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We report a case of botfly myiasis presenting as an ankle cellulitis in a teenager returning from Guyana. Main clinical features and therapeutic approaches are described.

MAM-3 and MAM-6 antigens were detected immunohistochemically in 34 cases of adenoid cystic carcinomas (ACC) of the salivary glands and these patterns were compared to these of epithelial membrane antigen (EM A) and laminin. ACC was histologically divided into three types; the cribriform pattern, the tubular and trabecular pattern, and the solid cluster pattern. Immunostaining of EMA and MAM-6 antigen had a similar distributions in the luminal borders of luminal tumor cells, whereas the MAM-3 antigen was slight or negative in luminal borders. Myoepithelial derived tumor cells of ACC accompanying hyaline stroma demonstrated positive staining for the MAM-6 antigen (whole cell positive type), and luminal tumor cells of microcysts showed strong staining for the MAM-3 antigen. Laminin staining was confined to the basement membrane and surface borders in pseudocyst cavities. In salivary gland ACC, laminin staining can be used as a marker of pseudocyst surfaces and immunostaining of EMA and the MAM-6 antigen as a marker of luminal borders of cyst. These two histo-chemical markers were useful for discriminating pseudocyst and cyst.

Immunohistochemical studies were performed to explore the distribution of S-100 protein and its alpha, beta subunits in 76 adenoid cystic carcinomas (ACC) of the salivary glands. Histopathologically. ACC was divided into cribriform, tubular, basaloid and trabecular types which could be mixed in the same tumor. S-100 protein was usually positive in tumor cells forming cribriform structures; foci of strongly positive tumor cells were also distributed in the luminal layer of tubular structures, and in areas transitional between cribriform and tubular patterns. S-100 alpha staining was confined to some tumor cells in cribriform areas, to luminal tumor cells in tubular structures and to few tumor cells in basaloid structures. S-100 beta reaction was usually localized to luminal surfaces in a fine granular pattern in tubular and microtubular structures in a distribution somewhat similar to that in the normal salivary gland. Great heterogeneity in the immunohistochemical distribution of S-100, S-100 alpha and S-100 beta proteins was found in the various histologic types of ACC and the pattern was different from that seen in pleomorphic adenomas. It is possible that the ACC tumor cells positive for S-100 protein may be closely related to true or modified myoepithelial cells.

A total of 31 patients surgically treated for salivary mucoepidermoid tumor had a comprehensive follow-up. Two groups were classified as: 16 with favorable outcome (no recurrence or late recurrences at 5 yr postoperatively and still alive; 15 with poor outcome (local recurrences before 5 yr, metastases, lethal evolution in 11 cases). We evaluated nucleolar organizer in every case, using AgNOR count. The AgNOR count seemed better than histologic criteria for establishing the prognosis of mucoepidermoid tumors. It correlated significantly with the clinical course: a high count was principally found in lethal forms, low counts (less than 1.8) were always detected in patients with a good outcome.

Mesenchymal chondrosarcoma (MCS), described in 1959 by LichtensteinBernstein, is a very rare malignant tumour. Only 46 cases have been previously reported in the jaws. Over a period of 30 years, four chondrosarcomas of mesenchymal type (of which one has already been published in 1987 with a three-month follow up) were treated in our department. Two patients have been followed for more than 17 years, of whom one has died of an intracranial extension and the other is still alive after surgical treatment of numerous recurrences and metastases. The two others are tumour-free with a follow up of 18 months and 11 years respectively. Histological, epidemiological and clinical features and treatment of MCS are discussed relevant to the data published in the literature.

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 33 - N° 4 - p. 366-367

Different techniques can be used to repair paralytic labial commissurae. Ideally, microsurgical procedures or dynamic suspension methods can correct kinetic paralysis but in certain patients (elderly subjects, poor general health, precarious postsurgical rehabilitation) such procedures may represent an excessively aggressive procedure. We therefore used static suspension of the paralytic labial commissurae based on desepidermization of a nasogeneal flap. This simple technique is easy to perform and is our method of choice for static suspension because the flap pulls the paralysed commissurae upward and doubles the tissue cover, helping overcome buccinator incompetence.

Cherubism is a hereditary bone disease, increasing the volume of both cheeks (whence the name, alluding to Renaissance paintings cherubs), during childhood. Usually cure or at least stabilisation is expected around the puberty. Some cases monstruously extensive impose a surgical management, sometimes difficult but with impressive results.

