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Abstract Pai syndrome was originally described as the association of a midline cleft lip, midline facial polyps, and lipoma of the central nervous system. However, only a few patients present with the full triad, and most exhibit a wide spectrum of phenotypic variability. The aim of this study was to phenotypically delineate Pai syndrome and to propose new criteria to facilitate a clinical diagnosis in the future. The study cohort consisted of seven case patients and an additional 60 cases diagnosed with Pai syndrome identified in a literature review. Only 23 of 67 patients presented the full triad as historically described by Pai et al. (1987). A congenital facial midline skin mass was always encountered, particularly affecting the nasal structures (60/67). A midline facial cleft was reported in 45 of 67 patients and a pericallosal lipoma in 42 of 67 patients. The proposed definition of Pai syndrome is the association of (1) a congenital nasal and/or mediofrontal skin mass and/or a mid-anterior alveolar process polyp as a mandatory criterion, and at least one of the following criteria: (2) midline cleft lip and/or midline alveolar cleft, and/or (3) a pericallosal lipoma or interhemispheric lipoma in the case of corpus callosum dysgenesis. [ABSTRACT FROM AUTHOR]

Résumé Les traumatismes de la face sont fréquents chez l’enfant et souvent banalisés. La face, très vascularisée, est le siège de saignements impressionnants sur le lieu de l’accident mais souvent sous-estimés chez l’enfant car il existe une vasoconstriction artérielle immédiate très développée. La masse sanguine est de 80 mL/kg chez le nouveau-né, soit 250 mL au total pour atteindre 70 mL/kg à partir de l’âge d’un an. L’évaluation doit être rigoureuse sous peine d’une décompensation brutale. Concernant les plaies, la réparation primaire doit être d’emblée parfaite ou optimale en cas de délabrement. Le dogme est d’être conservateur et le parage doit être minimaliste. La réparation minutieuse nécessite souvent une anesthésie générale, surtout chez les jeunes enfants afin de permettre un affrontement parfait des berges et des lignes cutanéo-muqueuses. Les pertes de substance doivent être traitées par cicatrisation dirigée. Il n’est jamais effectué de lambeaux immédiats chez l’enfant pour les raisons développées plus loin. Vu l’élasticité du squelette facial, les fractures nécessitent un choc violent pour survenir mais la clinique peut être trompeuse. Deux fractures sont souvent peu symptomatiques au niveau des signes faciaux et peuvent être méconnues : la fracture du condyle et sa complication l’ankylose osseuse temporomandibulaire, la fracture du plancher de l’orbite et sa diplopie définitive. Il faut savoir suspecter une maltraitance devant des lésions d’âges différents, et une discordance entre l’histoire racontée et les lésions constatées. Une fois éliminée l’urgence vitale, l’urgence faciale est d’abord à l’œil car les plaies et contusions du globe, souvent sous-évaluées, menacent la vision et relèvent de l’urgence ophtalmologique. L’urgence est ensuite la fracture du plancher de l’orbite sous sa forme dite « en trappe », apanage de l’enfant. La fracture du plancher de l’orbite associée à une immobilité de l’œil et des vomissements incoercibles est la 2 e vraie urgence car elle met en jeu le pronostic de la motricité de l’œil et nécessite une intervention en urgence. Enfin, les traumatismes dentaires de l’enfant ne doivent pas être négligés en raison de leurs conséquences fonctionnelles et esthétiques. La cicatrisation primaire est le plus souvent rapide mais les cicatrices restent longtemps inflammatoires. Le risque hypertrophique existe en cas de contusions et dilacérations associées aux plaies mais aussi pendant la période pubertaire et dans certaines localisations. L’âge interfère sur le résultat car la croissance va soit améliorer soit aggraver le résultat initial, en fonction de la localisation et du mécanisme. Le suivi spécialisé secondaire et prolongé est capital au plan fonctionnel, esthétique et psychologique. Summary Facial traumas are common in children but often unconsidered. Facial injury is responsible of impressive bleeding because of the rich vascularization of the face; this bleeding is often underestimated because of the immediate arterial vasoconstriction that is very strong for children. The blood volume is 80 ml/kg for a newborn, with a total of 250 ml, reaching 70 ml/kg at one year of age. The evaluation must be rigorously performed due to the risk of a sudden decompensation. Regarding the wounds, the primary repair must be performed directly neat or optimal in case of damaged tissues. The rule is to keep maximum of the integrity and to limit debridement. Careful repair often requires general anesthesia, especially in young children, to facilitate a perfect joining of the edges and of the mucocutaneous lines. Losses of substance should be treated by directed cicatrization. Flaps are never performed in children as a first intention for reasons developed below. Given the elasticity of the facial skeleton, fractures require a brutal shock to occur, but the clinical signs can be misleading. For instance, too specific and sometimes ignored, fractures can show weakly symptomatic signs : the fractures of the condylar and the orbital floor, with their respective complication that are temporomandibular bone ankylosis and definitive diplopia. Possible children abuse should be suspected in case of different age lesions and discrepancies between the told story and types of injuries. Once the vital urgency is eliminated, the orbital emergency should be first considered in facial traumas within the ophthalmology specialty because wounds and contusions of the globe are often under-evaluated and threaten the vision. The second emergency is the orbital floor fracture in its ‘trapdoor’ type, specific to the child. Combined with a motionless eye and uncontrollable vomiting, this is the second true urgency because it involves the prognosis of the oculomotricity and requires emergency surgery. Finally, dental trauma should not be overlooked because of their functional and aesthetic consequences. Primary cicatrization is usually rapid but scars remain inflammatory during a long time. The risk of hypertrophy exists in case of contusions and lacerations associated with wounds but also during puberty and in some locations. Age interfere with the result because growth will either improve or worsen the initial result, depending on the location and mechanism. The secondary specialized and prolonged managing and monitoring is capital on the functional, aesthetic and psychological points of view. [ABSTRACT FROM AUTHOR]

