Primary carcinoma of the larynx in females: A case series.

Background and aim: In north Africa, laryngeal carcinomas remain a predominately male pathology. While in many countries the gap between men and women is narrowing. This study aimed to examine the epidemiological, clinical, therapeutic, and follow up data of a case series of 23 female patients treated for laryngeal carcinoma. Patients and methods: Medical records of a case series of 23 patients for primary carcinoma of the larynx at the Department of Head and Neck Surgery of the 20 August Hospital of Casablanca, between January 2012 and September 2016, were reviewed. Demographic, clinical, endoscopic, radiological, surgical, and follow-up data were collected. Results: 7% of all the patients treated for LC were women, The most affected age group was between 60 and 79 years (52%), 52% had no major risk factor, all patients had an epidermoid carcinoma, 48% of patients had T2 tumors. T1, T3, and T4a were found in respectively 17%, 22%, and 13%. N1 in 43% of the cases (n = 10), N0 in 35% (n = 8), N2b in 17% (n = 4), N2c in 4% (n = 1). All patients were M0. All the patients in this series have undergone surgical treatment. At 5 years, the survival rate was 83%. Conclusion: Since the proportions of women in published studies are limited, there are still many controversies about gender differences in laryngeal cancer. Therefore, further studies should seek a clearer understanding of factors involved in female laryngeal cancer to adopt more appropriately the measures of prevention and early diagnosis.

Cervical approach to cervico-mediastinal goiters: Experience of a Moroccan ENT tertiary center - Case series.

BACKGROUND: The purpose of the study was to analyze and discuss the demographic, clinical, radiological, therapeutic and postoperative findings of the Cervico-mediastinal goiters (CMG) treated through a cervical approach admitted in the ENT department of Ibn Rochd university hospital, Casablanca, Morocco between January 2014 and January 2020. MATERIELS AND METHODS: Over a period of 6 years, 116 patients underwent surgical treatment for CMG. It was defined as a goiter extending below the plane of superior thoracic aperture on CT scan. All our patients had clinical, biological and radiological assessment before surgery. A nasofibroscopy was carried out pre and postoperatively. All the CMG have been extracted trough a cervical approach by an experimented ENT surgeon. RESULTS: 84,48% of the CMG was diving into the anterior mediastinum and 15.52% into the posterior. The CMGs extended above, at, and below the level of the aortic arch respectively in 76.72%, 18.10% and 5.17% of the patients. All of 116 goiters were successfully removed through a cervical approach. No patient required a sternotomy. Postoperatively, vocal cord paralysis was transient in 3 patients (2.58%) and permanent in 2 patients (1.72%). Hypocalcemia was transient in 10 patients (8.62%) and permanent in 2 patients (1.72%). Final histology found 106 benign multinodular goiters (91.37%), 7 papillary carcinomas (6.03%) and 3 vesicular carcinomas (2.58%). No death was noted. CONCLUSIONS: With expertise in thyroid surgery, cervical approach for CMGs is safe and sufficient in the majority of the cases with low morbidity rate and no mortality.

Locally advanced maxillary sinus carcinoma controlled by para-latero-nasal approach.

Sino-nasal cancers are a rare pathology, with an incidence of 0.2-0.8% of all cancers, and less than 5% of ENT cancers. The site that is most often affected is the maxillary sinus in 35% of cases, followed by ethmoid sinus (30%) and of the nasal cavity in (16%). Several histological variants are described, but squamous cell carcinoma remains the most frequent in the maxillary sinus. Its diagnosis is often late making local control very difficult. Multimodal treatment allows an improvement in the survival rate compared to single treatment. Due to the progress of endoscopic surgery, external surgery is neglected. With this work we want to highlight the value to the external approach, especially in advanced cases.

Malignant tumors of the hard palate: Report of 4 cases and review of the literature.

INTRODUCTION: Cancer of the hard palate is a fairly rare malignant tumor. Different histological types have been described in the hard palate, and that can affect its different structures. Diagnosis is based on biopsy with histological examination and possibly on immunohistochemical markers to confirm the diagnosis and exclude other diagnostic hypotheses. The aim of this study was to determine histopathologic, clinical and therapeutic characteristics of malignant tumors of the hard palate. PATIENTS AND METHODS: A retrospective review of 4 patients who underwent Surgical resection by trans oral approach was performed for different histological types of malignant tumors of the hard palate. These included squamous cell carcinoma (case1 and case 2), mucosal melanoma (case 3), and adenocarcinoma (case 4). RESULTS: The T stage was analyzed for all cases. Two cases were classified as T2 stage with a tumor size between 2 and 4 cm and the two others, given the extension to the maxillary and nasal cavity were classified as T4a. Cervical lymph node metastasis was found in three patients. DISCUSSION: Surgical resection is the treatment of choice for malignant tumors of the hard palate. There is a variety of surgical procedures that can be used via a trans oral approach. Reconstruction of palatal defects with a prosthesis is sufficient, whereas larger defects will require a local, regional or even microvascular free tissue flap. The differences between these surgical techniques are presented, and indications are discussed. CONCLUSION: The therapeutic management for malignant tumors of the hard palate is essentially surgical, with or without postoperative radiotherapy, discussed on a case-by-case basis. Survival rate depends on several factors, including early diagnosis, histological characteristic and appropriate management.

