Facial reanimation by muscle-nerve neurotization after facial nerve sacrifice. Case report.

INTRODUCTION: Recovering a certain degree of mimicry after sacrifice of the facial nerve is a clinically recognized finding. The authors report a case of hemifacial reanimation suggesting a phenomenon of neurotization from muscle-to-nerve. CLINICAL CASE: A woman benefited from a parotidectomy with sacrifice of the left facial nerve indicated for recurrent tumor in the gland. The distal branches of the facial nerve, isolated at the time of resection, were buried in the masseter muscle underneath. The patient recovered a voluntary hémifacial motricity. The electromyographic analysis of the motor activity of the zygomaticus major before and after block of the masseter nerve showed a dependence between mimic muscles and the masseter muscle. DISCUSSION: Several hypotheses have been advanced to explain the spontaneous reanimation of facial paralysis. The clinical case makes it possible to argue in favor of muscle-to-nerve neurotization from masseter muscle to distal branches of the facial nerve. It illustrates the quality of motricity that can be obtained thanks to this procedure. CONCLUSION: The authors describe a simple implantation technique of distal branches of the facial nerve in the masseter muscle during a radical parotidectomy with facial nerve sacrifice and recovery of resting tone but also a quality voluntary mimicry.

[Split temporalis muscle flap vascularized by the superficial temporal pedicle]. / Le lambeau de muscle temporal dédoublé vascularisé par le pédicule temporal superficiel.

INTRODUCTION: The temporalis muscle has been used for more than a century for facial reconstruction. But this flap cannot fill defects beyond the midline. Splitting the temporalis muscle in the plane of the tendon insertion allows lengthening the flap and crossing the midline. TECHNICAL NOTE: The scalp incision is followed by a subcutaneous dissection, taking care to spare hair follicles and superficial temporal vessels. Then the temporalis muscle is detached by a strictly subperiosteal dissection and deep temporal pedicles are dissected and ligated. The flap is split in the plane of the insertion tendon up to its distal end. DISCUSSION: This technique allows reconstructing cranio-facial defect beyond the midline with well-vascularized tissue.

[Implant insertion in distracted bone for reconstruction after gunshot injury]. / Pose d'implants en os distracté chez les patients reconstruits après traumatisme balistique.

Distraction osteogenesis is a tissue engineering technique with two clinical applications in maxillofacial surgery: alveolar distraction and basal bone distraction. Even if it appears to be a binding and major surgery, distraction osteogenesis applied to facial bone, and especially to the mandible, has the great advantage of producing a pluritissular reconstruction of ideal quality and quantity, suitable for the ultimate goal of dental implant rehabilitation management. This technique had some drawbacks due to technical constraints related to the material. Distraction osteogenesis is well placed in the armamentarium of reconstructive surgery techniques for bone defects caused by trauma or tumor. It allows rapid restoration of adequate physiological conditions for mandibular dental implant placement. We reviewed the various modifications of this technique.

["Double barrel" free fibula flap and vascular risk. A national investigation in France]. / Lambeau libre de péroné en « double barre ¼ et risque vasculaire. Enquête nationale.

INTRODUCTION: The free fibula flap is the most commonly used flap for mandibular reconstruction thanks to its multiple advantages. Its main drawback is the thin width of the bone section. The "double barrel" fibula flap is a solution to this problem allowing reconstruction of both basilar and alveolar ridges for a stable prosthetic dental rehabilitation. The authors wanted to assess its use, in France, to evaluate its reliability, and to determine its indications. PATIENTS AND METHODS: The authors sent a questionnaire to the 25 French Maxillo-Facial University Hospital Departments. Questions concerned the surgical technique, its indications, and the operative results, between January 2002 and December 2007. RESULTS: Out of the 18 teams who answered, 16 used a free fibula flap for mandibular reconstruction but only seven used the double barrel technique, for a total of 24 double barrel reconstructions. Only one total necrosis was reported. The indications for double barrel fibula flap were nearly all for corpus reconstruction and the operating overtime was less than one hour. DISCUSSION: The international literature review analysis gives results which compare to French ones, with a weak rate of necrosis despite the intermediate rectangular ostectomy. This technique may be recommended especially since it does not increase the operative time much and it improves dental restoration.

[Repair of palatal fistulae in cleft patients]. / Fermeture des fistules palatines séquellaires de fentes.

