Treatment of multiple traumatized anterior teeth associated with an alveolar bone fracture in a 15-year-old school boy: a 2.5-year follow up.

We report a case of multiple dental traumas in a 15-year-old school boy who was hit by a stone. Clinical examinations revealed the avulsion of teeth 21, 22, and 23, an uncomplicated crown fracture of tooth 41, and a complicated crown fracture (CCF) of teeth 11, 31, and 33. An alveolar bone fracture and a root fracture in the apical third of tooth 23 were as well noted on radiographs. The avulsed teeth were replanted and rigidly splinted after an extraoral dry time of 90 min. Endodontic treatments were performed on teeth with CCFs. The dental morphology was restored using polyethylene fiber-reinforced composite resin. Endodontic obturations were performed on replanted teeth after the arrest of external root resorptions by a long-term calcium hydroxide dressing. Esthetics and function were recovered with a 2.5-year follow-up period.

[MRI exploration for the evaluation of orbital implant biocolonization in children enucleated for retinoblastoma]. / Apport de l'IRM dans la surveillance de la biocolonisation des implants intra-orbitaires chez des enfants énucléés pour rétinoblastome.

PURPOSE: To evaluate the contribution of MRI exploration for the evaluation of orbital prothesis biocolonization. PATIENTS AND METHODS: We studied ten eyes of ten children who underwent enucleation for retinoblastoma and synthetic hydroxyapatite orbital implantation. Each patient was examined by MRI imaging with gadolinium within 2 months to 1 year. RESULTS: After gadolinium administration, five implants showed an enhancement. Nodular enhancement around the implant was noted in one patient with a recurrence of retinoblastoma, and brain metastases were shown in two cases. None of the orbital implants was rejected. CONCLUSION: Fibrovascular colonization reduces the risk of orbital implant migration. Magnetic resonance imaging is safe and effective in detecting extrusion or tolerance of the orbital implant.

[Radiotherapy in the treatment of retinoblastoma: about 40 cases]. / Place de la radiothérapie dans le traitement du rétinoblastome : à propos de 40 cas.

PURPOSE: The aim of this study is to analyze the results and the complications of radiotherapy in the treatment of retinoblastoma. PATIENTS AND METHODS: Between 1994 and 2004, 40 children received radiotherapy for a retinoblastoma in Salah Azaiz Institute. The average age of the patients was 36 months (four to 132 months). There were 16 girls and 24 boys. Sixteen children presented a bilateral disease and 24 children a unilateral disease. Twenty eyes and thirty-six orbital cavities in 40 children with retinoblastoma were treated by radiotherapy. One child with a unilateral anterior retinoblastoma was treated with 106 ruthenium brachytherapy. External radiotherapy has been used to treat the 39 patients. In 20 cases the irradiation was conservative and in 36 cases postoperatively. The latter (n=36) presented at least one risk factor of relapses noted in the histological examination. The average dose was 44 Gy (1.8 to 2 Gy per fraction, five fractions weekly). This radiotherapy was associated with chemotherapy in 24 cases. RESULTS: Thirty-five children were followed with an average follow-up of 53 months (3-108 months). The average delay of relapses was of 10 months (two to 26 months). We found four orbital relapses and seven metastasis in nine children. The conservation of the eye with a useful visual field was noted in 18 cases among the 20 conservative irradiated eyes. The major therapeutic complication was the growth defect of the bones face. A femoral bone sarcoma was noted five years after the end of the irradiation and chemotherapy in one case. CONCLUSION: If the radiotherapy offers the advantage of the functional conservation and the improvement of the local control, its indications are more and more restricted in favor of the other therapeutic methods (chemotherapy, thermochemotherapy) and this considering the iatrogene risk. The development of new techniques of brachytherapy and the progresses of the conformational radiotherapy appear to reduce considerably this risk.

[Orbital metastasis of liposarcoma]. / Métastase orbitaire d'un liposarcome.

INTRODUCTION: Liposarcoma, the most common soft tissue sarcoma in adults, rarely involves the orbit. Primary orbital liposarcomas are extremely rare, with less than 30 cases previously reported. Metastatic orbital liposarcomas are also extremely rare, with only a few cases documented in the literature. We report a new case of an orbital metastatic liposarcoma and review the literature. OBSERVATION: A 57-year-old man with a history 5 years before of myxoid liposarcoma on the right calf, completely surgically resected, was admitted for recent proptosis of the left eye. A computed tomographic scan revealed a heterogeneously enhancing, left orbital mass measuring 30x23x20 mm. The mass adhered to the internal medial muscle without extension to the optic nerve. A biopsy was taken, which showed typical aspects of myxoid liposarcoma. The patient underwent an orbital left exenteration after first refusing any proposed treatment. CONCLUSION: Liposarcoma metastatic to the orbit is exceptional. It should be suspected in a patient with exophthalmia caused by a space-occupying lesion and a history of liposarcoma.

