Thyroid tuberculosis associated with papillary microcarcinoma: case report and review of literature.

Introduction: Thyroid tuberculosis (TB) is extremely rare. Infection may first occur in the thyroid gland or may be secondary to TB in other parts of the body. The diagnosis is rarely made clinically because the disease's variable presentation often resembles that of a malignancy or an euthyroid nodular goiter. Case report: We present the case of a 40-year-old woman, who presented multiple thyroid nodules in both lobes. Two of these nodules were classified as EU-TIRADS V (European Thyroid Imaging and Reporting Data System). The ultrasound also found an adenopathy of the inferior part of the jugular lymphatic chain, in favor of malignancy. The histopathological examination after total thyroidectomy showed thyroid TB, associated to a papillary microcarcinoma of the right thyroid lobe, and the final examination of the adenopathy showed similar granulomas with caseous necrosis, and no signs of metastasis. Clinical discussion: Thyroid TB is very rare. Its diagnosis is difficult due to a lack of specific signs and symptoms, which is why the diagnosis is most commonly made on pathological examination after thyroid surgery. It is well known that mycobacterial infection creates an environment of chronic and persistent inflammation, with possible DNA damage. This can create a microenvironment that is highly conductive to carcinogenesis, which could explain the discovery of papillary microcarcinoma in addition to thyroid TB in our patient. Conclusion: This report presents a rare case of malicious growth development of thyroid nodules and thyroid TB. Therefore, physicians must always be vigilant when managing thyroid nodules, as there is always the possibility of malignant lesions associated to an inflammatory or infectious cause.

Evaluation of the endoscopic revision of dacryocystorhinostomy failure cases: a cohort study.

Introduction: The dacryocystorhinostomy (DCR) procedure is linked to a high success rate; however, cases of tearing recurrence are not rare and should be managed efficiently. Thus, evaluating cases of DCR failure allows highlighting the factors significantly impacting the results in order to realize better controlled primary surgeries. Material and method: Twenty-eight patients were operated in our Otolaryngology Department for endoscopic revision of DCR failure between January 2019 and June 2022. Their clinical presentation, postoperative evolution, and findings of the primary and revision surgeries were assessed until the actual follow-up. Results: The first surgery was based on an external approach in 17 patients and the bicanalicular silicone tube intubation was kept for a mean of 4.25 months. The recurrence delay varied from 0.5 to 9 months. Revision surgery revealed synechia in 10 patients, a completely closed DCR ostium in 22 patients (78.57%) by mucosal scarring and granulation, and lacrimal sac fibrosis in 16 patients (57.14%). A significant correlation was found between maintenance of the silicone intubation tube greater than or equal to 3 months and lacrimal sac fibrosis (P=0.016<0.05). Conclusion: Thus, better controlled primary surgeries with optimal exposure, wild marsupialisation of the lacrimal sac and no longer systematic bicanalicular intubation which should be dedicated to difficult anatomies and canalicular affections should guarantee better functional results.

Correlation between caloric test results and VHIT VOR gains in unilateral horizontal canal deficits: a cross-sectional study.

