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Introduction The eyelids reconstruction presents an aesthetic, but above all, a functional challenge. It must allow the good protection of the cornea. The development of perforator flaps is major in recent years and is gradually spreading to the face, which has pushed us to apply it to palpebral surgery. Material and method Since 2014, in the maxillofacial surgery department of St Etienne, four patients have benefited from a palpebral reconstruction. A temporal perforator flap, dissected on a perforator of the superficial temporal artery was performed for the anterior lamella and a palatal mucosa graft for the tarsal reconstruction. Results The results were satisfying. Functionally, this technique allowed good occlusion of the eyelid and prevented the occurrence of ocular complications. On the aesthetic view, the position of the neo-eyelids is satisfying. No patient need retouching. The perforator flap allowed a significant mobilization without distortion of neighboring tissues, and maintaining frontal contractility. Discussion This contemporary approach to flap dissection provides a good functional result, reduces the sequelae of the donor site and does not impose a secondary aesthetic gesture. However, despite these advantages, this type of dissection has the disadvantage of being technically more delicate and requires a trained operator.

Extracellular vesicles (EVs) or exosomes have been implicated in the pathophysiology of infections and cancer. The negative regulatory factor (Nef) encoded by simian immunodeficiency virus (SIV) and human immunodeficiency virus (HIV) plays a critical role in the progression to AIDS and impairs endosomal trafficking. Whether HIV-1 Nef can be loaded into EVs has been the subject of controversy, and nothing is known about the connection between SIV Nef and EVs. We find that both SIV and HIV-1 Nef proteins are present in affinity-purified EVs derived from cultured cells, as well as in EVs from SIV-infected macaques. Nef-positive EVs were functional, i.e., capable of membrane fusion and depositing their content into recipient cells. The EVs were able to transfer Nef into recipient cells. This suggests that Nef readily enters the exosome biogenesis pathway, whereas HIV virions are assembled at the plasma membrane. It suggests a novel mechanism by which lentiviruses can influence uninfected and uninfectable, i.e., CD4-negative, cells., IMPORTANCE Extracellular vesicles (EVs) transfer biologically active materials from one cell to another, either within the adjacent microenvironment or further removed. EVs also package viral RNAs, microRNAs, and proteins, which contributes to the pathophysiology of infection. In this report, we show that both human immunodeficiency virus (HIV) and simian immunodeficiency virus (SIV) incorporate the virus-encoded Nef protein into EVs, including EVs circulating in the blood of SIV-infected macaques and that this presents a novel mechanism of Nef transfer to naive and even otherwise non-infectable cells. Nef is dispensable for viral replication but essential for AIDS progression in vivo. Demonstrating that Nef incorporation into EVs is conserved across species implicates EVs as novel mediators of the pathophysiology of HIV. It could help explain the biological effects that HIV has on CD4-negative cells and EVs could become biomarkers of disease progression.

Les auteurs rapportent trois observations d’epithelioma spino-cellulaire de la columelle envahissant la sous-cloison. L’exerese large de ces tumeurs a pose le probleme d’une reparation a cheval sur plusieurs sous-unites esthetiques nasales. Apres une revue chronologique des procedes de reconstruction de la columelle, les auteurs justifient le choix du lambeau nasogenien dans ces trois cas cliniques, alors qu’il n’a que rarement retenu leur attention pour les rhinopoieses partielles.

There are many lips kinetic disorders whose clinical appearances greatly differ. An acute examination directs toward the diagnosis on a neurologic, neurogenous, muscular, myogenous, medicamentous, dermatological or psychiatric etiology. The authors review the different etiologies that have to be discussed, in order to choose the appropriate further investigations and specialized examinations, before a possible surgical treatment.

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.

Lengthening temporalis myoplasty is indicated in long-standing and congenital facial paralysis. Its principle is the transfer of the coronoid tendinous insertions onto the lip and the nasolabial fold. Knowledge of the anatomy of this strong and wide tendon is necessary for successful use of its anatomic advantages. A study on 10 cadavers (20 temporalis muscles) confirmed the surgical anatomy found during lengthening temporalis myoplasty procedures: the strong tendon, when freed from the coronoid process, is 4-6 cm wide.

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.