[Umbilical hernia. New repair technique with a minimal scar]. / Hernie ombilicale. Technique nouvelle de réparation avec cicatrice a minima.

OBJECTIVE: Describe a surgical technique concerning the treatment of umbilical hernias that have a diameter less than 5 cm, with a reduction of scars. PATIENTS AND METHOD: After analysing the different techniques of umbilical hernias repair, the authors suggest a new personal technique. The surgical treatment consists in removing the hernia sack after double M incision of the umbilical skin, repairing the abdominal wall by Quenu technique, folding the abdominal muscles and reconstructing the umbilicus. RESULTS: The results, which are achieved on nine patients, with check up two years after, confirm the validity of the technique. DISCUSSION AND CONCLUSIONS: The scars after umbilical hernia surgical treatment are very important and visible because of their being located on the middle line of the abdominal wall. For the female patient in particular, this scar represents a great psychological annoyance. The double M technique leaves only an invisible scar with a good functional result.

[The persistence of ontogenic characteristics in the adult masseter muscle]. / Persistance de caractères ontogéniques dans le muscle masséter adulte.

During embryonic and foetal development, the masseter is formed from two successive generations of muscle fibers in a manner which is very similar to that which has been previously described for other skeletal muscles. This phenotype is characterised by the persistence of ontogenic myosin isoforms (embryonic and foetal myosin heavy chains, embryonic light chain) and by the presence of two distinct populations of fibers: small diameter fibers which coexpress the embryonic, foetal and fast isoforms of the myosin heavy chains but never express the slow isoform; large diameter fibers which express the slow myosin heavy chain either exclusively or in variable associations with the other isoforms. These characteristics of the human masseter muscle probably correspond not only to its embryological origin and its special innervation, but also to the functional constraints to which it is submitted after birth.

Cyclopia: a radiological and anatomical craniofacial post mortem study.

Cyclopia is a rare foetal malformation characterized by a single palpebral fissure and a proboscis associated with severe brain malformation. Approximately 1.05 in 100,000 births including stillbirths are identified as cyclopian. Cyclopia is not compatible with life. The authors present an anatomical and histological study of the fronto-orbito-maxillary region carried out after 3-D CT reconstruction in a 21 week-old foetus with cyclopia. Anatomical and histological observations suggest that the integrity of the trigeminal nerves is very important for the normal development of the embryological structures of the face. Fusion of the facial processes in the midline takes place even if central prosencephalic structures are absent. For this reason the face in cyclopia, in both its positive and negative aspects, constitutes a model for the study of the normal development of this region.

[The first appearance of Meckel's cartilage in the fetus]. / Le cartilage de Meckel au début de la période foetale.

Meckel's cartilage plays an important role in the topographical organisation and in the differentiation of the facial structure during the embryonal and even much later during the foetal period. Our observations on serial sections carried out in two human foetuses aged 12 and 16 weeks indicate that the two dorsal (tympanic) and ventral (mandibular) branches of Meckel's cartilage are perfectly defined at 16 weeks. In the dorsal branch, the primordia of the incus and of head of the malleus are still composed on non-ossified cartilage. In the ventral branch, it is also possible to describe at 16 weeks three posterior, medial and anterior parts which are composed of cartilage. The initiating role played by the ventral part of Meckel's cartilage on the ossification of the mandible leads during the embryonal period to the formation of the mandibular primary growth center, which is therefore clearly defined in our first stage at 12 weeks. The partial fibrous evolution and the regression of the major part of the ventral branch of Meckel's cartilage only start after 16 weeks of intrauterine life.

[Plastic surgery of the penis after circumcision]. / Plastie pénienne après circoncision.

One of the possible complications of circumcision is excessive resection of penile skin. This technical note describes two penile plasty techniques using scrotal skin after excessive circumcision.

Endermologie: humoral repercussions and estrogen interaction.

Endermologie is a motorized rhythmic folding-unfolding and suction technique of the panniculus adiposus. Our study shows that one 40-min Endermologie session produces no noticeable changes in biological parameters, except for plasma estradiol levels, which vary significantly, first by decreasing during the session, then by increasing afterward. Such an Endermologie/estrogen interaction can be compared to the clinical effects observed in some patients undergoing regular Endermologie treatment: return of menses in amenorrheal patients and a trophic effect on skin and subcutaneous connective tissue comparable to that observed during postmenopausal hormone replacement therapy. Understanding such an interaction with the estrogen metabolism requires additional studies and opens many paths for research on therapeutic applications before and after menopause beyond refinement of the body contour and improvement of the appearance of the panniculus adiposus.

