Manejo quirúrgico de los carcinomas diferenciados de tiroides Experiencia en un país de bajos ingresos / SURGICAL MANAGEMENT OF DIFFERENTIATED THYROID CARCINOMAS. EXPERIENCE IN A LOW INCOME COUNTRY

ience in the management of differentiated thyroid carcinomas in a low- income country. Materials and Methods: We performed a retrospective study in our department where 21 cases of differentiated thyroid carcinomas were recorded from February 2001 to December 2010. Results: We performed 334 thyroidectomies for 326 patients. Of this group, 21 differentiated thyroid carcinomas were diagnosed. Differentiated thyroid carcinomas represented 6.4% of all thyroid neoplasm managed during the same period (n=326). Median age was 44 years (range 13 - 75 years). Male to female ratio was 1:20. Six (6) patients underwent primary hemithyroidectomy in other institutions while the fifteen left were entirely managed in our clinic. Of them, one patient was referred with positive fine needle aspiration cytology for papillary thyroid carcinoma (incidental detection by fine needle aspiration biopsy) and another had history of sinus pyriform fistula. Pathology of surgical specimens showed 13 cases of papillary thyroid carcinomas and 8 cases of follicular thyroid carcinomas with association to Hashimoto thyroiditis and Grave's disease in respectively in 1 case. Twenty cases were incidentally discovered by thyroid surgery and undergone completion thyroidectomy with prophylactic central neck dissection, completion thyroidectomy alone, modified lateral neck dissection alone and surveillance respectively in 13, 1, 1 and 6 cases. Complications of thyroid surgery were bilateral recurrent laryngeal nerve paralysis and hematoma respectively in 1 case. Median hospital stay was 5 days ranged from 3 to 15 days. During the follow-up period, most of our patients were lost of follow-up. Conclusion: Management guidelines of differentiated thyroid carcinomas are well established but not applicable to low- income country for several reasons. National guidelines, based on further researches, must then be implemented to improve our practice

[The Study Of Biomedical Waste Management In Sanitary District Of Goudry In Senegal]. / Etude De La Gestion Des Dechets Biomedicaux Dans Le District Sanitaire De Goudiry Au Senegal.

AIM: Of this study was to explore, in the sanitary district of Goudiry, the practice of biomedical waste management and to analyze its impact. MATERIALS AND METHODS: The sample consisted of seven health posts, among a total of 11, drawn by simple random sampling and a health centre (district hospital). Data were collected through structured interviews with all staff, participant observation and from secondary data. RESULTS: The district facilities surveyed produced 111.9 kg (or 16.0 kg/d) over seven days. Waste management is inadequate at all levels. CONCLUSION: Actions needed to improve waste management are sensitization and training of actors, the involvement of all the stakeholders (local authorities, population, health workers), and advocacy with policy makers.

BUT: Il s'agissait d'explorer, au niveau du district sanitaire de Goudiry, la pratique de la gestion des déchets biomédicaux et d'en analyser les conséquences. MATÉRIELS ET MÉTHODES: L'échantillon était constitué de sept Postes de Santé tirés sur 11postes par un sondage aléatoire simple et d'un Centre de Santé dont toutes les unités fonctionnelles ont été incluses dans l'étude. Les données ont été recueillies au travers des entretiens structurés avec l'ensemble du personnel, des observations participantes et de la recherche documentaire. RÉSULTATS: Le District, en sept jours, avait produit 111,9 Kg (soit 16,0 kg/j). La gestion des déchets était inadéquate à tous les niveaux. CONCLUSION: A cet effet, pour améliorer la gestion des déchets, les actions à mener étaient la sensibilisation et la formation des acteurs, l'implication de toutes les parties prenantes (collectivités locales, population, personnel sanitaire), et le plaidoyer auprès des décideurs.

