all soft-tissue sarcomas. Their occurrence in a cervical site is rare, unlike that in the inguinal region, the retroperitoneum or the lower limbs. Their diagnosis is mainly established by the histopathological study. Computed tomography and magnetic resonance imaging are particularly useful to choose the surgical approach. The technique chosen for this infratemporal tumor was a transmandibular cervical approach. Evolution was favorable, and the patient has currently had no reoccurrence after two years.
Adult↗
[Subtotal functional laryngectomy with cricohyoidopexy].
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Cricoid Cartilage↗
[Partial surgery in treatment of cancers of the piriform sinus and lateral epilarynx].
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Follow-Up Studies↗
[Medium-malignancy tumors of the parotid gland].
Among the 437 parotidectomies performed from 1966 to 1989, we observed 2 acinar-cell tumors and 11 mucoepidermoid carcinomas, ie. 3%. The acinar-cell tumors occurred in 2 men aged 45 and 71. A conservative complete parotidectomy was performed in both cases with a 6 and 7-year survival without local recurrence. The mucoepidermoid tumors affected 4 women and 7 men. The clinical appearance in 2 cases was highly suggestive of a malignant tumor, the picture including facial palsy, fixed gaze and adenopathy. In spite of excision completed by radiation therapy, the outcome soon was unfavorable. In the other 9 patients presenting with a limited tumor of the parotid gland, the facial nerve had to be partly sacrificed in 2 cases because no dissection was possible even under a microscope. The prognosis was generally favorable in the limited forms with 6/6 patients alive at more than 5 years and 3 patients alive at 3 years, 2 years and 1 year. Postoperative radiation therapy was not performed systematically, but only in 2/3 of cases (ill-delineated or ill-differentiated tumor).
Adolescent↗
[Laryngectomy with Tucker's epiglottoplasty].
From 1980 to 1987, 37 patients were operated with a reconstructive anterior frontal laryngectomy including epiglottoplasty such as described by Tucker. These patients presented with epidermoid carcinomas of the glottis. The carcinological results are satisfactory, with a survival rate of 33 of 37 patients at 3 years and 22 of 25 patients at 5 years. However, the control of the paraglottic space still is insufficient after this type of surgery, and we reserve it for the tumors confined to the glottic level, without impairment of mobility. The anterior frontal laryngectomy performed is extensive and frontolateral. It is used for a few of its former indications, as showed by the comparison of the periods before and after 1980.
Carcinoma, Squamous Cell↗
[Enlarged transfacial approach in the surgery of tumors of the ethmoid].
Cancers and tumours of the ethmoid bone are characterized by the possibility of extension towards the lamina cribrosa and within the cranium. Removal via a combined neurosurgical and paralateronasal route would appear to provide a more favourable prognosis for the patient. It is, however, a particularly cumbersome approach, and the neurosurgical follow up may be difficult. This is why we recommend a direct approach to both the ethmoid bone and the anterior part of the base of the cranium via a transfacial route, thus permitting complete removal of the tumour and of any intracranial extension through the lamina cribrosa. A number of points of technique are important: the line of the skin incision and the flap of cranial periosteum, operative examination and exploration of the upper part of the tumour, the reconstruction of the meningeal barrier and, if necessary the base of the cranium. The price to be paid for this approach route is the scar which is, however, always of minimum size and well tolerated by patients. Operative follow up is simple--which is the major advantage of the technique--and the carcinological prognosis appears to be as satisfactory as for the combined route.
Ethmoid Sinus↗
Surgical treatment of angiofibromas of the nasopharynx--34 cases.
Between 1966 and 1987 we have treated 34 angiofibromas. The patients were between 9 to 28 years of age (average 16.5 years). The tumour extension was determined formerly by tomography and angiography, but these two methods have been replaced by angioscanning, which give the best results. Nineteen patients were classified stage I, fourteen stage II and one stage III. The surgical approach was transmaxillary in most cases. After tumour resection, two local recurrences were seen and a second operation was necessary to achieve a definitive cure in these patients.
Adolescent↗
[Endonasal ethmoidectomy in the treatment of polyposis].
The authors report their experience with 210 microsurgical ethmoidectomies carried out in 109 patients between 1980 and 1987. In 23 patients the anatomy was considerably modified due to previous surgery. Asthma was present in 56 patients and 25 patients suffered from Widal's syndrome. The complications noted included 1 case of meningitis cured by antibiotics and a case of transient diplopia. Patients were monitored for 1 to 6 years; In 69 cases no recurrence was noted (63% of cases), 31 patients (28%) only required minor local procedures for slight recurrence (28%). On the other hand, 6 patients (5.5%) required a second surgical procedure for recurrence between 3 and 6 years.
Asthma↗
[Cystadenolymphoma of the parotid gland. A study of 40 cases].
A statistical review of 40 cases of adenolymphoma (Whartin's tumor) of the parotid gland is presented. In 10% of the cases, other tumors are found in the same concerned gland. Therefore, the authors perform a subtotal parotidectomy rather than a simple removal of the tumor of a superficial parotidectomy. This policy reduces the risk of facial nerve injury by repeated dissection.
Adenolymphoma↗
[Anomalies of the first branchial cleft].
These are cysts and fistulae which closely adherent to the external auditory canal and drain through the high lateral cervical suprahyoid site. Misdiagnosis is common with these lesions and inadequate removal leads to surgical failure. A review of the embryology of this region is necessary since we intend to explain the clinical aspects and the variable relationship to the facial nerve. Eight cases are described and the literature pertaining to first branchial cleft syndrome is reviewed. Diagnostic and management problems will be discussed. A full exposure of the parotid gland and facial nerve is essential to complete removal and facial nerve preservation.
Adult↗
[Post-traumatic intracavernous aneurysms. 2 cases].
The authors describe two cases of post-traumatic aneurysms of the intracavernous carotid artery. They analyze the difficulties they have encountered during direct approach. Direct cure was impossible for the first patient because of the arterial wall dilaceration. In the second case, the aneurysm has been treated upon by stitching. A second operation with injection of biological glue into the cavernous sinus was required because of the secondary formation of a carotido-cavernous fistula in front of a second metal fragment.
Adolescent↗