Périchondrites aiguës du pavillon de l'oreille. A propos de 23 cas

Objectifs : Notre objectif était d'évaluer les facteurs étiologiques, les agents pathogènes, le traitement et les séquelles des périchondrites. Patients et méthodes : Il s'agit d'une étude rétrospective, sur une période de 8 ans (janvier 2009 à décembre 2016), portant sur les cas de périchondrite aiguë au service d'ORL du CHNU de Fann. Résultats : Vingt-deux dossiers ont été colligés avec un cas de périchondrite bilatérale. Le sex-ratio était de 0.37 ; l'âge moyen de 27 ans. La durée d'évolution moyenne était de 23 jours. La circonstance de survenue était un piercing dans 36% des cas. Dix-neuf de nos patients présentaient une périchondrite collectée, soit 86% des cas. Quinze de nos patients avaient bénéficié d'un examen bactériologique de pus, soit 68% des cas. Le Pseudomonas aeruginosa était retrouvé dans 66.6% des cas, sensible dans 90% des cas à la ciprofloxacine et dans 10% des cas aux aminosides. La culture était négative dans 26.6% des cas. La durée moyenne d'hospitalisation était de 7 jours ; la durée moyenne du traitement de 13 jours. L'évolution était satisfaisante chez tous nos patients, avec une absence de séquelles dans 72.7% des cas. Conclusion : La périchondrite aiguë du pavillon de l'oreille se développe souvent suite à un traumatisme externe mineur. Le Pseudomonas aeruginosa représente le principal agent causal d'où l'intérêt d'une antibiothérapie probabiliste active sur ce dernier. Un traitement précoce permet de prévenir les séquelles morphologiques inesthétiques

Manejo quirúrgico de los carcinomas diferenciados de tiroides Experiencia en un país de bajos ingresos / SURGICAL MANAGEMENT OF DIFFERENTIATED THYROID CARCINOMAS. EXPERIENCE IN A LOW INCOME COUNTRY

ience in the management of differentiated thyroid carcinomas in a low- income country. Materials and Methods: We performed a retrospective study in our department where 21 cases of differentiated thyroid carcinomas were recorded from February 2001 to December 2010. Results: We performed 334 thyroidectomies for 326 patients. Of this group, 21 differentiated thyroid carcinomas were diagnosed. Differentiated thyroid carcinomas represented 6.4% of all thyroid neoplasm managed during the same period (n=326). Median age was 44 years (range 13 - 75 years). Male to female ratio was 1:20. Six (6) patients underwent primary hemithyroidectomy in other institutions while the fifteen left were entirely managed in our clinic. Of them, one patient was referred with positive fine needle aspiration cytology for papillary thyroid carcinoma (incidental detection by fine needle aspiration biopsy) and another had history of sinus pyriform fistula. Pathology of surgical specimens showed 13 cases of papillary thyroid carcinomas and 8 cases of follicular thyroid carcinomas with association to Hashimoto thyroiditis and Grave's disease in respectively in 1 case. Twenty cases were incidentally discovered by thyroid surgery and undergone completion thyroidectomy with prophylactic central neck dissection, completion thyroidectomy alone, modified lateral neck dissection alone and surveillance respectively in 13, 1, 1 and 6 cases. Complications of thyroid surgery were bilateral recurrent laryngeal nerve paralysis and hematoma respectively in 1 case. Median hospital stay was 5 days ranged from 3 to 15 days. During the follow-up period, most of our patients were lost of follow-up. Conclusion: Management guidelines of differentiated thyroid carcinomas are well established but not applicable to low- income country for several reasons. National guidelines, based on further researches, must then be implemented to improve our practice

Kyste valléculaire symptomatique de l'adulte. A propos d'un cas

Les kystes valléculaires encore appelés kystes épiglottiques ou kystes basi-linguaux sont des kystes canalaires qui traduisent l'obstruction et la rétention de mucus au niveau des canaux excréteurs, des glandes sous-muqueuses. Ils peuvent se manifester chez le nouveau-né par une détresse respiratoire aiguë, chez l'adulte ils sont le plus souvent asymptomatiques et sont découverts lors d'une laryngoscopie indirecte ou lors d'une intubation.L'objectif de ce travail était de rapporter un cas de kyste valléculaire symptomatique chez un adulte de 50 ans pris en charge au service d'ORL et de chirurgie cervico-faciale de Hôpital Général de Grand Yoff, Dakar, Sénégal. La nasofibroscopie a objectivé une formation kystique arrondie siégeant au niveau de la vallécule gauche. La tomodensitométrie cervico-faciale a mis en évidence une masse valléculaire gauche hypodense homogène plaquant l'épiglotte contre le plan glottique. Au plan thérapeutique, nous avions effectué une ponction première du kyste suivie de son exérèse complète par électrocoagulation de la base d'implantation. Les suites opératoires étaient simples

Paralysie récurrentielle bilatérale : l'aryténoïdopexie est-elle toujours compétitive ?

