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Introduction: Dermoid cysts of the submandibular region are rare. We report an exceptional case with extension to the neck., Observation: The patient presented with a voluminous left submandibular cystic tumor with extension to the neck and to floor of the mouth. Ultrasonography and CT scan contributed to the diagnosis and to chose the best surgical approach in case of large cyst. In our case, the tumor was removed using a double cervical and intraoral approach. Histopathological examination confirmed a dermoid cyst., Discussion: We report an exceptional case of dermoid cyst originating from submandibular region. A double surgical approach was necessary for tumor resection. Tumor removal must be complete; the submandibular gland may be removed if necessary., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

Introduction: The infrahyoid myocutaneous flap was described by Wang et al. in 1986. The horizontal design of the skin paddle is a modification of this technique allowing for a smaller scar. We have been systematically using this modified technique for 10 years. We had for aim to describe the interest of the horizontal infrahyoid myocutaneous flap for cervicofacial carcinology., Patients and Methods: A horizontal infrahyoid myocutaneous flap procedure was performed in 276 cervicofacial carcinology patients for lesions of the mouth floor, the mandibular gum, the oropharynx and the tongue between March 1997 and March 2007., Results: No complications were observed in 252 patients. No patient presented with total flap necrosis., Discussion: Modifying the infrahyoid myocutaneous flap technique with a horizontal design of the skin paddle does not modify the reliability of the flap and prevents more extensive scars. The main indications of this technique are defects of the mouth floor, the tongue and the oropharynx.

Introduction: Most cancers of the oral cavity are epidermoid carcinomas. The prognosis is made on the patient's general health status and the tumoral stage. The UICC TNM staging classification system is one of the most important factors taken in consideration for the prognosis. But this classification in oral epidermoid carcinomas does not include the tumor thickness (except for T4 tumors). Several studies demonstrated that tumor thickness could influence the prognosis in epidermoid carcinoma and other types of cancers. The aim of our retrospective study was to assess the prognostic value of tumor thickness in oral epidermoid carcinoma., Patients and Methods: The study included patients with mouth floor or mobile tongue epidermoid carcinoma classified T1N0, T2N0 and T3N0 between 1985 and 2005. All patients were treated with a curative intention. A pathologist analysed the tumor thickness and cervical lymph nodes. All the slides were examined to measure tumor thickness in millimetres., Results: Three hundred and five patient files were reviewed and 124 patients were included, with 94 men (75.8%), and a mean age of 59.3 years (17-93). The mean and median tumor thickness were respectively 7.7 and 6.5 mm (0.4-30). The median tumor thickness was chosen for the study. There was a statistically significant link between the five-year probability of global survival and the initial tumor thickness and between neck node invasion and tumor thickness (p<0.05)., Discussion: This study suggests that tumor thickness should be taken in consideration in T1N0, T2N0 and T3N0 mouth floor and mobile tongue epidermoid carcinomas. In the future, the clinical evaluation of tumor thickness will help determine the therapeutic management.

Introduction: Patient's age is known to have no influence on either treatment or prognosis of oral squamous cell carcinoma., Observation: A 94-year old female patient, with a squamous cell carcinoma of the floor of the mouth, stage pT1pN0cM0, was classically treated by surgical tumor resection, selective neck dissection and immediate surgical reconstruction with a vascularized radial flap., Discussion: This clinical case, which could be a record taking into account the patient's advanced age, confirms that treatment decision of oral squamous cell carcinoma must not be influenced by age. Only some age-related comorbidities must be considered.

Introduction: Postoperative monitoring of free flaps with microdialysis allows early diagnosis of anastomotic complications. Feasibi-lity studies are required to examine flap accessibility for oral cavity reconstruction., Cases: We present our preliminary findings in two patients who underwent radial free flap reconstruction of the floor of the mouth. For the first patient, a microprobe was used to monitor the flap for 45 hours. In the second case, an abdominal microprobe served as a control in healthy skin with another probe located in the cutaneous flap for 4 days. Flap monitoring, starting from the recovery room, was successful with easy manipulations for the nurse. Correlation between the monitoring curves and the clinical aspect of the flap was excellent., Discussion: The microprobe should be short (1 cm), and carefully anchored. Naso-gastric feeding is required during monitoring. A close correlation has been found between glucose level and systolic pressure. The use of a comparative microprobe in healthy abdominal skin is helpful in learning to use the dialysis curves.

