Endoscopic resection of forehead osteomas: Technical notes.

INTRODUCTION: Forehead osteoma is an uncommon benign bone tumor that causes cosmetic disfigurement and occasional pain. Traditional excision directly over the lesion creates a visible scar on the forehead. PROCEDURE: We describe a method of endoscopic resection of the forehead osteoma, via incisions within the hairline. The access incision was hidden behind the frontal hairline and the dissection plane went in the subperiosteal layer. The injury of the nerve branch and vessel can be easily avoided and endorsed by manipulating the endoscope. CONCLUSION: Aesthetic considerations are important features in the craniomaxillofacial region. Especially for patients who are not willing to accept the risk of a prominent forehead scar. Endoscopic resection of forehead osteomas might be a useful tool in forehead osteoma resections. It might be an alternative tool in an Oral and Maxillofacial Surgeon's and in a Plastic Surgeon's repertoire.

Paranasal sinus osteomas: Diagnosis and treatment.

INTRODUCTION: Osteoma is the most common benign tumor of the nose and paranasal sinuses. It is a slow-growing bony tumor, often asymptomatic, occurring mainly in frontal and ethmoid sinuses. Theories regarding the origin of osteomas are still discussed. The aims of the study were to describe diagnosis circumstances in our series and to set out our respective indications for open and endoscopic approaches in the treatment of nasosinusal osteomas. PATIENTS AND METHODS: A retrospective study was conducted on the files of all the patients treated for a paranasal sinus osteoma in our department between 1990 and 2013. Diagnosis circumstances and kind of treatment were collected and analyzed. RESULTS: The files of 45 patients (mean age: 49.2; sex-ratio: 1.19) could be collected. The most common symptom was headache found in all patients. The most common location was the frontal sinus (30 cases). Thirty-nine open procedures were performed. Four osteomas were removed under endoscopic assistance. In one case, a combined approach has been used. Overall complication rate was 11.1%. Symptoms improved in all patients. Two recurrences were observed. DISCUSSION: Surgical indications in paranasal sinus osteomas are theorically well codified. However, approaches remain controversial. In our experience, the preferred approach was the open one. Endoscopic techniques, when indicated, are more challenging and need sophisticated instrumentation and a long learning curve.

[Management of ocular and orbital complications in acute sinusitis]. / Prise en charge des complications oculo-orbitaires des sinusites aiguës.

PURPOSE: Describe the clinical presentations of orbital complications of acute sinusitis and discuss therapeutic approaches. METHODS: Retrospective study of 29 cases of acute sinusitis with orbital extension hospitalized over a period of 12years (2000 to 2012). RESULTS: There were 23 men and 6 women. The mean age was 15.75years. The average time until consultation was 7.68 days. Sinusitis was ethmoido-maxillary in 20 cases, ethmoidal in 6 cases, and frontal in 3 cases. Orbital extension was grouped according to the Chandler classification: stage I (3 cases), stage II (3 cases), stage III (15 cases), stage IV (8 cases). Antibiotic therapy was prescribed in all cases. Surgery was performed in 22 cases. Bacterial cultures revealed streptococcus (2 cases), aspergillus fumigatus (1 case) and were negative in 8 cases. The outcome was favorable in 27 cases. In two cases, the outcome was unfavorable with associated intracranial complications. DISCUSSION: Oculoorbital extension of acute sinusitis is a diagnostic and therapeutic emergency. Paranasal sinus CT is essential to confirm orbital extension and identify the causative sinus. Intravenous antibiotic therapy is the main treatment. The roles of corticosteroid and heparin therapy remain controversial. Surgery is indicated in the case of abscess or high visual risk. Endoscopic endonasal surgery appears to have a double role, in diagnosis and treatment.

[Ophthalmic complications of nasosinus mucoceles]. / Complications ophtalmiques des mucocèles rhino-sinusiennes.

INTRODUCTION: A nasosinus mucocele is a pseudocystic process filled with mucus arising within the sinus. Despite its benign histology, potential ophthalimic risks are related to mass effect and expansion to the orbit by bone destruction with compression of optic nerves. PURPOSE: We describe mechanisms of ophthalimic involvement in patients with paranasal sinus mucoceles, radiological appearance, treatment and prognosis of this disease. MATERIALS AND METHODS: We report 5 cases of paranasal sinus mucocele with ophthalmic complications seen between January 2007 and December 2011 on the ENT and MFS service of La Rabta University hospital. RESULTS: The reason for consultation was: unilateral proptosis in 4 patients, diplopia in 2 patients and medial canthal swelling in 3 patients. Facial computed tomography showed a mucocele in the frontal sinus in two patients, in the ethmoid-frontal sinuses in two patients and in the ethmoid-maxillary sinuses in one patient. We found erosion of the orbital walls and displacement of the globe in all cases, extra-axial proptosis in one case, compression of the extraocular muscles in 4 cases and stretching of the optic nerve in three cases. All patients were treated initially with antibiotics then surgery. The postoperative course was uneventful with no recurrence. CONCLUSION: It is necessary to diagnose mucoceles as early as possible and plan surgical excision before growth of the mass irreversibly compromises visual function.

