Cartilaginous Myringoplasty: Anatomical and Functional Results.

INTRODUCTION:  Myringoplasty remains a topical subject. Our study aims at analyzing the anatomical and functional results of cartilaginous myringoplasty, and also determining the main factors that could influence its results. MATERIALS AND METHODS:  A retrospective study of 51 cases of tympanic perforations operated at the ENT department of the Hassan II University Hospital of Fez between January 2018 and November 2021. Only the patients with exclusive cartilage myringoplasty were included. The anatomical and functional results of cartilage myringoplasty were evaluated and analyzed according to several variables. The statistical analysis was performed using SPSS Statistics software. RESULTS:  The average age of our patients was 35, with a sex ratio of 2.45. The perforation was anterior in 58%, posterior in 12%, and central in 30% of the cases. The average pre-operative audiometric air bone gap (ABG) was 29.3 dB. The most commonly used graft was the conchal cartilage in 89% of cases. A complete cicatrization has been noticed in 92%, and at six months after surgery, a complete closure of the ABG has been observed in 43% of cases, a significant hearing improvement with an ABG between 11 and 20 dB in 24%, a hearing recovery with an ABG between 21 and 30 dB in 21%, and an ABG > 30 dB in 12% of the cases. A statically significant relationship (p<0.05) has been found between the functional or anatomical failure of the myringoplasty; the different predictive factors were: the young age (less than 16 years), the inflammatory state of the tympanic cavity, the anterior location, and large size of the perforation. CONCLUSION: Cartilaginous myringoplasty provides good anatomical and auditory results. The pre-operative predictive factors, such as age, complete and sufficient drying of the ear, the size and location of the perforation, and the size of the used cartilage, should all be considered for a better anatomical and functional outcome.

Cephalic Tetanus Presenting as Peripheral Facial Palsy: A Case Report.

Tetanus is a serious disease that has become rare in countries that adopt an effective and sustainable vaccination strategy; however, tetanus remains a fairly common problem in developing countries. The diagnosis of tetanus is fairly easy. However, its cephalic form is a rare but potentially life-threatening neurological condition caused by the bacteria Clostridium tetani, which can result in symptoms such as spasms, rigidity, and paralysis of various muscles and nerves in the head and neck region. This article is about a 43-year-old man who had presumed an idiopathic facial palsy at the beginning and who turned out after the evolution of the clinical picture that it is cephalic tetanus. In this article, we will see the subtleties and clinical elements that have allowed us to rectify the diagnosis. Peripheral facial palsy can be a presenting symptom of cephalic tetanus and should be considered in patients with a history of tetanus infection or exposure. Early recognition and prompt treatment of cephalic tetanus are crucial in preventing complications and improving outcomes. Treatment typically involves the administration of tetanus immunoglobulin and antibiotics, as well as supportive care for any associated symptoms or complications.

Schwannoma of the descending loop of the hypoglossal nerve: case report.

Schwannomas of the descending loop of the hypoglossal nerve are very rare. Existing literature of the schwannoma of the descending loop of the hypoglossal nerve is limited to two previously reported case. They are slow-growing tumors that may masquerade a carotid body tumor. We herein described a rare case of schwannoma of the descending loop of the hypoglossal nerve in the s right latero-cervical region with diagnostic imaging and histopathological findings. A 37-years-old woman has had a palpable firm, mobile mass in the right latero-cervical region, of imaging, MR images showed homogeneous hypointensity on T1-weighted imaging (T1-WI), heterogeneous hyperintensity on T2-WI, and heterogeneous enhancement on contrast-enhanced T1-WI. Diagnostic imaging using computed tomography (CT) and magnetic resonance imaging (MRI) was suspected of Chemodectoma or neurogenic tumor. At operation, a 4 cm mass arising from the descending loop of the hypoglossal nerve of was resected en bloc with the loop itself; Final diagnosis was confirmed on the basis of histopathological finding and intraoperative findings. Postoperative course was uneventful and the patient is free from disease recurrence at tree-year follow-up. En bloc resection remains the real curative treatment of Schwannomas, ensuring unlimited freedom from disease, although causing functional impairment which may be significant. Nonetheless recurrence should be prevented as, besides requiring reintervention, it may harbor a malignant evolution towards sarcoma. Schwannomas of the descending loop of the hypoglossal nerve may masquerade a chemodectoma of the carotid bifurcation and can be curatively resected without any functional impairment. This case confirmed the differential diagnosis on the basis of the intraoperative finding that the tumor was continuous with the hypoglossal nerve.

Absence of GJB3 and GJB6 mutations in Moroccan familial and sporadic patients with autosomal recessive non-syndromic deafness.

UNLABELLED: Deafness is an etiologically heterogeneous trait with a wide variety of genetic and environmental causes. It is generally considered that genetic factors account for at least half of all cases of profound congenital deafness, which can be classified in two categories - dominant or recessive - according to the mode of inheritance and in two types - syndromic or non-syndromic - according to the presence or absence of some other specific clinical features. Mutations in the gene GJB2, encoding the gap junction protein connexion 26, are considered to be responsible for up to 50% of familial cases of autosomal recessive non-syndromic hearing loss and for up to 15-30% of the sporadic cases. It has also been reported that mutations in the GJB6 and GJB3 genes contribute to autosomal recessive and autosomal dominant hearing defects in many populations. OBJECTIVE: The aim of this study was to screen mutations in GJB6 and GJB3 genes in Moroccan patients with autosomal non-syndromic hearing loss. METHODS: We carried out 95 patients with non-syndromic hearing loss. The patients, who were negative for homozygous mutations in GJB2 gene and GJB6-D13S1830 deletion, were tested for the coding regions of GJB6 and GJB3 genes by direct sequencing. RESULTS: No deleterious mutation in GJB6 and GJB3 genes was detected in all deaf patients tested. Only a C357T silent transition in heterozygous state was found in the GJB3 gene in one patient. CONCLUSION: The present data demonstrated that mutations in the GJB6 and GJB3 genes are an infrequent cause of non-syndromic deafness in Morocco.