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1.
Eur Arch Otorhinolaryngol ; 280(10): 4569-4576, 2023 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-37233750

RESUMO

PURPOSE: Despite sharing the same staging system as oral cavity cancers, upper gingiva and hard palate (UGHP) squamous cell carcinoma (SCC) have several features that make them a different entity. We aimed to analyze oncological outcomes and adverse prognostic factors of UGHP SCC, and assess an alternate T classification specific to UGHP SCC. METHODS: Retrospective bicentric study including all patients treated by surgery for a UGHP SCC between 2006 and 2021. RESULTS: We included 123 patients with a median age of 75 years. After a median follow-up of 45 months, the 5-year overall survival (OS), disease-free survival (DFS) and local control (LC) were 57.3%, 52.7% and 74.7%, respectively. Perineural invasion, tumor size, bone invasion, pT classification and pN classification were statistically associated with poorer OS, DFS and LC on univariate analysis. On multivariable analysis, the following variable were statistically associated with a poorer OS: past history of HN radiotherapy (p = 0.018), age > 70 years (p = 0.005), perineural invasions (p = 0.019) and bone invasion (p = 0.030). Median survivals after isolated local recurrence were 17.7 and 3 months in case of surgical and non-surgical treatment, respectively (p = 0.066). The alternate classification allowed better patient distribution among T-categories, however without improving prognostication. CONCLUSION: There is a broad variety of clinical and pathological factors influencing prognosis of SCC of the UGHP. A comprehensive knowledge of their prognostic factors may pave the way towards a specific and more appropriate classification for these tumors.


Assuntos
Carcinoma de Células Escamosas , Neoplasias de Cabeça e Pescoço , Humanos , Idoso , Estudos Retrospectivos , Prognóstico , Palato Duro/cirurgia , Gengiva/patologia , Esvaziamento Cervical , Carcinoma de Células Escamosas/cirurgia , Carcinoma de Células Escamosas de Cabeça e Pescoço/patologia , Neoplasias de Cabeça e Pescoço/patologia , Estadiamento de Neoplasias , Recidiva Local de Neoplasia/patologia
2.
Clin Oral Investig ; 27(11): 6781-6788, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-37792221

RESUMO

OBJECTIVES: Transitioning from non-outpatient orthognathic surgery to outpatient surgery is a new challenge, and it is essential to target the eligible population as precisely as possible. Several authors describe series of outpatient orthognathic surgery but do not include the reasons for their success or failure. The main aim of this study was to identify the factors significantly associated with "successful" outpatient orthognathic treatment. The secondary objective was to determine the factors significantly associated with prolonged hospital stays (≥ 2 nights). MATERIALS AND METHODS: A prospective cohort study including patients undergoing orthognathic surgery was conducted over a period of 1 year. We recorded the prognostic factors that contributed to successful outpatient treatment and prolonged hospital stays. These factors were evaluated by bivariate and multivariate analysis. RESULTS: A total of 102 patients were included, and the success rate of treatment was 65%. The variables that were isolated by multivariate analysis were: patients over the age of 22, procedures ending before 1 pm, brief operations, the absence of both postoperative vomiting and the administration of morphine. CONCLUSION: Patient selection, organisation of outpatient facilities and anaesthetic protocols contribute to the development of outpatient orthognathic surgery. These initial considerations provide a framework for our practice, but the considerations that predict the failure of outpatient surgery will need to be clarified. CLINICAL RELEVANCE: Orthognathic surgery can be performed on outpatient basis in selected cases. Age, the operative time, procedure end time, postoperative vomiting and the administration of morphine are associated with the success of outpatient care.


Assuntos
Cirurgia Ortognática , Procedimentos Cirúrgicos Ortognáticos , Humanos , Tempo de Internação , Estudos Prospectivos , Procedimentos Cirúrgicos Ambulatórios , Procedimentos Cirúrgicos Ortognáticos/métodos , Náusea e Vômito Pós-Operatórios , Pacientes Ambulatoriais , Derivados da Morfina , Estudos Retrospectivos
3.
Strahlenther Onkol ; 198(2): 150-158, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34786604

