The Petrosquamosal Sinus: A Rare Vascular Variant Encountered During Cochlear Implantation Surgery

The petrosquamosal sinus is a rare and almost unknown emissary vein of the temporal bone. It traverses the middle cranial fossa along the petrosquamosal fissure and connects dural sinuses with extracranial venous networks. It is known to undergo normal involution during fetal and early postnatal life, and therefore is rarely found in humans. When encountered during surgery, it can be a significant source of bleeding hindering proper visualization of important surgical landmarks. Here we report the case of a PSS, encountered in a child during cochlear implantation surgery. We discuss its clinical significance and impact on the surgical approach. Laryngoscope, 2024.

Isolated Sudden Bilateral Neurosensory Hearing Loss as a Presentation of Lyme Neuroborreliosis: A Case Study

Lyme neuroborreliosis (LNB) is a rare but potentially serious manifestation of Lyme disease, caused by the spirochete Borrelia burgdorferi. Although LNB can affect various neurological systems, neurosensory hearing loss as the sole presentation is uncommon. We report a case of a 23-year-old woman who presented with a 2-month history of temporal headache, tinnitus, and instability, which was followed by sudden bilateral hearing loss without any other associated symptoms. Pure-tone audiometry revealed profound bilateral hearing loss. Serological testing for various pathogens was negative, except for B. burgdorferi IgM, which was confirmed using Western blot analysis. The patient received doxycycline treatment; unfortunately, no recovery of hearing was observed. This case report highlights the importance of considering LNB as a potential cause of neurosensory hearing loss, particularly in areas where Lyme disease is endemic, as well as the need for timely diagnosis and treatment to prevent potential complications.

Cochlear Implant Outcomes: Quality of Life in Prelingually Deafened, Late-Implanted Patients

AIMS

Reevaluating and expanding cochlear implantation's (CI) indication while measuring the quality of life (QoL) outcomes regarding the parent's point of view of prelingually deafened, late-implanted patients, which are widely known to showcases a limited improvement in speech recognition.

MATERIALS AND METHODS

A retrospective descriptive and analytic study to assess QoL outcomes from CI in 64 early deafened, late-implanted patients, according to their parent's perspective, between January 2009 and December 2019, using the Nottingham Pediatric Cochlear Implant Program (Nottingham University Hospital, Nottingham, United Kingdom) "Children with cochlear implantation: parents perspective."

RESULTS

The most represented age interval is the 5 and 7 interval and the mean age is 10.09 years. There was no sex predominance, with rural origin and high school academicals level preponderance. Fourteen children had experienced neonatal icterus, eight had meningitis, and seven were the result of related marriage. The age of the first consultation was typically over 2 years old, with only 45 schooled children. Age had a significantly statistic correlation between Self-reliance and Well-being and happiness subscales. History of receiving aid and speech therapy has a clear correlation with Self-reliance, Well-being and happiness, and Communication and Education. Schooling statuses, sex, age of appearance, and communication mode were not correlated to any subscale score, and with the exception of Effect of implantation, all the other "Children with cochlear implantation: parent's perspective" subscales were intercorrelated.

CONCLUSION

Properly validated QoL assessments for CI are a must, as outcomes of CI expand beyond audiometric performances to include the improvement of QoL.

Parotid's Intranodal Palisaded Myofibroblastoma: A Very Rare Tumour

Intranodal palisaded myofibroblastoma is a rare benign tumor of the lymph nodes, that arises from smooth muscle cells or myofibroblast, chiefly in the inguinal lymph nodes. Intranodal palisaded myofibroblastoma of the parotid gland is exceedingly scarce, even more, its recurrent characteristic; which underlines the grave importance of a long, strict monitoring and surveillance plan. Alongside these salient points in this unusual case, we also aim to highlight the peculiar difficulties inevitably faced, given the unfortunate lack of typical pathognomonic clinical and radiological features. We therefore, report a rare case of recurrent intranodal palisaded myofibroblastoma, arising in the felt parotid gland in a 53-year-old male patient, diagnosed by anatomopathological and immunopathological analysis. Described as benign tumor intranodal palisaded myofibroblastoma is a scarce myofibroblastic neoplasm of the lymph nodes. Histological and immunopathological features represent the determining factors for the diagnosis, of this favorable prognosis tumor.

Laryngeal Lipoma: An Uncommon Localization, Case Report and Literature Review

Lipomas are common mesenchymal begin tumors, the head and neck localization accounts for less than 15% of the body lipomas and the laryngeal locating accounting for 0.6%. Laryngeal lipoma can be isolated and intrinsic, submucosal or even pedicled endoluminal mass. Symptoms of the laryngeal localization of this benign tumor is logically determined by its size and location. Surgical excision remains the key treatment as this tumor characterized by its high rates of local recurrence. We thus report a rare localization of this benign tumor in 76-year-old patient admitted to the emergency room for an acute laryngeal dyspnea.

Health-Related Quality of Life in Children With Cochlear Implants From Parents' Perspective

Background and Objectives

: To evaluate the health-related quality of life (HRQoL) in parents of children with cochlear implants and assess influencing factors. These data can enable practitioners to support patients and their families in utilizing the cochlear implant and its benefits to the fullest extent.

