Optimized centrifugation preparation of the platelet rich plasma: Literature review.

Nowadays, the Platelet Rich Plasma (PRP) is frequently used for its therapeutic effects on wound healing, and this due to secretion of many growth factors. However, no standardized procedure has been set up. The aim of this article is to check the various preparations (centrifugation time and speed). This review recorded all the international articles published between 2007 and 2018, for which the assessment criteria were the platelet concentration and/or the growth factor release rate. A multitude of protocols has been looked at with a simple or double centrifugation. All of them have shown an increase in the platelet concentration allowing a therapeutic effect. However, when the centrifugation force is extended, platelets can possibly be altered. The diversity of methods can be linked to the use of various centrifuges. A procedure with simple centrifugation would be a good compromise for the day-to-day use of the PRP in surgery.

The mucous cyst, a rare and delayed complication after rhinoplasty.

INTRODUCTION: Rhinoplasty is frequently performed worldwide, and patients and surgeons both expect good cosmetic results without any deformity recurrence. We report a rare case of mucous cyst occurred after post-traumatic rhinoseptoplasty. OBSERVATION: A 27-year old woman presented a median mass of the nose root 7 years after prior rhinoseptoplasty. Investigations showed a subcutaneous lesion of 10.5×24.5mm. The surgery consisted on an external rhinoplasty allowing cyst removal, bilateral osteotomies and reconstruction of the nasal dorsum by deep temporal fascia graft. Histological examination confirmed the diagnosis of begnin mucous cyst. No recurrence was observed at 1-year follow-up. DISCUSSION: Mucous cyst post rhinoplasty is rare and is probably due to accidental mucosal material implantation into the subcutaneous plane during rhinoplasty. This complication can be avoided by adequate infiltration and hydrodissection, careful dissection, and avoidance of unnecessary trauma during osteotomies.

[Orbitofrontal bone reconstruction with cutting guides]. / Reconstruction orbito-frontale osseuse sur mesure par guides de coupes.

INTRODUCTION: Reconstruction of craniofacial defects due to traumatic injuries is a challenge for a reconstructive surgeon, given the functional impact, the aesthetic impact and the geometric complexity of the craniofacial skeleton. The use of cutting and repositioning guides enables a new approach from the craniofacial reconstruction with bone grafts on measure. We are presented to illustrate this technique the case of a patient. OBSERVATION: The patient was 50 years old, he presented a traumatic facial sequelar: a left frontal craniofacial deformation, an enlarged left orbit with enophthalmos and valgus left zygoma. The patient had a permanent diplopia, an important aesthetic and social gene impeding daily life. Surgical planning was performed for optimal care. We performed a cranioplasty frontotemporal by bone parietal duplication, osteotomy of zygoma and intra-orbital bone graft customized using cutting guides. The bone pieces were positioned with the repositioning books. DISCUSSION: This presentation illustrates a novel application of cutting guides. This technique has the advantage of using customized autologous bone. This is the gold standard, it requires surgical experience.

Posterior cranial vault distraction osteogenesis in craniofacial surgery: Technical note.

INTRODUCTION: Posterior cranial vault distraction is a treatment for intracranial hypertension in certain cases of craniosynostosis and faciocraniosynostosis. It allows the harmonization of the skull back and prevents turricephaly. This study presents the surgical technique. TECHNICAL NOTE: Posterior cranial vault distraction osteogenesis consists of a circular osteotomy of the skull back. Four distractors are placed on the cranial flap without detachment of the dura mater. The distraction is carried out over nearly 1 month with an objective of 20mm. The technique's effectiveness is judged on the correction of the skull back shape and the disappearance of clinical and radiological signs of intracranial hypertension. DISCUSSION: Posterior cranial vault distraction osteogenesis enables a large increase in cranial volume and a correction of the dysmorphic skull back. This easy surgery and the low rate of complications make this technique a main surgical approach in the management of faciocraniosynostosis.

Frontal cranioplasty in fronto-metaphyseal dysplasia.

