[Spontaneous posterior sphenoid sinus fistula].

Objective: Describe a rare localization of spontaneous cerebrospinal fistula.

Case Report: A 75-year-old women was admitted for bacterial meningitis arising from a sinus infection. She had not experienced facial or head trauma.

[The pedicled musculo-cutaneous latissimus dorsi flap].

The pedicled musculo-cutaneous latissimus dorsi flap presents many advantages and merits to be used more frequently in head and neck surgery because a large musculo-cutaneous pallet with an excellent vitality can be obtained. The flap reaches easily the inferior third of the face thanks to its rotation arc, leading to a discreet aesthetic scar. For this reason, its use is interesting especially for women.

[An unusual tumor of the larynx: malignant fibrous histiocytoma. Apropos of a case. Review of the literature].

On the basis of one case, the authors report about an exceptional tumor of the larynx: malignant fibrous histiocytoma. This tumor, belonging to the soft-tissue sarcomas, usually develops in the limbs. The histological diagnosis is still difficult, in spite of the help provided by immunocytochemistry and fine structural analysis.

[The scapular osteocutaneous flap. Technic, indications in cervicofacial surgery].

The authors describe 10 cases of mandibular reconstruction following transmandibular buccopharyngectomy, using scapular osteocutaneous flaps. Repair of mandibular substance loss due to neoplastic surgery becomes a problem. Composite bone resections are associated with mucous and muscular defect formation.

[Spheno-ethmoidectomy in recurrent nasal polyposis. Technic, indications, results].

Spheno-ethmoidectomy can be legitimately included within the therapeutic schema for nasosinusal polyposis causing incapacity and resistant to medical treatment. Benefiting from recent technical progress, a very precise medical therapeutic framework and improved knowledge of ethmoid surgical anatomy, a marked reduction in complications of this operation has been observed. Results of a series of 175 ethmoidectomies performed in 90 patients confirm the good results reported in the literature, even though follow up is still insufficient.

[Requisite selection of surgical technics in the treatment of cancer of the larynx].

Rules for functional surgery of cancer of larynx are defined by means of a detaited analysis of results of 43 cases of reconstructive anterior frontal laryngectomy, 17 cases of crico-hyoide-epiglottopexy and 32 cases of crico-hyoidopexy. The carcinologic features of this surgery are discussed, and emphasis placed on the importance of the paraglottic space and its functional conditions in the light of recent physiologic data. Surgical procedures used are outlined with, for each of them, the neoplastic localization suitable for treatment and a critical analysis of postoperative functional results.

[Value of thallium scintigraphy in thyroid pathology].

The value of thallium 201 (Tl 201) scintigraphy was investigated in 45 patients with thyroid affections. Scintigrams were performed with both technetium 99 m (Tc 99 m) and Tl 201. Of the 27 patients with 43 thyroid nodules confirmed histologically (16 patients were operated upon and needle puncture cytology conducted in 11 cases), all cold nodules to Tc 99 m and Tl 201 were found to be benign.

[Glottic reconstruction with a flap of thyroid perichondrium].

Laryngoplasty was performed using the perichondrium of the thyroid cartilage or a sternohyoid muscle flap. Techniques and results are described using this method, applied for glottic reconstruction after vertical partial laryngectomy of the frontolateral type and after cordectomy. Anatomic and functional results in 15 cases are described, ultrasound imaging showing in all cases an improvement in basic laryngeal function, and in the timbre and strength of the voice.

[Role of musculocutaneous flaps in pelvibuccopharyngectomy].

Musculocutaneous flaps were used for reconstruction after excision of large base of tongue or lateral oropharyngeal wall tumors in 50 patients, the most frequently employed flap in both regions being one from pectoralis major. Results showed marked reliability for these types of flaps for repair in these two areas, and they have now supplanted conventional single pedicle skin flaps. Various flaps supplying different useful surfaces are required, the platysma or sternocleidomastoid muscles being used for small areas, the pectoral or trapezius muscles for medium sized gaps and the latissimus dorsi for extensive repairs.

[Total circular pharyngolaryngectomy. A method of reconstruction with a free forearm skin flap].

The reconstruction of the digestive tube after total circular pharyngo-laryngectomy continues to pose a number of problems. Fistulae and delayed healing of the mucosa are common problems after musculo-cutaneous flaps. They are due, on the one hand, to a spring effect of the flap which interferes with tubulisation and, on the other hand, to the problematical suture of the thick thoracic wall skin to the fine oesophageal mucosa.