Flap failure is mostly caused by venous thrombosis of the anastomosis. The failure rate is higher in post-irradiated neck. To reduce the risk of venous thrombosis, the authors propose to harvest the radial forearm flap using the cephalic vein as the drainage vein and as a pedicle. Only a single arterial anastomosis is carried out. This technique has been described already in patients who underwent head and neck ablative surgery with radical neck dissection. The authors report 2 cases in patients with post-irradiated neck. The flap transfers were successful in the 2 cases. The operative time of harvesting this hybrid version is the same with the conventional free flap technique. This version of the radial forearm flap can be a method of choice for some complex microvascular reconstruction in the head and neck region.

Squamous cell carcinomas of the oral cavity were treated in 157 patients by surgery as first-line (104) or salvage (53) treatment. Postoperative irradiation delivered either for locally advanced tumors (stade III-IV) or for unfavorable histological data (nodal or surgical margins involvement). The retrospective study with a mean time of follow-up of 2.5 years shows a loco-regional control rate of 75% statistically influenced by histological nodal status (p < 0.01). Cumulative and cause specific survival rates at 5 years are 41.1% and 57.2% respectively. T stage was found to be a prognostic factor of survival (p < 0.01) as bone involvement (p < 0.05). Surgical margins are influent on local control and survival only in absence of radiation.

The temporal fasciocutaneous scalp flap (TFSF) is used as mucosal reconstruction in 22 oropharyngeal and oral carcinomas. The anatomical basis of the flap and the clinical observations are described. The qualities of such a flap clearly appear: high liability and plasticity, perfectly adapted with oropharyngeal and oral mucosal loss. However attention must be payed to reconstruction of the anterior floor of the mouth which seems to be the limit of the rotation arc. Within these limits the TFSH has an inconspicuous donor site scar and low morbidity quite resumed by the hair regrowth on the intral-oral skin paddle.

Postoperative blindness due to ischemic optic neuropathy is a rare and dramatic complication. A review of the literature from 1960 until nowadays reveal several physiopathological mechanisms of the blindness. Through the description of their clinic case of a fourty seven years old man showing definitive postoperative blindness after sustaining surgery for epidermoid carcinoma of the mouth floor, the authors suggest as etiology the conjunction of the following factors: brain venous high pressure, head and neck oedema, hypotension and the vascular state of the patient. Special perioperative care taking in account the risk factors is needed to prevent this complication.

In cases of surgically removed mandibular symphysis malignancies, the bone and mouth floor were reconstructed using osteo-musculo-cutaneous flaps. In our experience, the latter provide the best results. Removed in dorsal decubitus, they allow floor replacement. During the dissection of the tumor site, we also preserve labial and chin structures, which favours a good restoration of phonation and swallowing.

The authors report functional results in a series of 81 patients with carcinoma of the floor of the mouth treated by surgical resection and reconstruction by nasolabial flap. The study confirms the literature concerning advantages and limits of such a flap. With regards to others techniques of reconstruction, nasolabial flap is still perfectly usefull in reconstruction of T2 T3 carcinomas of the floor of the mouth.

In this study, primary we present briefly the main anatomic elements that concern the tongue as also the clinical and other structures of the cancer of the oral cavity. Simultaneously, we notice our experience from the use of the tongue flap in 16 patients with cancer of the floor of the oral cavity. This procedure is simple, easy, brief and it does not cause aesthetic problems to patients. It is also emphasized that this method does not create functional disabilities to the rest part of the tongue, with result the patients not have disturbances in speech, in chewing or in swallowing.

The author reports twelve Trauner mylo-hyoid plasties, recommending:--a medial incision forming a covering flap on the medial aspect of the body of the mandible after lowering of the floor of the mouth,--disinsertion not only of the mylo-hyoid but of all the retro-symphyseal muscles,--keeping in place the temporary prosthesis, in part fashioned inside the mouth, for five weeks.