Subjects and Methods

: A retrospective descriptive and analytic study was conducted at the Implantation center Mohammed VI. Parents of cochlear implant patients were asked to fill out forms and answer a questionnaire. Participants included parents of children <15 years old who underwent unilateral cochlear implantation between January 2009 and December 2019, presenting with bilateral severe to profound neurosensory deafness. Participants completed the children with cochlear implantation: parent's perspective (CCIPP) HRQoL questionnaire.

Results

: The mean age of the children was 6.49±2.55 years. The mean time between implantation for each patient and this study was calculated as 4.33±2.05 years. There was a positive correlation between this variable and the following subscales: communication, well-being and happiness, and the process of implantation. For these subscales, the score was higher as the delay was greater. Parents of children who received speech therapy before implantation were more satisfied on the following subscales: communication, general functioning, well-being and happiness, implantation process, implantation effectiveness, and support for the child.

Conclusions

: The HRQoL is better in families of children who received their implant at an early age. This finding raises awareness of the importance of systemic screening in newborns.

Endobronchial Tuberculosis Simulating Acute Foreign Body Inhalation: A Case Report

Endobronchial tuberculosis is a rare form of pulmonary tuberculosis, that can be due to the rupture of an infected lymph node through bronchial wall or lymphatic spread to the lining of the bronchial tree. Clinical presentation is non-specific, and can simulate inhalation of a foreign body. Otolaryngologists should be aware of its presentation often atypical. The following case is an unusual presentation of endobronchial tuberculosis in a 23-month-old patient initially diagnosed as a foreign body in the respiratory tract with acute dyspnea with unilateral wheezing and suspected foreign body on chest computed tomography. Bronchoscopy revealed a granulomatous mass in carina and both primary bronchi. Granuloma ablation improved patient's respiratory status. The pathology revealed an epithelioid and gigantic cellular with caseous necrosis compatible with tuberculosis. This unusual presentation of tuberculosis should be known to otolaryngologists and pediatricians in view of the frequency of tuberculosis in our context as well as increase in its incidence.

A tonsillar location of a malignant schwannoma: a case report

Introduction

Malignant schwannoma is a malignant tumor of differentiation of Schwann cells or perineural cells.

Observation

The patient was a 74-year-old woman with no particular pathological history. She presented swallowing difficulty of solids and odynophagia, evolving for 1 year. Physical examination revealed a budding tumor of the left palatine tonsil without cervical adenopathy. The CT scan confirmed the lesions and the absence of tumor extensions. Histological and immunohistochemical examination of the biopsy sample of the tonsil tumor concluded to be a malignant schwannoma. The patient underwent a tonsillectomy with postoperative follow-up.

Discussion

Malignant schwannomas are aggressive tumors. They usually occur in young adults. They mainly affect nerves and soft tissues. Occurrence in the amygdala is rare.

Conclusion

The association of malignant schwannoma of the palatine tonsil and advanced age is rare.

Combinatorial effects of non-thermal plasma oxidation processes and photocatalytic activity on the inactivation of bacteria and degradation of toxic compounds in wastewater

The simultaneous presence of hazardous chemicals and pathogenic microorganisms in wastewater is tremendously endangering the environment and human health. Therefore, developing a mitigation strategy for adequately degrading toxic compounds and inactivating/killing microorganisms is urgently needed to protect ecosystems. In this paper, the synergetic effects of the photocatalytic activity of TiO₂ and Cu–TiO₂ nanoparticles (NPs) and the oxidation processes of non-thermal atmospheric pressure plasma (NTAPP) were comprehensively investigated for both the inactivation/killing of common water contaminating bacteria (Escherichia coli (E. coli)) and the degradation of direct textile wastewater (DTW). The photocatalytic NPs were synthesized using the hydrothermal method and further characterized employing field emission scanning electron microscopy (FESEM), X-ray diffraction (XRD), ultraviolet-visible diffuse reflection spectroscopy (UV-Vis DRS) and photoluminescence (PL). Results revealed the predominant presence of the typical anatase phase for both the flower-like TiO₂ and the multipod-like Cu–TiO₂ structures. UV-Vis DRS and PL analyses showed that the addition of Cu dopants reduced the bandgap and increased oxygen defect vacancies of TiO₂. The inactivation of E. coli in suspension and degradation of DTW were then examined upon treating the aqueous media with various plasma alone and plasma/NPs conditions (Ar plasma, Ar + O₂ plasma and Ar + N₂ plasma, Ar plasma + TiO₂ NPs and Ar plasma + Cu–TiO₂ NPs). Primary and secondary excited species such as OH˙, O, H and N₂* generated in plasma during the processes were recognized by in situ optical emission spectrometry (OES) measurements. Several other spectroscopic analyses were further employed to quantify some reactive oxygen species (ROS) such as OH, H₂O₂ and O₃ generated during the processes. Moreover, the changes in the pH and electrical conductivity (EC) of the solutions were also assessed. The inactivation of bacteria was examined by the colony-forming unit (CFU) method after plating the treated suspensions on agar, and the degradation of organic compounds in DTW was further validated by measuring the total organic carbon (TOC) removal efficiency. All results collectively revealed that the combinatorial plasma-photocatalysis strategy involving Cu–TiO₂ NPs and argon plasma jet produced higher concentrations of ROS and proved to be a promising one-step wastewater treatment effectively killing microorganisms and degrading toxic organic compounds.

