[Diffuse sclerosing osteomyelitis of the mandible and SAPHO syndrome]. / Ostéomyélite sclérosante diffuse mandibulaire et syndrome de SAPHO.

BACKGROUND: Diffuse sclerosing osteomyelitis of the mandible (DSOM) and SAPHO (synovitis, acne, palmo-plantar pustulosis and psoriasis, hyperosteosis, osteitis) syndrome are not commonly associated. SAPHO has not been described to date in the stomatology and maxillo-facial surgery literature in French. Were report here a homogeneous series of 12 patients with DSOM. MATERIAL AND METHODS: All patients had mandibular osteitis. RESULTS: Five patients with multifocal osteitis wre considered to present SAPHO syndrome because of the associated skin lesions. One patient with a unique focus of mandibular osteitis and palmo-plantar pustulosis probably had early-stage SAPHO syndrome. The diagnosis in the other cases was diffuse sclerosis osteitis of the mandible. DISCUSSION: We compared our series with those reported in the literature, emphasizing diagnostic and therapeutic difficulties. Diffuse sclerosing osteomyelitis of the mandible should be distinguished from microbial osteitis. Early diagnosis is required to avoid successive and unnecessary dental avulsions. There is a possible link between DSOM and SAPHO and all patients should have a complete work-up including whole-body scintigraphy to search for other foci. A biopsy is indicated to rule out malignancy. Nonsteroidal antiinflammatory drugs can improve patient comfort in this particularly long syndrome. Although the efficacy is demonstrated, surgery and antibiotics can only delay relapse for a few months.

[Traumatic superior orbital fissure syndrome: report of 4 cases and review of literature]. / Syndrome de la fissure orbitaire supérieure post-traumatique: à propos de 4 cas et revue de la littérature.

PURPOSE: The authors retrospectively analyzed four cases of posttraumatic superior orbital fissure syndrome and reviewed the literature. METHOD: Four patients (three male and one female) were followed for this complication in the department from october 1995 to december 1996. RESULTS: The mean age was 31 years, the median follow-up was 8 month. Computed tomography showed involvement of the superior orbital fissure but no in three patients, in the fourth. The treatment consisted of osteosynthesis of craniofacial fracture in three patients and corticosteroid therapy in the last one. All patients presented partial recuperation of external ophthalmoplegia and ptosis. Twelve months after the traumatism, one patient underwent surgery for persistant ptosis and diplopia. CONCLUSION: The superior orbital fissure syndrome is an exceptional complication of orbital traumas. Partial recuperation of the neuro-ophthalmologic function usually occurs within a period of several months.

[Post-traumatic enophthalmos. Physiopathologic considerations and current therapeutics]. / Enophtalmies post-traumatriques. Considérations physiopathologiques et thérapeutiques actuelles.

The article is an overview of the available literature on post-traumatic enophthalmos (PTE). The PTE has a clinical definition and its diagnosis is based on a clinical examination. Fully assessment of the deformity requires complete ophthalmological examination and a measurement of the globe backward displacement by the mean of Hertel's ophthalmometer. Focusing on the pathophysiology, we insist on the role of periorbit and extraocular muscle retraction; nevertheless, according to most of the author's, opinion, the main pattern of the PTE seems to be the increased orbital post-traumatic volume, as it can be demonstrated by computed tomography (CT scan). In fact, thorough evaluation of the deformity needs at less a CT scan examination, providing horizontal and coronal slices. Sometimes, even a three-dimensional reconstruction can be obtained, helping the surgeon assessing the orbital deformity pre-operatively. We present five patients victims of a high-energy facial injury (motor vehicular accidents is responsible for an overwhelming majority of cases) leading to severe orbital lesions, and presenting a PTE as the main sequelae. We use homologous bone grafts to repair orbital fractures, especially calvarial bone. Osteotomy of the zygomatic bone (total or partial) can be proposed, combined with grafting of the orbit, to improve the correction of PTE. Most of all, patients with acute orbital trauma must be operated on as quick as possible: the sooner the surgery, the lower the probability for the PTE to occur.

Primary spheno-orbital angiosarcoma: case report and review of the literature.

