Influence des facteurs épidémio-cliniques dans le résultat fonctionnel de la septoplastie: étude de 250 cas / Epidemiological and clinical predictive factors of success in septoplasty: Study of 250 patients

to describe the epidemiological and clinical aspects, to evaluate the surgical result and to identify the prognostic factors for the success of septoplasty. Methods: It was a retrospective study including 250 patients operated on for a septoplasty collected over a 6-yearperiod. The evaluation of our results was made using 2 tools: NOSE scale and the visual satisfaction scale. Results: In our series, there was a male predominance with a sex ratio of 1.4. The mean age of the patients was 32.7 years. The medical history was dominated by allergic rhinitis in 38.4% of cases. Nasal trauma was noted in 45.2% of cases. A subjective quantification of respiratory discomfort by the NOSE score made it possible to divide them into 3 groups:Group 1: Severe ON: 65.2% of cases; Group 2: Moderate ON: 31.6% of cases; Group 3: Mild ON: 3.2% of cases. Our analytical study of the epidemiological and clinical factors that may influence the functional results showed that: Severe or moderate overall discomfort, severe ON (NOSE scale> 50) or moderate (NOSE scale between 26 and 50), DS classified zone I, II, III according to the Cottle classification, a quasi-obstructive deviation were considered as a predictor of the success of septoplasty. Conclusion: Several factors can influence the results of a septoplasty that must be considered before any surgical indication.

Schwannome endonasal à localisation turbinale inférieure. A propos d'un cas

Introduction : Le schwannome est une tumeur bénigne développée aux dépens des cellules de Schwann des nerfs périphériques. La localisation endonasale en particulier au niveau des cornets est rare. Observation : Nous rapportons le cas d'une femme de 23 ans reçue dans notre structure pour une masse de la fosse nasale droite localisée au niveau du cornet inférieur, obstruant totalement la lumière nasale, sans envahissement local. Après un bilan endoscopique et radiologique, l'exérèse a été effectuée par voie endoscopique endonasale. L'analyse de la pièce opératoire avait mis en évidence un schwannome. Avec un recul de 24 mois nous n'avons pas noté de récidive. Conclusion : Le schwannome à point de départ turbinal inférieur constitue une entité rare. Il doit être considéré dans le diagnostic différentiel d'une tumeur bénigne unilatérale des cavités naso-sinusiennes

Prise en charge chirurgicale des mucocèles naso-sinusiennes

Introduction : Les mucocèles nasosinusiennes sont des pseudo-tumeurs d'allure kystique, relativement rares. Malgré leur bénignité, elles ont une tendance expansive et destructrice. Buts : Proposer une stratégie thérapeutique appropriée des mucocèles naso-sinuisennes.Matériel et Méthodes : Etude rétrospective portant sur 43 patients opérés entre 1992 et 2012. Résultats :Il s'agit de 27 hommes et de 16 femmes. L'âge moyen était de 47 ans. Des antécédents de traumatisme crânio-facial, de chirurgie nasosinusienne ou du massif facial ont été retrouvés respectivement dans 16.27%, 25.58% et 9,3% des cas. Les localisations éthmoïdo-frontales étaient les plus fréquentes (14 cas). Les voies endoscopique endonasale, mixte ou externe ont été utilisées dans 30, 4 et 9 cas. Conclusion : La voie endoscopique endonasale est actuellement la voie de référence pour le traitement des mucocèles. La voie externe garde certaines indications. La marsupialisation est le traitement de choix permettant le respect de la physiologie sinusienn

Carcinome adénoïde kystique de la fosse nasale : à propos d'un cas et revue de littérature

Parmi les tumeurs de la tête et du cou, le carcinome adénoïde kystique ne représenteque 1%. C'est la tumeur maligne la plus fréquente des glandes salivaires accessoires.Sa localisation dans la fosse nasale est exceptionnelle. Nous rapportons un cas de carcinome adénoïde kystique de la fosse nasale chez une patiente de 42 ans qui se présente pour une symptomatologie nasale. La tomodensitométrie objective un processus tissulaire de la fosse nasale droite, l'endoscopie montre une tumeur s'étendant au vestibule avec à la biopsie un carcinome adénoïde kystique. La prise en charge chirurgicale a consisté en une exérèse de la tumeur avec maxillectomie totale suivie d'une radiothérapie

