[Contribution of the musculocutaneous flap of pectoralis major in head and neck oncology: 26 observations in Senegal]. / Apport du lambeau musculo-cutané du pectoralis major en carcinologie cervico-faciale: 26 observations au Sénégal.

INTRODUCTION: The pectoralis major musculocutaneous flap constitutes a significant advance in cervicofacial carcinology. At our institution, it has allowed most surgical problems to be resolved in a single-stage procedure. The objective of this study was to report our experience with this flap. PATIENTS AND METHODS: This retrospective study includes 26 cases observed over a 10-year period (January 1994-December 2003). The parameters studied were clinical and paraclinical. All patients included in this study received a pectoralis major musculocutaneous flap. Patients treated using another type of flap were not included. RESULTS: Mean patient age was 51 years (range, 20 to 74). The sex ratio was 12 (24 men and 2 women). At the time of admission, 73% of patients showed marked impairment of general condition. In 21 patients (81%), the effect of the pectoralis major musculocutaneous flap was observed immediately after surgery unlike pharyngostome (19%) in which the flap is used in a second stage procedure. With a mean follow-up of 7 years, failure has been observed in 4 cases (15%). CONCLUSION: The pectoralis major musculocutaneous flap is an excellent tool for cervicofacial reconstruction after carcinological exeresis. It reduces the duration of hospitalization. Acquiring proper flap harvesting technique is an important factor in improving outcome.

[Solitary neurofibroma of the maxillary sinus]. / Neurofibrome isolé du sinus maxillaire.

OBJECTIVE: To illustrate the rarity and difficulty diagnosing maxillary sinus neurofibroma through a case report. PATIENTS AND METHODS: A 35-year-old female consulted our department for left cheek swelling evolving over 6 months, upper gum swelling, and a dental occlusion disorder. RESULTS: A computed tomography scan showed a tumor of the left maxillary sinus with bone destruction. Histological examination of a biopsy fragment found an in situ carcinoma. A maxillary resection was performed to excise the tumor. Histological examination of the specimen showed a neurofibroma. No sign of recurrence was noted after 8 months of follow-up. CONCLUSION: The difficulty diagnosing maxillary sinus neurofibroma is related to its nonspecific clinical and radiological signs. Consequently, the otorhinolaryngologist must keep this rare histological variety in mind within the range of tumors of the paranasal sinuses.

[The otolaryngological manifestations of gastroesophageal reflux disease]. / Manifestations oto-rhino-laryngologiques du reflux gastro-oesophagien (RGO).

The otolaryngological symptoms during gastro-oesophageal reflux disease may be very frequent. When the global estimation in the literature go round 20%, the prevalence in the African studies is variable, between 4 and 43 %. The most common disease encountered are laryngitis and pharyngitis's manifestations. When it is not possible to perform the oesophageal pH-metry, the most sensitive examination in gastro-oesophageal reflux, endoscopic examination and therapeutic test with IPP can be proposed to any patient with ENT symptoms and manifestations of gastro-oesophageal reflux.

[The Study Of Biomedical Waste Management In Sanitary District Of Goudry In Senegal]. / Etude De La Gestion Des Dechets Biomedicaux Dans Le District Sanitaire De Goudiry Au Senegal.

AIM: Of this study was to explore, in the sanitary district of Goudiry, the practice of biomedical waste management and to analyze its impact. MATERIALS AND METHODS: The sample consisted of seven health posts, among a total of 11, drawn by simple random sampling and a health centre (district hospital). Data were collected through structured interviews with all staff, participant observation and from secondary data. RESULTS: The district facilities surveyed produced 111.9 kg (or 16.0 kg/d) over seven days. Waste management is inadequate at all levels. CONCLUSION: Actions needed to improve waste management are sensitization and training of actors, the involvement of all the stakeholders (local authorities, population, health workers), and advocacy with policy makers.

BUT: Il s'agissait d'explorer, au niveau du district sanitaire de Goudiry, la pratique de la gestion des déchets biomédicaux et d'en analyser les conséquences. MATÉRIELS ET MÉTHODES: L'échantillon était constitué de sept Postes de Santé tirés sur 11postes par un sondage aléatoire simple et d'un Centre de Santé dont toutes les unités fonctionnelles ont été incluses dans l'étude. Les données ont été recueillies au travers des entretiens structurés avec l'ensemble du personnel, des observations participantes et de la recherche documentaire. RÉSULTATS: Le District, en sept jours, avait produit 111,9 Kg (soit 16,0 kg/j). La gestion des déchets était inadéquate à tous les niveaux. CONCLUSION: A cet effet, pour améliorer la gestion des déchets, les actions à mener étaient la sensibilisation et la formation des acteurs, l'implication de toutes les parties prenantes (collectivités locales, population, personnel sanitaire), et le plaidoyer auprès des décideurs.

