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.

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.

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.

Malignant external otitis complicated by spinal cord compression: Case report.

Introduction: Malignant otitis externa is a life-threatening infectious pathology that occurs mainly in diabetic patients; in a picture of otorrhea, with facial paralysis. We report the case of a necrotizing otitis externa, treated with antibiotics, which was complicated a few months later by spinal compression. Observation: This is the case of a 60-year-old patient, diabetic, who presented a painful otorrhea associated to left facial palsy.The diagnosis of necrotizing otitis externa was retained after performing a CT scan of the temporal bone.6 months after medical treatment, the patient became has been complicated by tetraparesis with respiratory distress. Discussion: Necrotizing otitis externa is an osteitis of the base of the skull, which occurs in the diabetic patient and which starts in the external ear and spreads by contiguity after infection of the temporal bone.It represented clinically by otalgia and purulent otorrhea.The role of imaging is to confirm the involvement and to specify the extension of the lesions. CT scan is useful to evaluate the bone involvement. MRI is the examination of choice for the study of soft tissues and is essential in advanced forms.Its treatment is based on antibiotic therapy for a minimum of 6 weeks. Conclusion: OEM is an infection occurring in elderly and diabetic patients. Imaging allows to confirm the diagnosis and to carry out the assessment of extension; but also has a great interest in the follow-up of these immunocompromised patients who are subject to complications with insidious evolution.

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.

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.

Unusual presentation of a soft palate mass: A rare case report of solitary extramedullary plasmacytoma.

INTRODUCTION: Plasmacytoma is a rare clonal neoplastic disorder of bone marrow that originates from plasma cells. It usually presents as a multiple myeloma (MM). Less than 5% of patients present with either a single bone lesion as a solitary bone plasmacytoma (SBP) or, even more rarely, as a soft tissue mass of monoclonal plasma cells representing a solitary extra medullary plasmacytoma (SEP). CASE PRESENTATION: We report a case of a 59-year-old man presenting with a mass of the soft palate evolving for a year. Physical examination showed an extension to the nasal cavity. Biopsy with immunohistochemical study demonstrated sheets of mononucleated plasmacytoid cells diffusely expressing CD138. The plasma cells showed monoclonal light chain Kappa. Further investigations did not show any other locations including bone and bone marrow. Thus, diagnosis of solitary extramedullary plasmacytoma of the soft palate was established. The patient was treated with chemotherapy with total remission on his one year follow-up. DISCUSSION: SEP may arise in any organ, either as a primary tumor or as part of a MM. Almost 90% of SEP arise in the head and neck, especially in the upper respiratory tract. Primary treatment for most patients is radiotherapy, but surgery may also be required, and multidisciplinary decision between surgeon, hematologist and radiotherapist is crucial for planning optimum care. CONCLUSION: SEP is an extremely rare condition which requires diagnostic and therapeutic management in the same level of MM. Prognosis is better than the two other forms (MM and SBP).

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.

Malignant tumors of the hard palate: Report of 4 cases and review of the literature.

INTRODUCTION: Cancer of the hard palate is a fairly rare malignant tumor. Different histological types have been described in the hard palate, and that can affect its different structures. Diagnosis is based on biopsy with histological examination and possibly on immunohistochemical markers to confirm the diagnosis and exclude other diagnostic hypotheses. The aim of this study was to determine histopathologic, clinical and therapeutic characteristics of malignant tumors of the hard palate. PATIENTS AND METHODS: A retrospective review of 4 patients who underwent Surgical resection by trans oral approach was performed for different histological types of malignant tumors of the hard palate. These included squamous cell carcinoma (case1 and case 2), mucosal melanoma (case 3), and adenocarcinoma (case 4). RESULTS: The T stage was analyzed for all cases. Two cases were classified as T2 stage with a tumor size between 2 and 4 cm and the two others, given the extension to the maxillary and nasal cavity were classified as T4a. Cervical lymph node metastasis was found in three patients. DISCUSSION: Surgical resection is the treatment of choice for malignant tumors of the hard palate. There is a variety of surgical procedures that can be used via a trans oral approach. Reconstruction of palatal defects with a prosthesis is sufficient, whereas larger defects will require a local, regional or even microvascular free tissue flap. The differences between these surgical techniques are presented, and indications are discussed. CONCLUSION: The therapeutic management for malignant tumors of the hard palate is essentially surgical, with or without postoperative radiotherapy, discussed on a case-by-case basis. Survival rate depends on several factors, including early diagnosis, histological characteristic and appropriate management.

