Improvised Vacuum-Assisted Closure for severe neck infection in poorly equipped conditions.

INTRODUCTION: Dental infections are common and are mainly due to dental caries. When left untreated, these infections can lead to severe life-threatening sepsis. CASE REPORT: The authors reported a case of a severe odontogenic deep neck space infection in a 54-year-old male. The patient was a heavy smoker with incidentally discovered diabetes. He was successfully treated by surgical drainage combined with an improvised Vacuum-Assisted Closure (VAC) system. The results of surgical drainage followed by insertion of an improvised VAC system were spectacular. The abscess resolved in response to dual-agent antibiotic therapy on day 17 and blood glucose control was achieved with insulin. Full-thickness skin graft was performed to repair the necrotic zone of the neck. DISCUSSION: The use of VAC can be a valuable alternative to conventional dressings and hyperbaric oxygen therapy in poorly equipped conditions. Public awareness campaigns remain the most effective form of prevention against these odontogenic infections.

Left parapharyngeal ectopic goitre associated with eutopic thyroid and postoperative Horner's syndrome.

INTRODUCTION: The authors report a case of left parapharyngeal ectopic goitre, in which resection was followed by postoperative Horner's syndrome, and describe the difficult management of this entity. CASE REPORT: A 25-year-old woman presented with upper oesophageal dysphagia and a well-demarcated left parapharyngeal mass displacing the great vessels laterally and posteriorly. The mass was resected via an exploratory neck incision. Histological examination of the operative specimen revealed hyperplastic thyroid parenchyma. The postoperative work-up revealed a eutopic and euthyroid thyroid gland. The postoperative course was marked by Horner's syndrome that persisted at 1-year follow-up. DISCUSSION: Parapharyngeal ectopic thyroid coexisting with a functional thyroid is extremely rare. Parapharyngeal masses are usually derived from the parotid gland and nerves. Surgery of the parapharyngeal space can cause injury to the sympathetic trunk, responsible for Horner's syndrome, as in our patient. CONCLUSION: Ectopic thyroid should be considered as a possible diagnosis of a parapharyngeal mass. Although rare, Horner's syndrome is a dreaded complication of surgery of the parapharyngeal space.

[Malignant parotid tumors: epidemiology in Togo]. / Tumeurs malignes de la parotide: épidémiologie au Togo.

INTRODUCTION: We had for aim to determine the epidemiological profile of malignant parotid tumors in sub-Saharan country: Togo. PATIENTS AND METHODS: We retrospectively studied the files of patients seen and treated for malignant parotid tumors, from January 1989 to December 31, 2008, at the Tokoin teaching hospital. Patients treated for another malignant tumor at the same time were excluded from the study. RESULT AND DISCUSSION: Ninety-six patients were included. Thirty-one tumors (32.29%) were malignant, in 18 male and 13 female patients with a sex ratio of 1.38. The average age was 39years (range 24-70years of age). Two patients could not undergo surgery. Histologically, there were 10 cases of squamous cell carcinoma (32.26%), 6 cases of adenoid cystic carcinoma (19.4%), 6 cases of adenocarcinoma (19.4%), 4 cases of carcinoma in pleomorphic adenoma (12.90%), 3 cases of mucoepidermoid carcinoma (9.7%), 1 case of acinar carcinoma (3.2%), and 1 case of cystadenocarcinoma (3.2%). DISCUSSION: Squamous cell carcinoma was the most frequent histological type observed in Togo, contrary to literature data for which mucoepidermoid carcinoma is the most frequent malignant parotid tumor.

A bulky dermoid cyst of the floor of the mouth.

INTRODUCTION: Bulky dermoid cysts of the floor of the mouth are very rare and may pose a problem of diagnosis. They also raise problems for the anesthesiologist and surgeon. We report the first case to be described in Togo. CASE REPORT: A 23-year-old man was admitted for a submental submandibular sublingual mass. It was soft, depressable, painless, without adenopathies, raising the tongue against the palate and creating a "second tongue-like" aspect. Resection on intra-oral route removed an intact cyst of 13cm long axis. Histology diagnosed dermoid cyst. DISCUSSION: Dermoid cysts of the floor of the mouth present as a submental sublingual mass, which may cause dyspnea and disorders of swallowing, chewing and/or vocal function. Differential diagnosis concerns sublingual, submental and cervical masses. Definitive diagnosis is founded on the histology specimen. Imaging may assist diagnosis. Intubation may be problematic. The resection approach may be intra-oral or cervical. CONCLUSION: Dermoid cysts of the floor of the mouth are rare. They may induce functional disorder. An intra-oral approach is preferable when possible.