OBJECTIVE: Angiosarcoma is a rare neoplasm that uncommonly involves the cranium. We report the second case in the literature of a primary right spheno-orbital malignant angiosarcoma. CLINICAL PRESENTATION: This 43-year-old man experienced a 3-month history of rapid growing temporal mass. The results of his neurological examination were normal. Neuroimaging revealed an intensively enhanced right spheno-orbital lesion, with destruction of the greater wing of the sphenoid bone and extension into the orbit, the infratemporal fossa, and the temporal fossa with infiltration of the dura mater but without parenchymal abnormality. INTERVENTION: The tumor was first biopsied and then totally removed, with exenteration of the right eye. The histological features were typical of angiosarcoma with immunohistochemical evidence of Factor VIII-related antigen produced by tumor cells. Neither radiotherapy nor chemotherapy was performed. The patient remained well during 16 months of follow-up, without evidence of recurrence on magnetic resonance images. CONCLUSION: We emphasize the benefit of wide surgical resection without systematic complementary treatment (radiotherapy and/or chemotherapy) in a case of primary angiosarcoma of the cranium. The literature is reviewed.

[Parietal grafts in maxillofacial and pre-implant surgery]. / Les greffons pariétaux en chirurgie maxillo-faciale et pré-implantaire.

Due to the recent regulations generated by the diversity of infectious risks, autologous bone is the standard graft material in maxillofacial surgery. Although synthetic biomaterials can be useful, they remain insufficient in many situations. Among the many sites offering graft material, monocortical parietal bone which is accessible within the craniocephalic operative field has distinguishing characteristics due to its membranous embryological origin and its mode of direct ossification which does not include a cartilaginous stage. The proportion of cancellous bone per unit volume is much higher than in enchondral bone (iliac bone, ribs...). These factors are undoubtedly the source of its main qualities--very little resorption and excellent capacity for bony integration--motivating its increasingly widespread use over the past twenty years. We present our experience in a series of patients who underwent surgery between 1992 and 1997. Parietal bone was used for orthognathic, pre-implant or reconstruction surgery after trauma or carcinological trauma. We present a description of the surgical procedures together with morbidity results and compare our findings with those found in large series in the literature, particularly concerning rare neuromeningeal complications. We discuss indications for parietal grafts and their course at the receiver site.

[Streptomyces somaliensis mycetoma with craniofacial involvement]. / Mycétome à Streptomyces somaliensis de localisation crânio-faciale.

Mycetoma is a chronic granulomatous infection of the skin from which grains of the causative organism are eliminated via the sinus tracts. We report a rare case of cephalic mycetoma, which presented with an extensive involvement of the skull vault, base and an extradural granuloma. The diagnosis and treatment of the disease are discussed.

[Gunshot wounds and injuries of the face in civilian practice]. / Plaies et traumatismes balistiques de la face en pratique civile.

Firearm wounds are relatively frequent in civilian practice. Due to the variable power of the weapons involved, a wide range of maxillofacial lesions are encountered and classification is a difficult task. In order to predict the gravity of the lesions, we have drawn a classification scheme from our experience with maxillofacial injuries. The scheme was based on the kind of ammunition which gives a better classification than the type of weapon. Three main categories have been identified.

[A large mucocele of unusual location]. / Une mucocèle de taille et de localisation inhabituelle.

We present the case of a patient who presented an unusually large mucoid cyst measuring 38 x 25 mm in an uncommon localization, the right maxillary. We examine the topographic and histological characteristics of mucoceles together with their treatment. The main differential diagnoses of liquid tumoral formations of the maxillary are also discussed.

[Florid cemento-osseous dysplasia: a poorly recognized entity. Apropos of 5 cases]. / La dysplasie cémento-osseuse floride: une entité mal connue. A propos de cinq cas.

We present five cases of florid osseous dysplasia observed in our department. There has been some confusion as to the terminology of this entity. We present here a review of the literature and outline the histological classification among odontogenic tumors as well as their epidemiology. The orthopantomogam is the mainstay radiological exploration, sometimes in association with a CT-scan. There are three main differential diagnoses: Paget's disease, Gardner's syndrome located in the maxillofacial area and diffuse sclerosing osteomyelitis. Asymtomatic forms motivate therapeutic abstenstion. When inflammatory, infectious or morphological complications appear, treatment relies on surgery in combination with long-term antibiotic regimens.

[Diffuse cervical cellulitis apropos of 15 cases]. / Cellulites cervicales diffuses à propos de 15 cas.

