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Purpose The increasing popularity of cosmetic surgery and its effect on facial recognition software has attracted the attention of many researchers. Indeed, after having undergone cosmetic surgery procedures, nonlinear modifications that are made to facial biometric landmarks may lead to difficulty in recognizing individuals, who received a surgery, by facial biometric systems. This finding motivated us to discuss this topic differently and take advantage of these modifications to objectively study, the results of cosmetic surgery. In this study, we propose facial biometry as a new method to objectively describe face changes after facelift surgery. Patients and Methods For this study, 37 females, aged between 50 and 80 years old, were selected. These patients underwent facelift surgery between January 2013 to December 2017. For comparison of the biometric facial features before and after facelift surgery, 7 direct measurements (4 linear and 3 angular) were performed. Results There was no significant difference between real and preoperative apparent age according to the FRS: (63.35 years +/- 6.52 VS 64.54 years +/- 7.49, p = 0.188> 0.05). The postoperative apparent age was significantly lower than the preoperative apparent age according to FRS (58.97 years +/- 7.19 VS 64.54 years +/- 7.49; p Conclusion Biometry enabled us to evaluate the preoperative and postoperative facial features of patients before and after facelift surgery and to determine objectively whether the estimated age was improved by the surgery.

Introduction Face recognition (FR) technology can be used in wide range of applications such as identity authentication, access control, and surveillance. Interests and research activities in face recognition have increased significantly over the past twenty years. Plastic surgery procedures can significantly alter facial appearance, thereby posing a serious challenge even to the state-of-the-art face matching algorithms. The purpose of this work was to detail the interaction between facial plastic surgery and facial recognition software and discuss the new challenges of this interaction. Material and methods The authors critically reviewed the literature from January 2000 to September 2019, to identify articles reporting interactions between facial plastic surgery and facial recognition algorithms and discuss the new challenges of these interactions. Controlled vocabulary terms and keywords were used in the search strategy and two authors independently analyzed data. Factors included in the analysis were: Author, Journal, Year, Scope, Study design, Plastic surgery, Data (volume, origin and processing), Identification accuracy and Conclusion (interaction/challenge). Results Forty-three research articles underwent data extraction and 28 articles were included in quantitative synthesis. Of the 28 articles, the most common study designs were experimental evaluation (n = 15, 53,5%), Evaluation Study studies (n = 7, 25%) and Review studies (n = 4, 14,3%). Fifty percent of the articles have been published in the last 4 years (14 articles, 50%). Most of the study scope was informatics (64,3%). Only 10 articles were published in medical journals. Rhytidectomy (face lift) is the most challenging procedure for the FR algorithms. Data volume varied from 4 to 2878 subjects. The proposed algorithms provide at least 15 to 99% better identification performance. Among these, only two papers discuss the new challenges of the interaction between facial plastic surgery and Face Recognition Algorithms. Conclusion In the context of advances in artificial intelligence, Internet connectivity and data integration, the purpose of this review is, to look forward to analyze the new interactions of facial plastic surgery and facial recognition algorithms, and to suggest avenues for future research and clinical application of this technology. Furthermore, to evaluate if plastic surgeons are prepared to discuss this technology with their patients. Plastic surgeons should be prepared to answer questions from patients about the fundamentals of facial recognition technology, and the potential effects of plastic surgery on facial recognition technology performance. Continued efforts are needed to provide scientifically rigorous data of facial biometric identification after facial plastic surgery and to include these notions in the routine consultation or consent process for patients seeking aesthetic facial surgery.

Background Childhood asthma still imposes a substantial burden on the health care system and community. Its management requires a significant direct cost. Several factors can influence the cost of asthma management, particularly severe asthma. There is scant information about the predictors of asthma-related cost. Thus, the purpose of this study was to estimate direct asthma-related cost among children with chronic asthma and to identify factors that have the greatest contribution to change it. Methods This cross-sectional study was carried out in Farhat Hached University Hospital in Sousse (Tunisia, Africa) over a period of three months (April-June 2018) among children with asthma aged 7-17 years. The direct cost was defined as the costs of health resources utilization and medication related to asthma in the past 12 months. Purchasing power parity technique was used to convert TND to USD. Multiple linear regression was performed to examine the association between dependent and independent variables. Results A total of 90 subjects participated in the study. The mean age was 9.81±2.56 and 55.6% were male. The annual mean of the total direct cost was USD 616.71±454. Multivariate analysis showed that the severity of asthma, inhalation technique and emotional domain of QOL predict asthma cost and that the latter was the best predictor (p = 0.005, p = 0.03, p = 0.004, respectively). This data indicates that for one child with mild asthma, correct inhaler technique, and moderate impairment of emotional function QOL domain, estimated asthma direct cost was equal to 1035.21 USD per 12 months. Conclusions This study showed that higher severity of asthma, incorrect inhaler technique and a lower score of emotional function increased direct cost related to asthma. These results are useful for health care providers and community since they provide information about the impact of modifiable risk factors on direct asthma cost. Key messages For one child with mild asthma, correct inhaler technique, and moderate impairment of emotional function QOL domain, estimated asthma direct cost was equal to 1035.21 USD per 12 months. Higher severity of asthma, incorrect inhaler technique and a lower score of emotional function increased direct cost related to asthma.

