OBJECTIVES:Pharyngocutaneous fistula (PCF) is the most frequent complication following total laryngectomy (TL). Its incidence increases in the presence of multiple risk factors related to the patient, the tumor, and the surgical procedure. Our study aimed to determine the incidence of PCF and its risk factors. METHODS:We performed a retrospective study including patients who underwent primary TL (PTL) or salvage TL (STL) between 2007 and 2023. We studied the factors that increased the risk of PCF occurrence, thar are related to the patient, the disease, and the received treatment. RESULTS:We included 132 patients with a male-to-female ratio of 32, who received PTL (91%) or STL (9%). The tumor was staged as T4a in 62% of patients. PCF occurred in 17 patients (13%) after a median of 14 days (5-36). PCF was managed conservatively in 13 patients (76%), while a surgical re-suture was required in four patients (24%).In the univariate analysis, preoperative anemia, STL, widened forward TL, wound infection, and preoperative hypoproteinemia were significantly associated with PCF. In the multivariate analysis, preoperative anemia (P = .012), wound infection (P = .049), and STL (P = .005) were risk factors of PCF. At the multivariate analysis, preoperative anemia [P = .012, odds ratio (OR) = 6.9], wound infection (P = .049, OR = 6.5), and STL (P = .005, OR = 18.45) were independent risk factors of PCF. CONCLUSION:We demonstrated that preoperative anemia, wound infection, and STL were independent risk factors of PCF following TL. Avoiding these circumstances can help prevent PCF occurrence.

Introduction and importance: A plunging ranula corresponds to an extravasation of saliva from the sublingual glands to the submandibular space and adjacent deep spaces. It is a very rare occurrence in children. Its management modalities are still controverted. Case presentation: We report a rare case of a seven-year-old child with no known medical history who presented with a sudden swelling on the floor of the mouth without any triggering factor. Physical examination revealed a bluish painless swelling at the floor of the mouth, fluctuant at palpation. It was associated with submental and submandibular swelling. Cervical computed tomography showed a right-side plunging ranula measuring 6 cm, extended to the ipsilateral submandibular space and the contralateral sublingual space. Multiple aspirations were performed followed by incision and drainage under local anesthesia, which evacuated the cyst. The aspirates of the cyst had a very vicious consistency. After a follow-up period of one year, no recurrence was observed. Clinical discussion: The diagnosis of plunging ranula is based on the clinical and radiological evaluation. Its management is still controverted; it is either conservative or surgical. Conclusion: This study highlights a rare occurrence of a sudden appearance of a plunging ranula in a child to emphasize the importance of making the appropriate diagnosis and management modality.

Tracheal adenoid cystic carcinoma is a rare malignancy. We report the case of a 65-year-old male who presented to our department due to a 3-month history of mild dysphagia without other associated symptoms. The neck, laryngeal, and hypopharyngeal examinations were normal. Ultrasound showed hypertrophy and marked hypoechogenicity of the left thyroid lobe without suspicious nodules. Fine needle aspiration of the hypoechogenic area revealed an adenoid cystic carcinoma. A tracheal origin was then suspected and it was confirmed by a flexible bronchoscopy that showed a tumor located in the proximal tracheal reducing its lumen by 50%. The biopsy confirmed the diagnosis of tracheal adenoid cystic carcinoma. We performed a computed tomography scan showing a mass at the angle between the trachea and esophagus infiltrating the left thyroid gland. Magnetic resonance imaging confirmed the tumor's important local and regionregional extension at the thyroid gland, esophagus, larynx, and mediastinum. The tumor was judged as unresectable and the patient received radiotherapy and an endotracheal sent. After a follow-up period of 2 years, the tumor remained stable, and the patient receivedThis study aims to determine the clinical, radiological, and therapeutic aspects of advanced adenoid cystic carcinoma.

The primary aim of this study is to determine the effects of associating local and systemic corticosteroids on electrical impedance of electrode contacts during the 6 months following cochlear implantation in children. We assessed the effect of this association along the electrode array to evaluate its impact on both basal and apical electrodes. In 2 different patient groups, the evolution of electrical impedances was investigated during 6 months post-implantation. Children in Group 1 received systemic corticosteroids (1 ml injection of 4 mg/ml Dexamethasone (DXM) intravenously 12 hours before the procedure followed by an injection of 1 ml of 4 mg/ml de DXM during the induction of anesthesia). Group 2 received the same systemic corticosteroids with local corticosteroid (intratympanic injection [ITI] of Methylprednisolone (MP) 40 mg/1 ml given at the start of the procedure). Impedances were assessed perioperatively, on the third post-operative day, at 1 week, 1 month, 2 months, 3 months, and 6 months after implantation. We compared the mean impedance values and the average impedance at the apical and basal electrodes between both groups. Impedances in Group 1 were significantly higher than those in Group 2, both perioperatively (P = .037) and on the third post-operative day (P = .027). Starting from the first week and throughout the 6 months post-implantation, the difference between both groups was not significant. When comparing impedances at the apical and basal electrodes between both groups, the mean impedance at the basal electrodes was significantly higher in Group 1 compared to Group 2 at 1 month (P = .042). The association of intratympanic and intravenous corticosteroids results in significantly reduced impedances during the early postoperative period. The basal electrodes have a more pronounced effect from this association. Based on these findings, this protocol is effective in lowering impedances in the short term but not in the medium term following cochlear implantation.

