Eccrine spiradenoma of nose: Surgical case report.

INTRODUCTION AND IMPORTANCE: Eccrine spiradenoma is a benign tumor of the eccrine sweat glands, preferentially affecting the scalp, face and trunk. Few cases are described in the literature, it is a fairly rare pathology. PRESENTATION OF THE CASE: We present the case of a 64-year-old man who consulted for an ulcerative and nodular lesion of the left side of the nose for 5 years. He was treated in our department (excision and reconstruction). Pathological examination revealed a benign eccrine spiradenoma. CLINICAL DISCUSSION: Eccrine spiradenoma is a relatively rare benign adnexal tumor. His diagnosis is based on histopathological examination. His treatment is surgical. In case of incomplete excision of the tumor, the risk of recurrence is always possible. The risk of malignant transformation exists, particularly for tumors with a long duration of evolution. CONCLUSION: Benign eccrine spiradenoma is a rare adnexal tumor, but it is important to know about it. The main risk is malignant transformation.

Intracranial angiomatous meningiomas: A 15-year, multicenter study.

BACKGROUND: Angiomatous meningiomas (AMs) represent a rare subtype of meningiomas in which the vascular component prevail. They represent less than 1% of all intracranial tumors and approximately 2.1% of all meningeal tumors (Hasselblatt et al., 2004). The purpose of this study was to determine the clinical characteristics, radiological features and prognosis of AMs based on a Tunisian multicenter experience in the management of 58 successive cases of intracranial AMs. To the best of our knowledge, this is the largest series reported to date. METHODS: We retrospectively reviewed 58 patients of AM treated in the departments of Neurosurgery of The Tunisian National Institute of Neurology, Sahloul University Hospital and Fattouma Bourguiba University Hospital from January 2001 to December 2015. Clinical characteristics, radiographic features and treatment modality, in the form of radical surgery, were noted. Statistical analysis was done with regards to recurrence free survival (RFS) and overall survival (OS) using Kaplan-Meier survival analysis. RESULTS: The median age of the patients on admission was 53.0 years (8-78). Twenty-two patients were males and thirty-six were females. The median duration of symptoms prior to presentation was six months. Signs of increased intracranial pressure were the most common presenting symptom followed by seizures, motor weakness and cranial nerves paresis. Cystic changes were observed in 50% of cases, moderate to severe peritumoral edema in 81% of cases and multiple signal voids suggestive of blood vessels in 86.2% of cases. Forty-two patients underwent Simpson I excision (72.4%) while fourteen had Simpson II excision (24.1%). A Simpson III resection was realized in two patients (3.5%). The surgical resection was hemorrhagic in 63.8% of cases and in 13.8% of cases, several blood transfusions were necessary to maintain hemodynamic stability. No adjunctive treatment was administered. Six out of the fifty-six patients of the Simpson I/II groups recurred while one of the two patients with Simpson III resection had tumor regrowth. Median duration of RFS was 103 months. Second surgery was realized in all cases with no subsequent recurrence. The extent of tumor resection and the location were found to correlate with the risk of developing recurrences (P=0.001). CONCLUSIONS: AMs represent a rare subtype of meningioma characterized by variable cystic components, large peritumoral edema and multiple areas of vascular signal voids. The mainstay of the treatment is gross total resection, ideally following a preoperative embolization. The fate of the tumor remnant after incomplete tumor resection still needs to be evaluated and we do not recommend the systematic use of post-operative adjuvant RT in all cases. As local recurrence can develop many years after initial treatment, Long-term follow-up is mandatory.

Osteolytic clear cell meningioma of the petrous bone occurring 36 years after posterior cranial fossa irradiation: Case report.

OBJECTIVE AND IMPORTANCE: While bone invasion and hyperostosis are frequent phenomena in meningiomas, primary intraosseous meningiomas are rare and their occurrence in the skull base is an extraordinary exception. Moreover, radiation-induced meningiomas represent a unique clinical dilemma given the fact that patients with these tumors had often received a prior full course of radiotherapy. CLINICAL PRESENTATION: A 42-year-old man presented with a 3-month history of progressively worsening facial asymmetry. His medical history was consistent for a posterior cranial fossa irradiation at the age of 6 years for a non-confirmed brain stem tumor. On admission his Karnofsky performance status was graded as 50% and his neurological examination showed a complete right facial nerve paralysis and hearing impairment. Computed tomography and magnetic resonance imaging demonstrated an osteolytic tumor invading the whole right petrous bone without intracranial involvement. INTERVENTION: As the tumor reached the external auditory canal, a tissue sample was obtained locally. Pathological examination of the lesion identified a grade II clear cell meningioma and the patient was consequently addressed for an intensity modulated radiation therapy. His condition remained unchanged till the most recent follow-up examination, 8 months later. CONCLUSIONS: To the best of our knowledge, a radiation induced osteolytic clear cell meningioma of the petrous bone has not been previously reported. As little literature exists regarding the use of adjuvant therapies for these tumors, intensity modulated radiation therapy remains an attractive treatment option in case of pervious irradiation and general status alteration.