Summary Introduction Forehead osteoma is an uncommon benign bone tumor that causes cosmetic disfigurement and occasional pain. Traditional excision directly over the lesion creates a visible scar on the forehead. Procedure We describe a method of endoscopic resection of the forehead osteoma, via incisions within the hairline. The access incision was hidden behind the frontal hairline and the dissection plane went in the subperiosteal layer. The injury of the nerve branch and vessel can be easily avoided and endorsed by manipulating the endoscope. Conclusion Aesthetic considerations are important features in the craniomaxillofacial region. Especially for patients who are not willing to accept the risk of a prominent forehead scar. Endoscopic resection of forehead osteomas might be a useful tool in forehead osteoma resections. It might be an alternative tool in an Oral and Maxillofacial Surgeon's and in a Plastic Surgeon's repertoire.

β Thalassemia is an inherited genetic disorder of hemoglobin synthesis characterized by a reduction of β chains of globin. Typical features of patients with β thalassemia are skeletal modifications, particularly in the skull and in the facial bones. In thalassemia major, involvement of the facial skeleton can result in severe disfigurement, often referred to as “rodent facies”. Various surgical approaches to correct the facial deformity have been advocated; however, treatment remains controversial. The worse the patient's systemic condition, the more unstable and more complicated the surgical procedure. Patient with multisystemic disorder and severe deformity, such as in our case, with a complete lack of cortical bone for bone fixation, might not be amenable to such procedures. Thorough knowledge of the multiple systemic manifestations, therapy, and prognosis of this syndrome is necessary to formulate a safe, comprehensive surgical plan for these patients.

International audience; Primary immunodeficiencies (PIDs) are a large group of diseases characterized by susceptibility to not only recurrent infections but also autoimmune diseases and malignancies. The aim of this study was to describe and analyze the distribution, clinical features and eventual outcome of PID among Tunisian patients. We reviewed the record of 710 patients diagnosed with Primary Immunodeficiency Diseases (PIDs) from the registry of the Tunisian Referral Centre for PIDs over a 25-year period. The male-to-female ratio was 1.4. The median age at the onset of symptoms was 6 months and at the time of diagnosis 2 years. The estimated prevalence was 4.3 per 100,000 populations. The consanguinity rate was found in 58.2 % of families. According to the International Union of Immunological Societies classification, spectrums of PIDs were as follows: combined T-cell and B-cell immunodeficiency disorders account for the most common category (28.6 %), followed by congenital defects of phagocyte (25.4 %), other well-defined immunodeficiency syndromes (22.7 %), predominant antibody deficiency diseases (17.7 %), diseases of immune dysregulation (4.8 %), defect of innate immunity (0.4 %) and complement deficiencies (0.4 %). Recurrent infections, particularly lower airway infections (62.3 %), presented the most common manifestation of PID patients. The overall mortality rate was 34.5 %, mainly observed with combined immunodeficiencies. The distribution of PIDs was different from that reported in Western countries, with a particularly high proportion of Combined Immunodeficiencies and phagocyte defects in number and/or function. More is needed to improve PID diagnosis and treatment in our country.

The nose is the central organ of the face. It has two essential roles, aesthetic and breathing. It is often seriously damaged in the context of facial burns, causing grotesque facial disfigurement. As this disfigurement is visible on frontal and profile views, the patient suffers both socially and psychologically. The nose is a three-dimensional organ. Reconstruction is therefore more difficult and needs to be more precise than in other parts of the face. Maintaining symmetry, contour and function are essential for successful nasal reconstruction. Multiple factors determine the optimal method of reconstruction, including the size of the defect, its depth and its site. Satisfactory social life is recovered only after multiple surgical procedures and long-term rehabilitation and physiotherapy.

Summary Esthetic modifications related to maxillary osteotomies are difficult to predict. The correlation between skeletal displacements and soft tissue modifications is quite variable. The data on transverse plane modifications is very limited. This review was focused on nasolabial modifications (nasal tip projection, nasolabial angle, alar width) after Le Fort I osteotomies and complementary surgery aiming at improving the esthetic results.