Complications des otites moyennes chroniques

Objectif de l'etude : Rapporter la frequence des complications des otites moyennes chroniques et presenter notre experience dans leur prise en charge. Materiel et methodes : Etude retrospective concernant la periode allant du 1er janvier 2000 au 31 decembre 2009. Les complications ont ete reparties en 2 grands groupes : extracraniennes et intracra-niennes. Resultats : 57 patients sur 350 recus pour OMC ont presente une complication; soit une frequence de 18;38 . Le cholesteatome etait le plus grand pourvoyeur de ces complications (84;2). Dix-neuf patients presentaient plus d'une complication; soit au total 76 cas. Les complications extracraniennes ont ete les plus frequentes; 63 cas (83); dominees par la mastoidite exteriorisee profuse (68;3). Les complications intracraniennes au nombre de 13 (17) etaient dominees par la meningite purulente otogene (46;2). La mastoidectomie associee a une antibiotherapie a large spectre; occupait une place im-portante dans la prise en charge de ces complications. Elle a ete realisee chez 45 patients (79). La mortalite a ete estimee a 3;5 (2 cas de deces). Un drainage neurochirurgical a ete effectue dans 4 cas (8;6). Conclusion : Cette etude se caracterise par un taux de complications d'OMC plus eleve que ceux rappor-tes dans la litterature; ainsi que par la predominance des formes etendues et des associations de complications chez un meme patient

[Primitive neuroectodermal tumor of the vagus nerve]. / Tumeur neuroectodermique primitive du nerf vague.

Primitive neuroectodermal tumors are a rare type of malignant neuroectodermal tumor that is very aggressive. Cervicofacial location is rare, even exceptional. We report a case of a 4-month-old male infant, referred from the pediatric clinic for severe supralaryngeal dyspnea, a firm mass under the left mandibular angle, mobile and extended to the parotid area, painful, with a curve of the left side wall of the oropharynx. Cervical computed tomodensitometry showed a well-limited mass in the carotid area, enhanced by the contrast product. A vascularized mass, which had developed at the expense of the vagus nerve, was removed surgically. Histology found a primitive neuroectodermal tumor.

Management of acquired cholesteatoma in children: a 15 year review in ENT service of CHNU de FANN Dakar.

OBJECTIVES: To analyze the epidemiology, diagnosis, management and the prognosis of cholesteatoma of the middle ear in children. METHODS: This was a retrospective study of 15 years (from 01 January 1995 to 31 December 2009) for patients aged 0-15 years admitted in ENT ward of FANN hospital for chronic otitis media complicated with cholesteatoma The parameters studied were epidemiology, clinical presentation, disease progression and management. RESULTS: Sixty-six participants were included. We noted a slight male predominance with a sex ratio of 1.44. The average mean age was 10 years. Most patients presented with signs of complications (69.7%) and mastoiditis was the most common complication (63.6%). The otorrhea was noted in almost all patients: n = 64 (97%) and deafness in 49 patients (74, 2%). There was a slight predominance of cholesteatoma on the right side (51.5%). Schuller's view of the mastoid cells was done in 21.2% of patients (n = 14) and showed sclerotic mastoid air cells for all them. Eighty-two percent (82%) of patients presented with conductive hearing loss. A radical mastoidectomy was performed in 66.7% and modified radical mastoidectomy in 33.3% of cases. Mean follow-up was 6 months. Recurrence of cholesteatoma was noted in 13% of cases. CONCLUSIONS: ENT ward of Hospital Fann is one of the two centers in Senegal where cholesteatoma of the middle ear are treated. This low number of cholesteatoma in children in a developing country is in relation to the fact that patients only present when complications develop: 70% of cases. The reason for this in our setting include insufficient human and manpower resources necessary for prompt management of the disease and also lack of awareness among the populace. In these settings we advocate canal wall down mastoidectomy (radical or modified radical) as the treatment of choice.

A case of cervical Pott's disease revealed by parapharyngeal abscess.

