[A furoncular ankle cellulitis in a teenager with a difference: Dermatobia hominis]. / Un passager clandestin à ne pas méconnaître: Dermatobia hominis, à propos d'un cas.

We report a case of botfly myiasis presenting as an ankle cellulitis in a teenager returning from Guyana. Main clinical features and therapeutic approaches are described.

Efficacy and tolerability of racecadotril in acute diarrhea in children.

BACKGROUND & AIMS: Oral rehydration therapy is the only treatment recommended by the World Health Organization in acute diarrhea in children. Antisecretory drugs available could not be used because of their side effects, except for racecadotril, which is efficient in acute diarrhea in adults. METHODS: The efficacy and tolerability of racecadotril (1.5 mg/kg administered orally 3 times daily) as adjuvant therapy to oral rehydration were compared with those of placebo in 172 infants aged 3 months to 4 years (mean age, 12.8 months) who had acute diarrhea. The treatment groups were comparable in terms of age, duration of diarrhea, number of stools, and causative microorganism at inclusion. RESULTS: During the first 48 hours of treatment, patients receiving racecadotril had a significantly lower stool output (grams per hour) than those receiving placebo. The 95% confidence interval was 43%-88% for the full data set (n = 166; P = 0.009) and 33%-75% for the per-protocol population (n = 116; P = 0.001). There was no difference between treatments depending on rotavirus status. Significant differences between treatment groups were also found after 24 hours of treatment: full data set (n = 167; P = 0.026) and per-protocol population (n = 121; P = 0.015). Tolerability was good in both groups of patients. CONCLUSIONS: This study demonstrates the efficacy (up to 50% reduction in stool output) and tolerability of racecadotril as adjuvant therapy to oral rehydration solution in the treatment of severe diarrhea in infants and children.

Mesenchymal chondrosarcoma of the jaws. Report of four cases.

Mesenchymal chondrosarcoma (MCS), described in 1959 by Lichtenstein & Bernstein, is a very rare malignant tumour. Only 46 cases have been previously reported in the jaws. Over a period of 30 years, four chondrosarcomas of mesenchymal type (of which one has already been published in 1987 with a three-month follow up) were treated in our department. Two patients have been followed for more than 17 years, of whom one has died of an intracranial extension and the other is still alive after surgical treatment of numerous recurrences and metastases. The two others are tumour-free with a follow up of 18 months and 11 years respectively. Histological, epidemiological and clinical features and treatment of MCS are discussed relevant to the data published in the literature.

[A simple procedure for the passive suspension of the paralyzed labial commissure]. / Procédé simple de suspension passive de la commissure labiale paralytique.

Different techniques can be used to repair paralytic labial commissurae. Ideally, microsurgical procedures or dynamic suspension methods can correct kinetic paralysis but in certain patients (elderly subjects, poor general health, precarious postsurgical rehabilitation) such procedures may represent an excessively aggressive procedure. We therefore used static suspension of the paralytic labial commissurae based on desepidermization of a nasogeneal flap. This simple technique is easy to perform and is our method of choice for static suspension because the flap pulls the paralysed commissurae upward and doubles the tissue cover, helping overcome buccinator incompetence.

[Cherubism and surgery]. / Chérubisme et chirurgie.

Cherubism is a hereditary bone disease, increasing the volume of both cheeks (whence the name, alluding to Renaissance paintings cherubs), during childhood. Usually cure or at least stabilisation is expected around the puberty. Some cases monstruously extensive impose a surgical management, sometimes difficult but with impressive results.

[Screening and diagnosis of epidermoid carcinoma of the oral mucosa. What conclusions are possible today concerning the respective roles of cytologic smear and biopsy?]. / Dépistage et diagnostic des carcinomes épidermoïdes de la muqueuse buccale (CB). Que peut-on conclure aujourd'hui du rôle respectif du frottis cytologique et de la biopsie?

Oral malignancies are a major problem in France where the consumption of alcoholic drinks is a traditional habit, often associated with heavy smoking. Contrary to other malignancies, at least in France mass screening has never been used to detect oral carcinoma. Preventive steps are very difficult to implement due to different economic reasons but mass screening in patients with records of heavy drinking/smoking, and/or pre-epitheliomatous lesions is an easy method after a short training of doctors in different specialties and cyto-pathologists. The mass screening is based upon the exfoliative character of the oral carcinomas which enables very easy and risk-free cytological smears and their classification in four grades. The reliability is more than 96%. However, Biopsy preserves its major importance for an accurate diagnosis but is most properly executed in cancer departments. This could bring oral cancer patients in adequate centers at a very early stage of the disease, and improve both prognosis and sequellae.

[Temporomandibular ankylosis: an analysis of hospital records and a review of the recent literature]. / Les ankyloses temporo-mandibulaires: analyse des dossiers du service et revue de la littérature récente.

Ankylosis of the temporomandibular joint has severe consequences due to its effect on eating, speaking, buccal hygiene and growth of the lower third of the face in children. Two therapeutic problems must be addressed: functional capacity (joint mobility) and morphological (correction of the facial deformation). The appropriate surgical techniques are still subject to debate. Each operator has a technique which gives satisfactory results. In our unit, we used two techniques with similar results. Early and prolonged rehabilitation still remains the only guarantee of success.

[Prosthetic treatment of mandibular pseudarthrosis using an articulated prosthesis]. / Traitement prothétique d'une pseudarthrose mandibulaire par prothèse articulée.