Contamination of water is a serious issue across the world. The proposed plasma synergetic treat has great potential to treat contaminated water in an environmentally friendly way.

The Tietz syndrome associated with cardiac malformation: a case report with literature review

Background

Tietz syndrome is a very rare clinical entity characterized by the association of profound bilateral congenital sensorineural deafness and generalized hypopigmentation of skin, eyes, and integuments (snow white appearance). It is an autosomal dominant syndrome due to a mutation in the melanocyte inducing transcription factor (MITF) gene. The association of a heart malformation has never been reported in this syndrome.

Case presentation

We report two cases of two cousins aged 5 years and 20 months respectively with a history of first degree consanguineous parents. Both girls presented with diffuse hypopigmentation of the skin, blond hair, blue eyes, and bilateral diffuse retinal hypopigmentation at ocular fundus exam. Bilateral profound sensorineural hearing loss was confirmed by auditory brainstem response in both cases. Echocardiography revealed a cardiac malformation such as interventricular communication in the older cousin and interatrial communication in the younger cousin. The family investigation did not reveal a similar case among ancestors. The diagnosis of Tietz syndrome was based on clinical criteria and pedigree. The older cousin underwent a total optical correction and a right unilateral cochlear implantation followed by speech therapy with a satisfactory result after a follow-up of two years. Unfortunately, the little cousin died following a head trauma.

Conclusions

Tietz syndrome is a rare autosomal dominant genetic disorder, characterized by generalized albinism with bilateral profound hearing loss. It results from a nontruncating mutation in the basic domain of in the MITF gene. Its management must include, in addition to hearing and ophthalmic rehabilitation, the research and treatment of cardiac malformations which may be life-threatening.

Oral amelanotic malignant melanoma: a case report

Amelanotic malignant melanoma is an extremely rare and aggressive oral tumor. Herein we report the case of a 42-year-old woman presented with a painful growth in anterior maxillary region. Intra-oral examination showed a non-pigmented exophytic mass occupying the anterior maxillary sector. Incisional biopsy with immunohistochemistry examination revealed a malignant melanoma as it strongly expressed melan A and S-100. Facial computed tomography showed extension to the maxillary bone and hard palate. After thoraco-abdominal computed tomography revealing absence of metastasis, tumor resection was performed respecting 2cm security margin. Oral localization of malignant melanoma is rare especially its amelanotic variant. Lack of pigmentation makes the diagnosis more difficult, usually resulting in treatment delay and making the prognosis even worse. Early detection by histological and immunochemistry examination combined to wide resection are the keys to improving the survival for patients with oral amelanotic melanoma.

Non-equilibrium atmospheric pressure plasma assisted degradation of the pharmaceutical drug valsartan: influence of catalyst and degradation environment

This paper investigated the degradation of the pharmaceutical drug Valsartan (VS) using non-equilibrium atmospheric pressure plasma (NEAPP) with various operating conditions. The heterogeneous photocatalyst ZnO nanoparticles (NP's) were synthesized using a hydrothermal process. The morphology, chemical composition and structure of as-synthesized ZnO NPs were examined by Field Emission Scanning Electron Microscopy (FE-SEM), Fourier Transform Infrared Spectroscopy (FTIR) and X-ray diffraction (XRD) analysis. Then, VS degradation was examined in three subsequent treatment conditions including plasma treatment alone, the combination of plasma with as-prepared ZnO NPs and various environments (air, oxygen and hydrogen peroxide) at fixed plasma operating potential and treatment time. The degradation efficiency of plasma-treated VS by various conditions was observed using UV-visible spectroscopy. Optical Emission Spectrometry (OES) was used to characterize the distribution and emission intensity of various reactive species (OH˙, N₂-SPS and O) during the degradation processes which plays a vital role in the degradation of VS. The role of OH˙ and H₂O₂ during the degradation process was further examined by chemical dosimetry and spectroscopic techniques. Furthermore, pH, conductivity and TOC of the untreated and plasma-treated VS were also investigated. The results on the degradation of VS showed that plasma treatment combined with ZnO NP's has a significant effect on degradation of molecules of VS than degradation processes carried out by other experimental conditions due to the formation of higher concentrations of various reactive oxygen and nitrogen species during the degradation processes.

