Search

Background: Dermal and subcutaneous inflammation following direct trauma is initially evocative of soft-tissue infection. However, two differential diagnoses must be considered: Morel-Lavallée syndrome and post-traumatic nodular fat necrosis., Patients and Methods: Case 1: a 51-year-old woman fell off her motorbike and had dermabrasions on her right and left tibial ridges that rapidly developed into dermo-hypodermitis of the entire limb. There was no improvement after 3 weeks of antibiotics. The patient was apyretic. She had a soft, non-inflammatory tumefaction on the inner aspect of her left knee. Ultrasound revealed subcutaneous collection in both legs. The surgeons confirmed a diagnosis of Morel-Lavallée syndrome and drained the two collections. Progress was good and the patient healed without major consequences. Case 2: following a fall on her stairs, a 40-year-old woman presented dermabrasions and haematomas on her left leg. Antibiotic therapy failed to prevent the progression of dermo-hypodermitis. The patient remained apyretic and there was no inflammatory syndrome. A CT scan showed thickening of a subcutaneous fat and fluid collection, resulting in diagnosis of post-traumatic nodular fat necrosis. Management was surgical and the outcome was good., Discussion: These two cases show two post-traumatic cutaneous complications: Morel-Lavallée syndrome and post-traumatic nodular fat necrosis. Morel-Lavallée syndrome occurs after tangential trauma next to richly vascularized tissue. Post-traumatic nodular fat necrosis is defined as necrosis of adipocytes. In both cases, diagnosis is confirmed by imagery (Ultrasonography, tomography)., Conclusion: Our two case reports show that inflammatory presentation of both Morel-Lavallée syndrome and post-traumatic nodular fat necrosis can lead to diagnostic and therapeutic errors while a surgical procedure is necessary since tissue necrosis can occur., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)

Central giant cell granuloma (CGCG) is a benign tumor that may be subdivided in a non-aggressive form and an aggressive form. In aggressive forms, tumor size and high recurrence risk need large surgical resections. In order to minimize surgical morbidity, especially in children, medical treatments acting on the tumor proliferation are currently being assessed: steroids (triamcinolone), anti-osteoclastic drugs (calcitonine, alendronate, denosumab), anti-angiogenic drugs (interferon α). However to date, there is no evidence for any superiority of medical over surgical treatment. Complete response is rarely obtained and additional surgery is often necessary to remove the tumor in case of tumor progression, to remove a remnant or to remodel bone. Moreover, these drugs have frequent local or systemic side effects such as osteonecrosis and growth deficiencies., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Basal cell carcinomas with symptomatic perineural invasion are rare entities. We report the case of a 60year-old man (with a grafted kidney), surgically treated in 2007 for a sclerodermiform basal cell carcinoma infiltrating the left nostril. Five years later, a painful left hemifacial hypoesthesia associated with an ulcus rodens of the nasolabial fold appeared. A biopsy confirmed a recurrence. MRI showed an enhancement of the trigeminal ganglion. The patient had a trigeminal perineural invasion secondary to a cutaneous basal cell carcinoma. He received a local intensity-modulated radiotherapy alone (70Gy in 33 sessions), administered from the skin tumour to the skull base. Three years after the end of treatment, the patient is in radiological and clinical remission, with partial recovery of the hypoesthesia. Evolution was marked by iterative corneal ulcers and decreased visual acuity. Modalities of treatment by surgery and/or radiation therapy and complications are poorly described in the literature., (Copyright © 2016. Published by Elsevier SAS.)

