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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

Melkersson-Rosenthal syndrome (MRS) is a rare disease, with unknown etiology characterized by oro-facial oedema, fissuring tongue and peripheral facial palsy. The mainstay treatment is corticosteroids. We report the case of a 38-year old female, who presented six recurrent episodes of left peripheral facial palsy associated with simultaneous oedema of the median frontal area, treated successfully by short course oral corticosteroids with neuromuscular facial re-education. However, the recovery of the last episode was incomplete and the patient kept a left House-Brackmann grade II facial palsy at six months. The median frontal area was slightly inflammatory, being the location of simultaneous repetitive oedema and the tongue was fissured. These cardinal symptoms realise the complete triad of Melkersson-Rosenthal syndrome (MRS). The histopathological examination of the lip biopsy showed lymphocytic inflammation around the blood vessels. Since the residual facial palsy was graded as mild dysfunction, the frontal oedema fully recovered and the fissured tongue was not painful, the treatment consisted on appropriate neuromuscular re-education. The 6 months follow-up showed no recurrence with a stable grade II left facial palsy. We present this case to supplement the rare literature data concerning the management of this rare entity. Patients should be prepared to the risk of recurrent episodes with longer duration of symptoms and more incomplete recoveries, which may indicate other therapeutic options.

Various pathological entities may manifest on imaging as unilateral or bilateral nasal and/or sinus opacity. The vast majority is represented by inflammatory pathologies, tumors are rare, but they are dominated mainly by benign tumors. Malignant diseases are uncommon, accounting for 3% of tumors of the head and neck. Advances in imaging using preoperative computed tomography and magnetic resonance imaging have been significantly marked in the diagnostic approach to sinonasal pathologies. Surgical modalities are influenced by preoperative knowledge of the nature and topography of the tumor. The aim of this work is to describe the clinical, radiological, and anatomopathological characteristics of sinonasal pathologies expressed by unilateral sinonasal opacity in imaging, to identify the clinicoradiological variables likely to predict malignancy, and to make a correlation between the radiological images and the anatomopathological result.

Skull base osteomyelitis (SBO), also referred to as malignant otitis externa (MOE) in its typical form, is usually a complication of otitis externa and severe uncommon and life-threatening condition requiring early diagnosis and long-term treatment in order to avoid its neurologic sequelae. We report the case of 69 years old female with a history of uncontrolled type 2 diabetes, who presented refractory and chronic right-sided purulent otorrhea with temporal headaches for 6 months, treated with no improvement by multiple attempts of ambulatory empiric therapy. After the appearance of grade III facial palsy and painful swelling in the right periorbital and zygomatic areas, the patient consulted in our department where a CT scan showed massive cortical and trabecular destruction of the right petrous bone and the mastoid extended to the lateral orbital wall, the zygomatic arch and the greater sphenoid wing realising extensive osteomyelitis of the skull base and the lateral face. The treatment was started immediately based on intravenous broad-spectrum antibiotics. Despite aggressive long-term treatment, the patient passed away, underlying the increased SBO morbidity and mortality secondary to delayed diagnosis.

Laryngotracheal stenosis (LTS) is a severe condition with a high morbidity rate, described as the narrowing of the upper airway diameter. The etiology of acquired LTS is dominated by prolonged tracheal intubation. The diagnosis is based on endoscopic examination and computed tomography scan imaging providing an exact analysis of the lesion, with precise measurements.We report a descriptive retrospective review based on the analysis of the medical records of a cohort of 18 patients, treated between January 2015 and January 2018 for an acquired LTS.The results showed predominance in young males. The majority (73%) was hospitalized in a reanimation unit under tracheal intubation while the others (27%) underwent a tracheostomy. The location of the stenosis was tracheal in 69% of the patients, laryngeal in 23%, and laryngotracheal in 8%, and the degree of obstruction exceeded 70% in 11.2%. The endoscopic treatment was based on dilatation and endoluminal calibration by the Montgomery T-tube in 77.7% of our patients, circumferential resection by CO2 laser in 11.1%, and endoscopic posterior cordectomy in 11.1% of the cases. The surgical treatment relied on the resection of the stenosis followed by T-tube calibration in 61.1% of our patients, the resection with a termino-terminal anastomosis in 11%, and supraglottic partial laryngectomy in one patient. The follow-up showed major improvement in the clinical symptomatology, but the biggest challenge in LTS remains the occurrence of restenosis.LTS is a severe condition and needs to be always considered in patients with inspiratory dyspnea and a medical history of tracheal intubation. It requires exhaustive endoscopic and imaging exploration with multidisciplinary management and long-term follow-up to prevent and detect the early signs of an eventual recurrence.

Highlights • Parathyroid lipoadenoma is a rare and anusual cause of primary hyperparathyroidism. • The clinical presentation usually resembles other causes of primary hyperparathyroidism. • Imaging is not always contributory considering its location. • Histologic criteria are specific. • The treatment is based on surgical resection with postoperative normalization of calcium and parathormon levels., Parathyroid lipoadenoma is a rare and anusual cause of primary hyperparathyroidism. The clinical presentation usually resembles other causes of primary hyperparathyroidism and the imaging is not always contributory considering its location. However, the histologic criteria are specific. We present a case that supplements and supports the rare literature data concerning the clinical and therapeutic aspects of parathyroid lipoadenoma. The case is about a 73 years old female with a right inferior parathyroid lipoadenoma that caused biological primary hyperparathyroidism. Initially followed and treated in Rheumatology department for hypercalcemia and osteoporosis, she was sent to our structure to diagnose and possibly treat the causal etiology. After non-contributory clinical examination and ultrasound imaging, the tumor was diagnosed in the cervical CT scan. The patient underwent successful surgical removal of the lipoadenoma, confirmed postoperatively on histological analysis. The follow up showed rapid normalization of the parathormon level. Even if it’s a rare condition, the diagnosis of lipoadenoma should always be considered in front of primary hyperparathyroidism with a parathyroid lesion.

