Preservation of the inferior alveolar vasculonervous bundle in mandibular resective therapies: systematic review and report of two cases.

BACKGROUND: Segmental surgical resection is a frequently indicated procedure to treat aggressive mandibular tumors. One of the most important complications derived from this technique is permanent paresthesia of the inferior alveolar nerve (IAN), which significantly affects the quality of life of patients who experience it. This could be avoided through maneuvers that preserve the IAN. The objective of this paper is to review the main techniques for IAN preservation and to present 2 cases with the technique used by the author. MATERIAL AND METHODS: A systematic review was performed according to the PRISMA guidelines, apropos of two clinical cases reported in this study. The MEDLINE/PubMed and Scopus databases were searched. Several variables were considered and are presented in detail in the form of tables and figures. In addition, 2 case reports with NAI preservation techniques are presented. RESULTS: 13 articles were finally obtained for analysis. 127 patients were evaluated, reporting mandibular resections associated with various pathologies. Various surgical techniques were used, all with the same goal of maintaining the IAN. In most of the patients, the maintenance of sensitivity was achieved, which was verified with different methods. CONCLUSIONS: Preservation of the IAN in maxillofacial surgical procedures where surgical resection of the mandibular bone has been performed is an alternative that has demonstrated successful results in terms of reducing postoperative sequelae and is currently positioned as a necessary and feasible procedure.

Lumbar and cervical stenosis. Frequency of the association, role of the ankylosing hyperostosis.

The authors report a study of 47 patients admitted for cervical myelopathy (N = 17) or symptomatic lumbar spinal stenosis (N = 30). Nine patients had clinical evidence of coexisting cervical myelopathy and lumbar spinal stenosis. Ten out of the 17 patients having cervical myelopathy had lumbar spinal stenosis as evidenced by sagittal tomography and/or computerized tomography. Nine out of the 30 patients admitted for symptomatic lumbar spinal stenosis had coexisting cervical canal stenosis as evidenced by sagittal tomography. Thirteen out of these 19 patients with both cervical and lumbar canal stenosis had also ankylosing spinal hyperostosis.

Radiographic identification of human remains through deformities and anomalies of post-cranial bones: a report of two cases.

Human remains can be identified radiographically by anomalies and deformities of the post-cranial bones when there are no old fractures and the cranium and extremities are not available. These anomalies and deformities of the sternum, vertebrae, sacrum and innominate bone are often protected from damage by scavengers. We report their use to exclude a proposed identity in one case and to confirm identity in another case. The value and number of these criteria and their pathogenesis is discussed with reference to their prevalence and their expression of inter- and intraindividual variability.

Nasopharyngeal tuberculosis.

Rhinopharyngeal tuberculosis is a rare pathological condition. It is most often associated with lymph node and pulmonary lesions, but it may be an isolated finding. The authors report a recent case of an isolated rhinopharyngeal tuberculosis in a 64-year-old female. A review of the literature is presented. They emphasize the clinical presentation, that, in all aspects, may resemble a malignant tumour of the nasopharynx, as well as the difficulty of obtaining a pathological and bacteriological diagnosis.

Mucoceles of the paranasal sinuses: uncommon location.

Mucoceles are the most common lesions causing expansion of the paranasal sinuses. The sinuses most commonly involved are, in decreasing order of frequency, frontal sinus, ethmoid sinuses, maxillary sinus and sphenoid sinus. We reviewed 46 cases of surgically proven mucoceles and the purpose of this study was to report five cases of mucoceles in an uncommon location.

Epileptogenic cerebral vascular malformations and MRI.

The results of magnetic resonance imaging (MRI) performed in 67 patients with cerebral vascular malformations (35 arteriovenous malformations [AVM], 29 cryptic malformations, 11 venous angiomas and 2 associated lesions) were studied retrospectively after the patient population was divided into epileptics [25] and non-epileptics [42]. Several criteria were determined for each type of malformation in the two groups. They included patient's age, site of the malformation in relation to the cortex, size of the malformation, presence of a perilesional high-intensity signal on T2-weighted sequences and evidence of recent haemorrhage. Epileptogenic AVMs seemed to be more superficial and more often associated with a perilesional parenchymatous high-intensity signal on T2-weighted sequences than non-epileptogenic malformations. Epileptogenic cryptic malformations were closer to the cortex, larger, and specifically but rarely associated with changes in signal of the adjacent brain tissue on T2-weighted sequences. The few angiomas associated with epilepsy were, paradoxically, located in the cerebellum.

