[Paranasal sinus mucoceles: About 32 cases]. / Les mucocèles naso-sinusiennes: à propos de 32 cas.

INTRODUCTION: Mucocele is a pseudo-cystic tumor of the paranasal sinuses. Despite its benign histological nature, it is aggressive towards neighboring structures (orbit and brain). Our aim was to study the epidemiological, clinical, therapeutic, and evolution aspects of this pathology. PATIENT AND METHODS: We conducted a retrospective study over a period of 9 years on 32 patients operated on and followed for mucocele in our department. RESULTS: Mean age was 43.28 years with a sex ratio to 1. Mucoceles were located in the fronto-ethmoid sinus (27 cases), the maxillary sinus (3 cases) and the sphenoid sinus (2 cases). The most common symptoms were periorbital swelling and exophthalmia. CT scan confirmed the diagnosis in the majority of cases. MRI was performed in 3 patients. Surgery consisted in a large marsupialization by endonasal approach in 30 cases, and by a combined approach in two cases. A recurrence was observed in two patients after a mean period of 18 months. DISCUSSION: Mucocele is a benign and expansive pseudo-cystic tumor, affecting mostly adults and developing in the paranasal sinuses. Clinical symptoms are not specific. It may reveal itself by ophthalmic or intracranial complications. Diagnosis is based on imaging (CT and MRI). Endonasal surgery has become the gold standard for the treatment of mucoceles and is endowed with low morbidity.

[Persistent otorrhea revealing a foreign body of the middle ear]. / Otorrhée persistante révélant un corps étranger de l'oreille moyenne.

OBJECTIVES: To report a rare clinical case of chronic otitis media due to an unknown foreign body in the middle ear and a literature review. PATIENT AND METHODS: A 14-year-old girl who had persistent otorrhea associated with hearing loss for two years. The clinical and CT scan exploration found an unknown foreign body in the middle ear. Extraction was performed by retroauricular surgery, complemented by myringoplasty. RESULTS: After two months of follow-up, the patient was free of symptoms. Otoscopy discovered an intact neotympanum. The follow-up audiogram was normal. CONCLUSIONS: Penetrating foreign bodies in the middle ear are infrequently encountered in practice in ear, nose, and throat pediatric emergencies. They may go unnoticed and be revealed by locoregional complications later, hence the importance of suggesting this diagnosis.

[Unusual location of pleomorphic adenoma: A series of 7 cases]. / Adénome pléomorphe à localisation inhabituelle: à propos d'une série de sept cas.

INTRODUCTION: The pleomorphic adenoma is a benign tumor of the salivary glands. Its location outside the main salivary glands defines the pleomorphic adenoma of atypical location. The aim of this study is to analyze the clinical, diagnostical and therapeutical features of this tumor at atypical locations through seven observations. PATIENTS AND METHODS: This work is a retrospective study. It has for objective to present 7 cases of pleomorphic adenoma developed on minor salivary glands diagnosed in Otolaryngology Head and Neck surgery department in Mohammed VI University hospital, between December 2003 and December 2010. RESULTS: We had 3 cases of pleomorphic adenoma of the hard palate and 1 case of each soft palate, superior lip, lower eyelid and nasal septum. The sex ratio woman/ man was 133. The symptomatology was variable according to the location of the tumor. The tumoral syndrome was constant. The diagnosis of pleomorphic adenoma was suspected at the clinical stage in 3 cases of palatal location. The CT scan was performed for all patients except in 2 cases of the tumor of the lip and the eyelid. We did not realize a magnetic resonance imaging nor of a fine needle aspiration to our patients. The preoperative biopsy was realized to 5 patients. The treatment consisted of a wide surgical excision of the tumor. The mean follow up of 3 years showed no signs of recurrence nor of malignant transformation. DISCUSSION/CONCLUSION: The pleomorphic adenoma of atypical location is rare. The clinical presentation is variable according to the tumor site and volume. The treatment is surgical. It is based on the early and complete excision of the tumor. The histo-pathological diagnosis is made. The diagnosis differential is with malignant tumors arising on minor salivary glands. The prognosis is favorable. Nevertheless, regular and prolonged follow-up of the patients is important to watch for complications.

Bilateral facial nerve schwannoma: A case report.