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

Highlights • Treatment of maxillary sinus carcinoma depends on its local and regional extension. It consists on a complete surgical excision followed most often by radiation therapy. • Surgical excision corresponds to a partial, total, or extended maxillectomy, with resection of the neighboring anatomical structures affected by the tumor. This tumor resection must respect three precise rules: The most complete possible excision of the tumor, adequate excision margins in order to avoid possible recurrence, while combining the most possible aesthetic result. • External approach is a therapeutic alternative when tumor extension does not allow satisfactory endoscopic resection. • Regardless of the surgical approach, maxillary sinus carcinoma has an overall survival rate of 63% at 12 months, 20% at 24 months and 9% at 5 years., Sino-nasal cancers are a rare pathology, with an incidence of 0.2–0.8% of all cancers, and less than 5% of ENT cancers. The site that is most often affected is the maxillary sinus in 35% of cases, followed by ethmoid sinus (30%) and of the nasal cavity in (16%). Several histological variants are described, but squamous cell carcinoma remains the most frequent in the maxillary sinus. Its diagnosis is often late making local control very difficult. Multimodal treatment allows an improvement in the survival rate compared to single treatment. Due to the progress of endoscopic surgery, external surgery is neglected. With this work we want to highlight the value to the external approach, especially in advanced cases.

Background The purpose of the study was to analyze and discuss the demographic, clinical, radiological, therapeutic and postoperative findings of the Cervico-mediastinal goiters (CMG) treated through a cervical approach admitted in the ENT department of Ibn Rochd university hospital, Casablanca, Morocco between January 2014 and January 2020. Materiels and methods Over a period of 6 years, 116 patients underwent surgical treatment for CMG. It was defined as a goiter extending below the plane of superior thoracic aperture on CT scan. All our patients had clinical, biological and radiological assessment before surgery. A nasofibroscopy was carried out pre and postoperatively. All the CMG have been extracted trough a cervical approach by an experimented ENT surgeon. Results 84,48% of the CMG was diving into the anterior mediastinum and 15.52% into the posterior. The CMGs extended above, at, and below the level of the aortic arch respectively in 76.72%, 18.10% and 5.17% of the patients. All of 116 goiters were successfully removed through a cervical approach. No patient required a sternotomy. Postoperatively, vocal cord paralysis was transient in 3 patients (2.58%) and permanent in 2 patients (1.72%). Hypocalcemia was transient in 10 patients (8.62%) and permanent in 2 patients (1.72%). Final histology found 106 benign multinodular goiters (91.37%), 7 papillary carcinomas (6.03%) and 3 vesicular carcinomas (2.58%). No death was noted. Conclusions With expertise in thyroid surgery, cervical approach for CMGs is safe and sufficient in the majority of the cases with low morbidity rate and no mortality., Highlights • In the literature, there is no consensus on the definition of cervico-mediastinal goiters. • CMG is a challenging disease that needs proper clinical, biological and radiological assessment. • Malignancy in a CMG is not higher than that of the cervical goiters and most of the foci in CMG were in the intrathoracic region. • With expertise in thyroid surgery, cervical approach for CMGs is safe and sufficient in the majority of the cases.

Introduction Malignant melanomas (MM) of the parotid gland are rather rare and when discovered in the parotid gland without an identifiable primary site, they are considered even rarer. Presentation of case We report a case of a 27 years-old woman who was admitted to our department with a complaint of a painless mass in the parotid area. Clinical examination and radiological investigations found a mass compatible with pleomorphic adenoma. Treatment consisted of superficial parotidectomy. The evolution was marked by the appearance of a tumefaction regarding the scar. A total parotidectomy with neck dissection was performed and the histopathological examination found an intraglandular melanoma. Conclusion Primary malignant melanoma may represent a serious diagnostic challenge. It should be considered in the differential diagnosis of parotid tumors even if it's rare., Highlights • Primary malignant melanoma of the parotid gland is estimated to be very rare. • Characterized by poor prognosis, difficult late diagnosis and classification. • Primary malignant melanoma may represent a serious diagnostic challenge. • It should be considered in the differential diagnosis of parotid tumors even if it’s rare. • There is not a clear consensus on their management treatment.

Highlights • Spindle cell hemangioma (SCH) is a rare vascular tumor that was considered to be intermediate -or low-grade malignancy, with biological behavior between a hemangioma and angiosarcoma. • The SCH is commonly found in the distal extremities. So far, only 16 cases have been described in the head and neck area. No previous case has been described in the infratemporal fossa. • SCH shows a proliferation of spindle cells composed of endothelial cells, pericytes and fibroblasts between dilated vascular spaces and immunoreactivity to endothelial markers., Introduction Spindle cell hemangioma (SCH) is a rare vascular tumor which was first described in 1986. It affects mostly the distal extremities. The head and neck are rarely involved. This article reports the first case of SCH in the infratemporal fossa. Presentation of case A 41-year-old woman presented with an 8-month history of right cheek swelling. Facial CT scan and MRI showed an intensely and heterogeneously enhancing tumor of the infratemporal fossa suggesting an angiomatous neoplasm. The mass was excised surgically through an anterior maxillary approach. The histopathological and immunohistochemistry analysis revealed a SCH. Conclusion This case report presents a unique presentation of a Spindle cell hemangioma in an unexpected location of the head and neck region. it underlines the importance for clinicians and pathologists to consider the Spindle cell hemangioma as a possible etiological diagnosis of infratemporal fossa tumors.

