[Management of cervico-cephalic plexiform neurofibromas: About 35 cases]. / Prise en charge des neurofibromes plexiformes cervico-céphaliques : à propos de 35 cas.

OBJECT: Plexiform neurofibroma is a characteristic lesion of Von Recklinghausen's disease. Conservative surgery is the most widely adopted treatment. However, it is very challenging because of its hemorrhagic nature and the infiltrative aspect of the lesions. The aim of this study was to evaluate our management. PATIENTS AND METHOD: A retrospective study over 16 years was realized and during this period 35 patients with neurofibroma with cervico-facial location were included. RESULTS: There were 18 men and 17 women with an average age of 23 years (3-50 years). The familial form was found in 9% of patients. Aesthetic discomfort was noted in all patients and functional impairment only occurred in 10% of patients. The NFP was localized at the hemiface in 11 cases, periorbital in 6 cases, naso-labial in 5 cases, scalp in 4 cases, jugal in 4 cases and cervico-chin in 5 cases. Size of the lesions averaged 11.6cm (4-45cm). Eighteen patients (51.4%) were operated including 10 by modeling resection, 05 cervico-facial lifting and 3 complete resections. Complication rate was 28% dominated by disunion wound. The average number of procedures was 1.6 (1 to 5). After 3 years average follow-up, aesthetic et functional results was assessed as good over 75 per cent of patients. CONCLUSION: Cervico-facial plexiform neurofibromas is challenging. Conservative surgery should be the gold standard and long time follow-up is recommended.

[Breast hypertrophy: preliminary study in Dakar]. / Les Hypertrophies Mammaires : Etude Preliminaire A Dakar.

The management of breast hypertrophy has become a new and increasing need in Senegal. The files of 47 patients presenting with breast hypertrophy were collated over twelve years. The mean age was 33,9 years. Three surgical techniques were used. The average sternal notch to nipple measurement was 33 cm. Surgery was performed on twenty-two patients, or 42 breast. The surgical technique of Mac Kissock was used in 50% of the cases, the inferior pedicle technique in 13.6% of the cases and the technique of Thorek in 36.4% of the cases. The average weight of tissue removed was 1.3 kg per breast. Our rate of post-operative complications was 9.5% , mostly suppurations. Close to 91% of the patients expressed being satisfied with the aesthetic result obtained. The surgery of breast hypertrophy is increasing in our activity.

[Management of nasolabial clefts: the issue in Dakar]. / Prise en charge des fentes nasolabiales: problématique à Dakar.

The management of patients with a cleft lip in developing countries is often the prerogative of humanitarian missions from developed countries. The goal of our work is to conduct a first epidemiological, clinical and therapeutic assessment of the management of cleft lips by a local team and to evidence the difficulties faced by us in our working conditions. In a retrospective study covering a period of about five years (January 2004 to March 2009), 205 cases of nasolabial clefts are assembled. The mean age at the time of the first visit is 17 months. A slight female predominance is observed. The majority of patients are from the capital city. A close relative with a cleft is found in 6.8% of them. In 44.9% of cases, it is a simple cleft lip. A cleft palate is associated in 47.8% of cases. Associated malformations are observed in 10.5% of cases. We operated on 110 patients. The mean age at the first surgery is two years. Millard's technique is our technique of choice. No operative mortality is observed. In 17.4% of cases, operative morbidity occurred in the form of suppuration with partial or complete early suture release. The esthetic result is satisfactory in 67.7% of cases. This management could be improved by creating a multidisciplinary team including--in addition to surgeons--dentists, speech-language pathologists, psychologists, etc.

[Paediatric head and neck burns sequelae]. / Les séquelles de brûlures cervicocéphaliques chez l'enfant.

