Cervicofacial Surgery Research Articles

Auricular and periauricular pathologies in the ENT department of Sylvanus Olympio Teaching Hospital in Lome (Togo)

The aim of this study is to describe the epidemiological aspects, clinical features and principles of management of different types of auricular and peri-auricular pathologies. This is a 5-year retrospective descriptive study (from May 1, 2018 to April 30, 2023) of the records of patients who consulted for a functional or cosmetic complaint relating to the auricle or periauricular region in the ENT and cervico-facial surgery department of the Centre hospitalier universitaire Sylvanus Olympio. A total of 159 cases over 5 years, i.e. an annual frequency of 31 cases, met the study criteria. The mean age of the patients was 22.2 years. Children and students accounted for 24.5% and 23.9% of cases respectively. Auricular pathologies accounted for 64.8% of cases and peri-auricular pathologies for 36.2%.Tumors and trauma accounted for 33.3% and 29.6% of cases respectively, and congenital pathologies were found in 29.9% of cases. Among traumatic lesions, intentional assault and battery was the cause in 21.3%, followed by road accidents in 17.2%. The right ear was affected in 48% and the lobule in 40.4%. Keloids accounted for 17.6% of all cases, and 53% of tumors and pseudotumors. The left ear was involved in 50% of cases. Piercing was the cause of keloids in 10.7% of cases. Auricular and peri-auricular pathologies were dominated by benign tumors, trauma and congenital pathologies, and involved young subjects. Management is based on the type of lesion, with functional and aesthetic considerations in mind.

Results of thyroidectomies according to general surgeons and otolaryngologist and cervico faciale surgeons at the general Hospital of Reference of Niamey, what differences in the protocols of management?

ObjectiveTo evaluate the surgical management of thyroid pathologies at the Reference General Hospital.MethodsThis was a retro-prospective study over 4 years 6 months carried out in the departments of General and Digestive Surgery (GDS) and Otorhinolaryngology and Cervico Facial Surgery (ORL/FCS). It involved 182 patients who underwent thyroid surgery.ResultsA frequency of thyroidectomy of 9.46% was found. Females predominated with a sex ratio of 0.1. The average age of patients was 42.85 years, a standard deviation 12.80. 84.06% of patients had consulted for anterior cervical mass. EU-TIRADS score 3 represented 7,14% of cases. Heteromultinodular goiter was the main indication for thyroid surgery (59.34%). Total thyroidectomy was the most commonly performed gesture in general surgery in 88,23% (n = 105), in Otorhinolaryngology, it was in the same proportion as lobo-isthmectomy at 47.61% (n = 30). The first route was video-assisted thyroidectomy 2.2% (n = 4). The recurrent laryngeal nerve was dissected and seen in 159 cases (87.36%) and parathyroid glands were also seen and preserved in 58.24% of cases (n = 106). In immediate postoperative surgery, the main complications were unilateral recurrent paralysis with dysphonia in 3.3% (n = 6) and compressive hematoma in 2.2% (n = 4). No deaths had been recorded.ConclusionTotal thyroidectomy was the most performed procedure in department of General and Digestive Surgery. Routine oral calcium and vitamin D supplementation in the general surgery ward, reduces the occurrence of hypocalcemia after total thyroidectomy and allows a safe and early exit. Standardizing protocols will further reduce complications.

Morphology of the inferior laryngeal nerve (recurrent nerve) in the anterior cervical region: A report of 30 thyroidectomies

Objective: To study the morphological peculiarities of the left and right Inferior Laryngeal Nerves (ILN) in the anterior cervical region and their variations induced by thyroid pathology. Materials and methods: The study concerned 30 patients who underwent thyroidectomy at the ENT and cervico-facial surgery department of Idrissa POUYE general hospital (HOGIP) from June 1st, 2018 to June 30, 2019. Age, sex, morphotype, operative indication, type of thyroidectomy, route, morphometry, and mode of termination of the ILN were studied. Results: The mean age was 42 years. There were 29 women and one man. Eleven patients (36.7%) were brevilinear, 8 patients (26.6%) were longilinear and 11 patients (36.7%) were of intermediate morphotype. Multinodular goiter was the indication for surgery in 18 cases. A total of 53 ILNs were studied (29 left and 24 right). Path variations concerned 8 left recurrent nerves (28%). The mean diameter of the ILN was 2mm. Longilinear patients and those with intermediate morphotypes had the longest recurrent nerves, while brevilinear patients had the thickest nerves. On the right, the ILN was bifid in 10 cases (41.6%), trifurcated in 3 cases (12.5%), and fan-shaped in 1 case (4.1%). On the left, it was bifid in 23 cases (79.3%) and trifurcated in 2 cases (6.8%). Conclusion: The caliber of the recurrent nerve is relatively large, and can sometimes be spindly, especially on the right. Morphotype may predict ILN dimensions. Extra-laryngeal division of the ILN is a common situation.