Cavernous hemangiomas of the orbit: MR imaging.

PURPOSE: To describe the MR imaging findings in eight patients with cavernous hemangioma of the orbit. METHODS: CT, MR imaging and echographic studies of eight patients with cavernous hemangioma localized in the orbit were reviewed. All patients presented with a progressive symptomatology: in seven cases with a painless proptosis, in one case with a failing of visual acuity of the concerned eye. The patients were examined with T2- and T1-weighted spin echo sequences, before and after intravenous administration of Gadolinium*, in axial, coronal and sagittal planes. In seven patients, a fat saturation prepulse was given after the Gd-enhanced study. Two patients were also examined with CT scan, with and without intravenous contrast administration. Three patients underwent a Doppler color-coded transorbital sonography. The analyzed criteria were: location, form, margins, size, signal or density. Seven patients underwent surgery with pathologically proved cavernous hemangioma. In one patient, therapy was conservative, because of the absence of significant clinical complaints. RESULTS: In all cases, MRI showed a well-defined intraconal mass. The lesions were homogeneous, isointense to muscle on the T1-weighted sequence and hyperintense to muscle on the T2-weighted sequences. In five cases, a peripheral rim, hypointense to the mass on the T1- and T2-weighted sequences could be observed. After Gadolinium*, six lesions showed initial central patchy enhancement. On the three following T1-Gadolinium* sequences, these lesions showed total and homogeneous filling. In two patients, the lesions showed immediate homogeneous enhancement. On CT, the orbital masses were spontaneously hyperdense, with associated focus of microcalcifications. On echography, the lesions appeared hyperechogenic, heterogeneous, with individualization of small areas of very slow flow. CONCLUSION: From the analysis of the MR appearance of an intraconal, well-defined mass, associating homogeneous signal, isointense to muscle on T1-weighted sequence, hyperintense on T2-weighted sequence, and especially progressive filling on Gd-enhanced sequences, the diagnosis of cavernous hemangioma may be highly suggestive, in a patient presenting a painless progressive proptosis.

[Dissection of the intracranial arteries. Apropos of 10 cases]. / Dissections des artères intracrâniennes. A propos de 10 observations.

Ten cases of spontaneous dissection of the cerebral arteries are reported. 3 males and 7 females aged 6 to 60 years (mean age 30 years) were investigated in the Department of Neuroradiology of Toulouse between 1989 and 1994 with CT, angiography and MRI. In 5 cases the dissection involved the carotid artery, in 5 cases the vertebro-basilar system. The clinical presentation was of two types: ischaemic stroke (7 cases) or subarachnoid haemorrhage (3 cases). Their evolution is never lethal, contrary to the classical descriptions of the literature. In all cases an initial angiography then follow up has been performed showing an irregular located arterial stenosis. The diagnosis of intracranial dissection is sometimes made in front of a dissequant aneurysm. In case of doubt, magnetic resonance (MR) imaging is helpful showing a linear hypersignal parallel to an arterial segmental stenosis, and angiography MR an irregular aspect and stenosis of the endoluminal artery.

[Complications of the intravascular treatment of intracranial aneurysms using metal microcoils. Embolization using coils in intracranial aneurysms]. / Complications du traitement endovasculaire des anévrysmes intracrâniens par micro-spires métalliques. Embolisation par coils des anévrysmes intracrâniens.

Embolization of intracranial aneurysms with coils. The authors present the results and complications of microcoils embolization of intracranial aneurysms in 28 patients. Fibers platinum microcoils were used (Target Therapeutic) 28 patients (males: 6, females: 22; mean age: 51 years) were treated, 27 suffered from sub-arachnoid hemorrhage (SAH) and one presented with a pseudotumoral syndrome (giant aneurysm). All patients were evaluated on the day of treatment, according to the World Federation of Neuro-Surgeon classification (W.F.N.S.) of SAH and after 4 months of follow-up. At a mean follow-up period of 4 months, according to Glasgow Outcome Scale (G.O.S.) there were 13 cases of good results, 5 cases of "moderate disability", 2 cases of "severe disability", 2 cases of "vegetative state" and 6 deaths. Complications were observed in 11/28 cases. Coils migration and malposition in the parent artery were linked to the procedure (mechanical detachable coil) and resulted in severe deficit (one case), transient disability (one case) or went unnoticed (4 cases). Primary or secondary complete occlusion was achieved in 8/28 patients (32%). A majority of cases (11 cases) ended with stable residual aneurysmal sac lumen while rebleeding occurred in 3 patients and was responsible for 2 deaths. In the third case a favourable outcome was obtained after balloon occlusion of the parent artery.

