Biomedical subjects
Publications and source records attributed to P Fleury.
A patient presented with a facial nerve neurinoma of unusual size and which gave particularly clear radiological images. The curious feature of this observation is that there was no pre-operative facial paralysis as happens in about 15 p. 100 of cases.
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The endaural approach has its in excision surgery of certain forms of jugular glomus tumor. --In the pure, tympanic form, a minimal or extended endaural approach is perfectly suitable. -- In tympano-mastoid forms, without involvement or with minimal involvement of the jugular foramen, a prolonged endaural approach may be used for wider operations involving the whole middle ear and mastoid around a bony aqueduct or an exposed VII. --Nevertheless, in the presence of tympano-jugular or tympano-masto-jugular forms, with marked involvement of jugular foramen, the greatest caution is necessary. It would appear that the endaural route may still be suggested but only for certain tumors, with the express reserve that angiographic studies defining its site and extent are favourable. By virtue of more and more highly developed techniques of exploration (scanner with contrast, films in subtraction) which may be used for measurement and precise localization of the tumor, indications for the type of approach may now be defined with even more precision. --It should be noted that if there is the slightest doubt, the slightest reserve, or the slightest fear that an endaural approach might be inadequate to deal with the situation, it should be definitely avoided with preference for a cervico-retro-auricular or cervicopre and retro-auricular approach, or radiotherapy only, or even abstenstion from operation, with observation. It is only if such rules of good sense and caution are respected that minimal, extended, prolonged endaural approaches will retain a worthy place in the surgical treatment of jugular glomus tumors.
The authors present 8 cases of rare tumors of the nasal septum and define a number of characteristic points on the basis of each of them. The following are presented: --a malignant nevus, the rarety of E.N.T. sites of such tumors is emphasized, as well as important role of immunotherapy in their treatment, alongside surgery and radio-therapy. --a keratoacanthoma, difficult in terms of differential diagnosis from a basal cell carcinoma. -- a cavernous hemangioma, excision of which must be wide if recurrence is to be avoided. --one very hemorrhagic mixed tumor. --one case of pseudo tumoral tuberculosis in a woman with no known past history of tuberculous disease. --one very painful glomus tumor, radical treatment of which is surgical, in preference to radiotherapy. --two cylindromas of the septum, one taking the form of a large, angiomatous polyp, which puts in question the name of cystic adenoid carcinoma, suggested for these non-cutaneous tumors.
The authors present two unusual operative findings during surgery for stapedo-vestibular ankylosis, of which no similar cases would appear to be found in the literature. The first case posed the problem of stapedo-vestibular ankylosis as a sequel of clinically latent otitis, the only manifestations of which were radiological opacity of the mastoid and an area of osteitis of the promontory, still active, in the absence of any other progressive inflammatory phenomena or sequelae. Surgery required curettage and opening of the promontory, associated with total stapedectomy and a Teflon-inter-position. The functional result was very good. The second case of typical bilateral stapedo-vestibular ankylosis suggested the possibility of "malignant" otospongiosis, or at all events, markedly progressive. Surgery led to opening of the labyrinth. After platinectomy and excision of a bony sequestrum, there remained only a large fossa with an area equivalent to 3 times that of a usual fenestra ovale. A Teflon-interposition piston was performed with a good result. These rare forms lead to discussion of:--Lobstein's disease, Paget's disease and parathyroid osteosis. Finally, the authors approach the problem of the therapeutic attitude to be adopted in the presence of such rare conditions.
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The authors present a case of a large neuroma of the hypoglossal nerve of unusual size and weight, the precise nature of which could be defined only after excision, since its cystic surface suggested a diagnosis of cystic lymphangioma. The following special features may be noted: The rarety of neuromas of the XIIth cranial nerve; the influence of the relations of the XIIth nerve with the posterior belly of the digastric and the myloid muscle on development of the neuroma; the false, cystic appearance which may lead to an erroneous diagnosis of tuberculosis, which in itself, would be a contra-indication to puncture for cytological examination of fluid; the tendency to hemorrhage at the time of excision; finally, the possible problems related to nerve section.
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