Biomedical subjects
Publications and source records attributed to M Cannoni.
The authors describe the extended trans-cochlear approach and define its indications on the basis of a series of 10 cases operated by the transcochlear approach, 6 of which were extended. This approach has a well defined indication between the trans-cochlear approach described by W. House and the infra-temporal approach described by Fish.
Among the various congenital cervicofacial swellings observed in children, three types are rarely encountered in general practice: auriculobranchial cysts and fistulae, thymic cysts and cystic lymphangiomas. To resolve diagnostic and therapeutic problems related to these rare lesions it is essential that their etiopathogenic bases be understood. Auriculobranchial cysts and fistulae present clinical symptoms (cervical, parotid, auricular) that are only poorly evidenced and are related mainly to infection. Surgical excision requires a wide approach route of the parotidectomy type with preliminary isolation of the facial nerve. Thymic cysts result from embryogenic anomalies leading to remnants from the 3rd endobranchial pouch and/or degenerative disorders of Hassal's corpuscles. Of mainly perioperative detection their exeresis requires investigation of possible inferior mediastinal prolongations and preservation of healthy thymic parenchyma. Cystic lymphangiomas arise from dysembryoplasia of the lymphatic system, two opposing pathogenic theories existing to explain their origin. They are serious lesions because of their dissecting tendencies and their inexorable growth in the vast majority of cases. Two forms of lymphangioma, from the embryologic, diagnostic and therapeutic points of view, can be distinguished: those of extraparotid origin and those developing from the parotid.
The reconstruction of the digestive tube after total circular pharyngo-laryngectomy continues to pose a number of problems. Fistulae and delayed healing of the mucosa are common problems after musculo-cutaneous flaps. They are due, on the one hand, to a spring effect of the flap which interferes with tubulisation and, on the other hand, to the problematical suture of the thick thoracic wall skin to the fine oesophageal mucosa. Free visceral plasties give first intention repairs with rapid return of eating, but they carry a mortality of 10 to 15%. The free ante-brachial plasty with a radial pedicle seems to be a satisfactory alternative due to the quality of the oesophageal reconstruction and the absence of mortality. The technique of forming the flap and the operative procedure are described. Five cases are presented. There were no failures and oral feeding could be re-commenced by the 21st day, on average.
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Three cases of primary fronto-orbital cholesteatoma are reported and the relevant ORL and neurosurgical literature reviewed. Clinical diagnosis of this rare affection is not simple but is suggested by signs of infero-internal exophthalmus, an external orbital mass or exteriorized sinusitis after chronic headache. Two characteristic features are seen on radiology. The essential therapeutic problem is to prevent late recurrences, their frequency appearing to have been underestimated. Secondary cholesteatoma of iatrogenic or post-traumatic development is seen more rarely, and produces an endosinus disease treated surgically through a conventional para-lateronasal approach. Primary cholesteatoma, the more common variety, originates in the frontal diploë, is perisinusal in location and can extend into neighboring structures, particularly the external orbital apophysis. A CT Scan is essential in order to detect endocrine extension. A surgical approach adapted to the perisinusal localization of the lesion must be adopted, as for example the Cairns-Unterberger approach.
Musculocutaneous flaps were used for reconstruction after excision of large base of tongue or lateral oropharyngeal wall tumors in 50 patients, the most frequently employed flap in both regions being one from pectoralis major. Results showed marked reliability for these types of flaps for repair in these two areas, and they have now supplanted conventional single pedicle skin flaps. Various flaps supplying different useful surfaces are required, the platysma or sternocleidomastoid muscles being used for small areas, the pectoral or trapezius muscles for medium sized gaps and the latissimus dorsi for extensive repairs. Postoperative and functional results were improved both after initial or repeat operations. The possibility of more extensive excisions should improve prognosis of these tumors, their severity being partly related to local recurrence. It is too early to conclude definitely in their use in initial surgery, but they are valid procedures following failure of radiotherapy, enabling certain patients to be treated again after 3 years in the absence of any other therapy.
Laryngoplasty was performed using the perichondrium of the thyroid cartilage or a sternohyoid muscle flap. Techniques and results are described using this method, applied for glottic reconstruction after vertical partial laryngectomy of the frontolateral type and after cordectomy. Anatomic and functional results in 15 cases are described, ultrasound imaging showing in all cases an improvement in basic laryngeal function, and in the timbre and strength of the voice.
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Medullary thyroid carcinoma (MTC) is hereditary in 20 to 25% of cases. It is inherited as an autosomal dominant trait. MTC can be considered as a sporadic form only after a clinical and biological survey of the two parents, siblings and children of the patient, using pentagastrin stimulation test. The authors have studied 36 patients from 26 families. Hereditary MTC with different clinical features, were discovered in two kindreds. The systematic investigation leads to the discovery of 7 cases in the first family, and of 3 in the second. The treatment of the disease at the first stage of its evolution has been possible when an early diagnosis had been made, such as in the second family.
A procedure was sought for shortening duration of operation through an enlarged translabyrinthine (ETL) approach in acoustic neurinoma surgery. Two factors appear to be of primary importance. First, the equipment used must be adapted for the purpose and of reliable quality: the 3 M craniotome for the extralabyrinthine phase, the Zimmer AMSCO ototome for the labyrinthine phase, and Yasargil's autostatic retractor to maintain retraction of the temporal lobe and lateral sinuses. Second, a precise operative methodology: wide exposure and retraction of the temporal lobe and lateral sinus in all cases to provide a panoramic view of the labyrinthine region; ablation of the incus and initiation of a posterior tympanotomy to assist dissection to expose the 2nd and 3rd portions of the facial nerve; labyrinthectomy and identification of the internal auditory canal (IAC) in the region of the small fossa of the hemisphere as an aid to continuation of the operation; identification of Limaçon's aqueduct, which is a barrier that must not be crossed when exposing the jugular bulb and mixed nerve regions; isolation of the facial nerve in the base of the IAC by reclining the superior restibular nerve, the facial nerve lying just behind the latter.
The value of thallium 201 (Tl 201) scintigraphy was investigated in 45 patients with thyroid affections. Scintigrams were performed with both technetium 99 m (Tc 99 m) and Tl 201. Of the 27 patients with 43 thyroid nodules confirmed histologically (16 patients were operated upon and needle puncture cytology conducted in 11 cases), all cold nodules to Tc 99 m and Tl 201 were found to be benign. Of the 28 hot nodules to Tl 201, cancer was demonstrated in 8 cases, equivalent to 72 p. 100 of false positives against the 47 p. 100 of all cases reported in the literature. In benign affections, thyroid topography to Tl 201 can now be obtained in patients with plummer's toxic nodules without the need for Quérido's test and without iodine saturation of the thyroid. Gonadal toxicity of Tl 201 prevents its routine use in patients under 35, who were excluded from this study.
Computerized gas meatography ( CGM ) represents the must reliable method for detection of stages I and II of acoustic neurinomas. A critical study of its indications was conducted based of results in a series of 14 tumors of less than 2 cm diameter and of 43 CGM . Although early auditory evoked potentials are currently the most significant selection criteria, procedures for detecting retrocochlear lesions remain unchanged, particularly for the ENT specialist.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.