Prise en charge des lithiases submandibulaires bilatérales au service de stomatologie et chirurgie maxillo-faciale du CHU de Treichville à propos d'un cas management / Bilateral submandibular lithiasis in the department of stomatology and maxillofacial surgery at Treichville University Hospital: A Case Report

Introduction : La lithiase est la plus courante des affections salivaires chez l'adulte. Elle touche principalement la glande submandibulaire. L'atteinte isolée d'une glande est habituelle. Cependant, la lithiase simultanée des deux glandes submandibulaires est moins fréquente. L'objectif était de décrire à partir de l'observation d'un cas, les caractéristiques physiopathologiques, diagnostiques et thérapeutiques de la lithiase submandibulaire bilatérale. Observation : Une patiente de 53 ans, commerçante a consulté en Mars 2022 au Service de Stomatologie et Chirurgie Maxillo-faciale du CHU de Treichville pour une tuméfaction submandibulaire bilatérale. Cette tuméfaction évoluait depuis un an et augmentait de volume au cours des repas. Les antécédents familiaux ont mis en évidence une lithiase submandibulaire bilatérale chez une tante. L'examen clinique a retrouvé une tumeur submandibulaire droite et gauche. L'échographie submandibulaire était en faveur d'une lithiase submandibulaire bilatérale. Une submandibulectomie bilatérale a été réalisée. Aucune complication post opératoire n'a été observée et la patiente est sortie de l'hôpital après deux jours d'hospitalisation. Discussion : Les antécédents familiaux de sialolithiase suggèrent la recherche d'une origine génétique ou familiale de la lithiase bilatérale des glandes submandibulaires, s'il n'existe pas une étiologie évidente ou probable. Conclusion : La lithiase submandibulaire bilatérale est un fait clinique rare mais qu'il faut savoir rechercher même en cas de lithiase submandibulaire isolée.

Introduction: Lithiasis is the most common salivary disease in adults. It mainly affects the submandibular gland. Isolated involvement of one gland is common. However, simultaneous lithiasis of both submandibular glands is less frequent. The objective was to describe, from the observation of a case, the physio-pathological, diagnostic, and therapeutic characteristics of bilateral submandibular lithiasis. Observation: A shopkeeper of 53 years old, consulted a doctor for bilateral submandibular swelling in March 2022 at the Stomatology and Maxillofacial Surgery at Treichville University Hospital. That swelling has been developing for a year. The family history revealed bilateral submandibular lithiasis in an aunt. Clinical examination showed a right and left submandibular tumor that gained volume during meals. The submandibular ultrasound showed bilateral submandibular lithiasis. A bilateral sub-mandibulectomy was performed. No postoperative complications were observed, and the patient was discharged after a two-day hospital stay. Discussion: In the absence of an obvious or probable etiology, a family history of sialolithiasis suggests a genetic or familial origin for bilateral submandibular gland lithiasis. Conclusion: Bilateral submandibular lithiasis is a rare clinical finding but should be investigated even in cases of isolated submandibular lithiasis

Evaluation of Public-Private Partnership in the Veterinary Domain Using Impact Pathway Methodology: In-depth Case Study in the Poultry Sector in Ethiopia.

Public-private partnerships (PPPs) in the veterinary domain are joint approaches in which public veterinary services and private actors such as private veterinarians, producers' associations, or private companies work together to address complex animal health challenges. They are implemented worldwide and can help to strengthen the capacities of veterinary services, but few have been evaluated. None of the evaluations developed in the veterinary domain explicitly addressed PPPs, their complex program design, their evolving governance, and coordination system, and their impacts. This work represents the first application of the participatory impact pathway methodology for the evaluation of a PPP in the veterinary domain. The PPP evaluated aimed at developing the poultry sector in Ethiopia and improving poultry health service coverage, particularly in remote areas. The combination of semi-structured interviews (n = 64) and collective reflection during three workshops (n participants = 26, 48, 18), captured the viewpoints of public and private partners, actors who influenced the partnership, and actors impacted by it. The context of the PPP was analyzed, and the causal relationships between the PPP and its impacts were investigated. This work showed that collaboration between the public and private sector occurred at several administrative levels. The actors considered a variety of impacts, on the economy, business, trust, and health, which were then measured through different indicators. The actors also identified the added value of the PPP to enrich those impacts. The participatory impact pathway methodology helped to strengthen the engagement of actors in the PPP and to formulate recommendations at the policy level to favor positive results. This case study represents a milestone in building a participatory evaluation framework of PPP in the veterinary domain.

