Duplication of the internal carotid artery and segmental aplasia of the vertebral arteries.

The internal carotid artery mainly supplies the brain. As the internal carotid artery contributes to the formation of the cerebral arterial circle, its variations are relevant in imaging, interventional radiology, and surgery. Knowledge of these variations is important for vascular anastomosis in free flap reconstruction and in arterial ligatures for haemostasis. During a cadaveric cervical dissection, a duplicated left internal carotid artery was incidentally observed in the carotid triangle of the neck. The internal carotid branches were dissected up to their distribution to the brain. The two branches of the left internal carotid artery penetrated into the base of the skull by the carotid canal and the foramen magnum, respectively. With the right internal carotid artery, they formed the cerebral arterial circle. The basilar artery was formed by the branch of the left internal carotid artery entering the skull by the foramen magnum. The right internal carotid artery and the two branches of the left internal carotid gave rise to all of the arteries of the cerebral arterial circle. The vertebral arteries did not contribute to its formation. This duplication of the internal carotid arteries is rare, as the literature does not describe any case of vertebral artery aplasia replaced by an internal carotid artery.

Transverse facial artery: Its role in blindness after cosmetic filler and botulinum toxin injections.

Masseter injections for cosmetic or pathological reasons are increasingly common, as are filler injections using dual or multiplane techniques in the lateral facial regions or for jawline contouring. The occurrence of blindness following these procedures often remains unexplained. This study aimed to determine the anatomical explanation for this debilitating complication by investigating the transverse facial artery and its relation to the masseter. For this purpose, we dissected 35 cheek specimens with latex injections and 10 specimens without latex. The external carotid artery was dissected up to its bifurcation into the maxillary and superficial temporal arteries. Results showed that the transverse facial artery arose from the superficial temporal or external carotid artery that runs between the zygomatic arch and the parotid duct. Three types of transverse facial arteries were observed: type I: a short artery that did not extend beyond the masseter muscle; type II: a transverse artery that ran to the nasolabial fold and anastomosed to the facial artery; and type III: a sizable transverse artery that substituted the hypoplastic facial artery, continued as the angular artery, and then anastomosed to the dorsal nasal artery. Knowledge of these three types of transverse facial arteries is a prerequisite to study the vascular territory. Type III provides an explanation for the occurrence of blindness after lateral face injections. We consequently define a line that runs from the tragus to the outer quarter of the upper lip as the risk area, while the safe zone is located on either side of this line.

Vascularization of the maxilla by a branch of the submandibular artery.

Vascular variations are common. A cervicofacial anatomical dissection carried out at the anatomy laboratory allowed us to document a rare vascular variation. The facial artery did not give rise to branches that led to the submandibular gland; an artery arising directly from the external carotid artery vascularized the submandibular gland and gave rise to the ascending palatine artery that led to the maxilla. We did not find cases in the literature where an artery emanated directly from the external carotid artery to vascularize the submandibular gland and that gave rise to an ascending palatine artery leading to the maxilla. Knowledge of the variations of the arterial vascularisation of the submandibular gland is important for submandibulectomies and transfers of the gland.

Arterial vascularization of occipital scalp: mapping of vascular cutaneous territories and surgical applications.

Although the vascular supply of the occipital region of the scalp is usually considered as depending on the occipital arteries, in our clinical experience the importance of the posterior auricular arteries seems to have been underestimated. Most of the authors consider that the occipital artery is the main artery to the vascular supply of this region. The role of the posterior auricular artery has not been clearly investigated. In order to describe the cutaneous territories of these two arteries, 20 occipital areas have been dissected after bilateral injection of coloured latex (40 occipital and 40 posterior auricular arteries studied), and 4 occipital areas have been dissected after selective injection of china ink in the occipital and posterior auricular arteries (4 occipital and 4 posterior auricular arteries injected). The occipital artery was deep from its origin to the arch constituted by the insertions of the trapezius and sternocleidomastoid muscles. Then the occipital artery was becoming superficial while ascending to the vertex. The cutaneous territory of the occipital arteries was paramedian and median (38% of the occipital area). The posterior auricular artery was superficial in the auriculomastoid sulcus and divided into three branches: auricular and mastoid as usually described and also a third terminal branch that we called "transverse nuchal artery". The posterior auricular arteries supplied the major part of the occipital area of the scalp (62%).

