Isolated invasive fungal sphenoid sinusitis-induced extensive bone erosion and severe meningoencephalitis: diagnosis and multidisciplinary management.

Invasive fungal sinusitis (IFS) is more common in immunosuppressed patients but can also occur in immunocompetent hosts. While the non-invasive type of fungal sinusitis has usually a good prognosis, IFS is a potentially lethal condition.We report the case of a woman in her 60s presenting an isolated fungal infection by Aspergillus fumigatus of the right sphenoid sinus, causing extensive bone erosion of its walls and complicated by severe meningoencephalitis. She was healthy without any immunosuppressive conditions. Methods of diagnosis, multidisciplinary management, follow-up and outcomes are documented.Early-stage diagnosis of sphenoid sinus pathologies is often delayed because patients are usually asymptomatic. IFS of the sphenoid is more aggressive than other paranasal sinus and carries significant mortality. Early diagnosis and aggressive and multidisciplinary treatment are crucial to reduce sequels and improve patient's survival.

Intraductal Carcinoma of the Parotid Gland as a Rare Neoplasm: A Case Report and Literature Review.

Background: Intraductal carcinoma is a rare low grade neoplasm of salivary glands with an excellent prognosis. It most frequently occurs in the parotid gland. Ectopic localizations are quite rare. Methods: This case report describes a man in his 60's who was referred to ear, nose and throat outpatient department with 1-month history of painless swelling of the right parotid region. Results: Ultrasound-guided fine-needle aspiration unveiled a cytologic specimen judged as "suspicious for malignancy" and patient underwent a partial superficial parotidectomy. Immunohistochemistry confirmed diagnosis of intraductal carcinoma of right parotid gland. Conclusions: There are few reported cases concerning this clinical entity following thorough review of the literature and recent developments with reference to the contribution of cytology and histopathology will probably modify its classification and management.

[Dysphagia with no obvious cause: globus pharyngeus]. / Une dysphagie sans cause évidente : le globus pharyngé.

Globus pharyngeus or globus sensation is an ordinary ENT referral. It comprises a persistent or intermittent painless feeling of a lump or foreign body in the throat and may be outlined as a tightening or choking sensation. It is usually long-lasting and has a tendency to recur. There are no established guidelines concerning diagnosis or treatment. History and clinical examination represent essential elements as they enable the practitioner to narrow the differential diagnosis and consider red flags. Therapeutic trial using PPI is recommended as initial first line treatment in the absence of red flags and paraclinical assessment can be proposed in nonresponsive patients. Management of this clinical condition consists of reassurance and offering speech therapy for refractory cases.

Le globus pharyngé est une plainte fréquente en consultation ORL. Il est défini comme une sensation, généralement chronique, de masse, blocage ou corps étranger persistant ou intermittent dans la gorge. Il n'existe pas de standards clairs concernant son diagnostic ou son traitement. L'anamnèse et l'examen clinique sont des éléments essentiels puisqu'ils permettent d'affiner les diagnostics différentiels et d'envisager une origine oncologique en présence de drapeaux rouges (tabagisme, consommation alcoolique). En l'absence de facteurs de risque, un traitement d'épreuve par IPP (inhibiteurs de la pompe à protons) est la première ligne de traitement. En l'absence d'amélioration, on peut proposer un bilan paraclinique. La prise en charge thérapeutique consiste à rassurer le patient et lui proposer des séances de logopédie pour les cas sévères.

Management Strategy of Intracranial Complications of Sinusitis: Our Experience and Review of the Literature.

