Search

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.

International audience

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.

Les avulsions de dents incluses sont d’une pratique courante. Le plus fréquemment, le dégagement osseux n’a pas de conséquences. Dans certains cas, il peut poser problème, s’il concerne un futur site d’implantation ou des structures anatomiques spécifiques, notamment dans le prémaxillaire (Sukegawa et al. Case Rep Dent. 2015; 2015: 974169). Pour ces situations, la piézochirugie apparait comme une technique peu invasive puisque la découpe est plus fine et plus précise qu’avec les instruments rotatifs (Pavlıékovaé et al. Int J Oral Maxillofac Surg. 2011 40:451-7). De plus, le fait de découper un volet puis de le repositionner en fin d’intervention constitue un moyen de préserver le volume osseux. Le cas rapporté est celui d’une avulsion d’un mesiodens par découpe puis repositionnement de l’épine nasale antérieure. Une jeune fille de 13 ans a été adressée par son orthodontiste pour avulsion d’un mesiodens avant prise en charge ODF. Un examen cone beam a précisé la position de cet odontoïde. D’une morphologie évoquant une incisive conoïde, la dent surnuméraire se présentait en position verticale ; sa couronne faisait saillie dans les fosses nasales, sous le vomer, et sa racine était en arrière de celles des incisives centrales. Lors d’une intervention menée sous anesthésie générale, l’ENA a été découpée par piézochirugie (incision en V de part et d’autre du plan médian) et luxée vers le haut, sans décollement de la muqueuse nasale. L’odontoïde a été sectionné au collet. Sa couronne d’abord puis sa racine ont été avulsées. Enfin, l’ENA a été repositionnée et fixée par une vis d’ostosynthèse positionnée légèrement en biais. Les suites ont été bonnes. La vis d’ostéosynthèse a été déposée un an plus tard. L’avulsion de cette dent, profondément incluse, par les techniques conventionnelles utilisant des instruments rotatifs aurait entraîné un délabrement important. Compte tenu de la situation inversée de l’axe de la dent, il aurait été difficile de la retirer par un abord palatin. De plus, son axe vertical compliquait la séparation couronne-racine, qui n’aurait été possible que par un accès nasal. Le choix d’une technique conservatrice de l’os (découpe puis repositionnement) semblait judicieux dans la mesure où il autorisait une bonne exposition du site et le morcellement cervical de la dent, tout en épargnant le volume osseux. Le fait de ne pas avoir décollé la muqueuse palatine a probablement contribué à la trophicité et la cicatrisation de l’ENA repositionnée. Les opérateurs ont pris le soin de ne pas placer la vis d’ostéosynthèse dans la suture entre les deux parties droite et gauche de l’ENA, afin de ne pas risquer de séparer ces deux os. Ce cas illustre une technique minimalement invasive qui a permis l’avulsion d’une dent surnuméraire profondément incluse en position verticale inversée, sans entraîner de lésion des dents voisines ni de la muqueuse nasale, tout en préservant le volume osseux de l’ENA.

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).

Introduction : L’association de plusieurs medicaments peut mener a des situations dangereuses, voire fatales. Objectifs pedagogiques : Cet article propose de faire le point sur les interactions medicamenteuses existant avec les substances prescrites par les chirurgiens-dentistes (antibiotiques, antifongiques, antalgiques, anti-inflammatoires). Un tableau synoptique expose l’ensemble des interactions contre-indiquees et deconseillees par l’Agence nationale de securite du medicament (ANSM), en detaillant leurs mecanismes et les repercussions cliniques pour chaque association dangereuse. Parmi ces medicaments, les plus impliques sont de loin les macrolides et les imidazoles (miconazole et metronidazole), suivis par les AINS et le tramadol. Cette revue est illustree par quatre cas cliniques tires de la base nationale de pharmacovigilance. Deux des personnes interessees par ces accidents sont decedees (interaction colchicine-clarithromycine et interaction antivitamine K-miconazole). Dans un autre cas d’interaction AVK-miconazole, on a observe une valeur d’INR a 27, mais sans toutefois conduire au deces de la patiente. Conclusion : La bonne connaissance des mecanismes de ces interactions devrait permettre d’eviter ces situations. En retour, l’odontologiste doit contribuer a la mise a jour des connaissances en signalant systematiquement tout effet indesirable aux centres de pharmacovigilance.

