[Tuberculosis of the upper aerodigestive tract]

Tuberculosis of upper aerodigestive tract is rare. Was to report our experience in the diagnosis and the management of this disease with a review of the literature. We carried a retrospective study between 1990 and 2005, about 10 cases. Diagnosis of tuberculosis was confirmed by histopathological examination. All patients were treated with antituberculous chemotherapy. Follow-up was based on clinical, biological and endoscopic examinations with a mean duration of 24 months. Mean age was 29 years. Nine patients were male. Clinical examination and panendoscopy showed nasal, pharyngeal and laryngeal lesions respectively in 1, 6 and 3 cases. Sputum examinations were negative in all cases. After confirming diagnosis by biopsy and anatomopathological examination, all patients received antituberculous treatment for 8 to 9 months. Nine patients were followed regularly. They had all recovered from their symptoms, and lesions had completely disappeared. Tuberculosis of upper aerodigestive tract must be suspected in front of unusual evolution of any nasal or laryngo-pharyngeal symptom. Early and well-conduced medical treatment achieves a good outcome

[Endonasal surgery in the management of choanal atresia]

To assess results after surgical management of choanalatresia in order to determine indications and advantages of endonasal surgery. We carry a retrospective study about 25 patients having choanal atresia treated in our department between 1987 and 2005. All patients had had nasal endoscopy and sinonasal CT. Treatment was surgical in all cases. Three surgical techniques were performed. Postoperative follow-up was endoscopic with a mean period of 4 years. Atresia was unilateral in 21 patients and bilateral in 4 neonates. After emergently putting of a Mayo cannula and endoscopic control, divulsion was performed in the 4 bilateral forms. For unilateral atresias, transpalatal approach was performed in 4 cases and endonasal approach in 17 cases. Fibrous restenosis occurred in 6 cases. It happened in 3 children operated by endonasal approach, in 2 operated by transpalatal approach and in one that underwent divulsion. All revision surgeries were performed by endonasal approach using the laser diode. Thus, a definitive repermeabilisation of malformed choana was achieved for all cases. Endonasal surgery is now the treatment of choice of choanal atresia, with a high success rate and minimal risks of complications

[Congenital cysts and fistulas of the neck in children and adolescents]

Congenital malformations of the neck make up a wide range of pathological processes in children. They present as cysts or fistulas. A retrospective study was performed in order to present an overview of the relevant embryology, pathophysiology, epidemiology and diagnostic modalities for these anomalies. It describes a serial of 117 children treated for congenital cysts and fistulas of the neck between 1994 and 2006. The average age was 12 years. Malformations of the midline included the thyroglossal duct cyst [89 cases], dermoId cysts [7 cases], thymic cysts [2 cases] and cervical cleft in one case. The commonest malformations of the laterocervical region were cysts and fistulas of the 2nd cleft [10 cases], fistulas of the 3rd cleft [5 cases] then cystic hygroma [2 cases]; the 4th cleft fistula was found in only one case. All the patients undertook a surgical treatment except one who had sclerotherapy for an extended cystic lymphangioma. The complications of these malformations, especially infectious, do not result from a difficult management, which is well codified but from the diagnosis delay. An accurate preoperative diagnosis and appropriate surgical therapy are essential to prevent recurrence and to ensure optimal cosmetic outcomes