Isolated tubal twist: A case series of a rare event occurring at different times in reproductive life.

INTRODUCTION AND IMPORTANCE: Isolated fallopian tube torsion (IFTT) is a rare but potentially serious cause of pelvic pain in women. Despite being a surgical emergency, this diagnosis is often overlooked before surgery. To raise awareness of this diagnosis among clinicians, we describe here five cases, which occurred at different times in reproductive life. CASES PRESENTATION: We present five cases of isolated fallopian tube torsion at different ages (13-54 years). It often manifests with sudden onset of acute pelvic pain in four cases and chronic pelvic pain in one case. At admission, patients were suspected of adnexal torsion (3 cases), genital infection (1 case), and renal pain (1 case). CT-scan showed IFTT in only one patient. Laparoscopic surgical management, performed by experienced surgeons, consisted of salpingectomy in 4 cases and conservative treatment in one case. The latter was complicated with hydrosalpinx 6 years later. All patients were followed in outpatient clinic at least one time after surgery and had favorable outcomes. CLINICAL DISCUSSION: Given the rarity of the pathology and the lack of pathognomonic imaging, IFTT is rarely diagnosed before surgery. Its etiology is still unknown but hydrosalpinx following an infectious process seems to be a major risk factor. CONCLUSION: Increasing awareness of this rare entity is advocated, especially in woman of reproductive age. Torsion should be evoked in front acute pelvic pain in patients with hydrosalpinx or paratubal cyst. Conservative management must be privileged especially in women of childbearing age and in pediatric population.

Voice outcomes after laser cordectomies: subjective evaluation using the voice handicap index

INTRODUCTION: A multitude of treatment modalities have been proposed in management of early laryngeal squamous cell cancers(SCC). With the improvement of survival rates of these tumours, the degree of voice impairment after treatment became a deciding parameter in the choice of treatment modality. Many reports based on objective tools showed acceptable voice outcomes in patients treated with transoral laser microsurgery (TLM). This is a single centre study representing voice outcomes in patients treated with TLM using a patient-self assessment tool.PATIENTS AND METHODS: we retrospectively reviewed medical data of patients treated with TLM between 2012 and 2017. Voice outcomes were evaluated using the Arabic version of the voice handicap index (VHI). Thirty patients participated in the questionnaire.Scores were collected then studied following type of cordectomy, resection of one or both vocal cords, number of laser sessions and age.RESULTS: The mean age was 62 years. Sex ratio was 14:1. We performed 3 type III cordectomies, 10 type IV and 17 type Va (extended to the Anterior commissure). Local control was achieved since the first cordectomy in 27 cases, after 2 laser sessions in 2 cases and after 1 laser session in 1 case. The VHI score was realized in a mean delay of 29 months after surgery. The overall mean VHI was 47 (VHI-F= 15, VHI-P= 17 and VHI-E= 15). The handicap severity was considered mild in 2 cases (overall VHI<30), severe in 2 other cases (overall VHI> 60) and moderate in the remaining cases .The mean VHI following type of cordectomy was 26 ±6, 43 ±5 and 53 ±4 respectively in type III, IV and Va cordectomies. The mean overall VHI was 60 ±10 when the resection was extended to controlateral vocal cord (VC). However, it was 45 ±12 when the resection was limited to a single vocal cord. The mean overall VHI increased from 44 ±11 when a unique laser session was performed to 62 ±8 when extra laser sessions were needed. Older patients had a mean VHI equals to 46 ±14. In younger patients it was 48 ±10.CONCLUSION: The VHI is a reliable self assessment tool based on subjective perception of the quality of voice. TLM in well trained hands offers acceptable functional outcomes

Voice outcomes after laser cordectomies: subjective evaluation using the voice handicap index

