[Oral metal foreign bodies]. / Corps étranger métallique de la cavité buccale.

Oral foreign bodies are most encountered in children. They rarely pose diagnostic problems. But the therapeutic management can use the therapeutic escalation from simple extraction chair to extraction per endoscopic under general anesthesia. We report an unusual case of metal foreign body (umbrella's support) penetrating the oral cavity and measuring 18 cm long in a 5 years-old boy. A radiograph of skull centered on the mouth as great interest in the diagnostic and particulary in the management of the metallic foreign body. The extraction of foreign body was done by oral approaches under general anesthesia.

[67 cases of face and neck cellulitis managed at the Brazzaville Teaching Hospital]. / 67 cas de cellulite cervico-faciale, pris en charge sous anesthésie locale au CHUB de Brazzaville.

INTRODUCTION: Face and neck cellulitis is an infection of cellular adipose tissues of the head and neck. These are common complications but true diagnostic and therapeutic emergencies. We had for aim to analyze the diagnostic and therapeutic aspects of these infections treated under local anesthesia at the Brazzaville teaching hospital. MATERIEL AND METHODS: We conducted a retrospective study from January 1, 1999 to December 31, 2008 on 67 cases of patients admitted to the ENT and Stomatology units of the Brazzaville teaching hospital. RESULTS: We included 47 male (70%) and 20 female (30%) patients (sex ratio 2.35) with a mean age 21 years (range 14-69 years of age). The cause of infection was dental in 75% of cases, lymph nodes in 24% of cases, and otologic in 1% of cases. The treatment was medical and surgical. DISCUSSION: Cervico-facial cellulitis more frequently concerns young adults. Neglect, poor oral hygiene, and ignorance contribute to the occurrence of these complications. The main portal of entry is dental. The authors recommend the antibiotic and corticosteroid therapy associated with incision and drainage.

[Childhood laterocervical abscess fistulized in the pharynx: a case study]. / Abcès latérocervical de l'enfant fistulisé dans le pharynx: à propos d'un cas.

Cervical adenophlegmon is frequently encountered in children. We report on a case of an exceptional direct communication between a retropharyngeal abscess and a cervical adenophlegmon, observed in a 25-month-old child. Treatment comprised double antibiotic therapy and retropharyngeal drainage, which led to the subsidence of the laterocervical abscess. The progression was uncomplicated.

[Inverted naso-sinusal papilloma: analytic study on 13 cases]. / Papillomes inversés naso-sinusiens: etude analytique de 13 cas.

OBJECTIVES: Inverted nasosinusal papilloma is a rare tumorous process involving mucosa of nasal fossa and paranasal sinus unilaterally. The authors studied inverted naso-sinusal papilloma observed and treated in ENT and Head and Neck department at Brazzaville University Hospital. MATERIAL AND METHODS: Retrospective study concerning 13 patients treated between 1988 and 2001. RESULTS: The average age is 34 years (range: 16 to 60 years); old nasal obstruction is the main symptom (12 cases); the diagnosis is histologic; association with Killian polyp (1 case), human papilloma virus infection (1 case) and rhinosporidiosis (1 case); large surgical removal (Caldwell-Luc, para-latero-nasal) and polypectomy associated to diathermy of tumorous insertion place permitted to have satisfactory results; the recurrencies were observed in four cases from 7 months to 10 years (average: 4 years); malignant transformation is noted in 2 cases with one case of inverted papilloma combined to Human Papilloma Virus infection. CONCLUSION: All naso-sinusal polypoid should have a histological study. Patients must be followed-up regularly; this is very difficult in Africa.

[Treatment of hyperthyroidisms in Brazzaville Teaching Hospital, Congo]. / Prise en charge des hyperthyroïdies au CHU de Brazzaville, Congo.

Between January 1994 and December 2003, a total of 118 patients (MIF = 1/13) with thyrotoxicosis was studied at the endocrine and metabolic diseases unit of the Centre Hospitalier Universitaire de Brazzaville, in Congo. 72 patients (61%) had Graves' hyperthyroidism, 23 (19.6%) had toxic multinodular goitre while the rest had toxic adenoma (7.6%), and thyroiditis (4.2%). The mean age was 26.6 +/- 7.9 years for Graves' cases and 49.4 +/- 9.3 years for toxic multinodular goitre cases. The clinical presentation was similar to other reported series. Thirty-seven patients (31.3%) did not return after the first admission. All patients responded to carbimazole therapy and no major side-effect was recognized. Ten patients (8.5%/) underwent subtotal thyroidectomy, among them one developed hypothyroidism a year later. The result of this study shows that thyrotoxicosis is not a rare condition in Congo.

