Extracranial head and neck neurogenic tumors: report of 47 cases.

UNLABELLED: Extracranial head and neck neurogenic tumors are rare and usually revealed by histological examination. The aim of this study was to review the clinical, radiological and therapeutic particularities of these tumors. METHODS: This retrospective study concerns 47 patients with neurogenic tumors of the head and neck, operated on between 1989 and 2011 (22 years period). All patients had complete physical examination and ultrasonography was performed when a cervical extension was found. CT scan and MRI were performed in 16 cases. Minimum follow up was 4 years. RESULTS:   A sinusonasal tumor was found in 9 cases and a cervical mass was seen in 28 cases. Parapharyngeal extension was observed in two cases. Two patients had tympano-jugular glomic tumors and 8 of them had a cervical soft tissue tumor. Complete surgical resection was performed in 46 patients. Histological examination revealed a benign tumor in 91% of cases (n=43), 24 of them were schwannomas. Malignant tumors were seen in 4 cases: esthesioneuroblastoma (3 cases) and malignant schwannoma (1 case). These patients received post operative radiotherapy. After surgery, two patients had Claude Bernard Horner syndrome and one had a definitive facial nerve palsy. CONCLUSION: Extracranial head and neck neurogenic tumors may have several aspects depending on their localisation and their histological type. Surgery, when performed, should be complete with minimum complications.

Pleomorphic adenoma of the parotid gland concomitant with tuberculosis infection: A case report and review of the literature.

Tuberculosis of the salivary glands and particularly of the parotid gland is a localization that remains rare even in endemic countries. The association of intra parotid tuberculosis with a benign tumor has been found only in rare cases in literature. A 50-year-old woman with a history of normal pressure hydrocephalus treated surgically, non-smoker, presented with a right parotid swelling progressively increasing in size for 3 years. Clinical examination revealed a 4 cm long, firm, mobile, painless parotid swelling without inflammatory signs and without accessory lymphadenopathy. The oropharyngeal examination was without abnormalities. Ultrasound showed a mass of 31 × 27 mm suggesting a pleomorphic adenoma. MRI confirmed the suspicion of a pleomorphic adenoma of both lobes. The patient underwent a conservative total parotidectomy. The extemporaneous examination was in favor of a pleomorphic adenoma while the final pathology showed the coexistence of active tuberculosis lesions. The patient was put on long-term antituberculosis treatment with good clinical evolution. The clinical presentation of parotid tuberculosis is nonspecific mimicking any other tumor and the diagnosis can only be made by histological examination. Therapeutic management is based on long-term antituberculosis treatment.

Respiratory epithelial adenomatoid hamartoma: A rare differential diagnosis of sinonasal mass.

Sino-nasal respiratory epithelial adenomatoid hamartomas (REAHs) are rare entity. They are benign tumors with excellent results after complete excision. We report a case of a 57-year-old male with a history of endoscopic surgery for right nasal polyps 20 years ago. The patient presented nasal obstruction that persisted for 10 years without anosmia nor epistaxis. Nasal endoscopy found a tissular mass filling the right nasal cavity extending to the nasopharynx. CT scan and MRI demonstrated soft tissue opacification of the right maxillary sinus and the homolateral anterior ethmoid cells with extension to the nasal cavity. The suspected diagnosis on imaging was an Inverted papilloma with a wide implantation base on the posterior part of the nasal septum. No endocranial or orbital extension was noted. The patient underwent endoscopic sinus surgery with complete extirpation of the tumor and a right ethmoidectomy. Histopathological assessment showed features consistent with REAH. No recurrence was noted at 1 year follow-up.

Laryngotracheal trauma-induced Macklin effect: A case report.

Laryngotracheal trauma is a relatively rare traumatic injury seen particularly in young male adults. Trauma due to strangulation is one of its most frequent circumstances. However rare, pneumomediastinum is a particular complication of severe blunt neck injuries leading to alveolar ruptures. This phenomenon, described as the Macklin effect, requires early diagnosis, and its management varies from conservative to surgical treatment depending on the severity of symptoms. Our aim is to describe the case of a 21-year-old male who presented with blunt neck trauma. Clinical and imaging findings revealed subcutaneous neck emphysema and pneumomediastinum. Treatment was conservative leading to complete resolution of the injuries and the patient was discharged after 2 weeks.

Necrotizing otitis externa: 19 cases' report.

