[Medico-legal assessment in the sequelae of burns (1st part)]. / Évaluation médicolégale des sequelles de brulures (1re partie).

The assessment of physical injury in after-effects of burns is very specific. Indeed, the evolution of burn scars is particular compared to the scarring process in general. The expert needs to know these specific aspects in order to objectively assess the after-effects due to burns, in order to compensate for the loss of autonomy in major burn victims. The assessment has to analyze all the effects, functional and aesthetic, of the after-effects due to burns and has to particularly specify: the mending, which can never be set before one year, the pressure test allowing to check the complete maturation of the scars; the functional disability which results from skin retractions (due to after-effects) on the limbs mobility but which also must consider the burnt skin surface; the aesthetic damage, often important, with a discrimination between hypertrophic and keloid scars; the suffering, always significant in view of specialized and prolonged therapeutics; the sexual damage, often unrecognized in this type of injured people.

[Sequelae of dental trauma: forensic medical aspects]. / Séquelles des traumatismes dentaires: aspects médico-légaux.

Dental trauma is a frequent condition which may occur alone or in combination with craniofacial trauma and/or other injuries. Many factors influence the gravity of the trauma and subsequent prognosis including age, anterior state, trauma etiology, treatment and follow up. In order to establish a prudent provisional or definitive expertise, the medical expert must have a panoramic view of the trauma. Time should be taken to consolidate facts and estimate prejudices on sound evidence. In certain cases outcome can be predicted. The medical expert should provide advice and counselling both for the patient and the mandating authority. In this article, iatrogenic dental accidents occurring during anesthesia or extraction will not be discussed.

[Surgical management of cutaneous pathomimia. A report case]. / Prise en charge chirurgicale de la pathomimie cutanée. A propos d'un cas avec revue de la littérature.

UNLABELLED: Cutaneous pathomimia is a behaviour disorder witch interest the skin. In some cases, self-mutilation can be serious and require a surgical treatment. CASE REPORT: A 60 year old woman consults for extensive scar interesting the face and the scalp and realising the aspect of burn face in cicatricle level. The treatment consisted on excision and skin graft. The patient was addressed to Psychodermatology consultation. Authors show the place of plastic surgery in management of cutaneous pathomimia.

[Vertical alveolar distraction osteogenesis of the posterior edentulous mandible: a case report]. / Distraction alvéolaire des secteurs postérieurs mandibulaires: à propos d'un cas clinique.

When it is necessary to increase the vertical height of the residual alveolar ridge, alveolar distraction osteogenesis has numerous advantages compared to other preprosthetic surgical procedures. It is frequently used for this purpose in the anterior region because of the obvious accessibility. The authors present a clinical case of edentulous posterior mandible, with insufficient vertical alveolar bone height, treated by alveolar distraction osteogenesis leading to three titanium fixtures. They explain their choice and discuss the preliminary results.

[Malignant lymphoma of the mandible. A new case]. / Lymphome malin de la mandibule. A propos d'un nouveau cas.

Primary extranodal malignant lymphoma is relatively rare. Clinical and radiological features may lead to the misdiagnosis of chronic osteomyelitis. We report a case of primary non-Hodgkin's lymphoma that involved the mandibular region in a 53-year-old man. Differential diagnosis with other mandibular diseases is difficult because there is a non specific clinico-radiological features and the difficulty of histologic interpretation. This pathology is important to recognize because of specific treatment. Global prognosis is relatively favorable if the lesion is localized.

[A very unusual complication of the extraction of a wisdom tooth]. / Complication très particulière de l'extraction d'une dent de sagesse.

We report here a case of a 42-year-old man who presented a major complication during wisdom tooth extraction. Secondarily after an extraction attempt to tooth migrated into the temporal fossa which required hemi-coronal surgical removal. We present a description of the surgical technique.

[Sports and facial injuries. Feasibility and limitations of an epidemiologic study]. / Sports et traumatismes faciaux. Tentative et limites d'une étude épidémiologique.

Our aim was to conduct an epidemiological study in order to better assess the frequency of maxillo-facial sport injuries. Only those activities that are practised within a sport or game association are included in the study. A standard letter was sent to all French sport and game associations (Olympic or not) as well as to some major insurance companies (73 sport and game associations and 11 insurance companies). However the scope of the study rapidly proved limited since over the two-month period considered only 16 sport associations and one insurance company returned an answer. The exploitable results are presented and a brief overview of the recent relevant international studies is given.

[An unusual fracture of the orbital floor]. / A propos d'une fracture insolite du plancher de l'orbite.