Introduction Solitary fibrous tumour (SFT), as are benign neoplasms of fibroblastic cells. Nasosinusal localisation is exremely rare, difficult to diagnose and to manage. Case report We report a rare case of Solitary fibrous tumour in the nasal cavity in a 47-year-old- woman, with complete surgical resection. Discussion SFTs are of mesenchymal origin, mainly from serous membranes. The head and neck region is affected with a percentage ranging from 5 to 27%. On the other hand, LTS unusually affects the nasal tract (NTS). Because of this rarity and its variable morphological appearance, it is difficult to distinguish TNS from other mesenchymal lesions. Conclusion Although there are no standard clinical guidelines, the preferred treatment for FLS is radical surgical resection., Highlights • Solitary fibrous tumour is an uncommon fusion neoplasm of spindled fibroblastic cells set in a branching vasculature with an unclear biologic behavior. • Nasosinusal localisation is exremely rare, difficult to diagnose and to manage. • Complete resecability is the most important prognostic factor in the treatment of SFT. • Advantages of the endoscopic approach include a panoramic and large view without external incision, low postoperative morbidity and a shorter hospital stay.

Highlights • Hard palate cancer is a rare malignant tumor. Different histological types have been described in the hard palate which can affect its different structures. • A retrospective review of 4 patients who underwent Surgical resection by trans oral approach was performed for different histological types of malignant tumors of the hard palate. • Surgical resection is the treatment of choice for malignant tumors of the hard palate. A variety of surgical procedures that can be used via a trans oral approach. • Survival rate depends on several factors, including early diagnosis, histological characteristic and appropriate management., Introduction Cancer of the hard palate is a fairly rare malignant tumor. Different histological types have been described in the hard palate, and that can affect its different structures. Diagnosis is based on biopsy with histological examination and possibly on immunohistochemical markers to confirm the diagnosis and exclude other diagnostic hypotheses. The aim of this study was to determine histopathologic, clinical and therapeutic characteristics of malignant tumors of the hard palate. Patients and methods A retrospective review of 4 patients who underwent Surgical resection by trans oral approach was performed for different histological types of malignant tumors of the hard palate. These included squamous cell carcinoma (case1 and case 2), mucosal melanoma (case 3), and adenocarcinoma (case 4). Results The T stage was analyzed for all cases. Two cases were classified as T2 stage with a tumor size between 2 and 4 cm and the two others, given the extension to the maxillary and nasal cavity were classified as T4a. Cervical lymph node metastasis was found in three patients. Discussion Surgical resection is the treatment of choice for malignant tumors of the hard palate. There is a variety of surgical procedures that can be used via a trans oral approach. Reconstruction of palatal defects with a prosthesis is sufficient, whereas larger defects will require a local, regional or even microvascular free tissue flap. The differences between these surgical techniques are presented, and indications are discussed. Conclusion The therapeutic management for malignant tumors of the hard palate is essentially surgical, with or without postoperative radiotherapy, discussed on a case-by-case basis. Survival rate depends on several factors, including early diagnosis, histological characteristic and appropriate management.

Squamous cell carcinoma (SCC) of the tongue is one of the most common cancers in the oral region, most frequently associated with lymph nodes metastases which influence the most the prognosis. The identification of predictive factors of occult cervical nodal metastases for N0 tumors will allow to adapt the treatment to the patient, avoiding over or under management. From 2014 to 2019, a cohort of 26 patients with SCC of the mobile tongue was reviewed by analysing the medical history, the epidemiological and clinical parameters, the tumor sites, aspects, diameters, depths of invasion, pathological degree, degree of differentiation, T classification and results of neck dissections. The incidence of occult cervical nodal metastases was up to 26,92% and a significant correlation was only found with the tumor depth invasion and the muscular invasion (p, Highlights • The tongue is the most deadly location of oral SCC and most commonly associated with nodal metastases. • The depth of invasion and muscular infiltration seem to influence the occurrence of nodal metastases. • Elective dissection (level I, II, III) with tumour excision is the effective treatment of N0 SSC of the tongue.

Highlights • Lemierre’s syndrome is a rare and potentially fatal entity. • Lemierre syndrome (Ls) is a rare septic thromboembolic complication of an infection of the oropharyngeal. • The incidence of Lemierre’s disease appears to be increasing. • A multidisciplinary approach is major point to treat patients with Lemierre’s syndrome., Introduction Lemierre's syndrome is a rare and potentially fatal entity characterized by the spread of an oropharyngeal infection, with secondary suppurative thrombophlebitis of the internal jugular vein and septic emboli. Presentation of case We discuss the case of a 52-year-old male who developed Lemierre’s syndrome following peritonsillar abscess. He presented with submandibular and submental swelling extending into the neck. His management included; incision and drainage of the abscesses; and prolonged anticoagulant therapy. Conclusion The incidence of Lemierre's disease appears to be increasing, perhaps due to ignorance of the disease by many clinicians, and diagnosis is often delayed with potentially fatal consequences.

