N. Romdhane

Les complications orbitaires des sinusites

PURPOSE Orbital complications of sinusitis are rare but serious, with potential functional and even fatal consequences. The purpose of this work is to study the epidemiological, clinical and paraclinical features of the orbital complications of sinusitis, as well as the various treatment modalities and clinical course. PATIENTS AND METHODS We report the results of a retrospective study of 34 cases of orbital complications of sinusitis, collected between 1998 and 2009. RESULTS Mean age was 19 years 3 months, with a clear male predominance. No predisposing factors were found. All patients presented with periorbital edema. In addition to periorbital edema, ophthalmological examination also revealed: proptosis in 19 patients, decreased visual acuity in eight patients and ocular motility disturbances in 10 patients. All patients underwent emergent facial CT, two patients underwent orbital ultrasound, and one underwent magnetic resonance imaging. Initial treatment was based on empiric intravenous antibiotic therapy. Orbital drainage was performed in 20 patients. Sinus drainage was performed in 16 patients (14 cases during the acute phase) with a middle meatotomy in all cases. The initial response was favorable in 97.5% of cases. One patient had a recurrence. Mean follow-up was 11 months. CONCLUSION Orbital complications of sinusitis are a diagnostic and therapeutic emergency. Imaging helps guide management. Directed treatment and early management can improve mortality and morbidity.

Tympanoplasty Outcomes In Dry and Wet Ears

Introduction: Chronic suppurative otitis media is a major public health problem in children and adults. Tympanoplasty is a surgical procedure which aims to prevent recurrent otorrhea and restore hearing ability. Objective: To compare the graft uptake and the hearing outcome of tympanoplasty in non cholesteatomatous chronic otitis media between wet and totally dry ears. Methods: A total of 108 wet ears (with mucoid discharge) and 232 dry ears (at least 3 months before surgery) with chronic suppurativeotitis media were operated on by myringoplasty between 2000 and 2014. Postoperative graft uptake and hearing gain rates were compared between both groups. Results: Cartilage was used in 100% of wet ears and 35% of dry ears. In the other cases, temporalis fascia was the chosen graft. Anatomical success rate was 88% for the wet ear group and 87.5% for the dry ear group. The hearing gain rate was 62%% for the wet ear group and 56% for the dry ear group. Differences were found to be statistically non significant for both graft intake (p=0.9) and hearing gain (p=0.29). In the wet ear group, only age <40 years was found to be a predictive factor of audio logical success in tympanoplasty (p=0.001). Conclusion: The success of myringoplasty is not adversely affected by the presence of mucoid ear discharge at time of surgery, and outcomes are comparable to those of the operation done for dry ears.

Valeur de l’examen extemporane en pathologie thyroïdienne

OBJECTIF : Etudier la valeur de l’examen extemporane dans la pathologie thyroidienne et identifier ses limites MATERIELS ET METHODES : Notre etude est retrospective incluant 800 examens extemporanes realises sur des pieces de resection thyroidienne colliges dans notre service sur une periode de 12 ans (2000-2011).Les resultats ont ete compares a ceux de l’examen anatomopathologique definitif. RESULTATS : Les resultats etaient concordants dans 96,5%, discordants dans 3,5 %. La sensibilite de l’examen extemporane tous types confondus etait de 78 % et la specificite de 100 % CONCLUSION : Notre etude a montre une specificite parfaite de l’examen extemporane cependant l’interpretation difficile des lesions thyroidiennes d’architecture vesiculaire expliquent une sensibilite de 78 %. Mots Cles : Thyroidectomie, examen extemporan OBJECTIVE : To assess the value of frozen-section examination in thyroid surgery and evaluate its limitations PATIENTS AND METHODES : This retrospective study examined the results of 800 frozen-sections of thyroid specimens analysed over the 12 –year period (2000-2011). Their results were compared with definitive anatomo-pathological examination RESULTS :Frozen-section diagnosis was concordant with subsequent histopathological examination in 96,5% ,discordant in 3,5%. The global specificity of frozen section analysis for all histological subtypes was 100 % and its sensitivity was 78 %. CONCLUSION : This study shows the good specificity of frozen section .Discordances between frozen-section and definitive diagnosis was associated with microfllicular lesions wich explain the sensibility of 78% Key Words: Thyroid surgery, frozen section examination