RESUMO

OBJECTIVE: This study aims to assess the outcomes of adjuvant interstitial brachytherapy (BT) to the tumor bed for oral cavity squamous cell carcinoma (SCC), and to compare the oncological outcomes and toxicity profile of low-dose-rate (LDR) and pulsed-dose-rate (PDR) BT. DESIGN: This retrospective single-center study included all patients who underwent postoperative LDR- or PDR-BT to the tumor bed as the sole adjuvant treatment for an oral tongue or floor of the mouth SCC between January 2000 and December 2020. RESULTS: A total of 79 patients were eligible for this study. The cohort was divided into an LDR group (n = 38) and a PDR group (n = 41). The median time interval between surgery and brachytherapy was 55 days. Median delivered total dose was 55 Gy and median hospital stay was 5 days. Five patients (8.3%) experienced grade 3-4 early toxicity, 2 in the LDR group and 3 in the PDR group. Late toxicities were present in 28 patients (44.4%) and were dominated by grade 1-2 residual pain and dysesthesia, without a statistical difference between the groups. After a median follow-up of 65.1 months, 5­year local control (LC), disease-free survival (DFS), and overall survival (OS) for the whole cohort were 76.3% (95% CI = 63.4-85.1), 61.6% (95% CI = 49.0-72.0), and 71.4% (95% CI = 58.6-80.8), respectively. CONCLUSION: Adjuvant BT after excision of oral cavity SCC provides satisfactory oncological outcomes along with good tolerance. In our study, PDR-BT showed similar oncological and functional results to LDR-BT in this indication.


Assuntos
Braquiterapia , Carcinoma de Células Escamosas , Neoplasias de Cabeça e Pescoço , Neoplasias Bucais , Braquiterapia/métodos , Carcinoma de Células Escamosas/radioterapia , Carcinoma de Células Escamosas/cirurgia , Humanos , Neoplasias Bucais/radioterapia , Neoplasias Bucais/cirurgia , Dosagem Radioterapêutica , Estudos Retrospectivos , Carcinoma de Células Escamosas de Cabeça e Pescoço
4.
Surg Radiol Anat ; 44(5): 637-644, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35576016

RESUMO

PURPOSE: This study assesses the anatomical features of the cutaneous fibular perforators and perforasomes of fibular free flap to determine the clinical implications therein. METHODS: This anatomical study was performed with 16 fresh cadavers after selective arterial injections of inked serum. The numbers of perforators, diameter, location of the perforasome center, perforator course, the distance between perforator origin and tibiofibular division, and the perforasome area were all documented. RESULTS: Thirty-one lower legs were dissected. Eighty-eight cutaneous perforators were found, averaging 2.8 per leg (1-4). The mean diameter was 1.7 mm and decreased from proximal to distal (p < 0.001). The centers of the perforasomes were aligned on an oblique projection from proximal to distal and anterior to posterior. Seventeen perforators (19%) were musculocutaneous, all in the proximal half of the leg, whereas 71 perforators were septocutaneous (81%), including 18 in the proximal half of the leg. Six of the uppermost perforators originated from the fibular artery less than 10 mm from the tibiofibular division. The mean area perforasome was 37.2 cm2 (7.9-106 cm2) and decreased from proximal to distal (p < 0.01). CONCLUSION: Distal and proximal fibular flap perforasomes sported different features. Large skin paddles supplied by large and often intramuscular perforators were found in the proximal half of the leg. Distal skin paddles were smaller, more posterior, and featured septocutaneous perforators. These factors should be considered in the skin paddle choice during the fibular free flap harvest.


Assuntos
Retalhos de Tecido Biológico , Retalho Perfurante , Artérias , Cadáver , Fíbula/irrigação sanguínea , Humanos , Retalho Perfurante/irrigação sanguínea , Pele/irrigação sanguínea
5.
Pain Med ; 21(6): 1240-1247, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-31369679