[Fistulized thyroid abscess revealing esophageal carcinoma in a young adult]

L’abcès de la thyroïde est une pathologie extrêmement rare. Son diagnostic est souvent fait tardivement, ce qui prédispose à de graves complications. Nous rapportons un cas d’abcès thyroïdien chez un adulte jeune qui s’est présenté aux urgences pour une tuméfaction basi-cervicale antérieure associée à une dysphonie, une dysphagie et une dyspnée. Une échographie cervicale mettait en évidence une collection du lobe thyroïdien gauche. Un scanner cervico-thoracique objectivait un abcès thyroïdien gauche, fistulisé dans les muscles sous hyoïdiens et le sinus piriforme gauche, avec épaississement de l’hypopharynx et de la bouche œsophagienne. La ponction ramenait un liquide purulent. Une panendoscopie révélait la présence d’une prolifération tumorale de la bouche œsophagienne. Une biopsie avec étude anatomopathologique a conclu à la présence d’un carcinome épidermoïde. Cette observation révèle que l’abcès thyroïdien peut être le mode de découverte d’un cancer de l’œsophage. D’où l’intérêt de rechercher une cause sous-jacente en cas d’abcès thyroïdien.

Fungal nasal septum abscess caused by Aspergillus flavus complicating sinonasal surgery

The fungal nasal septum abscess is a rare localized invasive form of fungal rhinosinusitis. Rare cases have been described in the literature. In this article, we intend to describe a new case of fungal nasal septum abscess caused by Aspergillus flavus in diabetic patient after sinonasal surgery. A 53-year-old woman with a history of uncontrolled type 2 diabetes and asthma developed a nasal septum abscess after a sinonasal endoscopic surgery which was performed for nasal polyposis. Needle aspiration of the abscess was performed and the pus cultures were positive for Aspergillus flavus. The patient was treated with antifungal drugs and surgical drainage of the abscess. A clinical and biological improvement was observed. Her case has been followed up for 18 months, and there hasn't been any recurrence of the infection. The fungal nasal septum abscess should be suspected in patients who do not respond adequately to standard treatment of nasal septum abscess, especially patients with risk factors of fungal rhinosinusitis.

Voluminous Laryngeal Schwannoma Treated with Endoscopic Laser Approach

Laryngeal schwannomas are rare benign encapsulated neurogenic tumors that represent less than 1.5% of all benign laryngeal tumors. We report a case of voluminous laryngeal schwannoma that was incidentally found during endotracheal intubation for thyroidectomy in a 43-year-old woman with clinical findings, features of radiologic and histopathologic examinations. The tumor was removed by CO₂ laser during microlaryngoscopy. In this case report, we present a challenging approach that can be used in diagnosis and treatment of laryngeal schwannomas. Complete removal of the tumor should be considered as the initial approach to minimize morbidity.

Choanal stenosis post radiotherapy for nasopharyngeal carcinoma: about an endoscopic management

Choanal atresia is a rare complication of radiation for nasopharyngeal carcinoma, which has to be early detected. Its treatment is based on endoscopic endonasale surgery. We report a rare case of choanal stenosis observed in a 54-year-old patient, Ho presented 4 years after the end of radiotherapy for nasopharyngeal carcinoma, a progressive bilateral nasal obstruction, anosmia, and rhinorrhea without bleeding. The diagnostic of fibrous stenosis was confirmed by endonasal endoscopic examination coupled to CT scan of nasopharynx. The recanalization via endoscopic endonasal surgery with tube calibration gave a great functional result with the improvement of nasal symptoms. Even after 6 months of follow-up, there were no signs of restenosis.

Woakes' syndrome

Woakes' syndrome is a rare entity defined as recurrent sinonasal polyposis with a consequent nasal pyramid deformity. Only a few cases are reported in the literature. The goal of this study is to present the features of Woakes' syndrome through a clinical case. A 42-year-old man presented with a history of ASA triad. He started self-medication for 5 years. He returned to the otorhinolaryngology department for the aggravation and persistence of symptoms. CT scans showed the deformity and thinning of the nasal bones. A functional endoscopic sinus surgery and correction of nasal pyramid deformity were performed. At 6 months' follow-up, good functional and aesthetic outcomes were observed. Woakes' syndrome was described more than 130 years ago. Treatment includes endoscopic sinonasal surgery and local treatment. Adequate management and good adherence to the therapeutic protocol could be factors to prevent this syndrome.

International consensus (ICON) on audiological assessment of hearing loss in children

The prevalence of hearing loss in newborns and infants is estimated between 1 to 3.47 cases per 1000 live births. Early diagnosis and rehabilitation of congenital hearing loss are mandatory in order to achieve a satisfactory linguistic and cognitive development. Without appropriate opportunities to learn language, these children will fall behind their normal hearing peers in communication, cognition, reading and socio-emotional development. After promising results, neonatal screening for hearing loss and audiological evaluation are becoming more extensively carried out. In planning universal neonatal hearing screening programs, transient evoked otoacoustic emissions and auditory brainstem responses are the gold standard for the screening and diagnosis program. However, there is no consensus regarding the use of audiometry and other electrophysiological tests (such as auditory steady-state responses) in current practices. Several screening and audiological assessment procedures have been described and advocated all around the world. But, a systematic scheme of performing diagnosis in the pediatric audiology population is lacking. A consensus conference was held at the International Federation of Oto-rhino-laryngological Societies Congress, in June 2017, to discuss the different current practices and to identify the best neonatal hearing screening and audiological assessment management. This article is intended to provide professionals with recommendations about the "best practice" based on consensus opinion of the session's speakers, and a review of the literature on the efficacy of various assessment options for children with hearing loss.

