Left parapharyngeal ectopic goitre associated with eutopic thyroid and postoperative Horner's syndrome.

INTRODUCTION: The authors report a case of left parapharyngeal ectopic goitre, in which resection was followed by postoperative Horner's syndrome, and describe the difficult management of this entity. CASE REPORT: A 25-year-old woman presented with upper oesophageal dysphagia and a well-demarcated left parapharyngeal mass displacing the great vessels laterally and posteriorly. The mass was resected via an exploratory neck incision. Histological examination of the operative specimen revealed hyperplastic thyroid parenchyma. The postoperative work-up revealed a eutopic and euthyroid thyroid gland. The postoperative course was marked by Horner's syndrome that persisted at 1-year follow-up. DISCUSSION: Parapharyngeal ectopic thyroid coexisting with a functional thyroid is extremely rare. Parapharyngeal masses are usually derived from the parotid gland and nerves. Surgery of the parapharyngeal space can cause injury to the sympathetic trunk, responsible for Horner's syndrome, as in our patient. CONCLUSION: Ectopic thyroid should be considered as a possible diagnosis of a parapharyngeal mass. Although rare, Horner's syndrome is a dreaded complication of surgery of the parapharyngeal space.

Improvised Vacuum-Assisted Closure for severe neck infection in poorly equipped conditions.

INTRODUCTION: Dental infections are common and are mainly due to dental caries. When left untreated, these infections can lead to severe life-threatening sepsis. CASE REPORT: The authors reported a case of a severe odontogenic deep neck space infection in a 54-year-old male. The patient was a heavy smoker with incidentally discovered diabetes. He was successfully treated by surgical drainage combined with an improvised Vacuum-Assisted Closure (VAC) system. The results of surgical drainage followed by insertion of an improvised VAC system were spectacular. The abscess resolved in response to dual-agent antibiotic therapy on day 17 and blood glucose control was achieved with insulin. Full-thickness skin graft was performed to repair the necrotic zone of the neck. DISCUSSION: The use of VAC can be a valuable alternative to conventional dressings and hyperbaric oxygen therapy in poorly equipped conditions. Public awareness campaigns remain the most effective form of prevention against these odontogenic infections.

[Thyroid oncology in ORL practice. Apropos of 87 cases]. / Oncologie thyroidienne en pratique ORL. A propos de 87 cas.

The authors report a high thyroid cancer incidence. The thyroidite and the patient age explain it. The thyroidectomy is not subordonated by an extemporane histologic examination.

[Bilateral choanal atresia in the newborn. Recommended management apropos of 1 case observed in Lomé, Togo]. / Atrésie choanale bilatérale du nouveau-né. Conduite préconisée à propos d'un cas observé à Lomé, Togo.

The bilateral choanal atresia is a neonatal emergency. Its diagnosis is easily evoked when faced with a respiratory distress and cyanosis. It is quickly confirmed by a nasal optic endoscopy or when a nasopharyngeal aspiration catheter is held up by an obstacle. Putting a pharyngeal Mayo's cannula is an urgent gesture. The treatment uses transnasal perforation of the septum followed for two months with frequent aspirations.

[Tracheotomy: review of five years at the University Hospital of Lome, Togo]. / Trachéotomie: bilan de cinq ans au Centre Hospitalier Universitaire de Lomé, Togo.

From a review of 37 cases, this retrospective study relates the activity of the Otorhinolaryngology service at the University Hospital Center of Lomé, as regards tracheostomy. It details: - a high rate of urgent tracheostomy (76%) for laryngeal carcinoma and papillomatosis; - a high rate of complication (29%) and death (5%). This is due to the urgency of tracheostomies, unsuitable cannulae, irregular nursing and prolonged cannula carrying. A better technique and rigorous supervision could reduce these complications.

[Sinus mucoceles. Apropos of 5 cases]. / Mucocèles sinusiennes. A propos de 5 observations.