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.

Introduction : Les migrations d’implants dans le sinus maxillaire font partie des nombreuses complications implantaires rapportees dans la litterature. L’objet de cet article est de presenter un cas de projection d’un implant dans le sinus maxillaire et sa prise en charge par une rehabilitation chirurgicale, implantaire et prothetique au regard de la litterature internationale. Observation : Une patiente de 63 ans s’est presentee a la consultation d’implantologie du centre de soins et de recherche dentaire de Montpellier suite a la projection d’un implant dans le sinus maxillaire par un praticien. La prise en charge de cette patiente a consiste au retrait de cet implant par une voie d’abord laterale sinusienne puis a une rehabilitation chirurgicale, implantaire et prothetique. Discussion : Comme frequemment rapporte dans la litterature, cette projection a fait suite a une technique operatoire mal maitrisee ou a une analyse radiographique preoperatoire insuffisante. Plusieurs attitudes therapeutiques sont possibles face a ce genre de complication. Le choix du retrait de l’implant ou de l’abstention therapeutique est determine entre autre en fonction de la symptomatologie.

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.

La gestion de l’insuffisance de volume osseux dans les secteurs posterieurs mandibulaires est un probleme courant en implantologie. Plusieurs techniques ont ete decrites afin d’augmenter le volume osseux alveolaire. Ces techniques incluent les greffes de blocs osseux en « onlay », la regeneration osseuse guidee, la distraction osteogenique et l’expansion transversale de crete par clivage sagittal. Dans cette derniere technique, le fragment osseux vestibulaire est luxe lateralement apres fracture en bois vert, et l’espace ainsi cree entre les corticales vestibulaire et linguale est comble par de l’os autogene, un substitut osseux ou simplement rempli par le caillot sanguin. L’expansion transversale de crete est habituellement realisee dans le meme temps operatoire que la pose des implants. Cette technique est plus adaptee au maxillaire qu’a la mandibule de par la qualite osseuse moins dense permettant une certaine flexibilite. A la mandibule, le risque de malfracture du fragment osseux vestibulaire est grand du fait d’une plus grande rigidite due a l’epaisseur des corticales. Une approche en deux etapes peut etre envisagee afin de reduire le risque de malfracture et de necrose osseuse. Cet article presente un cas clinique d’expansion transversale modifie, en deux temps operatoires : trois semaines apres la corticotomie d’un segment osseux rectangulaire vestibulaire, la crete alveolaire a ete clivee sagittalement en laissant le perioste relie au segment vestibulaire lateralise, et deux implants ont ete mis en place.

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.

International audience

Les carcinomes des voies aerodigestives superieures se situent au 4 rang des cancers les plus frequents pour le sexe masculin ; les principaux facteurs de risque sont l’alcool, le tabac et les infections a papillomavirus. Par ailleurs, les implants dentaires representent une therapeutique de plus en plus populaire. Peu de cas de carcinomes epidermoides developpes autour d’implants dentaires ont ete rapportes (Gallego et al. 2008, Meijer et al. 2010). Les implants pourraient constituer un facteur irritant et/ou un cofacteur inflammatoire (Jane-Salas et al. 2011). Mais le role cancerigene n'a pas ete clairement etabli (Abu El-Naaj et al. 2007, Bhatavadekar 2011) et une simple coincidence topographique ne peut etre ecartee

Actuellement en plein essor, la sedation consciente par melange equimolaire oxygene-protoxyde d’azote (MEOPA) permet de prendre en charge davantage de patients au fauteuil et donc de limiter le nombre des anesthesies generales, notamment chez les enfants (Vaysse et al. 2004). Ayant fait la remarque empirique que les resultats de cette technique etaient moins bons a la fin d’une bouteille de gaz (en comparaison a une bouteille neuve), les auteurs ont souhaite etudier l’effet de la pression du gaz sur l’efficacite de la sedation.