RESUMO

OBJECTIVES: The primary aim of our study was to evaluate and compare the accuracy of ultrasound (US)-guided distal suprascapular nerve (dSSN) and proximal SSN (pSSN) blocks. Secondary aims were to compare the phrenic nerve involvement between groups and to describe the anatomical features of the sensory branches of the dSSN. METHODS: pSSN and dSSN blocks were performed in 14 cadavers (28 shoulders). Ten mL of 0.2% ropivacaine colored with methylene blue was injected under US guidance. Accuracy was determined using SSN staining and the distance between predefined anatomical landmarks and the targeted SSN. The phrenic nerve (PN) was judged to be colored or not. The distribution of the sensory branches that originate from the 14 dSSNs is described. Quantitative data are expressed as median (range). RESULTS: The pSSN was dyed more frequently than the dSSN (13 vs 11, P = 0.59). The targeted SSN was close to the suprascapular notch (1.3 [0-5.2] cm) and the origin of the SSN (1.4 [0.2-4.5] cm) for dSSN and pSSN blocks, respectively (P = 0.62). For dSSN blocks, the most frequent injection site was the supraspinous fossa. Three PNs were marked in pSSN blocks, compared with none in dSSN blocks (P = 0.22). Three sensory branches were identified for all 14 dSSNs: the medial subacromial branch, the lateral subacromial branch, and the posterior glenohumeral branch. CONCLUSIONS: US-guided pSSN and dSSN blocks can be realized with accuracy. A distal approach to the SSN could be an alternative to interscalene brachial plexus block for the management of postoperative pain after shoulder surgery in high-respiratory risk patients.


Assuntos
Nervos Periféricos , Ultrassonografia de Intervenção , Cadáver , Humanos , Injeções Intra-Articulares , Ultrassonografia
6.
Strahlenther Onkol ; 195(6): 496-503, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30877351

RESUMO

BACKGROUND: The decision between definitive radio(chemo)therapy (RCT) or a surgical strategy, i. e. surgery ± adjuvant radio(chemo)therapy for optimal treatment of oropharyngeal cancer is highly debated. Human papillomavirus(HPV)-related tumours are a distinct entity associated with p16 overexpression. While this represents a major prognostic factor, its predictive significance remains unknown. RESULTS: Among 183 consecutive unselected patients treated between 2009 and 2013 with a state-of-the-art surgical procedure ± adjuvant radio(chemo)therapy or definitive RCT including intensity-modulated radiotherapy, 3­year disease-free survival (DFS) was 74 vs. 57%, respectively (p = 0.007). When focusing on p16+ patients (49%), there was no significant difference in tumour control rate between surgery ± radio(chemo)therapy and the definitive RCT group (3-year DFS 83 vs. 82%, respectively; p = 0.48). However, delayed severe dysphagia was significantly lower in favour of definitive RCT: 35 vs. 4%, respectively; p = 0.0002. CONCLUSION: Our results highlight distinct outcomes after definitive RCT or initial surgical treatment according to p16 status, which should thus be considered during the decision process.


Assuntos
Quimiorradioterapia , Inibidor p16 de Quinase Dependente de Ciclina/genética , Técnicas de Apoio para a Decisão , Expressão Gênica/genética , Neoplasias Orofaríngeas/genética , Adulto , Idoso , Idoso de 80 Anos ou mais , Terapia Combinada , Intervalo Livre de Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Orofaríngeas/mortalidade , Neoplasias Orofaríngeas/radioterapia , Neoplasias Orofaríngeas/cirurgia
7.
Acta Derm Venereol ; 99(13): 1241-1245, 2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31408185

RESUMO

Ten to fifty percent of high-risk cutaneous squamous cell carcinoma may potentially metastasize. However, the concept of sentinel lymph node biopsy remains controversial for cutaneous squamous cell carcinoma. The aim of this study was to identify prognostic factors associated with sentinel lymph node positivity. A bicentric retrospective analysis was conducted between January 2006 and January 2018. All patients undergoing sentinel lymph node biopsy for high-risk cutaneous squamous cell carcinoma were included, based on the criteria of the prognostic classification of the French Society of Dermatology. Seventy-four patients were included. Five (6.8%) procedures failed. Of the 69 patients assessed, the positive sentinel lymph node biopsy rate was 11.6% (n = 8) with a false negative rate of 5.7% (n = 4). The positivity of sentinel lymph node biopsy was associated with tumour size (p = 0.0194). Sentinel lymph node biopsy is an effective staging procedure for clinically N0 high-risk cutaneous squamous cell carcinoma, with an acceptable morbidity. To date, 2 risk factors of sentinel lymph node positivity have been identified with statistical significance: tumour size and poor tumour differentiation.


