Management of Large Maxillomandibular Osteofibrous Dysplasia as Part of a Humanitarian Mission.

PURPOSE: Maxillomandibular ossifying fibroma is a benign tumor that affects young adults. Complete excision can allow satisfactory management with no recurrence. During a humanitarian mission, one is confronted with many types of damage from these fibromas. Their management requires wide resection (mandibulectomy interrupter or maxillectomy) and free flap reconstruction. However, technical conditions during a humanitarian mission might not allow the performance of a free flap reconstruction. How can such patients be managed? Should these patients receive a straightforward intervention performed on site during the mission or should they go to another country with a technical platform suitable for microsurgical reconstruction? PATIENTS AND METHODS: During a humanitarian mission in Ouagadougou, Burkina Faso, 6 patients with large ossifying fibromas traveled to France to undergo wide excision of the lesion and free flap reconstruction using the fibula. The Enfants du Noma paid for the travel and medical costs. RESULTS: No flap was lost. Four patients (67%) had local (disunity of scar or local infection) or general (malaria) complications that quickly resolved. CONCLUSIONS: Most teams agree that free flaps should not be performed during humanitarian missions, and only 1 German team practices in Sokoto, Nigeria. Therefore, medical travel is an attractive solution that allows optimal management and requires financial assistance from humanitarian organizations.

The contribution of telemedicine to humanitarian surgery.

Telemedicine enables us to push back the geographical and interactive boundaries of medicine. With a role in humanitarian missions, it is particularly pertinent at two key stages: the preparation phase, and at postoperative follow-up after the mission. It is our intention to describe our experience of telemedicine within a humanitarian context. Four teleconsultations were organized between departments of maxillofacial surgery in Caen (France) and in Bamako (Mali). 21 patients were assessed regarding their care. The preparation phase, taking place several weeks before the mission, allowed us to meet the patients preselected by Prof Traore. We were also able to review imaging, such as previous X-rays or preoperative CT scans. After discussion between the two teams, a decision on the coordination of patient care was reached, namely surgery performed by Prof Traore and the local team in Bamako, or surgery during the next mission to Ouagadougou. Several weeks after the mission, patients attended postoperative consultation by means of teleconsultation. This covered wound assessment, management of complications, and scheduling of follow-up surgery. The benefits of telemedicine in humanitarian projects are manifold: real-time exchange of specialist skills with Malian colleagues, collective therapeutic decisions, academic value, and anticipation of anesthetic and surgical needs before missions.

Cleft palate caused by congenital teratoma.

A cleft palate results from incomplete fusion of the lateral palatine processes, the median nasal septum and the median palatine process. This case report describes a rare case of congenital teratoma originating from the nasal septum that may have interfered with the fusion of the palatal shelves during embryonic development, resulting in a cleft palate. An infant girl was born at 40 weeks of gestation weighing 3020 g with a complete cleft palate associated with a large central nasopharyngeal tumour. Computed tomography (CT) of the head showed a well defined mass of mixed density. The tumour was attached to the nasal septum in direct contact with the cleft palate. A biopsy confirmed the teratoma. Tumour resection was performed at 5 months, soft palate reconstruction at 7 months and hard palate closure at 14 months. There was no sign of local recurrence 1 year later. Most teratomas are benign and the prognosis is usually good. However, recurrence is not rare if germ cell carcinomatous foci are present within the teratoma. For these reasons, we advocate the use of a two-stage procedure in which closure of the cleft palate is postponed until histological examination confirms complete excision of the teratoma.