Resume Objectif L’objectif de ce travail est de comparer deux parametres biologiques, la proteine C-reactive (CRP) et la procalcitonine (PCT) dans la detection des lesions renales aigues confirmees par la scintigraphie au DMSA, dans les pyelonephrites aigues (PNA) chez l’enfant. Patients et methodes Etude prospective menee sur une annee, incluant les enfants presentant un premier episode de PNA. Tous les enfants ont eu un dosage de la PCT, la CRP et l’hemogramme. Resultats Parmi les 75 patients inclus, 33 avaient des lesions renales aigues (groupe A) et 42 enfants avaient une scintigraphie au DMSA normale (groupe B). Dans le groupe A, la valeur moyenne de la PCT etait plus elevee que dans le groupe B avec une difference significative (8,81 ng/mL versus 1,7 ng/mL, p = 0,01). Le calcul de l’air sous la courbe ROC de la CRP et de la PCT a trouve que la PCT a un seuil de 0,76 ng/mL etait plus performante dans la detection des lesions renales aigues par rapport a la CRP a un seuil de 70 mg/L avec une meilleure sensibilite, valeur predictive negative et indice de Youden (82 % versus 70 % ; 84 % versus 70 % et 0,58 versus 0,25). Conclusions Notre etude a confirme la bonne sensibilite et la bonne specificite du dosage de la PCT dans le diagnostic des lesions aigues du parenchyme renal des infections urinaires de l’enfant febrile.

Major histocompatibility complex class II (MHC-II) expression deficiency is a combined primary immunodeficiency leading to the impairment of the cellular and humoral immune responses. A majority of affected patients belong to consanguineous families particularly from the Maghreb, where a founder effect for a highly frequent mutation (named c.338-25_338del26) in the RFXANK gene was reported. Herein, we report the largest single Maghrebian country series of MHC-II deficient patients.In Tunisia, among 551 PIDs diagnosed from 1993 to 2011, 54 had an MHC-II deficiency. The clinical features and immunological investigations were retrospectively analyzed in 34 children of them belonging to 28 kindred. The genetic study included the c.338-25_338del26 screening by the amplification of the affected region using polymerase chain reaction (PCR) followed by direct sequencing.Consanguinity was present in 22 out of 28 families. Mean age at the first infection was 6.1 months. Chronic diarrhea with failure to thrive and pulmonary infections were the most common manifestations occurring in 26 and 28 patients respectively. The most specific laboratory findings were the defect of MHC-II (HLA-DR) expression in all patients. The c.338-25_338del26 mutation was identified in 25 of them.In Maghrebian settings, pediatricians should definitely consider this diagnosis in the presence of an early onset of severe and recurrent infections of the respiratory and intestinal tracts, particularly protracted diarrhea with a failure to thrive. The founder effect for the c.338-25_338del26 mutation in the RFXANK gene is also confirmed, facilitating prenatal diagnosis as a preventive approach in the Tunisian affected families with severe forms, particularly in the context of limited access to bone marrow transplantation.

Introduction In Tunisia, asymptomatic carriage of Leishmania is poorly documented. Objective The aim of the present study was to estimate the frequency of asymptomatic infection among the family members of patients with patent visceral leishmaniasis by using the Western blotting kit based on 14 and 16 kDa bands. Material and methods We tested 94 sera collected from 24 patients with patent visceral leishmaniasis and 70 from their families’ members. Results The rate of seropositivity was 100% in the group of patients and 54.3% in the group of families’ members. The analysis of the Western blotting patterns showed that the 33 kDa, 24 kDa and to a lesser extent the 22 kDa band were very indicative of patent visceral leishmaniasis in contrast to asymptomatic infection where these bands were very rarely detected. Conclusion The results reported herein showed the high frequency of asymptomatic carriers of Leishmania among the families’ members of visceral leishmaniasis cases and the usefulness of the Western blotting as a screening technique and in distinguishing between patent visceral leishmaniasis and the asymptomatic carriage of Leishmania.

Resume Introduction Les fibromatoses agressives sont des tumeurs benignes ; mais elles sont responsables d’une grande morbidite dans les localisations cervicofaciales. Elles sont caracterisees par une capacite infiltrante tres invasive et un taux de recidives locales tres eleve. Leur prise en charge constitue un veritable defi. Cas clinique Nous rapportons le cas d’un enfant âge de dix ans presentant une fibromatose agressive de la levre superieure. Chez ce patient, le traitement medical a ete decide pour eviter une chirurgie mutilante. Il a eu une excellente reponse a la chimiotherapie a base de methotrexate et vinblastine. Discussion La principale arme therapeutique efficace contre les fibromatoses agressives de l’extremite cervicofaciale reste la resection chirurgicale complete. Mais, dans le cas particulier de l’enfant, le traitement ne se discute pas de la meme facon, en effet le pronostic esthetique et fonctionnel, dans ce cas, est primordial. La chimiotherapie a base de methotrexate et vinblastine constitue une bonne alternative.

