Primary carcinoma of the larynx in females: A case series.

Background and aim: In north Africa, laryngeal carcinomas remain a predominately male pathology. While in many countries the gap between men and women is narrowing. This study aimed to examine the epidemiological, clinical, therapeutic, and follow up data of a case series of 23 female patients treated for laryngeal carcinoma. Patients and methods: Medical records of a case series of 23 patients for primary carcinoma of the larynx at the Department of Head and Neck Surgery of the 20 August Hospital of Casablanca, between January 2012 and September 2016, were reviewed. Demographic, clinical, endoscopic, radiological, surgical, and follow-up data were collected. Results: 7% of all the patients treated for LC were women, The most affected age group was between 60 and 79 years (52%), 52% had no major risk factor, all patients had an epidermoid carcinoma, 48% of patients had T2 tumors. T1, T3, and T4a were found in respectively 17%, 22%, and 13%. N1 in 43% of the cases (n = 10), N0 in 35% (n = 8), N2b in 17% (n = 4), N2c in 4% (n = 1). All patients were M0. All the patients in this series have undergone surgical treatment. At 5 years, the survival rate was 83%. Conclusion: Since the proportions of women in published studies are limited, there are still many controversies about gender differences in laryngeal cancer. Therefore, further studies should seek a clearer understanding of factors involved in female laryngeal cancer to adopt more appropriately the measures of prevention and early diagnosis.

Cervical approach to cervico-mediastinal goiters: Experience of a Moroccan ENT tertiary center - Case series.

BACKGROUND: The purpose of the study was to analyze and discuss the demographic, clinical, radiological, therapeutic and postoperative findings of the Cervico-mediastinal goiters (CMG) treated through a cervical approach admitted in the ENT department of Ibn Rochd university hospital, Casablanca, Morocco between January 2014 and January 2020. MATERIELS AND METHODS: Over a period of 6 years, 116 patients underwent surgical treatment for CMG. It was defined as a goiter extending below the plane of superior thoracic aperture on CT scan. All our patients had clinical, biological and radiological assessment before surgery. A nasofibroscopy was carried out pre and postoperatively. All the CMG have been extracted trough a cervical approach by an experimented ENT surgeon. RESULTS: 84,48% of the CMG was diving into the anterior mediastinum and 15.52% into the posterior. The CMGs extended above, at, and below the level of the aortic arch respectively in 76.72%, 18.10% and 5.17% of the patients. All of 116 goiters were successfully removed through a cervical approach. No patient required a sternotomy. Postoperatively, vocal cord paralysis was transient in 3 patients (2.58%) and permanent in 2 patients (1.72%). Hypocalcemia was transient in 10 patients (8.62%) and permanent in 2 patients (1.72%). Final histology found 106 benign multinodular goiters (91.37%), 7 papillary carcinomas (6.03%) and 3 vesicular carcinomas (2.58%). No death was noted. CONCLUSIONS: With expertise in thyroid surgery, cervical approach for CMGs is safe and sufficient in the majority of the cases with low morbidity rate and no mortality.

Spindle cell hemangioma in the infratemporal fossa: A unique case report.

INTRODUCTION: Spindle cell hemangioma (SCH) is a rare vascular tumor which was first described in 1986. It affects mostly the distal extremities. The head and neck are rarely involved. This article reports the first case of SCH in the infratemporal fossa. PRESENTATION OF CASE: A 41-year-old woman presented with an 8-month history of right cheek swelling. Facial CT scan and MRI showed an intensely and heterogeneously enhancing tumor of the infratemporal fossa suggesting an angiomatous neoplasm. The mass was excised surgically through an anterior maxillary approach. The histopathological and immunohistochemistry analysis revealed a SCH. CONCLUSION: This case report presents a unique presentation of a Spindle cell hemangioma in an unexpected location of the head and neck region. it underlines the importance for clinicians and pathologists to consider the Spindle cell hemangioma as a possible etiological diagnosis of infratemporal fossa tumors.

Substernal goiter: Experience with 50 cases.

INTRODUCTION: Goiter is localized or generalized thyroid hypertrophy. It is usually cervical, but may show intra-thoracic development beyond the thoracic inlet and down to the mediastinum: i.e., substernal goiter. The purpose of this study was to analyze the epidemiological, clinical and paraclinical profile of substernal goiter and the difficulties of management. MATERIAL AND METHODS: A retrospective study included 50 cases from our ENT department. RESULTS: Mean age was 47 years, with a sex ratio of 0.06. Clinical symptomatology was dominated by medial anterior cervical swelling. Compression signs were observed in 26 patients, and cervical lymph nodes in 3. Mean time to consultation was 7 years. Fiberoptic endoscopy found vocal cord palsy in 3 patients. Cervical ultrasonography was the first-line diagnostic test. Cervical-thoracic CT scan was requested in 45 patients to study thoracic extension and the relation of the thyroid mass with the supra-aortic vascular axes. Treatment systematically comprised total thyroidectomy on a cervical approach. There were 6 cases of malignancy. DISCUSSION-CONCLUSION: Substernal goitre is fairly frequent. Despite particularities, an exclusively cervical approach is sufficient in a large majority of cases. The substernal nature of the goitre did not have major impact on postoperative complications.