Objective: Sinusitis or rhinosinusitis is a very common disease worldwide, and in some cases, it leads to intracranial complications (ICS). These are more common in immunocompromised patients or with underlying comorbidities, but even healthy individuals, can be affected. Nowadays, ICS have become less common thanks to improved antibiotic therapies, radiological diagnostic methods, surgical techniques and skills. Nonetheless, they can still cause significant morbidity and mortality. For this reason, management of these complications requires a multidisciplinary approach to plan and customize treatment options. This paper presents our strategy in the management of a series of intracranial complications induced by acute sinusitis and compares our experience and outcomes with the literature. Study design: Single institute experience, retrospective analysis of cases series and literature review. Methods: Adult and child patients who were treated for ICS in the Department of Otorhinolaryngology at Sion Hospital, in Switzerland from 2016 to 2020 were included. Their symptoms, medical history, clinical and radiological findings, treatment, and outcome were documented. Results: Eight patients (6 males- 2 females) aged from 14 to 88 y.o., were enrolled. None had any previous history of chronic, or recurrent sinusitis. Moreover, very few presented specific rhinological symptoms, but with neurological or other symptoms. Computed tomography (CT) and Magnetic Resonance Imaging (MRI) were used to confirm the diagnosis of all ICS. All types of known intracranial complications were observed in our cohort with a wide range of extension and severity of sinusitis. A multidisciplinary approach with individual treatments was tailored to each patient. Outcomes were favorable in almost all patients with neither recurrence, nor neurological sequels being observed in the follow-up. Only one patient was lost due to fatal complications of advanced lung cancer. Conclusion: ICS remain a challenging clinical problem due to substantial associated morbidity and mortality. The incidence of these complications is relatively low. Therapeutical management guidelines are lacking. Early detection and multidisciplinary approach are key to successful treatment.

Unexpected foreign body induced refractory maxillary sinusitis.

Maxillary sinusitis induced by ipsilateral dental manipulation often carries the risk of sinusal foreign body impaction. Adequate evaluation mandates radiological exploration of the sinus. Management requires complete foreign body removal, surgical drainage of the sinus, and closure of any oroantral communication or fistula.

Atypical localisation of pleomorphic adenoma issue from heterotopic salivary tissue in the supraclavicular region: diagnosis and management.

Heterotopic salivary tissue (HST) is a normal salivary tissue located outsides the major and minor salivary glands. Multiple sites of localisation of heterotopias have been described, the occurrence of HST in the neck is rare and it may have several clinical manifestation. We report the case of 72-year-old Caucasian man presenting a suspect mass on the left-sided supraclavicular region. He is known for melanoma of the right elbow, surgically treated 11 years ago. The final diagnosis of pleomorphic adenoma of HST was retained. Methods of diagnosis and management are documented. Neoplasms arising from HST are uncommon with approximately 80% of benign tumours. Warthin's tumour is the most frequent. The localisation of these neoplasms in the lower neck is very rare and often causes a diagnostic pitfall. Histological analysis provides certainty of diagnosis, defines management and follow-up.

[Facial and orbital emphysema after blowing : a review]. / Emphysème facial et intra-orbitaire après mouchage : revue de la littérature.

Facial and orbital emphysema without any trauma is an uncommon condition that might occur after nose blowing or sneezing efforts. It is usually self-limited and resolves spontaneously within two weeks. Surgical treatment is only reserved in case of complications such as neurological deficiencies or infection of the ocular globe. We report the case of a 42 year-old patient presenting a right spontaneous facial and orbital emphysema following nose blowing, treated by conservative measures, with a systematic review of the literature.

L'emphysème facio-orbitaire atraumatique est un phénomène peu commun pouvant se produire lors du mouchage ou d'éternuements. Il est habituellement contenu et d'évolution spontanément régressive en 2 semaines. Une indication à un traitement chirurgical est réservée en cas de complications telles qu'un déficit neuro-ophtalmique ou une infection du globe oculaire. Nous présentons le cas d'un patient de 42 ans sans antécédent de traumatisme craniofacial, se présentant aux urgences avec un important emphysème facial et intra-orbitaire à droite, spontané survenu lors du mouchage, et traité de manière conservative, ainsi qu'une revue de la littérature.

Advantages of otorhinolaryngologist performed transcervical ultrasonography in the management of peritonsillar abscess.