Resume Introduction La chirurgie de reduction mammaire s’inscrit souvent dans un contexte de legere surcharge ponderale et de troubles psychologiques mineurs. Les auteurs proposent une etude pour identifier les profils ponderaux pre- et postoperatoires selon l’âge et le type histologique de l’hypertrophie mammaire (HTM). Patientes et methode Il s’agit d’une etude retrospective sur 100 patientes operees d’une reduction mammaire (> 300 g par sein) en 2007. Deux groupes ont ete constitues : le premier groupe (G1) comprenant les 50 plus jeunes patientes (âge moyen : 31,5 ans) et le second groupe (G2) comprenant les 50 plus âgees (âge moyen : 47,2 ans). Les donnees evaluees etaient : les variations ponderales pre- et postoperatoires selon l’âge et les sous-types histologiques avec calcul de l’indice de masse corporelle (BMI), les donnees de l’intervention incluant le poids de resection de la piece et les complications. Resultats Les patientes consultant pour une HTM sont en surcharge ponderale moderee (BMI moyen tout âge confondu 28,22). La perte de poids preoperatoire est faible malgre la demande systematique (perte de poids Conclusion Les variations ponderales postoperatoires sont significatives uniquement chez les jeunes patientes presentant une forme constitutionnelle d’HTM (les formes glandulaires ou mixte). Nous pensons qu’en plus de l’amelioration fonctionnelle liee a la chirurgie, ces jeunes patientes perdent le poids qu’elles ont pris initialement pour harmoniser leur silhouette.

Resume Introduction Les sequelles de brulures profondes de la region thoracomammaire ont la particularite d’empecher le developpement de la glande mammaire chez l’adolescente, car le tissu cicatriciel devient une enveloppe inextensible. Chez l’adulte, les retractions cicatricielles provoquent des deformations du sein, pouvant aller jusqu’a son amputation. Le but de ce travail est de preciser l’interet de l’expansion cutanee dans la reconstruction mammaire en terrain brule, chez l’adolescente prepubere et chez l’adulte. Patientes et methodes Nous avons realise une etude retrospective sur 25 ans incluant des patientes traitees chirurgicalement pour des sequelles de brulures thoracomammaires. Les parametres etudies ont ete : les techniques chirurgicales utilisees etape par etape en fonction des sequelles, le delai moyen entre chaque intervention, et les resultats morphologiques et esthetiques obtenus. Resultats Vingt-huit patientes ont ete operees entre 1983 et 2008. Chaque patiente a ete operee 4,5 fois en moyenne (deux a 12 fois) sur une periode moyenne de 6,3 ans (un a 19 ans). Les patientes adultes ont presente un nombre d’intervention plus eleve (5,5 en moyenne) que les adolescentes prepuberes (2,4 en moyenne). Le nombre d’expansion cutanee moyen par patiente a ete de 1,2 (0 a trois). Soixante-deux expandeurs ont ete poses (un a huit), de volume moyen 390 cm 3 (180–1200). La duree moyenne de l’expansion cutanee est de sept mois (quatre a dix). Vingt-cinq protheses mammaires ont ete posees, 11 mois en moyenne (six a 17) apres le debridement. Trois changements de protheses ont eu lieu en moyenne 5,3 ans apres la pose (trois a huit). La symetrisation et la reconstruction de la plaque areolomamolonnaire ont ete realisees en general en meme temps, un an apres la derniere intervention. Toutes les patientes ont ete satisfaites du resultat esthetique et morphologique. Ces resultats, analyses sur une periode de 25 ans, montrent une evolution qualitative certaine et une diminution des complications postoperatoires. Discussion L’expansion cutanee locoregionale apporte des resultats tres satisfaisants. Chez l’adolescente prepubere, l’apport des lambeaux cutanes d’expansion permet le developpement quasi normal de la glande mammaire. Chez la femme adulte, elle apporte l’enveloppe cutanee qui pourra accueillir si necessaire le complement de volume : l’implant mammaire d’augmentation. Le lipomodelage chirurgical et les lambeaux musculocutanes d’expansion, autres alternatives dans la reconstruction du volume mammaire, sont egalement discutes. La reconstruction mammaire en terrain brule donne des resultats morphologiques satisfaisants pour la majorite des patientes malgre la forme du sein souvent imparfaite et la persistance des cicatrices multiples.

Resume La maladie de Gaucher est une maladie lysosomiale non exceptionnelle en Tunisie. Le type 1 est de loin le plus frequent. L’atteinte pulmonaire est consideree comme rare mais souvent grave. Elle peut avoir plusieurs mecanismes puisqu’il peut s’agir d’une atteinte interstitielle secondaire a l’infiltration par les cellules de Gaucher, d’une hypertension arterielle pulmonaire ou des shunts arterio-veineux intrapulmonaire. Nous rapportons une observation d’un syndrome hepatopulmonaire compliquant une maladie de Gaucher type 1 chez un enfant âge de 14 ans. Le diagnostic de la maladie de Gaucher a ete confirme a l’âge de deux ans par le dosage enzymatique de la β-glucosidase intraleucocytaire. L’enfant a presente une dyspnee d’aggravation progressive avec un hippocratisme digital et une cyanose peribuccale. Les gaz du sang arteriel a l’air ambiant ont montre une hypoxemie severe avec une pression arterielle en oxygene (PaO2) a 56,9 mmHg. Le diagnostic du syndrome hepatopulmonaire a ete confirme par la constatation d’un shunt intrapulmonaire a l’echographie cardiaque couplee a l’epreuve aux microbulles et la scintigraphie pulmonaire de perfusion aux macroagregats d’albumine. Le traitement enzymatique substitutif de la maladie de Gaucher etant indisponible pour notre patient, il a ete traite symptomatiquement par une oxygenotherapie a domicile. La severite du syndrome hepatopulmonaire nous incite a pratiquer regulierement un depistage precoce chez les enfants ayant une maladie hepatique chronique.

