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

[Orbital complications of sinusitis]. / Les complications orbitaires des sinusites.

PURPOSE: Orbital complications of sinusitis are rare but serious, with potential functional and even fatal consequences. The purpose of this work is to study the epidemiological, clinical and paraclinical features of the orbital complications of sinusitis, as well as the various treatment modalities and clinical course. PATIENTS AND METHODS: We report the results of a retrospective study of 34 cases of orbital complications of sinusitis, collected between 1998 and 2009. RESULTS: Mean age was 19 years 3 months, with a clear male predominance. No predisposing factors were found. All patients presented with periorbital edema. In addition to periorbital edema, ophthalmological examination also revealed: proptosis in 19 patients, decreased visual acuity in eight patients and ocular motility disturbances in 10 patients. All patients underwent emergent facial CT, two patients underwent orbital ultrasound, and one underwent magnetic resonance imaging. Initial treatment was based on empiric intravenous antibiotic therapy. Orbital drainage was performed in 20 patients. Sinus drainage was performed in 16 patients (14 cases during the acute phase) with a middle meatotomy in all cases. The initial response was favorable in 97.5% of cases. One patient had a recurrence. Mean follow-up was 11 months. CONCLUSION: Orbital complications of sinusitis are a diagnostic and therapeutic emergency. Imaging helps guide management. Directed treatment and early management can improve mortality and morbidity.

[Sinonasal inverted papilloma: 43 cases]. / Le papillome inversé nasosinusien : 43 cas.

PURPOSE: Inverted papilloma (IP) is a common epithelial tumor arising from the nasal vault. The aim of our study was to evaluate the advantages, the results and the limits in the treatment of this tumor. PATIENTS AND METHOD: Retrospective study of 43 patients over the period 1989-2009. RESULTS: The mean age was 53.3 years. We found a maxillary sinus extension in 40 cases and ethmoidal extension in 27 cases. Twenty-nine patients were treated through an endoscopic endonasal approach. A vestibular approach was used in three patients. A paralateral nasal approach was used for 12 cases. We observed a recurrence in 9.3% of the all cases. CONCLUSION: The treatment of IP is surgical. Their high potential of local aggressiveness, fear of recurrence and the possibility of the occurrence of a malignancy require radical treatment.

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

[An unusual lesion of the nasopharynx: oncocytic metaplasia]. / Une lésion inhabituelle du nasopharynx : la métaplasie oncocytaire.

Oncocytic metaplasia of the nasopharynx is an exceptional lesion which exact etiopathogenesis, although largely discussed, still remains controversial. The purpose of this paper is to present the epidemiological characteristics and clinical signs of this lesion and to study its pathogenesis and its therapeutic modalities. We report two cases that occurred respectively in a 53- and 60-year-old woman. The first presented with pharyngeal dysesthesia and otalgia. The endoscopic examination revealed an irregularity of the posterior wall of the nasopharynx. The second patient presented with tinnitus, discomfort of the left ear and bilateral hearing loss. Endoscopic exam revealed a bilateral structural abnormality to the eardrum. Microscopy showed focal oncocytic metaplasia of the nasopharynx mucosa in both cases. There was a positive outcare for both patients after excisional biopsy. Oncocytic metaplasia seems to be in relation to the stimulation of sympathic neuropeptidergic nerve fibers which target epithelial, connective, endothelial and lymphoid cells.

Rhinocerebral mucormycosis: five cases and a literature review.

OBJECTIVE: In this retrospective study, we describe our experience in the diagnosis and management of rhinocerebral mucormycosis (RCM), a rapidly lethal fungal infection. METHODOLOGY: Between 1997 and 2007, five patients hospitalized for suspicion of RCM. Computed tomography was performed in all cases, and diagnosis was confirmed after anatomopathological or mycological examination. All patients underwent medical and surgical treatment. Follow-up was clinical and radiological with a mean period of 17 months. RESULTS: All patients were diabetic. Exophthalmia, rhinorrhea, and ophthalmoplegia were the most frequent symptoms observed. One patient had loss of visual acuity and another exhibited peripheral facial palsy. One patient had extensive hemifacial cutaneous necrosis. Nasal endoscopy revealed black necrotic lesions in one case, and another patient had a tumefaction localised in the left middle meatus. Necrotic lesions were most often found in the orbit, the maxillary and the ethmoidal sinuses on computed tomography (four cases for each site). One patient had thrombophlebitis of the cavernous sinus, and another had an intracranial extension. All patients were administered ordinary insulin and intravenous amphotericin B. Surgical debridement of the nasal cavity and the involved sinuses was performed through lateral rhinotomy (four cases) or endoscopy (one case). Unilateral orbital exenteration was associated in two cases. Progression was favourable in four cases; one patient died from sepsis despite aggressive treatment. CONCLUSION: Early diagnosis is crucial for the management of RCM. Treatment of underlying disorders, use of intravenous amphotericin B, and aggressive surgical intervention are key in reducing morbidity and mortality rates.

