Ranula as the First Symptom of HIV Infection in Young Patients.

INTRODUCTION: Oral manifestations are often the earliest HIV signs. Salivary gland diseases are a common form of HIV expression. A ranula can occur in association with HIV. However, this manifestation is rarely considered as the disease sentinel sign. We present two cases of children consulting for a ranula, leading to the diagnosis of a previously unknown HIV infection. Case Reports. Two children, respectively, 5 and 13, were treated for a ranula by marsupialization. Relapse occurred in both cases, and thereafter, a ranula excision was performed. While the follow-up was uneventful, HIV infection was diagnosed during the patients' care. The only sign or symptom observed was the ranula. A routine HIV testing of ranula patients would have allowed earlier care. CONCLUSION: Routine HIV testing of patients with a ranula is justified and may be recommended, especially for children. Ranula excision associated with the sublingual gland resection is suggested in order to avoid recurrence.

Risk factors assessment in fibular free flap mandibular reconstruction.

INTRODUCTION: The fibular free flap (FFF) is the best choice method for mandibular reconstruction. However, the failure and the complications risk factors (RF) are not yet fully identified. This study aims to analyze these RF in order to improve the success rate. MATERIAL: This retrospective study includes all patients who benefited from a FFF mandibular reconstruction between the first of January, 2014 and the thirty-first of December, 2018 in the Department of Stomatology and Maxillofacial Surgery department of the CHU Saint-Pierre Hospital, Brussels, Belgium. RESULTS: Thirty patients benefited from this intervention. The overall success rate was 90%. Majority of the patients were men (67%) (mean age: 52 years). The main associated co-morbidities were: alcohol (50%), tobacco consumption (67%) and previous radiotherapy (20%). The mean operative time was 9,5hours. The morbidities rates at the receiving site (RS) and the donor site (DS) were respectively 43% and 30%. Infection and dehiscence of the RS were the main complications. Statistical analysis identified RF for RS infections: atherosclerosis and operative time; RS dehiscence (previous cervical dissection and secondary reconstruction); flap necrosis (ischemia time, rate of infection at the recipient site, history of radiation therapy, alcohol consumption, National Nosocomial Infection Surveillance score (NNISS), and history of cervical dissection); and DS morbidities (NNISS and dehiscence rate at the DS in the early period). CONCLUSION: The FFF mandibular reconstruction offers a significant success rate. Nevertheless, this study highlighted several failure and complications RF of the procedure. Previous neck dissection and radiotherapy, operative and the ischemia time, were RF associated with complication at the RS. Furthermore, the NNIS score and the dehiscence rate were also reported as RF for FFF necrosis.

Head and neck reconstruction: The supraclavicular flap: technical note.

INTRODUCTION: Defects reconstruction after oncologic resection is challenging and complex in head and neck tumors. The aim of this retrospective study is to evaluate the use of the supraclavicular artery island flap (SCAIF) in head and neck reconstruction, in particular, when traditional free flaps is not recommended. METHODS: We reviewed our two years' experience of the use of SCAIF on a total of 15 cases. In 10 cases, it was used as an alternative to free flaps after head and neck tumors resection. In 5 cases, SCAIF was used for revision surgery after a free flap failure. The indications for flap use have been defects due to resection of stage II-IV cancer in the head and neck region. The operative site, time, complications and functional outcomes were assessed. RESULTS: We identified 15 patients with a total of 16 SCAIF. One patient had received bilateral SCAIF. Out of the patients, 10 were men and 5 were women. Head and neck oncologic patients underwent tumor resection followed by immediate reconstruction using SCAIF. Among those 15 patients, 10 received previous radiotherapy in the head and neck region. All the patients had undergone multiple surgical procedures. Mean flap dimensions were 6.0cm (range, 5-7cm) wide and 22.0cm (range, 14-26cm) long. The proximal part of the flap was de-epithelialized to match the defect, resulting in a mean skin paddle length of 8.0cm (range, 5-12cm). After an average follow-up duration of 13 months (range 3-20 months), the flap survival rate was 90%. Two patients had had a partial loss of the flap. All the flaps were harvested in less than one hour. The donor sites were closed primarily and did not require any additional surgery. No donor site wound dehiscence had been reported. No infection or cellulitis were observed. None of the patients reported any functional donor site morbidity. CONCLUSIONS: The supraclavicular flap provides a safe option for head and neck reconstruction of oncologic defects when traditional free flap is not recommended. It is also an excellent alternative to radial forearm free flap (RFFF) in head and neck soft tissue reconstruction, especially in vessel-depleted neck.

Malnutrition in head and neck cancer patients: Impacts and indications of a prophylactic percutaneous endoscopic gastrostomy.