Our retrospective study of 5 cases of sinus mucocele confirmed its rarity and occurrence at any age. This uncommon disease might be due to an association of inflammation, ostium closure and hypersecretion. The volume of the fronto-ethmoidal mucocele let us operate on patients either by orbito-superciliary route or through the frontal scalp. Functional endoscopic surgery, presently suggested for mucocele treatment, was not used because of our lack of experience in this surgical method.

[Relapsing polychondritis. Apropos of a case]. / Polychondrite chronique atrophiante. A propos d'une observation.

The relapsing polychondritis is a rare autoimmune disease. The pathologist finds a fibrous degeneration of the cartilage of the body. A case relapsing polychondritis is presented and the disorders of the disease are reviewed. The larynx and trachea location is a fact of a poor prognosis.

[Choanal atresia: an abnormality not to be overlooked. Study of three cases in the University Hospital Center of Lome, Togo]. / Atrésie choanale: une malformation à ne pas méconnaitre. Etude de trois cas au Centre Hospitalier Universitaire de Lome, Togo.

Choanal atresia is an uncommon congenital malformation which the midwife or obstetrician must recognize at birth. In this report the authors describe three cases observed at the University Hospital Center of Lome, Togo, in which diagnosis was made late, i.e. at the ages of 7 days, 13 days and 8 months. Atresia identified by rhinoscopy was bilateral in one case and unilateral in two cases. All three cases were treated by transnasal divulsion, using a rubber catheter in 2 cases and a curette in one case, followed by calibration with a Portex catheter that was removed after two months. At 6 months after treatment, all three children presented normal nasal ventilation. Since it can be easily diagnosed and treated, choanal atresia is curable and better training is needed to ensure detection at birth.

[Foreign bodies of the esophagus: etiologic and therapeutic aspects. Experience at the CHU of Lomé (Togo)]. / Corps étrangers oesophagiens: aperçu étiologique et thérapeutique. Expérience du CHU de Lomé (Togo).

AIM: To give details of the management of esophageal foreign bodies (EFB) at our hospital. DESIGN: Retrospective case review. SETTING: ENT ward of Tokoin Teaching Hospital, Lome, Togo. PATIENTS: All 105 patients admitted to the hospital for ingestion of foreign bodies between January 1990 and December 1993. The outcome for each patient was determined by examining hospital records of demographic information, identification of the foreign body and the removal procedure used. RESULTS: EFBs accounted for 6.5% of all hospital admissions. The objects ingested included coins (59.0% of cases), particularly in 2 to 5 year-old children, fish bones (12.4%), meatballs, meat bones and dentures, particularly in adults. The foreign objects were mostly removed by esophagoscopy, but sharp objects required esophagotomy (2.9%). One patient died (0.9% of cases) due to mediastinitis caused by perforation of the esophagus by a chicken bone. CONCLUSION: Community health education programs, increasing awareness of household accidents might reduce the number of emergency hospital admissions for ingestion of foreign bodies.

[Cervico-facial cellulitis of oral and dental origin: study of 26 cases at the Lomé University Hospital]. / Cellulites cervico-faciales d'origine bucco-dentaire: étude de 26 cas au CHU de Lomé.

The authors report 26 cases of cervico-facial cellulitis of mouth and dental origin. They highlight the severity of those affections. The original entry is dental caries in 88.4% of cases. Adequate treatment consisting of a surgical drainage, a suppression of the original entry and antibiotherapy combining a penicillin, an aminoglycosid and metronidazol. Preventive therapeutic measures are prescribed.

[Our experience of carcinoma of the larynx in Togo]. / Notre expérience du cancer du larynx au Togo.

This is a retrospective study of 33 patients with squamous cell carcinoma of the larynx from the end ward at Tokoin Teaching Hospital in Lomé. This series is from 1981 and 1995 (1 T1, 6 T2, 15 T3, 11 T4). This is an uncommon cancer. No etiological factors were identified. The high proportion requiring emergency tracheotomy (36.36%) and of T3-T4 cases (78.78%) are explained by the long delay before the first medical visit. Only 13 patients (36.36%) had a total laryngectomy. The prognosis was unfavourable.

