Biomedical subjects
Publications and source records attributed to Y Guerrier.
Surgery catch up radiotherapy failures. Oncologic results are satisfactory. Rescue surgery can be to underline, doesn't synonymous of total laryngectomy.
The tympanic cavity is to be subdivided. The mesotympanum is surrounded by the epitympanum, the hypotympanum, the protympanum and the retrotympanum. The epitympanum coincides with the attic (epitympanic recess). The roof of the epitympanum corresponds to the paries tegmentalis, made up of a pertrous and a squamous part; the tegmen tympani represents only the petrous part of the roof. The fossula supratubaria (M. Andrea and Y. Guerrier) is to be considered as an anterior extension of the anterior epitympanum; its presence is practically constant. This is fully described. It's the key for cholesteatoma surgery. The epitympanal arteries are different according to the recessus walls and we note that the petrous part of the roof has a different vascularisation from the squamous part.
Unfortunately, cancer of the larynx is a frequent occurrence. In most cases, surgical treatment gives the best chances of survival. However, this type of surgery has always been dreaded and the loss of the voice has been the consequence most justly feared by patients and doctors alike. Our knowledge of anatomy and pathology has given us a better understanding of tumerous evolution in cancer of the larynx as well as the knowledge that the larynx is not a single block, but an organ composed of compartments with anatomically designated limits separating the segments. Therefore, in certain precise but numerous cases, segmentary surgery is possible. This segmentary surgery, which has proven effective from the oncological point of view, is at the same time functional, preserving the voice and normal respiration. A definition has been developed for partial laryngectomy, either vertical (laryngofissure and cordectomy, frontal-lateral laryngectomy, hemiglottectomy) or horizontal (supraglottic laryngectomy with neck dissection) and their indications have been specified. Over the last twenty years, functional subtotal laryngectomy or reconstructive laryngectomy have appeared (J. J. Piquet, Labayle). These have proven their reliability on the functional level as well as on the level of the lesions. These techniques have transformed surgery for cancer of the larynx. Early diagnosis of cancer of the larynx is essential as is the medical procedure for determining the best adapted type of surgery for each patient to save his life and his voice.
We report a retrospective study of 161 cases of vestibular or epilaryngeal cancer treated by horizontal laryngectomy. The different factors affecting prognosis were analyzed statistically. Three groups were distinguished according to the size and primary site of the tumor: (1) a group with a very poor prognosis, which included patients with large tumors of the epilarynx; (2) a group with an average prognosis, which included small tumors of the epilarynx and large tumors with their primary site in the vestibule; (3) a group with a favorable prognosis which included tumors classified as T1 or T2 that were initially located in the vestibule.
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The branchial apparatus is a keystone in the embryonic arrangement of the neck region. However the developing cervical region is also under the influence of the fundamental metamerism of the body--the formation of sonites-, which gives origin to the cervical spine, the prechordal space and the anterior cervical area. The developmental history of the cranial portion depends on the connection between these two distinct systems of segmentation.
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60 patients, aged 15-51 years, with chronic allergic or bacterial maxillary sinusitis, were entered in a controlled, double-blind study comparing the efficacy of endonasal irrigations of tixocortol pivalate (Pivalone)-neomycin and neomycin. The treatment lasted 11 days and was administered once daily. A ventilometric measurement of sinus pressure was performed every two endonasal irrigations to assess treatment efficacy. The percentage of nasal deobstruction was significantly higher with tixocortol pivalate-neomycin than with neomycin alone by the fifth examination (9th day) regardless of the etiology of the sinusitis (allergic or bacterial). After 11 days of treatment, significantly better results were obtained in cases of bacterial sinusitis (94% deobstruction with tixocortol pivalate-neomycin versus 74% with neomycin) than in cases of allergic sinusitis (69% deobstruction with tixocortol pivalate-neomycin versus 36% with neomycin).
Carcinoid tumors of the larynx are very rare: only 11 cases have been described in the available literature. We report another case, and discuss the nature of the cells of origin and the relationship between these tumors and another rare laryngeal tumor, the oat cell carcinoma.
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Parapharyngeal tumors are neoplasms which protrude beyond the parapharyngeal wall. The anatomy of the cephalic parapharyngeal space allows the identification of four sites - one retropharyngeal and three lateropharyngeal - each having its own particular pathological characteristics. Clinical examination and paramedical testing permit an exact determination of tumor configuration and will often permit diagnosis of tumor type. With the pre-operative diagnosis established, the surgeon can choose his approach and formulate a plan for excision according to the tumor site.
It is essential to recognize certain laryngeal and hypopharyngeal landmarks in order to choose the most appropriate surgical approach for excision of a tumor in any given site: that the larynx has two embryological origins, branchial and non-branchial, separated by the glottis, that the cartilaginous skeleton and the ossification of the thyroid cartilage provide a means for the spread of endolaryngeal cancer, that the pre-epiglottic region is divided in two by a medial wall and is closely connected to the endolarynx through the hollow vascular channels of the fibro-cartilage of the epiglottis, that the connective intralaryngeal tissue - conus elasticus, anterior commissure ligament, conoid ligament, and the articular capsule of the crico-arytenoid joint - must be taken into consideration to explain the spread of the tumor, that there exists the concept of arytenoid unity, that element of the branchial larynx which must be conserved in any functional oncologic surgery to the larynx and pharynx.
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Mucoepidermoid and acini cel carcinoma of the salivary glands are relatively rare and have a tendency to recur locally and sometimes metastasize to lymph nodes and at a distance. Such an evolution is difficult to predict even if one uses anatomo-pathological criteria, which explains the uncertain prognostic of these neoplasms and the difficulty encountered in establishing their therapy. Seven cases of mucoepidermoid carcinoma and five cases of acinic cell carcinoma are reported with statistical, clinical, and anatomo-pathological data. The evolution of these tumors are studied according to the therapy used, which leads us to establish a therapeutic protocol.
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