Search

Resume Introduction Nous avons evalue les reconstructions des pertes de substances partielles de l’helix par le lambeau d’Antia-Buch et nous avons compare nos resultats a ceux des autres techniques decrites dans la litterature. Materiels et methodes Entre novembre 1998 et novembre 2002, nous avons realise 19 lambeaux d’Antia-Buch : 15 cas apres exerese carcinologique et quatre cas post-traumatiques. Les pertes de substances allaient de 15 a 40 mm. Entre 30 et 40 mm, la technique chirurgicale etait modifiee selon Fata. L’evaluation a pris en compte la satisfaction des patients, l’harmonie de l’ourlet heliceen evaluee par l’equipe chirurgicale, la presence eventuelle d’une encoche a la jonction ente les deux lambeaux et l’importance de la microtie postoperatoire. Resultats Toutes les reconstructions ont pu etre menees a bien sans complication. La technique de Fata a ete necessaire chez huit patients. Tous les patients etaient satisfaits du resultat esthetique, bien que la microtie ait ete systematique. La reconstruction de l’ourlet heliceen a ete jugee bonne chez 16 patients et moyenne chez trois autres patients. Neuf patients avaient une encoche sur le bord libre de l’helix. Discussion La reconstruction par le lambeau d’Antia-Buch est une technique simple et rapide, realisable en un temps, sous anesthesie locale. Elle permet une reconstruction harmonieuse de l’helix et du pavillon de l’oreille avec un tissu de meme nature, au prix d’une rancon cicatricielle minime, d’une constante microtie et parfois d’une encoche sur le bord libre de l’helix.

Introduction Le kyste osseux anevrysmal (KOA) est une pseudo-tumeur benigne qui realise une cavitation osseuse uni ou multiloculaire a contenu hematique. Observation Nous rapportons un cas de kyste osseux anevrysmal (KOA) du condyle mandibulaire gauche decouvert chez un enfant de 10 ans avec notion de traumatisme mandibulaire survenu un an auparavant. Il a beneficie d’une exerese tumorale suivie de reconstruction immediate par greffon chondro-costal. Les suites ont ete marquees par la survenue d’une hyperplasie cartilagineuse. Discussion La pathogenie du KOA repose sur trois theories, traumatique, vasculaire et tumorale primaire. Plusieurs examens complementaires font evoquer le diagnostic de KOA. L’examen anatomopathologique, peu aise et presentant des ecueils, reste le seul examen de certitude. Le traitement de choix est la resection avec exerese large suivie de la reconstruction immediate.

Introduction La tumeur triton maligne (TTM) est un sous-type de tumeur maligne des gaines nerveuses peripheriques qui presente une composante rhabdomyosarcomateuse. C’est une tumeur maligne rare, qui fut decrite pour la premiere fois en 1932, et dont le pronostic reste sombre. Les localisations ethmoido-nasales sont exceptionnelles avec seulement 10 cas rapportes dans la litterature. Observation Nous rapportons le cas d’une patiente âgee de 80 ans qui presentait une obstruction de la fosse nasale droite evoluant depuis plusieurs annees sans anosmie. La consultation a ete motivee par des epistaxis recidivantes. La tumeur, au scanner, occupait l’ensemble de l’ethmoide droit, du sinus maxillaire droit et de la fosse nasale homolaterale. L’exerese a ete effectuee par voie medio-faciale. Le diagnostic histologique a ete schwannosarcome de bas grade avec un contingent rhabdo-myosarcomateux discretement etendu, c’est-a-dire une TTM. Il n’y a pas eu de traitement complementaire. Huit mois plus tard, la tumeur a recidive avec une atteinte cerebrale. Malgre une reprise chirurgicale en double equipe avec les neurochirurgiens et une radiotherapie la tumeur a de nouveau recidive au niveau ethmoido-nasale. Apres 5 ans d’evolution, la patiente est toujours en poursuite evolutive locale sans metastase. Discussion La TTM des cavites naso-sinusiennes est une maladie rare mais qui doit faire partie des diagnostics differentiels des tumeurs malignes des cavites naso-sinusiennes. La plupart des cas, en dehors des localisations ethmoido-nasales, sont associes a une neurofibromatose de von Recklinhausen et surviennent chez le sujet jeune (35 ans en moyenne). Mais il existe des cas sporadiques notamment chez les femmes plus âgees ou apres radiotherapie. Le pronostic est un peu moins sombre pour les localisations ethmoido-nasales.

