[A thyroid pathology: The great simulator]. / Une pathologie thyroïdienne : la grande simulatrice.

INTRODUCTION: Tuberculosis remains a major public health problem in developing countries. Thyroid localization is very rare, and often the cause of misdiagnosis. Pathological anatomy plays an important role in the diagnosis of certainty. The authors report a case of primary thyroid tuberculosis in a 22-year-old patient. We highlight the epidemiological particularities of this case, and discuss diagnostic methods and the contribution of pathological anatomy. OBSERVATION: A 22 year-old male patient, with no reported pathological history, was seen in the clinic for the management of an isolated anterior cervical swelling that had been evolving for two months. Clinical examination revealed only a small thyroid nodule, with no inflammatory or vascular features. Biological tests were unremarkable. Ultrasound revealed a 2.4cm hypoechoic, homogeneous, poorly vascularized tissue mass in the left lobe, classified as EU-TIRADS 3. Fine needle aspiration with cytopathological study revealed a necrotizing granulomatous lesion suggestive of tuberculosis. A lobo-isthmectomy was performed, and histopathology revealed thyroid parenchyma destroyed by tubercular granulomas. The postoperative course was straightforward, with an exeat on postoperative day 6. Anti-tuberculosis treatment was instituted for 6 months. Three- and six-month follow-up examinations were unremarkable. The evolution was favorable, with recovery after treatment. CONCLUSION: Primary thyroid tuberculosis is rare. Cytology is important for orientation, and often helps to avoid misdiagnosis. The diagnosis should be considered in the presence of any thyroid mass in a patient from a tuberculosis-endemic region.

Facial nerve monitoring during parotid gland surgery: a systematic review and meta-analysis.

INTRODUCTION: Facial nerve injury remains the most severe complication of parotid gland surgery. However, the use of intraoperative facial nerve monitoring (IFNM) during parotid gland surgery among Otolaryngologist-Head and Neck Surgeons continues to be a matter of debate. MATERIALS AND METHODS: A systematic review and meta-analysis of the literature was conducted including articles from 1970 to 2019 to try to determine the effectiveness of intraoperative facial nerve monitoring in preventing immediate and permanent postoperative facial nerve weakness in patients undergoing primary parotidectomy. Acceptable studies included controlled series that evaluated facial nerve function following primary parotidectomy with or without intraoperative facial nerve monitoring. RESULTS: Ten articles met inclusion criteria, with a total of 1069 patients included in the final meta-analysis. The incidence of immediate and permanent postoperative weakness following parotidectomy was significantly lower in the IFNM group compared to the unmonitored group (23.4% vs. 38.4%; p = 0.001) and (5.7% vs. 13.6%; p = 0.001) when all studies were included. However, when we analyze just prospective data, we are not able to find any significant difference. CONCLUSION: Our study suggests that IFNM may decrease the risk of immediate post-operative and permanent facial nerve weakness in primary parotid gland surgery. However, due to the low evidence level, additional prospective-randomized trials are needed to determine if these results can be translated into improved surgical safety and improved patient satisfaction.

[Basicervical ectopic goiter associated with a eutopic thyroid gland: a case report]. / Une association d'un goitre ectopique basi-cervical et d'une glande thyroïde eutopique: à propos d'un cas.

Thyroid gland is an endocrine gland playing a major role in energy and phosphocalcic metabolism, among others. It commonly occurs in the anterior cervical and pretracheal region. Ectopic thyroid is quite rare. It is dominated by ectopic basilingual thyroid. We here report the case of a patient with goiter in normal cervical position (eutopic) and ectopic thyroid tissue in basicervical position. Cervicotomy revealed the ectopic nodule and the diagnosis was confirmed by histology. This clinical case illustrates a differential diagnosis of cervical masses.

Gingival metastasis of a breast carcinoma.

We report a case of metastasis to the gingiva of breast carcinoma. The breast tumor was treated with neoadjuvant chemotherapy followed by a radical mastectomy associated with axillary dissection. The gingival lesion occurred 7 months after surgery; the metastasis was confirmed by a biopsy.

[Post-intubation tracheal lacerations during cervical spine surgery: about 3 cases]. / Plaies trachéales post intubations dans la chirurgie cervicale: à propos de 3 cas.

We report 3 rare cases of post-intubation tracheal lacerations detected during cervical spine surgery. Our study involved 3 patients aged 27, 30 and 42 years admitted to the operating room for total thyroidectomy for heterogeneous multinodular goitre under general anesthesia. Orotracheal intubation using 7.5 rigid guide probe and balloon cuff was performed. During surgery we discovered a protrusion of the balloon cuff at the surgical site through posterolateral tracheal rupture. The treatment was based on closure of the tracheal rupture in 2 cases and on surgical abstention in the third case, followed by a drainage of the thyroid lodge. The postoperative course was uneventful. Post-intubation tracheal lacerations are rare. Intraoperative detection during cervical spine surgery is exceptional. They have multiple causes: intubation difficulties, membranous rupture caused by probe beak, by a rigid guide, coughing effort with inflated balloon at the awakening, balloon hyperinflation, structural and anatomical changes of the trachea in patients with chronic goiter. There is no consensus about treatment.

An Unusual Laryngeal Foreign Body in Adult.

The accidental aspiration of a foreign body is a frequent domestic accident among children but a rare occurrence in adults. The laryngeal impaction of a coin is an unusual accident; only a few cases have been reported in the literature. Diagnosis is mostly achieved by clinicoradiological examinations. The authors report an uncommon case of laryngeal impaction of a coin in a 21-year-old patient, presenting with dysphonia without dyspnea or stridor. The extraction was performed by endoscopy.

L'amygdalectomie et l'adénoïdectomie à l'hôpital pour enfants de Diamniadio au Sénégal : une évaluation de 3 ans

INTRODUCTION. Les indications de l'amygdalectomie et l'adénoïdectomie sont un sujet de controverse. Notre objectif était de discuter nos indications opératoires en les confrontant à la littérature tout en précisant notre particularité dans la prise en charge des patients dans un hôpital pédiatrique sénégalais. METHODES. Etude rétrospective descriptive au service d'Oto-rhino-laryngologie de l'hôpital pour Enfants de Diamniadio du 1er janvier 2013 au 31 décembre 2015 incluant tous les patients de moins de 15 ans opérés d'une adénoïdectomie, d'une amygdalectomie ou d'une adéno-amygdalectomie. Les variables étudiées étaient l'âge, le sexe, l'indication opératoire, le type de chirurgie et la morbidité. RESULTATS. 522 patients ont été inclus. L'âge moyen était de 4 ans 9 mois avec des extrêmes de 4 mois et 15 ans. L'obstruction respiratoire chronique était la première indication opératoire (63%). Elle était dominée par le syndrome d'apnée obstructive du sommeil retrouvée chez 264 patients (50,6%). Avant l'âge de 10 ans, les indications opératoires étaient dominées par l'obstruction respiratoire chronique (68,2%). Après 10 ans, les infections prédominaient (81,5%). L'adéno-amygdalectomie était le geste chirurgical le plus réalisé (43,7%). La morbidité était de 0,6%, représentée exclusivement par un cas d'hémorragie postopératoire immédiate et deux cas d'hémorragie secondaire.CONCLUSION. L'obstruction respiratoire chronique est la principale indication opératoire particulièrement avant l'âge de 10 ans. Les complications postopératoires sont rares