Urgences ORL de l'enfant au CHU de Yopougon (Côte d'Ivoire)

Objectif : Décrire les caractéristiques épidémiologiques, cliniques et thérapeutiques des urgences ORL de l'enfant dans le service d'ORL-CCF du CHU de Yopougon.Patients et méthodes : Il s'agissait d'une étude prospective transversale portant sur les patients âgés de moins de quinze ans reçus en urgence sur une période de dix mois. Résultats : Cent-vingt-six (126) enfants sur 239 patients ont été reçus en urgence (52,72%). Le sexe masculin représentait 57,94% d'enfants avec un sex-ratio de 1,37. L'âge moyen était de 4,26 ans ± 3,59 (extrêmes 1 jour et 15 ans). Dans cet échantillon, 73,81% des patients ont été reçus pendant la garde en dehors des heures de consultation dont 30,95% les week-ends. Les urgences absolues représentaient 14,30% des cas. Les corps étrangers, les traumatismes externes et les tuméfactions cervicales fébriles ont été observés dans respectivement 50%, 15,08% et 7,14% des cas. La prise en charge était multi-disciplinaire dans 11,12% des cas. Elle concernait en plus de l'ORL, la pédiatrie, la neurochirurgie et la réanimation. Le traitement était médical dans 50% des cas parfois associé aux méthodes physiques (9,52%) ou médico-chirurgicales dans 26,98% des cas. Les méthodes physiques seules ont été suffisantes dans 18 cas (14,29%). Cinq abstentions thérapeutiques (3,97%) ont été répertoriées. L'évolution était favorable dans 90 cas (71,43%). Il a été noté 1 cas de décès. Conclusion : La prévention des accidents de la voie publique et la surveillance des enfants sont des mesures à prendre pour réduire la prévalence des urgences ORL dans notre pratique quotidienne

[Harlequin syndrome in a melanoderm patient]. / Syndrome d'Arlequin chez un patient mélanoderme.

INTRODUCTION: Harlequin's syndrome is a neurological disorder due to a dysfunction of the sympathetic innervation of the face. It has been rarely reported in the literature. The authors report one case occurring in a melanoderm patient. OBSERVATION: A 38-year-old melanoderm man, without any history of surgery or neck trauma, consulted for a strictly right unilateral facial hyperhidrosis. Clinical and radiological investigations concluded to an idiopathic Harlequin's syndrome. Therapeutic abstention was proposed because of non-invalidating symptoms. DISCUSSION: Harlequin's syndrome is a rare sudoral and vaso-motor disorder. On dark skin, flush and erythrosis may be subtle and the diagnosis less obvious. Etiologies are varied but essentially idiopathic. Its association with others dysautonomic facial syndromes is possible. Main differential diagnosis is the Frey's syndrome. Treatment is not clearly codified.

[Sinonasal mucormycosis revealed by a necrotic velar ulceration]. / Mucormycose rhinosinusienne révélée par une ulcération nécrotique vélopalatine.

INTRODUCTION: Mucormycosis is a deep mycosis which has been spreading out in recent years. It is still poorly understood and poorly described in sub-Saharan Africa. The authors report a case of sinonasal localization, of fatal evolution and late diagnosis in a young child. OBSERVATION: It is about a 13-year-old child suffering from chronic rhinosinus syndrome for two years. He was observed in stomatology for a necrotic velar ulceration that have occurred for three months. The clinical, radiological and histological explorations were in favor of a sinonasal mucormycosis. The administration of amphotericin B and the surgical treatment did not slow down the fatal evolution. CONCLUSION: Mucormycosis should not be dealt with any diagnostic error and no therapeutic improvisation. It has to be thought about when dealing with a rhinosinusal syndrome with cleft ulceration.