Nasal foreign bodies: Results of a study of 260 cases.

AIMS: Insertion of a foreign body in the nasal cavity is a very common incident in children. It is easily diagnosed, but the type of foreign body varies and extraction can sometimes be difficult, with risk of complications. The present study reports nasal foreign bodies seen in emergency in our ENT department, with an update on the state of knowledge. MATERIALS AND METHODS: A prospective study between May and August 2011 included all patients admitted to the ENT emergency unit for nasal foreign body. Data comprised age, gender, circumstances of discovery, symptoms, type of foreign body, extraction method and complications. RESULTS: Two hundred and sixty cases of nasal foreign body were included, representing 4.3% of all consultations in the unit. Mean age was 3 years (range: 1-16 years); the sex ratio was 1.4 (male predominance). The incident was reported by a family member or the actual child in 76.9% of cases (n=199), or discovered following nasal symptoms in 23.1% (n=61). The main types of foreign body were non-organic synthetic beads in 18.8% of cases and vegetable forms in 17.7%. Extraction was easy, using forceps, micro-hooks or suction, in 91.53% of cases. Complications comprised infection (n=48), epistaxis (n=18) and nasal septum perforation (n=1). CONCLUSION: Nasal foreign bodies are a frequent accident in medical practice, especially in young children. They are generally harmless, but may incur complications if overlooked or when a button cell is involved, whence the importance of timely extraction. The best treatment, however, remains prevention.

Complicated actinomycosis of the temporal bone: A historical case report.

INTRODUCTION: Actinomycosis is a chronic infection caused by anaerobic Gram-positive bacteria belonging to the Actinomyces family. The zones of predilection of this infection are mainly the head, neck and abdominal regions. CASE REPORT: We report the case of a 30-year-old man admitted for aggressive right oto-mastoiditis complicated by facial nerve palsy and sensorineural hearing loss. CT scan demonstrated extensive destruction of the temporal bone. The patient underwent radical mastoidectomy followed by long-term antibiotic therapy. DISCUSSION: Its non-specific symptoms and atypical course, combined with difficult isolation of the causative agent, make actinomycosis a difficult infection to diagnose. Actinomycosis very rarely involves the temporal region, as fewer than 30 cases have been reported in the literature. Treatment of this form of actinomycosis is based on surgery and prolonged antibiotic therapy. Surgical treatment is designed to reduce the bacterial load by mechanical debridement and create aerobic conditions. CONCLUSION: Compared to other cases reported in the literature, the case of temporal actinomycosis reported here was distinguished by its highly aggressive nature. Temporal actinomycosis should be suspected in the context of chronic otitis media with an atypical course. Treatment is based on a combination of surgery and antibiotics.

[A rare and unusual cause of dysphonia: The leech]. / Une cause rare et inhabituelle d'une dysphonie: la sangsue.

We report a case of dysphonia associated with intermittent episodes of hemoptysis low abundance in a patient aged 32, clinical examination is normal, nasofibroscopie objective a leech at the laryngeal orifice, extracted by direct laryngoscopy in emergency.

[Malignant melanoma of the mandibular gingiva]. / Le mélanome malin de la gencive mandibulaire.

INTRODUCTION: The oral melanoma (OM) account for 1% of all melanomas. The prognosis is poor despite an adequate locoregional control of the disease. OBSERVATION: A 47 year old women consulted for a blackish lesion of the mandibular gingiva next to tooth 37. Intraoral examination showed a dark pigmented lesion on the lingual side of the left mandibular molar region, extending from tooth 37 to the trine retro left molar. The biopsy confirmed the diagnosis of mucosal nodular melanoma. A wide surgical excision without ipsilateral neck dissection was performed. The treatment was completed by 30 Gy external beam radiotherapy, the patient died 18 months after the first consultation. DISCUSSION: Oral melanomas have a poor prognosis probably because they are generally detected late. The most common sites for oral melanomas are the palate and maxillary gingival, malignant melanoma of the mandibular gingiva is extremely rare. About 30% of OM is preceded by areas of oral pigmentation for several months or years. The prognosis is poor with a 5% to 20% five-year survival rate.

[Epidemiology of paediatric emergencies in ENT]. / Epidémiologie des urgences pédiatriques en ORL.

OBJECTIVE: To assess the prevalence and severity of pediatric emergencies in ENT in Casablanca. MATERIAL AND METHODS: This is a retrospective study over two years from January 1st 2010 to December 31, 2011, covering 2220 pediatric othorhinolaryngology emergencies observed in the emergency department of the "20 August Casablanca" hospital. RESULTS: Males predominate and account for 72.25% compared to 27.74% of girls. The mean age was 7.5 years ranging from 03 months to 15 years. Five pathologies top the list; head and neck wounds (28.11%), foreign bodies (21.62%), infectious emergencies (21.57%), blunt trauma (16.39%), and finally hemorrhages from natural orifices (11.22%). CONCLUSION: This study assessed the prevalence and severity of ENT emergencies in children in Casablanca.