The literature is rich in case reports of intraosseous haemangioma, although most of these are actually cases of venous or capillary malformations. To illustrate this confusion in terminology, we present three cases of slow-flow vascular malformations misnamed as intraosseous haemangioma. A retrospective study of children diagnosed with intraosseous haemangioma was conducted. Clinical and radiological data were evaluated. Histopathological examinations and immunohistochemical studies were redone by three independent pathologists to classify the lesions according to the International Society for the Study of Vascular Anomalies (ISSVA) and World Health Organization (WHO) classifications. Three children who had presented with jaw haemangiomas were identified. Computed tomography scan patterns were not specific. All tumours were GLUT-1-negative and D2-40-negative. The lesions were classified as central haemangiomas according to the WHO, and as slow-flow malformations according to the ISSVA. The classification of vascular anomalies is based on clinical, radiological, and histological differences between vascular tumours and malformations. Based on this classification, the evolution of the lesion can be predicted and adequate treatment applied. The binary ISSVA classification is widely accepted and should be applied for all vascular lesions. [ABSTRACT FROM AUTHOR]

Dysmorphogenesis of the mandible complicates assessment of the course of the inferior alveolar nerve in patients with craniofacial microsomia. Our aim in the present study was to correlate the anatomical description of the course with the Pruzansky classification (which indicates the severity of hemifacial microsomia), in the mandibles of 22 affected patients using 3-dimensional computed tomography (CT). We measured the distance between fixed landmarks on the normal and the microsomic sides. The normal sides served as controls. In the group of five patients with type I disease, we found no significant differences between the unaffected and the microsomic side. In the nine patients with Pruzansky type II disease morphological views of the course showed a between-side difference in the length of the bony canal and the height of the mandibular ramus. In the five patients with Pruzansky type III disease, there was no bony canal. Three-dimensional CT analysis may be of value in plotting the course of the inferior alveolar nerve and assisting the surgeon in mandibular osteotomy or distraction osteogenesis. [ABSTRACT FROM AUTHOR]