Two cases with complete loss of the tooth-bearing portion of the mandible were repaired with a prosthesis. This type of defect can involve the loss of a large number of teeth and aggression to the remaining teeth must be limited as much as possible. A two-part "articulated" prosthesis with two rings appears to be the best adapted system. This method takes into account the requirements of for additional conventional prostheses and thus makes it possible to save the remaining teeth.

[Maxillary ameloblastoma. Apropos of a case and review of the literature]. / Améloblastome maxillaire. A propos d'un cas et revue de la littérature.

Although ameloblastoma is one of the benign odontogenic tumors, the maxillary localisations often grow more infiltratively and show higher recurrency than the mandibular localisations. The authors report a case of ameloblastoma in maxillary sinus and sketch out the operative methods with a literature review.

[Surgery of the infratemporal fossa. An improved cutaneous access technic]. / Chirurgie de la fosse infra-temporale. Une voie d'abord cutanée améliorée.

UNLABELLED: Surgery in the infra-temporal area, formerly known as the pterygo-maxillary area, is not often performed and raises several problems including the route of access and indications and contraindications. Many procedures have been proposed by ENT or maxillo-facial surgeons dealing with cancer. ANATOMY: The infratemporal area is a basically pyramidal shaped, very deep region of the face. The base of the pyramid formed by the medial aspect of the ramus is triangular and the upper surface of the pyramid is the floor of the skull. The anteromedial aspect corresponds to the posterior aspect of the maxillary bone and the posteroinferior aspect to the pterygomaxillary fascia. INDICATIONS: This type of surgery is generally indicated for locoregional cancers and exceptionally for benign tumors originating in this area, e.g. angiomas, neurinomas of the dental or lingual nerve, either as single tumours or as part of a Recklinhausen disease. Most often, the surgeon is faced with the problem of infra-temporal invasion of a tumour originating outside the area: malignant tumour of the sinus (epidermoid epithelioma), salivary glands, bone tumours, etc. The main problem is naturally to determine the route of access, via the ramus, the parotid, the maxillary sinus or the submandibular region. In the author's opinion, the upper route via a coronal incision combined with a lifting incision on the same side is a particularly interesting approach. Different situations may arise: parotidectomy is required with preservation of the VIIth nerve, resection of the ramus or anterior section, making it possible to fold back the lateral part involved and thus provide sufficient access.

[The trapezoid face: transversal excess in the maxillary area]. / Le visage trapézoïdal: excès transversal au niveau de l'étage inférieur de la face.

The patient who consults for "big cheeks" usually desires correction for an excess of tissue in the masseter region. First all neoplastic pathologies recognized by their unilateral asymmetry are excluded in order to focus on bilateral phenomena. Three anatomical elements can be responsible either alone or in association for this excess: the parotid gland, the masseter muscle and the angle of the jaw. The clinical and complementary examinations leading to the etiological diagnosis are described. The treatment recommended is specific to the structure involved and is not necessarily surgical.

[Radiologic pitfalls of mandibular fractures]. / Pièges radiologiques des fractures mandibulaires.

Analysis of a large series of patients treated for mandibular fractures showed pitfalls in assessment of radiologic images in six cases. Factors predisposing to these radiologic pitfalls are discussed, multiple radiographic projections being suggested if discordance exists between radiologic and clinical findings, to obtain maximum data from a three dimensional picture of the mandible.

[Cherubism. Apropos of a major case]. / Le chérubisme. A propos d'un cas majeur.

Cherubism is a benign, hereditary giant-cell lesion located in the mandible and both maxillaries, which appears during childhood as a painless bilateral swelling, progressing until puberty and then receding spontaneously without normally requiring any treatment. In a previous publication, the authors had presented the case of three young children from the same Algerian sibship, who were eventually all operated when surgery proved to be necessary. The case published in this presentation is that of a young Italian girl presenting with a monstrous form of cherubism. In view of this malignant form, the authors decided to perform surgical treatment in several steps in order to decrease this abnormality as much as possible, considering the physical and psychological consequences reported.

[Complex reconstruction of the lower lip. Apropos of various cases]. / Reconstruction complexe de la lèvre inférieure. A propos de quelques cas.

Preservation of buccal cavity relations raises problems when treating extensive defects of lower lip. After a review of anatomical features, several case reports are presented to illustrate the advantages and inconveniences of three interventions for labial reconstruction.

[mandibular reconstruction by free bone flaps with micro-anastomosis. Our current indications]. / Reconstruction mandibulaire par lambeaux libres osseux micro-anastomosés. Nos indications actuelles.

The frequency with which difficulties were encountered in the reconstruction of the continuity of the mandible led us to attempt to systematize our indications. Although grafts, composite pedicle flaps and prosthetic guides still have their appropriate applications. Local conditions are more and more frequently amenable to free flaps. The factors guiding our choice are presented in detail: physical conditions, etiology and anatomy of the defect. In addition, the reason for choosing the type of free flap--iliac crest, fibula or external brachial--is discussed.

[The maxillofacial surgeon faced with the HIV-positive patient: risks and prevention]. / Le chirurgien maxillo-facial face au patient H.I.V. positif: risques et prévention.

Prevention against the transmission of the HIV must be universal today, which means that it applies to all patients. Blood, tissues, the CSF are infected, but nasal secreta, tears and saliva are not contaminated unless they contain blood. The statistical risk of an HIV serological conversion when making an injection is an estimate of 0.1 to 0.3%, one hundred times less than with the hepatitis B virus. The best protection for maxillofacial surgeons, who are very exposed by the manipulation of objects (needle, wires) and by considerable projections of blood (rotary motor) is not a systematic HIV serological test for all patients, but goggles with side screens, a double pair of gloves and the use of an antiseptic acting on the HIV in case of staining.