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INTRODUCTION AND IMPORTANCE: Primary intracranial neuroendocrine tumors (NETs) are exceedingly rare, often posing diagnostic challenges, particularly in non-secreting variants. These tumors may initially present with nonspecific symptoms, leading to delayed diagnosis and potential neurological complications. CASE REPORT: We present the case of a 33-year-old male admitted with a one-year history of progressively worsening headache accompanied by acute left ptosis and diplopia. Initial examination revealed left eye ptosis and hypotropia, indicative of third and fourth cranial nerve paralysis. Cavoscopy revealed a mild anterior wall bulge of the sphenoid with normal mucosa. MRI imaging unveiled an expansive clival process extending towards the sellar region and left cavernous sinus, completely occupying the sphenoid sinus and exerting mass effect on the pituitary stalk. Hormonal assays were within reference ranges, ruling out a hormonally-active tumor. Endoscopic endonasal surgery for biopsy revealed a low-grade neuroendocrine tumor positive for cytokeratin AE1/AE2, chromogranin A, synaptophysin, and beta-catenin, with a Ki-67-labeling index <2 %. Somatostatin receptor scintigraphy confirmed intense hyper fixation of the tracer in the sphenoidal tumor, supporting its neuroendocrine origin. The patient declined surgical intervention after informed consent, opting for C1 somatostatin analogs prior to radiotherapy. One-year follow-up demonstrated symptom stability with no tumor progression. CLINICAL DISCUSSION: To this day, no consensus among reports concerning the optimal management of these cases. Imaging assessment is crucial to validate the primary nature of the tumor and to exclude any distant localization. Various therapeutic modalities, such as surgery, radiotherapy, and somatostatin analogs, should be considered based on the specific characteristics and extent of the tumor. CONCLUSION: Our case is a clear reminder that neuroendocrine tumors should be considered as a differential diagnosis for skull base neoplasms.

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Introduction: Thyroid tuberculosis (TB) is extremely rare. Infection may first occur in the thyroid gland or may be secondary to TB in other parts of the body. The diagnosis is rarely made clinically because the disease's variable presentation often resembles that of a malignancy or an euthyroid nodular goiter. Case report: We present the case of a 40-year-old woman, who presented multiple thyroid nodules in both lobes. Two of these nodules were classified as EU-TIRADS V (European Thyroid Imaging and Reporting Data System). The ultrasound also found an adenopathy of the inferior part of the jugular lymphatic chain, in favor of malignancy. The histopathological examination after total thyroidectomy showed thyroid TB, associated to a papillary microcarcinoma of the right thyroid lobe, and the final examination of the adenopathy showed similar granulomas with caseous necrosis, and no signs of metastasis. Clinical discussion: Thyroid TB is very rare. Its diagnosis is difficult due to a lack of specific signs and symptoms, which is why the diagnosis is most commonly made on pathological examination after thyroid surgery. It is well known that mycobacterial infection creates an environment of chronic and persistent inflammation, with possible DNA damage. This can create a microenvironment that is highly conductive to carcinogenesis, which could explain the discovery of papillary microcarcinoma in addition to thyroid TB in our patient. Conclusion: This report presents a rare case of malicious growth development of thyroid nodules and thyroid TB. Therefore, physicians must always be vigilant when managing thyroid nodules, as there is always the possibility of malignant lesions associated to an inflammatory or infectious cause.

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Our study of the most representative case series of children and teenagers with thyroid cancer in Morocco (22 cases) aimed to highlight the characteristics of this cancer among children and teenagers and to compare results with those in the international literature. We conducted a retrospective, descriptive study of patients with differentiated thyroid cancer, hospitalized in the Department of Otolaryngology-Head and Neck Surgery at the Hospital in Casablanca, Morocco, over the period January 1995-March 2015. We collected data about 22 cases that met our inclusion criteria. The average age of our patients was 14 years, sex-ratio was 3.4, most of our patients presented with thyroid nodule associated, in 22.7% of cases, with cervical lymphadenopathy and in 9.1% of cases with signs of compression. All patients underwent total thyroidectomy followed by lymph node dissection in 31.82% of cases. The diagnosis of thyroid cancer was based on anatomo-pathological examination of the surgical specimen which confirmed the diagnosis of papillary carcinoma in 95.4% of cases and of vesicular carcinoma in 4.5% of cases. 100% of cases received I-131 RAI treatment followed by thyroid hormone replacement therapy. Close supervision and regular monitoring enabled the detection of nodal metastasis in 3 patients and of distance metastases in 4 patients. Differentiated thyroid cancer among children and teenagers is rare but aggressive, its treatment is based on surgery associated with iratherapy enabling excellent prognosis.