Orbitopalpebral anomalies in mandibulofacial dysostosis (Treacher-Collins syndrome) can be difficult to correct surgically and most authors recommend correction of the malar bone after the age of 8 years. We propose a new, early surgical approach for periorbital defects that involves initial implantation of autologous fat and subperiosteal malar lift with a pedicled upper eyelid flap. We prospectively studied 5 children, 3 of whom had previously had orbital reconstruction. Initial fat graft into the periorbital area was followed by a subperiosteal malar lift with lateral canthopexy, and a pedicled upper eyelid flap if needed. Two surgeons independently assessed the patients’ characteristics including scleral show before and after operation, antimongoloid palpebral fissures, canthal dystopia, number 6 cleft (Tessier classification), skin quality, and surgical and ophthalmic complications. Before operation 3 patients had had ophthalmic problems. Postoperative evaluation showed improvements in scleral show, canthal dystopia, and skin quality, and correction of antimongoloid palpebral fissures and subcutaneous number 6 clefts. There were no postoperative complications. The proposed protocol gave satisfactory aesthetic and functional results in children with Treacher-Collins syndrome. We recommend that it is considered for periorbital reconstruction in all patients with a mandibulofacial deformity. [ABSTRACT FROM AUTHOR]

The present work addresses the coupling of a flamelet database that can accurately represent the flame structure in composition space with a low-Mach approximation of the Navier-Stokes equations. An advancement of the CFI combustion model, which is currently based on laminar premixed flamelets, is used for chemistry tabulation. This model can be applied to different combustion regimes from premixed to non-premixed combustion, although this work is concentrated on turbulent premixed flames for Reynolds-averaged Navier-Stokes (RANS) and large-eddy simulations (LES). A premixed confined jet flame, which has been investigated experimentally at the German Aerospace Center (DLR) is used for validation in adiabatic conditions showing satisfactory agreement. [ABSTRACT FROM AUTHOR]

Abstract: Bioaccessibility tests can be used to improve contaminated land risk assessments. For organic pollutants a ‘sink’ is required within these tests to better mimic their desorption under the physiological conditions prevailing in the intestinal tract, where a steep diffusion gradient for the removal of organic pollutants from the soil matrix would exist. This is currently ignored in most PBET systems. By combining the CEPBET bioaccessibility test with an infinite sink, the removal of PAH from spiked solutions was monitored. Less than 10% of spiked PAH remained in the stomach media after 1 h, 10% by 4 h in the small intestine compartment and c.15% after 16 h in the colon. The addition of the infinite sink increased bioaccessibility estimates for field soils by a factor of 1.2–2.8, confirming its importance for robust PBET tests. TOC or BC were not the only factors controlling desorption of the PAH from the soils. [Copyright &y& Elsevier]

Abstract: The process of talo-calcaneal superposition is one of the most important steps in the transformation of the reptilian foot (primitive) into the mammalian foot (modern). This change was developed in certain families of mammal-like reptiles and transitional mammals during the Mesozoic age and represents a different path in the morphological development of the foot to that of other dominant reptiles (Dinosaurs, etc.). The talo-calcaneal superposition takes place during the embryonic stage of human life and ends during the primary stages of the foetal period of the same. This study aims to demonstrate the similarities between the phylogenic and ontogenic development of the said morphological change. [Copyright &y& Elsevier]

The hydrocarbon levels in the clam Meretrix meretrix at selected locations along the Saudi Arabian Gulf coastline for the period 1981/90 (prior to the 1991 Gulf War) are compared to those from the war and post-war periods. Five of the nine sites in the study were affected bythe war oil spill. There was no significant impact in the n-alkane levels. However dibenzothiophenes and phenanthrenes increased significantly in the clam tissue during the war period. These values returnedto pre-war levels after a short period of time (within two years). The data from the sites affected by the oil spill are compared with data from the other four unaffected sites in the study that are locatedfurther to the south. [ABSTRACT FROM AUTHOR]