Introduction : La Paralysie Récurrentielle (PR) bilatérale en adduction est une situation clinique dramatique. Le traitement repose sur la chirurgie par voie endoscopique couplée au laser. Ce procédé thérapeutique est inaccessible dans beaucoup de pays en développement. La chirurgie par voie externe peut-elle constituer une alternative ? Matériel et méthodes : Nous avons mené une étude rétrospective portant sur 20 patients, porteurs d'une PR bilatérale en adduction post-thyroïdectomie, sur une période de 12 ans. Tous les malades ont été traités par abord chirurgical cervical externe. L'appréciation des résultats se faisait sur la possibilité de décanulation et la qualité de la voix.Résultats : Tous les malades étaient de sexe féminin avec un âge moyen de 43 ans. La PR était une complication de la thyroïdectomie totale dans 85% des cas et subtotale dans 15% des cas. L'abord latéral du larynx nous a permis de réaliser 16 aryténoïdopexies selon King et 2 aryténoïdectomies associées à une cordopexie selon Graaf Woodman. L'abord antérieur par thyrotomie, effectué dans 4 cas, a permis de réaliser une aryténoïdectomie dans 1 cas et une cordo-aryténoïdectomie dans 3 cas. La décanulation a été effective chez tous les malades après un délai moyen de 30 jours. Après analyse perceptuelle, chez 11 patients, la qualité de la voix était jugée bonne dans 4cas (36.63%), passable dans 2 (18.18%) et mauvaise dans 5 (45.46%).Conclusion : Nos résultats sont satisfaisants et comparables à ceux des séries des pays développés, usant des procédés endoscopiques au laser

Corps étrangers laryngo-trachéo-bronchiques : à propos de 130 cas

Objectifs : Les objectifs de notre étude étaient de décrire les aspects épidémiologiques, diagnostiques et thérapeutiques des corps étrangers des voies respiratoires inférieures à la clinique d'ORL et de chirurgie cervico-faciale du centre Hospitalier National et Universitaire de Fann. Patients et méthodes : Il s'agit d'une étude rétrospective, couvrant la période du 1er janvier 2011 au 31 décembre 2013. Nous avons colligé, durant cette période, 130 dossiers de patients âgés de moins de 18 ans qui étaient reçus pour inhalation de corps étrangers. Les endoscopies blanches étaient exclues. Les paramètres étudiés étaient : l'âge, le sexe, la présence ou non d'un syndrome de pénétration, les signes fonctionnels, le délai de consultation, le traitement effectué, la localisation endoscopique, la nature du corps étranger, les données de l'imagerie, l'indication de la trachéotomie et les complications. L'analyse des données était effectuée avec le logiciel Sphinx Lexica V 4.5 2003. Résultats : L'âge moyen de nos patients était de 3,84 ans avec des extrêmes allant de 4 mois à 17 ans. Une prédominance féminine était notée avec un sex-ratio de 0,91. Les patients évacués d'autres pays représen- taient 6,9% des cas. Le délai moyen de consultation était de 8,05 jours. Le syndrome de pénétration était retrouvé dans 78,5% des cas. La radiographie standard mettait en évidence un corps étranger radio-opaque dans 33,1% des cas. La localisation laryngée était la plus fréquente, elle représentait 26,7% des cas. La graine d'arachide était le corps étranger le plus fréquemment retrouvé soit 39,2%. Onze patients étaient trachéotomisés. Quatre cas de décès ont été rapportés soit 3% des cas.Conclusion : L'inhalation d'un corps étranger est un problème de santé publique. L'augmentation de l'incidence de cet accident et la transition épidémiologique impose une meilleure prévention

Solitary neurofibroma originating from the posterior nasal septum: Transnasal endoscopic resection.

INTRODUCTION: The head and neck region is one of the locations of neurogenic tumors such as neurofibroma. Although mostly associated with neurofibromatosis, it can be solitary. The present study reports a very rare case of solitary neurofibroma originating from the posterior nasal septum. CASE PRESENTATION: A 48-year-old female presented with tumor in the right nasal cavity. The tumor, originating in the posterior nasal septum, extended to the posterior sinuses and nasopharynx. Following endoscopic and radiological assessment, the tumor was resected by transnasal endoscopic surgery. Histological examination showed the tumor to be a neurofibroma. At 14months' follow-up, there was no recurrence. DISCUSSION AND CONCLUSIONS: However rare, solitary neurofibroma must be considered in the differential diagnosis of unilateral benign tumor involving nasal and paranasal sinuses. A transnasal endoscopic approach should be considered for treatment.