OBJECTIVE:Vocal assessment post thyroidectomy is mainly based on laryngeal endoscopy. The purpose of our study is to assess vocal outcomes following thyroidectomy objectively based on the visual analysis of the glottal area and on acoustic parameters. STUDY DESIGN:Prospective analytical study. METHODS:We included patients who underwent thyroidectomy between September 2021 and February 2022. We performed vocal assessment preoperatively and postoperatively on Day 1 and Month 1 based on acoustic and visual glottal area analysis. The analyzed video-endoscopic glottal features included Maximal and Minimal glottal areas (MaxGA and MinGA), Amplitude Ratio (Ramp), and Phase Symmetry Index (PSI). The analyzed acoustic parameters were fundamental frequency (F0), Jitter, shimmer, harmonic-to-noise ratio (HNR), and glottal-to-noise excitation (GNE). RESULTS:We included 51 patients. At Day 1, we noted vocal fold palsy in nine patients. It persisted in three patients at Month1. MaxGA decreased significantly at Day 1 and Month 1 expressing the limitation of vocal folds (VFs) opening. PSI increased significantly on Day 1 and recovered at Month 1. Ramp decreased significantly on Day 1 then recovered partially at Month 1. F0 decreased significantly on Day 1 without a significant change of the other acoustic parameters. MaxGA correlated significantly with shimmer, GNE, and HNR. CONCLUSION:In our study, thyroid surgery resulted in MaxGA decrease reflecting a dysfunction of VFs abduction. It also resulted in transient asymmetrical VFs movements without causing acoustic and vocal alteration. Glottal area analysis can present an accurate modality to assess VFs movements post thyroidectomy even without associated clinical manifestations.

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Congenital facial nerve (FN) malformations are uncommon. Our aim is to determine the clinical and radiological features of FN malformations along with the associated cochlear and vestibular malformations. We conducted a retrospective study including children with a profound sensorineural hearing loss who were candidates for cochlear implantation. We evaluated the presence of FN malformations through temporal bone computed tomography scan and magnetic resonance imaging. We recorded an aberrant FN course in five out of 165 patients in a total of 9 ears. They consisted of a bifurcation of the mastoid segment, an anterior or posterior displacement of the labyrinthine segment and a hypoplasia of the geniculate ganglion. Associated inner ear malformations included vestibular aqueduct dilation, cochlear hypoplasia and total labyrinthine aplasia. We noted a bilateral agenesis of the cochlear nerve in three patients. Facial nerve malformations should be suspected in patients presenting a congenital hearing loss especially in association with other temporal bone malformations. Their pre-operative discovery is helpful in planning the surgical procedure.

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Hyoid bone fracture unrelated to strangulation is a rare occurrence characterized by a subtle presentation. However, it may manifest as a fatal respiratory distress due to airway obstruction. We present 2 cases of hyoid bone fractures that occurred following a traffic accident in 2 male patients. Both patients presented with either a neck pain or a dysphagia. Physical examination findings were limited to neck sensibility at palpation, saliva stasis, and laryngeal congestion at the laryngeal endoscopy. In both patients, the diagnosis was confirmed through computed tomography. In the first patient, the fracture was simple and located at the body of the hyoid bone, while in the second patient, it involved the greater horn with a medial displacement of the fractured fragment. Due to the clinical presentation, we successfully treated both our patients conservatively through a 48 hour observation, analgesics, steroids, antibiotics, neck rest, and semiliquid diet. This study highlights a rare occurrence of 2 cases of hyoid bone fracture unrelated to strangulation, which emphasizes on the importance of a high clinical suspicion to make the diagnosis of this entity.