Résumé Objectif de l’étude Les « volumateurs » à base d’acide hyaluronique réticulé sont la référence pour traiter les rides superficielles, les plis profonds et les creux liés au vieillissement du visage. Cette étude a pour objectif d’évaluer, en plus des effets d’augmentation de volume, les effets sur la souplesse et l’élasticité des tissus cicatriciels, de 3 acides hyaluroniques réticulés commercialisés (dosés à 15 mg/mL, 17,5 mg/mL et 20 mg/mL), après chirurgie réparatrice chez des patients atteints d’anomalies faciales congénitales ou acquises. Patients et méthode Nous avons débuté l’usage des acides hyaluroniques réticulés en gel injectable dans ces indications en 2013 et avons réalisé à ce jour 46 séances d’injections, chez 32 patients âgés de 13–32 ans. Les résultats ont été évalués par le patient lui-même et par un chirurgien, environ 15 jours après les injections et 6–18 mois plus tard. Résultats Les acides hyaluroniques réticulés ont apporté des résultats morphologiques et esthétiques très subtils, en complément des interventions chirurgicales, avec un niveau de satisfaction élevé des patients. Dans les zones cicatricielles fibreuses, la première session d’injections améliorait la souplesse et l’élasticité ; la seconde session améliorait les volumes. Les acides hyaluroniques sont capables de restaurer simultanément les volumes manquants et l’élasticité des tissus cicatriciels. Conclusion Au-delà de leur fonction de volumateur, un second effet des acides hyaluroniques réticulés est démontré cliniquement : l’augmentation de la souplesse et de l’élasticité des tissus cicatriciel fibreux. Plusieurs études expérimentales corroborent nos résultats en démontrant qu’ils modifient la composition des matrices extra cellulaires notamment en stimulant la production d’élastine et de collagène. Summary Background Cross-linked hyaluronic acid-based fillers have gained rapid acceptance for treating facial wrinkles, deep tissue folds and sunken areas due to aging. This study evaluates, in addition to space-filling properties, their effects on softness and elasticity as a secondary effect, following injection of 3 commercially available cross-linked hyaluronic acid-based fillers (15 mg/mL, 17,5 mg/mL and 20 mg/mL) in patients presenting with congenital or acquired facial malformations. Patients et methods We started injecting gels of cross-linked hyaluronic acid-based fillers in those cases in 2013; we performed 46 sessions of injections in 32 patients, aged from 13–32. Clinical assessment was performed by the patient himself and by a plastic surgeon, 15 days after injections and 6–18 months later. Results Cross-linked hyaluronic acid-based fillers offered very subtle cosmetic results and supplemented surgery with a very high level of satisfaction of the patients. When injected in fibrosis, the first session enhanced softness and elasticity; the second session enhanced the volume. Cross-linked hyaluronic acid-based fillers fill sunken areas and better softness and elasticity of scar tissues. Conclusion In addition to their well-understood space-filling function, as a secondary effect, the authors demonstrate that cross-linked hyaluronic acid-based fillers improve softness and elasticity of scarring tissues. Many experimental studies support our observations, showing that cross-linked hyaluronic acid stimulates the production of several extra-cellular matrix components, including dermal collagen and elastin. [ABSTRACT FROM AUTHOR]

