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A 68-year-old patient presents with chronic right-sided otorrhea associated with hypoacousis and chronic cough. Otoscopy showed multiple perforations of the right eardrum. The search of acid-fast bacilli was positive for direct examination of sputum and negative for the examination of ear pus. A antituberculosis treatment has been initiated.

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Introduction : Les personnes âgées du fait de la particularité de leur terrain, ont-elles des spécificités du point de vue de la pathologie ORL au Burkina Faso ? Cette étude s'est fixée pour objectif de répondre à cette question en étudiant la morbidité et la mortalité du sujet âgé en ORL au CHU YO de Ouagadougou. Patients et méthodes : Il s'est agi d'une étude rétrospective à visée descriptive qui a inclus tous les patients âgés de 60 ans et plus reçus dans le service d'O.R.L. du CHU YO de janvier 2007 à décembre 2011, soit une période de 5 ans. Résultats : Trois-cent trente-trois (333) sujets âgés ont été reçus dans le service pendant la période de l'étude sur un total de 16.404 patients, soit une fréquence de 2,03%. Le sex-ratio H/F était de 1,19. L'âge moyen des patients était de 67,61 ans avec des extrêmes de 60 et 91 ans. L'HTA était le facteur de comorbidité le plus observé, soit 20,1% des cas. La pathologie pharyngo-laryngée représentait 35,1%, suivie de la pathologie cervico-faciale 26,9% et de la pathologie otologique 23,5%. Les principaux motifs de consultation étaient : la tuméfaction cervicale 17,9% la dysphagie 10,7% et l'hypoacousie 5,7%. Les anti-inflammatoires et les antibiotiques étaient les médicaments les plus prescrits. L'endoscopie sous anesthésie était l'acte de chirurgie le plus réalisé dans 24,6%. Conclusion : La fréquentation du service ORL par les sujets âgés est relativement faible, cependant des besoins accrus en matière de prise en charge des pathologies pharyngo-laryngées en ORL se dégagent dans ce groupe spécifique de la population

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Introduction : Pathologie histologiquement bénigne, elle peut cependant mettre en jeu le pronostic vital du patient par ses complications obstructives. Nous voulons à travers cette étude faire le point sur cette affection afin d'améliorer notre prise en charge.Moyens et méthodes : Nous avons mené une étude rétrospective de janvier 2004 à décembre 2013 dans le service ORL du CHU Yalgado Ouédraogo. Cinquante-deux dossiers cliniques complets comportant une confirmation histologique ont été inclus dans l'étude.Résultats : La Papillomatose Laryngée (PL) a représenté 0,38% de nos consultations. La moyenne d'âge de nos patients était de 16 ans avec un sex-ratio de 1,12. La dysphonie a été le principal motif de consultation, elle a été isolée (49%) ou associée à d'autres signes cliniques (51%). La nasofibroscopie et la laryngoscopie directe nous ont permis de mettre en évidence les grappes de papillome mais la confirmation diagnostique a été histologique. Notre traitement a consisté à pratiquer un épluchage à la pince par voie endoscopique des grappes de papillomes. En post-opératoire 73% de nos patients ont récidivé et 1 cas de cancérisation a été diagnostiqué 9 ans après la fin traitement. Conclusion : Le diagnostic positif de la PL est relativement aisé. Cependant l'absence de traitement curatif efficace en fait une affection à évolution imprévisible

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INTRODUCTION: Pseudo-tumoral fongal rhinosinusitis is a rare and benign illness due to saprophyte germ, Aspergillus flavus. OBSERVATION: We reported two cases of invasive pseudo-tumoral fongal rhinosinusitis. CT scan helped with diagnosis and allowed for extension assessment. Complete surgical excision was done through external approach. Bacteriological examination evidenced the germ. DISCUSSION: Pseudo-tumoral invasive fongal rhinosinusitis remains a potentially serious pathology because of its local aggressiveness and its multiple extensions.

