L'actinomycose en ORL : à propos de 7 cas

Objectif :L'actinomycose est une infection rare due à une bactérie anaérobie à Gram positif saprophyte des cavités naturelles de l'homme. Le but de ce travail est d'illustrer les difficultés diagnostiques de cette pathologie et de montrer l'importance de l'examen anatomopathologique dans ce cadre.Matériel et méthodes :Il s'agit d'une étude rétrospective de 7 cas d'actinomycose colligés entre les années 1998 et 2015.Résultats :L'étude a intéressé 4 femmes et 3 hommes d'âge moyen de 42 ans (16 à 70 ans). Tous les patients n'avaient pas d'antécédents odontogéniques ni traumatiques. Les localisations étaient nasopharyngées dans 4 cas et sub-mandibulaires dans 3 cas. La symptomatologie était peu spécifique. Une rhinorrhée purulente était notée dans 3 cas, une obstruction nasale bilatérale dans 2 cas, une haleine fétide dans 1 cas et une anosmie dans 1 cas. Le motif de consultation était une tuméfaction submandibulaire dans 3 cas. L'échographie et le scanner n'ont pas aidé au diagnostic positif d'actinomycose. L'examen bactériologique était négatif dans tous les cas. Le diagnostic préliminaire d'actinomycose n'a été évoqué par notre équipe dans aucun cas. Le diagnostic était confirmé en postopératoire par l'examen anatomopathologique d'un prélèvement biopsique dans tous les cas. Il avait mis en évidence des grains actinomycosiques. L'évolution était dans tous les cas favorable après un traitement à base de pénicilline G associé à la chirurgie.Conclusion :L'actinomycose peut prendre des aspects trompeurs prêtant à confusion avec des affections tumorales ou infectieuses à pyogènes. Aucune imagerie ne peut fournir des informations spécifiques pour le diagnostic. Les résultats négatifs des examens bactériologiques doivent être interprétés avec prudence. L'examen anatomopathologique est d'un grand apport pour poser le diagnostic

Spontaneous cholesteatoma of the external auditory canal: the utility of CT.

Spontaneous external auditory canal (EAC) cholesteatoma is a rare disease. The symptoms are nonspecific. It is diagnosed by clinical examination and radiological investigation. The clinical examination alone is often insufficient for accurately assessing spread of the cholesteatoma into the temporal bone, meaning cross-sectional imaging modalities are required, and specifically computed tomography. We report three cases of spontaneous cholesteatoma of the external auditory canal. All of our patients underwent surgery. In two cases, the cholesteatoma was restricted to the external auditory canal, while in one case, it was complicated by a fistula with the lateral semicircular canal. Good anatomical and functional results were obtained in all three cases, with the external auditory canal patent and a good calibre on completion.

[Congenital cholesteatoma in children]. / Cholestéatome congéntial.

OBJECTIVES: To report on two cases of congenital cholesteatoma in patients aged 1 month. To review the clinical and radiological features of congenital cholesteatoma and to clarify the contribution of the CT scan in the diagnosis and the preoperative workup. PATIENTS AND METHODS: The authors report two observations of congenital cholesteatoma. These children were investigated using high-resolution CT. The treatment was surgical in both cases. RESULTS: The children were 1 month old, presenting with facial paralysis. In the otoscopic exam, the tympanic membrane was normal in both cases, with a whitish retrotympanic soft mass. The diagnosis of congenital cholesteatoma was made based on the CT data. CONCLUSION: Congenital cholesteatoma is rare. Otoscopic examination must be undertaken during the physical exam of a child at a young age to establish an early diagnosis. CT scan allows positive diagnosis and a precise preoperative workup.

[What are the alternative criteria for fine needle aspiration biopsy of a thyroid nodule?]. / Quels critères alternatifs à la cytoponction d'un nodule thyroïdien ?