Necrotizing otitis externa is an uncommon but severe infectious disease of the external auditory canal. Patients at risk are those immunodepressed or having diabetes. The causal germ is often Pseudomonas aeruginosa. Over a period of 10 years (1997-2006), we treated 19 patients: 94.7% had diabetes (insulin dependent in 6 cases). The causal germ was P. aeruginosa in 59% of cases. The pretherapeutic work-up included a computed tomography and a scintigraphy practiced in order to confirm diagnosis and assess the extension. Medical treatment was based on a parenteral antibiotic therapy using a third-generation cephalosporin and a fluoroquinolones. Local treatment of the auditory canal including cleaning and application of antimicrobial agents was performed in all the cases. Surgical debridement of soft tissue and infected bone was performed in one patient who did not respond to medical management. Repeated scintigraphies with gallium were used to follow the course under treatment in only three cases. We had a 89.4% cure rate with only three cases of recurrence. We reviewed the data in the literature on necrotizing otitis externa and present the important diagnostic, imaging, and therapeutic aspects of the disease.

[Recurrent upper respiratory tract infections in children and allergy. A cross-sectional study of 100 cases]. / Infections recidivantes des voies aeriennes superieures de l'enfant et allergie. Etude transversale à propos de 100 cas.

BACKGROUND: Upper respiratory tract (URT) infections are common in children. The knowledge of their risk factors allows in some cases better management. The aim of our study is to evaluate the role of allergy in this pathology. METHODS: Through a cross-sectional study about 100 children having recurrent URT infections, we evaluated the prevalence of allergy in order to find a relation between the two pathologies in general, and between allergy and each recurrent pathology. The results were compared with those of a reference group involving 164 children. RESULTS: Our study confirms a statistically significant association between allergy and recurrent URT infections (p=0.01), also between allergy and rhinopharyngitis (p=0.02), rhinosinusitis (p=0.001) and acute otitis media (p=0.01). CONCLUSION: Allergy represents a risk factor for recurrent URT infections, particularly for rhinopharyngitis, rhinosinusitis and acute otitis media. Adequate management of allergy may consequently be beneficial for the treatment and the prevention of these infections.

[The laryngopyocele]. / La pyolaryngocele.

BACKGROUND: The laryngopyocele is a laryngocele complication. AIM: We report two cases that were treated in Habib Thameur Hospital ENT service. CASES: There were an 81 old woman and a 31 old man who consult for an infectious syndrome with a lateral neck masses. The diagnosis was obtained by clinical and endoscopic examination and was confirmed by CT. The man was operated. On antibiotics were precribed for both. They had a well recovery.

[Chronic laryngitis in adults]. / Les laryngites chroniques de l'adulte.

BACKGROUND: Chronic laryngitis is a lingering inflammation of the laryngeal mucosa, caused by specific aetiology and often irritative factors. AIM: To discuss clinic and therapeutic aspects of the pathology. METHODS: We report a retrospective stuy about 25 patients treated and followed for non specific chronic laryngitis over a period of 11 years (1994-2004). RESULTS: The average age of the patients was 54.2 years. Tobacco intoxication was noted in 72.7 of cases and Gastroesophageal reflux in 2 cases. The endoscopic examination of laryngeal lesions, realised in all cases, notes laryngeal keratosis in 88% of cases and congestive laryngitis in 12%. Histological analysis of the lesions reveals a dysplasia in 44% of cases. Clinical and endoscopic follow up of the patients discover malignant development in 5 patients. CONCLUSION: The treatment of chronic laryngitis is based on the suppression of etiologic factors and on laryngeal microsurgery with micro instruments and with laser techniques.

[Plummer Vinson syndrome]. / Syndrome de Plummer Vinson.

BACKGROUND: Plummer Vinson syndrome is a rare affection which affects mainly white women. It is characterized by dysphagia, iron deficiency and the presence of superior esophageal web. AIM: The purpose of this study is to precise the epidemiological, clinical, paraclinical and therapeutical features of the affection. METHODS: We report 19 cases of Plummer Vinson syndrome collected over 15 years (1990- 2004). RESULTS: Dysphagia is the main symptom observed in 100% of the cases. 89.4% of the patients had anemia and 15 hyposideremy. All the patients were treated with iron supplementation and endoscopic treatment (dilatation and rupture of esophageal webs). Three patients necessitate multiple sessions of endoscopic dilatation and 15 had favourable evolution. The malignancy was observed in one case.

[Idiopathic sudden sensorineural hearing loss. What's the appropriate management?]. / La surdite brusque. Quelle prise en charge therapeutique?

BACKGROUND: Sudden sensorineural hearing loss remains a challenge in otology. Controverses affect mainly etiopathogeny and treatment. AIM: To evaluate our experience in the diagnosis and the treatment of sudden hearing loss METHODS: We report a retrospective study, including 30 patients presenting a Sudden sensorineural hearing loss. All patients were hospitalized for treatment. The audiometry evaluated the hearing deafness before and after treatment. RESULTS: The average age was of 48 years. In all the cases no etiology has been found. All The patients were hospitalized and corticotherapy was administrated in all cases. It was associated to hyperbare oxygenotherapy in 7 patients. Recovery was observed mainly in patients with moderate (71.4%) and severe hearing deficiency (69.2%). CONCLUSION: Corticosteroids are the less controversed treatment of sudden sensorineural hearing loss.