INTRODUCTION: We report a case of cervical Pott's disease revealed by parapharyngeal abscess. CASE REPORT: A seven-year-old boy was admitted with a three-week history of painful fluctuating left lateral cervical swelling, associated with night sweats. Examination found trismus, through which a lateral pharyngeal bulge could be observed. Incision and drainage of the abscess on a combined cervical-oropharyngeal approach was performed under general anesthesia, associated to non-specific antibiotherapy by parenteral route. Bacteriology was negative. After one week of antibiotherapy, fever persisted with onset of torticollis. A diagnosis of tuberculosis was considered. Tuberculin skin test was positive at 16.5 mm. A second sample by pharyngeal aspiration showed caseous pus with acid-fast bacilli. Cervical spine CT found a retrostyloid abscess with atlantoaxial lysis. Cervical Pott's disease complicated by Grisel syndrome was diagnosed. Antituberculosis therapy was initiated. Results at five months' follow-up were satisfactory. DISCUSSION/CONCLUSION: Parapharyngeal abscess with an etiology of Pott's disease is rare. Modern imaging is highly contributive to diagnosis and follow-up of lesion regression under treatment.

Osteolipoma: an unusual tumor of the parotid region.

PURPOSE OF STUDY: Oncology of the parotid region is rich and varied, like its components. During his career, the ENT surgeon may come across such an exceptional tumor as osteolipoma. The aim of this study was to describe the rarity and the etiopathogeny of osteolipoma with parapharyngeal location. PATIENTS AND METHOD: We had the opportunity to find this uncommon tumor in a 21-year-old female patient. The mass located in the parotid region was hard, barely mobile and at first looked like a parotid tumor. Total parotidectomy with facial nerve preservation was performed. It revealed a stony and dented tumor inside the internal lobe of the parotid located in the parapharyngeal space between the vertical portion of the mandible anteriorly and the styloid apophyse posteriorly. Macroscopic examination of the piece evidenced a lipomatous mass with hard as bone nodes in its middle. Histology revealed an osteolipoma. CONCLUSION: A review of the literature shows the uncommon occurrence of this type of tumor. A few rare cases were reported among which two involving the parapharyngeal space.

[Contribution of the musculocutaneous flap of pectoralis major in head and neck oncology: 26 observations in Senegal]. / Apport du lambeau musculo-cutané du pectoralis major en carcinologie cervico-faciale: 26 observations au Sénégal.

INTRODUCTION: The pectoralis major musculocutaneous flap constitutes a significant advance in cervicofacial carcinology. At our institution, it has allowed most surgical problems to be resolved in a single-stage procedure. The objective of this study was to report our experience with this flap. PATIENTS AND METHODS: This retrospective study includes 26 cases observed over a 10-year period (January 1994-December 2003). The parameters studied were clinical and paraclinical. All patients included in this study received a pectoralis major musculocutaneous flap. Patients treated using another type of flap were not included. RESULTS: Mean patient age was 51 years (range, 20 to 74). The sex ratio was 12 (24 men and 2 women). At the time of admission, 73% of patients showed marked impairment of general condition. In 21 patients (81%), the effect of the pectoralis major musculocutaneous flap was observed immediately after surgery unlike pharyngostome (19%) in which the flap is used in a second stage procedure. With a mean follow-up of 7 years, failure has been observed in 4 cases (15%). CONCLUSION: The pectoralis major musculocutaneous flap is an excellent tool for cervicofacial reconstruction after carcinological exeresis. It reduces the duration of hospitalization. Acquiring proper flap harvesting technique is an important factor in improving outcome.

[Solitary neurofibroma of the maxillary sinus]. / Neurofibrome isolé du sinus maxillaire.

OBJECTIVE: To illustrate the rarity and difficulty diagnosing maxillary sinus neurofibroma through a case report. PATIENTS AND METHODS: A 35-year-old female consulted our department for left cheek swelling evolving over 6 months, upper gum swelling, and a dental occlusion disorder. RESULTS: A computed tomography scan showed a tumor of the left maxillary sinus with bone destruction. Histological examination of a biopsy fragment found an in situ carcinoma. A maxillary resection was performed to excise the tumor. Histological examination of the specimen showed a neurofibroma. No sign of recurrence was noted after 8 months of follow-up. CONCLUSION: The difficulty diagnosing maxillary sinus neurofibroma is related to its nonspecific clinical and radiological signs. Consequently, the otorhinolaryngologist must keep this rare histological variety in mind within the range of tumors of the paranasal sinuses.

