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Les fistules carotidocaverneuses sont une pathologie peu fréquente, le plus souvent dues à un violent traumatisme de l'étage antérieur de la base du crâne. Ces fistules post-traumatiques se traduisent par une symptomatologie bruyante faite d'une exophtalmie pulsatile avec un chémosis hémorragique associé à des signes neurologiques non spécifiques (céphalées, acouphène, etc.) – et ce contrairement aux fistules spontanées, dont le tableau clinique reste plus discret. Le diagnostic positif est d'abord orienté par le scanner orbitaire, éliminant les autres causes d'orbitopathies inflammatoires (Basedow), puis confirmé par l'artériographie qui permet de classer la fistule, selon la classification de Barrow, en fistules directe/indirecte (branches méningées de la carotide interne et/ou carotide externe), haut débit/bas débit. Le traitement actuel des fistules repose sur l'embolisation par ballonnet par voie artérielle ou coils par voie veineuse. L'abstention thérapeutique est parfois préférée pour les fistules à bas débit, qui peuvent se thromboser spontanément, contrairement aux fistules à haut débit qui peuvent mettre en jeu le pronostic vital et fonctionnel en l'absence de traitement. [ABSTRACT FROM AUTHOR]

Résumé La prévention du vieillissement est avant tout liée à une bonne hygiène de vie, qui reste indépendante des causes génétiques d’accentuation du vieillissement. Les causes du vieillissement structurel du visage varient de la gravité à la perte de volume, à la contraction des muscles de la mimique, additionné du vieillissement biologique naturel des tissus concernés. Parmi les techniques chirurgicales récentes, on peut s’intéresser : pour la région frontale au lifting endoscopique et au lifting du front non endoscopique. Le lifting des sourcils par excision cutanée au-dessus du sourcil peut simplifier certaines situations ; pour la région centro-faciale, le risque reste la malposition palpébrale secondaire. Pour l’éviter on peut réaliser un Smas jugal sus-zygomatique associé à une réinjection de graisse ou faire un lifting temporo-malaire, plus efficaces en latéral qu’en médio-palpébral. Pour une action plus médiane avec une élévation verticale, soit existent des lifting centro-faciaux avec ouverture complète de l’orbiculaire palpébral, soit très limitée en externe comme dans le lifting malaire concentrique, pour minimiser cette malposition palpébrale. Une proposition de traitement du délicat chemosis par injection corticoïde malaire inféro-externe préperiostée est envisagée. Sur l’ovale, la section du depressor anguli oris et de la suspension de l’espace pré masséterin restent intéressantes. Enfin, sur le cou, en plus des actions sur le bord postérieur du platysma ou sur les digastriques, un lambeau de platysma latéral suspendu à la mastoïde est intéressant. Une dernière technique de lift du cou, avec fixation du platysma au fascia cervical profond et associée au lambeau platysmal latéral est proposée pour essayer de stabiliser le mieux possible cette région en limitant les risques. Summary Prevention of aging is mainly obtained through appropriate health practices, modulated by the genetic causes of aging. Causes of facial structural aging include gravity, volume loss, contraction of the mimic muscles and obviously biological aging of tissues. Among the very numerous new surgical technique of facial rejuvenation, we could point out: for the frontal region, obviously we are focus on the endoscopic and non-endoscopic frontal lifts. But also, we should note the transcutaneous Brow Shaping which with a well defined, step by step technique is indeed a simple way to improve a possible difficult situation; concerning the mid-face lift, as the main risk is the secondary eyelid malposition, a high Smas or a temporo-malar lift can be performed. It ensures a good temporal effect but there is nearly no improvement at the mid-pupilla level. A mid-face lift is nevertheless mandatory to achieve an efficient skin removal on the mid-pupilla line. This is performed most of the time with a complete orbicularis oculi muscle opening, and only with a small lateral opening in case of the concentric malar lift, which minimize the risk of eyelid malposition. Based on a new description of the lymphatic draining of the lower lid, a new treatment of the chemosis is proposed with a corticoid injection at infero-lateral part of the malar area, in the preperiosteal plane. For the oval, the DAO section and the suspension of the middle premasseter space beyond the anterior border of the masseter where the Smas overlies the buccal fat pad, stay efficients. Regarding the neck, the suspension of the posterior border of the platysma to the Loré’s fascia, the digastric corset with or without a platysma corset are advanced and valuable techniques. Lately, a new option was described using a lateral skin-platysma flap to minimize platysma bands and even more recently a neck lift with fixation of the anterior platysma to the deep cervical fascia and suspension of the lateral platysma flap. [ABSTRACT FROM AUTHOR]