Oral malignancies are a major problem in France where the consumption of alcoholic drinks is a traditional habit, often associated with heavy smoking. Contrary to other malignancies, at least in France mass screening has never been used to detect oral carcinoma. Preventive steps are very difficult to implement due to different economic reasons but mass screening in patients with records of heavy drinking/smoking, and/or pre-epitheliomatous lesions is an easy method after a short training of doctors in different specialties and cyto-pathologists. The mass screening is based upon the exfoliative character of the oral carcinomas which enables very easy and risk-free cytological smears and their classification in four grades. The reliability is more than 96%. However, Biopsy preserves its major importance for an accurate diagnosis but is most properly executed in cancer departments. This could bring oral cancer patients in adequate centers at a very early stage of the disease, and improve both prognosis and sequellae.

Ankylosis of the temporomandibular joint has severe consequences due to its effect on eating, speaking, buccal hygiene and growth of the lower third of the face in children. Two therapeutic problems must be addressed: functional capacity (joint mobility) and morphological (correction of the facial deformation). The appropriate surgical techniques are still subject to debate. Each operator has a technique which gives satisfactory results. In our unit, we used two techniques with similar results. Early and prolonged rehabilitation still remains the only guarantee of success.

Surgery in the infra-temporal area, formerly known as the pterygo-maxillary area, is not often performed and raises several problems including the route of access and indications and contraindications. Many procedures have been proposed by ENT or maxillo-facial surgeons dealing with cancer.The infratemporal area is a basically pyramidal shaped, very deep region of the face. The base of the pyramid formed by the medial aspect of the ramus is triangular and the upper surface of the pyramid is the floor of the skull. The anteromedial aspect corresponds to the posterior aspect of the maxillary bone and the posteroinferior aspect to the pterygomaxillary fascia.This type of surgery is generally indicated for locoregional cancers and exceptionally for benign tumors originating in this area, e.g. angiomas, neurinomas of the dental or lingual nerve, either as single tumours or as part of a Recklinhausen disease. Most often, the surgeon is faced with the problem of infra-temporal invasion of a tumour originating outside the area: malignant tumour of the sinus (epidermoid epithelioma), salivary glands, bone tumours, etc. The main problem is naturally to determine the route of access, via the ramus, the parotid, the maxillary sinus or the submandibular region. In the author's opinion, the upper route via a coronal incision combined with a lifting incision on the same side is a particularly interesting approach. Different situations may arise: parotidectomy is required with preservation of the VIIth nerve, resection of the ramus or anterior section, making it possible to fold back the lateral part involved and thus provide sufficient access.

Although ameloblastoma is one of the benign odontogenic tumors, the maxillary localisations often grow more infiltratively and show higher recurrency than the mandibular localisations. The authors report a case of ameloblastoma in maxillary sinus and sketch out the operative methods with a literature review.

Two cases with complete loss of the tooth-bearing portion of the mandible were repaired with a prosthesis. This type of defect can involve the loss of a large number of teeth and aggression to the remaining teeth must be limited as much as possible. A two-part "articulated" prosthesis with two rings appears to be the best adapted system. This method takes into account the requirements of for additional conventional prostheses and thus makes it possible to save the remaining teeth.

The patient who consults for "big cheeks" usually desires correction for an excess of tissue in the masseter region. First all neoplastic pathologies recognized by their unilateral asymmetry are excluded in order to focus on bilateral phenomena. Three anatomical elements can be responsible either alone or in association for this excess: the parotid gland, the masseter muscle and the angle of the jaw. The clinical and complementary examinations leading to the etiological diagnosis are described. The treatment recommended is specific to the structure involved and is not necessarily surgical.

Cherubism is a benign, hereditary giant-cell lesion located in the mandible and both maxillaries, which appears during childhood as a painless bilateral swelling, progressing until puberty and then receding spontaneously without normally requiring any treatment. In a previous publication, the authors had presented the case of three young children from the same Algerian sibship, who were eventually all operated when surgery proved to be necessary. The case published in this presentation is that of a young Italian girl presenting with a monstrous form of cherubism. In view of this malignant form, the authors decided to perform surgical treatment in several steps in order to decrease this abnormality as much as possible, considering the physical and psychological consequences reported.

Analysis of a large series of patients treated for mandibular fractures showed pitfalls in assessment of radiologic images in six cases. Factors predisposing to these radiologic pitfalls are discussed, multiple radiographic projections being suggested if discordance exists between radiologic and clinical findings, to obtain maximum data from a three dimensional picture of the mandible.

