[Aesthetic reconstructive surgery of the lip]. / Chirurgie réparatrice et esthétique labiale.

Lip reconstruction can be performed with numerous surgical techniques. The aim was here to present these usual techniques and to focus on the details that can be used to obtain the most favourable results. The goal of this surgery, that represents a compromise between function and aesthetic, has to be kept in mind to prevent mistakes that decrease the quality of the result.

[Extended resection and radiotherapy for primary intraosseous maxillary carcinoma]. / Carcinome intra-osseux primitif des maxillaires traités par exérèse large et radiothérapie.

INTRODUCTION: Primary intraosseous maxillary carcinoma is a rare squamous cell carcinoma developing from remnants of the odontogenic epithelium. Risk factors are unknown and it may occur at any age. Little epidemiological data is available and few series include a sufficient number of patients. We assessed the prognosis of these tumors after wide exeresis (margin of 2 cm) followed by adjuvant radiotherapy. METHODS: We reviewed the treatment and outcome data in nine cases of primary intraosseous maxillary carcinoma from 1995 to 2010. The WHO diagnostic criteria were used. We analyzed the demographic, clinical, and radiological data, as well as the type of treatment and the outcome of patients. RESULTS: The gender ratio was 3.5/1, and the mean age 40.2 years. The most frequent presentation was a unilocular osteolytic lesion with an irregular contour, between 24 and 60 mm, in the mandibular angle. Extended tumor resection was performed in all patients. Reconstruction was performed with a fibula flap in seven patients. Five patients underwent adjuvant radiotherapy. The survival rate at 2 years was 100%. The mean follow-up was 6.9 years (2-14 years) at the end of the study. Two patients were treated for a relapse and one died after 3 years of follow-up. DISCUSSION: The combined treatment was efficient on primary intraosseous maxillary carcinoma. The diagnosis is made with strict clinical, radiological, and histological criteria. The intraosseous location of these tumors requires an early diagnosis and aggressive treatment combining broad exeresis followed by adjuvant radiotherapy to avoid recurrence and have an optimal survival rate.

[Maxillary sinusitis of odontogenic origin: surgical treatment]. / Sinusites maxillaires d'origine dentaire : traitement chirurgical.

PURPOSE: The frequency of maxillary sinusitis of dental origin (MSDO) is under estimated. The medical and surgical treatment has improved thanks to endoscopic guidance. We report our experience and strategy in the treatment of MSDO. PATIENTS AND METHODS: Twenty-two patients presenting with MSDO were treated between 1998 and 2008. The results were evaluated on clinical, functional, sinusal, and odontologic signs. RESULTS: MSDO accounted for 16% of surgically managed sinusitis. CT was performed in 95% of cases. The etiologies were apical leakage in seven patients, migration of a tooth or root during extraction, or presence of ectopic tooth in the sinus in nine patients, a cyst in three patients, and oroantral communication in three patients. Surgery was performed after antibiotic and NSAID treatment. The first surgical step was the treatment of the odontogenic source. The second step was sinus drainage by endoscopic treatment in 64%, Caldwell-Luc in 23%, and drainage by oroantral communication enlarged then closed in the same operative time in 13%. The follow up ranged from 3 months to 10 years. Early postoperative superinfection was observed in two patients. Two patients presented with recurrent sinusitis. The postoperative sequels were hyposmia in three patients, dental pulpotomy, and trigeminal neuralgia in five patients treated by Caldwell-Luc surgery. DISCUSSION: Nasal endoscopy has improved the surgical management of MSDO. It makes curettage and exclusion of sinus cavities obsolete. It is reliable and has a low rate of complications. The best treatment remains prevention.

[Severe vascular complications of Le Fort I osteotomy]. / Complications vasculaires graves de l'ostéotomie de Le Fort I.

INTRODUCTION: Le Fort I osteotomy is a common orthognathic procedure. This surgery presents risk of severe vascular complications because of local anatomy. The aim of our study was to collect data on vascular complications of Le Fort I osteotomies performed in our department, describe the diagnostic and therapeutic aspects, and discuss prevention. PATIENTS AND METHODS: A retrospective analysis was made on the files of patient having undergone Le Fort 1 osteotomy, between 1998 and 2007. Severe vascular complications were recorded, defined as postoperative hemorrhagic or ischemic complications severe enough to require a specific procedure. RESULTS: Nine hundred and sixteen patient files were included (39% male and 61% female patients, mean-age: 24.42 years; range: 13 to 59 years). Five patients presented with severe hemorrhagic complication. There was no ischemic complication. Three hemorrhagic episodes occurred in the immediate postoperative phase. In two cases, delayed hemorrhagic complication occurred, diagnosed as a pseudo-aneurysm by angiography. These were treated by hyperselective embolization. DISCUSSION: Vascular complications of Le Fort I osteotomies are rare (0.55% in our series). They are most frequently hemorrhagic complications.

[Risk factors for recurrence of maxillary odontogenic keratocysts]. / Les facteurs de risque de récidive des kératokystes odontogéniques des maxillaires.

PURPOSE: The odontogenic keratocyst is a benign tumor with a high recurrence rate and aggressive behavior. We analyzed the risk factors for recurrence of odontogenic keratocysts and compared our results to published ones. PATIENTS AND METHODS: Thirty-two patients (36 odontogenic keratocysts) were treated in our department between 1996 and 2006. We retrospectively analyzed recurrence according to anatomoclinic, histopathological, and prognostic parameters. RESULTS: The patients' mean age was 41 years. The sex ratio was 1.28 with male predominance. The mandible was the most common site (30 cases). The most common radiological finding was a unilocular cyst in 75 % of cases. The primary treatment was conservative surgery for all patients. Twelve recurrences were observed in eight patients between 2 and 10 years of follow-up. All recurrences occurred in the mandible with 41 % in the angle and ramus. Multilocular cysts recurred in 55 % of cases, unilocular in 11 %. The recurrence rate of orthokeratocysts was 40 %. The presence of satellite cysts and extension to soft tissues were associated with a high rate of recurrence (60 %). Sixty-six percent of infected cysts recurred and among these, eight were enucleated in several fragments. DISCUSSION: The recurrence rate of odontogenic keratocysts is higher in case of mandibular posterior region localization and multilocular keratocysts. This might be explained by the difficult surgical accessibility. Some histological findings including the presence of satellite cysts and orthokeratocysts are associated with a higher recurrence rate. Cyst infection and treatment modalities influence the recurrence rate.

[Mandibular desmoplastic fibroma: diagnosis and therapeutics difficulties]. / Fibrome desmoïde mandibulaire : difficultés diagnostiques et thérapeutiques.

INTRODUCTION: The desmoplastic fibroma is a rare bone tumor, characterized by aggressive local infiltration, with frequent recurrence. The most common site is the mandible. Radioclinical signs are not specific and the histological diagnosis may be difficult. CASE: A 16 year-old male patient consulted for a painless and hard left mandibular swelling, without inferior alveolar nerve disorders. The tumor extended from tooth 31 to tooth 35, the mucosa was healthy. The panoramic view showed a multilocular osteolytic lesion with dental root resorption. CT scan showed expansion of bony cortex with rupture of the outer cortical. The biopsy indicated a desmoplastic fibroma or a fibrosarcoma. A second histological analysis combined with an immuno-histochemical study proved the diagnosis of desmoplastic fibroma. DISCUSSION: The desmoplastic fibroma has a polymorphous symptomatology. Radiological signs are unspecific. Anatomopathology combined with immuno-histochemistry can prove the diagnosis and guide the treatment.