[Postoperative cervicofacial subcutaneous emphysema]

Two cases of post-operative subcutaneous emphysema are reported. After excessive airway pressure, air or anaesthetic gases may spread to the neck, mediastinum, abdomen or pleural cavity. Pathogenesis and mechanisms are discussed. Possible aetiologic factors are outlined. The consequences of this condition are limited after adequate emergency treatment.

Unilateral congenital choanal atresia and maxillary sinus development

Most authors feel that the maxillary sinus and dento-alveolar arch do not develop normally in case of choanal atresia. This as explained by respiratory deficiency on the atretic side. A series of 11 cases of unilateral choanal atresia, either untreated or treated after the period of maximum growth, have been studied by clinical examination, serial X-rays and cephalometric tracings in order to compare atretic and normal sides. No significant difference has been found, neither for size nor shape of the maxillary sinus. These observations are therefore in contradiction to earlier reported findings and require further study.

[Lower trapezius musculocutaneous flap for the repair of neoplastic loss of substance of the ear]

Large defects created by oncological resections of the auricular area require to fill and cover the gap to achieve their reconstruction. The lower trapezius myocutaneous island flap meets these two principles more easily and more reliably than previous loco-regional skin flaps. About two patients, who undergone resection of spread carcinoma of the external ear, the authors discuss the advantages and disadvantages of this flap, that appears seldom utilised; they point out some practical problems encountered when raising the flap.

[Mandibular osteitis and tertiary syphilis]

The authors report the case of a 65 years old man, who suffered from an osteitis, involving the mandible. Within a few months, and despite of a well established treatment, sequestration occurred following a pathologic fracture. No specific germ was encountered after several laboratory examinations. The discovery of a primary syphilis forty years ago, confrontation of clinic and paraclinic data, suggested the actual osteitis could be a complication of tertiary syphilis. A specific treatment was started, and the situation improved progressively. After five months of treatment, mandibular reconstruction was decided. Diagnostic arguments are discussed, and the case is compared with those, not numerous, reported in the literature.

[Association of posterior laryngeal cleft and atresia of the oesophagus. Two cases treated successfully (author's transl)]

Two rare cases of oesophageal atresia associated with a posterior laryngeal cleft were treated successfully: a so-called "O" interarytenoid cleft recognised secondarily to the type II atresia, not treated surgically; a so-called II cricoid cleft recognised before the treatment of type I atresia was closed in a first stage by an anterior transl-laryngeal approach. A bibliographical review is followed by a discussion of the diagnosis aspects and therapeutic possibilities of laryngeal cleft, the approach, the timing of surgery on the basis of its type and the type of oesophageal atresia.

Normal vestibular responses to air caloric tests in children

One hundred and forty normal children, divided into four age-groups (2-3, 4-5, 6-7, 8-10 years old) have been submitted to a vestibular examination by caloric tests with air, and the responses were recorded. This technique is sure and easily reproducible. Frequency of nystagmus, and maximum eye speed in slow phase of nystagmus (M.E.S.) were examined during 30 sec after caloric stimulation. Frequency of nystagmus increases, and M.E.S. decreases as the children become older. A significant difference between the 2-3 and 4-5 year old groups is also noticed. Normal variations are fixed for each age group. A quantitative relation between frequency, M.E.S. and height is established.

[Febrile acute torticollis (author's transl)]

Febrile acute torticollis in the child represents a special clinical picture. Of variable cause, it may be indicative of an inflammatory, infectious or dystrophic pathology affecting any of the anatomical structures of the neck. Treatment is quite clearly defined, and it may be a therapeutic emergency. All ENT specialists must be familiar with this since they are most likely to be the first physician to whom such a child is brought.

[The treatment of chronic cholesteatomatous otitis media in the child (author's transl)]

On the basis of 38 cases seen in the child, with a postoperative follow-up of more than 2 years, the authors note the special and early aggressive nature of cholesteatoma of the middle year at this age. Its development depends upon tubal factors which in general remain in an underlying position but involve the risk of inducing direct complications during the postoperative course. These reasons lead to the suggestion of a technique involving sacrifice of the osseous meatus and tympanoplasty which often saves hearing. Preservation of the osseous meatus is still to be recommended in limited forms and in the absence of any notable tubal factor, not encountered in this series.

[Digestive duplications affecting the pharynx or fistulae of the fourth endo-branchial pouch. Four cases (author's transl)]

Four cases of children with recurrent latero-cervical epithelial cystic tumours which where identified as exceptional derivatives of the 4th endobranchial pouch on the basis of their connections with the pharynx and in particular the piriform fossa. The opportunity is taken to review the characteristics of equally rare digestive, duplications and congenital diverticula at a cervical and buccopharyngeal level. This diagnosis was made initially in the first of these cases.

[Respiratory and swallowing difficulties after oesophageal atresia (author's transl)]

The main reason for these problems is a tracheo-oesophageal fistula, either recurrence of the T.O. fistula, either persistance of a fistula which has been neglected during surgery. It has been observed in 7 infants from 19 operated atresias with such problems. These functionnal troubles may be produced by different other anomalies: oesophageal stenosis and or dyskinesia often observed, gastro-oesophageal reflux, associated anomalies of the larynx or trachea; laryngeal paralysis, tracheomalacia, tracheal epithelium metaplasia, tracheal compression by abnormal vessel, neurological dysmaturity, loss of swallowing reflex after a long postoperative course. Radiography and endoscopy are fundamental and complementary investigations. Endoscopy, under general anesthesia, must be minute (with optics), explore oesophageal and laryngo-tracheo-bronchic tract, and use several tests to demonstrate permeability of the fistula when it has been located. A special technique is presented. Several points must be outlined: 1--classical symptoms of persistant fistula are not reliable in authors' experience; any recurrent respiratory and swallowing problem requires investigations; 2--endoscopy and radiographic study have to be repeated sometimes to prove fistula; 3--responsability of some anomalies must be always discussed, because of their possible association with a fistula; several fistulas may also exist.