Biomedical subjects
Publications and source records attributed to F Devars.
Reporting one case of negliged laryngeal traumatism, the authors expose their laryngeal injuries attitude. They detail admitted classification and propose a management which is based on initial respiratory functions. In view of the case, as extreme situation, laryngeal subtotal surgery was the better management, because of association with polytraumatism, which not permitted earlier treatment.
The sixty laryngectomees currently wearing a voice prosthesis in our service were subjected to some questions concerned with their voice rehabilitation, the customary conditions of use of the prosthesis or oesophageal voice, and their wish to wear a prosthesis if they had to choose again. This subjective study shows that 81% of prosthetic voices are sufficient to very good, and 29% of oesophageal voices are sufficient to good. The prosthesis is consistently more used than oesophageal voice. 79% of the patients would wish to have a voice prosthesis if they had not one.
106 ENT localized carcinomas (97 men and 9 women) in adults under 45 years old are reviewed. The mean age was 40.0 years old and most suffered from an alcoholic and/or nicotine addiction. 89.6% expressed an epidermoid carcinoma and buccal cavity and larynx lesions represented the most frequent locations, followed by the pharynx. Overall survival does not differ from that of an older population but some locations seem to have a very poor prognosis: mobile tongue, vallecula, piriform sinus and amygdala. On the other hand, the laryngeal locations confirm their favorable prognosis.
Based on a series of 57 children who were operated for velar clefts, the authors studied the different associated aspects of middle ear inflammatory pathology: physiopathology, occurrence, evolution, complications. Seromucous otitis was initially found in 87% of the cases. Three years after surgery, it persisted in 70% of the cases. These children should be monitored on a long-term basis for timely detection of any and all evolution towards chronic otitis or even cholesteatomas.
The course of otitis media with effusion was analysed on two groups of children, the first one of 133 serous otitis found at the same time as other troubles, the second one of 127 children all treated by tympanotomy tubes, in association with other treatments. In the first group, the cure rate is just better than one half. A normal control one month after surgery has some prognostical value, this results remaining in 3 cases on four. The great size of removed adenoïds has prognostical value too, further surgeries for transtympanic tubes being less frequent. In the second group, we can see likely good mean or long term result of tympanic tubes, most of the complications happening on cleft palate cases. The various treatments: adenoïdectomy, antibiotics, steroïds, thermalism, eustachian tube physiotherapy, mucolytics, decongestants and anti-histaminics are discussed in regard to recent studies.
The authors report on 26 cases of patients treated by subglosso-epiglottectomy from 1978 to 1989. Whilst as far as survival and local oncological control are concerned the results are encouraging, the functional results are disappointing.
The authors report four cases of severe deglutition disorders after partial laryngectomy. Three had collagen injection and one had a plastic reconstruction. They propose to use dynamic imagery in order to have a better selection of the patients.
The authors report a new case of laryngeal leiomyosarcoma. The patient was a 43-year-old-man. The tumor extended to the left vocal cord, the paraglottic space and the deep layers of the left false vocal cord. Histologically, the lesion showed the typical pattern of a grade-3 leiomyosarcoma. Immunochemical studies revealed a strong positive staining with the actin smooth muscle antisera. A partial laryngectomy was performed. There was no evidence of recurrent or metastatic disease 10 months after surgery.
Percutaneous endoscopic gastrostomy (PEG), is an enteral feeding procedure, easy to tolerate and simple to perform. PEG appears to be an alternative to surgical gastrostomy. Used in ten patients with E.N.T. cancer, we only observe two minor complications. Advisable in a first time for the feeding of patients with palliative treatment, we propose PEG for patients in position to have a long and difficult rehabilitation of swallowing.
Carcinological surgery of the pharyngo-velar region poses delicate problems of reconstruction in exereses exceeding the midline. To avoid false alimentary pathways through the nose and phonatory problems (open rhinolalia), we propose the use, with or without the combination of a muscular cutaneous flap, of a free antecubital flap or of a latter is apparently fully satisfactory on the functional plane with the additional advantage of not leaving any aesthetic sequellae.
The term cellulo-adenectomy involves dissection of all the neck jugulo-carotid lymph nodes below the digastric muscle and above the omo-hyoid muscle. From the study of 133 cases treated by primary surgery, it can be said that this technique is essentially diagnosis to verify the actual integrity of the jugulo-carotid lymph trunk in patients who are clinically NO and who present a lymphophile ENT tumour. Such a technique necessitates a macroscopic lymph examination with an extemporaneous anatomical and pathological examination. Subsequent therapy depends on the result; for N+ patients, further surgery and/or irradiation, irrespective of the site; for a confirmed N- patient, additional therapy depending on the site of the tumour. Our experience has shown that this approach is safe and enables the treatment of the lymph glands to be better adapted to the reality of the neoplastic invasion.
In children, cholesteatoma is closely related to dysfunction of the eustachian tube and evolves inside a malleable temporal bone. The importance of auditory and speech functions in such patients has caused us to use a very particular clinical philosophy. At the present time we have studied 154 cases of cholesteatomas in children under 15 years old. The following three points have been shown: the pathogenesis of a cholesteatoma can be of the primary type, secondary (due to an unfavorable extension of retraction pocket or to squamous cell migration) or even be iatrogenic; anatomical and clinical findings (with X-ray studies) predicate the treatment used; surgical treatment frequently requires a "second-look" operation.
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We report two cases of giant cell tumor of bone (osteoclastoma) associated with Paget's disease. One appeared on the left cubitus in a 68-year-old male patient while the second involved the right maxillary sinus in a 79-year-old woman. Histopathological study was completed by ultrastructural and immunocytological studies. They were demonstrated to contain intranuclear virus-like filamentous inclusions in the osteoclasts. However, we cannot obtain positive response with antisera against measles virus and respiratory syncitial virus. These data are confronted to the hypothesis for a viral aetiology of Paget's disease and giant cell tumor of bone, associated or not to Paget's disease.
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Performance of a voice prosthesis, used to restore speech in patients following total laryngectomy, was evaluated by measuring in vitro, as well as in vivo, airflow resistances. The pressure-flow characteristics of the device were analyzed using the standard pressure-flow diagram (to calculate airway resistance) and a Moody plot (to determine the different flow patterns). The flow rate and the pressure drop were measured with a Fleisch pneumotachograph and a variable reluctance transducer, respectively. Total device resistances were found in the range of 34-50 cm H2O/L/s when the flow-rates ranged from 0.05 to 0.35 L/s. Comparison of these resistances with those of other commercially available devices showed that our voice prosthesis had the lowest resistance.
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