Spindle cell hemangioma in the infratemporal fossa: A unique case report.

INTRODUCTION: Spindle cell hemangioma (SCH) is a rare vascular tumor which was first described in 1986. It affects mostly the distal extremities. The head and neck are rarely involved. This article reports the first case of SCH in the infratemporal fossa. PRESENTATION OF CASE: A 41-year-old woman presented with an 8-month history of right cheek swelling. Facial CT scan and MRI showed an intensely and heterogeneously enhancing tumor of the infratemporal fossa suggesting an angiomatous neoplasm. The mass was excised surgically through an anterior maxillary approach. The histopathological and immunohistochemistry analysis revealed a SCH. CONCLUSION: This case report presents a unique presentation of a Spindle cell hemangioma in an unexpected location of the head and neck region. it underlines the importance for clinicians and pathologists to consider the Spindle cell hemangioma as a possible etiological diagnosis of infratemporal fossa tumors.

Quality of life assessment in patients treated with nasal corticotherapy for allergic rhinitis: A cohort study.

INTRODUCTION: Allergic rhinitis (AR) is a chronic nasal pathology induced by an inflammation of the mucous membranes due to a dependent IgE reaction following allergenic exposure. The main symptoms are rhinorrhea, nasal itching, nasal obstruction and sneezing bursts. It highly affects the patient quality of life (QoL) in many levels making it a public health issue.The aim of this study is to assess the QoL of patients with AR as well as the level of its improvement after nasal corticotherapy. MATERIALS AND METHODS: From June 2019 to February 2020, a prospective study was carried out based on the use of the validated Arabic version of the RQLQ (Rhinoconjunctivitis Quality of Life Questionnaire) on a cohort of AR patients to measure their QoL before and after three months of treatment by "Budesonide". RESULTS: A total of 70 patients participated in the study with an average age of 39.54 years with a sex ratio of 0.60. Their total RQLQ score was up to 4.28, improved to 2.35 after treatment. Also, a statistically significant improvement in sub-scores was also observed (p < 0.001): activities (from 4.43 to 2.29), nasal symptoms (from 5.00 to 2.80), eye symptoms (from 3.38 to 1.80), practical problems (from 4.29 to 2.18), general problems (from 4.63 to 2.78) and emotional state (from 4.28 to 2.43). CONCLUSION: The RQLQ is a reliable tool to evaluate the QoL in AR patients, stating the negative influence of AR on patients daily life and the effectiveness of nasal corticosteroid treatment.

Embryonal mastoid rhabdomyosarcoma in a three years old child: A case report.

INTRODUCTION: Rhabdomyosarcoma is the most common malignant soft tissue tumor in the pediatric age, especially in the head and neck region; in the orbit and the nasopharynx. The middle ear is a very rare site for this neoplasm as it accounts for only 10 % of head neck rhabdomyosarcoma. PRESENTATION OF CASE: We report here the case of a three years-old child who was admitted to the emergency room for a left parotid and retro-auricular swelling with grade V facial palsy. The patient experienced chronic otorrhea with left facial palsy for two months. Two weeks later, a left parotid swelling appeared and gradually increased in size with weight loss. Computed tomography showed a slightly dense tissue lesion in the left mastoid. The patient underwent a diagnostic mastoidectomy. Pathology and immunohistochemical study were compatible with an embryonic rhabdomyosarcoma. CONCLUSION: Rhabdomyosarcoma should be considered as a differential diagnosis of any mastoiditis resistant to treatment in a young child. Because of its serious prognosis, rhabdomyosarcoma must be diagnosed at an early stage to increase chances of recovery.

Simultaneous bilateral traumatic facial palsy with different treatment protocols.

