Clinical image: Cervicofacial rotation skin flap in PLWD patients.

This article outlines a surgical protocol designed for people living with dementia (PLWD). It proposes that simultaneous resection and reconstruction of skin cancer can minimizes the need for initial care. The method outlined involves primary closure via a cervicofacial rotation flap technique and the use of monofilament resorbable sutures.

Retrospective study evaluating dental side effects of radiotherapy in patients treated for head and neck cancer.

INTRODUCTION: Head and neck cancer squamous cell carcinoma (HNSCC) is the seventh most common cancer worldwide with around 600,000 new diagnosis each year. Nowadays, in locally advanced disease, radiotherapy (RT) play an important role, this with or without chemotherapy in organ preservation strategies. More specific for early stage localized disease, RT (or surgery) seems to give similar results on locoregional control (LRC) and choice is made according to the organ preservation issue. Despite the fact that technical improvements have been made to optimize the radiation dose delivery and minimize the normal tissue toxicity, RT is associated with potential early and late toxicities. Osteoradionecrosis of the jaw (ORNJ), especially seen after teeth extraction, is one of the associated toxicities and can significantly impair the patient's quality of life. Because of the fear of developing ORNJ, one is very reluctant to extract or place a dental implant post-radiotherapy, especially in high irradiation dose zones (>40 Gy). Hence, it is important to define teeth at risk of future extraction before initiating RT and to handle those in high-risk irradiation zones. In order to optimise extractions, we created a predictive model of the expected irradiation dose, and thus the need for extraction, to the teeth bearing bones. The aim of this study is to validate our model and to define the potential relationship between the radiation dose received by each tooth and the dental complications observed. MATERIAL AND METHODS: Between March 2012 and March 2018, patients with HNSCC treated by intensity modulated RT were retrospectively analysed. The mean irradiation dose for each tooth was generated on the administered treatment plan by contouring each tooth separately on each dosimetric scan section using dedicated software (Eclipse, Varian). In order to validate our predictive model, we compared the actual generated/administered teeth irradiation doses with the irradiation doses predicted by our model. RESULTS: Our predictive model was accurate in 69.6% of the cases. In 12.5% of cases the predicted dose was higher than the calculated dose and lower in 17,8% of the cases. A correct- or over-estimation (is the latter being clinically less worrying than an underestimated dose) was achieved in 82% of cases. For the 18% of cases underfitting, the mean margin of error was 5.7 Gy. No statistically significant association was found between the development of caries and doses to the teeth, doses to the parotid glands or dental hygiene. However, a significant association between dental irradiation at more than 40 Gy and the occurrence of dental fractures (p = 0.0002) were demonstrated. CONCLUSIONS: Our predictive model seems to be 82% accurate for dose prediction, hence might be helpful for optimizing/minimizing prophylactic extractions. Indeed, following our model, professionals could decide not to extract damaged teeth in areas not at risk of ORNJ, lowering morbidity during and after RT. Contrary to the literature, no relationship was found between the occurrence of dental caries and parotid irradiation and the patient's oral hygiene. However, for the first time, a highly significant correlation between the occurrence of dental fracture and dental irradiation at more than 40 Gy was observed.

Healing of particulate allografts mixed with platelet concentrates in ridge preservation and sinus lift: a prospective histomorphometric study.

The objective of the present study was to evaluate the bone quality of sinus and alveolar grafts following filling with particulate allogenous bone (DFDBA 300-500µm) and platelet concentrate (platelet-rich fibrin, PRF). A prospective interventional clinical study was carried out. A total of 40 bone cores, 2mm in diameter, were taken from 21 patients: 22 from grafted alveoli, 7 from grafted sinus sites, and 11 from native bone used as a control. Fixed, paraffin-embedded samples were subjected to histological staining with hematoxylin-eosin and Masson's trichrome. Bone maturity of the samples was evaluated by two independent operators using histomorphometric analysis. There existed a greater proportion of lamellar neoformed bone than woven neoformed bone as the healing time increased. Moreover, there was also an increasing proportion of newly formed bone in the grafted sockets as a function of healing time (average: 41.22% ≤ 5 months, 55.89% Ëƒ 5 months). Resorption of DFDBA particles also appears to be correlated with healing time in the grafted socket (average: 15.43 ≤ 5 months, 13.72% Ëƒ 5 months). In conclusion, performing sinus lift and alveolar socket preservation techniques using DFDBA and PRF results in high quality, mature bone tissue according to histological criteria.

[Oral allergies]. / Les allergies orales.