[Pott's puffy tumor, a rare complication of frontal sinusitis]. / Tumeur de Pott, complication rare de la sinusite frontale.

Port's puffy tumour (PPT), corresponding to frontal osteomyelitis causing erosion of the anterior wall of the frontal sinus and subperiosteal abscess, is a rare but serious complication of frontal sinusitis or trauma to the region. It can occur even despite the use of antibiotics and requires surgical drainage of the abscess, excision of pathological tissues and obliteration of the frontal sinus by various materials. It can rarely progress to life-threatening intracranial extension. Practitioners must be extremely cautious in the presence of clinical signs suggestive of Pott's puffy tumour. The aim of this article is to present a case of progressively evolving PPT in a patient of 28 years by frontal headaches that are aggravated by painful swelling front soft and fluctuating by palpation and that has fistulated at the right upper eyelid. CT scan of the face revealed the presence of a discontinuity bone at the anterior wall of the right frontal sinus. The treatment consisted of surgery and antibiotics. The patient remained asymptomatic after a decline of 18 months.

[Recurrent ameloblastoma on a rib graft after 33 years (a case report and review of the literature)]. / Récidive d'un améloblastome sur greffe costale après 33 ans (à propos d'un cas et revue de la littérature).

INTRODUCTION: The recurrence of an ameloblastoma is generally due to insufficient margins of resection or to the aggressiveness of the tumour which is regarded as locally malignant. Recurrencies on autologus osseous graft are rare in the literature. We report the case of a recurrent ameloblastoma on autologus rib graft which occurred 33 years after the surgery. OBSERVATION: A 59 year old man, underwent at the age of 26 years a tumoral removal of a left mandibular cyst with reconstruction by costal graft. The histopathologic diagnosis was an ameloblastoma with healthy limits and without invasion of the soft tissues. He consulted recently for a tumour located at the left side of the symphysis and presenting an endo-oral component bending at the level of the floor of the mouth. The CTscan objectified a cystic hypodensity well defined inside the rib graft. The patient underwent a surgery performed by a mixed approach (endo-oral and cervical). The tumour was removed with macroscopically healthy margins. CONCLUSION: The pathogenesis of the recurrence of an ameloblastoma on autologus osseous graft is still not well understood. Thus, it is recommended to get healthy margins in case of en bloc resection requiring to make the limits of the resection at least at one centimeter from the tumour. A very longterm follow-up clinical and radiological is also mandatory.

[Complications of chronic otitis media]. / Complications des otites moyennes chroniques.

INTRODUCTION: The complications of chronic otitis media have become less frequent since the advent of antibiotics. However, they continue to show a high incidence in developing countries. OBJECTIVES: The aim of this study was to determine the impact of these complications in Morocco and to study the epidemiological, clinical, paraclinical and therapeutic patterns. PATIENTS AND METHODS: This is a retrospective study conducted between January 1998 and December 2005. All patients presenting to the ENT department of the hôpital du 20 Août of Casablanca, Morocco, with complications of chronic otitis media and hospitalized during this period were included. RESULTS: We selected 47 out of 824 patients hospitalized for chronic otitis media, for a 5.7% incidence of complications, including 15 intracranial complications (1.8%) dominated by meningitis (nine cases) and cerebral abscess (five cases), and 32 extracranial complications (3.8%) dominated by mastoiditis (21 cases) and facial paralysis (eight cases). The cholesteatoma was found in 70% of the patients. The open atticomastoidectomy was the surgical technique chosen in 80% of the cases, associated with specific treatment depending on the complication. Progression was favorable in 90% of the cases. CONCLUSION: With this study, the authors review the high incidence of complications of chronic otitis media in Morocco, and therefore the need to diagnose and treat all cases of chronic otitis media early to prevent the very dangerous (for example, intracranial) complications.

[Multiple metastases of a mandibular ameloblastoma]. / Métastases multiples d'un améloblastome mandibulaire.

INTRODUCTION: Ameloblastoma is a benign odontogenic tumor which can be locally aggressive and invasive. Metastases are rare but possible and must be considered as a malignant form of the tumor. OBSERVATION: A 50-year-old woman presented a jugal metastasis of a mandibular ameloblastom which had been treated several times 28 years earlier. Six months after resection of the metastasis, the patient developed multiple cervical node metastases which were removed by radical curettage. Five months later, new metastases developed on the scalp and three months later a voluminous metastasis involving the right hemiface extended to the base of the skull. Surgical resection was only partial followed by radiotherapy. Ten months later the outcome was favorable. DISCUSSION: The absence of any histological sign of malignity in the primary tumor and in the metastases, as observed in our patient, is remarkable. Metastases generally develop in the lung (61-80% of cases). Metastases to the scalp have never been described. The time to development of a metastasis is generally very long and metastases usually remain asymptomatic. Progression is very slow, like for the primary tumor. Several factors predictive of metastasis have been described: female gender, age at onset of primary tumor (2nd to 3rd decade) and multiple local recurrences. There is no standard treatment for metastases. Chemotherapy is not effective. Radiotherapy may be effective, particularly when lesions are not accessible to surgery. Surgical resection remains the treatment of choice.