[Posterior scleritis: six case reports]. / Les sclérites postérieures: à propos de 6 cas.

PURPOSE: To study the clinical features, management guidelines, and the course of the disease in six patients with posterior scleritis. SUBJECTS AND METHODS: Six patients with posterior scleritis were enrolled in this retrospective study. All patients underwent a complete ophthalmic examination, fluorescein angiography, and B-scan ultrasonography. Systemic evaluation included physical examination and laboratory screening investigations. Medical management included systemic indomethacin (two cases), oral steroids (two cases), intravenous pulses of methylprednisolone followed by tapered oral steroids (two cases). One patient underwent immunosuppressive therapy (azathioprine) because of steroid dependence. RESULTS: The main presenting symptoms were pain (six cases) and decreased vision (four cases). Chorioretinal changes included chorioretinal folds (six cases), retinal folds (five cases), optic disc edema (five cases), serous retinal detachment (two cases), and a subretinal mass (one case). Ultrasonography disclosed sclerochoroidal thickening in all cases and retrobulbar edema in three cases. Systemic evaluation was unremarkable in five cases and revealed Behçet's disease in one case. All patients showed a good response to medical treatment. CONCLUSION: Posterior scleritis has protean manifestations and can be easily overlooked. This diagnosis must be considered in all inflammatory and painful ocular disorders with no obvious etiology. B-scan ultrasonography is the most useful diagnostic tool in such patients. The disease usually shows a good response to systemic anti-inflammatory therapy.

[Bilateral uveal melanomas. Five case reports]. / Le mélanome malin bilatéral de l'uvée. A propos de 5 cas.

PURPOSE: Uveal malignant melanoma is the most common primary intraocular tumor in adults. The occurrence of bilateral uveal melanoma is an extremely rare event, but the observed frequency is nevertheless higher than what can be attributed to chance. Possible responsible factors may include a genetic predisposition. PATIENTS AND METHODS: This retrospective study investigated the charts of patients examined from July 1988 to July 2001. For each patient, the clinical characteristics of the tumor (diameter, thickness, location), treatments, and results were noted, as were the eye involved, the presence of ocular melanocytosis, cutaneous melanoma, and second primary cancers. The information was then subjected to statistical analysis. RESULTS: Of 2 461 patients with unilateral primary uveal melanoma, five were identified as having bilateral uveal melanoma (0.2%). The expected number of cases would be less than one, hypothesizing an incidence of second melanoma identical to the incidence of a primary melanoma in the general population. The interval between the diagnosis of first and second primary uveal melanomas ranged from 0 to 6 years (median, 2 years). There was no clinical evidence of ocular melanocytosis in any of the five patients. The uveal melanoma was choroidal in three patients and affected the ciliary body or iris and choroid in two patients. DISCUSSION: The discrepancy between the estimated incidence (thought by Shammas to be one case every 18 years) and the observed incidence of bilateral primary uveal melanoma could be the result of many possible factors. An increased incidence of unilateral uveal melanoma could be a cause but in fact the incidence of uveal melanoma seems stable. Uveal melanoma may have been misdiagnosed in earlier years. The presence of a genetic predisposition to uveal melanoma is a possible explanation (suspected because of bilateral cases, familial cases and association with other primary malignancies). Ocular melanocytosis, which is described as more common in patients with bilateral uveal melanoma, was not seen in our series. CONCLUSION: Bilateral primary uveal melanoma occurs more frequently than expected. Unidentified germline mutations may be involved in pathogenesis. These cases serve as a reminder of the of the importance of careful examination of the second eye.

[Canal preparation of fluorotic teeth]. / La préparation canalaire sur dents fluorotiques.

This study compared the effectiveness of nine root-canal preparation techniques of fluorotic teeth. Seventy-three canal systems from 53 extracted human fluorotic teeth were instrumented. Pre-and postinstrumentation measurements were taken of the root canal systems in the cervical, middle and apical thirds; they proved the efficiency of the method using Rispi and Helifile. The results of this study were also extrapolated to the clinical situation.