Oral allergies to dental materials are a growing problem and remain poorly diagnosed by health professionals. The complaints of patients with oral allergy are various and include sensations of burning or stinging of the oral mucosa, sensations of dryness of the oral cavity, or general symptoms such as headache, dyspepsia, asthenia, arthralgia, and myalgia. Signs suggestive of oral allergy include erythema, edema, purpuric patches on the palate, ulcerations of the oral mucosa (canker sore), gingivitis, glossitis mimicking geographic tongue, angular cheilitis, peri-oral eczema or the presence of lichenoid reactions of the oral mucosa. The diagnosis of an allergy will include data from the anamnesis, the clinical examination, as well as the results of allergy tests: epicutaneous tests (patch tests) or cutaneous tests (prick tests), possibly completed by a blood test ( in vitro lymphoblastic transformation test ou LTT).

Les allergies orales aux matériaux dentaires représentent un problème croissant et demeurent peu diagnostiquées par les professionnels de la santé. Les plaintes des patients présentant une allergie buccale sont variées et compor tent des sensations de brûlures ou de picotements de la muqueuse buccale, des sensations de sécheresse de la cavité buccale ou des symptômes généraux de type céphalée, dyspepsie, asthénie, arthralgies, myalgies. Les signes qui peuvent faire suspecter une allergie de la cavité buccale sont la présence d'un érythème, d'un oedème ou piqueté purpurique du palais, des ulcérations de la muqueuse buccale (aphtes), une gingivite, une glossite dépapillante, une perlèche, un eczéma péribuccal ou encore la présence de réactions lichénoïdes de la muqueuse buccale. Le diagnostic d'une allergie comprendra les données de l'anamnèse, de l'examen clinique, ainsi que les résultats des tests d'allergies : tests épicutanés (patch tests) ou cutanés (prick tests), complétés éventuellement par un test sanguin (test de transformation lymphoblastique in vitro ou LTT).

[Risk factors generally neglected in oral surgery and implantology: the high LDL-cholesterol and the insufficient level of vitamin D]. / Des facteurs de risque généralement négligés en chirurgie orale et en implantologie : le taux élevé de LDL-cholestérol et le taux insuffisant de la vitamine D.

INTRODUCTION: Vitamin D deficiency is widespread throughout the world. Vitamin D has an important role in the regulation of phosphocalcic metabolism as well as in a large number of biological and metabolic processes. According to some studies, there is a correlation between vitamin D and LDL-cholesterol levels. A deficiency of vitamin D and / or a high level of LDL-cholesterol could represent risk factors for bone healing and osteointegration of dental implants. The purpose of our study is to demonstrate the reality of the problem of deficiency or deprivation in vitamin D in a population of patients requiring oral and / or implant surgery. MATERIAL AND METHODS: 46 cases of patients having undergone oral surgery together with preoperative blood test were analyzed. The results of the dosages of 25-hydroxy-vitamin D (25-OH-D), total cholesterol, LDL-cholesterol, HDL-cholesterol were collected and compared with reference values. Statistical tests were performed to determine the possible correlations between the 25-OH-D level and other blood parameters. RESULTS: 38 patients out of 46 (82.6 %) are defective in vitamin D, and 7 patients out of 46 (15.2 %) are deficient. LDL-cholesterol levels were high in 15 patients out of 33 (45.5 %). There was a non-significant correlation between LDLcholesterol and vitamin D levels. Total cholesterol was high in 42 % of patients. We observed a significant correlation between total cholesterol and vitamin D levels. CONCLUSION: According to our study, it appears that a preoperative assessment including the dosage of vitamin D, total cholesterol and LDLcholesterol may be of interest in patients requiring oral and / or implant surgery by correcting if necessary blood parameters and promoting bone metabolism.