Tympanoplasty is one of the most performed procedures in ENT. The aggressiveness of its microscopic approach has led otologists to adopt the endoscopic approach as a less invasive alternative. The purpose of this work is to appreciate the advantages and disadvantages of this surgical technique. We conducted a prospective descriptive cross-sectional study on 20 interventions within the ENT department of August the 20th 1953 Hospital of Casablanca from April 2019 to June 2019. The average age of operated patients was 36.3 years. Perforations were unilateral in (71%) of the cases with a predominance of the anterior (29%) and subtotal (36%) locations. The tympanoplasties were performed by 3 different senior otologic surgeons, and were left in (57%). The mean operating time was (59.5 min) and the mean anesthesia duration was 75.1 min. Intraoperative vision allowed us to fully visualize the margins of all perforations (100%) and anatomical structures of the middle ear in almost all interventions. The first procedures carried out were filled with difficulties whose management of intraoperative bleeding was the main one in (42.8%) of the cases. (57%) procedures were described as easy. No complication was detected intraoperatively or immediately postoperatively. Endoscopic tympanoplasty has several advantages, including: Minimally invasive approach to the middle ear; panoramic perioperative vision; Gain of operating time; decrease in the duration of anesthesia; Valuable educational tool; postoperative comfort; Decrease in hospital stay and early return to daily activities; Better aesthetic rendering; cost and transportability. However, we also note a number of disadvantages of endoscopic tympanoplasty, particularly: performing the procedure with one hand; difficulty passing through the EAC; 2D vision that alters the perception of depth; management of intraoperative bleeding; fogging; learning curve.

The pyriform sinus fistula is a rare condition described as an epithelialized tract connecting the skin of the neck to the foregut, and may result in cervical cysts and iterative abscesses misleading the diagnosis. The clinical and radiological examinations are all useful. Surgery stands as one of the most effective therapeutic options consisting on the total excision on the eventual cyst, and the fistula that is followed to its inner opening on the pyriform sinus. We present a case of a 3-years-old boy with a pyriform sinus fistula that caused recurrent neck abscesses treated independently delaying the diagnosis. Once in our structure, after radiological examination and antibiotics to cool the infection down, the surgery removed the cyst with its tract that opened in the pyriform sinus. The follow up showed an effective result with the total disappearance of the lesion with no more infectious episodes. Even if it's a rare condition, the diagnosis of apyriform sinus fistula must be considered in front of every patient with a history of recurrentlatero cervical abscess., Highlights • The pyriform sinus fistula is a rare condition described as an epithelialized tract connecting the skin of the neck to the foregut, and may result in cervical cysts and iterative abscesses misleading the diagnosis • The clinical and radiological examinations are all useful • Surgery stands as one of the most effective therapeutic options consisting on the total excision on the eventual cyst, and the fistula that is followed to its inner opening on the pyriform sinus

Highlights • Rhabomyosarcoma (RMS) can be localized in the cervico-facial region and in an adult. • Its diagnosis is histological with an immunohistochemical study. • RMS in adults require neoadjuvant chemotherapy combined with locoregional treatment by tumor excision surgery followed by radiotherapy. • RMS of the head and neck of adults have a poor prognosis., Introduction Rhabdomyosarcoma (RMS) is a malignant mesenchymal neoplasm uncommon in adults. Presentation of case We report the case of an alveolar rhabdomyosarcoma in a rare location and in an adult. It concerns a 46-year-old woman with a mandibular location invading the parotid gland. The Immunohistochemical analysis revealed intense positivity for myogenin and desmin, favoring the diagnosis of alveolar rhabdomyosarcoma. The patient had a right hemi-mandibulectomy with parotidectomy and received chemotherapy with radiotherapy. The evolution was good up to 2 years postoperatively then the patient relapsed with a recurrence of tumour rapidly progressing and metastases in the cervical spine. Discussion RMS is an aggressive but rare disease that is one of the most common malignant head and neck tumors in children. The predilection sites of adult rhabdomyosarcoma are the extremities. Current treatment includes a combination of ablative surgery, chemotherapy, and radiation therapy. Conclusion The prognosis of head and neck rhabdomyosarcomas in adults remains very poor given the often initially advanced stage of the disease and the high metastatic potential.

Introduction Ectopic thyroid tissue can be found in many sites. Ectopic thyroid tissue may also be involved in the same processes as normal thyroid gland. These processes include tumors, inflammation and hyperplasia. The appearance of such tissue in rare locations may lead to diagnostic and therapeutic dilemmas. Presentation of Ccase We report a rare case of primary papillary carcinoma in an ectopic thyroid in the jugulocarotid regionbased on the bifurcation of the carotid artery, in a 62-year-old woman with history of diabetes and high blood pressure, with a normal thyroid gland. Discussion The origin of lateral ectopic thyroid tissue is not fully understood and controversial.The lateral localisation is a rare entity and debated extensively in the literature. Conclusion Though rare, the possibility of an ectopic thyroid carcinoma must always be considered by the surgeon in cases of a pathological mass in the neck.

Nodular hidradenoma is a rare benign adnexal tumor. It is most frequently encountered in the head and neck region, trunk, and extremities. This tumor exhibits a high recurrence rate, and an association with malignancy.Many names have been used to describe this pathology.We report the case of a nodular hidradenoma in a 30-year-old moroccan woman who presented with a 2-year history of a swelling in her right preauricular region. Histological examination revealed the typical appearance of a nodular hidradenoma. The tumor was excised and one year after the initial presentation, there was no sign of recurrence. We emphasize the importance of wide surgical excision with appropriate margins to prevent local recurrence. A close follow up of the patients is recommended., Highlights • Nodular hidradenoma is a rare benign adnexal tumor. Itis most frequently encountered in the head and neck region, trunk, and extremities. • This tumor exhibit a high recurrence rate, and an association with malignancy. • We emphasize the importance of wide surgical excision with appropriate margins to prevent local recurrence. A close follow up of the patients is recommended.