[Laryngeal papillomatosis in children: therapeutic problems apropos of 39 cases at the Lomé University Hospital Center]. / Papillomatose laryngée de l'enfant: problèmes thérapeutiques à propos de 39 cas au CHU de Lomé.

The retrospective study about 39 cases of laryngeal papillomatosis emphasizes the management difficulties due to slenderness of therapeutical resources, delayed consultations because of health under education of the community and patients' discouragement during treatment of such a relapsing disease. Consequently, tracheostomy was needed immediately (25.64%), breaking of the voice (48.72%) was noted as well as school backwardness. The use of laser and interferon in laryngeal papillomatosis treatment is for the future in Togo.

[Tumours of the accessory salivary glands. Epidemiological and anatomopathological aspects]. / Tumeurs des glandes salivaires accessoires. Aspects epidémiologiques et anatomopathologiques.

INTRODUCTION: Several series of studies on the tumours of the accessory salivary glands have shed light on their anatomopathological and epidemiological aspects in Western countries. Only a few studies of this kind have been carried out in our countries. OBJECTIVES: To study the anatomopathological and epidemiological aspects of the accessory salivary glands in order to compare the literature data. METHODOLOGY: This is an analytic, descriptive and retrospective study conducted over a period of 10 years at the ENT and the Anatomo-pathology Departments of the CHU in Lomé. RESULTS: Tumours of the salivary glands represented in our study 17.19% of the ORL tumours. Tumours of the accessory salivary glands represented 71.43% of tumours of the salivary glands. Benign tumours represented 71.43% and malignant tumours 21.43%. Women were more affected than men. The average age of appearance of benign tumours was 47.87 years for men and 31.91 year for women. The average age of appearance of malignant tumours was 38 years far the women. The commonest site was the palate. The majority of benign tumours were pleomorphic adenomas. Adenoid cystic carcinoma was the principal malignant tumor. CONCLUSION: Pleomorphic adenoma and adenoid cystic carcinoma were the principal tumours of the accessory salivary glands. The commonest site was the palate. Women were more affected than men. The average age of appearance of malignant tumours was seven years later than benign tumours. (full article translated in English available on www.ent-review.com).

[Malignant non-Hodgkin's lymphoma of the lip: a case report]. / Lymphome malin non-hodgkinien de la lèvre: à propos d'un cas.

The non Hodgkin's lymphoma of the lip is rare. A 3-year-old child with non-Hodgkin's lymphoma of the upper lip (stage I in the Ann Harbor system) was reported. An immunodeficiency, been in correspondence with a food deficiency, was probably a causal factor. A post-chemotherapy residual lesion justified a surgery.

[Factors related to pathologies in the early neonatal period at the University Hospital Center of Lome (Togo)]. / Facteurs lies aux pathologies en periode neonatale precoce au CHU-Tokoin de Lome (Togo).

PIP: Early neonatal mortality is responsible for almost 75% of overall neonatal mortality in West Africa. In a prospective study of 3174 live births, the authors examined the pathologies diagnosed in newborns aged 0-7 days admitted to the Neonatology Unit of Tokoin Hospital in Lome, explored the factors associated with these pathologies, and studied their hospital evolution. The study was conducted over a 6-month period from early February to the end of July 1996. 250 subjects were included in the study. Infection (36.4%), cerebral disturbance (19.6%), prematurity (16.4%), respiratory difficulties (7.6%), and hemorrhagic disease (4.8%) were the main pathologies observed during the early neonatal period, affecting 84.8% of all subjects. The overall death rate was 52.8%, of which 64.4% died during the first 48 hours of hospitalization. Neonatal and maternal factors associated with these pathologies are discussed. The main factors linked to these pathologies during the early neonatal period are the condition of young primiparous women, the low socioeconomic level of the mothers, poor pregnancy management, and the poor perinatal environment.^ieng

[Intracranial and cranial complications of paranasal sinusitis. Report of 4 cases at the Lomé University Hospital Center]. / Complications craniennes et endocraniennes des sinusites para-nasales. Observations de 4 cas au CHU de Lomé.

