[Contribution of the musculocutaneous flap of pectoralis major in head and neck oncology: 26 observations in Senegal]. / Apport du lambeau musculo-cutané du pectoralis major en carcinologie cervico-faciale: 26 observations au Sénégal.

INTRODUCTION: The pectoralis major musculocutaneous flap constitutes a significant advance in cervicofacial carcinology. At our institution, it has allowed most surgical problems to be resolved in a single-stage procedure. The objective of this study was to report our experience with this flap. PATIENTS AND METHODS: This retrospective study includes 26 cases observed over a 10-year period (January 1994-December 2003). The parameters studied were clinical and paraclinical. All patients included in this study received a pectoralis major musculocutaneous flap. Patients treated using another type of flap were not included. RESULTS: Mean patient age was 51 years (range, 20 to 74). The sex ratio was 12 (24 men and 2 women). At the time of admission, 73% of patients showed marked impairment of general condition. In 21 patients (81%), the effect of the pectoralis major musculocutaneous flap was observed immediately after surgery unlike pharyngostome (19%) in which the flap is used in a second stage procedure. With a mean follow-up of 7 years, failure has been observed in 4 cases (15%). CONCLUSION: The pectoralis major musculocutaneous flap is an excellent tool for cervicofacial reconstruction after carcinological exeresis. It reduces the duration of hospitalization. Acquiring proper flap harvesting technique is an important factor in improving outcome.

[Solitary neurofibroma of the maxillary sinus]. / Neurofibrome isolé du sinus maxillaire.

OBJECTIVE: To illustrate the rarity and difficulty diagnosing maxillary sinus neurofibroma through a case report. PATIENTS AND METHODS: A 35-year-old female consulted our department for left cheek swelling evolving over 6 months, upper gum swelling, and a dental occlusion disorder. RESULTS: A computed tomography scan showed a tumor of the left maxillary sinus with bone destruction. Histological examination of a biopsy fragment found an in situ carcinoma. A maxillary resection was performed to excise the tumor. Histological examination of the specimen showed a neurofibroma. No sign of recurrence was noted after 8 months of follow-up. CONCLUSION: The difficulty diagnosing maxillary sinus neurofibroma is related to its nonspecific clinical and radiological signs. Consequently, the otorhinolaryngologist must keep this rare histological variety in mind within the range of tumors of the paranasal sinuses.

Laryngeal papillomatosis in Senegal: A ten-year experience.

OBJECTIVES: The objectives of this study were to describe the epidemiological, clinical and therapeutic characteristics of laryngeal papillomatosis in the Fann teaching hospital ENT department in Dakar, Senegal. PATIENTS AND METHODS: We retrospectively reviewed all cases of laryngeal papillomatosis managed in the Fann teaching hospital ENT department between 1st January 2006 and 31st December 2015. Epidemiological, clinical and therapeutic characteristics of laryngeal papillomatosis were studied. Statistical analysis was performed with SPSS 18 software. RESULTS: The median age at diagnosis was 11 years and the sex ratio was 1.88. The mean time to consultation was 4.5 years. The predominant symptom was dysphonia, present in all cases, followed by laryngeal dyspnoea in 64.6% of cases. The glottic area was involved in all patients. Tracheostomy was performed in 20.8% of cases. All patients in our study underwent endoscopic excision of the lesions. CONCLUSION: Laryngeal papillomatosis is the most common benign tumor in children, but it can also occur in adults. Treatment has been revolutionized by progress in endoscopy and antiviral therapy. However, tracheostomy still occupies an important place in our practice.

[The neurotologic evaluation of vestibular schwannomas. Results of audiological and vestibular testing in 100 consecutive cases]. / L' evaluation neurotologique audio-vestibulaire des schwannomes vestibulaires. A propos de 100 cas.