Facial nerve schwannoma (FNS) is an uncommon disease, bilateral FNS are exceptional. We describe a case of a 23-year-old man who presented a bilateral 3rd segment facial nerve schwannoma, without neurofibromatosis disease. We discuss the clinical presentation, radiologic findings and management of this case. Facial nerve schwannoma can present in various ways. The imaging appearance of FNS is more varied than originally described. Our case demonstrates an uncommon presentation of a relatively rare tumor in which the tumor has been respected. During this time, the tumor may be followed by radiologic imaging.

[Acute miliary tuberculosis or Isambert disease: a case report]. / Miliaire tuberculeuse aiguë du pharynx ou maladie d'Isambert : à propos d'un cas.

Pharynx tuberculosis consists in a set of active lesions in granulomatous-type mucosa, resulting from Mycobacterium tuberculosis infection. In an endemic context, this diagnosis should be raised in cases of head and neck disease. A recent observation of a case of acute miliary tuberculosis gave us the opportunity to conduct a literature review of this disorder. This 9-year-old girl presented with dysphagia associated with pharyngeal discomfort, snoring, and hoarseness lasting for 8 months. This pharyngeal syndrome occurred in the context of an impaired general condition. Clinical examination found a diffuse mucosal granulation aspect in the oropharynx. The workup showed an inflammatory syndrome with a strong positive intradermal tuberculin reaction. The biopsy found an aspect of giant cell granuloma with caseous necrosis. The course was favorable on antituberculous chemotherapy. Tuberculosis is a chronic bacterial infection caused by a bacterium belonging to the M. tuberculosis complex. Pharyngeal tuberculosis remains a rare disease, but several epidemiological parameters show an upsurge of this disease, prompting us to report this observation.

Capillary hemangioma of the middle ear: one case report and review of the literature.

Hemangiomas are rare benign vascular tumors; there are several types including the capillary hemangiomas, we present the case of an exceptional localization of capillary hemangioma in the middle ear. We report the case of a 60-year-old female which consults for episodes of pulsatile tinnitus, otorragies, and hearing loss of the left ear. The clinical examination revealed a reddish polypoid mass in the left external auditory canal, the radiological tests showed a vascular mass in the middle left ear. The tumor was surgically removed, the histological study revealed a capillary hemangioma. The incidence of hemangiomas in the temporal bone, especially in the middle ear, is exceptional. Medical imaging guides to the vascular nature of these tumors that make confusion with other vascular tumors such as tympanic paragangliomas. The management is often surgical and the final diagnosis is histological.

[Capillary-cavernous hemangioma of the nasal septum]. / Hémangiome capillaire caverneux du septum nasal.

INTRODUCTION: Hemangioma are rare benign vascular tumors. Histologically, there are several types including capillary, cavernous and mixed hemangioma. We present a very rare mixed hemangioma of the nasal septum. CASE REPORT: A 30-year-old woman consulted for unilateral epistaxis and nasal obstruction. CT scan revealed a tumor filling the rhinopharynx, strongly enhanced after injection of contrast medium. It was pedicled on the posterior and superior nasal septum. Arteriography revealed a vascular blush. Tumor exeresis was performed by paralateronasal approach and endoscopic surgery. The histological examination identified a mixed hemangioma. DISCUSSION: Capillary and cavernous hemangiomas are rare and benign vascular tumors developing in the skin and subcutaneous tissues of the head and neck, and/or oral and nasal mucosa. No mixed hemangioma exclusively involving the nasal septum had been previously reported. Complete surgical resection is the treatment of choice, providing a favorable prognosis with low risk of recurrence.

[A giant lipoma of parapharyngeal space in a child]. / Un volumineux lipome de l'espace parapharyng chez un enfant.

INTRODUCTION: Tumors of the parapharyngeal space are rare and composing a wide variety of histological types. The aim of this study was to report a case of giant parapharyngeal lipoma in a child and to present clinical, paraclinical, and treatment aspects. CASE REPORT: A 14-year-old child presented with a painless progressive mass on the right side of the upper neck. It was growing asymptomatically since 2 years. Cervical CT-scan and MR showed a low-density mass in the right parapharyngeal, consistent with a mass of adipose tissue origin. The mass was surgically removed via cervical-parotid approach. The fatty mass was completely excised. Histopathology confirmed it to be a lipoma. The patient has been followed up for three years, and there have been no signs of recurrence. CONCLUSION: Diagnostic orientation in parapharyngeals tumors is necessary for better care. This guidance is being facilitated through imaging advances. Their surgical approaches and complete excision depend on volumes, localizations and their proximity to neurovascular structures.

