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Gingival hyperplasia is a relatively frequent pathologic condition during orthodontic treatment. Oral hygiene can be easily altered in such cases because of additive and irritative effects of orthodontics appliances. So, adequate control of the gingival inflammation is required. The present case reports on a 13-year-old boy who developed, during orthodontic treatment, a gingival hypertrophy that was successfully treated with periodontal surgery consisting on an apically positioned flap procedure. For this purpose, multidisciplinary approach involving orthodontist and periodontist was crucial in the perspective of optimal clinical issues.

Based on the principle of the sphere of MONSON, the Broadrick flag technique constitutes a relatively simple means to determine the plan of occlusion, by using a radius fixes of 104 mm. The theory of MONSON was debated a long time. Our work consists of a clinical study realized in the CCTD of Casablanca, on 31 completely toothed cases normocclusion. Its objective was triple: to calculate on the profile teleradiographies, the anatomical and geometrical rays used for the construction of SPEE curve, to see if there is concordance between these two rays and finally to compare them with the theoretical value of 104 mm. From the obtained results it would seem that: The 104 mm value, cannot be considered as a standard average to be used to determine the curve of occlusion, also the articulator such as it is designed currently cannot be used in all the patient's about is the values of their rays. In the absence of molars, the anatomical radius cannot be used in place of the geometrical radius to determine the curve of occlusion. The measured gap between the obtained curve and the plan of occlusion remains not insignificant, he can reach 3 mm for the anatomical radius and 3,5 mm for the geometrical radius. In the total edentate, the cephalometric determination of occlusion plane, by basing itself on the anatomical radius or the geometrical radius is not possible.

The daily business of every orthodontist is to correct malocclusions and the patient's accompanying unesthetic appearance, thus enhancing his/her social integration and boosting their self-esteem. Consequently, we considered it necessary to have the facial esthetics of the Moroccan population assessed by two panels, one a lay group representing the general public, the other a panel of professionals. We conducted a transverse descriptive inquiry on 100 students from the Casablanca School of Dental Medicine. Views showing the full face, profile and three-quarters smile were submitted for evaluation by the lay and professional panels. Statistical comparison showed a significant correlation between the two panels. Cephalometric findings of the eight cases judged to be the most attractive were compared with Steiner analysis and showed concordance for the majority of the measurements studied. Likewise, comparison of the opinions of the male and female sections of the panels demonstrated significant concordance.

Multibracket orthodontic appliances increase dental plaque retention and make teethbrushing more difficult for patients. As a result, advice from the orthodontist on oral hygiene along with patient motivation regarding teethbrushing are particularly important. The aim of this study was to compare the efficacy of electric toothbrushes with that of manual brushing associated with mouth-rinses comprising chlorhexidine (0.12%) and 0% alcohol. To this end, 84 patients receiving current orthodontic treatment were randomly selected from patients treated at the Dento-Facial Orthopedics department in the Casablanca Dental Consultation and Treatment Center. Selected patients were divided into three groups: Group 1: manual teethbrushing; Group 2: electric teethbrushing; Group 3: manual brushing combined with mouth rinse. Oral hygiene was assessed using the Loe-Silness plaque and gingival indices. Measurements were made before and 4 weeks after the observation period. Results were subjected to statistical comparison in order to determine the group showing greatest improvement and to deduce the best means of controlling bacterial plaque. The electric toothbrush and the chlorhexidine mouth rinse appear to control dental plaque more effectively than manual teethbrushing alone. Following this study, patients receiving multibracket treatment were invited to combine manual brushing with short clinical mouth-rinsing sessions or to use an electric toothbrush.

To illustrate the value of cross-sectional imaging (CT, MRI) for the diagnosis and follow-up of intracranial hydatid cysts in children.Retrospective study of 9 cases of intracranial hydatid cysts in children seen over a period of 8 years. Precontrast and postcontrast 5 mm thick axial CT images were obtained in 7 cases. Noncontrast sagittal, axial and coronal T1W and T2W images were obtained in 2 cases.Mean patient age was 7.5 years. Intracranial hypertension was the main presenting clinical symptom. A single supratentorial cyst with significant mass effect upon the ventricular system and midline structures was observed in all cases. All patients underwent surgery with good outcome in all cases.CT is the imaging modality of choice for diagnosis and postoperative follow-up of intracranial hydatid cysts in children. MRI is most helpful for further characterization when multiple or atypical cysts are present to optimize management.

