Laryngeal tuberculosis: about 04 cases.

The purpose of this study is to present epidemiological, clinical, radiological, histological characteristics and treatment of laryngeal tuberculosis. It is also aimed at making the point about diagnosis difficulties. This retrospective study was conducted over three years; it concerned 4 cases, 3 males and one female. The average age was 35 years. Three of the 4 cases have had a cervical CT scan. All patients have had a laryngoscopy with biopsy and anatomopathological study. The onset modes of the disease have been progressive for all the patients. Topographical study has shown two epiglottic locations, one at the vocal cords and the other one at the posterior commissure. The diagnosis was orientated in the 3 cases by the CT scan and confirmed by anatomopathological exam in all cases. All patients have received anti-TB drugs with good evolution. The laryngeal location of tuberculosis is unusual. The clinical picture is nonspecific, raising the issue of differential diagnosis with tumor pathology. Sectional imaging and CT scan can guide the diagnosis and a positive diagnosis is often discovered on the occasion of a tumor biopsy of a pseudo-tumor lesion. Treatment is based on anti-TB drugs.

Kikuchi-Fujimoto Disease: A Rare Cause of Acute Laryngeal Dyspnea.

Kikuchi-Fujimoto disease (KFD) is an uncommon benign and self-limited condition characterized mainly by fever and lymphadenopathy. It rarely presents with life-threatening symptoms. Our paper reports the case of a 32 years-old woman who presented with acute laryngeal dyspnea and important neck-swelling, that later proved to be secondary to KFD.

The Role of Surgery in the Treatment of Cervical Lymph Node Tuberculosis.

Cervical lymph node tuberculosis is a public health problem in Morocco and the rest of the world. Its paucibacillary nature makes diagnosis and treatment difficult. This is a descriptive-analytical retrospective study presenting 104 cases of patients with manifestations of cervical lymph node tuberculosis confirmed by pathological examination (100%), associated in some cases with positive bacteriology (40.6%), treated and followed up in the otolaryngology (ENT) department of the Cheikh Khalifa International University Hospital (HUICK) over a period of 5 years and 9 months (from January 01, 2017, to September 30, 2022). In our study, 14 patients (i.e., 13.5%) had a history of tuberculosis (all locations); only four (i.e., 3.8%) of them had confirmed cervical lymph node tuberculosis, of which three were still under treatment: two of them presented for treatment failure (i.e., 1.9%) and one patient for a paradoxical reaction (i.e., 1%). Three pulmonary locations (i.e., 2.9%) and one mediastinal location (i.e., 1%) were found. Surgery associated with histological study was the key to the diagnosis of tuberculosis in our study. Its procedures were: excisional biopsy for 26 patients (i.e., 25%), adenectomy for 54 patients (i.e., 51.9%), lymph node dissection for 15 patients (i.e., 14.4%), and lymphadenectomy for nine patients (i.e., 8.7%). In some cases, drainage (+/- curettage) was recommended in addition to the surgical procedure in 14 patients (i.e., 13.5%). All our patients benefited from post-surgical anti-bacillary treatment. Lymphorrhea was the only operative complication and it affected two patients (i.e., 1.9%). Meanwhile, the relapse rate was 10.6% (i.e., 11 patients), the treatment failure rate was 3.8% (i.e., four patients), and the paradoxical reaction affected 2.9% (i.e., three patients). The latter had all benefited from a simple biopsy. This indicates that a more extensive surgical procedure gives better results with a better healing rate. In conclusion, anti-bacillary treatment remains the reference treatment for lymph node tuberculosis. However, surgery holds great promise as the first-line treatment in case of fistula or abscess or in the event of failure or if complications occur.

Influence of the Size and Location of the Perforation on the Anatomical Results of Myringoplasty.

