Biomedical subjects

M Cannoni

Publications and source records attributed to M Cannoni.

At least 37 records · Page 2Linked to original sources

PubMed1993

[Cholesteatoma of the middle ear in children. Apropos of 80 cases and review of the literature].

Cholesteatoma occurs in 10% of cases of chronic otitis in children. In most children, the clinical form is very similar to acquired cholesteatoma in the adult. However, we observed certain clinical variations in our retrospective series of 80 cases seen in our unit over the past 8 years. In most all cases, otorrhoea and hypoacousia were the presenting signs. The tympanic membrane was fully intact in 10% of the cases raising the possibility of congenital pathogenesis. An analysis of the correlations between per-operative observations and tomodensitometric results was conducted. Closed tympanoplasty, with a second operation 11 months later, was performed in 84% of the cases. Residual cholesteatoma was observed in 41% of the second operations and relapse occurred in 16%. These anatomic and functional findings, compared with those in the literature, demonstrate that no major difference in the published series. Presently the most important point is to separate acquired and congenital forms, which differ in terms of pathogenesis and clinical presentation, but are treated in the same manner. Progress in the treatment of cholesteatoma of the middle ear in children will come from prevention through earlier diagnosis of pathological manifestations in the ear nose and throat, in particular blocked Eustachian tubes, and through follow-up and treatment of pre-cholesteatomous states, as well as further advances in fundamental research.

Adolescent↗

PubMed1993

[Deafness caused by malformation of the inner ear. Current contribution of x-ray computed tomography].

Hearing loss due to malformations of the auditory system may involve morphologic abnormalities of the external canal, the middle ear, or the inner ear. Various combined malformations are possible. Audiologic assessment and computed tomography make it possible to perform a precise diagnostic evaluation of inner ear malformations. In a series of 71 children with congenital sensorineural hearing loss, 31 had computed tomographic evidence of malformations. Since 19 children had bilateral lesions, a total of 50 ears were studied. The cochleovestibular abnormalities were typed and correlated to the severity and progression of hearing impairment. The 3 most frequently encountered malformations were: 1) isolated large cochlear aqueduct (n = 12), 2) large vestibular aqueduct (n = 8) and 3) the Mondini malformation (n = 7). The most severe hearing losses were associated with cochlear hypoplasia and incomplete cochlear segmentation. The severity of hearing impairment decreased with the following abnormalities in the order given: 1) large cochlear aqueduct, 2) Mondini malformation and 3) large vestibular aqueduct. Among the 15 patients with progressive hearing loss, 13 had large cochlear aqueducts either isolated or concomitant with other lesions. While certain evident abnormalities, such as cochlear aplasia or Mondini malformation, are relatively easy to diagnose, other more subtle morphologic changes, such as large cochlear aqueduct, still need to be better defined according to precise criteria for radiographic evaluation.

Child↗

PubMed1993

[Enlarged trans-temporal crania fossa approach. Technique and indications].

The authors report their experience using an enlarged middle cranial fossa approach for the removal of 33 acoustic neurinomas and 10 cerebellopontine angle meningiomas. The Technique is defined. This approach proved suitable for stage I neurinomas, ensuring total removal in all 13 patients with stage I lesions, hearing conservation in 9 (69.2%) of these patients, grade 1 + 2 facial nerve function in 80% of patients and grade 3 function in 20% of patients. While total removal was always possible for stage II neurinomas, the functional results were poor with hearing conservation in only 3 of 15 patients (20%), grade 1 + 2 facial nerve function in 45% of patients and grade 3 function in 54% of patients. Total removal was possible in only 1 of 4 patients with stage III neurinomas. This approach proved excellent for cerebellopontine anale meningiomas, providing wide access to the tumor and protecting the acoustico-facial bundle situated behind the tumor. Among the 10 patients operated by this route, 8 had conservation of hearing and all 10 had normal facial motricity (grade I) at 3 months.

Hearing Disorders↗

PubMed1993

[Rhinosinusal manifestations of cystic fibrosis].

The generalized disorders which characterize cystic fibrosis often involve the nose and paranasal sinuses and may frequently lead to the development of nasal polyps. A retrospective study of 78 patients with cystic fibrosis, 3 to 28 years old, was undertaken in order to determine the incidence of nasal involvement and to define an approach to the treatment of disabling recurrent nasal polyposis. 65% of these patients presented chronic symptoms such as rhinorrhea, nasal obstruction and disturbances of smell. Nasal polyps were found in 50% of patients and were more frequent in adults than in children. Clinical symptoms were directly related to the extent of polyp development which could be classified according to 3 groups. CT scans showed maxillary sinus involvement in almost all patients. The incidence and extent of ethmoidal sinus involvement on CT scans was correlated to the grade of polyp development. Medical treatment of polyposis failed in all cases. Polypectomy was always followed by recurrence. Intranasal ethmoidectomy seems to be an interesting alternative, since 73% of patients undergoing this procedure had clinical improvement.