Squamous carcinoma of the hypopharynx in children in Sénégal: between disarray and enigma.

INTRODUCTION: The squamous carcinoma of the hypopharynx constitutes the first reason of hospitalization in our department. Different studies have been realized about it and showed an epidemiological profile characterized by the young age of the patients and the predominance of female. OBJECTIVES: To specify the place of the children in hypopharynx cancers. To evaluate the epidemiological criteria and the difficulties in the management. MATERIALS AND METHODS: Retrospective study of 11 years (1995-2005). Collection of the data concerning the epidemiology, clinical and paraclinical findings, the treatment, and the evolution was carried out at the University Department of Otorhinolaryngology in Dakar (Sénégal). RESULTS: 15 charts of children have been collected. They presented in the majority of the cases, an advanced cancer, with 93% of T3T4. The lesion was localized at the retro-cricoid area in 4 cases, the pyriform sinus in 3 cases, the oesophagus junction in 2 cases, and the posterior wall in 1 case. In 5 cases the lesion was spreading to the totality of the hypopharynx. No case of smoking or alcohol has been noted. The anemia has been noted in 86.7% of the cases. A case of papillomatosis of the mouth and lips has been noted. The treatment was for most of cases as symptomatic, like tracheotomy with or without gastrostomy. The evolution was fatal with 11 deaths (73.33%). DISCUSSION: Our set is the richest set through the world of hypopharyngeal cancers in children. The Plummer-Vinson syndrome noted in 86.7% of the cases and the viral infection by HPV could play a role in the genesis of this cancer. CONCLUSION: The cancer of the hypopharynx essentially affects the young women in Sénégal without alcohol or tobacco consumption. It does not save the children, with an awful prognosis, however. So, it is imperative to organize a vast campaign of information of the populations on the bad prognosis of this cancer and to lead a large-scale epidemiological investigation, to get a better understanding of this cancer in our country.

[The otolaryngological manifestations of gastroesophageal reflux disease]. / Manifestations oto-rhino-laryngologiques du reflux gastro-oesophagien (RGO).

The otolaryngological symptoms during gastro-oesophageal reflux disease may be very frequent. When the global estimation in the literature go round 20%, the prevalence in the African studies is variable, between 4 and 43 %. The most common disease encountered are laryngitis and pharyngitis's manifestations. When it is not possible to perform the oesophageal pH-metry, the most sensitive examination in gastro-oesophageal reflux, endoscopic examination and therapeutic test with IPP can be proposed to any patient with ENT symptoms and manifestations of gastro-oesophageal reflux.

[Cranioencephalic complications of middle ear cholesteatoma: report of 4 cases]. / Complications infectieuses cranio-encephaliques de l'otite moyenne chronique cholesteatomateuse. A propos de 4 observations.

INTRODUCTION: Cranial and intracranial complications can be observed during middle ear cholesteatoma's evolution. We report our experience of management of infectious cholesteatoma's cranioencephalic complications. MATERIAL AND METHODS: In a three year period, we had consecutively admitted 4 patients with cranioencephalic complications of middle ear cholesteatoma, in the Ear Nose and Throat (ENT) department of the university teaching hospital of Dakar. After preoperative investigations with computed tomography scan (CT scan) of brain and temporal bone. The patients had been operated after paraclinic assessment. RESULTS: The finding showed one case of temporal bone otogenic extensive osteomyelitis with multifocal extradural empyema, 3 cases of brain abscess associated with subdural empyema and meningitis in 1 case. For 3 patients (75%), neurosurgical drainage and mastoidectomy were performed, associated with antibiotic treatment. The mastaidectomy was performed in the same time of the surgical procedure or delayed. One patient, with brain abscess, died before surgical intervention. With a follow up of 15 months, we have noticed stable mastoidectomies cavities and no neurological recurrence symptoms. CONCLUSION: These complications can be prevented by early treatment of chronic otitis media diseases. The appropriated management of these complications necessitate collaboration between otorhinolaryngologists and neuro surgeons.