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Introduction: The dacryocystorhinostomy (DCR) procedure is linked to a high success rate; however, cases of tearing recurrence are not rare and should be managed efficiently. Thus, evaluating cases of DCR failure allows highlighting the factors significantly impacting the results in order to realize better controlled primary surgeries. Material and method: Twenty-eight patients were operated in our Otolaryngology Department for endoscopic revision of DCR failure between January 2019 and June 2022. Their clinical presentation, postoperative evolution, and findings of the primary and revision surgeries were assessed until the actual follow-up. Results: The first surgery was based on an external approach in 17 patients and the bicanalicular silicone tube intubation was kept for a mean of 4.25 months. The recurrence delay varied from 0.5 to 9 months. Revision surgery revealed synechia in 10 patients, a completely closed DCR ostium in 22 patients (78.57%) by mucosal scarring and granulation, and lacrimal sac fibrosis in 16 patients (57.14%). A significant correlation was found between maintenance of the silicone intubation tube greater than or equal to 3 months and lacrimal sac fibrosis (P=0.016<0.05). Conclusion: Thus, better controlled primary surgeries with optimal exposure, wild marsupialisation of the lacrimal sac and no longer systematic bicanalicular intubation which should be dedicated to difficult anatomies and canalicular affections should guarantee better functional results.

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The purpose of the study is to evaluate the correlation between caloric test results and video head impulse test (VHIT) vestibulo-ocular reflex (VOR) gains in unilateral horizontal canal deficits in order to define a possible threshold value above which caloric deficits should be associated with predictable low VHIT VOR gains. Caloric test and VHIT were realised in 105 patients presenting with symptoms of rotational vertigo occurring within the last 2 weeks. The authors defined the cutoff value for a caloric abnormality as more than 15% of canal deficit, which allowed us to divide our patients on groups based on the severity of their caloric asymmetry. Then, the authors performed the VHIT considering abnormal horizontal gain as less than 0.8 with catch-up saccades. The authors evaluated the prevalence of results dissociation between the two tests and the correlation between the caloric asymmetry and the horizontal VHIT VOR gains in each group according to the severity of canal deficit. The correlation was considered statistically significant if P less than 0.05 (Fisher's exact test). The caloric test revealed a significant unilateral deficit in 50 patients (47.6%). The interval of deficit between 21 and 40% included 25 patients, 18 (72%) presenting with normal VHIT VOR gains versus 7. On the other hand, for the 12 patients in the intervals of 81-100% of deficit, the VHIT VOR gain was highly abnormal in all cases. In comparison with the normal caloric test group, a correlation between each interval of caloric deficits and VHIT VOR gains has been assessed. This correlation was significant in the interval of 41-60% (P=0.04 <0,05) and in the interval of 81-99% next to patients with a total deficit of 100% (P=0.006 <0.05 for each). It appears that simultaneous affection of high vestibular frequencies evaluated on VHIT may be more likely and predictable above a minimal threshold of 40% caloric asymmetry, with better discrimination between normal and abnormal VHIT above 80%. Thus, they are two complementary tests to use as a couple rather than a replacement one for the other.

