Les goitres plongeants : particularites cliniques; radiologiques et therapeutiques

Introduction: Les goitres plongeants; devenus rares de nos jours; posent des problemes diagnostiques et chirurgicaux particuliers. Leur prise en charge est facilitee par l'apport de la tomodensitometrie permettant de planifier l'attitude therapeutique.Le but de ce travail est de preciser les modalites d'exploration et de prise en charge chirurgicale des goitres plongeants. Materiels et methodes : Nous rapportons une etude retrospective portant sur42 cas de goitre plongeant colliges sur une periode de 11 ans entre 2001 et 2011. Resultats : L'age moyen de nos patients etait de 56;9 ans (36-86 ans). Le sex-ratio etait de 0;13. La tumefaction basi-cervicale etait le motif de consultation le plus frequent; rapportee dans 74 des cas associee a des signes de compression oesotracheale dans 45 des cas.Une paralysie recurrentielle unilaterale a ete objectivee dans 3 cas.Une radiographie de thorax a montre un elargissement mediastinal dans 23 des cas avec deviation tracheale chez 63 des malades. Une TDM cervico-thoracique pratiquee dans 85 des cas a confirme le diagnostic. Le traitement chirurgical etait mene par voie cervicale exclusive chez tous les patients. Une paralysie recurentielle a ete observee dans 3 cas. Aucune hypoparathyroidie definitive n'a ete rapportee avec un reculmoyen de 24mois. Conclusion : Les goitres plongeants devenus rares du fait de la prise en charge plus precoce des nodules thyroidiens. Ils posent actuellement moins de difficultes therapeutiques. L'indication chirurgicale est toujours formelle devant le risque vital qu'ils posent

Laryngocele à propos de 9 cas

La laryngocele est une pathologie rare. elle est definit par la dilatation progressive du saccule larynge. Le diagnostic est suspecte par l'examen clinique; sa prise en charge est encore discutee. nous rapportons une etude retrospective portant sur 9 patients ayant ete suivis et traites pour une laryngocele. La serie a ete colligee sur une periode de 14 ans; allant de 1998 a 2011. Six de nos patients avaient une laryngocele externe; deux patients avaient une laryngocele mixte et un patient avait une laryngocele interne. Une surinfection a ete notee chez trois patients realisant ainsi le tableau de pyolaryngocele. Tous les patients ont eu un examen clinique complet comportant un examen OrL et cervico-facial ainsi qu'un examen larynge au nasofibroscope. La tomodensitometrie cervicale a ete realisee de facon systematique. Huit de nos malades ont ete abordes par voie cervicale permettant une exerese complete du sac. Le recul moyen etait de 38 mois sans recidive. Toute laryngocele decouverte; doit etre traitee afin d'eviter les complications essentiellement locales pouvant mettre en jeu le pronostic vital. Les modalites therapeutiques dependent du type de la laryngocele

[Tumors of salivary glands: anatomical study and clinical epidemiology of a series of 180 cases]

The salivary gland tumors are rare [less than 3% of all tumors] and poorly known. In fact, they are numerous and histologically difficult to diagnose. This work aims to point at the different histological types of salivary gland tumors, to draw out the principal epidemiological, clinical, radiological and histological characteristics, and to compare our cases to those of the literature. Accordingly, we performed a descriptive type study about 180 cases of salivary gland tumors from the departments of pathology and oto-rhino-laryngology of Habib Thameur hospital during 25 years, extending from April 1979 to December 2004. Benign tumors were predominant [88%], while malignant ones represented 12% of our cases dominated by carcinomas. The sex-ratio was 0.96. Parotid gland location was the most frequent one, and pleomorphic adenoma was the most frequent tumor [62%]. Histological diversity of salivary tumors results in difficulties for differential diagnosis. These problems can be solved by a precise diagnostic approach and sometimes by an immunohistochemistry study

Causes and management of failure in endoscopic middle meatus antrostomies

The aim of this study is to analyse the causes and the management of failed endoscopic middle meatus antrostomies [EMMA] in chronic sinusitis and benign sinonasal lesions or tumors. We carried a retrospective study about 257 EMMA cases performed in our department for 201 patients between 1996 and 2006. All patients had complete ORL examination and preoperative sinonasal CT. After surgery, preoperative and postoperative symptoms were compared and nasal endoscopy was performed in all cases. Persistent rhinologic and radiological symptoms were considered as a failure of surgery. In these cases, revision surgery was performed, either by endoscopic approach or by Caldwell-Luc procedure. Mean follow-up period was 2 years. The indication of surgery was the presence of chronic sinusitis, benign lesions or benign tumors in 53.2%, 41.8% and 5% of cases respectively. Seventy-one EMMA procedures failed [27.6%]. Causes of failure were mainly represented by the presence of synechia [38%], ostium stenosis [24%], medical causes and comorbidity [15.5%], persistent or recurrent lesions [15.5%] and missed natural ostium [7%]. Nineteen patients [9.4%] required revision surgery because of persistent symptoms after medical therapy. Either endoscopic or vestibular approaches were performed. Seventy-three percent of the revision cases respond to surgical treatment with complete resolution of symptoms. Failure of EMMA can be due to numerous and variable causes. The management of failed EMMA includes medical therapy, revision endoscopic surgery or vestibular approaches

