[Hair micrograft technique for eyebrow reconstruction]. / Reconstruction du sourcil par microgreffe capillaire.

SUBJECT: The eyebrow reconstruction should restore an eyebrow with a natural shape and with matching hair direction. METHOD: We describe the micrograft hair technique for eyebrow reconstruction, using either hair from the opposite eyebrow or hair from the scalp. We illustrate our technique with three clinical cases: a traumatic eyebrow injury, a burn scar and a progressive hair loss. DISCUSSION: We insist on the advantages of this technique which is simple, "taylor-made" and which allows to choose the hair direction according to the eyebrow topography. The micrograft hair technique has many advantages in comparison with scalp strip grafting or hair-bearing island scalp flap techniques. CONCLUSION: The eyebrow reconstruction using micrograft hair technique is a simple effective technique offering a better cosmetic result than usual techniques by achieving a natural hair direction and density.

Cinegammography and 3-D emission tomoscintigraphy for evaluation of revascularized mandibular bone grafts: a preliminary report.

The following reports a study conducted to investigate a scintigraphic monitoring procedure for bone free flap in mandibular reconstruction. This procedure is based on the one hand, on vascular and bone cinegammography, and on the other hand, on vascular and bone 3-D tomoscintigraphy. We used a prospective cohort study design. All patients who underwent free flap mandibular reconstruction from April 1993 to April 1998 in the Salpêtrière University Hospital, France (20 cases) have been evaluated in relation to this scintigraphic procedure. Vascular and bone scintigraphy were performed within the second week after surgery during 2 consecutive days. All images were read by one author (J.- Y. B.), who did not know the skin status of the flap. The results were compared with the viability of revascularized bone grafts as evaluated by the skin status and Greenberg classification based on bone radiographs three months after reconstruction. Vascular cinegammography seems to be closely related to anastomosis patency. Bone cinegammography gives appreciable information on bone viability. 3-D vascular tomoscintigraphy remains difficult to interpret. 3-D bone tomoscintigraphy gives precise information on the viability of the different segments of the bone flap. These results suggest that vascular and bone 3-D tomoscintigraphy coupled with cinegammography have an excellent prognostic value. In the event of partial failure it can give information on the location of the impaired patency and on the osseous fragment which has lost any viability.

[Unusual breast scars]. / Des cicatrices mammaires inhabituelles.

The authors report the case of an unusual form of skin tattoo, discovered on the breasts of a young woman, corresponding to several scars forming a symbolic image, performed deliberately with a burning object. This form of mutilation is called "branding". Imported from England, it is developing in France as a result of fashion, but its followers could one day regret the permanent scars left by this deep burn.

[Loss of substance of the lateral region of the face]. / Pertes de substance de la région latérale de la face.

The lateral region of the face is often exposed to trauma and may also be the site of tumor localization. Exeresis may lead to major tissue loss. We report several surgical techniques, from the most simple to more complicated, available for facial repair. Neighboring regions in the frontal or temporal area are used but a submental flap may also be useful.

[Comparison of anatomy and imaging of the orbital area and the nasolacrimal duct]. / Comparaison anatomie-imagerie de la région orbitaire et du canal lacrymo-nasal.

The orbit and its appendages were analysed on anatomical sections, CT scans and magnetic resonance imaging in order to define the various constituents of the orbitonasolacrimal apparatus in the various planes. The series of sections presented should enable surgeons to define the landmarks in this region, especially in the approach to deep structures.

[A simple procedure for the passive suspension of the paralyzed labial commissure]. / Procédé simple de suspension passive de la commissure labiale paralytique.

Different techniques can be used to repair paralytic labial commissurae. Ideally, microsurgical procedures or dynamic suspension methods can correct kinetic paralysis but in certain patients (elderly subjects, poor general health, precarious postsurgical rehabilitation) such procedures may represent an excessively aggressive procedure. We therefore used static suspension of the paralytic labial commissurae based on desepidermization of a nasogeneal flap. This simple technique is easy to perform and is our method of choice for static suspension because the flap pulls the paralysed commissurae upward and doubles the tissue cover, helping overcome buccinator incompetence.

[Fracture of the medial wall of the orbit. Apropos of 4 cases]. / Fracture de la paroi médiale de l'orbite. A propos de 4 observations.

Fractures or the medial wall of the orbit are uncommon and clinical signs are often discreet. This report was focused on isolated fractures of the medial wall of the orbit. Blow-out trauma is usually the cause. In these cases the clinical signs ranged from simple ecchymosis to blindness by haematoma of the orbital cone. Computed tomography is a major tool for diagnosis and making therapeutic indications for these fractures. Treatment depends on the oculomotor involvements as measured by forced duction tests.

[The trapezoid face: transversal excess in the maxillary area]. / Le visage trapézoïdal: excès transversal au niveau de l'étage inférieur de la face.