[Tumors of salivary glands: anatomical study and clinical epidemiology of a series of 180 cases]. / Les tumeurs des glandes salivaires: etude anatomo-clinique et. Epidemiologique d'une série de 180 cas.

BACKGROUND: 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. AIM: 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. METHODS: 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. RESULTS: 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%). CONCLUSION: 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.

Necrotizing otitis externa: 19 cases' report.

Necrotizing otitis externa is an uncommon but severe infectious disease of the external auditory canal. Patients at risk are those immunodepressed or having diabetes. The causal germ is often Pseudomonas aeruginosa. Over a period of 10 years (1997-2006), we treated 19 patients: 94.7% had diabetes (insulin dependent in 6 cases). The causal germ was P. aeruginosa in 59% of cases. The pretherapeutic work-up included a computed tomography and a scintigraphy practiced in order to confirm diagnosis and assess the extension. Medical treatment was based on a parenteral antibiotic therapy using a third-generation cephalosporin and a fluoroquinolones. Local treatment of the auditory canal including cleaning and application of antimicrobial agents was performed in all the cases. Surgical debridement of soft tissue and infected bone was performed in one patient who did not respond to medical management. Repeated scintigraphies with gallium were used to follow the course under treatment in only three cases. We had a 89.4% cure rate with only three cases of recurrence. We reviewed the data in the literature on necrotizing otitis externa and present the important diagnostic, imaging, and therapeutic aspects of the disease.

Cartilage graft in type I tympanoplasty: audiological and otological outcome.

The aim of this study is to evaluate anatomical and audiological results of cartilage tympanoplasty compared to fascia tympanoplasty in the reconstruction of tympanic membrane perforations. We carry a retrospective study about 380 patients operated in our department between 1998 and 2005. Patients were classified into two groups: 90 (23.6%) undergo cartilage tympanoplasty and 290 (76.4%) fascia tympanoplasty. In each group, we calculated the average of pre and postoperative air bone gap (ABG) and the average air conduction gain (ACG) at 250-4,000 Hz. The surgical technique is explained in detail. We detail and analyze the audiological and anatomical results in each group. Successful closure of the tympanic membrane perforation was achieved in 97% of the cartilage group as compared to 94% of the fascia group. The average ACG was 21 +/- 11 dB in cartilage group and 20 +/- 22 dB in fascia group. With an average follow-up of 2 years, residual perforation was observed in 2.2% in cartilage group. Reperforation of fascia graft and retraction were noted in 2.1 and 1%, respectively. The authors show the great reliability of cartilage tympanoplasty to close tympanic membrane perforations. We recommend using cartilage as a first choice, especially in stable or evolutive chronic otitis media, and in recurrent perforation of the tympanic membrane.

[Recurrent upper respiratory tract infections in children and allergy. A cross-sectional study of 100 cases]. / Infections recidivantes des voies aeriennes superieures de l'enfant et allergie. Etude transversale à propos de 100 cas.

BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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.

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

[Plummer Vinson syndrome]. / Syndrome de Plummer Vinson.

BACKGROUND: 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. METHODS: We report 19 cases of Plummer Vinson syndrome collected over 15 years (1990- 2004). RESULTS: 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 endoscopic 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.

[The laryngopyocele]. / La pyolaryngocele.

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 precribed for both. They had a well recovery.

[Chronic laryngitis in adults]. / Les laryngites chroniques de l'adulte.

BACKGROUND: Chronic laryngitis is a lingering inflammation of the laryngeal mucosa, caused by specific aetiology and often irritative factors. AIM: To discuss clinic and therapeutic aspects of the pathology. METHODS: We report a retrospective stuy about 25 patients treated and followed for non specific chronic laryngitis over a period of 11 years (1994-2004). RESULTS: 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, realised 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. CONCLUSION: The treatment of chronic laryngitis is based on the suppression of etiologic factors and on laryngeal microsurgery with micro instruments and with laser techniques.

[Idiopathic sudden sensorineural hearing loss. What's the appropriate management?]. / La surdite brusque. Quelle prise en charge therapeutique?

BACKGROUND: Sudden sensorineural hearing loss remains a challenge in otology. Controverses 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]. / La sarcoïdose naso-sinusienne.

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). Theses 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 extension was negative in 3 cases. The corticoid treatment in local pulverization was sufficient in 2 cases. The corticoid treatment by systematic way was necessary among 2 patients. Favourable out look 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 diagnosis is the directed biopsy, easy in this localization.

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