Cartilaginous Myringoplasty: Anatomical and Functional Results.

INTRODUCTION:  Myringoplasty remains a topical subject. Our study aims at analyzing the anatomical and functional results of cartilaginous myringoplasty, and also determining the main factors that could influence its results. MATERIALS AND METHODS:  A retrospective study of 51 cases of tympanic perforations operated at the ENT department of the Hassan II University Hospital of Fez between January 2018 and November 2021. Only the patients with exclusive cartilage myringoplasty were included. The anatomical and functional results of cartilage myringoplasty were evaluated and analyzed according to several variables. The statistical analysis was performed using SPSS Statistics software. RESULTS:  The average age of our patients was 35, with a sex ratio of 2.45. The perforation was anterior in 58%, posterior in 12%, and central in 30% of the cases. The average pre-operative audiometric air bone gap (ABG) was 29.3 dB. The most commonly used graft was the conchal cartilage in 89% of cases. A complete cicatrization has been noticed in 92%, and at six months after surgery, a complete closure of the ABG has been observed in 43% of cases, a significant hearing improvement with an ABG between 11 and 20 dB in 24%, a hearing recovery with an ABG between 21 and 30 dB in 21%, and an ABG > 30 dB in 12% of the cases. A statically significant relationship (p<0.05) has been found between the functional or anatomical failure of the myringoplasty; the different predictive factors were: the young age (less than 16 years), the inflammatory state of the tympanic cavity, the anterior location, and large size of the perforation. CONCLUSION: Cartilaginous myringoplasty provides good anatomical and auditory results. The pre-operative predictive factors, such as age, complete and sufficient drying of the ear, the size and location of the perforation, and the size of the used cartilage, should all be considered for a better anatomical and functional outcome.

[Laryngeal tuberculosis]. / La tuberculose laryngée.

INTRODUCTION: The aim of this study was to highlight the diagnostic problems posed by laryngeal tuberculosis and to incite practitioners to seek it more frequently, especially with the current resurgence in tuberculosis. PATIENTS AND METHODS: Eleven cases of laryngeal tuberculosis were diagnosed over a period of 4 years and included in a retrospective study. RESULTS: We identified seven men and four women (average age 43 years). Dysphonia was the primary symptom. Direct laryngoscopy revealed more often a budding ulcerative aspect and allowed us to perform laryngeal biopsy; the pathologic study confirmed the diagnosis in all patients. Medical treatment for tuberculosis for a short period of 6 months was introduced. In all cases, the long-term evolution was favourable, with an average of 15 months. DISCUSSION AND CONCLUSION: The topography of tuberculosis is diverse, with many sites of localization. The otorhinolaryngologist must be able to discuss the diagnosis of laryngeal tuberculosis, especially when suggested by the clinical context.

[Cervical tuberculous lymphadenitis: the location of surgery]. / Tuberculose ganglionnaire cervicale: place de la chirurgie.

INTRODUCTION: In spite of the current effectiveness of antibacillary chemotherapy in most tubercular sites, peripheral lymph node involvement continues to pose a challenge to treatment. PATIENTS AND METHODS: It is a retrospective study, from 2002 to 2005, of 326 patients treated at the otorhinolaryngology department of Hassan II University Hospital, Fez, Morocco, for cervical lymph node tuberculosis. RESULTS: The tuberculosis of lymph nodes accounts for more than 23% of all affections managed in our department. The mean age of our patients was 32 years. A slight female predominance was noted. All of our patients benefited from surgery with diagnostic and/or therapeutic purposes. The treatment was supplemented by two rifampicine-isoniazide-pyrazinamide/four rifampicine-isoniazide antibacillary chemotherapy. The course of disease was marked by lymph node recurrence and failure of medical treatment in 54 patients. DISCUSSION: In the absence of, or in waiting for, bacteriologic confirmation, the surgery keeps a place impossible to circumvent, either as a diagnostic or therapeutic operation, in first-line treatment in the presence of a cold abscess, an inexhaustible fistula, lymphadenitis with atypical mycobacteria, and a large and calcified lymph-node mass for which medical treatment will not be sufficient, or in secondary surgery in the event of failure or progress under medical treatment or in case of residual adenopathy at the end of an appropriate medical treatment. CONCLUSION: Surgery still has an important place in the management of tuberculosis of lymph nodes.