OBJECTIVES: Treatment of oronasal fistulae in cleft patients remains a surgical challenge because of its high failure rate. The authors report the results of an aggressive surgical technique using the total elevation of palatal mucoperiosteum, even for small fistulae. METHODS: This approach was used on twelve consecutive patients, from five to 33 years of age, presenting with a Pittsburgh classification type IV palatal fistulae. The surgical procedure was total elevation of the hard palate mucoperiosteum starting from the dental sulcus combined with sealed double layer sutures. Clinical and photographical control was made at least 6 months after to detect a possible relapse. RESULTS: The success rate was 100%. No relapsing fistula was observed with follow-up ranging from 6 to 36 months. DISCUSSION: This technique allows wide exposure and safe closure of the nasal layer. It is simple and leaves no raw bone surface exposed and no additional scar. The authors think it can be used in all type IV fistulae less than 1cm wide. Several other surgical techniques have been described to close palatal fistulae: local turnover flaps, pedicled flaps from adjacent oral tissue, tongue flaps, tissue expansion, and even free flaps. Obturator prostheses have also been used. The technique we report, even if more aggressive, seems to be more reliable with fewer relapse and sequelae.

[Foreign body granuloma due to Horsley wax®]. / Granulome à corps étrangers sur cire d'Horsley®.

INTRODUCTION: Horsley wax® is an efficient bone haemostatic agent commonly used in bone surgery. But it is non resorbable and surgeons should be aware of possible complications, which can appear many years later. OBSERVATION: We report three cases of foreign body granulomas due to bone wax. A 14-years-old female patient with an Apert syndrome underwent Le Fort III osteotomy and distraction osteogenesis; 3 years later, an inflammatory granuloma appeared in the temporal area. A 23-years-old female patient, traffic accident casualty, complained about pain in the hip 1 year after undergoing cervical spine surgery with iliac bone graft. A 35-years-old female patient underwent rhinoplasty with anterior nasal aperture surgery. She presented with an inflammatory reaction requiring several subsequent surgeries. DISCUSSION: Using Horsley wax® must be performed according to recommendations so as to prevent inflammatory or infectious complications, and to allow good bone healing. Surgeons must mention its use in the surgical report to avoid a delayed diagnosis in case of complications. There are alternatives to bone wax but they are less effective.

[Lipofilling and weight gain. Case report and review of the literature]. / Lipomodelage et prise de poids. A propos d'un cas et revue de la littérature.

Since Coleman's studies, lipofilling has become an easy, reliable and reproducible surgical technique particularly in severe Romberg's syndrome that is characterised by a progressive facial hemi-atrophy of cutaneous and subcutaneous tissues. Considering a young patient case, the authors expose a rare complication of lipofilling: deterioration of the aesthetic results after a significative weight gain due to corticosteroids, oral contraception and a change of lifestyle. Lipofilling is an adipocyte graft realised after centrifugation of liposuction products. Thus, the increasing volume of the fat graft remains hypertrophic and hyperplasic theories. Indeed, the technique produces a concentrated fat graft that realises an asymmetry of fat distribution in both sides of the face. The authors present their preliminary results.

[Benign cartilaginous tumors of the jaws]. / Tumeurs cartilagineuses bénignes des mâchoires.

Benign cartilaginous tumors are a rare entity in jaw bones. The histogenesis is still discussed but an embryological hypothesis is suggested. Chondroma, osteochondroma, chondroblastoma and chondromyxoid fibroma are the main benign maxillary cartilaginous tumors.

Serum antibody responses to Helicobacter pylori and the cagA marker in patients with mucosa-associated lymphoid tissue lymphoma.

The lymphoma of the mucosa-associated lymphoid tissue (MALT) of the stomach has been linked to Helicobacter pylori infection, but the mechanisms involved in B-cell proliferation remain elusive. In a search for putative H. pylori-specific monoclonal immunoglobulin production, an H. pylori strain was isolated from 10 patients with MALT lymphoma and used to detect the specific serum antibody response to the homologous strain by immunoblotting. Moreover, the antigenicity of the different strains was compared by using each of the 10 sera. We found that the different strains induced highly variable patterns of systemic immunoglobulin G antibody response, although several bacterial antigens, such as the 60-kDa urease B, were often recognized by the different sera. The cagA marker was detected in the strains by PCR with specific primers and by dot blot analysis, and the CagA protein was found in the sera of 4 of the 10 patients by immunoblotting. In conclusion, MALT lymphoma patients, like other patients with H. pylori gastritis, exhibit a polymorphic systemic antibody response, despite an apparently similar antigenic profile. The CagA marker of pathogenicity is not associated with this disease.