Starvation ketoacidosis in pregnancy presenting as euglycaemic, high anion gap metabolic acidosis: A case report highlighting the significance of early recognition and prompt intervention.

Starvation ketoacidosis (SKA) constitutes an important consideration in the pregnant patient who presents with profound metabolic acidosis. Pregnancy-related changes predispose the patient to develop SKA following relatively short periods (12 - 14 hours) of 'starvation'. Patients also typically look clinically well in relation to the significant metabolic derangements that accompany the condition. Prompt recognition and early institution of appropriate therapy is therefore extremely important in terms of optimising maternal and fetal outcome. We describe a pregnant patient with SKA who presented with profound euglycaemic ketoacidosis that resolved rapidly following the early initiation of appropriate therapy. Furthermore, appropriate therapy resulted in our patient avoiding the need for an emergency caesarean section, which is often reported in this scenario. The ensuing discussion addresses SKA in pregnancy, the unique features of our patient, and management considerations from a maternal and fetal perspective. We also discuss the various causes of ketoacidosis such as diabetic ketoacidosis (DKA), euglycaemic DKA, alcohol-induced euglycaemic ketoacidosis and SKA in pregnant patients.

[Treatment of two cases of periodic sleep apnea by maxillo-facial surgery]. / Traitement de deux cas d'apnées périodiques du sommeil par chirurgie maxillo-faciale.

Juvenile temporomandibular bony ankylosis may generate micro- and retroposition of the mandible. Collapse of the upper airway during sleep due to muscle atonia awakens the patient, leading to compensative diurnal hypersomnia. In severe cases, alveolar hypoventilation may result in anoxic seizure, sudden death or development of life threatening cor pulmonale. The corrective surgical procedure for adult is an anterior sagittal osteotomy and in the growing child, costochondral grafting is proposed. Pre and post operative polysomnograms with recording of oxygen saturation are objective measures of good surgical results.

[Basal cell nevus]. / La naevomatose basocellulaire.

The main features of the nevoid basal cell syndrome, also called Gorlin-Goltz-syndrome, are basal cell nevi, jaw cysts, anomalies of the vertebras and ribs, and intracerebral calcifications. The diagnosis is often incidentally made by discovery of bilateral jaw cysts, as it was in the case of our patient and her family. The therapy is the complete enucleation of the cyst. The cavity is filled with homologous cancellous bone graft. Recurrence and little cysts are treated with the solution of Carnoy eliminating remaining microcysts.

[Resection and reconstruction of mandible for treatment of two rare benign tumors]. / Résection et reconstruction de la mandibule pour le traitement de deux tumeurs bénignes rares.

Odontogenic myxoma and particularly juvenile fibromatosis are rare benign tumors in the maxillo-facial region. The aggressive local and sometimes voluminous development of these tumors may necessitate partial mandibulectomy. Autologous bone graft from the iliac crest is the best material for mandibular reconstruction because of its functional and esthetic results. If osteosynthesis of the graft is achieved by means of internal wiring, several weeks of intermaxillary fixation are required, whereas internal rigid fixation with plate and screws allows the patient to open the mouth more rapidly.

[2 rare tumors of the mandible. Removal and reconstruction]. / Deux tumeurs peu fréquentes de la mandibule. Exérèse et reconstruction.

Odontogenic myxoma and particularly juvenile fibromatosis are rare benign tumors in the maxillo-facial region. The aggressive local and sometimes voluminous development of these tumors may necessitate partial mandibulectomy. Autologous bone graft from the iliac crest is the best material for mandibular reconstruction because of its functional and esthetic results. If osteosynthesis of the graft is achieved by means of internal wiring, several weeks of intermaxillary fixation are required, whereas internal rigid fixation with plate and screws allows the patient to open the mouth more rapidly.

[2 infrequent tumors of the mandible. Removal and reconstruction]. / Deux tumeurs peu fréquentes de la mandibule. Exérèse et reconstruction.

