[Neural jaw tumors]. / Tumeurs nerveuses des mâchoires.

Neural tumors occurring in the jaw are neurofibroma and schwannoma, and more rarely ganglioneuroma. Pterionic meningioma are extremely rare. Schwannoma, or neurinoma are formed along the cranial nerve pathway, exclusively from axonal sheath Schwann cells. Neurofibroma are due to the proliferation of several cell types. When identified, screening for type I neurofibromatosis is mandatory. Surgery is the only treatment for facial neural tumors. Functional and esthetic issues are common. Recurrence and malignant transformation are severe complications of neurofibroma.

[Part III: free periosteal flaps as a treatment for mandibular osteoradionecrosis]. / Partie III : les lambeaux libres périostés dans le traitement des ostéoradionécroses mandibulaires.

INTRODUCTION: The vascularized periosteal free flap transposes a non-irradiated soft tissue with neo-angiogenesis, bone induction, and osteogenesis qualities. Its technique and interest are studied for early osteoradionecrosis. MATERIAL AND METHOD: A retrospective study was made between 1992 and 2002. Thirty-four patients were selected among the 59 cases operated for osteoradionecrosis; all patients were classified stage II and I on the Epstein scale. Twenty-six patients were reconstructed using a non-periosteum free flap (bone, muscular or cutaneous flap), and eight patients were reconstructed using a "periosteum free flap". The study was clinical, radiological, and histological. RESULTS: Osteoradionecrosis evolved for two of the eight patients having undergone periosteum free flap surgery. Operative morbidity and the number of reoperation were less important than for the rest of the series. The reconstruction was satisfactory on a functional and esthetic level. A bone production was noted for two patients of the "periosteum" group. DISCUSSION: Periosteum free flap surgery is an alternative for early osteoradionecrosis. The periosteum brings osteo-induction and osteogenesis, and revascularization recorded clinically, radiologically, and histologically, even on an irradiated area.

[Columella defects: yet a challenge!]. / Les pertes de substance de la columelle : encore un défi !

The repair of nasal defects is thought to be the most ancient of facial reconstructive procedures, dating back to at least 3000 BC in India. In spite of the development of nasal reconstruction concepts, leading to remarkable esthetic and functional improvements, columella reconstruction is yet a contemporary challenge. Columella defects may result from trauma, infections, carcinoma resection, syphilis, bilateral cleft lip, etc. Maintaining symmetry, contour and function are essential for a successful columella reconstruction. Multiple factors help to determine the optimal repair method, including the size of the defect, its depth and location, and the strength of the underlying nasal framework. This article presents a range of techniques and discusses the application of these methods to specific columella defects. A chronological review of columellar reconstruction procedures used for this partial rhinoplasty is exposed.

[Mandibular osteoradionecrosis. Part II: efficiency of revascularization surgery]. / Osteoradionécroses mandibulaires. Partie II : efficacité de la chirurgie de revascularisation.

INTRODUCTION: The physiopathology of osteoradionecrosis (ORN) is linked to vascular and cellular aspects of bone physiology. The authors had for aim to check whether the transposition of non-irradiated tissues could repair vascular and bone lesions. MATERIAL AND METHOD: A retrospective study was made from 1992 to 2002 on all patients operated for a mandibular ORN (59 patients). The reconstructions performed with a bone flap (42%), bone composite flap (34%), periosteal free flap (14%), cutaneous flap (4%), or muscular flap (5%) were assessed. The radiological and clinical results and the effect of re-vascularization were analyzed. RESULTS: A skin paddle was required in 47% of cases, impairing dental rehabilitation. The bone flap had to be osteotomized in 25% of iliac flaps, and 75% of fibula flaps. The free flap reconstruction had a 90% success rate. Complications were observed in 60% of cases and were more frequent when the stage was higher. The analysis of the surgical technique allowed determining its interest. DISCUSSION: The analysis of results showed the feasibility of this technique in irradiated tissues. The iliac bone free flap was the best solution taking into consideration the shape, bone volume and vestibular morphology. The osteo-induction by a non-irradiated tissue transplantation was demonstrated clinically and radiologically.

