Pectoralis major muscle flap reconstruction after a total laryngectomy widened anteriorly: A case report.

INTRODUCTION AND IMPORTANCE: The pectoralis major flap is one of the leading regional pedicled flaps for reconstructive surgery of the head and neck, particularly in oncology after tumor resection. Despite the increasing use of free flaps, this type of flap is still highly recommended in defined indications. It is a highly reliable flap in terms of viability. CASE PRESENTATION: We report the case of a man treated in our ENT department for a squamous cell carcinoma of the three laryngeal stages, anteriorly very extensive and requiring total laryngectomy extended to the skin and subcutaneous planes opposite, followed by reconstruction with a flap of the pectoralis major muscle. Post-surgical outcome was excellent. CLINICAL DISCUSSION: Aryan was the first person to describe the use of the pectoralis major muscle flap. Since then, several studies have demonstrated the great value of this flap in face and neck reconstruction, thanks to its wide indications and excellent viability rate. CONCLUSION: The pectoralis major muscle flap represents a valuable reconstructive option for substance loss in the cervicofacial region despite the great development of microsurgery and free flaps.

Diagnosis of an atypical presentation of basal cell carcinoma of the nasal pyramid: Case report.

INTRODUCTION AND IMPORTANCE: Basal cell carcinoma is a common form of skin cancer whose global incidence is rising rapidly, with over 70 % of locations on the face. In contrast to their low mortality, their morbidity is high. Extensive basal cell carcinomas and infiltrative lesions are associated with a high recurrence rate, which can result a serious esthetic and functional damage. CASE PRESENTATION: We report the case of a 65-year-old female patient, who consulted our ENT department for a large ulcerating lesion of the nasal pyramid. CT scan revealed a lesion of the nasal pyramid measuring 38 mm in long axis, which appeared to come into contact with the anterior part of the nasal septum. The pathological findings were consistent with an infiltrating basal cell carcinoma. The patient underwent surgical resection with reconstruction using a forehead flap. CLINICAL DISCUSSION: Following ANAES guidelines, when the diagnosis of a poor-prognosis BCC is uncertain, or when major reconstruction is required at the time of surgery, biopsy is strongly recommended to confirm the diagnosis. The evolution of BCCs is essentially local, and they rarely metastasize, with a maximum incidence rate of 0.55 %, of which around 85 % appears on the face. Thus, local extension of BCCs mainly involves adjacent tissues, including the perichondrium, in which case imaging is necessary to assess the extent of damage. The most common and effective treatment is surgical excision, with a margin of healthy tissue around the tumor. CONCLUSION: Because early diagnosis and carcinological excision are the keys to a good prognosis. We must insist on the role of primary and secondary prevention, and on the importance of early diagnosis.

Management of a rare case of parapharyngeal lipoma presentation of case.

INTRODUCTION AND IMPORTANCE: Parapharyngeal masses are rare but critical because of their deep location and their important anatomical relationships with the surrounding structures. Their management poses a challenge in terms of etiological diagnosis and adequate therapeutic approach. The clinical and especially the radiological examination have an important role not only for the diagnosis but also for the determination of the appropriate management and for the orientation towards the nature of the mass. CASE PRESENTATION: We present the case of a 44-year-old man with a parapharyngeal lipoma that caused mainly obstructive sleep apnea syndrome. Once in our structure after a radiological examination (MRI and CT scan), a decision for surgical management was made. Surgery consisted on a combined cervical and endobuccal approach. The follow-up showed an effective result with the total resolution of the discomfort caused by the mass, which improved the patient's quality of life. CLINICAL DISCUSSION: Tumors in this space represent less than 1 % of all head and neck tumors and are usually benign. Symptoms leading the patient to consult a doctor only appear after a significant volume of the mass, which makes the severity of this pathology. Imaging, namely CT and MRI, should be requested systematically in case of suspicion of any parapharyngeal mass. Several surgical approaches are described in the literature, the choice between them depends on the nature of the mass, its location and especially its extension, hence the interest of preoperative imaging. CONCLUSION: The main take-away lessons are the great value of imaging in the diagnosis and treatment of parapharyngeal space masses, the relationships of this region and its content make the surgery very delicate, so it's so important to choose the appropriate surgical approach.

The outcomes of congenital torticollis delayed surgery in older children: A case series.

INTRODUCTION AND IMPORTANCE: Congenital muscular torticollis is a benign affection defined as a contracture or fibrosis of the sternocleidomastoid muscle, causing ipsilateral inclination and contralateral rotation of the face and chin. The management is multidisciplinary, usually surgical and should start at very early age in infants to secure better results. Thus, the purpose of our study is to report the outcomes of delayed surgery performed in older children above 5 years old with late diagnosis. CASE PRESENTATION: We report the cases of 4 patients aged between 5 and 11 years old and followed in our department for congenital torticollis. They were all born by vaginal delivery with vacuum extraction in two cases of breech presentation. Even if the condition is present at birth, most parents were not bothered by the cervical vicious neck position of their children until a later age, delaying the diagnosis. The clinical examination found a flexed head position on the right side in all cases, with contralateral rotation. Regarding the age, we proposed surgical treatment immediately for two of them, while two were sent to our department after multiple ineffective physiotherapy sessions. The surgery consisted on right distal tenotomy and a cervical collar was prescribed next to physiotherapy. They all had successful results with correction of head position and improvement of cervical range motion. CLINICAL DISCUSSION: Children treated early with active and well monitored rehabilitation, recover completely and regain normal head position and mobility rapidly. In older children, above 5 years, they are more likely to develop sequels such as asymmetry of facial movement. CONCLUSION: Delayed diagnosis after the age of 5 years old still can be managed successfully with a correction of the head position and rotation motion. However, in these older children, physiotherapy alone cannot be effective and should be associated to surgery. Moreover, once the diagnosis is done, surgical treatment should be performed to avoid wasting more time.