Resume Introduction L’evolution intracrânienne du melanome cutane est habituellement due a des metastases. L’evolution neurotrope des tumeurs malignes vers l’endocrâne concerne principalement les nerfs trijumeau et facial. Parmi les types histologiques de tumeurs neurotropes, le melanome constitue une entite rare. Observation Un patient a presente un melanome desmoplastique palpebral inferieur. L’evolution a ete marquee par l’envahissement du sinus caverneux, puis du nerf mandibulaire a partir du nerf maxillaire. Discussion Cette evolution neurotrope doit attirer l’attention en cas de lesion tumorale a proximite d’un nerf. Une chirurgie d’exerese large doit etre preconisee dans ce type de tumeur. Dans le cadre de la surveillance d’un melanome, notamment desmoplastique, tout signe neurologique moteur ou sensitif doit faire discuter une exploration approfondie par IRM.

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.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.

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.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.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.

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.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.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.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.

Aneurysmal bone cyst (ABC) is a pseudotumor of bone consisting of a septated cystic cavity filled with blood.We report a case of aneurysmal bone cyst of the left mandibular condyle discovered in a 10-year-old child with a history of mandibular trauma which had occurred one year earlier. The treatment consisted in surgical excision of the lesion and reconstruction using a chondro-costal graft. The post operative development led to a chondral hyperplasia.We discuss the pathogenesis of the ABC centered on three theories, traumatic, vascular and tumoral of primary lesion. There are several complementary examinations to establish the diagnosis of ABC but the histopathological examination is the only way to confirm the diagnosis. The differential diagnosis of ABC is not an easy task. Surgical management with removal followed by immediate reconstruction is preferred.

The combination of a malignant peripheral nerve sheath tumor with rhabdomyosarcomatous elements has been termed Malignant Triton Tumor (MTT). This tumor was first reported in 1932 and the prognosis was poor. Involvement of the sinonasal tract is rare with only 10 case reports.We report the case of a 80-year-old woman who presented an obstruction of the right nasal fossa which developed over several years without anosmia. She consulted because of recurrent epistaxis. The CT-scan revealed a tumor occupying the right ethmoid the right maxillary sinus and the homolateral nasal fossa. Resection was achieved via an extended mediofacial route. The histological diagnosis was low-grade schwannosarcoma with a discretely extended rhabdomyosarcomatous component, i.e. MTT. No complementary treatment was given. Eight months later, the tumor relapsed with cerebral involvement. Despite new surgery with two teams, a neurosurgical and a radiotherapy team, the tumor relapsed at the ethmoid-nasal level. After five years, the patient is alive with local progression without metastasis.MTT of the sinonasal tract is a rare disease that clinicians should be aware of and that must be included in the differential diagnosis of malignant lesions involving the sinonasal tract. Most of the reported cases involving localizations other than the ethmoidonasal cavities, are associated with von Recklinhausen neurofibromatosis and occurr in young subjects (mean age 35 years). There have however been sporadic cases, mainly in older women or after radiotherapy. The prognosis is somewhat better for ethmoidonasal localizations.

Chondrosarcomas are rarely observed in the infratemporal fossa. We report a rare case with temporal extension into the middle cerebral fossa without meningoencephalic invasion. Surgical excision was followed by radiotherapy. The patient died 7 years later from another cause free of tumoral recurrence. We discuss the current understanding of cephalic chondrosarcomas involving the infratemporal fossa.

Resume Observation Un pneumomediastin a ete decouvert fortuitement sur un scanner prescrit dans un contexte de traumatisme crânien et facial. L’emphyseme a ete secondairement rapporte a une fracture de la paroi anterolaterale du maxillaire. L’evolution a ete favorable apres une simple surveillance clinique et radiographique. Discussion La decouverte d’un pneumomediastin doit en premier lieu faire evoquer une plaie tracheale ou œsophagienne, dont le pronostic est grave. Le scanner en coupes axiales avec reconstructions tridimensionnelles nous a permis d’eviter une endoscopie sous anesthesie generale. L’antibioprophylaxie systematique est discutable.

