[Unusual location of pleomorphic adenoma: A series of 7 cases]. / Adénome pléomorphe à localisation inhabituelle: à propos d'une série de sept cas.

INTRODUCTION: The pleomorphic adenoma is a benign tumor of the salivary glands. Its location outside the main salivary glands defines the pleomorphic adenoma of atypical location. The aim of this study is to analyze the clinical, diagnostical and therapeutical features of this tumor at atypical locations through seven observations. PATIENTS AND METHODS: This work is a retrospective study. It has for objective to present 7 cases of pleomorphic adenoma developed on minor salivary glands diagnosed in Otolaryngology Head and Neck surgery department in Mohammed VI University hospital, between December 2003 and December 2010. RESULTS: We had 3 cases of pleomorphic adenoma of the hard palate and 1 case of each soft palate, superior lip, lower eyelid and nasal septum. The sex ratio woman/ man was 133. The symptomatology was variable according to the location of the tumor. The tumoral syndrome was constant. The diagnosis of pleomorphic adenoma was suspected at the clinical stage in 3 cases of palatal location. The CT scan was performed for all patients except in 2 cases of the tumor of the lip and the eyelid. We did not realize a magnetic resonance imaging nor of a fine needle aspiration to our patients. The preoperative biopsy was realized to 5 patients. The treatment consisted of a wide surgical excision of the tumor. The mean follow up of 3 years showed no signs of recurrence nor of malignant transformation. DISCUSSION/CONCLUSION: The pleomorphic adenoma of atypical location is rare. The clinical presentation is variable according to the tumor site and volume. The treatment is surgical. It is based on the early and complete excision of the tumor. The histo-pathological diagnosis is made. The diagnosis differential is with malignant tumors arising on minor salivary glands. The prognosis is favorable. Nevertheless, regular and prolonged follow-up of the patients is important to watch for complications.

Bilateral facial nerve schwannoma: A case report.

Facial nerve schwannoma (FNS) is an uncommon disease, bilateral FNS are exceptional. We describe a case of a 23-year-old man who presented a bilateral 3rd segment facial nerve schwannoma, without neurofibromatosis disease. We discuss the clinical presentation, radiologic findings and management of this case. Facial nerve schwannoma can present in various ways. The imaging appearance of FNS is more varied than originally described. Our case demonstrates an uncommon presentation of a relatively rare tumor in which the tumor has been respected. During this time, the tumor may be followed by radiologic imaging.

[Capillary-cavernous hemangioma of the nasal septum]. / Hémangiome capillaire caverneux du septum nasal.

INTRODUCTION: Hemangioma are rare benign vascular tumors. Histologically, there are several types including capillary, cavernous and mixed hemangioma. We present a very rare mixed hemangioma of the nasal septum. CASE REPORT: A 30-year-old woman consulted for unilateral epistaxis and nasal obstruction. CT scan revealed a tumor filling the rhinopharynx, strongly enhanced after injection of contrast medium. It was pedicled on the posterior and superior nasal septum. Arteriography revealed a vascular blush. Tumor exeresis was performed by paralateronasal approach and endoscopic surgery. The histological examination identified a mixed hemangioma. DISCUSSION: Capillary and cavernous hemangiomas are rare and benign vascular tumors developing in the skin and subcutaneous tissues of the head and neck, and/or oral and nasal mucosa. No mixed hemangioma exclusively involving the nasal septum had been previously reported. Complete surgical resection is the treatment of choice, providing a favorable prognosis with low risk of recurrence.

[Hydatid cyst of the thyroid in a child]. / Kyste hydatique de la thyroïde chez l'enfant.

INTRODUCTION: Hydatidosis is an anthropozoonosis due to the development of the Echinococcus granulosus in humans. Thyroid gland involvement is rather rare. The authors report a very rare case of thyroid gland hydatidosis in a child. OBSERVATION: A 6-year-old male child presented with an isolated neck mass. Cervical ultrasonography suggested a cystic thyroid nodule. No invasive investigation was performed. Hepatic ultrasound and chest radiography were normal. Hydatid serology was negative. The tumor was en-bloc removed by cervicotomy. Its content was fluid, crystal clear, with membranes confirming the hydatid origin. There was no recurrence after 9 months. DISCUSSION: Even though hydatidosis in the thyroid is rare, it should be considered in case of anterior cervical tumor, for patients living in endemic zones. The only radical treatment is surgery. An en-bloc resection must be performed with a cystectomy, isthmolobectomy, or total thyroidectomy.