[One step surgery for severe African endocrine exophtalmia: clinical case]. / Chirurgie en un temps d'une exophtalmie basedowienne africaine sévère: présentation d'un cas clinique.

INTRODUCTION: The association hyperthyroidism-exophtalmia is pathognomonic of the Graves disease. Classically, the treatment is based on a pluridisciplinary step-by-step approach with a precise chronology. In some African places, these optimal conditions are not present. When confronted to such particular situations, it can be proposed to treat surgically at the same time the endocrine disease and the ophthalmologic complications. OBSERVATION: The authors report the case of a 42-year-old women suffering of a great thyreotoxic goiter with severe bilateral exophtalmia, treated by thyroidectomy and orbital decompression in the same session with a good result after 18 months. DISCUSSION: This non-conventional approach can be useful in particular situations when the medical environment is not optimal. It permits the radical treatment of their disease and improves the prognosis of patients with poor capacities for survey.

[Diagnostic and therapeutic aspects of parotid tumors in the Maxillofacial Surgery Department of the University Hospital Center in Treichville, Abidjan]. / Les aspects diagnostiques et thérapeutiques des tumeurs parotidiennes en chirurgie maxillo-faciale au CHU de Treichville Abidjan.

INTRODUCTION: Taking charge of parotid tumors in an African setting is difficult because of the weakness of the technical, delayed consultation, treatment of traditional healers, tumor volume, secondary infection and ulceration of some of them. OBJECTIVE: Identify the epidemiological, clinical, evolutive and therapeutic in order to propose an adapted scheme to the management of these tumors in our African conditions. MATERIALS AND METHODS: This is a retrospective study of 38 patients with parotid tumors operated and hospitalized in the department of stomatology and maxillofacial surgery university hospital of Treichville (Abidjan), during the period from January 2005 to December 2009 included, so a period of 5 years. RESULTS: The study involved 21 (55.3%) men for 17 (44.7%) women aged between 8 and 75 years came to 76.31% for parotid tumor. In 55.26% patients consulted between 1 and 5 years. Clinically: general condition was preserved in 91.1%, tumor size ranged between 5 and 10 cm in 60.53%, they were in the form of nodules in 78.9%, were covered with healthy skin in 78.95%, appeared as isolated tumor in 72.06%. Ultrasound examination was the most paraclinical exam used (65.79%). The tumors were benign in 76.3% dominated by pleomorphic adenoma (63.2%). The most common malignant tumor was muco epidermoid carcinoma (7.9%). Exo-facial parotidectomy was the most common technique used (60.52%). The rate of patient follow-up at 2 years was 5.26%. CONCLUSION: Social and cultural conditions of the management of tumors and lack of technical platform lead us to propose the total parotidectomy for a better cure rate of patients.

[Diagnostic and surgical approach to an hourglass-shaped nasopalatine glioma in an infant]. / Approche diagnostique et chirurgicale d'un gliome naso-palatin "en sablier" chez un nourrisson.

The authors report a case of glioma nasopalatine Multifoil in wallet, location-intra nasal and palatal left. The nasal glioma is a rare congenital malformation presenting as a nasal mass composed of neuroglial tissue heteropias resulting from an abnormality in embryonic development. It is a benign tumor that fits into the nosology of the masses of the midline. This abnormality arises primarily a diagnostic problem because often mistaken for a meningo-encephalocele or a nasal dermoid cyst. Localization nose and palate, an hourglass, is extremely rare if not exceptional; The computed tomography (CT) has enabled the accurate assessment of injury and has guided the choice of surgical technique. The resection was done successfully without recurrence. Histology examination of the surgical specimen confirmed the nature of astrocytic neuroglial tumor. The location of the tumor pedide palate to that of the left nostril is special and especially histological diagnosis of this congenital malformation.