Otosclerosis Surgery: Predictive Factors of Functional Results: 21 Cases

Introduction: Otosclerosis is an osteodystrophy of the otic capsula which is anatomically expressed by a stapedo-vestibular ankylosis. The objective of this work is to evaluate the audiometric result and to determine the predictive factors of functional failure. Materials and methods: we conducted a retrospective study about 21 ears operated for otosclerosis, within the department of otolaryngology and cervicofacial surgery CHU Mohammed VI Oujda over a period of 3 years (2016-2020). Epidemiological, clinical of patients and preoperative and postoperative audiometry at 12 months were analyzed. Surgical success was defined by a postoperative Rinne (RPO) ≤ 10db. Results: The mean age of the patients was 37,76 years. Female gender was predominant with a sex ratio of 2. The mean time to consultation was 4.2 years. The clinical picture was dominated by deafness which was constant in all patients. Tinnitus was present in 62% of cases. We retained 2 independent factors significantly predictive of functional failure: an age at surgery over 40 years and an audiometric stage III or IV of Aubry. Conclusion: Early post-operative air-bone gap is useful to detect early failure of stapes surgery. Although advanced otosclerosis was considered a negative factor for hearing gain, thanks to stapes surgery patients with advanced otoscle- rosis can better benefit from appropriate hearing aids.

The Incidence and the Risk Factors for Pharyngocutaneous Fistula following Primary and Salvage Total Laryngectomy

The pharyngocutaneous fistula (PCF) is the most common complication following a total laryngectomy (TL) with a wide range of incidence and various potential risk factors. The aim was to analyse the incidence and potential risk factors for PCF formation in a large study set collected over a longer period of time. In the retrospective study at the Department of Otorhinolaryngology and Cervicofacial Surgery of Ljubljana, 422 patients who were treated for head and neck cancer by TL between 2007 and 2020 were included. The comprehensive clinicopathologic data were collected including potential risk factors related to the patient, disease, surgical treatment and post-operative period for the development of fistulae. The patients were categorized into a group with the fistula (a study group) and one without it (a control group). The PCF then developed in 23.9% of patients. The incidence following a primary TL was 20.8% and 32.7% following salvage TL (p = 0.012). The results demonstrated that surgical wound infection, piriform sinus invasion, salvage TL, and total radiation dose were determined as independent risk factors for PCF formation. A diminishing surgical wound infection rate would contribute to a further reduction of the PCF rate.

Impact of Preemptive Postoperative Pressure Support Ventilation and Physiotherapy on Postoperative Pulmonary Complications after Major Cervicofacial Cancer Surgery: A before and after Study.

Introduction: Complex cervicofacial cancer surgery with free flap reconstruction is known to have a high incidence of postoperative pulmonary complications (PPCs). We hypothesized that by implementing an optimized respiratory protocol, including preemptive postoperative pressure support ventilation, physiotherapy, and critical respiratory support and follow-up, we could decrease the incidence of PPCs. Patients and methods: We evaluated the incidence of PPCs over two periods in two groups of patients having a routine or optimized postoperative respiratory protocol: 156 adult patients undergoing major cervicofacial cancer surgery were assessed; 91 were in Group 1 (routine) and 65 were in Group 2 (optimized). In Group 1, no ventilatory support sessions were performed. The incidence of pulmonary complications in both groups was compared using a multivariate analysis. Mortality was also compared until one year postoperatively. Results: In Group 2 with an optimized protocol, the mean number of ventilatory support sessions was 3.7 ± 1 (minimum 2, maximum 6). The incidence of respiratory complications, which was 34% in Group 1 (routine), was reduced by 59% OR = 0.41 (0.16; 0.95), p = 0.043) to 21% for the optimized Group 2. No difference in mortality was found. Conclusions: The present retrospective study showed that using an optimized preemptive respiratory pressure support ventilation combined with physiotherapy after a major cervicofacial surgery could possibly help reduce the incidence of pulmonary complications. Prospective studies are needed to verify these findings.

