[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.

[Vascular tumors of the nasal cavities: a retrospective study of 10 cases]. / Les tumeurs vasculaires des cavités nasales: etude rétrospective a propos de 10 cas.

UNLABELLED: Vascular tumors of the sinus cavities are rarely documented in the literature. They are characterized by a histological diversity. They can be benign or malignant. The most common histologic type is the hemangioma. Their management is not well codified, it benefited from advances in modern imaging and endoscopic surgery. The objective of the work is to study anatomical and clinical characteristics, therapeutic and outcome. PATIENTS AND METHODS: The observations of 10 vascular tumors of the nasal cavities collected between January 2009 and July 2011 were studied retrospectively. The management of these tumors was based on nasal endoscopy, imaging, biopsy, and some angiography for embolization. The epidemiological parameters, histopathological, clinical, therapeutic and outcome were studied. RESULTS: The average age was 25.4 years, male was marked with a sex ratio of 4. Epistaxis was the revealing sign. All tumors were benign, with a predominance of the hemangioma (4 cases), followed by angiofibroma of the septum (3 cases) and nasopharyngeal angiofibroma (3 cases). All patients were operated, by endonasal technique in 7 cas/10 and transfacial road in 3 cases. Embolization was performed in 5 patients, there were two hemangiomas and 3 nasopharyngeal fibromas. No case of recurrence has been noted so far. CONCLUSION: The vascular tumors of the nasal cavities are difficult to treat, especially when they reach a large volume and at an extension to adjacent areas, which makes the surgical procedure difficult and bloody. The use of selective embolization in these cases is required.

[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.

[Eagle syndrom: A case report]. / Le syndrome de Eagle : à propos d'un cas.

INTRODUCTION: The Eagle syndrome is a rare entity characterized by a hypertrophy of the styloid process responsible for clinical signs in connection with compression of the vasculonervous structures of vicinity. CASE REPORT: Female 40 years old who complained for 7 years about intense right temporo-parietal headache, associated with ocular pains, otalgia, tinnitus and swallowing problems. These symptoms were unilateral. The only notable antecedent was an extraction of the wisdom teeth of the lower arc 10 years before. CONCLUSION: The Eagle syndrome is an unusual syndrome ignored by the majority of the clinicians. The simple palpation of the oropharyngeal walls (tonsils) makes it possible to evoke the diagnosis. This suspicion will be confirmed by Xrays. The surgery presents few risks and the patient is released of symptoms very quickly.

[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.

[Cervicofacial lymphangioma in adults (10 case reports)]. / Les lymphangiomes cervico-faciaux de l'adulte (à propos de 10 cas).

INTRODUCTION: Cystic cervico-facial lymphangioma (DDFL) are relatively rare. Because of their size and site, they pose a real problem in treatment. The authors present a retrospective study about 10 cases. MATERIALS & METHODS: The mean age of this series of patients was 31 years, with a slight female preponderance. Ultrasound scanning is sufficient to establish the diagnosis. CT or MRI scan helps to show whether there is parapharyngeal or mediastinal extension. RESULTS: Every patient in this series underwent operation. We had one recurrence and two postoperative neurological sequelae. DISCUSSION: Although there is little difficulty in the diagnosis of this condition, it is difficult to treat because of extension which involve the face, the floor of mouth and tongue base, and also the major structures in neck. Current interest is centred on treating these lesions with sclerosis agents, either for recurrence or, according to some authors, as a first therapeutic option.

[Laryngeal tuberculosis: apropos of 15 cases]. / La tuberculose laryngée: à propos de 15 cas.

Based on a retrospective study over a six year period, we report 15 cases of tuberculosis of the larynx, confirmed histologically. Dysphonia was the main symptom. The diagnosis rests on direct laryngoscopy and biopsy, with histology. Medical treatment achieves a good outcome.

[Unusual benign tumors of the larynx: report of 17 cases]. / Les tumeurs bénignes rares du larynx: á propos de 17 cas.

Rare benign tumours of the larynx (RBTL) form a heterogeneous group. The clinical picture is non-specific. Based on a series of 17 cases of RBTL treated in our department, we wish to draw attention to the diagnosis, treatment and clinical course of these tumours. The mean age of the patients was 37 years, with the male sex predominating. The presenting symptom was most commonly progressive dysphonia, while 5 patients were admitted in respiratory distress. Examination and special investigations revealed 8 cases of laryngocoele, 6 cases of angioma, 2 cases of schwannoma, and one of chondroma. Treatment was surgical, by an external approach in 10 cases and endoscopically in 7. The postoperative course was satisfactory. No long-term recurrences were encountered. Conservative surgery by an external or endoscopic approach has revolutionised the functional outcome in these benign tumours.

[Endonasal surgery: results of surgery of ethmoido-frontal mucoceles]. / La chirurgie endonasale: résultats dans la chirurgie des mucocèles ethmoido-frontales.