[Nasopharyngeal tuberculosis]. / Tuberculose du cavum.

Nasopharyngeal tuberculosis is increasingly frequent and poses a diagnostic and therapeutic problem. Through a retrospective study spread out over 4 years, we brought back six cases of nasopharyngeal tuberculosis, including two men and four women of an average age of 41 years. The diagnosis was made, for all of our patients, after histologic study when we found typical tuberculosis lesions on biopsy specimens. The diagnosis of tuberculosis was established; all patients had an antituberculosis medical treatment in a department of infectious diseases. In all cases, the long-term evolution was favourable, with an average passing of 11 months.

[Middle ear tuberculosis]. / Tuberculose de l'oreille moyenne.

OBJECTIVES: The aim of this study was to emphasize the difficulties of diagnosing middle ear tuberculosis because of its nonspecific symptoms and to incite the physician to seek it more frequently. MATERIAL AND METHOD: Six cases of middle ear tuberculosis were diagnosed within a 4-year period and included in a retrospective study. RESULTS: We listed two men and four women with an average age of 41 years. Two patients had a mastoidectomy with a histologic examination that enabled us to rectify the diagnosis. The medical treatment was based on a bactericidal chemotherapy. In all cases, the long-term evolution was favourable, with 11 months an average passing. CONCLUSION: The symptoms of middle ear tuberculosis are misleading. Pathologic findings are increasingly taking a more important place in the diagnosis, which the new techniques of serologic tests will surely improve.

[Hydatid cyst of the parotid gland: six cases]. / Kyste hydatique parotidien: a propos de six cas.

Primary hydatid cyst of the parotid gland is still an exceptional localization. The parotid gland is an uncommon site, even in our country, in which echinococcal disease is endemic. We report six cases of primary hydatid cyst of the parotid gland who presented with an isolated mass. The diagnosis was based on ultrasonography, which showed a parotid gland cystic mass. The echinococcal immunologic test (enzyme-linked immunosorbent assay) was positive in two cases. The surgical treatment consisted of total resection of the cyst, without rupture of the cystic wall and preserving the gland, in four cases and resection of the prominent dome in two cases. The diagnosis was confirmed on macroscopic examination of the resected pieces. In all cases, the postoperative course was uneventful. There was no recurrence at the 17-month follow-up.

[Langerhans cell histiocytosis of the thyroid]. / Histiocytose langerhansienne de la thyroïde.

INTRODUCTION: Langerhans cell histiocytosis, also known as histiocytosis X, has a broad clinical spectrum and highly variable prognosis. Its localization in the thyroid gland is relatively rare and presents particular diagnostic and therapeutic difficulties. CASE: A 38-year-old man consulted for an anterior cervical mass that dated back to childhood but which had grown substantially in volume over the past seven months. The workup indicated a left thyroid nodule. We performed a thyroid lobectomy with isthmusectomy. Immunohistochemical and pathology analyses showed Langerhans cell histiocytosis of the thyroid. The immediate postoperative course and subsequent outcome were good (follow-up: 34 months). CONCLUSION: Diagnosis and treatment of Langerhans cell histiocytosis in the thyroid gland often require multidisciplinary cooperation to analyze clinical, radiological, and pathology findings.

[Laryngeal chondrosarcoma]. / Chondrosarcome laryngé.

Chondrosarcoma is a malignant tumor relatively rare on the larynx, and raises diagnostic and therapeutic difficulties. Its diagnosis often requires the recourse to a radiological, endoscopic and anatomopathologic confrontation. Its treatment is exclusively surgical. It is based on broad excision sometimes mutilating and requires in this kind of localization a multidisciplinary collaboration between ORL, vascular surgeon and radiotherapy. In the light of a new very conclusive observation and data of the literature, we wanted to give a progress report on the clinical and therapeutic positions of the various authors.