[Occult pneumothorax: Does it take drain before elective surgery?]. / Pneumothorax occulte : faut-il drainer avant une intervention chirurgicale programmée ?

Pneumothorax occult is defined by the presence of a non-visible to standard asymptomatic pneumothorax and pulmonary diagnosed only by X-ray computed tomography. The presence of this type of pneumothorax before planned surgery is a rare situation. What to do remains non-consensual. Through two clinic cases and a literature review, the authors discuss the modalities of management of this entity.

[A rare cause of anosmia: nasosinusal tuberculosis]. / Une cause rare d'anosmie: la tuberculose nasosinusienne.

We report the case of a 46-year-old-woman who presented with anosmia and nasal obstruction. Primary nasal tuberculosis was discovered. Primary nasal tuberculosis is very rare. Women are more touched than men. Symptomatology is often unilateral with nasal obstruction, anterior rhinorrhea or epistaxis. Diagnosis relies on the anatomopathologic and bacteriological examinations. The treatment is mainly medical based on antituberculosis drugs. In the light of this case report, a review of the literature was made.

[Pseudo-tumoral Aspergillus rhinosinusitis of dental origin]. / Sinusite aspergillaire d'origine dentaire dans sa forme pseudo-tumorale.

INTRODUCTION: Sinonasal aspergillosis is caused by the interaction between the sinonasal mucosa with a cosmopolite fungus (Aspergillus), it is on the increase, this is an infection whose evolution is unpredictable requiring early diagnosis and appropriate support. We report a case of Aspergillus rhinosinusitis of dental origin in pseudo-tumoral form with a review of the literature. CLINICAL CASE: A 31 years-old, women, consulted for a right nasal obstruction with purulent rhinorrhea after dental treatment. On examination, there was a bulge of the inner canthus of the right eye and a mass in the right nasal cavity. The CT scanner showed a process of the left naso-sinus cavity centered by calcic image density. The patient underwent a total excision of the mass endoscopically. Mycological and pathological examination concluded that the etiology was Aspergillus fumigatus. The patient had not received any antifungal treatment. The postoperative course was uneventful. The evolution was favourable with no recurrence after 9 months. DISCUSSION: Aspergillus rhinosinusitis of dental origin is usually due to the emergence of canalicular filling paste into the maxillary sinus through and oral cavity and sinus fistula, neglected it can progress to invasive pseudo-tumoral form. The clinical presentation is nonspecific and the diagnosis often involves imaging (scanner). Mycological and histological examinations are essential for diagnosis. The treatment is based on surgery sometimes associated with antifungal treatment.

[Aspergillus ethmoiditis associated with orbital abscess]. / Ethmoïdite aspergillaire compliquée d'un abcès orbitaire.

The authors report a case of Aspergillus ethmoiditis associated with an orbital abscess, diagnosed in an immunocompetent 6-year-old child, this is a rare infection and diagnosis is difficult, cause of a delayed treatment and frightening prognosis. Mycoses have emerged as important infections in clinical practice; this phenomenon is explained by the ever-growing number of immunocompromised patients and the increasing number of people traveling in areas where fungal diseases are endemic. Surgery with mycological and anatomopathologic examination can suggest a fungal infection confirmed by culture and contribute to institute adequate treatment.

[Temporomandibular joint primitive tumors and pseudo tumors]. / Pseudotumeurs et tumeurs primitives de l'articulation temporomandibulaire.

The temporomandibular joint (TMJ) can be the site of bone, cartilaginous, or synovial tumors. There is no well-defined histological classification. We listed all benign tumors, malignant primitive tumors, and rare pseudo tumors of the TMJ. We provide a list to help for the diagnosis and the differential diagnosis of non-tumoral lesions by far the most frequent.

