[Post-mastectomy necrotizing fasciitis and immediate prosthetic breast reconstruction: First case report]. / Fasciite nécrosante postmastectomie et reconstruction mammaire immédiate par prothèse : premier cas rapporté.

Necrotizing fasciitis is a rapidly progressive soft tissue infection extending from the skin to the fascia, resulting in extensive necrosis. It is a very rare but serious complication, with mortality ranging from 10 to 15%. Optimal management involves early diagnosis followed by treatment combining antibiotic therapy and wide surgical removal as soon as possible. Localisation in the breast is uncommon. Although most cases are primary necrotizing fasciitis of the breast, several cases of necrotizing fasciitis have been reported in the post-operative aftermath of breast surgery. We present a case of necrotizing fasciitis of the breast following submammary mastectomy with immediate reconstruction using a pre-pectoral silicone implant, which resulted in multiple organ failure and the death of the patient despite optimal medical and surgical management. This is the first case to occur after immediate breast reconstruction.

[Landscape and evolution of the transgender demand in the maxillo-facial surgery: the CHU of Liège as reference center]. / Évolution de la demande transgenre en chirurgie maxillo-faciale : le CHU de Liège comme centre de référence.

The history of transgenderism is reaching a new turning point. From the medical beginnings of the 1940's to the real innovations of the last decade, surgery can, more than ever, contribute to the gender reassignment process. This article will firstly describe the evolution of the transgender demand, and will then review the specificities of male and female facial anatomy. We will conclude by defining the maxillofacial surgical field and the new role of the reference center at the University Hospital of Liège in this promise of treatment, that is both intimate and innovative.

L'histoire du transgendérisme prend un nouveau tournant. Des balbutiements médicaux des années 1940 aux véritables innovations du dernier lustre, la chirurgie peut, plus que jamais, prendre place dans le processus de réassignation de genre. Cet article visera tout d'abord à retracer le cheminement de la demande transgenre, et rappellera ensuite les spécificités de l'anatomie faciale des genres féminin et masculin. Nous terminerons par définir l'horizon interventionnel maxillo-facial et la place nouvelle du centre de référence du CHU de Liège dans cette promesse de prise en charge, aussi intime qu'innovante.

[Mastectomy, the initial surgical procedure in transgender patients]. / Mastectomie, procédure chirurgicale initiale chez les patients transgenres.

In our society, the number of gender affirming surgeries is increasing. Mastectomy is usually the initial surgical procedure performed for the treatment of gender dysphoria in transgender men. It has been shown to improve quality of life and to promote assimilation into the new genre. Creating an aesthetic male chest requires adjustment of the breast tissue volume, proper placement of nipple areola complex, and removal of the inframammary fold. Although many papers have been published on this topic, there is still no consensus as to which surgical technique should be preferred. This article deals with the procedures performed in our plastic surgery department at CHU in Liège and reviews the literature relating to the various surgical techniques, postoperative complications as well as patient satisfaction.

Dans notre société, le nombre de chirurgies d'affirmation de genre est en augmentation. La mastectomie est généralement la procédure chirurgicale initiale réalisée dans le traitement de la dysphorie de genre chez l'homme transgenre. Il a été démontré qu'elle améliore la qualité de vie et favorise l'assimilation au nouveau genre. La création d'une poitrine masculine esthétique nécessite un ajustement du volume du tissu mammaire, un placement approprié de la plaque aréolo-mamelonnaire et la suppression du pli infra-mammaire. Bien que de nombreux articles aient été publiés sur le sujet, il n'y a pas encore de réel consensus quant à la technique chirurgicale à privilégier. Cet article fait le bilan des interventions réalisées au sein du Service de Chirurgie plastique au CHU de Liège et revoit la littérature relative aux différentes techniques chirurgicales utilisées, aux complications postopératoires ainsi qu'à la satisfaction des patients.

[Infective stomatitis of the palate]. / Localización palatina de las estomatitis infecciosas.