Profile of parotid gland tumours: experience of 93 cases over a period of 16 years.

OBJECTIVE: The pathology of the salivary glands focuses on that of the parotid gland. The purpose of this study is to clarify and explain the epidemiological features of parotid tumors in a Senegalese context, to highlight the importance of clinical examination when access to complementary investigations is limited, to discuss respective indications and finally to describe certain aspects of treatment in our context. MATERIALS AND METHODS: This retrospective study of 114 cases of parotidectomy spans 16 years, from 1992 to 2007. It was performed in the ENT department of University Hospital of Fann, Senegal. All patients operated on for chronic mass of the parotid region for whom histological results were available when initially included. Benign swellings were subsequently excluded. The study parameters were epidemiological, clinical, paraclinical and surgical. RESULTS: The 114 parotidectomies showed a predominance of benign tumours: 63 procedures (55.26%) essentially concerned pleomorphic adenoma; 30 cases (26.31%) concerned malignant tumours, mainly parotid adenocarcinoma. There were 21 cases of benign swelling (18.4%). The study focused on the series of 93 cases of benign and malignant tumours of the parotid gland. Both sexes were affected similarly. All age groups were concerned, from 5 to 89 years. A total of 97% of patients underwent surgery: conservative total parotidectomy in 75.51% of cases. CONCLUSION: Although there are features specific to the local context, the epidemiological profile of parotid tumours is well-known. Indications for complementary investigations are discussed, as availability in Senegal is restricted, highlighting the important role of clinical examination in the management of parotid tumours.

Complications des otites moyennes chroniques

Objectif de l'etude : Rapporter la frequence des complications des otites moyennes chroniques et presenter notre experience dans leur prise en charge. Materiel et methodes : Etude retrospective concernant la periode allant du 1er janvier 2000 au 31 decembre 2009. Les complications ont ete reparties en 2 grands groupes : extracraniennes et intracra-niennes. Resultats : 57 patients sur 350 recus pour OMC ont presente une complication; soit une frequence de 18;38 . Le cholesteatome etait le plus grand pourvoyeur de ces complications (84;2). Dix-neuf patients presentaient plus d'une complication; soit au total 76 cas. Les complications extracraniennes ont ete les plus frequentes; 63 cas (83); dominees par la mastoidite exteriorisee profuse (68;3). Les complications intracraniennes au nombre de 13 (17) etaient dominees par la meningite purulente otogene (46;2). La mastoidectomie associee a une antibiotherapie a large spectre; occupait une place im-portante dans la prise en charge de ces complications. Elle a ete realisee chez 45 patients (79). La mortalite a ete estimee a 3;5 (2 cas de deces). Un drainage neurochirurgical a ete effectue dans 4 cas (8;6). Conclusion : Cette etude se caracterise par un taux de complications d'OMC plus eleve que ceux rappor-tes dans la litterature; ainsi que par la predominance des formes etendues et des associations de complications chez un meme patient

[Primitive neuroectodermal tumor of the vagus nerve]. / Tumeur neuroectodermique primitive du nerf vague.

Primitive neuroectodermal tumors are a rare type of malignant neuroectodermal tumor that is very aggressive. Cervicofacial location is rare, even exceptional. We report a case of a 4-month-old male infant, referred from the pediatric clinic for severe supralaryngeal dyspnea, a firm mass under the left mandibular angle, mobile and extended to the parotid area, painful, with a curve of the left side wall of the oropharynx. Cervical computed tomodensitometry showed a well-limited mass in the carotid area, enhanced by the contrast product. A vascularized mass, which had developed at the expense of the vagus nerve, was removed surgically. Histology found a primitive neuroectodermal tumor.

Management of acquired cholesteatoma in children: a 15 year review in ENT service of CHNU de FANN Dakar.

OBJECTIVES: To analyze the epidemiology, diagnosis, management and the prognosis of cholesteatoma of the middle ear in children. METHODS: This was a retrospective study of 15 years (from 01 January 1995 to 31 December 2009) for patients aged 0-15 years admitted in ENT ward of FANN hospital for chronic otitis media complicated with cholesteatoma The parameters studied were epidemiology, clinical presentation, disease progression and management. RESULTS: Sixty-six participants were included. We noted a slight male predominance with a sex ratio of 1.44. The average mean age was 10 years. Most patients presented with signs of complications (69.7%) and mastoiditis was the most common complication (63.6%). The otorrhea was noted in almost all patients: n = 64 (97%) and deafness in 49 patients (74, 2%). There was a slight predominance of cholesteatoma on the right side (51.5%). Schuller's view of the mastoid cells was done in 21.2% of patients (n = 14) and showed sclerotic mastoid air cells for all them. Eighty-two percent (82%) of patients presented with conductive hearing loss. A radical mastoidectomy was performed in 66.7% and modified radical mastoidectomy in 33.3% of cases. Mean follow-up was 6 months. Recurrence of cholesteatoma was noted in 13% of cases. CONCLUSIONS: ENT ward of Hospital Fann is one of the two centers in Senegal where cholesteatoma of the middle ear are treated. This low number of cholesteatoma in children in a developing country is in relation to the fact that patients only present when complications develop: 70% of cases. The reason for this in our setting include insufficient human and manpower resources necessary for prompt management of the disease and also lack of awareness among the populace. In these settings we advocate canal wall down mastoidectomy (radical or modified radical) as the treatment of choice.

