Adenosine and neuropathic pain.

Recent studies have reported the possibilities of relieving neuropathic pain by administering adenosine or its analogs. In order to determine if there exists a metabolic anomaly of this nucleoside in patients with neuropathic pain, circulating adenosine levels were compared in three patient groups. The first was composed of individuals suffering from neuropathic pain, the second of patients with nervous system lesions in the absence of pain, and the third was composed of patients suffering from pain resulting from excessive nociception. The adenosine blood levels of these patients were compared to those of a control group. Finally, adenosine in the cerebrospinal fluid (CSF) of some patients was also assayed. The results show that there are reduced levels of blood and CSF adenosine in patients with neuropathic pain. This adenosine deficiency could explain the potential therapeutic effects of administering adenosine or its analogs.

Adenosine and migraine.

BACKGROUND: Adenosine is a powerful natural vasodilator that participates in the control of cerebral and meningeal blood flow. In this context, it could be involved in the pathophysiology of migraine, since it was previously reported that intravenous adenosine can precipitate crises in migraine patients. METHODS: We have investigated circulating adenosine levels in 12 patients suffering from migraine without aura, during crises and in crisis-free periods, and have compared the levels noted to those of a population of 10 controls. To determine if there are interactions between adenosine and serotonin, we examined the effect of adenosine and antagonists on the uptake and the release of (14C) serotonin by platelets. RESULTS AND CONCLUSION: We have reached a dual conclusion: 1) during migraine headaches there is an increase (mean 68%) in circulating adenosine levels and this increase may participate in cephalalgia; 2) activation of A2 receptors by adenosine causes a dose-dependent serotonin uptake by platelets. This inhibition of uptake could participate in the rapid elimination of serotonin in migraine sufferers. As a result of this, the use of adenosine antagonists could be an effective complementary treatment for migraine.

"Axial split osteotomy" of free fibular flaps for mandible reconstruction: preliminary results.

Vascularized free flaps are now considered the most appropriate choice for mandible reconstruction because they offer excellent cosmetic and functional results. Various techniques have been proposed. Free fibular flaps have numerous advantages in terms of versatility and contouring. Shaping can be achieved by wedge osteotomy with excellent results. However, this technique leads to bone loss and may be difficult in the later stages of the procedure. The purpose of this report is to describe a simple and safe flap-shaping method involving axial split osteotomy.

Comparison of different materials for interposition arthroplasty in treatment of temporomandibular joint ankylosis surgery: long-term follow-up in 25 cases.

A variety of interposition materials have been used to prevent recurrence after arthroplasty in treatment of temporomandibular joint ankylosis. The purpose of this retrospective study of our experience was to compare the different materials (skin, temporal muscle, homologous cartilage) used for interposition arthroplasty over a period of 22 years. A total of 25 patients (32 joints) with at least 3 years of follow-up were included. Good results were achieved in 92% of cases using total full thickness skin graft and 83% of cases using temporal muscle flap. Homologous cartilage gave poor results.

Clinical results of therapeutic temporomandibular joint arthroscopy: a prospective study of 34 arthroscopies with prediscal section and retrodiscal coagulation.

Thirty-four therapeutic temporomandibular arthroscopies were done during a 24-month period for patients with debilitating joint disorders (mainly disc displacements with or without reduction) who had not responded to non-invasive treatment. Lysis and lavage with prediscal section and retrodiscal coagulation were the techniques used. Analysis of the results indicated subjective improvement of pain in 71% of cases, noise in 78%, jaw opening in 88% and diet in 97% and objective evidence of disappearance of noise in 29% and improvement of jaw opening in 94% (mean 9.24 mm). In jaw opening, improvement was highly significant, compared with the preoperative results, P < 0.01. We conclude that temporomandibular arthroscopy is safe and indicated in disc displacements and joint luxation if medical treatment has failed.

[Acquired hemophilia caused by antifactor VIIIc antibodies. Apropos of 3 cases]. / "Hémophilie acquise" par anticorps antifacteur VIII c. A propos de 3 observations.

