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Retropharyngeal abscesses are rare in adults. They occur mostly in immunocompromised patients or as a foreign body complication. We report 5 cases of retropharyngeal abscess collected in the ENT Department of CHU Mohammed VI of Marrakech, during a two-year period (December 2008 to December 2009). Local trauma by foreign body ingestion was the aetiology in four patients. The presenting symptoms, for all patients, were fever, odynophagia, torticollis, and trismus, and the clinical examination showed bulging of the posterior wall of the oropharynx. The radiography of cervical spine showed prevertebral thickening in all cases, this thickening was associated with an aspect of vertebral lysis of the fourth cervical vertebra in one case. A CT scan was performed in all our cases and showed features of retropharyngeal abscess which was associated, in one case, with spondylodiscitis. The biological assessment found one case of diabetes. The intradermal reaction to the tuberculin was clearly positive in one case. Endobuccal abscess puncture was practiced in 4 cases; only one organism was identified by culture:Staphylococcus aureustreatment was based on triple intravenous antibiotics and anti-Koch's therapy (in one case), and the surgical drainage under general anesthesia was also performed in the case of the diabetes patient which required also the correction of hyperglycemia in intensive care unit. The outcome was good in all our patients. The diagnosis of retropharyngeal abscess can be difficult and one must seek a comorbidity; a tuberculosis aetiology must be considered in countries with a high prevalence. The management of these cases is based on antibiotics and surgical drainage.

SummaryIntroductionThe aim of this article is to describe the clinical, radiological, and therapeutic aspects of well-differentiated liposarcomas of the hypopharynx.Case presentationWe report the case of a 34-year-old woman seen for dysphonia and dyspnea. The nasal endoscopy found a well-delimited ovoid tumefaction, attached at the right lateral wall of the hypopharynx. The diagnosis of a well-differentiated liposarcoma was made based on the histopathology of the surgical specimen.Discussion/conclusionThe incidence of well-differentiated liposarcoma of the head and neck is extremely low. The imaging is not specific. Wide surgical resection is sufficient. Histopathological review confirms the diagnosis.

Tumors of the parapharyngeal space are rare and composing a wide variety of histological types. The aim of this study was to report a case of giant parapharyngeal lipoma in a child and to present clinical, paraclinical, and treatment aspects.A 14-year-old child presented with a painless progressive mass on the right side of the upper neck. It was growing asymptomatically since 2 years. Cervical CT-scan and MR showed a low-density mass in the right parapharyngeal, consistent with a mass of adipose tissue origin. The mass was surgically removed via cervical-parotid approach. The fatty mass was completely excised. Histopathology confirmed it to be a lipoma. The patient has been followed up for three years, and there have been no signs of recurrence.Diagnostic orientation in parapharyngeals tumors is necessary for better care. This guidance is being facilitated through imaging advances. Their surgical approaches and complete excision depend on volumes, localizations and their proximity to neurovascular structures.

Cephalic tetanus is a rare presentation of localized tetanus (1 to 3% of localized presentations). It is a very rare cause of peripheral facial palsy.We report a case of cephalic tetanus revealed by peripheral facial palsy and trismus.Facial peripheral palsy often appears after trismus. It is very rarely the first symptom of cephalic tetanus, making the diagnosis difficult.

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.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.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.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.

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.

The pleomorphic adenoma is the most common benign neoplasm of primary salivary glands. However, its intranasal localization is exceptional. We report a case of pleomorphic adenoma of the nasal septum.A 64-year-old man presented with a left rhinological syndrome with nasal obstruction. A facial CT-scan showed a heterogeneous tumor of the nasal septum obstructing the left nasal vestibule. The biopsy analysis proved the histological characteristics of a pleomorphic adenoma, and was further confirmed by immunohistochemical study. The lesion was completely removed by endonasal surgery. There was no recurrence 18 months after surgery.The treatment of nasal pleomorphic adenomas must take into account lesion localization, esthetic complications, and evolutionary potential of the lesions. Long-term follow-up is recommended because of the risk of recurrence or malignant degeneration.

The orbital apex syndrome is defined by the association of visual loss, ophtalmoplegia, blepharoptosis, proptosis along with forehead and upper eyelid anesthesia. This syndrome is secondary to traumatism, malignancy or infection of orbital apex. Herpes zoster is an uncommon cause. We discuss the physiopathologic mechanism, evolution and management of this affection.

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.

Osteoarticular tuberculosis is the fourth leading extrapulmonary localization of tuberculosis. The disease has a progressive course and is often diagnosed in the stage of bone destruction, causing an important diagnostic problem in diabetics with nervous osteoarthropathy. We report the case of a 23-year-old patient with multicomplicated diabetes type 1, treated for pulmonary tuberculosis who consulted after a trauma distended the left ankle. Bone biopsy was performed because of the diagnostic doubt between diabetes and infectious osteoarthropathy. Pathology reported active tuberculosis. Osteoarticular tuberculosis is still a severe disease because of the functional prognosis that requires early diagnosis, a difficult task in some conditions particularly in the diabetic where the disease may mimic nervous osteoarthropathy. Bone biopsy should be performed if there is a doubt.

The authors report one case of percutaneous angioplasty of atherosclerotic symptomatic stenosis of brachiocephalic artery. Angioplasty had been performed using an occlusive balloon in internal carotid artery to realize a cerebral protection. This safer technics allowed to heal the stenosis and the brachiocephalic steal syndrome, without cerebral embolies.

Summary Introduction Congenital internal jugular phlebectasia corresponds to congenital dilatation of the vein without tortuosity. More than one hundred cases of phlebectasia involving the neck veins have been reported in the literature. The authors describe the clinical features, treatment and outcome of this anomaly. Case report A six-year-old child with no particular past medical history presented with a two-year history of progressively enlarging mass on the right side of the neck. Physical examination revealed a non-pulsatile mass that was increased in size by all manoeuvres increasing intrathoracic pressure. Neck computed tomography confirmed the diagnosis of internal jugular vein phlebectasia. In the absence of complications, simple surveillance was advised with a follow-up of 20 months with no complications. Discussion/Conclusion Congenital internal jugular phlebectasia is a rare condition. Management must include imaging to confirm the diagnosis. Long-term surveillance is recommended and surgery is only required in the presence of complications.