60 patients, aged 15–51 years, with chronic allergic or bacterial maxillary sinusitis, were entered in a controlled, double-blind study comparing the efficacy of endonasal irrigations of tixocortol pivalate (Pivalone® )-neomycin and neomycin. The treatment lasted 11 days and was administered once daily. A ventilometric measurement of sinus pressure was performed every two endonasal irrigations to assess treatment efficacy. The percentage of nasal deobstruction was significantly higher with tixocortol pivalate-neomycin than with neomycin alone by the fifth examination (9th day) regardless of the etiology of the sinusitis (allergic or bacterial). After 11 days of treatment, significantly better results were obtained in cases of bacterial sinusitis (94% deobstruction with tixocortol pivalate-neomycin versus 74% with neomycin) than in cases of allergic sinusitis (69% deobstruction with tixocortol pivalate-neomycin versus 36% with neomycin).
This study is based on a very large series of histological sections of non-tumour-bearing larynges, most of them in the horizontal plane. Six hundred sections in one larynx were performed to show the constitution of the anterior region of the larynx at all levels. Although the same tissues are present (fibres, glands and vessels) in almost the entire extent of the anterior segment of the larynx, there is a small zone immediately above the vocal cords with neither glands nor vessels. The authors designate this zone as 'plane O' which separates the anterior commissure from the thyro-epiglottic ligament. It is not possible to separate the anterior commissure from the most anterior portion of the subglottis, because the glands and vessels are in continuity. There are 2 regions of the anterior part of the larynx: a supraglottic (vestibulo-epiglottic) and a glottic-subglottic to which the anterior commissure belongs.
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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