Chromomycosis is a chronic infection caused by various fungi. Bone involvement is exceptional. The purpose of this report is to describe a case of chromoblastomycosis localized on the tarsal bone in a 27-year-old man from southern Morocco. The patient was a former barefoot long-distance runner. He presented with thickening of the skin with a cutaneous fistula on the left forefoot. These manifestations had been ongoing for 2 years. Imaging demonstrated scattered lytic lesions involving tarsal bone and the base of the third metatarsus. Definitive diagnosis was based on direct mycological examination and anatomopathology. Medical and surgical treatment led to stabilization of the lesions. No recurrence was observed during follow-up examination two years later.

Patients undergoing orthodontic treatment can experience an unpleasant painful sensation. This has been proven by several studies. Controling pain during orthodontic treatment is in the interest of both practitioner and patient. The aim of this study was to compare the effect of ibuprofen and paracetamol on orthodontic pain. To this end, a sample of 56 patients was divided into two groups: Pain levels were assessed using the visual analog scale at 2h, 6h, 24h, day 2, day 3 and day 7 after insertion of the first archwire. Results show that there is no significant difference between ibuprofen and paracetamol regarding control of orthodontic pain except during the first two hours after archwire insertion when paracetamol was observed to be slightly more effective than ibuprofen. Comparison by age and gender revealed no significant differences. Thus, we can conclude that paracetamol and ibuprofen are painkillers of choice in the relief of orthodontically-related pain.

Temporal bone trauma is frequent but difficult to assess due to the diversity of clinical presentations and complex anatomy. We have sought to assess the different types of fractures and complications on high-resolution CT. Materials and methods. Descriptive retrospective study over a 24 month period performed in the ENT radiology section of the Mohammed VI university medical center in Marrakech. A total of 38 cases of temporal bone trauma were reviewed. All patients underwent ENT evaluation and high-resolution CT of the temporal bone using 1mm axial and coronal sections.Mean patient age was 33 years (range: 14-55 years) with male predominance (sex ratio: 36/2). Clinical symptoms were mainly otorrhagia and conductive hearing loss. Oblique extra-labyrinthine fractures were most frequent. Two cases of pneumolabyrinth were noted. Management was conservative in most cases with deafness in 3 cases.High-resolution CT of the temporal bone provides accurate depiction of lesions explaining the clinical symptoms and helps guide management. MRI is complimentary to further assess the labyrinth and VII-VIII nerve complex.

Sacrococcygeal teratomas are rare congenital tumors, generally discovered at birth. These tumors are seldom observed in children. Radical resection must be performed to avoid potentially malignant recurrence even if the primary lesion is benign. We report a case in an 8-year-old girl who did not have a past medical history. Since the age of 2 years, she presented a progressive sacral tumefaction with no neurological deficit. The MRI showed a large sacrococcygeal cyst in hypointense-signal T1-weighted imaging with no contrast enhancement, and a hyperintense signal in T2-weighted imaging. At surgery, the tumor was totally removed. The intraoperative aspect was that of a viscous cyst. The histological study showed a sacrococcygeal teratoma.

A 47-year-old man with a history of lung adenocarcinoma presented a red and painful right eye with loss of visual acuity after the 5th course of chemotherapy. The ophthalmologic exam showed visual acuity at 3/10 and diffuse iris nodular lesions in the same eye. The fundus was not visible. The controlateral eye was normal. The ocular scan showed iris tumors without choroidal metastasis. Systemic medical evaluation demonstrated no other metastases. The patient died 1 year later.