[A giant lipoma of parapharyngeal space in a child]. / Un volumineux lipome de l'espace parapharyng chez un enfant.

INTRODUCTION: Tumors of the parapharyngeal space are rare and composing a wide variety of histological types. The aim of this study was to report a case of giant parapharyngeal lipoma in a child and to present clinical, paraclinical, and treatment aspects. CASE REPORT: A 14-year-old child presented with a painless progressive mass on the right side of the upper neck. It was growing asymptomatically since 2 years. Cervical CT-scan and MR showed a low-density mass in the right parapharyngeal, consistent with a mass of adipose tissue origin. The mass was surgically removed via cervical-parotid approach. The fatty mass was completely excised. Histopathology confirmed it to be a lipoma. The patient has been followed up for three years, and there have been no signs of recurrence. CONCLUSION: Diagnostic orientation in parapharyngeals tumors is necessary for better care. This guidance is being facilitated through imaging advances. Their surgical approaches and complete excision depend on volumes, localizations and their proximity to neurovascular structures.

[Cholesteatoma by osteoma of the external auditory canal]. / Cholestéatome sur ostéome du méat auditif externe.

Osteoma in the external auditory canal (EAC) is an uncommon benign tumor. The association of a cholesteatoma with an osteoma of EAC is extremely rare. We report a case of a 26-year-old woman with an osteoma of the left EAC that was complicated by a cholesteatoma in the EAC between the osteoma and left tympanic membrane. Surgical removal of the osteoma and cholesteatoma proved successful by postauricular approach. The follow up without recurrence is 24 months. Osteoma of the EAC is a solitary, unilateral, and slow-growing bony benign tumor. The foremost differential diagnosis is exostose that is multiple and bilateral. Cholesteatoma of the EAC is uncommon. Its basic pathogenesis is a chronic occlusion of the EAC. Surgical treatment avoids complications related to local aggressiveness of cholesteatoma.

Retropharyngeal abscess in adults: five case reports and review of the literature.

Retropharyngeal abscesses are rare in adults. They occur mostly in immunocompromised patients or as a foreign body complication. We report 5 cases of retropharyngeal abscess collected in the ENT Department of CHU Mohammed VI of Marrakech, during a two-year period (December 2008 to December 2009). Local trauma by foreign body ingestion was the aetiology in four patients. The presenting symptoms, for all patients, were fever, odynophagia, torticollis, and trismus, and the clinical examination showed bulging of the posterior wall of the oropharynx. The radiography of cervical spine showed prevertebral thickening in all cases, this thickening was associated with an aspect of vertebral lysis of the fourth cervical vertebra in one case. A CT scan was performed in all our cases and showed features of retropharyngeal abscess which was associated, in one case, with spondylodiscitis. The biological assessment found one case of diabetes. The intradermal reaction to the tuberculin was clearly positive in one case. Endobuccal abscess puncture was practiced in 4 cases; only one organism was identified by culture: Staphylococcus aureus treatment was based on triple intravenous antibiotics and anti-Koch's therapy (in one case), and the surgical drainage under general anesthesia was also performed in the case of the diabetes patient which required also the correction of hyperglycemia in intensive care unit. The outcome was good in all our patients. The diagnosis of retropharyngeal abscess can be difficult and one must seek a comorbidity; a tuberculosis aetiology must be considered in countries with a high prevalence. The management of these cases is based on antibiotics and surgical drainage.

A case of penetrating axillary trauma.

INTRODUCTION: Deep penetrating traumas of the axilla extending to the neck are rare and potentially dangerous. OBSERVATION: An 11-year-old child presented with an impressive penetrating axillary injury extending to the neck after falling on a tree branch. The wound was explored in the operating room (OR). A fragment of the branch was removed without injuring any vascular structure. The only lesion concerned the hypopharynx. DISCUSSION: Cervical wounds may have an axillary origin. These wounds must be systematically explored in the OR, given the risk of upper airway obstruction and vascular lesion.