Assuntos
Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células Escamosas/patologia , Biópsia de Linfonodo Sentinela/métodos , Linfonodo Sentinela/patologia , Neoplasias Cutâneas/mortalidade , Neoplasias Cutâneas/patologia , Adulto , Idoso , Carcinoma de Células Escamosas/terapia , Estudos de Coortes , Intervalo Livre de Doença , Feminino , França , Hospitais Universitários , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica/patologia , Estadiamento de Neoplasias , Prognóstico , Estudos Retrospectivos , Medição de Risco , Neoplasias Cutâneas/terapia , Estatísticas não Paramétricas , Análise de Sobrevida , Resultado do Tratamento , Carga Tumoral
8.
Dermatology ; 232(5): 550-557, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27676268

RESUMO

BACKGROUND: There are limited data on the esthetic, functional, and morphological outcomes of surgical treatment of facial basal cell carcinoma (BCC). OBJECTIVE: The aim of our study was to assess the determinants of the evaluation of both the patients and the investigator of the esthetic, functional, and morphological impact of the surgical treatment of facial BCC. METHODS: A prospective observational study evaluated 111 patients treated surgically for facial BCCs (n = 135 BCCs), using the Patient and Observer Scar Assessment Scale (POSAS), a validated and reliable scale designed for the evaluation of all types of scars by professionals and patients. RESULTS: Scar assessment rated by the patients was very good. Skin aging was associated with a better surgical outcome as evaluated by POSAS (OR = 0.30, 95% CI: 0.09-0.98; p = 0.04). Conversely, histologically infiltrative or sclerosing BCC (OR = 2.33, 95% CI: 0.95-5.71; p = 0.06) was independently associated with poorer POSAS. In terms of the investigator's evaluation, aging signs (protective factor: OR = 0.17, 95% CI: 0.04-0.73; p = 0.01), location on the H-zone of the face (risk factor: OR = 2.95, 95% CI: 1.07-8.15; p = 0.03), and histologically infiltrative or sclerosing BCC (risk factor: OR = 2.89, 95% CI: 1.01-8.29; p = 0.04) were independently associated with POSAS. CONCLUSION: Esthetic, functional, and morphological outcomes of facial BCC surgery provide high patient satisfaction overall. Taking wider margins requires specific measures to improve the surgical outcome.


Assuntos
Carcinoma Basocelular/cirurgia , Cicatriz/etiologia , Procedimentos Cirúrgicos Dermatológicos/efeitos adversos , Neoplasias Faciais/cirurgia , Neoplasias Cutâneas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Basocelular/patologia , Cicatriz/patologia , Procedimentos Cirúrgicos Dermatológicos/métodos , Estética , Neoplasias Faciais/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Medidas de Resultados Relatados pelo Paciente , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Envelhecimento da Pele , Neoplasias Cutâneas/patologia , Inquéritos e Questionários , Resultado do Tratamento
9.
J Labelled Comp Radiopharm ; 58(7): 274-80, 2015 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-26017396

RESUMO

Lymphomas are the most frequent haematological malignancy. In non-Hodgkin's lymphomas (NHL), more than 90% of tumor cells express the cluster of differentiation (CD) 20 antigen. At the end of frontline therapy, the evaluation of remission is based on computed tomography (CT) and positron emission tomography coupled with computer tomography (PET/CT) with [(18)F]-fluorodeoxyglucose ([(18)F]FDG). Unfortunately, these techniques are not specific and cannot distinguish residual active tumor from inflammation. The aim of this study was to develop a specific radiotracer of NHL CD 20+ cells for clinical applications. The radiolabelling technique presented, based on the use of tricarbonyl compound, does not include an antibody reduction because this step could damage the protein. Actually, rituximab, an anti-CD 20 chimeric antibody used for the treatment of these NHL, was radiolabelled with Isolink® (99m)Tc-tricarbonyl compound in a three-step procedure without using a specific antibody reducer. Radiolabelling yield was greater than 97%. In vitro experiments showed a conservation of antibody integrity. In vivo experiments using Single-photon emission computed tomography/CT showed significant tumor targeting 24 h after injection of the radiotracer. It was consequently possible to develop an immunoradiolabelling method to specifically detect the residual disease. As this procedure is fast, reproducible and gentle, it will be possible to comply with Good Manufacturing Practices.