To assess the indication for operative and nonoperative management of renal stab wounds in patients hospitalised over the last six years.Retrospectively studied of 20 cases over the last six years with penetrating kidney trauma, managed in two urologic departments of Marrakech and Casablanca. We studied the signs on admission (haematuria, blood pressure, haemoglobin and serum creatinine), associated lesions, treatment and complications. The imaging procedures comprised abdomen ultrasonography and abdomen computed tomography scan (CT).The mean age was 25-year-old (range: 14-50 years), macroscopic hematuria was present in 95%. The weapon introduction site was the left lumbar fossa in 15 cases, the right lumbar fossa in four cases and the left flank in one case. Six patients (30%) presented with haemodynamic instability. Anaemia (10g/dl) was found in 14 cases (70%) and blood transfusion was necessary in eight cases (40%). According to the American Association of Trauma Surgery (AATS) classification of kidney trauma, our patients were classified as follows: Grade I (two cases), Grade II (four cases), Grade III (six cases), Grade IV (five cases) and Grade V (three cases). The conservative management was adopted for 15 patients (75%), and two patients had a double pigtel ureteric stent for an important leakage of the contrast product. A CT scan was systematically performed ten days after the trauma and the kidney traumas lesions were often stabilized. Nephrectomy was performed for 5 patients (25%) grade IV (two cases) and grade V (three cases). The patients were discharged after a mean period of 12 days (six to 33 days).The development of interventional radiology, endourological drainage techniques and medical intensive care helps to limit the complications and to manage conservatively with a correct resuscitation for selected patient. A grade V is a surgical indication.

Isolated central nervous system (CNS) tuberculoma is rare. Central nervous system tuberculosis (TB) is associated with high morbidity and mortality despite modern methods of detection and treatment. The authors report a case of a giant cerebellar tuberculoma mimicking a malignant tumor and review the literature.A six-year-old girl, with no past medical history, vaccinated for her age, presented with a three-month history of occipitocervical cephalalgia, complicated by gait disturbances. The MRI showed a left cerebellar tumor suggestive of a medulloblastoma. At surgery, a nodular, avascular lesion was found and pathological examination confirmed tuberculoma. Intracranial tuberculoma is an uncommon variety of central nervous system tuberculosis. The prognosis is related to the rapidity of diagnosis, surgical resection and the complementary antituberculosis treatment.Intracranial tuberculoma is an uncommon variety of central nervous system infection. Prognosis is improved by a quick diagnosis, surgical removal, and associated antituberculoma therapy.

Spinal tuberculosis is a frequent skeletal involvement in tuberculosis. We report 122 cases between 1983 and 1998 of Pott's disease explored by plain radiographies in all cases, CT-scan in 22 cases and MRI in 6 cases. The lesion involved one localization in 98 cases, two localizations in 9 cases and multiple localizations in 15 cases. The usual form associating the discal and vertebral involvement was noted in 70%. Unusual forms were seen in 30% of the cases The localizations were: posterior arch (20 cases), centrosomatic (10 cases), suboccipital (4 cases) and subligamentar (2 cases). In addition, the CT scan noted vertebral lesion with soft tissue abscess in all cases and epidural lesion in 9 cases. MRI performed in 6 cases showed epidural lesions in 4 cases: epiduritis (2 cases) and abscess (2 cases). The disco-vertebral puncture-biopsy, performed in 12 cases, confirmed the diagnosis in 7 cases. The diagnosis of Pott's disease was confirmed biologically in 30 cases. Radiographic exploration of Pott's disease is improved by the contributions of CT and MRI which can identify sequestra, perilesional sclerosis and epidural or soft tissue abscesses. Discovertebral aspiration biopsy provides the key to diagnosis.

Authors report spontaneous necrosis of a sellar hemangiopericytoma, in a 44 year old man, revealed by a right cavernous syndrome. The initial CT scan showed a right sellar and parasellar spontaneous hyperdense process, intensely and homogeneously enhanced by contrast-agent. This process invaded the right cavernous sinus and extended to the sphenoid sinus. Magnetic resonance imaging showed a lesion in isointense on T1-weighted sequence and slightly hyperintense on T2-weighted sequence, with an intense and homogenous enhancement. The follow-up CT scan performed 6 months later, showed a total necrosis of the lesion. Angiography showed a slightly vascularised process, with mass effect on the carotid and sylvian vessels. The sellar and parasellar localization of hemangiopericytoma is rare. The spontaneous necrosis is exceptional, but it enabled us to distinguish it from meningioma.