The purpose of the study is to evaluate the correlation between caloric test results and video head impulse test (VHIT) vestibulo-ocular reflex (VOR) gains in unilateral horizontal canal deficits in order to define a possible threshold value above which caloric deficits should be associated with predictable low VHIT VOR gains. Caloric test and VHIT were realised in 105 patients presenting with symptoms of rotational vertigo occurring within the last 2 weeks. The authors defined the cutoff value for a caloric abnormality as more than 15% of canal deficit, which allowed us to divide our patients on groups based on the severity of their caloric asymmetry. Then, the authors performed the VHIT considering abnormal horizontal gain as less than 0.8 with catch-up saccades. The authors evaluated the prevalence of results dissociation between the two tests and the correlation between the caloric asymmetry and the horizontal VHIT VOR gains in each group according to the severity of canal deficit. The correlation was considered statistically significant if P less than 0.05 (Fisher's exact test). The caloric test revealed a significant unilateral deficit in 50 patients (47.6%). The interval of deficit between 21 and 40% included 25 patients, 18 (72%) presenting with normal VHIT VOR gains versus 7. On the other hand, for the 12 patients in the intervals of 81-100% of deficit, the VHIT VOR gain was highly abnormal in all cases. In comparison with the normal caloric test group, a correlation between each interval of caloric deficits and VHIT VOR gains has been assessed. This correlation was significant in the interval of 41-60% (P=0.04 <0,05) and in the interval of 81-99% next to patients with a total deficit of 100% (P=0.006 <0.05 for each). It appears that simultaneous affection of high vestibular frequencies evaluated on VHIT may be more likely and predictable above a minimal threshold of 40% caloric asymmetry, with better discrimination between normal and abnormal VHIT above 80%. Thus, they are two complementary tests to use as a couple rather than a replacement one for the other.

Retromandibular venous ectasia presenting as a parotid mass: An interesting case report.

INTRODUCTION: Retromandibular vein ectasia is a rare lesion that is often misdiagnosed and should be considered in the differential diagnosis of neck masses. An accurate radiological diagnosis can avoid unnecessary invasive procedures. PRESENTATION OF CASE: A 63-year-old patient presented with positional, left parotid swelling, whose ultrasound and magnetic resonance angiography indicated retromandibular vein ectasia. Therefore, no intervention or follow-up was needed for the lesion because it was asymptomatic. DISCUSSION: Retromandibular venous ectasia is an unusual focal dilatation of the retromandibular vein that occurs without thrombosis or obstruction of the proximal veins. They may present as an intermittent swelling of the neck, which is triggered by the Valsalva maneuver. Contrast-enhanced MRI is the preferred imaging modality for diagnosis, interventional planning, and evaluation of post-therapeutic efficacy. Conservative or surgical management depends on clinical symptomatology. CONCLUSION: Retromandibular vein ectasia is a rare and generally misdiagnosed condition. It should be considered in the differential diagnosis of neck masses. Appropriate radiological investigation allows early diagnosis and prevents unnecessary invasive. Management is conservative in the absence of significant symptoms and risks.

Cervicofacial cystic lymphangiomas in 17 childrens: A case series.

Introduction: Cystic lymphangiomas are rare dysembrioplasias that occur mostly in children. Although benign, these tumors remain potentially life-threatening, due to the possible compression of the upper airway. The management of cystic lymphangiomas is still somewhat controversial, with surgery generally being the first-line treatment. Patients and methods: 17 patients were included in this retrospective study, all aged less than 18 years old and treated for head and neck cystic lymphangiomas at our department between 2007 and 2017. All these patients had received surgical treatment alone. The relevant data were analyzed with SPSS software. Results: 17 patients were included, with a sex ratio M/F of 1,4, and an average age of 4 years old. Complete resection of the tumor could only be completed in 12 patients. No postoperative complications were observed in our series. All the patients were followed for a minimum of 2 years after treatment. Conclusion: Cystic lymphangiomas are rare tumors of mysterious origins. The main symptom is swelling of the affected area. In our series, the results of the surgery were promising and consistent with results reported in the literature. A follow-up study with a larger population could be interesting, to further examine potential prognostic factors.

CT scan findings impact on hearing thresholds in otosclerosis: A study of 108 patients.

