[Delayed endoscopic reconstruction of the anterior wall of the frontal sinus: Technical note]. / Reconstruction différée de la paroi antérieure du sinus frontal par voie endoscopique: note technique.

INTRODUCTION: Reconstruction of the anterior wall of the frontal sinus usually requires a coronal incision. This extended approach may lead to paresthesia, unsightly scars, bruises and cicatricial alopecia. These complications encouraged several authors to endoscopic management of this kind of fractures. We present a delayed technique of reconstruction of the anterior wall of the frontal sinus by means of endoscopic hydroxyapatite filling. TECHNICAL NOTE: Two incisions were performed behind the hair line. Subperiosteal dissection using a periosteal elevator was performed. A 30° angled endoscope was used to visualize the depression. The latter was filled by Hydroset® (Stryker, USA) as a bone substitute. DISCUSSION: In the absence of contra-indication, the reconstruction of the anterior wall of the frontal sinus by means of endoscopic hydroxyapatite filling has many advantages including uneventful outcome, reduction of the hospital stay and a fast learning curve.

Intra-mandibular adenoid cystic carcinoma.

Intra-mandibular localization of adenoid cystic carcinoma is rare. This tumor is characterized by progressive local, regional, and distant aggressiveness. We reviewed the latest data on this rare type of cancer with a small number of reported cases, alack of consensus for its treatment, and its bad prognosis.

[Functional results after temporomandibular joint reconstruction using a total joint prosthesis (part II)]. / Résultats fonctionnels après reconstruction de l'articulation temporo-mandibulaire par prothèse totale (2e partie).

INTRODUCTION: Temporomandibular joint (TMJ) disorders are usually managed medically. But partial or total reconstruction may be indicated according to the severity and the functional impairment. We assessed the functional results after total TMJ reconstruction using the Biomet Microfixation® prosthesis (Jacksonville, FL, USA). MATERIAL AND METHODS: We reviewed the files of patients having undergone reconstruction, between 2009 and 2010, with a total TMJ prosthesis. We analyzed the pre- and postoperative mouth opening, the pre- and postoperative occlusion, pre- and postoperative pain according to a simple spoken scale ranging from 0 (no pain) to 4 (severe pain). RESULTS: Twelve total TMJ prostheses were placed in five women and three men (mean age 49.2 years). Restriction of mouth opening was the first cause of consultation. The etiology was trauma for four patients. Three patients had preoperative malocclusion. Four patients had bilateral reconstruction. Preoperative pain ranged between 2 and 4. The average initial mouth opening was 17.8mm. There was neither infection nor any major complication. No prosthesis was removed. The mean follow-up was 18.5 months. At the end of the study, pain ranged between 0 and 2. All patients with preoperative malocclusion resumed an Angle class I postoperatively. The average postoperative mouth opening was 39.5mm. DISCUSSION: Total TMJ reconstruction with the Biomet Microfixation® prosthesis improves mouth opening and reduces pain.

[Maxillofacial reconstruction with radial forearm osteofasciocutaneous free flap]. / Le lambeau ostéo-fascio-cutané antébrachial radial dans la reconstruction maxillo-faciale.

INTRODUCTION: Maxillofacial defects often affect various type of tissues and require reconstruction using composite flaps. The radial forearm osteofasciocutaneous free flap is one of the least used. We present the preliminary results of maxillofacial reconstruction using this free flap. MATERIALS AND METHODS: We reviewed the records of patients having undergone a radial forearm osteofasciocutaneous flap procedure between 2009 and 2011. Mandibular defect were staged according to HCL classification. Maxillary defects were staged according to Cordeiro and Santamaria's classification. Functional results (swallowing and speech) were assessed at the sixth month. RESULTS: The mean age of the 10 patients was 60.2 years. The average length of bone defect was 8 cm. The average cutaneous defect area was 36.8 cm(2). The mandibular defect was LCL in six cases, L in one case, and C in one case. The two cases of maxillary bone loss were classified IIIa. Six of the 10 microsurgical anastomoses were contralateral to the lesion. There was no reconstruction failure. Three patients had mild speech disorders, five had moderate speech disorders, and two major speech disorders. Four patients had a normal food intake, three patients needed mixed food, and three patients liquid food. DISCUSSION: The indications of radial forearm osteofasciocutaneous free flap for complex maxillofacial reconstructions should be extended. Its vascularization is less compromised by arteritis. Its pedicle may be long and adequate for a contralateral anastomosis. It is reliable and easy to harvest. But the bone quality is not as good as fibula.

[Computer-assisted temporomandibular joint reconstruction]. / Reconstruction de l'articulation temporomandibulaire assistée par ordinateur.

Prosthetic replacement of TMJ is gradually becoming a common procedure because of good functional and aesthetic results and low morbidity. Prosthetic models available can be standard or custom-made. Custom-made prosthesis are usually reserved for complex cases, but we think that computer assistance for custom-made prosthesis should be indicated for each case because it gives a greater implant stability and fewer complications. Computer assistance will further enlarge TMJ prosthesis replacement indications.

[Multiple ossifying trichilemmal cysts of the scalp: a familial case]. / Kystes trichilemmaux ossifiants multiples du cuir chevelu : un cas familial.

INTRODUCTION: The trichilemmal cyst, also called pilar cyst, is a dermal epithelial cyst originating from the pilar follicle. It usually occurs in the scalp. Hereditary and ossifying cases are rare. CASE REPORT: We report the case of a 61-year-old woman presenting with familial multiple trichilemmal cysts, located in the scalp. The histological examination after surgical exeresis confirmed the diagnosis. The trichilemmal cysts featured intra-cystic ossification. The wide dimension of the lesions dimension imposed an extensive surgical scalp exeresis. Reconstruction was performed with a flap after skin expansion. DISCUSSION: The trichilemmal cyst is a benign tumor of skin appendages with a slow outcome. Multiple locations may require an extensive surgical scalp exeresis and lead to a problematic reconstruction. Hereditary cases require familial follow-up to prevent such problems.