Bilateral facial nerve schwannoma: A case report

Facial nerve schwannoma (FNS) is an uncommon disease, bilateral FNS are exceptional. We describe a case of a 23-year-old man who presented a bilateral 3rd segment facial nerve schwannoma, without neurofibromatosis disease. We discuss the clinical presentation, radiologic findings and management of this case. Facial nerve schwannoma can present in various ways. The imaging appearance of FNS is more varied than originally described. Our case demonstrates an uncommon presentation of a relatively rare tumor in which the tumor has been respected. During this time, the tumor may be followed by radiologic imaging.

[Cholesteatoma by osteoma of the external auditory canal]

Osteoma in the external auditory canal (EAC) is an uncommon benign tumor. The association of a cholesteatoma with an osteoma of EAC is extremely rare. We report a case of a 26-year-old woman with an osteoma of the left EAC that was complicated by a cholesteatoma in the EAC between the osteoma and left tympanic membrane. Surgical removal of the osteoma and cholesteatoma proved successful by postauricular approach. The follow up without recurrence is 24 months. Osteoma of the EAC is a solitary, unilateral, and slow-growing bony benign tumor. The foremost differential diagnosis is exostose that is multiple and bilateral. Cholesteatoma of the EAC is uncommon. Its basic pathogenesis is a chronic occlusion of the EAC. Surgical treatment avoids complications related to local aggressiveness of cholesteatoma.

[Myofibroma of the mandibule: a case report]

INTRODUCTION

Myofibromatosis is a rare tumor. Two forms are described, solitary and multicentric, the solitary type is more common and is localized mainly on the head and the neck, mandible involvement is rare. The recent observation of a patient with a myofibrome of the mandible has given the opportunity to conduct an analysis and review of the literature of this disease rarely encountered.

MATERIALS AND METHODS

We report a case illustrating solitary myofibroma of the mandible in a 16 year old man.

RESULTS

The histological diagnosis was done on the identification of the spindle-shaped tumoral proliferation and the positive expression of the anti-vimentine, anti-smooth, muscle actin anti desmin. The treatment was surgical.

DISCUSSION

myofibromatosis often presents as a painless, well-circumscribed, solid nodule. Imagery is very useful to assess lesion extension and for the therapeutic followup. The diagnosis is made on anatomopathological findings and immunohistochemical assessment. The treatment of the solitary myofibromatosis is primarily surgical and its prognosis is excellent contrary to the multicentric form.

[Nasal septal abscess complicating acute sinusitis in a child]

Nasal septal abscess is a rare complication of acute sinusitis in children. We report the case of a 9-year-old girl who presented at the emergency unit with a bilateral eyelid edema evolving over 2 days, associated with bilateral rhinorrhea and nasal obstruction. Clinical examination found a tumefied nasal septum and nasal obstruction. A computed tomography scan of the nose and paranasal sinuses showed pansinusitis with an abscess of the nasal septum. Treatment consisted in the evacuation of the abscess associated with a triple antibiotic therapy. Progression was favorable. Acute sinusitis is seldom complicated by an abscess of the nasal septum, and very few cases are reported in the literature. Early diagnosis and treatment can avoid complications, which engage not only the functional but also the vital prognosis.

[Leeches of the upper aerodigestive tract]

INTRODUCTION

The leech is an aquatic worm living in fresh water, especially in tropical areas. It may be found exceptionally in the upper aerodigestive tract (UADT) after consumption of spring water or water from natural wells, after swimming in still waters (lakes and dams). The author's objective was to study epidemiological, clinical, therapeutic, and evolutive aspects of this infestation.

PATIENT AND METHODS

This prospective 2-year study was carried out from January 1, 2007 to December 31, 2008. We included all patients consulting at the emergency unit presenting with leeches in the UADT.

RESULTS

Twenty patients living in rural settings were included: 16 children, mostly boys (sex ratio 3:1). All cases were recorded during the summer season, with 14 cases due to consumption of fresh water and six due to swimming in still waters. The delay between infestation and onset of symptoms ranged from 2 to 15 days. Leeches were found in the oropharynx (six cases), the nasopharynx (five cases), the hypopharynx (six cases), and the glottis (three cases). An anemia syndrome was noted in four patients. All parasites were removed. All patients were given local antiseptics and analgesics. Patients with anemia were given iron supplementation. The outcome was favorable for all patients.

DISCUSSION

UADT leeches are not uncommon in Morocco. The infestation is usually observed in the summer. Symptoms vary according to UADT localization. The diagnosis should be made rapidly to prevent complications. Whatever the localization, removing the parasite is difficult. In laryngeal localizations induction general anesthesia is recommended, without intubation. Evolution after treatment is rapidly favorable, with complete disappearance of symptoms.

A laryngocele revealing a small cell lung carcinoma

BACKGROUND

Laryngocele is defined as an abnormal dilatation of the laryngeal ventricle. It is a very rare entity, and the exact underlying mechanism is still unclear. Laryngoceles are associated with larynx carcinoma but not yet lung cancer.

CASE PRESENTATION

A 46-year-old man presented with stridor, wheezing, dyspnea at rest, hoarseness evolving over two months, and cyanosis secondary to cervical swelling. His medical history included a 72 pack-year smoking habit and chronic obstructive pulmonary disease for 10 years. Airway management included a surgical tracheotomy for respiratory distress. A neck CT revealed laryngocele. A chest X-ray showed a left basal pulmonary opacity. Bronchoscopic exploration found an infiltrated and narrow left stem bronchus with complete stenosis of the lingula. Pathology revealed a small cell lung carcinoma.

CONCLUSION

Our case shows the possible association of laryngocele and lung carcinoma. The pathophysiology was explained by the long history of tobacco smoking and the underlying chronic obstructive pulmonary disease with chronic cough.

[Retropharyngeal abscess revealing diabetes: a case report]

Retropharyngeal abscess, a rare event in adults, is usually observed in immunodeficient persons or subsequent to foreign bodies. We report a case of retropharyngeal abscess which revealed diabetes mellitus. A 47-year-old woman with an uneventful history complained of fever, dysphagia and trismus. Clinical findings were swelling of the pharyngeal posterior wall. The CT scan showed an abscess in the retropharyngeal space. Puncture revealed the purulent nature of the collection. The bacteriological study identified a Gram-negative aerobic germ (Citrobacter freundii). Laboratory tests disclosed diabetes mellitus with ketosis. The treatment consisted in surgical drainage and lavage of the retropharyngeal space using a saline solution with gentamycin associated with infusion of appropriate antibiotics. Abscess formation in the retropharyngeal space is a rare event in adults. The immunological status of the patient should be carefully explored. Management requires drainage of the collection and infusion of active antibiotics.