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Biomedical subjects

M Zanaret

Publications and source records attributed to M Zanaret.

At least 73 records · Page 4Linked to original sources
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

[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

[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

[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↗
PubMed1991

[Infratemporal region extension of malignant tumors of the parotid with deep development. Hypotheses on deep extension of parotid tumors according to benign or malignant characteristics].

The infratemporal and paratonsillar regions can be the site of propagation of parotid tumors. Our personal experience with 3 cases of malignant parotid tumors extending into the infratemporal region and the study of the literature seem to show that: benign tumors, such as pleiomorphic adenomas, develop in depth towards the paratonsillar regin and not towards the infratemporal region; and conversely, malignant tumors rather invade the infratemporal regin and not the paratonsillar region. This extension occurs along the neurovascular axis through Juvara's retrocondylar buttonhole. If this notion was confirmed, it might have a semiological and therapeutic interest.

Adenoma, Pleomorphic↗
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

[Surgical excision of giant venous angioma of the face under extracorporeal circulation: apropos of a case by a multidisciplinary team].

Because of the risk of haemorrhage related to their resection, deep angiomas of the face are often considered to be inaccessible to treatment. The use of cardiopulmonary bypass with profound hypothermia allows the surgeon to operate in a bloodless field, enabling almost oncological resection of the tumour. The authors report a case of venous angioma of the submaxillary region treated in this way after failure of limited surgery and embolisation. Complete resection of the lesion was achieved and the defect was repaired with a pectoralis major flap and a latissimus dorsi flap. The authors stress the value of a multidisciplinary approach: a cardiac surgeon for CPB, an ENT surgeon for resection and a plastic surgeon for reconstruction.

Extracorporeal Circulation↗
PubMed1991

[Nervous tumors of the infratemporal fossa].

Six cases of neurogenic tumors developing in the infratemporal fossa are reported. These are neuromas or neurofibromas in 5 cases and meningioma in 1 case only. The first 4 cases are primary tumors of the infratemporal fossa, while the last 2 tumors have developed into the temporal fossa from neighboring lesions. Computed tomography and RMI are irreplaceable techniques to assess the extension of such tumors and their connection with the neighboring organs, and to guide the treatment, which must be surgical whenever possible. Complete exeresis of the tumor is difficult. These examinations are also essential for follow-up and for the early detection of possible recurrence.

Adult↗
PubMed1990

[Excision-reconstruction of voluminous facial angioma under extracorporeal circulation and deep hypothermia].

The authors report a case of voluminous cervicofacial angioma with pelvi-lingual extension which had undergone multiple operations and had embolized. The exeresis consisted of cutaneous sacrifice of 10 x 10 cm combined with a longitudinal hemi-pelvi-glossectomy. Two pediculated musculocutaneous strips of greater pectoris and greater dorsal muscle were associated for reconstruction. The operation took place under extracorporeal circulation by femoral cannulation and deep hypothermia. Post-operative recovery was simple, with resumption of normal phonation and eating. No recurrence was observed upon arteriographic control at six months. The use of extracorporeal circulation is exceptional outside cardiac problems (low tracheal stenosis, intracranial aneurysm). The authors suggest the value of this technique for the treatment of angiomas purportedly inoperable because of the risk of major blood loss.

Adult↗
PubMed1990

[The scapular osteocutaneous flap. Technic, indications in cervicofacial surgery].

The authors describe 10 cases of mandibular reconstruction following transmandibular buccopharyngectomy, using scapular osteocutaneous flaps. Repair of mandibular substance loss due to neoplastic surgery becomes a problem. Composite bone resections are associated with mucous and muscular defect formation. There is dual advantage in using this type of flap: on the one hand, reliability is great, independently of the case (revisions or other types of surgery) because of the presence of constant elements in the vascular pedicle; on the other hand, the cutaneous flap and the bone transplant are independent from each other, such plasticity affording equally successful symphyseal and lateral repair.

Bone Transplantation↗
PubMed1990

[Results of surgery of acoustic neuroma via translabyrinth and suprapetrous approaches. Development of a classification by House and Brackmann based on facial function].