Ossifying fibroma of the maxillary sinus at the Kara (Togo) Teaching Hospital.

INTRODUCTION: Ossifying fibroma of the jaw is a benign tumorous disease, somewhat rare and aggressive. It frequently targets the mandible, but seldom the maxillary. CASE STUDY: The present study reports the first case of left maxillary sinus fibroma treated at the Kara Teaching Hospital in North Togo. It occurred in a 29-year-old patient who experienced slow-growing tumefaction of the left maxillary sinus, resulting in deformation of the left side of the face in the maxillary region and ipsilateral nasal obstruction. Orthopantomography showed a displacement of teeth 21, 22, and 23 with an abnormal degree of opacity at the dental roots. The CT scan of the nose and sinuses revealed a tumorous lesion of expanding bony density increasing in volume at the outer wall of the left maxillary sinus, of regular shape that contained microscopic calcifications, extending into the ipsilateral orbital floor and pushing the surrounding soft tissues forward without invading them. The histopathological examination of the tumor confirmed the diagnosis of ossifying fibroma. DISCUSSION: Ossifying fibroma or fibrous osteoma is a rare and benign lesion developing insidiously with a polymorphous aspect. Of unknown etiology, most frequently located in the mandible, it is differentiated from other types of fibroma in its clinical, radiological, and histological aspects. However, only examination of the gross specimen can provide the final diagnosis. Treatment requires surgery. CONCLUSION: Surgical treatment entailed the complete macroscopic enucleoresection. Recovery has been favorable at 2 years of follow-up.

[Imflammatory myofibroblastic tumour of nose and paranasal sinuses in a little girl of 7-year-old]. / Tumeur myofibroblastique inflammatoire endonasale chez une fillette de 7 ans.

Inflammatory myofibroblastic tumours (IMTs) are clinical and pathological distinct entities with controversial biological entities. IMTs have been described in the lungs, abdomen, retroperitoneum and extremities but rarely in the head and neck region. This case report corresponds to an IMT of the nose and the paranasal sinuses in a little girl of 7 years of age. The computed tomography scan showed an expanding tumoral process without skull destruction. First case report in the west African region, this observation describes the treatment instituted according to the possible care in our medical area, and the treatment when the patient was referred to a centre with efficient technical platform. This case underlines the aggressiveness of this type of tumour: an invasive tumour with local-regional extension and high recurrence potential. Currently, after 2 years, the tumoral process is considered cured after several radical surgical excisions.

[Mandibular tumours: epidemology, diagnostic and therapeutic aspects concerning 91 cases]. / Tumeurs mandibulaires: aspects epidemiologiques, diagnostiques et therapeutiques a propos de 91 cas.

UNLABELLED: Oro-facial tumours are frequent and raise post-operational functional and aesthetic problems. What might be the situation of the mandibular tumours at CHU Tokoin-Lome (University Hospital Centre of Lome-Tokion). OBJECTIVES: The aim of this study was to determined epidemiological, diagnostic and therapeutic aspects concerning the mandibular tumours. METHOD: This retrospective study concerning 91 colligated files from January 1988 to December 2006 at the Oto-rhino-laryngologic and Cervico-Maxillo-Facial Surgery Service of the University Hospital Centre ( CHU) of Lome-Tokoin. The main inclusion criteria was the anatomopathological examination of the tumour. RESULTS: The mandibular tumours represented 19.95% of the Oto-rhino-laryngological and Cervico-Maxillo-Facial tumours. They were diagnosed with annual average of 5 cases. The most affected age bracket was one going from 10 to 39 years , or the equivalent of 68.13% of the patients. The spreading of these tumours in both sexes was equal. 80.21% of patients were examined after a development period going from 0 to 4 years. The major circumstances of findings were the mandibular tumefaction (98.9%) dental or mandibular pains (48.35%). The favourite seat of these mandibular tumours was the hemi mandible (48.35%). The odontologic tumours were the predominant histological types or the equivalent of 64.84% of the mandibular tumours. The benign forms were the most frequent (72.88%), the ameloblastoma in particular. The treatment was a surgical one. The partial resection of the mandibular bone was the surgical technique that was the most used (67.03%). The short-term development was preferred (69%). The long-term follow-up was difficult. CONCLUSION: The mandibular tumours were relatively frequent and predominated by the ameloblastoma. The findings circumstances were predominated by the mandibular tumefaction. The treatment was the preservative surgery as advocated by the majority of authors.

