21 research outputs found
Imperforation choanale aspects cliniques, approache therapeutique
No Abstract. Journal Tunisien d\'ORL et de chirurgie cervico-faciale Vol. 17 2006: pp. 30-3
Fistule et kyste nasofrontaux : a propos dâun cas
Introduction : Les fistules nasofrontales correspondent Ă la persistance dâune communication anormale dâorigine embryologique entre la couche profonde de la peau et le systĂšme nerveux. Ils peuvent ĂȘtre associĂ©s Ă un kyste dermoĂŻde ou Ă©pidermoĂŻde.Ils peuvent ĂȘtre rĂ©vĂ©lĂ©s par une infection loco-rĂ©gionale et surtout neuro-mĂ©ningĂ©e qui fait toute la gravitĂ© de cette malformation congĂ©nitale. Notre objectif est dâinsister sur les caractĂ©ristiques de cette pathologie pour un diagnostic prĂ©coce.Observation : Il sâagit dâun enfant ĂągĂ© de 2 ans, qui prĂ©sente depuis sa naissance une fistule cutanĂ©e au niveau du dos du nez laissant sourdre du pus de façon intermittente. Lâimagerie a objectivĂ©e une formation kystique basi-frontale mĂ©diane, associĂ©e Ă une dĂ©hiscence de lâos frontal gauche avec dĂ©faut de dĂ©veloppement de lâapophyse crista galli. Le diagnostic de fistule associĂ©e Ă un kyste nasofrontal a Ă©tĂ© retenu. Le patient a Ă©tĂ© opĂ©rĂ© par voie bicoronale. En per-opĂ©ratoire, nous avons dĂ©couvert un kyste extra-dural mais adhĂ©rant au feuillet externe de la dure-mĂšre. La paroi kystique a Ă©tĂ© dissĂ©quĂ©e puis enlevĂ©e en totalitĂ©. Le dĂ©fect osseux de lâos frontal gauche a Ă©tĂ© colmatĂ© par de la poudre dâos et du surgicel. Les suites opĂ©ratoires étaient simples et lâexamen anatomopathologique a confirmĂ© quâil sâagit dâun kyste dermoĂŻde nasofrontal. Une fistulectomie a Ă©tĂ© rĂ©alisĂ©e 6 mois plus tard avec bonne Ă©volution.Conclusion : Lâapport de lâimagerie est indispensable pour le diagnostic positif et topographique desfistules et kystes nasofrontaux. Le risque de complications infectieuses impose un traitement chirurgical. Le but de la chirurgie doit ĂȘtre une rĂ©section totale, seule garante de lâabsence de rĂ©cidive Ă long terme.Mots-clĂ©s : fistule nasofrontale, kyste nasofrontal, tomodensitomĂ©trie, imagerie par rĂ©sonance magnĂ©tique, craniotomie frontaleIntroduction : Naso frontal fistula correspond to the persistence of an abnormal communication of embryological origin between the deep layer of the skin and the nervous system. They can be associated with dermoid or epidermoid cyst. They can be revealed by a locoregional and especially neuro-meningeal infection, wich makes all the severity of this malformation.Case-report : A 2 year-old child presents since birth cutaneous fistula at the nasal dorsum with intermittent purulent effuse. Imaging showed medial basi-frontal cyst, associated with dehiscence of the left frontal bone and defective development of the crista galli. The diagnosis of fistula associated with nasofrontal cyst was retained. The patient was operated by bicoronal approach. Intraoperatively, we found an extradural cyst but adhering to the outer layer of the dura mater. The cyst wall was dissected and removed totally. The bone defect of the left frontal bone was clogged with bone powder and surgicel. The postoperative course was uneventful and pathologic examination confirmed that this is a nasofrontal dermoid cyst. Fistulectomy was performed 6 months later with good evolution.Conclusion : Contribution of imaging is essential for positive and topographic diagnosis of nasofrontal fistulas and cysts. The risk of infectious complications requires surgical treatment. The goal of surgery should be a total resection, the only guarantee of the absence of long-term recurrence.Keywords : nasofrontal fistula, nasofrontal cyst, computed tomography, magnetic resonance imaging, frontal craniotom
Kyste AmygdaloĂŻde Oropharynge A Propos D\'un Cas
Le kyste amygdaloïde est une tumeur kystique latéro-cervicale haute rare, issue de la 2Úme fente branchiale. Il représente 2% des tumeurs latéro-cervicales du cou, et 6,1à 85,2% des anomalies de la deuxiÚme fente. La forme oropharyngée est trÚs rare.