[Cranioencephalic complications of middle ear cholesteatoma: report of 4 cases]. / Complications infectieuses cranio-encephaliques de l'otite moyenne chronique cholesteatomateuse. A propos de 4 observations.

INTRODUCTION: Cranial and intracranial complications can be observed during middle ear cholesteatoma's evolution. We report our experience of management of infectious cholesteatoma's cranioencephalic complications. MATERIAL AND METHODS: In a three year period, we had consecutively admitted 4 patients with cranioencephalic complications of middle ear cholesteatoma, in the Ear Nose and Throat (ENT) department of the university teaching hospital of Dakar. After preoperative investigations with computed tomography scan (CT scan) of brain and temporal bone. The patients had been operated after paraclinic assessment. RESULTS: The finding showed one case of temporal bone otogenic extensive osteomyelitis with multifocal extradural empyema, 3 cases of brain abscess associated with subdural empyema and meningitis in 1 case. For 3 patients (75%), neurosurgical drainage and mastoidectomy were performed, associated with antibiotic treatment. The mastaidectomy was performed in the same time of the surgical procedure or delayed. One patient, with brain abscess, died before surgical intervention. With a follow up of 15 months, we have noticed stable mastoidectomies cavities and no neurological recurrence symptoms. CONCLUSION: These complications can be prevented by early treatment of chronic otitis media diseases. The appropriated management of these complications necessitate collaboration between otorhinolaryngologists and neuro surgeons.

[Hyperthyroidism surgery: experience of ENT department of hospital center of Thies]. / Chirurgie de l'hyperthyroidie: experience du service d'ORL du centre hospitalier regional de Thies.

INTRODUCTION: The treatment of hyperthyroidism includes different therapeutics means of which surgery. The objectives of this study were to evaluate the place of the surgery in the treatment of hyperthyroidism and to describes the complications. PATIENTS AND METHODS: It is a retrospective study on 22 patients treated by thyroidectomy from March 2002 to April 2004. The biological confirmation was systematic. A medical preparation has been done in all the cases. A total thyroidectomy has been done in 13 cases and a subtotal in 9 cases. RESULTS: The mean age was 37 years. There were 20 women and 2 men. An euthyroidism has obtained after surgery. There complications were: 1/22 temporary palsy of recurrent nerve 1/22 acute hypoparathyroidism 1/22 post-operative death (haematoma) CONCLUSION: Surgery seems to be a good alternative to antithyroid agents, which are constraining and often ineffective in the long term, and to radioactive iodine who leads to a long follow-up because of induced hypothyroidy. With increasing surgical skill, the risk of recurrent or parathyroid injury is greatly decreased.

[Head and neck paragangliomas in Senegal. About 8 cases]. / Paragangliomes de la tête et du cou au Sénégal.

UNLABELLED: Paragangliomas are uncommon neoplasms with rare occurrence in the head and neck area. OBJECTIVE: The purpose of this study was to report the experience of management of these rare tumors by a team of Ear, Nose, and Throat (ENT) surgeons working in the context of a sub-Saharan country. MATERIAL AND METHODS: We conducted a retrospective study in the Ear, Nose and throat Department of a Dakar university hospital. The study concerned 8 patients with a highly vascular tumor located in the neck and temporal bone. The preoperative investigations were computed tomography scanning (CT scan) using contrast injection in 88% and Doppler ultrasonography for the patients with a neck mass. All the patients underwent surgery except one. In 2 cases, the management with a team of vascular surgeons was necessary. Histological examination of the tumor was realized in all cases. RESULTS: The tumor was located in the neck in 5 cases (62,5%) with a carotid body tumor in three patients (37,5%) and vagal location in two (25%). The temporal bone was involved in three patients with a tympano-jugular location (37,5%). All the neck masses were operated on via a unique cervical approach. The tympano-jugular tumors were treated by radical mastoidectomy in two patients. In the third patient with a tympano-jugular tumor, with important involvement of the temporal bone, only the neck extension was operated. The histological diagnosis of paraganglioma was confirmed in all patients. Radiation therapy was delivered in two patients (25%), to complete surgery in the event of extensive temporal bone tumor and exclusive in one case of an inoperable vagal tumor. The outcomes, marked early death in one patient (14%), were good in the short and mid term for the others patients. CONCLUSION: With the improvement of technological infrastructures, particularly with developing modern imaging, we have better knowledge of paragangliomas in the head and neck area, in our experience in a developing country. However, therapeutic approaches are still limited by modest humans and material resources.

[Subdural empyema complicating acute frontal sinusitis. Four cases report]. / Empyème sous-dural compliquant une sinusite frontale aiguë. A propos de 4 cas.