The authors report a case of an heterotopic pregnancy where the transabdominal US was more useful than endovaginal US. The embryon in this case was located in upper zone of the right iliac fossa, inaccessible to endovaginal US. Both methods are complementary.

The authors report a case of bilateral malignant teratoma of the mediastinum in a 40 year old female presenting with chest pain. Two separate bilateral soft tissue masses were noted in the mediastinum at imaging. On the right side, the mass was heterogeneous with large calcification and infiltration of the pericardium. On the left side, the mass was well defined, heterogeneous and without evidence of local invasion. The analysis of samples obtained by US guided puncture biopsy and surgical specimen of the two masses confirmed the diagnosis of pluricellular malignant teratoma. Mediastinal malignant teratomas represent 1 to 5% of all mediastinal tumors. To our knowledge, no case of synchronous bilateral mediastinal teratoma has never been reported.

To report the radiological polymorphism of angiomyolipoma (AML).[corrected] A retrospective series of eight cases of AML explored by US and CT scan. The diagnosis was radiological in seven cases and histopathological in one case.Five cases of AML were discovered fortuitously. The tuberous sclerosis of Bourneville disease (TSB) was noted in five cases. The cverage age was 37 years with female predominance noted in seven cases. The AML were multiple in half cases all of thein had TSB. The tumoral size ranged from 0.5 cm and 20 cm. The US showed an homogenous hyperechogenique mass in six cases and heterogenous in two cases. The CT scan showed polymorph parenchymal lesions. The fatty component was detected in seven cases. An intratumoral bleeding was noted in one case.The radiological feature of AML is variable, related to tumoral size. It's typical when a tumor of kidney contains fat. An association with TSB is a supplementary argument of diagnosis.

We report a series of 10 cases of centrosomatic tuberculosis of the spine. The mean age of the patients was 36 years. Plain x-rays of the spine showed isolated defects in 3 cases, a defect with wedge fracture in 3 and a wedge fracture alone in 2. A sequestrum was found in 2 cases and bony condensation around the defect in 6. A CT scan performed in 3 cases showed, in addition to the bone lesions, a perilesional bony condensation in all cases. Soft tissue abscess formation was noted in 1 case and epidural involvement in the 2 others. MRI performed in 2 cases evidenced an alteration of the vertebral body signal with localized anterior epiduritis at the site of a small epidural abscess. CT scan and MRI contribute usefully to the radiographic diagnosis of centrosomatic tuberculosis, evidencing sequestra, bony condensation at the periphery of defects, and the presence of soft tissue abscesses and or epidural involvement. When these signs are absent, the differential diagnosis may be difficult with other causes of tumor formation, requiring vertebral biopsy.

Analysis of imaging features of malignant stromal tumors of the small bowel and review of literature.9 cases of malignant stromal tumor of the small bowel with histological proof were imaged at US (8 cases), small bowel series (9 cases) and CT scan (3 cases).There were 6 cases of leiomyosarcoma and 3 cases of malignant schwannoma. Tumors involved the jejunum in 3 patients, the ileum in 4 patients, and the duodenum in 2 patients. The main clinical presentation was an abdominal mass (8 cases), which appeared heterogeneous and hypoechoic with eccentric lumen at US confirming its GI origin (7 cases). Small bowel series showed a bulky cavitary mass opacified via a thin fistula (7 cases), an ileo-ileal intussusception (1 case) and enlarged duodenal lumen (1 case). CT performed in 3 cases showed an intraperitoneal mass with soft-tissue density. A communication with the GI tract was noted in 1 case, and in another case, it showed an intestinal intussusception. US guided biopsy performed in 3 cases provided diagnosis in 2 cases (malignant schwannoma, leiomyosarcoma). Tumor growth was exophytic in 8 cases and dumbbell-shaped in 1 case.The imaging features of malignant stromal tumors of the small bowel are similar. It varies with the type of tumor growth and its size. The diagnosis may be suggested based on imaging features.