INTRODUCTION: Fronto-metaphyseal dysplasia (FMD), also called Gorlin-Cohen syndrome, is a rare syndrome initially described in 1969 by Gorlin and Cohen. Patients present skeletal dysplasia, craniofacial malformations and digit abnormalities. Craniofacial phenotype of FMD is characterized by supraorbital hyperostosis, hypertelorism, down-slanting palpebral fissures, broad nasal bridge and micrognathia. Here, we report the first adult case of craniofacial reconstruction with frontal cranioplasty in a patient with FMD. OBSERVATION: A 21-year-old male patient presented with aesthetic requests related to his facial abnormalities. The patient underwent a fronto-orbital cranioplasty using a coronal approach. Orbital, frontal and nasal hyperostoses were contoured in order to obtain a symmetric result. The patient had no postoperative complication. Aesthetic results were satisfactory and stable after 6 months of follow-up. DISCUSSION: The density and the quality of craniofacial bones were normal and this may account for the stability of cranioplasty results over time. Because bone was normal, cranioplasty is safety and stable in FMD.

Rapid maxillary expansion in adults: Can multislice computed tomography help choose between orthopedic or surgical treatment?

INTRODUCTION: The aim of this study was to evaluate the accuracy of Multislice Computed Tomography (MSCT) in the detection resistance areas on the midpalatal suture (MPS) and thus to evaluate if MSCT could be a help in the kind of maxillary expansion to be used (pure orthodontic or surgically-aided) for the correction of transverse maxillary deficiencies in adults. METHODS: Ten MSCT were obtained from 10 MPS removed from fresh corpses (mean age: 79.4; extreme: 70-86). Three standardized radiological regions of interest (ROI) were identified on each MPS and were classified into "open" (group 1) or "closed" (group 2) by 3 independent radiologists. The 30 ROI were then histologically analyzed according to 3 criteria: mean suture width (MSW), obliteration index (OI) and interdigitation index (Ii). RESULTS: Nine ROI were classified in group 1 (closed) and 21 in group 2 (open). On the histological examination, the mean MSW was 396.9µm in group 1 and 227.1µm in group 2. OI was 3.098% and 9.309% and Ii was 1.25 and 1.34 respectively. Statistically significant difference between the 2 groups was only found for the MSW. We conclude that MSCT allows for the evaluation of the width of the MPS, but not for the evaluation of the other possible parameters of resistance we used. Therefore, it cannot predict precisely the amount of résistance in the MPS and is not suited for the choice between pure orthodontic or surgically-aided expansion.

Rapid onset of squamous cell carcinoma in a thin skin graft donor site.

BACKGROUND: Squamous cell carcinomas are malignant tumours of epithelial origin that can appear on sites subjected to chronic inflammation after a period of several years. The rapid development of squamous cell carcinoma at the donor site for a thin skin graft is a rare and poorly understood situation. PATIENTS AND METHODS: We report the case of a patient undergoing thin skin grafting to cover the area of removal of a vertex squamous cell carcinoma and in whom squamous cell carcinoma appeared at the donor site within 9 weeks. DISCUSSION: In our case, we ruled out intraoperative contamination because two sets of surgical instruments were used. Given the number of cases reported in the literature, a chance event seems unlikely. The hypothesis of an acute inflammatory process caused by scarring of the thin skin graft site appears to us the most convincing. Development of cancer at the graft donor site may thus be added to the list of complications of thin skin grafting.

Orthognathic surgery improves quality of life and depression, but not anxiety, and patients with higher preoperative depression scores improve less.

This study assessed quality of life (QoL), depression, and anxiety before and after orthognathic surgery and identified risk factors for poorer postoperative outcome. This multicentre prospective study included 140 patients from five French medical centres. We assessed patients before surgery (T1), 3 months after surgery (T2), and 12 months after surgery (T3). We assessed the severity of the orofacial deformity, physical, psychological, social, and environmental QoL (WHOQOL-BREF), and depression and anxiety (GHQ-28). Risk factors for poorer outcome were identified using linear mixed models. Between baseline and 12 months, there was significant improvement in psychological and social QoL and in depression (although below the norms reported in the general population), but not in anxiety. Physical QoL was poorer in patients who were younger, who had a mild orofacial deformity, and who were depressed. Psychological QoL was poorer in younger patients and in depressed patients. Social QoL was poorer in patients who were single, who had a mild orofacial deformity, and who were depressed. Although orthognathic surgery provides a moderate improvement in psychological and social QoL, the systematic screening and treatment of depression could further improve QoL after surgery because it is a major predictor of poor QoL in this population.

