Les cellulites cervico-faciales graves, facteurs et critères de gravité

La cellulite cervico-faciale grave est une infection polymicrobienne extensive et redoutable du tissu  cellulo-adipeux de la face et du cou. L'objectif de cette étude est d'analyser certains facteurs favorisants et d'évaluer les critères de gravité en fonction des formes anatomo-cliniques. Il s'agit d'une étude  rétrospective réalisée, entre janvier 2007 et décembre 2012, au service de chirurgie maxillo faciale de l'hôpital militaire Avicenne de Marrakech. Sur 147 cas de cellulites cervico-faciales pris en charge au niveau du service, 13 dossiers de cellulites graves ont été retenus. Neuf hommes (69%) et quatre femmes (31%) ont fait l'objet de cette étude, avec un âge moyen de 35 ans. Tous les patients ont été adressés pour prise en charge secondaire après avoir pris des anti-inflammatoires (AI). Sept cas (54%) étaient immunocompétents. La cause dentaire était soulevée chez neufs cas (69%). Cinq cas (38%) ont présenté une forme pseudo phlegmoneuse avec des signes compressifs des voies aérodigestives.L'extension médiastinale a été observée chez quatre patients (31%). La forme nécrosante extensive a été retrouvée dans trois cas (23%). L'étude bactériologique, réalisée chez tous les patients, avait mis en évidence une flore microbienne mixte et polymorphe. Les cellulites cervico-faciales graves posent un réel problème de prise en charge thérapeutique. L'analyse des facteurs favorisants et l'évaluation des critères de gravité dans cette série ont permis de limiter une évolution défavorable.Key words: Cellulites, graves, critères de gravités, facteurs favorisants 

Neonatal Necrotizing Enterocolitis

Necrotizing enterocolitis (NEC) is a gastrointestinal disease that mostly affects premature infants. It involves infection and inflammation that causes destruction of the bowel. Although it affects only 1 in 2,000 to 4,000 births, or between 1 and 5% of neonatal intensive care unit admissions, NEC is the most common and serious gastrointestinal disorder among hospitalized preterm infants. We present a very representative abdominal X-ray of this disease

Congenital Chylothorax

Although pleural effusion is a rare cause of respiratory distress in newborns, being familiar with this disease is very important because of the generally favorable prognosis when the diagnosis is done early and therapy is prompt. We report a case of a full-term baby diagnosed with respiratory distress after 1 week of life. An X-ray of his chest showed a left pleural effusion. Moreover, a thoracentesis combined with a biochemical study of the pleural fluid confirmed the diagnosis of chylothorax. In our case, the conservative therapy was successful. The baby was followed up for a period of 6 months, with no evidence of recurrence. We have concluded, therefore, that conservative management should be the first line of treatment in chylothorax cases. If it does not work, a surgical approach might be considered

A columellar deformity caused by a congenital schwannoma

Schwannoma is a benign neoplasm arising from Schwann cells of the peripheral nerve. It very rarely located in the nasal tip. We report two cases of congenital schwannoma of the nasal columella and discuss the surgical approach of such tumor.Case report: Case 1: An 18 year-old female was referred to us for a very slow growing tumor of the columella. The deformity had been present since the birth. The patient underwent an excision of its tumor using an open rhinoplasty approach. The histological examination revealed a schwannoma. No recurrence was found within 2 years of follow up.Case 2: A 4 month male baby presenting a congenital tumor of his columella. He underwent an excision using open rhinoplasty approach. The histological examination showed a plexiform schwannoma.Discussion: Schwannoma of the nasal tip is a benign tumor that gradually causes aesthetic and functional disorders. Congenital schwannoma of columella is an extremely rare clinical situation. Its diagnosis and treatment can pose certain challenges. The treatment is surgical excision and histological analysis of the specimen. Open rhinoplasty approach provided a good surgical exploration and a good cosmetic result on this nasal tip tumor

Update on the management of orbitozygomatic fractures

Orbitozygomatic fractures are an important aspect of facial trauma. Although the literature in maxillofacial surgery is rich on the question, this article resulting from the experience of a maxillofacial surgeon brings additional data in the knowledge of the subject. This is particularly the case with regard to the principles of examination, the pathways first, the principles of restraint and osteosynthesis, and the various surgery-related complications, as well as the precautions to be adopted to minimize them. The most important thing to remember is that the management approach is often variable, and the right choice is summed up in the clinical perception and level of expertise and comfort of the surgeon, while also considering the patient's point of view