Localisation nasosinusienne des tumeurs plasmocytaires

Introduction : Les tumeurs plasmocytaires representent 3 a 4 des tumeurs des cavites naso-sinusiennes. Elles necessitent un bilan diagnostique specifique et une prise en charge adequate. Nous nous proposons d'etudier les particularites diagnostiques et therapeutiques des plasmocytomes naso-sinusiens. Materiel et methodes : Notre etude est retrospective comportant 5 cas de plasmocytomes naso-sinusiens confirmes histologiquement. Resultats : Il s'agit de 3 hommes et 2 femmes ages de 32 a 77 ans. Le plasmocytome avait une localisation sphenoidale dans un cas; nasale dans 2 cas; ethmoido-nasale dans un cas et naso-maxillaire dans le cas restant. Il s'agissait d'un myelome multiple dans un cas. Trois patients ont eu une radiotherapie. Celle-ci etait associee a une chimiotherapie dans le cas du myelome multiple et a une exerese chirurgicale dans les 2 autres cas La chirurgie a ete seule dans un cas. La chimiotherapie exclusive a ete proposee dans un cas de plasmocytome localement avance mais le patient a ete perdu de vue. Pour les patients suivis; une seule recidive a ete notee a 18 mois. Conclusion : La presentation clinique des plasmocytomes nasosinusiens est aspecifique. Le diagnostic est confirme par l'histologie. Le pronostic est domine par la presence ou non d'un myelome multiple et par la taille tumorale. Un suivi prolonge est necessaire

Immunologic Factors in Patients with Chronic Polypoid Sinusitis

Background: Nasal polyposis is the benign protrusion of soft tissue into the nasal cavity; with multifactorial origin. This study is designed to examine the suggested role of IgE and CD and CD lymphocytes in the pathogenesis of 4 8 nasal polyposis. Method: Blood samples were taken from 32 patients with chronic polypoid sinusitis and 32 controls. CD and CD 4 8 total lymphocyte count were determined by flow cytometry and the level of serum IgE was measured by ELISA. Nasal discharge samples were also collected for determining IgE level in both patients and controls during surgery. Results: In 68.8of patients a history of allergy was present. The level of nasal discharge IgE was significantly higher (p0.001) in patients compared to controls; but the difference between serum IgE levels was not significant (p 0.05). CD concentration and blood lymphocytes were 8 significantly higher (p0.001) in the patients group; while CD concentration was significantly lower (p0.001) in 4 them. Finally; CD /CD ratio was significantly lower 4 8 (p0.001) in the patients group. Conclusion: This study suggests that a change in the amount of CD and CD lymphocytes and an increased 4 8 level of local IgE contribute to nasal polyposis; but the results should be confirmed in more extensive studies including cytokine analyses. Such increasing insights in the patho physiology of nasal polyposis open perspectives for new pharmacological treatment options; with immunologic factors as potential targets.of patients a history of allergy was present. The level of nasal discharge IgE was significantly higher (p0.001) in patients compared to controls; but the difference between serum IgE levels was not significant (p 0.05). CD concentration and blood lymphocytes were 8 significantly higher (p0.001) in the patients group; while CD concentration was significantly lower (p0.001) in 4 them. Finally; CD /CD ratio was significantly lower 4 8 (p0.001) in the patients group. Conclusion: This study suggests that a change in the amount of CD and CD lymphocytes and an increased 4 8 level of local IgE contribute to nasal polyposis; but the results should be confirmed in more extensive studies including cytokine analyses. Such increasing insights in the patho physiology of nasal polyposis open perspectives for new pharmacological treatment options; with immunologic factors as potential targets

Immunological Role of Nasal Staphylococcus aureus Carriage in Patients with Persistent at Allergic Rhinitis

