[Pneumomediastinum, a rare complication secondary to a minor maxillary fracture]. / Le pneumomédiastin, une complication rare d'une fracture mineure du maxillaire.

OBSERVATION: A pneumomediastinum was discovered fortuitously on a CT scan prescribed to a patient for facial and cranial trauma. Emphysema was attributed secondarily to an anterolateral maxillary wall fracture. The evolution was favorable after simple clinical and radiological surveillance. DISCUSSION: The observation of a pneumomediastinum should first be related to a tracheal or esophageal wound with a severe prognosis. Endoscopy under general anesthesia was not necessary for our patient thanks to CT scan with 3D reconstruction. There is no consensus for systematic antibioprophylaxis.

[Management of whole-scalp tumour: the Poncet-Spiegler cylindroma or turban tumour]. / Le cylindrome de Poncet-Spiegler étendu du cuir chevelu ou tumeur en turban: prise en charge chirurgicale.

INTRODUCTION: The Poncet-Spiegler cylindroma (PSC) is a benign annexal cutaneous tumor which preferentially develops on the scalp, neck, or forehead. Localizations may be isolated or multiple and often affect the young adult. The lesions grow progressively. When the scalp is completely involved, it presents as a "turban tumor". Treatment is surgery and may be difficult when the tumor is extended. We report the management of turban tumor. OBSERVATION: A 25 year-old female patient was first treated by partial scalp nodule exeresis and histology documented a PSC. She was lost to follow-up. But 9 years later, she was managed for a turban like PSC. The treatment was a complete scalp exeresis and secondary reconstruction with a skin graft. Follow-up was uneventful with a progressive functional and cosmetic improvement and after 2 years, there was no relapse. DISCUSSION: As for most tumors, management depends on the size of the PSC. An aggressive surgical treatment must be considered if the PSC is extended. In case of turban tumor, total scalp exeresis and secondary reconstruction with a skin graft is recommended.

[Intracranial spread of a melanoma of the face: the trigeminal pathway]. / Extension intracrânienne d'un mélanome de la face: la voie trigéminale.

INTRODUCTION: The intracranial evolution of cutaneous melanoma is usually due to metastases. Neurotropic invasion mainly concerns the trigeminal and the facial nerves. The melanoma is a rare entity among neurotropic tumors. OBSERVATION: A patient presented with a desmoplastic melanoma of the lower lid, complicated by a perineural extension to the cavernous sinus and the mandibular nerve via the maxillary nerve. DISCUSSION: This neurotropic evolution should be carefully monitored when close to a nerve. Extensive surgical excision including peripheral nerves in the vicinity of such tumors is recommended. MRI should be performed when a motor or sensitive disorder appears in the course of a desmoplastic melanoma.

[Cheek defect reconstruction with a vertical translation flap: nine cases]. / Reconstruction jugale par lambeau à translation verticale: neuf cas.

INTRODUCTION: Cheeks are frequently the sites of common skin tumors. Surgery is the common treatment of those lesions and the operative defect can be important. The aim of this study was to present reconstruction of lateromedial cheek defects with a vertical translation flap. PATIENTS AND METHODS: Nine patients (three women and six men) with a mean age of 46 years (21-74) were included. The defect was located in the medial part of the cheek in all cases with a mean diameter of 5 cm (4-6). The incision was made between the cheek, lateral nasal area, upper and lower lips, and chin aesthetic units. Then the flap was vertically translated and the upper end was fixed to the adjacent periosteum. The average follow-up was four years. RESULTS: In all cases the defect was covered and there was no case flap necrosis. In one case a postoperative paresia of the marginal ramus was noted and two patients presented with minor ectropion without lagopthalmia. DISCUSSION: In our experience this type of flap is indicated in large cheek defects without extension to nasal ala, upper lip, and lower eyelid.

[Hybrid osteosynthesis in orthognathic surgery: 28 cases of Le Fort I osteotomy]. / Ostéosynthèse hybride en chirurgie orthognathique: 28 cas d'ostéotomie de Le Fort I.

INTRODUCTION: The use of resorbable materials in orthognathic surgery is presently the object of numerous clinical and experimental studies. Their main drawbacks are their lack of rigidity and induced chronic inflammatory reactions. The purpose of this study was to propose and to test an original system of hybrid osteosynthesis associating a single titanium plate with three resorbable plates in Le Fort I osteotomies in the absence of maxillary expansion, or two titanium plates with two resorbable plates in case of maxillary expansion. METHODS: Our retrospective study concerned 28 patients operated between 2002 and 2005. A clinical follow-up of over one year detected the specific complications of the hybrid system and a cephalometric study analyzed the secondary relapse 5 months after surgery. These results were compared to the literature. RESULTS: One case of mobility and a case of instability of the jaw were observed, along with 5 cases of local chronic inflammatory reaction. The radiological results found a secondary sub-clinical relapse. The removal of the titanium material under local anesthesia was performed without difficulties in ambulatory care, which avoided a new hospitalization for the patient and a new general anesthesia. DISCUSSION: The hybrid system allowed obtaining a postoperative stability of the jaw comparable to that obtained by the exclusive use of titanium plates with an acceptable morbidity. This method of osteosynthesis combined the advantages of the resorbable material (removal of titanium plates under local anesthesia) and of titanium material (stability of the procedure). However this method requires a good experience of working with resorbable material, a good follow-up, and cooperative patients. These encouraging results urge us to extend the indications to mandibular sagittal osteotomy and to bi-maxillary osteotomies.

[Epidemiologic and clinical study of macrostomias. Report series of ten observations]. / Etude épidémiologique et clinique des macrostomies. A propos d'une série de dix observations.

INTRODUCTION: Macrostomia or lateral cleft or commissural cleft or transverse cleft is a rare facial cleft in comparison with standard cleft lip and palate. METHOD: A retrospective study of 10 cases of congenital macrostomia is realised. For each case a retrospective study with epidemiologic and clinic features was realised. RESULTS AND DISCUSSION: From these clinical considerations, a new classification with direct surgical consequences is proposed.