Limits to the practice of craniofacial oncology in Black Africa: the example of cancer of the larynx]

Cervico-facial carcinology is currently one of the major concerns of oto-rhino-laryngologists. The authors have chosen laryngeal cancers to determine the limits of the practice of such cervico-facial carcinology in the topics. Over a 10-year period, 61 patients with a suspected malignant laryngeal disease were examined at the E.N.T. Clinic of the University Hospital in Dakar. Histological confirmation was found in only 38 patients, and a curative treatment was undertaken with 27 patients. No significant differentiation could be found from the results as far as sex, age and histology were concerned. On the other hand, the TNM breakdown of our 36 carcinomas revealed that in 78% of the cases large tumours (T3, T4) were involved. In the vast majority of these cases (18/27), treatment was purely surgical, with a total laryngectomy in 90% of the cases. Pharyngostomas accounted for the majority of the early postoperative complications (6/14). Over 10 years of practice, 70% of our patients have died or have been lost from sight. These poor results are due to numerous factors, including late consultation, the lack of specialists and the insufficiency of technical facilities. To improve results, the authors recommended the setting-up of proper cancer institutes.     

Anatomical basis of neuropathies and damage to the ilioinguinal nerve during repairs of groin hernias. (about 100 dissections)

Surgical access to the inguinal region, notably during hernia repairs, exposes the ilioinguinal nerve to the risk of damage at the origin of the neuralgia. The incidence of these post-operative neuropathies and their medicolegal consequences justify this study about the anatomical variations of the ilioinguinal nerve. With the aim of preventing its damage during repairs of groin hernias and identifying the factors of onset of chronic spontaneous neuropathy of the ilioinguinal nerve, we dissected 100 inguinal regions of 51 fresh adult corpses. The nerve was absent in seven cases and double in one case. Out of the 94 ilioinguinal nerves observed, we analyzed the path in relation to the inguinal ligament and the connections with the walls of the inguinal canal and its content. The ilioinguinal nerve travels along the superficial surface of the internal oblique muscle, passing on average 1.015 cm from the inguinal ligament. In one case, the fibers of the internal oblique muscle spanned it in several places. The nerve was antero-funicular in 78.72% of cases and perforated the fascia of the external oblique in 28.72% of cases. The terminal division took place in the inguinal canal in 86% of cases, with terminal branches that sometimes perforated the fascia of the external oblique. These results enabled us to better understand the etiopathogenic aspects of certain neuropathies of the groin and to propose techniques useful for the protection of the nerve during repairs of groin hernias.