Lateral cervical thymic cyst in a child: a case report

BACKGROUND

Cervical thymic cysts are uncommon lesions, rarely considered in the differential diagnosis of neck cysts in children.

CASE PRESENTATION

We report a rare case of multiloculated thymic cyst in an 8-year-old boy on the right side of the neck. Perioperative diagnosis was a cystic hygroma. Macroscopic examination showed a cystic mass measuring 6.5 cm in total length. Histopathology of the excised specimen revealed thymic tissue with prominent Hassall's corpuscles associated with multiloculated cyst. The cyst wall is bordered by a flattened or multilayered epithelium, often abraded.

CONCLUSION

This case is presented here for its rarity and should be included in the differential diagnosis of neck masses in children. So, it's a lesion to be well aware of, particularly by pathologists.

[Papillary carcinoma on thyroglossal duct cyst: report of two cases]

L'objectif de ce travail est de présenté deux cas de carcinomes papillaire sur kystes du tractus thyréoglosse (KTT) et d'exposer notre attitude thérapeutique. Il s'agit de deux patientes, une âgée de 30 ans et l'autre de 45 ans, qui ont été opéré dans notre centre. Le diagnostic du carcinome papillaire sur KTT a été retenu après étude anatomopathologique du kyste après exérèse selon la technique de Sistrunk. Une thyroïdectomie totale suivie d'une irathérapie et d'une hormonothérapie freinatrice a été réalisé chez l'une des patientes, pour l'autre une thyroïdectomie totale associée à une hormonothérapie freinatrice a été préconisé. L'évolution été favorable après un recule de 4 ans pour la première patiente et de 2 ans pour la deuxième. La thyroïdectomie totale après exérèse complète du KTT est le traitement recommandé pour le carcinome papillaire sur KTT. Il a été démontré qu'un cancer latent de la thyroïde peut être développé même après des années après l'exérèse du KTT. Le traitement du carcinome papillaire sur KTT est bien codifié, permettant un excellent pronostic.

[Paranasal sinus mucoceles: About 32 cases]

INTRODUCTION

Mucocele is a pseudo-cystic tumor of the paranasal sinuses. Despite its benign histological nature, it is aggressive towards neighboring structures (orbit and brain). Our aim was to study the epidemiological, clinical, therapeutic, and evolution aspects of this pathology.

PATIENT AND METHODS

We conducted a retrospective study over a period of 9 years on 32 patients operated on and followed for mucocele in our department.

RESULTS

Mean age was 43.28 years with a sex ratio to 1. Mucoceles were located in the fronto-ethmoid sinus (27 cases), the maxillary sinus (3 cases) and the sphenoid sinus (2 cases). The most common symptoms were periorbital swelling and exophthalmia. CT scan confirmed the diagnosis in the majority of cases. MRI was performed in 3 patients. Surgery consisted in a large marsupialization by endonasal approach in 30 cases, and by a combined approach in two cases. A recurrence was observed in two patients after a mean period of 18 months.

DISCUSSION

Mucocele is a benign and expansive pseudo-cystic tumor, affecting mostly adults and developing in the paranasal sinuses. Clinical symptoms are not specific. It may reveal itself by ophthalmic or intracranial complications. Diagnosis is based on imaging (CT and MRI). Endonasal surgery has become the gold standard for the treatment of mucoceles and is endowed with low morbidity.

[Orbital cellulitis: prospective study about 75 cases]

Les cellulites orbitaires est une affection grave par ses complications aussi bien locales, locorégionales que générales, pouvant engager le pronostic vital et fonctionnel, surtout lorsque le diagnostic est tardif et la prise en charge inappropriée. Le but de cette étude est de décrire les aspects épidémiologiques, cliniques, thérapeutiques et évolutifs des cellulites orbitaires et d'insister sur la nécessité d'un diagnostic et d'un traitement précoces, afin d’éviter ses complications. Il s'agit d'une étude prospective concernent 75 patients présentant une cellulite orbitaire, menée au service d'Ophtalmologie et d'ORL au CHU Mohammed VI de Marrakech, de Septembre 2010 au Avril 2014. L’âge moyen des patients était de 24 ans allant de 2 ans à 70 ans. La porte d'entrée était dominée par l'atteinte sinusienne retrouvée chez 43 malades. L'examen ophtalmologique a montré une BAV chez 20% des patients avec une cécité bilatérale chez un patient et unilatérale chez 3, un chémosis (82%), une exophtalmie (85,71%), un ptosis (30%), une ophtalmoplégie (66%), une fistule orbitaire (4 cas), et une kératite d'exposition chez 8 cas. L'analyse des résultats tomodensitométriques a noté: 24 cas de cellulite pré septale (45%), 20 cas de cellulite orbitaire (15%), 2 cas d'abcès sous périosté (5%) et 14 cas d'abcès orbitaire (35%). 20 patients ont bénéficié d'un traitement chirurgical associé au traitement médical, ayant consisté en un drainage de l'abcès orbitaire dans 24 cas, une ethmoidectomie antérieure par voie endoscopique avec drainage d'un abcès sous-périosté dans 2 cas à et un drainage d'une collection abcédée des parties molles dans 6 cas. La cellulite orbitaire est une urgence thérapeutique qui met en jeu le pronostic visuel et vital. Causés le plus fréquemment par les traumatismes oculaires post chirurgicale ou AVP, les sinusites, les fractures orbitaires, et les corps étrangers intraoculaires. Les infections rétro-septales sont les plus graves, nécessitant une exploration par imagerie en coupes. L’évolution de la cellulite orbitaire est toujours grave en l'absence d'un traitement médical et chirurgical strict. Le traitement précoce et adapté représente un élément pronostique très important. Les cellulites orbitaires est une affection grave pouvant engager le pronostic vital et fonctionnel, surtout lorsque le diagnostic est tardif et la prise en charge inappropriée.