INTRODUCTION: A multitude of treatment modalities have been proposed in management of early laryngeal squamous cell cancers (SCC). With the improvement of survival rates of these tumours, the degree of voice impairment after treatment became a deciding parameter in the choice of treatment modality. Many reports based on objective tools showed acceptable voice outcomes in patients treated with transoral laser microsurgery (TLM). This is a single centre study representing voice outcomes in patients treated with TLM using a patient-self assessment tool.PATIENTS AND METHODS: we retrospectively reviewed medical data of patients treated with TLM between 2012 and 2017. Voice outcomes were evaluated using the Arabic version of the voice handicap index (VHI). Thirty patients participated in the questionnaire. Scores were collected then studied following type of cordectomy, resection of one or both vocal cords, number of laser sessions and age.RESULTS: The mean age was 62 years. Sex ratio was 14:1. We performed 3 type III cordectomies, 10 type IV and 17 type Va (extended to the Anterior commissure). Local control was achieved since the rst cordectomy in 27 cases, after 2 laser sessions in 2 cases and after 1 laser session in 1 case. The VHI score was realized in a mean delay of 29 months after surgery. The overall mean VHI was 47 (VHI-F= 15, VHI-P= 17 and VHI-E= 15). The handicap severity was considered mild in 2 cases (overall VHI<30), severe in 2 other cases (overall VHI> 60) and moderate in the remaining cases .The mean VHI following type of cordectomy was 26 ±6, 43 ±5 and 53 ±4 respectively in type III, IV and Va cordectomies. The mean overall VHI was 60 ±10 when the resection was extended to controlateral vocal cord (VC). However, it was 45 ±12 when the resection was limited to a single vocal cord. The mean overall VHI increased from 44 ±11 when a unique laser session was performed to 62 ±8 when extra laser sessions were needed. Older patients had a mean VHI equals to 46 ±14. In younger patients it was 48 ±10. CONCLUSION: The VHI is a reliable self-assessment tool based on subjective perception of the quality of voice. TLM in well trained hands offers acceptable functional outcomes

Septoplastie chez l'enfant: indications et résultats

Introduction : Pendant plusieurs décennies, la pratique de septoplastie chez l'enfant était proscrite par la majorité des chirurgiens par crainte d'altération de la croissance craniofaciale. Actuellement, la septoplastie est de plus en plus indiquée chez l'enfant avec de bons résultats fonctionnels. Le but de ce travail est de révéler les particularités de la septoplastie chez l'enfant, de comparer les différentes techniques opératoires proposées etd'évaluer les résultats obtenus.Méthodes : Notre étude est rétrospective monocentrique transversale portant sur 34 enfants opérés de septoplastie sur une période de 15 ans [2000-2014].Résultats : L'âge moyen de nos patients était de 13 ans avec un sex-ratio de 5,8. Les antécédents d'adénoïdectomie ont été notés dans 9% des cas associés à une amygdalectomie dans 6% des cas. La déviation septale était posttraumatique dans 59% des cas.Elle était de siège antérieur dans 91% des cas. A côté de la déviation de la cloison nasale, nous avons noté une déviation de la pyramide nasale dans 32% des cas et un polype de Killian associé dans 3% des cas. L'indication opératoire était posée sur l'évaluation subjective de la gêne respiratoire et du degré de la déformation nasale. Une obstruction nasale sévère avec réduction importante du flux aérien a été retrouvée dans 73% des cas. Tous nos patients ont été opérés sous anesthésie générale. L'intervention était pratiquée selon la technique de Cottle dans 88% des cas et par voie endoscopique dans 12% des cas. Elle a consisté à une reposition simple de la cloison nasale dans 3% des cas, une dépose repose de la cloison dans 41% des cas, une résection sous muqueuse du cartilage dans 56% des cas. On n'a pas noté de complications majeurs post opératoires.Après un recul moyen de 22 mois, nous avons un bon résultat fonctionnel dans 88% des cas. La persistance de l'obstruction nasale a été notée dans 12% des cas et était en rapport avec la déviation septale dans 6% des cas. Une reprise chirurgicale était indiquée dans 6% des cas.Conclusion :La septoplastie de l'enfant doit être un geste conservateur limité à la zone pathologique. Le suivi post opératoire est clinique et prolongé

[Management of ocular and orbital complications in acute sinusitis]. / Prise en charge des complications oculo-orbitaires des sinusites aiguës.

