Azza Mediouni

Introduction : Une évaluation préopératoire précise de la sténose trachéale est essentielle pour orienter le traitement. La bronchoscopie est le« gold standard », mais le scanner offre des résultats prometteurs. Cette étude compare la précision du scanner et de la bronchoscopie dans lacaractérisation de la sténose trachéale.Méthodes : Une étude descriptive et analytique sur 10 ans (2013-2023) a inclus 20 patients atteints de sténose trachéale confirmée par scanner etbronchoscopie. Les paramètres étudiés incluaient la distance sténose-glotte, l’atteinte sous-glottique, la longueur de la sténose, le grade de sténose(classification de Meyer-Cotton) et l’état de la muqueuse.Résultats : La distance moyenne sténose-glotte était de 34 mm dans les deux examens, avec une corrélation significative (r=0,777, p=0,000).La longueur moyenne était de 17,6 mm au scanner et 15,8 mm à la bronchoscopie, avec une corrélation significative (r=0,689, p=0,001). Dansdeux cas, la sténose était infranchissable par le bronchoscope. Le scanner a correctement prédit le grade de sténose dans 70 % des cas (r=0,736,p=0,000). La sensibilité pour détecter l’atteinte sous-glottique était de 50 % et pour les granulomes de 25 %, avec des spécificités respectives de94,4 % et 93,8 %.Conclusion : Le scanner corrèle bien avec la bronchoscopie pour mesurer la distance, la longueur et le grade de sténose, mais reste limité pourdétecter l'atteinte sous-glottique et les granulomes. Une combinaison des deux techniques est recommandée pour une évaluation optimale avanttraitement.

Obstructive sleep apnea (OSA) may be linked to various factors that narrow the upper airways, such as obesity, adenotonsillar hypertrophy and craniofacial abnormalities. Hypothyroidism has also been described as a risk factor for OSA. However, the implication of goiter independently of thyroid function in the occurrence of OSA remains unclear. We present the case of a 66-year-old woman with a large compressive multinodular goiter for whom total thyroidectomy was indicated. During the preoperative assessment, the patient had a body mass index (BMI) of 37.8 kg/m² with symptoms of OSA. Respiratory polygraphy confirmed the diagnosis of severe OSA (apnea–hypopnea index (AHI) = 32), and treatment with continuous positive airway pressure (CPAP) was initiated prior to thyroid surgery. Surprisingly, after total thyroidectomy, OSA symptoms disappeared, and the patient abandoned CPAP therapy. Subsequent respiratory polygraphy after thyroidectomy showed a decrease in AHI to a normal value (AHI < 5). Interestingly, there was no change in BMI or other factors explaining the resolution of OSA, except for thyroidectomy. This case report suggests that goiter can be considered a risk factor for OSA. However, prospective studies are needed to accurately assess the effects of goiter on the occurrence of OSA according to its dimensions and local extension.

Obstructive sleep apnea (OSA) may be linked to various factors that narrow the upper airways, such as obesity, adenotonsillar hypertrophy and craniofacial abnormalities. Hypothyroidism has also been described as a risk factor for OSA. However, the implication of goiter independently of thyroid function in the occurrence of OSA remains unclear. We present the case of a 66-year-old patient, with a large compressive multinodular goiter for whom total thyroidectomy was indicated. During the preoperative assessment, the patient showed a body mass index (BMI) of 37.8 kg/m2 with symptoms of OSA. Respiratory polygraphy confirmed the diagnosis of severe OSA (apnea hypopnea index: AHI=32) and treatment with continuous positive airway pressure (CPAP) was initiated prior to thyroid surgery. Surprisingly, after total thyroidectomy, OSA symptoms disappeared and the patient abandoned CPAP therapy. Subsequent respiratory polygraphy after thyroidectomy showed a decrease in AHI to a normal value (AHI < 5). Interestingly, there was no change in BMI or other factors explaining the resolution of OSA, except for thyroidectomy. This case report suggests that goiter can be considered a risk factor for OSA. However, prospective studies are needed to accurately assess the effects of goiter on occurrence of OSA according to its dimensions and local extension.

The distinction between tuberculosis and sarcoidosis presents sometimes a clinical challenge. Their sequential occurrence in the same patient is uncommon. We present the case of a 42-year-old female with a proven diagnosis of tuberculous lymphadenitis who has developed successively nasal tuberculosis and pulmonary and liver sarcoidosis.

Non‐recurrent Laryngeal nerve is constantly associated with Arteria Lusoria. Knowing this association is the basis of predicting this condition preoperatively. Ultrasonography assessment before thyroid and parathyroid surgery should include identification of brachiocephalic trunk division. Absence of its visualization indicates Arteria Lusoria and then non‐recurrent laryngeal nerve.

Non recurrent laryngeal nerve (NRLN) is an extremely rare entity constantly associated with an aberrant right subclavian artery also called arteria lusoria. Knowing this association can help predicting a NRLN preoperatively and thus to prevent its injury. We present two patients in whome this association was proven.