Highlights • Recurrent thyroid cancer in cervical soft tissue following conventional thyroid surgery with functional neck dissection are extremely rare. However, some authors suggest that those subcutaneous lesions may result by surgical implantation of thyroid neoplasms. • Multiple possible factors associated with recurrence can be speculated such as proliferation and attachment of carcinoma cells transported in the bloodstream to soft tissue, surgical skills and instrument contamination during specimen manipulation. • A comprehensive long-term postoperative evaluation should be completed to minimize the risk cervical soft tissue recurrence., Introduction Thyroid cancer is the most common type of malignant endocrine cancer. Differentiated thyroid cancer, which includes papillary and follicular cancers, represents majority (90%) of all thyroid cancers and has a favorable prognosis. However, a minority of patients develops loco-regional recurrence. Case report We report here a rare case of a 63 years-old man who underwent total thyroidectomy in 2015 for multinodular goiter whose histopathological examination revealed a papillary thyroid carcinoma. He received 6 weeks later a 100 mCi of radioactive iodine therapy. In 2017, he was admitted for multiple cervical lymph nodes with high serum thyroglobulin level (234 ng/mL) which required a bilateral central and lateral neck dissection. He was readmitted in 2019 for multiple subcutaneous neck nodules with high serum thyroglobulin level (197 ng/mL). The histopathological examination of the excised nodules revealed a papillary thyroid carcinoma. The patient showed no sign of recurrence after 2 years follow-up. Conclusion Local soft tissue recurrence followed surgical implantation should be suspected when nodules are determined alongside the thyroid after previous thyroid surgery. Therapy for these soft tissue implants may be difficult; a comprehensive long-term postoperative evaluation should be completed to minimize the risk of recurrence in cervical soft tissue.

Introduction The cervical lymphoepithelial or branchial cleft cyst are benign dysembryologic cystic tumors developing in the anterolateral region of the neck. They are relatively uncommon anomalies. The aims of this study are to analyze the anatomoclinical features and to discuss the modalities of care for the management of this disease. Presentation of case We report a case of a 70 years-old woman who was admitted to our department with a complaint of painless mass in the right supraclavicular region. Clinical examination and radiological investigations found a mass compatible with cervical cyst. Treatment consisted of the complete resection of the cyst. histopathological examination found a Cervical lymphoepithelial cyst. Conclusion The cervical lymphoepithelial can be easily misdiagnosed. It is imperative that clinicians make an accurate diagnosis for appropriate treatment (that is, surgical excision)., Highlights • The cervical lymphoepithelial or branchial cleft cyst are relatively uncommon anomalies. • The branchial cleft cyst, or cervical lymphoepithelial cyst, is a pathological entity whose etiology has yet to be delineated. • The cervical lymphoepithelial can be easily misdiagnosed. • The surgery is the treatment of choice.

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). 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., Highlights • Chronic rhinosinusitis with polyposis highly affects the patient quality of life in many levels making it a public health issue. • The aim of this study is to highlight the potential relationship between symptom scores, asthma and ESS outcomes. • SNOT-22 scores were significantly reduced in the postoperative period in the asthma and non-asthma groups, with no significant difference between the 2 groups.

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., Highlights • The fourth arch anomaly is very rare, and few reports are available in the literature • This congenital anomaly manifests as recurrent cervical abscesses or acute suppurative thyroiditis in most cases. • Recently, minimally invasive endoscopic surgery has revolutionized the management of the pyriform fossa sinus in children.

Background Paediatric tympanoplasty is now a common surgical procedure. The age from which it could be proposed varies regarding children specificities such as Eustachian tube dysfunction, the high incidence of upper airway infections and the immaturity of the immune system. The aim of this study is to describe the specific constitutional, epidemiological and operative aspects as well as the anatomical and functional results of tympanoplasty in children. Methods From 2014 to 2018, a cohort of 95 patients with ages between 6 and 16 years, operated for a type I tympanoplasty, was reviewed by analysing the medical history, the epidemiological and clinical parameters, in addition to the operative features and the functional results. Results The mean age at surgery was 11,7 years. The main risk factors of tympanic perforation were recurrent otitis (78,9%), auricular trauma (16,8%) and tonsillar and adenoid hypertrophy (7,4%). Good anatomical postoperative results with a closed and reinforced neo-tympanic membrane were seen in 90 (94,7%) cases, while a significant improvement of the hearing loss was observed in 87 (91.6%) patients, with a mean value of 34,23 dB HL before and 21,9 dB HL after surgery (p, Highlights o The indications of type I tympanoplasty in children remain a subject of debate. o Eustachian tube maturity influences the result. o Treatment of chronic otitis media prevents tympanic perforations. o Good outcome is obtained if surgery is adapted to each child.

Esophageal perforation following an impacted foreign body (FB) is a rare and potentially life-threatening condition. Early clinical suspicion and imaging are important for a targeted management to achieve a good outcome. Endoscopic extraction of esophageal FB is a good and safe treatment alternative while the surgical procedure remains a necessary option for many patients. We present the case of a 50 years old woman, with no relevant medical history, who accidently ingested a chicken bone during a meal causing mild dysphagia. The patient consulted immediately but was reassured after normal clinical examination. We received the patient 9 days later with severe dysphagia and cervicomediastinal cellulitis. The cervical CT scan showed the significant collection and the FB impacted in the cervical esophagus wall. A first endoscopic exploration drained the pus and allowed the placement of a nasogastric tube. However, the removal of the FB required an open cervical surgery with the evacuation of the collection and the suture of the esophageal perforation followed by the placement of a drainage tube. The patient medical state improved rapidly and no further incidents were noted. The diagnosis of esophageal FB should be meticulous in order to avoid such life-threatening complications., Highlights • Esophageal perforation secondary to an impacted foreign body is a rare and potentially life-threatening condition. • Early clinical suspicion and imaging are important for a targeted management. • Endoscopic extraction of esophageal foreign body is a good and safe treatment alternative that should be considered first. • Surgical procedure, even more invasive, remains a necessary option for many patients.