INTRODUCTION: Type 1 tympanoplasty (myringoplasty) is the surgical closure of a perforated eardrum. Its purpose is to restore the integrity of the tympanic membrane and to improve hearing in the affected ear. Nowadays, we note the increasing use of cartilage as material for the reconstruction of the tympanic membrane. The main objective of our study is to evaluate the influence of size and perforation site on the results of type 1 tympanoplasties performed in our department. MATERIALS AND METHODS:  We carried out a retrospective study of a series of myringoplasties spread over a period of four years and five months from January 1, 2017, to May 31, 2021. For every patient, we collected data regarding age, sex, perforation size, location, and closure of the tympanic membrane after myringoplasty. The audiological results for air conduction (AC) and bone conduction (BC), as well as air-bone gap reduction following surgery, were noted. Follow-up audiograms were performed at the following intervals: two months, four months, and eight months postoperatively. The frequencies tested included 250, 500, 1000, 2000, and 4000 Hz. Similarly, the air-bone gap was estimated on the mean of all frequencies. A chi-squared test and Mann-Whitney test were used to compare qualitative and quantitative variables, respectively. RESULTS: A total of 123 myringoplasties were included in this study. Closure of the tympanic membrane was achieved successfully in 85.7% for one-quadrant-size perforations (24 cases), and in 76.2% for two-quadrant-size perforations (16 cases). When 50-75% of the tympanic membrane was absent at the time of diagnosis, full repairment was achieved in 89.6% of the patients (n = 24), and in 85.0% (n = 34) when the perforation was subtotal. Recurrences have not happened more significantly for one location of the tympanic defect compared to another. Indeed, failures for anterior quadrant perforations were 14 whereas other sites represented 19 cases of non-integrated grafts. The audition was significantly improved from pre-operatively (AC mean of 48.7 dBs with ranges from 24 to 90 dBs) to post-operatively (30.7 dBs AC with ranges from 10-80 dBs) (p = 0,002). The average postoperative audiometric Rinne was 18 dBs with a gain of 15.37 dBs. DISCUSSION: Patients with bilateral perforations (tubal dysfunction, allergic rhinitis) are more likely to develop recurrences. Thus, the series considering many patients operated on twice has high failure rates. Good compliance with anti-allergic treatment and with hygiene rules (in particular ear sealing) is essential for the closure of anterior perforations. CONCLUSION:  It seems through our study that there is no correlation between the size and location of the perforation and its postoperative closure. Risk factors such as smoking, anemia, intraoperative bleeding, and gastroesophageal reflux are important and determining in the healing process.

Strangled by His Nerves-Cervical Plexiform Neurofibroma With Infantile Spinal Neurofibromatosis: Case Report in a 14 Years Old Child.

Background: Neurofibromatoses are a rare group of autosomal dominant tumor suppressor phacomatoses syndromes. Neurofibromatosis type 1 (NF1 or Von Recklinghausen's disease) is the most commonly found type of neurofibromatosis, and constitutes the most commonly found autosomal dominant disease of the nervous system. Case presentation: We report a case of a 14-year-old boy who reported a 3-year-history of a slowly enlarging right lateral cervical mass. He has a medical history of a progressive limping gait disorder with scoliotic attitude. MRI identified a dumb-bell shaped intradural right cervical process through right paravertebral gutter on C2 to C4, a second intradural dorsal mass with the same characteristics through left paravertebral gutter on D4 and D5 and a large tissue-like mass infiltrating the lumbosacral subcutaneous soft tissues. A Surgical excision of the cervical and lumbar masses was performed with a good outcome after surgical excision. Conclusions: This case illustrates the need for a collaboration of both neurological and head and neck surgeons in terms of managing difficulties related to a cervical neurofibroma. Benign plexiform neurofibromas are rapidly growing tumors, particularly in children and adolescents, which makes all the importance of early detection and appropriate treatment. Repeated interventions are usually needed in order to adapt and stabilize the tumors extension.

[Clinical and therapeutic features of herpes zoster oticus: a case report]. / Zona otitique, aspects cliniques et thérapeutiques: à propos d'un cas.

Ear shingles, also called herpes zoster oticus, are a viral infection of the outer, middle and/or inner ear due to varicella zoster virus (VZV). Patients with ear involvement associated with facial palsy are clinically diagnosed with Ramsay-Hunt´s syndrome. We here report the case of a 25-year-old patient with herpes zoster oticus associated with peripheral facial palsy, without other associated signs. This study and literature review investigate the various clinical, para-clinical and evolutionary features of herpes zoster oticus and the therapeutic approaches.