[Cysts and congenital fistulas of the face and the neck. About 78 cases]. / Kystes et fistules congénitaux de la face et du cou. A propos de 78 cas.

The cysts and congenital fistulas of the face and neck induce frequent malformations in Oto-Rhino-Laryngology. A retrospective study on these malformations has been carried out from January 1986 to December 2001 in the Oto-Rhino-Laryngology unit of the Brazzaville Teaching Hospital. This study considered the epidemio-clinical aspects, the modes of therapeutic treatment and the evolution of these congenital pathologies. The cysts and congenital fistulas represented 2% of the consultations in the service. Patients were aged of 10 months to 50 years (average age: 21 +/- 5 years) among them 49 men (63%) and 29 women (37%). The pathology appeared in childhood in 41% of the cases and during adult age in 59% of the cases. The main circumstances of discovery were: cystic swelling (72%), infectious complication (18%) and productive fistula (10%). The clinical forms have been dominated by the cysts of the thyreoglossal tractus (72%), followed by the pre-auricular fistulas (10%), the amygdaloid (9%), dermoid (6%) and nasopalatine (3%) cysts. The treatment was in any case surgical. A good embryo-pathogenic knowleldge should contribute to a complete surgical exeresis, a necessary condition to avoid recurrence.

[Thyroid disorders in the Brazzaville Teaching Hospital]. / La pathologie thyroïdienne au Centre hospitalier universitaire de Brazzaville.

The authors report their experience with thyroid disorders. Between January 1994 and December 2003, a total of 567 patients (sex ratio: 1/20, men to women) with thyroid disease were examined in the endocrine and metabolic department of the Brazzaville Teaching Hospital. Their mean age was 43 years. 333 (58.7%) had a simple goiter, 118 (20.8%) hyperthyroidism, most often related to Graves' disease (60.8%). Other disorders included multinodular goiters (19.2%), toxic adenoma (7.1%) and thyroiditis (13.8%). Hypothyroidism was identified in 7.4% of cases, mainly following thyroid surgery. Thyroid cancer was rare (4 cases).

[Hypersialorrhea in mental retardation: interest of salivary denervation]. / L'hypersialorrhee chez le retarde mental: interet d'une denervation salivaire.

Hypersialorrhea with mental retardation is a handicapping clinical situation with a greater psychoaffective impact and a risk of dyspneic attack by a pharyngeal salivary stasis and a disappointing treatment. We report an observation about a 22 years old child; as for as this child is concerned, the treatment has been a salivary denervation. This method is simple, efficient and without risk.

[Association of HIV and parotid cysts]. / A propos d'une association VIH et masses kystiques parotidiennes.

Parotid cystics are included in salivary glands affection, found with persons infected by the human immunodeficiency virus. This study reports 28 cases registered in the oto-rhino-laryngology service of Brazzaville university hospital. The interested age is between 32 and 57 years old. The HIV profile reveals a prevailing of HIV1 (20 cases). The dia-gnosis is clinical, echographic and by the exploratory puncture. The therapeuratic approach (iterative puncture and compressive dressing) adopted to these brittle patients and with limited resource, permitted to get satisfactory results.

[Cervico-facial and ENT symptoms due to HIV infection in tropical area. About 253 Congolese cases]. / Les manifestations ORL et cervico-faciales de l'infection par le VIH en zone tropicale. A propos de 253 cas congolais.

