[Testicular choriocarcinoma presenting as cutaneous metastasis. A case report and review of the literature]. / Les métastases cutanées révélatrices des choriocarcinomes: revue de la littérature. A propos d'une localisation nasale d'origine testiculaire.

Choriocarcinoma are germinal tumors from testicular cells in men or foetal trophoblast in women. Cutaneous metastasis are very rare. The authors report a case of angioma-like tumor in a 22-year-old man which was a cutaneous metastasis of a testicular carcinoma. Diagnosis was of course histologic. Testicular echography showed an intra testicular tumor, pulmonary and abdominal CT-scan showed multiple metastases. Orchidectomy and retroperitoneal lymphadenectomy were performed before a general chemotherapy. Patient died 14 months after diagnosis. Only 11 cases of cutaneous metastasis of choriocarcinoma were found in the world literature (7 men and 4 women). All cases showed diagnosis trap for plastic surgeon.

Giant foot schwannoma.

Schwannoma of the foot is rare; only 12 cases have been reported. A schwannoma is a benign neurogenic tumour derived from Schwann cells. The diagnosis is often delayed because the symptoms are mainly those of compression disorders. We describe a 7cm schwannoma of the heel in a 30-year-old man. Ten years earlier a schwannoma was removed from the same site. The recurrent lesion was widely excised and a medial plantar flap was used to repair the heel.

[Nasal involvement in atrophic polychondritis. A case report]. / L'atteinte nasale dans la polychondrite atrophiante. A propos d'une observation.

Relapsing polychondritis is a rare and little known inflammatory disease. The case of a 29-year-old woman who presented with a one-year history of saddle nose is discussed in this article. After waiting for one year, rhinoplasty was decided, with a good result at the 18th month. We prefer to use a calvarial bone graft for this disease and to only operate under stable and minor conditions.

Extracranial cephalic schwannomas: a series of 15 patients.

The aim of this study was to report a series of extracranial cephalic schwannomas. Fifteen patients with extracranial schwannomas treated between 1981 and 1999 are presented, and their clinical course during a median follow-up of 4.1 years is discussed. There is a female predominance. No specific factors have been identified. Their diagnosis is often delayed (median, 2.6 years). There is no predominant side. The orbit represents the most frequent location of schwannomas (26%). The trigeminal nerve is the most often affected (53%). Computed tomography and magnetic resonance imaging contribute to the diagnosis. Macroscopically, the schwannoma is a well-defined tumor of ovoid form and brownish color. It is formed of soft tissues and is fragmented easily. Diagnosis is often evident on microscopic examination. The only treatment is surgery. It consists of enucleation after opening the epineurium using an operating microscope, without interruption of the continuity of the nerve. The authors have observed only two relapses (the first two patients operated without a microscope). Total excision allows recovery. Nerve injuries have variable prognosis. It is necessary in juvenile populations to search for neurofibromatosis. All schwannomas required surgical treatment using an operating microscope to obtain total recovery.

[Reconstruction of the mouth floor using a musculo-mucosal buccinator flap supplied by facial vessels. Report of ten cases]. / Le lambeau myo-muqueux de buccinateur pédiculé sur les vaisseaux faciaux. Intérêt dans la reconstruction du plancher de la cavité buccale. A propos de 10 cas.

The buccinator muscle is a wide, flat quadrangular muscle. Its medial surface is covered by the oral mucosa. It receives its arterial blood supply from two main arteries: the facial and buccal arteries. A musculo-mucosal flap can be raised on the facial artery with or without the facial vein. In the case of absence of the facial vein, venous drainage is possible into the peri-arterial loose areolar tissue. A nasolabial skin incision facilitates facial artery identification and simplifies flap dissection in the loose areolar plane, superficial to the facial artery. The mean dimensions of the flap are 3.5 cm in width and 7 cm in length. The flap extends from the superior buccal sulcus to the inferior alveolar ridge. Its rotation enables reconstruction of the anterior and lateral floor of the mouth. The donor site is closed in two layers. The authors present a series of ten patients reconstructed with this flap after excision of a squamous cell carcinoma of the floor of the mouth. The results are excellent with perfect tongue function and no esthetic sequelae. The facial artery should be preserved during neck dissection, and the ipsilateral mandibular molar teeth must be extracted. Its simplicity and reliability makes this flap a useful alternative in floor of mouth reconstruction.

[Extracranial cephalic schwannomas. Apropos of 13 cases]. / Les schwannomes exocraniens de l'extrémité céphalique. A propos de 13 observations.

The authors report a series of 13 extracranial cephalic schwannomas, treated between 1981 and 1998. Schwannomas are rare and benign tumors derived from Schwann cells. Cephalic sites represent 2.5% of all schwannomas. Their diagnosis is often delayed, because symptoms mainly consist of compression disorders. There is a female predominance. The age distribution is homogeneous. There are no risk factors. There is no predominant side. The orbit and jugular foramen are the most frequent sites. The trigeminal nerve is usually involved. CT scan and magnetic resonance imaging (MRI) specify the topography and characteristics of the tumor and can contribute to the diagnosis. Macroscopically, schwannoma is a well-demarcated, ovoid or spherical, brownish tumor, off-centered from the nerve. It is composed of soft, easily fragmented tissue. The diagnosis is often obvious on microscopic examination and rarely requires immunohistochemical confirmation. The only treatment is surgical. It consists enucleation after opening the epineurium, using on operating microscope, without disruption of the nerve. Total excision ensures recovery. The authors have observed only one recurrence (first patient operated without microscope). Compression disorders regress completely. Nerve injuries have a variable prognosis. Malignant transformation is exceptional. Type II neurofibromatosis must be excluded in young patients.

[Neurocutaneous flap of the external saphenous nerve. A safe, easy and fast procedure for covering loss of substances of the ankle. A propos of 5 cases]. / Le lambeau neuro-cutané de nerf saphene externe. Un procédé sûr, simple et rapide pour la couverture des pertes de substance de la cheville. A propos de cinq cas.

The distally based sural neurocutaneous flap is another procedure to cover the heel. It is an island flap based on the vascular axis of the sural nerve in the lower two thirds of the leg. The nerve is included in the pedicle after proximal section (it is therefore not a sensitive flap). The size of the flap, length of the pedicle, absence of vascular sacrifice, the simple procedure, and minor consequences at the donor site led us to use this technique five time over on period of four months with success.

[Unusual use of a tissue expander]. / Utilisation inhabituelle d'un expandeur tissulaire.

Postpneumonectomy syndrome is a rare but serious complication. Mediastinal shift leads to compression of the remaining main bronchus. Repositioning of the mediastinum in the midline allows partial or total recovery. To maintain mediastinal position, the pneumonectomy space must be filled by a tissue expander.