High intensity exercise affects diurnal variation of some biological markers in trained subjects.

The study investigated if markers of muscle injury and antioxidant status were affected by a Wingate test performed at 2 different times of day. 15 young male footballers performed 2 tests (randomized) at 07:00-h and 17:00-h. Fasting blood samples were collected before and 3 min after each test for assessment of markers of muscle injury and antioxidant status. Resting oral temperature was recorded during each session. Peak power (10.76 ± 1.05 vs. 11.15 ± 0.83 W.kg( - 1)) and fatigue index (0.41 ± 0.04 vs. 0.49 ± 0.13%) during the Wingate test, and core temperature, were significantly higher (all p<0.05) in the evening. Markers of muscle injury were significantly higher in the evening before and after exercise (e. g., 148.7 ± 67.05 vs. 195 ± 74.6 and 191.6 ± 79.52 vs. 263.6 ± 96.06 IU.L (- 1), respectively, for creatine kinase; both p<0.001). Antioxidant parameters increased after the Wingate test but only resting values were significantly higher in the morning (e. g., 1.33 ± 0.19 vs. 1.19 ± 0.14 µmol.L (- 1) for total antioxidant status; p<0.05). The results indicate that muscle injury and antioxidant activity after the Wingate test were higher in the evening, suggesting a possible link between the biochemical measures and the diurnal fluctuation of anaerobic performance. However, repetition of this study after prescribed rather than self-selected exercise intensity is recommended.

[Pediatric mucoceles: clinical aspects and therapeutic approaches]. / Mucocèles de l'enfant : présentations cliniques et modalités thérapeutiques.

INTRODUCTION: Paranasal sinuses mucoceles are extremely rare in children and adolescents. The objective of this study was to assess their clinical presentations and the contribution of endoscopic surgery in their management. MATERIAL AND METHODS: we retrospectively reviewed 11 children with paranasal sinus mucoceles who were managed during a period of 15 years (1995-2009). RESULTS: The mean age was 11.8 years with a sex ratio of 2.66. One patient had a history of nasal polyposis surgery. The symptomatology was dominated by ophthalmological complains. The ethmoïd sinus was the main localization. Orbital extension was found in eight cases, pyomucocele in one case. The surgical management was endoscopic (nine cases), and by an external approach (two cases). Two cases of recurrence were assessed. The mean follow-up was 22.3 months. DISCUSSION: Paranasal sinuses mucocele is exceptional in children. Cystic fibrosis is the main etiologic factor. The symptoms depend on the location and size of the mucocele. The treatment is surgical and most authors prefer the endoscopic approach.

[Granulomatous invasive aspergillosis rhinosinusitis]. / La rhinosinusite aspergillaire invasive granulomateuse.

INTRODUCTION: Granulomatous invasive aspergillosis rhinosinusitis is a rare disease. Anatomopathologic and mycological examination allows the diagnosis. Treatment must be rapidly started in order to avoid orbital and intracranial complications. OBJECTIVES: To analyze the main clinical, radiological, histopathological, mycological and therapeutic aspects of granulomatous invasive aspergillosis rhinosinusitis. PATIENTS AND METHODS: This is a retrospective study included five patients operated for granulomatous invasive aspergillosis rhinosinusitis at the Otorhinolaryngology Head and Neck Department of La Rabta Hospital from 2000 to 2011. RESULTS: These are four women and one man with mean age of 24.8 years. Functional symptoms were dominated by nasal obstruction and purulent rhinorrhea. Imaging showed a unilateral pansinusien filling extended to the nasal cavity with bone lysis. An orbital and endocranial extension was noted in two cases. Endonasal approach was performed in four patients and external approach in one patient. Anatomopathologic and mycological examination confirmed the diagnosis. All patients were started on antifungal therapy. One reccurence had been noted. Endonasal approach was performed. CONCLUSION: Granulomatous invasive aspergillosis rhinosinusitis is a rare infection. The prognosis is particularly serious which warrants a rapid therapeutic care to avoid complications.

[Fifty-four cases of nasolabial cysts]. / Le kyste nasolabial: 54 cas.