Retained needles are frequently observed in intravenous drug users. However, an incidental discovery of multiple needles at the neck seldom occurs. These foreign bodies remain either asymptomatic or cause local and central complications that can be fatal. We report the case of a 43-year-old male having a medical record of human immunodeficiency virus and hepatitis C who presented to our department with a 3-day history of a febrile lateral neck swelling. He reported a history of repetitive intravenous drug use and previous abscesses that were surgically drained. We noted a left and tender 8 cm neck swelling with torticollis. Computed tomography scan showed a collected myositis of the sternocleidomastoid muscle in association to multiple metallic foreign bodies at the neck that were compatible with the aspect of broken needles. Imagery also showed a thrombosis of the ipsilateral jugular vein. No central embolism of a foreign body was noted. We performed a surgical drainage of the muscular abscess and managed to retrieve a 1 cm broken needle that was retained at the level of the collection. We did not retrieve the other needles since they were asymptomatic. The patient was placed under intravenous antibiotics for 1 week followed by oral amoxicillin-clavulanate with a total regression of the cellulitis. At the further follow-ups, the rest of the foreign bodies remained asymptomatic. Our study emphasizes on the importance of suspecting a retained foreign body in intravenous drug users to ensure an adequate management of the possible complications and to protect the medical team from incidental needle injuries.

ObjectivesVocal dysfunction is a frequent complication following thyroidectomy that can be associated with a negative impact on patients’ quality of life. Although the effect of thyroidectomy on acoustic features has been widely studied, the examination of glottal flow characteristics to assess vocal outcomes following thyroid gland surgery has not been included in empirical research, to date. The goal of our study was to evaluate early and short-term vocal outcomes following thyroidectomy based on the analysis of glottal acoustic features during speech production.Study designProspective analytical study.Materials and methodsWe evaluated vocal outcomes in patients who underwent thyroidectomy between September 2021 and March 2022. We extracted glottal flow features from their vocal recordings preceding surgery and postoperatively at Day1 and Month1 postoperatively. The extraction of glottal features was performed using a signal processing-based approach. We extracted the following features: Open quotients (OQ1 and OQ2), Quasi-open quotient (QoQ), Closing quotient (ClQ), Amplitude quotient (AQ), Normalized Amplitude quotient (NAQ) and Speed quotients (SQ1 and SQ2).We included 39 patients. OQ2 and QoQ decreased significantly at Day1 and Month1. OQ1 and NAQ decreased significantly at Month1. ClQ remained stable at both postoperative assessments. AQ decrease was not significant at both dates. SQ1 increased at Day1 and Month1 but the change was not significant. SQ2 decreased significantly at both Day1 and Month1. OQ, QoQ, AQ, NAQ, and SQ2 did not recover at Month1. We noted that the decrease of SQ1 and SQ2 correlated significantly with the increase of the Voice Handicap Index-10 (VHI-10) at Month1.ConclusionThe analysis of glottal acoustic features can be a reliable modality to detect vocal changes following thyroidectomy. Thyroidectomy was associated with a vocal dysfunction that was manifested by the decrease of open, amplitude, and speed quotients. Glottal features can present a potential tool to objectively assess the effect of thyroidectomy on vocal folds movements.

Introduction and importance: Superior ophthalmic vein thrombosis (SOVT) is a very rare condition that can occur following either septic or aspetic causes. Early recognition and management is important in order to avoid vision-threatening and fatal complications.Case presentation: A 28-year-old man presented with orbital cellulitis complicating acute pansinusitis. CT scan revealed ipsilateral SOVT. The patient received intravenous antibiotics and anticoagulation with strict ophthalmic monitoring. No orbital complications were recorded during the course of treatment.Clinical discussion: SOVT is caused either by septic or aseptic causes. Treatment depends on the etiology. Cor-ticosteroids and anticoagulants are controversial.Conclusion: Early diagnosis is key to successful management of SOVT.

Background: Postoperative pain increases the risk of postoperative complications and may predispose patients to chronic post-surgical pain. This study aims to evaluate the impact of ketamine wound infiltration versus placebo at the end of thyroid surgery on postoperative pain and analgesic requirements. Methods: In this randomized controlled trial, we prospectively studied patients who underwent thyroid surgery. Patients were randomized into two groups: group S, where local infiltration was performed using 10 ml of a physiological saline solution; and group K, where 10 ml of a solution containing 2 mg/kg ketamine was infiltrated. Standardized thyroidectomies were performed in the 2 groups. Pain perception was measured using a visual analog scale (VAS) every 10 minutes in the post-anesthetic care unit (PACU) for 2 hours and thereafter every 6 hours during the first 24 hours. The opioid requirement in the PACU was evaluated. A comparison between the 2 groups was carried out. Results: Postoperatively, the mean VAS was higher in group S compared to group K during all PACU stay periods and the first 24 hours. Pain scores during swallowing were significantly lower for group K in the PACU at 0, 10, and 20 minutes. The mean morphine consumption in the PACU was 0.71 mg and 0 mg respectively in group S and group K (p=0.03). The incidence of nausea and vomiting was similar in both groups. Conclusions: Ketamine wound infiltration is an efficient modality to reduce postoperative opioid consumption compared to a placebo after thyroid surgery.