[Fournier's gangrene: Cervical and facial extension. A very rare case]. / Gangrène gazeuse périnéo-fessière à extension cervico-faciale. À propos d'un cas exceptionnel.

Fournier's gangrene is a fearsome disease with a bad prognosis and a mortality rate ranging between 10 and 80% according to the literature. It is extensive in 13 to 54% of cases. Up to date, cervico-facial extension has never been reported. We describe the case of a 51-year-old overweighed woman with a history of type 2 diabetes and a narrow lumbar canal who was referred to our institution for significant fatigue and increasingly painful legs. A diagnosis of Fournier's gangrene was made after correlating the physical findings with the results of a full body scan. Diffuse subcutaneous emphysema involving the face, neck, mediastinum, abdominal wall, right buttock, perineum and the right thigh was identified. Treatment included multiple surgical debridements, admission to intensive care unit, and an efficient antibiotic therapy that enabled preservation of the patient's life. To our knowledge, this is the first case of cervical and mediastinal extension of Fournier's gangrene to be reported. No clear guidelines exit on the management of this complication (cervico-facial and mediastinal drainage). We share our experience of this unusual case.

Monsplasty after massive weight loss: Assessment of its aesthetic and functional impact.

INTRODUCTION: Massive weight loss frequently leads to a ptosis or a pubic bulge. This deformation is a source of functional as well as aesthetic discomfort, and it also has psychological repercussions. We have analyzed the degree of satisfaction reported by 23 female patients having undergone a monsplasty procedure and have also proposed a decisional algorithm designed to facilitate surgical care according to type of pubic deformation. MATERIALS AND METHODS: This is a one-year prospective study involving 23 female patients having undergone a monsplasty procedure following massive weight loss. The interventions were all carried out in standardized fashion by the same surgeon according to stage of deformation. Analysis of the patients' degree of aesthetic and functional satisfaction was performed using a questionnaire filled out during preoperative and postoperative consultations, the latter taking place 6 months to one year after the operation. It included a self-esteem assessment based on the Rosenberg scale, appraisal of functional benefits (clothing, sexual activity, daily physical activities, intimate hygiene) and evaluation of the pubis in aesthetic terms. RESULTS: Assessment of impact on self-esteem revealed average improvement of 10.08 points, rising from 25.87 to 35.95. All of the patients, without exception, were satisfied or very satisfied with the impact of monsplasty on the different items under evaluation. stage 3 and stage 4 patients were particularly sensitive to improvement involving personal hygiene, physical activities and the clothes they wore. In most cases, they likewise reported a positive impact on their sexual experience. CONCLUSION: Abdominoplasty or body lift without monsplasty can entail long-lasting aesthetic and functional discomfort. Thorough preoperative semiological analysis is essential to optimized surgical care conducive to successful integration of the monsplasty. An appropriate caretaking attitude enhances both the aesthetic result and patient self-esteem.

[Posttraumatic enophthalmos correction by bone graft: Why the unpredictable results?]. / Correction de l'énophtalmie post-traumatique par greffe osseuse: pourquoi des résultats inconstants?