[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

Le kyste de la vallecule a propos de 2 observations

Le kyste de la vallecule est une malformation laryngee rare pouvant parfois mettre en jeu le pronostic vital. Diagnostique et traite a temps; le risque de complications et de morbidite peut etre ecarte. Les auteurs rapportent 2 cas de kystes de la vallecule. La tomodensitometrie a confirme la presence d'une formation kystique prenant origine au niveau de la vallecule. Une laryngoscopie directe a ete faite pour les 2 patients sous anesthesie generale. Le premier malade a eu une resection endoscopique complete du kyste et le 2eme une large marsupialisation au Laser. L'examen anatomopathologique a confirme la benignite de la formation kystique dans les 2 cas

[Recurrent upper respiratory tract infections in children and allergy: a cross-sectional study of 100 cases]

Upper respiratory tract [URT] infections are common in children. The knowledge of their risk factors allows in some cases better management. The aim of our study is to evaluate the role of allergy in this pathology. Through a cross-sectional study about 100 children having recurrent URT infections, we evaluated the prevalence of allergy in order to find a relation between the two pathologies in general, and between allergy and each recurrent pathology. The results were compared with those of a reference group involving 164 children. Our study confirms a statistically significant association between allergy and, recurrent URT infections [p=0,01], also between allergy and rhinopharyngitis [p=0,02], rhinosinusitis [p=0,001] and acute otitis media [p=0,01]. Allergy represents a risk factor for recurrent URT infections, particularly for rhinopharyngitis, rhinosinusitis and acute otitis media. Adequate management of allergy may consequently be beneficial for the treatment and the prevention of these infections

Plummer vinson syndrome

Plummer Vinson syndrome is a rare affection which affects mainly white women. It is characterized by dysphagia, iron deficiency and the presence of superior esophageal web. Aim: The purpose of this study is to precise the epidemiological, clinical, paraclinical and therapeutical features of the affection. We report 19 cases of Plummer Vinson syndrome collected over 15 years [1990- 2004]. Dysphagia is the main symptom observed in 100% of the cases. 89,4% of the patients had anemia and 15 hyposideremy. All the patients were treated with iron supplementation and endosco-pic treatment [dilatation and rupture of esophageal webs]. Three patients necessitate multiple sessions of endoscopic dilatation and 15 had favourable evolution. The malignancy was observed in one case

[Idiopathic sudden sensorineural hearing loss what's the appropriate management]

Background: Sudden sensorineural hearing loss remains a challenge in otology, controverse affect mainly etiopathogeny and treatment

Aim: To evaluate our experience in the diagnosis and the treatment of sudden hearing loss

Methods: We report a retrospective study including 30 patients presenting a Sudden sensorineural hearing loss. All patients were hospitalized for treatment. The audiometry evaluated the hearing deafness before and after treatment

Results: The average age was of 48 years. In all the cases no etiology has been found

All The patients were hospitalized and corticotherapy was administrated in all cases. It was associated to hyperbare oxygenotherapy in 7 patients

Recovery was observed mainly in patients with moderate [71.4%] and severe hearing deficiency [69.2%]

Conclusion: corticosteroids are the less controversed treatment of sudden sensorineural hearing loss

[Naso-sinusienne sarcoidosis]

Background: Sarcoidosis is an ubiquity disease, which can infiltrate all tissues. The cutaneous and ophthalmologic thoracic localizations are most frequent. The nasosinusienne localisation is rare

Aim: The authors report their observations of 4 patients: 2 men and 2 women with a mean age 47,5 years [42-56]. These cases was diagnosed and treated between January 1998 and December 2003 in the ENT service of the Habib Thameur hospital

Cases: The diagnosis was related to a nasal or a sinuses biopsy. The assessment of extention was negative in 3 cases. The corticoid treatment in local pulverization was sufficient in 2 cases. The corticoid treatment by systematic way was obtained in all the cases. The naso sinusienne localization is rare, it is exceptionally isolated. The clinical and radiological symptoms are not specifics. Principal element of the symptoms are not specifics. Principal element of the diagnosis is the directed biopsy, easy in this localization

[ laryngopyocele]

Background: The laryngopyocele is a laryngocele complication

Aim: We report two cases that were treated in Habib Thameur Hospital ENT service

Cases: There were an 81 old woman and a 31 old man who consult for an infectious syndrome with a lateral neck masses. The diagnosis was obtained by clinical and endoscopic examination and was confirmed by CT. The man was operated. On antibiotics were prescribed for both. They had a well recovery

[Chronic laryngitis in adults]