[Naso-sinusienne sarcoidosis]. / La sarcoïdose naso-sinusienne.

BACKGROUND: Sarcoidosis is an ubiquity disease, which can infiltrate all tissues. The cutaneous and ophthalmologic thoracic localizations are most frequent. The nasosinusienne localisation is rare. AIM: The authors report their observations of 4 patients: 2 men and 2 women with a mean age 47.5 years (42-56). Theses cases was diagnosed and treated between january 1998 and December 2003 in the ENT service of the Habib Thameur hospital. CASES: The diagnosis was related to a nasal or a sinuses biopsy. The assessment of extension was negative in 3 cases. The corticoid treatment in local pulverization was sufficient in 2 cases. The corticoid treatment by systematic way was necessary among 2 patients. Favourable out look was obtained in all the cases. The naso sinusienne localization is rare, it is exceptionally isolated. The clinical and radiological symptoms are not specifics. Principal element of the diagnosis is the directed biopsy, easy in this localization.

[Cervico-facial lymphangiomas. What's the appropriate management?]. / Les lymphangiomes kystiques cervicofaciaux. Quelle prise en charge thérapeutique?

BACKGROUND: Cystic hygroma is a benign and uncommon vascular tumor. Therapeutic difficulties are variables and are discussed with regard to different clinical forms. The curative treatment is surgical. AIM: The purpose of this study is to discuss the management of the vascular malformation. PATIENTS AND METHODS: We present a retrospective study over a period of 11 years (1995- 2005); about 12 patients treated and followed in ENT department of Habib Thameur Hospital of Tunis. RESULTS: The average age of the patients was 29 years and the average size of the tumor was 7 cm in diameter. A voluminous cervical mass was noted in 3 cases. Local inflammation with respiratory restriction were observed in one patient. Surgical treatment was performed in 8 cases without recurrences. Injection of sclerosing agent (Ethibloc) was indicated in 4 cases because of the volume of the tumor. The following was marked by reduction of the tumor volume. Surgical excision was completed in one case. CONCLUSION: The management of lymphangioma is challenging. Surgical excision is the best treatment in limited forms. The prognosis of voluminous lymphangiomas is transformed by sclerosing injections.

Management of foreign bodies in the aerodigestive tract.

Foreign body (FB) aspiration and ingestion are frequently encountered by emergent otolaryngology services. The authors describe their experience in the management of FB cases in the aerodigestive tract. We carry a retrospective study about 626 patients who came or were referred to our department between 1996 and 2007 with a history or suspicion of a FB in the aerodigestive tract (except nasal and oropharyngeal FB). All of them have undergone rigid endoscopy under general anaesthesia. Children younger than 10 years were the most involved (36.9%) followed by patients between 71 and 80 years old (11.3%). The FB were visible on clinical examination in 39 cases. Chest and neck X-ray, showed radio-opaque FB in 302 cases (48.7%). A total of 626 rigid endoscopies were performed. FB were encountered in 549 patients (87.7%). The most involved sites were the oesophagus (51.9%) followed by the tracheobronchial tree (33.9%) and the hypopharynx (13.5%). Bones (22%) and coins (20.1%) were the most frequently encountered FB. Successful removal was achieved in 521 cases (94.9% of the FB found). The complication rate after rigid endoscopy was 1.3%. FB in the aerodigestive tract are frequent and may lead to severe complications. Removal through the rigid endoscope still has its place as the most reliable method. Prevention and public education for this serious problem should be considered.

[Sinonasal inverted papilloma: 43 cases]. / Le papillome inversé nasosinusien : 43 cas.

PURPOSE: Inverted papilloma (IP) is a common epithelial tumor arising from the nasal vault. The aim of our study was to evaluate the advantages, the results and the limits in the treatment of this tumor. PATIENTS AND METHOD: Retrospective study of 43 patients over the period 1989-2009. RESULTS: The mean age was 53.3 years. We found a maxillary sinus extension in 40 cases and ethmoidal extension in 27 cases. Twenty-nine patients were treated through an endoscopic endonasal approach. A vestibular approach was used in three patients. A paralateral nasal approach was used for 12 cases. We observed a recurrence in 9.3% of the all cases. CONCLUSION: The treatment of IP is surgical. Their high potential of local aggressiveness, fear of recurrence and the possibility of the occurrence of a malignancy require radical treatment.