INTRODUCTION: Bilateral simultaneous facial palsy is a rare clinical entity. Traumatic origin is even rarer. Long-term sequelae are disabling. Therefore, rapid and adequate management is crucial. CASE PRESENTATION: Herein we present a case report of a traumatic bilateral facial palsy in a 43 years old male treated with surgery in one side and conservative treatment in the other side. He achieved eye closure at his 10 months follow up. DISCUSSION: Electroneurography showing more than 90 % of facial nerve degeneration and electromyography revealing no regeneration potentials are identified as surgical indications. The perigeniculate region is the most commonly injured portion of the facial nerve with temporal bone fractures. Surgical approach to this area remains controversial; transmastoid, middle fossa craniotomy or a combination of both. CONCLUSION: It is important to discuss expectations with the patient as it might take 12 months to regain maximal nerve function.

Thyroid papillary carcinoma with an insular component metastasizing to the sella turcica and sphenoid sinus: Case report.

INTRODUCTION: Papillary carcinoma accounts for approximately 80% of all thyroid carcinomas. It is associated with relatively good survival. Distant metastases occur in approximately 10% of the patients, with the lung and bone being the most commonly reported sites. We present a case of unusual metastasis to the sphenoid bone and sella turcica from papillary thyroid carcinoma with an insular component. CASE PRESENTATION: We present a case of 70 years old female patient who presents a voluminous goiter with an 11 cm mass of the left sixth rib. Trans-parietal biopsy proved its metastatic origin from a thyroid papillary carcinoma. The patient was treated with total thyroidectomy and radiation therapy as the metastatic tissue is radioiodine refractory. Pathology revealed a papillary carcinoma with an insular component. A year later, the patient develops another metastasis to the sphenoid bone extending to the sella turcica, cavernous sinus, and carotid arteries. Treatment was based on kinase inhibitor. DISCUSSION: Metastatic invasion of the skull develops in 2.5%-5.8% of differentiated thyroid carcinoma and mostly affects the sella turcica, pituitary gland, cavernous sinus and sphenoid sinus. The presence of an insular component in a well-differentiated thyroid carcinoma seems to be associated with a poor prognosis. For cases where the metastatic disease is found to be resistant to conventional therapies, some clinical trials show promise with the use of tyrosine kinase inhibitors such as Sorafenib. CONCLUSION: Management of such uncommon cases remains challenging and should take in consideration evidence based guidelines, prognostic factors, disease progression path and treatment morbidity.

Assessment of chronic sinonasal dysfunction and cross-cultural adaptation of the DyNaChron questionnaire.

OBJECTIVE: Sinonasal pathologies generate six principal symptoms with major organic and psychosocial impact that can be studied on a self-administered questionnaire assessing chronic sinonasal dysfunction independently of etiology. The objective of the present study was to translate, culturally adapt and validate the DyNaChron questionnaire for Arabic-speaking Moroccan patients. METHODS: The translation and cross-cultural adaptation of DyNaChron followed international guidelines. 164 patients filled out the questionnaire at day 0 and day 7 (without treatment) and day 60 after treatment. A prospective multicenter study validated the questionnaire for internal consistency, test-retest reliability and sensitivity to change. RESULTS: Mean age was 35 years, with male predominance (63%). Nasal obstruction was the most frequent symptom (97.6%). Internal consistency on Cronbach alpha was high (0.97). Reproducibility on intraclass correlation (ICC) was excellent (0.84). Sensitivity to change was excellent for the majority of patients (effect size=0.97-6.69; SRM=2.47-6.74). CONCLUSION: This study of a cross-cultural Moroccan adaptation of the DyNaChron questionnaire showed good validity, reproducibility and sensitivity to change, and better representation of all symptoms generated by chronic sinonasal dysfunction. It can be used to evaluate the psychosocial and organic impact of chronic sinonasal dysfunction and to assess treatment.

Keratoameloblastoma of the mandible.

INTRODUCTION: Keratoameloblastoma is an extremely rare odontogenic tumor, as only 18 cases have been reported in the literature. CASE REPORT: The authors report a case of keratoameloblastoma in a 32-year-old woman and review the literature concerning the clinical features, radiological appearance, histopathological findings and treatment options. DISCUSSION: Keratoameloblastoma is a rare tumor observed more frequently in males (sex ratio: 3:1) characterized by extensive keratin production in odontogenic islets and fibrous stroma.