Introduction: Tooth extraction for patients treated by AVK and/or platelet aggregation inhibitor is performed according to local habits rather than to a consensus. We had for objective to assess hemorrhagic and thromboembolic risks for patients for whom treatment with AVK and/or platelet aggregation inhibitor was modified before tooth extraction., Materials and Methods: Ninety-three patient files were examined retrospectively. The following data was collected: epidemiological data, ASA score, nature and changes of antithrombotic therapy, preoperative INR, number teeth extracted, postoperative complications (bleeding and thromboembolic events)., Results: Thirty-seven patients were treated with oral anticoagulants, 41 by a platelet aggregation inhibitor, 10 by double platelet aggregation inhibitor therapy, and 5 by an AVK-platelet aggregation inhibitor combination. At D0, the mean INR was decreased to 1.4, 4 patients with high thromboembolic risk had received heparin relay treatment; the treatment was stopped for 9 of the 56 patients on monotherapy with antiplatelet therapy, 4 were switched from clopidogrel to lysine acetylate; clopidogrel was stopped for 7 patients under combination therapy. Seven hundred and twenty-six avulsions (mean 8.1 per patient) were performed, 41 patients presented with mild/moderate bleeding, easily resolved. A patient presented with delayed hemorrhage at D6 (AVK overdose). No thromboembolic complication was reported., Discussion: The modification of antithrombotic treatment, as for surgery at high risk of bleeding, seems to limit the risk of bleeding without increasing thromboembolic risk., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

Introduction: The gold standard management of mandibular fractures is open reduction and osteosynthesis associated with intermaxillary fixation. The use of intermaxillary fixation screws for 20 years has considerably reduced the number of intermaxillary fixation with arch bars. The aim of our review was to identify current indications and contraindications of each technique., Intermaxillary Fixation Techniques: We present a short history and compare the two techniques with recently published assets, drawbacks, and complications., Discussion: The indications of intermaxillary fixation screws are uni- or bifocal fractures without or with minimal displacement. Their use is contraindicated in any other type of fracture, which should still be treated with arch bar fixation., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Giant cell tumors and pseudogiant cell tumors of the jaws are divided into cherubism, central giant cell granuloma (CGCG), aneurysmal cyst, giant cell tumor, and hyperparathyroidism-jaw tumor. These tumors have variable clinical characteristics, such as bilateral tumors in cherubism, disseminated tumors in hyperparathyroidism, or focal tumors in other types. Their radiological presentation is quite similar with presence of well-delimitated uni- or multilocular radiolucency. The primary surgical treatment must be conservative. Anatomopathology gives the histologic diagnosis, with presence of giant cells. Some tumors are locally aggressive leading to larger bone exeresis. The nosology of these giant-cell tumors remains unclear, especially for giant cell central granuloma and giant cell tumors.

Background: The predictive value of regression in melanoma is debated., Aim of the Study: A retrospective single-centre study to evaluate the correlation between regression in primary skin tumor and the presence of micrometastases in sentinel lymph nodes., Patients and Methods: Histological signs of regression in 84 melanomas (>1 mm) with corresponding sentinel lymph nodes were studied by two independent pathologists., Results: Regression was seen in 40 skin melanoma tumors while micrometastasis was seen in 24. Of the tumors with micrometastasis, only 10 were regressive (RR: 0.47, p=0.49). Breslow value>2 mm and male sex were predictive for node micrometastasis (RR: 4.6, p=0.03 and RR: 7.6, p=0.006, respectively). On multivariate analysis, these two factors were independent., Comments: These data suggest that regression in primary cutaneous melanoma is not predictive for lymph node metastasis.

Introduction: The evaluation of the bite forces coupled with EMG activity of masseter muscles allows to point out temporo-mandibular joint disorders. The intense practice of sports induces stress which may affect the mandibular statics, due to an hyperfunction of the elevator masticatory muscles, especially the masseter muscles. This concept has led us to compare the maximum isometric bite forces of sedentary and physically trained subjects., Material and Methods: The aim of this experimentation is to study the maximum isometric bite forces of the premolars, with a force transducer, for two groups of physically trained and sedentary volunteers (25 subjects), with distinction between male and female subjects. Subjects with normal denture and no temporo-mandibular joint disorder were retained. EMG and force recording were synchronized and recorded during 10 seconds of maximal contraction., Results: The male subjects developed a maximal bite-force significantly higher (p < 0.05) compared to the female subjects. There is no significant difference between subjects practising a sport (at least 6 hours a week) and sedentary ones. The evolution of force during the contraction is different between sexes. EMG activity allowed to control that subjects developed a maximal force and an increase in muscular fatigability of physically active females compared to sedentary ones was noticed., Discussion: The difference of maximal force between men and women is similar to the one found for the locomotor muscles. The analysis of the evolution of the force according to the contraction duration, might be linked to a different distribution of muscular fibers according to the sex. The practice of a sport might increase the fatigability of the masseter muscles and might be a factor inducing a muscular imbalance of the mandibular posture. But the relatively low number of subjects and the absence of well defined distinctions between different kinds of sport limit our conclusions.