The intranasal approach for mucoceles of the sinuses represents an advance in the techniques of sinus surgery. The object of our study is to show the value of this type of surgery by reviewing 16 cases of fronto-ethmoidal mucoceles undergoing surgery in our department. The approach was purely intranasal. Surgery consisted of wide marsupialisation of the nasal cavities. The immediate postoperative progress was good. There were no complication in this series; neither was there any recurrence. The follow up period was from 3 months to 5 years. As the follow-up period was too short in some of the cases, no firm conclusions can be drawn. Yet despite this limitation, it seems that the intranasal approach is to be preferred in dealing with mucoceles of the sinuses.

The antrochoanal polyp.

The antrochoanal polyp is a particular pathology of nasal fossae and sinuses. Since the first description made by Killian, several pathogenic mechanisms and surgical techniques have been reported. The polyp exeresis is classically made using the Caldwell-Luc approach. The aim of our study is to lay stress on the interest of endonasal surgery compared to other surgical procedures. Between 1996 and 1998, we operated on 12 cases by endonasal approach. Diagnosis is made upon clinical, CT-scan and pathological data. In all cases, an extended middle meatotomy is performed. In 3 cases, it is associated with an inferior meatotomy. The polyp pedicle is systematically coagulated at level of its maxillary implantation area. No recurrence, nor operative complication are noted. The average follow-up is 12 months.

[Parotid tumors: a report of 120 cases]. / Les tumeurs de la parotide (à propos de 120 cas).

The treatment of the parotid tumors was clarified for a majority of the tumors, in spite of her histology diversity. The authors report in a retrospective study 120 cases of a parotid gland tumors during ten years over. They insist on the difficult of therapeutics, the histological diversity and the complications and sequelles of the surgery. The diagnosis was especially clinical and completed by scan and or a sialography. The superficial or total parotidectomy with preservation of facial nerve was realized in eighty-nine percent. The functional courage and the radiotherapy were associated respectively in eleven and seventeen patients. The histology was dominated by the benign tumors. The complications and sequelles were a facial paralysis definitive and a Frey's syndrome respectively in three percent cases. The ninety-seven percent patients were controlled with a mean follow up of three years. After results we must know every histologic type for to adapt his treatment. And the same complications and the sequelles were noted in all surgery type.

[Otorrhea on transtympanic aerator]. / Les otorrhées sur aérateur transtympanique.

BACKGROUND: Purulent otorrhea is the most common complication of tympanostomy tubes. POPULATION AND METHODS: Results of culture of otorrhea in 33 consecutive cases were compared to two similar studies performed 4 and 8 years ago in the same institution. RESULTS: The most frequent organisms were Pseudomonas aeruginosa, Haemophilus influenzae, Staphylococcus aureus and Streptococcus pneumoniae (45, 24, 21 and 15% of the cases, respectively). Such flora resembles that of external otitis and chronic otitis media (P aeruginosa and S pneumoniae). CONCLUSION: Sensitivity of the organisms encountered in these otorrheas favors the use of topical drops rather than oral antibiotics as the first choice of treatment.

[Paranasal sinus mucocele]. / Les mucocèles sinusiennes.

A retrospective study of 25 sinuses mucoceles over a ten year period is presented. The authors insist on epidemics and diagnostics characteristics of this pathology and discuss the various therapeutics means.

[Apropos of an uncommon disease of the larynx: pyolaryngocele]. / A propos d'une pathologie rare du larynx: la pyolaryngocèle.

The laryngopyocele is a rare complication of laryngocele. About one case of laryngopyocele and review of literature, the authors recall the main characteristics of this affection. Its clinical picture is often alarming. The CT scan, not often made emmergenceley, give a characteristic image. The treatment is mainly surgical but also endoscopic, then facilitated by the use of laser. The fact of thinking to this diagnosis toward a laryngeal dyspnea with fever permit sometimes to avoid tracheotomy then usually made emmergencely.

[Laryngocele as an etiology of respiratory distress]. / La laryngocèle comme étiologie de la détresse respiratoire.

Laryngocele is usually benign affection of the larynx. But serious forms of clinical emergency necessitating tracheotomy are possible. We reported 3 cases. New methods of treatment are presented endoscopic resection and laser marsupialization.

[Nasosinusal inverted papilloma. Apropos of 6 cases]. / Le papillome inversé naso-sinusien. A propos de six cas.

We report in this study six cases of the inverted papillomas of the nose, that we have noticed in the ORL's department in 20 august hospital from 87 to february 1992. It's about patients aged from 12 to 60 years old, a child, a woman and four tabagic men, one of who has an allergic rhinitis. The clinical symptomatology is evocative of our patients and is especially marked by the unilateral nasal obstruction. The radiology which has an important resort permitted to lean the diagnosis and to precise the extension of the tumor. The anatomopathologic examination permittedus confirm the diagnosis with certitude. The surgical treatment is chosen for the whole of our patients. The evolution in all the cases is satisfying. We neither notice a recurrence nor a malignant transformation.