A rare cause of bilateral exophthalmos: about one case with a sphenoid mucocele

Background: Mucocele is a benign cystic pseudo-tumor that develops within the sinus cavities. The most frequent locations are frontal and frontoethmoidal. The sphenoidal forms are rare. We report a case of sphenoidal mucocele revealed by bilateral exophthalmos. Methods and results: We report the case of a 14 year old male patient, without any particular pathological history, referred by his ophthalmologist for bilateral nasal obstruction, bilateral exophthalmos and visual acuity decrease evolving since one year. The ENT examination found a large, renitrant mass, filling the entire right nasal cavity. This mass pushed the nasal septum to the left. The CT scan showed a large sphenoidal, hypodense mass evoking a mucocele. The patient underwent endonasal marsupialization by endoscopic guidance. Conclusions: Sphenoidal mucocele is a rare cause of bilateral exophthalmos. The diagnosis can be misplaced when the signs are overt extra-sinus. Hence the interest of CT in order to eliminate other differential dignostics.

Complications of sinusitis: An 80-case series from the ENT and neurosurgery departments of the Fann university hospital center of Dakar, Senegal

INTRODUCTION

Locoregional complications of sinusitis are dominated by oculo-orbital and/or cranioencephalic manifestations that may be life-threatening or jeopardize functional prognosis. The aim of this study was to report epidemiological, diagnostic and therapeutic aspects.

MATERIALS AND METHODS

A retrospective study included inpatients managed for sinusitis complications in the ENT and neurosurgery departments of the Fann university hospital center in Dakar, Senegal between January 1, 2005 and December 31, 2016.

RESULTS

In all, 80 files were collected. Mean age was 18.5 years, with male predominance. Mean time to treatment was 18.2 days. Cranio-encephalic complications were the most frequent (54 cases; 67.5%): mainly subdural empyema (30 cases) and brain abscess (10 cases). Seventeen patients (21.25%) had oculo-orbital complications: mainly orbital cellulitis (52.9%) and preseptal cellulitis (29.4%). Nine patients (11.25%) had both cranioencephalic and oculo-orbital complications. Acute sinusitis (82.5%) was the main cause of complications. 52.5% of patients showed pansinus involvement. Medical treatment consisted in broad-spectrum antibiotic therapy combining third-generation cephalosporins, metronidazole and gentamycin in cranio-encephalic complications and clavulanic acid and metronidazole in oculo-orbital complications. Thirty-four patients (42.5%) underwent surgical sinus drainage. Neurosurgical drainage was performed in 35 cases (43.75%). Post-treatment course was marked by 6.25% mortality (5 cases) and 16.25% sequelae.

CONCLUSION

With 6.25% mortality and a high rate of functional sequelae, complications of sinusitis are a serious concern in our region. Improving prognosis requires earlier management and better coordination between health professionals.

[Hyperthyroidism surgery: experience of ENT department of hospital center of Thies]

INTRODUCTION

The treatment of hyperthyroidism includes different therapeutics means of which surgery. The objectives of this study were to evaluate the place of the surgery in the treatment of hyperthyroidism and to describes the complications.

PATIENTS AND METHODS

It is a retrospective study on 22 patients treated by thyroidectomy from March 2002 to April 2004. The biological confirmation was systematic. A medical preparation has been done in all the cases. A total thyroidectomy has been done in 13 cases and a subtotal in 9 cases.

RESULTS

The mean age was 37 years. There were 20 women and 2 men. An euthyroidism has obtained after surgery. There complications were: 1/22 temporary palsy of recurrent nerve 1/22 acute hypoparathyroidism 1/22 post-operative death (haematoma)

CONCLUSION

Surgery seems to be a good alternative to antithyroid agents, which are constraining and often ineffective in the long term, and to radioactive iodine who leads to a long follow-up because of induced hypothyroidy. With increasing surgical skill, the risk of recurrent or parathyroid injury is greatly decreased.