Two studies were conducted consecutively on two series of post-operative acoustic neurinoma patients. The first one included 104 patients over a period spanning from January 1982 through April 1986; the second one bore on 75 cases enrolled between October 1985 and April 1988. Post-operative complications, sequelae, and findings were analyzed. As far as facial function was concerned, this was assessed on the basis of a classification worked out by J.W. House and D.E. Brackmann. For the first series (93 patients tested, 86 followed up and 7 who completed and returned a form arranged from Brackmann's questionnaire), the following results were obtained: 94% with anatomically intact nerves, including 50.0% grade I; 8.6% grade II; 10.7% grade III; 12.8% grade IV; 4.3% grade V, and 2.2% grade VI cases. 10 nerve sections pertaining to grade III and grade IV surgical repair cases including 10 hypoglossofacial anatomoses were reported. In the second series, 75 patients were followed up for at least 2 years. The facial nerve condition was recorded at the end of the operation, corresponding to the beginning of the nerve recuperation period. A very tight relationship was noted between the nerve condition and the end result as reflected by facial function; such correlation was also found to exist between facial function and tumor size. Likewise, end-point facial function was strictly dependent upon the incipient recuperation phase, whenever palsy had been complete or partial post-operatively. That is to say, if recovery started out after the third month following surgery, the affected hemiface would never retrieve its normal or subnormal function (grade I and II as per J.W. House and D.E. Brackmann). In this series, facial function was restored in 45%, 15%, 21%, 11%, 1%, and 0 cases corresponding to grade I, II, III, IV, V and VI, respectively. Five grade III and IV nerve sections were repaired via five hypoglossofacial anastomosis operations. We propose a slight modification be brought to the House-Brackmann classification. The aim of this study was to accurately assess the complications and sequelae secondary to surgical ablation of unilateral acoustic neurinoma by an otoneurosurgical team utilizing almost exclusively the broadened translabyrinthic (B.TL) and medial cerebral fossa or supra-petrous (SP) approaches Despite achievements realized since W.F. House [23] described those, the main problem encountered has been-excluding major complications which are fortunately rare, remains the preservation of normal or subnormal facial function.

Adult↗
PubMed1989

[Congenital cholesteatoma of the petrous bone. Etiopathogenic discussions apropos of 11 cases].

The authors report on 11 cases of congenital cholesteatomas, treated between 1979 and 1988. In all cases, there was a long-standing history of deafness. The diagnosis revealed 6 cophoses, 5 cases of mixed deafness, 9 cases of impairment of the facial nerve (7 cases of paralysis including 4 with sudden onset and 2 hemispasms), 2 facial neuralgias with facial hypesthesia, one Gradenigo-Lannois syndrome, 2 leaks of the C.S.F. (1 nasal, 1 very abundant auricular leak). In 6 cases, the surgical approach route was trans-cochlear, and in 5 cases surpa-petrosal, two of which were extended to a petrectomy. Of the 5 cases of partial deafness, only one was preserved. In 5 cases, the facial nerve was destroyed at the level of the ganglion of the facial nerve, a region where a frankly epidermal tissue is always found. In 4 cases the facial nerve was repaired (three hypo-glosso-facial anastomoses and one end-to-end suture, after re-routing). The authors share the opinion of Fisch that the origin of the intra-petrosal congenital cholesteatoma always occurs at the level of the ganglion of the facial nerve.

Adolescent↗
PubMed1989

[Laterocervical paraganglioma].

Diagnostic and surgical features of lateral cervical chemodectomas are discussed in relation to a personal series of 16 patients with carotid body tumors and 10 with tumors of the intravagal glomus. Clinically, these affections are poor in symptomatology, those of the carotid glomus presenting as an isolated cervical tumor, intravagal glomus tumors as parapharyngeal masses of the restrostyloid type. Arteriographic findings are discussed in detail, as they constitute the only pathognomonic signs, enable differentiation between the two tumor sites, and supply essential pre-operative data: location of the pedicles, possible invasion of arterial walls, and the limits of the tumor. Surgical approach should be wide to enable control of the distal end of the internal carotid artery, if necessary under the base of the cranium, excision of the tumor usually being possible by employing the sub-adventitial resection technique.

Adult↗
PubMed1989

[Superficial temporal fascia pedicle flap. Applications in cervicofacial surgery. Apropos of 20 cases].

The superficial temporal fascia is formed by a fine fibro-muscular layer situated between the subcutaneous plane of the temporal region and the temporal muscle aponeurosis. The superficial temporal artery and its branches run within the fascia which acts as a veritable vessel carrying sheet. The therefore useful in that in minimises esthetic and functional complications at the donor site. This reliable, polyvalent arterialised aponeurotic type flap behaves above all as a covering or interpositional flap. Our clinical experience involves 20 cases, in addition to the applications already published: covering material in cases of loss of facial substance, otopoiesis, organisation of open techniques, we propose its use during oro-bucco-pharyngoplasty and for sealing the base of the skull.

Adolescent↗
PubMed1989

[Cancer of the thyroid in children].

Study of a personal series of 10 cases of thyroid cancer in children and a review of the literature reveals what we consider to be the 3 problems which are posed by this pathology in children: 1. The frequency of isolated cervical adenopathy in the initial symptomatology may be confused with congenital swelling or inflammatory adenopathy. 2. The surgical management depends on the histological nature: total thyroidectomy, lymph node excision, risk to the parathyroid gland and IRAtherapy all depend on the histological data. 3. Finally, the long term prognosis of these cancers is unknown. Schematically, differentiated cancers including papillary carcinomas have a good or indeed excellent prognosis, while medullary carcinomas have a prognosis which will imminently depend on the extrathyroid involvement, the quality of thyroidectomy and lymph node clearance. This highlights the problem of screening for subclinical disease in familial forms of the disease.

Adolescent↗