[Foreign bodies in ENT: ten-year experience]

Les corps étrangers (CE) représentent une pathologie fréquemment rencontrée en pratique ORL d'urgence. Ils peuvent constituer une urgence vitale par leur aspect ou leur siège. Nous présentons le bilan de dix ans sur la prise en charge des CE de la sphère ORL avec une revue de la littérature. Il s'agit d'une étude rétrospective entre Janvier 2004 et Décembre 2013, incluant tous les cas de CE des voies aéro-digestives supérieures et auriculaires colligés dans le service d'ORL au CHU Mohammed VI de Marrakech au Maroc. Sur les 1317 cas de CE de la sphère ORL colligés durant cette période, 80,48% concernaient les enfants. Le sex-ratio était de 1,5. L’âge moyen était de 12,92 ans. Les CE œsophagiens étaient les plus fréquents (47,53%). Les complications ont été rencontrées dans 11,69% des cas. Les CE dans la sphère ORL restent fréquents en pratique quotidienne surtout chez les enfants. Leur prise en charge nécessite une intervention rapide avec un matériel adapté et des médecins entrainés. La prévention reste la meilleure solution.

[Evaluation of the results of cochlear implantation]

Les implants cochléaires sont des prothèses électro-acoustiques qui ont pour rôle de pallier une déficience bilatérale de l'oreille interne, qu'elle soit profonde ou sévère, acquise ou congénitale. Nous rapportons l'expérience du service d'Oto-rhino-laryngologie et de chirurgie cervico-faciale de l'hôpital universitaire Mohammed VI de Marrakech, dont l'objectif est d'évaluer l'implantation cochléaire et de préciser les facteurs influençant les résultats dans notre pratique. Le profil APCEI a été utilisé pour évaluer les résultats orthophoniques. Il s'agit d'une étude rétrospective étalée sur une période de 7 ans (Décembre 2007 à Décembre 2014). Durant cette période; 54 patients ont été implantés et suivient dans notre formation. Il s'agit de 30 filles et 24 garçons atteints d'une surdité sévères à profonde bilatérale, dont 48 enfants avaient une surdité pré-linguale. L'âge moyen d'implantation cochléaire pédiatrique était de 5,15 ans. L'implantation était unilatérale chez tous les patients. L'intervention était suivie par des réglages et une rééducation orthophonique régulière. L'évaluation était réalisée par la même équipe chaque mois durant les premiers 6 mois, puis tous les 6 mois. La durée moyenne de suivi était de 30,86 mois. Tous les patients ont tiré un bénéfice de leurs implants avec une variabilité interindividuelle. Les bons résultats étaient corrélés à l'implantation précoce, à un investissement parental important et au un bon suivi de la rééducation orthophonique. L'implantation cochléaire a révolutionnée la prise en charge de la surdité profonde et sévère. C'est une technique sûre, efficace lorsqu'elle s'adresse à des populations correctement sélectionnées.

Retropharyngeal abscess revealing a migrant foreign body complicated by mediastinitis: a case report

Pharyngeal foreign bodies are quite common. Their diagnosis is usually easy. The risk of complications including retropharyngeal abscess and mediastinitis is rare and it depends mainly on the nature of the foreign body and the period of the therapeutic management. The occurrence of these complications darkens the prognosis of this affection usually benign. We report a 21 years old patient, without any significant history, admitted to the emergency for a high painful dysphagia and impaired general condition with fever 20 days after trauma in the posterior pharyngeal wall following a meal. The radiological assessment including cervico-thoracic CT scan had objectified the presence of a metallic foreign body in the retropharyngeal space associated with a retropharyngeal abscess and aggravated by a mediastinitis following the migration of the foreign body to the chest. Biological markers of infection were very increased. The therapeutic management consisted of a surgical drainage of the collections by a cervicotomy with removal of the foreign body. The outcome was favorable clinically and biologically. Pharyngeal foreign bodies are common and favorable when the diagnosis and extraction are made on time. The occurrence of complications, especially retropharyngeal abscess and mediastinitis is rare and burdened with a high morbidity and mortality.

[Persistent otorrhea revealing a foreign body of the middle ear]

OBJECTIVES

To report a rare clinical case of chronic otitis media due to an unknown foreign body in the middle ear and a literature review.

PATIENT AND METHODS

A 14-year-old girl who had persistent otorrhea associated with hearing loss for two years. The clinical and CT scan exploration found an unknown foreign body in the middle ear. Extraction was performed by retroauricular surgery, complemented by myringoplasty.

