Les corps étrangers en ORL: expérience de dix ans

Les corps étrangers (CE) représentent une pathologie fréquemment rencontrée en pratique ORL d'urgence. Ils peuvent constituer une urgence vitale par leur aspect ou leur siège. Nous présentons le bilan de dix ans sur la prise en charge des CE de la sphère ORL avec une revue de la  littérature. Il s'agit d'une étude rétrospective entre Janvier 2004 et Décembre 2013, incluant tous les cas de CE des voies aéro-digestives supérieures et auriculaires colligés dans le service d'ORL au CHU Mohammed VI de Marrakech au Maroc. Sur les 1317 cas de CE de la sphère ORL colligés durant cette période, 80,48% concernaient les enfants. Le sex-ratio était de 1,5. L'âge moyen était de 12,92 ans. Les CE oesophagiens étaient les plus fréquents (47,53%). Les complications ont été rencontrées dans 11,69% des cas. Les CE dans la sphère ORL restent fréquents en pratique quotidienne surtout chez les enfants. Leur prise en charge nécessite une intervention rapide avec un matériel adapté et des médecins entrainés. La prévention reste la meilleure solution

Retropharyngeal Abscess in Adults: Five Case Reports and Review of the Literature

Retropharyngeal abscesses are rare in adults. They occur mostly in immunocompromised patients or as a foreign body complication. We report 5 cases of retropharyngeal abscess collected in the ENT Department of CHU Mohammed VI of Marrakech, during a two-year period (December 2008 to December 2009). Local trauma by foreign body ingestion was the aetiology in four patients. The presenting symptoms, for all patients, were fever, odynophagia, torticollis, and trismus, and the clinical examination showed bulging of the posterior wall of the oropharynx. The radiography of cervical spine showed prevertebral thickening in all cases, this thickening was associated with an aspect of vertebral lysis of the fourth cervical vertebra in one case. A CT scan was performed in all our cases and showed features of retropharyngeal abscess which was associated, in one case, with spondylodiscitis. The biological assessment found one case of diabetes. The intradermal reaction to the tuberculin was clearly positive in one case. Endobuccal abscess puncture was practiced in 4 cases; only one organism was identified by culture: Staphylococcus aureus treatment was based on triple intravenous antibiotics and anti-Koch's therapy (in one case), and the surgical drainage under general anesthesia was also performed in the case of the diabetes patient which required also the correction of hyperglycemia in intensive care unit. The outcome was good in all our patients. The diagnosis of retropharyngeal abscess can be difficult and one must seek a comorbidity; a tuberculosis aetiology must be considered in countries with a high prevalence. The management of these cases is based on antibiotics and surgical drainage