Résumé Introduction Le traitement des paralysies faciales congénitales par myoplastie d’allongement du muscle temporalis améliore la tension des lèvres et réhabilite le sourire. Le syndrome de Moebius étant hétérogène, une évaluation prudente est nécessaire avant de pratiquer une myoplastie. Cette série montre l’apport de l’électromyogramme, qui explore les fonctions motrices du muscle temporalis et du nerf trijumeau. Méthode Cette étude rétrospective inclut 18 patients ayant un défaut d’élévation de la commissure labiale avec sourire absent ou disgracieux. Le temporalis a été enregistré de façon bilatérale. L’analyse a porté sur l’organisation du tracé de contraction volontaire et de repos. Les tracés ont été qualifiés de normal, neurogène, et de faible amplitude. Le résultat de la myoplastie a été évalué sur l’élévation de la commissure (mm) comme bon (≥ 10), moyen (> 5), ou faible (≤ 5). Résultats L’intervention a été récusée pour 5 patients devant des tracés électromyographiques neurogènes (2) ou de faible amplitude (3). La myoplastie a été pratiquée chez 7 patients (âge : 8–17 ans), unilatérale (3) ou bilatérale (4). L’électromyogramme préopératoire était normal (3) ou montrait des signes neurogènes modérés (2) ou un tracé d’amplitude insuffisante (2). Le recul postopératoire était de 2 à 12 ans, avec des résultats bons (5), moyen (1) et faible (1). Conclusion L’électromyogramme du temporalis peut détecter un déficit moteur ou un trouble praxique et fournir une information utile à encourager ou récuser la myoplastie ou intensifier la rééducation et informer le patient d’un résultat possiblement modeste. Summary Background/objectives Temporalis muscle lengthening myoplasty improves tightening of the lips and rehabilitates smile for patients with congenital facial palsies. Because Moebius syndrome is heterogeneous, a careful evaluation is mandatory before deciding to perform myoplasty. This series shows the role of electromyography for investigating temporalis muscle and trigeminal nerve motor functions. Methods We conducted a retrospective study of 18 patients with no upward movements of the labial commissure and absent or unsightly smile. Electromyography was used to study the temporalis muscle bilaterally. Analysis focused on the recruitment pattern of voluntary contraction and electrical silence or activity at rest. Traces were classified as normal, neurogenic, or low-amplitude. Functional outcomes of myoplasty were evaluated by measuring the upward movement of the commissure (mm), and qualified as high (≥ 10), medium (> 5), or little (≤ 5). Results Surgery was cancelled for 5 patients with abnormal electromyographic signs, neurogenic (2) or low-amplitude (3). Myoplasty was performed in 7 patients (age: 8–17 years), unilaterally (3) or bilaterally (4). Preoperative electromyogram was normal (3), or showed moderate neurogenic (2) or low-amplitude (2) changes. Follow-up period after surgery was from 2 to 12 years; functional outcomes were high (5), medium (1), or little (1). Conclusion Electromyographic study of the temporalis can detect muscle denervation or atrophy, or dyspraxia, and guide decision to encourage or discourage performing myoplasty, or enhance rehabilitation programme and make the patient aware of possibly modest outcome. [ABSTRACT FROM AUTHOR]