INTRODUCTION: Head and neck cancer (HNC) patients often experience malnutrition before and during treatment. Prophylactic gastrostomy has emerged as an efficient tool for ensuring adequate nutrition. However, there is no suitable algorithm able to identify patients at high risk of malnutrition. The aim of this study was to describe the nutritional management, to assess the impact of prophylactic gastrostomy, and to identify predictors of malnutrition. METHODS: This retrospective study included 152 patients treated with surgery, radiotherapy, or chemotherapy for HNC. The patients were classified according to their gastrostomy status (prophylactic or non-prophylactic). Nutritional, tumoral and treatment characteristics were reported. Clinical and nutritional outcomes were measured 6 weeks after the beginning of treatment. In order to describe the nutritional management and the impact of prophylactic gastrostomy on patients, univariate analysis was generated using chi-square test and Mann-Whitney test or Student's t-test. Logistic regression was performed to identify factors associated with malnutrition. RESULTS: Forty-one patients received prophylactic gastrostomy whereas 111 patients had no nutritional support. Prophylactic gastrostomy placement was associated with a lower initial body mass index, with severe malnutrition, and with initial oral intake disorder. Patients who did not experienced prophylactic gastrostomy had much worse outcomes such as hospital readmissions (P=0.042), relative weight loss at 6 weeks (P<0.0001), dysphagia, severe malnutrition, and poor state of health (P=0.001). Our complication rates (4.9%) were lower than the usual range (5.9-9.3%) and no life-threatening complication was reported. Positive N status, oral intake disorder, concomitant radiochemotherapy, nasopharyngeal, and hypopharyngeal tumor site were significant predictive factors for malnutrition. CONCLUSIONS: Prophylactic percutaneous endoscopic gastrostomy showed advantages in terms of hospital readmissions, relative weight loss at 6 weeks, dysphagia, severe malnutrition, and poor state of health. Tumoral, nutritional and treatment characteristics seem to be predictors for malnutrition. Hence, physicians should integrate these factors in their nutrition algorithm approach.

Mandibular incisive canal and lingual foramina characterization by cone-beam computed tomography.

INTRODUCTION: Many patients have haemorrhagic and neurologic complications after surgery at the symphysis region, while this area between the mental foramina is commonly considered to be risk-free because the presence of vasculo-nervous anastomoses found in the mandibular incisive canal (MIC) and lingual foramina (LF). The purpose of our study was to better analyse these anatomical structures to better identify and preserve them during surgery. PATIENTS AND METHODS: This prospective radio-anatomical study evaluated the presence, morphology and topography of MIC and median LF (MLF) and paramedian LF (PLF) by cone-beam computed tomography according to age, gender and dentition of 50 consecutive patients. RESULTS: Among the MIC, 99% were visualized at their origin. Their visibility decreased gradually towards the symphysis. The MIC had a larger diameter and followed a significantly more superficial and more vestibular way in older patients. At least, one MLF by hemimandible was found whereas PLF were found only in 68% of the cases. The mean distance from the basal border was 7.11mm for the lower MLF, 16.33mm for the upper MLF and varied from 11.15 to 10.85mm for the left and right PLF. CONCLUSION: Our study suggests that MIC and LF are constant structures with anatomical variations and that three-dimensional topographic study of the interforaminal region would be beneficial in patients requiring surgery in this area to reduce the risk of haemorrhage and neurologic complications.

[Ulcerations and erosions of the oral mucosa]. / Ulcérations et érosions de la muqueuse buccale.

Ulcerations and erosions of the oral mucosa are common and occur at any age. Their knowledge and recognition are essential to ensure optimal care at the earliest stage. Etiologies are numerous and the subject of different classifications. In this work, the authors address the most frequently encountered lesions, describing their main clinical presentations. A review of treatments is then proposed.

Les ulcérations et érosions de la muqueuse buccale sont fréquentes et surviennent à tout âge. Leurs connaissance et reconnaissance sont essentielles afin d'assurer une prise en charge optimale et la plus précoce possible. Les étiologies sont très nombreuses et font l'objet de différentes classifications. Dans ce travail, les auteurs abordent les lésions les plus fréquemment rencontrées, en décrivant leurs principales présentations cliniques. Une revue des traitements est ensuite proposée.

[Evolution of the indications of orthognathic surgery]. / L'évolution des indications de la chirurgie orthognatique.

Orthognathic surgery evolved over the last 30 years, which has reduced the morbidity of interventions and widened its field of indication. The management of dysmorphosis, obstructive sleep apnea syndrome, fracture sequelae and facial esthetics can be managed successfully thanks to these interventions, the scarring of which is almost absent.

La chirurgie orthognatique a connu une évolution au cours des 30 dernières années qui a eu pour conséquence de diminuer la morbidité des interventions et d'élargir son champ d'indication. La prise en charge des dysmorphoses, du syndrome d'apnées obstructives du sommeil, des séquelles de fractures et de l'esthétique de la face peut être gérée avec succès grâce à ces interventions dont la sanction cicatricielle est quasiment absente.

[Chronic maxillary rhinosinusitis of dental origin: report of 2 cases]. / Rhinosinusites chroniques maxillaires d'origine dentaire : à propos de 2 cas.

Chronic maxillary rhinosinusitis of dental origin represents approximately 5 % of chronic maxillary rhinosinusitis. The diagnosis of this pathology is often delayed and mainly based on endoscopy and medical imaging. Its treatment is complex and requires the involvement of several teams. This article discusses two cases of chronic maxillary rhinosinusitis secondary to dental treatment. A literature review on the epidemiology, diagnosis, treatment and complications are also introduced.