A homogeneous series of 15 cases of diffuse cervical cellulitis originating in the oropharyngeal area were collected from December 1990 to April 1995. Despite early management, diffusion of the infectious processus was rapid with extension and development of severe mediastinal or pulmonary complications. When diffuse cervical cellulitis is suspected, early and adapted aggressive treatment must be initiated immediately: suppression of the causal factor, surgical exploration with repeated drainage depending on the clinical course assessed on CT scans, antibiotics effective against the aero-anaerobic flora. This aggressive attitude is required to avoid potentially severe morbidity. Anti-inflammatory drugs, taken alone or with unadapted antibiotics was implicated in 11 cases as a favoring factor.

[Continuous elastic skin expansion for closure of the loss of substance of the scalp]. / Extension cutanée élastique continue pour fermeture d'une perte de substance du cuir chevelu.

The authors present a case report of a traumatic defect of the scalp involving all layers including galea and periost measuring 10 x 14 cm. The surgical repair of the scalp avulsion was obtained in 3 weeks using Continuous Skin Extension procedure with Kirschner pins threaded through the wound margins, held together with elastic bands. Traction forces were modified twice a week in our patient basis. No undermining was necessary. The authors analyse the benefits of this technic and describe the alternative surgical procedure. This technique is easy to handle, cheap, safe, and requires a single surgical step. Furthermore, it quickly allows the patient to proceed with his work.

[Paradental cyst]. / Le kyste paradentaire.

The paradental cyst is an odontogenic inflammatory cyst (WHO classification, 1992). It has been rarely described in the french literature and includes: The inflammatory paradental cyst which occurs on the buccal or distal aspects of an erupted third mandibular molar or of a canine (first description by Main in 1970); the mandibular infected buccal cyst which occurs on the buccal surface of the mandibular second or first molar in children around 6-8 years of age with an associated history of inflammatory signs (Stoneman and North, 1993). The histological features are the same as those of the radicular cyst. Prognosis is excellent after enucleation. This paper present an additional case report of a paradental cyst located on a second mandibular molar.

[Orbital paraganglioma. Apropos of a case and review of the literature]. / Paragangliome orbitaire. A propos d'un cas et revue de la littérature.

Paragangliomas are exceptional in the orbit. Among the 47 cases reported in the world literature more than 1/3 has been classified as alveolar soft part sarcoma. Diagnosis of paraganglioma was confirmed on the basis of pathology reports in only 10. We observed a case in a 46-year-old woman who presented with a tumour of the orbit. The histology examination and the ultrastructure determined by electron microscopy confirmed the diagnosis of paraganglioma. Characteristic histologic features are discussed together with a review of the literature.

[Malignant xanthogranuloma of the mandible. Presentation of a case and review of the literature]. / Xanthogranulome malin de la mandibule. Présentation d'un cas et revue de la littérature.

A malignant xanthogranuloma located in the mandible presented as a tumefaction of the alveolar crest with labiomental hypoaesthesia in a 52-years-old woman. The patient was treated with combined chemoradiotherapy and remained in complete remission for 14 years. Epidemiologic features (age, sex, race) of this tumour are discussed in light of the 24 cases reported in the literature. Histology features and possible treatment protocols as well as observed results are discussed. Five-year survival rate in malignant cervicofacial xanthogranulomas is estimated at 48%.

[Pseudo-tumoral osteitis of the mandible in children]. / Ostéite pseudo-tumorale de la mandibule chez l'enfant.

Infections with a dental origin are sometimes complicated with chronic osteoperiostitis and are seen clinically as a pseudotumour. We present a case together with the diagnostic and therapeutic approaches.

[A comparative study of rhabdomyosarcoma with cervicofacial involvement in children and adults. A therapeutic protocol]. / Etude comparative des rhabdomyosarcomes à localisation cervico-faciale chez l'enfant et chez l'adulte. Protocole thérapeutique.

Rhabdomyosarcoma is a malignant tumour of striated muscles. It is usually encountered in children and rarely in adults. In this study we compared sex ratios, aetiologic factors, different localizations, development stages, modes of extension and treatment as well as prognosis in children and adults with cervicofacial localizations. The differences observed led to the conclusion that cervicofacial rhabdomyosarcomas in children and adults are two very different pathological entities.