Relevance of Choukroun's Platelet-Rich Fibrin (PRF) and SMAS flap in primary reconstruction after superficial or subtotal parotidectomy in patients with focal pleiomorphic adenoma: a new technique.

AIM OF THE STUDY: Parotidectomy leaves a retromandibular hollow area in proportion with the amount of gland resected. Many surgeons perform primary reconstruction after superficial or subtotal parotidectomy in patients with exo-facial pleiomorphic focal adenoma. Many techniques have been proposed. We present a new technique of filling of the parotidectomy chamber by a second generation leucocyte and platelet concentrate, Platelet-Rich Fibrin (PRF, Choukroun's method). PATIENTS AND METHODS: 10 patients were included in this preliminary study. Subtotal parotidectomy was performed through classic procedure or lifting procedure. The macroscopic security margin of resection usually allowed performance of a SMAS flap. PRF was prepared following the original Choukroun's method. RESULTS AND DISCUSSION: PRF slow resorption after filling of the exeresis cavity, offers a key aesthetic interest. The fibrin matrix of this biomaterial has many angiogenic and healing properties. Synergetic action of the fibrin and the platelets cytokines within PRF may improve revascularization and postoperative resumption of facial nerve function. The membrane formed by the fibrin dense fibrillary network, as well as the SMAS flap, may help to prevent the Frey's syndrome. CONCLUSION: We propose the use of PRF as a filling, healing and interposition material after parotidectomy for benign parotid tumors. Preliminary results are very encouraging. Longer prospective evaluation of this technique is necessary.

[Nasal glial heterotopia: embryological and clinical approaches]. / Hétérotopie gliale nasale: approches clinique et embryologique.

INTRODUCTION: Nasal gliomas or heterotopia are nonhereditary congenital malformations composed of heterotopic neuroglial tissue. They usually present in infancy. Evaluation should include preoperative imaging with CT scan and/or MRI to rule out intracranial extension. There have been several cases reported in which nasal gliomas were misdiagnosed as capillary hemangiomas. The differential diagnosis includes prenasal space developmental impairment, which are nasoethmoidal meningoencephaloceles, nasal dermoid and epidermoid cysts. CASE REPORT: We describe the case of a newborn male infant presenting at birth with a paramedial nasal glioma. An embryological and clinical analysis of nasal gliomas is proposed. DISCUSSION: Nasal glioma is an uncommon congenital lesion presenting as a large panel of midline craniofacial anomalies. The embryological and anatomical origins of nasal gliomas are reviewed. The most known embryological theory was described by Grünwald in 1910 and is called the "prenasal space" theory. This theory is very attractive because of the embryopathogenic continuum proposed among dermoids, gliomas, and encephaloceles. In this article, we discuss major embryological theories on nasal gliomas pathogenesis and propose that while the prenasal space theory can explain the occurrence and the continuum between basal anterior or prenasal encephaloceles and gliomas, it cannot explain the occurrence of craniofacial demoids of the same topography. Better knowledge of embryological mechanisms implicated in the pathogenesis of nasal gliomas can help clinical management of this kind of malformations.

Alveolar soft-part sarcoma of the cheek.

Alveolar soft-part sarcoma is a rare malignant tumour of uncertain histogenesis, the two main sites of which are the lower extremities in adults and the head and neck in children. We know of only three case reports of intraoral locations without tongue involvement. Here, we describe the first case of an alveolar soft-part sarcoma of the cheek which presented in a patient over 30 years old and had an extremely rapid and eventually fatal evolution. We have also reviewed hypotheses about its aetiology.

[Extracorporeal lithotripsy in the treatment of salivary lithiasis. A prospective study apropos of 27 cases]. / La lithotripsie extra-corporelle dans le traitement de la lithiase salivaire. Une étude prospective à propos de 27 cas.