The complications of paranasal sinusitis are rare (only 4 cases have been observed during 5 years). The acute frontal sinusitis is the most frequent cause. The diagnosis of the frontal osteitis and the extradural abscess is made during the course of the surgical intervention. An antibiotherapy combining an ampicillin and a gentamicin is used. The treatment of the complication and the causative sinusitis is a guarantee of recovery.

[Choanal atresia. An unrecognized malformation. Report of 3 cases at the Lomé University Hospital Center]. / Atrésie choanale. Une malformation à ne pas méconnaître. Etude de 3 cas au Centre Hospitalier Universitaire de Lomé.

The choanal atresia is a rare congenital malformation. Its clinical diagnosis is easy and must be done at the birth by the midwife or the obstetrician. We recommend the aspiration in all hospital maternity wards. This attitude avoids the unrecognized of an unilateral choanal atresia. The authors report three cases with a successfully treatment.

[Our experience with the education of deaf-mute children in Senegal: the Integrated Medico-psycho-Pedagogical Day School (EMPPI) of Dakar]. / Notre expérience en éducation des enfants sourds-muets au Sénégal: l'Externat Médico-psycho-pédagogique intégré (EMPPI) de Dakar.

The authors document a public education establishment for deaf-and-dumb children which uses the verbo-tonal method of Yugoslav Professor PETAR GUBERINA. They describe the educational activities, and draw a positive and encouraging picture of results obtained from its 8 years of operation, in spite of many difficulties.

[Partial laryngectomies at the University Hospital Center of Dakar]. / Laryngectomies partielles au Centre Hospitalier Universitaire de Dakar.

Our experience on partial laryngectomies stretched on a period of 16 years. In an unfavorable medical environment, we issue our indicative criteria throughout this experience. From January 1st 1981 to December, 31st 1996, 14 patients have had a partial laryngectomy in University Hospital Center of Dakar. The average year was 56 and the sex-ratio was 1 woman out of 13 men. There were 13 carcinomas and 1 cas of acute dysplasia. 4 patients have had vertical partial laryngectomy, 5 have had a horizontal partial laryngectomy and 5 a partial laryngectomy on the upper out of the cricoid cartilage with the ganglia. After a 3 years close look, on 10 patients, we noted that 1 died, 1 disappeared, and 8 still were living. Carcinological failures consisted in 3 development by stages and 1 cas of a 2nd localisation. As for as functional results, the removal of the nozzle and the elimination of the nasogastric grohe of supply, were effective for respective average allotted time of 11 and 12 days. This laryngeal partial surgery seem scarce in our practice (12% of the patient who have had it). The improvement of results go to the choice of indications, the information the formation and the acquisition of technical stools more efficient.

[Cancers of the larynx: what therapeutic strategy to use in Senegal?]. / Cancers du larynx: quelle stratégie thérapeutique au Sénégal?

The technical method's deficiency limits the respect of therapeutic principles of cervico-facial oncology in our practice. In a period of 16 years, 116 patients, aged of 24 to 81 years, sex male in a majority have had laryngectomy for extended cancer. In 88% of cases total laryngectomy has been realized and in 12% of cases a partial laryngectomy has been realized. In 101 patients, 87%, a neck dissection have been associated to the laryngectomy. The post operative radiotherapy have been realized in 51 patients. The immediate results are marked by the unexpected arrival of pharyngeal fistula in 34 patients. 7 cases of death have been noticed. The global survival have been 35% in 3 years and 30% in 5 years. The fatal cases have been loco-regional cases and occur during the 18 first months. The surgery option, which is our choice, must be maintained and the neck dissection more vigorous.