INTRODUCTION: Nasolabial cysts (NLC) are a rare condition presenting as cystic epithelial lesion. We report the clinical and radiological (CT scan) aspects of this rare clinical entity and we assess the various available surgical treatment. PATIENTS AND METHODS: Fifty-four patients presenting with NLC underwent surgery between 2000 and 2009. The diagnosis was made on clinical and radiological arguments and confirmed by histological examination after surgical excision. The studied parameters were: gender, functional signs having led to consultation, localization, results of radiological exploration, treatment modalities, anatomopathology and postoperative evolution. RESULTS: The average age of the 30 men and 24 women was 38 years with extremes ranging between 24 and 53 years. The reason for consultation was swelling of the anterior nasal floor in every case and a nasal obstruction for 33 patients. The average time between initial swelling and consultation was 18 months. Swelling was unilateral for 52 patients. CT scan was prescribed for 20 patients and revealed a cystic mass with an average diameter of 23 mm. Cyst excision was made under general anesthesia in every case. Most of the patients (52) were operated via a vestibular approach. Histological examination confirmed the diagnosis of nasolabial cyst in every case. DISCUSSION: NLC is a rare condition which must be suggested when a cystic mass is found in the anterior nasal floor. CT scan confirms the diagnosis and cyst extension. Cyst excision is performed by vestibular approach. The endoscopic marsupialization is an interesting new therapeutic alternative.

[Study of the intronic polymorphism of the angiotensin 1 converting enzyme among coronary Tunisians]. / Étude du polymorphisme intronique de l'enzyme de conversion de l'angiotensine I chez des coronariens tunisiens.

BACKGROUND: The acute coronary syndromes (ACS) are classified among the major causes of mortality in the industrialized countries. The increased angiotensin I converting enzyme (ACEI) activity related to a genetic polymorphism constitutes a hereditary predisposition to these syndromes. AIM: Evaluate the ACEI activity in Tunisian patients with coronary heart disease, and investigate the association between this activity and an intronic deletion of 287 pb on the intron 16 of the ACEI gene. PATIENTS AND METHODS: Seventy-two coronary patients and 34 control subjects are recruited for our study. ACEI activity was measured by kinetic method. The intronic deletion was identified by PCR technique. RESULTS: An increased activity of ACEI was observed in patients compared with control subjects (84.38 ± 33.83 UI/L vs 59.06 ± 18.2 UI/L, P=10(-5)). The molecular study showed a raised relative frequency of D/D genotype (51.4%) among patients, whereas among the witnesses, I/I genotype prevailed (62%). D/D genotype is always associated with highest ACEI activity for the patients and the control subjects. CONCLUSION: The molecular studies and the biochemical investigations of the various parameters of cardiovascular risk (including the ACEI) direct towards a better treatment.

[Carcinoid tumor of the larynx]. / Tumeur carcinoïde du larynx.

OBJECTIVE: Carcinoid tumors are among the exceptional neoplasms of the larynx. The literature is reviewed and the problems with diagnosis and management of this rare tumor are discussed. METHODS: The authors report a case of a carcinoid tumor of the larynx. RESULTS: This paper describes the case of a well-differentiated carcinoid tumor of the aryepiglottic fold in a 59-year-old woman who presented with hoarseness lasting eight months. After surgical excision, the patient developed recurrence of the disease 14 years later. CONCLUSION: Carcinoid tumors require accurate diagnosis because of their varied clinical behavior and prognosis. The typical carcinoid treatment of choice is conservative surgery.

Predictors of smoking initiation among schoolchildren in Tunisia: a 4 years cohort study.

OBJECTIVE: To identify predictors of smoking initiation among non smoking Tunisian school children; and to propose efficient antismoking strategies in order to prevent smoking initiation. METHODS: It was a cohort study surveying prospectively for four years pupils attending schools in Sousse city in Tunisia. 441 non smoking pupils aged 13-15 years attending secondary schools in Sousse. Data were collected by a self administered questionnaire during class session. Two ways cross tabulation, univariate and multivariate logistic regression analyses were the main analytical methods. RESULTS: 57.1% of the surveyed population were girls, 42.9 % were boys. 63% had at least one of their peers who smoked. Before 1999, 16.6% had already tried to smoke, 29.5% had already experienced alcohol. In 2003, smoking prevalence was 17%. 4.8% were girls; 33.3% of boys; p<0,001). 69.9 % of these smokers declared that they would carry on smoking during the following five years. Predictors which were highly associated with smoking initiation were previous experimentation with alcohol and tobacco, having a smoking best friend, lack of sensitization from the part of the school, believing that smoking makes one feel cool and that tobacco shouldn't be forbidden in public places. CONCLUSION: Intervention programs should target young children to avoid experiencing the first cigarette. Multidisciplinary management including community and school based intervention highlighted by mass media campaigns may provide schoolchildren with skills to resist smoking peers prompts to adopt unhealthy habits such as smoking.

[Report of a case of Lyell syndrome]. / A propos d'un cas de syndrome de Lyell.

Toxic epidermal necrolysis (TEN) is a rare drug-induced disease characterized by extensive epidermal destruction. We reported here a case of Lyell syndrome which happened few hours later after treatment associating lincomycine chlorhydrate with nonsteroidol anti-inflammatory drugs. The 28-year-old female patient developed many visceral complications with biochemical and haematological disorders. This syndrome is a dermatological emergency whose vital prognosis is displayed.