LES MUCOCELES SINUSIENNES : ASPECTS DIAGNOSTIQUES ET THERAPEUTIQUES, A PROPOS DE 16 CAS

Introduction: The sinus mucoceles are expansive pseudokystic benign tumours, whose wall is the sinus wall at least modified and of which sticky and aseptic contents.Patients and method: Our work is a retrospective study, bearing on 16 cases of sinus mucoceles in the service of ORL of hospital ANTAKI of Marrakech, from January 2000 to December 2006. It was interested in the characters epidemiologic, clinical, radiological, therapeutic and evolutionary of this pathology. Results: The average age in our series is 49 years, with extremes of 25 years and 81 years, and a sex ratio of a unit. The sinusal case histories were noted among four patients. The time with the consultation was 2 months in 48 months. The ethmoïdo-frontal sinus mucoceles in 12 cases (75% of the cases), were followed by the maxillary mucoceles in 2 cases (12,5 % of the cases) and by the sphenoid sinus mucocele in 2 cases (12,5%). In the ethmoïdo-frontal form, clinical symptomatology was dominated by the exophthalmia (100%), the tumefaction of the interior angle of the eye (100%) and the cephalus (67%). In the sphenoid form, the cephalus, the fall of vision and the exophtalmy dominated the clinical picture. In the maxillary form, the nasal obstruction associated with rhinorrhea was found among all patients. All the patients underwent an endoscopic visualization in the search of a suspect endonasal lesion. It highlighted a component endonasale of the mucocele in 60%. The diagnosis was marked in all the cases by the tomodensitometry of the sines which highlighted an orbital regional extension, endocranial or endonasal and guided the choice of the way initially and the knowledge of operational difficulties. The marsupialisation by endonasal way under endoscopic guidance was made among nine patients, including five ethmoido-frontal cases of mucocele, two cases of maxillaries mucoceles and two cases of sphenoid mucoceles. The initially combined way was used in seven ethmoido-frontal cases of mucoceles in front of the insufficiency of the gesture of marsupialisation. An anatomopathologic study of the mucocele wall did not objectify malignant lesions. The evolution noted two cases of recidivism. The retreat was 3 years and 10 months. Discussion: the sinus mucocele is an unsual pathology. Diagnosis is radio-clinical. Treatment is surgical. The endoscopic way take more and more place than the conventional surgery.Introduction : Les mucocèles sinusiennes sont des tumeurs bénignes pseudokystiques expansives des sinus dont la paroi est la paroi sinusienne plus ou moins modifiée, et dont le contenu gluant et aseptique. Patients et méthode : Notre travail est une étude rétrospective, portant sur 16 cas de mucocèles sinusiennes colligés au service d'ORL de l'hôpital ANTAKI de Marrakech, de Janvier 2000 à Décembre 2006. Résultats : La moyenne d'âge dans notre série a été de 49 ans, avec des extrêmes de 25 ans et 81 ans, et un sexe ratio d'une unité. Le délai à la consultation a été de 2 mois à 48 mois. Les mucocèles ethmoïdo-frontales ont été retrouvés dans 12 cas (75% des cas), suivies par les mucocèles maxillaires dans 2 cas (12,5% des cas) et par les mucocèles sphénoïdales dans 2 cas (12,5%). Dans la forme ethmoïdo-frontale, la symptomatologie clinique a été dominée par l'exophtalmie (100%), la tuméfaction de l'angle interne de l’oeil (100%) et les céphalées (67%). Dans la forme sphénoïdale, les céphalées et la baisse de l'acuité visuelle et l'exophtalmie dominaient le tableau c1inique. Dans la forme maxillaire, l'obstruction nasale associée à une rhinorrhée a été retrouvée chez tous les patients. L'endoscopie nasale a mis en évidence une composante endonasale de la mucocèle dans 60% des cas. La tomodensitométrie des sinus a mis en évidence une extension régionale orbitaire, endocrânienne ou endonasale. La marsupialisation par voie endonasale sous guidage endoscopique a été faite chez neuf patients. La voie d’abord combinée a été utilisée dans sept cas. L'étude anatomopathologique de la paroi mucocélique n'a pas objectivé de lésions malignes. L'évolution a noté deux cas de récidive. Le recul moyen est de 3ans et 10 mois. Discussion : la mucocèle sinusienne est une pathologie rare. Son diagnostic est radio-clinique. Le traitement est chirurgical. La voie endoscopique prend de plus en plus place par rapport à la chirurgie conventionnelle

CORPS ETRANGER VEGETAL INTRA-ORBITAIRE : A PROPOS D’UN CAS

Foreign vegetative bodies of the orbit are rare. They are often missing read and they can lead to potentially serious orbital and intra skull complications. We report the case of a ten years old child suffering right orbital traumatism caused by a chip of wood. He has consulted the doctor a month later for orbital cellulitis associated with skin fistula. The scanner has shown a right orbital foreign body. The ablation orbitotomy earlier piece of wood with a suitable antibiotic treatment has allowed a clinical improvement with visual recovery. The notion of orbital traumatism as well as the inflammatory, secondary orbital syndrom should suspect the presence of a foreign intra-orbital body, urging complementary medical examinations.Les corps étrangers végétaux de l’orbite sont rares. Ils sont souvent méconnus, pouvant entrainer des complications orbitaires et intracrâniennes potentiellement graves. Nous rapportons l’observation d’un enfant de 10 ans victime d’un traumatisme orbitaire droit provoqué par un morceau de bois. Il consulte 1 mois plus tard pour une cellulite orbitaire associée à une fistule cutanée. Le scanner a montré la présence d’un corps étranger orbitaire droit. L’ablation par orbitotomie antérieure du fragment de bois associée à un traitement antibiotique adapté a permis une amélioration clinique avec récupération visuelle. La notion de traumatisme orbitaire et un syndrome inflammatoire orbitaire secondaire doivent faire suspecter la présence d’un corps étranger intra-orbitaire et encourager la réalisation d’examens complémentaires en urgence pour une meilleure prise en charge