The various anatomopathologic forms of orbital fractures correspond to precise pathophysiologic mechanisms. We would like to detail an exceptional case of an orbital fracture in professional a diver. This case can be associated to barotraumatic accidents categories. After a brief review of the anatomy and the pathophysiological fractures of the orbit, we examine the different mechanisms which can be linked to this particular and unexpected pathology.

[In situ penicillin therapy in the treatment of epulis]. / Pénicillinothérapie in situ dans le traitement des épulis.

An epulis is a hyperplastic tumor of the oral mucosa. The pathophysiology of epulis is unclear. Standard treatment consists of surgical excision but in situ penicillin therapy was recently proposed. In situ treatment consists of injecting 1,000,000 IU of penicillin G into the tumor every three days until complete disappearance is obtained. Absence of allergy to penicillin must be ascertained prior to treatment. The purpose of this report is to describe results in 5 patients presenting different histological forms of epulis treated by in situ penicillin therapy at the Dental Care Center of Rabat, Morocco. Complete disappearance of the tumor was achieved after 3 to 5 injections in all 5 patients. In 4 patients the tumor first necrotized and then fell off. In the remaining patient, the tumor regressed gradually. No complications were observed and no recurrence has been noted with follow-up ranging from 24 to 30 months. Since in situ penicillin therapy is more cosmetic, easier to perform, and less expensive than surgical excision, it should be included in the arsenal of therapeutic modalities for management of epulis.

[Mammaplasty with an L-shaped scar and a pre-established design. Apropos of 80 cases]. / Plastie mammaire à cicatrice en L et à dessin pré-établi. A propos de 80 cas.

Over recent years, surgeons have tried to reduce the reduction mammaplasty scar. In this context, we use a surgical technique described by J.P. Chavoin, privileging "the remaining breast". Three advantages of this surgical method are derived from its technical choices: a superior dermal pedicle for preservation of the areolar nipple complex, preoperative drawing and finally a short incision with an inverted L scar. A retrospective study of 80 patients with 27 months of follow-up defines the advantages and disadvantages of this technique. Discomfort, indications, quality of results are evaluated with charts. Preoperative drawing and technique are described. This study shows this to be a reliable technique with good and constant results. Lastly, its indication is described in comparison with other techniques designed to achieve. Its preferential indication is moderately severe hypertrophy (500 g), which represents the majority of patients consulting us, but it can also be used in severe hypertrophy or even gigantomastia. Reduction of asymmetry also constitutes a good indication, facilitated by rigorous skin drawing based on precise anatomical landmarks. In addition to its broad indications, its advantages are marked vascular safety, rapid execution, constant results, while preserving the median part of the thorax from any scars.

[Role of coral blocks in cheek augmentation surgery. Prospective study of 23 patients]. / Intérêt des blocs de corail dans les plasties d'augmentation des pommettes. Etude prospective portant sur 23 patients.

A two-year multicentre prospective study was performed from 1992 to 1995 in order to evaluate the real value of various kinds of coral blocks as bone substitute in maxillofacial surgery. This study was supported by the French National Agency for Research Valorization (GBM/TEP procedure). Ten Maxillofacial Surgery Units were included. During this time, 28 coral blocks (23 patients) of two different shapes were used as malar implants for correction of congenital or acquired zygomatic hypoplasia. The mean follow-up was 1.8 year (min: 1.5; max: 2). The tolerance was perfect for 89% of cases. The radiologic opacity never decreased more than 30% and the volume augmentation was always stable at the end of the follow-up period. Three implants were removed because of septic complications. Rigid fixation between the implant and the zygomatic bone appears to be the most important factor of success. On the other hand, the surgical approach (endo- or exo-buccal) does not seem to influence the success rate. The aesthetic improvement was always evaluated as satisfactory and stable by the patients and the surgeons. The authors discuss the real value of the various kinds of biomaterials and especially coral, comparing their personal data with those of the literature. Coral blocks clearly constitute a safe and reliable bone substitute, but further investigations are required to determine its long-term behavior.

[The coral orbital floor. Its value in traumatology. The results of a multicenter study of 83 cases]. / Le plancher orbitaire en corail. Son intérêt en traumatologie. Résultats d'une étude multicentrique portant sur 83 cas.

