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.

Cholesterol granuloma of the maxilla.

Intra-osseous cholesterol granuloma (CG) is a rare and benign lesion. Very few cases of CG of the jaws have been described in the literature. CG of the jaws seems to be due to the accumulation of cholesterol of hematogenous origin in odontogenic cysts. We report on one case of CG of the maxilla treated by surgical enucleation in a 46-year-old man who presented an asymptomatic swelling of the maxilla.

[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.

[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.

Significant decrease of facial cellulitis admissions during COVID-19 lockdown in France: A multicentric comparative study.

During the 2020 coronavirus pandemic, a lockdown was imposed in France during the first wave. An apparent decrease in incidence of cellulitis of odontogenic origin was noticed then. This study aimed to compare the incidence of cellulitis during this extraordinary period with the same period in 2018 and 2019, based on retrospective multicentric data. All maxillofacial surgery departments in French public hospitals were contacted. Responders were asked to include all patients admitted for the surgical drainage of a head and neck abscess of odontogenic origin during the first 2020 lockdown period, and in a similar time frame in 2018 and 2019 (control group), based on screening the French diagnostic and therapeutic classification of medical acts. We report a 44% significant nationwide decrease in the incidence of admissions for cellulitis. There were 187 patients in 2020 for 334 and 333 patients in 2018/2019 respectively. The reasons to explain this finding are hypothetical (organizational reasons leading to earlier management, patients' fear to seek for medical management, usual excess in surgical indications or concomitant decrease of non-steroidal anti-inflammatory drugs delivery). Whatever the explanation, it would be of great interest to find it out in order to improve the prevention of cellulitis.

Multiband superconductivity in the Chevrel phases SnMo6S8 and PbMo6S8.

Sub-Kelvin scanning tunneling spectroscopy in the Chevrel phases SnMo6S8 and PbMo6S8 reveals two distinct superconducting gaps with Δ1=3 meV, Δ2∼1.0 meV and Δ1=3.1 meV, Δ2∼1.4 meV, respectively. The gap distribution is strongly anisotropic, with Δ2 predominantly seen when scanning across unit-cell steps on the (001) sample surface. The spectra are well fitted by an anisotropic two-band BCS s-wave gap function. Our spectroscopic data are confirmed by electronic heat capacity measurements, which also provide evidence for a twin-gap scenario.

Is reverse frontal cranioplasty eligible for the correction of both the forehead deformities and the intracranial hypertension in craniosynostosis? Comparison of the preoperative and postoperative intracranial volumes.

BACKGROUND: This study aimed to describe the surgical technique of reverse frontal cranioplasty (RFC), the aesthetical modification as well as the modification of intracranial volume (ICV) to assess its potential eligibility for the treatment of the intracranial hypertension (IH). MATERIALS AND METHODS: A retrospective monocentric study included the patients with a history of craniosynostosis with a forehead deformity who underwent RFC. A subjective outcome questionnaire (SOQ) was conducted with each patient or their parent to determine their level of satisfaction after RFC. Pre- and postoperative computed tomography (CT) scans were analyzed and compared to investigate the ICV change and fronto-nasal angle. RESULTS: Eleven patients were included in the study (6 female and 5 male) with a mean age of 10.9 years old (range 3-23 years) and an average follow-up of 4.5 years (1-11 years). All patients responded to the questionnaire with a high level of overall satisfaction (mean 9.1/10). The mean preoperative FNA was 134° ± 5° while the mean postoperative angle was 126.4° ± 6, corresponding to an average decrease of 7.6° (95% CI, 4.0-11.2°; p < 0.001). One patient with preoperative IH had a clinical recurrence during the follow-up. The ICV was significantly higher after the surgery (p < 0.0001), with an average increase of 3.2% (95% CI, 2.3-4.1%). CONCLUSION: Reverse (RFC) is a useful technique for the correction of the frontal malformations related to craniosynostosis, such as a sloping forehead and/or a lack of the supraorbital projection. Regarding the limited gain of intracranial volume (ICV), it should not be used alone as primary cranial expansion surgery for craniosynostosis with intracranial hypertension (IH).

An ultra-high-vacuum rotating sample manipulator with cryogenic cooling.

We report a homebuilt ultra-high-vacuum (UHV) rotating sample manipulator with cryogenic cooling. The sample holder is thermally anchored to a built-in cryogenic cold head through flexible copper beryllium strips, permitting continuous sample rotation. A similar contact mechanism is implemented for electrical wiring to the sample holder for thermometry. The apparatus thus enables continuous sample rotation at regulated cryogenic temperatures in a UHV environment. We discuss applications of this apparatus for cryogenic sputtering.

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.

Management of Intrauterine Device Migrated into the Bladder: A Case Report and Literature Review.

Intrauterine device represents the most reversible method of contraceptive worldwide. Its insertion is a medical procedure not free from complication. We report a rare case of intravesical migration of a copper intrauterine device inserted 18 months earlier in a 28-year-old multiparous woman. The patient presented with irritative lower urinary tract symptoms, and she was managed endoscopically. This case underscores the role of cystoscopy in irritative lower urinary tract symptoms post IUD insertion.

Real-space vortex glass imaging and the vortex phase diagram of SnMo6S8.

Using scanning tunneling microscopy at 400 mK, we have obtained maps of around 100 vortices in SnMo(6)S(8) from 2-9 T. The orientational and positional disorder at 5 and 9 T show that these are the first large-scale images of a vortex glass. At higher temperature a magnetization peak effect is observed, whose upper boundary coincides with a lambda anomaly in the specific heat. Our data favor a kinetic glass description of the vortex melting transition, indicating that vortex topological disorder persists at fields and temperatures far below the peak effect in low-T(c) superconductors.