Facteurs predictifs de gravite des cellulites cervico-faciales diffuses d'origine dentaire : a propos de 78 cas

Introduction : La cellulite cervico-faciale est une dermohypodermite qui prend origine au niveau de la graisse hypodermique a partir d'effraction d'un foyer dentaire. Sa gravite reside d'une part dans sa forme diffuse avec risque d'obstruction des voies aeriennes et de mediastinite et d'autre part dans sa forme necrosante avec risque de fasciite necrosante et de gangrene gazeuse. en l'absence de prise en charge multidisciplinaire et urgente; l'evolution de ces formes grave se fera vers le sepsis; le choc septique et le Syndrome de defaillance multi viscerales. L'objectif est de retrouver des facteurs predictifs d'extension allant de l'atteinte des voies aeriennes superieures a l'infiltration mediastinale; ainsi que des facteurs predictifs du type de cellulite (phlegmoneuse ou necrotique). Patients et methode : etude retrospective faite sur une periode de 7ans qui a permis d'exploiter 78 dossiers de cellulites cervico-faciales diffuses (CCFD) colligees au service d'OrL et chirurgie maxillo-faciale du CHU de rabat; l'atteinte des voies aeriennes(VaS) l'atteinte mediastinale et le type de cellulite ont ete retenu sur la tomodensitometrie. afin de degager les elements predictifs de gravite statistiquement significatifs; l'evaluation a porte sur l'analyse des elements epidemiologiques; cliniques; par acliniques et evolutifs en comparant respectivement les groupes de CCFD avec et sans atteinte des voies aeriennes(VaS); avec et sans atteinte mediastinales; et en cas de formes necrosantes versus cellulites phlegmoneuses. L'analyse statistique a ete faite par le logiciel spss version 13.01 et les comparaisons ont ete realisees en utilisant les tests khi 2 et le test exact de Fisher pour les variables qualitatives; le test student et anOVa pour les variables quantitatives. Resultats : Cette serie comporte 44 hommes et 34 femmes; L'age moyen est 32 ans. Les facteurs favorisants significatifs sont; Le mauvais etat buccodentaire et l'ethylotabagisme; alors que les aInS et Le diabete ne sont pas significatifs. Le diagnostic est clinique; et la tomodensitometrie permet l'etude de l'extension; le type; et de suivre l'evolution sous traitement. Les signes cliniques significatifs sont; l'alteration de l'etat general; le sepsis; la dyspnee; et les crepitations sous cutanees. Tous les malades ont ete hospitalises; dont 15 en reanimation; avec signification statistique pour le sepsis; l'atteinte mediastinale; et la cellulite necrosante ou gangreneuse. Le drainage chirurgical (44;9) avec signification pour mediastinites. L'evolution etait favorable chez 75 patients ;3 deces par choc septique Conclusion : Cette etude a montree comme decrit dans la litterature que la CCFD predomine chez le sujet jeune de sexe masculin; que la mauvaise hygiene bucco-dentaire intervient dans la genese de la cellulite phlegmoneuse avec infiltration des VaS et que l'ethylotabagisme a un effet dans les formes graves cervico-mediastinales et necrosantes .la clinique a permit le diagnostic mais elle a sous estimee l'atteinte des VaS et mediastinale et c'est la tomodensitometrie qui permit de preciser l'extension et le type de cellulite. L'antibiotherapie etait comparable a la litterature; le drainage chirurgical des CCFD a ete realise sous anesthesie generale avec intubation classique ou sous fibroscope; La tracheotomie n'est pas recommandee en premiere intention que lorsqu'elle etait inevitable. Le recours a la chirurgie en urgence etait pour les memes imperatifs que la litterature dans les formes necrotiques; dans l'atteinte mediastinale; et en cas de sepsis

[Intractable epistaxis in Osler-Rendu-Weber syndrome]. / Épistaxis grave de la maladie de Rendu-Osler-Weber.