[Towel clip reduction of zygomatic arch fracture]. / Réduction des fractures de l'arcade zygomatique par pince fixe-champ.

INTRODUCTION: Isolated fractures of the zygomatic arch (IFZA) are common in maxillofacial emergencies. They usually require a closed reduction. Several reduction techniques have been proposed. The reduction using a Ginestet-type hook is the gold standard technique. DISCUSSION: The reduction using a towel clip under local anesthesia is an economical, simple, reliable and safe alternative technique for the reduction of IFZA. We describe this procedure.

Effect of organic amendments on the mobility of trace elements in phytoremediated techno-soils: role of the humic substances.

The efficiency of aided phytostabilization using organic amendments such as ramial chipped wood (RCW) and composted sewage sludge (CSS) was studied on contaminated techno-soils, on nine experimental plots. The objective was to characterize the role of fulvic (FA) and humic acids (HA) on the mobilization of trace elements, specifically As, Cu, Mo, Pb and Zn. Results showed that the addition of CSS increased the total organic carbon and nitrogen content more than with RCW and as a result, the C/N ratio in the CSS soil was higher than in the RCW and non-amended (NE) soil, reflecting the high decomposition of soil organic matter in the CSS soil compared with the other soils. The RCW and CSS amendments increased the hydrogen index (HI) values and the oxygen index (OI) values compared with the NE soil, especially for the soil treated with CSS which contained more aliphatic than aromatic compounds. The addition of CSS to the techno-soil significantly increased the percentage of C org associated with the HA fractions compared with the RCW and NE soils. The soil amended with CSS showed the highest E 4/E 6 ratio and the lowest E 2/E 3 ratio of FA. Zn and As were more abundant in the FA fraction than in the HA fraction, whereas Pb, Cu and Mo were more associated to HA than to FA in the treated and untreated soils, which may explain the difference in their mobility and availability.

[A pediatric case of hydatid cyst in the infratemporal fossa]. / Kyste hydatique de la fosse infratemporale chez un enfant.

INTRODUCTION: Hydatid cyst or disease is an anthropozoonosis due to the development of the larval form of the taenia Echinococcus granulosus in humans. It is endemic in Morocco. The location of a hydatid cyst in the infratemporal fossa (ITF) is extremely rare. The authors report a pediatric case. OBSERVATION: An 11 year old child was admitted to hospital with a history of left latero-facial swelling gradually increasing in volume for 2 months, CT scan of the face revealed a cystic formation of 7 cm diameter sitting at the left ITF, hydatid serology was negative. A transzygomatic approach allowed the excision of the cyst. The histopathological examination of the resected specimen confirmed the diagnosis of hydatid cyst. DISCUSSION: The location at the infratemporal fossa of an expansive process such as hydatid cyst in children may have a particular impact on adjacent structures and a more meaningful clinical expression. The rate of growth of hydatid cysts is highly variable and ranges from 1 to 5 cm a year. Hydatid serology is often negative. CT examination is the gold-standard radiological examination. Surgical removal of the hydatid cyst is the most effective treatment. The transzygomatic approach allowed a sufficient access to the cyst and a good quality of excision.

[Primary intraosseous mucoepidermoid carcinoma of the jaws]. / Carcinome muco-épidermoïde intra-osseux des mâchoires.

INTRODUCTION: A mucoepidermoid carcinoma (MEC) is a malignant salivary gland tumor. Its primitive intraosseous maxillary localization is rare. We report a case with a difficult diagnosis. CASE REPORT: A 42-year-old female patient consulted atypical right sinus area pain. The CT scan revealed a heterogeneous tumor lyzing the right maxillary. The surgical treatment was broad resection. The pathological examination indicated an intramaxillary MEC. The surgical treatment was completed by postoperative radiotherapy. DISCUSSION: Primary intraosseous MEC of the jaws is rare and often affects the mandible. Its intraosseous maxillary localization is even rarer. Its etiopathogenesis is still unknown. The treatment is usually surgical, and the prognosis is based on histological criteria.

[Submental intubation in maxillofacial traumatology]. / L'intubation sous-mentonnière en traumatologie maxillofaciale.

