Current Management of Congenital Choanal Atresia:

Background

Congenital Choanal Artesia (CCA) is a rare cause of upper airway obstruction, yet it is the most common congenital anomaly of the nose. While the unilateral condition could be undiagnosed, bilateral CCA may be life-threatening, especially for newborns. Some CCA may be associated with other congenital abnormalities, which leads to a systematic screening during the diagnostic assessment. The diagnosis is easy. However, surgical management is still controversial.

Methods

We conducted a retrospective study gathering data on management of CCA over 42 months. We reported epidemiological aspects and results of our series, and discussed management issues.

Results

We operated 22 choanae using the endoscopic technique. The age of bilateral CCA patients on the day of surgery ranged from 8 to 21 days (mean 11.7+/_ 2.6 days). Their birth weight ranged from 2.9 to 4.5 kg (mean 3.4 +/_ 0.5 kg), and their gestational age ranged from 30 to 41 weeks. Surgery duration for neonatal bilateral CCA repair ranged from 75 to 110 min (mean 90 min +/_ 11.5 min). We performed an exclusive endonasal endoscopic approach for all patients with no stenting or mitomycin C application. We deplore one post operative complication related to minor palatal perforation resolved spontaneously.

Conclusion

Since newborns solely depend on nasal breathing during the first month of life, bilateral CCA is an emergency. Endonasal endoscopic management is the primary procedure. Currently, surgery steps are standardized. However, how to prevent post-operative synechiae and restenosis is still controversial. The mainstream is meticulous post-operative nursing with frequent endonasal saline irrigation, regular removal of crust, and prevention of inflammation due to reflux or infection.

"OCTOPUS": An Intelligent Tool for Assisted Multidisciplinary ORL Oncology Meetings-Preliminary Study

Current sessions of multidisciplinary team meetings (MDMs) have several limitations, including increased costs and duration, as well as limited discussion time for each case. To address these issues, we have developed a computer application called OCTOPUS, which helps manage the patients' list for MDMs. The application allows for the generation of automatic MDM decisions based on predetermined criteria filled in by the patient's doctor and algorithms that comply with the latest oncology guidelines from the National Comprehensive Cancer Network. These decisions must be validated by the MDM faculty members. In cases of nonagreement or complex cases, the application proposes a "face-to-face MDM." The internal mailing system connects all members and allows for the request of a second opinion regarding pathology or imaging results. Initial results suggest that this ergonomic tool provides more flexibility in time management and improved uniformity in selecting cases that would most benefit from face-to-face MDMs.

Squamous cell carcinoma associated with an active cutaneous leishmaniasis in immunocompetent patient: case presentation of an unlikely association and literature—review

Background

Association between leishmaniasis and malignancy can be classified into four categories: leishmaniasis mimicking malignancy, leishmaniasis co-existing with malignancy, malignancy developing in patients with leishmaniasis scar, and leishmaniasis developing in patients with malignancy. In immunocompetent patients, the main form of association is cutaneous squamous cell carcinoma (cSCC) developing within cutaneous leishmaniasis scar years after cutaneous leishmaniasis is cured. Association of active cutaneous leishmaniasis and cSCC is exceptional, we are aware of two more cases.

Case presentation

A 30-year-old man presented with 2 years history of an unhealed wound on the dorsum nasi. As there still exist few sites of leishmaniasis in Morocco, systematic screening for leishmania was performed. Leishmania bodies were identified on slit skin smear by Giemsa staining. The patient received local antibiotic and on-site injections of 4 cc of meglumine antimonate for 2 months without any improvement. The lesion volume has increased significantly, a biopsy revealed an invasive squamous cell carcinoma. After staging assessment, the patient underwent a complete removal of the nasal tumor with a 1-cm margin, associated with right modified radical neck dissection. Histopathological examination confirmed the diagnosis of SCC with no lymph nodes metastasis. Nasal reconstruction was performed 2 weeks later using a frontal flap. Oncology meeting board advised adjuvant radiation on the tumor. The patient is followed up regularly and remains free of disease for a year now.