Adolescent↗

PubMed1993

[Functional results of the surgery of unilateral acoustic neuroma].

The authors sent a circumstantial questionnaire to 224 surviving patients out of a 228 unilateral acoustic neurinoma operated on from June 83 to December 90 range of patients in order to assess their complaints. Seventy-two per cent of these neurinomas were Stade III or IV of Koos. Translabyrhintine approach was used for 85% and suprapetrous approach for 15%. The post-operative mortality rate is 1.75%. At the end of the procedure, the removal seemed total in 99% of cases and the anatomical facial nerve continuity was preserved in 94% of cases. Our patients kept or recovered a normal (Grade I of House--52%) or almost normal (Grade II of House--14%) facial motion in 66% of cases. A normal facial rest stretching with a complete eyelid closure but an asymmetrical facial mimic (Grade III of House) were in 20% of cases, and a more important facial palsy with incomplete eyelid closure was in 4% of cases (Grade IV of House). Patients needed an hypoglosso-facial anastomosis in 10% of cases. Always, this anastomosis restored a good facial motion near the Grade III of House. Hearing preservation was achieved for 45% of the attempts (through a suprapetrous approach) but hearing so preserved was functional (pure tone loss less than 50 db) in 37.5% of cases (5% of all the patients of this series) and only 61% of these patients kept or recovered a normal or almost normal facial motion. Varying, often regressive, complications were observed: C.S.F. leakages (7.5%) through the operative wound in two third of cases, owing to a pressure raising due to meningitis or C.S.F. circulatory constraint and usually cured by lumbar punctures and, if need be, antibiotics and, in one third of cases, through the tympanic cavity then nostril because of a hole remaining on the petrous drilled wall and usually needing a reintervention, swallowing difficulties (3%), due to a contralateral vagus nerve palsy in half of cases, postoperative hematomas (1.75%), fatal in one out of two times, brain traumatism (1.75%), meningitis (0.4%). The answers of patients were proper enough to be used for this study in 80% of cases (178). Their subjective answers about facial motion agreed with our objective assessment in 84% of cases that is emphasizing the difficulties of all attempt to this type of valuation. Our patients point out balance troubles in 67% of cases.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗

PubMed1992

Intranasal ethmoidectomy in nasal polyposis in children. Indications and results.

Nasal polyposis in children is a rare pathology that is difficult to treat, with results that are often disappointing. The aim of this paper is focused on the surgical possibilities of ethmoidectomy by endonasal approach. Thirty-nine ethmoidectomies were performed in 24 children with a mean age of 12 years (cystic fibrosis, n = 7; Woakes' syndrome, n = 2; isolated polyposis, n = 15). The decision for surgical treatment was based upon the severity of initial symptoms, principally nasal obstruction, lack of improvement after medical treatment, and the assurance of good surgical follow-up. Twenty-three children were followed up for a mean of 3 years. Complete recurrence was noted in 13% of the cases (n = 3). In all the other cases, including those with partial recurrence, the lives of the children were transformed. Ethmoidectomy by endonasal approach is reliable if the appropriate surgical techniques are strictly followed. It has proven its efficacy in children with nasal polyposis with results that are very encouraging compared to previously proposed therapies.

Adolescent↗

PubMed1992

[Lower turbinectomy with endoscopic guidance. Mid-term results].

The authors report about their experience with partial lower turbinectomy. Twenty-nine cases were followed up over an average time lapse of 2 years. Anterior rhinomanometry was performed pre- and postoperatively in all patients. The results include 26 successful operations (90%) and 3 failures, one case of hemorrhage on pack removal and one of synechia. In view of the 3 failures, the authors are presently favorable to subtotal lower turbinectomy.

Adolescent↗

PubMed1992

[Comparative study of cartilaginous and synthetic laryngotracheoplasty. An experimental study in rabbits].