Nous rapportons une observation d\'un kyste amygdaloïde oropharyngé, chez une femme de 56 ans. Aucune symptomatologie particuliÚre n\'a été notée. L\'examen clinique a révélé une tuméfaction de la loge amygdalienne droite, refoulant le pilier antérieur. La TDM a objectivé
un processus expansif nĂ©crosĂ© de l\'amygdale palatine droite comblant l\'espace parapharyngĂ© droit, en contact avec la base de la langue et le muscle ptĂ©rygoĂŻdien mĂ©dial homolatĂ©ral. Une rĂ©section complĂšte et sans rupture du kyste a Ă©tĂ© pratiquĂ©e par voie transorale, le geste a Ă©tĂ© complĂ©tĂ© par une amygdalectomie droite. L\'histologie a confirmĂ© le diagnostic par la co-existence d\'un revĂȘtement Ă©pithĂ©lial et d\'une infiltration de tissu lymphoĂŻde. Le recul est de 6 mois sans rĂ©cidiveSecond branchial cleft cysts are the most common type of branchial abnormalities and usually found high in the neck. Oropharyngeal presence of branchial cleft cyst is very rare. We report a case of oropharyngeal branchial cleft cyst in 56 years women, wich had any specific symptom. Radiologic examination (TDM) revealed an expansive mass of the palatin tonsil.
It was removed completely with right palatin tonsil. Cyst had a squamous epithelium-lined wall with lymphoid aggregation in histopathologic study, which was chareacteristic
finding of branchial cleft cyst. There was no evidence of recurrence for 6 months for follow-up. We review reported oropharyngeal or nasopharyngeal presentation of these cases in literature and embryologic explanation. Keywords: Oropharyngeal, branchial, cysts Journal Tunisien d\'ORL et de chirurgie cervico-faciale Vol. 18 2007: pp. 49-5
Fistules perilymphatiques post-traumatiques
Introduction : La fistule pĂ©ri-lymphatique (FPL) post-traumatique rĂ©alise une communication anormale entre le compartiment liquidien pĂ©rilymphatique et lâoreille moyenne. Son diagnostic est souvent difficile du fait du tableau clinique parfois incomplet. Lâimagerie est indispensable afin dâĂ©tayer le diagnostic. Le traitement repose sur la chirurgie.MatĂ©riel et mĂ©thodes : Il sâagit dâune Ă©tude rĂ©trospective Ă propos de 13 patients colligĂ©s sur une pĂ©riode de 13 ans (1996-2008). Un examen ORL complet, une audiomĂ©trie et une imagerie (tomodensitomĂ©trie des rochers) ont Ă©tĂ© rĂ©alisĂ©s dans tous les cas. Tous les patients ont bĂ©nĂ©ficiĂ© dâun traitement mĂ©dical et ont Ă©tĂ© opĂ©rĂ©s sous anesthĂ©sie gĂ©nĂ©rale. Le contrĂŽle ultĂ©rieur Ă©tait clinique, audiomĂ©trique et radiologique avec un recul moyen de 22 mois.RĂ©sultats : LâĂąge moyen Ă©tait de 29 ans (20-47 ans) et le sex-ratio 3,33. Les signes fonctionnels Ă©taient essentiellement reprĂ©sentĂ©s par lâhypoacousie dans 12 cas (92,3%), les vertiges dans 11 cas (84,6%) et les acouphĂšnes dans 4 cas (30,8%). LâĂ©coulement dâun liquide eau de roche par lâoreille a Ă©tĂ© rapportĂ© par 2 patients (15,4%). Lâexamen clinique trouvait un nystagmus spontanĂ© battant du cĂŽtĂ© controlatĂ©ral au traumatisme chez un seul patient, et un signe de la fistule positif chez 2 patients (15,4%). A lâaudiomĂ©trie, 9 patients (69,3%) avaient une surditĂ© de perception ou mixte dont 6 cas de cophose. Une surditĂ© de transmission a Ă©tĂ© objectivĂ©e dans 3 cas. Un patient avait une audition subnormale. La TDM des rochers a montrĂ© une fracture extra-labyrinthique dans 5 cas (38,5%) et une fracture trans-labyrinthique ou mixte dans 6 cas (46,2%). Un pneumolabyrinthe a Ă©tĂ© constatĂ© chez 5 patients (38,5%). Une exploration chirurgicale a Ă©tĂ© indiquĂ©e chez tous les patients. En per-opĂ©ratoire, une FPL a Ă©tĂ© mise en Ă©vidence dans tous les cas. Le siĂšge de la fistule Ă©tait au niveau du promontoire et/ou au niveau des fenĂȘtres. Un colmatage de la fistule a Ă©tĂ© rĂ©alisĂ© dans tous les cas. Les matĂ©riaux utilisĂ©s Ă©taient essentiellement de lâaponĂ©vrose temporale superficielle, du pĂ©richondre tragal et de la graisse. En post-opĂ©ratoire, les vertiges se sont amĂ©liorĂ©s chez 9 patients parmi les 11 vertigineux (81,8%). Lâaudition Ă©tait amĂ©liorĂ©e chez 2 patients parmi les 9 ayant une surditĂ© de perception ou mixte (18,2%).Conclusion : La fistule pĂ©rilymphatique post-traumatique est de diagnostic difficile. Celui-ci est Ă©tayĂ© par un faisceau dâarguments