A case of cervical Pott's disease revealed by parapharyngeal abscess.

INTRODUCTION: We report a case of cervical Pott's disease revealed by parapharyngeal abscess. CASE REPORT: A seven-year-old boy was admitted with a three-week history of painful fluctuating left lateral cervical swelling, associated with night sweats. Examination found trismus, through which a lateral pharyngeal bulge could be observed. Incision and drainage of the abscess on a combined cervical-oropharyngeal approach was performed under general anesthesia, associated to non-specific antibiotherapy by parenteral route. Bacteriology was negative. After one week of antibiotherapy, fever persisted with onset of torticollis. A diagnosis of tuberculosis was considered. Tuberculin skin test was positive at 16.5 mm. A second sample by pharyngeal aspiration showed caseous pus with acid-fast bacilli. Cervical spine CT found a retrostyloid abscess with atlantoaxial lysis. Cervical Pott's disease complicated by Grisel syndrome was diagnosed. Antituberculosis therapy was initiated. Results at five months' follow-up were satisfactory. DISCUSSION/CONCLUSION: Parapharyngeal abscess with an etiology of Pott's disease is rare. Modern imaging is highly contributive to diagnosis and follow-up of lesion regression under treatment.

Osteolipoma: an unusual tumor of the parotid region.

PURPOSE OF STUDY: Oncology of the parotid region is rich and varied, like its components. During his career, the ENT surgeon may come across such an exceptional tumor as osteolipoma. The aim of this study was to describe the rarity and the etiopathogeny of osteolipoma with parapharyngeal location. PATIENTS AND METHOD: We had the opportunity to find this uncommon tumor in a 21-year-old female patient. The mass located in the parotid region was hard, barely mobile and at first looked like a parotid tumor. Total parotidectomy with facial nerve preservation was performed. It revealed a stony and dented tumor inside the internal lobe of the parotid located in the parapharyngeal space between the vertical portion of the mandible anteriorly and the styloid apophyse posteriorly. Macroscopic examination of the piece evidenced a lipomatous mass with hard as bone nodes in its middle. Histology revealed an osteolipoma. CONCLUSION: A review of the literature shows the uncommon occurrence of this type of tumor. A few rare cases were reported among which two involving the parapharyngeal space.

Squamous carcinoma of the hypopharynx in children in Sénégal: between disarray and enigma.

INTRODUCTION: The squamous carcinoma of the hypopharynx constitutes the first reason of hospitalization in our department. Different studies have been realized about it and showed an epidemiological profile characterized by the young age of the patients and the predominance of female. OBJECTIVES: To specify the place of the children in hypopharynx cancers. To evaluate the epidemiological criteria and the difficulties in the management. MATERIALS AND METHODS: Retrospective study of 11 years (1995-2005). Collection of the data concerning the epidemiology, clinical and paraclinical findings, the treatment, and the evolution was carried out at the University Department of Otorhinolaryngology in Dakar (Sénégal). RESULTS: 15 charts of children have been collected. They presented in the majority of the cases, an advanced cancer, with 93% of T3T4. The lesion was localized at the retro-cricoid area in 4 cases, the pyriform sinus in 3 cases, the oesophagus junction in 2 cases, and the posterior wall in 1 case. In 5 cases the lesion was spreading to the totality of the hypopharynx. No case of smoking or alcohol has been noted. The anemia has been noted in 86.7% of the cases. A case of papillomatosis of the mouth and lips has been noted. The treatment was for most of cases as symptomatic, like tracheotomy with or without gastrostomy. The evolution was fatal with 11 deaths (73.33%). DISCUSSION: Our set is the richest set through the world of hypopharyngeal cancers in children. The Plummer-Vinson syndrome noted in 86.7% of the cases and the viral infection by HPV could play a role in the genesis of this cancer. CONCLUSION: The cancer of the hypopharynx essentially affects the young women in Sénégal without alcohol or tobacco consumption. It does not save the children, with an awful prognosis, however. So, it is imperative to organize a vast campaign of information of the populations on the bad prognosis of this cancer and to lead a large-scale epidemiological investigation, to get a better understanding of this cancer in our country.