Background: The relationship between the location of otosclerotic zones and hearing thresholds has been evaluated in several studies and has generated different conflicting reports. This study was carried out in order to evaluate the relationship between otosclerotic zones extension on CT scan and pure tone audiometry (PTA) thresholds, before and after stapedotomy. Materials and Methods: 108 patients with a positive surgical diagnosis of otosclerosis, operated by the same surgeon, were enrolled in this retrospective study, performed in a tertiary referral hospital between 2015 and 2018. Results: PTA thresholds were significantly poorer in cases of extensive otosclerosis (peri cochlear, peri vestibular, or internal auditory canal hypodensities, p = 0,001). However, for cases with hypodensity extending to the endosteum of cochlea (Type III), we have noted a significant improvement in postoperative PTA thresholds (Mean AC (air conduction) = 32,8 ± 8,16/62,97 ± 12,28 dB), Mean BC (bone conduction) = 18,3 ± 8,56/26,25 ± 15,93 dB). Conclusions: In our study, extensive and multifocal otosclerosis lesions had a statistically significant negative impact on postoperative AC and BC threshold; however, type III lesions tend to be associated with a very good prognosis.

Odontogenic myxoma of the maxilla: A rare case report and review of the literature.

Introduction: Odontogenic myxoma (OM) is an uncommon benign odontogenic tumor arising from the jaw bone. The diagnosis poses a challenge because its clinical features overlap with those of other benign and malignant neoplasms. Although surgery is usually the choice treatment, there is still some controversy concerning surgical techniques and proper indications. Case report: We present the unusual case of an odontogenic myxoma involving the maxilla, diagnosed in a 31 years old patient presenting to our department for facial swelling through computed imaging and pathological analysis. After careful consideration, the patient was treated with conservative surgery, with a satisfying end result. Discussion: Because of its slow growth, odontogenic myxoma is often asymptomatic. The diagnosis is based on clinical, radiological and histological caracteristics. Complete surgical excision is the treatment of choice, but it can be challenging because of the tumor's indistinct margins. Conclusion: Though there are still no clear guidelines for the management of OM in the head and neck region, the general consensus is that the surgical excision should be complete, and patients treated in a conservative manner should benefit from regular follow-ups.

Association of multifocal Hodgkin's lymphoma and tuberculosis infection: A challenging entity.

The association of Hodgkin's lymphoma and Tuberculosis is a rare entity, resulting in misdiagnose or delay in diagnosis of both diseases, since they share similar signs and symptoms, laboratory tests results and imaging procedures. We report the case of a 63 years old man who consulted for a clinical presentation of pulmonary and cervico-thoracic lymph nodes tuberculosis confirmed at the histopathological examination. The evolution after 5 months of antituberculous treatment was marked by the increase in size of the cervical nodes with a papular skin rash, diffuse abdominal pain and more weight loss. The FDG-PET-scan showed multiple confluent hypermetabolic lymphadenopathies on the whole upper body with cervical skin extension, next to hypermetabolic splenomegaly and focal liver hypermetabolism; next to a bilateral pleural effusion. The histopathological examination of the cervical lymph node specimen concluded to a Hodgkin lymphoma classified as Ann Arbor stage III. The chemotherapy protocol was started, while completing his antituberculous treatment. The patient passed away a few weeks later due to a septic shock. We present this case to supplement the rare literature data concerning the association of Hodgkin's lymphoma and Tuberculosis, defining how they impact the prognosis of one another, in order to comfort the importance of tuberculosis screening in lymphoma patients, especially in endemic areas.

Cross-Cultural Adaption and Validation of the Moroccain Arabic Version of the Chronic Ear Survey.

The aim of this study was to translate and verify the psychometric properties of the CES (Chronic Ear Survey Score) in the Moroccan Arabic dialect as well as the evaluation of the quality of life of patients suffering from suppurative chronic otitis media. A cross-sectional study was carried out between 1st April 2016 and 10 January 2017 in ENT department of the 20 August hospital Casablanca. The data were collected using an anonymous questionnaire administered by the physician. The CES scale used has been translated according to international recommendations. Internal Reliability was evaluated by the Cronbach alpha coefficient and validity was calculated through the Spearman coefficient of correlations. Statistical analysis was done using SPSS 20.0. A total of 107 patients were enrolled in the study with an average age of 35 years (standard deviation = 13 years) with a sex ratio of 0.70. About 35.5% of patients perceived their disease as severe. The mean CES was 48 (standard deviation = 15) indicating a significant decrease in the quality of life of patients suffering from CSOM. Good internal reliability was noted (alpha = 0.72). CES scores increased significantly with perceived severity (p < 0.001). The Arabic version of the CES has good psychometric properties attesting to its reliability and validity. Its use would make it possible to better evaluate the quality of life of patients suffering from chronic otitis media and thus be able to compare and choose the optimal therapeutic methods based on the results of this questionnaire especially before and after surgery.