RESULTS

After two months of follow-up, the patient was free of symptoms. Otoscopy discovered an intact neotympanum. The follow-up audiogram was normal.

CONCLUSIONS

Penetrating foreign bodies in the middle ear are infrequently encountered in practice in ear, nose, and throat pediatric emergencies. They may go unnoticed and be revealed by locoregional complications later, hence the importance of suggesting this diagnosis.

Bilateral facial nerve schwannoma: A case report

Facial nerve schwannoma (FNS) is an uncommon disease, bilateral FNS are exceptional. We describe a case of a 23-year-old man who presented a bilateral 3rd segment facial nerve schwannoma, without neurofibromatosis disease. We discuss the clinical presentation, radiologic findings and management of this case. Facial nerve schwannoma can present in various ways. The imaging appearance of FNS is more varied than originally described. Our case demonstrates an uncommon presentation of a relatively rare tumor in which the tumor has been respected. During this time, the tumor may be followed by radiologic imaging.

[Unusual location of pleomorphic adenoma: A series of 7 cases]

INTRODUCTION

The pleomorphic adenoma is a benign tumor of the salivary glands. Its location outside the main salivary glands defines the pleomorphic adenoma of atypical location. The aim of this study is to analyze the clinical, diagnostical and therapeutical features of this tumor at atypical locations through seven observations.

PATIENTS AND METHODS

This work is a retrospective study. It has for objective to present 7 cases of pleomorphic adenoma developed on minor salivary glands diagnosed in Otolaryngology Head and Neck surgery department in Mohammed VI University hospital, between December 2003 and December 2010.

RESULTS

We had 3 cases of pleomorphic adenoma of the hard palate and 1 case of each soft palate, superior lip, lower eyelid and nasal septum. The sex ratio woman/ man was 133. The symptomatology was variable according to the location of the tumor. The tumoral syndrome was constant. The diagnosis of pleomorphic adenoma was suspected at the clinical stage in 3 cases of palatal location. The CT scan was performed for all patients except in 2 cases of the tumor of the lip and the eyelid. We did not realize a magnetic resonance imaging nor of a fine needle aspiration to our patients. The preoperative biopsy was realized to 5 patients. The treatment consisted of a wide surgical excision of the tumor. The mean follow up of 3 years showed no signs of recurrence nor of malignant transformation.

DISCUSSION/CONCLUSION

The pleomorphic adenoma of atypical location is rare. The clinical presentation is variable according to the tumor site and volume. The treatment is surgical. It is based on the early and complete excision of the tumor. The histo-pathological diagnosis is made. The diagnosis differential is with malignant tumors arising on minor salivary glands. The prognosis is favorable. Nevertheless, regular and prolonged follow-up of the patients is important to watch for complications.

[Acute miliary tuberculosis or Isambert disease: a case report]

Pharynx tuberculosis consists in a set of active lesions in granulomatous-type mucosa, resulting from Mycobacterium tuberculosis infection. In an endemic context, this diagnosis should be raised in cases of head and neck disease. A recent observation of a case of acute miliary tuberculosis gave us the opportunity to conduct a literature review of this disorder. This 9-year-old girl presented with dysphagia associated with pharyngeal discomfort, snoring, and hoarseness lasting for 8 months. This pharyngeal syndrome occurred in the context of an impaired general condition. Clinical examination found a diffuse mucosal granulation aspect in the oropharynx. The workup showed an inflammatory syndrome with a strong positive intradermal tuberculin reaction. The biopsy found an aspect of giant cell granuloma with caseous necrosis. The course was favorable on antituberculous chemotherapy. Tuberculosis is a chronic bacterial infection caused by a bacterium belonging to the M. tuberculosis complex. Pharyngeal tuberculosis remains a rare disease, but several epidemiological parameters show an upsurge of this disease, prompting us to report this observation.

Alteration in Matrix Metalloproteinases (MMPS) Activity in Fibroblast Cell Line by Dexamethasone: A Possible Mechanism in Corticosteroid-Induced Glaucoma

Corticosteroids are often used as anti-inflammatory agents in a variety of inflammatory diseases. It is well established that long-term administration of corticosteroids predisposed the patients to develop glaucoma. Although the exact pathophysiology of steroid-induced glaucoma is unknown, it is assumed that Matrix metalloproteinases (MMPs) have a role in its pathogenesis. To study and estimate the pathophysiological effects of MMPs in glaucoma, we established an in vitro cell culture model. We also employed a precise proliferation assay to analyze cytotoxic effect of dexamethasone. The influence of dexamethasone on MMPs production was investigated using an in vitro gelatin Zymography. Cytotoxcity analysis of Dexamethasone revealed no significant cell death in low concentration. However, it caused 50% and 70% cell death at 80 and 100 mg/mL respectively. It also revealed an inhibitory effect on MMPs by dexamethasone in a dose dependent fashion. It may be concluded that an alteration in the level of MMPs expression by dexamethasone interferes with ocular fluid drainage and may contribute to the pathogenesis of glaucoma.

