Une complication ophtalmologique du chérubisme

INTRODUCTION

Cherubism is a rare familial fibro-osseous lesion usually observed in children. The diagnosis is clinical and radiological. Outcome is generally favorable, but with a risk of ophthalmologic complications, especially lower eyelid retraction, proptosis, diplopia, displacement of eyeball and loss of visual acuity. Clinicians must be aware of these complications for proper detection and specific treatment.

OBSERVATION

We report a case of cherubism observed in a 10-year-old boy who presented exophthalmia with reduced visual acuity on the right due to reduction of the volume of the orbital cavity and compression of the optic nerve. Partial maxillectomy was required for decompression.

DISCUSSION

Cherubism can lead to various types of ophthalmologic complications. Exophthalmos and loss of visual acuity due to compression of the optic nerve are the most common. Surgery is generally not required, but can become crucial in selected patients.

[Odontogenic myxoma of the maxillary]

INTRODUCTION

Odontogenic myxoma is a rare benign tumor that arises from the mesenchymal portion of the tooth germ. It has a va-riable non-specific clinical and radiological appearance, and may be confused with other lesions such as ameloblastoma.

CASE REPORT

We describe the case of a young, African male patient with a large odontogenic myxoma of the maxillary. The patient presented a painless firm swelling of the left maxillary. The radiograph showed a radiolucent lesion that was compatible with several diagnoses.

DISCUSSION

The diagnosis was based on clinical, radiographic and histopathologic features. This tumor is locally aggressive, inducing important facial deformation and tooth displacement. Radical treatment with surgery or prosthesis is needed due to the high rate of recurrence.

[Temporomandibular osteomyelitis secondary to progressive necrotizing otitis externa]

INTRODUCTION

Osteomyelitis of the temporomandibular joint is a rare complication of invasive external otitis, often occurring after inappropriate initial treatment of the causal affection.

OBSERVATION

A 65-year-old diabetic man was treated for invasive otitis externa complicated by destructive osteomyelitis of the ipsilateral temporomandibular joint. The diagnosis was suspected clinically and confirmed by imaging. The course was favorable with medical treatment.

DISCUSSION

Osteomyelitis is an extremely unusual complication of invasive otitis externa. Diffusion of the infection toward the temporomandibular joint can be secondary to an osteitis of the bony canal or spread via congenital dehiscences of the external auditory canal. Pain, limitation of mouth opening and auricular swelling are the main clinical signs. Treatment is essentially medical, based on adapted antibiotic therapy.

[Association of Bezold's abscess and sigmoid sinus thrombosis. A case report]

Bezold's abscess and sigmoid sinus thrombosis are both classic complications of otitis media. However, since the introduction of antibiotics both have become very rare. Very few cases of these complications occurring concomitantly have been reported. We describe the clinical case of a 45 year old male with a 10 year history of neglected right ear cholesteatoma. The patient presented to our department with a 10 day history of purulent right otorrhea, otalgia, increasing headach, pyrexia and suppurating right parapharyngeal mass. CT scan confirmed right middle ear cholesteatoma associated with ipsilateral Bezold abscess and and sigmoid sinus thrombosis. Treatment was by mastoidectomy, broad spectrum intravenous antibiotics and anticoagulation. The patient made a full uncomplicated recovery. The association between chronic middle ear disease, sigmoid sinus thrombosis and Bezold abscess are discussed.

[Mastoid eosinophilic granuloma: a case report]

OBJECTIVES

Langerhans cell histiocytosis is a proliferating cell disease that may take various forms characterised by bone, skin lymph nodes and visceral lesions. Eosinophilic granuloma is a localised form of histiocytosis X, or Langerhans' cells histiocytosis, a benign form with unknown aetiology. At the head and neck level, it is usually located on the temporal, and usually occur in association with multifocal disease; however, isolated lesions may occur in the mastoid bone alone.

METHODS

The author's present a case of a patient with unifocal eosinophilic granuloma limited to the mastoid treated in ENT and radiotherapy departments.

RESULTS

CT scan demonstrated an osteolytic lesion of the mastoid. The biopsy and immunohistochemical study confirmed the diagnosis. A surgery followed by a radiotherapy (20 Gy) have stabilised the situation. There is no recurrency after one year.