OBJECTIVES: To determine the results and sensitivity of a comprehensive audiological and vestibular work-up in patients presenting with vestibular schwannoma (VS). MATERIAL AND METHODS: One hundred consecutive cases of VS diagnosed from January 2004 to May 2005 were prospectively studied. The tumour size was classified according to Koos classification and hearing was assessed according to the five-stage classification from the Tokyo consensus. A comprehensive work-up was conducted in all patients, including pure tone and speech audiometry, Brainstem Evoked Audiologic Potentials (BEAP) assessment, Vestibular Evoked Myogenic Potentials (VEMP) examination and bithermal caloric testing using videonystagmography, on both sides. BEAP responses were considered as normal or endocochlear when interwave intervals were normal, absent because of poor hearing or retrocochlear when wave 1 to 5 interval > 4.3 ms and/or when this interval was greater than > 0.25 ms between sides, or when no response was recorded when hearing was preserved. VEMP were considered as normal absent or diminished (amplitude < 50%, as compared with contralateral). Caloric responses were considered normal, reduced (reduced by > or = 30%) absent (reduced by > 80%). RESULTS: Fifty-six women and 44 men were examined (mean age 57.8 years). Left and right side were equally affected. Vertigo, tinnitus and hearing loss were the main presenting symptom in 21%, 32% and 68% of the cases, respectively. Eighty-two per cent were operated, 17% simply monitored and 1% irradiated. The tumours were Stage 1, 2, 3 and 4 in 14%, 28%, 21% and 37%, respectively. Hearing was class A in 9%, Class B in 34%, Class C in 14% and Class E-D in 43% of the cases. Globally, BEAP showed a retrocochlear pattern in 64% of the cases and no response in 30%. Abnormal responses of VEMP were observed in 94% of the cases. Caloric testing was abnormal in 61% and normal in 11%. Responses could not be analyzed in 28% of patients. Only one patient showed normal responses to the whole work-up (99% sensitivity). This patient had a small intrameatal tumour and actually complained of contralateral symptoms. CONCLUSION: The results suggest that a full audiovestibular assessment can help diagnose VS of all sizes. But false-negative results remain possible in small intrameatal tumours (1%). In addition it can give useful postoperative prognostic information.

[Cranioencephalic complications of middle ear cholesteatoma: report of 4 cases]. / Complications infectieuses cranio-encephaliques de l'otite moyenne chronique cholesteatomateuse. A propos de 4 observations.

INTRODUCTION: Cranial and intracranial complications can be observed during middle ear cholesteatoma's evolution. We report our experience of management of infectious cholesteatoma's cranioencephalic complications. MATERIAL AND METHODS: In a three year period, we had consecutively admitted 4 patients with cranioencephalic complications of middle ear cholesteatoma, in the Ear Nose and Throat (ENT) department of the university teaching hospital of Dakar. After preoperative investigations with computed tomography scan (CT scan) of brain and temporal bone. The patients had been operated after paraclinic assessment. RESULTS: The finding showed one case of temporal bone otogenic extensive osteomyelitis with multifocal extradural empyema, 3 cases of brain abscess associated with subdural empyema and meningitis in 1 case. For 3 patients (75%), neurosurgical drainage and mastoidectomy were performed, associated with antibiotic treatment. The mastaidectomy was performed in the same time of the surgical procedure or delayed. One patient, with brain abscess, died before surgical intervention. With a follow up of 15 months, we have noticed stable mastoidectomies cavities and no neurological recurrence symptoms. CONCLUSION: These complications can be prevented by early treatment of chronic otitis media diseases. The appropriated management of these complications necessitate collaboration between otorhinolaryngologists and neuro surgeons.

[Hyperthyroidism surgery: experience of ENT department of hospital center of Thies]. / Chirurgie de l'hyperthyroidie: experience du service d'ORL du centre hospitalier regional de Thies.