The most significant advance in the treatment of laryngotracheal stenosis in children is the augmentative laryngotracheoplasty using a graft of autologous rib cartilage (ARC). In order to reduce the potential morbidity of this technique due to the additional surgical procedure, the use of a ceramic, hydroxyapatite (HA), implant was compared to ARC in a randomized experimental study in 99 New Zealand rabbits: 32 rabbits had ARC grafts, 33 had HA implants covered with a graft of perichondrium (HAP) and 33 had naked HA implants. At 3 months, immediately before necropsy, there was no significant clinical difference between the 3 groups of animals. Histological examination was performed in 81 animals. Implants were found in 54 specimens. More implants were found in the ARC group than in the HA groups (p < 0.003). No difference was noted between the 3 groups in the epithelial covering of the implant, the amount of inflammation, the analysis of the interface between the implant and the cricoid cartilage and in the viability of the graft. No implant was found in 27 animals. However, scar bands of approximately the same width as the implant were responsible for cricoid diastasis in 23 cases. Therefore, it seems that the missing implant played the role of spacer. While this experimental study does not eliminate HA as a augmentative implant in the subglottic region of the rabbit, the evolution of the scar bans must be followed for a longer period in rabbits before considering the clinical application of this technique.

Animals↗

PubMed1992

[Giant cholesterol cysts of the petrous apex].

In connection with their two own cases, the authors deal about the giant cholesterol cysts of the petrous apex. The lesions which are to be differentiated from epidermoid cysts are cholesterol granulomas. Their petrous apex location explains their characteristic large appearance. As each cholesterol granuloma, they occur when a bony cell is obstructed. This chronic obstruction induces mucosal edema then bleedings which lead to the formation and, by the lack of drainage, to the accumulation of cholesterol crystals. These crystals initiate a non specific reaction to foreign bodies, a granuloma, which also can bleed. Thus, a continuous cycle perpetuates the growth of the lesion. This lesion, when it is localized in the petrous apex, can reach a big size before the appearance of some signs. Usually, these are otologic (sensorineural hearing loss, tinnitus, vertigo) and/or cranial nerve palsies (V, VI, VII). C.T. scan (well defined, sharply marginated bony expansible lesion with isodense to the brain central part) and M.R.I. (central region of increased intensity on both T1 and T2 weighted images and peripheral rim of markedly decreased signal intensity in all instances) features are characteristic enough to allow diagnose with other petrous apex lesions (cholesteatoma, mucocele, epithelial cyst, histiocytosis X, ...). Surgical treatment must try to evacuate and to aerate the cavity or perhaps to obliterate it with fatty pieces in order to prevent the recurrence.

Adult↗

PubMed1992

[Repair of the auricular area after petrosectomy].

The authors report a retrospective series of 12 patients presenting periauricular tumors having invaded the external auditory canal and concha: 5 squamous cell carcinomas, 3 basal cell carcinomas, 2 Darrier-Ferrand sarcomas, 1 parotidean adenocarcinoma, 1 radionecrosis. The operation included an extralabyrinthic petrosectomy, an amputation of the pavilion, and a ganglionic evidement following a histological analysis. The reconstruction processes used 3 pedicle grafts and 9 free grafts. The carcinological extension modalities of the cancers invading the entire external auditory canal require the sacrifice of the tympanic cavity and an external temporalectomy in a single block for carcinological and functional reasons. The massive invasion of the concha inevitably leads to the sacrifice of the auricular pavilion. The best means of reconstruction is with the free graft of the musculus latissimus dorsi. The price to be pay esthetically must be reduced by the placement of an epithesis.

Adult↗

PubMed1992

[How to evaluate velar insufficiency?].

The evaluation of velar insufficiency is absolutely necessary in order to assess the results of surgery of the labial palatal cleft. In addition to the clinical examination which remains indispensable, the aerophonometer, applicable to adults and children as from the age of 3, enables simultaneous measurement of the flow of buccal air, the flow of nasal air, and the buccal phonogram. The comparison of the lines, the relation of the nasal air and buccal air flows, upon the emission of two standard sentences with and without nasal components, enables an objective assessment of velar functioning.

Child, Preschool↗

PubMed1992

[Medico-surgical management of chronic maxillary sinusitis in adults].

Every maxillary sinusitis suspected of chronicity has to be fully investigated by CT-scan. Failure of medical treatment will confirm chronic disease and will lead to surgery. According to the authors, endoscopic middle meatotomy is the treatment of choice, possibly associated with anterior ethmoidectomy and/or inferior meatotomy.

Adrenal Cortex Hormones↗

PubMed1992

[A multiparameter method of computer-assisted objective vocal evaluation].