Amelanotic Malignant Mucosal Melanoma of the Nasal Cavity: Case Report and Literature Review.

Sinonasal malignant melanoma is a rare but aggressive tumor of the head and neck area. It has a poor prognosis. Common symptoms are nasal obstruction, epistaxis, or purulent rhinorrhea. Diagnosis relies on histopathology with immunohistochemistry (IHC) studies. Surgery is the essential treatment, most often supplemented by radiotherapy or immunotherapy. A 63-year-old female patient, with a history of right dacryocystorhinostomy and Parkinson's disease, consulted for symptoms of right nasal obstruction with increasing intensity accompanied by two episodes of mild unilateral epistaxis. Rigid optic examination showed a white-pinkish right obstructive supra-centimetric endonasal tumor. CT revealed an extensive tissue process of the right nasal cavity invading the maxillary sinus, the inferior and middle conchas. A biopsy of the lesion was conducted under local anesthesia. The immunohistochemical study has shown undifferentiated tumor with positive antibody anti PS100 and anti-melan A evoking malignant sinonasal melanoma. The patient underwent two surgeries for maxillectomies as she presented a first local recurrence. She was started on adjuvant radiotherapy. At one year of follow-up, she does not present any local or general signs of disease. Sinonasal melanoma is a particular entity of head and neck mucosal melanomas. The highest incidence is described to be in the seventh and eighth decades of life with no sex difference. IHC profiling of different melanoma subtypes showed the importance of alterations in the KIT gene, this genetic data may constitute a therapeutic target. After surgery, the important local recurrence rates and regional failure justify adjuvant radiotherapy also for resections in free margins. Most authors consider that prophylactic neck dissection is not necessary. Preoperative imaging features (CT scan) are characteristic and helpful for diagnosis. IHC is essential, has a high sensitivity for differentiating achromic melanomas from other neoplasms. Sinonasal achromic melanoma is a very uncommon tumor, invasive, and frequently associated with distant metastasis. Paraclinic examinations are essential for staging and guiding therapeutic management. Immunotherapy is a promising ground of research as it comes to metastatic and advanced disease.

[Management of a giant cervical lipoma: case report and literature review]. / Prise en charge d'un lipome cervical géant: à propos d'un cas et revue de la littérature.

Lipoma is the most common of soft tissue tumours. It rarely occurs in the head and neck. Patients with fast-growing large sized lesion (> 10cm) should be suspected to have a cancer. We here report the case of a patient presenting with unusual cervical lipoma (size: approximately 46cm), diagnosed based on imaging tests, including computed tomography (CT) scan. Patient´s management was based on surgery.

Burkitt's lymphoma of medial part of clavicle: Case report of unusual localization.

INTRODUCTION: Burkitt lymphoma is a form of non-Hodgkin's lymphoma in which cancer starts in immune cells called B-cells. Recognized as a fast-growing human tumor, it is considered as a medical emergency requiring immediate diagnostic and therapeutic intervention. However, intensive chemotherapy can achieve long-term survival in more than half the people with Burkitt lymphoma. CASE REPORT: We report a case of Burkitt's lymphoma of medial part of clavicle was diagnosed in a 60 years year-old man and review the literature concerning the clinical features, radiological appearance, histopathological findings and treatment options. DISCUSSION: Clinical course of Burkitt lymphoma is aggressive and rapid, commonly occurs in children and young adults with frequent involvement of Bone Marrow, associated with impaired immunity and is rapidly fatal if left untreated, early diagnosis can be life saving for Burkitt lymphoma. As per the literature available this is the second case of Burkitt's lymphoma presenting primarily in medial part of clavicle.

A unique association of bifacial weakness, paresthesia and vestibulocochlear neuritis as post-COVID-19 manifestation in pregnant women: a case report.