Spindle cell hemangioma in the infratemporal fossa: A unique case report.

INTRODUCTION: Spindle cell hemangioma (SCH) is a rare vascular tumor which was first described in 1986. It affects mostly the distal extremities. The head and neck are rarely involved. This article reports the first case of SCH in the infratemporal fossa. PRESENTATION OF CASE: A 41-year-old woman presented with an 8-month history of right cheek swelling. Facial CT scan and MRI showed an intensely and heterogeneously enhancing tumor of the infratemporal fossa suggesting an angiomatous neoplasm. The mass was excised surgically through an anterior maxillary approach. The histopathological and immunohistochemistry analysis revealed a SCH. CONCLUSION: This case report presents a unique presentation of a Spindle cell hemangioma in an unexpected location of the head and neck region. it underlines the importance for clinicians and pathologists to consider the Spindle cell hemangioma as a possible etiological diagnosis of infratemporal fossa tumors.

Quality of life assessment in patients treated with nasal corticotherapy for allergic rhinitis: A cohort study.

INTRODUCTION: Allergic rhinitis (AR) is a chronic nasal pathology induced by an inflammation of the mucous membranes due to a dependent IgE reaction following allergenic exposure. The main symptoms are rhinorrhea, nasal itching, nasal obstruction and sneezing bursts. It highly affects the patient quality of life (QoL) in many levels making it a public health issue.The aim of this study is to assess the QoL of patients with AR as well as the level of its improvement after nasal corticotherapy. MATERIALS AND METHODS: From June 2019 to February 2020, a prospective study was carried out based on the use of the validated Arabic version of the RQLQ (Rhinoconjunctivitis Quality of Life Questionnaire) on a cohort of AR patients to measure their QoL before and after three months of treatment by "Budesonide". RESULTS: A total of 70 patients participated in the study with an average age of 39.54 years with a sex ratio of 0.60. Their total RQLQ score was up to 4.28, improved to 2.35 after treatment. Also, a statistically significant improvement in sub-scores was also observed (p < 0.001): activities (from 4.43 to 2.29), nasal symptoms (from 5.00 to 2.80), eye symptoms (from 3.38 to 1.80), practical problems (from 4.29 to 2.18), general problems (from 4.63 to 2.78) and emotional state (from 4.28 to 2.43). CONCLUSION: The RQLQ is a reliable tool to evaluate the QoL in AR patients, stating the negative influence of AR on patients daily life and the effectiveness of nasal corticosteroid treatment.

Simultaneous bilateral traumatic facial palsy with different treatment protocols.

INTRODUCTION: Bilateral simultaneous facial palsy is a rare clinical entity. Traumatic origin is even rarer. Long-term sequelae are disabling. Therefore, rapid and adequate management is crucial. CASE PRESENTATION: Herein we present a case report of a traumatic bilateral facial palsy in a 43 years old male treated with surgery in one side and conservative treatment in the other side. He achieved eye closure at his 10 months follow up. DISCUSSION: Electroneurography showing more than 90 % of facial nerve degeneration and electromyography revealing no regeneration potentials are identified as surgical indications. The perigeniculate region is the most commonly injured portion of the facial nerve with temporal bone fractures. Surgical approach to this area remains controversial; transmastoid, middle fossa craniotomy or a combination of both. CONCLUSION: It is important to discuss expectations with the patient as it might take 12 months to regain maximal nerve function.

Thyroid papillary carcinoma with an insular component metastasizing to the sella turcica and sphenoid sinus: Case report.

