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INTRODUCTION AND IMPORTANCE: Extracranial meningiomas of the sinonasal tract are rare tumors. The diagnosis is not generally evident. We report, through an observation, the clinical particularities, the diagnostic difficulties and the therapeutic approach of primary sinonasal meningiomas. CASE PRESENTATION: We report the case of a 54-year-old woman who presented with complaints of right nasal obstruction with the notion of recurrent epistaxis evolving for one year. At the examination, nasal endoscopy found a voluminous purplish-gray mass filling both the middle meatus and the olfactory cleft. The CT examination showed an ethmoïdonasal tumoral process extending to orbital cavity and infratemporal fossa without endocranial extension. A transnasal approach was performed, histopathological examination demonstrates a méningothélial meningioma rank1. The clinical, endoscopic and CT controls did not show tumor residue or a local recurrence. CLINICAL DISCUSSION: Meningioma is a common non-glial intracranial neoplasm. Primary or secondary extracranial meningioma (depending on whether they are isolated or associated with an intracranial tumor) location is uncommon, clinical presentation is nonspecific. Diagnostic confirmation is anatomopathological with immunohistochemically study. Imaging confirms the primary nature of these tumors. The prognosis is favorable after complete surgical excision without further adjuvant treatment. CONCLUSION: Primary nasosinus meningiomas are rare, with non-specific symtomatology and common with other local pathologies. Imaging confirms the primary character of these tumors, anatomopathological examination completed by immunohistochemical study confirms the diagnosis. Surgery with complete exeresis remains the best option with a good prognosis.

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The sphenoethmoidal meningocele is a herniation of the meninges through a communication of the skull base with an aeric cavity. It means the presence of an osteomeningeal breach, which is manifested by cerebrospinal rhinorrhea and nasal obstruction. iIs diagnosis is based on a very specific radiological assessment and biology allows the dosage of certain substances to confirm the nature of the cerebrospinal fluid, such as beta-2-transferrin, Once the breach has been found, the endoscopic route exclusively allows the pathology to be treated and the defect to be reconstructed using different materials before the occurrence of serious complications such as meningitis.

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Tuberculosis is an infectious disease caused by a bacterium called Mycobacterium tuberculosis. According to the World Health Organization, tuberculosis is the leading cause of death by an infectious disease worldwide. We describe here a rare case of tuberculosis that presented as a giant nodule of the soft palate mimicking a tumor. A 50-year-old man was admitted to the oral and facial surgery department for odynophagia and nocturnal snoring. The clinical examination of the oral cavity revealed a mass on the right side of the soft palate, pushing back the uvula on the left, measuring 3 cm in length, nodular in appearance, hard to palpate, and painless with no inflammatory sign of the mucosa opposite. A contrast-injected cervicofacial scan and magnetic resonance imaging were requested that showed a heterogeneous mass on the right side of the soft palate. The therapeutic decision was to perform a biopsy under general anaesthesia, with a histopathological study of the mass. Intraoperatively, the mass was detachable and completely removable. The definite histopathological examination of the surgical specimen was in favour of tuberculosis of the soft palate.

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Amygdaloid cysts are benign dysembryological cystic tumors that develop in the antero-lateral part of the neck; they represent 2% of laterocervical tumors of the neck; they are among the most frequent gill anomalies; they represent 6.1% to 85.2% of second cleft anomalies. They are due to the persistence of the cervical sinus during the differentiation of the branchial apparatus. They are manifested by a laterocervical swelling located at the anterior edge of the sterno-cleido-mastoid muscle. Their cystic nature is confirmed by ultrasound and CT. Treatment consists of surgical excision. We report the case of a 33-year-old man who consulted for a huge right laterocervical swelling that had been evolving for 16 months without any other associated symptoms. An exploratory cervicotomy with an anatomo-pathological study was performed, and the histological diagnosis retained was an amygdaloid cyst without signs of malignancy. The objective of this work is to analyze the anatomo-clinical characteristics and discuss the methods of management and the therapeutic indications of this affection.

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A pleomorphic adenoma or mixed tumor is a heterogeneous benign tumor of the salivary glands. The most frequent site is the parotid gland. It is rare in the accessory salivary glands, preferably located in the oral mucosa (roof of the mouth, floor of the mouth, cheeks, and lips). The diagnosis of pleomorphic adenoma of the palate can only be made on a biopsy while remaining vigilant about the possible existence of other neoplastic foci within it. Definitive anatomopathology after excision is mandatory. Here, we present a clinical case of pleomorphic adenoma of the palate. We propose to specify the epidemiological, diagnostic, and therapeutic particularities of these tumors as well as their evolutionary characteristics.