INTRODUCTION: The treatment of hyperthyroidism includes different therapeutics means of which surgery. The objectives of this study were to evaluate the place of the surgery in the treatment of hyperthyroidism and to describes the complications. PATIENTS AND METHODS: It is a retrospective study on 22 patients treated by thyroidectomy from March 2002 to April 2004. The biological confirmation was systematic. A medical preparation has been done in all the cases. A total thyroidectomy has been done in 13 cases and a subtotal in 9 cases. RESULTS: The mean age was 37 years. There were 20 women and 2 men. An euthyroidism has obtained after surgery. There complications were: 1/22 temporary palsy of recurrent nerve 1/22 acute hypoparathyroidism 1/22 post-operative death (haematoma) CONCLUSION: Surgery seems to be a good alternative to antithyroid agents, which are constraining and often ineffective in the long term, and to radioactive iodine who leads to a long follow-up because of induced hypothyroidy. With increasing surgical skill, the risk of recurrent or parathyroid injury is greatly decreased.

[Head and neck paragangliomas in Senegal. About 8 cases]. / Paragangliomes de la tête et du cou au Sénégal.

UNLABELLED: Paragangliomas are uncommon neoplasms with rare occurrence in the head and neck area. OBJECTIVE: The purpose of this study was to report the experience of management of these rare tumors by a team of Ear, Nose, and Throat (ENT) surgeons working in the context of a sub-Saharan country. MATERIAL AND METHODS: We conducted a retrospective study in the Ear, Nose and throat Department of a Dakar university hospital. The study concerned 8 patients with a highly vascular tumor located in the neck and temporal bone. The preoperative investigations were computed tomography scanning (CT scan) using contrast injection in 88% and Doppler ultrasonography for the patients with a neck mass. All the patients underwent surgery except one. In 2 cases, the management with a team of vascular surgeons was necessary. Histological examination of the tumor was realized in all cases. RESULTS: The tumor was located in the neck in 5 cases (62,5%) with a carotid body tumor in three patients (37,5%) and vagal location in two (25%). The temporal bone was involved in three patients with a tympano-jugular location (37,5%). All the neck masses were operated on via a unique cervical approach. The tympano-jugular tumors were treated by radical mastoidectomy in two patients. In the third patient with a tympano-jugular tumor, with important involvement of the temporal bone, only the neck extension was operated. The histological diagnosis of paraganglioma was confirmed in all patients. Radiation therapy was delivered in two patients (25%), to complete surgery in the event of extensive temporal bone tumor and exclusive in one case of an inoperable vagal tumor. The outcomes, marked early death in one patient (14%), were good in the short and mid term for the others patients. CONCLUSION: With the improvement of technological infrastructures, particularly with developing modern imaging, we have better knowledge of paragangliomas in the head and neck area, in our experience in a developing country. However, therapeutic approaches are still limited by modest humans and material resources.

[Subdural empyema complicating acute frontal sinusitis. Four cases report]. / Empyème sous-dural compliquant une sinusite frontale aiguë. A propos de 4 cas.

OBJECTIVE: Subdural empyema is a collected cranioencephalic suppuration between arachnoid and dura meninge space. Subdural empyema occurring after sinusitis is an uncommon but serious complication of paranasal sinus infections. The purpose of this study is to aware the clinician about this condition. MATERIAL ET METHOD: Four young male children had been admitted with expressed fronto-ethmoid sinusitis. The intracranial infection was confirmed by computed tomography scan of brain and sinus. Both drainage of the sinus and intracranial suppuration was performed at the same time surgical procedure and antibiotics administered during 4 weeks. RESULTS: The subdural empyema was localized in the right temporoparietal region in 1 case, in the frontal lobe in the others cases. In 1 case, the frontal subdural empyema was associated with an inerhemispherique collection. One patient underwent a second drainage. Immediate post-operative outcomes were temporally complicated with convulsions and focal neurological deficit, in 1 case. This symptoms had regressed spontaneously. There was no case of death. The functional prognosis was bad, marked by lost vision in 2 cases, which was bilateral in 1 case. CONCLUSION: A high index of suspicion of intracranial extension of sinus infection must recommended neuroradiological investigations. When suppurative collection is confirmed, an appropriated management of the infection between otorhinolaryngologists and neurosurgeons is necessary.