We report a case of dermoid cyst arising in the cavernous sinus and parapharyngium areas through the foramen lacerum. A 12-year-old girl was hospitalized in October 1966 for progressive intracranial hypertension. CT before a prior surgical intervention in 1994 showed an intracranial process suggesting a dermoid cyst. CT performed in October 1996 showed a temporal process at the left side measuring 8 cm x 5 cm and well circumscribed with a thin wall. This process extended towards the parapharyngium area through the foramen lacerum. The exocranial part measured 4 cm in diameter. The density of the process strongly suggested a mature dermoid cyst with fatty and calcium components. The histology study confirmed the diagnosis of dermoid cyst. The frequency of intracranial dermoid cysts is 2 to 3 times less than that of epidermoid cysts. This is an uncommon process accounting for 1% of intracranial tumors occurring in children. In the sustentorial spaces, the process occurs more frequently in the parasellar area. To our knowledge, exocranial extension has not been reported to date.

Angiosarcoma of the breast in an uncommon entity. The authors report a well documented case of angiosarcoma. The patient, a 23 years old woman, had a voluminous mass of the left breast without inflammation. The evolution was rapidly fatal. Physical examination revealed a large painful breast mass with purplish discoloration cutaneous area in front of the lesion. The palpation revealed a thrill. The mammography had shown an area of increased density in the left breast. A complementary ultrasound examination detected a well circumscribed voluminous mass with hypoechogenic heterogenous echostructure. The Doppler examination detected a venous blood flow in the tumor. This finding was compatible with vascular tumor as angioma or angiosarcoma. The angioscanner showed a peripheral vascular enhancement and a centripetal diffusion of the contrast product. This vascular kinetic is seen commontly in the angioma. Magnetic resonance imaging in the T1 and T2 relaxation times detected an intermediate signal mass with bleeding areas. The patient had had a mastectomy and the histopathologic examination confirmed the diagnostic of angiosarcoma. The radiological aspacts of angiosarcoma of the breast are discussed depending on the literature data.

Transthoracic needle biopsy is a reliable method for the diagnosis of thoracic lesions, specially when they are peripleral.The main objective was to evaluate the results of US guidance for thoracic needle biopsy in 159 cases.Overall sensitivity was 83% as tissue was obtained in 132/159 cases. In 24 cases, 2 or 3 biopsies were necessary. In 17 cases, analysis was made on cytology only with a 70.6% sensitivity. One pneumothorax and two cases of hemoptisies were encountered.US guidance is a useful method for the diagnosis of peripheral thoracic masses, yielding a high sensitivity and a very low complication rate.

Appendicular mucocele is a rare lesion presenting a combination of several histological lesions. It generally ruptures into the peritoneum and rarely into the retroperitoneum. The objective of this study was to examine the various radiological appearances of appendicular mucocele and to report three cases of mucocele which ruptured into the retroperitoneum. This retrospective series of 6 cases of histologically confirmed appendicular mucocele was collected by the Central Radiology Department of Ibn Rochd University Hospital in Casablanca. The mean age of the patients was 61.6 years (33 years-77 years) and the sex ratio was 4/2. A plain abdominal X-ray and ultrasonography were performed in all patients. Five patients were examined by CT scan and two underwent a barium enema. Five out of six mucoceles ruptured: into the peritoneal cavity in 2 cases with gelatinous ascites and into the retroperitoneum in 3 cases. The plain abdominal X-ray showed a mass in the right flank, which was calcified in 2 cases. Ultrasonography and CT scan were suggestive of the diagnosis of appendicular mucocele in only two cases. The case of non ruptured mucocele consisted of a clearly delimited, thin-walled collection. A loculated effusion with scalloping on the liver was observed in the two cases of gelatinous ascites. In the three cases of mucocele rupturing into the retroperitoneum, ultrasonography and CT scan showed a loculated retroperitoneal collection. This collection extended into the right psoas in 2 out of 3 cases. Gelatinous ascites is the usual complication of appendicular mucocele; but in rare cases of mucocele of a retrocaecal appendix, the mucus may enter the retroperitoneum.