The Prescription of Antibiotics in ENT Diseases in the ENT and Surgery Department Cervico-Facial at Sikasso Hospital

Antibiotics are chemical compounds elaborated by a micro-organism or produced by synthesis and whose specific activity manifests itself in doses on the micro-organisms. They are commonly used in the management of infectious pathologies in ENT and Cervico-Facial Surgery. This study aims to evaluate the use of antibiotics in the therapeutic arsenal in the ENT-CCF department of the Sikasso hospital. This is a 4-month prospective study from November 1, 2016 to February 28, 2017 on the prescription of antibiotics in the ENT department of Sikasso hospital. Four hundred (400) patients were included in this study. The following variables were collected: gender, age, occupation, reason for consultation, history, prescription and evolution. During the study period 400 patients were retained. Among which 293 benefited from a prescription of antibiotics that is 73.25% of the cases and (107 cases) 26.75% without antibiotics. The female sex was predominant with 57% of cases, i.e. a sex ratio of 1.32. More than half of the work force were made up of learners and preschoolers. The reasons for consultation were dominated by otalgia with 35.8% followed by odynophagia in 15% of cases. 76.75% of our patients had no history. The prevalence of antibiotic therapy was 73.25%, including 49.83% amoxi+clavulanic acid, 10.92% cephalosporin, 10.60% macrolides, 3.75% sulfonamides, 1.70% amoxicillin and ear drops in 23.2% of cases. Apart from antibiotic therapy, antihistamines were the most prescribed with 32.75% followed by nasal corticosteroids in 23.36% of cases. Non-steroidal anti- inflammatory drugs were associated with the antibiotic in 33.78%, followed by the analgesic-nasal corticosteroid- antihistamine combination in 15.35% of cases. The evolution was favorable in 83.62% of cases, unfavorable in 10.92% of cases and 5.46% of patients did not show up for the check-up appointment on the 7th day. It was a prospective study of four (04) months on the place of antibiotic therapy ......

Epidemiological, Clinical and Therapeutic Aspects of Acute Otitis Media in the Otorhinolaryngology and Cervicofacial Surgery Department of the Sikasso Hospital / Mali

Acute otitis media (AOM) is a viral or bacterial infection of the middle ear most often following nasopharyngitis. It is seen at any age, but particularly common in children. The aim of this work is to describe the main clinical and therapeutic epidemiological aspects of acute otitis media.in the ENT department of Sikasso hospital. This is a prospective and descriptive study carried out in the ENT department of Sikasso hospital over a period of 04 months. Two hundred and ten patients were included in this study. The following variables: Ages, sex, residence, reason for consultation, time to consultation, risk factors, clinical and therapeutic aspects were collected. The study population consisted of patients seen in the service in whom the diagnosis of AOM was retained and who gave their verbal consent/assent. We identified 210 cases of AOM in 04 months out of 1716 consultations, i.e. a prevalence of 12.20%. The average age of the patients was 14 years old, with extremes of 24 days to 75 years old, children under 05 years old accounted for 46.02%. We recorded a female predominance of 51.90%. The majority of patients 82.90% resided in the city Sikasso. I'otalgia was the main reason for consultation with 50.48%, followed by otorrhea 25.24%, hearing loss with or without tinnitus in 17.61%, the presence of foreign bodies 5.71% and traumatic causes 0.96% of cases. The average consultation time was less than one week in 74.29% of cases. Among the predisposing factors, nasopharyngitis and purulent rhinitis were associated with AOM in 64.30% of cases, followed by adenotonsillitis in 23.33%, passive smoking in 4.76% and 1 case (0.47%) of soft palate. The AOM was congestive in 57.14%, suppurative in 42.86 of which 32.38% were perforated. Treatment was with antibioticsin 90.95% of cases. The evolution under treatment was favorable at 07 days in 81.42% of cases. Two cases of paracentesis were made. Acute otitis media affects all ages, particularly common in children under .....

Opioid Reduced Anesthesia in Major Oncologic Cervicofacial Surgery: A Retrospective Study.

