[Primary intraosseous mucoepidermoid carcinoma of the jaws]. / Carcinome muco-épidermoïde intra-osseux des mâchoires.

INTRODUCTION: A mucoepidermoid carcinoma (MEC) is a malignant salivary gland tumor. Its primitive intraosseous maxillary localization is rare. We report a case with a difficult diagnosis. CASE REPORT: A 42-year-old female patient consulted atypical right sinus area pain. The CT scan revealed a heterogeneous tumor lyzing the right maxillary. The surgical treatment was broad resection. The pathological examination indicated an intramaxillary MEC. The surgical treatment was completed by postoperative radiotherapy. DISCUSSION: Primary intraosseous MEC of the jaws is rare and often affects the mandible. Its intraosseous maxillary localization is even rarer. Its etiopathogenesis is still unknown. The treatment is usually surgical, and the prognosis is based on histological criteria.

[Submental intubation in maxillofacial traumatology]. / L'intubation sous-mentonnière en traumatologie maxillofaciale.

INTRODUCTION: Free access to the upper respiratory tract may be a challenge for the management of severe facial trauma. Tracheotomy is routinely used in this case. Submental intubation is little used, but it is an alternative to tracheotomy. MATERIAL AND METHOD: A retrospective study was made over 1 year. Sixteen patients with facial smash were included. Patients who had undergone an immediate tracheotomy or a long-term intubation were excluded. Submental intubation was used in all patients with the same protocol. The studied data was: operative time, duration of ventilator disconnection, postoperative complications, and scar assessment. RESULTS: The average operative time was seven minutes. No speech disorder, hematoma, or postoperative infection was observed. The scar was barely visible in 13 cases out of 16. DISCUSSION: Submental intubation seems to be a reliable, simple and easy to learn technique. A perfect knowledge of the local anatomy allows opening the airway without any risk of hematoma. Incision packing reduces the bacterial inoculum and infectious risk. The residual scarring is minimal.

[Reconstruction of the lower third of the ear with a Crikelair flap]. / Reconstruction du tiers inférieur de l'auricule par lambeau de Crikelair.

Amputation of the lower third of the ear includes full thickness earlobe defects. Earlobe reconstruction depends on the covering and scaffold technique used. The Crikelair cervical skin flap is one of the available techniques for reconstruction. We discuss its assets and drawbacks by comparing it with alternative procedures.

[Facial wounds: an epidemiological review of 850 cases]. / Plaies faciales : étude épidémiologique de 850 cas.

BACKGROUND: Facial wound are among the most frequent emergencies. They often affect a young population. We studied the epidemiological profile of facial wounds admitted in our hospital. PATIENTS AND METHODS: This prospective study was carried out in the Emergency Unit from June 2008 to June 2009. It included all patients having presented with at least one facial wound. The analysed parameters were patient, trauma, and wound characteristics. RESULTS: Eight hundred and fifty patients were included, 20% of whom were female patients. The most frequent etiologies were traffic accidents for men, assault for women, and domestic accidents for children. Alcohol abuse was involved in 12.4% of the cases. The most frequent wound localization was frontal (35.4%). A craniofacial organ (eye, brain…) was affected in 6.1% of the cases; the wound was associated to a craniofacial fracture in 9.6% of the cases, and to an extrafacial lesion in 22% of the cases. DISCUSSION: Facial wounds are a frequent emergency. They are predominant in young male patients. The high frequency of traffic accident and alcohol abuse requires an adequate prevention policy.

[Barraquer-Simons syndrome]. / Syndrome de Barraquer-Simons.

The Barraquer-Simons syndrome is a rare acquired acral partial lipodystrophy of unknown etiology. It progressively develops during childhood. It leads to a complete loss of subcutaneous fat in the face, neck, trunk and upper limbs. The disease is more common in female than male patients and causes facial dysmorphy. Free fat transplantation seems to be an appropriate technique to treat facial abnormalities encountered in this syndrome.