OBJECTIVES: To identify the clinical and paraclinical factors of thyroid nodule malignancy (in absence of ultrasound-guided fine needle aspiration biopsy data). PATIENTS AND METHODS: This retrospective study was conducted on a cohort of 282 patients admitted for management of a thyroid nodule disease. All patients had undergone surgery and the specimen had been analyzed anatomically and pathologically. Forty-four patients had malignant disease. Epidemiological, clinical, and paraclinical data, as well as the anatomical and pathological characteristics of the specimen were collected for each patient. RESULTS: We showed that the epidemiological data (sex and age), the nodule's characteristics (consistency, irregularities of the edges and fixity to underlying structures, and size), the presence of adenopathies, signs of compression, and the presence of calcifications were the predictability criteria of malignant disease. However, the scintigraphic aspect, the echostructure, and the hormonal status were not significant. CONCLUSION: This study underscores that a relevant clinical and paraclinical analysis remains highly contributive in the presurgical identification of factors predictive of malignancy of a thyroid nodule, notably in countries where technological tools are not always available.

Profil ganglionnaire des micro carcinomes papillaires de la thyroide

La prise en charge des microcarcinomes papillaires de la thyroide est controversee surtout en matiere de curages ganglionnaires. Objectif : determiner le profil ganglionnaire des microcarcinomes papillaires de la thyroide afin de planifier une prise en charge adequate. Materiel et methodes : C'est une etude retrospective portant sur 20 cas de microcarcinomes papillaires de la thyroide colliges sur une periode de 14 ans (1994-2007). Resultats : il s'agissait de 18 femmes et 2 hommes d'un age moyen de 46 ans. Les micro carcinomes etaient de decouverte per-operatoire dans 50des cas. Ils etaient unifocaux dans 80des cas et non encapsules dans 40des cas. Leur taille etait superieure a 0;5cm dans 35des cas. Cinquante six pour cent des curages ganglionnaires etaient positifs. Une metastase ganglionnaire a ete retrouvee dans 83pour les tumeurs de taille superieure a 0;5cm. Conclusion : plusieurs parametres conditionnent les metastases ganglionnaires cervicales en matiere de microcarcinomes papillaires de la thyroide. La conduite therapeutique doit les prendre en consideration

Indications et resultats de la septoplastie chez l'enfant

La septoplastie chez l'enfant est un sujet de controverse jusqu'a nos jours. Notre etude est retrospective a propos de 47 cas colliges au service ORL de l'hopital Tahar Sfar de Mahdia sur une periode de 19 ans (1988-2006). L'age moyen de nos malades est de 13;8 ans. Le sexe masculin est predominant (63;8). Tous nos malades ont beneficie d'un examen rhinologique et un bilan radiologique standard. A cote de la deviation de la cloison nasale nous avons note une deviation de la pyramide nasale chez 4 malades. Tous nos malades ont beneficie d'une septoplastie sous anesthesie generale. Apres un recul moyen de 2 ans nous avons un bon resultat fonctionnel (fosses nasales permeables) chez 37 malades

Facteurs predilectifs de la malignite d'un nodule thyroidien

Buts : etudier les facteurs predictifs de malignite des nodules thyroidiens et comparer nos resultats a ceux de la litterature. Patients et methodes : Il s'agit d'une etude retrospective a propos de 282 cas de nodules thyroidiens operes a l' hopital de Mahdia entre 1988 et 2003. Resultats : L'age moyen etait de 44 ans. Le risque de malignite des nodules thyroidiens etait de 15;6 . Ce risque etait plus important chez les hommes (50) que chez les femmes (13;3). Certains facteurs etaient hautement predictifs de malignite comme l'age superieur a 60 ans; les signes de compression; les adenopathies cervicales et le caractere fixe et dure du nodule thyroidien Conclusion : Certains signes cliniques et para cliniques ont une grande valeur en matiere de benignite ou de malignite des nodules thyroidiens

[Detection of EBV by PCR in fresh and paraffin embedded samples of cavum tumour]. / Détection de l'EBV par PCR dans des biopsies fraîches et enrobées en paraffine du cancer du cavum.

The nasopharyngeal carcinoma (NPC) is frequent in Tunisia. It's the second ORL cancer of men after the larynx one. To analyse the NPC characteristics in our population, we determined the frequency of EBV infection in 47 paraffin-embedded and 6 fresh NPC biopsies. We first extracted the DNA from tumoral tissus and then amplified viral sequences by PCR to detect and to type the infecting virus (EBV-A or ABV-B). Our results showed that amplifiable DNA has been obtained from 34/47 paraffin-embedded NPC biopsies while 13/47 of the others biopsies contained degraded and not amplifiable DNA. All the fresh biopsies allowed to obtain DNA with good quality. The EBV infection frequency in paraffin-embedded NPC biopsies is 35% while EBV is detected in all fresh biopsies (6/6). Our analyse also showed that the EBV-A is predominant in our population compared to EBV-B as it was shown in most countries of the world. This study clearly shows that PCR results obtained with paraffin-embedded NPC biopsies are divergeant from those obtained with fresh biopsies. Because of DNA degradation in paraffin-embedded NPC biopsies, the biology molecular results from that kind of samples is criticable. Moreover the results obtained from fresh NPC biopsies confirmed the quasi-constant association of EBV with undifferenciated carcinoma nasopharyngeal type.