The nasolabial cyst is a rare, non-odontogenic, soft tissue cyst that develops submucosally in the anterior nasal floor. This cyst accounts for 0.7% of all non-odontogenic cysts. Bilateral nasolabial cyst represents only 10% of the cases. This cyst originates from the remnants of embryonic nasolacrimal duct tissue. Generally, patients present with swelling and facial deformity and rarely local pain. The definite diagnosis should be based on clinical, radiological and above all histopathologic findings. The treatment is enucleation of the cystic tissue. Following is a case report of a bilateral nasolabial cyst in a 40-year-old woman who presented with a chronic nasal obstruction.

Introduction Juvenile ossifying fibroma (OF) is a benign fibro-osseous tumor, affecting the bones of the face. It’s locally very aggressive, with a strong tendency to recur. We report a case of a juvenile psammomatoid ossifying fibroma (JPOF) complicated with exophthalmos undergoing an entirely endoscopic resection. Clinical presentation A 14-years-old, young woman presented with a 7 months history of headache and right chronic tearing complicated with exophthalmos. Nasal endoscopy revealed a polylobed mass filling the right nasal cavity, the ophthalmic examination showed an isolated exophthalmos. CT scan revealed a well-limited benign mass covered by a thick shell of bone, pushing out the orbital lamina papyracea responsible for a grade 1 exophthalmos. On the facial MRI, we excluded intracranial or intraorbital involvement. A biopsy of the mass describes a psammomatoid juvenile ossifying fibroma. The patient underwent endoscopic transnasal approach with image-guided neuro-navigation system. Clinical discussion JPOF is an aggressive variant of ossifying fibroma occurring predominantly in children with a predilection for the paranasal sinuses. CT scan images show a characteristic well-limited benign expansile mass covered by a thick shell of bone, but sometimes it’s mistaken for a mucocele. MRI helps with excluding intracranial or intraorbital involvement. Endonasal endoscopic approaches have been increasingly used and it tends to become the new standard of care. Conclusion Treatment consists of complete surgical removal; incomplete resection is associated with a high local recurrence rate. Clinician should keep in mind the need for clinical and radiological follow-up for many years.

Highlights • Leiomyosarcoma of the larynx a very rare malignancy. • Leiomyosarcoma of the larynx may represent a serious diagnostic challenge. • No therapeutic protocol has been established yet. • Treatment modalities depends on size, location, extension of the tumor. • The prognosis is conditioned by the quality of surgical excision and the occurrence of recurrence and metastases., Introduction Leiomyosarcoma is a rare mesenchymal tumor that originates from smooth muscle cells. Head and neck LMSs represent only 3% of all leiomyosarcomas with less than 50 cases of laryngeal LMS reported in the literature till now. Case presentation We report a case of 50-year-old male presented at our ENT department for a chronic hoarseness. Clinical examination investigations found small submucosal lesion in the right vocal cord. Treatment consisted of CO2 Laser excision of the lesion. The evolution was marked by the appearance of a tumefaction in the left submandibular region and a severe dyspnea requiring an emergency tracheotomy. Paraclinical examination investigations found a supraglottis–glottis-subglottis tumor. A total laryngectomy with bilateral functional neck dissection was performed and the histopathological examination found a laryngeal leiomyosarcoma. Conclusion LMS of the larynx a very rare malignancy. The accurate diagnosis is histological. Surgery is the mainstay of treatment. Its prognosis is correlated to local recurrence and distant metastases.

Highlights • Synovial sarcoma is a rare malignant neoplasm. • The location in pharynx is extremely rare. • The diagnosis of synovial sarcoma is confirmed by surgical biopsy. • The objective of this study is to describe the clinical, radiological and histological features of pharyngeal synovial sarcoma and to discuss its therapeutic management., Introduction Synovial sarcoma is a rare tumor to be encountered in the head and neck region and is always a challenge in terms of diagnosis, treatment, as our case. Presentation of case We present a 23-year old female patient with synovial sarcoma of posterolateral pharyngeal wall. The radiological and clinicopathological features along with various diagnostic tests and treatment options are discussed. Discussion The objective of this study is to describe - from a clinical case reported from our institution, and from literature review- the clinical, radiological and histological features of pharyngeal synovial sarcoma and to discuss its therapeutic management. Conclusion Synovial sarcoma of pharynx is extremely a rare tumor in current practice.

Laryngeal impaction of a foreign body is a rare condition. Most of the foreign bodies aspirated pass through in and lodge lower in the airways. Diagnosis of a laryngeal foreign body can be challenging, especially if it's small, radiolucent and when there is incomplete airway obstruction. We are reporting a case of laryngeal foreign body in a 2-year-old child that was misdiagnosed as laryngitis. The clinical presentation, investigation and management are discussed.

Highlights • Adenoid cystic carcinoma of the maxillary sinus is a rare tumor. • Adenoid cystic carcinoma of the maxillary sinus may represent a serious diagnostic. • Characterized by very slow growth pattern, high local recurrence rate, and distant metastases mainly to the lungs and bones. • Poor overall long-term prognosis, compared to other ACCs of the head and neck., Introduction Maxillary sinus adenoid cystic carcinoma (MSACC) is a rare malignancy with a propensity for distant metastasis Case presentation We report a case of a 55 years-old male who was admitted to our department with a complaint of right nasal obstruction and anosmia. Clinical examination, radiological investigations and histopathological examination found a mass compatible with advanced adenoid cystic carcinoma of the right maxillary sinus. Treatment consisted of radio chemotherapy. Conclusion Adenoid cystic carcinoma of the maxillary sinus may represent a serious diagnostic challenge. It should be considered in the differential diagnosis of Sino nasal tumors even if it’s rare.

