Osteite frontale post-sinusitique : etude retrospective a propos de 31 cas

Objectif : L'osteite frontale post-sinusitique est definie par l'extension de l'infection du sinus frontal aux structures osseuses adjacentes. Elle constitue une urgence diagnostique et therapeutique. Le but de ce travail est d'analyser les particularites epidemiologiques; cliniques et paracliniques; et de passer en revue les differentes attitudes therapeutiques devant cette pathologie. Materiel et methodes : Il s'agit d'une etude retrospective portant sur 31 patients diagnostiques et traites entre 1996 et 2010. Tous les patients ont beneficie d'un examen ORL et neurologique complet; d'un bilan biologique et d'une tomodensitometrie du massif facial et cerebrale. L'antibiotherapie a ete administree par voie intraveineuse. Le drainage chirurgical du sinus frontal se faisait soit par trepanation; soit par confection d'un volet frontal; soit par mise en place d'unclou de Lemoyne. Le drainage par voie endonasale comportait une meatotomie moyenne avec ethmoidectomie anterieure. La cranialisation du sinus frontal se faisait par voie coronale. L'evolution a ete evaluee sur des criteres cliniques; biologiques et radiologiques. Resultats : L'age moyen etait de 24;4 ans (8-62 ans) et le sex-ratio etait de 4;16. Les cephalees frontales (10 cas) et les signes d'hypertension intracranienne (8 cas) etaient les signes fonctionnels les plus frequents. Une tumefaction frontale etait notee chez 9 patients; associee dans 5 cas a une tumefaction orbitaire au niveau de l'angle interne de l'oeil. Les signes rhinologiques etaient domines par la rhinorrhee purulente (9 cas) et l'obstruction nasale (5 cas). L'endoscopie nasale trouvait du pus au niveau du meat moyen dans 12 cas. La TDM a revele un aspect typique d'osteite frontale sous forme d'un foyer d'osteolyse. Un abces sous-perioste etait associe chez 7 patients. Une extension intracranienne a ete notee dans 15 cas et orbitaire dans 7 cas. L'examen bacteriologique a mis en evidence un germe dans 8 cas. Les germes les plus frequents etaient le streptocoque et le staphylocoque aureus (3 cas pour chacun). Le traitement antibiotique a ete instaure d'emblee chez tous les patients. Pour le traitement chirurgical initial; 9 patients ont beneficie d'un drainage frontal et 2 autres d'un drainage orbitaire. Par ailleurs; 4 patients ont eu un drainage d'abces sous perioste seul. Celui-ci a ete associe a une cranialisation d'emblee dans un autre cas. Pour les patients ayant des complications endocraniennes; un drainage d'empyeme a ete realise dans 14 cas; associe chez 6 d'entre eux a une cranialisation d'emblee. Un drainage d'abces cerebral a ete pratique chez un autre patient. L'evolution clinique et radiologique a ete favorable chez 24 patients (77;4). Les sept autres patients ont necessite une reprise chirurgicale devant la persistance ou l'aggravation de la symptomatologie clinique. L'evolution ulterieure a ete favorable. Conclusion : L'osteite frontale post-sinusitique est une affection rare et grave. Son diagnostic; qui repose sur la clinique et l'imagerie; doit etre precoce. Un traitement adequat doit etre instaure afin de prevenir des complications qui peuvent mettre en jeu le pronostic vital

Kyste amygdaloide oropharynge : a propos d'un cas

Le kyste amygdaloide est une tumeur kystique latero-cervicale haute rare; issue de la 2eme fente branchiale. Il represente 2 des tumeurs latero-cervicales du cou; et 6;1a 85;2 des anomalies de la deuxieme fente. La forme oropharyngee est tres rare. Nous rapportons une observation d'un kyste amygdaloide oropharynge; chez une femme de 56 ans. Aucune symptomatologie particuliere n'a ete notee. L'examen clinique a revele une tumefaction de la loge amygdalienne droite; refoulant le pilier anterieur. La TDM a objective un processus expansif necrose de l'amygdale palatine droite comblant l'espace parapharynge droit; en contact avec la base de la langue et le muscle pterygoidien medial homolateral. Une resection complete et sans rupture du kyste a ete pratiquee par voie transorale; le geste a ete complete par une amyg- dalectomie droite. L'histologie a confirme le diagnostic par la co-existence d'un revetement epithelial et d'une infiltration de tissu lymphoide. Le recul est de 6 mois sans recidive

[Toxic nodular goitre associated with papillary thyroid carcinoma and primary hyperparathyroidism]. / Association d'un goitre multinodulaire toxique, d'un carcinome papillaire de la thyroïde, et d'une hyperparathyroïdie primaire.