[The pectoralis major flap: anatomic basis and indications in head and neck cancer surgery]. / Le lambeau de pectoralis major: bases anatomiques et indications en chirurgie carcinologique cervico-faciale.

INTRODUCTION: The Pectorals Major Pedicle Flap has been described by ARIYAN in 1979. Authors expound the anatomic basis of this flap and case's experience . MATERIALS AND METHODS: The study carried out in the laboratory concerned 14 corpses (11 men and 3 women). Concerning Clinical cases, from January 1st 1994 to December 31st 2003, 26 patients have had a pectoralis major flap in the Otorhinolaryngology and Head and Neck department of the University of Dakar. RESULTS: The average year was 51 and the sex ratio was 2 women (7.69%)out of 24 men (92.31%). We repaired the pharyngostoma in 20 cases, the oropharynx in 3 cases, the mucosal defect in the mouth in 2 cases and the parotid gland in 1 case. The pectoralis major flap was favourable in 9 cases . We noted 8 cases of partial necrosis and 5 cases of total necrosis. Four (4) cases of death were to be deplored in post operative immediate. CONCLUSION: Reconstruction by pectoralis major flap is scarce in our practice. The improvement of the results goes through the indications choice and the acquisition of more efficient technical stools.

Profile of parotid gland tumours: experience of 93 cases over a period of 16 years.

OBJECTIVE: The pathology of the salivary glands focuses on that of the parotid gland. The purpose of this study is to clarify and explain the epidemiological features of parotid tumors in a Senegalese context, to highlight the importance of clinical examination when access to complementary investigations is limited, to discuss respective indications and finally to describe certain aspects of treatment in our context. MATERIALS AND METHODS: This retrospective study of 114 cases of parotidectomy spans 16 years, from 1992 to 2007. It was performed in the ENT department of University Hospital of Fann, Senegal. All patients operated on for chronic mass of the parotid region for whom histological results were available when initially included. Benign swellings were subsequently excluded. The study parameters were epidemiological, clinical, paraclinical and surgical. RESULTS: The 114 parotidectomies showed a predominance of benign tumours: 63 procedures (55.26%) essentially concerned pleomorphic adenoma; 30 cases (26.31%) concerned malignant tumours, mainly parotid adenocarcinoma. There were 21 cases of benign swelling (18.4%). The study focused on the series of 93 cases of benign and malignant tumours of the parotid gland. Both sexes were affected similarly. All age groups were concerned, from 5 to 89 years. A total of 97% of patients underwent surgery: conservative total parotidectomy in 75.51% of cases. CONCLUSION: Although there are features specific to the local context, the epidemiological profile of parotid tumours is well-known. Indications for complementary investigations are discussed, as availability in Senegal is restricted, highlighting the important role of clinical examination in the management of parotid tumours.

[Laryngeal foreign bodies: management in children in Senegal]. / Corps étrangers laryngés: prise en charge chez l'enfant au Sénégal.

UNLABELLED: Inhalation of foreign bodies is a frequent accident in children. It remains severe in the case of laryngeal foreign bodies. PATIENTS AND METHODS: Retrospectively, for a 16-year period, 65 laryngeal foreign bodies have been treated (44.8%), among 145 cases of airway foreign bodies, in the ENT department of Dakar University hospital. Etiological, clinical and therapeutic aspects were reviewed. RESULTS: Average age was 36 months, with a sex-ratio of 2.42 in favour of males. The time lag (time between the accident and admission to the department) was particularly long; 73.33% of the children were admitted more than 24 hours after the event. Eighty-three percent of the patients presented greater or lesser laryngeal dyspnea. Tracheostomy was performed in 55.4% of the patients. Average duration for abiation of the canula was ten days. Three cases of death were recorded (4.16%). DISCUSSION: The frequency of 44.8% for laryngeal localization of foreign bodies appears to be the highest in the literature. If the appropriate treatment for foreign bodies in the respiratory tract is endoscopic removal, the tracheostomy nevertheless occupies a central place in the management of the disease. This procedure may be recommended to all ENT specialists working in similar conditions. In spite of its inherent complications, tracheostomy allows reduction of mortality in relation to laryngeal foreign bodies. Improvement of prognosis requires prevention based on widespread public information and improving technical infrastructures.