Pilomatrixoma is a rare benign skin tumor differentiating toward hair matrix cells usually encountered in the head and neck region. It is most frequently appearing in the first and second decades of life. Histopathological examination is essential to make definitive diagnosis. Herein, we present an atypical case of multiple pilomatrixomas. A 69-year-old man with multiple voluminous masses over the scalp. Among the three lesions, one was clinically suspicious for malignancy, it measured 17 cm and was ulcerated in places. Histopathology confirmed the diagnosis of pilomatrixoma. The tumors were removed surgically with free margins. Otolaryngologist should be familiar with this benign tumor when evaluating soft-tissue mass in the head and neck region., Highlights • Pilomatrixoma, is a particular and uncommon type benign subcutaneous tumors arising from the cutaneous adnexa. • Otolaryngologist should be familiar with this benign tumor when evaluating soft-tissue mass in the head and neck region. • Clinical follow-up of these lesions is necessary to avoid recurrence and malignant transformation.

Introduction Lipoblastoma is a rare benign tumor arising from embryonic white fat which occurs in the early childhood. It usually arises on the extremities and considered as a rare cause of a pediatric head and neck masses. The aim of this study is to shed light on lipoblastomas as a differential diagnosis of rapidly growing soft fatty masses of children in neck and head area. Patients and methods A retrospective review of 3 patients with lipoblastoma, underwent Surgical resection (case 1 and 2) by cervical approach. The third patient with a facial lipoblastoma was not operated due to the high risk of facial paralysis. Review of literature, diagnostic methods and genetics of lipomatous tumors are discussed. Results Complete surgical excision via a cervical approach demonstrated irregular lobules of immature fat cells separated by a loose, myxoid connective tissue. Histology analysis confirmed the diagnosis of lipoblastoma. Discussion Lipoblastoma is a rare childhood tumor, even rarer in head and neck area. The pathogenesis is unknown, though it is believed to arise from altered embryogenesis of human white fat and genetic predisposition, as chromosome 8 abnormalities may be implicated in the development of lipoblastoma. The presumptive diagnosis is performed by imaging. The most important differential diagnosis of lipoblastoma is myxoid liposarcoma. The mainstay of treatment is complete non-mutilating resection of the tumor to avoid recurrence. Conclusion Lipoblastoma should be suspected in case of heterogeneous fatty tumor in head and neck area, and included as a differential diagnosis of cervical masses in children younger than 3 years. The mainstay of treatment is complete surgical excision with a good prognosis., Highlights • Lipoblastoma should be suspected in case of heterogeneous fatty tumor in head and neck area, in children younger than 3 years. • Otolaryngologist should be familiar with this benign tumor when evaluating soft-tissue mass in the head and neck region. • Complete non-mutilating resection of the tumor is the treatment of choice • clinical follow-up of these lesions is necessary to avoid recurrence and malignant transformation.

Introduction: Mucoepidermoid carcinoma (MEC) is a rare malignant tumor that develops from the salivary glands. Its treatment includes surgery associated or not with radiotherapy depending on the histological grade. We report the case of a 38-year-old patient. Methods: We report a case of a mucoepidermoid carcinoma of the palate, and we specify the clinical, therapeutic and progressive characteristics of this attack. Case Report: She is a 38-year-old woman with no significant medical history. The clinical examination revealed a localized mass at the level of the hard palate, with a smooth normal-looking mucosa measuring 4 cm in long axis, the rest of the clinical examination was normal. Pathology examination confirmed the diagnosis of low-grade CME. Magnetic resonance imaging was performed objectifying a lesion localized at the level of the submucosa of the palate without bone extension either to the tongue or to the nasal cavity. The treatment consisted in excision of the lesion with margin, with monthly monitoring for 6 months with good progress. Conclusion: The discovery of a CME in young patients is rare. This observation makes it possible to take stock of the management of this type of cancer according to histological characteristics.

Highlights • Primary lymphoma of the larynx is extremely rare, representing less than 1% of all primary laryngeal neoplasms which consists mainly of non-Hodgkin lymphomas. • Diagnosis requires immunohistopathological examination of the laryngeal mass. • The clinicopathological characteristics and rational treatment of primary laryngeal lymphoma are still unclear and need to be further defined due to the paucity of this pathology., Introduction Primary lymphoma of the larynx is extremely rare, representing less than 1% of all primary laryngeal neoplasms. It consists mainly of non-Hodgkin lymphomas (NHLs), represented particularly by diffuse large B-cell. Extranodal natural killer/T-cell lymphoma, presented in larynx is a rare condition that accounts for less than 11% of all lymphomas without distinctive clinicopathologic features, as well as challenging pathologic diagnosis. Case report We report here a case of a 64-years-old man who presented with primary lymphoma type T of the subglottic larynx. A histopathological examination of the biopsy confirmed non-Hodgkin T cell lymphoma. Given his age, he underwent chemotherapy and radiation therapy. The patient was disease-free after 18 months follow up. Conclusion The clinicopathological characteristics and rational treatment of primary laryngeal lymphoma are still unclear and need to be further defined due to the paucity of this pathology.