The skin is the body's protective barrier and is very much exposed to assaults and thus to burns. The aim of this work is to consider the special features of cervicofacial burns sequelae in children in a sub-Saharan environment and to review their management. This retrospective study, performed in the Department of Paediatric Surgery at Aristide Le Dantec Teaching Hospital in Dakar (Senegal), examined 27 patient files dating between May 2001 and April 2008. The children's average age at first visit was 6.7 years and the m:f sex ratio was 1.7:1. The sequelae were topographically distributed as follows: face (66.7%), neck (29.6%), scalp (11.1%). Regarding the type of sequelae observed, adhesions predominated (33.3%), followed by keloid or hypertrophic scars (25.9%), eyelid ectropions (18.5%), scalp alopecias (11.1%), chronic ulcerations (7.4%), and discolorations (3.7%).Surgical treatment was used in 55.7% of the cases: Z-plasty, followed or not followed by skin graft for adhesion treatment, as well as adhesion lysis followed by grafting for eyelid ectropion treatment. The surgical morbidity rate was 20% and no mortality was reported. Keloid scars were treated medically with intralesional corticosteroid injections. Apart from the emergency situation, cervicofacial burns in children lead to severe aesthetic and functional damage. Any improvement in prognosis in such burns depends on improvements in the quality of initial care and on raising parents' awareness of accidents in the home.

[Morel-Lavallée lesion in orthopaedic surgery (Nineteen cases)]. / Épanchement de Morel-Lavallée en chirurgie orthopédique (À propos de 19 cas).

AIMS: The object of this work is the study of especially ancient clinical forms of the effusion of Morel-Lavallée, to discuss the place of deep fascial fenestration by Ronceray and to propose criteria of therapeutic indication. PATIENTS AND METHOD: Our study concerns a continuous retrospective series over 20 years from 1989 till 2009. Eleven men and eight women, 36.7 year-old on average were treated for an effusion of Morel-Lavallée. The dominant etiology was represented by the accidents of the public highway. The collection was discovered after 41.4 days on average (extremes of 1-180 days). The volume of the collection was on average of 1237cm(3) (extremes 60cm(3)-12L). RESULTS: The conservative treatment concerned all patients who had a recent collection lower than three weeks and three others who had an ancient collection. The surgical treatment was established after all 10 times among which four in first intention and six times after failure of the previous treatment. The cure was obtained in 91% of the patients who had a recent collection by the only conservative method and among four patients by the method of Ronceray. To the three others, it was obtained after iterative unbridlings and talcage treatment. CONCLUSION: The authors insist on certain rare forms met in Africa in particular the "virtual form", the ancient forms and the too plentiful forms (12L). They plead for use deep fascial fenestrations by Ronceray for these last ones.

[Post-burn scar contractures in children in the lower limb]. / Les Cicatrices Retractiles Post-Brulures Du Membre Inferieur Chez L'Enfant.

Il s'agit d'une étude faisant ressortir les aspects épidémiologiques, cliniques et thérapeutiques des séquelles de brûlures du membre inférieur chez l'enfant, à propos de 42 cas colligés au service de chirurgie infantile de l'Hôpital Aristide Le Dantec (Sénégal). L'âge moyen retrouvé est de 5 ans et 3 mois, et le sex-ratio garçons/filles de 1,8/1. La brûlure thermique est causée par une flamme dans 33% des cas, par un liquide chaud dans 21% des cas, et par des braises dans 21% des cas. Les cicatrices rétractiles intéressent le genou et le creux poplité dans 47% des cas et le pied dans 45% des cas. Elles sont bilatérales dans 21% des cas, et concernent une autre localisation associée dans 21% des cas. Quant aux brides, 21% ont bénéficié d'une chirurgie, avec un délai moyen de 3 ans et 2 mois après la brûlure. Cette procédure chirurgicale consiste en une plastie en Z dans 91% des cas, à laquelle est associée une greffe de peau dans 54% des cas. Une rééducation fonctionnelle est pratiquée chez 54% des opérés. Parallèlement aux données de la littérature, nos résultats montrent que l'optimisation de la prise en charge passe par une meilleure prévention des accidents domestiques et une bonne codification thérapeutique.