[Hyperthyroidism surgery: experience of ENT department of hospital center of Thies]. / Chirurgie de l'hyperthyroidie: experience du service d'ORL du centre hospitalier regional de Thies.

INTRODUCTION: The treatment of hyperthyroidism includes different therapeutics means of which surgery. The objectives of this study were to evaluate the place of the surgery in the treatment of hyperthyroidism and to describes the complications. PATIENTS AND METHODS: It is a retrospective study on 22 patients treated by thyroidectomy from March 2002 to April 2004. The biological confirmation was systematic. A medical preparation has been done in all the cases. A total thyroidectomy has been done in 13 cases and a subtotal in 9 cases. RESULTS: The mean age was 37 years. There were 20 women and 2 men. An euthyroidism has obtained after surgery. There complications were: 1/22 temporary palsy of recurrent nerve 1/22 acute hypoparathyroidism 1/22 post-operative death (haematoma) CONCLUSION: Surgery seems to be a good alternative to antithyroid agents, which are constraining and often ineffective in the long term, and to radioactive iodine who leads to a long follow-up because of induced hypothyroidy. With increasing surgical skill, the risk of recurrent or parathyroid injury is greatly decreased.

[Subdural empyema complicating acute frontal sinusitis. Four cases report]. / Empyème sous-dural compliquant une sinusite frontale aiguë. A propos de 4 cas.

OBJECTIVE: Subdural empyema is a collected cranioencephalic suppuration between arachnoid and dura meninge space. Subdural empyema occurring after sinusitis is an uncommon but serious complication of paranasal sinus infections. The purpose of this study is to aware the clinician about this condition. MATERIAL ET METHOD: Four young male children had been admitted with expressed fronto-ethmoid sinusitis. The intracranial infection was confirmed by computed tomography scan of brain and sinus. Both drainage of the sinus and intracranial suppuration was performed at the same time surgical procedure and antibiotics administered during 4 weeks. RESULTS: The subdural empyema was localized in the right temporoparietal region in 1 case, in the frontal lobe in the others cases. In 1 case, the frontal subdural empyema was associated with an inerhemispherique collection. One patient underwent a second drainage. Immediate post-operative outcomes were temporally complicated with convulsions and focal neurological deficit, in 1 case. This symptoms had regressed spontaneously. There was no case of death. The functional prognosis was bad, marked by lost vision in 2 cases, which was bilateral in 1 case. CONCLUSION: A high index of suspicion of intracranial extension of sinus infection must recommended neuroradiological investigations. When suppurative collection is confirmed, an appropriated management of the infection between otorhinolaryngologists and neurosurgeons is necessary.

[The pectoralis major flap: anatomic basis and indications in head and neck cancer surgery]. / Le lambeau de pectoralis major: bases anatomiques et indications en chirurgie carcinologique cervico-faciale.

INTRODUCTION: The Pectorals Major Pedicle Flap has been described by ARIYAN in 1979. Authors expound the anatomic basis of this flap and case's experience . MATERIALS AND METHODS: The study carried out in the laboratory concerned 14 corpses (11 men and 3 women). Concerning Clinical cases, from January 1st 1994 to December 31st 2003, 26 patients have had a pectoralis major flap in the Otorhinolaryngology and Head and Neck department of the University of Dakar. RESULTS: The average year was 51 and the sex ratio was 2 women (7.69%)out of 24 men (92.31%). We repaired the pharyngostoma in 20 cases, the oropharynx in 3 cases, the mucosal defect in the mouth in 2 cases and the parotid gland in 1 case. The pectoralis major flap was favourable in 9 cases . We noted 8 cases of partial necrosis and 5 cases of total necrosis. Four (4) cases of death were to be deplored in post operative immediate. CONCLUSION: Reconstruction by pectoralis major flap is scarce in our practice. The improvement of the results goes through the indications choice and the acquisition of more efficient technical stools.