SARS-CoV-2 is an infection due to a novel virus belonging to the coronavirus family. Since December 2019, first human cases of COVID-19 have been identified in Wuhan (China) and rapidly has been progressed to a global pandemic declared by the world health organization (WHO) on March 11th 2020. The major complication of COVID-19, is pneumonia, but other presentations like cardiovascular and neurological complications have been reported. Herein, we report a first case of pregnant women presented with bifacial weakness and paraesthesia (BFP) associated to a vestibulocochlear neuritis as post-COVID-19 manifestation. This is a 36-year-old Moroccan female patient with a history of SARS-CoV-2 positive 6 weeks before admission. She presented to the emergency department with rapid bifacial paralysis, bilateral lower extremity paresthesia, vertigo, nausea, vomiting and right auricular pain. An acute stroke was ruled out after neurological examination and brain MRI. Clinical presentation, neurophysiological, audiometry and videonystagmography workup additionally to CSF findings were suggestive of a variant of Guillain Barré Syndrome (GBS), which is BFP associated to right vestibulocochlear neuritis. The patient was treated with Intravenous immunoglobulins (IVIG) therapy associated with intravenous steroids. The patient made a complete recovery of the right facial palsy and the sensorineural hearing loss but still have tingling in lower limbs and left facial palsy at 2 weeks´ follow-up. BFP can be induced by COVID-19 as a postinfectious immune-mediated complication. Regarding the pathophysiology of vestibular neuritis, is probably similar to other viral infection causing nerve damage. Clinicians should consider the association of vestibulocochlear neuritis and BFP as a post SARS-CoV-2 manifestation.

Bilateral Traumatic Facial Paralysis with Hearing Impairment and Abducens Palsy.

The temporal bone is often affected in basilar skull fractures. Fractures involving the petrous portion are particularly significant, as they may be associated with neurovascular sequelae. Bilateral facial paralysis secondary to bilateral temporal bone fracture is a rare clinical entity, even more so when associated with other cranial nerve damage such as abducens nerve paralysis and hearing impairment. Only 4 similar cases have been reported in the literature to date. In this paper, we describe a 28-year-old male patient with bilateral facial paralysis, unilateral abducens palsy, and bilateral hearing loss due to bitemporal fractures that developed after a motor vehicle accident. Conservative management was preferred. The 6-month follow-up showed remarkable improvement. This report highlights the effectiveness of conservative management in posttraumatic complete facial and abducens palsy.

Personal Protective Equipment and Headaches: Cross-Sectional Study Among Moroccan Healthcare Workers During COVID-19 Pandemic.

Background Healthcare workers in frontline during the coronavirus 19 disease (COVID-19) pandemic are mandated to wear specific personal protective equipment (PPE) including high filtrating masks and/or eye protection during extended period of time. Compressive headaches secondary to PPE use including N95 masks have been reported. We aim to describe subtypes of headache related to PPE use in our hospital in Casablanca and working condition factors associated with it. Methods We conducted a cross-sectional study among healthcare workers in frontline at Cheikh khalifa International University Hospital, using an online questionnaire. We collected demographic data, comorbidities and previous headaches history. Data about working conditions during pandemic, type and duration of PPE use were described. We calculated the prevalence of De Novo or an aggravated headache among healthcare workers. We studied correlations between PPE related headaches and working conditions and trends in PPE use during the pandemic. Finally, we described the overall discomfort related to PPE use. Results A total of 155 healthcare workers responded to the questionnaire. The N95 masks were the most used type (95.5%) associated with an eye protection in 61.3%. The overall prevalence of headache related to PPE was 62%. It was experienced De Novo in 32.9%, while it was an aggravation of pre-existing headache in 29%. Working more than 8 hours per shift during the pandemic was correlated to De novo headache (p = 0.008). The profession of doctor and working more than 12 hours per shift were correlated to aggravated headache (p = 0.02, p = 0.023). Healthcare workers experienced moderate discomfort, blurred vision and reduced concentration. They judged their professional performance mildly reduced by the use of PPE. Conclusion The increased use of PPE, especially high filtrating masks during the COVID-19 outbreak is responsible for generating headaches in healthcare workers on frontline either De novo or as an aggravation of pre-existing one. Working conditions have the greater impact on generating these types of headaches more than any pre-existing comorbidity. These findings should be considered to accommodate health care professionals to increase efficacy and adherence to protective measures during pandemic.