Preservation of buccal cavity relations raises problems when treating extensive defects of lower lip. After a review of anatomical features, several case reports are presented to illustrate the advantages and inconveniences of three interventions for labial reconstruction.

The frequency with which difficulties were encountered in the reconstruction of the continuity of the mandible led us to attempt to systematize our indications. Although grafts, composite pedicle flaps and prosthetic guides still have their appropriate applications. Local conditions are more and more frequently amenable to free flaps. The factors guiding our choice are presented in detail: physical conditions, etiology and anatomy of the defect. In addition, the reason for choosing the type of free flap--iliac crest, fibula or external brachial--is discussed.

Despite a thorough examination it is not always possible to detect the primary cancer responsible for malignant cervical adenopathy. In the vast majority of cases the metastases arise from an epidermoid carcinoma of the upper respiratory or digestive tract. A possible diagnostic, but also therapeutic procedure is exploratory cervicotomy with extemporaneous examination. The prognosis is poor, both locally (glandular involvement) and generally (metastatic spread).

A case of malignant lymphoepithelial lesion of the submandibular gland is reported in a 71-years-old woman. The carcinoma showed a poorly differentiated pattern and its epidermoid nature was obvious after immunohistochemistry and electron microscopy. The epithelial nests were lying in an abundant lymphoid stroma consisting of small lymphocytes. A recurrence occurred ten months after surgical treatment. This observation is compared with those already related in the literature.

An unexpected finding on histology in a 73 years old patient was an isolated suborbital plexiform neurofibroma. Since this tumor is specific for von Recklinghausen's disease, the diagnosis was that of a minor form of the disease. The different cephalic manifestations of von Recklinghausen's disease are reviewed.

Prevention against the transmission of the HIV must be universal today, which means that it applies to all patients. Blood, tissues, the CSF are infected, but nasal secreta, tears and saliva are not contaminated unless they contain blood. The statistical risk of an HIV serological conversion when making an injection is an estimate of 0.1 to 0.3%, one hundred times less than with the hepatitis B virus. The best protection for maxillofacial surgeons, who are very exposed by the manipulation of objects (needle, wires) and by considerable projections of blood (rotary motor) is not a systematic HIV serological test for all patients, but goggles with side screens, a double pair of gloves and the use of an antiseptic acting on the HIV in case of staining.

The method of patient referral; the patient's physical predisposition, the localization and the treatment undertaken for the different mandibular fractures seen by SOS Face over the past two years were analyzed. The 312 mandibular fractures were used to reevaluate the commonly accepted statistics concerning these parameters.

Among a series of 76 adenoid cystic carcinomas (ACC), 51 cases with cibriform or trabecular patterns were selected for an immunohistochemical study. These tumors were composed of three types of cells: basaloid, myoepithelial and ductal luminal acinous or tubular cells with a variable amount of each cell type from one case to another. Monoclonal antibodies (MoAb) against keratins (PKK1, KL1, K8.12, K8.13, K4.62 anti-cytokeratins antibodies) and against vimentin were used. Tubular cells were characteristically marked by anti-cytokeratins MoAb, but with a great heterogeneity of keratin distribution. In myoepithelial cells, keratin was absent or slightly positive and vimentin was present, with co-expression of the two types of filaments in some cells. Like myoepithelial cells, basaloid cells were positive to anti-vimentin antibody and negative or slightly positive to anti-keratin antibodies, with sometimes a co-expression of vimentin and keratin filaments in the same cell. Histogenesis of adenoid cystic carcinomas was discussed. Progenitor intercalated duct reserve cells may change into ductal luminal and myoepithelial tumor cells. Otherwise, basaloid cells, arising also from intercalated duct reserve cells, are able to acquire some secretory organites.

With regard to medicolegal problems, semantics are of considerable importance: indeed, depending on whether we call grafting or transplantation of an organ the operation that takes a living organ to reimplant it in the same person or the operation that takes a living organ from a donor to reimplant it in a recipient, the issues raised are completely different. The transposition of a dental organ does not raise any particular problems apart from the technical requirements to be met; there is no special problem of prevention or ethics to be taken into consideration. The problem is a completely different one when it means taking a living organ from a living or dead subject and reimplanting it in another subject. All measures decreed from the point of view of law and regulations that are dictated by considerations of prevention and ethics must then be strictly applied.

