Biomedical subjects

M Zanaret

Publications and source records attributed to M Zanaret.

At least 19 recordsLinked to original sources

PubMed1998

Postoperative follow-up of juvenile nasopharyngeal angiofibromas: assessment by CT scan and MR imaging.

The purpose of this study was to assess the radiological findings after surgical removal of juvenile nasopharyngeal angiofibromas (JNA). The postoperative CT and MRI scans of ten patients were reviewed. The cured group included six patients. The non-controlled group included six patients with eight recurrences. Two patients belonged to both groups as they were also followed and cured after surgery for relapse. Four recurrences were asymptomatic and diagnosed by imaging. The imaging patterns were matched to the patients clinical status and endoscopic findings. In the cured group, non-enhanced residual soft tissue masses were seen in all cases. In the non-controlled group, recurrence was always demonstrated on early postoperative CT or MR as a dramatically enhanced mass. The recurrence was located in the lateral or superior aspect of the nasopharynx (n = 3), deep to the fossa of Rosenmuller (n = 4) or out of the nasopharynx (n = 1). In two cases a remaining enhanced mass disappeared spontaneously on iterated examinations. Because of numerous asymptomatic relapses, a radiological workup is recommended four months after surgery, even in patients with normal endoscopy, to rule out posterolateral or extranasopharyngeal recurrences. Spontaneous evolution of residual masses must be appreciated on iterated imaging examinations.

Adolescent↗

PubMed1998

[Chondrosarcoma in nasal fossae and Maffucci's syndrome].

INTRODUCTION: Maffucci's syndrome is a congenital non-hereditary disease very similar to Ollier's disease and associates multiple cutaneous hemangiomas, dyschondroplasia and often enchondromas. EXEGESIS: We report a unique case involving synchronous localization of chondrosarcoma in nasal fossae and anterior chest wall, disclosing Maffucci's syndrome. CONCLUSION: Atypical chondrosarcoma localization must lead to further investigation of potential multiple enchondromatosis.

Adult↗

PubMed1998

[Geometric modeling and virtual endoscopy of the laryngo-tracheal lumen from computerized tomography images: initial applications to laryngo-tracheal pathology in the child].

Endoscopy is an essential stage in the management of laryngo-tracheal disorders in the infant, but remains a difficult procedure. CT scanning is used to confirm the abnormality and to estimate the degree to which the airway is compromised. The authors describe virtual endoscopy of the larynx and trachea based on a mathematical model, itself constructed from CT images. This work is based on a methodology developed at the Hôpital de la Timone for modelling the aorta. By applying this methodology to the study of laryngo-tracheal disorders, it is possible to establish the relevant pre-treatment measurements (length, diameter, degree of narrowing). This preliminary study has been carried out in 8 cases, in parallel with their clinical treatment. It has allowed us to single out the 3 typical examples which are presented in detail, and to show the advantages of this new approach: immediate and precise measurements, presentation which it is not possible to achieve with conventional techniques of 3-dimensional imaging, and demonstration of the degree of encroachment of the externe stenoses. When taken as part of the management of the patient, this technique complements the findings of real endoscopy, or replaces them, thus reducing the costs of hospital admission and the risks inherent in this procedure.

Adolescent↗

PubMed1998

[Selection of electrophysiological investigations for diagnosis in idiopathic facial palsy. Twenty years experience in an ENT department].

Electrophysiological exploration of the facial nerve requires different tests to differetciate the importance of the block, denervation and canal conduction. We must answer five questions: 1) Assessing the degree and the phase of the nerve lesion, 2) Deciding on the advisability of a facial decompression in the early stage of the palsy, 3) Evaluating the prognosis, 4) Choosing the best therapeutic approach, 5) Detecting facial hyperkinesis in an infraclinic period. In order to answer these questions, we select the following methods: 1) Quantified Electroneuronography should be applied as early as the 2nd day after onset, repeated on the 7th and 10th days. Unfortunately this is not always possible for practical reasons. In any case a minimum of two investigations should be performed during the 12 first days. 2) We add Computer EMG in order to control the evolution of the blocked fibers with regard to denervated fibers. 3) Blink reflex and Stapedius reflex are investigated from the 3rd day. After the acute phase of the palsy, recovery is detected by the reappearance of the blink and stapedius reflexes and the evolution of the computed EMG. These tests are sufficient for answering the five questions mentioned above without discomfort for the patient.