[Tongue necrosis under corticosteroids]. / Nécrose de langue sous corticoïdes.

INTRODUCTION: The tongue is a common location for Horton necrotic injuries. But some herpetic lesions can show similar symptoms to the disease and complicate the diagnosis. CASE REPORT: A 67-year-old woman, treated by corticosteroids for Horton disease, presented a central, deep, and very painful ulceration of the tongue. The spreading of necrosis despite treatment was an indication for biopsy, giving the diagnosis of herpetic infection. Valacyclovir was efficient within 15 days. DISCUSSION: This necrotic injury looks like herpetic stomatitis presented by severely immunodeficient AIDS patients. No case under corticosteroids had been described so far. The tongue-limited location is exceptional.

[Mandibular osteoradionecrosis: part I: severity factors]. / Ostéoradionécroses mandibulaires: partie I: facteurs de gravité

INTRODUCTION: The severe evolution for some patient presenting with osteoradionecrosis, even if classified in the same stages as other patients, suggests that there are aggravating factors. MATERIAL AND METHOD: A retrospective study was made between 1992 and 2002 on all patient operated for mandibular osteoradionecrosis. Fifty-nine patients were included and the mandibular defects were reconstructed with a bone or a composite free flap (fibula 21%, iliac crest 49%, scapula 6%, antebrachial 3%), and with a periosteal free flap (13%). RESULTS: The study included severe cases (87% of stage II or III) operated on several times without success. Free flap reconstruction was successful in 90% of the cases. However, complications were present in 60% of cases (24% minor complications, 48% major complications), and were more frequent with a higher stage. The analysis allowed identifying morbidity factors. DISCUSSION: Studying the morbidity allowed identifying severity factors of osteoradionecrosis; spontaneous onset, important irradiation (important dose, bone proximity of the tumor, bilateral damage), vascular damage (symphyseal localization, lack of sequestrum, facial artery ligature, active tobacco addiction), actinomycosis colonization, non-observance of medical treatment. Understanding aggravating factors should allow us to offer more efficient surgery on an early osteoradionecrosis stage, also decreasing the morbidity linked to reconstructive surgery.

[Mediatisation and "facial graft" or "to whom belongs the facial graft"?]. / Médiatisation et "greffe de visage" ou "à qui appartient la greffe de visage"?

Mediatisation of a scientific event could be neither controlled, nor verifiable. The experience which has been lived through the first worldwide allotransplantation of composite tissues of the face confirms that the actors of a surgical innovation are not the owners. Because there is neither confidentiality nor possible patent. Curiously the scientific world, providing with a sharing ethic, which rightly privileges the free spreading of knowledge in the way that most people could benefit of it. Obviously it is made without denied controversy, for truth as purpose. This scientific word that way joins the media one, with a specific ethic of the duty of information, but also interested in mercantile preoccupations quick to cultivate controversy not to enlighten this truth but to better sell pictures or papers. Than the author should only sustain this instrumentation which could certainly flatter him, and from which he could used, but in reality that paralysed him a little to go on in serenity with his shadow worker way.

Comparison of two computer-assisted surgery techniques to guide a mandibular distraction osteogenesis procedure. Technical note.

The accuracy of distracted facial bone displacement depends on the preoperative clinical assessment, surgical planning and technique. The aim of this study was to evaluate two different techniques to guide the mandibular distraction surgical procedure using an intraoral device. This study was performed on a fresh cadavre. 3D reconstructions from a computed tomographic (CT) acquisition were used for the two techniques. The first technique comprised a customised stereolithographic template and the second technique used a computer-assisted surgery (CAS) unit to guide the osteotomy and the positioning and screwing of the distractor device. Both methods were planned and compared with the same 3D software. The authors discuss the feasibility and reliability of the two techniques. The accuracy of the two techniques appears to be comparable for clinical applications, although the rapid prototyping template technique appears to be more satisfactory.