This is a retrospective case-controlled study of 172 patients with major cervicofacial oncologic surgery. Group ORA (dexmedetomidine and lidocaine), n = 86, was compared to patients treated with standard opioid based anesthesia, Group control, n = 86. The main endpoint was to study perioperative opioid consumption and postoperative pain scores, and the secondary endpoint was to observe opioid related side effects. The ORA group received 6.2 ± 3.1 mg morphine titration at the end of surgery, while the control group received 10.1 ± 3.7 mg p < 0.0001; there was no significant difference in post-operative analgesia requirements and pain scores between the groups. Intraoperatively, the ORA protocol yielded bradycardia in 4 persons, while in the control group, only 2 persons had bradycardia necessitating intervention, p < 0.05. Postoperatively, episodes of hypoxemia (50%) and the need for additional pressure-assisted ventilation (6%), was significantly different in the ORA group than in the control group (70% and 19%), p < 0.05. There was no difference between the two groups for the incidence of nausea and vomiting, ileus, or postoperative delirium. ORA was not associated with a decrease in postoperative pain and opioid requirement, but possibly reduced the incidence of hypoxemia and the use of additional pressure-assisted ventilation, although we cannot rule out confounding factors. The possible benefits of ORA remain to be demonstrated by prospective studies.

Evaluation of the impact of the Covid-19 pandemic on the teaching of otolaryngology and cervico-facial surgery

Evaluation of the impact of the Covid-19 pandemic on the teaching of otolaryngology and cervico-facial surgery

Ambulatory ENT Surgery: Eight Years of Experience in A Tropical Environment

Introduction Ambulatory surgery allows minimizing the time spent in the hospital, which could reduce the transmission of nosocomial pathologies and the occupation of hospital resources and infrastructures. The objective of the study was to assess the ambulatory activity of the ENT department of Military Teaching Hospital of Cotonou since its creation. Materials and methods The study was monocentric retrospective covering an eight-year period from January 1, 2013, to January 1, 2021. It concerned all ENT surgeries where the patient was discharged on the same day, regardless of the type of anaesthesia used. A pre-established survey form was used to collect data from the medical records. The variables studied were socio-demographic factors, eligibility criteria, indications and conversion to inpatient mode. Results Over the study period half of the procedures performed (334 patients) corresponded to indications for outpatient surgery and then were included. Of these, 130 patients (38.9%) were rejected for various contraindications like geographical and financial accessibility and communication difficulties. A total of 204 patients (61.1%) underwent ENT ambulatory surgery. The sex ratio was 3 males to 5 females (0.6). Children under 15 years of age accounted for 43.7% (n=146). Tonsillectomy with or without adenoidectomy was the most frequent surgery accounting for half of the outpatient surgery cases. Pharyngeal surgery was the most performed: (126 patients) followed by cervico-facial surgery (44 patients). Reconversion to inpatient mode occurred in 39 patients (19.12%). No respiratory complications were noted. No deaths were recorded. Conclusions Ambulatory care is a mode of management mainly used for pharyngeal surgery, in particular tonsillectomy and adenoidectomy in children. The main contraindications to patient eligibility were geographical and financial accessibility and communication difficulties. This activity would benefit from being better structured with specific staff and premises.

LARYNGOTRACHEO BRONCHIAL FOREIGN BODY: ABOUT 27 CASES

Laryngotracheobronchial foreign bodies in children (CLTB) is a serious accident that can be life threatening. The penetration syndrome is often obvious, but endoscopy can be used for both diagnosis and treatment. The objective of this study is to analyse the different epidemiological, clinical, paraclinical, therapeutic and evolutionary aspects of laryngotracheobronchial foreign bodies in children in the ENT and cervicofacial surgery department of the military hospital of Nouakchott. This is a prospective study spread over a period of 30 months from December 1, 2019 to May 31, 2022, on children with foreign body inhalation, aged less than 15 years. The average age of our patients was 6.7 years with extremes ranging from 01 year to 14 years. A male predominance was noted with a sex ratio of 2.37. Patients evacuated from the interior of the country represented 33.33% of cases. The average admission time was 33 days. The clinical condition of the child on arrival was varied: a strictly normal examination in 29.62% of cases, coughing in 70% of cases, respiratory distress with signs of struggle in 25.92%, alteration of the general condition with signs of exhaustion in 14.81% of cases. Standard radiography showed a radiopaque foreign body in 52% of cases. Rigid bronchoscopy was performed in all our patients (27 cases), and allowed extraction of EC in 100% of cases. The right bronchial location was observed in 51.81% of cases. Non-organic foreign bodies were found in 52%. The outcome was favourable in 96.29% of cases, death and tracheal stenosis were observed in 3.7% respectively.

