J. Blancal

Value of systematic analysis of the olfactory cleft in case of cerebrospinal rhinorrhea: incidence of olfactory arachnoid dilatation

To report on the presence of olfactory arachnoid dilatations (OAD), a previously undescribed radiologic feature of spontaneous cerebrospinal fluid (CSF) rhinorrhea originating from the cribriform plate of the ethmoid bone. The medical records of all patients treated between 2001 and 2011 at a tertiary care center for a spontaneous CSF rhinorrhea originating from the cribriform plate were retrospectively reviewed. The radiological work-up included high-resolution computed tomography and magnetic resonance imaging with at least the following sequences: T1, T2, and T2 with fast imaging employing steady state acquisition (FIESTA). Thirty cases were identified. The mean age at diagnosis was 49. Fourteen patients (47xa0%) had a body mass index (BMI) of 30 or more and 3 patients (10xa0%) had a BMI between 25 and 29.9. Five patients had a history of meningitis. The imaging work-up revealed a bone defect of the cribriform plate in 6 cases (20xa0%), associated to a typical meningocele in 14 cases (47xa0%). In ten patients (33xa0%), there was no defect of the cribriform plate, but ultrathin coronal T2-FIESTA sequences revealed an OAD, i.e. a dilatation of the arachnoid sheath of the olfactory fibers, in nine cases (30xa0%), or a “pseudo-polyp” outlined by a thin layer of arachnoid (1 patient, 3xa0%). Preoperative imaging should be carefully analyzed for the presence of OAD or “pseudo-polyp” in patients presenting with a CSF rhinorrhea without bony defect of the cribriform plate.

Intérêt du lambeau turbino-septal pour les sinusotomies frontales de type Draf 2b

But de la presentation Les mucoceles distales, les sinusites frontales rebelles multi-operees voire plus recemment les meningoceles du sinus frontal peuvent etre une abordees par une sinusotomie frontale avec resection du plancher du sinus frontal. Dans le cadre d’une chirurgie mini-invasive, l’abord peut etre realise de facon unilaterale (Drafxa02b) pour eviter la resection d’une partie de la cloison (Drafxa03). Neanmoins l’etroitesse de la voie d’abord expose a un risque de stenose secondaire. L’objectif de l’etude est de presenter la technique de lambeau turbino-septal et son interet dans le Drafxa02b. Materiel et methodes Etude retrospective portant sur les patients avec intention de traitement par Draf 2b et lambeau turbino-septal. Description de la technique du lambeau turbino-septal, analyse de l’indication operatoire, des conditions anatomiques, de la realisation chirurgicale et du taux de guerison. Resultats Au cours des deux dernieres annees, l’indication d’un Draf 2b avec lambeau turbino-septal a ete portee dans 20xa0cas. Dans deux cas ce lambeau n’a pu etre preserve. En revanche dans 18xa0cas le lambeau a ete preserve et a permis de tapisser la paroi posterieure de la sinusotomie. Nous presenterons le taux de reussite a distance de facon globale et en fonction de la pathologie, des antecedents chirurgicaux et de la taille du plancher du sinus. Conclusion La realisation d’un lambeau turbino-septal, qui doit etre preleve des le debut de la procedure, est susceptible de reduire le taux d’echec des procedures de Drafxa02b.

Corticothérapie intratympanique de rattrapage pour les surdités brusques sévères ou profondes

But de la presentation Intratympanic corticosteroids (IT) have been proposed to treat idiopathic sensorineural hearing loss (SNHL). The aim of this study was to evaluate the results of intratympanic steroids as a salvage treatment for severe SNHL in a control group study. Materiel et methodes A regimen of three IT steroids was offered to patients who failed a 7-days intravenous steroid treatment. Eighty-four patients underwent IT salvage treatment (IT GROUP). Their outcomes were compared with those of 255 control patients with severe SNHL who received the same intravenous steroid regimen without salvage IT steroid therapy (CONTROL GROUP). Types of SNHL were classified into five subgroups according to their audiogram patterns. Resultats The initial pure tone averages (PTA) were 77xa0±xa029xa0dB and 78xa0±xa035xa0dB in the IT GROUP and the CONTROL GROUP, respectively (pxa0=xa00.68). Fifty-six percent of the patients in the IT GROUP had a hearing improvement ofxa0>xa015xa0dB after one month. The average hearing improvements after one month were 26.5xa0±xa028xa0dB and 27.9xa0±xa024xa0dB in the IT GROUP and the CONTROL GROUP, respectively (pxa0=xa00.67). However, for patients with a type E audiogram pattern (total deafness), there was a substantial hearing gain. Conclusion Although intratympanic steroids failed to show a global auditory benefit as a salvage treatment for the whole population of patients with severe SNHL, our data suggest that a salvage treatment with intratympanic dexamethasone may be offered to patients with total deafness for whom the first systemic treatment has failed.

Papillomes inversés du sinus frontal : voies d’abord chirurgical et résultats à long-terme

Conclusion.— L’adénocarcinome est une tumeur localement agressive avec un risque de récidive essentiellement durant les trois premières années. La chronologie des récidives souligne la nécessité d’un suivi radio-clinique rapproché, tous les quatre mois la première année puis tous les six mois. Cette série de patients pris en charge par voie endoscopique exclusive combinée à une radiothérapie adjuvante sur huit ans retrouve des résultats oncologiques similaires à ceux obtenus par la technique de référence, la résection craniofaciale.