INTRODUCTION: La déficience en vitamine D est largement répandue dans le monde. Or la vitamine D a un rôle important dans la régulation du métabolisme phosphocalcique ainsi que dans un grand nombre de processus biologiques et métaboliques. Selon certaines études, il existerait une corrélation entre le taux de vitamine D et le taux de LDL-cholestérol. Une déficience en vitamine D et/ou un taux élevé de LDL-cholestérol pourraient représenter des facteurs de risques de cicatrisation osseuse et d'ostéointégration d'implants dentaires. Le but de notre étude est d'objectiver, dans une population de patients devant bénéficier d'une chirurgie orale et/ou implantaire, la réalité du problème de déficience ou de carence en vitamine D. Matériel et méthode : 46 dossiers de patients ayant bénéficié d'une intervention chirurgicale buccodentaire et d'une prise de sang ont été analysés. Les résultats du dosage de 25-hydroxyvitamine D (25-OH-D), cholestérol total, LDL-cholestérol, HDL-cholestérol ont été recueillis et comparés aux valeurs de références. Des tests statistiques ont été réalisés afin d'établir les corrélations éventuelles entre le taux de 25-OH-D et les autres paramètres sanguins. Résultats : 38 patients sur 46 (82,6 %) sont déficients en vitamine D, et 7 patients sur 46 (15,2 %) sont carencés. Le taux de LDLcholestérol est élevé chez 15 patients sur 33 (45,5 %). Il existe une corrélation non significative entre le taux de LDL-cholestérol et le taux de vitamine D. Le taux de cholestérol total est élevé chez 42 % des patients. Nous observons une corrélation significative entre le taux de cholestérol total et le taux de vitamine D. CONCLUSION: D'après notre étude, il apparaît qu'un bilan préopératoire incluant le dosage de la vitamine D, du cholestérol total et du LDLcholestérol pourrait s'avérer intéressant afin de corriger si nécessaire ces paramètres sanguins et favoriser le métabolisme osseux dans un contexte de chirurgie orale et/ou implantaire.

[Use of extraoral implants for nasal rehabilitation with epithesis after carcinologic surgery. A case report]. / Utilisation d'implants extra-oraux dans le cadre d'une réhabilitation nasale par une épithèse après exérèse carcinologique. Présentation d'un cas.

Maxillofacial defect caused by cancer treatment represents a problem affecting the quality of life of patients. Epithethic solutions are indicated if plastic surgery reconstruction is not a valid option for an extensive defect. We present the case of a 42 years-old woman, who had undergone a total nasal resection, for a well-differentiated epidermoid carcinoma of the tip of the nose. The anatomopathologic analysis of the piece of resection showed free margins, and did not reveal any ganglionar metastasis. No radiotherapy was applied. Three months later, four extraoral implants were placed in the frontal and paranasal areas with a transcutaneous approach, in order to avoid crusting resulting from trans-nasal mucosa emergence of the fixtures. After four months, each implant as a bone anchorage was connected with a prosthetic retention device to be connected to the nasal epithese. After four weeks, cutaneous healing allowed the prosthetic steps to be achieved. The use of extraoral fixtures as bone anchorage for a nasal epithesis represents an alternative to more heavy and time-consuming surgical reconstruction techniques. Another advantage is that the site can be monitored easily because the epithesis is removable, as for the carcinologic follow-up. It allows a good retention of the nasal epithesis and an esthetic result which is satisfying for the patient.

[Allergies to dental metals. Titanium: a new allergen]. / Les allergies aux métaux dentaires. Un allergène émergent: le titane.

Oral allergies are underdiagnosed by dental health professionals. Patients with an oral allergy complain of various symptoms such as burning or tingling sensations, with or without oral dryness or loss of taste, or of more general symptoms such as headache, dyspepsia, asthenia, arthralgia, myalgia. The signs of oral allergy include erythema, labial oedema or purpuric patches on the palate, oral ulcers, gingivitis, geographical tongue, angular cheilitis, perioral eczematous eruption, or lichenoid reactions localized on the oral mucosa. There is an increase in the prevalence of oral allergies to metals used in dental materials. Allergy to gold included in dental prosthesis has been well documented since the years eighties. Recently, titanium, used in orthopedic devices and oral implants, considered as an inert material, can induce toxicity or allergic type I or IV reactions. These reactions to titanium could be responsible for unexplained successive failure cases of dental implants in some patients (named "cluster patients"). The risk of an allergy to titanium is increased in patients who are allergic to other metals. In these patients, an evaluation of allergy is recommended, in order to exclude any problem with titanium medical devices. We stress the importance of a multidisciplinary approach to take into account patients with an oral allergy, with participation of specialists from dental and dermatologic fields.

Oral allergies to dental materials.

Oral allergies represent a pathological entity not well known nor diagnosed by dental health professionals. The purpose of this work is to present an information relative to the multidisciplinary steps to be done to solve allergy problems. Three clinical examples of contact oral allergies (to mercury, or gold, or methacrylates) are presented, as to illustrate signs and symptoms of an oral allergy to the more frequent dental materials implied.We discuss the problem of oral allergies from what is known from the scientific literature. We stress the importance of a multidisciplinary approach to take into account patients with an oral allergy, with participation of specialists from dental and dermatologic fields.

[The use of platelet concentrates: platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) in bone reconstruction prior to dental implant surgery]. / L'intérêt de l'utilisation des facteurs plaquettaires de la coagulation: platelet-rich plasma (PRP) et platelet-rich fibrin (PRF) dans la reconstruction osseuse pré-implantaire.