Addressing hypertelorism: Indications and techniques.

From its first descriptions in the early 1920s to today's use of cutting guides via computer-assisted surgery, surgical techniques to address hypertelorism have progressed. The present article aims to provide historical background and an overview of the development of surgical techniques during the late 20th century and in recent years. First, a historical overview identifies the most important surgical advances leading to the present state of the art. Each major surgical innovation is described, to explain the changes in this surgical field, according to the type of approach. Then, a precise description of today's most recent practices is provided, with particular emphasis on the spectacular advances deriving from computer-assisted surgery. A thorough description of the use of cutting guides throughout the surgical phase is given.

Virtual 3D planning of osteotomies for craniosynostoses and complex craniofacial malformations.

INTRODUCTION AND OBJECTIVES: Computer-assisted surgery has been more and more widely used in craniofacial surgery in recent years. It is useful in many situations: stereolithographic models, surgical simulations of osteotomies and bone repositioning, and cutting guides and customized implants. The present paper argues that computer-assisted surgery is particularly useful in complex cases such as rare malformations, or to address the sequelae of previous surgeries. The various advantages of the technique are emphasized from a surgical and from a teaching standpoint. MATERIALS AND METHODS: Forty cases of various computer-assisted surgeries were analyzed, allowing a comprehensive review of outcomes in cases such as craniosynostosis, complex craniosynostosis, hypertelorism, craniosynostosis sequelae and cranio-facial and orbital trauma. RESULTS: Results were promising in all of the cases reviewed, except in a few cases for which computer-assisted surgery with cutting guides may not be necessary. In these specific cases, the pedagogical input is nevertheless interesting for residents and students. CONCLUSION: Computer-assisted surgery is revolutionizing the surgical approach to complex craniofacial malformations, as well as easing management of less complex ones. It is likely that in the years to come this technique will supersede previous ones. However, using this technique implies being willing to rely on a non-human device. We need to consider computer-assisted surgery as a tool that can change surgical practices. The surgeon can rely on it, yet nothing will replace his/her eye and experience. It is the combination of both this experience and the appropriate use of computer-assisted surgery that, ultimately, leads to successful surgery.

Management of isolated and complex craniosynostosis residual deformities: What are the maxillofacial tools?

Treatment of craniosynostosis is complex and has greatly progressed in recent decades. From the early stages in the 1950s to today's most recent techniques, surgeons have faced the challenge of overcoming the deformities often caused by such invasive, complex surgeries. In the most recent years, new techniques have been developed that address surgical sequelae, including those of surgery performed in childhood. After a general introduction on craniosynostosis, the present paper describes the various types of deformity that may result from complex surgery and offers an overview of the various tools available to surgeons. An explanation of each indication and procedure is given.

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.

GIANT BLADDER STONE IN A PATIENT WITH TUMOR OF THE BLADDER: A RARE CO-MORBIDITY.

Bladder stones are considered carcinogenic factor for bladder cancer. Concomitant association between giant bladder stone and bladder cancer is rare. We report a case of giant bladder stone complicated by bladder cancer. Bladder cancer was discovered fortuitously. This association of bladder growth necessitated biopsy of the bladder for histopathological study during cystolithotomy.

A rare location for a common tumor: Lingual lipoma.

Lipomas are the most common benign tumors in human body but their occurrence in the oral cavity is very rare. They present as a slow growing, yellowish submucosal and painless mass. The treatment consists of a simple surgical excision. The histopathologic examination confirms the diagnosis. We present a case of tongue lipoma.

Outcomes of functional treatment versus open reduction and internal fixation of condylar mandibular fracture with articular impact: A retrospective study of 83 adults.

INTRODUCTION: The treatment of fractures in the mandibular condylar process remains controversial. The aim of this study was to assess the outcomes of isolated functional treatment versus open reduction and internal fixation (ORIF) of mandibular condylar fracture with articular impact based on clinical and radiological criteria. MATERIALS AND METHODS: Eighty-three patients with a mandibular condylar fracture with articular impact were included in this retrospective study. They were divided according to Loukota, Spiessl and Schroll, Mercier and Rasse, Neff, and Hlawitschka classifications. Two groups were created: operated patients (operated) and non-operated patients (non-operated). Occlusal and functional features were evaluated using clinical measurements at 1, 3, 6, and 12 months after the treatment as well as radiological measurements performed preoperatively, 6 weeks later, and at the end of the follow-up. RESULTS: A male predominance was observed in the data (69.9%, P<0.0001). Isolated functional treatment was applied in 55 patients (66.26%). Twenty-eight patients (33.7%) were operated upon using a pre-auricular or modified Risdon's approach. Maximal mouth opening (MMO) was lesser in "operated" group compared to "non-operated" group until 6 months (25.75mm vs 31.96mm, 34.76mm vs 37.95mm, 38.06mm vs 41.87mm respectively 1, 3 and, 6 months, P<0.05). Results were satisfactory 1 year after treatment (41.29mm vs 45.22mm, P>0.05). There was no difference concerning temporo-mandibular joint dysfunctions between operated and non-operated patients. For unilateral fractures, the loss of height of the ramus was significantly higher in operated patients initially compared to "non-operated" group (P=0.0137). After surgical correction, there was no difference between the two sides of mandible. At the end of the follow-up, the there was no difference between operated and non-operated ramus (P=0.1304 and 0.6420). CONCLUSION: The present study showed that a properly followed isolated functional treatment provided similar clinical results to ORIF for mandibular condylar fractures with articular impact. Surgical treatment should be preferred when the loss of height of the ramus is severe to restore the ramus height since adult condylar remodeling is less efficient than in children.

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.