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La tubercolosi e un’infezione micobatterica cronica che colpisce preferenzialmente l’albero respiratorio, ma che puo interessare, in circa un terzo dei casi, numerosi altri organi (tubercolosi extrapolmonare). Quando non e linfonodale, la tubercolosi della sfera ORL resta rara. La diagnosi e, spesso, difficile e tardiva, in quanto i segni clinici sono aspecifici. Essa si basa essenzialmente sull’analisi istologica e batteriologica del tessuto granulomatoso prelevato. Il rischio di comparsa e aumentato in caso di immunodepressione, legata in particolare al virus dell’immunodeficienza umana (HIV), e in caso di stato socioeconomico sfavorevole, in particolare in una zona endemica. Trattata correttamente, la tubercolosi causata da ceppi sensibili agli antitubercolari guarisce quasi sistematicamente, ma la comparsa, a livello mondiale, di forme multiresistenti complica la sua gestione. La chirurgia trova il suo posto nella diagnosi, in caso di complicanza e per la riparazione delle sequele.

The schwannoma of the glossopharyngeal nerve is a rare etiology among the tumor masses developed in the parapharyngeal space.We report the case of a 33 years old woman in whom a large schwannoma of the left glossopharyngeal nerve was discovered incidentally on a brain MRI. Respiratory evolutionary prognosis imposed trans-oral surgical treatment.We discuss the diagnostic and therapeutic strategy for the benign tumors of the parapharyngeal space.The schwannoma of the glossopharyngeal nerve is a benign rare lesion. The difficulty lies on the surgical strategy and the choice of the approach. The functional suites are marked by difficulty swallowing and require intensive speech therapy.

Les abcès intracrâniens constituent la complication la plus redoutable des foyers infectieux ORL et dentaires. Si leur incidence actuelle est faible, 1,3/100 000/an, toutes causes confondues, leur pronostic demeure sombre. Les auteurs rapportent huit ans d’expérience oto-neurochirugicale diagnostique et thérapeutique des patients porteurs d’abcès cérébraux d’origine pétro mastoïdienne. La présentation clinique initiale générale et neurologique, la topographie et les signes radiologiques de la collection, la bactériologie, les données per-opératoires ainsi que l’évolution clinique post-opératoire ont été évalués. De janvier 2005 à octobre 2013, 59 patients ont été traités pour un abcès cérébral dans notre service. Dans cette série, un foyer oto-gène a été découvert pour cinq hommes et deux femmes [Sex-ratio 2,5 :1]. L’âge médian au moment du diagnostic était de 56 ans [21-76]. Tous les patients ont bénéficié d’une prise en charge neurochirurgicale et oto-chirurgicale en urgence. La durée moyenne d’hospitalisation était de 33,7 jours [19-50 ; Écart-type = 13,4]. La durée moyenne de suivi était de 40,6 mois [2-98]. Aucun patient n’est décédé au cours du suivi. L’orientation clinique est difficile en contexte d’urgence, ce qui justifie le recours au scanner cérébral sans et avec injection au moindre doute devant l’association de signes neurologiques focaux et infectieux. La prise en charge oto-neurochirurgicale, urgente, est indispensable. Cette association de compétences améliore le pronostic.

To describe 18 cases of patients treated for advanced cutaneous squamous cell carcinoma (CSCC) of the head metastasing to cervical lymph nodes and parotid gland. To estimate their survival and the risk factors of metastases.18 cases of patients affected by CSCC of the head, metastatic to parotid and cervical lymph nodes were afterward analyzed. Two populations were differentiated: the patients already treated for their CSCC, with secondary appearance of metastases in the Population A, the patients by whom the metastase is concomitantly discovered to the CSCC in the Population B.The treatment consisted of a parotidectomy and neck dissection, possibly associated with excision of the primary tumour. Adjuvant radiotherapy was systematic. Metastatic progression was on lungs most of the time (57%), in patients of the population B (80%), or of whom primitive CSCC was of bad forecast (group 2) (78%). The mortality was bound to the complications induced by distant metastases (63%), at 5 years it was superior in the population B (100%) than in the population A (77%).CSCC of the head, metastatic to parotid and cervical lymph nodes have a severe prognosis for survival in spite of an optimal curative treatment applied to fragile old patients.

The authors in this article, made from a review of the scientific literature (PubMed search engine), indicate the current position of positron emission tomography with 18F-fluro-2-deoxy-D-glucose coupled computed tomography (PET-CT) in the early and late post-treatment follow up of squamous cell carcinomas of the upper aerodigestive tract. The aim of this follow up is twofold: Early detection of locoregional progressive evolution or metastatic progression and search for a possible second metachronous cancer in patients at risk.