The autologous platelet concentrates--Platelet-Rich Plasma (PRP) and Platelet-Rich Fibrin (PRF)--are used in various medical fields, particularly in oral and maxillofacial surgery. These concentrates contain high levels of growth factors, including the 3 isomers of PDGF (platelet-derived growth factor), 2 of the numerous transforming growth factors (TGF-beta), the insulinlike growth factor (IGF), the epithelial growth factor (EGF) and the vascular endothelial growth factor (VEGF), which are the key elements in wound healing, particularly in bone regeneration. Platelet concentrates are easy to apply in clinical practice and offer potential benefits including rapid wound healing and bone regeneration, and can therefore be considered to be new therapeutic adjuvants. In dental implant surgery they are used in bone reconstruction prior or concomitant to implant procedures, and also for dental extraction socket preservation. Their use result in enhanced bone graft density and maturation. A literature review on the use of PRP/PRF in maxillofacial and dental implant surgery is proposed.

[Precancerous and cancerous lesions of the oral cavity]. / Les lésions précancéreuses et cancéreuses de la cavité buccale.

Precancerous states of the oral mucosa refers to pathologies in which there is a risk of malignancy development, compared to normal mucosa. Some histological alterations characteristic of precancerous lesions can be easily detected in a biopsy of the lesion, allowing their classification, and hence adequate treatment. A systematic examination of the oral mucosa in patients is recommended, especially in patients who show risk factors such as tabagism and/or alcohol consumption, in order to contribute to a decrease in the incidence of malignant tumor of the oral cavity.

[Osteochemonecrosis of the jaws and bisphosphonates: a case report and literature review]. / Ostéochimionécrose maxillo-mandibulaire et bisphosphonates. A propos d'un cas et revue de la littérature.

Jaws osteonecrosis were, in most cases, caused by external irradiation. It was otherwise a rare occurrence. However, bisphosphonates have recently been associated with osteonecrosis of the mandible or the maxilla. Bisphosphonates are widely used in the treatment of osteoporosis, multiple myeloma and osteolytic bone metastases. They inhibit bone resorption by osteoclasts and disrupt the bone turnover. The so-caused bone expositions are painful and prone to surinfection. Even after cessation of the bisphosphonates, the results of medical and surgical treatment are very inconsistent. A thorough dental check-up is recommended before initiating a course of bisphosphonates.

[Expression of caspase 3 and p53 during physiological apoptosis and apoptosis induced by three teratologic agents during early craniofacial development of the mouse embryo]. / L'expression de la caspase 3 et la protéine p53 au cours de l'apoptose physiologique et induite par 3 agents tératogènes au cours du developpement crânimofacial précoce de l'embryon de souris.

The neural crest-derived mesectoderm gives rise to physiologic apoptosis areas in early vertebrate embryos. Certain teratologic agents increase this phenomenon. The purpose of this work was to detect caspase 3 (which is associated with the apoptosis cascade) and p53 in cell death areas, both during physiological apoptosis and during apoptosis induced by three agents (retinoic acid, methyl-triazene, irradiation). Antibody revelation was performed using the aBC peroxidase kit. Quantifications were also performed on histological sections. We observed caspase 3 uptake on some apoptotic and preapoptotic cells in control embryos, and in the embryos exposed to the three teratogens. Immunoreactivity generally preceded the development of cytological features of apoptosis. However, p53 was expressed only in the embryos exposed to ionizing radiation and methyl-triazene (an alkylating agent), but not significantly in embryos exposed to retinoic acid. The present results throw some light on apoptosis mechanisms in several teratologic conditions.

[Oral verrucous carcinoma]. / Le carcinome verruqueux oral.

Verrucous carcinoma is a rare, low-grade, well-differentiated form of squamous cell carcinoma seen on skin and mucosa. It is a slow-growing and locally aggressive tumor whose standard treatment is surgery. A case of strongly invasive oral verrucous carcinoma is presented with the medical history. The differential diagnosis of this neoplasm is difficult and requires clinic and pathologic data confrontation. In this paper, the importance of knowing the malignant potential of this lesion is stressed. Indeed, in 20% of verrucous carcinoma, foci of squamous cell carcinoma can be found. A review of literature and a differential diagnosis of verrucous carcinoma are presented.

[Histologic and ultrastructural features of cell death both physiological and induced by two different teratogens in branchial arches of mouse embryo]. / Aspects histologiques et ultrastructuraux de la mort cellulaire programmée et induite par deux agents tératogènes dans les arcs viscéraux de l'embryon de souris.