Lateral neck ectopic thyroid carcinoma: Rare location for ectopic malignancy.

Lateral neck ectopic thyroid tissue remains a rare entity that can be affected by any lesion involving the gland. The origin of lateral neck ectopic thyroid carcinomas still debated between a metastatic disease secondary to thyroid primary tumor and primary malignancy on the ectopic tissue. Anyway, it should indicate an exploration of the gland. We report the case of a 36 years old female with one year history of hyperthyroidism who was admitted for multinodular grade II goiter with a firm mass in the left level II of the lateral neck. The thyroid scintigraphy demonstrated multiple functioning nodules corresponding to toxic multinodular goiter; in addition to two cold hypofunctional nodules. The cervical ultrasound showed a voluminous multinodular goiter classified as EU TIRADS 5. The surgical procedure exposed a multinodular mass, lateral to the internal jugular vein, with the appearance and structure of the thyroid gland and no connection to it. The thyroid gland was exposed next through a collar incision. Each mass was dissected and removed individually. The histopathology examination of the thyroid gland found papillary carcinoma extracapsular extension. The pathology results of the other mass reported multiple colloid nodules with cystic component, papillary in appearance, with the same cancer proliferation, compatible with ectopic thyroid tissue with papillary carcinoma. No lymph node tissue was found. The patient was sent for complementary RAItherapy. We report a rare case of lateral neck ectopic thyroid papillary carcinoma that supplements and supports the lacking literature data concerning the management of this rare entity.

Validation of a Moroccan Arabic Version of the Tinnitus Handicap Inventory (THI-M).

OBJECTIVE: Cultural adaptation of the tinnitus handicap inventory questionnaire to the Moroccan dialect version. METHOD: We conducted a prospective study over a 3 years period (January 2017-January 2020) in the Otolaryngology Department of Casablanca University hospital. Translation was produced by a forward-backward procedure with analysis of the psychometric properties of the Moroccan version of the tinnitus handicap inventory. RESULTS: The final Moroccan version of Tinnitus Handicap Inventory (THI) was given to 83 otosclerosis patients suffering from tinnitus. They filled the questionnaire twice before surgery and 1 year after surgery.The item-total correlations are all statistically significant (p < 0.001) and vary between 0.279 (item 15) and 0.817 (item 12).The internal consistency of the Moroccan version of THI, assessed through Cronbach's α, was found to be excellent at 0.953. The interclass correlation showed an excellent reliability for all subscales (0.999-1).THI scores decreased significantly from baseline to 1-year postoperative follow-up on all subscale scores, indicating clinical improvement. CONCLUSION: The Moroccan version of THI has a good reliability comparable with translations in other languages and the original version. It is a valid tool to assess tinnitus improvement after otosclerosis surgery.

Head and neck paragangliomas: Ten years of experience in a third health center. A cohort study.