[Identification of high risks regions of schistosomiasis in Côte d'lvoire]. / Identification des régions à haut risque de schistosomoses en Côte d'lvoire.

Regional and national epidemiological data being not available for coherent and efficient control strategies, the identification of high risk zones of schistosomiasis was set up in 5 regions of Côte d'lvoire in April 1999. The inquiry was conducted by questionnaire in 1291 primary schools including 119624 pupils. After less than 2 months, the results revealed blood in urines and in stools in respectively 22035 (18.6%) and 27555 (23.3%) pupils. Out of 1089 (99.8%) schools at risk of schistosomae, 358 (32.9%) are high risk schools. They are to be found especially in the Agnéby (30.8%) and the Marahoué (19.9%) regions identified as high risk areas where actions of control are then important to implement. They are followed by the Lakes regions (15%), the Middle-Comoé (12.6%) and Southern-Comoé (8.9%). These results should help to develop the schistosomiasis control in Côte d'lvoire.

Prise en charge des fractures associées des membres et de la face. Notre experience au CHU de Treicheville (Abidjan)

Trente six (36) dossiers de patients présentant unefracture concomitante des membres et de la face ontété revus de façon rétrospective. Il s'agissait de 26hommes et 10 femmes âgés en moyenne de 32,91 ans(extrêmes 03 à 70 ans) tous admis au CHU de Treichvilleentre janvier 1998 et octobre 2003.Les accidents dela voie publique représentaient l'étiologie la plusfréquente (77,8%). Le membre inférieur était intéressédans 69,44% des cas et les lésions maxillo-faciales selocalisaient à l'étage inférieur dans 61,11%. Lesassociations lésionnelles fréquentes étaient lesfractures mandibulaires associées aux fractures dufémur (13,88%). Les sièges des fractures étaient divers etaucune association n'était significativement pré-pondérante pour expliquer des circonstancesétiopathogéniques particulières.Les moyens thérapeutiques utilisés dans les deuxspécialités ont été dominés par les traitementsorthopédiques. En définitive, 36,11% des patients ontété pris en charge dans le même temps opératoire,séparément et de façon différée pour 63,89% destraumatisés.L'évolution a été simple chez 29 patients, soit80,6% avec une consolidation acquise pour toutesles lésions fracturaires. Des complications ont étéobservées et se résumaient en 5 sepsis superficielset une nécrose commissurale. Une séquelle a typede raideur du poignet a été constaté.Au sein d'une même structure hospitalière la priseen charge des fractures maxillo faciales et desmembres doit obéir à une concertation préalable entreles spécialités afin de permettre un traitement rapideet complet des lésions

[Land-use and urinary schistosomiasis in Daloa (Côte d'Ivoire)]. / Gestion de l'espace et schistosomose urinaire a Daloa (Côte d'Ivoire).

The relation between agricultural land development of inland-valleys and health population has been studied in a town of the Ivorian forest area using urinary schistosomiasis as an indicator. Snails were collected during 4 months in rice fields and water holes used for market gardening of two urban inland-valleys (Batagnihi and Gakognihi). Prevalence of schistosomiasis was evaluated in two districts, Kennedy II and Fadiga, located close to the investigated inland-valleys. Schistosomiasis risk was higher in the Batagnihi where rice cultivation was more developed and prevalence of urinary schistosomiasis was higher in the Kennedy II district which is close to this inland-valley particularly among the Northern migrant people. The Kennedy II population has much more contacts with the inland-valley because of rice cultivation and social status. The higher socio-economic level of the Fadiga population limiting its contacts with the inland-valley can explain this result.