Having on base a wide and selective review of the literature, it has seemed to us interesting to detail the infective pathology on this location or sometimes occurring. This region is, as well will see, the seat of a rich pathology. We pretend on the other hand to reassess the importance of the meticulous examination of the oral cavity in "systemic problems". We describe the palatal infections divided in four groups: bacterial, viral, fungal and parasitory, according to the causal agent. We review the palatine manifestations of other fewer current syndromes as well.

[Maxillo-facial aspects of dento-alveolar trauma]. / Aspects maxillo-faciaux de la traumatologie dento-alvéolaire.

The management of oral injuries requires expertise in dental and medical cares. The need for a multidisciplinary assessment, including medical, has to be ascertained early. Diagnostic and management procedures are described as well as concomitant lesions such as maxillofacial bony fractures.

[A case of very late malignant degeneration of pleomorphic adenoma]. / Un cas de dégénérescence maligne très tardive d'un adénome pléomorphe.

Incomplete excision of a pleomorphic adenoma exposes to a high risk of recurrence and tumor spread, making secondary surgery more difficult or a malignant transformation with a poor vital prognosis likely. Three histological types of pleomorphic adenomas can be observed when the tumor undergoes a transformation, namely the carcinoma ex-pleomorphic adenoma, the true malignant mixed tumor and the benign metastasizing mixed tumour.

[Combination of successive free transplants and osseointegrated implants in the reconstruction of the upper jaw]. / Association de transplants libres successifs et d'implants ostéo-intégrés dans la reconstruction d'un maxillaire supérieur.

Various free flap transfers can be associated to reconstruct a defect after resections in the head and neck region. The use of these flaps can be synchronous (one-stage surgery) or metachronous (two-stage surgery) in order to correct or improve secondary residual deformities. A two-stage use of free flaps, first with an osteocutaneous scapular flap and second with a fascial radial forearm flap, is reported after total maxillectomy. The osteocutaneous scapular flap was used to restore function (swallowing, chewing, speech and cheek projection) and the radial forearm flap to improve esthetic facial morphology. Minor ancillary procedures were subsequently necessary to achieve the final result (brow lift, tarsal straightening and facial lift).

Presurgical orthodontic decompensation of mandibular incisors.

The effects of presurgical orthodontic decompensation on lower incisor inclination and angle ANB were studied using a modified Pancherz method of cephalometric analysis. Two groups of patients with mandibular hyperplasia were studied: one group (Group 1) of nineteen cases which required orthodontic decompensation and another (Group 2) of twenty-one cases which did not. The cephalometric changes which occurred in Group 1 were compared with the significant cephalometric differences existing between the two groups with respect to incisor inclination (ILi/OL; P < .001) and the sagittal relation (ANB; P < 0.05). After orthodontic treatment the average lower incisal angulation of the treated group was the same as that in the untreated group; the variations (S.D) being 3.6 degrees and 7.4 degrees respectively indicating that the clinical assessment of the orthodontic treatment effect was quite high.

Experience with e-PTFE membrane application to bone grafting of cleft maxilla.

Previous clinical studies and animal experiments have demonstrated that the placement of expanded polytetrafluoroethylene (e-PTFE) membranes (GORE-TEX) may be valuable for bone regeneration in nonosteogenic areas. This study aimed to explore the application of this technique to bone grafting of wide alveolopalatal clefts. Ten patients with bilateral clefts were selected and during a 2-week period, all received autogenic cancellous iliac bone bilaterally. The membrane was placed nasally and orally on the larger cleft side and removed after 3-6 months. All patients have been followed for 14 months. Bone graft incorporation was successful except for one patient (membrane side), who was regrafted 1 year later. However, soft-tissue problems with membrane exposure occurred in the majority of patients, while on the nonmembrane side, healing was uneventful in all cases. Further research in membrane technology is necessary before this method can be accepted for cleft grafting.

The angioarchitecture of the rat mandibular joint synovium.