Electromyography↗

PubMed1997

[Hypoglossal-facial anastomosis. A report of 60 cases].

The authors report their experience of 60 cases of hypoglosso-facial anastomosis. The results of this retrospective series were analysed by the same examiner according to the House and Brackmann classification. The surgical technique is rapidly described, with emphasis on the important points. The results are analysed as a function of the interval between the anastomosis and facial paralysis: better and more rapid results are obtained when surgery is performed early (80% of grade 3 with immediate surgery versus 50% in very late surgery after more than 4 years). However, grade 3 or 4 can be obtained in every case, even in the case of very late surgery. Other favourable prognostic factors were revealed by this study: specialized rehabilitation and especially the patient's psychological must be integrated in this nerve transfer. In view of these good results and the limited adverse effects (atrophy of the hemi-tongue, eye-mouth synkinesias), hypoglosso-facial anastomosis must be part of the therapeutic strategy of total, permanent facial paralysis.

Adolescent↗

PubMed1996

Objective evaluation of dysphonia: preliminary results of a device allowing simultaneous acoustic and aerodynamic measurements.

Voice quality analysis was performed in 88 normal speakers and 157 dysphonic speakers using a device that allows simultaneous study of acoustic and aerodynamic parameters during pronunciation of a sustained /a/. We compared the results with those of voice quality grading by a jury. The Mann-Whitney test showed significant differences between the grades of dysphonia for all the parameters chosen. Comparison of results (using discriminant factorial analysis) with perceptual evaluation by a jury showed concordance in 66.1%. Based on these preliminary results, the authors conclude that their protocol overlooks some relevant voice parameters like middle-term variations. Further study will be undertaken to take into account this type of variations.

Adolescent↗

PubMed1996

[Dental rehabilitation using osseointegrated implants: treatment of oro-maxillo-facial cancer. A preliminary study of 7 cases].

Edentulism is often reported after treatment for malignancy of oral cavity. The resulting deformities from loss of teeth and bone create a "social invalid" with difficulties in articulation and mastication. Prosthetic rehabilitation was difficult because of two problems: the risk of osteoradionecrosis development and local anatomic modifications. The introduction of osseointegrated implants improved results of oromandibular reconstruction. A preliminary report of nineteen Branemark implants of seven patients is reported here. Implants have been in place and functioning for a period of one to four years. No major complication occurred and osseointegration permitted good oral rehabilitation. Placement of osseointegrated implants in osteomyocutaneous flaps and in irradiated bone is discussed.

Adult↗

PubMed1996

[Bone anchored auditory prosthesis. Indications, clinical and audiometric results].

Fourteen patients with conductive or mixed hearing loss were fitted with 16 BAHA. Three patients had congenital malformation of the auditory canal. Eleven patients had sequelae after bilateral chronic otitis media. All implants were osseointegrated. In 81% of the patients, no skin reactions around the abutment occured. The subjective evaluation was investigated by means of a questionnaire. All patients preferred their BAHA to their previous hearing aid and 93% are globally satisfied. Patients were evaluated in sound field, preoperatively and postoperatively using warble tones (mean on the average pure tone threshold at 0.5 1 and 2 kHz of 51.5 dB unaided to 22.6 dB aided with BAHA), speech reception threshold (mean of 51.1 dB unaided to 21.9 dB aided with BAHA) and speech discrimination. In three cases, we find an "antenna" effect, an improvement in reception wearing the Titanium screw and the abutment without the hearing aid connected.

Adolescent↗

PubMed1996

[Preliminary study of acoustic and aerodynamic parameters after Tucker frontal anterior laryngectomy].