[Cystic lymphangioma: a practical problem of cervical oncology. Apropos of 4 cases]. / Le lymphangiome kystique: un problème pratique de l'oncologie cervicale. A propos de 4 observations.

Cystic hygroma is a benign dysembryoplasia of the lymphatic system of mainly cervical expression. Clinical findings of a stereotyped nature were found in 4 cases of this particular aspect of infantile surgical affections. On operation there was an obvious relation with the internal jugular vein, and an entire segment had to be removed in 2 cases. These data confirm conventional pathogenic theories.

[Thyroid oncology in everyday practice. Apropos of 105 cases]. / L'oncologie thyroïdienne en pratique. A propos de 105 dossiers.

The charts of 105 patients treated for histologically documented nodular thyroid disease from 1976 to 1991 were analysed to determine the various diagnostic and therapeutic problems posed by the management of thyroid nodules in everyday clinical practice. The incidence of solitary nodular and multinodular disease was almost identical, 45.7% and 41% respectively. Radionucleid imaging was performed in only 61.9% (65) of patients and showed a distinct predominance of cold nodules as compared to multiheteronodular goiters, 67.7% (44/65) and 21.5% (14/65), respectively. Histological confirmation of diagnosis, obtained after fixation of the surgical specimen in paraffin, revealed a vast majority of benign versus malignant disease, 89.5% and 10.5%, respectively. 13.6% of cold nodules proved to be cancers. Extensive surgical resection either subtotal or total thyroidectomy, was performed in 41.6% of patients. Improvements in clinical practice and screening of goiters in endemic areas must contribute to a better definition of the surgical management of thyroid nodules.

[Profile of cancers of the hypopharynx in Senegal]. / Profil des cancers de l'hypopharynx au Sénégal.

A retrospective study of carcinomas of the hypopharynx was conducted to examine the epidemiological and clinical features of this cancer in Senegal. An analysis of 66 cases showed a very particular distribution in Senegal with more female (57.6%) than male cases. Average age at diagnosis was 33 years. Advanced cancer (T3-T4) was noted in 65% of the cases, but the first physical examination noted the absence of cervical nodes in 53.6% of the cases. Location at the piriform sinus was observed in 41% of the cases, followed by the posterior wall of the hypopharynx (25.7%). Chronic anemia with iron deficiency was seen in 30% of the cases, probably an important etiological factor of the cancer in Senegal. This point would be the goal of a future prospective study.

[Retropharyngeal abscess. 6 case reports]. / Les abcès rétropharyngés. A propos de 6 observations.

From 1983 to 1991, 6 cases of retropharyngeal abscess were treated at the University Hospital Center of Dakar. A retrospective review of these cases showed that most occurred in children between the ages of 3 months and 3 years. All patients were examined late, i.e. with a delay of more than one week between the onset of symptoms and consultation of a specialist. The clinical signs were dysphagia, dyspnea, and, in all but one case, fever. In 5 patients, diagnosis was based on the observation of a mass in the middle section of the posterior wall of the pharynx that led to peroral incision and drainage without general anesthesia. In the remaining patient, whose abscess involved the lower part of the wall, endoscopy was necessary to allow diagnosis and incision under general anesthesia after tracheotomy. In all cases, complete healing was obtained after 10-day single-agent antimicrobial therapy. Practitioners in tropical areas should bear in mind that retropharyngeal abscesses are not uncommon in these regions and that they can cause serious complications (rupture and mediastinal extension).

[Limits to the practice of craniofacial oncology in Black Africa: the example of cancer of the larynx]. / Limites á l'exercice de la carcinologie cervico-faciale en Afrique Noire: l'exemple des cancers du larynx.

