Extracranial head and neck neurogenic tumors: report of 47 cases.

UNLABELLED: Extracranial head and neck neurogenic tumors are rare and usually revealed by histological examination. The aim of this study was to review the clinical, radiological and therapeutic particularities of these tumors. METHODS: This retrospective study concerns 47 patients with neurogenic tumors of the head and neck, operated on between 1989 and 2011 (22 years period). All patients had complete physical examination and ultrasonography was performed when a cervical extension was found. CT scan and MRI were performed in 16 cases. Minimum follow up was 4 years. RESULTS:   A sinusonasal tumor was found in 9 cases and a cervical mass was seen in 28 cases. Parapharyngeal extension was observed in two cases. Two patients had tympano-jugular glomic tumors and 8 of them had a cervical soft tissue tumor. Complete surgical resection was performed in 46 patients. Histological examination revealed a benign tumor in 91% of cases (n=43), 24 of them were schwannomas. Malignant tumors were seen in 4 cases: esthesioneuroblastoma (3 cases) and malignant schwannoma (1 case). These patients received post operative radiotherapy. After surgery, two patients had Claude Bernard Horner syndrome and one had a definitive facial nerve palsy. CONCLUSION: Extracranial head and neck neurogenic tumors may have several aspects depending on their localisation and their histological type. Surgery, when performed, should be complete with minimum complications.

[An unusual lesion of the nasopharynx: oncocytic metaplasia]. / Une lésion inhabituelle du nasopharynx : la métaplasie oncocytaire.

Oncocytic metaplasia of the nasopharynx is an exceptional lesion which exact etiopathogenesis, although largely discussed, still remains controversial. The purpose of this paper is to present the epidemiological characteristics and clinical signs of this lesion and to study its pathogenesis and its therapeutic modalities. We report two cases that occurred respectively in a 53- and 60-year-old woman. The first presented with pharyngeal dysesthesia and otalgia. The endoscopic examination revealed an irregularity of the posterior wall of the nasopharynx. The second patient presented with tinnitus, discomfort of the left ear and bilateral hearing loss. Endoscopic exam revealed a bilateral structural abnormality to the eardrum. Microscopy showed focal oncocytic metaplasia of the nasopharynx mucosa in both cases. There was a positive outcare for both patients after excisional biopsy. Oncocytic metaplasia seems to be in relation to the stimulation of sympathic neuropeptidergic nerve fibers which target epithelial, connective, endothelial and lymphoid cells.

Necrotizing otitis externa: 19 cases' report.

Necrotizing otitis externa is an uncommon but severe infectious disease of the external auditory canal. Patients at risk are those immunodepressed or having diabetes. The causal germ is often Pseudomonas aeruginosa. Over a period of 10 years (1997-2006), we treated 19 patients: 94.7% had diabetes (insulin dependent in 6 cases). The causal germ was P. aeruginosa in 59% of cases. The pretherapeutic work-up included a computed tomography and a scintigraphy practiced in order to confirm diagnosis and assess the extension. Medical treatment was based on a parenteral antibiotic therapy using a third-generation cephalosporin and a fluoroquinolones. Local treatment of the auditory canal including cleaning and application of antimicrobial agents was performed in all the cases. Surgical debridement of soft tissue and infected bone was performed in one patient who did not respond to medical management. Repeated scintigraphies with gallium were used to follow the course under treatment in only three cases. We had a 89.4% cure rate with only three cases of recurrence. We reviewed the data in the literature on necrotizing otitis externa and present the important diagnostic, imaging, and therapeutic aspects of the disease.

[Recurrent upper respiratory tract infections in children and allergy. A cross-sectional study of 100 cases]. / Infections recidivantes des voies aeriennes superieures de l'enfant et allergie. Etude transversale à propos de 100 cas.