[Perforation and haemorrhage duodenal bulbar ulcers in a child: a case report]. / Perforation et hémorragie d'ulcères du bulbe duodénal chez une enfant.

A perforation rarely reveals a primary duodenal ulcer. The occurring of digestive haemorrhage in post operative followings evokes spontaneously a stress ulcer. We report an observation of a child who presented on fourth day delay after operation an ulcer of the anterior duodenal bulbar face and a haemorrhage of the posterior bulbar face. A 7-year-old girl with no particular pathological antecedent was admitted for abdominal pain, bile vomiting and constipation evolving since 6 days. Clinical examination revealed a general state thickening, an infectious syndrome, a meteoric and general abdominal sensitivity. The abdominal radiography without preparation showed a pneumoperitoneum. The surgical exploration discovered a perforated ulcer on the bulbar anterior face. A simple closure associated with omental patch was performed. Four days after operation, she presented an abundant digestive haemorrhage with shock. The resuscitation did not improve the patient's general state. The upper digestive endoscopy revealed a haemorrhage of the posterior bulbar face. An adrenalin injection stopped the bleeding. The treatment by neutron pump inhibitors and an eradicating treatment of Helicobacter pylori permitted the healing of the ulcers. The occurring of digestive haemorrhage in the followings of surgical intervention for perforated ulcer involves an upper digestive endoscopy. This examination can reveal misdiagnosed ulcer during the surgical exploration and permits to perform a haemostatic act.

Strangulated umbilical hernias in children.

Umbilical hernia is a frequent pathology of the anterior abdominal wall in children. The hernia ring closes usually before 4 years, but a strangulation can occur. It is an exceptional complication according to the literature data. Since this complication is rare, we undertook a retrospective study of these strangulations in a 5-year period from January 1997 to December 2001 at Aristide Le Dantec hospital. We collected 41 cases that underwent emergency surgery operations for strangulated umbilical hernias, which represent about 15% of umbilical hernias operated during the same period. The age range was 8 months to 10 years and the average age was 14 months. All the children were examined within 24 h after the onset of the disease and the surgery was immediately performed. In five cases the bowel was necrosed and perforated and we performed a resection followed immediately by an anastomosis. In the follow up, two children presented wound infections and a hernia recurred in one child. There was no mortality. This study conducts us to question western reports which recommend conservative therapy for umbilical hernia in children.

[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.

[Umbilical reconstruction in children. Prospective report of 77 cases]. / Les plasties cutanées ombilicales chez l'enfant. Etude prospective chez 77 patients.

Umbilical hernia is as frequent pathology in our country. The skin excess is a real problem for the surgeon because it is inesthetical. We report 77 cases of children with umbilical hernia who we operated between 1999 and 2000. Fifty-five of them have a umbilical plasty. For this, we used three surgical techniques: lateral left plasty, "horseshoe" plasty and umbilical graft. We classed our results into three groups: 40 good results, seven middle results and three bad results. Twenty-seven patients are lost. These three surgical techniques are a simple and safe solution to this problem of skin excess in the umbilical hernia.

[Evaluation of the management of femoral shaft fractures in children by flexible intramedullary nailing]. / Evaluation du traitement des fractures de la diaphyse fémorale chez l'enfant par embrochage centromédullaire elastique stable (ECMES).