INTRODUCTION: Free access to the upper respiratory tract may be a challenge for the management of severe facial trauma. Tracheotomy is routinely used in this case. Submental intubation is little used, but it is an alternative to tracheotomy. MATERIAL AND METHOD: A retrospective study was made over 1 year. Sixteen patients with facial smash were included. Patients who had undergone an immediate tracheotomy or a long-term intubation were excluded. Submental intubation was used in all patients with the same protocol. The studied data was: operative time, duration of ventilator disconnection, postoperative complications, and scar assessment. RESULTS: The average operative time was seven minutes. No speech disorder, hematoma, or postoperative infection was observed. The scar was barely visible in 13 cases out of 16. DISCUSSION: Submental intubation seems to be a reliable, simple and easy to learn technique. A perfect knowledge of the local anatomy allows opening the airway without any risk of hematoma. Incision packing reduces the bacterial inoculum and infectious risk. The residual scarring is minimal.

[Reconstruction of the lower third of the ear with a Crikelair flap]. / Reconstruction du tiers inférieur de l'auricule par lambeau de Crikelair.

Amputation of the lower third of the ear includes full thickness earlobe defects. Earlobe reconstruction depends on the covering and scaffold technique used. The Crikelair cervical skin flap is one of the available techniques for reconstruction. We discuss its assets and drawbacks by comparing it with alternative procedures.

Endoscopic endonasal management of congenital intranasal meningocele in a 2-month-old infant.

INTRODUCTION: Nasal meningocele, which is usually congenital, is a rare anomaly resulting from meningeal herniation into the nasal cavities through a bone defect in the skull base. CASE REPORT: An 8-day-old boy was referred with respiratory disturbance and nasal obstruction. Examination showed a cyst-like grayish swelling filling the right nasal cavity. CT scan showed opacity, of fluid-like density, filling the right nasal fossa, in contact with a small bony defect in the right cribriform plate. MRI ruled out herniated brain parenchyma and enabled diagnosis of meningocele. The patient was operated on at the age of 2 months through a transnasal endoscopic approach. Immediate postoperative course was favorable. MRI control at 8 months was normal. DISCUSSION: Modern imaging (CT scan and MRI) is of paramount importance in the preoperative evaluation of nasal meningocele. Endoscopic endonasal (EE) surgery is currently the treatment of choice. CONCLUSION: Steady progress in instrumentation, technique and skills will increase the feasibility of skull-base surgery using an endonasal approach in the pediatric population.

[Facial wounds: an epidemiological review of 850 cases]. / Plaies faciales : étude épidémiologique de 850 cas.

BACKGROUND: Facial wound are among the most frequent emergencies. They often affect a young population. We studied the epidemiological profile of facial wounds admitted in our hospital. PATIENTS AND METHODS: This prospective study was carried out in the Emergency Unit from June 2008 to June 2009. It included all patients having presented with at least one facial wound. The analysed parameters were patient, trauma, and wound characteristics. RESULTS: Eight hundred and fifty patients were included, 20% of whom were female patients. The most frequent etiologies were traffic accidents for men, assault for women, and domestic accidents for children. Alcohol abuse was involved in 12.4% of the cases. The most frequent wound localization was frontal (35.4%). A craniofacial organ (eye, brain…) was affected in 6.1% of the cases; the wound was associated to a craniofacial fracture in 9.6% of the cases, and to an extrafacial lesion in 22% of the cases. DISCUSSION: Facial wounds are a frequent emergency. They are predominant in young male patients. The high frequency of traffic accident and alcohol abuse requires an adequate prevention policy.

[Barraquer-Simons syndrome]. / Syndrome de Barraquer-Simons.

The Barraquer-Simons syndrome is a rare acquired acral partial lipodystrophy of unknown etiology. It progressively develops during childhood. It leads to a complete loss of subcutaneous fat in the face, neck, trunk and upper limbs. The disease is more common in female than male patients and causes facial dysmorphy. Free fat transplantation seems to be an appropriate technique to treat facial abnormalities encountered in this syndrome.

[Medial cleft lip: one diagnosis masking another]. / Les fentes labio-palatines médianes : un diagnostic qui en cache un autre.

UNLABELLED: Median cleft lip and palate are one of the facial manifestations of holoprosencephaly, a brain malformation resulting from a defect in the development of the prosencephalon, the embryonic precursor of the forebrain. It can occur in isolation or as part of a broader pattern of malformation in many different syndromes. The diagnosis of holoprosencephaly requires a complete malformative assessment. FIRST CASE: a newborn baby seen at birth for a median cleft lip associated with a complex craniofacial malformation. The search for malformations revealed the absence of the median cerebral structure and trisomy 13. The baby died at 48 h. SECOND CASE: A 28-day-old newborn baby consulting for a median cleft lip and palate. The brain ultrasounds showed no anomalies of the median cerebral structure. The malformative assessment revealed no other malformation. DISCUSSION: Holoprosencephaly is a complex developmental brain malformation. From the advances in neuroimaging and genetics, our understanding of the etiology and pathogenesis of this condition has advanced dramatically. This advance should lead to improved management of common medical complications and more optimal family counseling. Surgical treatment is the preferred therapy for viable malformations.