Tumeurs mandibulaires : aspects epidemiologiques; diagnostiques et therapeutiques a propos de 91 cas

Les tumeurs oro-faciales sont frequentes et posent des problemes fonctionnels et esthetiques post operatoires. Quelle pourrait etre la situation des tumeurs mandibulaires au CHU Tokoin de Lome ? Objectifs : Cette etude s'est fixee pour objectifs; de determiner les aspects epidemiologiques; diagnostiques et therapeutiques des tumeurs de la mandibule au Togo. Methodologie : Il s'est agi d'une etude retrospective sur 91 dossiers colliges de janvier 1988 a decembre 2006 au service d'Oto-rhino-laryngologie et de Chirurgie Cervico-Maxillo- Faciale du Centre Hospitalier Universitaire Tokoin de Lome. Le critere d'inclusion majeur a ete l'examen anatomopathologique de la tumeur. Resultats : Les tumeurs de la mandibule ont represente 19;95des tumeurs oto-rhinolaryngologiques et cervico maxillo faciales. Elles ont ete diagnostiquees avec une moyenne annuelle de 5 cas. La tranche d'age la plus touchee a ete celle de 10 a 39 ans soit 68;13des patients. La repartition de ces tumeurs dans les deux sexes a ete egale. 80;21des patients ont consulte apres une duree d'evolution allant de 0 a 4 ans. Les principales circonstances de decouverte ont ete la tumefaction mandibulaire (98;9) et la douleur dentaire ou mandibulaire (48;35). Le siege de predilection de ces tumeurs mandibulaires a ete l'hemi mandibule (48;35). Les tumeurs odontogenes ont ete les types histologiques predominants soit 64;84des tumeurs de la mandibule. Les formes benignes ont ete les plus frequentes (72;88); en particulier l'ameloblastome. Le traitement a ete chirurgical. La resection partielle de l'os mandibulaire a ete la technique chirurgicale la plus utilisee (67;03). L'evolution a court terme a ete favorable (69) ; le suivi a long terme a ete difficile. Conclusion : Les tumeurs de la mandibule ont ete relativement frequentes et dominees par l'ameloblastome. Les circonstances de decouverte sont dominees par la tumefaction mandibulaire. Le traitement a ete la chirurgie conservatrice comme le preconisent la plupart des auteurs

[Tumours of the accessory salivary glands. Epidemiological and anatomopathological aspects]. / Tumeurs des glandes salivaires accessoires. Aspects epidémiologiques et anatomopathologiques.

INTRODUCTION: Several series of studies on the tumours of the accessory salivary glands have shed light on their anatomopathological and epidemiological aspects in Western countries. Only a few studies of this kind have been carried out in our countries. OBJECTIVES: To study the anatomopathological and epidemiological aspects of the accessory salivary glands in order to compare the literature data. METHODOLOGY: This is an analytic, descriptive and retrospective study conducted over a period of 10 years at the ENT and the Anatomo-pathology Departments of the CHU in Lomé. RESULTS: Tumours of the salivary glands represented in our study 17.19% of the ORL tumours. Tumours of the accessory salivary glands represented 71.43% of tumours of the salivary glands. Benign tumours represented 71.43% and malignant tumours 21.43%. Women were more affected than men. The average age of appearance of benign tumours was 47.87 years for men and 31.91 year for women. The average age of appearance of malignant tumours was 38 years far the women. The commonest site was the palate. The majority of benign tumours were pleomorphic adenomas. Adenoid cystic carcinoma was the principal malignant tumor. CONCLUSION: Pleomorphic adenoma and adenoid cystic carcinoma were the principal tumours of the accessory salivary glands. The commonest site was the palate. Women were more affected than men. The average age of appearance of malignant tumours was seven years later than benign tumours. (full article translated in English available on www.ent-review.com).