BACKGROUND: Upper respiratory tract (URT) infections are common in children. The knowledge of their risk factors allows in some cases better management. The aim of our study is to evaluate the role of allergy in this pathology. METHODS: Through a cross-sectional study about 100 children having recurrent URT infections, we evaluated the prevalence of allergy in order to find a relation between the two pathologies in general, and between allergy and each recurrent pathology. The results were compared with those of a reference group involving 164 children. RESULTS: Our study confirms a statistically significant association between allergy and recurrent URT infections (p=0.01), also between allergy and rhinopharyngitis (p=0.02), rhinosinusitis (p=0.001) and acute otitis media (p=0.01). CONCLUSION: Allergy represents a risk factor for recurrent URT infections, particularly for rhinopharyngitis, rhinosinusitis and acute otitis media. Adequate management of allergy may consequently be beneficial for the treatment and the prevention of these infections.

[Plummer Vinson syndrome]. / Syndrome de Plummer Vinson.

BACKGROUND: Plummer Vinson syndrome is a rare affection which affects mainly white women. It is characterized by dysphagia, iron deficiency and the presence of superior esophageal web. AIM: The purpose of this study is to precise the epidemiological, clinical, paraclinical and therapeutical features of the affection. METHODS: We report 19 cases of Plummer Vinson syndrome collected over 15 years (1990- 2004). RESULTS: Dysphagia is the main symptom observed in 100% of the cases. 89.4% of the patients had anemia and 15 hyposideremy. All the patients were treated with iron supplementation and endoscopic treatment (dilatation and rupture of esophageal webs). Three patients necessitate multiple sessions of endoscopic dilatation and 15 had favourable evolution. The malignancy was observed in one case.

[The laryngopyocele]. / La pyolaryngocele.

BACKGROUND: The laryngopyocele is a laryngocele complication. AIM: We report two cases that were treated in Habib Thameur Hospital ENT service. CASES: There were an 81 old woman and a 31 old man who consult for an infectious syndrome with a lateral neck masses. The diagnosis was obtained by clinical and endoscopic examination and was confirmed by CT. The man was operated. On antibiotics were precribed for both. They had a well recovery.

[Chronic laryngitis in adults]. / Les laryngites chroniques de l'adulte.

BACKGROUND: Chronic laryngitis is a lingering inflammation of the laryngeal mucosa, caused by specific aetiology and often irritative factors. AIM: To discuss clinic and therapeutic aspects of the pathology. METHODS: We report a retrospective stuy about 25 patients treated and followed for non specific chronic laryngitis over a period of 11 years (1994-2004). RESULTS: The average age of the patients was 54.2 years. Tobacco intoxication was noted in 72.7 of cases and Gastroesophageal reflux in 2 cases. The endoscopic examination of laryngeal lesions, realised in all cases, notes laryngeal keratosis in 88% of cases and congestive laryngitis in 12%. Histological analysis of the lesions reveals a dysplasia in 44% of cases. Clinical and endoscopic follow up of the patients discover malignant development in 5 patients. CONCLUSION: The treatment of chronic laryngitis is based on the suppression of etiologic factors and on laryngeal microsurgery with micro instruments and with laser techniques.

[Idiopathic sudden sensorineural hearing loss. What's the appropriate management?]. / La surdite brusque. Quelle prise en charge therapeutique?

BACKGROUND: Sudden sensorineural hearing loss remains a challenge in otology. Controverses affect mainly etiopathogeny and treatment. AIM: To evaluate our experience in the diagnosis and the treatment of sudden hearing loss METHODS: We report a retrospective study, including 30 patients presenting a Sudden sensorineural hearing loss. All patients were hospitalized for treatment. The audiometry evaluated the hearing deafness before and after treatment. RESULTS: The average age was of 48 years. In all the cases no etiology has been found. All The patients were hospitalized and corticotherapy was administrated in all cases. It was associated to hyperbare oxygenotherapy in 7 patients. Recovery was observed mainly in patients with moderate (71.4%) and severe hearing deficiency (69.2%). CONCLUSION: Corticosteroids are the less controversed treatment of sudden sensorineural hearing loss.