In a prospective study, we evaluated the efficacy of extracorporeal lithotripsy (ECL) in the treatment of salivary stones. We define the indications for the treatment of submaxillary and parotid stones, depending on the diameter and the location of the stone. Twenty-seven patients were treated by ECL. All had a unique stone, in the salivary duct, with a diameter greater than 2 mm; the site was the parotid gland for ten cases, the submaxillary gland for seventeen cases. After six months, the results from a clinical and ultrasonography point of view, were the following: total efficacy or complete desintegration of the stone: 9 cases; partial efficacy or fragmentation of the calculi, with residual fragments with a diameter of less than 2 mm, which could be flushed out with possible spontaneous clearance: 10 cases; failure or the lack of the reduction in the size of the stone or partial fragmentation into concrements with a diameter of more than 2 mm: 8 cases. Based on our experience and the results reported in the medical literature, we propose an therapeutic approach to symptomatic salivary stones. ECL is the most preferable treatment for stones of the parotid duct or parotid gland. The treatment of stones of the submaxillary gland depends on the site and the size of the calculi; ECL should be proposed as first-line treatment when the stone diameter ranges from 2 to 10 mm and when it is situated in the pelvis of the duct or in the proximal duct; surgical resection of the submandibular gland is indicated when the stone is situated in the gland itself or when the diameter is more than 10 mm; when it is situated in the distal duct, a marsupialization should be performed.

[Gorlin-Goltz syndrome. Apropos of a maxillary cyst]. / Syndrome de Gorlin-Goltz. A propos d'un kyste du maxillaire.

We report a case of Gorlin-Goltz syndrome and recall the principle features of this uncommon disease. The syndrome associates multiple skeletal malformations, skin tumors and epidermoid maxillary cyst. We discuss the differential diagnosis of maxillary cysts.

[Laryngeal mask and reduction of nasal bone fractures]. / Masque laryngé et réduction des fractures des os propres du nez.

A retrospective study was conducted in 116 patients who underwent anesthesia for reduction of nasal fracture under laryngeal mask for ventilation and protection of the airways. One patient had secondary intubation due to difficult insertion of the laryngeal mask. No episode of hypoxemia related to blood inhalation occurred. The laryngeal mask may be proposed to maintain the airway in this surgical procedure.

Treatment of salivary stones by extracorporeal lithotripsy.

PURPOSE: This study was designed to evaluate the efficacy of extracorporeal lithotripsy (ECL) in the treatment of salivary stones. PATIENTS AND METHODS: In a prospective study, an additional 15 patients suffering from sialolithiasis were treated by applying extracorporeally generated shock waves. No patients needed general anaesthesia, sedatives, or analgesics. RESULTS: Treatment was effective in 80% of the 15 patients in this series (5 total efficacy and 7 partial efficacy). Only minor complications were observed. CONCLUSION: Lithotripsy is a promising nonsurgical therapy for the treatment of sialolithiasis.

[Treatment of salivary gland calculi by extracorporeal lithotripsy]. / Traitement des calculs salivaires par lithotripsie extracorporelle.

This study was designed to evaluate the efficacy of extracorporeal lithotripsy (ECL) in the treatment of salivary stones. In a prospective study, 15 patients suffering from sialolithiasis were treated by applying extracorporeally generated shock waves. No patients needed general anaesthesia, sedatives, or analgesics. Treatment was effective in 80% of the 15 patients in this series (5 total efficacy, and 7 partial efficacy). Only minor complications were observed. Lithotripsy is a promising nonsurgical therapy for the treatment of sialolithiasis.

["Beret" flap and other flaps in the reconstruction of cancer related loss of substance of the ear]. / Le lambeau "en béret" et les autres lambeaux dans la reconstruction des pertes de substance carcinologiques de l'oreille.

Major tissue loss involving the ears and periauricular area due to carcinologic exeresis is an important problem in reconstructive surgery. We present the "béret" flap, a frontal flap with an occipital pedicle, emphasizing the simplicity of the procedure and its reliability. We present our personal experience and data in the literature and recall the main clinical and histological features of these tumors as well as the clinical course and treatment.

[Concomitant radiochemotherapy in locally advanced ORL cancers: a prospective study of 68 cases]. / Radiochimiothérapie concomitante dans les cancers ORL localement avancés: étude prospective de 68 patients.

From January 1988 to July 1992, 68 patients presenting with a locally advanced and unresectable carcinoma of the head and neck region were given 3 to 5 courses of chemotherapy (5-FU 1 g/m2, day 1 to 3, cisplatin 4 mg/m2, day 1 and 2, 15 mg/m2 day 8) combined with simultaneous radiotherapy. Patients were enrolled in two protocols. In the initial one a 70 Gy total dose was delivered in 105 days, and in the latter the same dose was given in only 63 days. Toxicity was moderate and acceptable. In the 62 evaluable patients, a complete response was observed in 62%, and partial response in 24%. The complete response rate was higher (80%) in the population enrolled in the second protocol. Overall the median survival is 18 months. At 2 and 3 years, the overall survival is 48% and 30% respectively. These results suggest an influence of overall treatment duration on complete response rate and survival.

