After facial nerve injury, in cerebello-pontine tumors surgery, hypoglossal-facial anastomosis is the most common procedure, to rehabilite a paralysed face, if direct facio-facial graft is not possible. This procedure must be done, in a second time, during the next year and followed with a specific reeducation. In seven patients operated between 1985 and 1996, we performed clinical evaluation and electrophysiological examination. The best evaluation is the clinical evaluation using the G. Freyss's facial testing. Best results are seen in early, specific and continued reeducation. All our patients have a good recovery of facial nerve function, but clinical examination and electrophysiological results are not correled with an objective video performance. The management of such patients needs efficient oto-neurosurgical team and specific trained physiotherapists.

The authors present 13 casualties observed after the bombing attempt in Djibouti (March 1987). All of them suffered blast injury to the ear. The scene and the circumstances of the explosion are described. A correlation is sought between the location and position of each casualty and the lesions he presented, with reference to animal experiment data, namely the shock waves propagation conditions. The otologic lesions are commented on with reference to acute acoustic trauma, and the need for a special study of vestibular outcome of blast injuries is emphasized.

Les anomalies auditives des musiciens de la Garde Republicaine (fanfares d'infanterie et de cavalerie) sont presentees et interpretees. La perception des hautes frequences est particulierement etudiee. Les percussionnistes et les instrumentistes a vent sont compares, en reference aux donnees de la litterature. Quelques caracteres specifiques a chaque instrument sont recherches. Les signes d'accompagnement (fatigue auditive, otalgies, phonophobie, acouphenes, troubles de l'equilibre, du sommeil et du psychisme) sont egalement evalues. L'importance de l'audiometrie «hautes frequences» (superieure a 8 KMz) pour la detection precoce des alterations auditives et son interet medico-legal sont mis en evidence

This multicentre study evaluates the distribution of ciprofloxacin into the tissue structures of the middle ear following multiple dosing of one 500 mg tablet every 12 h. The samples were taken perioperatively from adult patients due to undergo surgery for chronic otitis. Administration of ciprofloxacin was instigated 9 days prior to the operation. The samples were taken at different intervals after the last dose in order to evaluate variations in concentration with time. The average peak concentrations recorded and the time taken to reach these concentrations were as follows: middle ear mucosa (n = 16): 5.54 +/- 3.46 micrograms/g (3-4 h): cortical bone of the mastoid process (n = 21): 1.07 +/- 1.29 micrograms/g (4 h). The measurements carried out 12 h after the last dose show that concentrations of ciprofloxacin in the middle ear mucosa were still at least as high as the minimum inhibitory concentration for this antibiotic for most of the pathogens implicated in acute exacerbations of chronic otitis. These results suggest that, administered as an oral dose of 500 mg every 12 h, ciprofloxacin may be an effective agent for the treatment of chronic suppurative otitis. These results now need to be backed up by clinical trials.

Cystic hygromas, infrequent in children, are even rarer in adults where they once were generally an unexpected operative findings. Now, with the progress in modern medical imaging the diagnosis can be suggested before operation. Analysis of the embryogenesis helps to explain the different anatomical and clinical forms and the relations of the cystic hygroma with neighboring tissues, particularly of renous origin, grases of cystic hygroma of the neck in adults are reported and discussed with 26 other well documented cases from the literature. The diagnosis can be confirmed only after operation and histological examination. Surgical removal is technically less difficulté in adults than in children and recurrences are rare.

This multicenter study evaluates the diffusion of ciprofloxacin into the tissue structures of the middle-ear after oral administration of 500 mg every 12 hours. Tissue samples were obtained, in per-operative period, in patients presenting with chronic otitis requiring surgery. Ciprofloxacin administration started 9 days before surgery. Samples were obtained at different intervals after the last administration in order to evaluate the variation in concentration with time. The average maximal concentrations and corresponding time were as follow : middle ear mucosa (n = 16) : 5.54 +/- 3.46 mug/g (3-4 hours), mastoid cortical bone (n = 21) : 1.07 +/- 1.29 mug/g (4 hours). Twelve hours after the last administration, ciprofloxacin concentrations are still at least equal to the MIC values for the pathogens generally isolated in exacerbation of chronic otitis. These data promise that ciprofloxacin given at a dosage of 500 mg every 12 hours, might be an effective agent for the treatment of chronic suppurative otitis. The clinical efficiency of this treatment regimen remains to be determined.