Malacoplakia is a form of chronic granulomatous inflammatory reaction that rarely affects the pediatric age group. The gastrointestinal system is the second most common site for the occurrence of malacoplakia. We report the case of a 9-year-old girl who was hospitalized for abdominal pain, chronic diarrhea, and rectal hemorrhage. The endoscopic examinations and histopathology confirmed the diagnosis of intestinal malacoplakia. We successfully treated her with oral levofloxacin. This disease does not have any specific clinical or biological signs, and the diagnosis is exclusively based on histology.

Resume Le processus styloide emerge de la portion petreuse de l’os temporal. Ce processus derive du second arc branchial. Sa longueur moyenne varie de 22 a 33 mm. L’hypertrophie du processus styloide ou syndrome d’Eagle peut etre une source de douleur cervicofaciale de diagnostic particulierement difficile. La pathogenie de cette anomalie n’est pas connue. L’origine traumatique est admise, meme si des donnees embryologiques recentes plaident pour une origine genetique avec des variations interindividuelles. Le diagnostic repose sur plusieurs elements : cervicalgies exacerbees lors de l’hyperextension cervicale et des mouvements cephaliques brusques, douleur typique provoquee par la palpation de la fosse tonsillaire, test diagnostique a la xylocaine et exploration radiologique. Le traitement est chirurgical par exerese du processus styloide, par voie cervicale ou intra-orale.

Glycogen storage disease type III (GSD III) is an autosomal recessive disorder characterized by excessive accumulation of abnormal glycogen in the liver and muscles and caused by deficiency in the glycogen debranching enzyme, the amylo-1,6-glucosidase (AGL). In this study, we report the clinical, biochemical and genotyping features of five unrelated GSD III patients coming from the same region in Tunisia. The concentration of erythrocyte glycogen and AGL activity were measured by colorimetric and fluorimetric methods, respectively. Four CA/TG microsatellite markers flanking the AGL gene in chromosome 1 were amplified with fluoresceinated primers. The full coding exons and their relevant exon-intron boundaries of the AGL gene were directly sequenced for the patients and their parents. All patients showed a striking increase of erythrocytes glycogen content. No AGL activity was detected in peripheral leukocytes. Sequencing of the AGL gene identified a c.3216_3217delGA (p.Glu1072AspfsX36) mutation in the five patients which leads to a premature termination, abolishing the AGL activity. Haplotype analysis showed that the mutation was associated with a common homozygote haplotype. Our results suggested the existence of a founder effect responsible for GSD III in this region of Tunisia.

Burns are devastating injuries scarring patients, both physically and psychologically, for life. This remains particularly true for facial burns. Eyelid burns occur in about 10% of thermal injuries and is a considerable challenge for the reconstructive surgeon given the particular anatomy of the eyelids. Reconstruction of the eyelids following burn injuries has been performed by plastic surgeons since the earliest days of reconstructive surgery, yet a consensus on a treatment regime has not been reached and plastic surgeons are divided on the subject. Controversies exist regarding the excision and debridement of eschar, temporary suture and surgical tarsorrhaphy, timing of surgery for eyelid contraction, and the role of full and split-thickness skin grafts in eyelid reconstruction. This paper describes the particularities of the treatment of burned eyelids in our Burn Center.

Resume La neuropathie hereditaire sensitive et autonome de type IV (HSAN IV) est un desordre autosomique recessif tres rare caracterise par des episodes recurrents de fievre, une anhidrose totale, une insensibilite a la douleur, une hypotonie et un retard mental. Nous rapportons les cas de 2 enfants tunisiens atteints de HSAN IV confirmee genetiquement. Il s’agissait de 2 freres issus de parents cousins germains chez qui la maladie s’etait manifestee a la periode neonatale par une fievre persistante et inexpliquee. Le 1 er enfant avait developpe a l’âge de 8 mois des convulsions febriles recidivantes et d’importantes lesions d’automutilation. Il etait decede 3 mois plus tard dans un tableau de septicemie et d’hyperthermie maligne. Le diagnostic de HSAN IV avait ete rapidement evoque et confirme genetiquement chez le 2 nd enfant. Ce dernier a beneficie d’un traitement symptomatique : humidification reguliere des yeux, bains froids et climatisation en cas de fievre, traitement precoce des foyers infectieux, gouttiere dentaire apres la poussee dentaire, chlorpromazine et surveillance etroite surtout apres l’acquisition de la marche. Ces mesures ont probablement contribue a eviter a ce patient les principales complications de la maladie que sont les hyperthermies malignes, les septicemies, les automutilations invalidantes, les ulcerations corneennes, les deformations articulaires et les fractures multiples. L’evolution differente de la maladie chez ces 2 freres met l’accent sur l’interet de ces mesures surtout pendant les 3 premieres annees de vie puisque la mortalite, les troubles de comportement et le retard mental diminuent nettement apres cet âge.