CONCLUSION

Unifocal eosinophilic granuloma of the temporal bone is a benign lesion of langerhans' cell histiocytosis. Its diagnosis is difficult when the disease remains isolated. Its treatment depend on its extension and its risks. The excellent prognosis does not dispense on regulary follow up.

[Non-Hodgkin lymphoma of the infratemporalis fossa: a case report]

Extranodal non-Hodgkin lymphoma of the head and neck is usually seen in the Waldeyer's ring. Localizations in the infratemporalis fossa are rare and to date, only seven cases have been reported. The clinical and radiographic features of non-Hodgkin lymphoma is non-specific. Positive diagnosis requires a pathologic examination, generally guided by immunohistochemistry results. We report a case and discuss the epidemiological, diagnostic, therapeutic and prognostic features of these tumors.

[Hemangiopericytoma of the infratemporalis fossa: apropos of two cases]

Hemangiopericytoma is a slow growing insidious potentially malignant vascular tumor that can occur anywhere in the body. Primary localization in the infratemporalis fossa, an area deep in the face, is uncommon and difficult to diagnose and treat. We present two cases of hemangiopericytoma observed in the infratemporalis fossa and recall the epidemiological and clinical features of these lesions, discussion diagnostic and therapeutic options.

[Massive lytic osteodystrophy or Gorham-Stout disease of the craniomaxillofacial area]

Gorham's disease also called idiopathic massive osteolysis represents a rare affection with unknown aetiology. This disease was described in different bones of the body but its location on maxillo-facial skeleton is particular by the number of cases in the world (only 32), by morphological, functional consequences and the prognosis. The authors describe a new case of male teenager (17 years old) who had a massive osteolysis of mandibular ramus, upper maxillary, malaire, sphenoid, temporal and occipital left bone. The authors give precision about epidemiological data, methods of diagnosis and therapeutic procedures.

[Chondrosarcoma of the jaw. A case localized to the mandible]

Chondrosarcoma is a malignant cartilaginous tumor rarely found in the jaw bone. Tumor progression is slow with strong propensity to local recurrence after surgical removal. The prognosis is poor and depends on the degree of differentiation and the quality of the resection. We report a case of mandibular chondrosarcoma that exhibited particularly massive extension to soft tissue. We discuss the epidemiology, diagnosis, treatment and follow-up of these tumors.

[Osteosarcoma of the jaws. Apropos of 12 cases]

We report 12 cases of osteosarcoma (10 located in the mandible and 2 in the maxilla). There were 8 men and 4 women who were older than usually observed in osteosarcoma at other sites (8 of 121 patients were over 30 and the average age was 34 years). Clinical signs were variable. Bone tumefaction was the most frequent sign, with a diameter greater than 5 cm in most cases (10 out of 12). Surgery alone was used for 8 patients and radiosurgery for 3. Follow-up is available for 8 patients. All presented local recurrence with extensive tumors progression. All died within an interval of 3 to 30 months despite palliative surgery and/or radiotherapy or chemotherapy.

Parameningeal rhabdomyosarcoma. Report of 19 cases

Parameningeal rhabdomyosarcomas are associated with a poor long term survival. This is due to the fact that they are aggressive tumours with early involvement of the skull base. The authors report a series of 19 cases between 1984 and 1995 with a relative proportion of children, male patients and tumours of embryonal type. Three patients were operated on and only one of them was found with tumour free margins. Systemic chemotherapy using the VAC-VAd protocol was administered in 18 patients and intrathecal chemotherapy was delivered in 5 patients with involvement of the skull base. Nine patients were irradiated with doses varying from 45 to 55 Gy. Twelve patients died from 20 days to 4 years after initial treatment; 6 were lost to follow up and only one patient is living without any evidence of disease after 11 years.

[Hemangiopericytoma with parotid localization. Apropos of a case]

The localisation of hemangiopericytoma in the parotid gland is rarely seen. The anatomo-clinic diagnosis is sometimes difficult, this tumor keeps a prognosis generally uncertain. The autors mean to study through one observation of the location of the hemangiopericytoma in the parotid gland, the modality of therapeutic, diagnosis and evolutionary of these tumors.