INTRODUCTION: Osler-Rendu-Weber syndrome is an inherited disorder characterized by mucocutaneous and visceral telangiectasia. It is often revealed by recurrent epistaxis. It is sometimes profuse and intractable. Hemostasis may be problematic. CASE STUDY: A 61-year-old male patient presented with severe epistaxis due to Osler-Rendu-Weber syndrome. Embolization of the external carotid branches was needed for hemostasis. DISCUSSION: Embolization of external carotid artery branches can be an effective therapeutic alternative when usual treatments fail.

[Leiomyosarcoma of the submandibular gland]. / Léiomyosarcome de la glande submandibulaire.

INTRODUCTION: A leiomyosarcoma is a malignant tumor of the smooth muscle. Its malignancy is difficult to assess. Submandibular gland involvement is extremely rare. OBSERVATION: A 62-year-old patient was admitted with a primary leiomyosarcoma of the submandibular gland. He was treated by surgery and radiotherapy. The patient died 11 months later from pulmonary metastases. DISCUSSION: LMS of the submandibular gland is extremely rare. Its diagnosis is very difficult because of the non-specific clinical and radiological signs. The histological diagnosis often relies on immunohistochemistry. Treatment is based on surgery associated to radiotherapy. The prognosis remains poor because of frequent recurrence and metastases.

[Bacteremia on femoral catheter infection: an unusual cause of orbital cellulitis]. / Bactériémie sur infection du cathéter fémoral: une cause inhabituelle de cellulite orbitaire.

The authors report a case of orbital cellulitis complicating bacteremia on central catheter infection. A 51-year-old man, with a history of diabetes and end-stage renal disease, was admitted for left exophthalmos with inflammatory chemosis, fever, and worsening of his general state. The CT scan showed exophthalmos with thickening of soft tissues and infiltration of the ocular fat without collection or sinus impairment. Orbital cellulitis was diagnosed. The etiological investigations showed Staphylococcus aureus bacteremia on femoral catheter infection. Progression was favorable with antibiotics and nursing care. The authors discuss the compromised prognosis of this disease and the need for rapid diagnosis and prompt therapeutic management.

[Papillary carcinoma in a thyroglossal duct cyst, a case report: Which management]. / Carcinome papillaire sur kyste du tractus thyréoglosse à propos d'un cas : quelle prise en charge ?

Cysts of the thyroglossal duct are common but malignant degeneration is rare, occurring only in 1% of the cases. The most frequent histological type is papillary carcinoma. The clinical presentation of these cancers is generally nonspecific, diagnosis being established postoperatively using the Sistrunk method. Debate remains open concerning appropriate management strategies and post-therapeutic follow-up for this type of neoplasia. We report the case of a 45-year-old patient who underwent surgery for an anterior neck mass that had developed over three years. Histology favored multifocal papillary carcinoma in a thyroglossal duct remant. Total thyroidectomy was performed. The postoperative protocol, established empirically due to the absence of consensus, included radioactive iodine and hormone suppression even though the thyroid was intact. After one year of follow-up, outcome has remained favorable.

[Tonsillitis tuberculous simulating tonsil cancer: case report]. / Amygdalite tuberculeuse simulant un cancer de l'amygdale: à propos d'un cas.

Tuberculous of the oral cavity is rare, the attack tonsil remains exceptional. We report case a 25-year-old young male, who consults for an ulceration of the left unilateral tonsil, with a homolateral adenopathy jugulo-carotidien. The examination anatomopathologic of the tonsil biopsy revealed a tuberculous of the tonsil. The patient profited from an antituberculous treatment, the evolution was good.

[Anatomical relationship between the frontal sinus ostium and the anterior ethmoidal artery: surgical implications]. / Rapports endoscopiques entre l'ostium du sinus frontal et l'artère ethmoïdale antérieure : implications chirurgicales.