Summary Introduction Bifid condyles are uncommon and include post-traumatic aberrant reorganization of the temporomandibular joint (TMJ) and congenital forms. Case report We report two cases of unilateral bifid condyles, responsible for functional dysfunction of the TMJ. The first case, probably of congenital origin, was oriented frontally. The second case, oriented in the sagittal plane, was probably post-traumatic. Functional treatment was used for both patients. Discussion Bifid condyles is asymptomatic in most cases. Their most frequent clinical consequence is TMJ pain. Surgical treatment is rarely indicated. Determining the congenital or post-traumatic origin of bifid condyles is often difficult. The orientation of the supernumerary condyle head could help for the etiological diagnosis.

Antineutrophil cytoplasmic antibodies are classical serological markers of small-vessels vasculitis. However, they have been described in many other pathological situations. The aim of this study was to determine through our experience, the main antineutrophil cytoplasmic antibodies-associated diseases and to investigate antigen targets of these antibodies. Forty complete observations of antineutrophil cytoplasmic antibodies (ANCA) positive patients either by indirect immunofluorescence or by enzyme immunoassay were analysed. Only five (12.5%) patients have small-vessels vasculitis. Among these, antineutrophil cytoplasmic antibodies were detected only by Elisa in one patient and they were exclusively directed against bactericidal permeability increasing protein in another one. Our study confirms the presence of antineutrophil cytoplasmic antibodies in different diseases. It demonstrates that antineutrophil cytoplasmic antibodies should be investigated by Elisa when indirect immunofluorescence is negative. In small-vessels vasculitis, Proteinase 3 and myeloperoxidase are mainly but not exclusively the antigenic targets of antineutrophil cytoplasmic antibodies.

Resume Introduction L’epidemiologie et le traitement des fractures mandibulaires varient d’un pays a un autre. Le but de notre travail etait d’exposer les specificites de cette pathologie au centre hospitalier universitaire (CHU) Charles-Nicolle de Tunis. Materiel et methodes L’âge, le sexe, l’etiologie, les localisations et les modalites de traitement des fractures survenues chez 685 patients hospitalises entre 1995 et 2004 ont ete analyses de maniere retrospective. Resultats Le sex-ratio etait de 6. L’âge moyen des patients etait de 28 ans (1–82 ans). Les causes les plus frequentes etaient les accidents de la voie publique (AVP) (45 %) et les actes de violence (22 %). L’angle mandibulaire etait la localisation la plus frequente (24,8 %), suivie par la region parasymphysaire (22,2 %). Le blocage maxillomandibulaire (BMM) a ete le traitement le plus frequent (56,6 %). L’osteosynthese au fil d’acier a ete le moyen de contention le plus utilise lors du traitement chirurgical. Les pertes dentaires et les troubles sensitifs dans le territoire du nerf dentaire inferieur (V3) ont ete les sequelles les plus frequentes. Discussion Nos donnees epidemiologiques correspondent globalement a celles retrouvees dans les pays en voie de developpement. L’analyse de telles donnees pourrait permettre de mieux organiser la prise en charge des traumatismes maxillofaciaux en Tunisie. Les choix therapeutiques dependent du type de fracture mais egalement des conditions economiques du pays.

Resume Introduction La fracture de l’os zygomatique est une pathologie frequente en chirurgie maxillofaciale et plastique. Ses repercussions esthetiques et fonctionnelles peuvent poser probleme au praticien. Le but de ce travail etait d’etudier l’epidemiologie, la clinique, le traitement et l’evolution de cette fracture, ainsi que d’exposer les particularites de sa prise en charge en Tunisie. Materiel et methodes Nous avons realise une etude retrospective sur dix ans incluant les dossiers des patients pris en charge pour une fracture de l’os malaire dans le service de chirurgie maxillofaciale et plastique de l’hopital Charles-Nicolle de Tunis. Nous avons ainsi inclus dans cette etude tous les cas operes selon des indications fonctionnelles ou morphologiques entre 1995 et 2004. Resultats Trois cent cinquante-six cas ont repondu aux criteres d’inclusion. La tranche d’âge la plus representee est la troisieme decade (34 %). La sexe-ratio est de 9/1. Les accidents de la voie publique sont responsables de 31 % des cas. La fracture-disjonction est le type le plus frequent de lesion (43,7 %) ; suivent, en frequence, les fractures de l’arcade zygomatique (34,53 %). Selon le deplacement et la stabilite des lesions, le traitement a ete soit chirurgical, soit orthopedique. En cas d’abord chirurgical, les osteosyntheses ont ete essentiellement realisees au fil d’acier. Le recul moyen est de neuf mois. Les troubles de la sensibilite dans le territoire du nerf sous-orbitaire sont la sequelle la plus frequente (8,7 %). Discussion Les fractures de l’os zygomatique de notre serie touchent essentiellement l’homme jeune et surviennent surtout au cours d’accidents de la voie publique. La tendance actuelle dans la prise en charge de ces fractures est la reduction sanglante et les osteosyntheses multiples.