Assuntos
Compostos Radiofarmacêuticos/síntese química , Rituximab/química , Tecnécio/química , Animais , Linhagem Celular Tumoral , Humanos , Camundongos , Compostos Radiofarmacêuticos/farmacocinética , Distribuição Tecidual , Tomografia Computadorizada de Emissão de Fóton Único
10.
J Craniofac Surg ; 26(7): 2148-51, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26468799

RESUMO

The authors describe a new material termed mineralized plasmatic matrix (MPM), a combination of platelets, fibrin concentrate, and autogenous bone to repair alveolar cleft defects. Autogenous cancellous bone is widely used to this end because such bone affords the functionalities (osteogenesis, osteoinduction, and osteoconduction) required for successful outcomes. To optimize these features, autologous blood products high in platelet concentrations have recently been developed. On the basis of our experience with PRP (platelet-rich plasma) and PRF (platelet-rich fibrin), we developed MPM, which contains platelets and fibrin concentrate in a liquid state; these materials can become bound to bone particles. The filling material is easy to shape and a PRF-type membrane is also generated. Ten patients with cleft lips and alveoli, with or without cleft palates (median, or uni- or bilateral) benefited from secondary bone grafts placed using our new material. We transferred autogenous bone from the iliac crest, an abundant source of cancellous bone associated with a high success rate. The 6-month outcomes of all patients were excellent in terms of both bone graft stability and closure of the oronasal fistulae. The preparation procedure is simple and the technical requirements minimal. Upon further optimization, MPM may serve as a third-generation platelet concentrate with potential applications in various fields.


Assuntos
Enxerto de Osso Alveolar/métodos , Autoenxertos/transplante , Plaquetas/fisiologia , Transplante Ósseo/métodos , Fibrina/uso terapêutico , Adolescente , Regeneração Óssea/fisiologia , Criança , Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Feminino , Seguimentos , Humanos , Ílio/transplante , Masculino , Doenças Nasais/cirurgia , Fístula Bucal/cirurgia , Osteogênese/fisiologia , Fístula do Sistema Respiratório/cirurgia , Resultado do Tratamento
11.
Dermatology ; 229(3): 183-9, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25171688

RESUMO

BACKGROUND: Sentinel lymph node biopsy (SLNB) is the most sensitive procedure for assessing nodal status in patients with primary melanoma. OBJECTIVE: To evaluate the predictive ability of usual primary melanoma prognosis factors of detecting sentinel lymph node (SLN) metastasis in patients with melanoma. PATIENTS AND METHODS: A cohort of 612 consecutive patients presenting with primary skin melanoma who underwent a SLNB was evaluated. Assessment of the determinants of SLN metastasis was based on general linear model analysis. The model performance was studied using the concordance statistic and the net reclassification index. The calibration was estimated using the Hosmer-Lemeshow test. RESULTS: The discrimination ability did not differ significantly between Breslow thickness (0.57), Clark index (0.61), ulceration (0.57) and histological subtype (0.55). Clark index, ulceration and Breslow thickness were all significant and independent determinants of SLN metastasis. The predictive ability of the final model was 0.657. CONCLUSION: Breslow thickness, Clark index and ulceration are independent predictors of a SLN metastasis.


Assuntos
Linfonodos/patologia , Melanoma/patologia , Melanoma/secundário , Biópsia de Linfonodo Sentinela/estatística & dados numéricos , Neoplasias Cutâneas/patologia , Úlcera Cutânea/patologia , Adulto , Idoso , Estudos de Coortes , Intervalos de Confiança , Intervalo Livre de Doença , Feminino , França , Humanos , Metástase Linfática/patologia , Masculino , Melanoma/mortalidade , Pessoa de Meia-Idade , Invasividade Neoplásica/patologia , Estadiamento de Neoplasias , Valor Preditivo dos Testes , Prognóstico , Análise de Regressão , Medição de Risco , Neoplasias Cutâneas/mortalidade , Análise de Sobrevida
12.
Head Neck ; 2024 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-38884458

RESUMO

OBJECTIVE: To elucidate the prognostic implications of mucosal and deep margin distances in oral tongue squamous cell carcinoma (OTSCC), and to assess a different margin cut-off value in T1-T2 versus T3-T4 tumors. METHODS: This single-center retrospective study included 223 patients who received surgery for a primary OTSCC between January 2017 and December 2021. RESULTS: Multivariable analysis showed that deep margin distance ≥3 mm in T1-T2 tumors and ≥5 mm in T3-T4 tumors was significantly associated with better RFS and OS. Mucosal and deep margin distances were globally clinically useful for 2-year RFS prediction of T1-T2 tumors, for which deep margins seemed to have more clinical utility than mucosal margins. The influence of margin distances on 2-year RFS seemed greater for T1-T2 tumors than T3-T4 tumors. CONCLUSION: Mucosal and deep margin distances were associated with OS and RFS in OTSCC. Shorter deep margin distances may be aimed for in T1-T2 versus T3-T4 tumors.