[Myofibroma of the mandibule: a case report]. / Myofibrome de la mandibule: à propos d'un cas.

INTRODUCTION: Myofibromatosis is a rare tumor. Two forms are described, solitary and multicentric, the solitary type is more common and is localized mainly on the head and the neck, mandible involvement is rare. The recent observation of a patient with a myofibrome of the mandible has given the opportunity to conduct an analysis and review of the literature of this disease rarely encountered. MATERIALS AND METHODS: We report a case illustrating solitary myofibroma of the mandible in a 16 year old man. RESULTS: The histological diagnosis was done on the identification of the spindle-shaped tumoral proliferation and the positive expression of the anti-vimentine, anti-smooth, muscle actin anti desmin. The treatment was surgical. DISCUSSION: myofibromatosis often presents as a painless, well-circumscribed, solid nodule. Imagery is very useful to assess lesion extension and for the therapeutic followup. The diagnosis is made on anatomopathological findings and immunohistochemical assessment. The treatment of the solitary myofibromatosis is primarily surgical and its prognosis is excellent contrary to the multicentric form.

[High-resolution CT of temporal bone trauma: review of 38 cases]. / L'apport du scanner dans les traumatismes du rocher: à propos de 38 cas.

PURPOSE: Temporal bone trauma is frequent but difficult to assess due to the diversity of clinical presentations and complex anatomy. We have sought to assess the different types of fractures and complications on high-resolution CT. Materials and methods. Descriptive retrospective study over a 24 month period performed in the ENT radiology section of the Mohammed VI university medical center in Marrakech. A total of 38 cases of temporal bone trauma were reviewed. All patients underwent ENT evaluation and high-resolution CT of the temporal bone using 1mm axial and coronal sections. RESULTS: Mean patient age was 33 years (range: 14-55 years) with male predominance (sex ratio: 36/2). Clinical symptoms were mainly otorrhagia and conductive hearing loss. Oblique extra-labyrinthine fractures were most frequent. Two cases of pneumolabyrinth were noted. Management was conservative in most cases with deafness in 3 cases. CONCLUSION: High-resolution CT of the temporal bone provides accurate depiction of lesions explaining the clinical symptoms and helps guide management. MRI is complimentary to further assess the labyrinth and VII-VIII nerve complex.

A laryngocele revealing a small cell lung carcinoma.

BACKGROUND: Laryngocele is defined as an abnormal dilatation of the laryngeal ventricle. It is a very rare entity, and the exact underlying mechanism is still unclear. Laryngoceles are associated with larynx carcinoma but not yet lung cancer. CASE PRESENTATION: A 46-year-old man presented with stridor, wheezing, dyspnea at rest, hoarseness evolving over two months, and cyanosis secondary to cervical swelling. His medical history included a 72 pack-year smoking habit and chronic obstructive pulmonary disease for 10 years. Airway management included a surgical tracheotomy for respiratory distress. A neck CT revealed laryngocele. A chest X-ray showed a left basal pulmonary opacity. Bronchoscopic exploration found an infiltrated and narrow left stem bronchus with complete stenosis of the lingula. Pathology revealed a small cell lung carcinoma. CONCLUSION: Our case shows the possible association of laryngocele and lung carcinoma. The pathophysiology was explained by the long history of tobacco smoking and the underlying chronic obstructive pulmonary disease with chronic cough.

[Leeches of the upper aerodigestive tract]. / Sangsues des voies aérodigestives supérieures.