The repair of nasal defects is thought to be the most ancient of facial reconstructive procedures, dating back to at least 3000 BC in India. In spite of the development of nasal reconstruction concepts, leading to remarkable esthetic and functional improvements, columella reconstruction is yet a contemporary challenge. Columella defects may result from trauma, infections, carcinoma resection, syphilis, bilateral cleft lip, etc. Maintaining symmetry, contour and function are essential for a successful columella reconstruction. Multiple factors help to determine the optimal repair method, including the size of the defect, its depth and location, and the strength of the underlying nasal framework. This article presents a range of techniques and discusses the application of these methods to specific columella defects. A chronological review of columellar reconstruction procedures used for this partial rhinoplasty is exposed.

Summary Cavernous hemangioma is the most frequent primary vascular orbital tumor in adults. This slowly evolving lesion is usually located behind the ocular globe, between the extrinsic muscles. It leads to axile exophthalmia. Surgical treatment is indicated when there is a risk of visual impairment. The prognosis is related to the size of the lesion and its extension. CT scan is rather unspecific, but MRI is highly sensitive and specific in case of progressive painless exophthalmia.

Resume L’hemangiome cutane infantile est une tumeur vasculaire benigne presente chez 10 % des nourrissons. Il fait partie du groupe des tumeurs vasculaires dans la classification de l’ international society for vascular anomalies (ISSVA). L’attitude chirurgicale classique est a l’abstention therapeutique avec traitement tardif des sequelles cutanees. Certaines localisations vont necessiter une prise en charge chirurgicale dite precoce, sans attendre l’involution complete de la lesion et donc le stade des sequelles. Il s’agit notamment d’hemangiomes periorificiels pouvant entrainer des deformations des structures anatomiques sous-jacentes ou des problemes de croissance. A travers nos observations, nous rappelons l’epidemiologie, la physiopathologie, les aspects cliniques, les particularites des localisations periorificielles et leurs traitements. Dans ces localisations, le temps intervient comme une quatrieme dimension qui va modifier, ameliorer ou aggraver le pronostic. La prise en charge necessite un veritable plan de traitement et des gestes precoces. Nous insistons sur le fait que le dogme de l’abstention therapeutique reste vrai pour une majorite d’enfants porteurs d’hemangiomes de petite taille et qu’une chirurgie precoce doit etre proposee pour les localisations periorifcielles de la face.

Amniotic band syndrome (ABS) is a collection of fetal congenital malformations affecting mainly the limbs, but also the craniofacial area. The pathogenic mechanism is still unclear. The facial malformations in ABS are multiple, polymorphous, and asymmetric. The type and extent of facial defects depend on band location and time of onset. Defects may include a combination of facial cleft, cleft palate and lip, ocular lesions, and cranial malformations. The management of this disease must be multidisciplinary and the outcome depends on the gravity of malformations.

Frontal pneumosinus dilatans is a rare entity that is documented only by a few reports. It is an abnormal expansion of the aerated frontal sinus, with sinus walls of normal thickness. The expansion of the bone may be generalized or focal. It is not only an aesthetic problem but may also have functional consequences. We herein present the case of a 23-year-old woman who had been referred to the maxillofacial and plastic unit in Sousse (Tunisia) complaining of a prominence on her right supraorbital region and forehead. The cause was unknown and there were no functional problems. Computed tomography showed a large pneumatized frontal sinus and confirmed the resulting bony prominence. The patient was taken to the operating room, where the frontal and supraorbital regions were exposed through a bicoronal incision. The anterior wall of the right frontal sinus was removed, and was divided into segments that were then fixed in the desired position using a titanium mesh plate. Excellent results were obtained, and the patient had no complaints and was satisfied with her appearance. She remained well two years postoperatively. Pneumosinus dilatans is an entity every plastic surgeon should be aware of because its treatment falls within the realm of craniofacial surgery. The etiology remains unclear, and surgical management is directed toward surgical exploration of the sinus to ensure recontouring of the anterior table of the frontal sinus to correct any cosmetic deformity. Several authors have published different surgical techniques. Level of Evidence 5![Graphic][1] Therapeutic [1]: /embed/inline-graphic-1.gif