Summary Introduction Solitary fibrous tumour (SFT) of the larynx is a rare benign mesenchymal tumour of adults. The diagnosis is based on a combination of histological and immunohistochemical signs. Case report The authors report the case of a patient with chronic laryngeal dysphonia and dyspnoea related to supraglottic SFT. Discussion/Conclusion The main challenge of surgery is to ensure healthy resection margins to avoid recurrence while preserving the functions of the upper aerodigestive tract. Surgery is the treatment of choice and provides an excellent prognosis. Long-term clinical follow-up is required to detect rare recurrences.

Resume Introduction La tumeur fibreuse solitaire (TFS) laryngee est une tumeur mesenchymateuse benigne rare de l’adulte dont le diagnostic repose sur un faisceau d’arguments histopathologiques, notamment immunohistochimiques. Presentation des cas Nous rapportons l’observation d’une patiente prise en charge pour une dysphonie et une dyspnee chroniques, liees a une TFS supraglottique. Discussion/Conclusion L’enjeu repose sur l’association d’une exerese en marges saines pour eviter la recidive avec une conservation des fonctions du carrefour des voies aerodigestives superieures. La chirurgie est le traitement de reference avec un excellent pronostic. Le suivi clinique se doit d’etre poursuivi a long terme pour depister les rares rechutes.

Resume Introduction L’emphyseme sous-cutane cervical et le pneumomediastin font souvent suite a un traumatisme, une chirurgie ou une infection. Plus rares sont ceux dit spontanes lorsqu’aucune cause n’est retrouvee. Toute manœuvre violente type Valsalva est un facteur predisposant connu. Lors d’un effort a glotte ferme comme l’eternuement, une rupture de la muqueuse peut creer un emphyseme cervical et un pneumomediastin. Presentation du cas Nous presentons le cas d’un homme de 30 ans qui, suite a un effort d’eternuement en se pincant simultanement les deux narines, a presente un emphyseme sous-cutane cervical complique d’un pneumomediastin, en lien avec une fistule du sinus piriforme. Discussion/Conclusion La rupture de la muqueuse du sinus piriforme est une complication rarissime de ce genre de manœuvre. Le risque d’infection a type de cellulite cervicale evoluant vers la mediastinite oblige une prise en charge hospitaliere. Pincer simultanement les deux fosses nasales lors de l’eternuement est une manœuvre dangereuse a proscrire.

Resume Introduction Le cancer du rein, en particulier le carcinome a cellules claires, presente une evolution clinique imprevisible avec un potentiel metastatique variable dans le temps et dans la localisation. Parmi les sites atypiques, 6 % concernent la region tete et cou. Les trois sites les plus frequents sont la thyroide, les sinus et la parotide. Presentation des cas Nous rapportons l’observation de deux localisations rares : la base de langue et le sinus sphenoidal. Discussion Leur faible radiosensibilite fait opter pour une chirurgie premiere suivie eventuellement par une radiotherapie. La rancon fonctionnelle en est l’enjeu afin d’eviter tout geste mutilant. Conclusion La survenue de ce type de metastases parfois des annees apres la decouverte du primitif renal explique la necessite de rechercher un tel antecedent dans l’anamnese d’un patient porteur d’une lesion suspecte de malignite au niveau de la region tete et cou.

Annales Francaises d'Oto-Rhino-Laryngologie et de pathologie cervico-faciale - Vol. 125 - N° 4 - p. 224-233

Resume Introduction. — Les dissections de l'artere carotide interne extracrânienne sont dues au clivage de la paroi arterielle par un hematome. Nous rapportons un cas de dissection spontanee. Exegese. — Un homme de 65 ans consultait pour un syndrome de Claude-Bernard-Horner douloureux associe a une paralysie du nerf grand hypoglosse. Aucun element anamnestique n'a suggere un traumatisme arteriel. L'imagerie par resonance magnetique a revele une dissection carotidienne. Conclusion. — L'hematome carotidien dissequant, en situation cervicale haute et sous-adventielle, peut comprimer les structures nerveuses de voisinage et respecter la lumiere arterielle. Un tel hematome peut passer inapercu a l'exploration ultrasonore et en angiographie. L'imagerie par resonance magnetique est alors un examen de choix et peut etre realisee en premiere intention. Le traitement repose sur les anticoagulants.