Lymph Node Tuberculosis in Otolaryngological Practice: A Study of 68 Cases at the Sourô Sanou University Hospital of Bobo Dioulasso, Burkina Faso

Introduction: Lymph node tuberculosis (LNTB) frequently affects peripheral cervical lymph node body sites. We aimed to study epidemiology and diagnostic and therapeutic characteristics of LNTB patients in ENT routine practice. Methods: We conducted a cross-sectional prospective study in the ENT and cervicofacial surgery department at the Sourô Sanou University Hospital of Bobo Dioulasso, Burkina Faso, for a period of 36 months. Results: There were 68 cases with LNTB, of which 54.4% were mostly men. The mean age and the median age were calculated at 37 ± 6.8 and 42 years, respectively. The patient’s age ranged between 3 and 81 years, and the most represented age group was from 30 to 60 years (62%). According to geographical origin, most patients (79%) originated from rural areas. In 6 cases (9%), patients reported diabetes and 12 patients were HIV positives (18%). Most clinical features leading to the ENT consultation were cervical lymph nodes (82%) and cervical scrofuloderma (18%). For the multiple locations, the lymphadenopathies involved mostly the transversal cervical chain (56%) and spinal chain (50%). Histopathology examination was the mostly diagnosed methods used in 68%. A 6-month anti-tuberculous treatment was given with a follow-up of 6 months without any relapse in 62 cases (97%). Conclusion: The frequency of 68 cases of LNTB in 3 years is underappreciated. Among all lymph node sites, transversal cervical chain and cervical spinal chain were mostly affected. Further advanced studies are recommended to determine the prevalence and contributing factors of LNTB in the study area.

Thyroid Cancers at the Adolphe SICE General Hospital in Pointe-Noire (Congo - Brazzaville): Clinicopathological and therapeutic aspects of 13 cases

Background: Thyroid cancers are relatively rare malignant tumours. In Africa, the incidence of thyroid cancer has been increasing since 1970 in most countries. In Congo-Brazzaville, this increase can be explained by the accessibility of diagnostic means (ultrasound, cytopuncture), and the increasingly common practice of thyroid surgery. Materials and Method: This was a retrospective descriptive study carried out in the ENT and cervico-facial surgery department of the Adolphe SICE General Hospital in Pointe-Noire, Republic of Congo. This study covered the period from January 2005 to December 2017, a period of twelve (12) years. Results: 383 patients underwent surgery for a thyroid tumour, and according to the inclusion criteria listed above, 13 cases of thyroid cancer were retained (3.4%). The average age was 55.4±24.1 years with extremes ranging from 25 to 100 years. The sex ratio M/F was 0.44. The clinical presentation was revealed as a multinodular goiter in 8 cases (61.5%). The most common histological type was papillary carcinoma in 10 cases (77%). Total thyroidectomy was performed in 84.6% of our patients; it was performed immediately in 69.2% of cases. The development of morphological techniques (immunohistochemistry, cytogenetics) has brought considerable progress in the diagnosis and therapeutic management of thyroid cancer in recent years. Keywords: Thyroid Cancer; Frequency; Diagnosis; Treatment; Pointe Noire (Congo)

Multiple Cranial Nerve Palsies in Otolaryngology Consultation: An Atypical Clinical Presentation Revealing Myasthenia Gravis

Introduction: Myasthenia gravis is a chronic autoimmune neuromuscular disease, presents with weakness and fatigability of striated skeletal muscles. It is a rare disease in Cameroon. We report an uncommon case of myasthenia gravis in a patient with feeding difficulties, notion of oronasal reflux and swallowing disorders as first complaints. Observation: We report the case of a 29-year-old woman consulted at our department of Otolaryngology and Cervico-Facial Surgery for dysphagia and swallowing disorders. She also presented with facial diplegia, oculomotor paralysis, nasal voice, and dysarthria which has been evolving for several years now. The clinical examination revealed multiple cranial nerve palsies. The complementary workup showed a decrement of more than 50% in the electroneuromyography and the presence of anti-acetylcholine receptor autoantibodies in the blood workup. A diagnosis of myasthenia confirms clinical presumption. We initially observed a worsening of neuromuscular disorders despite the pyridostigmine treatment and subsequently a clear improvement of the clinical features concerning swallowing and speech disorders, oculomotricity and facial diplegia under a treatment combining prednisone and azathioprine. Conclusion: Myasthenia gravis is a rare and potentially fatal autoimmune neuromuscular disease. We thus highlight the atypical clinical presentation and therapeutic itinerary of our patient and the importance to think about this clinical diagnosis in front of any multiple cranial nerve paralysis in otolaryngology consultation.