[Bucco-sinusal site of primary leiomyosarcoma]. / Localisation bucco-sinusienne d'un leiomyosarcome primitif.

The leiomyosarcoma, a malignant smooth muscle tumor, is common in uterus and gastro intestinal track. Only 27 cases of oral cavity localisation have been report in literature since 1908. We report a case of primary leiomyosarcoma of palate in 26 years old woman. The diagnosis is made by histopathological examination after biopsy. The extension is revealed by clinical symptoms and scan examination. The treatment is based on wide surgery Chemotherapy and radiotherapy could be proposed. The prognosis of the lesion depends of metastatic development, few cases have been present with metastases developed after one year, two years and five years. Generally their localisation are liver, lungs or lymph nodes. In our case after two years post operative a second lesion is revealed and the patient died quickly.

[2 cases of unilateral nasal obstruction related to rhinolithiasis]. / Deux cas d'obstruction nasale unilatérale liée à une rhinolithiase.

Authors report two cases of 31 and 42 year old women who for many years had a unilateral nasal obstruction: first case due to a large polyp, second one due to a mucosal inflammation but both caused by a rhinolithiasis. The latter is formed over several years around a vegetable seed or a piece of material neglected since childhood. The rhinolithiasis is a calcareous concretion formed in layers visible by X-rays. This type of growth is usually enhanced by weak economic development of certain countries.

Skull base chondroma of extracranial origin.

METHODS: Two cases of chondroma at the skull base, most probably of extracranial origin, are presented: one at the apex of the petrous pyramid and the other in the infratemporal fossa. RESULTS: In the second case, the surgical findings suggested that the tumor originated in the cartilagineous part of the eustachian tube. The world literature was reviewed and only three cases of extracranial chondromas at the skull base, and ten cases of chondromas of the nasopharynx have been described so far. CONCLUSIONS: The potential origins of chondromas at the skull base are discussed: Cartilagineous remnants at the basisphenoid and basiocciput or the cartilagineous part of the eustachian tube seem to be the most probable origin.

Nasal dermoid sinus cyst.

Nasal dermoid sinus cyst is one of the diagnoses of midline nasal masses in children. This retrospective study analyzes the various theories regarding the origin of this congenital abnormality, the differential diagnosis, and the value of magnetic resonance imaging, as well as the various surgical options available.

[Injection of collagen in recurrent paralysis after thoracic surgery]. / L'injection de collagène dans les paralysies récurrentielles après chirurgie thoracique.

The author describes a new technique of treatment of recurrent laryngeal nerve paralysis by intra-cordal injection of collagen after thoracic surgery. After description of the collagen used and the technique of injection, the author presents the results. It is a new method, simple, efficient, well tolerated, giving patients a voice, and treating their swallowing troubles.

Middle ear adenoma. A tumor displaying mucinous and neuroendocrine differentiation.

Middle ear adenoma (MEA) is a distinctive, rare entity that appears to be derived from the lining epithelium of the middle ear mucosa. We report four cases of MEA displaying the typical histologic growth pattern. Two distinct tumor cell immunophenotypes were identified in all cases; the first type exhibited positivity with anti-epithelial membrane antigen and anti-keratin antibodies, and the second type showed immunoreactivity with anti-keratin, anti-vimentin, and anti-neuron-specific enolase antibodies. Ultrastructural studies revealed bidirectional mucinous and neuroendocrine differentiation, demonstrated by the presence of two distinct cell types containing apically located mucous granules and basally concentrated neuroendocrine granules, respectively. The presence of neuroendocrine differentiation was supported by the immunohistochemical detection of vasoactive intestinal polypeptide in the tumor cells in one case and neuron-specific enolase in three cases. These findings suggest that the potential for mixed mucinous/neuroendocrine differentiation described in other endodermally derived tumors also exists in middle ear mucosa. We also believe that the rare lesions diagnosed as primary carcinoid tumors of the middle ear might in fact be MEA with predominant or only neuroendocrine differentiation. The clinical course of our four cases and our review of the pertinent literature confirm the benign nature of MEA and indicate that these tumors should be treated by complete local excision without additional therapy.