The association of a toxic multinodular goitre with papillary thyroid carcinoma and primary hyperparathyroidism is very rare. Only one case is reported in the literature, we present the second one. It is a 51 year old woman, who initially presented with a toxic nodular goitre. The diagnosis of primary hyperparathyroidism was made following renal complications and the discovery of papillary thyroid carcinoma was incidental during the surgical treatment of parathyroid adenoma. Whilst the association of those three diseases is exceptional, the coexistence of any two of them is relatively frequent without any known common etiopathogenetis. It is recognised that hyperparathyroidism can be found in hyperthyroid patients, but the diagnosis of hyperparathyroidism in these cases is very difficult. The fortuitous discovery of papillary thyroid carcinoma during parathyroid surgery has already been reported but in most cases it is a microcarcinoma. In patients presenting with hyperthyroidism the risk of an associated carcinoma is generally felt to be negligeable. However, this associations is not rare. The association of primary hyperparathyroidism, hyperthyroidism and papillary carcinoma of the thyroid is rare. However, the authors suggest that the presence of any of the pathologies should trigger a search for the other two.

[Cold parapharyngeal abscess in spondylodiscitis]. / Les abcès froids parapharyngés sur spondylodiscite.

BACKGROUND: The principle danger of pharyngeal abscess is the risk of rupture overflow into the upper respiratory track. Pyogenic abscesses are the most frequent and tuberculosis is rare. We report two cases of retro and parapharyngeal abscesses with tuberculous spondylodiscitis. CASE REPORTS: The first case occurred in a 54-year-old woman, the second in a 19-year-old man. Both had a laterocervical swelling associated with a oropharyneal bulge that progressed over several months. Computed tomography showed abscess formation and spinal disease in both cases. Drainage of the abscess led to the distological diagnosis of tuberculosis. Medical management was successful with resolution of the abscess and spinal lesions. DISCUSSION: Spinal tuberculosis should be suspected in patients with a parapharyngeal abscess without detectable portal that progresses slowly. A biopsy specimen is required for diagnosis. Magnetic resonance imaging can provide early evidence of spondylodiscities. Medical treatment is indicated.

[Amniotic band syndrome. Case report]. / La maladie des brides amniotiques. A propos d'une observation.

Amniotic band syndrome is a rare fetal malformation involving limb ring strictions, cranio-facial and trunck abnormalities. The authors report a case of 5 months old infant with also facial cleft. The plastic reconstructive surgery leads to a better functional result. This affection represents a sporadic disease without genetic causes. The pregnancy ultrasonography visualise fetal abnormalities.

[Nasal localization of the Crohn's disease]. / La localisation nasale de la maladie de Crohn.

Crohn's diseases is a chronic granulomatous inflammatory disease of the gastrointestinal tract. Any part of the gastrointestinal tract may be affected, and 9% of cases have oral lesions (1). Nasal involvement is exceptionally rare. We report a case of nasal involvement revealed by chronic atrophic rhinitis in a patient with known Crohn's disease.

[Fistula of the 4th endobranchial pouch: a case report]. / Les fistules de la 4ème fente endobranchiale: à propos d'une observation.

The congenital fistula of the 4th branchial pouch is rare. Clinical and therapeutic difficulties are often found. The authors describe a new case of fistula of the fourth endobronchial pouch and precise the embryogenesis, the clinical diagnosis and the surgical treatment.

[Staphylococcal infection of the face. 52 cases]. / Infection staphylococcique de la face. 52 observations.

Severe staphylococcal infections, and notably those affecting the face, are frequent in Tunisia. We report 52 cases observed between December 1981 and September 1989. The epidemiological, clinical and therapeutic features of the disease are presented. New antibiotics have reduced the mortality rate to 4%. Lethal cases and sequelae are due to delayed treatment. This demonstrates the importance of an early treatment and, above all, of prevention by vigorous chemotherapy of even the mildest facial skin infections.