PURPOSE OF THE STUDY: Posttraumatic enophthalmos cause complex cosmetic problems to fix. In order to get better results, we wanted to calculate the volume of parietal bone graft needed to be put in place, know where to place it in orbit and study soft tissues' participation. PATIENTS AND METHOD: In a retrospective study, we have calculated on scanner the volume of bone and soft tissue as well as the volume and the location of the graft. We have compared, between two groups ("good result" and "insufficient result"), graft volumes, taking into account differences in bone's volume between the healthy and the traumatized orbit. A comparison of the locations of the graft was also made. We were trying to find out if these factors were involved in the quality of the result. RESULTS: Twenty-nine surgeries on 24 patients were analyzed. The average bone's volume of an orbit with enophthalmos was 24.76 cm(3) for 17.12 cm(3) of soft tissue. Retro-lens distance was the most reliable measurement method of enophthalmos (P=0.001). There was a trend to a more substantial over-correction in the group "good result". A significant increase (P=0.0008) of soft tissue volumes in the traumatized orbit was found. CONCLUSION: This last result is surprising. Many authors believe that there is a scar retraction of soft tissues. But Kronish et al. showed an increase of the fat density and connective tissue. This, together with the assumption of a weathering of the ligament suspension of the globe, may affect our aesthetic results. MRI, ultrasound and anatomopathological studies would allow a better understanding of the fat, muscle and ligament pathophysiologies of an orbit with enophthalmos.

[Oropharyngeal toothbrush perforation in an infant]. / Plaie transfilante oropharyngée par une brosse à dent chez un nourrisson.

INTRODUCTION: Oral impalement injuries are common in children. We report a case of severe pharyngeal toothbrush perforation in a 15-month-old infant. OBSERVATION: A 15-month-old child was admitted for a penetrating oral injury caused by a toothbrush. There was no hemorrhagic or neurological complication. A CT scan showed the toothbrush in the right parapharyngeal region with its extremity in the mastoid region. Exploration and extraction of the toothbrush was performed under general anesthesia. The outcome was uneventful. DISCUSSION: Penetrating oral cavity wounds caused by a toothbrush in children may be severe and must be explored in the operating room. A preoperative CT scan must be performed to complete the assessment of lesions. The risk of infection is high and an antibiotic prophylaxis is recommended. Neurological and vascular complications may occur but they are rare.

[Improving the esthetic results and patient satisfaction in orthognatic surgery]. / Améliorer le résultat esthétique et la satisfaction du patient en chirurgie orthognatique.

The objectives of dental and maxillary defect management have changed over the last decade. Occlusal improvement is required, but it is expected to come with a good esthetic result for patients, especially for adults, and mentioned or not preoperatively. Thus, the maxillofacial surgeon must include complementary data in his therapeutic scheme, beyond the one provided by the cephalometric analysis. This chapter was drafted in pluridisciplinary mode to this end. A psychological approach and post-operative satisfaction are crucial factors that were studied prospectively (MD Battini and Courtois) and are a part of this chapter. Esthetic labial standard are also described, based on the results of a retrospective study (MD Hardy, Laure and Goga). Doctor Belhaouari presents solutions to embellish lips with filling products, initially or later. Finally, the complementary surgical techniques that can be used during orthognatic surgery are listed: lipofilling, rhinoplasty, surgery of mandibular angles, apposition of piriform aperture.

[CT-scan evaluation of calvarial bone donor site reconstruction using calcium phosphate cement]. / Évaluation tomodensitométrique de la reconstruction des sites donneurs calvariaux par ciment de phosphate de calcium.

UNLABELLED: The aim of reconstructing a calvarial donor site with biomaterial is to reconstruct the skull vault. The aim of this retrospective study was to assess the quality of reconstruction of calvarial bone with Hydroset™ (Stryker™) in patients having undergone monocortical parietal bone graft harvesting. PATIENTS AND METHOD: The donor sites of patients having undergone calvarial bone harvesting had been reconstructed with Hydroset™ cement over a period of four years. Calvarial bone reconstruction and the thickness of the parietal bone were evaluated by CT scan. RESULTS: Twenty-six patients had undergone reconstruction. The CT scan revealed a good integration of Hydroset™ with maintained thickness of the biomaterial. The parietal bone thickness was increased by 0.67 mm on average (P=0.002). DISCUSSION: The reconstruction of calvarial donor site bone defect with Hydroset™, after a monocortical harvesting, demonstrates parietal osseous thickness maintained in time.