[Hard palate B cell lymphoma with spontaneous regression]. / Régression spontanée d'un lymphome B à grandes cellules du palais.

INTRODUCTION: Non-Hodgkin lymphomas are common cancers that can develop in the upper aero-digestive tract. We describe a case of a large B-cell palatine lymphoma with spontaneous clinical regression. CASE: A 58-year-old female patient presented with a sub-mucosal lesion of the hard palate. CT scan and magnetic resonance imaging revealed a lesion invading the right posterior palatine canal. At the second consultation, 15 days after performing the biopsy, the lesion had disappeared. PET scan proved the absence of lesion. Lymph node biopsy supported the diagnosis of large B-cell lymphoma. DISCUSSION: Large B-cell lymphoma of the hard palate is a rare disease. Only 27 cases have been described in the international literature. The anatomopathological analysis is often difficult to perform. The final diagnosis is often made by immunochemistry. The usual treatment is R-CHOP chemotherapy (cyclophosphamide, adriamycin, vincristine, prednisone combined to rituximab) with a 5-year survival rate at 55%.

[Oral candidiasis and dentures]. / Candidoses orales et prothèses dentaires.

Yeasts belonging to the Candida genus usually colonize the human oral cavity. Immunocompromised patients or individuals with an imbalance of their oral microflora can develop yeast infections from this reservoir. However, saliva protects oral mucosa against candidosis; in turn, dry mouth is associated with increased yeast counts and candidosis risk. In vivo and in vitro studies have shown Candida incorporation into biofilms covering different biomaterials such as dentures: these biofilms may be an increased risk factor for invasive candidosis when the host immune system is compromised. Daily denture brushing is recommended to all wearers. Family or healthcare workers must take over this task when there is autonomy loss, especially in the elderly. In case of candidosis in denture wearers, decontamination of dentures is mandatory. Antimycotics (azoles, nystatin) must be kept for curative treatments of infected patients; they are less active against Candida biofilms on dentures and could lead to emergent resistance if applied daily to dentures against yeast colonization. There are several antiphlogistic solutions with antifungal properties. Nevertheless, literature data does not integrate all aspects of denture care: welfare of denture wearers, prevention of candidosis, biomaterial defects after decontamination processing, and taking into account possible Candida biofilm development. Daily brushing of dentures remains the key recommendation.

[Bisphosphonates and osteonecrosis of the jaw]. / Bisphosphonates et ostéonécrose maxillomandibulaire.

Today, bisphosphonates are very frequently used to relieve patients suffering from various bone diseases, mainly bone metastases and osteoporosis. They have been associated with numerous cases of maxillar and mandibullar osteonecrosis, a severe affection characterized by a high morbidity and for which no consensual treatment has been found yet. After a short update, the authors reviewed indications for bisphosphonates and its pharmacological properties. The pathogenesis, predisposing factors, symptoms, and clinical evaluation of this particular necrosis are described. Preventive and therapeutic managements are suggested.

[Precancerous and cancerous lesions of the oral cavity]. / Les lésions précancéreuses et cancéreuses de la cavité buccale.

Precancerous states of the oral mucosa refers to pathologies in which there is a risk of malignancy development, compared to normal mucosa. Some histological alterations characteristic of precancerous lesions can be easily detected in a biopsy of the lesion, allowing their classification, and hence adequate treatment. A systematic examination of the oral mucosa in patients is recommended, especially in patients who show risk factors such as tabagism and/or alcohol consumption, in order to contribute to a decrease in the incidence of malignant tumor of the oral cavity.

[Orthodontics, orthognatic surgery and their functional environment]. / Orthodontie, chirurgie orthognatique et environnement fonctionnel.

Dento-dental and dento-maxillary dysharmonies and maxillo-mandibular dysmorphologies are impairments that can be treated either by orthodontics and surgery, or with a combination of orthodontics and orthognatic surgery. Respiration, deglutition, phonation and succion play a predominant role in the occurrence of maxillofacial dysmorphologies. Contributing factors to such impairments include upper airway function disorders such as respiration, deglutition, phonation, sucking. Abnormal functions must be extensively studied in management of maxillofacial patients in order to achieve stable results and to avoid relapses.

[Management of patient with sleep apnea syndrome]. / Prise en charge du syndrome des apnées du sommeil.

Obstruction sleep apnea (OSA) syndrome is a frequent problem observed in 2% of females and 4% of male patients. It is considered as a public health problem regarding its high neuropsychological and cardiovascular morbidity. Precipitating factors include male gender, high blood pressure, obesity and maxillofacial morphological abnormalities. Even if Continuous Positive Airway Pressure (CPAP) is the treatment of choice in OSA, stomatological orthesis and bimaxillary advancement surgery give excellent results and keep place within our therapeutic arsenal. Multidisciplinary management of SAOS patients enables us to deliver adequate and adapted therapy to each patient.