[Allergic fungal rhinosinusitis]. / Rhinosinusite fongique allergique (RSF).

INTRODUCTION: Definition, diagnosis and treatment of allergic fungal sinusitis remain difficult and controversial despite the increasing number of publications. We report a case of an allergic fungal sinusitis with a review of the literature. CLINICAL CASE: A 45-year-old man consulted for sinusal polyposis resistant to steroid therapy, clinical examination objectified bilateral nasal polyps and covered with scabs. CT scan of the sinuses disclosed a sinuse filled with a tissue density material containing air with lysis of the left maxillary sinus, hypereosinophilia, the IgE levels were high. Finally, mycological investigation allowed the identification of Aspergillus fumigatus. The patient underwent total ethmoidectomy, histological study found an allergic mucin and inflammatory mucosa with numerous eosinophils. The postoperative course was good and the patient was given oral steroids. The clinical and radiological evolution was favorable without recurrence with a follow-up of three years. DISCUSSION: A set of clinical, radiological, histopathological, immunoallergological and mycological criteria is necessary for precise diagnosis and to avoid fungal drift. The treatment is based on endoscopic surgery associated with corticosteroid.

[Pseudo-tumoral Aspergillus rhinosinusitis of dental origin]. / Sinusite aspergillaire d'origine dentaire dans sa forme pseudo-tumorale.

INTRODUCTION: Sinonasal aspergillosis is caused by the interaction between the sinonasal mucosa with a cosmopolite fungus (Aspergillus), it is on the increase, this is an infection whose evolution is unpredictable requiring early diagnosis and appropriate support. We report a case of Aspergillus rhinosinusitis of dental origin in pseudo-tumoral form with a review of the literature. CLINICAL CASE: A 31 years-old, women, consulted for a right nasal obstruction with purulent rhinorrhea after dental treatment. On examination, there was a bulge of the inner canthus of the right eye and a mass in the right nasal cavity. The CT scanner showed a process of the left naso-sinus cavity centered by calcic image density. The patient underwent a total excision of the mass endoscopically. Mycological and pathological examination concluded that the etiology was Aspergillus fumigatus. The patient had not received any antifungal treatment. The postoperative course was uneventful. The evolution was favourable with no recurrence after 9 months. DISCUSSION: Aspergillus rhinosinusitis of dental origin is usually due to the emergence of canalicular filling paste into the maxillary sinus through and oral cavity and sinus fistula, neglected it can progress to invasive pseudo-tumoral form. The clinical presentation is nonspecific and the diagnosis often involves imaging (scanner). Mycological and histological examinations are essential for diagnosis. The treatment is based on surgery sometimes associated with antifungal treatment.

[Aspergillus ethmoiditis associated with orbital abscess]. / Ethmoïdite aspergillaire compliquée d'un abcès orbitaire.

The authors report a case of Aspergillus ethmoiditis associated with an orbital abscess, diagnosed in an immunocompetent 6-year-old child, this is a rare infection and diagnosis is difficult, cause of a delayed treatment and frightening prognosis. Mycoses have emerged as important infections in clinical practice; this phenomenon is explained by the ever-growing number of immunocompromised patients and the increasing number of people traveling in areas where fungal diseases are endemic. Surgery with mycological and anatomopathologic examination can suggest a fungal infection confirmed by culture and contribute to institute adequate treatment.

Salvage surgery after radiotherapy for oropharyngeal cancer. Treatment complications and oncological results.

AIMS: Surgery is the only available curative treatment option following failure of radiation therapy for oropharyngeal cancer. This study was designed to analyse the postoperative morbidity and survival rate in patents undergoing salvage surgery. MATERIAL AND METHODS: Single-centre retrospective study in a tertiary referral centre. RESULTS: One hundred and five patients were included, with tumour recurrence in 72 cases, and disease progression in 33 cases, despite radiotherapy. Seventy-seven tumours were located in the tonsillar fossa or glossotonsillar sulcus. Ninety-four tumours were classified as rT2-T3 and 83 were classified as rN0. Segmental mandibulectomy was performed in 77 cases. Cervical lymph node dissection was performed in 96 cases. Pharyngeal reconstruction was performed with a myocutaneous flap in 90 cases. Forty-one local complications were observed, including 12 orocutaneous fistulae and/or neck abscesses, associated with carotid artery rupture in three cases. Twenty patients experienced general complications. The mean decannulation and feeding times were 20 and 30 days, respectively. The 5-year disease-free survival was 21%. On univariate analysis, survival was poorer in patients with disease progression (P=0.01); survival was also correlated with tumour site (P=0.02), rT status (P=0.03), rN (P=0.048), and quality of resection (P=0.04). On multivariate analysis, tumour size (P=0.03) and the interval between the end of radiotherapy and surgery (P=0.02) were the two main prognostic factors for survival. CONCLUSION: The results of this study confirm the high local complication rate of salvage surgery for oropharyngeal cancer and the poor overall survival.

[Leiomyosarcoma of the submandibular gland]. / Léiomyosarcome de la glande submandibulaire.

INTRODUCTION: A leiomyosarcoma is a malignant tumor of the smooth muscle. Its malignancy is difficult to assess. Submandibular gland involvement is extremely rare. OBSERVATION: A 62-year-old patient was admitted with a primary leiomyosarcoma of the submandibular gland. He was treated by surgery and radiotherapy. The patient died 11 months later from pulmonary metastases. DISCUSSION: LMS of the submandibular gland is extremely rare. Its diagnosis is very difficult because of the non-specific clinical and radiological signs. The histological diagnosis often relies on immunohistochemistry. Treatment is based on surgery associated to radiotherapy. The prognosis remains poor because of frequent recurrence and metastases.