Résumé Introduction L’incidence des nævi congénitaux est de 1/20 000 nouveau-nés par an, 14 % des nævi congénitaux intéressent la région tête et cou. Les nævi de la région orbitaire sont particulièrement difficiles à prendre en charge sur le plan esthétique et fonctionnel. Les objectifs de cette étude étaient de réaliser une analyse des différentes présentations cliniques des nævi congénitaux de la région orbito-palpébrale chez l’enfant afin d’établir un algorithme thérapeutique. Patients et méthodes Nous avons réalisé une étude bi-centrique rétrospective incluant 51 enfants porteurs d’un nævus congénital de la région orbito-palpébrale. Nous avons étudié les formes cliniques, les traitements proposés et leurs résultats. Résultats Parmi les 51 patients, 19 ont bénéficié d’une exérèse plastie directe seule, trois d’une exérèse greffe de peau totale seule, 15 d’une combinaison de traitements dont quatre ont eu un expandeur et 14 étaient en abstention thérapeutique/surveillance. La durée moyenne de suivi était de 6,6 ans. Dans 33 cas, persistait une zone nævique résiduelle. Les séquelles postopératoires étaient : les dyschromies cicatricielles ( n = 17), les déformations anatomiques de l’œil ( n = 10), les résurgences næviques ( n = 8), les déformations canthales internes ( n = 5) et les ectropions ( n = 1). Conclusion L’évaluation de nos pratiques montre une place plus importante à l’abstention thérapeutique lorsque le préjudice esthétique est accepté par le patient et que le nævus ne présente pas de sur-risque de dégénérescence maligne. Afin de minimiser le risque de séquelles postopératoires nous proposons un algorithme thérapeutique dans la prise en charge des nævi congénitaux orbitaires. Summary Introduction The incidence of congenital nevi is one over 20,000 newborns per year, 14 % of them are located in the head and neck area. Nevi of the orbital region are particularly difficult to handle on the aesthetic and functional side. The objectives of this study were to conduct an analysis of different clinical presentations of congenital nevi of the eyelid orbital region in children to establish a treatment algorithm. Materiel and methods We realised a bi-centric retrospective study including 51 children with orbito-palpebral congenital nevi. We analysed the different clinical presentations, their treatments and their results. Results Nineteen underwent direct suture excision; three a total skin graft; 15 a combination of treatments, among them four underwent tissular expansion and 14 patients were not operated and clinically followed-up. The average follow-up time was 6.6 years. In 33 cases residual nevic area was still present. The postoperative sequelae were: dyschromia ( n = 17), anatomical deformation of the eye ( n = 10), nevi outbreaks ( n = 8), internal canthus deformation ( n = 5) and ectropion ( n = 1). Conclusion The results of our study show that therapeutic abstention is preferred when the aesthetic wrong is accepted by the patient and when there is not a higher risk of malignant degeneration. In order to minimise the risk of postoperative sequelae, we propose a therapeutic algorithm for the management of congenital orbital nevi. [ABSTRACT FROM AUTHOR]

Surgical management of giantmelanoticnaeviremains a surgical challenge. Tissue expansion provides tissue of the same quality for the repair of defects. The aim of this study is to review tissular expansion for giant melanotic naevi. Materials and methods: We conducted a retrospective study from 2000 to 2012. All children patients who underwent a tissular expansion for giant congenital naevi had been included. Epidemiological data, surgical procedure, complication rate and results had been analysed. Results: Thirty-tree patients had been included; they underwent 61 procedures with 79 tissular-expansion prosthesis. Previous surgery, mostly simple excision had been performed before tissular expansion. Complete naevus excision had been performed in 63.3% of the cases. Complications occurred in 45% of the cases, however in 50% of them were minor. Iterative surgery increased the complication rate. Conclusion: Tissular expansion is a valuable option for giant congenital naevus. However, complication rate remained high, especially when iterative surgery is needed. [ABSTRACT FROM AUTHOR]

Résumé: La brûlure est une destruction plus ou moins profonde de l’enveloppe cutanée. La profondeur de la lésion conditionne la gravité des séquelles fonctionnelles et esthétiques. La prévention des infections, facteur d’approfondissement de la brûlure, est essentielle au cours de la prise en charge des brûlures, elle se fait grâce aux soins locaux. Actuellement, le pansement qui prévaut dans la majorité des Centres de brûlés est un bandage recouvrant un produit antibactérien appliqué sur la brûlure. L’intérêt de ce pansement est d’empêcher la survenue d’une infection locale. À l’inverse, le traitement par exposition à l’air, basé sur la notion que la plaie est contaminée, vise à diminuer les effets de cette contamination en créant un environnement peu favorable à la multiplication et au développement des germes. L’exposition à l’air des zones brûlées permet la formation d’une croûte à la surface de la brûlure, véritable barrière naturelle contre l’infection. Les îlots épidermiques résiduels sont préservés ainsi que les acteurs de la cicatrisation spontanée. La face profonde de la croûte délimite le plan d’excision chirurgical, facilitant le clivage et évitant les excisions tangentielles profondes. La mise en œuvre de cette technique est facile et elle est particulièrement bien adaptée à la pédiatrie. Le traitement n’est pas douloureux et les activités de l’enfant ne sont pas entravées par des bandages. Le respect de la qualité de vie de l’enfant hospitalisé et l’efficience médico-économique de ce pansement lui confèrent une place de choix dans le traitement des brûlures de l’enfant. [ABSTRACT FROM AUTHOR]