Mucormycosis with hemipansinusitis and left orbital involvement was observed in a 66-year-old diabetic woman. Diagnosis was confirmed by mycology and pathology examinations. The patient was treated surgically with wide exeresis of necrotic tissue and medically with amphotericin B and insulin. Cure was obtained after three months of treatment at the cost of retraction of the left nostril due to infectious lysis and resection of the nasal infrastructure. The sinus involvement was exceptional compared with reports in the literature. Mucormycosis is an uncommon condition caused by opportunistic infection in immunodepressed subjects. The causal agent is a fungus belonging to the Rhizopus, Absidia or Mucor genera. Prognosis is poor with overall mortality reaching 50%.

A case of extreme macroglossia was observed in a patient with amyloid disease and dysglobulinaemia. A medial diamond-shaped glossectomy was required to reduce the size of the tongue. The details of the surgical and anaesthetic procedure are presented. This type of surgery, greatly appreciated by the patient, can only be undertaken after careful preparation. The reported cases are rare and the indication for surgery is difficult due to the unpredictable nature of the local and general clinical course of the disease.

Cephalic localization of liposarcoma is exceptional. We report three cases, in an 87-year-old patient with liposarcoma of the tongue, a 78-year-old patient with multiple recurrent liposarcoma of the orbit and a 42-year-old patient with ethmoido-orbital liposarcoma of metastasis origin. These three cases and a review of the literature were the basis of a summary of the incidence, the anatomic classification and therapeutic options for this type of liposarcomas.

This relates the case of a 19-years old female suffering from Takayasu's disease, who sustained injury with extradural hematoma formation calling for emergent evacuation thereof. The immediate postoperative period in this neurosurgical patient was characterized by extended necrosis of the scalp and underlying bone, due to low blood supply to the head in connection with her disease. The authors review the main characteristics of this rare inflammatory arteriopathy, and point out to the multidisciplinary collaboration which prompted healing of the patient's loss of substance.

Fortunately, serious orbital complications of sinus surgery occur rarely and are only very seldom reported. A case of bilateral Caldwell-Luc type operation for management of nasal polyposis was complicated by orbital luxation because of excessive intraorbital pressure consecutive to a blow in fracture. Enucleation of the eyeball will be required. Secondary surgery is performed to reduce the fractures and create a conjunctival pouch for the ocular prosthesis. Medico-legal consequences of the first operation (expert's report and trial) are related. A literature review provides rare examples of similar cases.

Necrotizing fasciitis is a synergic infection, the chief causal agents of which are beta-hemolytic group A streptococci. The authors insistingly review the different aspects of this rare affection and stress the importance of emergent medical and surgical management, as the evolution of the disease is still often lethal.

We report two cases of wide orbital resection requiring the use of an oculo-palpebro-jugal prosthesis. The latter being indispensable in the treatment of advanced orbital cancer in order to facilitate social reinsertion.

The authors review a uniform series of 15 cases of parotidectomized children aged below 10 years. From an etiological viewpoint, there were 6 different types of interventions, as 4 children had lymphangiomas, 2 had angiomas, 3 had tuberculous lymphadenopathy, 2 presented wounds in the area of the parotid, 1 had a pleomorphic adenoma, and there was 1 Ewing's sarcoma and 1 complex malformation of the hemiface. The analysis of such diverse cases provides an opportunity for precision in the indications, the technical procedures, and the outcome of parotidectomy performed in the child.

Washio's temporo-retro-auricular flap was used to repair point of nose in three children and one ala nasi amputated by dog bites. Details of the technique are presented and long-term results discussed. Despite two inconveniences--dyschromia and relative stenosis of nares--this method compares favorably with other surgical procedures and over the time has proved to be one worth recommending.

Over the period extending from 1950 to 1978, the treatment of mandibular fractures at the CHU of Lyon followed a dual evolutionary course. On the one hand, fractures of the dental part of the bone were treated more and more often surgically via the endobuccal approach, by osteosynthesis using miniature screwed plates. On the other hand, fractures of the region of the condyle benefited from mechanotherapy according to professor Delaire's technique. These therapeutical trends have led to frank improvement in the outcome of these patients, both from the functional and esthetical points of view.

A patient with intramandibular angioma and arteriovenous fistula (high output arterial angiodysplasia) required 4 separate hyperselective embolizations and a surgical excision. The problems of embolization, surgical technique and indications for operation of this happily rare, serious vascular malformation are analyzed.