[Papillary carcinoma in a thyroglossal duct cyst, a case report: Which management]. / Carcinome papillaire sur kyste du tractus thyréoglosse à propos d'un cas : quelle prise en charge ?

Cysts of the thyroglossal duct are common but malignant degeneration is rare, occurring only in 1% of the cases. The most frequent histological type is papillary carcinoma. The clinical presentation of these cancers is generally nonspecific, diagnosis being established postoperatively using the Sistrunk method. Debate remains open concerning appropriate management strategies and post-therapeutic follow-up for this type of neoplasia. We report the case of a 45-year-old patient who underwent surgery for an anterior neck mass that had developed over three years. Histology favored multifocal papillary carcinoma in a thyroglossal duct remant. Total thyroidectomy was performed. The postoperative protocol, established empirically due to the absence of consensus, included radioactive iodine and hormone suppression even though the thyroid was intact. After one year of follow-up, outcome has remained favorable.

Non-traumatic nasal septal abscess due to acute spheno-ethmoiditis.

Non-traumatic nasal septal abscesses (NSAs) are rare and those associated with acute sinusitis are even rarer. We report a case of a 12-year-old female child with NSA and complicating acute spheno-ethmoiditis that was diagnosed by physical examination and computed tomography (CT) scan. The NSA was treated by surgical incision and drainage of the abscess, endoscopic aspiration of pus from the spheno-ethmoidal recess, systemic antibiotic therapy, and nasal cleansing.

[Tonsillitis tuberculous simulating tonsil cancer: case report]. / Amygdalite tuberculeuse simulant un cancer de l'amygdale: à propos d'un cas.

Tuberculous of the oral cavity is rare, the attack tonsil remains exceptional. We report case a 25-year-old young male, who consults for an ulceration of the left unilateral tonsil, with a homolateral adenopathy jugulo-carotidien. The examination anatomopathologic of the tonsil biopsy revealed a tuberculous of the tonsil. The patient profited from an antituberculous treatment, the evolution was good.

[Treatment of a voluminous rhinophyma]. / Traitement d'un volumineux rhinophyma.

OBJECTIVE: The purpose of this study was to present an advanced case of rhinophyma and to discuss the pathophysiology, clinical presentation and treatment of this pathology. CASE REPORT: A 75-year-old patient presented to the ENT out-patient department with a large rhinophyma causing nasal obstruction and eating problems in addition to its aesthetic social burden. RESULTS: The patient was operated under antibiotic coverage. The operated site was left to heal and later covered with a full-thickness skin graft. During the 5-year postoperative follow-up period, there were no complications, no recurrence of the rhinophyma, and the patient retained a good aesthetic result. CONCLUSION: Rhinophyma is the highest of the four grades of rosacea progression. The diagnosis is usually clinical. Surgical treatment is reserved for the advanced nodular forms and is performed under antibiotic coverage in order to prevent the risk of chondrolysis of the nasal cartilages.

[Alveolar rhabdomyosarcoma of the parotid gland]. / Rhabdomyosarcome alvéolaire de la glande parotide.

INTRODUCTION: Alveolar rhabdomyosarcoma of salivary glands is a rare malignant neoplasm, presenting a striated muscular differentiation. It is typically observed in children, adolescents, and young adults but can sometimes be diagnosed in older people. OBSERVATION: We report the case of a 57 year-old man presenting with a primary alveolar rhabdomyosarcoma of the parotid gland. The patient was treated by surgery and radiotherapy. DISCUSSION: According to literature data, alveolar rhabdomyosarcoma of the parotid gland is exceptionally described after 40 years of age. In that case it has the worst prognosis and its lethality is due mainly to its very early metastasis.

[Laryngeal tuberculosis: a case report]. / La tuberculose laryngée: à propos d'un cas.

The laryngeal tuberculous is the most frequent granulomatous disease of the larynx. It is generally associated with a pulmonary cave, and represents a prognosis element extremely serious and can be complicated extreme dysphagia and pains. Among all the extrapulmonary localisations. The isolated laryngée localisation is rare. It is secondary the dissemination coming hematogen, air or lymphatic way. All the structures of the larynx can be reached. The beginning is progressive and insidious and appears by the dysphony, cough, the odynophagy and dyspnea. We report the case of laryngeal tuberculosis in a 21 year old young man. The authors point out the characteristics of this localization and insist on the biopsy in front of any chronic laryngitis no aetiology. The treatment is medical.

[Primary nasal tuberculosis: a case report]. / La tuberculose nasale primaire: a propos d'un cas.

We report a case of a 36 year old woman who presented a chronic rhinitis and a hypertrophy of the inferior turbinates. Primary nasal tuberculosis was discovered by chance after the inferior turbinectomy. Primary nasal tuberculosis is very rare and is more frequent in women. Symptomatology is often unilateral with nasal obstruction, anterior rhinorrhea or epistaxis. The clinical examination may discover ulceration or a polyp located generally in the nasal septum or the inferior turbinate. Diagnosis relies on the anatomopathologic and bacteriological examinations. The treatment is mainly medical based on antituberculosis drugs. In the light of this case report, a review of the literature was made.