Biomedical subjects
Publications and source records attributed to J A Darras.
Endonasal surgery of paranasal polyposis. Two hundred and fifty one microscopical sphenoethmoidectomies with a major complication rate of 2.6% are reported. Long term results are analysed. Nasal obstruction disappears in 96% and persists in 70% of the cases 5 years later. Through topical steroid therapy and surgical experience polyp recurrence rate is reduced to 30%.
Subtotal laryngectomy with CHP have prolongated post operative care because aspiration. In 16% of cases a new surgical procedure is necessary. The authors have used a implant of madreporic coral placed in the base of the tongue just behind the hyoid bone to achieve a total closure of the larynx during swallowing. This operation has stopped aspiration in 2 cases very quickly.
The authors assess the possibility to perform subtotal laryngectomy for extensive tumors of the endolarynx. They describe a particular variety of T3/T4 tumor extending anteriorly to the thyroid cartilage or to the pre-epiglottic space. Such tumors do not affect the arytenoid cartilages posteriorly, which makes functional subtotal laryngectomy with CHP or CHEP possible. This surgery was performed in 28 patients from 1972 to 1985, with 20 patients still living after 5 years, ie. 72% of all cases.
From 1980 to 1987, 37 patients were operated with a reconstructive anterior frontal laryngectomy including epiglottoplasty such as described by Tucker. These patients presented with epidermoid carcinomas of the glottis. The carcinological results are satisfactory, with a survival rate of 33 of 37 patients at 3 years and 22 of 25 patients at 5 years. However, the control of the paraglottic space still is insufficient after this type of surgery, and we reserve it for the tumors confined to the glottic level, without impairment of mobility. The anterior frontal laryngectomy performed is extensive and frontolateral. It is used for a few of its former indications, as showed by the comparison of the periods before and after 1980.
This is a retrospective study of 38 patients who were operated on for inflammatory (31) or tumoral tracheal stenosis. A cervical approach was possible in 20 cases; a sternotomy was required in 8 cases and a thoracotomy in 5 cases. Per-operative ventilation was satisfactory for all patients. There were 2 deaths in patients suffering from chronic airflow obstruction. There were 2 immediate and 13 late post-operative stenosis; 9 of these were symptomatic and required treatment which was successful in 7 cases. 25 of the 30 patients (among 33 survivors) who were followed-up were symptomless; 4 patients who had operations for a tumour had a larger than 3 years survival.
The authors report their experience with 210 microsurgical ethmoidectomies carried out in 109 patients between 1980 and 1987. In 23 patients the anatomy was considerably modified due to previous surgery. Asthma was present in 56 patients and 25 patients suffered from Widal's syndrome. The complications noted included 1 case of meningitis cured by antibiotics and a case of transient diplopia. Patients were monitored for 1 to 6 years; In 69 cases no recurrence was noted (63% of cases), 31 patients (28%) only required minor local procedures for slight recurrence (28%). On the other hand, 6 patients (5.5%) required a second surgical procedure for recurrence between 3 and 6 years.
Treatment of severe cricoid stenosis with fixed vocal cords is difficult, the often used Réthi operation producing 20 to 30% of unsuccessful results. Use of a hyoid bone pedicle flap allows anterior enlargement with cricoid ring reconstruction, in addition to the classical posterior enlargement, and was successful in 8 of 9 cases treated by this method.
Cancer developing on a chronic laryngitis or bilateral superficial cancer of vocal cords still pose management problems to surgeons. Double cordectomy presents the inconvenience of opening the larynx in the median line and the need for insertion of a dilating piece removed during a second stage. These disadvantages can be avoided by an extracartilaginous glottectomy by median opening of thyroid cartilage, monoblock ablation of both vocal cords and immediate closure of larynx by lowering of ventricular bands. A wide larynx is obtained with a loud but veiled voice.
Operative technique for functional subtotal laryngectomy with cricohyoidopexy is described and results analyzed in 120 patients after follow up for more than 5 years. Actuarial survival was 61% for the vestibules and 79% for the cords. Indications for Majer-Piquet, Labayle cricohyoidopexies and cricohyoido-epiglottopexies are discussed.
From 1970 through 1982, 106 patients with carcinoma of the tonsillar region were treated by trans-mandibular bucco-pharyngectomy (composite resection) in the ENT department of Prof. Piquet at Lille University. After a brief reminder of the surgical process, the authors study the group of the operated patients (localization and classification of the UICC 1979), present the oncological results (crude 3-year survival of 58% and 5 years as 35%) and analyse them. According to several other series, they specify their therapeutic attitudes.
A homogeneous series of 106 cases of malignant tumor of tonsillar region was treated by first intention surgery. Treatment proposed for these patients with ulcerated or infiltration tumors often extending to pillars or to tongue was transmandibular buccopharyngectomy with curettage of glands and postoperative radiotherapy. Unadjusted survival rate at 3 years was 62% (T2 and T3) and at 5 years 35%. Clinical glandular enlargement, detected in 50% of cases, resulted in poorer prognosis, which decreased from 48% at 5 years to 25% in patients with histologic metastasis in lymph nodes.
This study is based on 29 juvenile angiofibroma, treated in 16 years. The average of age is 16.3 years but 24% of patients are over 20 years old. Scanner is the best mean to known the extension to the base of the skull and pterygoïd fossa. Angiography is not yet necessary and may be dangerous. The surgical approach is transmaxillary in most cases, with a very low average of recurrence = 10% and 1 post operative death.
Explore the source record for details and available documents.
Twelve patients (8 with appendicular laryngeal cysts and 4 with laryngoceles) were treated in the ENT Unit, Lille between 1980 and 1983. Therapy was by laser through endoscopic guidance, and consisted of resection of the ventricular band to allow marsupialization of the cyst or mixed laryngocele in the endolarynx. Treatment was effective in all cases with restoration of a normal larynx within 2 to 3 months, even in patients with external laryngoceles. This method is of particular interest in bilateral lesions.
One of the most important technical advances in cervicofacial plastic surgery over the last few years is undoubtedly the use of the musculocutaneous flap from pectoralis major. A review of its application in 57 cases showed the flap to be of excellent viability (5% total necrosis of flap), and to offer multiple possibilities during primary surgery or that following radiation. Indications and excision limits can be extended, particularly in buccopharyngeal surgery, providing and appreciable functional gain (particularly disappearance of pain), even though long-term carcinologic advantages are deceiving.
Explore the source record for details and available documents.
Explore the source record for details and available documents.