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Introduction and importance: the diagnosis of thyroid tuberculosis is often difficult, on account of its rarity even in countries with endemic tuberculosis, and on account of its non-specific clinical, biological and radiological presentation. Case presentation: A 38-year-old woman presented with swelling in the anterior part of the neck for 7 years. Clinical and radiological examination found multinodular goiter and fine needle aspiration cytology showed colloidal cells with follicular cells. A total thyroidectomy was performed and histological examination of showed epithelioid and giganto-cellular granulomatous with caseous necrosis, confirming the diagnosis of tuberculous thyroiditis. Clinical discussion: Tuberculosis of the thyroid gland is a very rare disease, the diagnosis is often made by fine needle aspiration cytology (FNAC), the treatment is mainly medical with antituberculosis drugs, but surgery remains a therapeutic means for some cases. Conclusion: The diagnosis of thyroid TB should be suspected in the presence of a thyroid swelling or nodule, especially in countries with a high prevalence of TB, to allow for early and appropriate management.

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Introduction: The systematic realization of biochemical and radiological examinations of the parathyroid has increased the incidence of primary hyperparathyroidism; which explains the increasing incidence of parathyroid surgery. Our study aims to predict the factors determining the diagnosis and management of parathyroid adenomas. Methods: We included 87 patients who presented with hyperparathyroidism and underwent parathyroid surgery. Ultrasound, computed tomography (CT), and more rarely sestamibi, were performed to localize the lesion preoperatively. Body mass index (BMI), blood and urine calcium and PTH concentrations before and after surgery, and preoperative vitamin D concentrations were evaluated. Results: In 90.8% of the cases, the location of the adenomas was retained thanks to cervical ultrasound, and in 86% of the cases, the ultrasound results were concordant with the intraoperative results, whereas the MIBI scanner was used in only 6 patients with a specificity and sensitivity of 100%, but these results cannot be taken into account because the sample is too small. No significant association was found between weight and preoperative vitamin D concentration, whereas we find a positive correlation between preoperative vitamin D concentration and adenoma weight (p = 0.001). Postoperative follow-up showed a positive relationship between the onset of hypocalcemia and vitamin D deficiency, and an inverse correlation between PTH concentration and postoperative hypocalcemia. All patients with an unknown vitamin profile (n:4) who developed postoperative hypocalcemia had a BMI greater than 25 kg/m2. The higher the PTH concentration in the preoperative period, the more profound the hypocalcemia. Conclusion: Further studies are needed to explore the role of vitamin D in the localization of parathyroid adenomas on the one hand, and to properly document the association between BMI and preoperative PTH concentration on the other.

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Introduction: Lesions of the nervus abducens, the 6th cranial nerve tend to be rare, usually occur suddenly following head injuries. The existence of the association of several lesions of the cranial pairs in spite of their rarity must lead the clinician to establish a complete lesion assessment before any cranial trauma. Case report: We describe an illustrative case of sixth nerve palsy associated to facial nerve palsy following a motor vehicle accident. A 36-year-old man had temporal bone fracture after a motor vehicle accident and developed horizontal diplopia and left-sided facial droop, Cranial tomography demonstrated left translabyrinthique bone temporal fracture and fracture of the petrous apex. Discussion: The petrous apex is an anatomical area rich in vascular and nervous elements. Any damage to this area, whether inflammatory, tumoral or traumatic, as described in this manuscript, can have an irreversible effect if a rapid diagnosis and management is not established. Conclusion: we report our experience with head trauma with exceptional manifestations, for a better knowledge of these affections, studies with a large number of patients are necessary.

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Neuroendocrine tumors are extremely rare in the middle ear. These tumors represent a spectrum of tumors with a diverse range of molecular abnormalities, functionality and anatomical locations. We present a rare case of middle ear neuroendocrine tumor, review the pathology and differential diagnosis of the tumors, and discuss the management and follow-up of patients with these tumors. We suspect that the middle ear neuroendocrine tumor is underdiagnosed and more cases can be detected through education and personal experience. Treatment is surgical resection, and long follow-up is recommended.

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Schwannoma arising from the cervical sympathetic chain are rare slow-growing tumors which represent a diagnostic challenge. We report a 80-year-old female patient presented with anterior neck triangle swelling. The radiological assessment was based on computed tomography and magnetic resonance imaging, which led to a preoperative diagnosis of vagus nerve schwannoma. However, surgical treatment revealed a cervical sympathetic chain mass rather than a vagus nerve mass. A complete removal was performed, and the anatomopathological examination was in favor of a schwannoma. In post-operative state, the patient presented a well-tolerated Horner's syndrome.