OBJECTIVES: The anterior ethmoidal artery represents a major danger in the dissection of the anterior ethmoid roof. In addition to hemorrhage, its injury exposes the patient to the risk of orbital haematoma and requires intraoperative and postoperative vigilance. The goal of this study was to describe the anatomical relationship between the frontal sinus ostium and the anterior ethmoidal artery, such as they are observed with the endoscope during nasalization. MATERIALS AND METHODS: Consecutive patients with no surgical history or agenesia of the frontal sinuses, with an indication for ethmoidal complete exenteration with ablation of the mucous membrane (nasalization), were included in a prospective descriptive study. When dissection of the anterior ethmoidal roof was finished, the relationship between the frontal sinus ostium and the anterior ethmoidal artery were filmed and drawn on a diagram during surgery. A photograph of the relationship between the frontal sinus ostium and anterior ethmoidal artery was selected afterward from the film. RESULTS: Sixty-eight ethmoids were operated (30 bilateral, eight unilateral) with no complications. The anterior ethmoidal artery was visible in 60 cases (88%), 31 out of 34 cases on the left side (45%) and 29 out of 34 cases on the right side (43%); it was not visible in eight cases (12%), three cases on the left (4.5%) and five cases on the right (7.5%). In the most frequent anatomical configuration (45 cases, 66%), the frontal sinus ostium was separated from the anterior ethmoidal artery by a single ethmoidal cell. The other anatomical configurations were: presence of two cells between the frontal sinus ostium and the anterior ethmoidal artery in 11 cases (16%), and three cells in one case (1%) or absence of the ethmoidal cell between the frontal sinus ostium and the anterior ethmoidal artery (the anterior ethmoidal artery was located on the posterior wedge of the frontal ostium) in three cases (4%). The comparison of the 30 bilateral cases showed a symmetrical relationship between the frontal sinus ostium and the anterior ethmoidal artery in 20 cases (67%). CONCLUSIONS: These data are addressed to surgeons seeking the anterior ethmoidal artery starting from the frontal sinus ostium. Localization of the frontal sinus ostium, which can be achieved by retrograde cannulation of the frontal sinus or using a transcutaneous frontal drain, appears to be a reliable technique to dissect the roof of the anterior ethmoid and locate the anterior ethmoidal artery.

Endoscopic surgery reveals that woodworkers' adenocarcinomas originate in the olfactory cleft.

The olfactory cleft is a narrow chamber located under the cribriform plate and between the turbinate wall of the ethmoidal labyrinth and the corresponding nasal septum. Nasal adenocarcinomas are mostly described as originating in the ethmoid sinus and operated via external approaches. We designed a prospective study on twenty consecutive woodworkers' adenocarcinomas without intracranial extension to determine the precise site of origin of the tumour. All patients were operated under endoscopic endonasal control according to a methodical surgical procedure as follows: 1) debulking of the tumour and identification of the middle turbinate or conchal lamina, 2) exenteration of the ethmoidal labyrinth according to the nasalisation procedure, and 3) exenteration of the olfactory cleft. Endoscopic endonasal surgery showed that woodworkers' adenocarcinomas constantly originated in the olfactory cleft, appearing as polyp-like neoplasms with well-defined bodies. Over a long period of time, they do not invade, but just displace and push out the surrounding structures, i.e. the nasal septum and the turbinate wall. More than the volume of the tumour, the precise location of the pedicle and especially its connection to the cribriform plate could be of major prognosis value.

[Alveolar rhabdomyosarcoma of the parotid gland]. / Rhabdomyosarcome alvéolaire de la glande parotide.

INTRODUCTION: Alveolar rhabdomyosarcoma of salivary glands is a rare malignant neoplasm, presenting a striated muscular differentiation. It is typically observed in children, adolescents, and young adults but can sometimes be diagnosed in older people. OBSERVATION: We report the case of a 57 year-old man presenting with a primary alveolar rhabdomyosarcoma of the parotid gland. The patient was treated by surgery and radiotherapy. DISCUSSION: According to literature data, alveolar rhabdomyosarcoma of the parotid gland is exceptionally described after 40 years of age. In that case it has the worst prognosis and its lethality is due mainly to its very early metastasis.