Tympanic Retraction Pockets: Diagnostic and Therapeutic Aspect

<i>Background</i>: Retraction pockets represent a form of chronic otitis considered to be a precholesteatomatous stage. This study aims to study the diagnostic and therapeutic aspects of tympanic retraction pockets in the ENT department of the University Hospital Center “Gabriel Touré”. <i>Patients and Method</i>: This was a prospective longitudinal study extended over 15 months; from February 1, 2020 to May 31, 2021 from the files of patients received as an outpatient in the ENT and Cervicofacial Surgery department of the CHU Gabriel Touré in Bamako. Were included any patient seen in an outpatient department at the otorhinolaryngology and head and neck surgery department of the CHU Gabriel Touré in Bamako with a pocket of tympanic retraction and who had consented to the study. Data collection was done using a previously established survey form. Data were entered in Word 2016 and analyzed using SPSS software. <i>Results</i>: The prevalence of retraction pockets was estimated at 1.2% of all consultations. The most represented age group was that of (25-39 years), i.e. 25.0%. The average age was 44.91 ± 20.05 years. The extremes of ages were 10 years and 81 years. The female sex was the most represented, at 63.9% with a sex ratio ꞊ 0.6. A history of otitis was present in half of the cases. Tinnitus was the main reason for consultation (50% of cases) followed by hearing loss (25%). The otoendoscopic examination had noted a predominance of lesions on the left (52%) and an attical seat in 30.6% of cases. The pockets were controllable and self-cleaning in all cases, and peelable in 75% of cases (stage I of the weevil classification) and non-peelable and controllable in 25% of the cases (stage II of weevil). Conductive hearing loss was found in 8.3% of cases, mixed hearing loss in 5.6% of cases and sensorineural hearing loss in 2.8% of cases. CT of the rock was performed in two patients, and showed erosion of the attic wall associated with tissue hypodensity in the attic. Medical treatment based on systemic corticosteroids and nasal decongestant was initiated in all our patients associated with quarterly monitoring for stages I of charachon, i.e. 75% of the workforce. The placement of a tympanostomy tube was performed in 8 patients classified (stage II of charachon) ie (2, 88%). Antroatticotomy associated with reinforcement tympanoplasty was performed in a patient (0,36%).

Management of Laryngo-Tracheo-Bronchial foreign bodies in children at the Adolphe SICE General Hospital in Pointe-Noire, Congo

Background: The objectives of our study were to describe the epidemiological, diagnostic, therapeutic and evolutionary aspects of laryngotracheobronchial foreign bodies. Patients and methods: This was a descriptive and retrospective study carried out over a period of 12 years (2007-2019), in the ENT and cervico-facial surgery department of the General Hospital Adolphe SICE of Pointe-Noire (Congo). Results: During this period, we collected 20 files of patients whose age varied from 1 to 10 years with an average age of 5 years who were received for foreign body inhalation. The average age of our patients was 5 years with extremes ranging from 1 to 10 years. A male predominance was noted with a sex ratio of 1.62. The average consultation time was 3 days (2 hours and 30 days), 12 patients (60%) were seen within the first 24 hours. The penetration syndrome was the most common functional sign in 10 cases (50%). The standard cervico-thoracic radiograph was normal in 7 cases (35%). The foreign body was opaque in 10 cases (50%), and in 1 case atelectasis was noted. CT scan was performed in 2 cases (10%). The larynx was the most common location. Indeed, the glottis was affected in 8 cases (61.5%), followed by the supraglottis in 3 cases (23.07%) and the subglottis in 2 cases (15.3%). The plastic toys were found more in the glottis in 6 cases (30%). The evolution after endoscopy was favourable in 17 cases (85%), 2 cases required thoracic surgery, and one death was recorded. Conclusion: Laryngo-tracheo-bronchial foreign bodies are frequent, they pose a public health problem. Their management depends on the strength of the relationship between the ENT surgeon and the anaesthetist. Keywords: Child; Laryngo-Tracheo-Bronchial Foreign Bodies; Endoscopy

Cervical trauma: Epidemiological, Diagnostic and Therapeutic aspects at the Adolphe SICE General Hospital in Pointe-Noire

