Results of thyroidectomies according to general surgeons and otolaryngologist and cervico faciale surgeons at the general Hospital of Reference of Niamey, what differences in the protocols of management?

OBJECTIVE: To evaluate the surgical management of thyroid pathologies at the Reference General Hospital. METHODS: This was a retro-prospective study over 4 years 6 months carried out in the departments of General and Digestive Surgery (GDS) and Otorhinolaryngology and Cervico Facial Surgery (ORL/FCS). It involved 182 patients who underwent thyroid surgery. RESULTS: A frequency of thyroidectomy of 9.46% was found. Females predominated with a sex ratio of 0.1. The average age of patients was 42.85 years, a standard deviation 12.80. 84.06% of patients had consulted for anterior cervical mass. EU-TIRADS score 3 represented 7,14% of cases. Heteromultinodular goiter was the main indication for thyroid surgery (59.34%). Total thyroidectomy was the most commonly performed gesture in general surgery in 88,23% (n = 105), in Otorhinolaryngology, it was in the same proportion as lobo-isthmectomy at 47.61% (n = 30). The first route was video-assisted thyroidectomy 2.2% (n = 4). The recurrent laryngeal nerve was dissected and seen in 159 cases (87.36%) and parathyroid glands were also seen and preserved in 58.24% of cases (n = 106). In immediate postoperative surgery, the main complications were unilateral recurrent paralysis with dysphonia in 3.3% (n = 6) and compressive hematoma in 2.2% (n = 4). No deaths had been recorded. CONCLUSION: Total thyroidectomy was the most performed procedure in department of General and Digestive Surgery. Routine oral calcium and vitamin D supplementation in the general surgery ward, reduces the occurrence of hypocalcemia after total thyroidectomy and allows a safe and early exit. Standardizing protocols will further reduce complications.

[Penetrating neck and facialinjury : arrow, an rare but still current etiology]. / Plaie cervico faciale : la fleche , une etiologie tres rare, encore d'actualite.

Penetrating neck and facial injuries are rare withonly a few cases reported in literature. Indeed, they are extremely rare in developed countries but remain relevant in our rural areas that are characterized by the recurrence of intertribal clashes. It was in thiscontextthatwereceivedtwo patients in the department of ENT of Niamey National Hospital. They presented with head and neck trauma. The middle stage of the neck in the first case and, in the left lateral face of the nasal pyramid in the second. Surgical management, under general anesthesia, enabled the removal of an arrow in both cases.

Les plaies pénétrantes cervico-faciales par flèche ont fait l'objet de très peu de publications dans la littérature. En effet, elles sont d'une extrême rareté dans les pays développés mais restent encore d'actualité dans nos régions à communautés majoritairement rurales, caractérisées par la récurrence des affrontements intertribaux. C'est dans un tel contexte que nous avons reçu deux patients au service d'ORL et CCF de l'hôpital national de Niamey. Ils présentaient un traumatisme cervico facial. L'agent vulnérant, une tige métallique, était enfoncé dans l'étage moyen du cou chez le premier et, dans la face latérale gauche de la pyramide nasale chez le second. Une prise en charge chirurgicale, sous anesthésie générale, a permis l'extraction d'une flèche dans les deux cas.

[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.

A case of cervical Pott's disease revealed by parapharyngeal abscess.

INTRODUCTION: We report a case of cervical Pott's disease revealed by parapharyngeal abscess. CASE REPORT: A seven-year-old boy was admitted with a three-week history of painful fluctuating left lateral cervical swelling, associated with night sweats. Examination found trismus, through which a lateral pharyngeal bulge could be observed. Incision and drainage of the abscess on a combined cervical-oropharyngeal approach was performed under general anesthesia, associated to non-specific antibiotherapy by parenteral route. Bacteriology was negative. After one week of antibiotherapy, fever persisted with onset of torticollis. A diagnosis of tuberculosis was considered. Tuberculin skin test was positive at 16.5 mm. A second sample by pharyngeal aspiration showed caseous pus with acid-fast bacilli. Cervical spine CT found a retrostyloid abscess with atlantoaxial lysis. Cervical Pott's disease complicated by Grisel syndrome was diagnosed. Antituberculosis therapy was initiated. Results at five months' follow-up were satisfactory. DISCUSSION/CONCLUSION: Parapharyngeal abscess with an etiology of Pott's disease is rare. Modern imaging is highly contributive to diagnosis and follow-up of lesion regression under treatment.