Head and neck paragangliomas are rare vascular tumors derived from the paraganglionic system, located at the carotid body, jugular vein, tympanic cavity and vagal nerve. From 2010 to 2020, a cohort of 26 patients divided in two groups, 15 with cervical paragangliomas and 11 with temporal bone paragangliomas, was reviewed by analysing the medical history, the epidemiological and clinical parameters, the imaging results and classification, the modality of treatment and outcome. Cervical paragangliomas present as firm and pulsatile mass with the characteristic aspect of "salt and pepper" on MRI T1 weighted sequences. The most common type on Shamblin classification was the type II. Total surgical resection was performed in 93,33% of cases. The sensitivity of MRI in the diagnosis of vagal paragangliomas was up to 75%, with a specificity of 90,91% and the correlation of the MRI results and the findings of surgical exploration is significant with p â©½ 0.02. Temporal bone paragangliomas appear as pulsatile mass behind the tympanic membrane, causing variable hearing loss in 90,90% of the cases. The facial nerve is the most frequently affected cranial nerve, in 36,36% of the cases. The main type according to FISH classification is the type B. Embolization was performed in all type C tumors. Surgery was the first line treatment while the inoperable patients were considered for radiotherapy. The aim of this study is to report the main clinical features of head and neck paragangliomas, the imaging tools and findings evaluating their sensitivity and specificity and the treatment protocol and outcome.

Left sinus pyriform fistula treated by minimally invasive approach: A case report.

INTRODUCTION: Abnormalities of the fourth branchial arch are less common than those of the second arch and usually present with inflammation of the left thyroid lobe. CASE PRESENTATION: We report the case of a 10 years old girl who presented to our department with recurrent cervical cellulitis, and who was diagnosed, upon endoscopic exploration, with a left sinus pyriform fistula. The patient was treated using mini-invasive surgery by electrocoagulation, with good clinical outcome. CONCLUSION: Branchial arch malformations are rare congenital malformations. The diagnosis is mainly based on clinical examination, imaging and, endoscopic investigations. The conservative attitude may be the treatment of choice, especially if the cervical mass is not well individualized.

A rare case of a laryngeal leiomyosarcoma with a lymph node metastasis.

INTRODUCTION: Leiomyosarcoma is a rare mesenchymal tumor that originates from smooth muscle cells. Head and neck LMSs represent only 3% of all leiomyosarcomas with less than 50 cases of laryngeal LMS reported in the literature till now. CASE PRESENTATION: We report a case of 50-year-old male presented at our ENT department for a chronic hoarseness. Clinical examination investigations found small submucosal lesion in the right vocal cord. Treatment consisted of CO2 Laser excision of the lesion. The evolution was marked by the appearance of a tumefaction in the left submandibular region and a severe dyspnea requiring an emergency tracheotomy. Paraclinical examination investigations found a supraglottis-glottis-subglottis tumor. A total laryngectomy with bilateral functional neck dissection was performed and the histopathological examination found a laryngeal leiomyosarcoma. CONCLUSION: LMS of the larynx a very rare malignancy. The accurate diagnosis is histological. Surgery is the mainstay of treatment. Its prognosis is correlated to local recurrence and distant metastases.

A rare cause of cervicomediastinal cellulitis: Oesophageal perforation case report.

Esophageal perforation following an impacted foreign body (FB) is a rare and potentially life-threatening condition. Early clinical suspicion and imaging are important for a targeted management to achieve a good outcome. Endoscopic extraction of esophageal FB is a good and safe treatment alternative while the surgical procedure remains a necessary option for many patients. We present the case of a 50 years old woman, with no relevant medical history, who accidently ingested a chicken bone during a meal causing mild dysphagia. The patient consulted immediately but was reassured after normal clinical examination. We received the patient 9 days later with severe dysphagia and cervicomediastinal cellulitis. The cervical CT scan showed the significant collection and the FB impacted in the cervical esophagus wall. A first endoscopic exploration drained the pus and allowed the placement of a nasogastric tube. However, the removal of the FB required an open cervical surgery with the evacuation of the collection and the suture of the esophageal perforation followed by the placement of a drainage tube. The patient medical state improved rapidly and no further incidents were noted. The diagnosis of esophageal FB should be meticulous in order to avoid such life-threatening complications.

Parathyroid lipoadenoma: The particularities of a rare entity a case report and review of the literature.