INTRODUCTION: The leech is an aquatic worm living in fresh water, especially in tropical areas. It may be found exceptionally in the upper aerodigestive tract (UADT) after consumption of spring water or water from natural wells, after swimming in still waters (lakes and dams). The author's objective was to study epidemiological, clinical, therapeutic, and evolutive aspects of this infestation. PATIENT AND METHODS: This prospective 2-year study was carried out from January 1, 2007 to December 31, 2008. We included all patients consulting at the emergency unit presenting with leeches in the UADT. RESULTS: Twenty patients living in rural settings were included: 16 children, mostly boys (sex ratio 3:1). All cases were recorded during the summer season, with 14 cases due to consumption of fresh water and six due to swimming in still waters. The delay between infestation and onset of symptoms ranged from 2 to 15 days. Leeches were found in the oropharynx (six cases), the nasopharynx (five cases), the hypopharynx (six cases), and the glottis (three cases). An anemia syndrome was noted in four patients. All parasites were removed. All patients were given local antiseptics and analgesics. Patients with anemia were given iron supplementation. The outcome was favorable for all patients. DISCUSSION: UADT leeches are not uncommon in Morocco. The infestation is usually observed in the summer. Symptoms vary according to UADT localization. The diagnosis should be made rapidly to prevent complications. Whatever the localization, removing the parasite is difficult. In laryngeal localizations induction general anesthesia is recommended, without intubation. Evolution after treatment is rapidly favorable, with complete disappearance of symptoms.

[Pleomorphic adenoma of the nasal septum]. / L'adénome pléomorphe du septum nasal.

INTRODUCTION: The pleomorphic adenoma is the most common benign neoplasm of primary salivary glands. However, its intranasal localization is exceptional. We report a case of pleomorphic adenoma of the nasal septum. CASE REPORT: A 64-year-old man presented with a left rhinological syndrome with nasal obstruction. A facial CT-scan showed a heterogeneous tumor of the nasal septum obstructing the left nasal vestibule. The biopsy analysis proved the histological characteristics of a pleomorphic adenoma, and was further confirmed by immunohistochemical study. The lesion was completely removed by endonasal surgery. There was no recurrence 18 months after surgery. DISCUSSION: The treatment of nasal pleomorphic adenomas must take into account lesion localization, esthetic complications, and evolutionary potential of the lesions. Long-term follow-up is recommended because of the risk of recurrence or malignant degeneration.

Diagnosis and management of palpebral anthrax.

Anthrax is an infectious disease that is not well known by ophthalmologists. In its cutaneous form, it may produce lesions of the eyelids. We report eight cases of palpebral anthrax. All patients presented with a black necrotic eschar and a tegumentary edema, with a history of contact with sick animals. The curative treatment was based on intravenous penicillin G in four cases and amoxicillin-clavulanic acid in the four other cases. The palpebral lesions resolved, leaving no clinical evidence of eyelid abnormalities in six patients. Only two patients developed a cicatricial ectropion and a palpebral symphysis. Although palpebral anthrax is a rare disease in humans, ophthalmologists should be aware of its symptoms and management.

[Orbital apex syndrome secondary to herpes zoster infection. A case report]. / Syndrome de l'apex orbitaire sur zona ophtalmique.

The orbital apex syndrome is defined by the association of visual loss, ophtalmoplegia, blepharoptosis, proptosis along with forehead and upper eyelid anesthesia. This syndrome is secondary to traumatism, malignancy or infection of orbital apex. Herpes zoster is an uncommon cause. We discuss the physiopathologic mechanism, evolution and management of this affection.

[Retropharyngeal abscess revealing diabetes: a case report]. / Abcès rétropharyngé révélateur d'un diabète: à propos d'un cas.

Retropharyngeal abscess, a rare event in adults, is usually observed in immunodeficient persons or subsequent to foreign bodies. We report a case of retropharyngeal abscess which revealed diabetes mellitus. A 47-year-old woman with an uneventful history complained of fever, dysphagia and trismus. Clinical findings were swelling of the pharyngeal posterior wall. The CT scan showed an abscess in the retropharyngeal space. Puncture revealed the purulent nature of the collection. The bacteriological study identified a Gram-negative aerobic germ (Citrobacter freundii). Laboratory tests disclosed diabetes mellitus with ketosis. The treatment consisted in surgical drainage and lavage of the retropharyngeal space using a saline solution with gentamycin associated with infusion of appropriate antibiotics. Abscess formation in the retropharyngeal space is a rare event in adults. The immunological status of the patient should be carefully explored. Management requires drainage of the collection and infusion of active antibiotics.

[Paranasal sinus mucoceles: About 32 cases]. / Les mucocèles naso-sinusiennes: à propos de 32 cas.