When facing cochleovestibular symptoms such as hearing loss, dizziness or unsteadiness, or a tinnitus evolving in the aftermath of a cranial trauma or overpressure in the form of inner ear barotrauma after diving or a from blast, a perilymphatic fistula must be considered.We present a homogenous prospective series of 16 cases of perilymphatic fistulae occurring after head trauma or overpressure between 2003 and 2011. Patients suspected of suffering from a perilymphatic fistula and presenting with the following criteria were included: the occurrence after a variable delay of cochleovestibular symptoms (vertigo, tinnitus, and hearing loss) in the aftermath of a head trauma or overpressure. All patients received medical treatment with intravenous corticosteroids. Failure of the initial treatment and in the presence of clinical data suggesting a perilymphatic fistula, an exploration of the middle ear was performed.13 patients (81.2% underwent surgical exploration with early and stable subtotal recovery of hearing in 90%, a rapid disappearance of vertigo in 89.9%, a loss of tinnitus in 45% and in 27% improvement.The diagnosis must be supported by various diagnostic tests. If evidence in favor of a perilymphatic fistula is credible, surgery has always achieved an excellent functional outcome.

Summary Introduction Kidney cancer, and especially clear cell carcinoma, has an unpredictable clinical course, with metastatic potential that is variable over time and in location. Six percent of atypical locations are ENT. The three most frequent sites are the thyroid, sinus and parotid gland. Case report We report two rare locations: the base of the tongue, and the sphenoid sinus. Discussion First-line treatment is surgical, due to low radiosensitivity, with radiation therapy as a possible second line. Functional impact is a prime issue, to avoid functional mutilation. Conclusion Such metastases may sometimes occur years after the discovery of the primitive renal tumor; any history of kidney cancer should, therefore, be noted in patients with suspect ENT lesions.

To present new interventional neuroradiology methods of management of an ICA injury during functional endoscopic sinus surgery (FESS).The authors report the case of a patient who presented an ICA injury during a FESS and who could undergo an embolization. This embolization stopped the epistaxis and saved the patient from a lethal issue without any aftereffect.After a review of the literature the authors describe the circumstances of occurrence, the urgent management and the modern treatment of an ICA injury. Along with the progress in neuroradiology, the embolization represents a top grade treatment of this complication. Embolization with stent keeps permeable the ICA axis which represents a major progress in the management.The success of the management of an ICA injury relies on the close collaboration between anesthesist, otorhinolaryngologist surgeon and interventional neuroradiologist. Since 2004, modern techniques of interventional neuroradiology using new stents allow to keep permeable the ICA axis.

Laryngeal tuberculosis is a rare condition. This new clinical pattern of tuberculosis should be recognized by clinicians.We report our experience with four cases of laryngeal tuberculosis.The principal differences in the disease pattern are an increase in the number of cases of primary laryngeal tuberculosis without any evident pulmonary involvement and the declining number of pseudotumor forms with an larger number of nonspecific laryngeal localizations.Tuberculosis should be entertained as a possible diagnosis in patients with nonspecific laryngeal disease. The diagnosis is confirmed by identification of granulomatous inflammation and acid-fast bacilli. New culture techniques and molecular biology methods such as polymerase chain reaction allow early identification of Mycobacterium tuberculosis.

But de la presentation Evaluer l’interet de la tomographie par emission de positons au 18F-fluro-2-deoxy-D-glucose dans la surveillance post-therapeutique precoce et tardive des carcinomes epidermoides des voies aerodigestives superieures. Materiel et methodes Il s’agit d’une etude retrospective, unicentrique, realisee au sein du service d’ORL et chirurgie cervico-faciale de notre institution entre janvier 2005 et decembre 2012 portant sur 160 patients adultes presentant un carcinome epidermoide des VADS traites de facon curative et surveilles par un protocole incluant un suivi clinique et la realisation d’une TEP-TDM a 4 mois puis en cas de controle locoregional et a distance, a 12 mois, 18 mois et 24 mois selon la duree du suivi. La TEP-TDM a ete evaluee pour le statut tumoral local, regional, a distance et pour le depistage de seconde localisation metachrone. Resultats Pour la tumeur primitive, la TEP-TDM a presente une sensibilite, une specificite, une valeur predictive positive, une valeur predictive negative et une efficacite diagnostique respectivement de 100 %, 98,6 %, 80 %, l00 % et 98,6 % a 4 mois ; 100 %, 97,2 %, 57,1 %, 100 % et 97,3 % a 12 mois ; 100 %, 100 %, 100 %, 100 % et 100 % a 18 mois ; 100 %, 98,6 %, 80 %, 100 % et 98,6 % a 24 mois. Pour le statut ganglionnaire de 100 %, 96,8 %, 78,9 %, l00 % et 97,2 % a 4 mois ; 80 %, 97,4 %, 57,1 %, 99,1 % et 96,2 % a 12 mois ; 100 %, 100 %, 100 %, 100 % et 100 % a 18 mois ; 100 %, 97,3 %, 60 %, 100 % et 97,2 % a 24 mois. Pour le statut metastatique a distance de 100 %, 93,3 %, 47 %, l00 % et 93,7 % a 4 mois ; 100 %, 98,3 %, 60 %, 100 % et 98,3 % a 12 mois ; 100 %, 100 %, 100 %, 100 % et 100 % a 18 mois ; 100 %, 98,7 %, 75 %, 100 % et 98,7 % a 24 mois. La TEP-TDM a depiste neuf secondes localisations metachrones a un stade infra-clinique. Conclusion Les resultats de notre etude demontrent l’excellente efficacite pour la surveillance post-therapeutique de la TEP-TDM a 4 puis 12, 18 et 24 mois compte tenu de sa bonne sensibilite, de sa valeur predictive negative et de son analyse globale. Nous proposons un algorithme de surveillance post-therapeutique.