Highlights • Sialolipoma is a rare salivary gland tumor defined histologically by mature adipocytes encasing normal salivary glandular components. • Complete excision of the mass with the lobes of the salivary glands involved seems to be adequate for definitive management. • Congenital sialolipoma should be kept in mind in the differential diagnosis of congenital parotid mass, especially when CT scanning shows a well‑circumscribed fat‑like tissue within the parotid gland. • Although surgical excision is usually sufficient to treat sialolipoma of the parotid gland, postoperative follow-up is necessary as multifocal lesions can potentially persist, which could lead to recurrence., Introduction Sialolipoma is an extremely rare salivary gland tumor characterized by a well circumscribed mass composed of glandular tissue and matures adipose elements. Herein,the aim of this article is to report the sixth case of congenital sialolipoma and the first case of recurrent congenital sialolipoma in infant, and discuss the clinicopathological and morphological features of sialolipoma and the possible cause of its recurrence. Case report A 3 year-old child presented with a recurrent mass of right parotid gland which progressed from birth, initially treated at the age of 4 months by simple tumorectomy and excision of the surrounding parotid tissue. The tumor recurred 4 months postoperatively. The radiological examination confirmed the parotid origin of the tumor. Histopathology was consistent with a sialolipoma. A superficial parotidectomy with preservation of the facial nerve was performed this time at the age of 3 years. Postoperative recovery proceeded without incident with normal facial nerve function. There was no recurrence at 36-month follow-up. Conclusion Although it is a very rare benign tumor, congenital sialolipoma should be kept in mind in the differential diagnosis of congenital parotid mass. The recurrence of congenital sialolipoma is dependent on its management, thus complete excision of the mass with the lobes of the salivary glands involved seems to be adequate for definitive management.

Highlights • Cervical lymph nodes are a common site of metastases for malignant tumors, most commonly developed from head and neck primary tumors. • Isolated supraclavicular lymph nodes should alert the clinician to consider non head and neck primary neoplasm. • Careful clinical examination, imaging tools and pathological analysis are necessary to establish an early diagnosis for adequate treatment., Cervical lymph nodes are a common site of metastases for malignant tumors, most commonly developed from head and neck primary tumors. But, they can also be secondary to distant primary tumors. We report the case of two patients treated in our Otorhinolaryngology and Head and Neck department for chronic supraclavicular lymphadenopathies, for whom further investigations showed lymph node metastasis originating from distant tumors. Thus, careful clinical examination, imaging tools, and if possible pathological analysis are necessary to establish an early diagnosis for adequate treatment.

Highlights • Penetrating craniofacial wounds caused by foreign bodies are a rare case of emergency facial surgery and require complex medical management. • Their management must be rapid and multidisciplinary. • The extraction of the foreign body should be under direct visual control in order to avoid or reduce the damage done to cerebral tissue., Introduction Penetrating craniofacial wounds due to foreign bodies, specifically sharp white blades, represent an eventual life threatening condition and a rare case of emergency facial surgery requiring a complex medical care. We report an original case of a penetrating craniofacial wound by a knife with a review of the literature concerning the tendencies, the complications and the specific medical care needed for these particular cranio-facial lesions. Presentation of case A 35 year old man admitted to our ENT emergency room with a penetrating craniofacial wound caused by a knife stuck in the cranio-orbital-nasal junction. A craniofacial profile x-ray showed the presence of the metallic foreign body, a knife, penetrating deeply to the base of the skull. Computed tomography showed that the transcranial metallic foreign body arrived in the right sellar region after passing through the nasal cavity and the right sphenoid sinus with hemosinus and suprentorial pneumocephaly. the management consisted of multidisciplinary management, and the extraction was performed successfully under 3D endoscopic control. Conclusion The majority of penetrating craniofacial wounds secondary to foreign bodies, regardless of their size, are rarely associated with major neurological symptoms and their management must be adapted to their potential severity.

Foreign bodies are often encountered by oral and maxillofacial surgeons and may present a diagnostic challenge due to many factors such as nature of foreign body material, the size of the object, difficult access and a close anatomical relationship of the foreign body to vital structures. We present an unusual case of a penetrating injury by a large metallic bar (15.0 cm) in a 5 year old child, embedded on the right side of the oral cavity. Penetrating injuries by blunt objects are a rare finding in maxillofacial region. In this case, we discuss the clinical presentation, diagnosis, surgical treatment and draw attention to this very rare situation.

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.

BACKGROUND: Pendred syndrome (PS) is an autosomal recessive disorder, caused by biallelic mutations in the SLC26A4 gene which codes for the pendrin protein. It is characterized by sensorineural hearing loss associated with dyshormonogenic goiter. Which is a common cause of congenital deafness. CASE PRESENTATION: Hereby we describe a case of a 21- year-old women who presented to the ORL department with an anterior cervical mass that gradually increased in volume over 3 years associated with severe hearing loss since birth for which the patient was provided with hearing aids. Pendred syndrome is suspected because of the present of goiter and congenital hearing loss. CONCLUSIONS: Clinical presentation is very variable. However, the association of goiter and progressive deafness suggests the diagnosis of Pendred syndrome.

Objective: Our study aims to analyze the epidemiological, clinical, radiological, and etiological aspects of this disease. Methods: We reviewed data from patients who consulted the same seigneur for hearing loss and in whom the otoscopic examination was normal with a conductive hearing loss objectively confirmed on tonal audiometry, for a period of one year (from October 2018 to October 2019). Epidemiological, clinical and paraclinical data were collected and recorded on-farm records. Results: The average age is 36 years. The M/F sex ratio was 1.5 in favor of the men. None of our patients reported a personal otologic history. Three patients reported a notion of head trauma and a similar case in the family was found in four patients. Hearing loss is the most frequent reason for consultation. Otoscopic examination shows a normal tympanic membrane without perforation in all patients. CT scan of the temporal bone was performed in all patients (100%); it was normal in 4 cases (17%), which required surgical exploration. However, he showed images of otosclerosis in 15 cases (65%), an image of congenital cholesteatoma in a single patient, tympanic glomus in a single patient, an incudo-malleolar dislocation in a single patient (4.5%), and an incudo-stapedial dislocation in a single patient (4.5%). Conclusion: Conductive hearing loss (CHL) is a diagnostic challenge for the physician that requires a schematic approach. The diagnosis is based on a combination of clinical and paraclinical arguments.