Among adenoid cystic carcinomas of salivary glands (ACCs), the solid basaloid type has a poor prognosis similar to that of undifferentiated adenocarcinomas. We studied 24 cases in immunohistochemistry using antibodies reactive with keratins of various molecular weights, vimentin, S-100 protein, and its A and B subunits. Our findings were correlated with the histological pattern and with the variable degree of differentiation of these carcinomas. In comparison with other types of ACC, intermediate filament proteins in this group were weakly expressed. The co-expression of cytokeratin and vimentin was noted in some cases. Additional features noted were the presence of cribriform cavities associated with solid lobules and areas of necrosis giving a comedocarcinomatous pattern. In these two variants, cells characterized by the dual expression of cytokeratin and S-100 protein were seen. In the highly malignant anaplastic variety, only a few cells were weakly positive with antisera to cytokeratin and vimentin. This group shows similarities to undifferentiated adenocarcinomas of salivary glands. Such similarities could be explained by the common origin of these tumours from intercalated ducts.

Thirty-two cases of adenoid cystic carcinoma (ACC) of the salivary glands were examined immunohistochemically by monoclonal antibodies to proteoglycans (PG) such as chondroitin 6 sulfate (C6SPG), chondrotin 4 sulfate (C4SPG), dermatan sulfate (DSPG), heparan sulfate (HSPG) and keratan sulfate (KSPG) in conjunction with specific enzymatic digestion. The cribriform structure of ACC consisted of basaloid, myoepithelium-derived, and luminal tumor cells. The myoepithelial tumor cells were positive for PG, whereas luminal tumor cells were unstained. Occasional pseudocysts also gave positive staining for PG. Tubular structures consisting of modified myoepithelial cells indicated a high intensity reaction for C6SPG and C4SPG, and a slight one for DSPG, HSPG, and KSPG. Immunodepositions in solid and cluster structures were comparatively light in terms of PG. Basement membrane in ACC stained strongly for C4SPG, slightly for C6SPG, and very slightly for DSPG, HSPG, and KSPG. In ACC, immunohistochemical staining of PG was regularly positive in myoepithelium-derived tumor cells, but was irregular in other types of tumor cells.

The B lymphomas formed the great majority (greater than 90%) of lymphomas in a series of 80 extra-nodal lymphomas of the cervico-facial region, all categorised by immuno-histochemistry. They also tended to be tumours of the highly malignant type (61%): lymphoblastic, immunoblastic, centroblastic and Burkitt's lymphomas.

Based on 8 cases, the authors study the mechanisms involved in post-traumatic enophthalmos and demonstrate that they result from an increase in orbital volume. There are no grounds to suggest that the disappearance of orbital fat is involved.

The classification of salivary lymphomas, including the ambiguous Mikulicz syndrome, has been considerably modified in recent years thanks to advances in immuno-histochemistry. Following the distinction between pseudo-lymphoma and true lymphoma, made possible by the latter, the situation has now become less clear due to the existence of possible transition between the two entities. Moreover, the increasing identification of a particular form of lymphoma involving the salivary glands in Sjogren's syndrome (MALT type lymphoma - centrocytic-like) analogous to that seen in the gastrointestinal tract, now opens up the possibility of very early diagnosis of these tumours. However, the significance in terms of treatment of this monoclonal variant as a tumour criterion still remains difficult to define.

The case reported here illustrates a rare variety of hereditary osteodysplasia, the pyknodysostosis. The patient, a 34-years-old man, had an history of prior fractures. He took medical advice for a mandibular osteitis consecutive to a tooth extraction. The clinical examination detected a dwarfism accompanied by cranial deformities and abbreviated terminal phalanges of the fingers. The histological study was performed on the mandibular sequestrum and on the adjacent bone. Besides of chronic osteitis, it exhibited an intense osteo-condensation with changes in collagen frame by polarized lumen. As to the 2 molars implanted in the sequestrum, they were ankylosed because of the loss of periodontal ligament. About this case, the differential diagnosis with osteopetrosis and cleidocranial dysostosis and the pathogenesis of the disease are discussed.

The rare case reported here was a mandibular metastasis of a malignant melanoma located in the nape of the neck and surgically removed. 4 years later, occurred a fibrosarcomatous mandibular tumour without local recurrence. The metastatic nature of this tumour was difficult to prove by means of immunohistochemical and ultrastructural methods. This case illustrated the eventuality of a desmoplastic change in metastasis of a common malignant melanoma. The histogenesis of this rare type of melanoma was discussed.