13.
Cancer Cell ; 2024 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-39454577

RESUMO

Cancer immunotherapies produce remarkable results in B cell malignancies; however, optimal cell surface targets for many solid cancers remain elusive. Here, we present an integrative proteomic, transcriptomic, and epigenomic analysis of tumor and normal tissues to identify biologically relevant cell surface immunotherapeutic targets for neuroblastoma, an often-fatal childhood cancer. Proteogenomic analyses reveal sixty high-confidence candidate immunotherapeutic targets, and we prioritize delta-like canonical notch ligand 1 (DLK1) for further study. High expression of DLK1 directly correlates with a super-enhancer. Immunofluorescence, flow cytometry, and immunohistochemistry show robust cell surface expression of DLK1. Short hairpin RNA mediated silencing of DLK1 in neuroblastoma cells results in increased cellular differentiation. ADCT-701, a DLK1-targeting antibody-drug conjugate (ADC), shows potent and specific cytotoxicity in DLK1-expressing neuroblastoma xenograft models. Since high DLK1 expression is found in several adult and pediatric cancers, our study demonstrates the utility of a proteogenomic approach and credentials DLK1 as an immunotherapeutic target.

14.
J Craniofac Surg ; 24(2): 667-9, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23524773

RESUMO

We report a case of an olfactory neuroblastoma revealed by atypical presentation with only ophthalmic symptoms. A 73-year-old woman presented with exophthalmos, left chemosis, decreased visual acuity, and diplopia. CT scan revealed a heterogeneous mass with isolated maxillary sinus, orbital floor, and lower eyelid invasion. This orbital lesion has no major ethmoidal extension (a single anterior ethmoidal cell appears retrospectively invaded). The biopsy sample of the hardened tumefaction revealed after histological examination an olfactory neuroblastoma (or esthesioneuroblastoma). The patient was treated by surgery (resection of the lesion and neck dissection) followed by postoperative irradiation.Olfactory neuroblastoma has no specific symptoms, but habitually presents as an ethmoidal lesion possibly accompanied with ophthalmic manifestations (in 20% to 30% of cases) due to orbital extension. This type of unusual presentation requires our attention, and we discuss the actual knowledge about the pathogenesis, clinical presentation, and treatment of this rare entity.


Assuntos
Estesioneuroblastoma Olfatório/diagnóstico por imagem , Estesioneuroblastoma Olfatório/cirurgia , Doenças Orbitárias/diagnóstico por imagem , Doenças Orbitárias/cirurgia , Idoso , Biópsia , Diagnóstico Diferencial , Estesioneuroblastoma Olfatório/patologia , Feminino , Humanos , Imageamento Tridimensional , Esvaziamento Cervical , Invasividade Neoplásica , Doenças Orbitárias/patologia , Tomografia Computadorizada por Raios X
15.
PLoS One ; 18(10): e0292391, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37812623

RESUMO

INTRODUCTION: Maxillary surgery alone can be proposed for the surgical management of class III malocclusion, but anticipating outcomes for the labiomental muscle complex is challenging due to the mandibular autorotation phenomenon. The objective of this study was to quantify the mandibular and labiomental movements induced by maxillary osteotomy alone in the management of class III malocclusion according to different clinical and surgical variables. METHODS: The post-operative changes in mandibular and labiomental shapes were studied by geometric morphometry from the pre- and post-operative lateral cephalometric radiograph of 25 patients. The explanatory variables tested were maxillary advancement, maxillary rotation, and divergence. RESULTS: Soft tissues repositioning are different from postoperative mandibular repositioning after maxillary osteotomy. Neuromuscular adjustments of mandible depend on divergence and the maxillary rotation. Labiomental response only depends on divergence. CONCLUSION: The surgical procedure does not have the same bone-related and musculocutaneous effects on patients with the same class III malocclusion. It is therefore essential for surgeons to understand the effects of their procedure on musculocutaneous tissues in order to best anticipate post-operative outcomes.