Retropharyngeal abscess in adults: five case reports and review of the literature.

Retropharyngeal abscesses are rare in adults. They occur mostly in immunocompromised patients or as a foreign body complication. We report 5 cases of retropharyngeal abscess collected in the ENT Department of CHU Mohammed VI of Marrakech, during a two-year period (December 2008 to December 2009). Local trauma by foreign body ingestion was the aetiology in four patients. The presenting symptoms, for all patients, were fever, odynophagia, torticollis, and trismus, and the clinical examination showed bulging of the posterior wall of the oropharynx. The radiography of cervical spine showed prevertebral thickening in all cases, this thickening was associated with an aspect of vertebral lysis of the fourth cervical vertebra in one case. A CT scan was performed in all our cases and showed features of retropharyngeal abscess which was associated, in one case, with spondylodiscitis. The biological assessment found one case of diabetes. The intradermal reaction to the tuberculin was clearly positive in one case. Endobuccal abscess puncture was practiced in 4 cases; only one organism was identified by culture: Staphylococcus aureus treatment was based on triple intravenous antibiotics and anti-Koch's therapy (in one case), and the surgical drainage under general anesthesia was also performed in the case of the diabetes patient which required also the correction of hyperglycemia in intensive care unit. The outcome was good in all our patients. The diagnosis of retropharyngeal abscess can be difficult and one must seek a comorbidity; a tuberculosis aetiology must be considered in countries with a high prevalence. The management of these cases is based on antibiotics and surgical drainage.

Congenital internal jugular phlebectasia.

INTRODUCTION: Congenital internal jugular phlebectasia corresponds to congenital dilatation of the vein without tortuosity. More than one hundred cases of phlebectasia involving the neck veins have been reported in the literature. The authors describe the clinical features, treatment and outcome of this anomaly. CASE REPORT: A six-year-old child with no particular past medical history presented with a two-year history of progressively enlarging mass on the right side of the neck. Physical examination revealed a non-pulsatile mass that was increased in size by all manoeuvres increasing intrathoracic pressure. Neck computed tomography confirmed the diagnosis of internal jugular vein phlebectasia. In the absence of complications, simple surveillance was advised with a follow-up of 20 months with no complications. DISCUSSION/CONCLUSION: Congenital internal jugular phlebectasia is a rare condition. Management must include imaging to confirm the diagnosis. Long-term surveillance is recommended and surgery is only required in the presence of complications.

[Tuberculosis of the parotid gland]. / La tuberculose de la glande parotide.

INTRODUCTION: Tuberculosis of the parotid gland is a rare entity, and the preoperative diagnosis is difficult as the symptomatology is nonspecific. The most cases reported in the literature were diagnosed on histological evaluation of parotidectomy specimen. OBSERVATION: We report a case of a three year old child without a history of tuberculosis, who presented with an isolated parotid mass for three months. Physical examination and ultrasonography suggested a benign tumour. Biological findings were unremarkable. The patient underwent superficial parotidectomy with preservation of the facial nerve, and the diagnosis of tuberculosis was made by histopathological study of the specimen. Antituberculosis treatment was given for six months. The postoperative course was uneventful. DISCUSSION-CONCLUSION: This case highlights that tuberculosis of the parotid gland must be kept in mind in the differential diagnosis of parotid swellings, in order to avoid parotidectomy, in a medically treatable condition.

[Cervical cystic lymphangioma in children]. / Lymphangiomes kystiques cervicaux chez l'enfant.

INTRODUCTION: Cervical cystic lymphangioma are rare and benign, but the prognosis can be serious in terms of its development and management. OBJECTIVES: To describe the epidemiological, clinical and therapeutic characteristics. MATERIALS AND METHODS: A retrospective study of eight cases. RESULTS: The mean age was 7 years, with a slight female predominance. Ultrasound scanning was sufficient to establish the diagnosis. CT scan or MRI scan was used if parapharyngeal or a mediastinal extension was suspected. All patients in this series underwent surgical excision. There were no postoperative complications or recurrence at one year post-surgery. DISCUSSION: These lesions present as soft compressible cervical swellings of variable size. Radiological imaging (CT, MRI) aid diagnosis and demonstrate extent, however final diagnosis is made by histopathological examination. The treatment of choice is surgical excision. Another option is the use of sclerosing agents. These are used by some surgeons as a first line treatment and also for surgical recurrence.