[Cerebral localizations of non-Hodgkin's malignant lymphoma. Contribution of x-ray computed tomography]. / Localisations cérébrales des lymphomes malins non hodgkiniens. Apport de la tomodensitométrie.

At the present time, CT scan imaging occupies an essential place in the diagnostic approach and course of cerebral non-Hodgkin's malignant lymphoma. Results of CT scan investigations are reported in 17 patients, 8 with primary and 9 with secondary lymphoma. The lesions observed, hypo-, iso- or faintly hyper-dense, took-up contrast almost constantly in an intense and well limited homogeneous manner. The subependymal infiltration noted was suggestive of the disease particularly since it was often associated with a paraventricular localization in the white substance, corpus callosum or central gray nuclei. However, no correlation existed with the primary or secondary nature or histologic type of lymphoma, and histopathologic confirmation was necessary from surgical biopsy specimen. Appearances of primary and secondary lymphoma are superimposable, apart from certain cases with co-existing secondary lymphoma and bone lysis or a contiguous endocranial tumor. Follow-up CT scan imaging confirms clinical remission, or recurrence raising the problem of radionecrosis.

[Cervical spine infection with Streptococcus anginosus. Case report]. / Infection du rachis cervical A streptococcus anginosus.

A case of cervical spine infection due to Streptococcus anginosus is reported. Streptococcus milleri is encountered in the mouth, gastro-intestinal tract, vagina and nasopharynx. It is an uncommon pathogen responsible of suppurative infections such as brain liver or spleen abscesses, intra-abdominal or soft tissue abscesses and pleural empyema. In rare cases it can cause spondylodiscitis and osteomyelitis. Based on the review of eight cases of spondylodiscitis or osteomyelitis, diagnosis and treatment are discussed.

[Comparative contribution of endoscopy, x-ray computed tomography and MRI in the preoperative evaluation of cancers of the endolarynx: apropos of 18 surgically-treated patients]. / Apports comparés de l'endoscopie, de la tomodensitométrie et de l'I.R.M. dans le bilan pré-opératoire des cancers de l'endolarynx: à propos de 18 patients opérés.

The authors carried out a prospective and comparative study of 18 patients with endolaryngeal carcinoma, with preoperative imaging of the extent of the disease by computed tomography (CT) and magnetic resonance imaging (MRI). The correlations between CT, MRI, endoscopy and postoperative histology are reported. It appears to the authors that the contribution of imaging is evident and that at present the reliability of CT is comparable to that of MRI, taking account of the current technical problems of MRI.

[The place of imaging in the investigation of the parotid and parapharyngeal space]. / Place de l'imagerie dans l'exploration de la parotide et de l'espace parapharyngé.

What strategy should be adopted and what results should be expected from imaging techniques in the various pathological process affecting the parotid and parapharyngeal space? When the pathological process is associated with morphological changes in the parotid, it is sometimes necessary to have recourse to imaging. MRI is the method of choice. Pathology in the parapharyngeal space (PPS) always requires an MRI and/or CT scan. It is necessary to have a very thorough understanding of the anatomy of the PPS and associated spaces to obtain a precise preoperative assessment and, where possible, an indication of the nature of the lesion.

[Etiological investigations in cerebral ischemic accidents]. / Exploration étiologique des accidents ischémiques cérébraux.

First-line investigations for all patients include full blood count, erythrocyte sedimentation rate, plasma glucose, plasma cholesterol, plasma electrolytes, creatinine. ECG, chest X-ray and colour Doppler sonography of the neck. Carotid selective arteriography is performed when colour Doppler of the symptomatic carotid artery shows a stenosis of about 70% or more, provided the patient is fit for carotid endarterectomy. The search for paroxysmal atrial fibrillation is worthwhile in patients with palpitations. Transesophageal echocardiography is indicated if a cardiac source of embolism is suspected on the basis of clinical examination, ECG or chest X-ray and in patients without any apparent cause of stroke, if an embolic mechanism is likely. Finally, in the young patient atherosclerosis is so rare that special etiological investigations are justified.