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INTRODUCTION AND IMPORTANCE: Congenital muscular torticollis is a benign affection defined as a contracture or fibrosis of the sternocleidomastoid muscle, causing ipsilateral inclination and contralateral rotation of the face and chin. The management is multidisciplinary, usually surgical and should start at very early age in infants to secure better results. Thus, the purpose of our study is to report the outcomes of delayed surgery performed in older children above 5 years old with late diagnosis. CASE PRESENTATION: We report the cases of 4 patients aged between 5 and 11 years old and followed in our department for congenital torticollis. They were all born by vaginal delivery with vacuum extraction in two cases of breech presentation. Even if the condition is present at birth, most parents were not bothered by the cervical vicious neck position of their children until a later age, delaying the diagnosis. The clinical examination found a flexed head position on the right side in all cases, with contralateral rotation. Regarding the age, we proposed surgical treatment immediately for two of them, while two were sent to our department after multiple ineffective physiotherapy sessions. The surgery consisted on right distal tenotomy and a cervical collar was prescribed next to physiotherapy. They all had successful results with correction of head position and improvement of cervical range motion. CLINICAL DISCUSSION: Children treated early with active and well monitored rehabilitation, recover completely and regain normal head position and mobility rapidly. In older children, above 5 years, they are more likely to develop sequels such as asymmetry of facial movement. CONCLUSION: Delayed diagnosis after the age of 5 years old still can be managed successfully with a correction of the head position and rotation motion. However, in these older children, physiotherapy alone cannot be effective and should be associated to surgery. Moreover, once the diagnosis is done, surgical treatment should be performed to avoid wasting more time.

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BACKGROUND: Isolated sphenoidal sinusitis is an uncommon cause of headaches in children and adolescents. Recognizing the condition on physical examination alone can be challenging, and delayed diagnosis often occurs. CASE PRESENTATION: A 4-year-old child presented with symptoms of headache, fever, and vomiting. Nasal endoscopy, computed tomography (CT), and magnetic resonance imaging (MRI) were used to confirm the diagnosis of isolated sphenoiditis. The patient was treated with antibiotics and steroids. However, the patient developed meningoencephalitis as a complication of the untreated isolated sphenoiditis. CONCLUSION: Isolated sphenoidal sinusitis can lead to serious complications if left untreated. Adjunctive imaging and prompt treatment are essential to prevent such complications in children and adolescents. This case highlights the importance of considering isolated sphenoiditis in the differential diagnosis of pediatric headaches and the need for early diagnosis and treatment.

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Squamous cell carcinoma (SCC) of the auricle is a rare and aggressive entity of cell carcinomas. It is mostly identified in older males with history of sun exposure. After histopathological confirmation, the initial assessment which consists of clinical and radiological evaluation will determine the therapeutic strategy. We report the case of a neglected SCC of the left pinna with parotid and temporo-mandibular infiltration. After surgical resection, the patient underwent a two staged reconstructive surgery. This was followed later on with radiotherapy and chemotherapy. The evolution was favourable for our patient during an 18 months follow-up. This case report underlines the importance of both curative and reconstructive surgery in successfully treating locally advanced tumors of the temporal bone.

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Introduction: Cystic lymphangiomas are rare dysembrioplasias that occur mostly in children. Although benign, these tumors remain potentially life-threatening, due to the possible compression of the upper airway. The management of cystic lymphangiomas is still somewhat controversial, with surgery generally being the first-line treatment. Patients and methods: 17 patients were included in this retrospective study, all aged less than 18 years old and treated for head and neck cystic lymphangiomas at our department between 2007 and 2017. All these patients had received surgical treatment alone. The relevant data were analyzed with SPSS software. Results: 17 patients were included, with a sex ratio M/F of 1,4, and an average age of 4 years old. Complete resection of the tumor could only be completed in 12 patients. No postoperative complications were observed in our series. All the patients were followed for a minimum of 2 years after treatment. Conclusion: Cystic lymphangiomas are rare tumors of mysterious origins. The main symptom is swelling of the affected area. In our series, the results of the surgery were promising and consistent with results reported in the literature. A follow-up study with a larger population could be interesting, to further examine potential prognostic factors.

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Hearing loss can result from a wide range of pathologies affecting patients of all ages. It may be due to abnormalities of the outer, middle or inner ear. In this article, we present a case of a 50 years old female patient presenting to the ENT and Head & Neck surgery department of 20 August hospital, complaining of bilateral hearing loss, in whom clinical examination found right attical retraction pocket with scales and left normal tympanic membrane. Complementary investigations revealed the association of two distinct conditions, rarely described in literature: otosclerosis, and chronic otitis media with cholesteatoma in right ear and left otosclerosis. The challenge in this case was to determine the therapeutic strategy: start with left otosclerosis? the right cholesteatoma? simultaneously treat otosclerosis and cholesteatoma right?