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INTRODUCTION: Stabbing is relatively frequent in Morocco and constitutes a major public health concern. Our observation is interesting by the particularity and the aggressiveness of the trauma leading to an irreversible bilateral blindness. CASE PRESENTATION: The present observation relates to a patient who was victim of a stabbing assault. The examination objectified a facial wound in front of the right lateral canthus with a broken weapon in place. An urgent craniofacial CT scan was performed showing a hyperdense penetrating path of the stabbing from the lateral wall of the right orbit, associated with a bursting of the globe, obliquely crossing the anterior ethmoid cells and severing the optic nerve on the left side. Surgical exploration was made with an extraction of the remaining part of the knife. Bilateral blindness was irreversible and the patient had a psychiatric follow up. CONCLUSION: Aggressions are a sad reality, expressing anger and violence on the part of a young adult, present in any society with often dreaded consequences.

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INTRODUCTION: Chondromyxoid fibroma (CMF) is a rare benign bone tumor that typically affects long bones, only 2% of CMFs involved facial bones or skull, zygomatic localization is extremely rare with only 8 cases reported in literature so far. PRESENTATION OF CASE: We report a case of 88 old years patient with painful swelling in the right zygomatic around 1 year, progressively increasing in volume, Computed tomography (CT) scan showed an osteolytic lesion in the right zygomatic bone with cortical destruction. Surgical management consisted of bone curettage using intra oral approach, the histopahological findings were in favor of the diagnosis of CMF. DISCUSSION: CF is a rare bone tumor and represents less than 1% of all bone tumors, the maxillofacial bones are rarely affected, with the mandible as a site of predilection, the zygomatic location is extremely rare. The clinical presentation is not typical, radiologically, the lesion is usually osteolytic with well defined margins.En bloc resection is the gold standard, some authors recommand conservative approach to avoid esthetic and functional sequels. CONCLUSION: We reported a very rare presentation of CF involving zygomatic bone treated by conservative approach.

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INTRODUCTION: Mandibular localization of tuberculosis is rare and represents less than 2% of skeletal locations. Its clinical and radiological features are not specific. In this paper, we report a case of fortuitous discovery of mandibular tuberculosis after a histopathological analysis of the surgical resected specimen during surgical management of an ameloblastoma. PRESENTATION OF CASE: A 50-year-old female patient was admitted to our department with a 2 years history of left cheek swelling, the clinical examination revealed a left cheek swelling, extending from the mandibular angle to below of temporomandibular joint, measuring approximately 5 cm in diameter. The swelling was firm to hard in consistency, and cervical lymphadenopathy of submandibular region was noticed. Computed tomography (CT) scan revealed a large multiloculated osteolytic expansive lesion measuring 56 ∗ 48 ∗ 53 mm. An interrupting hemimandibulectomy, was performed from the left parasymphys opposite to 33 tooth, extending to the left temporomandibular joint. The histopathological findings confirmed the diagnosis of ameloblastoma, with negative free margin. A mandibular and lymph node tuberculosis were associated with giant cells and caseating necrosis. The patient was successfully treated with a standard anti-tuberculosis therapy. DISCUSSION: Ameloblastoma is a benign odontogenic tumor, 80% of these tumors are found in the mandible. Primary mandibular tuberculosis is an extremely rare entity. Its clinical presentation is not specific. Radiologically, tuberculosis has no characteristic appearance. However, it is possible to evoke it in case of a lytic image of the mandible. The positive diagnosis is based on histology. The treatment is medical, but surgery is necessary for some cases. CONCLUSION: The association between ameloblastoma and mandibular tuberculosis represents an extremely rare entity. Mandibular tuberculosis is rare and should be considered as a possible diagnosis in pandemic areas.

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INTRODUCTION: Woakes' syndrome is a rare condition commonly defined as recurrent sinonasal polyposis with consecutive destruction of the nasal pyramid. Till now, only a few cases have been reported in the literature. The purpose of this paper is to present the features of woakes' syndrome through two new clinical cases, adding some valuable insight to the recently reported cases. CASE REPORT: We report a series of two consecutive adults male and female patients, aged 55 and 58 years, with Samter's triad, who presented recurrent nasal polyposis and progressive broadening of the nasal dorsum. Facial CT showed in both patients the same radiologic pattern of nasal and paranasal cavities obliteration with nasal bone deformation. Both patients underwent functional endoscopic sinus surgery and correction of the bony nasal vault deformity without osteotomies. At 3 months follow-up, the nasal air passage remained free and aesthetic outcomes were observed. DISCUSSION: having been described over 130 years ago, the etiology of woakes' syndrome remains unclear. Treatment includes topical treatment and sinonasal surgery. Surgical treatment of the nasal dorsum deformity is rarely addressed. CONCLUSION: These observations suggest that the external nose deformity may be successfully corrected by digital compression, in combination with endoscopic sinus surgery.