Conclusion

Although many cancers are related to infection (viral or parasitic), there is no proven link between leishmaniasis and malignancy. However, there are many etiopathogenic theories based on pathology finding that involve chronic inflammation inducing dysplasia, mitotic abnormalities, and expression of p53.

Middle turbinate primary mucocele in a child masquerading as a nasal tumour

Middle turbinate primary mucocele in a child masquerading as a nasal tumour.

INTRODUCTION

Nasal obstruction in children is a very common complaint in daily ENT consultations. The common cold, rhinosinusitis, allergic rhinitis, hypertrophy and inflammation of the adenoid pad are very common causes of nasal obstruction, but there are numerous other causes for which the clinician must be aware.

METHODOLOGY

The authors report a very unusual case of a primary mucocele of the middle turbinate of a 7-year-old girl masquerading as a nasal tumour.

RESULTS

The mucocele was successfully marsupialized surgically using an endonasal endoscopic approach. The authors report the case, imaging, and review the pertinent literature.

CONCLUSION

Clinicians must be aware of less common aetiologies of nasal obstruction in order to orientate the diagnostic work-up and to propose adequate management.

Acoustic assessment of erygmophonic speech of Moroccan laryngectomized patients

Introduction

Acoustic evaluation of alaryngeal voices is among the most prominent issues in speech analysis field. In fact, many methods have been developed to date to substitute the classic perceptual evaluation. The Aim of this study is to present our experience in erygmophonic speech objective assessment and to discuss the most widely used methods of acoustic speech appraisal. through a prospective case-control study we have measured acoustic parameters of speech quality during one year of erygmophonic rehabilitation therapy of Moroccan laryngectomized patients.

Methods

We have assessed acoustic parameters of erygmophonic speech samples of eleven laryngectomized patients through the speech rehabilitation therapy. Acoustic parameters were obtained by perturbation analysis method and linear predictive coding algorithms also through the broadband spectrogram.

Results

Using perturbation analysis methods, we have found erygmophonic voice to be significantly poorer than normal speech and it exhibits higher formant frequency values. However, erygmophonic voice shows also higher and extremely variable Error values that were greater than the acceptable level. And thus, live a doubt on the reliability of those analytic methods results.

Conclusion

Acoustic parameters for objective evaluation of alaryngeal voices should allow a reliable representation of the perceptual evaluation of the quality of speech. This requirement has not been fulfilled by the common methods used so far. Therefore, acoustical assessment of erygmophonic speech needs more investigations.

Acute febrile torticollis in youth: clinical investigation and current management

Acute febrile torticollis in children is a rare and a special clinical picture of variable causes. It may indicate an inflammatory or an infectious pathology affecting any of the anatomical structures of the neck. Treatment is quite clearly defined, and it may be a therapeutic emergency. It is a condition that all ENT specialists must be familiar with since they are most likely to be the first physician to whom such a child is brought

Vertebral artery dissection due to an esophageal foreign body migration: a case report

Unintentional foreign bodies‘ swallowing is a fairly common occurrence in ENT consultation especially among children. They usually pass through the gastrointestinal tract without complications. Migration of a foreign body through the esophageal wall is rare. It represents about 1% to 4% of all cases of foreign bodies‘ ingestion. A 16 year's old female patient has presented to ENT emergency with a painful dysphagia following an accidental ingestion of a metallic pin. Cervical X ray confirmed the presence of the pin while endoscopic investigations have shown no foreign body. Cervical CT scan revealed the migration of the foreign body through the esophageal wall with left vertebral artery dissection. Endoscopic management has been sufficient with an uneventful post operative follow up. Esophageal foreign bodies are very diverse mainly dominated by fish bones (60%) and chicken bones (16%). Metallic pins are rare. The major risks of migration of those foreign bodies are cervical abscess, mediastinitis and oeso-vascular fistulae. Cases of self extrusion through the skin have been reported. Migration of a foreign body through the esophageal wall is rare. Endoscopic management has been sufficient.