Hematemesis on an esophageal foreign body revealing a double aortic arch: a case study.

A double aortic arch is a rare abnormality of the aortic arch caused by the persistence of the distal part of the right dorsal aorta. It can be manifested by respiratory and/or digestive symptoms. We report a case of double aortic arch revealed by an esophageal foreign body complicated by haematemesis in a 13-year-old boy having required multidisciplinary care.

[Oto-rhino-laryngological and cervico-maxillofacial pathologies among hospitalized older patients: epidemiological, diagnostical and therapeutical aspects in Lomé, Togo]. / Pathologies ORL et cervico-maxillo-faciales du sujet âgé en hospitalisation : aspects épidémiologiques, diagnostiques et thérapeutiques à Lomé, Togo.

Introduction: In developing countries, 10% of the population is over 60 years old and this proportion is increasing rapidly. The general objective of this study was to describe the profile and management of the elderly subject aged 60 and over, hospitalized in the ENT (Ear, Nose and Throat) and Head/Neck surgery department of the Sylvanus Olympio University Hospital in Lomé, from 2012 to 2021. Method: Retrospective descriptive study. After reviewing the files, selection of patients aged 60 and over, regardless of sex, and hospitalized for an ENT pathology from January 2012 to December 2021. Not included in our study were files of elderly subjects hospitalized but whose age was imprecise, or empty or very incomplete files. Results: A total of 296 cases were included, representing 6.7% of the department's activities. The mean age of the patients was 72 ± 7.3 years with extremes of 60 and 95 years. The age group 6069 years represented 59.5%. The sex ratio M/F was 0.92. Infectious/inflammatory lesions were found in 138 patients (46.6%) including 38.9% of acute cellulitis of dental origin, and tumors were found in 135 patients (45.6%). Tumors were malignant in 59 patients (43.7%) and benign in 76 patients (56.3%). Thyroid was the site of 46 (60.5%) benign lesions and larynx of 29 (49.2%) malignant lesions. Poor oral hygiene, use of non-steroidal anti-inflammatory drugs, diabetes and the combination of smoking and alcohol were the factors favoring the occurrence of acute cellulitis of dental origin in 89.6%, 80.9%, 20.0% and 2.6% of cases respectively (p<0.001). The combination of smoking and alcohol was a factor favoring the occurrence of malignancy in 39% (p<0.001). Surgical treatment was performed in 234 patients (79.1%). With a case lethality rate of 21%, acute cellulitis of dental origin was the leading cause of death (p<0.001). Conclusion: The most frequent pathologies of the ENT sphere in the elderly in our tropical context were infectious and tumoral, largely dominated by acute cellulitis of dental origin, thyroid adenoma and squamous cell carcinoma of the larynx. Despite the tendency to balance infectious and tumoral pathologies, the proportion of acute cellulitis of dental origin remains twice as high as that of malignant tumors. It contrasts with data from other sub-Saharan series where tumoral pathology remains predominant in the elderly. It is important to provide dental care assistance to the elderly and to advocate for the development of geriatrics and access to universal health coverage for the elderly in Togo.

[Necrotizing fasciitis of the posterior neck. A rare clinical form of head and neck cellulitis: a case report from Togo]. / Fasciite nécrosante de la nuque, une forme clinique rare des cellulites cervico-faciales : à propos d'un cas au Togo.

We report the case of a 75-year-old diabetic patient who presented with posterior cervical necrotizing fasciitis complicating cellulitis. Medical management in intensive care and surgical drainage were undertaken; sequential excision of the necrotic tissue left a large loss of substance of the nuchal region for which we opted for directed healing in the first instance. The definitive coverage of this loss of substance by locoregional rotation flap or by thin skin grafting was discussed. However, it was refused by the patient.

Papillary carcinoma on thyroglossal tract cyst: our attitude toward a rare pathology whose management is often controversial.

Malignant degeneration on remnants of the thyroglossal tract is a very rare phenomenon. In our practice setting, we report the management of papillary carcinoma on a thyroglossal tract cyst. This was a 44-year-old female patient with a postoperative diagnosis of papillary carcinoma of the thyroglossal tract with an atypical clinical and ultrasound presentation. She subsequently underwent total thyroidectomy and bilateral recurrent lymph node dissection, with resection of fibrous scar tissue in the previously operated hyoid region. We have discussed our therapeutic attitude to this rare pathology, the management of which is the subject of controversy.

Multiple Squamous Cell Carcinoma in a Patient Using Skin Bleaching Products in Togo.

