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Oral ulcers have a number of causes, and as a result, their etiology can be difficult to determine. Clinical management can range from simple treatment of the symptoms to extensive surgical excision, as in the case of malignant ulcers. Nicorandil, an antiangina drug, has been identified as a potential trigger for cutaneomucosal ulcers. This article reviews the importance of taking a full medical history when seeking to identify the side effects of treatments. We present the case of a 70-year-old patient with chronic ulceration of the oral mucosa. Determining the cause of ulceration as a side effect of taking nicorandil was delayed because the team that initially managed the patient hypothesized a malignant etiology. As a result, a partial glossectomy was performed for diagnostic and therapeutic purposes. After extensive examination of the patient's medical history and current treatments, nicorandil was identified as the potential trigger. The patient finally recovered after discontinuation of nicorandil.

Introduction: For dental avulsion, surgery may be invasive where it affects bone volume and may cause damage to the surrounding anatomical structures. Piezosurgery is a minimally invasive surgery due to the thin and precise cutting of the tooth compared with conventional burs. Technique: the authors have presented the case of a thirteen-year-old girl referred by her orthodontists for the extraction of a supernumerary tooth. The anterior nasal spine (ANS) was cut using piezosurgical techniques, repositioned and fixed using osteosynthesis with a bone screw. Postoperative follow ups were promising, and the bone screw was taken out a year later. Comments: The preservation of the nasal mucosa had probably aided in the trophicity and healing of ANS. The minimal bone loss by piezosurgical techniques allowed for the replacement of ANS and its osteosynthesis. Conclusion: This case describes a minimally invasive procedure which allowed for the removal of a deeply impacted supernumerary tooth, without damaging the surrounding teeth or nasal mucosa, and maintaining ANS bone volume.

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Introduction: Pycnodysostosis, or Toulouse Lautrec's disease, is a rare lysosomal genetic disease with an autosomal recessive transmission, and it is classified as one of the osteo-chondro-dysplasias (ICD-10). Patients with pycnodysostosis manifest with several clinical features, including osteosclerosis, bone fragility, short stature and acro-osteolysis of the distal phalanges. Maxillofacial symptoms mainly associate a lack of maxillary and mandibular growth, open mandibular angle, and significant dental crowding. Observations: This work presents the case of two sisters suffering from pycnodysostosis as part of a family affected by it (mother and maternal aunt also affected). The first patient has received regular monitoring and oral care. The second one suffered from spontaneous mandibular osteomyelitis, which was difficult to treat and cure. Discussion: Oral symptoms of this disease make maintaining oral hygiene difficult and predispose to tooth decay and periodontal disease. The most common complications are mandibular osteomyelitis and pathological fractures. Pycnodysostosis must be differentiated from osteopetrosis and cleidocranial dysplasia. Conclusion: These cases illustrate the difficulty of managing the patients suffering from pycnodysostosis, whose treatment may be difficult.

Fuchs syndrome is a particular type of erythema multiforme major; the lesions are only found on the mucosae and specifically affect oral, ocular, and genital mucosae. The cause is not always immediately apparent, which is why this pathology requires a rigorous, detailed clinical examination to eliminate a differential diagnosis. The severity of the symptoms, particularly of oral and ocular symptoms, requires immediate treatment. The treatment of this pathology requires a multiple-drug regime. Through a clinical case study, the objective of this work is to help guide practitioners when diagnosing and treating this pathology as no current consensus exists on these 2 subjects. The authors present the case of a 29-year-old patient who was suffering from a recurring outbreak of Fuchs syndrome, suspected of having been triggered by Mycoplasma pneumoniae. After completing the treatment program based on colchicine and prednisolone, the patient was relieved from pain and has not suffered from any further periodic eruptions of erythema multiforme.

Hereditary hemorrhagic telangiectasia (HHT) case with history of embolization and Young’s procedure: surgical management. Introduction: Osler–Weber–Rendu disease hereditary hemorrhagic telangiectasia (HHT) is a genetic vascular dysplasia. It causes hemorrhagic manifestations, cutaneous and mucosal telangiectasia and visceral vascular shunts, which sometimes lead to brain abscesses after dental avulsion. Acute epistaxis can be managed by vascular ligature or selective embolization. In rare cases, management can even go as far as nasal closure. Observation: A case of five dental avulsions is described, in a patient affected by HHT who previously underwent a bilateral embolization in the area of the facial artery as well as Young’s procedure for frequent epistaxis. Comments-Conclusion: The management of patients affected by HHT needs rigorous hemostatic methods and outpatient postoperative monitoring. Additionally, the remarkable imaging from panoramic radiography used in this case was instrumental in keeping track of embolization, by clearly highlighting the arterial pathways.