OBJECTIVE: Subdural empyema is a collected cranioencephalic suppuration between arachnoid and dura meninge space. Subdural empyema occurring after sinusitis is an uncommon but serious complication of paranasal sinus infections. The purpose of this study is to aware the clinician about this condition. MATERIAL ET METHOD: Four young male children had been admitted with expressed fronto-ethmoid sinusitis. The intracranial infection was confirmed by computed tomography scan of brain and sinus. Both drainage of the sinus and intracranial suppuration was performed at the same time surgical procedure and antibiotics administered during 4 weeks. RESULTS: The subdural empyema was localized in the right temporoparietal region in 1 case, in the frontal lobe in the others cases. In 1 case, the frontal subdural empyema was associated with an inerhemispherique collection. One patient underwent a second drainage. Immediate post-operative outcomes were temporally complicated with convulsions and focal neurological deficit, in 1 case. This symptoms had regressed spontaneously. There was no case of death. The functional prognosis was bad, marked by lost vision in 2 cases, which was bilateral in 1 case. CONCLUSION: A high index of suspicion of intracranial extension of sinus infection must recommended neuroradiological investigations. When suppurative collection is confirmed, an appropriated management of the infection between otorhinolaryngologists and neurosurgeons is necessary.

[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.

[Unusual history of a foreign body of the oropharynx]. / Histoire insolite d'un corps étranger de l'oropharynx.

The foreign bodies of oropharynx rarely make difficulties, whether diagnostic or treatment is concerned. However we considered interesting to report the following observation: an unusual or even anecdotal case. The matter is plantlife foreign body, which penetrated in oropharynx and only made exit four weeks later ... through the Meatus acusticus externus (external auditive duct).

[Thyroglossal duct cysts. Apropos of 17 cases in the National Hospital Center in Ouagadougou, Burkina Faso]. / Les kystes du tractus thyréoglosse. A propos de 17 observations au CHN de Ouagadougou, Burkina Faso.

The thyroglossal duct cysts originate from thyroglossal duct involution default. The case record of 17 patients admitted for that disease in the ORL department of the national hospital of Ouagadougou during those past 7 years, is reviewed. They represent 1.5% of patients operated in this department during the same period, all diseases concerned. In the present report, the thyroglossal duct cysts are essentially observed in children under 10 years old (13/17 patients). In most of the cases (12/17), our patients have needed medical advice for an anterior cervical tumefaction 7 years after the first symptoms. Between clinical and paraclinical findings we give preference to the first ones that can avoid, in most of the cases, a lot of complementary tests which are of limited interest and too expensive in our countries. In the therapeutic field, the Sistrunk technic has been recognized since 1920 as the best method. Our patients who have been operated according to that technic have no tendency to relapse.

[Laryngeal foreign bodies: management in children in Senegal]. / Corps étrangers laryngés: prise en charge chez l'enfant au Sénégal.

UNLABELLED: Inhalation of foreign bodies is a frequent accident in children. It remains severe in the case of laryngeal foreign bodies. PATIENTS AND METHODS: Retrospectively, for a 16-year period, 65 laryngeal foreign bodies have been treated (44.8%), among 145 cases of airway foreign bodies, in the ENT department of Dakar University hospital. Etiological, clinical and therapeutic aspects were reviewed. RESULTS: Average age was 36 months, with a sex-ratio of 2.42 in favour of males. The time lag (time between the accident and admission to the department) was particularly long; 73.33% of the children were admitted more than 24 hours after the event. Eighty-three percent of the patients presented greater or lesser laryngeal dyspnea. Tracheostomy was performed in 55.4% of the patients. Average duration for abiation of the canula was ten days. Three cases of death were recorded (4.16%). DISCUSSION: The frequency of 44.8% for laryngeal localization of foreign bodies appears to be the highest in the literature. If the appropriate treatment for foreign bodies in the respiratory tract is endoscopic removal, the tracheostomy nevertheless occupies a central place in the management of the disease. This procedure may be recommended to all ENT specialists working in similar conditions. In spite of its inherent complications, tracheostomy allows reduction of mortality in relation to laryngeal foreign bodies. Improvement of prognosis requires prevention based on widespread public information and improving technical infrastructures.

[Cystic lymphangioma: a practical problem of cervical oncology. Apropos of 4 cases]. / Le lymphangiome kystique: un problème pratique de l'oncologie cervicale. A propos de 4 observations.

Cystic hygroma is a benign dysembryoplasia of the lymphatic system of mainly cervical expression. Clinical findings of a stereotyped nature were found in 4 cases of this particular aspect of infantile surgical affections. On operation there was an obvious relation with the internal jugular vein, and an entire segment had to be removed in 2 cases. These data confirm conventional pathogenic theories.

[Lipoma of the larynx]. / Lipome du larynx.

Cancer is the most frequently observed tumor of the larynx, benign laryngeal tumors being as rare as they are varied. A case is reported of lipoma of larynx revealed by a respiratory distress syndrome.