[Cherubism: a new case with review of literature]. / Le chérubisme: à propos d'une nouvelle observation avec revue de la littérature.

OBJECTIVES: To evaluate radiological characteristics of cherubism. MATERIAL AND METHODS: We report the case of a 7-year-old boy presented with facial deformity, bilateral mandibular swellings, right exophthalmia and dislocated teeth. Panoramic radiograph, Computed tomography scan and MR imaging were performed. RESULTS: Panoramic radiograph revealed multiloculated osteolysis involving the entire mandible and the right maxilla with dislocated teeth. Computed tomography scan showed multicystic expansive bony masses without cortical disruption occupying the mandible and right maxilla with extension to the orbital floor. On MR, these lesions demonstrated intermediate inhomogeneous signal intensity on T1 and T2 weighted images with high enhancement after gadolinium administration. MRI was useful in identifying orbital involvement. These clinical and radiological findings are in favor of the diagnosis of cherubism. CONCLUSION: Cherubism is a rare hereditary benign lesion of the mandible that appears in childhood as bilateral painless swellings which progress until puberty, then spontaneously regress. Plain radiographs and computed tomography scan are sufficient for diagnosis. MR imaging is useful to study the expansion to soft tissues, in particular in the aggressive forms, and establish preoperative vascular assessment. The treatment is plastic and aims to correct the facial deformities.

[The misleading blue tympanic membrane. Prolapse of the internal jugular vein]. / Le piège du tympan bleu. La procidence du golfe de la veine jugulaire interne.

The authors report a case of a jugular bulb dehiscence extending to the tympanic cavity. They alert that the finding of a blue mass in the middle ear should evok the possibility of a vascular variant or abnormalitie. High resolution CT is extremely helpful in the correct diagnosis by showing the subtle and characteristic bone changes.

[Peri-bulbar anesthesia for cataract surgery]. / Anesthésie péribulbaire pour chirurgie de la cataracte.

Ninety-five peribulbar blocks for cataract extraction with intraocular lens implantation were performed by an anaesthetist over a period of 6 months. The quality of the block was assessed by the ophthalmologist and the anaesthetist. No dangerous local or systemic complications were observed. Peribulbar anaesthesia is increasingly preferred to retrobulbar block on account of its easiness and safety.

[A rare cause of multiple lacunae of the cranial vault and temporal bone in adults: histiocytosis X]. / Une cause rare de lacunes multiples de la voûte et de l'os temporal chez l'adulte: l'histiocytose X.

Histiocytosis X is an uncommon disease. Temporal bone involvement is a frequent head and neck manifestation. Most patients are under fifteen years of age. The authors report a case of a bilateral extensive temporal involvement complicated with vertigo and peripheric facial palsy. CT plays a dominant role in the diagnosis because of the ability to identify bone destruction, soft tissue involvement and intra-cranial histiocytosis more accurately.

[Mondini's malformation. Apropos of a case]. / La malformation de Mondini. A propos d'un cas.

Mondini's malformation is a rare internal ear malformation. It's often discovered in childhood in the course of perception deafness check up, or repetitive meningitis in some other cases. The authors report a case of complex Mondini's malformation with fistulas of cerebro-spinal-fluid in oval and round windows, and stress the interest of high resolution computed tomography.

[Malignant otitis externa (2 cases)]. / L'otite externe maligne (à propos de deux observations).

Malignant external otitis is a progressive necrotizing otitis. It's a rare severe and evolutive clinical entities, old diabetics are the most victim. Pseudomonas aeruginosa is the bacteria responsible in the most cases. Prognostic vital can be affected, treatment must be energic, rapid and well adapted. The authors report two old diabetic women presenting a malignant external otitis and discuss etiopathogenic, physiopathologic, diagnosis and treatment of this illness.