AIM OF THE STUDY: To observe and compare cell death process both physiological and associated with the administration of two different teratogens (irradiation and retinoic acid) inside cephalic mesectoderm. MATERIAL AND METHODS: Irradiated mice: 2 Gy were administered to E 9 embryos. Retinoic acid: 60 mg/kg were gave to E 8 or E 9 embryos. E 9 - 9.5 and E 10 embryos were removed. E 9 - E 9.5 and E 10 control specimens were collected. We used semi-thin sections and ultra-thin sections observed with transmission electron microscope. RESULTS: The major process is apoptosis, which is increased in experimental embryos compared to control specimens. However, autophagy was observed in retinoic acid-treated embryos, while necrosis can rarely occurs after irradiation. CONCLUSION: If the common process seems to be apoptosis, both teratological models differs owing to their respective secondary features. These differences should be explained by the specific pathogenesis of both teratological agents: ligand-receptor reaction and Hox system disruption in retinoic acid administration, direct aggression against DNA and diffuse cell death process following irradiation. Furthermore, congenital malformations induced by these teratogens are quite different. This can be partially explained by a specific blow of different cellular subpopulations.

[Heat shock proteins, embryogenesis and evolution]. / Protéines de choc thermique, embryogénèse et évolution.

We present results about immunohistochemical identification of several heat shock proteins (HSP'S) during mouse normal and teratological embryogenesis. Apoptotic cells express very specifically and precociously HSP 110. This fact permits to identify apoptotic cells before apparition of morphologic features of apoptosis, but also to quantify the process of cell death in some teratological models, particularly administration of retinoic acid. HSP 86 is expressed in some cell populations, and particularly permanent in germ cells. Our observations brought us to discuss the potential protective role of HSP on germ cells, and the consequence of their inactivation in the macroevolution process, as well as the role of apoptosis in teratology.

[The stomatology and maxillo-facial surgery department]. / Le Service de Stomatologie et de Chirurgie Maxillo-Faciale.

Initially devoted to emergencies, the Department of Oral and Maxillofacial Surgery has grown considerably since 1979. The department now consists of a Maxillofacial Surgery Unit supplemented by several specialised Units in charge of oncology, orthodontics and orthognathic surgery, implantology and all dental specialities. The main themes of research developed in the department include the healing process of oral tissues, the teratogenic effects of various compounds on the cranio-facial region, the study of apoptosis, the role of heat shock proteins, and the management of craniofacial dysmorphosis. These studies have a direct impact on patient management.

Chaperones in the parotid gland: localization of heat shock proteins in human adult salivary glands.

Heat shock proteins (HSPs) are expressed or increased in response to various biological stresses. Moreover, these 'stress proteins' seem to be expressed by some cells living in physiological conditions. From then on, they could play an important physiological role in normal cell functioning. The best-known physiological role of these HSP proteins is to act as 'molecular chaperones'. In this context, we have investigated the immunohistochemical expression of HSP27, HSP70, HSP90 and HSP110 in 10 human adult salivary glands. To highlight the presence of RNAm encoding HSP70, an in situ hybridization was performed. In our material, HSP27 was strongly expressed in the cytoplasm of striated duct cells and in some myoepithelial cells. The same localization was less stained for HSP70 and HSP90. The immunocytochemical reaction was weak or negative for HSP110 in striated ducts. HSPs were not expressed in acinic cells. In situ hybridization gave a positive signal in striated ducts with a probe encoding HSP70. Epithelial cells of the striated ducts and myoepithelial cells expressed HSP27, HSP70 and HSP90. These HSPs probably act in part as molecular chaperones for protein synthesis, transport and for several interactions between HSPs and different proteins.

[Expression of heat shock proteins in salivary gland tumors. Immunohistochemical study of HSP27, HSP70, HSP90, and HSP110: apropos of 50 cases]. / Expression des protéines de choc thermique dans les tumeurs des glandes salivaires.

Heat shock proteins (HSPs) are known to be increased in response to biological stress. Recently some authors described their presence in tumors. Our immunohistochemical investigations revealed the expression of HSP27, HSP70, HSP90 and HSP110 in most of benign tumors of salivary glands (33 cases). In the malignant tumors, the reaction was immunopositive for HSP70 and HSP90 in 13/17 cases; but HSP27 and HSP110 were only expressed in 5/17 cases. In conclusion HSPs were expressed less in malignant than in benign cells. These results suggest that the loss of some HSPs may be a possible sign of malignancy.