Particularités du cancer du larynx chez le sujet jeune / Epidemiological and clinical predictive factors of success in septoplasty: Study of 250 patients

Discuter à travers une étude descriptive ainsi qu'une revue de la littérature, les particularités cliniques, démographiques et pronostiques des patients de moins de 45 ans, ayant un cancer du larynx. Materiels et Methodes: Il s'agit d'une étude rétrospective descriptive portant sur des patients atteints d'un cancer du larynx, âgés de moins de 45 ans suivis dans le service d'ORL et de chirurgie cervico-faciale du CHU Habib Bourguiba Sfax durant la période s'étendant de 1989 à 2018. Resultats: Nous avons trouvé 31 patients avec une prédominance masculine. Un cancer dans la famille a été trouvé dans 16,12% des cas sans corrélation statistique avec le stade avancé de la maladie. Une importante intoxication tabagique a été trouvée (96%). Trois patients avaient une laryngite chronique et un patient une papillomatose laryngée avec des lésions de dysplasie. Les motifs de consultation étaient dominés par la dysphonie (87%). La maladie a été classée en stades avancés dans 70% des cas. Le traitement chirurgical était préconisé chez 87% des patients et la préservation fonctionnelle chez 38,7%. Le taux de survie globale et sans maladie étaient respectivement, à un an de 96% et 84%, à 3 ans de 87% et 76%, et à 5 ans de 77% et 75% Conclusion: Notre travail n'a pas permis de retenir de différence en termes de données cliniques, de l'évolution de la maladie, de l'algorithme thérapeutique ni du pronostic entre les jeunes patients et les plus âgés

Choanal atresia: Diagnosis and management

Objective: Choanal atresia (CA) is a rare congenital malformation caused by the obliteration of the posterior choanae by an atretic plate. The aim of our study is to describe the diagnosis and management modalities of CA and to determine the factors associated with recurrence. Materials and methods: This is a retrospective study based on the medical records of patients with CA managed in our department in the period between 2002 and 2021. We studied the clinical features and management modalities of each patient. For patients who developed a recurrence, we determined the factors associated with recurrence based on a bivariate analysis. Results: We studied the medical records of 26 patients with either a bilateral (n=8) or a unilateral (n=16) form of CA. The median age at surgery was two days for bilateral forms and 5 years and 4 months for unilateral forms. At computed tomography scan, CA was mixed (n=20), bony (n=4) or membranous (n=2). All patients underwent intranasal endoscopic surgical treatment using cold instruments alone in membranous forms and combined to the drilling of the atretic plate in bony and mixed forms. The surgical management included the resection of the posterior part of the vomer bone and the placement of nasal stents in 10 and 16 patients respectively. We recorded 6 cases of recurrence requiring a surgical re-intervention. The presence of associated cranio-facial malformations was the only factor associated with recurrence (p=0,001). Conclusion: Choanal atresia diagnosis was based on nasal endoscopy and CT scan. Surgical treatment using transnasal endoscopic approach was an effective and safe technique. Associated local malformations was a factor associated with re-stenosis

Smell disorders evolution after chronic rhinosinusitis with polyps surgery

: The effects of chronic rhino sinusitis with polyps (CRSWP) surgery on smell symptoms have not been sufficiently studied. The aim of this study was to evaluate the impact of CRSWP surgery on smell symptoms over short and long-term follow-up and to identify the factors that might influence their evolution. Patients and methods: This was a retrospective study about 184 patients operated endoscopically for CRSWP. In post operative period, long-term local steroids were prescribed systematically. The sense of smell was evaluated preand post-operatively according to a subjective score (1: good smell, 2: hyposmia, 3: anosmia). Some factors, related to the patient, the CRSWP and the treatment, were tested in order to identify predictors of smell outcome after surgery.. Results: Before surgery, the anosmia and the hyposmia were noted in 90.8% and in 8.7% of cases, respectively. At six months after surgery, the improvement of olfactory score was significant: 84% of patient had the score 1 compared with 0.5% preoperatively (p < 0.0001). This improvement was maintained during the 2 first years and decreased significantly at 3 years, although an average delay of polyps recurrence was 23.4 months. Among the factors studied in our series, only the observance of postoperative corticosteroids was retained as a predictor of smell recovery after surgery (p = 0,011). Conclusion: CRSWP surgery can significantly improve the smell sense, especially during the two first years. This effect can be sustainable if good post operative compliance for local corticosteroid are achieved

Smell disorders evolution after chronic rhinosinusitis with polyps surgery

The effects of chronic rhino sinusitis with polyps (CRSWP) surgery on smell symptoms have not been sufficiently studied. The aim of this study was to evaluate the impact of CRSWP surgery on smell symptoms over short and long-term follow-up and to identify the factors that might influence their evolution. Patients and methods: This was a retrospective study about 184 patients operated endoscopically for CRSWP. In post operative period, long-term local steroids were prescribed systematically. The sense of smell was evaluated preand post-operatively according to a subjective score (1: good smell, 2: hyposmia, 3: anosmia). Some factors, related to the patient, the CRSWP and the treatment, were tested in order to identify predictors of smell outcome after surgery.. Results: Before surgery, the anosmia and the hyposmia were noted in 90.8% and in 8.7% of cases, respectively. At six months after surgery, the improvement of olfactory score was significant: 84% of patient had the score 1 compared with 0.5% preoperatively (p < 0.0001). This improvement was maintained during the 2 first years and decreased significantly at 3 years, although an average delay of polyps recurrence was 23.4 months. Among the factors studied in our series, only the observance of postoperative corticosteroids was retained as a predictor of smell recovery after surgery (p = 0,011). Conclusion: CRSWP surgery can significantly improve the smell sense, especially during the two first years. This effect can be sustainable if good post operative compliance for local corticosteroid are achieved.