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INTRODUCTION: The aim of the study was to evaluate the survival and locoregional recurrence in patients with advanced oral and oropharyngeal squamous cell carcinoma treated by surgery with free flap reconstruction followed or not by radiochemotherapy. POPULATION AND METHODS: A retrospective study was performed on 188 patients treated by surgery with microvascular reconstruction with or without postoperative radiochemotherapy for an advanced stage squamous carcinoma of the oral cavity and/or of the oropharynx. All patients underwent free flap reconstruction. The study parameters were survival and recurrence rates. RESULTS: The 5-year overall survival, disease specific survival, and disease free survival rates were 54%, 65%, and 61% respectively. A high level of comorbidity was the only factor that influenced the survival rate. The overall recurrence rate was 34%. Only 9% of patients having recurred were treated successfully. The survival rate after locoregional recurrence and metastasis was 6% at 2 years. DISCUSSION: Surgery and postoperative radiochemotherapy allows for an acceptable survival rate for patients with advanced oral and oropharyngeal squamous cell carcinoma.

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Primitive neuroectodermal tumors are a rare type of malignant neuroectodermal tumor that is very aggressive. Cervicofacial location is rare, even exceptional. We report a case of a 4-month-old male infant, referred from the pediatric clinic for severe supralaryngeal dyspnea, a firm mass under the left mandibular angle, mobile and extended to the parotid area, painful, with a curve of the left side wall of the oropharynx. Cervical computed tomodensitometry showed a well-limited mass in the carotid area, enhanced by the contrast product. A vascularized mass, which had developed at the expense of the vagus nerve, was removed surgically. Histology found a primitive neuroectodermal tumor.

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OBJECTIVE: The primary objective of this study was to determine the clinical and pathological prognostic factors in locally advanced oral cavity cancers treated by primary surgery. METHODS: All patients treated by primary surgery with free-flap reconstruction for locally advanced oral cavity squamous cell carcinoma in our institution between 2000 and 2010 were included in this retrospective study. Overall, cause-specific and locoregional disease-free survivals were determined by Kaplan-Meier analyses. Clinical and histological prognostic factors were assessed by univariate (Log Rank tests) and multivariate (Cox models) analyses. RESULTS: A total of 149 patients (102 men and 47 women; mean age=61.3±12.1 years) were included in the study. Five-year overall, cause-specific and locoregional disease-free survivals were 55%, 68% and 71%, respectively. Age, comorbidity and tumour size (histological evaluation) were significantly correlated with overall survival (P<0.05). Age, tumour size, bone invasion and surgical margins were significantly correlated with locoregional disease-free survival (P<0.05). CONCLUSION: The main prognostic factors identified in this study were clinical (age and comorbidity) and histological (pathological tumour size, bone invasion and surgical margins).

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OBJECTIVE: The objective of this study was to evaluate the prognostic impact of tumour multifocality in papillary thyroid microcarcinoma (PTMC). METHODS: All patients who underwent total thyroidectomy and central neck dissection for PTMC in our institution between 1990 and 2007 were included in this retrospective study. Statistical correlations between tumour multifocality and various clinical or pathological prognostic parameters were assessed by univariate and multivariate analyses. RESULTS: A total of 160 patients (133 women and 27 men; mean age: 47.8±13.7 years) were included in this study. Tumour multifocality was demonstrated in 59 (37%) patients. Central neck metastatic lymph node involvement was identified in 46 (28%) patients. No statistical correlation was demonstrated between tumour multifocality and the following factors: age, gender, tumour size, extension beyond the thyroid, metastatic central neck lymph node involvement and risk of recurrence. A tumour diameter greater than 5mm was associated with a higher risk of recurrence (P=0.008). CONCLUSION: Tumour multifocality does not appear to have a prognostic impact in PTMC.