cliniques et paracliniques et nâest confirmĂ© quâen per-opĂ©ratoire. Lâindication dâune exploration chirurgicale et son dĂ©lai dĂ©pendent essentiellement de la symptomatologie clinique et de son Ă©volution dans le temps.Mots-clĂ©s : fistule pĂ©rilymphatique, traumatisme, vertige, surditĂ©, tomodensitomĂ©trie, chirurgieIntroduction: Post-traumatic perilymphatic fistula (PLF) realises an abnormal communication between the perilymphatic fluid compartment and the middle ear. Its diagnosis is often difficult because the clinical presentation is sometimes incomplete. Imaging is essential in order to support the diagnosis. Treatment is based on surgery.Materials and Methods: We carry a retrospective study about 13 patients collected over a period of 13 years (1996-2008). A complete ENT examination, audiometry and imaging (petrous CT scan) were performed in all cases. All patients received medical treatment and were operated under general anaesthesia. Subsequent control was clinical, radiological and audiometric with a mean period of 22 months.Results: Mean age was 29 years (20-47 years) and sex ratio 3.33. Symptoms were mainly hearing loss in 12 cases (92.3%), vertigo in 11 cases (84.6%) and tinnitus in 4 cases (30.8%). Flow of liquid from the ear was reported by 2 patients (15.4%). Clinical examination showed spontaneous nystagmus beating to the contralateral side of the trauma in one patient, and a positive sign of the fistula in 2 patients (15.4%). At audiometry, 9 patients (69.3%) had sensorineural or mixed deafness, of which 6 cases of cophosis. Transmission deafness was found in 3 cases. One patient had a subnormal hearing. Petrous CT scan showed extra-labyrinthic fracture in 5 cases (38.5%) and trans-labyrinthic or mixed fracture in 6 cases (46.2%). A pneumolabyrinth was found in 5 patients (38.5%). Surgical exploration was indicated in all patients. PLF was found in all cases. The localization of the fistula was at the promontory and / or at the windows. Blockage of the fistula was achieved in all cases. Materials used were essentially superficial temporal fascia, tragal perichondrium and fat. Postoperatively, vertigo improved in 9 patients among 11 (81.8%). Hearing was improved in 2 patients among the 9 having sensorineural or mixed deafness (18.2%).Conclusion: Post-traumatic perilymphatic fistula trauma is difficult to diagnose. This is supported by a beam of clinical and paraclinical arguments, and is confirmed intraoperatively. The indication for surgical exploration and its delay depend mainly on clinical symptomatology and its evolution over time.Keywords: perilymphatic fistula, trauma, vertigo, deafness, CT scan, surger
Fistules perilymphatiques post-traumatiques a propos de 13 cas
Introduction : La fistule pĂ©ri-lymphatique (fPL) post-traumatique rĂ©alise une communication anormale entre le compartiment liquidien pĂ©rilymphatique et lâoreille moyenne. Son diagnostic est souvent difficile du fait du tableau clinique parfois incomplet. Lâimagerie est indispensable afin dâĂ©tayer le diagnostic. Le traitement repose sur la chirurgie.Patients et mĂ©thode : : il sâagit dâune Ă©tude rĂ©trospective Ă propos de 13 patients colligĂ©s sur une pĂ©riode de 13 ans (1996-2008). un examen ORL complet, une audiomĂ©trie et une imagerie (tomodensitomĂ©trie des rochers) ont Ă©tĂ© rĂ©alisĂ©s dans tous les cas. Tous les patients ont bĂ©nĂ©ficiĂ© dâun traitement mĂ©dical et ont Ă©tĂ© opĂ©rĂ©s sous anesthĂ©sie gĂ©nĂ©rale. Le contrĂŽle ultĂ©rieur Ă©tait clinique, audiomĂ©trique et radiologique avec un recul moyen de 22 mois.RĂ©sultats :LâĂąge moyen Ă©tait de 29 ans (20-47 ans) et le sex-ratio 3,33. Les signes fonctionnels Ă©taient essentiellement reprĂ©sentĂ©s par lâhypoacousie dans 12 cas (92,3%), les vertiges dans 11 cas (84,6%) et les acouphĂšnes dans 4 cas (30,8%). LâĂ©coulement dâun liquide eau de roche par lâoreille a Ă©tĂ© rapportĂ© par 2 patients (15,4%). Lâexamen clinique trouvait un nystagmus spontanĂ© battant du cĂŽtĂ© controlatĂ©ral au traumatisme chez un seul patient, et un signe de la fistule positif chez 2 patients (15,4%). A lâaudiomĂ©trie, 9 patients (69,3%) avaient une surditĂ© de perception ou mixte dont 6 cas de cophose. une surditĂ© de transmission a Ă©tĂ© objectivĂ©e dans 3 