La pratique de l'echographie dans le district sanitaire de San-Pedro

Notre travail est une etude comportant une enquete prospective sur une periode de six mois (de septembre 2003 a fevrier 2004) portant sur l'analyse de 902 Comptes rendus d'examens echographiques de l'unite d'echographie du CHR de San-Pedro et une enquete prospective portant sur l'entretien avec 74 prescripteurs du district sanitaire dudit departement. Son but essentiel est de montrer l'interet de l'echographie dans un district sanitaire provincial. Il ressort de cette etude que l'echographie affirme de plus en plus son efficacite dans l'exploration obstetricale; abdominale; pelvienne; testiculaire; mammaire; thyroidienne; parotidienne et des tissus mous. Malheureusement; l'echographie n'a pas ete exploitee dans un but therapeutique ou interventionnel durant la periode de notre etude. Le district sanitaire de San-Pedro dispose d'un echographe pour 60.574 habitants et d'un radiologue pour 242.188 habitants. Les patients provenaient pour la plupart de la ville de San-Pedro (71.73pour cent). C'etait le plus souvent des adolescents et des adultes jeunes (84;92pour cent) de sexe feminin (82;71pour cent) avec une forte prevalence de l'echographie pelvienne chez les femmes et de l'echographie abdominale chez les hommes. Les explorations obstetricales etaient les plus frequentes avec 44.35pour cent des cas; suivies des explorations pelviennes feminines et des explorations abdominales respectivement avec 29.27pour cent et 21;40pour cent des cas. Les atteintes annexielle uterines dominaient la pathologie pelvienne (60;81pour cent) avec une prevalence des dystrophies ovariennes (71;09pour cent) des cas. Au niveau abdominal; les affections hepatiques etaient les plus frequentes (30;81pour cent) avec une predominance des hepatomegalies homogenes (52.16pour cent des cas). 63;51pour cent des prescripteurs etaient satisfaits des prestations echographiques. Pour 45pour cent d'entre eux le cout constitue un obstacle a la prescription de l'examen echographiques. L'echographie constitue une source de rentabilite financiere de l'ordre 1.6. Outre sa rentabilite financiere et diagnostique; l'echographie est interessante innocuite et ses depenses de fonctionnement faibles. Son installation dans un hospitalier regional rapproche les populations de l'un des moyens d'exploration en imagerie medicale les plus adaptes aux diagnostics de pathologies frequemment rencontrees

[Geographic approach to urinary schistosomiasis in an average African town, Daloa (Ivory Coast)]. / Approche géographique de la schistosomiase urinaire dans une ville moyenne africaine, Daloa (Côte d'Ivoire).

Agricultural activity occurs within many medium size towns in developing countries. Rural influences and urbanization, which may be well or poorly managed, combine to create new health problems. A geographical approach is useful for evaluating the ability of the health care system to deal efficiently with these problems. Such an approach should take into account the urban environment and human population, health care and spatial differentiation factors. Relevant health indicators were selected to analyze the geographical patterns of health risk and of the health care system. These factors were analyzed according to area, at various levels. Field studies were carried out and aerial photographs and the various available maps were also studied. Results were compared to determine whether the health care system was appropriate for the health needs of the town. Urinary schistosomiasis is a useful example for assessing the value of the suggested methodology. The risk of transmission of this disease is high so its early detection is vital. The ability of the health care system to detect infection was assessed.

Geographic approach to urinary schistosomiasis in an average african town, daloa

Agricultural activity occurs within many medium size towns in developing countries. Rural influences and urbanization, which may be well or poorly managed, combine to create new health problems. A geographical approach is useful for evaluating the ability of the health care system to deal efficiently with these problems. Such an approach should take into account the urban environment and human population, health care and spatial differentiation factors. Relevant health indicators were selected to analyze the geographical patterns of health risk and of the health care system. These factors were analyzed according to area, at various levels. Field studies were carried out and aerial photographs and the various available maps were also studied. Results were compared to determine whether the health care system was appropriate for the health needs of the town. Urinary schistosomiasis is a useful example for assessing the value of the suggested methodology. The risk of transmission of this disease is high so its early detection is vital. The ability of the health care system to detect infection was assessed.