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INTRODUCTION: The internal jugular vein thrombosis is usually due to intravenous drug abuse, prolonged central venous catheterization or deep head-neck infections or trauma. Related malignancies, or inflammatory etiologies are described. Our case is interesting by the ingestion of a sewing needle that passes from the pharynx to the internal jugular vein via migration, leading to life-threatening complications: deep neck space infection and internal jugular vein thrombosis. CASE REPORT: We report a case of a 40 years old patient, for acute cervical cellulitis in a context of odynophagia and fever, a CT scan revealed a jugular vein thrombosis, penetrated by a metal density foreign body. The diagnosis of ingested foreign body complicated by cervical cellulitis and thrombosis of the internal jugular vein was made. The patient underwent neck surgery with intravenous antibiotics. The postoperative course was uneventful, after one year of follow-up, no complications have been observed. DISCUSSION: no consensus has been reached concerning the management of postoperative and post traumatic vein thrombosis. Taking into account the risk of extension of the thrombus and the hemorrhagic risk each case should involve discussions among a multidisciplinary team. CONCLUSION: The internal jugular vein thrombosis is a rare complication of ingested foreign bodies which may lead to life threat. The early diagnosis and adequate treatment of its life-threatening complications may result in excellent prognosis.

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External auditory canal cholesteatoma is defined as an accumulation of keratin leading to osteolytic bony erosion. It is a rare or underdiagnosed otologic entity. Our study aims to illustrate one case of external auditory canal cholesteatoma. Hypertensive diabetic patient, 65 years of age, under therapy suffering from severe right earache, insomnia, hearing loss, small purulent otorrhea and right facial paralysis grade V since 3 months. Initially the diagnosis was malignant external otitis. The patient underwent antibiotic therapy without improvement. Otologic examination showed burgeoning ulcerative lesion of the posterior wall of the right external auditory meatus. Systematic lesion biopsy was performed and confirmed the diagnosis of cholesteatoma. The patient underwent open technique tympanoplasty. External auditory canal cholesteatoma is rare, clinical symptoms are not specific, coronal CT scan makes a major contribution to a positive diagnosis showing bony crater of external auditory meatus. Treatment depends on the extent of the lesions. It can be based on simple local cares or on open technique tympanoplasty. External auditory canal cholesteatoma may have multiple clinical aspects and lend to confusion with other pathologies of the external auditory meatus.

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Sinus barotrauma is the second most frequently reported injury after middle ear barotrauma. The front sinus is the most common site affected. This is a rare and specific pathology. We here report the case of a 26-year-old patient having severe left frontal pain with ipsilateral epistaxis after a dive. CT scan showed left frontal hemosinus. Patient evolution was good after therapy. Frontal sinus barotraumas are accidents related to the variations in environmental pressure. Epistaxis is a sign of serious health condition, CT scanner plays a role in evaluating potential predisposing factors and establishing monitoring procedures. Patient treatment aims to relieve symptoms and to remove predisposing factors. Frontal sinus barotraumas are a rare injury ; orbital and encephalic complications are exceptional. Their treatment coincides with that of their causal pathology.

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Malignant otitis externa is also referred to as skull base osteomyelitis. Pseudomonas aeruginosa is the most common offending pathogen. However, fungal origin is not uncommon. 80-year-old patient having persistent left earache since two months despite adequate treatment. Otologic examination showed signs of inflammation in the auricular pavilion, ear canal stenosis with granulomas and purulent otorrhea. CT scan showed a filled otomastoid, extensive inflammatory process affecting the pre-auricular and retro-auricular tissues and lysis of the tympanic bulla. Given the lack of improvement, mycological examination was performed which revealed the presence of Candida Albicans. Cases of malignant otitis externa caused by Candida albicans are rarely reported. Fungal origin should be suspected in patients who have negative bacteriological samples and no improvement despite adequate antibiotic treatment. It should be confirmed by sometimes multiple mycological samples. Malignant otitis externa caused by Candida albicans is a rare potentially mortal infection.

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