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Observation: A pneumomediastinum was discovered fortuitously on a CT scan prescribed to a patient for facial and cranial trauma. Emphysema was attributed secondarily to an anterolateral maxillary wall fracture. The evolution was favorable after simple clinical and radiological surveillance., Discussion: The observation of a pneumomediastinum should first be related to a tracheal or esophageal wound with a severe prognosis. Endoscopy under general anesthesia was not necessary for our patient thanks to CT scan with 3D reconstruction. There is no consensus for systematic antibioprophylaxis.

Introduction: The Poncet-Spiegler cylindroma (PSC) is a benign annexal cutaneous tumor which preferentially develops on the scalp, neck, or forehead. Localizations may be isolated or multiple and often affect the young adult. The lesions grow progressively. When the scalp is completely involved, it presents as a "turban tumor". Treatment is surgery and may be difficult when the tumor is extended. We report the management of turban tumor., Observation: A 25 year-old female patient was first treated by partial scalp nodule exeresis and histology documented a PSC. She was lost to follow-up. But 9 years later, she was managed for a turban like PSC. The treatment was a complete scalp exeresis and secondary reconstruction with a skin graft. Follow-up was uneventful with a progressive functional and cosmetic improvement and after 2 years, there was no relapse., Discussion: As for most tumors, management depends on the size of the PSC. An aggressive surgical treatment must be considered if the PSC is extended. In case of turban tumor, total scalp exeresis and secondary reconstruction with a skin graft is recommended.

Introduction: The aim of this study was to evaluate the results of ear defect reconstruction using the Antia-Buch flap technique and to compare it to other techniques described in international literature., Materials and Methods: We performed 19 Antia-Buch flaps between November 1998 and November 2002: 15 cases after neoplastic treatment and four post-traumatic cases. Defect ranged between 15 and 40 mm. Between 30 and 40 mm, we used Fata's modification. The final assessment took into account patient satisfaction, cosmetic aspect of reconstruction assessed by the medical team, the presence of a notch at the helical rim and the degree of microtia., Results: All ear reconstructions were successful. No complications were reported. Fata's modification was used for eight patients. All the patients were satisfied with the result in spite of a systematic microtia. The cosmetic aspect was considered as good for 16 patients, average for three. Nine patients presented with a notch at the helical rim., Discussion: Reconstruction using the Antia-Buch flap is a simple and fast operative technique performed in a single operation under local anesthesia. It allows for a harmonious reconstruction of the helix and auricle with a tissue of same nature, and only a tiny cicatricial ransom, systematic microtia and frequent notch on the helical rim.

Introduction: The intracranial evolution of cutaneous melanoma is usually due to metastases. Neurotropic invasion mainly concerns the trigeminal and the facial nerves. The melanoma is a rare entity among neurotropic tumors., Observation: A patient presented with a desmoplastic melanoma of the lower lid, complicated by a perineural extension to the cavernous sinus and the mandibular nerve via the maxillary nerve., Discussion: This neurotropic evolution should be carefully monitored when close to a nerve. Extensive surgical excision including peripheral nerves in the vicinity of such tumors is recommended. MRI should be performed when a motor or sensitive disorder appears in the course of a desmoplastic melanoma.

Case Report: A 23 year-old girl was admitted for a facial tumefaction, fixed to the mandible. The X-rays showed a fuzzy osteolytic lesion of the mandibular angle. The CT-scan confirmed the rupture of the cortical bone and the extension to the soft tissue. Biopsy provided the diagnosis of granulocytic monoblastic sarcoma (chloroma). Chemotherapy was efficient., Discussion: Mandibular localizations of chloroma are rare. Granulocytic monoblastic sarcoma is a localized tumor made of extramedullar immature granulocytes, in general associated (or more rarely preceded by) with leukemia. Early diagnosis is important because high dose chemotherapy induction may completely cure leukemia.

We report three cases of squamous cell carcinoma of the columella invading the sub-partitions. Wide resection raised the problem of several nasal esthetics sub-units. A chronological review of columella reconstruction procedures explained why the nasolabial fragment rarely used for partial rhinopoiesis, was appropriate in these three patients.

We describe a case of branchial cyst from the first branchial cleft in an 8-year-old patient, emphasizing the diagnostic difficulties of this type of lesion and the clinical aspects as well as the details of surgical treatment. The embryogenic origin and the anatomic relation with the facial nerve is recalled. Surgical treatment is indicated.

The Chinese or radial forearm flap, first described by Yang et al. (1981), is useful both as a free or a pedicle flap. This flap has proved to be one of the safest and most versatile flap in widely differing clinical situations. It is generally classified as a fasciocutaneous flap, but can also be used together with a segment of radius as a composite flap. However, the most common objection to this flap is the donor-site morbidity. The donor defect is significant, with a poor graft take over the exposed tendons. Inclusion of bone in the flap leads to a greater contour defect and to a risk of fracture. Many suggestions are given to minimize the complications on the donor-site defect. The surgical technique, the advantages, the disadvantages, and at least the indications of this flap are detailed.

Recommended treatment for head and neck cancer associates surgery and radiotherapy. Indication for bone-anchored epitheses in irradiated patients is also a common situation. The outcome of the implant appears to be improved with a special protocol for hyperbaric oxygen therapy, antibiotic therapy and calcitherapy. The problem of radiotherapy in patients with titanium osseointegrated implants is also discussed.