Three patients with mandibular ameloblastomas were treated by hemimandibulectomy followed by immediate reconstruction by a single-block mandibular homograft prepared at a distance from the operating field and taken from the bone section removed after visual and radiologic control of total tumoral separation. This procedure is simpler and more economic, rapid and reliable that conventional reconstruction using rib or iliac homografts. It is indicated for those limited cases of ameloblastoma or benign bone tumors which, even though possessing similar prognoses by their site (coronal...) or their tendency for recurrence and thus requiring interruptive resection, are sufficiently small to ensure total tumor excision and the recovery of a sufficiently thick bone piece for an ideal homograft. The procedure is of particular interest in the elderly and/or debilitated patients, and may be useful after abusive hemimandibulectomy.

Histopathology of mandibular swellings in two women aged 68 and 73 years respectively provided a diagnosis of Paget's disease. The complementary biological tests (phosphorus-calcium metabolism, alkaline phosphatase, hydroxyprolinuria) performed showed the increase in bone metabolism, while imaging techniques (conventional radiography, scintigraphy, CT scan) demonstrated numerous subclinical bony foci. Treatment of the facial deformity, if desirable esthetically or functionally necessary (alveolitis, osteitis) can only be surgical. If there is biological bone hypermetabolism, medical (diphosphonate, calcitonin) can be discussed with the rheumatologists. Evolutive risks are represented by rare sarcomatous transformations, osteomyelitis on Paget and monstrous deformities of the face, as in one of the patients reported who had refused all treatment over 37 years.

Fibrinogen glue of human origin was used in 44 patients. Indications are of two types: as a glue mainly for dermoepidermoid grafts but also to assist mucosal suturing and bone obturation, and for hemostasis after extractions in patients with coagulation disorders (hemophilia, cirrhosis, leukemia). Positive results were obtained, particularly in hemophilic patients, the incidence and severity of secondary hemorrhage appearing to diminish.

A case is reported of progressive ossifying myositis (fibrodysplasia ossificans progressiva, Münchmeyer's disease) with onset at 16 years of age by a lesion of internal pterygoid with limitation of opening of mouth. Surgery to relieve ankylosis was followed by recurrence. Diagnosis was established only after the appearance of lesions in other regions (sternocleidomastoid, latissimus dorsi, lumbar muscles...). Clinical and paraclinical signs of this exceptionally rare disease are reviewed and diagnostic difficulties at onset of the disease discussed. Treatment of acute myositis episodes with diphosphonates delays passage to the ossification stage, allowing local surgery to be performed with less risk of relapse.

Malignant fibrous histiocytomas, or MFH, have been individualized only since the last two decades. These sarcomas which usually develop from soft tissues are no longer considered rare, except in some of their facial sinus localizations. Two chapters will be particularly developed: the paramount significance of anatomopathological investigations owing to the difficulty in establishing the diagnosis, since MFHs may be mistaken for benign processes; the treatment which is, generally speaking, the same as for bone sarcomas.

Common features in two patients with chronic suppurative lesions of the maxillofacial region from vegetable foreign bodies were : foreign body origin of the accident ; chronic nature of the suppuration (7 and 23 months respectively) ; multiple operations by different surgical teams ; radiotransparency of the foreign bodies. Positive signs on CT scanning can confirm the diagnosis, but cannot exclude it when normal images are obtained. The number and localization of wood fragments may limit the value of the scan, and fistulography and xeroradiography may then provide confirmation of the diagnosis. Operative treatment may be difficult due to fragmentation of the wood into multiple pieces, a possible source of recurrence of infection.

Principal features of histiocytosis X are discussed in relation to 5 cases treated in the department. Clinical signs are known. Bone scintiscans are of importance for evaluation of extension of the disease. Surgical treatment is the rule until more effective therapy becomes available and has a diagnostic rather than curative aim. The major problem remains the progressive dental mutilation.

It is exceptional for surgery to become necessary after the use of miniaturized plate and screws. When it is required it is because of faulty reduction or contention, mucosal disunion or an infective focus, or a combination of these factors. Surgery provides good final results, but 2 to 4 supplementary months of immobility are needed, and it can be avoided by respecting the indications and practical necessities of this method.

Maxillofacial injuries due to sporting activities represent approximately 10% of all cases of injury admitted to the University Hospital Center, Lyon, France, and more than half of these occur in football or rugby players. The causes of these accidents (blows against another player, the ground, the field equipment or the game accessories) are discussed. Lesions are generally simple in young, fit adults and results of surgical treatment satisfactory, apart from the rare cases of facial disruption. Preventive measures include examination for aptitude for sporting activities, adequate referring of games and the wearing of helmets, masks and inter-maxillary protective bars.