Parathyroid lipoadenoma is a rare and anusual cause of primary hyperparathyroidism. The clinical presentation usually resembles other causes of primary hyperparathyroidism and the imaging is not always contributory considering its location. However, the histologic criteria are specific. We present a case that supplements and supports the rare literature data concerning the clinical and therapeutic aspects of parathyroid lipoadenoma. The case is about a 73 years old female with a right inferior parathyroid lipoadenoma that caused biological primary hyperparathyroidism. Initially followed and treated in Rheumatology department for hypercalcemia and osteoporosis, she was sent to our structure to diagnose and possibly treat the causal etiology. After non-contributory clinical examination and ultrasound imaging, the tumor was diagnosed in the cervical CT scan. The patient underwent successful surgical removal of the lipoadenoma, confirmed postoperatively on histological analysis. The follow up showed rapid normalization of the parathormon level. Even if it's a rare condition, the diagnosis of lipoadenoma should always be considered in front of primary hyperparathyroidism with a parathyroid lesion.

A rare case of recurrent congenital sialolipoma of parotid gland in a 3­year­old child: A case report and review of literature.

INTRODUCTION: Sialolipoma is an extremely rare salivary gland tumor characterized by a well circumscribed mass composed of glandular tissue and matures adipose elements. Herein,the aim of this article is to report the sixth case of congenital sialolipoma and the first case of recurrent congenital sialolipoma in infant, and discuss the clinicopathological and morphological features of sialolipoma and the possible cause of its recurrence. CASE REPORT: A 3 year-old child presented with a recurrent mass of right parotid gland which progressed from birth, initially treated at the age of 4 months by simple tumorectomy and excision of the surrounding parotid tissue. The tumor recurred 4 months postoperatively. The radiological examination confirmed the parotid origin of the tumor. Histopathology was consistent with a sialolipoma. A superficial parotidectomy with preservation of the facial nerve was performed this time at the age of 3 years. Postoperative recovery proceeded without incident with normal facial nerve function. There was no recurrence at 36-month follow-up. CONCLUSION: Although it is a very rare benign tumor, congenital sialolipoma should be kept in mind in the differential diagnosis of congenital parotid mass. The recurrence of congenital sialolipoma is dependent on its management, thus complete excision of the mass with the lobes of the salivary glands involved seems to be adequate for definitive management.

Supraclavicular lymph node metastases from distant primary tumors: Case reports and review of the literature.

Cervical lymph nodes are a common site of metastases for malignant tumors, most commonly developed from head and neck primary tumors. But, they can also be secondary to distant primary tumors. We report the case of two patients treated in our Otorhinolaryngology and Head and Neck department for chronic supraclavicular lymphadenopathies, for whom further investigations showed lymph node metastasis originating from distant tumors. Thus, careful clinical examination, imaging tools, and if possible pathological analysis are necessary to establish an early diagnosis for adequate treatment.

A rare case of a penetrating cranio-facial foreign body stuck in the skull base.

INTRODUCTION: Penetrating craniofacial wounds due to foreign bodies, specifically sharp white blades, represent an eventual life threatening condition and a rare case of emergency facial surgery requiring a complex medical care. We report an original case of a penetrating craniofacial wound by a knife with a review of the literature concerning the tendencies, the complications and the specific medical care needed for these particular cranio-facial lesions. PRESENTATION OF CASE: A 35 year old man admitted to our ENT emergency room with a penetrating craniofacial wound caused by a knife stuck in the cranio-orbital-nasal junction. A craniofacial profile x-ray showed the presence of the metallic foreign body, a knife, penetrating deeply to the base of the skull. Computed tomography showed that the transcranial metallic foreign body arrived in the right sellar region after passing through the nasal cavity and the right sphenoid sinus with hemosinus and suprentorial pneumocephaly. the management consisted of multidisciplinary management, and the extraction was performed successfully under 3D endoscopic control. CONCLUSION: The majority of penetrating craniofacial wounds secondary to foreign bodies, regardless of their size, are rarely associated with major neurological symptoms and their management must be adapted to their potential severity.