The aim of this study is to validate an aid for the evaluation of dysphonia with objective measurements. We recorded exhaled airflow, fundamental frequency and sound level pressure, for a sustained vowel "a", with 51 dysphonic subjects and 15 normal subjects. The following measurements are made on these three parameters: mean value, standard deviation and coefficient of variation. The exhaled airflow volume was also computed for a duration of 2 seconds. A principal components analysis of the measurements indicated that it is possible to recognise the classes of vocal evaluation and vocal pathology. These findings reinforce on objective aid for the vocal evaluation of dysphonia.

Diagnosis, Computer-Assisted↗

PubMed1992

[Laryngotracheal fissure in infants. Indications, technique, results].

Since laryngotracheofissiure, or anterior cricotomy, has been introduced in 1980, the number of tracheotomies performed in infants has decreased as this procedure is an alternative to tracheotomy for difficult extubation. Since then, the indications of this procedure have become wider, but a number of preoperative criteria, such as the pulmonary capacity, must be strictly assessed. We report on our experience with 14 children who underwent laryngotracheofissiure during the past 4 years. The indications, the surgical technique and the results are evaluated.

Cricoid Cartilage↗

PubMed1991

Subglottic cyst in a newborn.

Subglottic laryngeal cysts in the newborn are extremely rare. It is difficult to establish if the cyst is acquired or congenital because respiratory distress requires intubation in the I.C.U. generally without prior endoscopy. A case report is presented, followed by a discussion of possible aetiology and management protocol; the advantages of the CO2 laser make excision of the cystic sac possible without tracheotomy.

Cysts↗

PubMed1991

[Nasopharyngeal fibroma. Forms extended to the infratemporal fossa].

There are two clinicopathologic forms of nasopharyngeal fibroma: a median, compact form for which surgical treatment is simple, and a racemose, pedicled form raising problems for exeresis due to its extensions into the infratemporal fossa and the middle cranial fossa. A 4-stage grading is essential, and it has become easier with the progress made by imaging. The clinical findings, the contribution of imaging and the surgical procedures are studied for stages III and IV. Statistics are presented for 26 nasopharyngeal fibromas, including 10 invasive forms. Two approaches of the infratemporal fossa have been used in this series; the PLN approach with a large fronto-naso-maxillary flap, and the pre-auricular infratemporal lateral approach. The exeresis of stage III lesions requires the lateral approach.

Adolescent↗

PubMed1991

[Surgery for hyperthyroidism. Results and current trends].

From 1974 to 1990, the same surgeon operated 96 cases of hyperthyroidism: 72 cases of Basedow's disease, and 24 basedoid goiters. The preliminary preparation with antithyroid agents, sedation, Lugol and beta-blockers is particularly important, as is rehydration, high-dose sedation and beta-blockers, if required, during the postoperative period. There are few complications: 1 hematoma, 1 permanent unilateral laryngeal paralysis, 1 permanent hypocalcemia, 5 transient psychical and/or cardiac disorders, 1 malignant exophthalmia. There was no thyrotoxic crisis. Long-term follow-up allows nothing 4 recurrences as well as hypothyroidism in 46% of all cases. The size of the thyroid remains left in place is closely related to hypothyroidism. One case of vesiculo-papillary carcinoma is noted among the 24 cases of basedoid goiters (4.5%), which justifies total thyroidectomy in such cases. There also was one papillary carcinoma among the 72 patients with Basedow's disease (1.3%).

Antithyroid Agents↗

PubMed1991

[Aneurysmal temporal bone cyst. Apropos of 2 new cases].

Aneurysmal bone cyst is a well known lesion on the metaphyse of lung tubular bones or on the spine. Unusually, it is detected on the skull and more rarely again on the temporal bone. The authors, talking about the eleven cases they have found in the literature and two recent personal cases, try to describe the main diagnostic dates of this temporal lesion which one has never known if it is a real tumor or a reactional dystrophic pseudotumor secondary to an intrabone circulatory incident, perhaps a phlebitis. As for all other locations, these temporal bone forms are more frequently encountered among adolescents or young adults and, because their blowing bone effect, give clinical signs which directly result from their aggressive behavior on the surrounding structures, in this particular location: temporal fossa swelling, otologic, ophthalmologic or stomatologic symptoms, facial or trigeminal nerves troubles and rarely central neurological signs. On CT-scan, it appears as a space-occupying lesion located in the temporal fossa, with a blowing bone aspect, with intracranial and infratemporal expansions. This CT scan lesion is heterogeneous and contrast enhanced except in its center which is hypodense, as a cyst. The MRI shows comparable pictures. Its total excision, made easier by a preoperative embolization, gives a total and definitive recovery.

Adolescent↗