Summary: Introduction: Orbital fractures represent 30 % of children facial fractures. Nausea and vomiting are more predictive of entrapment than local trauma stigmatisms. Entrapment and diplopia are more frequent in adults. Delay for surgery is unclear in literature varying from 6 hours to days. The aim of this study is to summarise the aspects of orbital floor fractures in children with regard to clinical and radiological presentation, management, and outcomes. Patients and methods: We conducted a retrospective study including 34 children presenting isolated orbital floor fracture. Clinical, radiological, ophthalmological, surgical data and outcomes were analyzed. Results: Mean age was 9.4 years. In 15% of cases, no local stigmatism of trauma was present. Entrapment fracture was the most frequent, with 81% of fat or muscles entrapment. In all, 27% of the patient had residual diplopia. Residual diplopia developed after trap-door fracture with muscle entrapment and a more than 24hours delay for surgery. Conclusion: Trap-door fracture is frequent in childhood population. Clinical diagnosis can be difficult. However, surgical treatment should be considered before 24hours to avoid complication as residual diplopia. [ABSTRACT FROM AUTHOR]

Summary: Introduction: The face is the area most vulnerable for dog bites in children. Surgical management is an emergency to prevent infection, functional and aesthetic outcomes. The aim of this study was to define a new gravity scale, and to determine a prevention policy. Patients and methods: In our maxillofacial and plastic surgery department, we conducted a retrospective study from 2002 to 2010, including 77 children under 16years old, victims of facial dog bite. We analyzed epidemiological, clinical data, surgical outcomes. Results: The mean age was 5.36years. Dogs were principally represented by class I and II dogs; 27,7% of them had ever bitten before. In almost all the cases, the dogs belong to the family or closers. Twenty-one percent of children belong to an unfavourable social environment; 71.43% of dog bites interested the central area of the face. The bites were deep in 77% of cases with amputation or extensive loss of substance in 31% of cases. The healing time was 10.54months. Nearly a third of patients required several surgeries; 41.56% of patients had aesthetic and functional sequelae; 35.1% of children had psychological problems afterward. Conclusion: Facial children dog bites require a multidisciplinary approach, and a long-term follow-up. We propose a new classification of dog bite severity, more appropriate to the face. [ABSTRACT FROM AUTHOR]

Summary: Introduction: The association of a pelvic hemangioma and malformations in the pelvic region are described as SACRAL or PELVIS syndrome. More recently, the acronym of LUMBAR syndrome has been used to describe the association of lower-body hemangioma and other cutaneous defects, urogenital anomalies, ulceration, myelopathy, bony deformities, anorectal malformations, arterial anomalies, and renal anomalies. We report herein 2 representative cases. Patients: Two girls presented with infantile hemangioma associated with genital malformation. One case was associated with spinal anomalies and the other one with the anus in the genital position. Conclusion: Segmented hemangiomas are commonly associated with extracutaneous abnormalities. By analogy with PHACE syndrome, PELVIS/SACRAL/LUMBAR syndromes describe the association of segmented hemangioma of the lower extremities associated with other trunk or lower-body malformations. The syndrome is often incomplete. [ABSTRACT FROM AUTHOR]

