Therapeutic Management of Primary Atrophic Rhinitis (Ozene): About 4 Cases.

Objective: To study the clinical characteristics and therapeutic means of primary atrophic rhinitis. Method: We present 4 cases of atrophic rhinitis caused by Klebsiella ozaenae observed in our hospital over a period of 5 years. Results: All patients presented the clinical triad: mucosal atrophy, presence of crusts, and cacosmia. Treatment was medical in 3 patients and surgical in 1 patient. We used rifampicin and sulfamethoxazole as antibiotics as well as trimethoprim for a period of 4 months. The surgical treatment consisted of recalibration of the nasal cavities by placing 2 silicone sticks in the subperiosteum. The evolution was marked by obstruction and cacosmia in 3 out of 4 patients. Conclusion: The treatment of primary atrophic rhinitis poses a problem for the clinician in terms of means and therapeutic effectiveness given that it is a chronic pathology requiring regular monitoring.

Sinonasal Burkitt Lymphoma in a 2-Year-Old Child: An Uncommon Case Report.

Burkitt Lymphoma (BL) is a highly aggressive B-type non-Hodgkin lymphoma. It rarely develops at the level of the sinonasal cavities, especially in young children. We present the case of a 2-year-old boy who presented with a 2-month history of nasal obstruction, snoring, and epistaxis followed by a recent dyspnea. Examination revealed a protruding tissue mass in the left nasal cavity. Computed tomography scan showed a homogenous soft-tissue mass in the left nasal cavity extending toward the ipsilateral orbit, infratemporal fossa, nasopharynx, as well as the ethmoid and maxillary sinuses. Magnetic resonance imaging revealed a homogenous infiltrating mass with a hypo-intense signal on T2-weighted images reaching the infratemporal fossa and oropharynx. Biopsy confirmed the diagnosis of BL. The patient was referred to the clinical hematology department and received complex chemotherapy. Following chemotherapy, imaging revealed significant regression of the mass. We performed a nasopharyngeal biopsy which confirmed the absence of any persistent disease. This case report highlights a rare case of an extensive sinonasal BL emphasizing the importance of a high level of suspicion to ensure an early diagnosis and treatment.

Association between mean platelet volume and cardiovascular disease in obstructive sleep apnea syndrome.

Objectives: Obstructive sleep apnea syndrome is associated with cardiovascular diseases. Mean platelet volume has emerged as a marker of prothrombotic conditions and cardiovascular risk. The aim of this study was to investigate the association between the mean platelet volume and cardiovascular diseases in patients with obstructive sleep apnea syndrome. Methods: The medical records of 207 patients were analyzed. Obstructive sleep apnea syndrome was diagnosed by polygraphy, and patients were classified according to apnea-hypopnea index: control group: individuals with simple snoring (apnea-hypopnea index < 5), mild obstructive sleep apnea syndrome group (5 ⩽ apnea-hypopnea index < 15), moderate obstructive sleep apnea syndrome group (15 ⩽ apnea-hypopnea index < 30), and severe obstructive sleep apnea syndrome group (apnea-hypopnea index ⩾ 30). Mean platelet volume was obtained from medical records. Cardiovascular diseases were defined if patients had hypertension, heart failure, coronary artery disease, or arrythmia. The independent predictors related to cardiovascular diseases in obstructive sleep apnea syndrome were determined by using multiple logistic regression analysis. Results: Of the patients, 175 were included in the analysis. Sixty-three (36%) were males and 112 (64%) were females. The mean age was 51.85 ± 11 years. There were, 26 (14.9%), 53 (30.3%), 38 (21.7%), and 58 (33.1%) participants in the simple snoring, mild, moderate, and severe obstructive sleep apnea syndrome groups, respectively. Cardiovascular diseases were significantly different between the four groups (p = 0.014). Mean platelet volume in severe obstructive sleep apnea syndrome group was significantly higher than in mild or moderate obstructive sleep apnea syndrome group and simple snoring group (p < 0.05). Moreover, there was a positive correlation between mean platelet volume levels and apnea-hypopnea index (r = 0.424; p < 0.001). The independent predictors of cardiovascular diseases in obstructive sleep apnea syndrome were age (p < 0.001; odds ratio = 1.134; confidence interval: 1.072-1.2), body mass index (p = 0.012; odds ratio: 1.105; confidence interval: 1.022-1.194), and mean platelet volume (p < 0.001; odds ratio: 2.092; confidence interval: 1.386-3.158). Conclusion: The present study demonstrated that there is an association between mean platelet volume levels and cardiovascular diseases in patients with obstructive sleep apnea syndrome.

