B-Ent最新文献

Mucormycosis is a rare disorder with a potentially lethal course caused by an opportunistic fungus of the Phycomycetes family. Rhinocerebral mucormycosis (RCM) is an acute fulminant form of invasive fungal sinusitis occurring principally in individuals who are immunologically or metabolically compromised. This form originates from one of the paranasal sinuses and may spread to the orbit or the intracranial space either by direct extension or using the unique capability of spreading along vascular walls, leaving the bony structure intact. Carotid artery occlusion is a complication of RCM. Because of the rapidity with which this disease progresses, prompt and aggressive therapy is essential. The morbidity and mortality of this disease are directly related to the length of time before diagnosis and treatment. The diagnosis is difficult because invasive mucormycosis may be present with no mucosal changes and a normal sinus CT scan. It is a histological diagnosis. Treatment of RCM includes early diagnosis, correction of underlying conditions, early and radical surgical debridement, and lipid formulation of amphotericin B. Multiple surgeries are often necessary for adequate debridement. We report a case of carotid artery occlusion due to RCM and discuss the literature on its early signs and symptoms, pathophysiology, and treatment options.

Objectives: NPDc arises from embryological tissue. It is classified among the epithelial non-odontogenic cysts according to the 1992 WHO histological typing of odontogenic tumors. The purpose of our report was to provide details about the pathophysiology, diagnosis and treatment of NPDc.

Case report: A 25 year-old male was referred by his practitioner regarding to an intermittent palatal swelling for 6 months. Diagnosis of NPDc was suggested on the basis of computed tomography (CT-scan). Excision was performed under general anaesthesia. There was no post-operative complication. Histological features confirmed an inflamed NPDc. Follow up was 22 months, without relapse.

Conclusion: NPDc occurs in approximately 1% of the population and forms approximately 12% of all jaw cyst tumors. NPDc may occur at any age, but main cases are seen between 40 and 60 years old. It has a slight male predilection. Black and white people are equally involved. NPDc is normally asymptomatic, unless it is infected. The most common symptom is swelling, usually in the anterior part of palate's midline. Diagnosis is based on radiographic and histological results. Treatment of choice is enucleation.

In a retrospective study based on parents' personal interviews, the diagnosis circumstances were analysed in a group of 88 deaf children (moderate to profound deafness). We reported first the age when the parents emitted doubts, and second the age of diagnosis. It appeared that the age of first suspicions, and of diagnosis, was correlated to the degree of deafness. The population of children was divided in two groups depending on the presence of a delay or not in the diagnosis. The first group (24 children) was diagnosed early because of neonatal screening, or of early suspicions by parents or pediatrician. In the second group (64 children) were a delay was observed, seven causes were identified with variable frequency according to the level of deafness. The first four main causes for delayed diagnosis were: 1) parents, 2) medical refutation, 3) otitis media with effusion (OME), 4) progressive hearing loss. In conclusion, the age of diagnosis and the age of first suspicions were too late. Universal neonatal screening is recommended but do not appear to be the exclusive procedure to reduce the diagnostic's delay. This analysis of the factors of delay, prompted us to recommend: 1) information to parents on deafness, 2) careful attention to parents suspicions, 3) an objective evaluation of auditory function,especially after OME cure and 4) a follow-up of children to identify progressive hearing loss.