Resume Introduction Le schwannome est une tumeur benigne du systeme nerveux peripherique de croissance tres lente. Sa localisation au niveau de la base de la langue est extremement rare et n’a ete rapportee dans la litterature qu’a deux reprises chez de tres jeunes patients. Observation Une patiente de 15 ans a ete hospitalisee en urgence pour hematemese de moyenne abondance. L’examen clinique a revele une tumefaction de la base de la langue a l’origine de ce saignement. Cette lesion evoluait depuis l’âge de trois ans sans qu’une prise en charge medicale n’ait ete effectuee. L’analyse post-exerese complete indiquait un schwannome de la base de la langue. Les suites postoperatoires ont ete simples et aucune recidive n’a ete detectee apres six mois. Discussion La particularite de cette observation etait le tres jeune âge de la patiente lors de l’apparition de la tumeur et sa localisation exceptionnelle a la base de la langue. Le pronostic est favorable en cas de lesion unique, apres exerese complete. Une neurofibromatose type 2 doit etre exclue, etant donne le risque de transformation maligne lie a cette maladie.

Summary Introduction Cemento-osseous dysplasia is a benign fibro-osseous lesion of the jaws. Its complications are very rare. Observation A panoramic x-ray was made to complete the pre-radiotherapy oral assessment of a 71-year-old female patient presenting with lung adenocarcinoma. This revealed a periapical fibro-osseous lesion on tooth no 46. She had presented with a similar lesion on tooth no 36, 16 years before. This had been treated by extraction and alveolar curettage. No surgical treatment was suggested for this recurrence on tooth no 46. Discussion The diagnosis of focal cemento-osseous dysplasia is usually made on radiological and clinical data. The risk for transition to a florid form is unknown. Exeresis surgery before radiotherapy is discussed.

Resume Introduction Le meningiome en plaque est une forme particuliere de meningiome, caracterisee morphologiquement par un aspect « en moquette ». Il se developpe a partir de la dure-mere et peut envahir l’os en regard. Nous presentons un cas exceptionnel par sa localisation et son evolution. Observation Une femme de 41 ans a consulte pour une tumefaction progressive de la region parietofrontale gauche. Au scanner, la diploe etait epaissie, sans lesion parenchymateuse. La lesion a ete resequee. L’histologie a confirme un meningiome en plaque qui a recidive apres sept ans. Discussion Le meningiome en plaque est une forme rare de meningiome touchant rarement la voute crânienne. Les recidives sont frequentes.

Summary Case A 72-year-old man presented with left exophthalmia, impaired visual acuity and ocular pain. CT revealed a posterolateral homogeneous unilocular cyst in the left orbital cavity. Ultrasound showed a 38 × 17 mm purely cystic retro-ocular thin lined mass. Hydatid serologic tests were positive. The cyst was completely enucleated, after irrigation with hypertonic saline solution. The diagnosis was confirmed histologically. Discussion The orbital hydatic cyst is a rare pathology in Western countries but remains relatively frequent in North-African countries. It can be observed in urban centers a high percentage of immigrant population. It is thus necessary to keep this pathology in mind when confronted to an intra-orbital cystic formation and to avoid its rupture.

Summary Introduction Aggressive fibromatosis is a rare histologically benign fibrous tumor with a potential for locoregional aggression. Treatment is not well defined and several therapeutic approaches have been proposed. Surgical treatment is the reference, chemotherapy, radiotherapy and homonotherapy being proposed as complementary treatment or for inoperable tumors. Case report A three-year-old patient underwent surgery for removal of a mandibular tumor. Pathology reported aggressive fibromatosis. The patient was given conservative treatment and was free of recurrence nine years after resection. Discussion Conservative surgery for aggressive mandibular fibromatosis appears to be preferable to radical mutilating surgery which would have a major impact on facial growth in children.

Introduction Le melanome malin des fosses nasales est une tumeur rare qui se manifeste souvent cliniquement par un syndrome tumoral obstructif unilateral volontiers hemorragique. Le diagnostic histopathologique de certitude est aise depuis l’apport des techniques immuno-histochimiques. Le traitement curatif est chirurgical. Observation Nous rapportons un cas historique de melanome malin des fosses nasales revele par une enorme tumefaction jugale chez un patient âge de 60 ans. Les syndromes obstructif et hemorragique etaient tardifs. Le patient a ete traite par une chimiotherapie palliative. Le patient est decede 4 mois apres le diagnostic. Discussion Le mode de revelation du melanome des fosses nasales de notre cas est exceptionnel et reflete une importante extension locoregionale. La tomodensitometrie et l’imagerie par resonance magnetique sont indispensables au bilan pretherapeutique et pour l’evaluation de cette extension, cependant le pronostic reste grave.