Carcinoma of the face is the skin disease most frequently encountered by plastic surgeons in everyday practice. Although basal cell carcinomas and squamous cell carcinomas are generally easy to recognize, their treatment remains subject to various schools of thought, or even individual practices, which are often difficult to define. This article defines a general plan of management of these tumours; their histological duality corresponds to a therapeutic duality. Resection of a basal cell carcinoma requires safety margins of 3 to 4 mm, versus at least 5 mm for a squamous cell carcinoma. In a high-risk subject, with a sclerodermiform carcinoma or undifferentiated squamous cell carcinoma, this safety margin may be as much as 10 mm or more. Frozen section examination is preferable in these situations. Six anatomical regions are studied selectively to define the main rules of reconstruction: nasal region, orbitopalpebral region, labial region, malar region, frontal region and auricular region. Each region will be subdivided into several subterritories, each requiring different strategies. The objectives, methods and indications of each reconstruction are selectively defined. The final strategy proposed is based not only on the author's personal experience, but also on the results of the national survey on carcinomas. As a complement to these therapeutic guidelines, the authors raise the problem of incomplete resection, which requires the definition of a peripheral infiltration index predictive of the recurrence rate. Surgery obviously cannot constitute exclusive treatment carcinomas, hence the value of presenting other methods currently available in the therapeutic armamentarium. Surveillance is essential in every case, determined by the patient's risk of recurrence or even metastatic dissemination.

Progress in plastic surgery has allowed an ever increasing extension of the indications for facial reconstruction. Although carcinomas are now detected earlier and earlier, the practitioner is nevertheless faced, several times during his working life, with "historical" cases. Although it is fairly rare to observe long-term progression of squamous cell carcinomas, basal cell carcinomas can take on considerable proportions due to their very low metastatic risk. In these situations, the dilemma between conservative management and performing an inevitably major procedure is never easy to resolve. Moreover, it is often the discomfort experienced by the patient's family which encourages him to accept the operation. The objective of the procedure is more often aesthetic rather than curative, although this latter objective must always be attempted. Consequently, the practitioner should never hesitate to defer reconstruction for several months in order to ensure reliable local surveillance. The value of epitheses is clearly established in this situation. When a reconstruction can be performed, "major" measures are generally necessary, making use of all of the regional or even distant plastic surgery techniques used for facial surgery. However, microsurgery is a last resort indication, which should only be used when the various pedicle flaps have been exhausted. The microsurgical delay technique (Jean-Marie Servant's "apple turnover" technique) is particularly useful in these situations. In the light of seven clinical cases, the authors try to define the essential concepts of this type of management. In fact, the respective limits of active intervention and conservative management are defined by each surgeon's common sense and experience. The constant improvement of the quality of epitheses make them the current treatment of choice for the restoration of extensive defects. Lastly, one of the main factors to be considered before taking any treatment decision is the psychology of these patients, as it is always difficult to explain the discovery of lesions at this advanced stage.