[Voluminous parotid cyst of the first branchial arch: a case report]. / Enorme kyste parotidien du premier arc branchial: à propos d´un cas.

Parotid branchial cysts are rare and poorly known congenital malformations of the first branchial cleft. They are characterized by three types of manifestations which may be associated to it or isolated, including inflammatory swelling of the subauricular and inferior portion of the parotid with or without cervico-cutaneous fistula projecting into the cervico-mandibular area and a fistula in the floor of the external auditory canal with or without otorrhea, with or without pretimpanic bridle on otoscopy. They often go unnoticed, except for superinfections. Diagnosis is based on interview, the occurrence of recurrent abscesses or superinfections. No complementary imaging examination should be systematically performed. In atypical forms, ultrasound as well as magnetic resonance imaging (MRI) could be necessary, particularly in patients with parotid swellings, in order to confirm cystic structure. Abscesses and recurrent superinfections are the most common complications. Treatment is based on surgical resection. We report the case of a patient with voluminous parotid cyst of the pharyngeal arch.

[The inferior laryngeal nerve: anatomical and surgical considerations about 60 thyroidectomy]. / Le nerf laryngé inférieur: considérations anatomiques et chirurgicales à propos de 60 thyroïdectomies.

Thyroid surgery requires a thorough knowledge of cervical anatomy and anatomical variations, in particular of the lower laryngeal nerve, in order to avoid iatrogenic lesions. The objective of our study was to analyze the relationships of the lower laryngeal nerve, the existence of branches of nerve division and a subjective appreciation of the size of the nerve. This is a prospective study of 1 year including 60 patients who underwent thyroidectomy. Sixty patients underwent surgery on the thyroid gland between February 2014 and January 2015 by the same principal operator (10 men and 50 women). The average age of our patients was 51 years. For men were performed 6 total thyroidectomies, 2 left lobo-isthmectomies and 2 right lobo-isthmectomies. For women were performed 33 total thyroidectomies, 8 left lobo-isthmectomies and 9 right lobo-isthmectomies. On the right, the nerve was superficial relative to the artery in 71.6% of cases; it was divided in 33.3% of cases and was abnormally thin in 16.6% of cases. On the left, the nerve was deep in relation to the artery in 83.3% of cases; it was divided in 15% of cases and was abnormally thin in 11.6% of cases. Knowledge of the anatomical variations of the lower laryngeal nerve is essential in thyroid surgery, the risk is particularly important on the right side given the sometimes very small caliber and the existence of branches of division more frequent than on the left side.

Medial migration of the tympanostomy tube: what is the optimal management option?

The tympanostomy tube insertion is the gold standard of treatment for secretory otitis media. Complications are associated with this surgery in 17% of cases. One of the rare but real complications is the medial migration of the tympanostomy tube. To our knowledge, this is the 14th case reported in childhood. Considering this rarity, there is no consensus for the management of this phenomenon. Some authors propose a surgical removal, while others prefer to observe whether the patient is asymptomatic. We reported a case of migration of the tympanostomy tube and described the detailed clinical features and management options. This case report and mini-review will broaden readers the knowledge of medial migration of the tympanostomy tube and may guide the relative treatment of this complication in the future.

[Neurologic thoracic outlet syndrome in children: about a case]. / Syndrome du défilé thoraco-brachial neurologique chez l'enfant: à propos d'un cas.

Thoracic Outlet Syndrome (NTOS) encloses the whole set of clinical manifestations associated with the compression of the trunks of the brachial plexus and/or of the subclavian vessels as they cross the thoracic outlet (cervico-thoraco-brachial junction). It rarely affects children. We here report the case of a young girl treated for neurologic NTOS caused by supernumerary cervical rib.

[Extra-nodal NK/T-cell lymphoma, nasal type presenting as orbital cellulitis]. / Un lymphome T/NK extra-ganglionnaire de type nasal se présentant comme une cellulite orbitaire.

