L'atteinte du sinus caverneux dans le carcinome adenoïde systique

Introduction: Head and neck adenoid cystic carcinoma (ACC) is a malignant epithelial neoplasm, developing from salivary gland tissue. Cavernous sinus and skull base invasion by perinervous spread is a particular behavior of this tumor entity. We report two cases of cavernous sinus invasion.Cases report: The first one was originated in the parotid gland, invaded infratemporal fossa and extended to cavernous sinus through perineural infiltration along trigeminal nerve. Second case of ACC was developed in submandibular gland. An invasion of cavernous sinus was observed two years later despite a surgical resection with post operative  chemoradiotherapy.Discussion: ACC is characterized by locally aggressive invasion and a strong tendency to recur. Perineural spread extension is common in ACC, as a precursor of skull base invasion and cavernous sinus involvment along the mandibular, maxillary and facial nerves. Magnetic resonance imaging (MRI) has a higher sensitivity and specificity in detecting perineural spread. Surgical therapy is the choice treatment although complete resection is not possible in all cases due to the infiltration andperineural spread. So, radiation therapy is considered effective, and has been used successfully in ACC invading cavernous sinus. The place of chemotherapy has yet to be determinate. The prognosis of these extensive tumors is bad because high frequency of local recurrence and distant metastases.Key-words: adenoid cystic carcinoma, cavernous sinus, skull base, perineural invasion

Traitement des diplegies laryngees en fermeture: Apport du laser

Introduction: Les diplegies laryngees en fermeture sont rares et mal tolerees par les patients. Leur prise en charge therapeutique a connu de nombreuses avancees au cours des dernieres annees. Le but de ce travail est dfetudier la place du laser dans leur prise en charge.Malades et methodes : Notre etude est retrospective a propos de six patients porteurs de diplegie laryngee en fermeture. Lfage moyen etait de 46 ans (16 et 70 ans). Lfetiologie etait une intubation prolongee ou traumatique dans 3 cas, post thyroidectomie totale dans deux autres cas et idiopathique dans 1 cas. Le traitement a consiste en une tracheotomie en urgence dans 5 cas. Tous les patients ont beneficie dans un secondtemps dfun traitement au laser apres 9 mois de surveillance.Resultats : La cordectomie posterieure a ete realisee en premier temps dans 4 cas. Elle etait bilaterale en deux temps dans 2 cas et unilaterale dans 2 cas. Une aryteno.dectomie initiale a ete realisee pour les deux autres patients. Une revision chirurgicale a consiste en une arytenoidectomie dans 2 cas et une cordotomie partielle posterieure controlaterale dans un cas. La decanulation etait bien toleree pour 4 patients. Un seul malade a garde une gene respiratoire sans veritabledyspnee avec une canule parlante fermee et la decanulation a ete refusee. Une voix satisfaisante a ete obtenue pour tous les malades. Des fausses route transitoires ont ete note dans 2 cas.Discussion : Actuellement, le traitement endoscopique au laser constitue le traitement de choix dans la diplegie laryngee et doit etre propose en premiere intension. Deux techniques principales sont decrites :  lfaryteno.dectomie au laser type Ossof et la cordectomie posterieure transverse de kashima. plusieurs series ont defendu chacune des deux techniques. Notre serie a montre que les deux techniques peuvent etre associees pour donner de meilleurs resultats.Mots cles : diplegie laryngee, Laser, aryteno.dectomie, cordectomie posterieure

Facteurs predictifs de survenue de pharyngostome après laryngectomie totale

Objectif : Déterminer l’incidence de survenue de la fistule pharyngo-cutanée ou pharyngostome après laryngectomie totale ainsi que les facteurs prédisposants.Matériel et méthodes: C’est une étude rétrospective qui a porté sur 187 malades ayant eu une laryngectomie totale à notre département (Janvier 1985-Décembre 2007). Nous avons étudié les facteurs cliniques, histologiques, les modalités thérapeutiques ainsi que évolutives à la recherche de corrélation avec la survenue de pharyngostome après laryngectomie totale. -Résultats : Les pharyngostomes ont été observé dans14,4% des cas. La chimioradiothérapie préopératoire était significativement corrélée à l’apparition de pharyngostome (p=0,008). L’infection postopératoire est un facteur hautement significatif de survenue de pharyngostome (p=0,000). De même que l’hémorragie postopératoire (p=0,016), les troubles de ladéglutition (p=0,037), et les bronchopneumopathies (p=0,032). La rupture capsulaire lors d’un envahissement ganglionnaire était très  significativement corrélée à la survenue d’un pharyngostome (p = 0,001).Conclusion : en présence de facteurs de risque significatifs de  pharyngostome, cette complication peut ainsi être prévue même si sa prévention demeure encore difficile.Mots-clés : Pharyngostome, Laryngectomie totale, Incidence, facteurs prédisposants