Anatomic study of tongue architecture based on fetal histological sections.

Tongue muscles are difficult to study by dissection and imaging methods because of the intermeshing of the muscular fibers. The study of the architecture of the tongue was based on 853 tongue sections of a fetus aged 32 weeks after conception. The analysis of the sections allowed demonstration of the different intrinsic and extrinsic muscles of the tongue, to determine their situation from the palatoglossus arch to the apex of the tongue. The tongue muscles are organized in different layers from cranial to caudal and from lateral to medial, one medial for the genioglossus muscle, one paramedial for the hyoglossus, the styloglossus and the inferior longitudinal muscles. In the anterior third of the tongue, the muscles presented a concentric organization.

The intra-lingual course of the nerves of the tongue.

The intra-lingual course of the nerves of tongue has never been studied in the human by the Sihler method. This technique was applied to six human tongues and allowed coloration of the nerves and illustration of the tongue. The course of the hypoglossal, glossopharyngeal, and lingual nerves was defined. Constant anastomoses between the lingual and hypoglossal nerves, between the glossopharyngeal nerve and the hypoglossal and lingual nerves, were demonstrated and may help explain the "neck-tongue" syndrome. This cartography of the nerves of the tongue allowed the definition of the motor and sensory consequences of tongue surgery.

Anatomical modifications of the temporomandibular joint during ageing.

It is essential to know the normal and pathological changes of ageing in the temporomandibular joint (TMJ) because of the frequency of pathology in this joint and the increased duration of life in current populations. A study was done on 70 TMJs harvested from 35 subjects older than 75 years. These joints were studied macroscopically, radiologically and histologically. Degenerative pathology of the TMJ affected more than 50% of the subjects studied and the disc was perforated in 7%. Ageing of the TMJ without any degenerative pathology is marked by radiographic signs which are not specific to the TMJ (cortical thinning, demineralisation). Histologically, amyloid degeneration was present in nearly 50% of TMJs studied.

[The epiglottis, a glosso-laryngeal structure: an anatomic study of its innervation]. / L'épiglotte, structure glosso-laryngée. Etude anatomique de son innervation.

The epiglottis is known as a laryngeal structure. The authors studied the innervation of epiglottis using the Sihler method on six human epiglottises. Innervation of the epiglottis depended on the rami from the vagus, glossopharyngeal and hypoglossal nerves. By its innervation, epiglottis seems to be a glosso-laryngeal structure, as is confirmed by embryology, histology and clinical applications.

[Contribution of maxillofacial signs in the diagnosis of Gardner syndrome]. / Intérêts des signes maxillo-faciaux dans le diagnostic du syndrome de Gardner.

Familial adenomatous polyposis (FAP) and Gardner syndrome are mendelian dominant inherited conditions. Both diseases are linked to mutations on the long arm of chromosome 5 (5q21) referred to as the adenomatous polyposis locus. Gardner syndrome involves endodermal, mesodermal and ectodermal layers. Nondigestive and maxillofacial lesions such as osteomas, odontomas, epidermoid inclusion cysts can disclose the syndrome. Colorectal cancer is the most important factor of prognosis.

[Kikuchi-Fujimoto disease: histiocytic necrotising lymphadenitis]. / Maladie de Kikuchi - Fujimoto: lymphadénite histiocytaire nécrosante.

