An unusual cause of Lemierre Syndrome

Lemierre syndrome is a rare, grave and life-threatening disease characterized by a septic thrombophlebitis of the internal jugular vein. Fusobacterium necrophorum is the most causative germ but sometimes others germs can be responsible. The authors report the first published case of Lemierre syndrome caused by a coinfection Levinea sp - Mycobacterium tuberculosis.

[Pseudo-tumoral invasive fungus infection of the maxillary sinus in Abidjan]

INTRODUCTION

The invasive fungal infection of the maxillary sinus is a rare and serious disease generally favored by immunosuppression. We report an exceptional case of pseudotumoral invasive fungal infection of the maxillary sinus in an immunocompetent patient.

OBSERVATION

A 32-year-old patient consulted for labial and left temporal swelling associated with proptosis and chemosis that has been developing for 18 months. The scanner objectified a filling of the left maxillary sinus, and the ipsilateral orbital cavity, and the surrounding muscles. Histological examination of the surgical specimen revealed invasive fungal infection of the left maxillary sinus. The relevant antifungal therapy, namely voriconazole, could not be administered due to the unavailability of the medicine. However, the patient has received 200mg of itraconazole every 12hours for three weeks. The change proved disappointing with recurrence and significant sequelae, sort of sagging of the right hemifacial, severe limitation of mouth opening and functional loss of the right eye.

CONCLUSION

The invasive fungus infections of the maxillary sinus and the orbit are exceptional in immunocompetent patient. Healing is based on early diagnosis and administration of the reference antifungal to face the risk of recurrence.

[Harlequin syndrome in a melanoderm patient]

INTRODUCTION

Harlequin's syndrome is a neurological disorder due to a dysfunction of the sympathetic innervation of the face. It has been rarely reported in the literature. The authors report one case occurring in a melanoderm patient.

OBSERVATION

A 38-year-old melanoderm man, without any history of surgery or neck trauma, consulted for a strictly right unilateral facial hyperhidrosis. Clinical and radiological investigations concluded to an idiopathic Harlequin's syndrome. Therapeutic abstention was proposed because of non-invalidating symptoms.

DISCUSSION

Harlequin's syndrome is a rare sudoral and vaso-motor disorder. On dark skin, flush and erythrosis may be subtle and the diagnosis less obvious. Etiologies are varied but essentially idiopathic. Its association with others dysautonomic facial syndromes is possible. Main differential diagnosis is the Frey's syndrome. Treatment is not clearly codified.

[A cervical necrotizing cellulitis revealing a Lemierre syndrome]

INTRODUCTION

Lemierre syndrome is characterized by a septic thrombophlebitis of the internal jugular vein (IJV) following an oropharyngeal infection.

CASE REPORT

We report a case of Lemierre syndrome that occurred in a context of angina and necrotizing cellulitis of the neck in a 45-year-old patient. The Doppler ultrasound exam of the neck vessels and a neck CT showed an IJV thrombophlebitis. No germ could be isolated in the samples (blood culture, pus). The treatment associated antibiotics, heparin and surgical debridement of the necrotic tissues with extraction of the thrombus after ligation and section of the IJV. The postoperative course was uneventful.

DISCUSSION

Lemierre syndrome is a rare but serious disease. Its low incidence makes him a forgotten disease. It should be systematically suspected in any oropharyngeal infection with the presence of a large painful swelling of the neck.

[Post-dental extraction tetanus. About an observation]

The authors report a case of tetanus diagnosed in the aftermath of tooth extraction, in the absence of any other front door.

OBSERVATION

A patient showed a persistent trismus several days after the extraction of tooth 38 performed at the dental office. The diffusion of tension and the appearance of paroxysms allowed the diagnosis of tetanus.

DISCUSSION

The possibility of occurrence of tetanus after a tooth extraction should be kept in mind before a persistent trismus with rapid expansion in the neck and limbs. The dentist should be aware of the symptoms of tetanus to refer the patient to a specialized department.

[Factors of failure of prosthetic restoration of the acquired losses of substance of the jawbone and the mandible in sub-Saharan Africa]

The obturating prostheses of the jawbone and the prostheses of rebuilding of the mandible make it possible to restore the losses of substance of the jawbone and of the mandible and to cure the functional and Aesthetic disorders which result from these losses of substance. The success of these prosthetic restorations can be compromised by technical, economic and cultural factors. The principal factors are the importance of the losses of substance, the reduced number of teeth, the poverty of the technical plate, the persistence of certain traditional concepts. The fight against these factors requires the promotion of therapeutic associations in maxillo-facial cancerology, the sensitizing of the populations to the early hospital consultations, the improvement of the technical plate of the prosthesis of the jawbone and the face, the facilitation of the access of the most underprivileged groups to the prosthetic restorations, the promotion of multi-field collaboration, the whole co-operation of the patient throughout the treatment and the follow-up postprothetic.

[Clinical significance of the Krogh-Poulsen bite test in mandibular dysfunction]

INTRODUCTION

The bite test was initially described as the Krogh-Poulsen test consists of biting a flat and thin wedge placed unilaterally between the molars. Temporomandibular joint (TMJ) pain located on the ipsilateral side is considered as muscular, when on the contralateral side pain signifies a joint problem. Although this test is widely used, no scientific evaluation of its real clinical value has been published.

MATERIAL AND METHOD

A prospective study is conducted in 32 patients exhibiting temporomandibular pain (n=40) at the bite test. The results of the bite test were compared with results of computed tomography of the TMJ. Several criteria are studied: joint space narrowing, retrusion of the mandibular condyle in occlusal position, bony signs of joint degeneration. Chi-square and Student's t test were used for statistical analysis of correlations between clinical findings and radiological abnormalities.

RESULTS

Significant results demonstrated a high degree of radiologically detectable disorders in patients with joint pain as defined by the bite test. All of these patients presented at least one radiological sign of joint disease. There was also a low degree of radiologically detected joint disturbance in patients with muscular pain according to the bite test, 70% of them presenting no radiological abnormality.

DISCUSSION

It is concluded that the bite test is of significant value for evaluation of TMJ disorders and can be useful for the indication of complementary radiological examinations.

[Ameloblastoma of the maxillary sinus. Apropos of a case]

The ameloblastoma is benign odontogen tumour developed from epithelial remains of MALASSEZ. Because of the inclination to invade in an inexorable way all the surrounding tissues and of the faculty of recurrence after removal, one attributes him the qualifier of good-hearted tumour to local wickedness. The mandibulary localization is the most frequent. Toward the maxillary, it is mostly observed in the tuberosity region. The authors report in the work one case of ameloblastoma developed from the pericoronal cyst of an intrasinusal ectopic canine tooth.