[Chronic maxillary rhinosinusitis of dental origin: report of 2 cases]. / Rhinosinusites chroniques maxillaires d'origine dentaire : à propos de 2 cas.

Chronic maxillary rhinosinusitis of dental origin represents approximately 5 % of chronic maxillary rhinosinusitis. The diagnosis of this pathology is often delayed and mainly based on endoscopy and medical imaging. Its treatment is complex and requires the involvement of several teams. This article discusses two cases of chronic maxillary rhinosinusitis secondary to dental treatment. A literature review on the epidemiology, diagnosis, treatment and complications are also introduced.

Maxillary sinusitis caused by the migration of a silastic implant used for an orbital floor reconstruction: a case report.

OBJECTIVE: The authors report on a patient whose unilateral chronic maxillary sinusitis was caused by the migration of a silastic implant used for orbital floor repair. CASE REPORT: A 32-year-old woman presented with a three-year history of right-sided maxillary discomfort that was associated with a purulent discharge. Her medical history included chronic allergic rhinitis and the placement of a silastic implant after a right orbital floor fracture at the age of 14. The silastic implant was then removed endoscopically in a right maxillary sinus meatotomy. The symptoms improved within three weeks after surgery. CONCLUSION: Orbital implant migration is a rare cause of chronic unilateral sinusitis, and it must be suspected on the basis of a careful anamnesis, appropriate clinical examination, and sinus computed tomography. Misdiagnosing such a condition may increase patient morbidity by leading to inappropriate treatment.

Second branchial cyst in the parapharyngealspace: a case report.

OBJECTIVE: We report the clinical findings and management of a large retro- and parapharyngeal branchial cyst in a 54-year-old man whose only complaint was a 12-month history of snoring. METHOD: Case report and a review of the world literature concerning parapharyngeal cysts are presented. RESULTS: On computed tomography (CT) images, a well-marginated cystic mass was observed in the left retro- and parapharyngeal spaces, with displacement of the left internal and common carotid arteries. The cyst contained thick, sterile, yellowish pus, without malignant cells. We performed a transoral resection without any surgical complications. No recurrence was observed 2 years later. CONCLUSION: Parapharyngeal branchial cysts are rare and often paucisymptomatic. The transoral approach can provide good exposure allowing complete resection without significant post-operative complications or cervical scarring.

Acromegaly presented as a cause of laryngeal dyspnea.

Acromegalic patients can develop obstructive sleep apnea syndrome or upper airflow obstruction. The development of dyspnea is unusual and the fixation of both vocal cords is exceptional. We report the case of a patient with bilateral vocal cord paralysis. Fiberoptic laryngoscopy and computed tomography (CT) of the neck showed a supra-glottic stenosis due to a swelling of the soft tissue. A tracheostomy was first performed. Thereafter, micro-laryngoscopy using laser vaporisation of the supra-glottic soft tissue was attempted but failed to remove the tracheostomy canula. Finally, blood tests and cerebral MRI revealed an acromegaly. The patient underwent a trans-sphenoidal resection of the pituitary adenoma. Fifteen months later, fiberoptic laryngoscopy showed bilateral restoration of vocal cord mobility and the tracheostomy canula was successfully removed after 18 months. Vocal cord fixation is probably due to hypopharyngeal and laryngeal soft tissue swelling and can be reversible after successful treatment of the adenoma.

High incidence of sensitization to ornamental plants in allergic rhinitis.

BACKGROUND: A few indoor plants have been described as potential allergens, in single case reports of allergic rhinitis. There is no data evaluating the prevalence of allergic sensitization to these plants. AIM: The relationship between owning indoor ornamental plants with the risk to be sensitized has been evaluated in atopic rhinitis. METHODS: A group of 59 patients with allergic rhinitis were submitted to skin prick tests (SPT) using both the leafs of their own plant and commercial extracts of the most frequent airborne allergens. A control group of 15 healthy subjects was tested with the same allergens. RESULTS: While no subject from the control group developed a significant SPT to any of the tested plants, 78% of allergic rhinitis had positive SPT to at least one plant, the most frequent sensitization being Ficus benjamina, yucca, ivy and palm tree. CONCLUSION: In allergic rhinitis, indoor plants should be considered as potential allergens.

[Diagnostic management of unilateral sensorineural hearing loss in adults]. / Prise en charge diagnostique d'une surdité de perception unilatérale de l'adulte.

Adult unilateral hearing loss is a frequent complaint observed by the E.N.T. specialist. With a pure tone audiometry, we can recognize a conductive hearing loss from a sensorineural hearing loss. In case of a conductive hearing loss, a temporal bone computed tomography is the first choice procedure. For the sensorineural hearing loss, the standard screening test is the brainstem evoked response auditory (BERA), which can be completed by a magnetic resonance imaging (MRI). The BERA have a false negatives level of 2 to 15% according to the studies, which means that a checking must be done 6 months later. The improvement of MR examination offers a better detection of very small tumours (2-3 mm). The cost of a MRI is equivalent to the cost of 2 BERA. In conclusion, we propose MRI as the only investigation to be performed in case of an unilateral sensorineural hearing loss.

Determination of the levels of expression of sarcolectin and calcyclin and of the percentages of apoptotic but not proliferating cells to enable distinction between recurrent and nonrecurrent cholesteatomas.

OBJECTIVES: To investigate in a series of cholesteatomas 1. whether subgroups of cholesteatomas with specific proliferative/apoptotic features exhibit distinct differentiation markers and 2. whether these different subgroups identified at the biological level relate to specific groups of clinically identified cholesteatomas. STUDY DESIGN: Analysis of 55 cholesteatomas resected by the same surgeon, by means of canal wall up and canal wall down surgical procedures. METHODS: Two differentiation markers were used: biotinylated sarcolectin (to identify sarcolectin-binding sites) and a monoclonal antibody directed against calcyclin (which is the S100A6 protein). The growth pattern in cholesteatomas was characterized at three distinct levels: 1. the cell proliferation level determined by means of the MIB-1 antibody, which enables the Ki-67 cell-cycle-related antigen to be identified on archival material; 2. the apoptosis level determined by means of the in situ labeling of nuclear DNA fragmentation (TUNEL staining); and 3. the p53 tumor suppressor gene-related product determined by means of p53 immunohistochemistry. RESULTS: The cholesteatomas that exhibited the highest proportion of apoptotic cells were those which exhibited the highest level of sarcolectin-binding sites (i.e., sialic acids). In contrast, the cholesteatomas exhibiting the lowest level of both proliferation and apoptosis showed the highest level of calcyclin. Recurrent cholesteatomas can be identified from nonrecurrent ones on the basis of three features, namely, the level of apoptotic cells, the way in which the apoptotic cells are distributed (i.e., homogeneously vs. heterogeneously), and the percentage of calcyclin-positive cells. CONCLUSIONS: The present data emphasize the existence of distinct subgroups of cholesteatomas identifiable at both cell kinetic and differentiation levels. Some of the biological variables used here to identify distinct biological subgroups of cholesteatomas in turn enabled some biological variables to be identified, so making it possible to classify the cholesteatomas in terms of recurrence versus nonrecurrence.