Abstract: Cleft lips and palates (CLPs) are the most common human facial malformations. Depending on the ethnic and/or geographical origin of the studied populations, they can affect up to 1/500 newborns. The treatment of these patients is multidisciplinary because these malformations have not only aesthetic consequences but also functional consequences as the phonation, hearing, deglutition, mastication and ventilation are altered. These consequences can also be psychological since the building of the body image, the way others perceive it, is likely to be seriously altered. In Europe there are over 210 reference hospitals for children affected by CLP. Besides, about 190 different protocols were identified. So far no generic protocol was recognized by the medical community as a whole. This discrepancy can be explained by the fact that the aesthetic and functional result of a protocol cannot be accurately assessed before adulthood when the child''s growth is complete. Patients presenting with CLP don’t usually seem to present with any serious psychological or psychiatric pathology. Yet a close review of the related literature shows that disorders are actually described: behavioural troubles, anxiety, depression and esthetical dissatisfaction with one''s face in children as well as in adults. The difficulty in interpreting these disorders lies in the various factors that are likely to impact this condition (family setting, importance and type of the cleft, surgery protocol, growth, social environment…). A multidisciplinary examination of the face and a careful consideration of concerned families show the importance of the psychological context and the risks of a disharmonious structuring of the parents-child relationships on the child''s development. The identification of the difficulties faced by these families, depending on the child''s age, can be easily identified. Of course they can be identified at birth when the family first sees the child and later on at each stage of the child''s life cycle (when starting at kindergarten where the child socialises for the very first time, at the start of the first year in primary school where pupils learn how to read and then at the start of secondary school which is yet another crucial step for the child due to the adolescence period). It is also obvious that an adult affected by CLP has a particularly heavy medical history as the patient had to go through various treatments and surgical interventions during his childhood and adolescence, which is even sometimes maintained at adulthood. Repeated appointments with the different specialists involved in their treatment punctuate their life as well as their parents’. This medico-surgical setting for facial malformations i.e. the features of the patient''s face which are largely involved in their interpersonal relationships and the expression of emotions can have serious consequences. Most children presenting with CLPs and living in France benefit from regular follow-up schemes carried out in competent reference centres by a multidisciplinary team whose members represent each of the fields of expertise involved in the correction of this malformation: infantile and maxillofacial surgery, otorhinolaryngology (or ENT), orthophony and dentofacial orthopedics. Only the two French reference centres benefit from the permanent presence of a psychologist. This raises the question whether every care centre should take into care these children and their parents’ mental health by offering psychological support during the course of the therapeutic follow-up scheme for these children, and this from an early age on as is recommended by the American Cleft Palate Craniofacial Association. [Copyright &y& Elsevier]

Summary: Performing a conventional Z-plasty on postburn scar tissue frequently leads to varying degrees of necrosis of the tips of the transposed flaps. In the conventional technique, the flaps are transposed first by anchoring the tips and then by performing the other sutures. In this order, the tips are subjected to a high degree of tension. Again, according to the conventional technique, perpendicular incisions are performed along the tips, which do not ensure the effective vascularisation of the tips in this context of postburn scarring tissue with loss of dermal blood flow. Two technical modifications are proposed: a different approach to the tension by first of all anchoring the base of the flaps and not by classical first suturing of the tips and the performance of oblique incisions away from the tips to ensure a maximum vascularisation of the subdermal fatty tissue. These two elements have allowed us to improve the results of our plasties. [Copyright &y& Elsevier]

Summary: Introduction: Congenital epulis is a rare benign tumor that originates from the mucosa of the dental alveolar ridge. Management of congenital epulis is unclear; most authors recommend surgical excision during infancy. Case report: We report a case of congenital epulis arising from the anterior mandibular region that was managed conservatively. This epulis did not interfere with breast-feeding or respiration. Subsequently, there was spontaneous involution of the lesion during the 1st year of life. Conclusion: Small and medium congenital epulis (<20mm) exceptionally compromises feeding and might regress spontaneously. Subsequently, conservative treatment should be adopted. Surgical treatment should be indicated only when major feeding or respiratory problems are present or when the clinical diagnosis is uncertain. [Copyright &y& Elsevier]