OBJECTIVES: Peritonsillar abscess (PTA) is a very common infection, in particular in pediatric and adolescent population. A distinction between peritonsillar cellulitis and abscess should be made to determine the appropriate treatment. Nonetheless, the difference cannot always be made on physical examination alone and often requires imaging by computed tomography (CT). Radiation exposure as well as the cost and waiting time question the use of CT in this pathology. We present our experience in the use of Transcutaneous Cervical Ultrasonography for the diagnosis and management of peritonsillar abscess in the adult population. STUDY DESIGN: Clinical-prospective. METHODS: Adult patients were evaluated for suspicion of PTA. Clinical findings were documented and all patients underwent a Transcutaneous Cervical Ultrasonography performed by a second otorhinolaryngology specialist well versed in Ultrasonography without knowing the clinical history, details of the physical examination, or the suspected side. Ultrasonography findings were later compared with the clinical examination and outcome of the medical or surgical management. RESULTS: Eight adult patients (range 18-53 year-old) were enrolled in the study. Six of them, had, ultrasonography findings compatible with a peritonsillar liquid collection underwent surgical drainage that confirmed and drained an abscess. On two patients, the ultrasonography images described an aspect of peritonsillar cellulitis that was managed conservatively and showed a favorable remission. No complications during stay or side effects or intolerance to the ultrasound were recorded. CONCLUSION: Transcutaneous Cervical ultrasonography is a fast, useful tool, better tolerated than the intra-oral ultrasonography in diagnosing PTA. It avoids all irradiation exposure is much cheaper and the waiting time is shorter. Worth noting, is the richness of information pertaining the anatomy, vessels and abscess location and extension, for the surgeon performing the exam just prior to surgery. The efficiency and training of otorhinolaryngology specialists with this technique shows numerous promising benefits and deserves to be further developed.

Spontaneous transethmoidal meningoencephalocele presenting in the form of recurrent unilateral nasal discharge: discussion of the diagnosis and endoscopic surgical management.

Meningoencephaloceles of the skull base most commonly occur as a sequela of head trauma or they can more rarely be congenital malformations. Several types of encephalocele exist depending on anatomic features and localisation. Clinical presentation and symptoms can vary. Different methods of management and repair of the concurring skull base defects have been described and ranging vary from endoscopic to open surgical approaches. We report the case of a 56-year-old Caucasian woman with the diagnosis of right sided spontaneous transethmoidal meninoencephalocele. Clinical presentation of this rare pathology, methods of diagnostic and management and its outcome are presented. Spontaneous skull base meningoencephaloceles are rare entities, without clear underlying etiologies. Multidisciplinary management is recommended. The transnasal endoscopic approach provides a wide skull base exposure with more advantages and less morbidity in comparison with the conventional open approach.

Deep radiation-induced ulcer following nasopharyngeal carcinoma: surgical management.

Nasopharyngeal carcinoma (NPC), an uncommon malignancy in Western Countries and Radiotherapy, remains an effective treatment. Its side effects are classified as either immediate or late; postradiation necrosis is as an important late side effect with a strong impact on the prognosis in patients with NPC. We report the case of 65-year-old Caucasian man presenting with a deep necrotic ulcer of the nasopharynx and osteoradionecrosis of the skull base that appeared 3 months after radiotherapy for nasopharyngeal carcinoma. Conservative treatment was applied with surgical management of the ulcer. Clinical and radiological outcomes are presented. Radiotherapy remains a good treatment option with varying degrees of side effects, in particular, postradiation necrosis and ulcer. Multiple options of treatment have been described. However, the surgical management could be indicated in cases of deep ulcer with life-threatening prognosis.

Sinonasal relapses of a primary isolated extranodal NK/T-cell lymphoma of the testis.

WHO first recognised extranodal NK/T-cell lymphoma (ENKTCL) in 2001, thanks to technical advances in anatomopathology and immunohistochemistry. It is divided into nasal and extranasal subgroups depending on the primary site. Primary isolated NK/T-cell lymphoma of the testis is rare. Typical recurrence sites of primary testicular NK/T-cell lymphoma are the gastrointestinal tract, lymph nodes, skin, spleen and central nervous system. Nasal relapses of a primary NK/T-cell lymphoma of the testis are very rare and according to our knowledge, no other case has been reported yet in the literature. The authors report the case of a 35-year-old Caucasian man relapsing twice in the nasal cavity 1 year after initial diagnosis and treatment of a primary isolated, stage IE, ENKTCL of the testis. We report the clinical and radiological presentation of the nasal relapses and the different modalities of treatment that were applied. Sinonasal relapses of an isolated primary NK/T-cell lymphoma of the testis are very rare. ENKTCL is a very aggressive entity, even at an early stage, therefore, requiring a multimodal treatment approach including chemotherapy and radiotherapy. New strategies to treat this disease are needed.

Dural venous sinus stenting as a stand-alone treatment for spontaneous skull base CSF leak secondary to venous pseudotumor cerebri syndrome.

