[Odontogenic cervical-facial cellulitis: report of 87 cases]. / Cellulites cervico-faciales odontogènes: à propos de 87 cas.

Cervical-facial cellulitis are infections of the cellular fatty spaces of the face and neck with a tendency towards locoregional extension, septic and thromboembolic complications that can affect the patient's vital and/or functional prognosis. The management is multidisciplinary including a medical component, surgical drainage associated with the treatment of the causal tooth. This is a retrospective study including 87 cases of odontogenic head and neck cellulitis hospitalized in the ENT and head and neck surgery department at Fattouma Bourguiba Monastir hospital over a period of 4 years between January 2017 and December 2020. The study included 48 women and 39 men. The most affected age group was young adults (54 %). The main contributing factors were poor oral hygiene (76 %), tobacco (41 %) and alcohol (19 %). Anti-inflammatory medicines intake was found in 31 % of cases. The average consultation time was 5 days. The main reason for consultation was painful head and neck swelling associated with trismus (70 %) and fever (52 %). The cervical-facial scan was performed in 93 % of patients. It revealed suppurative cellulitis (64 %), extension to upper aerodigestive ways (20 %), compression of upper aero-digestive tract (11,5 %), Lemierre syndrome (4,6 %) and gangrenous cellulitis with mediastinal extension (1,1 %). All patients received large spectrum antibiotic, associated in 25 % of cases with surgical drainage. Treatment of the dental cause was performed in all patients. The evolution was favourable in 98,9 % of cases. There is only one death due to a septic shock (1,1 %), which is consistent with most of the results reported in the literature. Head and neck cellulitis can affect the functional and vital prognosis of the patient in the absence of rapid and adequate management. The treatment remains primarily preventive.

Les cellulites cervico-faciales sont des infections des espaces cellulo-graisseux de la face et du cou. Leur gravité est corrélée à leur extension locorégionale. Les complications septiques et thromboemboliques peuvent mettre en jeu le pronostic vital et/ou fonctionnel du patient. La prise en charge est multidisciplinaire, se basant sur un trépied thérapeutique comportant un volet médical (antibiothérapie), un drainage chirurgical et un traitement de la dent causale. Il s'agit d'une étude rétrospective ayant colligé 87 cas de cellulites cervico-faciales odontogènes hospitalisés au service d'ORL et de Chirurgie cervico-faciale au CHU Fattouma Bourguiba Monastir sur une période de 4 ans entre janvier 2017 et décembre 2020. L'étude comportait 48 femmes et 39 hommes. La tranche d'âge la plus touchée était l'adulte jeune (54 %). Les principaux facteurs favorisants étaient la mauvaise hygiène bucco-dentaire (76 %), le tabac (41 %) et l'alcool (19 %). La notion de prise d'anti-inflammatoires non stéroïdiens était retrouvée dans 31 % des cas. Le délai moyen de consultation était de 5 jours. Le principal motif de consultation était une tuméfaction cervico-faciale douloureuse associée à un trismus (70 %) et une fièvre (52 %). Le scanner cervico-facial a été réalisé chez 93 % des patients. Il a objectivé une cellulite suppurée (64 %), une extension aux espaces profonds (20 %), une compression des voies aéro-digestives supérieures (11,5 %), un syndrome de Lemierre (4,6 %) et une cellulite gangréneuse avec extension médiastinale (1,1 %). Tous les malades ont bénéficié d'une antibiothérapie à large spectre. Seuls 25 % ont eu un drainage chirurgical associé. Le traitement de la porte d'entrée a été réalisé chez tous les patients. L'évolution a été favorable dans 98,9 % des cas. On recense un seul décès dû à un choc septique (1,1 %), ce qui est concordant avec la majorité des résultats rapportés dans la littérature. Les cellulites cervico-faciales peuvent mettre en jeu le pronostic fonctionnel et vital du patient en l'absence de prise en charge rapide et adéquate. Le traitement reste avant tout préventif.

Desmoid tumours of the head and neck: A case report.