[Malignant non-Hodgkin's lymphoma of the lip: a case report]. / Lymphome malin non-hodgkinien de la lèvre: à propos d'un cas.

The non Hodgkin's lymphoma of the lip is rare. A 3-year-old child with non-Hodgkin's lymphoma of the upper lip (stage I in the Ann Harbor system) was reported. An immunodeficiency, been in correspondence with a food deficiency, was probably a causal factor. A post-chemotherapy residual lesion justified a surgery.

[Partial laryngectomies at the University Hospital Center of Dakar]. / Laryngectomies partielles au Centre Hospitalier Universitaire de Dakar.

Our experience on partial laryngectomies stretched on a period of 16 years. In an unfavorable medical environment, we issue our indicative criteria throughout this experience. From January 1st 1981 to December, 31st 1996, 14 patients have had a partial laryngectomy in University Hospital Center of Dakar. The average year was 56 and the sex-ratio was 1 woman out of 13 men. There were 13 carcinomas and 1 cas of acute dysplasia. 4 patients have had vertical partial laryngectomy, 5 have had a horizontal partial laryngectomy and 5 a partial laryngectomy on the upper out of the cricoid cartilage with the ganglia. After a 3 years close look, on 10 patients, we noted that 1 died, 1 disappeared, and 8 still were living. Carcinological failures consisted in 3 development by stages and 1 cas of a 2nd localisation. As for as functional results, the removal of the nozzle and the elimination of the nasogastric grohe of supply, were effective for respective average allotted time of 11 and 12 days. This laryngeal partial surgery seem scarce in our practice (12% of the patient who have had it). The improvement of results go to the choice of indications, the information the formation and the acquisition of technical stools more efficient.

[Factors related to pathologies in the early neonatal period at the University Hospital Center of Lome (Togo)]. / Facteurs lies aux pathologies en periode neonatale precoce au CHU-Tokoin de Lome (Togo).

PIP: Early neonatal mortality is responsible for almost 75% of overall neonatal mortality in West Africa. In a prospective study of 3174 live births, the authors examined the pathologies diagnosed in newborns aged 0-7 days admitted to the Neonatology Unit of Tokoin Hospital in Lome, explored the factors associated with these pathologies, and studied their hospital evolution. The study was conducted over a 6-month period from early February to the end of July 1996. 250 subjects were included in the study. Infection (36.4%), cerebral disturbance (19.6%), prematurity (16.4%), respiratory difficulties (7.6%), and hemorrhagic disease (4.8%) were the main pathologies observed during the early neonatal period, affecting 84.8% of all subjects. The overall death rate was 52.8%, of which 64.4% died during the first 48 hours of hospitalization. Neonatal and maternal factors associated with these pathologies are discussed. The main factors linked to these pathologies during the early neonatal period are the condition of young primiparous women, the low socioeconomic level of the mothers, poor pregnancy management, and the poor perinatal environment.^ieng

[Our experience of carcinoma of the larynx in Togo]. / Notre expérience du cancer du larynx au Togo.

This is a retrospective study of 33 patients with squamous cell carcinoma of the larynx from the end ward at Tokoin Teaching Hospital in Lomé. This series is from 1981 and 1995 (1 T1, 6 T2, 15 T3, 11 T4). This is an uncommon cancer. No etiological factors were identified. The high proportion requiring emergency tracheotomy (36.36%) and of T3-T4 cases (78.78%) are explained by the long delay before the first medical visit. Only 13 patients (36.36%) had a total laryngectomy. The prognosis was unfavourable.

[Cancers of the larynx: what therapeutic strategy to use in Senegal?]. / Cancers du larynx: quelle stratégie thérapeutique au Sénégal?