cas. un patient avait une audition subnormale. La TdM des rochers a montrĂ© une fracture extra-labyrinthique dans 5 cas (38,5%) et une fracture trans-labyrinthique ou mixte dans 6 cas (46,2%). un pneumolabyrinthe a Ă©tĂ© constatĂ© chez 5 patients (38,5%). une exploration chirurgicale a Ă©tĂ© indiquĂ©e chez tous les patients. En per-opĂ©ratoire, une fPL a Ă©tĂ© mise en Ă©vidence dans tous les cas. Le siĂšge de la fistule Ă©tait au niveau du promontoire et/ou au niveau des fenĂȘtres. un colmatage de la fistule a Ă©tĂ© rĂ©alisĂ© dans tous les cas. Les matĂ©riaux utilisĂ©s Ă©taient essentiellement de lâaponĂ©vrose temporale superficielle, du pĂ©richondre tragal et de la graisse. En post-opĂ©ratoire, les vertiges se sont amĂ©liorĂ©s chez  patients parmi les 11 vertigineux (81,8%). Lâaudition Ă©tait amĂ©liorĂ©e chez 2 patients parmi les 9 ayant une surditĂ© de perception ou mixte (18,2%).Conclusion : La fistule pĂ©rilymphatique post-traumatique est de diagnostic difficile. Celui-ci est Ă©tayĂ© par un faisceau dâarguments cliniques et paracliniques et nâest confirmĂ© quâen per-opĂ©ratoire. Lâindication dâune exploration chirurgicale et son dĂ©lai dĂ©pendent essentiellement de la symptomatologie clinique et de son Ă©volution dans le temps.Mots clĂ©s : fistule pĂ©rilymphatique, traumatisme, vertige, surditĂ©, tomodensitomĂ©trie, chirurgieObjective : Post-traumatic perilymphatic fistula (PLf) realises an abnormal communication between the perilymphatic fluid compartment and the middle ear. its diagnosis is often difficult because the clinical presentation is sometimes incomplete. imaging is essential in order to support the diagnosis. Treatment is based on surgery.Patients and methods : We carry a retrospective study about 13 patients collected over a period of 13 years (1996- 2008). A complete ENT examination, audiometry and imaging (petrous CT scan) were performed in all cases. All patients received medical treatment and were operated under general anaesthesia. Subsequent control was clinical, radiological and audiometric with a mean period of 22 months.Mean age was 29 years (20-47 years) and sex ratio 3.33. Symptoms were mainly hearing loss in 12 cases (92.3%), vertigo in 11 cases (84.6%) and tinnitus in 4 cases (30.8%). flow of liquid from the ear was reported by 2 patients (15.4%). Clinical examination showed spontaneous nystagmus beating to the contralateral side of the trauma in one patient, and a positive sign of the fistula in 2 patients (15.4%). At audiometry, 9 patients (69.3%) had sensorineural or mixed deafness, of which 6 cases of cophosis. Transmission deafness was found in 3 cases. One patient had a subnormal hearing. Petrous CT scan showed extra-labyrinthic fracture in 5 cases (38.5%) and trans-labyrinthic or mixed fracture in 6 cases (46.2%). A pneumolabyrinth was found in 5 patients (38.5%). Surgical exploration was indicated in all patients. PLf was found in all cases. The localization of the fistula was at the promontory and / or at the windows. Blockage of the fistula was achieved in all cases. Materials used were essentially superficial temporal fascia, tragal perichondrium and fat. Postoperatively, vertigo improved in 9 patients among 11 (81.8%). Hearing was improved in 2 patients among the 9 having sensorineural or mixed deafness (18.2%).Conclusion: TPost-traumatic perilymphatic fistula trauma is difficult to diagnose. This is supported by a beam of clinical and paraclinical arguments, and is confirmed intraoperatively. The indication for surgical exploration and its delay depend mainly on clinical symptomatology and its evolution over time.Keywords : perilymphatic fistula, trauma, vertigo, deafness, CT scan, surger
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Improved control of Septoria tritici blotch in durum wheat using cultivar mixtures