[Naso-sinusienne sarcoidosis]. / La sarcoïdose naso-sinusienne.

BACKGROUND: Sarcoidosis is an ubiquity disease, which can infiltrate all tissues. The cutaneous and ophthalmologic thoracic localizations are most frequent. The nasosinusienne localisation is rare. AIM: The authors report their observations of 4 patients: 2 men and 2 women with a mean age 47.5 years (42-56). Theses cases was diagnosed and treated between january 1998 and December 2003 in the ENT service of the Habib Thameur hospital. CASES: The diagnosis was related to a nasal or a sinuses biopsy. The assessment of extension was negative in 3 cases. The corticoid treatment in local pulverization was sufficient in 2 cases. The corticoid treatment by systematic way was necessary among 2 patients. Favourable out look was obtained in all the cases. The naso sinusienne localization is rare, it is exceptionally isolated. The clinical and radiological symptoms are not specifics. Principal element of the diagnosis is the directed biopsy, easy in this localization.

[Cervico-facial lymphangiomas. What's the appropriate management?]. / Les lymphangiomes kystiques cervicofaciaux. Quelle prise en charge thérapeutique?

BACKGROUND: Cystic hygroma is a benign and uncommon vascular tumor. Therapeutic difficulties are variables and are discussed with regard to different clinical forms. The curative treatment is surgical. AIM: The purpose of this study is to discuss the management of the vascular malformation. PATIENTS AND METHODS: We present a retrospective study over a period of 11 years (1995- 2005); about 12 patients treated and followed in ENT department of Habib Thameur Hospital of Tunis. RESULTS: The average age of the patients was 29 years and the average size of the tumor was 7 cm in diameter. A voluminous cervical mass was noted in 3 cases. Local inflammation with respiratory restriction were observed in one patient. Surgical treatment was performed in 8 cases without recurrences. Injection of sclerosing agent (Ethibloc) was indicated in 4 cases because of the volume of the tumor. The following was marked by reduction of the tumor volume. Surgical excision was completed in one case. CONCLUSION: The management of lymphangioma is challenging. Surgical excision is the best treatment in limited forms. The prognosis of voluminous lymphangiomas is transformed by sclerosing injections.

[Rhinoscleroma]. / Le rhinosclerome.

PURPOSE OF STUDY: Rhinoscleroma is a chronic infectious granuloma due to Klebsiella rhinoscléromatis. The aim of the study is to precise clinical. paraclinical and therapeutic aspects of rhinosclérome. MATERIAL AND METHODS: We propose a study about 3 cases of rhinosclérome collected in a period of 15 years. Nasal endoscopy was realised in all cases with a bacteriological sampling and a histological examination of nasal lesions. We realised nasosinusien scanner in all cases. RESULTS: All patients have a progressive and bilateral nasal obstruction. Cruts rhinitis was observed in 2 cases. Laryngal scleroma was observed in one case. The diagnosis was confirmed by histological examination and bacteriological sampling. All patients were treated with fluoroquinolones. The evolution was satisfactory in 2 cases. CONCLUSION: Sclérome is a cosmopolitan disease which requires early diagnosis and treatment.

[Surgical treatment of Basedow's disease. Retrospective study of 40 cases]. / Le traitement chirurgical de la maladie de Basedow. Etude rétrospective à propos de 40 cas.

Graves' disease is an autoimmune disorder. Its diagnosis is easy. Its treatment is delicate in lack of etiologic treatment. We report a retrospective study of 40 cases operated in nine years period. The failure of the medical treatment constituted the main operative indication in our series (57.5%). A subtotal thyroidectomy have been accomplished in 72.5% and total thyroidectomy in 22.5% of cases. We noted one case of definitive hypoparathyroidism after surgery. Our endocrinal results were characterised by the occurrence of hyperthyroidism in 2 cases after subtotal thyroidectomy. For many authors, surgery is the best treatment of graves' disorder and the actual tendency is to realise a total thyroidectomy. Our results encourage us to adhere to the therapeutic method.