Infections profondes de l'espace cervical-défis diagnostiques et thérapeutiques Introduction. Les infections des espaces plus profonds du cou sont souvent un défi clinique, en tant qu'urgences médico-chirurgicales à un mauvais pronostic et un potentiel mortel dans l'absence d'un diagnostic précoce et bien appliqué. Rapport du cas 1. Le premier cas présenté est celui d'une femme de 72 ans atteinte d'anémie due au syndrome myélodysplasique, admise au service d'hématologie. Les symptômes étaient une dysphagie avec odynophagie et une tuméfaction sous-maxillaire droite, sur un fond apyrétique. Dans ce cas, l'infection a commencé par un abcès péri-amygdalien qui s'est ensuite développé en un abcès para-pharyngé. Les principales difficultés médicales sont apparues après la chirurgie, l'état général du patient s'aggravant malgré l'évolution favorable de la plaie chirurgicale. Une récupération totale, y compris la déglutition, était possible deux mois après avoir quitte l'hôpital. Rapport du cas 2. La deuxième patiente est une jeune femme de 26 ans avec un bon statut social et matériel, sans comorbidités associées.
Cervical lymph node metastases of squamous cell carcinoma from occult primary constitute about 3-5% of all patients with carcinoma of unknown primary site (CUP). Identification of subgroups with favorable prognosis is of decisive importance for the therapy of patients with CUP syndrome, including prolonged survival from directed treatment. The patients with neck node metastases from occult head and neck cancer have clinical features and prognosis similar to other head and neck malignancies. Treatment of patients with metastatic squamous cell carcinoma involving cervical lymph nodes of an unknown primary origin should be similar to that of patients with locally advanced carcinoma of the head and neck. Therapeutic approaches include surgery (lymph node excision or neck dissection), with or without post-operative radiotherapy, radiotherapy alone and radiotherapy followed by surgery. In early stages (N1), neck dissection and radiotherapy seem to have similar efficacy, whereas more advanced cases (N2, N3) necessitate combined approaches. The extent of radiotherapy (irradiation of bilateral neck and mucosa versus ipsilateral neck radiotherapy) remains debatable. A potential benefit from extensive radiotherapy should be weighted against its acute and late morbidity and difficulties in re-irradiation in the case of subsequent primary emergence. The role of other methods, such as chemotherapy and hyperthermia, remains to be determined.
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