In connection with three observations, we discuss clinical and biological characteristics of "acquired haemophilia". We insist on therapeutics problems: in all the cases corticosteroid and or immunosuppressive drugs are indicated: haemorrhagic accidents treatment depend on the clinical state severity and on the inhibitor concentration: indications of substitutive therapy, plasmapheresis and activated concentrate are considered.

[Ophthalmic manifestations of nasal obstruction]. / Manifestations ophtalmiques orbito-palpébrales de l'obstruction nasale.

Ophthalmic manifestations of nasal obstruction can involve palpebral, orbital and ophthalmic disturbances. They can be the consequence of -Direct contact with the nasal obstruction because the orbital cavity drains partly in to the nasal fossae: rings, lipoptosis, blephaochalasis, fat protrusions, aggravation of exophthalmy in Grave's disease. -Oral breathing: there are modifications in the shape of the palpebral fissure (round eye) by stretching of the facial mask and modifications of the orbital rims (sad eye) due to a lack of naso sinusal expansion, often associated with malocclusion. -A biomechanical correlation between the dental occlusion and the orbital area because of the presence of the maxillary sinus. Every occlusal disorder has an influence on projections of the supra-and infraorbital rims.

[Ophthalmic manifestations of masticulatory system dysfunctions]. / Manifestations ophtalmologiques des dysfonctionnements de l'appareil manducateur.

Temporomandibular joint dysfunctions may involve ophthalmic symptoms such as orbital pain, asthenopia, or anisocoria. These ophthalmic manifestations may be the first signs or the complications of masticatory system dysfunctions. Treatment of these ophthalmic symptoms begins with treatment of the temporomandibular joint dysfunctions.

[Hard palate mucosal graft for posterior lamella repair]. / Greffe de fibro-muqueuse palatine en chirurgie palpébrale.

Several techniques have been proposed for posterior lamella repair. The ideal gaft should be easy and safe to harvest, be lined by mucosa and be rigid enough to support the lower lid against retraction. Hard palate mucosal grafts meet these criteria. The surgical procedure is done under local or general anaesthesia and a graft up to a 40 x 20 mm can be harvested. Paramedian and subperiostal harvest is recommended, local complications are less frequent (bleeding and sensory lesions) and the hard palate mucosa is of better quality at this site (thinner graft with fewer salivary glands but rigid enough due to the periostal layer). Donor site complications such as local bleeding can be reduced by meticulous surgical technique and local postoperative care such as compression using a mouthguard. The main indications for hard palate mucosal graft are lower eyelid reconstruction and management of lower eyelid retraction.

[Hypoglossia-hypodactylia syndrome: apropos of a case with maxillo-mandibular synostosis, glossopalatine ankylosis and cleft palate]. / Syndrome hypoglossie-hypodactylie: à propos d'un cas avec synostose maxillomandibulaire, ankylose glossopalatine et fente palatine.

BACKGROUND: The hypoglossia-hypodactylia syndrome, a combination of limb hypogenesis and micrognathia is exceptionally associated with glossopalatine ankylosis and cleft palate. CASE REPORT: A twin girl from monochorionic pregnancy had hypoglossia and micrognathia with anterior maxillo-mandibular fusion, glossopalatine ankylosis and cleft palate. Her left foot was amputated distal to the talus and calcaneous; her right foot had only one phallange. The second phallange of the second finger was hypoplastic on her right hand. There was no abnormality on left hand. Her sister was unaffected. The maxillo-mandibular fusion was divided on second day. The infant was able to suckle on the tenth day. Episodes of airway obstruction occurred on cardiorespiratory recording and the patient was further monitored at home. CONCLUSION: This case suggests that the hemodynamic disorders due to multiple vascular connections from monochorionic pregnancies may have induced ischemic lesions of hypoglossia-hypodactylia. Other malformations and signs of brain stem dysfunction should be detected.

[Hemorrhagic mandibular metastasis of renal origin: usefulness of therapeutic embolization]. / Métastase mandibulaire hémorragique d'origine rénale: intérêt de l'embolisation thérapeutique.