Assuntos
Má Oclusão Classe III de Angle , Humanos , Má Oclusão Classe III de Angle/cirurgia , Mandíbula/diagnóstico por imagem , Mandíbula/cirurgia , Osteotomia/métodos , Maxila/cirurgia , Craniotomia , Cefalometria/métodos
16.
Surg Radiol Anat ; 34(6): 509-12, 2012 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-22367059

RESUMO

PURPOSE: Despite the intrathoracic part being short, the right laryngeal recurrent nerve is often injured during thoracic surgery. The aim of this cadaver study was to understand the mechanisms of right laryngeal recurrent nerve injuries during thoracic surgery and to describe anatomical landmarks for its preservation. METHODS: Dissections were performed on 10 fresh human cadavers. A right anterolateral thoracic wall segment was removed, preserving the first rib. Dissections were carried out to identify the following structures: first rib, esophagus, trachea, right main bronchus, right brachiocephalic and subclavian vessels, azygos vein, phrenic nerve, vagus nerve, and right laryngeal recurrent nerve. RESULTS: The distance between the origin of the right laryngeal recurrent nerve and its adjacent structures was assessed. Moderate traction of the thoracic part of the vagus nerve resulted in a downward translation of the right laryngeal recurrent nerve's origin. In such conditions, the right laryngeal recurrent nerve's origin was distant of 14.8 mm (±2.89 mm) from the subclavian artery. CONCLUSIONS: Intraoperative incidence of right laryngeal recurrent nerve direct injury could be decreased by understanding the detailed course of its intrathoracic part. Moreover, traction on the intrathoracic part of the right vagus nerve may result in indirect lesions of the right laryngeal recurrent nerve: stretch induced lesions and nerve vasculature's lesions.


Assuntos
Pesos e Medidas Corporais/métodos , Traumatismos do Nervo Laríngeo Recorrente/prevenção & controle , Nervo Laríngeo Recorrente/anatomia & histologia , Cirurgia Torácica , Cadáver , Dissecação , Feminino , Humanos , Masculino , Risco
17.
Surg Radiol Anat ; 34(5): 441-6, 2012 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-22198418

RESUMO

The aim of this study was to determine the prevalence of precaval right renal artery and to investigate the distribution of renal arteries and veins. We discuss a theory of development of renal vascular variants. We retrospectively reviewed 120 arterial phase contrast material-enhanced spiral computerized tomography scans of the abdomen (1- to 2-mm section thickness) performed during a two-month period. Forty percent of the study group (48 patients) had one artery and one vein on each side, with typical course. There was a 9.17% prevalence of precaval right renal artery: 10 patients had a lower pole accessory artery in precaval position and one patient had the main and the accessory arteries that pass anterior to the inferior vena cava. In these cases, associated variations of renal vessels were higher than in the patients without precaval artery variant. There were multiple arteries in 28.3% of the right kidneys and in 26.7% of the left ones. Variants of the right renal vein consisted in multiple veins in 20% (24 cases). We detected no case of multiple left renal veins, but we described variations of its course (circum- or retroaortic vein) in 9.17% (11 cases). Twenty-six patients (21.7%) had associated variations of the renal pedicle. The current technical support allows for a minimally invasive study of vessels anatomy. In our study the prevalence of a precaval right renal artery appears to be higher than previously reported (9.17%). Knowledge on anatomical variations of right renal artery and associated renal vessels variations has major clinical implications.


Assuntos
Rim/irrigação sanguínea , Radiografia Abdominal/métodos , Artéria Renal/anatomia & histologia , Tomografia Computadorizada Espiral/métodos , Meios de Contraste , Feminino , Humanos , Iopamidol/análogos & derivados , Rim/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Artéria Renal/diagnóstico por imagem , Veias Renais/anatomia & histologia , Veias Renais/diagnóstico por imagem , Estudos Retrospectivos
18.
Surg Radiol Anat ; 32(10): 971-7, 2010 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-20373100