Background: The cosmetic use of skin bleaching products is common among women in sub-Saharan Africa despite numerous reported cutaneous and systemic complications. We report the first case of squamous cell carcinoma in a woman using skin bleaching products in Togo. Case Report. A 65-year-old woman with a 30-year history of skin bleaching products use consulted in dermatology for a tumor of the neck that had been evolving for 2 years. There was no personal or family history of cancer. The patient was obese (BMI = 38.3 kg/m2) and had high blood pressure. Clinical examination noted multiple ulcerative and cauliflower tumors of the neck. The presence of stretch marks, skin atrophy, and ochronosis was noted in the examination of the rest of skin. There were no lymph nodes. HIV serology was negative. Histology of a tumor biopsy concluded to an invasive skin squamous cell carcinoma. The cervical, thoracic, abdominal, and pelvic TDM revealed pulmonary metastases. The patient underwent complete surgical removal of the right latero-cervical tumor. The left latero-cervical tumors were not removed because they infiltrated the large vessels. Chemotherapy before surgery was prescribed but not honored for financial reasons. The patient died 2 months after her first consultation in respiratory distress. Conclusion: Squamous cell carcinoma is one of the complications of skin bleaching in sub-Saharan Africa. It is necessary to intensify awareness campaigns on the complications of this practice, in order to reduce their incidence, in our context where this practice is very frequent.

Late Diagnosis of Bilateral Choanal Atresia: A Case Report of a Nine-Year-Old Girl.

Bilateral choanal atresia is a surgical emergency because of the risk of neonate death from acute asphyxia if treatment is delayed. Its diagnostic confirmation is often endoscopic or CT scan and requires a search for associated malformations. We present the case of a nine-year-old girl who was referred to the ENT department with suspected adenoid pathology. Her medical history showed respiratory distress at birth treated as a neonatal infection. We suspected bilateral choanal atresia due to the absence of fogging on mirror test and failure to pass a 6Fr or 8Fr suction catheter through the nasal cavity into the nasopharynx. Facial CT confirmed the presence of bilateral mixed osteo-membranous choanal atresia. Transpalatal choanoplasty was successfully performed with pre and postoperative endoscopic examination. This clinical case adds to the limited literature on bilateral choanal atresia diagnosed long after birth, raising once again the lack of knowledge of choanal atresia by some health workers, emergency neonatal care, the mechanism of breathing in the newborn, and the management of this malformation. Transpalatal choanoplasty is a good alternative when technical conditions do not allow an endoscopic endonasal approach.

Solitary neurofibroma of the right lateral wall of the oropharynx.

Solitary neurofibroma of the oropharynx is extremely rare. Imaging explorations may be necessary, but the diagnostic certainty is pathological. We report a case of benign tumour of the oropharynx in a 25-year-old woman who was seen for a consultation with dysphagia, a change in voice and dyspnea in the supine position. The excision was performed under general anaesthesia with orotracheal intubation via the oropharyngeal route. Pathological examination of the surgical specimen revealed neurofibroma. Although rare, solitary neurofibroma of the oropharynx should be considered in any benign tumour in the area.

[Primitive oto-rhino-laryngology and cervico-maxillofacial tumors: epidemiological and histological aspects]. / Cancers primitifs oto-rhino-laryngologiques et cervico-maxillo-faciaux: aspects épidémiologiques et histopathologiques.

INTRODUCTION: Establish the panorama of primitive oto-rhino-laryngology and cervico-maxillofacial tumors diagnosed at a reference center in Togo. METHODS: We conducted a retrospective, descriptive study of cancers diagnosed at the ORL and cervico-maxillofacial surgery department of the CHU Sylvanus Olympio of Lomé. It was conducted over a period of 10 years (1 January 2005 - 31 December 2014). RESULTS: ORL and cervico-maxillofacial tumors account for 0.48% of consultations and 15.3% of all ORL tumors. The average age of patients was 47 years, ranging from 3 months to 86 years. We noted a male predominance; the sex ratio was 1.45. Drinking alcohol and smoking tobacco prevailed in the cancer of the larynx. Upper aerodigestive tract (UAT) tumors accounted for 64,8%, with a prevalence of cancers of the oral cavity (36,2% of UAT), followed by cancers of the oropharynx (18,5% of UAT) and finally by cancers of the larynx (18,1% of UAT). Primary malignant cervical adenopathies accounted for 18%. The rarest lesions were cancers of the ear and of maxillomandibular bone tissue (2.24% each). Histology was dominated by squamous cell carcinoma (61.4%) followed by non-Hodgkin lymphoma (23.2%). CONCLUSION: ORL and cervico-maxillofacial tumors are frequent in Togo and can be diagnosed at any age. The predominant tumor types reported are those of the oral cavity, pharynx and primary malignant cervical adenopathies.