Pectoralis major muscle flap reconstruction after a total laryngectomy widened anteriorly: A case report.

INTRODUCTION AND IMPORTANCE: The pectoralis major flap is one of the leading regional pedicled flaps for reconstructive surgery of the head and neck, particularly in oncology after tumor resection. Despite the increasing use of free flaps, this type of flap is still highly recommended in defined indications. It is a highly reliable flap in terms of viability. CASE PRESENTATION: We report the case of a man treated in our ENT department for a squamous cell carcinoma of the three laryngeal stages, anteriorly very extensive and requiring total laryngectomy extended to the skin and subcutaneous planes opposite, followed by reconstruction with a flap of the pectoralis major muscle. Post-surgical outcome was excellent. CLINICAL DISCUSSION: Aryan was the first person to describe the use of the pectoralis major muscle flap. Since then, several studies have demonstrated the great value of this flap in face and neck reconstruction, thanks to its wide indications and excellent viability rate. CONCLUSION: The pectoralis major muscle flap represents a valuable reconstructive option for substance loss in the cervicofacial region despite the great development of microsurgery and free flaps.

Diagnosis of an atypical presentation of basal cell carcinoma of the nasal pyramid: Case report.

INTRODUCTION AND IMPORTANCE: Basal cell carcinoma is a common form of skin cancer whose global incidence is rising rapidly, with over 70 % of locations on the face. In contrast to their low mortality, their morbidity is high. Extensive basal cell carcinomas and infiltrative lesions are associated with a high recurrence rate, which can result a serious esthetic and functional damage. CASE PRESENTATION: We report the case of a 65-year-old female patient, who consulted our ENT department for a large ulcerating lesion of the nasal pyramid. CT scan revealed a lesion of the nasal pyramid measuring 38 mm in long axis, which appeared to come into contact with the anterior part of the nasal septum. The pathological findings were consistent with an infiltrating basal cell carcinoma. The patient underwent surgical resection with reconstruction using a forehead flap. CLINICAL DISCUSSION: Following ANAES guidelines, when the diagnosis of a poor-prognosis BCC is uncertain, or when major reconstruction is required at the time of surgery, biopsy is strongly recommended to confirm the diagnosis. The evolution of BCCs is essentially local, and they rarely metastasize, with a maximum incidence rate of 0.55 %, of which around 85 % appears on the face. Thus, local extension of BCCs mainly involves adjacent tissues, including the perichondrium, in which case imaging is necessary to assess the extent of damage. The most common and effective treatment is surgical excision, with a margin of healthy tissue around the tumor. CONCLUSION: Because early diagnosis and carcinological excision are the keys to a good prognosis. We must insist on the role of primary and secondary prevention, and on the importance of early diagnosis.

Extra-renal rhabdoid tumor in an adult presenting as cervical adenopathy with spondylodiscitis.

INTRODUCTION AND IMPORTANCE: Rhabdoid tumor (RT) is among the most aggressive and lethal types of cancer. It most commonly arises in the central nervous system, kidney, or soft tissues. It typically affects young children. CASE PRESENTATION: We present a case of a 21 years old man with an extrarenal rhabdoid tumor (ERRT) in the neck extending to the vertebra and epidural space. Clinical presentation was at first misleading as it presented as infectious spondylodiscitis with cervical adenopathies. The patient developed quadriplegia a few days after biopsy was taken and succumbed to his disease a week later. CLINICAL DISCUSSION: The diagnosis of MRT is mainly based on histopathology, immunohistochemistry and molecular studies. Loss of INI1 expression due to biallelic mutation of the SMARCB1 gene is characteristic. Because of the lack of standardized treatment protocols for MRT, various combinations of chemotherapeutic drugs are used. However, prognosis remains poor especially for cervical vertebral localization as it results in a rapid fatal outcome secondary to respiratory failure. CONCLUSION: SMARCB1-related biology and potential therapeutic targets are the main focus of preclinical investigations that aim to expand treatment options and improve patient's survival.

The outcomes of congenital torticollis delayed surgery in older children: A case series.

