[Langerhans cell histiocytosis revealed by a temporomandibular joint disorder: Report of a case and review of the craniofacial expressions]. / Histiocytose langerhansienne révélée par un désordre de l'appareil manducateur : rapport d'un cas et revue de la littérature des atteintes crâniofaciales.

INTRODUCTION: Langerhans cell histiocytosis (HL) is a rare disease that can affect all tissues. Oral manifestations such as mucosal ulcer and tooth mobility are often the first signs of the disease. We report a rare case of mandibular condyle unifocal HL mimicking a temporomandibular joint disorder. CASE REPORT: A 44-year-old patient presented with a left temporomandibular disorder with painful left preauricular swelling. The imaging assessment found a bone lesion of the left mandibular condyle. A curettage with biopsy was used to diagnose HL. Six months later, the patient had no more pain. DISCUSSION: The craniofacial clinical expressions of HL mainly concern the bones, which can cause: pain, swelling, fracture, compression of noble organs. The other sites are: oral cavity, skin, lymph nodes, or eyes. Isolated forms are generally benign, and their treatment is discussed between abstention and non-aggressive surgery.

Management of an extended bone-invasive basal cell carcinoma of the median forehead.

We report the case of a 35-year-old male patient managed for extended basal cell carcinoma of the median forehead, invading the frontal bone. Bone reconstruction was performed by a splitting of calvaria and skin reconstruction was performed using two frontal flaps dissected into complete vascular island, covering a skin defect of about 8cm in diameter (including safety margins). Wound healing was achieved after 4 weeks despite a median area of suffering and a temporary leak of cerebrospinal fluid of favorable evolution. The result at 5 years was excellent, with the patient's return to normal daily life and total satisfaction.

Nasomaxillary fracture: Retrospective review of 11 consecutive patients and literature review.

PURPOSE: Nasomaxillary fractures can be mistaken for fractures confined to the nasal bones, resulting in inappropriate treatments that jeopardize patient outcomes. Our purpose here was to provide information on nasomaxillary fractures via a retrospective study and literature review. MATERIAL AND METHODS: We retrospectively collected clinical, computed tomography (CT), therapeutic, and outcome data in consecutive patients managed for unilateral impacted nasomaxillary fractures at our centre over a 5-year period (2013-2017). Long-term outcomes were further assessed by administering scoring tools for subjectively assessed cosmesis, nasal obstruction, and pain during a telephone interview. RESULTS: The 11 included patients had a mean age of 33.4 years. The clinical manifestations included nasal asymmetry in all 11 patients and infra-orbital rim step-off deformity in 9 patients. Consistent CT findings were involvement of the nasal bone, canine pillar, and anterior maxillary bone; and presence of blood within the maxillary sinus. The treatment in 8 patients consisted in open reduction and internal fixation via the intraoral approach, with or without an added infra-orbital approach; 1 patient was managed by endonasal reduction and 2 patients declined reduction. Almost 1 year after surgery, the cosmetic outcome was good (mean score, 22/25) and few patients reported nasal obstruction (mean score, 3.6/20) or pain (mean score, 1.6/10). CONCLUSION: Nasomaxillary fracture is a specific entity that must be differentiated from nasal bone fracture. Open reduction and internal fixation via the intraoral approach, with an added infra-orbital approach if needed, provides good outcomes.

Dental implants in a patient with left mandibular fibrous dysplasia: Two-year outcomes on the normal and affected sides.

Dental rehabilitation raises specific challenges in patients with mandibular fibrous dysplasia. We report the 2-year post-operative outcomes on the normal and affected sides in a 64-year-old female with focal left mandibular fibrous dysplasia and bilateral posterior edentulism. On the left, bone shaving of the lesion to restore sufficient vertical height was followed by the insertion of two dental implants. Three dental implants were inserted into the normal bone on the right. Dental prostheses were added 6 months later. Two years after the first procedure, no complications had been recorded and the patient reported similar high satisfaction for both sides. This comparison of outcomes of dental implants inserted into dysplastic versus normal bone in the same patient suggests that dental implants may constitute a valid option for managing edentulism in selected patients with fibrous dysplasia, provided appropriate precautions are taken.

Maxillary metastasis from a hepatocellular carcinoma: Report of an uncommon presentation and literature review.

INTRODUCTION: Oral metastases from hepatocellular carcinoma (HCC) are very rare, and predominate in the mandible. We report an exceptional case of maxillary metastasis revealing HCC. CASE REPORT: A 56-year-old man with a previous medical history of alcohol abuse presented to our department with a 3-week evolving oral mass. Physical examination showed a left maxillary tumor. The biopsy revealed a HCC and a multi-metastatic HCC with portal thrombosis and a pulmonary embolism was discovered following a CT-scan. A state of advanced malnutrition contraindicated sorafenib chemotherapy. Thus, external irradiation was proposed, without success. The patient subsequently died 50 days later. DISCUSSION: Maxillary HCC metastases are extremely rare. The average age of HCC jaw metastases appearance in patients has been reported to be approximately 57 years, men are more affected than women are, and the mean life expectancy is 12 months following the diagnosis. These patients require palliative treatment. Local recurrences occur very early after possible surgery, and expose the patient to life-threatening bleeding.