PURPOSE: Describe the clinical presentations of orbital complications of acute sinusitis and discuss therapeutic approaches. METHODS: Retrospective study of 29 cases of acute sinusitis with orbital extension hospitalized over a period of 12years (2000 to 2012). RESULTS: There were 23 men and 6 women. The mean age was 15.75years. The average time until consultation was 7.68 days. Sinusitis was ethmoido-maxillary in 20 cases, ethmoidal in 6 cases, and frontal in 3 cases. Orbital extension was grouped according to the Chandler classification: stage I (3 cases), stage II (3 cases), stage III (15 cases), stage IV (8 cases). Antibiotic therapy was prescribed in all cases. Surgery was performed in 22 cases. Bacterial cultures revealed streptococcus (2 cases), aspergillus fumigatus (1 case) and were negative in 8 cases. The outcome was favorable in 27 cases. In two cases, the outcome was unfavorable with associated intracranial complications. DISCUSSION: Oculoorbital extension of acute sinusitis is a diagnostic and therapeutic emergency. Paranasal sinus CT is essential to confirm orbital extension and identify the causative sinus. Intravenous antibiotic therapy is the main treatment. The roles of corticosteroid and heparin therapy remain controversial. Surgery is indicated in the case of abscess or high visual risk. Endoscopic endonasal surgery appears to have a double role, in diagnosis and treatment.

Endoscopic endonasal management of congenital intranasal meningocele in a 2-month-old infant.

INTRODUCTION: Nasal meningocele, which is usually congenital, is a rare anomaly resulting from meningeal herniation into the nasal cavities through a bone defect in the skull base. CASE REPORT: An 8-day-old boy was referred with respiratory disturbance and nasal obstruction. Examination showed a cyst-like grayish swelling filling the right nasal cavity. CT scan showed opacity, of fluid-like density, filling the right nasal fossa, in contact with a small bony defect in the right cribriform plate. MRI ruled out herniated brain parenchyma and enabled diagnosis of meningocele. The patient was operated on at the age of 2 months through a transnasal endoscopic approach. Immediate postoperative course was favorable. MRI control at 8 months was normal. DISCUSSION: Modern imaging (CT scan and MRI) is of paramount importance in the preoperative evaluation of nasal meningocele. Endoscopic endonasal (EE) surgery is currently the treatment of choice. CONCLUSION: Steady progress in instrumentation, technique and skills will increase the feasibility of skull-base surgery using an endonasal approach in the pediatric population.

[Granulomatous invasive aspergillosis rhinosinusitis]. / La rhinosinusite aspergillaire invasive granulomateuse.

INTRODUCTION: Granulomatous invasive aspergillosis rhinosinusitis is a rare disease. Anatomopathologic and mycological examination allows the diagnosis. Treatment must be rapidly started in order to avoid orbital and intracranial complications. OBJECTIVES: To analyze the main clinical, radiological, histopathological, mycological and therapeutic aspects of granulomatous invasive aspergillosis rhinosinusitis. PATIENTS AND METHODS: This is a retrospective study included five patients operated for granulomatous invasive aspergillosis rhinosinusitis at the Otorhinolaryngology Head and Neck Department of La Rabta Hospital from 2000 to 2011. RESULTS: These are four women and one man with mean age of 24.8 years. Functional symptoms were dominated by nasal obstruction and purulent rhinorrhea. Imaging showed a unilateral pansinusien filling extended to the nasal cavity with bone lysis. An orbital and endocranial extension was noted in two cases. Endonasal approach was performed in four patients and external approach in one patient. Anatomopathologic and mycological examination confirmed the diagnosis. All patients were started on antifungal therapy. One reccurence had been noted. Endonasal approach was performed. CONCLUSION: Granulomatous invasive aspergillosis rhinosinusitis is a rare infection. The prognosis is particularly serious which warrants a rapid therapeutic care to avoid complications.

Tuberculose extra ganglionnaire de la tete et du cou

Les localisations ORL extra ganglionnaires de la tuberculose sont peu communes. La symptomatologie clinique est trompeuse; posant ainsi le probleme de diagnostic differentiel avec la pathologie tumorale. Nous rapportons 12 cas de localisations extra ganglionnaires de tuberculose; colliges au service ORL de l'EPS Fattouma Bourguiba de Monastir entre 1995 et 2009. L'age moyen de nos patients est de 38 ans. L'etude topographique a montre 3 localisations laryngees; 3 au niveau des glandes salivaires; 2 amygdaliennes; 2 rhinopharyngees; 2 rhino sinusiennes. Le diagnostic etait anatomopathologique dans tous les cas. Tous nos patients ont recu un traitement antituberculeux avec une bonne evolution