RESUMO

PURPOSE: An ideal way to treat osteoradionecrosis of the jaws is to transfer an osteogenic, appropriately vascularized flap to the affected site. The corticoperiosteal femoral medial supracondylar flap is being used increasingly in the treatment of complex pseudarthrosis of long bones, but is yet to find robust indications for use in the treatment of osteoradionecrosis of the jaw, the reasons being a lack of anatomical data concerning its vascular supply and the local constraints of its routine harvest. This study presents an anatomical study and literature review to explore its potentials in clinical practice. MATERIALS AND METHODS: A total of 25 legs were dissected following vascular injection of colored neopren. The descending genicular artery (DGA) and veins were studied with particular attention paid to anatomical variations found in their branches. Calibers and length of the vessels were recorded. RESULTS: Many anatomical variations of the DGA were found and a classification proposed. The mean caliber of the DGA at the origin was 1.9 mm, and for the vein, 1.8 mm. The mean useful length of the pedicle was 7.9 cm. A case is reported. CONCLUSION: A clear anatomical knowledge (and, therefore, a sound classification system to grade flap harvesting potential) is the key first step prior to extensive clinical use of this flap. Various anatomical patterns of the pedicle are frequently encountered; branches can be elusive when raising the flap. Vascular imaging is therefore a critical step in identifying types and subtypes before surgery.


Assuntos
Doenças Mandibulares/cirurgia , Osteorradionecrose/cirurgia , Retalhos Cirúrgicos/irrigação sanguínea , Coxa da Perna/irrigação sanguínea , Adulto , Idoso , Carcinoma de Células Escamosas/radioterapia , Feminino , Humanos , Neoplasias Laríngeas/radioterapia , Masculino , Pessoa de Meia-Idade , Radioterapia Adjuvante/efeitos adversos , Neoplasias da Língua/radioterapia
19.
PLoS One ; 15(11): e0240558, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33156821

RESUMO

PURPOSE: The gold-standard for reconstruction of large mandibular defects is the use of free flaps of vascularized autologous bone with the fibula as the preferred donor site. The use of "custom cutting guides" for this indication is becoming increasingly prevalent. But cost of the procedure averages around 2,500 dollars per patient excluding treatment and entails selection criteria. We think it is possible to standardize mandibular reconstructions from an anatomical mean. The objective of this study was to perform a mandibular morphometric analysis in order to obtain a set of "mean" measurements, which can be used by all surgeons interested in mandibular reconstruction. METHODS: We performed a morphometric analysis consisting of three-dimensional mandibular reconstructions of 30 men and 30 women. Several reference points were set and defined to evaluate specific lengths and angles of interest. We conducted an intra and inter-sexual descriptive analysis of measurements obtained. RESULTS: We did not identify any major intra-sexual differences within each group. The gonial angle is more open in women and the measurements characterizing the basilar contour are more prominent in men. We did not identify any differences in alveolar region parameters. CONCLUSION: The results of this study constitute a morphological tool for surgeons, from bone graft to free flap. These results also confirm us that the use of «custom cutting guides¼ for mandibular reconstruction may be excessive. It is pertinent to examine the value of "custom made" mandibular reconstructions since the differences observed are of the order of millimeters.


Assuntos
Mandíbula/diagnóstico por imagem , Reconstrução Mandibular/métodos , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Adulto , Feminino , Humanos , Masculino , Mandíbula/cirurgia , Pessoa de Meia-Idade , Estudos Retrospectivos , Retalhos Cirúrgicos/cirurgia , Tomografia Computadorizada por Raios X , Adulto Jovem
20.
Med Sci (Paris) ; 39(11): 899-903, 2023 11.
Artigo em Francês | MEDLINE | ID: mdl-38018938

RESUMO

Title: L'actualité scientifique vue par les étudiants du Master Biologie-Santé de l'université de Montpellier. Abstract: L'unité d'enseignement « Immunopathologie ¼ qui propose les brèves présentées dans ce numéro est suivie par des étudiants de divers parcours du Master Biologie Santé de l'université de Montpellier. Ce Master rassemble des étudiants issus du domaine des sciences et technologies et de domaines de la santé. On y étudie les bases physiopathologiques des maladies immunologiques, les cibles thérapeutiques et les mécanismes d'échappement des microorganismes et des tumeurs Les articles présentés ont été choisis par les étudiants selon leur domaine de prédilection.


Assuntos
Biologia , Estudantes , Humanos , Universidades
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