The purpose of this study was to evaluate the morphological and functional outcomes of femoral shaft fractures of the child using a centromedullary elastic nailing. We led a retrospective study including 22 children operated from January 1997 to December 2000 at the surgical emergency department of "Hôpital Aristide Le Dantec". The follow-up was made in the department of paediatric surgery. The patients included 16 boys and 6 girls presenting a total of 23 femoral shaft fractures. The main circumstance was traffic accident(15 cases). All the children underwent an ascending centromedullary elastic nailing controlled by a C-arm after a period of traction. The outcomes were appreciated after a period of 10 months. We observed: A union in all cases, four infections well managed by antibiotics, one vicious callus of 15 degrees, a mobility limitation of knee in two cases (45 degrees and 100 degrees), an inferior limb length inequality in one case, scabs in one patient who died at the 3rd month of a septicopyohemia. The functional evaluation of the outcomes (flexion, extension, limb length inequality) and morphological outcomes (axis, consolidation) showed 21 good results and one bad result. The centromedullary elastic nailing is a safe procedure owing to the low complication rates and the rapid consolidation allowing an early walk in femoral shaft fractures, compared with the orthopaedic treatment.

[Evaluation of the management of omphalocele at Dakar]. / Evaluation de la prise en charge de l'omphalocèle a Dakar.

Omphalocele is a congenital malformation of the abdominal wall of children, characterized by an ombilical defect living the abdominal organ visible through a translucent amniotic membrana. The goals of this study were to describe the epidemiological, clinical and therapeutic characteristics at the University Teaching Hospital of Dakar. We conducted a retrospective study at the UniversityTeaching Hospital of Dakar from January 1997 to December 2002. Fifty cases of Omphalocele diagnosed at the Unit of Paediatric Surgery of the Department of General Surgery at Aristide Le Dantec Hospital, were included in this study. We described the epidemiological, clinical and therapeutic characteristics of omphalocele. Omphalocele is a condition diagnosed late in boys from poor sphere. The study revealed that weight from birth, omphalocele size, local state, and existance of associated malformation correlated with death rate. The treatment option was a spontaneous epidermisation as described by Grob in the absence of omphalocele rupture wich imposed a primary closure of abdominal wall. The overall death rate was 42%. The improvement of results will need an antenative diagnosis, paediatric reanimation unit wich will notably reduce death rate.

[The ovarian tumors in children. A report of 12 cases]. / Les tumeurs ovariennes de l'enfant: a propos de 12 cas.

The objectives emphasize the diagnosis and therapical problems concerning the child's ovary tumors for a better care in our conditions of work. We collected in a retrospective study 12 cases of ovarian tumors during 30 years. The middle age of the patients was of 11 years with extremes of 2 years and 15. The circumstances of discovery of the tumor were represented by order of frequency by an abdominal tumor (10 cases), an abdominal pain (8 cases) and of the compression signs digestive or urinary (6 cases). The medical imagery (echography, intravenous urography, Chest X-ray) permitted to evoke in the majority of the cases the ovarian origin of the mass. The surgical treatment consisted in an ovariectomy (5 times), an salpingo - ovariectomy (6 times) and a surgery of partial exeresis associated to a chemotherapy. The operative continuations were simple. A patient died of intercurrentes complications. The histological exam of the operative piece showed that it was about benign tumors. However a brought closer surveillance proves to be necessary had consideration to the two noted recidivisms.

[Cervical teratomas in the child (apropos of 8 cases)]. / Tératomes cervicaux chez l'enfant (à propos de 8 cas).

Eight cases of cervical teratomas in children are reported including 4 boys and 4 girls. Six patients presented within the first 10 days of life. The tumor was congenital in 7 cases. In 3 neonates it produced severe respiratory distress. Neural and chondral tissues were predominant but all three germ layers were represented. All patients were operated upon, with a 2/8 mortality. The main clinical and histopathological features of these rare tumors are reviewed. Early total surgical removal is the cornerstone of treatment.

[A case report of epididymo-testicular bilharziasis in a child]. / A propos d'un cas de bilharziome épididymo-testiculaire chez l'enfant.

The disease was revealed by a tumor of the left testis. Ultrasound showed an enlargement of testis and epididymis with some hypoechogenic areas resembling epididymo-orchitis or tumor. The location of bilharzial lesions in the testis is very rare. The main sign of urogenital bilharziosis, hematuria, was present. Orchidectomy is the treatment of choice when the testis is destroyed and only histological study is able to confirm the nature of testicular mass.