INTRODUCTION: Papillary carcinoma accounts for approximately 80% of all thyroid carcinomas. It is associated with relatively good survival. Distant metastases occur in approximately 10% of the patients, with the lung and bone being the most commonly reported sites. We present a case of unusual metastasis to the sphenoid bone and sella turcica from papillary thyroid carcinoma with an insular component. CASE PRESENTATION: We present a case of 70 years old female patient who presents a voluminous goiter with an 11 cm mass of the left sixth rib. Trans-parietal biopsy proved its metastatic origin from a thyroid papillary carcinoma. The patient was treated with total thyroidectomy and radiation therapy as the metastatic tissue is radioiodine refractory. Pathology revealed a papillary carcinoma with an insular component. A year later, the patient develops another metastasis to the sphenoid bone extending to the sella turcica, cavernous sinus, and carotid arteries. Treatment was based on kinase inhibitor. DISCUSSION: Metastatic invasion of the skull develops in 2.5%-5.8% of differentiated thyroid carcinoma and mostly affects the sella turcica, pituitary gland, cavernous sinus and sphenoid sinus. The presence of an insular component in a well-differentiated thyroid carcinoma seems to be associated with a poor prognosis. For cases where the metastatic disease is found to be resistant to conventional therapies, some clinical trials show promise with the use of tyrosine kinase inhibitors such as Sorafenib. CONCLUSION: Management of such uncommon cases remains challenging and should take in consideration evidence based guidelines, prognostic factors, disease progression path and treatment morbidity.

Carcinome adénoïde kystique de la fosse nasale : à propos d'un cas et revue de littérature

Parmi les tumeurs de la tête et du cou, le carcinome adénoïde kystique ne représenteque 1%. C'est la tumeur maligne la plus fréquente des glandes salivaires accessoires.Sa localisation dans la fosse nasale est exceptionnelle. Nous rapportons un cas de carcinome adénoïde kystique de la fosse nasale chez une patiente de 42 ans qui se présente pour une symptomatologie nasale. La tomodensitométrie objective un processus tissulaire de la fosse nasale droite, l'endoscopie montre une tumeur s'étendant au vestibule avec à la biopsie un carcinome adénoïde kystique. La prise en charge chirurgicale a consisté en une exérèse de la tumeur avec maxillectomie totale suivie d'une radiothérapie

Uncommon presentation of orbital schwanomma: A case report.

INTRODUCTION: Schwannomas are well-differentiated solitary benign tumors that originate from the schwann cells of the nerve sheath, constitute 1-8% of all head and neck tumors and 1-4% of the orbital tumors. SUMMARY OF THE CLINICAL CASE: A 57-year-old female patient visited our department, because she has a blindness of the right eye associated with an irreducible exophthalmia classified grade III, 4 years ago. Radiological exploration showed a mass in the orbital cone in relation to a probable optic nerve schwannoma confirmed by biopsy. The affected eye was exenterated because of delayed diagnosis. DISCUSSION AND CONCLUSION: In this review we discuss the pertinent clinical findings of this rare lesion and review the literature relative to optic nerve and solitary orbital schwannomas and insist that aggressive surgery with total mass removal should be warned by early diagnosis.

Histoplasma capsulatum sinusitis: Possible way of revelation to the disseminated form of histoplasmosis in HIV patients: Case report and literature review.

INTRODUCTION: Histoplasma capsulatum is rarely found in nose and sinuses in immunocompetent and even in immunosupressed patients. A literature review revealed rare cases of H. capsulatum sinusitis and the case we describe in this paper is the first case of H. capsulatum sinusitis in Morocco. The purpose of our work is to present a rare case of H. capsulatum sinusitis and a literature review. CASE REPORT: A male patient, at his 39 presented to the emergency with suffered from nasal congestion and yellow postnasal rhinorrhea, occasional headaches and epistaxis for over than two months. He had human immunodeficiency virus (HIV) infection for 6 years with failing treatment adherence and he had an opportunistic infection and unconfirmed pulmonary tuberculosis treated 3 years ago. Computerized tomography from paranasal sinus revealed complete opacification of the ethmoid-maxillary sinuses in the right fossa, consistent with acute sinusitis. The cultures of the sinus aspirate, skin biopsy, were positive for H. capsulatum and the histology of the nasal mucosa and skin biopsy specimen of the rash evoking a sinusitis and cutaneous histoplasmosis. The patient was started a treatment with intravenous amphotericin B at a rate of 1 mg/kg/day with clear clinical and biological improvement. DISCUSSION: Cultures and histopathologic study confirm histoplasmosis. Itraconazole and amphotericin B are the first line drugs. CONCLUSION: Patients with progressive disseminated histoplasmosis and those with AIDS should be treated with amphotericin B, and the ENT should suspect of opportunistic agents in immunosupressed patients with sinusitis.

[Prevention and treatment of mucositis in children with oral cancers: Practical recommendations]. / Actualités de la prévention et du traitement des mucites orales chez les enfants cancéreux : recommandations pratiques.