Secondary surgical decompression of the inferior alveolar nerve after overfilling of endodontic sealer into the mandibular canal: Case report and literature review.

The authors report the case of a 43-year-old woman who underwent endodontic treatment of the right second mandibular molar with substantial extrusion of endodontic material into the mandibular canal. The patient presented at the Department of Oral and Maxillofacial Surgery with a persistent total anaesthesia of the lower lip and chin after two months. 2D panoramic view and 3D CT-scan examination highlighted the overfilling into the mandibular canal with a more than 50% stenosis of the canal and a consequently significant compression of the dental pedicle. A surgical decompression of the inferior alveolar nerve was performed through an inferior vestibular approach, using PiezoSurgery®. The tooth was conserved. After a period of 8days, paraesthesia of the lower lip and chin appeared. Thermoalgic sensitivity was recovered at 1month. At 3months postoperatively, the patient had recovered protopathic and epicritic sensitivity. Dental prosthetic rehabilitation was finally achieved one year postoperatively. The authors discuss the physiopathology of nervous injuries during dental procedures, and further strategies in the case of persistent neurologic disorders.

Lateral skull base chondroblastoma resected with facial nerve posterior transposition.

INTRODUCTION: Chondroblastoma is a rare tumor that can involve the temporal bone. Because it is a benign tumor, functional surgery must be proposed. We report a case of a patient with a massive chondroblastoma operated on with preservation of the facial nerve, and description of the surgical technique. CASE PRESENTATION: A 37-year-old man presented with a 9-month history of a growing left pre-auricular mass and hearing loss. Neuroimaging showed an osteolytic mass invading the temporal bone and temporomandibular joint. Excision was performed via a transpetrosal and transcochlear approach with posterior transposition of the facial nerve. EMG monitoring was effective in preventing facial palsy. Four years later, no sign of recurrence was observed. DISCUSSION: Chondroblastoma is a locally aggressive tumor, especially when located in the petrous bone and temporomandibular joint. The suggested treatment is a complete excision.

[Original three-dimensional reconstruction of a case of metopism associated with a unilateral complete absence of the left frontal sinus: Clinical interest and review of the literature]. / Représentation tridimensionnelle originale d'un cas de métopisme associé à une agénésie unilatérale complète du sinus frontal gauche : intérêt clinique et revue de la littérature.

Metopism (complete persistence of the metopic suture in adults) is a rare but not exceptional variation of the calvaria. Hypoplasia or aplasia of the frontal sinus may be associated without evident correlation. Nevertheless, a misdiagnosis of these variations may have clinical consequences, especially in a traumatic context. The aim of this paper was to report a case of metopism associated with a unilateral aplasia of the left frontal sinus, originally illustrated with 3D image fusion volume rendering reconstructions.

Lower lip cancer: Mohs micrographic surgery and reconstruction as a multidisciplinary effort.

Lower lip cancer treated as a multidisciplinary effort has advantages in cost savings, conservation of tissue, and tumor elimination. This article discusses the technique of eradication of the lesion by the Mohs micrographic surgeon and secondary reconstruction by the oral and maxillofacial surgeon, and illustrates the results of this cooperative effort.

Infiltrating lipomas of the upper extremities.

The typical lipoma is an encapsulated subdermal tumor, usually easily removed if necessary. We recently encountered two lipomas that infiltrated muscles of the forearm. Excision of infiltrating lipomas may be complicated by their deep location and potential involvement of vascular and neural structures. This paper should increase dermatologists' awareness of this uncommon variant and facilitate appropriate referral for definitive treatment. We believe that this is the first report in the dermatologic literature of infiltrating lipoma of the upper extremity.

Nasal cartilage fenestration in the application of full-thickness skin grafts.

A technique is described that enables the application of full-thickness skin grafts to bare cartilage exposed in surgical wounds on the nose. By fenestrating the cartilage so that the lining on the inner side is exposed, the graft is able to receive a blood supply adequate for its survival.

Button bolsters in dermatologic surgery.

Ordinary plastic buttons may be used as bolster devices to relieve tension across wounds. This article describes the method of placement of those "button bolsters" and suggests two methods of closing the wound once they are in place. This simple technique is easily mastered and gives additional wound closure security in the initial phase of wound healing.

Surgical pearls.

This article contains a potpurri of surgically related stratagems, alternative techniques, and philosophies. These surgical pearls have been selected for their simplicity, usefulness, and applicability.

Visualized basting sutures in the application of full-thickness skin grafts.

This paper describes a simple technique for inserting basting sutures to secure full-thickness skin grafts. By applying the suture under visualized conditions before fully securing the perimeter of the graft, exact placement and knot security of the basting suture can be enhanced, and injury to underlying structures can be avoided. Furthermore, by securing the center of the graft early in the repair, alignment on and conformation to the underlying wound bed is improved.

The suspension suture.

The suspension suture is a tension-reducing stitch that anchors the undersurface of a flap or elliptical wound edge to the underlying periosteum. The technique of placing the stitch is described and the indications for and the benefits derived from its use are discussed.