Within the clinical context of carinomas of the upper respiratory/digestive tract (special underlying features, frequency of multiple localisations), pelvi-gingival tumours pose special problems essentially related to the proximity of the mandible. Over the past 15 years, treatment protocols at the Institut Gustave-Roussy have been progressively oriented towards a surgical solution preceded by short period of chemotherapy and followed by radiotherapy on an "as required" basis. In certain instances (bone resection with defect, especially naterior), such excision surgery results in serious functional and aesthetic impairment and cannot be envisaged in the absence of concomitant reparative surgery. The latter is clearly defined as far as the soft tissues are concerned thanks to the use of facial or thoracic flaps, whilst solutions for restoring bone continuity remain imperfect. The difficulties of covering a bone transplant and the need for postoperative radiotherapy compromise its future. From a tumour standpoint, the results are aggravated essentially by the existence of bone involvement or of histological lymph node invasion. Furthermore, it is closely related to the manifestations of the malignant disease in general. The survival obtained with the current therapeutic protocol is 38% at 3 years and 32% at 5 years.

A retrospective study was conducted on 85 case-reports of patients with epithelioma of anterior and anterolateral region of floor of mouth operated upon in the Stomatology and Maxillofacial Surgery Clinic of Salpêtrière hospital, Paris. An update review of recent advances in surgery for reconstruction of floor of mouth is completed by results of study of the case-reports showing evolution of ideas related to functional results and to vital prognosis (as function of tumoral stage).

A historical review is followed by a case report concerning a 58-year-old man cured of a pelvilingual carcinoma at the price of severe mutilation in whom it was possible, with the aid of cutaneo-cylindircal grafts, to close a buccocervical fistula and to anatomically reconstruct the tongue. This rare case proves that after treatment for carcinoma, stomatological plastic surgery is possible when cure is certain and the patient's general condition good.

The authors describe ten patients with calculi in various regions of the submandibular gland, who were operated upon using the buccal approach, and review the different therapeutic procedures available. Though removal of the submandibular gland is a mutilating operation and has many sequelae when operated upon through the submandibular approach, it is still, surprisingly, the standard operative procedure for removal of posterior calculi, even though Delaire had already expressed his logical preference for the buccal approach, 23 years ago. This procedure was used in the 10 cases reported here and results were very good, and there were no sequelae. A strict operative technique is necessary, including general anaesthesia and dissection of Wharthon's duct along its whole length as the essential factors.

So-called "moniblock" excision, an attractive technique for the treatment of carcinomas of the tongue and floor of the mouth, benefits considerably from the use of pediculated flaps which ensure closure of the buccal cavity and thus diminish or even eliminate the risk of septic cervical cellulitis. The authors report 27 cases of carcinoma treated using this technique involving plastic repair using a temporo-frontal flap inserted in the buccal cavity via the temporal groove after resection of the coronal and the zygomatic arch.

Results are reported of the use of four temporal muscle flaps for reconstruction of the floor of mouth and the velo-amygdalo-palatine region after transmaxillary buccopharyngectomy for malignant tumor. The good vascularization of the temporal flap ensured very satisfactory immediate and long term results.

Prosthetic Surgery must not be considered as an exceptional process. It is likely to transform the comfort and stability of a complete prosthesis if the indications are well laid down. Two elements combine towards its success. 1. The surgical action, which may be -- a limited vestibuloplasty, destined to abolish the small ligaments, the hyperplasias or the polypoid formations; --an extensive vestibuloplasty, intended to deepen the non-retentive vestibules. The process of choice is a super-periosteal plasty of the CLARKE or VRASSE and BATAILLE type. It may be used above all on the mandible. For the maxilla, CELESNIK's intervention may be associated with it; --free skin grafts. They do not always give the results anticipated because of the cicatrical retraction which is almost constantly observed. 2. The retention is as important as the surgery. It is carried out by an anchorage with wires, in a hammock or transcutaneous, and by a plate of resin lined with a layer of elastomeres of silicon. The material appears very much superior to the sponges of polyvinylic alcohol advocated by VRASSE and NETTER.

A technique of secondary reconstruction of the buccal floor after non interruptive pelvimandibulectomy by thin-split graft enables insertion of a dental prosthesis to assist functional recovery. Results of 46 grafts of this type performed at the Institut Gustave Roussy, Villejuif, France, including 21 cases previously analysed in the Annales d'oto-laryngologie, Paris 1985.