Nasal carriage of staphylococcus aureus (S.aureus) exerts immunomodulatory effect in patients with atopic dermatitis and it may contribute to airway inflammation and allergic response in patients with allergic rhinitis. We Aim to investigate the frequency of nasal S.aureus carriage in patients with persistent allergic rhinitis and its possible influence on their symptoms and immune markers. We chosed 20 non smoker patients with house dust mite (HDM) allergy causing allergic rhinitis and 20 non smoker healthy subjects matched for age and sex. For all subjects rhinoscopy was done; skin prick test; nasal culture for S.aureus; nasal interleukin 4;nasal total IgE; serum total IgE and serum specific IgE(SSIgE) for HDM. Nasal S.aureus was detected in 16/20 patients (80) and 5/20 (25) in healthy subjects with highly significant statistical difference p0.01. Correlation of nasal staph.aureus count and different systemic and local immune markers revealed highly significant positive correlation between nasal S.aureus count and serum total IgE (r

Immunological Role of Nasal Staphylococcus aureus Carriage in Patients with Persistent at Allergic Rhinitis

Nasal carriage of staphylococcus aureus (S.aureus) exerts immunomodulatory effect in patients with atopic dermatitis and it may contribute to airway inflammation and allergic response in patients with allergic rhinitis. We Aim to investigate the frequency of nasal S.aureus carriage in patients with persistent allergic rhinitis and its possible influence on their symptoms and immune markers. We chosed 20 non smoker patients with house dust mite (HDM) allergy causing allergic rhinitis and 20 non smoker healthy subjects matched for age and sex. For all subjects rhinoscopy was done; skin prick test; nasal culture for S.aureus; nasal interleukin 4;nasal total IgE; serum total IgE and serum specific IgE(SSIgE) for HDM. Nasal S.aureus was detected in 16/20 patients (80) and 5/20 (25) in healthy subjects with highly significant statistical difference p0.01. Correlation of nasal staph.aureus count and different systemic and local immune markers revealed highly significant positive correlation between nasal S.aureus count and serum total IgE (r

Traditional Open Surgery for Advanced Benign Nasal Tumours in an Era of Endoscopy: Review of 38 Cases

During the past decade open nasal surgery has been overtaken by endoscopic resection in the management of benign sinonasal tumours in the advanced countries. However; due to limited availability of endoscopic surgical facilities and training in most parts of sub-Saharan Africa; open surgery still seems popular. This report determines the indications and outcome of open nasal surgery for benign tumours in a resource - poor tertiary centre in sub-Saharan Africa and compares with endoscopic resection. This is retrospective study of 38 open surgeries done by the authors for cases of benign sinonasal tumours. Seventeen (45) caldwel-luc procedures; 12 (31) external (lynch-howarth) fronto-ethmoidectomy and 9(24) lateral rhinotomy were carried out. The indications were simple nasal polyps 17(45); mucocoele 10(26); inverted paplloma 8(21); invasive fungal sinusitis 2(5) and ossifying fibroma 1(2). Postoperatively; recurrence was 1/17(6) caldwel-Luc surgery and 1/9 (11) lateral rhinotomy for inverted papilloma. Facial scar was seen in 21/38(55) but the cosmetic effect of the scars was acceptable to our patients. Postoperative stay was between 5 to 17 days. We conclude that open nasal surgery met the therapeutic expectations of our patients. The recurrence rate compared with that of endoscopic resection reported in the literature and cosmetic effect of facial scar was acceptable to the patients; however; postoperative stay in the hospital is longer. It is our hope that this will serve as a baseline to compare the result of endoscopic nasal surgery in future when it becomes a widespread procedure in the developing countries

Revue generale sur les rhinolithiases : a propos de 20 cas

Cette etude rapporte 20 cas de rhinolithiases colliges entre 1990 et 2007. La population concernee surtout des adultes (55de sexe feminin) ayant le plus souvent des conditions socio-economiques defavorables. Le tableau clinique est simple et non specifique : rhinite obstructive purulente unilaterale et fetide. Des presentations deroutantes sont possibles mais rares (infection sinusienne; oculo-palpebrale). Le diagnostic repose sur l'examen endonasal notamment a l'optique rigide. Le scanner est tres interessant pour un bon bilan loco-regional permettant en particulier de reconnaitre les lesions associees ou sous-jacentes. L'extraction par les voies naturelles le plus souvent sous anesthesie locale etait le procede therapeutique habituel. Les rhinolithes avaient entre 5 et 50 mm de diametre avec seulement 3 corps etranger associes (15). Les complications sont rares (epistaxis : 10) et l'evolution etait le plus souvent favorable