Spindle cell lipoma (SCL) is a rare variety of lipoma that mostly arises in male patients and rarely affects the oral cavity. The floor of the mouth is an uncommon site for SCL, and very few cases have been reported in this location. A case of SCL is reported in a 70-year-old woman who had noticed a swelling of the floor of the mouth without any functional consequence. Both ultrasonography and RMI suggested a diagnosis of ranula, whereas clinical palpation showed a nonfluctuant mass. The lesion was excised under local anesthesia. A 37×32 mm encapsulated yellow mass was removed. Histological features (mature adipocytes and CD34+ spindle cells) led to a diagnosis of SCL. Medical imaging assessment of this lesion could have been influenced by the high frequency of the ranulas in the floor of the mouth. This case appears to be quite infrequent because of its location (floor of the mouth), its size (over 3.5 cm), and the patient’s gender (female).

International audience; Plasminogen deficiency is a rare congenital condition that leads to pseudomembraneous lesions, such as ligneous conjunctivitis and ligneous gingivitis. Because of its rarity, ligneous gingivitis is not a pathology one may easily suspect from its clinical symptoms. We report the case of a 35-year-old Caucasian woman who experienced gum masses with white spots, but no pain. Based on the clinical picture, one could refute a diagnosis of necrotizing ulcerative periodontitis. Several biopsies were taken. The last ones showed an amorphous eosinophilic substance that could be fibrin. Plasmatic dosage of plasminogen (activity level 44%) confirmed the hypothesis of ligneous gingivitis. This report appears to be a very rare diagnosis of a ligneous gingivitis without major conjunctivitis, associated with a moderate plasminogen deficiency.

Introduction Companies selling dental implant guided systems mostly offer similar surgical guides. The purpose of this paper is to present an innovative-guided surgery system which originality lies in its guidance device, and to report the author's experience in using this system for dental implant surgery. Technical protocol Two parallel tubes on either side of the drilling axis guide the successive drills and the implant placement. As a result of the lateral guidance, there is no friction of the drills on the surgical guide, which would damage it or contaminate the drilling hole with particles torn out from the guide. No radiological guide is needed during the radiographic examination stage. No successive diameter reduction tubes are requested. This guide can be used for all brands of implants. Discussion In our experience, 67 implants (31 titanium and 36 zircon implants) were placed in 35 patients with guided surgery system. Multiple clinical cases were treated with this system: ‘one-stage’ or a ‘two-stage’ surgical protocol, with flap and flapless surgical techniques, and with delayed or immediate loading. Clinical cases treated revealed good implant placement with planning. The widely open design of this guide allows irrigation and practitioner's sight control under conditions comparable to those of operations performed without surgical guide. Conclusion This dental implant guided system appears to be a significant advance in the field of implant surgical guides.

The occurrence of a simple bone cyst (SBC) is known to be more frequent among the patients affected by florid osseous dysplasia (FOD). Conventional treatment of SBC involves surgical fenestration of the cavity, which frequently leads to resolution. However, in the cases of large cavities, such as those found in cases of FOD, the advisability of surgical intervention remains in question. Two cases of SBC associated with a FOD are reported in two African women (Cameroonian 36 years old and Gabonese 72 years old). The large size of the SBC cavities appears unusual and exceptional being possibly the largest (12 cm diameter) reported case in the literature). Following surgical exploration and fenestration in these cases, the size of the SBC did not stop increasing, though a significant amount of new bone clearly appeared at the fenestration sites seen on the control CT scans (1 year later). In the light of the two presented cases, the outcome of the surgical treatment of large SBC associated with a FOD appears unconvincing, as the cavities did not decrease in volume. Though the patient did not appear to suffer any detrimental effects of surgical intervention, the benefit of such intervention remains in question and the outcome in these two case studies suggests that in the absence of symptoms, long term follow up is all that is necessary.

Objectives:To evaluate the prevalence of palatine tonsilloliths.Methods:150 consecutive CT examinations (75 males and 75 females) were read.Results:Tonsilloliths were found in 37 patients (24.6%; confidence interval 17.7–31.6%), of which 18 (48%) had a bilateral location. No influence of sex or age was observed (p = 0.37 and p = 0.57, respectively). 26 patients (70%) had more than 1 concretion. The largest tonsillolith was 7 mm. None of the tonsilloliths found were involved in the reason for prescribing the CT. The radiographic density of the tonsilloliths was between 216 and 2959 HU.Conclusions:Palatine tonsilloliths could affect approximately one-quarter of the population. This prevalence is likely to be underestimated in daily clinical practice because small concretions do not result in any functional impairment and are not visible on orthopantomographs.

International audience; Confocal Raman microscopy, a non-invasive, label-free, and high spatial resolution imaging technique is employed to trace the anticancer drug paclitaxel in living Michigan Cancer Foundation- 7 (MCF-7) cells. The Raman images were treated by K-mean cluster analysis to detect the drug in cells. Distribution of paclitaxel in cells is verified by calculating the correlation coefficient between the reference spectrum of the drug and the whole Raman image spectra. A time dependent gradual diffusion of paclitaxel all over the cell is observed suggesting a complementary picture of the pharmaceutical action of this drug based on rapid binding of free tubulin to crystallized paclitaxel.

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