INTRODUCTION: Mucocele is a pseudo-cystic tumor of the paranasal sinuses. Despite its benign histological nature, it is aggressive towards neighboring structures (orbit and brain). Our aim was to study the epidemiological, clinical, therapeutic, and evolution aspects of this pathology. PATIENT AND METHODS: We conducted a retrospective study over a period of 9 years on 32 patients operated on and followed for mucocele in our department. RESULTS: Mean age was 43.28 years with a sex ratio to 1. Mucoceles were located in the fronto-ethmoid sinus (27 cases), the maxillary sinus (3 cases) and the sphenoid sinus (2 cases). The most common symptoms were periorbital swelling and exophthalmia. CT scan confirmed the diagnosis in the majority of cases. MRI was performed in 3 patients. Surgery consisted in a large marsupialization by endonasal approach in 30 cases, and by a combined approach in two cases. A recurrence was observed in two patients after a mean period of 18 months. DISCUSSION: Mucocele is a benign and expansive pseudo-cystic tumor, affecting mostly adults and developing in the paranasal sinuses. Clinical symptoms are not specific. It may reveal itself by ophthalmic or intracranial complications. Diagnosis is based on imaging (CT and MRI). Endonasal surgery has become the gold standard for the treatment of mucoceles and is endowed with low morbidity.

[Persistent otorrhea revealing a foreign body of the middle ear]. / Otorrhée persistante révélant un corps étranger de l'oreille moyenne.

OBJECTIVES: To report a rare clinical case of chronic otitis media due to an unknown foreign body in the middle ear and a literature review. PATIENT AND METHODS: A 14-year-old girl who had persistent otorrhea associated with hearing loss for two years. The clinical and CT scan exploration found an unknown foreign body in the middle ear. Extraction was performed by retroauricular surgery, complemented by myringoplasty. RESULTS: After two months of follow-up, the patient was free of symptoms. Otoscopy discovered an intact neotympanum. The follow-up audiogram was normal. CONCLUSIONS: Penetrating foreign bodies in the middle ear are infrequently encountered in practice in ear, nose, and throat pediatric emergencies. They may go unnoticed and be revealed by locoregional complications later, hence the importance of suggesting this diagnosis.

[Acute miliary tuberculosis or Isambert disease: a case report]. / Miliaire tuberculeuse aiguë du pharynx ou maladie d'Isambert : à propos d'un cas.

Pharynx tuberculosis consists in a set of active lesions in granulomatous-type mucosa, resulting from Mycobacterium tuberculosis infection. In an endemic context, this diagnosis should be raised in cases of head and neck disease. A recent observation of a case of acute miliary tuberculosis gave us the opportunity to conduct a literature review of this disorder. This 9-year-old girl presented with dysphagia associated with pharyngeal discomfort, snoring, and hoarseness lasting for 8 months. This pharyngeal syndrome occurred in the context of an impaired general condition. Clinical examination found a diffuse mucosal granulation aspect in the oropharynx. The workup showed an inflammatory syndrome with a strong positive intradermal tuberculin reaction. The biopsy found an aspect of giant cell granuloma with caseous necrosis. The course was favorable on antituberculous chemotherapy. Tuberculosis is a chronic bacterial infection caused by a bacterium belonging to the M. tuberculosis complex. Pharyngeal tuberculosis remains a rare disease, but several epidemiological parameters show an upsurge of this disease, prompting us to report this observation.

Capillary hemangioma of the middle ear: one case report and review of the literature.

Hemangiomas are rare benign vascular tumors; there are several types including the capillary hemangiomas, we present the case of an exceptional localization of capillary hemangioma in the middle ear. We report the case of a 60-year-old female which consults for episodes of pulsatile tinnitus, otorragies, and hearing loss of the left ear. The clinical examination revealed a reddish polypoid mass in the left external auditory canal, the radiological tests showed a vascular mass in the middle left ear. The tumor was surgically removed, the histological study revealed a capillary hemangioma. The incidence of hemangiomas in the temporal bone, especially in the middle ear, is exceptional. Medical imaging guides to the vascular nature of these tumors that make confusion with other vascular tumors such as tympanic paragangliomas. The management is often surgical and the final diagnosis is histological.