[Cystic cervicofacial lymphangioma]. / Lymphangiomes kystiques cervico-faciaux.

A review of fifteen new cases of cystic cervicofacial lymphangiomas is presented. While discussing the different localizations of these malformations, the authors emphasize the relationships existing between this type of malformation and both the facial nerve and the vasculonervous axis of the neck. They recommend surgical management. 1-to-10 years' follow-up revealed one case of local recurrence associated with incomplete excision.

[Involvement of the cranial nerves disclosing multiple myeloma]. / Atteintes des paires crâniennes révélatrices de la maladie de Kahler.

Diseases of cranial nerves are very seldom associated with multiple myeloma. However, their occurrence as a harbinger of multiple myeloma seems to bear a particular significance and is worth mentioning. In the present paper, we discuss two cases in which disorders of cranial nerves heralded Kahler's disease. The patients presented with posterior laterocondylar space and cochleovestibular (otoliquorrhea) syndromes, respectively. We stress the diagnostic problems involved and analyze the pathogenesis of diseases of the nervous system associated with multiple myeloma. Diseases of cranial nerves are seldom associated with multiple myeloma. Nonetheless, the clinical setting and laboratory tests will direct the diagnosis. The same does not hold true when one is confronted with Collet-Sicard's syndrome or cochleovestibular syndrome accompanied by otoliquorrhea.

[Cysts and fistulas of the 1st cleft. Apropos of 5 cases]. / Kystes et fistules de la première fente. A propos de 5 cas.

The authors describe 5 cases of auriculobranchial anomalies, including 2 fistulas, 2 cysts, and 1 case of combined cyst + fistula of the primary cleft. They take this opportunity to review the underlying pathogenic mechanism, the clinical manifestations and therapeutic procedures.

[Adenoid cystic carcinoma in the head and neck. A retrospective study of 12 cases]. / Les carcinomes adénoïdes kystiques à localisation cervico-faciale. Etude rétrospective de douze cas.

Basing themselves on a series of twelve cases of cervicofacial cylindromas, the authors review the different clinical data pertaining to the evolution of these tumors, which they find to be prevalent in females aged around sixty. Cylindromas predominantly occur in the submandibular and accessory salivary glands. Out of twelve cases, the report mentions three local recurrences and two pulmonary metastases. Management was surgical in all instances.

[Tuberculosis of the upper digestive and respiratory tract]. / Tuberculose des voies aéro-digestives supérieures (V.A.D.S.).

Based on seventeen cases of upper digestive and respiratory tract tuberculosis, the authors review the different localizations of the disease. The mean age of the patients is 34 years old. The diagnostic is based on bacteriological and especially histological examination. The prognostic of the affection is excellent if tuberculosis chemotherapy is used for a minimum of 9 months.

[Efficacy of Cefsulodin in pyocyanic otologic infections, apropos of 55 cases]. / Efficacité de la cefsulodine dans les infections otologiques à pyocyanique, à propos de 55 cas.

Our work consists of a comparative study of 4 therapeutic protocols for treatment of otological infection from the pyocyanic bacillus, and more specifically of 19 patients with a necrotizing malignant otitis, 24 patients with perichondritis and 12 patients suffering from a post-operative infection. The association of Cefsulodin (a 3rd generation Cephalosporin) and Gentamicin gave the best results. A major decrease of the time of treatment and a total absence of infectious complications were in fact recorded. The adjuvant therapies were duly observed for the 4 protocols, in particularly the surgical treatment and the treatment of the site (diabetes).

[Cysts and fistulas of the lateral neck. Apropos of 18 cases with a review of the literature]. / Les kystes et les fistules latéraux du cou. A propos de 18 cas avec revue de la littérature.

Lateral cysts and fistulas of the neck are branchial cleft malformations. Lateral fistulas occurring at the basis of the neck account for about 5% of all congenital neck fistulas. Concerning 18 personal case observations of 2nd and 3rd branchial arch cysts, the authors report the chief clinical findings in this type of malformation, as well as discussing fistulography as a valuable investigational technique. They present the characteristics of surgical therapy as the sole possible solution.