[Complications of head and neck expansion: Acting on modifiable factors. A study of 98 prothesis]. / Complications de l'expansion cutanée cervico faciale : agir sur les facteurs modifiables. Étude sur 98 prothèses.

BACKGROUND: Tissue expansion is a key tool in the therapeutic arsenal that is proposed for repairing soft tissue losses of the head and neck. This technique, however interesting it may be, is not without its risks. The aim of this work is to identify the different steps of this procedure, determine the complications risk factors inherent to each step of the expansion and propose recommendations to improve functional and aesthetic results. PATIENTS AND METHODS: We carried out a retrospective study on tissue expansion of the head and neck over a period of 10 years extending from January 2009 to December 2018, with at least one year follow-up for each patient. Our study counted 63 patients with the placement of 98 prostheses. We considered the various variables involved in the expansion process in order to determine those that increase the risk of complications. RESULTS: In our series we counted 66.3 % of complications and 22.4 % of failures. We found that a young age increased the risk of skin suffering and that smoking increased the risk of hematoma occurrence. Neck expansion was found to be the riskiest site of expansion followed by the scalp that increased the risk of exposure (especially the parietal section of the scalp). The face is considered as an interesting site for expansion. We found that the use of multiple expanders is an attractive alternative to iterative expansions and to the choice of large expanders. CONCLUSION: Tissue expansion of the head and neck requires careful planning that takes into account each step of the process.

Long-term therapeutic outcomes of facial arteriovenous malformations: A retrospective bi-centric study of 30 cases.

INTRODUCTION: Among vascular malformations, arteriovenous malformations (AVM) are potentially the most invasive and destructive especially when located on the face. Their management is still subject to controversy and yet no consensus exists. Our aim was to report long-term therapeutic outcomes for patients with facial AVM managed either by embolization alone or by resection with/without preoperative embolization. MATERIAL AND METHODS: A bi-centric retrospective study was carried out covering the period from 2001 to 2018 including 30 patients with a facial AVM. Outcomes were categorized as follows: with 1=controlled disease, 2=improved disease (residual, no expansion), 3=persistent or stable disease (neither improved nor worsened), and 4=recurrent or worsened disease. RESULTS: The initial treatment modality was embolization (n=5, 16.7%), surgical resection (n=16, 53.3%), and surgical resection after embolization (n=9, 30%). The follow-up period ranged from 12 to 216 months with a median of 54.9 months. Taking all treatment modalities together, disease control was achieved in 60% of the cases. Disease control was achieved in 77.8% of the cases after embolization followed by surgery, in 68.7% after surgery alone and in none of the cases after embolization alone. CONCLUSIONS: According to our results, optimal treatment is based on a combination of embolization followed by a well-conducted surgical treatment.

[Complications of head and neck skin expansion]. / Complications de l'expansion cutanée cervico-faciale.

INTRODUCTION: Skin expansion is a good solution for the reconstruction of head and neck defects. We assessed the complications of cervico-facial skin expansion technique to draft recommendations so as to minimize risks. METHODS: We made a retrospective study from 1990 to 2005. Complications were analyzed according to age, sex, etiology, area to reconstruct, location of the expander, expander volume and number, simultaneous single or repeated technique, type of expander, duration of expansion, and type of flap used for reconstruction. RESULTS: One hundred and thirty-nine tissue expanders were placed in 114 patients. The rate of complications was 60.4%. Age was not a risk factor (P=0.21; Fisher's exact test). The early complications were not related to the expander volume (P=0.32; Fisher's exact test). Infection was the most frequent complication (51.3%). Hypertrophic or large scars, retraction, or cording accounted for 32.4% of sequels. A rate of 6.5% of total and 6.5% of partial failure were recorded. Infection was the cause of 77.8% of total or partial failure. DISCUSSION: The complications of head and neck soft tissue expansion are often minor. The rate of reconstruction failure remains acceptable.

[Facial infantile aggressive fibromatosis: a frequent localization of an exceptional tumor!]. / La fibromatose agressive faciale chez l'enfant: une localisation fréquente d'une tumeur exceptionnelle !

INTRODUCTION: Although fibromatosis is considered as benign tumor, it can have significant morbidity, particularly when it occurs in the head and neck. Their propensity for infiltrative local growth with encroachment on vital structures and their tendency to recur make fibromatoses of the head and neck extremely challenging lesions. CASE REPORT: We report the case of a 10-year-old boy with desmoid fibromatosis of the upper lip. For this patient, the medical treatment has been decided to avoid a mutilating surgery. He had a good result with chemotherapy using methotrexate and vinblastine. DISCUSSION: According to the literature, surgery is the most common treatment of fibromatosis in the head and neck region. However, particularly in children, alternative modes of therapy must be considered because of the high recurrence rate and to avoid mutilating operations. Chemotherapy using methotrexate and vinblastine may be a reasonable choice.

[Fractured zygoma: a review of 356 cases]. / Les fractures de l'os zygomatique : à propos de 356 cas.

INTRODUCTION: Fractures of the zygomatic complex with its accompanying functional and esthetic deficits are a fairly common phenomenon in the practice of maxillofacial and plastic surgery. The purpose of this paper is to provide a review, based on collected data, on the topic of "fractured zygoma". The review is presented under the headings of epidemiology, fracture patterns, treatment modalities and complications. Throughout the paper comparison is made with published data from around the world. METHODS: A 10-year retrospective audit was undertaken of all hospitalized patients, at the department of maxillo facial and plastic surgery in Charles Nicolle Hospital (Tunisia), who had sustained a fractured zygoma from 1995 to 2004. RESULTS: A total of 356 fractures were sustained. Patients in the third decade of life (34%) recorded the highest incidence. The sex distribution is markedly higher for males than for females (9/1). Road traffic accidents (31%) were the predominant etiology. Tetrapod fractures (43.7%) were the most frequent type of fractures followed by zygomatic arch fractures (34.53%). Cases were managed by either closed or open reduction. Percutaneous reduction was the commonest technique employed. However, in unstable fractures necessitated open reduction, transosseous wiring was the most frequently employed fixation. Patients were followed-up routinely, for an average of nine months. Inferior orbital nerve dysfunctions were seen in 8.7% of cases. DISCUSSION: Epidemiological findings are similar to those reported in the literature. Males sustained more fractures than females and road traffic accidents were the commonest cause of zygomatic fractures. Open reduction and internal fixation is advocated for the unstable, markedly displaced or comminuted fractures.

[Mandibular aggressive fibromatosis]. / Fibromatose agressive mandibulaire.

INTRODUCTION: Aggressive fibromatosis is a rare histologically benign fibrous tumor with a potential for locoregional aggression. Treatment is not well defined and several therapeutic approaches have been proposed. Surgical treatment is the reference, chemotherapy, radiotherapy and homonotherapy being proposed as complementary treatment or for inoperable tumors. CASE REPORT: A three-year-old patient underwent surgery for removal of a mandibular tumor. Pathology reported aggressive fibromatosis. The patient was given conservative treatment and was free of recurrence nine years after resection. DISCUSSION: Conservative surgery for aggressive mandibular fibromatosis appears to be preferable to radical mutilating surgery which would have a major impact on facial growth in children.