The synovium (or synovial membrane) lines all intra-articular surfaces of synovial joints except for the articulating surfaces. This study describes the angioarchitecture of the synovium of the adult rat temporomandibular joint using microvascular corrosion casts and scanning electron microscopy. To corroborate findings, India ink-injected, thick-sectioned specimens (200 microns) and haematoxylin and eosin-stained tissue sections (7 microns) were analysed. Rostrally, the synovial membrane was fed by several layers of vessels branching towards the superficial lining of highly convoluted capillary loops. Arterioles were rare, and venules organized in large plexuses. The membrane thinned out in the caudal direction. Villi were present on the surface. They were flat, with a core of two parallel linear feeder vessels, one arteriole and one venule, which were interconnected by capillary loops. At the periphery of the articulating surfaces, the vessels of the synovial layer were flatter. Caudally, the synovial membrane of the richly vascularized retrodiscal pad showed many synovial folds. Feeder vessels were directed rostrally and branched in all directions. The number of subdivisions depended on the size of the synovial fold. Again, venules were organized in plexuses and lining capillaries were convoluted. The densely capillarized synovial membrane with its folds and villi is considered well adapted to serve synovial fluid production and joint dynamics.

The angioarchitecture of the rat mandibular joint bilaminar zone.

In mammals, temporomandibular-joint articular disc attachments have a bilaminar pattern. The three-dimensional angioarchitecture of the bilaminar zone in the adult rat was described using scanning election microscopy of microvascular corrosion casts (47 specimens) and light microscopy of Indian ink-injected, cleared, thick-sectioned temporomandibular joints (6 specimens). The bilaminar zone had an axial core of feeder vessels composed primarily of flat venules which were organized in plexuses. Arterioles were few and slender. In both laminae, there were usually three branching levels until vessels approached the surface of the lamina, where a dense capillary meshwork was formed. Both laminae ended abruptly at the periphery of the avascular disc with a single, slightly undulating marginal vessel. This marginal vessel, which faced the avascular disc, was definitely larger in diameter than the other superficial capillaries and was rather a postcapillary venule than a capillary. Functionally, this marginal venule might be important in sustaining nutrition of the avascular disc centre by allowing bidirectional blood flow during jaw movements.

The fine vasculature of the rat mandibular joint.

There is no detailed description of the fine vasculature of the rat mandibular joint in the literature. The gross vasculature of the cephalic area and of the mandible is known, but without particular emphasis on the joint itself. This article describes the fine vasculature of the rat mandibular joint, using transverse (coronal) and sagittal thick sections of specimens injected with India ink and analyzed with light microscopy. The main vascular supply to the joint comes from the rostral and caudal aspects. Medially, the joint is directly vascularized by vessels from the lateral pterygoid muscle. Rostrally, the synovial membrane and the bilaminar zone of the disc are supplied by articular branches from the rostral deep temporal vessels, terminal branches of the maxillary artery. Caudally, the rich synovium of the retrodiscal pad and the bilaminar zone are supplied by the articular branches of the caudal deep temporal artery, a branch of the maxillary artery. Venous return is into the short, but large retroarticular vein which empties into the maxillary vein together with the vein from the transverse sinus exiting from the postglenoid foramen. Intra-articular synovial membranes own rich venous plexuses, and are lined by a dense capillary network. The central part of the fibrous articular disc is avascular in adult rats, and is circumferentially lined by a rim of capillaries from the bilaminar zone.

Chondrosarcoma of the mandible presenting as periodontal lesions: report of 2 cases.

A review of the literature and the addition of 2 cases in the mandibular symphyseal region serve to illustrate the protean presentation of chondrosarcomas. These 2 cases presented as periodontal lesions with associated bone loss. A high index of suspicion is required to make an early diagnosis. The importance of submitting biopsy specimens for histology is stressed, and it is recommended that definitive treatment be carried out as rapidly as possible after diagnosis is known. The surgical procedures undertaken were conservative, and patients have remained disease-free after 3.5 years and 3 years respectively. For small lesions, early segmental resection is not necessary in this region. Only recurrence should be treated by symphyseal resection with its increased morbidity. Close follow-up is mandatory.

Microvascular corrosion casting of the rat mandibular joint: a technical approach.