Currently, not objective method has been demonstrated to be reliable for the evaluation of vocal handicap after partial laryngectomy. Such a tool would allow objective assessment of the post-operative voice and its clinical course as well as a comparison of different surgical techniques in terms of voice quality. We used a EVA device to measure simultaneously acoustic and aerodynamic parameters. We included 23 normal subjects and 34 patients who had undergone a Tucker laryngectomy. All subjects were males. At sustained voice production, acoustic measures of vibration stability (jitter, coefficient of variation in the fundamental frequency, shimmer, coefficient of variation in intensity) and air leak from the glottis (buccal air flow over intensity). The quality of voice in operated patients was judged by a jury of listeners who assigned a global score to voice quality. Results were analyzed to verify the correlation between objective measurements and the jury's score, taken as the reference measurement. The pertinence of the objective measurements was demonstrated for the stability of the frequency and the glottal air leak. Multiple regression analysis demonstrated that total variance of the objective measurements accounted for 84.7% of the scores provided by the jury (R2 = 0.847, p < 0.0001). These satisfactory results emphasize the interest of multiparametric analysis including aerodynamic measurements. These preliminary results led to the hypothesis that objective and subjective measurements could be useful in techniques aimed at improving voice quality (temporal organization of vibratory instability, work on intralaryngeal pressures).

Acoustics↗

PubMed1996

[Orbito-maxillo-facial rehabilitation with osteointegrated prostheses].

This investigation was conducted to evaluate 20 cases of implant-retained prosthetic rehabilitation (mean follow-up of 35 months). Ear, nose, orbit and complex defects of the face have been restored. Our main indication was reconstruction in cancer patients after tumor surgery (n = 14). Rehabilitation was also performed in traumatic disorders (n = 3) and congenital aural malformations (n = 3). Fifty seven titanium fixtures have been implanted with an integration success rate of 98%. We also report 6 cases of maxillary or mandibulary functional rehabilitation. The use of osteointegrated implants to provide support for maxillo-facial prosthesis is a new and valuable technique when reconstructive plastic surgery is not envisageable.

Adult↗

PubMed1995

Role of magnetic resonance imaging in predicting late facial motor function after removal of vestibular schwannomas by the translabyrinthine approach.

Facial motor function was assessed in 61 patients 18 months after surgical resection, by the translabyrinthine approach, of vestibular schwannoma involving both the cerebellopontine angle (CPA) and the auditory canal. Pre-operative magnetic resonance imaging (MRI) was performed to measure the maximum extracanalicular diameter of the tumour between the porus and the farthest extension in the CPA on transverse slices and to calculate extracanalicular tumour volume. Post-operative facial motor function was graded according to the House and Brackmann system. There was a statistically significant relationship between late facial motor function and extracanalicular diameter. The best cut-off point for good and poor results was 20mm. There was no relationship between the tumour volume and the late post-operative facial motor function grade. In this study the best pre-operative radiological predictor of the late facial motor function in patients operated on by the translabyrinthine approach was the maximum diameter measured by MRI.

Adult↗

PubMed1995

[Objective vocal evaluation of dysphonia by simultaneous measurement of acoustic and aerodynamic parameters with the EVA device].

Authors present the analysis of the voice in 88 normal subjects and 159 dysphonic patients by simultaneously measurements of Jitter (acoustical short-term indicator of aperiodicity) and "Glottal Leakage" (aerodynamic parameter calculated by the ratio of Oral Airflow and Intensity). All the measurements were performed, with EVA apparatus, on the most stable part of a steady-state vowel /a/. The reference method was the rating by a jury along a global perceptual scale. Statistical tests confirm that Jitter and "Glottal Leakage" are relevant to evaluate the quality of the voice. Discriminant analysis allows to find out a fairly-good rate of discrimination of 63.1% (Randomly rating would have been 25%) The authors conclude on the interest of such a protocol and present suggestions to improve it by taking in count phénomena during the vocal attack and middle-term variations.

Acoustics↗

PubMed1995

[Surgical anatomy of the parathyroid glands. Apropos of 200 cases. Practical implications].

An operative procedure aimed at decreasing the risk of post-surgery hypothyroidism was proposed on the basis of parathyroid gland surgical anatomy described from a retrospective study of 200 thyroidectomies performed by the same operator It is almost always possible to visualize 1 or parathyroids during thyroid procedures. This fact makes it possible to reduce the rate of definitive hypoparathyroidism to less than 5% in surgery for invasive cancer of the thyroid and to 1% for non-invasive cancers requiring total thyroidectomy and uni or bilateral mediastinorecurrent curettage.