Most spontaneous CSF leaks (SCSFL) are associated with an underlying pseudotumor cerebri syndrome (PTCS). Treatment generally includes surgical leak repair and PTCS correction, as untreated PTCS carries a risk of recurrence. We describe a 72-year-old woman with rhinorrhea, aural fullness, and posterior nasal drip. CT and MRI showed signs of CSF hypovolemia and PTCS, as well as bilateral transverse sinus stenoses. CT and MRI cisternography documented CSF leaks through the right cribriform plate and the posterior aspect of the petrous bone. Opening CSF pressure was 6 cm H2O. Dural venous sinus stenting (DVSS) was performed after failed conservative treatment. Rhinorrhea resolved 3 days after stenting, aural fullness 1 month later. After 6 months, signs of CSF hypovolemia had disappeared on MRI and the stents were patent. After 9 months, the patient had a transient, spontaneously resolving episode of rhinorrhea. She has been symptom-free for the remaining 39 months of follow-up.

Navigation-guided biopsy of retropharyngeal lymph nodes.

The impact of metastasis to the retropharyngeal lymph node group is poorly understood because of the difficult access to the retropharyngeal space (RPS). In 20%-50% of surgically treated oropharyngeal, hypopharyngeal, and cervical oesophageal carcinomas, we can find metastases to the retropharyngeal lymph nodes (RPLNs). 1 The use of a three-dimensional (3D)-imaging-guided navigation system to perform a biopsy for a suspicion of metastasis in an RPLN can provide advantages in terms of better precision and 3D orientation with protection of the surrounding critical structures. We report two cases of an open biopsy by transoral and transnasal approaches for a suspicion of metastasis in a retropharyngeal lymph node in two patients with oropharyngeal and pulmonary cancer, respectively, by using the 3D imaging-guided navigation system. In the both cases, the biopsies performed were very accurate and allowed to get a full histological analysis and diagnosis. The use of the navigation system as a means to perform biopsies in the soft tissue of the neck is rarely reported and up to date few reports can be found in the literature. This technique can provide multiple advantages when compared with other conventional methods. The procedure is simple, safe and minimally invasive.

Repair of displaced thyroid cartilage fracture using miniplate osteosynthesis.

Acute laryngeal trauma is estimated to occur in approximately one patient per 14 500 to 42 500 emergency room admissions. If the larynx is injured, its vital functions are affected and can be threatened in case of severe injury. Soft cartilage offers no protective advantage, which is the reason why young as well as older individuals are at risk of thyroid cartilage fracture. Experimentation on cadaver larynx has demonstrated that virtually all laryngeal fractures are longitudinally oriented. Furthermore, muscular pull can contribute to a misalignment of the fractures. As stated by Bent and Porubsky, a fracture is considered severely rather than moderately displaced, if it is freely mobile on physical examination, has more than two fracture lines or demonstrates a displacement greater than the width of the thyroid cartilage on CT imaging. We present two cases of severely displaced thyroid cartilage fracture treated in our department by open reduction and internal fixation using miniplates. Functional and radiological outcomes were excellent.

Thoracocervicofacial Emphysema after Heimlich's Maneuvre.

We report an extremely rare example of a thoracocervicofacial subcutaneous emphysema after Heimlich maneuver case.

Residual fistula of fourth branchial arch anomalies and recurrent left-side cervical abscess: clinical case and review of the literature.

Congenital fourth branchial arch anomalies are uncommon entities. Most of these anomalies are diagnosed in childhood. The majority of cases occur on the left side. The clinical presentation of these anomalies varies with age. A respiratory distress is the usual clinical presentation in neonates, cervical cutaneous fistulas in late childhood or acute suppurative thyroiditis. Multiples diagnostic options have been described with different modalities of treatment. The majority of cases of fourth branchial arch anomalies are described only in case reports. We report a clinical case of recurrent cervical abscess in a young woman due to a residual fistula of fourth branchial arch.

Acquired form of angioedema of the head and neck related to a deficiency in c1-inhibitor: a case report with a review of the literature.

Angioedema related to a deficiency in the C1-inhibitor protein is characterized by its lack of response to therapies including antihistamine, steroids, and epinephrine. In the case of laryngeal edema, mortality rate is approximately 30 percent. The first case of the acquired form of angioedema related to a deficiency in C1-inhibitor was published in 1972. In our paper, we present a case of an acquired form of angioedema of the oropharyngeal region secondary to the simultaneous occurrence of two causative factors: neutralization of C1-inhibitor by an autoantibody and the use of an angiotensin convertin enzyme inhibitor.