The rat mandibular joint is a ginglymoarthrodial joint deeply hidden under the zygomatic process of the squamosal bone. This joint was studied by scanning electron microscopy (SEM) of microvascular corrosion casts in 47 adult rats. Six additional rats were injected with India ink and thick sections of the joint area were examined by light microscopy. The small size of the joint (2.5 mm x 1.5 mm in occlusion), the existence of two slit-like joint compartments, the close proximity of bones and soft tissues in a mobile structure, and the intimate relationships of the joint with adjacent skeletal muscles made the vascular mapping difficult. Five different technical procedures (protocols) were tested. The most satisfactory approach is, briefly, as follows: each rat was injected simultaneously via both common carotid arteries with 9.5 ml of casting medium (Mercox-CL-2B diluted 4:1 with monomeric methyl methacrylate), and with an additional volume of 0.5 ml of the same medium after ligation of the external jugular veins used for outflow. After polymerization of the injected resin, the rats were frozen, and the heads were severed and spliced sagittally into two halves. These specimens were cut in the transversal (coronal) and sagittal planes into small blocks. Each block was then cut systematically either in the transversal or parasagittal plane running through the joint. Afterwards thick slices were macerated in warm (45 degrees C) 15% KOH, rinsed, (some were decalcified in 2% HCl), rinsed again in tap water, frozen in distilled water, freeze-dried, mounted, dissected, coated and examined under the SEM at 5 kV.

Anatomy of the human temporomandibular joint. An updated comprehensive review.

This article is an in-depth review of the current knowledge on human temporomandibular joints (TMJ's). All aspects of joint anatomy are described with emphasis on adaptability to biochemical stimuli throughout life. Each TMJ is a pressure-bearing compound double synovial joint. TMJ's are unique in having a movement not only controlled by the morphology of the joint per se but also by the dentition at the other end of the lever system. During life the temporal, condylar and discal articular surfaces undergo remodelling. The synovium is an important joint component which contributes to nourish and lubricate the avascular surfaces and has bactericidal properties. The joint capsule has privileged relationships anteriorly with the lateral pterygoid muscle. This muscle has two heads that show functionally reciprocal activation. The exact insertion and role of the superior head of the lateral pterygoid muscle remains controversial. The disc has a very low coefficient of friction and compensates for the lack of congruence between articular surfaces. Biomechanically it is stabilized between condyle and articular eminence by its thick rim which has special viscoelastic properties. Apart from the viscoelastic deformations the other important mechanism of disc stabilization seems to be related with the structure of some of the disc attachments.

Osteochondroma of the coronoid process of the mandible. Report of a case and review of the literature.

A review of the literature and the addition of one case have revealed that, on the basis of strict histologic criteria, there are presently 30 published cases of osteochondroma of the coronoid process of the mandible. Twenty-one cases (70%) were men. Most osteochondromas developed before the age of 40 years. The lesions were mushroomlike in more than two thirds of the cases. Deformity of surrounding structures and facial deformity was found in most cases. The surgical approach was intraoral in the majority of cases. None of the reported cases showed a recurrence.

Feasibility of osteotomies in fibrous dysplasia of the jaws.

Two examples are presented of osteotomies performed simultaneously with surgical recontouring in cases of fibrous dysplasia of the jaws. Osteotomies are necessary when a coexistent discrepancy in jaw relationship is present. This provides a functional as well as aesthetic result. Rigid miniplate fixation was utilised, and dysplastic bone healing was uneventful, and found clinically not to differ from that of normal bone. Osteotomy is thus feasible in dysplastic bone, and may complement recontouring in achieving a better result.

Pneumoparotid during dental treatment.

A rare case of pneumoparotid originating during dental treatment is reported. The condition should be considered in the differential diagnosis of acute parotid swellings. It is transient and does not usually require any treatment.

Melanotic neuroectodermal tumour of infancy: a case report emphasizing the importance of computed tomography.

A case is reported of the rare melanotic neuroectodermal tumour of infancy involving the maxilla of a 4-month-old girl. The role of CT is discussed with particular reference to the diagnosis.