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.
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Difficult indications for certain partial laryngectomies are presented. Anatomically, the difficulties stem from the thyroid cartilage and from the paraglottic space in which invasion (difficult to determine) is contradictory for partial surgery. The principal objective is the cure of the laryngeal cancer all in maintaining laryngeal function. The surgeon must conserve a 'minimal' arytenoid unit' (the whole formed by the pharyngoepiglottic fold, the aryepiglottic fold, the arytenoid and the corresponding cord). Other difficulties not carcinogenic are found: physical conditions, social and professional situation, and preexisting local problems (associated laryngocel or previous vocal palsy). Finally, carcinogenic difficulties can be seen: the situation of the tumor, the rapidity of its evolution, anatomopathologic type, presence of nodes and metastases and previous physiotherapy and chemotherapy.
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The authors specify the role of the ossification process of the larynx cartilages. Only the epiglottis may be considered as a cartilage. The use of microangiography made it possible to describe some peculiar features of the microvascular pattern. The vascular patterns of the thyroid, cricoid and arithenoids cartilages are similar to one another; the cartilage and its two perichondriums must be considered as a complete whole. The epiglottis shows a peculiar vascular pattern. The authors insist upon the important role of the vascular pattern in pathologic studies.
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The authors deal in turn with: -- the anatomical classification of disorders of the sense of smell, -- the various clinical and instrumental methods used to investigate the sense of smell, -- a practical method of investigation enabling the topography and the nature of the lesion to be found when a patient presents with a disorders involving the sense of smell. Finally, a classification of the various disorders which may be observed is suggested based on the topography of the lesion in the olfactory system.
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Out of 543 tracheotomized patients, 227 survived and 12 of them developed a tracheal stenosis syndrome (5,28 p. 100) including: 3 supra-ostial stenosis, 1 ostial and supra-ostial stenosis, 1 ostial stenosis, 3 intermediate stenosis and 4 distal stenosis. In two cases, the stenosis was found out during the removal of the cannula and in the other cases from 3 days to 8 months after the decannulation. The deffered treatment consisted in an anti-inflammatory medical treatment treatment (one case), in a permanent dilation with an Albouker tube (two cases), and in a resection of the stenosed tracheal part plus an anastomosis. Good results were obtained in 9 cases including the recovery of a satisfactory tracheal diameter. Because of a recurrence of the stenosis after resection and anastomosis, it was necessary, in two cases, to resort to another resection and, upon another occasion, to place a permanent cannulation. Finally, in one case, 2 Rethi operations were necessary to get a sub-normal tracheal diameter. From these facts, it emerges that tracheal stenosis are less important if, during the tracheotomy, a partial resection of the tracheal wall is effected (rather than an inverted U flap folded back at the bottom) together with the putting in of a cannula equipped with an elongated cylindrical cuff requiring a less important filing-up pressure (although just as efficient as far as tightness is concerned).
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