Odontogenic myxoma and particularly juvenile fibromatosis are rare benign tumors in the maxillo-facial region. The aggressive local and sometimes voluminous development of these tumors may necessitate partial mandibulectomy. Autologous bone graft from the iliac crest is the best material for mandibular reconstruction because of its functional and esthetic results. If osteosynthesis of the graft is achieved by means of internal wiring, several weeks of intermaxillary fixation are required, whereas internal rigid fixation with plate and screws allows the patient to open the mouth more rapidly.

[Difficult intubation in maxillofacial surgery. Tracheotomy or fibroscopy?]. / L'intubation difficile en chirurgie maxillo-faciale. Trachéotomie ou fibroscopie?

Prior to general anesthesia, some maxillofacial conditions may require tracheostomy or, in recent years, fiberoptic endotracheal intubation. This technic is efficient but delicate and therefore needs a skilled qualified operator. However, fiberoptic endoscope may avoid the inconvenience of tracheostomy. This article presents our method of fiberoptic endotracheal intubation with the specific indications and results.

[Sleep obstructive apnea syndrome and temporomandibular ankylosis. Maxillofacial correction for adults and children]. / Syndrome d'apnées obstructives du sommeil et ankylose temporo-mandibulaire. Correction maxillo-faciale pour l'adulte et l'enfant.

Juvenile temporomandibular bony ankylosis may generate micro- and retroposition of the mandible. Collapse of the upper airway during sleep due to muscle atonia awakens the patient, leading to compensative diurnal hypersomnia. In severe cases, alveolar hypoventilation may result in anoxic seizure, sudden death or development of life threatening cor pulmonale. The corrective surgical procedure for adult is an anterior sagittal osteotomy and in the growing child, costochondral grafting is proposed. Pre- and post-operative polysomnograms with recording of oxygen saturation are objective measures of good surgical results.

Deliberate, fixed extra-articular obstruction. Treatment of choice for subluxation and true recurrent dislocation of the temporomandibular joint.

Temporomandibular dislocation and subluxation are two pathological situations both characterized by hypermobility of the condyle. We believe that when luxation is recurrent and when subluxation becomes painful or is accompanied by disc dysfunction, surgical intervention is indicated. We are impressed by Gosserez and Dautrey's (1967) method of augmentation of the tubercle, or extra-articular obstruction, which is a modification of Leclerc and Girard's (1943) original procedure. The advantages of this technique are described and results are based on a series of 38 patients.

Homologous cancellous bone grafts for large jaw defects caused by bone cysts.

For more than 10 years homologous bone stored at -20 degrees C has been used to fill large bone cavities after cystectomy. This article outlines the principles of collecting, storing, and preserving the homograft, presents special aspects of the surgical technique, and reports long-term results.

[Solitary plasmocytoma of the mandible]. / Plasmocytome solitaire de la mandibule.

The authors present a case of solitary bony plasmocytoma of the mandibule, with local amyloid deposition. Diagnosis was made at extemporaneous pathological examination, then confirmed by the examination of the fixed surgical sample. Immunoenzymologically the proliferation proved to be monoclonal, with secretion of kappa light chain. The patient was treated by surgical curettage and homologous cancelous bone filling, followed by 5,500 rads of electrontherapy. He was then regularly controlled during 8 years and remained free from local recurrence. All investigations in search of dissemination (Kahler disease) remained negative.

[Mucoepidermoid tumor of the mandible (author's transl)]. / Tumeur muco-épidermoïde intra-mandibulaire.

The diagnosis of a mucoepidermoid tumor of the mandible has been made by pathological examination. This asymptomatic tumor was discovered on a routine radiographic film. Our 44 years old male patient was treated by surgical means. We have found 62 cases in the literature; intra-osseous cases of mucoepidermoid tumor seem to be rather scarce. Let us recall the presence of salivary glands in the mandible, a possible explanation of the occurrence of intra-osseous glandular tumor.