A juvenile pleomorphic adenoma of the palate.

Salivary gland tumors in children are rare; involvement of accessory salivary glands is exceptional. We report a case of pleomorphic adenoma of the palate in a child (an 8-year-old girl) addressed by her dentist for discovering a swelling in the palate. Clinical examination revealed a firm, non-tender, nodular swelling in the left hard palate, measuring 1.5 cm × 1.5 cm, situated adjacent to the upper left second molar. Physical examination did not show signs of inflammation or surface ulceration. Oral cavity computed tomography scan did not show bone lysis. The tumor was removed with negative margins. No recurrence was noted. We aim to describe the clinical, radiological features, as well as the management of this rare localization of pleomorphic adenoma.

Tracheocele: A Rare Entity.

Introduction: Tracheocele or tracheal diverticulum is an uncommon benign entity that can be congenital or acquired. It is usually diagnosed incidentally on cervicothoracic imaging. Our aim is to describe the etiopathogenic, clinical and paraclinical features of the tracheocele as well as its therapeutic modalities. Case Report: We report 2 cases of asymptomatic congenital tracheocele occurred in a boy and a woman, incidentally found on cervical CT scan done for accidental ingestion of chicken bone and infected thyroid hematocele respectively. The tracheocele, in our 2 cases, was probably congenital: no risk factors were noted and the opening of the tracheocele was narrow. The tracheocele was located in the right posterolateral tracheal wall in the 2 cases. It communicated with the tracheal lumen in one case. The female patient underwent a right lobectomy and resection of the tracheocele. For the boy, our attitude was conservative. The evolution was uneventful in the 2 cases. Conclusions: The presence or absence of risk factors, CT scan, bronchoscopy and histologic exam may distinguish between congenital and acquired forms. Asymptomatic patients are managed conservatively. Surgical resection is the treatment of choice for symptomatic patients.

Isolated frontal sinus fungus ball: Diagnostic and therapeutic features and the role of endonasal endoscopic approach.

Fungus ball (FB) is a non invasive form of fungal sinusitis that generally affects immunocompetent subjects. Isolated involvement of the frontal sinus is extremely rare. The treatment is surgical. Previously, it was based on the external approach. Recently, the endoscopic approach has been increasingly employed. We report three cases of frontal sinus fungus ball. Two patients underwent endoscopic endonasal frontal Draf type IIb sinusotomy with complete removal of the pathologic material. The third patient had an external approach due to the extensive pneumatisation of the frontal sinus, the defect in its floor and the orbital involvement. There were no intraoperative or postoperative complications. No recurrence of the disease was observed during the three, two and twelve months' follow up period, respectively. Correct clinical and radiological diagnosis of isolated frontal sinus FB still remains a challenge. Endoscopic sinus surgery with endonasal Draf type IIb or type III frontal sinusotomy is effective for the treatment of frontal sinus FB. It is the treatment of choice and replaces the traditional external approaches.

Organized Hematoma of the Maxillary Sinus: Report of Two Cases.

INTRODUCTION: Organized hematoma of the maxillary sinus (OHMS) is a rare benign disease that can be locally aggressive. The diagnosis of this condition is challenging. CASE REPORTS: We report two cases of OHMS presented with recurrent nasal bleeding, nasal obstruction and anosmia. Radiological findings were suggestive of a vascularised lesion in the first case and a malignant tumor of the maxillary sinus in the second case. Both patients underwent an endonasal endoscopic surgery, There was no recurrence at 19 months' and six months' follow-up respectively. CONCLUSIONS: OHMS should be included in the differential diagnosis if a patient presents with history of recurrent epistaxis and nasal obstruction and radiological findings reveal an expansible maxillary mass with or without bone erosion. Correct preoperative diagnosis is important to avoid unnecessary extensive surgery. The prognosis is very good and minimally invasive surgery such as endonasal endoscopic surgery can cure it completely.