The patient who consults for "big cheeks" usually desires correction for an excess of tissue in the masseter region. First all neoplastic pathologies recognized by their unilateral asymmetry are excluded in order to focus on bilateral phenomena. Three anatomical elements can be responsible either alone or in association for this excess: the parotid gland, the masseter muscle and the angle of the jaw. The clinical and complementary examinations leading to the etiological diagnosis are described. The treatment recommended is specific to the structure involved and is not necessarily surgical.

[Radiologic pitfalls of mandibular fractures]. / Pièges radiologiques des fractures mandibulaires.

Analysis of a large series of patients treated for mandibular fractures showed pitfalls in assessment of radiologic images in six cases. Factors predisposing to these radiologic pitfalls are discussed, multiple radiographic projections being suggested if discordance exists between radiologic and clinical findings, to obtain maximum data from a three dimensional picture of the mandible.

[Baldness: indications]. / Calvitie: indications.

The author presents his indications for the various types of baldness. Grafts, for which the technique used has been recently modified, allow covering small patches of alopecia, especially on the anterior frontal line. High-hinged flaps are used for more advanced baldness. Lastly, scalp lift and scalp expansion allow solving the problem of extensive baldness of the vertex and of the anterior frontal line.

[Cherubism. Apropos of a major case]. / Le chérubisme. A propos d'un cas majeur.

Cherubism is a benign, hereditary giant-cell lesion located in the mandible and both maxillaries, which appears during childhood as a painless bilateral swelling, progressing until puberty and then receding spontaneously without normally requiring any treatment. In a previous publication, the authors had presented the case of three young children from the same Algerian sibship, who were eventually all operated when surgery proved to be necessary. The case published in this presentation is that of a young Italian girl presenting with a monstrous form of cherubism. In view of this malignant form, the authors decided to perform surgical treatment in several steps in order to decrease this abnormality as much as possible, considering the physical and psychological consequences reported.

[Complex reconstruction of the lower lip. Apropos of various cases]. / Reconstruction complexe de la lèvre inférieure. A propos de quelques cas.

Preservation of buccal cavity relations raises problems when treating extensive defects of lower lip. After a review of anatomical features, several case reports are presented to illustrate the advantages and inconveniences of three interventions for labial reconstruction.

[mandibular reconstruction by free bone flaps with micro-anastomosis. Our current indications]. / Reconstruction mandibulaire par lambeaux libres osseux micro-anastomosés. Nos indications actuelles.

The frequency with which difficulties were encountered in the reconstruction of the continuity of the mandible led us to attempt to systematize our indications. Although grafts, composite pedicle flaps and prosthetic guides still have their appropriate applications. Local conditions are more and more frequently amenable to free flaps. The factors guiding our choice are presented in detail: physical conditions, etiology and anatomy of the defect. In addition, the reason for choosing the type of free flap--iliac crest, fibula or external brachial--is discussed.

[Value of interrupted resection of the lateral crus in surgery of the nasal tip]. / Intérêt de la résection interruptrice de la crus latérale dans la chirurgie de la pointe du nez.

Three goals have to be achieved in the surgery of the tip of the nose. Separately or joined together, they contribute to modify the height, rotation or width of the tip. Interrupting resection of the upper legs gives the ability to modify both the projection and the rotation of the tip. The authors present this technique, emphasizing the precise location of the knee of the upper legs and the interest to perform interrupting resections laterally to this region.

[The maxillofacial surgeon faced with the HIV-positive patient: risks and prevention]. / Le chirurgien maxillo-facial face au patient H.I.V. positif: risques et prévention.

Prevention against the transmission of the HIV must be universal today, which means that it applies to all patients. Blood, tissues, the CSF are infected, but nasal secreta, tears and saliva are not contaminated unless they contain blood. The statistical risk of an HIV serological conversion when making an injection is an estimate of 0.1 to 0.3%, one hundred times less than with the hepatitis B virus. The best protection for maxillofacial surgeons, who are very exposed by the manipulation of objects (needle, wires) and by considerable projections of blood (rotary motor) is not a systematic HIV serological test for all patients, but goggles with side screens, a double pair of gloves and the use of an antiseptic acting on the HIV in case of staining.

[Mandibular fractures. Our patient enrollment during the past 2 years]. / Fractures mandibulaires. Notre recrutement au cours de ces deux dernières années.

The method of patient referral; the patient's physical predisposition, the localization and the treatment undertaken for the different mandibular fractures seen by SOS Face over the past two years were analyzed. The 312 mandibular fractures were used to reevaluate the commonly accepted statistics concerning these parameters.

[Isolated sub-orbital plexiform neurofibroma]. / Neurofibrome plexiforme sous-orbitaire isolé.

An unexpected finding on histology in a 73 years old patient was an isolated suborbital plexiform neurofibroma. Since this tumor is specific for von Recklinghausen's disease, the diagnosis was that of a minor form of the disease. The different cephalic manifestations of von Recklinghausen's disease are reviewed.