BACKGROUND: Vascular metastatic tumors of the mandible are unusual and management of bleeding may be difficult. CASE REPORT: An 83-year-old woman with a mandibular metastasis from a renal-cell carcinoma developed oral pain and episodes of bleeding of 2-weeks duration. Embolization was successful in stopping blood loss which occurred during surgical biopsy. Eight months after embolization, the patient is pain free and no bleeding has recurred. DISCUSSION: Embolization during arteriography procedures for tumor exploration can be useful in acute situations to improve survival and patient comfort. The aim may be palliative care or preparation for curative excision.

[Melkersson-Rosenthal syndrome. Value of reduction cheiloplasty]. / Syndrome de Melkersson-Rosenthal Intérêt de la chéiloplastie de réduction.

INTRODUCTION: The interest of cheiloplasty is not precisely defined in the treatment of Melkersson-Rosenthal syndrome (MRS). OBSERVATION: The case of a 32-year-old woman, suffering from a typical MRS is reported. The lack of efficacy of various classical molecules (corticoseroids, hydroxychloroquine, dapsone, colchicine, clofazimine) led to a surgical therapy, consisting in cheiloplasty. Systemic corticosteroids were associated. The result was good, with a follow-up of 2 years. COMMENTS: Cheiloplasty is essentially of cosmetical interest, in the MRS, once the inflammatory process has been stopped (almost one year). Medical treatment (corticosteroids), is to be continued after surgery, to avoid recurrence.

[Intracranial penetration of the mandibular condyle: report on three cases (author's transl)]. / Pénétration intracrânienne du condyle mandibulaire. A propos de trois cas.

Three cases of intracranial penetrations of the mandibular condyle condyle are reported, the published literature reviewed, and therapy discussed. Often unrecognized during initial examinations, they are diagnosed when the patient is seen several months later with permanent constriction of the jaws. Frontal and sagittal tomographic examinations should therefore be performed in the articular region in all cases when it is involved in injuries. Orthopedic reduction gives good results in recent injuries, long-standing cases with temporomandibular ankylosis requiring sub-condylar resection by the pre-auricular approach.

[Not Available]. / Avancement mandibulaire par greffon cartilagineux rétrocondylien.

Most of dentofacial abnomalies are due to mandibular retrognathisms. These abnomalies are surgically treated mostly by mandibular lenghtening with the help of the sagittal split osteotomy although other procedures could be used. Mandibular distraction and advancement of the receding lower jaw by retrocondylar cartilagenous graft are the two main alternatives. The retrocondylar cartilagenous graft has been introduced by Leon Dufourmentel in 1929. This procedure has strong anatomical and physiological basis and has to be better known because it is effective and respects the temporo-mandibular joint. The permanent advancement of the mandible is assured by a retrocondylar graft placed in the pretympanal and extra-articular space located between tympanal bone and retrocondylar venous plexus. All the mandibule retrognathisms should be treated through this approach, especially with associated obstruction sleep apnea syndrome.

[Malar valgisation in narrow face patients]. / Intérêt de la valgisation fonctionnelle des malaires dans les faces étroites.

Most of the "narrow faces" are secondary to a maxillo-malar hypoplasia consecutive to chronic nasal obstruction. Functional malar valgisation by transmalar osteotomy allows a simple and safe correction of this dysmorphic aspect. Interpositional bone graft and osteosynthesis by miniplate avoid mucous inflammation, maxillary sinusitis and/or relapse observed with use of biomaterials. Correction of "narrow faces" by malar osteotomy is natural and long term results are stable. Functional and esthetic rhinoplasty is often associated. Our clinical experience in 15 cases is reported.

[Impacted canine tooth and the eyebrow: the orbit-eyelid impact of occlusal dysfunction]. / Canine incluse et sourcil: conséquences orbito-palpébrales des dysfonctions occlusales.

The orbital region and the dental occlusion are biomechanicaly interdependant. The maxillary basal bone is located in the orbital region due to the presence of the maxillary sinus. Any trouble of the dental occlusion such as a retained canine can involve a lack of projection of the supra and the infra-orbital rim. This lack of projection of the infra-orbital rim is responsible of lower eyelid fat pad; the lack of projection of the supra-orbital rim is responsible of an eyebrow-forehead ptosis. Clinical variations can be observed according to the side of the preeminent eye.