Oral mucositis is an inflammation of the mucosa of the oral cavity of various etiologies. This is a common and debilitating complication in children treated with chemoradiotherapy for cancer. Its management remains a major concern both for the doctor than the patient. It affects the quality of life of patients and families. It may initiate the functional and vital prognosis because of the judgment of cancer treatment. Several treatment options are available, but there is no clear consensus therapeutic especially for the pediatric population. We have identified, through a comprehensive literature search indexed publications on this subject in order to review the pharmacological and non-pharmacological approaches that have been used to prevent and treat oral mucositis. Thus, current recommendations for the management of oral mucositis are very limited, and therefore the standard of care for this complication was palliative. In recent years several studies have revealed that the use of low-energy laser was particularly interesting in the prevention and treatment of radiation-induced or chemically induced mucositis. It significantly reduces the pain, the severity and duration of the ulcer by promoting wound healing. Randomized controlled trials with a large number of patients are expected to establish preventive and therapeutic protocols. Treatment with low power laser, known devoid of side effects, is a very promising oncology care to support radio-induced mucositis and chemotherapy.

Angiosarcoma of the auricle.

INTRODUCTION: Angiosarcomas are rare but aggressive vascular cancers of endothelial cell origin. The diagnosis is often difficult, based on specific immunohistological features. They characteristically present a high local recurrence rate and an early metastatic potential. CASE REPORT: We report a case of angiosarcoma of the auricle in a 31-year-old female patient who presented with swelling of the left ear for 3 years. Histological examination demonstrated angiosarcoma. Treatment consisted of surgery followed by postoperative radiotherapy. DISCUSSION: This case report describes the epidemiological and clinical profile and the treatment and outcome of angiosarcoma of the auricle, together with a review of the literature, demonstrating certain diagnostic and therapeutic difficulties in the management of this aggressive tumour.

Uncommon situation and presentation of chronic sclerosing sialadenitis.

Chronic sclerosing sialadenitis of the parotid gland is a very uncommon chronic inflammatory salivary gland disease. Clinically, it presents as a slow-growing painful. Histologically, it showed a chronic inflammation and fibrosis. This case report highlights the clinical, radiological and histological aspects of this disease. We report unusual case of chronic sclerosing sialadenitis of the parotid in a 12-year-old man. CT detected a mass of tissue density in the right parotid. The evolution was marked by spontaneous fistula allowing a surgical biopsy. The mass regressed after corticosteroids. The follow-up was normal. The location, age and presentation make our case very interesting.

[Head and neck localizations of hydatid cyst: A series of 17 cases]. / Localisations cervico-faciales du kyste hydatique : série de 17 cas.

INTRODUCTION: Head and neck localizations of hydatid cyst are very rare (1% of human cases) even in countries where echinococcosis is endemic (human sites). Our objective was to report the epidemiological, and clinical characteristics and the management of head and neck localizations of hydatid cyst. MATERIALS AND METHODS: A retrospective descriptive study of 17 cases of head and neck hydatid cysts taken in charge in our department between 2000 and 2014 was conducted. RESULTS: The mean age was 35 years. Male were slightly predominant (sex ratio: 1.12). Eighty-eight percent of the patients had regular contact with dogs and 53% were of rural origin. The soft tissues of the head and neck were involved in six patients, the parotid gland in 6 patients, the thyroid in 4 patients and the submaxillary gland in one patient. Complete surgical resection of the lesions was systematically done. Hydatid disease was confirmed in all the cases by histology. The outcome was uneventful in all the patients with a mean follow-up of 2 years. CONCLUSION: Given the lack of recommendations for the surgical treatment of head and neck hydatid cysts, we advocate a total resection of the affected organ if there is no functional risk. Otherwise, an excision of the cyst and of the surrounding tissues combined with an abundant washing-out of the residual cavity must be done, especially in case of intraoperative breaking of the cyst.

Substernal goiter: Experience with 50 cases.

INTRODUCTION: Goiter is localized or generalized thyroid hypertrophy. It is usually cervical, but may show intra-thoracic development beyond the thoracic inlet and down to the mediastinum: i.e., substernal goiter. The purpose of this study was to analyze the epidemiological, clinical and paraclinical profile of substernal goiter and the difficulties of management. MATERIAL AND METHODS: A retrospective study included 50 cases from our ENT department. RESULTS: Mean age was 47 years, with a sex ratio of 0.06. Clinical symptomatology was dominated by medial anterior cervical swelling. Compression signs were observed in 26 patients, and cervical lymph nodes in 3. Mean time to consultation was 7 years. Fiberoptic endoscopy found vocal cord palsy in 3 patients. Cervical ultrasonography was the first-line diagnostic test. Cervical-thoracic CT scan was requested in 45 patients to study thoracic extension and the relation of the thyroid mass with the supra-aortic vascular axes. Treatment systematically comprised total thyroidectomy on a cervical approach. There were 6 cases of malignancy. DISCUSSION-CONCLUSION: Substernal goitre is fairly frequent. Despite particularities, an exclusively cervical approach is sufficient in a large majority of cases. The substernal nature of the goitre did not have major impact on postoperative complications.