While ocular involvement is well documented in association with neurofibromatosis type 1 (NF-1), conjunctival neurofibromas are very rare. We describe a challenging NF-1 case of a patient with a conjunctival neurofibroma in association with lower lid involutional entropion and severe conjunctival chemosis. A 65 year-old male presented with age-related left lower lid laxity, retractor dehiscence, inferior conjunctival chemosis and significant ocular discomfort. The patient underwent a left lower lid lateral tarsal strip procedure with retractor plication without much improvement in the chemosis and discomfort. However post-operatively it became evident that an injected mass was present in the left inferior fornix. Surgical debulking of this mass allowed for resolution of the patient’s signs and symptoms as well as proper lower lid alignment. Histopathologic diagnosis with S100 and CD34 positivity confirmed a conjunctival neurofibroma. Although uncommon, it is important to consider the possibility of a conjunctival mass in a patient with persistent chemosis and recurrent lower lid instability, particularly when confronted with a neurocutaneous syndrome.

Exposure keratopathy is a sight-threatening complication which can occur in patients admitted to intensive care units. This is a prospective study over a period of 5 months in the intensive care unit of the specialty hospital of the IBN SINA medical center, with a capacity of 8 beds. The purpose of our study was to determine the incidence of and risk factors for exposure keratopathy in intensive care settings. Forty-two percent of patients developed exposure keratopathy, 48% exhibited chemosis, and 40% showed lagophthalmos with the cornea visible in 30% of cases. The frequency of keratopathy was significantly higher in patients with chemosis and lagophthalmos (P<0.0001). Lagophthalmos was significantly related to chemosis (P<0.0001). Chemosis in the ventilated patient, also known as "ventilator eye," is a serious complication leading to the risk of keratopathy. The risk factors for keratopathy found in our series were chemosis (OR=25.28, 95% CI=[3.339-191.52] P-value=0.002), lagophthalmos (OR=40.8, 95% CI=[4.347-383.666] P-value=0.001) and length of stay in intensive care (OR=12.28, 95% CI=[1.476-102.230] P-value=0.020). Several methods might be used and adapted to each case for prevention of exposure keratopathy, and we found that raising nursing staff awareness is of paramount importance., (Copyright © 2022. Published by Elsevier Masson SAS.)

Prevention of aging is mainly obtained through appropriate health practices, modulated by the genetic causes of aging. Causes of facial structural aging include gravity, volume loss, contraction of the mimic muscles and obviously biological aging of tissues. Among the very numerous new surgical technique of facial rejuvenation, we could point out: for the frontal region, obviously we are focus on the endoscopic and non-endoscopic frontal lifts. But also, we should note the transcutaneous Brow Shaping which with a well defined, step by step technique is indeed a simple way to improve a possible difficult situation; concerning the mid-face lift, as the main risk is the secondary eyelid malposition, a high Smas or a temporo-malar lift can be performed. It ensures a good temporal effect but there is nearly no improvement at the mid-pupilla level. A mid-face lift is nevertheless mandatory to achieve an efficient skin removal on the mid-pupilla line. This is performed most of the time with a complete orbicularis oculi muscle opening, and only with a small lateral opening in case of the concentric malar lift, which minimize the risk of eyelid malposition. Based on a new description of the lymphatic draining of the lower lid, a new treatment of the chemosis is proposed with a corticoid injection at infero-lateral part of the malar area, in the preperiosteal plane. For the oval, the DAO section and the suspension of the middle premasseter space beyond the anterior border of the masseter where the Smas overlies the buccal fat pad, stay efficients. Regarding the neck, the suspension of the posterior border of the platysma to the Loré's fascia, the digastric corset with or without a platysma corset are advanced and valuable techniques. Lately, a new option was described using a lateral skin-platysma flap to minimize platysma bands and even more recently a neck lift with fixation of the anterior platysma to the deep cervical fascia and suspension of the lateral platysma flap., (Copyright © 2017. Published by Elsevier Masson SAS.)