Humans↗

PubMed1995

[Reconstructive anterior frontal laryngectomy. Long-term results in T2 glottic cancers].

Between 1982 and 1992, we performed near total laryngectomy with epiglottic reconstruction in 142 patients with state T1 and T2 according to the 1987 Union Internationale contre le Cancer. In this paper, we report our experience with 61 T2 patient who were followed-up 5 years or until death. Actuarial survival was 83%. Actuarial tumor control was obtained in 91%. There were no post-operative mortalities and follow-up was usually simple. All patients underwent decanulation and were able to eat by normal track. The main drawback of this technique is speech disability. We use near total laryngectomy with epiglottic reconstruction in certain T2 patients selected according to local extension. This choice is justified by good functional results and an excellent local control. The contraindications are age over 75 years, poor patient cooperation, cardiac or pulmonary disease, fixation of the arytenoids, subglottic extension of more than 1 cm in front and 0.5 cm laterally, and extensive involvement of the ventricular folds or anterior commissure.

Adult↗

PubMed1994

Major complications of sinus surgery: a review of 1192 procedures.

Based on this review of 1192 intranasal sinus procedures under endoscopic control with video assistance, the risk of major complications was estimated to be about 1.3 per cent. Ethmoidectomy was the most hazardous procedure. Operation by a right-handed surgeon standing on the right side of the patient was an added risk factor. We stress ways of achieving prevention, peroperative recognition of cerebrospinal fluid leaks and proper management of complications.

Adolescent↗

PubMed1994

Difference in the height of the right and left ethmoidal roofs: a possible risk factor for ethmoidal surgery. Prospective study of 150 CT scans.

A prospective study of 150 CT scans showed that the right ethmoidal roof was lower than the left in 8.6 per cent of cases. The reverse situation, i.e. the right higher than the left, was observed in only 1.2 per cent of cases. This finding could account for the higher reported incidence of endocranial complications associated with right ethmoidectomy. Coronal CT scans allowing comparison of the right and left ethmoidal roofs should always be made before undertaking intranasal ethmoidectomy.

Adult↗

PubMed1994

[Surgical approach of the petrous vertical segment and upper cervical internal carotid].

The main obstacle to successful management of aneurysms involving the high cervical internal carotid artery (ICA) is to obtain an adequate exposure. In this report we describe our experience in 5 patients presenting carotid aneurysms at the skull base, intermediately below the carotid foramen. Exposure is achieved in two stages. The cervical stage consists in resection of the styloid processes and muscles followed by anterior displacement of the mandibular condyle. This exposes the vertical segment of the petrous ICA. The petrous stage consists in partial petrectomy exposing the jugular bulb and the third segment of the facial nerve. Using this route, the vertical intrapetrous segment of the ICA can be drilled away without damaging the middle ear. In our series, no vascular complications occurred. Damage involving the facial glossopharyngeal and vagal nerves is discussed. This approach appears to be a suitable alternative to the conventional infratemporal approach which sacrifices the middle ear.

Adolescent↗

PubMed1994

[Mandibular reconstruction using an iliac crest free flap vascularized by the deep circumflex iliac vessels. A clinical study apropos of 30 cases].

Thirty cases of mandibular defects were reconstructed with a free iliac flap vascularised by the deep circumflex iliac vessels. Twenty five of these cases involved soft tissue damage with a defect of the mandible. The surgical procedure described by I. Taylor was used. Three anatomical variations of the pedicle were found. The features of the iliac bone are particularly suitable for mandibular reconstruction. The natural shape of the iliac bone does not require complex osteotomies and its healing capacity allows simple osteosynthesis. The thickness of the muscular pedicle, and thus the flap, is determined by the position of the lower edge of the skin components with respect to the iliac crest. This type of flap currently remains very useful in reconstruction of major mandibular and adjacent soft tissue destruction because of the very low incidence of failure (2 cases) and complications.

Adolescent↗