INTRODUCTION: Desmoid tumours of the head and neck, also known as fibromatosis, are rare, locally invasive benign tumours with high recurrence rate, causing considerable morbidity. Complete surgical excision of desmoid tumours is considered to be the only effective treatment. CASE REPORT: We present a case of fibromatosis of the right posterolateral region of the neck in a 56-year-old woman who presented with right neck mass. The patient underwent complete excision of the tumour with no adjuvant therapy. No recurrence or neurological deficit was observed 2 years after surgery. CONCLUSION: Although desmoid tumour is a benign neoplasm with no metastatic potential, treatment is challenging due to its aggressive, infiltrative behaviour with a tendency to recur.

Primary sinonasal meningioma.

INTRODUCTION: Primary meningiomas of the sinonasal tract are rare tumors. Their positive diagnosis is difficult to establish. From one case observation, we report the clinical features, the diagnosis difficulties and the therapeutic modalities of primary meningioma of the sinonasal tract. CASE REPORT: A seventeen-year-old girl consulted for a left unilateral nasal obstruction with progressive evolution without episodes of epistaxis, smell disorder or headaches over a year. Physical examination revealed a grayish polypoid tumor in the left nasal fossa. CT scan evidenced an isodense lesion of the left nasal fossa slightly enhanced pushing back the lateral nasal wall without invasion or intracranial connection. Biopsy was in favour of an inverted papilloma. The tumor was resected via endoscopic approach. Pathological examination established the diagnosis of meningothelial menigioma. The prognosis was favourable without recurrence after a six-month follow-up. CONCLUSION: The positive diagnosis of primary sinonasal meningioma is difficult to establish because of their infrequent occurrence in this ectopic site and of their non-specific clinical appearance. The final diagnosis rests on the histological examination. Immunohistochemical studies are helpful to establish the accurate diagnosis. Imaging confirms the primitive nature of these tumors. Prognosis is excellent after complete surgical extirpation without the necessity of adjuvant therapy.

[Para-pharyngeal tumors, contribution of imaging]. / Tumeurs parapharyngées, apport de l'imagerie.

OBJECTIVES: Para-pharyngeal tumors are located deeply. Imaging is mandatory for their management. We conducted a retrospective study to determine the contribution of imaging for their diagnosis and treatment. PATIENTS AND METHODS: Imaging was performed for 20 cases of primary para-pharyngeal tumors between 1986 and 2008. We compared the imaging to the anatomic and histological features of these tumors. RESULTS: Computed tomography and MRI confirmed the para-pharyngeal location of tumors. Tumors were located in the prestyloid compartment in eight cases, in the retrostyloid compartment in five cases, and in the retropharyngeal compartment in one case. Six tumors had filled all the para-pharyngeal space. Salivary gland tumors had filled the prestyloid space in two cases, and in two other malignant cases all para-pharyngeal space were invaded. MRI failed to differentiate the nature of tumor and its malignancy except when there was obvious bone erosion. The treatment was mainly surgical. The mean follow-up was 5 years 6 months. DISCUSSION: Imaging contributes to the etiological diagnosis and assesses tumor extension, thus helping to choose the surgical approach. MRI is the most contributive examination; its resolution is more adapted to the diagnosis of deep tumors. CT scan is contributive when studying the bone structure.

B-cell lymphoma of the mandible.

INTRODUCTION: Primary malignant lymphoma of the mandible is rare. It is frequently mistaken for a dental lesion, delaying diagnosis. We here report a case of mandibular lymphoma and present the clinical and radiological characteristics and means of treatment of this pathology. CASE REPORT: A 17-year-old woman consulted for right facial tumefaction with 1 year's evolution. Clinical examination found a mass facing the horizontal branch of the mandible, extending to the right parotid region without cutaneous involvement. CT and MRI showed a large expansive process of mandibular origin with parotid, temporal and intracranial extension. Biopsy indicated large B-cell lymphoma. The patient showed good evolution 2 years after chemotherapy. CONCLUSION: Lymphoma is the second most frequent form of head and neck tumor, after epidermoid carcinoma. Only 0.6% of locations are mandibular, almost always consisting of B-cell lymphoma. They are often initially misdiagnosed as a dental pathology. Complete remission after chemotherapy ranges from 60 to 80% at 1 year.