An Unusual Cervical Penetrating Wound Extended to the Right Pleural Dome

The solution of continuity of the tissues of the neck with rupture of the platysma muscle is called a cervical penetrating wound. The authors report a case of an unusual penetrating neck wound extended to the pleural dome by stabbing a psychiatric patient. They describe the diagnostic circumstances, the therapeutic approach and discuss data from the literature. It was a 26-year-old young woman, who was received in ENT for a penetrating neck wound with a stab wound following a suicide attempt. The diagnosis of a penetrating stab wound to the neck extending to the right pleural dome was retained. The exploratory cervicotomy with the extraction of the foreign body found a knife blade penetrating the anterior base of the right side of the neck to the right pleural dome, sparing the noble vasculo-nervous and aero-digestive organs of the neck. The postoperative course was simple and the evolution was favourable. This unusual penetrating wound of the neck is spectacular and remarkable for the absence of involvement of noble organs despite the involvement of the pleural dome. However, it remains a concern in psychiatric patients and requires multidisciplinary management and systemic management in order to avoid recurrence.

Place of Partial Arytenoidectomy in the Management of Bilateral Vocal Cord Immobilitis

Surgical management of laryngeal paralysis varies depending on whether the vocal cords are in abduction, adduction or paramedian position. Various surgical techniques have been described including partial arytenoidectomy which is reported to give good surgical results that are stable over time. The objective of the study was to analyze the surgical therapeutic elements of bilateral paralysis, especially to assess partial arytenoidectomy, one of the most performed techniques. This was a descriptive retrospective study of cases of bilateral immobility admitted between January 1st 2008 and March 31st 2018 and treated surgically. Socio-demographic and therapeutic data were collected. The survey involved 46 patients, with an equal number of male and female (23) with 50% of male patients and 23 patients were female, or a sex ratio of 1. The average age of the patients was 56 ± 17 years ranging between 14 and 89 years. Posterior partial arytenoidectomy was the most widely performed surgical technique (26 patients or 56.5%), followed by cordopexia or lateral-fixing of a vocal cord (19.6%) and posterior cordectomy (17.4%). Patients who received a partial arytenoidectomy and cordopexia had their vocal cords either in adduction or in the paramedian position. Those who received a posterior cordectomy had their vocal cords in adduction. 18 patients (39.13%) were taken to the operating theatre in less than 6 hours, 28 (60.9%) had no post-operative complications, and 9 patients received a surgical enlargement resumption. In post-operative follow-up, 11 patients suffered pulmonary aspiration corrected after speech therapy;26 patients (56.5%) did not. Partial arytenoidectomy remains the most performed surgical procedure in the management of closed bilateral laryngeal paralysis at the Mont-Godinne University Hospital. It allows a reliable and durable breathing function over time with less impact on the voice.

Clinical and Therapeutic Characteristics of Acute Maxillary Rhinosinusitis in a Hospital of Cotonou

Introduction: Acute maxillary rhinosinusitis (AMRS) is one of the most common ear, nose and throat infections. The aim of this study was to contribute to the improvement of the management of the condition in sub-Saharan Africa. Material and Method: This was a cross-sectional, descriptive study that ran from January 1, 2017 to December 31, 2021 in the ENT-HNS department of the “Centre Hospitalier et Universitaire de Zone de Suru-Léré” (CHUZ SL) in Cotonou, Benin. It involved all patients who consulted during the study period and in whom the diagnosis of acute maxillary rhinosinusitis was made. Results: A total of 405 cases were identified. The mean age was 34.26 ± 15.26 years with extremes of 9 and 63 years. The predominance was female with a sex ratio of 0.61. Acute maxillary rhinosinusitis was bilateral in 371 cases (91.60%). The main symptoms were facial pain in 346 cases (85.43%), mucopurulent rhinorrhea: 315 cases (77.78%), headache: 283 cases (69.88%), and nasal obstruction: 244 cases (60.25%). The most frequent physical signs were pain on pressure of the maxillary sinus points in 405 cases or 100%, purulent secretions at the middle meatus: 11.35%, hyperemia of the nasal mucosa: 53.58%, hypertrophy of the middle turbinate: 41.48% and discharge of pus on the posterior pharyngeal wall: 36.79%. Amoxicillin + clavulanic acid was the main antibiotic prescribed. Vasoconstrictors were used in 228 cases 56.30%. The evolution was favorable in all cases. Conclusion: The diagnosis of acute maxillary rhinosinusitis is clinical. Treatment with antibiotic gives good results.

A Rare Tumor of the Scalp: Papilliferous Cystadenoma

Introduction: Papilliferous cystadenoma is a rare adnexal tumor of early childhood. Case Report: We report a case of papilliferous cystadenoma of the scalp in a 22-year-old adult with no previous history of the disease. She had been presenting with a slowly progressing scalp mass for about 10 years. The mass was mildly pruritic and painless, but the patient reported several painful episodes treated with local herbal applications and unspecified antibiotics. On inspection, the lesion was raised, granular, sessile and vegetated, greyish in color, with an irregular surface, nippled and hemispherical in shape. On palpation, the lesion was painless, fleshy and surrounded by crusts that were easily removed by applying a saline-moistened compress. The patient underwent excision with at least 4-mm margins. Pathological examination of the operative specimen revealed a papilliferous syringocystadenoma. There was no tumor recurrence after three years. Conclusion: Papilliferous cystadenoma is a rare benign tumor of the scalp requiring clinical analysis and surgical excision to confirm its histological nature. Post-operative follow-up is necessary due to frequent recurrences.

Diffuse Cervico-Facial Cellulitis: Epidemiological, Diagnostic and Therapeutic Aspects at the Teaching Hospital CNHU HKM of Cotonou

Purpose of the work: to study the epidemiological, clinical and therapeutic aspects of diffuse cervico-facial cellulitis collected within the ENT-CCF surgery department of the CNHU of Cotonou. Materials and method: the study was a descriptive retrospective carried out from January 1st, 2018 to December 31st, 2020. It concerned new cases of diffuse cervico-facial cellulitis identified during the period. Results: in 3 years, 55 cases of diffuse cervico-facial cellulitis were identified out of 1101 hospitalized patients. The frequency was 4.99%. Per year, 18 cases of cervico-facial cellulitis are recorded. The mean age of the patients was 41.3 years with extremes of 15 years and 85 years. A clear male predominance was noted with a sex ratio of 1.29. Painful cervico-facial swelling was the most common reason for medical consultation (47 patients or 85.5% of cases). Thirty patients (54.5%) showed a deterioration in general condition. Several clinical forms of diffuse cervico-facial cellulitis have been described, in particular the gangrenous form, the suppurative, necrotizing form and LUDWIG’s angina. The portal of entry was dental in 50 patients (91% of cases), favored by poor oral hygiene and self-medication with non-steroidal anti-inflammatory drugs (NSAIDs). The medico-surgical treatment implemented was favorable for 47 patients (85.5%). Conclusion: Diffuse cervico-facial cellulitis remains a frequent medical-surgical emergency in the CCF ENT department at the Teaching Hospital of Cotonou. Mainly of odontogenic origin, it is encountered in different clinical forms.