Background: Postoperative pain increases the risk of postoperative complications and may predispose patients to chronic post-surgical pain. This study aims to evaluate the impact of ketamine wound infiltration versus placebo at the end of thyroid surgery on postoperative pain and analgesic requirements. Methods: In this randomized controlled trial, we prospectively studied patients who underwent thyroid surgery. Patients were randomized into two groups: group S, where local infiltration was performed using 10 ml of a physiological saline solution; and group K, where 10 ml of a solution containing 2 mg/kg ketamine was infiltrated. Standardized thyroidectomies were performed in the 2 groups. Pain perception was measured using a visual analog scale (VAS) every 10 minutes in the post-anesthetic care unit (PACU) for 2 hours and thereafter every 6 hours during the first 24 hours. The opioid requirement in the PACU was evaluated. A comparison between the 2 groups was carried out. Results: Postoperatively, the mean VAS was higher in group S compared to group K during all PACU stay periods and the first 24 hours. Pain scores during swallowing were significantly lower for group K in the PACU at 0, 10, and 20 minutes. The mean morphine consumption in the PACU was 0.71 mg and 0 mg respectively in group S and group K (p=0.03). The incidence of nausea and vomiting was similar in both groups. Conclusions: Ketamine wound infiltration is an efficient modality to reduce postoperative opioid consumption compared to a placebo after thyroid surgery.

After a thyroid surgery, patients often endure a pain when speaking and suffer from an unpleasant voice change. Sometimes, this change is temporary. Other times, it is due to a laryngeal nerve damage. Therefore, otorhinolaryngologists need to employ sophisticated tools to objectively detect the possible injury in order to prescribe a suitable treatment. To this purpose, they resort to computer vision based techniques to objectively analyze the functioning of the vocal folds before and after the surgery. Our work falls within this framework with a collaboration with the ENT department of the University Hospital Center Habib Bourguiba of Sfax. In this paper, we propose an end-to-end video based solution. We start by preparing and creating the reference database. The glottal region is delineated in each frame. For each patient, relevant features of the glottal area are extracted in video sequences before and after the surgery. Univariate and multivariate statistical tests are performed to decide if these features have significantly changed due to the surgery. The experimental results indicate the relevance of the proposed approach.

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Burkitt Lymphoma (BL) is a highly aggressive B-type non-Hodgkin lymphoma. It rarely develops at the level of the sinonasal cavities, especially in young children. We present the case of a 2-year-old boy who presented with a 2-month history of nasal obstruction, snoring, and epistaxis followed by a recent dyspnea. Examination revealed a protruding tissue mass in the left nasal cavity. Computed tomography scan showed a homogenous soft-tissue mass in the left nasal cavity extending toward the ipsilateral orbit, infratemporal fossa, nasopharynx, as well as the ethmoid and maxillary sinuses. Magnetic resonance imaging revealed a homogenous infiltrating mass with a hypo-intense signal on T2-weighted images reaching the infratemporal fossa and oropharynx. Biopsy confirmed the diagnosis of BL. The patient was referred to the clinical hematology department and received complex chemotherapy. Following chemotherapy, imaging revealed significant regression of the mass. We performed a nasopharyngeal biopsy which confirmed the absence of any persistent disease. This case report highlights a rare case of an extensive sinonasal BL emphasizing the importance of a high level of suspicion to ensure an early diagnosis and treatment.

After thyroid surgery, some patients complain of voice disorders, recurrent laryngeal nerve palsy, hoarseness, and breathing problems, which can significantly impact their quality of life. In this paper, we sought to assess and identify the impact of thyroidectomy on voice quality by following some patients before and after surgery. To accomplish this, we collected a dataset of voice recordings from patients one day before, one day after, and one month after thyroid surgery. Then, we extracted acoustic features related to harmonicity and pitch variations in amplitude and duration and used statistical tests to study the discrimination abilities of these features in preoperative and postoperative. The results revealed that the (mean, max, min, and median) fundamental frequency values were not significantly decreased in the first postoperative stage. However, they changed significantly in the second postoperative stage. For females, the Max (F0) was not changed after one day and one month. The other parameters did not differ between the preoperative and postoperative. The analysis and results clarify that thyroidectomy can affect voice quality for up to one month. Further studies are needed to fully understand the factors behind these alterations.