[Maxillary bone sarcoidosis]. / Sarcoïdose osseuse maxillaire.

INTRODUCTION: Sarcoidosis is an unexplained systemic granulomatosis. Bone localizations of the disease are rare. We report a maxillary localization. CASE: A 35-year-old patient consulted for facial dysmorphia first observed 2 years before. This swelling was associated to nodular panniculitis lesions and xerostomia. The facial asymmetry was due to maxillary gingival and alveolar swelling. It was associated with scarring in the legs and a purple nodular facial lesion. Lip and jaw biopsies revealed epithelioid and giant cell granulomas without caseous necrosis. The panoramic dental X-ray showed diffuse horizontal alveolar ridge lysis and CT scan revealed an osteolytic lesion of the right maxilla associated to a bone-condensing lesion of the left hemi-mandible. DISCUSSION: The diagnosis of sarcoidosis is made in case of epithelioid and giant cell granulomas without caseous necrosis and the ruling out of other possible diagnoses, including tuberculosis. Bone involvement is rare; face and maxillary localization are extremely rare. The recommended treatment is corticosteroids. Facial remodeling surgery is not recommended.

[Medial cleft lip: one diagnosis masking another]. / Les fentes labio-palatines médianes : un diagnostic qui en cache un autre.

UNLABELLED: Median cleft lip and palate are one of the facial manifestations of holoprosencephaly, a brain malformation resulting from a defect in the development of the prosencephalon, the embryonic precursor of the forebrain. It can occur in isolation or as part of a broader pattern of malformation in many different syndromes. The diagnosis of holoprosencephaly requires a complete malformative assessment. FIRST CASE: a newborn baby seen at birth for a median cleft lip associated with a complex craniofacial malformation. The search for malformations revealed the absence of the median cerebral structure and trisomy 13. The baby died at 48 h. SECOND CASE: A 28-day-old newborn baby consulting for a median cleft lip and palate. The brain ultrasounds showed no anomalies of the median cerebral structure. The malformative assessment revealed no other malformation. DISCUSSION: Holoprosencephaly is a complex developmental brain malformation. From the advances in neuroimaging and genetics, our understanding of the etiology and pathogenesis of this condition has advanced dramatically. This advance should lead to improved management of common medical complications and more optimal family counseling. Surgical treatment is the preferred therapy for viable malformations.

[A maxillary lip bumper used to manage labial self-mutilation]. / Utilisation du lip bumper ou pare-choc labial dans la prise en charge d'une autophagie labiale.

INTRODUCTION: The repair of facial self-mutilation often fails if the reconstruction is not protected. The authors report a case of a lip self-mutilation treated by an orthodontic device: the "lip bumper". OBSERVATION: A four-year-old patient presented with self-mutilation of the lower lip in a context of multiple malformations. The defect concerned two third of the lower lip. The treatment combined antibiotics, local care, psychiatric management and a lip bumper. The evolution was favorable without need for secondary reconstruction. DISCUSSION: The lip bumper is a simple orthodontic device. It pushes the lower lip away from the dental arch. It is used to stop the pattern "agitation-mutilation-infection".

Mandibular metastases from an ileum stromal tumor.

INTRODUCTION: Metastatic disease of the jaws is unusual and accounts for 1 to 4% of oral cavity malignancies. Jaw metastases from the gastrointestinal (GI) tract usually evolve from adenocarcinoma of the esophagus, colon, and rectum. Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the GI tract defined by a positive C-Kit (CD117). These tumors are thought to arise from Cajal cells in GI tract walls, essential for intestine motor function. The small intestine harbors only 30% of GIST. After reviewing the literature, no case of jaw metastases from GIST was found. The purpose of this study was to report the first case of mandibular metastases arising from a stromal tumor of the ileum. CASE REPORT: A 68-year-old man presented with a painful swelling in the parasymphysis and left molar mandibular area having grown progressively for 3 weeks. The oral mucosa was macroscopically normal. The orthopantomograph showed radiolucency. A CT-Scan revealed an irregular osteolytic lesion with invasion of soft-tissues. Biopsy proved a stromal tumor. A complete CT-Scan analysis revealed an ileum tumor. Biopsies and immunochemistry proved an ileum stromal tumor. All tumoral cells expressed the C-Kit in the ileum and the mandible. The patient was treated with imatinib but died 11 months after the diagnosis. DISCUSSION: The prevalence of GIST is low but the true incidence may be higher because of under-diagnosis. To our knowledge, this is the first well-documented case report of jaw metastasis from ileum GIST. GIST should be included in the differential diagnosis of intramandibular tumor in patients with prior or current non-oral malignancy.