In human immunodeficiency virus infection as well as in related syndromes, cervico-facial and otorhino-laryngologic manifestations are current. A retrospective study in Oto-Rhino-Laryngology service of Brazzaville University Hospital from December 1995 to November 2001 has been reported. 253 patients were selected from a total of 1352 consultations. The study population is young (average age: 34 +/- 4.8 years), and most of the patients are 30 to 49 years old (75.9%). Men represent 51% and women 49%. Although sexual multipartnership (59.7%) is the main risk factor, traditional practices (22.8%) are not neglictible in Africa. Among all cases, human immunodeficiency virus type 1 is found in 72.3% of cases. The affections are located in the neck (40.5%), ear (24.9%), pharynx (17.3%), rhinosinus (13.3%), oral cavity and vestibule (2.7%) and larynx (1.3%). These main affections are represented by: parotidosis (20.1%), peripheric facial paralysis (15.4%), pharyngeal candidiasis (14.6%), sinusitis (14.2%) and ganglial tuberculosis (11.5%). Lymphoma (7 cases), kaposi's sarcoma (7 cases) and epidermoid carcinoma (1 case) are the malignant affections identified in 15 cases (6%). The diagnosis of some affections like cystic parotiditis (11%), noma (1.6%), African histoplasmosis (0.4%) and rhinoscleroma (0.4%) constitutes this study particularity The Oto-rhino-laryngologist's role is important in early diagnosis of HIV infection as well as in the followed-up of patients.

[Ectopic tooth in the nasal cavity]. / Dent incluse dans la fosse nasale.

The eruption of a canine tooth into the nasal cavity constitutes one topographic form of dental ectopy. We report a case and discuss the diagnostic aspects and diverse pathogenic theories proposed. This unusual situation should be suspected in patients with nasal obstruction and unilateral fetid purulent rhinorrhea.

[Laryngeal papillomatosis: value of early diagnosis, apropos of 7 cases diagnosed at the University Hospital Center in Brazzaville, Congo]. / La papillomatose laryngee: interet d'un diagnostic precoce, a propos de 7 cas diagnostiques au CHU de Brazzaville, Congo.

Laryngeal papillomatosis is a benign tumor process that occurs most commonly in children but can also affect adults. The purpose of this report is to describe a series of 7 cases treated at the Otorhinolaryngology Department of the University Hospital Center in Brazzaville, Congo. Special focus is placed on particularities and pitfalls of management. There were 4 girls and 3 boys with a mean age of 8.4 years (range, 7 to 10 years). The mean duration between the onset of symptoms and diagnosis was 3.4 years (range, 1 to 5 years). The initial symptom was choking in 3 cases, hoarseness in 2, and combined choking and hoarseness in 2. Tracheotomy was required in 3 cases. Instrumental debulking was performed in all cases. Two patients died due to obstruction of the cannula. Outcome was favorable in the remaining 5 cases. Our experience highlights the need for early diagnosis for optimal therapeutic outcome. In this regard information campaigns are necessary to educate doctors and parents.

[Intranasal rhinosporidiosis: presentation of the 1st case seen in the Congo]. / Rhinosporidiose endonasale: présentation du premier cas observé au Congo.

Rhinosporidiosis, granulomatosis affection due to Rhinosporidium seeberi, is rare in Africa. We report the first Congolese case observed in a 37 year old adult, who presented a tumorous formation obstructing the left nasal fossa, having developed over more than 5 years, occasionally accompanied by epistaxis. Diagnosis was made through an anatomo-pathological examination of the exeresis biopsy. The treatment essentially consisted in surgical tumorous exeresis, followed by electrocoagulation of the implantation area. Evolution has been favourable with a rebound of 7 years. In order to measure the frequency of rhinosporidiosis in Africa, anatomo-pathological examination of all O.R.L. polyps must be systematic.

[Sudden deafness in sickle cell anemia: a case report]. / La surdité brutale chez le drépanocytaire: à propos d'un cas.

The non-expected deafness is quite obvious or easily diagnosed cause. The sickle cell disease is one of the aetiologies of this one. We present one case observed on a 30 years old patient. There is a close connection between the vascular factor of the non-expect deafness and the erythrocytic falciformation of sickle cell anaemia causing the obliteration of the terminal auditory internal artery and generating the ischaemia of the cochlea anoxia. The high sensitivity of the cochlea to anoxia and its great fragility require an early therapy in order to recover auditory capacity. Patients suffering from sickle cell disease should be encouraged to have a regular assessment of audition.

[Rare but dangerous foreign body of the external auditory canal: alkaline batteries]. / Corps étranger rare mais dangereux des conduits auditifs externes: les batteries alcalines.

About an observation in a 3 year-old child of the alkaline drum kits in the external acoustic lacunae, the authors underline that they are rare but dangerous. The mechanisms of toxic activity of these piles are exposed, as well as the complications that they engender and the principles of their treatment. The ablation should be carried out as quickly as possible. The excision is usually possible by natural pathways. However, attention should be paid to preventing post-operational stenosis by using gauze and administering careful local treatment.