Search

Guidelines for the diagnosis and treatment of cutaneous squamous cell carcinoma and precursor lesions J.J. Bonerandi, C. Beauvillain, L. Caquant, J.F. Chassagne, V. Chaussade,** P. Clavere, C. Desouches, F. Garnier, J.L. Grolleau, M. Grossin,*** A. Jourdain, J.Y. Lemonnier, H. Maillard, N. Ortonne, E. Rio,**** E. Simon, J.F. Sei,** J.J. Grob, L. Martin,* for the French Dermatology Recommendations Association (aRED) Department of Dermatology, La Timone University Hospital, Marseille, France Department of ENT, Nantes University Hospital, Nantes, France Department of Maxillofacial Surgery, Saint-Etienne University Hospital, Saint-Etienne, France Department of Maxillofacial Surgery, Nancy University Hospital, Nancy, France **Department of Dermatology, Ambroise-Pare University Hospital, Boulogne-Billancourt, France Department of Oncoradiotherapy, Limoges University Hospital, Limoges, France Plastic Surgery, Private Practice, Marseille, France General Practitioner, Angers, France Department of Plastic Surgery, Toulouse University Hospital, Toulouse, France ***Department of Pathology, Louis-Mourier University Hospital, Colombes, France ENT, Private Practice, Laval, France Department of Gerontology, Orleans Hospital, Orleans, France Department of Dermatology, Le Mans Hospital, Le Mans, France Department of Pathology, Henri-Mondor University Hospital, Creteil, France ****Department of Oncoradiotherapy, CLCC Nantes, Nantes, France Department of Dermatology, Angers University Hospital, Angers, France *Correspondence: Prof. Ludovic Martin. E-mail: lumartin@chu-angers.fr

Summary Introduction The use of resorbable materials in orthognathic surgery is presently the object of numerous clinical and experimental studies. Their main drawbacks are their lack of rigidity and induced chronic inflammatory reactions. The purpose of this study was to propose and to test an original system of hybrid osteosynthesis associating a single titanium plate with three resorbable plates in Le Fort I osteotomies in the absence of maxillary expansion, or two titanium plates with two resorbable plates in case of maxillary expansion. Methods Our retrospective study concerned 28 patients operated between 2002 and 2005. A clinical follow-up of over one year detected the specific complications of the hybrid system and a cephalometric study analyzed the secondary relapse 5 months after surgery. These results were compared to the literature. Results One case of mobility and a case of instability of the jaw were observed, along with 5 cases of local chronic inflammatory reaction. The radiological results found a secondary sub-clinical relapse. The removal of the titanium material under local anesthesia was performed without difficulties in ambulatory care, which avoided a new hospitalization for the patient and a new general anesthesia. Discussion The hybrid system allowed obtaining a postoperative stability of the jaw comparable to that obtained by the exclusive use of titanium plates with an acceptable morbidity. This method of osteosynthesis combined the advantages of the resorbable material (removal of titanium plates under local anesthesia) and of titanium material (stability of the procedure). However this method requires a good experience of working with resorbable material, a good follow-up, and cooperative patients. These encouraging results urge us to extend the indications to mandibular sagittal osteotomy and to bi-maxillary osteotomies.

Resume Introduction. – La macrostomie congenitale fait partie des fentes faciales dites rares par opposition aux fentes labioalveolopalatines. Materiel et methode. – Nous rapportons une serie de dix patients porteurs de macrostomies congenitales. Une etude retrospective epidemiologique et clinique de chaque cas a ensuite ete realisee. Resultats et Discussion. – De ces constatations cliniques, ressort une classification simple ayant des repercussions directes sur la sequence therapeutique.

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.

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.