[Mouth floor and mobile tongue epidermoid carcinomas thickness: prognostic value]. / Epaisseur de l'infiltration tumorale des carcinomes épidermoïdes du plancher buccal et de la langue mobile : valeur pronostique.

INTRODUCTION: Most cancers of the oral cavity are epidermoid carcinomas. The prognosis is made on the patient's general health status and the tumoral stage. The UICC TNM staging classification system is one of the most important factors taken in consideration for the prognosis. But this classification in oral epidermoid carcinomas does not include the tumor thickness (except for T4 tumors). Several studies demonstrated that tumor thickness could influence the prognosis in epidermoid carcinoma and other types of cancers. The aim of our retrospective study was to assess the prognostic value of tumor thickness in oral epidermoid carcinoma. PATIENTS AND METHODS: The study included patients with mouth floor or mobile tongue epidermoid carcinoma classified T1N0, T2N0 and T3N0 between 1985 and 2005. All patients were treated with a curative intention. A pathologist analysed the tumor thickness and cervical lymph nodes. All the slides were examined to measure tumor thickness in millimetres. RESULTS: Three hundred and five patient files were reviewed and 124 patients were included, with 94 men (75.8%), and a mean age of 59.3 years (17-93). The mean and median tumor thickness were respectively 7.7 and 6.5 mm (0.4-30). The median tumor thickness was chosen for the study. There was a statistically significant link between the five-year probability of global survival and the initial tumor thickness and between neck node invasion and tumor thickness (p<0.05). DISCUSSION: This study suggests that tumor thickness should be taken in consideration in T1N0, T2N0 and T3N0 mouth floor and mobile tongue epidermoid carcinomas. In the future, the clinical evaluation of tumor thickness will help determine the therapeutic management.

[The pedicled submental flap]. / Le lambeau sous-mental pédiculé.

INTRODUCTION: Facial reconstruction technique can be simple or complicated. The choice of performing a flap is made according to several criteria. Since its first description the submental flap has been used in several indications. The aim of this article was to document maxillofacial surgeons on this flap technique. ANATOMY: The submental artery is a major branch of the facial artery. This artery runs medial to the mandible and ends next to the mandibular symphysis. The submental artery supplies the submandibular lymph nodes, submandibular salivary gland, mylohyoid and digastric muscles, and the skin of the chin. The submental vein drains the tissues of the chin as well as the submandibular region. TECHNIQUE: The integrity of the facial artery is a sine qua none condition before performing this flap. It is important that the submandibular gland and the submental vessels be well exposed. The anterior belly of the homolateral digastric muscle must be included in the flap. The donor side is closed after a large subcutaneous dissection of the neck and chin. INDICATIONS: The pedicled submental flap is indicated in defects of the oral cavity and the lower two-thirds of the face. ADVANTAGES: The submental flap is relatively easy to raise. This flap avoids dyschromia and provides soft-tissues presenting with the same quality as that of the tissue surrounding the defect. Sequels on the donor side are minor. DISADVANTAGES: The submental flap is not indicated if a submental neck dissection is needed or in case of intraoral/frontal reconstruction with bearded skin. The submental flap is a simple and reliable procedure, with good aesthetics results and minor sequels.