INTRODUCTION AND IMPORTANCE: Congenital muscular torticollis is a benign affection defined as a contracture or fibrosis of the sternocleidomastoid muscle, causing ipsilateral inclination and contralateral rotation of the face and chin. The management is multidisciplinary, usually surgical and should start at very early age in infants to secure better results. Thus, the purpose of our study is to report the outcomes of delayed surgery performed in older children above 5 years old with late diagnosis. CASE PRESENTATION: We report the cases of 4 patients aged between 5 and 11 years old and followed in our department for congenital torticollis. They were all born by vaginal delivery with vacuum extraction in two cases of breech presentation. Even if the condition is present at birth, most parents were not bothered by the cervical vicious neck position of their children until a later age, delaying the diagnosis. The clinical examination found a flexed head position on the right side in all cases, with contralateral rotation. Regarding the age, we proposed surgical treatment immediately for two of them, while two were sent to our department after multiple ineffective physiotherapy sessions. The surgery consisted on right distal tenotomy and a cervical collar was prescribed next to physiotherapy. They all had successful results with correction of head position and improvement of cervical range motion. CLINICAL DISCUSSION: Children treated early with active and well monitored rehabilitation, recover completely and regain normal head position and mobility rapidly. In older children, above 5 years, they are more likely to develop sequels such as asymmetry of facial movement. CONCLUSION: Delayed diagnosis after the age of 5 years old still can be managed successfully with a correction of the head position and rotation motion. However, in these older children, physiotherapy alone cannot be effective and should be associated to surgery. Moreover, once the diagnosis is done, surgical treatment should be performed to avoid wasting more time.

Management of a rare case of parapharyngeal lipoma presentation of case.

INTRODUCTION AND IMPORTANCE: Parapharyngeal masses are rare but critical because of their deep location and their important anatomical relationships with the surrounding structures. Their management poses a challenge in terms of etiological diagnosis and adequate therapeutic approach. The clinical and especially the radiological examination have an important role not only for the diagnosis but also for the determination of the appropriate management and for the orientation towards the nature of the mass. CASE PRESENTATION: We present the case of a 44-year-old man with a parapharyngeal lipoma that caused mainly obstructive sleep apnea syndrome. Once in our structure after a radiological examination (MRI and CT scan), a decision for surgical management was made. Surgery consisted on a combined cervical and endobuccal approach. The follow-up showed an effective result with the total resolution of the discomfort caused by the mass, which improved the patient's quality of life. CLINICAL DISCUSSION: Tumors in this space represent less than 1 % of all head and neck tumors and are usually benign. Symptoms leading the patient to consult a doctor only appear after a significant volume of the mass, which makes the severity of this pathology. Imaging, namely CT and MRI, should be requested systematically in case of suspicion of any parapharyngeal mass. Several surgical approaches are described in the literature, the choice between them depends on the nature of the mass, its location and especially its extension, hence the interest of preoperative imaging. CONCLUSION: The main take-away lessons are the great value of imaging in the diagnosis and treatment of parapharyngeal space masses, the relationships of this region and its content make the surgery very delicate, so it's so important to choose the appropriate surgical approach.

Primary carcinoma of the larynx in females: A case series.

Background and aim: In north Africa, laryngeal carcinomas remain a predominately male pathology. While in many countries the gap between men and women is narrowing. This study aimed to examine the epidemiological, clinical, therapeutic, and follow up data of a case series of 23 female patients treated for laryngeal carcinoma. Patients and methods: Medical records of a case series of 23 patients for primary carcinoma of the larynx at the Department of Head and Neck Surgery of the 20 August Hospital of Casablanca, between January 2012 and September 2016, were reviewed. Demographic, clinical, endoscopic, radiological, surgical, and follow-up data were collected. Results: 7% of all the patients treated for LC were women, The most affected age group was between 60 and 79 years (52%), 52% had no major risk factor, all patients had an epidermoid carcinoma, 48% of patients had T2 tumors. T1, T3, and T4a were found in respectively 17%, 22%, and 13%. N1 in 43% of the cases (n = 10), N0 in 35% (n = 8), N2b in 17% (n = 4), N2c in 4% (n = 1). All patients were M0. All the patients in this series have undergone surgical treatment. At 5 years, the survival rate was 83%. Conclusion: Since the proportions of women in published studies are limited, there are still many controversies about gender differences in laryngeal cancer. Therefore, further studies should seek a clearer understanding of factors involved in female laryngeal cancer to adopt more appropriately the measures of prevention and early diagnosis.

Primary laryngeal T-cell lymphoma: A case report and review of the literature.