The technical method's deficiency limits the respect of therapeutic principles of cervico-facial oncology in our practice. In a period of 16 years, 116 patients, aged of 24 to 81 years, sex male in a majority have had laryngectomy for extended cancer. In 88% of cases total laryngectomy has been realized and in 12% of cases a partial laryngectomy has been realized. In 101 patients, 87%, a neck dissection have been associated to the laryngectomy. The post operative radiotherapy have been realized in 51 patients. The immediate results are marked by the unexpected arrival of pharyngeal fistula in 34 patients. 7 cases of death have been noticed. The global survival have been 35% in 3 years and 30% in 5 years. The fatal cases have been loco-regional cases and occur during the 18 first months. The surgery option, which is our choice, must be maintained and the neck dissection more vigorous.

Peripheral facial paralysis (PFP) and HIV infection in Togo.

OBJECTIVES: The purpose of this study was to determine the seroprevalence of HIV in a group of 150 patients with PFP and to study the semiological and evolutive aspect of PFP in patients with or without HIV. MATERIAL AND METHODS: This semilongitudinal study was conducted during 6 years (1990-1995) at the Lomé teaching hospital. Patients consulting for PFP had the HIV test and regular controls. RESULTS: The HIV seroprevalence was 52%. The average age was 31.4+/-8.81 years There was no difference on clinical features between patients with or without HIV infection. Cerebrospinal fluid was normal in patients without HIV infection, but it showed pleiocytosis in patients with HIV infection (87.88%). Of the HIV carriers 14% presented a recurrence. A total of 26.32% of the patients screened in 1990 developed AIDS when followed up. CONCLUSION: Peripheral facial paralysis is frequently associated to HIV infection. An HIV test must be proposed to all patients with PFP in Africa.

[Foreign bodies of the esophagus: etiologic and therapeutic aspects. Experience at the CHU of Lomé (Togo)]. / Corps étrangers oesophagiens: aperçu étiologique et thérapeutique. Expérience du CHU de Lomé (Togo).

AIM: To give details of the management of esophageal foreign bodies (EFB) at our hospital. DESIGN: Retrospective case review. SETTING: ENT ward of Tokoin Teaching Hospital, Lome, Togo. PATIENTS: All 105 patients admitted to the hospital for ingestion of foreign bodies between January 1990 and December 1993. The outcome for each patient was determined by examining hospital records of demographic information, identification of the foreign body and the removal procedure used. RESULTS: EFBs accounted for 6.5% of all hospital admissions. The objects ingested included coins (59.0% of cases), particularly in 2 to 5 year-old children, fish bones (12.4%), meatballs, meat bones and dentures, particularly in adults. The foreign objects were mostly removed by esophagoscopy, but sharp objects required esophagotomy (2.9%). One patient died (0.9% of cases) due to mediastinitis caused by perforation of the esophagus by a chicken bone. CONCLUSION: Community health education programs, increasing awareness of household accidents might reduce the number of emergency hospital admissions for ingestion of foreign bodies.

[Tracheotomy: review of five years at the University Hospital of Lome, Togo]. / Trachéotomie: bilan de cinq ans au Centre Hospitalier Universitaire de Lomé, Togo.

From a review of 37 cases, this retrospective study relates the activity of the Otorhinolaryngology service at the University Hospital Center of Lomé, as regards tracheostomy. It details: - a high rate of urgent tracheostomy (76%) for laryngeal carcinoma and papillomatosis; - a high rate of complication (29%) and death (5%). This is due to the urgency of tracheostomies, unsuitable cannulae, irregular nursing and prolonged cannula carrying. A better technique and rigorous supervision could reduce these complications.

[Sinus mucoceles. Apropos of 5 cases]. / Mucocèles sinusiennes. A propos de 5 observations.

Our retrospective study of 5 cases of sinus mucocele confirmed its rarity and occurrence at any age. This uncommon disease might be due to an association of inflammation, ostium closure and hypersecretion. The volume of the fronto-ethmoidal mucocele let us operate on patients either by orbito-superciliary route or through the frontal scalp. Functional endoscopic surgery, presently suggested for mucocele treatment, was not used because of our lack of experience in this surgical method.