Introduction: Cervical spine injuries are relatively rare, and caused by external sharp and vulnating agents. They can be potentially serious and life-threatening. The aim of this work was to describe the epidemiological, clinical and therapeutic aspects. Patients and Method: This was a descriptive, retrospective, cross-sectional study of the records of patients with neck trauma from January 1, 2005 to December 31, 2018, conducted in the ENT and Cervico-Facial Surgery Department of the Adolphe SICE Hospital in Pointe-Noire (Congo-Brazzaville). Results: The study included 30 patients from a total of 107 cases of cervicofacial trauma. The average annual incidence of cervical trauma was 2 cases per year, with a predominance of males, including 25 males (83.3%) and 5 females (16.6%), i.e. a sex ratio of 5:1. The average age was 34.4 years with extremes of 17 to 70 years. 50% of our patients were single. The circumstances of occurrence were represented by knives (83% of cases), followed by road traffic injuries (13%) and firearms (3%). Sharp objects were the most common cause of injury (83%). The mechanism of injury was a section in 87% and a contusion in 13%. Neck pain was the main symptom in 100% of cases. The wound represented 87% of the physical examination, followed by edema and hemorrhage in 33% and 20% respectively. The trauma was isolated in 80% of cases and in a context of polytrauma in 4%. Exploratory and reparative cervicotomy was the most common surgical procedure, 87%, followed by tracheotomy, 27%. The evolution was simple, in spite of the parietal suppuration noted in 10% of the cases. Conclusion: Despite their rarity, cervical trauma remains a worrying surgical emergency in our work context. These traumas are the prerogative of young adult males in connection with external vulnating agents with high traumatic risk. Keywords: Trauma ; penetrating wound; Neck; Cervicotomy

The Impact of Laryngopharyngeal Reflux on Occurrence and Clinical Course of Recurrent Respiratory Papillomatosis.

Laryngopharyngeal reflux (LPR) has been proposed both as a trigger for recurrent respiratory papillomatosis (RRP) onset and as a factor favoring an aggressive clinical course. In this prospective study, 106 participants were recruited within a period of 24 months at the Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana. This study compared a group of RRP patients (N=36) with a group of LPR patients (N=28) and a group of healthy participants (N=42) based on Reflux Symptom Index (RSI), Reflux Finding Scores (RFS), and saliva analyses (pH, pepsin concentration, bile acid concentration, and pepsin enzymatic activity). The RRP group compared to the LPR group showed a statistically significant difference only in RSI and RFS scores, while the RRP group compared to healthy controls showed significantly higher values in all tested parameters (RSI score, RFS, saliva pH, pepsin concentration, bile acids concentration, pepsin enzymatic activity). LPR is common in RRP patients and significantly more prevalent compared to healthy controls. Our results show that saliva analyses are a better office-based tool than RSI questionnaires and RFS scores for diagnosing LPR in RRP patients. 3 Laryngoscope, 132:619-625, 2022.

Place of Middle Meatotomy in the Management of Rhinologic Chronic Sinusitis

Introduction: Middle meatotomy is an effective surgical technique in the management of chronic sinusitis rebels to medical treatment. It is an optimal therapeutic option in the face of a chronic sinusitis particularly of rhinological origin.&#x0D; Patients and method: It is a descriptive retrospective study over an 11-year period from January 2009 to December 2019 at the service of Otolaryngology and Cervico-facial surgery (ORL-CCF) at the Andohatapenaka University Hospital Antananarivo Madagascar. Our study includes subjects who have benefited from an average meatotomy on chronic sinusitis.&#x0D; Results: We collected 320 patients of average age of 33.78 years. Repetitive maxillary sinusitis and rhinogenic allergies are the determinants of chronic sinusitis. Nasal obstruction was the constant functional sign and anterior rhinoscopy revealed a red nasal mucosa with enlarged inferior turbinate. All of our patients received an incidence X-ray of Blondeau. The average meatotomy was achieved in all our patients and among them, a proportion of 12.50% of the cases operated at the same time of a medium meatotomy and opening of other meatus. Complementary turbinal surgery was used in 25% of cases.&#x0D; Therapeutic efficacy was assessed subjectively by the subject’s functional signs. Favourable trends were reported in 75.30% of cases.&#x0D; Conclusion: Chronic sinusitis is a naso-sinus condition requiring medical-surgical management. The middle meatotomy is the first step in the surgical management of chronic rhinological sinusitis rebellious to medical means.