Mixtures of cultivars with contrasting levels of disease resistance are capable of suppressing infectious diseases in wheat, as demonstrated in numerous field experiments. Most studies focused on airborne pathogens in bread wheat, while splash-dispersed pathogens have received less attention, and no studies have been conducted in durum wheat. We conducted a two-year field experiment in Tunisia, a major durum wheat producer in the Mediterranean region, to evaluate the performance of cultivar mixtures in controlling the polycyclic, splash-dispersed disease Septoria tritici blotch (STB) in durum wheat. To measure STB severity, we used a novel, high-throughput method based on digital analysis of images captured from 3074 infected leaves collected from 42 and 40 experimental plots on the first and the second year, respectively. This method allowed us to quantify pathogen reproduction on wheat leaves and to acquire a large dataset that exceeds previous studies with respect to accuracy and statistical power. Our analyses show that introducing only 25% of a disease-resistant cultivar into a pure stand of a susceptible cultivar provides a substantial reduction of almost 50% in disease severity. However, adding a second resistant cultivar to the mixture did not further improve disease control, contrary to predictions of epidemiological theory. Susceptible cultivars can be agronomically superior to resistant cultivars or be better accepted by growers for other reasons. Hence, if mixtures with only a moderate proportion of the resistant cultivar provide similar degree of disease control as resistant pure stands, as our analysis indicates, such mixtures are more likely to be accepted by growers
Les méthodes d'analyse de ségrégation en mélange et d'association marqueur-trait révÚlent des marqueurs AFLP communs de résistance à la septoriose chez un ancien blé dur de Tunisie
Bulk segregant analysis and marker-trait association reveal common AFLP markers for resistance to septoria leaf blotch in Tunisian old durum wheat. Septoria tritici blotch (STB) caused by the fungus Mycosphaerella graminicola is currently the major foliar disease of durum wheat in Tunisia. Most of the Tunisian elite cultivars show little or no resistance to this pathogen. Recently, some Tunisian landraces including 'Agili' have been identified as highly resistant to the virulent STB pathotype, 'Tun06'. In order to identify amplified fragment length polymorphism (AFLP) markers associated with resistance to STB, we used bulk segregant analysis (BSA) in two F3 biparental populations derived from crosses between the resistant durum wheat accession 'Agili' and the susceptible cultivars 'Karim' and 'Khiar' and Association Mapping (AM) in a collection of 110 old durum wheat landraces. Out of the 24 EcoRI/MseI primer combinations tested, 4 were polymorphic between resistant and susceptible DNA pools. Screened on the parents and 9 to 12 progenies from each bulk, these polymorphic AFLP primer combinations revealed EcoACT/MseCTC-241, EcoACA/MseCTT-128, and EcoAGG/MseCTC-104 as specific alleles to resistant individuals suggesting their linkage to a gene for resistance to STB. Binary logistic regression analysis on the diversity panel showed that two AFLP markers out of the three identified by BSA were significantly associated with the resistance. EcoACT/MseCTC-241 was the significantly associated allele at P < 7.10-8 and was identified at a genetic distance of 1.2 cM to the resistance gene. This result indicates the efficiency of using landrace populations to detect potential markers for qualitative resistance
Sarcome d'ewing du rocher
Introduction : Primary cranial Ewing's sarcoma is rare. This tumor was first described in 1921, since then, only a few cases have been reported in the literature.Aim: the aim of this study is to report the clinical and therapeutic aspects of primary cranial Ewing's sarcoma.Method: We report a case of Ewing's sarcoma of the temporal bone in a 16 months child diagnosed and treated in our department of ENT of Tunis.Result: the diagnostic of Ewing's sarcoma was made after bleeding ear. Histological confirmation was made following biopsy. After neoadjuvant chemotherapy, the tumor was surgically excised and the patient underwent chemotherapy. Neither recurrence nor distant metastasis was noted a 34 months.Conclusion: Although the prognosis of Ewing's sarcoma in general is often poor because of early metastasis to the lungs and/or to other bones, the same tumor occurring in the cranium can often be successfully managed by intensive therapy with radical excision and radiochemotherapy.Keywords: Ewing's; head and neck; Sarcoma; childre