Umbilical restoration in abdominal dermolipectomy: A simple double-Y, double-M technique.

The authors present a simple technique for restoration of the umbilicus in abdominal dermolipectomy. This procedure is represented by a double-Y cutaneous incision on the abdominal skin and by a double-M cutaneous incision on the umbilical skin. This technique restores a neoumbilicus with multiple small skin flaps and conceals the periumbilical scar at the bottom of the umbilicus. Different designs and figures are proposed to explain the procedure.

Central giant cell granuloma of the palate; unusual localisation in a five year old child.

The central giant cell granuloma of the maxillo-mandibular region is a relatively uncommon lesion (3.5%-0.1%). Essentially, it occurs in the second decade of life and it is mainly located in the mandibular region. The female/male ratio is 3:1. The authors present an unusual localisation of central giant cell granuloma in a five year old child's maxillary bone. After a surgical curettage of the lesion, an eighteen months follow-up examination did not show any recurrence.

Temporomandibular region in the Franceschetti's Syndrome. Anatomical study.

Franceschetti's syndrome is a rare, non-fatal, hereditary malformation, usually bilateral, which symmetrically affects orbits, mandible and ear. The authors propose an anatomical description of the temporomandibular region after the dissection of a newborn baby suffering from Franceschetti's Syndrome, dead soon after the birth. A discussion on the different etiopathogenical theories is made. The authors conclude that an alteration of the development of nerve trigeminal branches is the cause of the malformations.

Deviated nose: technical proposition for prevention of recurrences.

After considering previously published studies and accordant with their observations during operations, the authors propose a surgical technique for the treatment of the deviated nose. Subpericondrial liberation of the upper lateral cartilages on the concave surface, with regard to the deviation, helps to prevent recurrences. After illustration of the surgical technique, some representative clinical cases are presented.

Mandibulo-facial dysostosis: comparison study of a neonate with mandibulo-facial dysostosis and a normal neonate.

Mandibulo-facial dysostosis (MFD) is a malformative syndrome with autosomal dominant transmission and variable expressivity that mainly affects derivatives of the first and second branchial arches. The subsurface anatomy of this condition is still partly unexplored since there have been only four reported dissections of MFD. A detailed dissection of the head and neck of a neonate with MFD is described and compared with a normal neonate. Theories of the pathogenesis are discussed on the basis of these observations.

[The adipose Bichat bolla flaps in repair of oroantral fistulas]. / Il lembo adiposo dalla bolla di Bichat nella riparazione delle communicazioni oroantrali.

The Authors review Literature concerning surgical treatment of oro-antral fistulas. After a brief discussion concerning the anatomy of the Bichat bulla, the Authors present two clinical cases of oro-antral fistulas with purulent sinusitis. The lesions were repaired using an adipose flap of the Bichat bulla which was sandwiched between the mucous flap and the bony defect. The partial introduction of the adipose flap in to the maxillary sinus through the bony defect, enabled the osteomyelitis bony edges to revascularize and created a pathway and biological substratum for re-epithelialization of the maxillary sinus. Clinical and radiological follow-up 24 months after treatment revealed stable closure of the fistula and normal ventilation of the maxillary sinus. On the basis of these results and those reported in Literature, the Authors advise employment of this technique, particularly in extensive oro-antral fistulas which do recur with other techniques and which, furthermore are complicated by local infectious processes.

[Viral implication in immature angiomas. Etiopathogenic hypothesis and immunohistopathologic study of eleven cases]. / L'implication virale dans les angiomes immatures. Hypothèse étiopathogénique et étude immunohistopathologique sur onze cas.

After assessing research into etiopathogeny of immature angiomas, the authors study immunohistopathological pieces taken from (eleven) patients. Results prove the presence of papilloma virus in the observed tissues, and a particular management of the immunity response. These results evoke a possible viral etiopathogeny at the origin of these lesions.