Extra-nodal NK/T-cell lymphoma, nasal type, is a rare form of malignant non-Hodgkin's lymphomas. It poses a diagnostic problem due to nonspecific symptoms. We report a case of NK/T-cell lymphoma simulating orbital cellulitis. The study involved a 46-year old female patient followed up for Behçet's disease. The patient was admitted with orbital cellulitis. CT scan of the midface showed pansinusitis with orbital infiltration.The patient had no improvement under antibiotic therapy. Surgical treatment with biopsy was performed. Histological examination showed inflammatory vasculitis and the patient underwent corticosteroid therapy with clinical improvement. The patient had recurrence requiring reoperation with ethmoid biopsies whose histological examination showed NK/T-cell lymphoma, nasal type. Treatment was based on radiochemotherapy and the patient died after two months. NK/T-cell lymphomas are aggressive, they primarily affect the nasal cavities and sinus. They cause angiodestruction and necrosis, resulting in unspecific symptoms. Biopsies are often negative, posing a problem of differential diagnosis. Treatment is based on radiotherapy and chemotherapy. Prognosis is reserved.

[Voluminous cervical amygdaloid cyst: about a case]. / Enorme kyste amygdaloïde cervical: à propos d'un cas.

Amygdaloid cysts are benign dysembryologic cystic tumors developing in the anterolateral portion of the neck. They account for 2% of all neck tumors located in the laterocervical region. They mostly result from branchial cleft abnormalities, accounting for 6.1-85.2% of all second branchial cleft abnormalities. They are due to the persistence of the cervical sinus during the differentiation of the branchial apparatus. They manifest as a laterocervical swelling in the anterior edge of the sternocleidomastoid muscle. The diagnosis of cyst is confirmed by ultrasound and CT scan. Treatment is based on surgical resection. We here report the case of a 24-year old woman presenting with voluminous left laterocervical swelling evolving over the past 3 years without any associated symptoms. Exploratory cervicotomy with anatomopathological examination were performed. The histologic diagnosis of amygdaloid cyst with no sign of malignancy was retained. This study aims to analyze the anatomoclinical features and to discuss the therapeutic options for the management of this disease.

[Supracricoid partial laryngectomy (SCPL) with either cricohyoidoepiglottopexy (CHEP): our experience with 16 cases]. / Laryngectomies partielles supra-cricoïdiennes avec reconstruction par CHEP: notre expérience sur 16 cas.

Partial laryngectomy with either cricohyoidoepiglottopexy (CHEP) are mainly used to treat glottic cancers becuse they ensure a satisfactory preservation of physiological functions and satisfactory local carcinologic control. Our study aimed to analyze the functional and carcinologic results of this surgical technique. We conducted a retrospective study of patients undergoing partial laryngectomy with either cricohyoidoepiglottopexy in our Hospital between 2011 and 2014. We analyzed the epidemiological data, the surgical peculiarities, the functional outcomes and the carcinologic control of the disease. A total of 16 patients were included in this study. All our patients had T1 or T2 glottis squamous cell carcinoma. Functional outcomes were generally simple, especially in cases where the preservation of the 2 cricoarytenoid units was possible (75% of cases). However post-operative complications were reported in 31.25%. Carcinologic control was satisfactory, only one patient experienced local recurrence. Partial laryngectomy with either cricohyoidoepiglottopexy (CHEP) is a safe surgery preserving physiological functions and ensuring satisfactory quality of life. It also allows for good carcinologic control (it is subject of course to compliance with surgical indications).

[Giant parathyroid carcinoma: diagnostic difficulties and therapeutic strategies]. / Carcinome parathyroïdien géant: difficultés diagnostiques et stratégies thérapeutiques.

Parathyroid carcinoma is a very rare malignancy responsible for 0.4 to 5.2% of hyperparathyroidism. Clinical diagnosis is difficult and treatment should be codified. Surgery is the only curative treatment. We report the case of a female patient treated for malignancy-associated hypercalcemia revealing parathyroid carcinoma. The patient underwent surgery; after three months she developed lymphatic recurrence. Given the absence of other secondary involvement, bilateral lymph node dissection followed by chemotherapy was performed. Parathyroid carcinoma is often suspected on the basis of biological, radiological and especially intraoperative macroscopic criteria, but definitive diagnosis is made histopathologically. Surgery is currently the only curative treatment and the role of adjuvant therapy is to establish.