After facial nerve injury, in cerebello-pontine tumors surgery, hypoglossal-facial anastomosis is the most common procedure, to rehabilite a paralysed face, if direct facio-facial graft is not possible. This procedure must be done, in a second time, during the next year and followed with a specific reeducation. In seven patients operated between 1985 and 1996, we performed clinical evaluation and electrophysiological examination. The best evaluation is the clinical evaluation using the G. Freyss's facial testing. Best results are seen in early, specific and continued reeducation. All our patients have a good recovery of facial nerve function, but clinical examination and electrophysiological results are not correled with an objective video performance. The management of such patients needs efficient oto-neurosurgical team and specific trained physiotherapists.

In the past ten years four sportsmen with a traumatic perilymphatic fistula were treated. Three of these four patients were surgically treated: two of them underwent a labyrinthectomy and with one of them, the oval window was grafted. After the analysis of these cases, we have made a study of the literature. Careful attention to the patient history and accurate review of the recurrent vestibulocochlear symptomatology isolate a clinical "audiovestibular syndrome of perilymphatic fistule". There is lack of precise preoperatoire diagnostic test. Nevertheless, entire positionnal audiometric test is a reliable and easy to perform test. The medical management is based on bed rest during a reasonable period. Only patients with significant suggestive symptomatology are surgically explored . They sometimes need destruction of vestibular function without preservation of hearing.

This report is of a pituitary abscess arising from chronic sinusitis. The MRI suggested a pituitary tumor with suprasellar extension and diagnosis was made operatively. Pituitary abscesses are rare entities. Despite the advent of MRI, diagnosis is often only made operatively.

To assess the value of high resolution fast spin echo T2 weighted (HR-FSE T2w) sequence for the diagnosis of acoustic neuroma. Two criteria for normality of the HR-FSE T2w examination are defined.114 patients underwent MR imaging at 1.5 T. The protocol included: axial images; 2 overlapped sequences focused on the internal auditory meatus (IAM), HR-FSE T2w acquisition (512 matrix, 3 mm sections with 1.5 mm overlapping); pre and postcontrast T1 weighted sequences focused on IAM. We defined two criteria for a normal HR-FSE T2w image: cerebellospinal fluid visible throughout the IAM, cochleo-vestibular and facial nerves visible in the IAM.31 examinations were abnormal with HR-FSE T2w sequence, 25 lesions were found on postcontrast T1 weighted sequence (i.e. 6 false-positive results and none false-negative). The sensitivity, specificity and negative predictive value of this HR-FSE T2w sequence were 100%, 97% and 100% respectively.the HR-FSE T2w sequence is the first-line method for detecting tumoral lesions of the IAM. If the 2 normality criteria are present on the HR-FSE T2w images, the T1w sequence with gadolinium injection is of no use; the injection of gadolinium remains necessary if only one of these criteria is lacking.

Being endemic in India and Sri Lanka, rhinosporidiosis is not much known in Africa where only few cases have been reported for the last 20 years. It is a chronic mycosis striking electively two target zones: nasal and conjunctival mucosae. Many features are still unknown about this pathogenic agent which belongs to the group of phycomycetes. But it has never been yet possible to cultivate it nor to inoculate it to animals. It has a cyclic development, well described by Ashworth. Its treatment is both surgical and medical (fungicides).