INTRODUCTION: Primary lymphoma of the larynx is extremely rare, representing less than 1% of all primary laryngeal neoplasms. It consists mainly of non-Hodgkin lymphomas (NHLs), represented particularly by diffuse large B-cell. Extranodal natural killer/T-cell lymphoma, presented in larynx is a rare condition that accounts for less than 11% of all lymphomas without distinctive clinicopathologic features, as well as challenging pathologic diagnosis. CASE REPORT: We report here a case of a 64-years-old man who presented with primary lymphoma type T of the subglottic larynx. A histopathological examination of the biopsy confirmed non-Hodgkin T cell lymphoma. Given his age, he underwent chemotherapy and radiation therapy. The patient was disease-free after 18 months follow up. CONCLUSION: The clinicopathological characteristics and rational treatment of primary laryngeal lymphoma are still unclear and need to be further defined due to the paucity of this pathology.

Cervical approach to cervico-mediastinal goiters: Experience of a Moroccan ENT tertiary center - Case series.

BACKGROUND: The purpose of the study was to analyze and discuss the demographic, clinical, radiological, therapeutic and postoperative findings of the Cervico-mediastinal goiters (CMG) treated through a cervical approach admitted in the ENT department of Ibn Rochd university hospital, Casablanca, Morocco between January 2014 and January 2020. MATERIELS AND METHODS: Over a period of 6 years, 116 patients underwent surgical treatment for CMG. It was defined as a goiter extending below the plane of superior thoracic aperture on CT scan. All our patients had clinical, biological and radiological assessment before surgery. A nasofibroscopy was carried out pre and postoperatively. All the CMG have been extracted trough a cervical approach by an experimented ENT surgeon. RESULTS: 84,48% of the CMG was diving into the anterior mediastinum and 15.52% into the posterior. The CMGs extended above, at, and below the level of the aortic arch respectively in 76.72%, 18.10% and 5.17% of the patients. All of 116 goiters were successfully removed through a cervical approach. No patient required a sternotomy. Postoperatively, vocal cord paralysis was transient in 3 patients (2.58%) and permanent in 2 patients (1.72%). Hypocalcemia was transient in 10 patients (8.62%) and permanent in 2 patients (1.72%). Final histology found 106 benign multinodular goiters (91.37%), 7 papillary carcinomas (6.03%) and 3 vesicular carcinomas (2.58%). No death was noted. CONCLUSIONS: With expertise in thyroid surgery, cervical approach for CMGs is safe and sufficient in the majority of the cases with low morbidity rate and no mortality.

Locally advanced maxillary sinus carcinoma controlled by para-latero-nasal approach.

Sino-nasal cancers are a rare pathology, with an incidence of 0.2-0.8% of all cancers, and less than 5% of ENT cancers. The site that is most often affected is the maxillary sinus in 35% of cases, followed by ethmoid sinus (30%) and of the nasal cavity in (16%). Several histological variants are described, but squamous cell carcinoma remains the most frequent in the maxillary sinus. Its diagnosis is often late making local control very difficult. Multimodal treatment allows an improvement in the survival rate compared to single treatment. Due to the progress of endoscopic surgery, external surgery is neglected. With this work we want to highlight the value to the external approach, especially in advanced cases.

Recurrence of thyroid carcinoma in cervical soft tissue following surgical implantation: Case report.

INTRODUCTION: Thyroid cancer is the most common type of malignant endocrine cancer. Differentiated thyroid cancer, which includes papillary and follicular cancers, represents majority (90%) of all thyroid cancers and has a favorable prognosis. However, a minority of patients develops loco-regional recurrence. CASE REPORT: We report here a rare case of a 63 years-old man who underwent total thyroidectomy in 2015 for multinodular goiter whose histopathological examination revealed a papillary thyroid carcinoma. He received 6 weeks later a 100 mCi of radioactive iodine therapy. In 2017, he was admitted for multiple cervical lymph nodes with high serum thyroglobulin level (234 ng/mL) which required a bilateral central and lateral neck dissection. He was readmitted in 2019 for multiple subcutaneous neck nodules with high serum thyroglobulin level (197 ng/mL). The histopathological examination of the excised nodules revealed a papillary thyroid carcinoma. The patient showed no sign of recurrence after 2 years follow-up. CONCLUSION: Local soft tissue recurrence followed surgical implantation should be suspected when nodules are determined alongside the thyroid after previous thyroid surgery. Therapy for these soft tissue implants may be difficult; a comprehensive long-term postoperative evaluation should be completed to minimize the risk of recurrence in cervical soft tissue.