BACKGROUND: Kikuchi-Fujimoto disease or necrotizing histiocyte lymphadenitis is a disease of unknown cause whose main clinical feature is adenopathy, generally in a cervical location. The disease was described for the first time in Japan in 1972 and the first case in France was reported in 1986. Clinicians should be aware of this uncommon disease in order to differentiate it from infectious adenitis, lymphoma and collagenosis. CASE REPORT: A 21-year-old woman consulted the emergency physician in January 2002 for a right cervical mass which had developed rapidly with no associated symptom. Other smaller masses developed within the following days. Laboratory results demonstrated discrete inflammation. All serologies tested were normal. Diagnostic cervicotomy was performed. The histological diagnosis was necrotizing adenitis. DISCUSSION: Necrotizing histiocyte lymphadenitis is generally observed in young women in their twenties. There has been no predominant ethnic background. Laboratory tests are normal excepting for discrete signs of inflammation. Diagnosis is provided by pathology and immunohistochemistry. The clinical course is generally spontaneously favorable in six months. Relapse is uncommon.

[Lichen and hepatitis C]. / Lichen et hépatite C.

We report a case of lichen planus in a patient with hepatitis C infection and discuss the relationship between these two diseases.

[A study of otomycoses in Yaoundé]. / Etude des otomycoses à Yaoundé.

The authors report the results of a six-month evaluation of otomycoses in the ENT Department of CHU and the Central Hospital of Yaoundé. We examined 2 592 patients of both sexes presenting with ear affections. The prevalence of Otomycoses is 6,09%. This is an adult problem with both sexes equally affected. Clinically the main symptoms were burning sensation in the ears, pruritus, sensation of fullness in the ear, hypoacousia and otorrhea. Clinical lesions are of many types including myringitis, tympanic perforation and otitis externa. The fungi responsible for these affections are mainly Aspergillus fumigatus (56,16%) for the Aaspergillus and Candida albicans (48,38%) for yeasts. The other species are Aspergillus niger, Aspergillus flavus, C. Krusei, C. pseudotropicalis, C. Tropicalis, Geotrichum candium and Torulopsis glabrata.

[Urethral prolapse in young girls: a rare pathology in pediatric surgery. Our experience apropos of 22 cases observed at the Cocody and Yopougon University Hospitals]. / Le prolapsus urétral chez la fillette: pathologie rare en chirurgie pédiatrique. Notre expérience à propos de 22 cas observés aux CHU de Cocody et Yopougon.

Twenty-two cases of prolapse of the urethral mucosa, a benign affection mainly encountered in young black girls, were observed over a 9-year period (1983-1992). This pathology is still poorly understood and the aetiology has not been clearly determined. Treatment protocols, medical and surgical, vary. We prefer exeresis of the prolapsed mucosa, followed by suture. The results have been quite satisfactory.

Photoperiodic and melatonin treatments for the control of seasonal reproduction in sheep and goats.

The control of seasonal reproductive activity in sheep and goats in open sheds, needs extra-light (E) during the photosensitive phase (equivalent to long days, LD), followed by treatment with melatonin (equivalent to short days, SD). In autumn-born Ile-de-France or Lacaune ram lambs, 2 months of E followed by decreasing daylength for 90 days, advanced onset of the first breeding season by allowing males to reach their maximum testis volume and sperm production earlier than for untreated ram lambs. Substitution of decreasing daylength with melatonin implants allowed a transient increase in testis volume. Adult Ile-de-France rams maintained under short light rhythms with 2 month-period, demonstrated, during at least 2 consecutive years, a testis volume equivalent to that observed during the normal breeding season. These light-treated rams produced, during non-breeding season, spermatozoa in the same quantity and quality as during the normal breeding season. In anovulatory out-of-season dairy goats, E treatment was demonstrated to be necessary before melatonin treatment and melatonin to be necessary after E treatment to stimulate oestrous and ovulatory activities. Stimulation of the anovulatory females by the introduction of treated males ("male effect"), appeared to be necessary to obtain maximum stimulation of the treated females. Two months of E, followed by melatonin treatment (daily injection or drenching or subcutaneous implants) allowed cycles with ovulation to be maintained for more than 2 months. Although effective for control of out-of-season reproductive activity, melatonin slightly decreased milk production when applied soon after kidding. So, total control of reproduction in sheep and goats by manipulation of photoperiod in open sheds and melatonin treatments appears feasible in both sexes.