[Anatomical features concerning the spinal accessory nerve. Apropos of 106 dissections of the neck in cadavers]. / Considérations anatomiques concernant le nerf spinal accessoire. A propos de 106 dissections du cou chez le cadavre.

Surgical treatment of cervical metastases from head and neck cancer involves different techniques as a function of indication. An anatomical structure of major importance during this surgery is the spinal accessory nerve, and 106 dissections were performed to examine relations of this nerve with cervical plexus, jugular vein, sterno-cleido-mastoid muscle and mastoid tip. Interesting conclusions were drawn with regard to technical procedures of value to surgeons involved in cervicofacial cancerology.

[Mucoceles of the maxillary sinus]. / Mucocéles du sinus maxillaire.

The term mucocele designates a cyst developing from a sinus mucosa, generally the frontal and/or ethmoidal sinuses. They present clinically as a benign tumor, and their diagnosis and treatment is usually simple. Maxillary sinus localizations are exceptional, however, and raise numerous problems in daily practice. Three cases of maxillary sinus mucoceles are reported.

[Thyroid oncology in everyday practice. Apropos of 105 cases]. / L'oncologie thyroïdienne en pratique. A propos de 105 dossiers.

The charts of 105 patients treated for histologically documented nodular thyroid disease from 1976 to 1991 were analysed to determine the various diagnostic and therapeutic problems posed by the management of thyroid nodules in everyday clinical practice. The incidence of solitary nodular and multinodular disease was almost identical, 45.7% and 41% respectively. Radionucleid imaging was performed in only 61.9% (65) of patients and showed a distinct predominance of cold nodules as compared to multiheteronodular goiters, 67.7% (44/65) and 21.5% (14/65), respectively. Histological confirmation of diagnosis, obtained after fixation of the surgical specimen in paraffin, revealed a vast majority of benign versus malignant disease, 89.5% and 10.5%, respectively. 13.6% of cold nodules proved to be cancers. Extensive surgical resection either subtotal or total thyroidectomy, was performed in 41.6% of patients. Improvements in clinical practice and screening of goiters in endemic areas must contribute to a better definition of the surgical management of thyroid nodules.

[Profile of cancers of the hypopharynx in Senegal]. / Profil des cancers de l'hypopharynx au Sénégal.

A retrospective study of carcinomas of the hypopharynx was conducted to examine the epidemiological and clinical features of this cancer in Senegal. An analysis of 66 cases showed a very particular distribution in Senegal with more female (57.6%) than male cases. Average age at diagnosis was 33 years. Advanced cancer (T3-T4) was noted in 65% of the cases, but the first physical examination noted the absence of cervical nodes in 53.6% of the cases. Location at the piriform sinus was observed in 41% of the cases, followed by the posterior wall of the hypopharynx (25.7%). Chronic anemia with iron deficiency was seen in 30% of the cases, probably an important etiological factor of the cancer in Senegal. This point would be the goal of a future prospective study.

[Penetrating wounds of the neck. Apropos of 4 cases]. / Plaies pénétrantes du cou. A propos de 4 cas.

Penetrating neck wounds are those which imply involvement of the platysma. For a long time the prerogative of wartime surgery they are now tending to become more frequent in civil practice. As with penetrating abdominal wounds they are serious and provoke varied lesions. Lesions encountered in the 4 cases reported affected vital structures such as the internal carotid artery, larynx, trachea, and esophagus. The main causes of these injuries: aggression, road or work accidents, attempted suicide, are summarized. These wounds raise, therefore, the problem of their repair, and thus of their exploration, which is tending to become systematic. However, though these injuries may be very impressive they can still be treated without major difficulties, on the condition that they be entrusted to an experienced cervicofacial surgeon.

[Retropharyngeal abscess. 6 case reports]. / Les abcès rétropharyngés. A propos de 6 observations.

From 1983 to 1991, 6 cases of retropharyngeal abscess were treated at the University Hospital Center of Dakar. A retrospective review of these cases showed that most occurred in children between the ages of 3 months and 3 years. All patients were examined late, i.e. with a delay of more than one week between the onset of symptoms and consultation of a specialist. The clinical signs were dysphagia, dyspnea, and, in all but one case, fever. In 5 patients, diagnosis was based on the observation of a mass in the middle section of the posterior wall of the pharynx that led to peroral incision and drainage without general anesthesia. In the remaining patient, whose abscess involved the lower part of the wall, endoscopy was necessary to allow diagnosis and incision under general anesthesia after tracheotomy. In all cases, complete healing was obtained after 10-day single-agent antimicrobial therapy. Practitioners in tropical areas should bear in mind that retropharyngeal abscesses are not uncommon in these regions and that they can cause serious complications (rupture and mediastinal extension).