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Background: The relationship between the location of otosclerotic zones and hearing thresholds has been evaluated in several studies and has generated different conflicting reports. This study was carried out in order to evaluate the relationship between otosclerotic zones extension on CT scan and pure tone audiometry (PTA) thresholds, before and after stapedotomy. Materials and Methods: 108 patients with a positive surgical diagnosis of otosclerosis, operated by the same surgeon, were enrolled in this retrospective study, performed in a tertiary referral hospital between 2015 and 2018. Results: PTA thresholds were significantly poorer in cases of extensive otosclerosis (peri cochlear, peri vestibular, or internal auditory canal hypodensities, p = 0,001). However, for cases with hypodensity extending to the endosteum of cochlea (Type III), we have noted a significant improvement in postoperative PTA thresholds (Mean AC (air conduction) = 32,8 ± 8,16/62,97 ± 12,28 dB), Mean BC (bone conduction) = 18,3 ± 8,56/26,25 ± 15,93 dB). Conclusions: In our study, extensive and multifocal otosclerosis lesions had a statistically significant negative impact on postoperative AC and BC threshold; however, type III lesions tend to be associated with a very good prognosis.

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Introduction: Odontogenic myxoma (OM) is an uncommon benign odontogenic tumor arising from the jaw bone. The diagnosis poses a challenge because its clinical features overlap with those of other benign and malignant neoplasms. Although surgery is usually the choice treatment, there is still some controversy concerning surgical techniques and proper indications. Case report: We present the unusual case of an odontogenic myxoma involving the maxilla, diagnosed in a 31 years old patient presenting to our department for facial swelling through computed imaging and pathological analysis. After careful consideration, the patient was treated with conservative surgery, with a satisfying end result. Discussion: Because of its slow growth, odontogenic myxoma is often asymptomatic. The diagnosis is based on clinical, radiological and histological caracteristics. Complete surgical excision is the treatment of choice, but it can be challenging because of the tumor's indistinct margins. Conclusion: Though there are still no clear guidelines for the management of OM in the head and neck region, the general consensus is that the surgical excision should be complete, and patients treated in a conservative manner should benefit from regular follow-ups.

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The aim of this study was to translate and verify the psychometric properties of the CES (Chronic Ear Survey Score) in the Moroccan Arabic dialect as well as the evaluation of the quality of life of patients suffering from suppurative chronic otitis media. A cross-sectional study was carried out between 1st April 2016 and 10 January 2017 in ENT department of the 20 August hospital Casablanca. The data were collected using an anonymous questionnaire administered by the physician. The CES scale used has been translated according to international recommendations. Internal Reliability was evaluated by the Cronbach alpha coefficient and validity was calculated through the Spearman coefficient of correlations. Statistical analysis was done using SPSS 20.0. A total of 107 patients were enrolled in the study with an average age of 35 years (standard deviation = 13 years) with a sex ratio of 0.70. About 35.5% of patients perceived their disease as severe. The mean CES was 48 (standard deviation = 15) indicating a significant decrease in the quality of life of patients suffering from CSOM. Good internal reliability was noted (alpha = 0.72). CES scores increased significantly with perceived severity (p < 0.001). The Arabic version of the CES has good psychometric properties attesting to its reliability and validity. Its use would make it possible to better evaluate the quality of life of patients suffering from chronic otitis media and thus be able to compare and choose the optimal therapeutic methods based on the results of this questionnaire especially before and after surgery.