Cystic hygromas, infrequent in children, are even rarer in adults where they are generally unexpected operative findings. Now, with the progress in modern medical imaging, the diagnosis can be suggested before operation. Analysis of the embryogenesis helps to explain the different anatomical and clinical forms and the relations of the cystic hygroma with neighboring tissues, particulary of veinous origin. 9 cases of cystic hygroma of the neck in adults are reported and discussed with 26 other well documented cases from the literature. The diagnosis can be confirmed only after operation and histological examination. Surgical removal is technically less difficult in adults than in children and recurrences are rare.

About a series of 20 aspergillus maxillary sinusitis, the correlation between this pathology and previous dental treatments is emphasized. In some cases such as sinusitis can occur without any dental pathology and/or in absence of foreign body on the X-rays. C.T. findings are the basis of the diagnosis. Surgical treatment, using endonasal micro surgery, has been performed in all cases.

Three petrous incisions, performed by an ENT-neurosurgery team, can be used for the resection of tumours of the cerebellopontine angle: transpetrosal incisions (posterior translabyrinthine and transcochlear) which provide large access to the IAM and the posterior surface of the petrous bone, but they sacrifice hearing. The suprapetrosal incision (reserved for tumours in the meatus) and the mastoidoretrosigmoid incision (for tumours less than or equal to 20 mm) preserve the labyrinth in an attempt to preserve hearing. The principal objectives of surgical resection of tumours of the cerebellopontine angle (85 % of which are acoustic neuromas) are total resection (to preserve the vital prognosis) and preservation of facial nerve function. Attempts to preserve hearing must be confined to cases selected by a complete clinical otological and audiometric examination.

Three petrous incisions, performed by an ENT-neurosurgery team, can be used for the resection of tumours of the cerebellopontine angle: transpetrosal incisions (posterior translabyrinthine and transcochlear) which provide large access to the IAM and the posterior surface of the petrous bone, but they sacrifice hearing. The suprapetrosal incision (reserved for tumours in the meatus) and the mastoidoretrosigmoid incision (for tumours less than or equal to 20 mm) preserve the labyrinth in an attempt to preserve hearing. The principal objectives of surgical resection of tumours of the cerebellopontine angle (85% of which are acoustic neuromas) are total resection (to preserve the vital prognosis) and preservation of facial nerve function. Attempts to preserve hearing must be confined to cases selected by a complete clinical otological and audiometric examination.

The surgical division of the parotid gland in three parts or << lobes >> in relation to facial nerve is a practical custom. After revising the surgical anatomy, the indications and operative technique of total parotidectomy with preservation of the facial nerve (TPP) are described. The discussion is open for pleomorphic adenomas of the superficial lobe, between some authors in favour of a superficial parotidectomy and others who perform a systematic TPP. Other surgical operations are total parotidectomy (TP) without preservation of the facial nerve, TP associated with a neck dissection, at lastly extensive or partial parotidectomies. Trans-parotid surgery uses the parotid region as an approach to neighbouring structures or regions.

Surgery for acoustic neuroma is highly risky for the facial nerve. This is why we have tried to assess immediate postoperative facial impairment by performing Hilger's test within the first few hours. Further evolution of the facial function showed the predictive value of Hilger's test as regards facial recovery. Indeed, a difference greater than 2 mA as compared with the opposite side indicates a lack of facial recovery at the 3rd postoperative month. In addition, facial muscle testing performed within the first postoperative 72 hours makes the prognosis of facial function recovery possible. Lack of facial recovery at the 3rd postoperative month was observed for neuromas with a diameter exceeding 2 cm. Preoperative assessment of the risk of facial sequellae is fundamental and essentially depends on the size of the tumor and on the surgical approach. Intraoperative facial monitoring allows better ensuring the preservation of the VIIth cranial nerve and consequently improves postoperative function.

The different methods of approaching the sphenoidal sinus by modern endo-nasal micro-surgery technics are presented with their anatomic basis and main topographic "landmarks". Advantages, inconveniences and indications of each of these approaching ways are emphasized within the setting of the sinus and turcic saddle surgery.

Aspergillosis fixation in the sphenoidal sinus is an exceptional occurrence when isolated. The clinical feature is misleading and the diagnosis often difficult; local and regional complications are dreadful. The authors report a case, presenting as an optic neuropathy, and the literature data.