A madreporic coral graft was used for orbital floor reconstruction following facial trauma. This report presents a multicentric study of 83 patients with a follow-up period of 15 to 24 months. The results of this study indicate no significant rejection or infection opposed to so many synthetic implants outcome. The radiological follow-up demonstrates a partially resorption of the implant within about 2 years and its replacements by new bone. Coral implant was used to correct enophthalmos or diplopia due to enlarged orbital dimensions. It was technically easy to insert and its anatomic shape does not require to be fashioned before use. Its inflexibility allows to bridge large bone defects and this implant should be considered as an attractive alternative to autogenous grafts, avoiding a second surgical site, in reconstructing orbital floor fractures.

[Role of autografts of cultured epidermis in the treatment of deep burns of the face. Preliminary results]. / Place des autogreffes d'épiderme de culture dans le traitement des brûlures profondes de la face. Résultats préliminaires.

Deep burns of the face raise the problem of skin cover after surgical detersion to limit the serious functional and aesthetic sequelae which they can induce. Autologous cultured epidermal grafts currently occupy an important place in the surgical treatment of the early phases of facial burns. The authors present their preliminary results of the use of this graft technique in patients with burns of more than 60% of the body surface, including the face. The surgical protocol is described, consisting of surgical detersion with benzoic acid, grafting and specific dressings. Three patients treated by this technique are then presented before concluding on the very interesting prospects of autologous culture epidermal grafts on a fibrin substrate. A clinical case of facial burns treated by this new type of graft is presented to conclude the discussion.

[Darier-Ferrand dermatofibrosarcoma. Apropos of a case with frontal involvement]. / Le dermato-fibro-sarcome de Darier et Ferrand. A propos d'un cas de localisation frontale.

One case of dermato-fibro-sarcoma protuberans is reported on a 36 years old man. It was an extensive forehead tumor which needed a radically surgical treatment. These excision called a reconstruction with cutaneous graft and scalp flaps. Three years after treatment, there was no evidence of recurrence or lymphadenopathy. The aesthetic results is good. The authors recalled with this observation the important points of this disease particularly characterized by slow invasive growth and local recurrence.

[Periosteal or juxtacortical chondroma of the mandibular condyle]. / Chondrome parostéal ou juxtacortical du condyle mandibulaire.

One case of juxtacortical chondroma is reported, and the authors review the clinical, radiological, pathological and therapeutic data concerning this tumour which was first individualised by Lichtenstein and Hall in 1952 but never described in this location. Conservative surgery with complete excision of the chondroma usually results in permanent cure.

[Verrucous epidermal nevus of the face]. / Le naevus épidermique verruqueux de la face.

The authors report a case of extensive verrucous epidermal naevus of the face in a 15 year old Senegalese boy. This is the second reported case in Western Africa following the case presented to the French Language African Medical Society in 1984 (B. Ndiaye). The skin lesion in the form of a naevus of variable dimensions is an essential manifestation of the epidermal naevus syndrome described by Solomon, Fretzin and Dewald in 1968. This syndrome consists of a variable but inconstant association of dysembryoplastic abnormalities affecting the central nervous system (epilepsy, mental retardation, hydrocephalus, localized central deficits), the eye (fibrous conjunctival tumours, corneal opacities, colobomas) and the bones (spine, clavicle, pelvis, limb bones). The bones may be affected by malformations or hypoplasia. The epidermal naevus generally has a linear verrucous appearance, but it is not exceptional to find Jadassohn's sebaceous naevus or even localized erythroderma ichthyosiformis. Mucosal lesions, especially oral, well described in 1960 by Brown and Gorlin, correspond to a particular localization of epidermal naevus and must be differentiated histologically from white sponge naevus, which has a fairly similar clinical appearance. This non-hereditary disease must be systematically investigated looking for visceral abnormalities which are very common. Lastly, in terms of therapy, surgery may be justified when the facial lesions are unsightly, extensive or disabling. Various techniques may be applied depending on the extent and the site of these naevi.

[Radiological aspects of giant cementoma of the jaws (Pindborg)]. / Les aspects radiologiques du cémentome géant des maxillaires (Pindborg).

In reference to 7 cases of Pindborg's giant cementoma in Senegalese women, the authors describe their radiological aspects. The different aspects of these tumors are emphasized according to their location on the maxilla or the mandible and whether they are anterior or posterior.

[Myxoma of the nerve sheath. Apropos of a case]. / Myxome de la gaine d'un nerf. A propos d'une observation.

A case of oral nerve sheath myxoma is presented with the findings of light microscopy and immunochemistry. The tumor consists of well-defined lobules which are separated by septa composed of fibrous connective tissue that reassembled the perineurium. Each lobule is composed of elongated and stellate cells in a basophilic mucoid matrix. Immunohistochemically, S-100 protein is strongly positive in all tumor cells. The histogenesis and differential diagnosis are discussed.