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The association of Hodgkin's lymphoma and Tuberculosis is a rare entity, resulting in misdiagnose or delay in diagnosis of both diseases, since they share similar signs and symptoms, laboratory tests results and imaging procedures. We report the case of a 63 years old man who consulted for a clinical presentation of pulmonary and cervico-thoracic lymph nodes tuberculosis confirmed at the histopathological examination. The evolution after 5 months of antituberculous treatment was marked by the increase in size of the cervical nodes with a papular skin rash, diffuse abdominal pain and more weight loss. The FDG-PET-scan showed multiple confluent hypermetabolic lymphadenopathies on the whole upper body with cervical skin extension, next to hypermetabolic splenomegaly and focal liver hypermetabolism; next to a bilateral pleural effusion. The histopathological examination of the cervical lymph node specimen concluded to a Hodgkin lymphoma classified as Ann Arbor stage III. The chemotherapy protocol was started, while completing his antituberculous treatment. The patient passed away a few weeks later due to a septic shock. We present this case to supplement the rare literature data concerning the association of Hodgkin's lymphoma and Tuberculosis, defining how they impact the prognosis of one another, in order to comfort the importance of tuberculosis screening in lymphoma patients, especially in endemic areas.

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Lateral neck ectopic thyroid tissue remains a rare entity that can be affected by any lesion involving the gland. The origin of lateral neck ectopic thyroid carcinomas still debated between a metastatic disease secondary to thyroid primary tumor and primary malignancy on the ectopic tissue. Anyway, it should indicate an exploration of the gland. We report the case of a 36 years old female with one year history of hyperthyroidism who was admitted for multinodular grade II goiter with a firm mass in the left level II of the lateral neck. The thyroid scintigraphy demonstrated multiple functioning nodules corresponding to toxic multinodular goiter; in addition to two cold hypofunctional nodules. The cervical ultrasound showed a voluminous multinodular goiter classified as EU TIRADS 5. The surgical procedure exposed a multinodular mass, lateral to the internal jugular vein, with the appearance and structure of the thyroid gland and no connection to it. The thyroid gland was exposed next through a collar incision. Each mass was dissected and removed individually. The histopathology examination of the thyroid gland found papillary carcinoma extracapsular extension. The pathology results of the other mass reported multiple colloid nodules with cystic component, papillary in appearance, with the same cancer proliferation, compatible with ectopic thyroid tissue with papillary carcinoma. No lymph node tissue was found. The patient was sent for complementary RAItherapy. We report a rare case of lateral neck ectopic thyroid papillary carcinoma that supplements and supports the lacking literature data concerning the management of this rare entity.

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OBJECTIVE: Cultural adaptation of the tinnitus handicap inventory questionnaire to the Moroccan dialect version. METHOD: We conducted a prospective study over a 3 years period (January 2017-January 2020) in the Otolaryngology Department of Casablanca University hospital. Translation was produced by a forward-backward procedure with analysis of the psychometric properties of the Moroccan version of the tinnitus handicap inventory. RESULTS: The final Moroccan version of Tinnitus Handicap Inventory (THI) was given to 83 otosclerosis patients suffering from tinnitus. They filled the questionnaire twice before surgery and 1 year after surgery.The item-total correlations are all statistically significant (p < 0.001) and vary between 0.279 (item 15) and 0.817 (item 12).The internal consistency of the Moroccan version of THI, assessed through Cronbach's α, was found to be excellent at 0.953. The interclass correlation showed an excellent reliability for all subscales (0.999-1).THI scores decreased significantly from baseline to 1-year postoperative follow-up on all subscale scores, indicating clinical improvement. CONCLUSION: The Moroccan version of THI has a good reliability comparable with translations in other languages and the original version. It is a valid tool to assess tinnitus improvement after otosclerosis surgery.

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INTRODUCTION: The fungal balls of the paranasal sinuses are usually seen in the maxillary and sphenoid sinuses. Although, the lesion of the concha bullosa, without sinus participation, is very uncommon. We report the case of a fungal ball of concha bullosa in an 88-year-old patient. OBJECTIVE: The objective of our review of literature is to investigate the epidemiological, clinical, paraclinical, and therapeutic characteristics of patients diagnosed with fungus ball in concha bullosa. METHODS: A case of a patient who was diagnosed with concha bullosa of a fungus ball is reported. Demographic data, clinical presentation, imaging, and treatments were recorded. Key images were obtained. A review of the literature was also performed. RESULTS: A total of 12 cases have been reported so far in the literature revealed by different symptoms. The mean age was 38.8 years and the gender ratio was ∼12 (female):1 (male). The endoscopic surgical approach was the most frequently used treatment and provides good outcomes. Neither postoperative complications nor recurrences were noted, however, there is insufficient follow-up data. CONCLUSION: Concha bullosa fungal ball is a rare diagnosis that can be revealed by different symptoms. It should be considered in patients with and unexplained chronic facial pain. A preoperative computed tomography scan is an essential tool in making a diagnosis. Endoscopic surgery is the treatment of choice, with a low morbidity and recurrence rate.