Sixty-three cell smears from oral mucosa were studied by scanning electron microscopy. Among them, smears from ten healthy controls showed three kinds of cells: flat (superficial) cells with linear anastomosing microridges and microvilli; polygonal (intermediate) cells with well-defined crests between their faces and numerous microvilli; and round (parabasal) cells entirely covered by microvilli. Twenty-five smears from patients with untreated squamous-cell carcinoma showed enlarged polymorphous cells (round, globular, and elongated); microvilli, variable in their dimensions, were irregularly distributed on their surfaces. Eighteen smears from patients with severe epithelial dysplasia showed polymorphous cells with discontinuous but obvious edges separating their faces and with irregular microvilli and ridges. Nine smears were also performed in patients with various other mucosal lesions (lichen planus, leukoplakia, white sponge naevus, pemphigus vulgaris, and herpes). All of these smears were studied comparatively between examination of smears and biopsies by light microscopy. The smears were truly reliable, particularly for distinguishing between dysplastic and tumoral cells. Diagn Cytopathol 1986;2:110-117.

119 cases of Sjogren's syndrome are described. Clinically, the female sex predominates (83% of cases); the average age is 56 years. Isolated sicca syndrome is noted in 31 % of cases; it is more often associated with rheumatoid polyarthritis (64%) or with another collagen disease (5%). In addition, in 5 patients, we have found a malignant lymphoproliferative disease in an accessory or a main salivary gland (4 non-Hodgkin malignant lymphomas, 1 chronic lymphoid leukaemia). In all cases, a biopsy from accessory labial glands or from a main salivary gland, corroborates the diagnosis.

The 3 cases of cherubism reported affected the mandible. They were all studied by means of histo-enzymological and ultrastructural methods. This study demonstrated 3 stages in the morphological evolution of the disease, corroborated by clinical data. The 1st stage was characterized by an osteolytic granuloma with round, fusiform and giant-cells and a high level of activity of acid phosphatase. The 2nd stage showed repair with proliferation of highly active fibroblasts (increase in activity of leucine aminopeptidase). The 3rd stage exhibited an osteogenesis with high activity of alkaline phosphatase and ATPase. The pathogenesis of this rare osteodysplasia is discussed.

46 cases of acquired immunodeficiency syndrome permit the authors to detail the particular aspects of the oral and facial lesions in AIDS. In patients at risk, a lymphadenopathic syndrome is thought to represent a prodromic phase of the illness. The authors insist upon the differences between the classic Kaposi's sarcoma and that associated with the AIDS (mean age and initial sites of tumor). One third of these sarcomas is completed by a digestive candidiasis. The review of the literature reveals squamous cell carcinoma and Burkitt's lymphoma with the AIDS. We must be aware of early diagnosis and transmission factors in the individuals at risk with tumors and opportunistic infection.

11 specimens were carried out in patients with idiopathic gingival hyperplasia (3 cases), gravidic hyperplasia (1 case), iatrogenic hyperplasia (5 cases after cyclosporin A administrated in patients with cardiac grafts, 2 cases after treatment by Adalat). By optic microscopy, the deep collagen base is thickened, associated sometimes to an inflammatory process. By histoenzymology, the fibroblasts have high activities of their oxidative enzymes and also of the enzymes of protein synthesis. The electron microscopy corroborates the numerous globular fibroblasts with well-developed rough endoplasmic reticulum. These results prove the main role of fibroblasts in these lesions and the etiopathogenesis of this hyperplasia is discussed.

Among a series of 42 ossifying fibromas and 32 fibrous dysplasias, 5 cases were studied by histoenzymological and electron microscopic methods. The histological study in 2/3 of cases is sufficient for the diagnosis between the two diseases: trabecular bone in a connective tissue with regular collagen fibres in the ossifying fibroma; nodular indented bony areas with irregular collagen frame in fibrous dysplasia. By histoenzymology, the diagnosis between the two affections is not easy: same activity of ATPases and alkaline phosphatases in fibroblasts and osteoblasts. By electron microscopy, the morphology of the two lesions is different: in ossifying fibroma, numerous well-differentiated osteoblasts and large areas of ossification are seen; in fibrous dysplasia, undifferentiated cells are numerous and the collagen frame is irregularly mineralized. This method is also useful for the histogenetic understanding of these two osteopathies.

Cherubism is a benign hereditary giant-cell lesion of the mandibular and maxillary spongiosa which appears during childhood between the age of 2 and 5 years and progresses until puberty when it spontaneously regresses. It appears as a bilateral, painless swelling. It normally requires no treatment. Three children in the same Algerian family who suffered from this disease were brought to our department. Radiographic examinations were carried out, giving good definition of the lesions. The 3 patients were finally operated on, as operative treatment was, effectively, necessary.