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INTRODUCTION: Cervical schwannoma is a benign peripheral nerve tumor specifically developing from Schwann cells. Cervical sympathetic chain schwannoma is rare. Following a case report, the authors describe its specific radiological and histological characteristics. Treatment is surgical. CLINICAL CASE: A 56-year-old woman consulted for an isolated left lateral cervical mass of several years' standing, but with recently associated pharyngeal discomfort. Cervical CT revealed a vascularized retrostyloid mass with venous-time enhancement, inducing anterior displacement of the jugulo-carotid axis. The tumor could not be identified on fine-needle aspiration cytology, and surgical resection was performed by cervicotomy. Surgical exploration found a tumor developing from the cervical sympathetic nerve, posterior to the jugular vein and carotid sheath. Histopathologic examination diagnosed schwannoma. Postoperative outcome featured Horner's syndrome. CONCLUSION: Cervical sympathetic chain schwannoma is a rare benign tumor, to be suspected in the presence of an isolated lateral cervical mass. Preoperative CT is mandatory to guide diagnosis; treatment is surgical, to confirm histologic diagnosis. Postoperative Horner's syndrome often confirms cervical sympathetic chain involvement.

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OBJECTIVE: The present study describes the clinical, radiological and histological features of laryngeal chondrosarcoma, on the basis of two clinical cases, and discusses management. CASE STUDIES: Two male patients, aged 63 and 51 years, presented with low-grade chondrosarcoma revealed respectively by a mass in the lateral neck and by laryngeal dyspnea. CT showed a tumoral process with calcification, developed from the thyroid and cricoid cartilage, respectively. The first patient underwent partial and the second total laryngectomy. DISCUSSION: Chondrosarcoma is diagnosed on the basis of combined clinical, radiological and histological signs. Differential diagnosis with chondroma may be difficult, especially in grade-1 chondrosarcoma. CONCLUSION: Laryngeal chondrosarcoma is a rare tumor. Management is basically surgical. Prognosis is generally good, depending essentially on histologic grade.

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OBJECTIVE: To evaluate the reliability of free-flap head and neck reconstruction in the elderly. MATERIAL AND METHODS: All patients who underwent free-flap head and neck reconstruction in our institution between 2000 and 2010 were included in this retrospective study. In all, 418 patients (301 men and 117 women) were enrolled, including 95 patients aged 70 years or older (mean age=60.2±11.6 years). The impact of age on free-flap failure and local and general complication rates was assessed on univariate and multivariate analysis. RESULTS: Advanced age had no impact on free-flap failure and local complications rate but was correlated with a higher risk of general complications (multivariate analysis: P=0.007). A high level of comorbidity also had a significant impact on the general complications rate (multivariate analysis: P=0.001). Patients who underwent circular total pharyngolaryngectomy showed elevated risk of free-flap failure (P=0.005) and local complications (P=0.001) on multivariate analysis. CONCLUSION: Free-flap reconstruction of the head and neck is safe and reliable in the elderly. Nevertheless, meticulous patient selection, mainly based on the level of comorbidity, is necessary.

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PURPOSE OF STUDY: Oncology of the parotid region is rich and varied, like its components. During his career, the ENT surgeon may come across such an exceptional tumor as osteolipoma. The aim of this study was to describe the rarity and the etiopathogeny of osteolipoma with parapharyngeal location. PATIENTS AND METHOD: We had the opportunity to find this uncommon tumor in a 21-year-old female patient. The mass located in the parotid region was hard, barely mobile and at first looked like a parotid tumor. Total parotidectomy with facial nerve preservation was performed. It revealed a stony and dented tumor inside the internal lobe of the parotid located in the parapharyngeal space between the vertical portion of the mandible anteriorly and the styloid apophyse posteriorly. Macroscopic examination of the piece evidenced a lipomatous mass with hard as bone nodes in its middle. Histology revealed an osteolipoma. CONCLUSION: A review of the literature shows the uncommon occurrence of this type of tumor. A few rare cases were reported among which two involving the parapharyngeal space.

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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.

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