Chronic laryngitis is a lingering inflammation of the laryngeal mucosa, caused by specifc aetiology and often irritative factors. To discuss clinic and therapeutic aspects of the pathology. We report a retrospective study about 25 patients treated and followed for non specific chronic laryngitis over a period of 11 years [1994-2004]. The average age of the patients was 54, 2 years. Tobacco intoxication was noted in 72,7 of cases and Gastroesophageal reflux in 2 cases. The endoscopic examination of laryngeal lesions, realized in all cases, notes laryngeal keratosis in 88% of cases and congestive laryngitis in 12%. Histological analysis of the lesions reveals a dysplasia in 44% of cases. Clinical and endoscopic follow up of the patients discover malignant development in 5 patients. The treatment of chronic laryngitis is based on the suppression of etiologic factors and on laryngeal microsurgery with micro instruments and with laser techniques

Prise en charge de l'hyperparathyroide primaire : a propos de 25 cas et revue de la litterature

Objectif : Les auteurs rapportent leur experience dans la prise en charge de l'hyperparathyroidie primaire (HPTP) et comparent leurs resultats par rapport aux donnees de la litterature en discutant les avantages potentiels des differentes techniques chirurgicales. Materiel et methodes : Il s'agit d'une etude retrospective a propos de 25 patients colli-ges sur 8 ans (1998-2005). Tous les patients ont beneficie d'une echographie cervicale; d'un bilan renal et d'un dosage de la calcemie et de la parathormonemie (PTH). Une TDM cervicale a ete pratiquee dans 8 cas et une IRM dans 3 cas. Une scintigraphie a la tetrofosmine a ete realisee dans 10 cas; et a double isotope (thallium 201-technetium 99) dans 2 cas. Une cervicotomie avec exploration bilaterale systematique des 2 loges thyroidiennes a ete pratiquee dans tous les cas. En postoperatoire; la surveillance a ete clinique et biologique avec un recul moyen de 22 mois. Resultats : La calcemie etait elevee chez 23 patients et la PTH dans tous les cas. L'echographie a detecte une hypertrophie d'une glande parathyroide chez 14 patients (56) et de 2 glandes chez 1 seul patient. La TDM cervicale a permis de localiser la lesion dans 5 cas. L'IRM etait normale dans les 3 cas ou elle a ete pratiquee. La scintigraphie a montre une hyperfixation dans 8 cas. Une exerese d'adenomes a ete pratiquee dans 92 et une parathyroidectomie subtotale dans 8 des cas. Le taux de guerison etait de 88 apres premiere intervention. Une reprise chirurgicale avec exerese d'adenome a ete pratiquee chez 2 patients (8). Par ailleurs aucune complication n'a ete notee en postopera-toire. Conclusion : La chirurgie parathyroidienne classique donne de bons resultats avec des taux de guerison eleves et un taux de morbidite global faible. Ces resultats sont comparables avec ceux de la litterature. La chirurgie mini-invasive donne des resultats semblables mais impose des imperatifs techniques; une imagerie performante et des patients rigoureusement selectionnes

[Surgical treatment of graves' disease. Retrospective study of 40 cases]

Graves' disease is an autoimmune disorder. Its diagnosis is easy. Its treatment is delicate in lack of etiologic treatment. We report a retrospective study of 40 cases operated in nine years period. The failure of the medical treatment constituted the main operative indication in our series [57,5 %]. A subtotal thyroidectomy have been accomplished in 72,5 % and total thyroidectomy in 22,5% of cases. We noted one case of definitive hypoparathyroidism after surgery. Our endocrinal results were caracterised by the occurrence of hyperthyroidism in 2 cases after subtotal thyroidectomy. For many authors, surgery is the best treatment of graves' disorder and the actual tendency is to realise a total thyroidectomy. Our results encourage us to adhere to the theraputic method

[Predictors factors of mortality in combined coronary and valvular surgery. 46 cases]

From 1994 and 2003, 46 patients underwent surgical myocardial revascularisation associated to valvular surgery. Surgical indications were for valvular disease in 13 cases [28%], for coronary disease in 16 cases [35%] and associated coronary and valvular disease in 17 cases [37 %]. Isolated conservative mitral repair was performed in 22 cases [48 %]; mitral valve replacement in 10 cases [41%], aortic valve replacement in 11 cases [46%] associated mitral and aortic surgery in 3 cases [13 %]. intro-aortic balloon pump was used in 4 patients [9 %]. In the post operative period complete atrio-ventricular heart bloc occurred in 2 cases. For the entire group, 8 deaths [17 %] occurred in the hospital, related to low cardiac output in 5 cases [63%].Long term follow up was achieved in a mean period of 18 months. 25 patients [68%] were asymptomatic and one late death occurred after severe heart failure. The predictive factors of hospital mortality were: preoperative ischemic mitral insufficiency. Various large series in the literature have documented operative risk of myocardial revascularisation when combined with valve surgery. In our group the high rate of hospital mortality [17 %] explanes the difficulties in medical and surgical care of this combined valvular and coronary disease especially in the perioperative period