[Head and neck paragangliomas in Senegal. About 8 cases]. / Paragangliomes de la tête et du cou au Sénégal.

UNLABELLED: Paragangliomas are uncommon neoplasms with rare occurrence in the head and neck area. OBJECTIVE: The purpose of this study was to report the experience of management of these rare tumors by a team of Ear, Nose, and Throat (ENT) surgeons working in the context of a sub-Saharan country. MATERIAL AND METHODS: We conducted a retrospective study in the Ear, Nose and throat Department of a Dakar university hospital. The study concerned 8 patients with a highly vascular tumor located in the neck and temporal bone. The preoperative investigations were computed tomography scanning (CT scan) using contrast injection in 88% and Doppler ultrasonography for the patients with a neck mass. All the patients underwent surgery except one. In 2 cases, the management with a team of vascular surgeons was necessary. Histological examination of the tumor was realized in all cases. RESULTS: The tumor was located in the neck in 5 cases (62,5%) with a carotid body tumor in three patients (37,5%) and vagal location in two (25%). The temporal bone was involved in three patients with a tympano-jugular location (37,5%). All the neck masses were operated on via a unique cervical approach. The tympano-jugular tumors were treated by radical mastoidectomy in two patients. In the third patient with a tympano-jugular tumor, with important involvement of the temporal bone, only the neck extension was operated. The histological diagnosis of paraganglioma was confirmed in all patients. Radiation therapy was delivered in two patients (25%), to complete surgery in the event of extensive temporal bone tumor and exclusive in one case of an inoperable vagal tumor. The outcomes, marked early death in one patient (14%), were good in the short and mid term for the others patients. CONCLUSION: With the improvement of technological infrastructures, particularly with developing modern imaging, we have better knowledge of paragangliomas in the head and neck area, in our experience in a developing country. However, therapeutic approaches are still limited by modest humans and material resources.

[A new case of rhinoscleroma with skin extension]. / Un nouveau cas de rhinosclérome avec atteinte cutanée.

Scleroma is a chronic and specific granulomatous disease of bacterial origin. Klebsialla rhinoscleromatis, a gram-negative bacillus. The majority of cases affect the upper airways, particularly the nose, thus justifying the term of rhinoscleroma. Extension to the palate, the upper lip and the skin is possible. A new case of rhinoscleroma with skin extension is reported. To us, this is the second case in Senegal (Casamance). Epidemiological, clinical, bacteriological and histological aspects of the disease are reviewed. Under suitable antibiotic, evolution is currently favorable.

[Management of recurrent post thyroidectomy abductor vocal cord paralysis at the Ear, Nose and Throat (ENT) department of the Dakar University Teaching Hospital: report of 14 cases]. / Prise en charge des paralysies recurrentielles post thyroïdectomie en adduction au service d'ORL du CHU de Dakar: a propos de 14 observations.

Latrogenic injury of the recurrent laryngeal nerve is a serious accident in the thyroid gland surgery. Bilateral losses of the abduction of the larynx, occurring during thyroidectomy, determine several dyspneas which often necessitate emergency tracheostomy. In second hand, 14 patients, who had undergone thyroidectomy, were admitted in the Ear, Nose and throat departement of Dakar university hospital with bilateral abductor vocal cord paralysis. Material consits of 12 women and 2 men. They were aged between 15 and 58 years old. Clinically, laryngeal dyspnea was noticed for all the patients and, emergency tracheostomy was performed for 10 patients (71,42%). Bilateral abductor vocal cord paralysis occurred after total or subtotal thyroidectomy in 12 cases. In the most cases (71,42%), the treatment was carried out, with arytenoidopexy, by extralaryngeal route. Successful results were noticed for 11 cases (78,6%) and decanulation was realised between 2 to 26 days after procedure operative. If results were satisfied for respiration, voice quality was bad.