The national survey concerning the therapeutic strategy for carcinomas of the face published here reviews the therapeutic strategies to this everyday disease. The 30 centres included in our statistics have a combined experience of several thousand cases. 61% of these centres operate on more than 50 carcinomas per year. The following conclusions can be drawn from these data. The general national option is for treatment of the defect by flaps than by skin graft, all reconstruction situations combined. In the case of skin grafts, the retroauricular and supraclavicular sites are the most frequently used. 71% of authors also perform skin grafts immediately after the initial resection. Directed healing is only indicated in the treatment of small defects with a preferential site: the medial canthus. Frozen section examination is requested at the time of the initial resection in an average of 24.3% of basal cell carcinomas versus 43.9% of squamous cell carcinomas, with a range of 0 to 100% in the two series. 16 resection sites were then proposed, to define the most frequent cases. Consensus was exceptional. At the very most, a fairly unified strategy was defined for defects of the eyelids and lips, where there is a preference for classical Abbé or Mustardé flaps for the lower eyelid. Similarly, kite flaps are usually preferred in the nasolabial region. In all other cases, the responses vary considerably and are submitted to statistical analysis, completed by a general discussion.

The authors give an Internet short historical record, then describe the different services offered and the possible applications for oral and maxillo-facial surgery. Electronic-mail (E-mail) provides the ability to compose, send and receive messages through the computer and allows exchanging informations with colleagues around the world. Programs, files and graphics can be transferred from one computer to another. The "news groups" are interesting in various subjects and allow a team work. We find several hundred sites about maxillo-facial surgery. These sites present a medical department, diagnosis problems or therapeutic solutions, medical press. Any information submitted is insecure and could be observed by a third party while in transit. Internet potential (educational benefits, digital access to medical literature, online consultation service) is mentioned in the end of the article.

Superiorly based nasolabial flap is an interesting solution for reconstruction of moderate size maxillary defects. The operative technique and its results are described. Advantages (reliability in flap vascularity, versatility, easiness of elevation) and limits of this procedure for closure maxillary defects are mentioned. Then they are compared to the other reconstructive maxillary techniques.

We present 114 cases of mandibular angle fractures treated by screwed miniplates placed through a transbuccal incision with transbuccal trochar instrumentation. Usually patients were young men who suffered traffic accidents. The mean hospitalization time was 7 days. 94.5% of the patients healed without incident, no malocclusion complication was observed. Two postoperative hematomas required surgical drainage without healing complication. One non union required removal of the miniplate and maxillo-mandibular immobilization. 2 temporary postoperative hypoaesthesiae were observed. One patient presented a pericoronary infection of a third impacted molar, four months after surgery, but the fracture was healed. The comparison of the results with the others in the literature confirms the reliability of this technique.

Head and neck bone sarcomas are very uncommon tumors. Therefore, treatment modalities are not clearly established. The medical record of 12 patients with bone sarcoma of the jaw were reviewed. Six patients with osteosarcoma underwent primary chemotherapy followed by wide surgical resection, radiation therapy or combined radiosurgical treatment. The 2 and 5 years survivals were 66% and 40% respectively. Five patients with chondrosarcoma were treated by wide surgical resection alone or combined with postoperative radiotherapy and possibly chemotherapy. All patients were alive; the mean follow-up was 9 years. One patient had Ewing's tumor. Osteosarcoma and chondrosarcoma in head and neck patients have a high rate of local recurrences. Surgery is the mainstay of treatment. Patients with voluminous tumors and high-grade lesions should receive postoperative radiotherapy. The role of chemotherapy has not been defined.

Soft tissue sarcomas of the head and neck account for less than 1% of all malignant neoplasms in this region. A significantly increased risk of treatment failure is associated with high histologic grade, leading to an aggressive treatment. The medical records of 17 patients with soft tissue sarcomas of the head and neck were reviewed. They were divided into two groups according to age: 13 adults and 4 children. The former underwent wide surgical excision with postoperative radiotherapy in some cases and possibly chemotherapy. The 2 and 5 years survivals were 54% and 46% respectively. The latter, with rhabdomyosarcoma, underwent multimodality treatment (chemotherapy, surgery, radiotherapy). The 2 years survival was 50%. The mainstay of treatment of soft tissue sarcomas of the head and neck in adults remains surgery. Patients with incomplete resection or high grade tumour should receive more aggressive treatment (surgery and postoperative radiotherapy). The use of systemic chemotherapy has showed no statistically significant improvement in local control or survival. However, for rhabdomyosarcoma in children, chemotherapy is an essential part of treatment.