Cervico-facial carcinology is currently one of the major concerns of oto-rhino-laryngologists. The authors have chosen laryngeal cancers to determine the limits of the practice of such cervico-facial carcinology in the topics. Over a 10-year period, 61 patients with a suspected malignant laryngeal disease were examined at the E.N.T. Clinic of the University Hospital in Dakar. Histological confirmation was found in only 38 patients, and a curative treatment was undertaken with 27 patients. No significant differentiation could be found from the results as far as sex, age and histology were concerned. On the other hand, the TNM breakdown of our 36 carcinomas revealed that in 78% of the cases large tumours (T3, T4) were involved. In the vast majority of these cases (18/27), treatment was purely surgical, with a total laryngectomy in 90% of the cases. Pharyngostomas accounted for the majority of the early postoperative complications (6/14). Over 10 years of practice, 70% of our patients have died or have been lost from sight. These poor results are due to numerous factors, including late consultation, the lack of specialists and the insufficiency of technical facilities. To improve results, the authors recommended the setting-up of proper cancer institutes.

[A new case of rhinoscleroma with skin extension]. / Un nouveau cas de rhinosclérome avec atteinte cutanée.

Scleroma is a chronic and specific granulomatous disease of bacterial origin. Klebsialla rhinoscleromatis, a gram-negative bacillus. The majority of cases affect the upper airways, particularly the nose, thus justifying the term of rhinoscleroma. Extension to the palate, the upper lip and the skin is possible. A new case of rhinoscleroma with skin extension is reported. To us, this is the second case in Senegal (Casamance). Epidemiological, clinical, bacteriological and histological aspects of the disease are reviewed. Under suitable antibiotic, evolution is currently favorable.

[Neck trauma in civil practice: a 16-year experience]. / Les traumatismes du cou en pratique civile: une expérience de 16 ans.

In spite of their seriousness, neck traumatism still are an unknown pathology. In a 16 years old hospital practice we have recorded 27 cases of neck traumatism. They concern, mainly, male adult. Accidental circumstances deal only with civil practice. The vulnerant agent is white weapon in 63% of the cases either in a suicide or aggression purpose. Because it occurs, mainly, with white weapons, penetrating wounds are more frequent (85%). Exploration cervicotomy has been indicated for 23 patients. But it was effective for only 22 patients. In 83% of cases surgery occurred in the first 48 hours delay. It permitted to find out a 78% score of aero-digestive tracks, and about 22% of vascular injury. We have recorded two death cases. One of them was noticed after surgery. These 27 cases do not, indeed, reflect the reality. Many people who died immediately after their accident may have undergone unseen neck traumatisms. By the same way, numbers of "closed" internal neck traumatisms have been misknown in the hospital. We, thus, suggest a reorganisation of surgical and medical emergencies in Senegal.

[Ethmoidal-frontal osteomas (report of 9 cases)]. / Les ostéomes ethmoido-frontaux (à propos de 9 observations).

Ethmoido-frontal osteomas, slowly-evolving, benign, bone tumours, are being studied anew, especially from a surgical point of view. Asymptomatic for a long period, they can be detected from bone tumour and ophthalmological manifestations (60% of the cases). An X-ray renders the diagnostic almost certain. ORL access is satisfactory in the great majority of cases, and controlled milling of the osteoma, according to BOURDIAL (1972) is the best means of removal. For the 9 cases observed, post operational follow-up was always straightforward.

[Cylindroma of the epiglottis]. / Cylindrome de l'épiglotte.

The observation of an exceptional laryngeal localization of an adenoid cystic carcinoma allows authors to review diagnostic, therapeutic and increasing problems of this glandular carcinoma. The reported case constitutes a histologic surprise. An economical removal has allowed to obtain a long remission without recurrence, nor metastasis; this never put back the principle of the broad surgery to institute when faced this type of cancer, but just emphasize the interest of an early treatment.