Quel bilan d’extension faut-il faire pour les carcinomes indifferencies du nasopharynx ?

Introduction: Nasopharyngeal carcinoma prognosis is often correlated with its local extension but especially lymphatic node and metastatic.The aimof our work was to study sensitivity and the specificity of clinical and paraclinic explorations in the initial assessmentPatients and methods : It .s about a retrospective study of 366 patients having nasopharyngeal carcinoma, diagnosed over eleven years period between 1993 and 2003 in Sfax hospital. Into pretherapeutic, all the patients had a complementary assessment including:- Nasopharyngeal tomodensitometry (TDM), in all the cases, extended to the cervical area in 112 cases and a magnetic resonnance Imagery (MRI) of the nasopharynx and cerebral in 18 cases.- Metastatic assessment: comprising systematically a chest radiography, an abdominal ultrasonography and an osseous scintiscanning. The statistical study comprised a descriptive study and an analytical study.Results : The metastasis diagnosis was retained in 39 cases (10,7%): osseous in 82%, hepatic in 23% and pulmonary in 12,8% of the cases. The tumour was associated to lymph node N3 in 25 cases (64%). At univariate study, we retained the presence of significant difference between the groups of the metastatic and lack metastatic patients for : the male sex, reason for consultation (cervical node, rhinologic signs and otologic signs) and cervical node at the examination.The multivariate analysis for all the factors was without interest. We choose the parameters according to the result of the univariate study, the literature and parameters' found among all patients with discovered CNP. It comes out from this study that the following elements are providers of metastases: age between 40 and 45years, male sex and cervical node N3a stage.Discussion : The assessment of extension is not standardized for all the authors. Indeed, for the study of the pulmonary extension (AJCC)/ (UICC) recommends the systematic practice of the chest radiography. For (NCCN), the practice of chest radiography is only for patients classified at the stage 2 and 3 in WHO classification. For KUMAR, LEUNG and our results, it is recommended systematically to practice the chest radiography . This radiography would be supplemented by a thoracic tomodensitometry with the least suspect lesion. For the hepatic assessment, some recommend the systematic practice of abdominal echography for the advanced nodestages (N3). For others, it will be indicated only for the symptomatic patients. For (AJCC)/ (UICC) abdominal echography is systematic.For the osseous assessment, KRAIPHIBUL recommends the practice of the osseous scintiscanning only for patients having signs of osseous call but LEUNG and SHAM recommend the practice of the osseous scintiscanning only for the patients having cervical node N3.Key words: Nasopharyngeal carcinoma/ extension assessment/ metastasis

Viscous dissipation and radiation effects on MHD natural convection in a square enclosure filled with a porous medium

Numerical two-dimensional analysis using finite difference approach with "line method" is performed on the laminar magneto-hydrodynamic natural convection in a square enclosure filled with a porous medium to investigate the effects of viscous dissipation and radiation. The enclosure heated from left vertical sidewall and cooled from an opposing right vertical sidewall. The top and bottom walls of the enclosure are considered adiabatic. The flow in the square enclosure is subjected to a uniform magnetic field at various orientation angles (φ = 0, 30, 45, 60 and 90). Numerical computations occur at wide ranges of Rayleigh number, viscous dissipation parameter, magnetic field orientation angles, Hartmann number and radiation parameter. Numerical results are presented with the aid of tables and graphical illustrations. The results of the present work explain that the local and average Nusselt numbers at the hot and cold sidewalls increase with increasing the radiation parameter. From the other side, the role of viscous dissipation parameter is to reduce the local and average Nusselt numbers at the hot left wall, while it improves them at the cold right wall. The results are compared with another published results and it found to be in a good agreemen