[Hydatid cyst of the thyroid in a child]

INTRODUCTION

Hydatidosis is an anthropozoonosis due to the development of the Echinococcus granulosus in humans. Thyroid gland involvement is rather rare. The authors report a very rare case of thyroid gland hydatidosis in a child.

OBSERVATION

A 6-year-old male child presented with an isolated neck mass. Cervical ultrasonography suggested a cystic thyroid nodule. No invasive investigation was performed. Hepatic ultrasound and chest radiography were normal. Hydatid serology was negative. The tumor was en-bloc removed by cervicotomy. Its content was fluid, crystal clear, with membranes confirming the hydatid origin. There was no recurrence after 9 months.

DISCUSSION

Even though hydatidosis in the thyroid is rare, it should be considered in case of anterior cervical tumor, for patients living in endemic zones. The only radical treatment is surgery. An en-bloc resection must be performed with a cystectomy, isthmolobectomy, or total thyroidectomy.

[Capillary-cavernous hemangioma of the nasal septum]

INTRODUCTION

Hemangioma are rare benign vascular tumors. Histologically, there are several types including capillary, cavernous and mixed hemangioma. We present a very rare mixed hemangioma of the nasal septum.

CASE REPORT

A 30-year-old woman consulted for unilateral epistaxis and nasal obstruction. CT scan revealed a tumor filling the rhinopharynx, strongly enhanced after injection of contrast medium. It was pedicled on the posterior and superior nasal septum. Arteriography revealed a vascular blush. Tumor exeresis was performed by paralateronasal approach and endoscopic surgery. The histological examination identified a mixed hemangioma.

DISCUSSION

Capillary and cavernous hemangiomas are rare and benign vascular tumors developing in the skin and subcutaneous tissues of the head and neck, and/or oral and nasal mucosa. No mixed hemangioma exclusively involving the nasal septum had been previously reported. Complete surgical resection is the treatment of choice, providing a favorable prognosis with low risk of recurrence.

[A giant lipoma of parapharyngeal space in a child]

INTRODUCTION

Tumors of the parapharyngeal space are rare and composing a wide variety of histological types. The aim of this study was to report a case of giant parapharyngeal lipoma in a child and to present clinical, paraclinical, and treatment aspects.

CASE REPORT

A 14-year-old child presented with a painless progressive mass on the right side of the upper neck. It was growing asymptomatically since 2 years. Cervical CT-scan and MR showed a low-density mass in the right parapharyngeal, consistent with a mass of adipose tissue origin. The mass was surgically removed via cervical-parotid approach. The fatty mass was completely excised. Histopathology confirmed it to be a lipoma. The patient has been followed up for three years, and there have been no signs of recurrence.

CONCLUSION

Diagnostic orientation in parapharyngeals tumors is necessary for better care. This guidance is being facilitated through imaging advances. Their surgical approaches and complete excision depend on volumes, localizations and their proximity to neurovascular structures.

[Cholesteatoma by osteoma of the external auditory canal]

Osteoma in the external auditory canal (EAC) is an uncommon benign tumor. The association of a cholesteatoma with an osteoma of EAC is extremely rare. We report a case of a 26-year-old woman with an osteoma of the left EAC that was complicated by a cholesteatoma in the EAC between the osteoma and left tympanic membrane. Surgical removal of the osteoma and cholesteatoma proved successful by postauricular approach. The follow up without recurrence is 24 months. Osteoma of the EAC is a solitary, unilateral, and slow-growing bony benign tumor. The foremost differential diagnosis is exostose that is multiple and bilateral. Cholesteatoma of the EAC is uncommon. Its basic pathogenesis is a chronic occlusion of the EAC. Surgical treatment avoids complications related to local aggressiveness of cholesteatoma.

Retropharyngeal abscess in adults: five case reports and review of the literature

Retropharyngeal abscesses are rare in adults. They occur mostly in immunocompromised patients or as a foreign body complication. We report 5 cases of retropharyngeal abscess collected in the ENT Department of CHU Mohammed VI of Marrakech, during a two-year period (December 2008 to December 2009). Local trauma by foreign body ingestion was the aetiology in four patients. The presenting symptoms, for all patients, were fever, odynophagia, torticollis, and trismus, and the clinical examination showed bulging of the posterior wall of the oropharynx. The radiography of cervical spine showed prevertebral thickening in all cases, this thickening was associated with an aspect of vertebral lysis of the fourth cervical vertebra in one case. A CT scan was performed in all our cases and showed features of retropharyngeal abscess which was associated, in one case, with spondylodiscitis. The biological assessment found one case of diabetes. The intradermal reaction to the tuberculin was clearly positive in one case. Endobuccal abscess puncture was practiced in 4 cases; only one organism was identified by culture: Staphylococcus aureus treatment was based on triple intravenous antibiotics and anti-Koch's therapy (in one case), and the surgical drainage under general anesthesia was also performed in the case of the diabetes patient which required also the correction of hyperglycemia in intensive care unit. The outcome was good in all our patients. The diagnosis of retropharyngeal abscess can be difficult and one must seek a comorbidity; a tuberculosis aetiology must be considered in countries with a high prevalence. The management of these cases is based on antibiotics and surgical drainage.