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INTRODUCTION: Chronic rhinosinusitis with polyposis (CRSwNP) is a multifactorial naso-sinusal inflammatory disease that affects 2-4% of the adult population. It highly affects the patient quality of life (QoL) in many levels making it a public health issue. The management of CRSwNP is based on a detailed clinical history, a complete endoscopic examination and a precise computed tomographic (CT) analysis. The aim of this study is to evaluate the prevalence and severity of the various CRS clinical manifestations as well as to highlight the potential relationship between symptom scores, asthma and ESS outcomes. PATIENTS AND METHODS: A retrospective cohort study was performed in the 20 August hospital, between January 2017 and December 2018, on patients diagnosed with CRS according to guidelines recommendations, and were beforehand refractory to initial medical therapy and elected to FESS. The patients were divided into two groups, the first group (G1) of patients with asthma and the second (G2) without asthma in order to expose an eventual significant difference in the improvement of symptoms after surgery. The Sino Nasal Outcome Test-22 (SNOT-22) was used to evaluate QOL. RESULTS: A total of 100 patients participated in the study with an average age of 44.53 years. The sex ratio was 1.04 (51% men). Asthma was present in 48% of patients while 20% of patients were intolerant to aspirin with a significant difference between the asthmatic and non-asthmatic group (p < 0.05). It appears that asthma was not objectively correlated with a higher Lund Mackay radiological score (p > 0.05). A higher significant improvement was observed between preoperative and postoperative SNOT-22 scores in group with asthma [42.7 ± 16.3 versus 11.8 ± 9.1] and in group without asthma [38.3 ± 15.1 versus 10.5 ± 14.2]. CONCLUSION: Asthma in CRS is an additional symptom in these patients, mainly reflected in the subset of nasal symptoms in SNOT-22. However, it did not significantly affect the quality of life of the CRSwNP population.

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Head and neck paragangliomas are rare vascular tumors derived from the paraganglionic system, located at the carotid body, jugular vein, tympanic cavity and vagal nerve. From 2010 to 2020, a cohort of 26 patients divided in two groups, 15 with cervical paragangliomas and 11 with temporal bone paragangliomas, was reviewed by analysing the medical history, the epidemiological and clinical parameters, the imaging results and classification, the modality of treatment and outcome. Cervical paragangliomas present as firm and pulsatile mass with the characteristic aspect of "salt and pepper" on MRI T1 weighted sequences. The most common type on Shamblin classification was the type II. Total surgical resection was performed in 93,33% of cases. The sensitivity of MRI in the diagnosis of vagal paragangliomas was up to 75%, with a specificity of 90,91% and the correlation of the MRI results and the findings of surgical exploration is significant with p â©½ 0.02. Temporal bone paragangliomas appear as pulsatile mass behind the tympanic membrane, causing variable hearing loss in 90,90% of the cases. The facial nerve is the most frequently affected cranial nerve, in 36,36% of the cases. The main type according to FISH classification is the type B. Embolization was performed in all type C tumors. Surgery was the first line treatment while the inoperable patients were considered for radiotherapy. The aim of this study is to report the main clinical features of head and neck paragangliomas, the imaging tools and findings evaluating their sensitivity and specificity and the treatment protocol and outcome.

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INTRODUCTION: Abnormalities of the fourth branchial arch are less common than those of the second arch and usually present with inflammation of the left thyroid lobe. CASE PRESENTATION: We report the case of a 10 years old girl who presented to our department with recurrent cervical cellulitis, and who was diagnosed, upon endoscopic exploration, with a left sinus pyriform fistula. The patient was treated using mini-invasive surgery by electrocoagulation, with good clinical outcome. CONCLUSION: Branchial arch malformations are rare congenital malformations. The diagnosis is mainly based on clinical examination, imaging and, endoscopic investigations. The conservative attitude may be the treatment of choice, especially if the cervical mass is not well individualized.