[Adenoid cystic carcinoma of the parotid with facial nerve invasion]

Adenoid cystic carcinoma comprises approximately 10% of all epithelial salivary neoplasms and most frequently involves the parotid. Perineural invasion is a common feature but intraneural invasion and spread is less common. The authors report a case of parotid adenoid cystic carcinoma with invasion and spread via the facial nerve with an emphasis on radiologic features. We report a case of a 47-year-old man presenting with a right submandibular mass evolving for 4 years. On physical examination, the mass was firm painless, well delineated. There was no facial paralysis. The magnetic resonance imaging [MRI] examination showed a right parotid gland solid mass located in the deep lobe of the parotid gland with mastoid bony involvement.The mass was heterogenously enhanced. High resolution non contrast computed tomographie [CT] scan of the temporal bone showed in the axial and coronal cuts, a widening of the mastoid segment of the facial canal with involvement of the facial nerve. Pathologic examination of the resected specimen revealed histological features of adenoid cystic carcinoma with intra neural invasion of the mastoid segment of the facial nerve. The surgical margins were free. The evolution was favourable 5 years later. This study confirms that multiplanar approach of MRI allows rapid detection of adenoid cystic carcinoma. The influence of intraneural invasion and spread on survival remains controversial

[Traumatic head injury in children in south Tunisia epidemiology, clinical manifestations and evolution. a propos 454 cases]

To determine epidemiological, causes, clinical and Para clinical manifestations and outcome in children with traumatic head injury in south Tunisia. A retrospective study over a 8 year period [1997 - 2004] of 454 children's with head injury admitted to the Intensive Care Unit [ICU] of a university hospital [Sfax-Tunisia]. Basic demographic, clinical, biological and radiological data were recorded on admission and during the ICU stay. Mean age [SD] was of 7, 2 - 3, 8 years. The main cause of trauma was traffic accidents [69, 4%]. There were a predominance of male patient's with a sex-ratio of 2, 21. The Score of coma of Glasgow adapted to the child, was on average from8-3 points. Extra-cranial pathology was present were observed in 38, 9%. The cerebral CT-Scan performed on admission for all patients was pathological in 86, 3% of the cases. The most observed lesions were meningeal Haemorrhage [35, 2%] and the cerebral contusion [34, 5%]. According to the " Traumatic Coma Dated Bank classification " we noted a high proportion of type 2 group[46%]. Secondary systemic insults were observed in 377 children [83%]. Evolution was marked by the death of 82 children [18%]. Among survivors, a good recovery was observed in 229 children [50%]. In Tunisia, head injury is a frequent cause of hospitalization. It is essentially involved in traffic accidents. The short term prognosis is poor with a high [18%] mortality. Prevention is highly advised