Retropharyngeal Abscess in Adults: Five Case Reports and Review of the Literature

Retropharyngeal abscesses are rare in adults. They occur mostly in immunocompromised patients or as a foreign body complication. We report 5 cases of retropharyngeal abscess collected in the ENT Department of CHU Mohammed VI of Marrakech, during a two-year period (December 2008 to December 2009). Local trauma by foreign body ingestion was the aetiology in four patients. The presenting symptoms, for all patients, were fever, odynophagia, torticollis, and trismus, and the clinical examination showed bulging of the posterior wall of the oropharynx. The radiography of cervical spine showed prevertebral thickening in all cases, this thickening was associated with an aspect of vertebral lysis of the fourth cervical vertebra in one case. A CT scan was performed in all our cases and showed features of retropharyngeal abscess which was associated, in one case, with spondylodiscitis. The biological assessment found one case of diabetes. The intradermal reaction to the tuberculin was clearly positive in one case. Endobuccal abscess puncture was practiced in 4 cases; only one organism was identified by culture: Staphylococcus aureus treatment was based on triple intravenous antibiotics and anti-Koch's therapy (in one case), and the surgical drainage under general anesthesia was also performed in the case of the diabetes patient which required also the correction of hyperglycemia in intensive care unit. The outcome was good in all our patients. The diagnosis of retropharyngeal abscess can be difficult and one must seek a comorbidity; a tuberculosis aetiology must be considered in countries with a high prevalence. The management of these cases is based on antibiotics and surgical drainage

Capillary Hemangioma of the Middle Ear: One Case Report and Review of the Literature

Hemangiomas are rare benign vascular tumors; there are several types including the capillary hemangiomas, we present the case of an exceptional localization of capillary hemangioma in the middle ear. We report the case of a 60-year-old female which consults for episodes of pulsatile tinnitus, otorragies, and hearing loss of the left ear. The clinical examination revealed a reddish polypoid mass in the left external auditory canal, the radiological tests showed a vascular mass in the middle left ear. The tumor was surgically removed, the histological study revealed a capillary hemangioma. The incidence of hemangiomas in the temporal bone, especially in the middle ear, is exceptional. Medical imaging guides to the vascular nature of these tumors that make confusion with other vascular tumors such as tympanic paragangliomas. The management is often surgical and the final diagnosis is histological

Rare predicted loss-of-function variants of type I IFN immunity genes are associated with life-threatening COVID-19

BackgroundWe previously reported that impaired type I IFN activity, due to inborn errors of TLR3- and TLR7-dependent type I interferon (IFN) immunity or to autoantibodies against type I IFN, account for 15-20% of cases of life-threatening COVID-19 in unvaccinated patients. Therefore, the determinants of life-threatening COVID-19 remain to be identified in similar to 80% of cases.MethodsWe report here a genome-wide rare variant burden association analysis in 3269 unvaccinated patients with life-threatening COVID-19, and 1373 unvaccinated SARS-CoV-2-infected individuals without pneumonia. Among the 928 patients tested for autoantibodies against type I IFN, a quarter (234) were positive and were excluded.ResultsNo gene reached genome-wide significance. Under a recessive model, the most significant gene with at-risk variants was TLR7, with an OR of 27.68 (95%CI 1.5-528.7, P=1.1x10(-4)) for biochemically loss-of-function (bLOF) variants. We replicated the enrichment in rare predicted LOF (pLOF) variants at 13 influenza susceptibility loci involved in TLR3-dependent type I IFN immunity (OR=3.70[95%CI 1.3-8.2], P=2.1x10(-4)). This enrichment was further strengthened by (1) adding the recently reported TYK2 and TLR7 COVID-19 loci, particularly under a recessive model (OR=19.65[95%CI 2.1-2635.4], P=3.4x10(-3)), and (2) considering as pLOF branchpoint variants with potentially strong impacts on splicing among the 15 loci (OR=4.40[9%CI 2.3-8.4], P=7.7x10(-8)). Finally, the patients with pLOF/bLOF variants at these 15 loci were significantly younger (mean age [SD]=43.3 [20.3] years) than the other patients (56.0 [17.3] years; P=1.68x10(-5)).ConclusionsRare variants of TLR3- and TLR7-dependent type I IFN immunity genes can underlie life-threatening COVID-19, particularly with recessive inheritance, in patients under 60 years old