[Stereomodel-assisted fibula free flap harvest and mandibular reconstruction: A technical note. Literature review of CAS and CAM applied to mandibular reconstruction]. / Reconstruction de la mandibule par lambeau libre de péroné assistée par une maquette tridimensionnelle : note technique. Revue de la littérature des techniques de CAO et FAO appliquées à la reconstruction mandibulaire.

PURPOSE: Mandibular reconstruction with fibula free flap harvest is currently the reference technique. Various preoperative processes have been developed to optimize this reconstruction. We report our experience with a simple, inexpensive, preoperative technique requiring a 3D printer, a device for maintaining mandibular reduction, a paper-cutting guide. TECHNICAL NOTE: Stereomodels of the mandible were obtained from computed tomography scan data and printed 3D in ABS. It allowed planning mandibular osteotomies, determine the angle between two bone fragments, and preoperatively modeling the osteosynthesis plate. A paper-cutting guide, and a simple device for maintaining mandibular reduction were also built. Two patients were operated on with this technique, with follow-up at 6 and 8 months. Reconstructions were successful with good clinical outcome in terms of mandibular contour and reconstructed segments positions. DISCUSSION: Preoperative planning of reconstruction may be used for mandibular osteotomies, fibular osteotomies, maintaining mandibular reduction, osteosynthesis, or placing implants for dental rehabilitation. The most complex procedures can virtually plan all these steps, but they are expensive and long to implement. Nevertheless, such procedures are quite expansive and require time not always compatible with carcinoma. Using a mandibular stereomodel is fast, easy, and cheap.

Neural-epithelial cell interplay: in vitro evidence that vagal mediators increase PGE2 production by human nasal epithelial cells.

During inflammatory states, airway epithelial cells are stimulated by various proinflammatory mediators to synthesize paracrine mediators including prostaglandin E2, which likely contributes to the recurrence of allergic inflammation. We studied the effects of acetylcholine (ACh) and substance P (SP) on PGE2 release because these two neuromediators are widely involved in airway inflammation, e.g., to trigger mucosal vasodilation and plasma exudation. PGE2 release was studied at baseline and after addition of ACh and SP (10(-10) to 10(-7) M) in primary cultures of human nasal epithelial cells from control mucosa, inflammatory non-atopic mucosa, and inflammatory atopic mucosa. The mediators' effects on COX 2 mRNA were assessed by Northern blotting. We also tested the effect of atropine and SR140333, inhibitors of ACh and SP, respectively. The spontaneous release of PGE2 was about three times higher in cells from atopic subjects. ACh and SP markedly increased PGE2 release (by more than 1.5 times) and this effect was similar whether the sampled tissues were inflammatory or not. In cells from atopic subjects this neuromediator effect led to a fivefold increase in PGE2 release, as compared to baseline production by cells from control mucosa. This stimulation of PGE2 release by neural mediators was inhibited by specific antagonists. ACh and SP increased COX 2 mRNA in the three groups. Thus, neuromediators can bolster PGE2 production in the airway, likely reinforcing inflammation. In conclusion, these data provide evidence that the interplay of nerve fibers and airway epithelial cells is likely important in inflammatory conditions as, e.g., allergy and asthma.

[Actinomycosis in otorhinolaryngology. Apropos of a case with localization in the nasal cavity]. / L'actinomycose en ORL. A propos d'un cas localisé aux fosses nasales.

The authors report an atypical case of actionomycosis implanted in the nasal cavity and occurring twenty years after septum surgery. Treatment by penicillin and surgical excision gave a good result. Cervicofacial actinomycosis is caused by actinomyctes which usually lives as a saprophyte in the oral cavity. A trauma is often found in the previous history. Diagnosis with tumors and abscess may be difficult. The histopathological examination shows typical aspects of the granuloma (gram+ and Grocott+) and the bacteriological isolation of the germ is difficult to obtain. Penicillin associated with surgical excision is the best therapy, but high doses must be used for a long time. The literature is reviewed without finding such a case.

Prevention of second primary tumours with etretinate in squamous cell carcinoma of the oral cavity and oropharynx. Results of a multicentric double-blind randomised study.

Patients who are cured from head and neck carcinomas remain at high risk for developing a second primary in the head and neck area. It is now clear that retinoids exert a prophylactic action on the development of epithelial cancers when tested on laboratory animals and on human premalignant lesions. They are now used in the chemoprevention of epithelial cancers in randomised trials evaluating their efficacy. We prospectively studied 316 patients who developed squamous cell carcinoma of the head and neck, classified as T1/T2, N0/N1 < or 3 cm, M0 according to the UICC TNM classification. Patients were randomly assigned to receive orally, either etretinate (a loading dose of 50 mg/day for the first month, followed by a dose of 25 mg/day in the following months) or a placebo for 24 months. Adjuvant treatment began no later than 15 days after surgery and/or the initiation of radiotherapy. The 5-year survival rate and disease-free survival rate are similar in the two groups. There are no significant differences regarding either local, regional and distant relapses. After a median follow-up of 41 months (range 0-81), 28 patients in the etretinate group and 29 in the placebo group developed a second cancer with, respectively, 12 and 13 in the head and neck region. Adjuvant treatment was definitively discontinued mainly due to toxicity in 33% of patients in the etretinate group versus 23% in the placebo group (P < 0.05). Etretinate, a second-generation retinoid, does not prevent second primary tumours in patients who have been treated for squamous cell carcinoma of the oral cavity and oropharynx.

[Giant cell tumor of the cricoid bone. Apropos of a case]. / Tumeur a cellules géantes du cricoïde. A propos d'un cas.

The authors report about one case of giant-cell tumor of the cricoid bone (osteoclastoma, myeloplaxic tumor). The diagnosis is difficult as the clinical and radiological symptoms are not specific. A detailed iconography sums up the clinicopathological characteristics of this tumor. The authors emphasize the necessity to perform wide exeresis surgery through total laryngectomy.

[High frequency jet ventilation in heated gas saturated in water vapor without a reserve of medical gas under pressure. An original method]. / Jet ventilation à haute fréquence en gaz réchauffés et saturés en vapeur d'eau sans réserve de gaz médical sous pression. Une méthode originale.

A prototype of high frequency jet ventilator is compared with a classic device: Gambro Soxijet ventilator. The advantages of the prototype are: no need of pressured medical gas; warming and saturated moisture of the gas. A powerful compressor (2 M3.H-1 flow--3 bar pressure) draws up the moistened and warmed gases and injects them into a double pneumatic capacity. The first capacity is pressure limited by a relief valve (3 bar). Exhausted gases flow back to the pump. A miniature pressure regulator, placed between the two capacities, rules the driving pressure. Gas mixture is injected through a solenoid valve controlled by an electronic twin-timer. Results of both devices are similar. However, our prototype seems to be very convenient for developing countries where medical gases under high pressure are not often available.

[Analysis of prognostic factors in cervicofacial carcinology using the Cox model. An example of piriform sinus cancer]. / L'analyse des facteurs pronostiques en carcinologie cervico-faciale par le modèle de Cox. Un exemple à propos du cancer du sinus piriforme.

Analysis of prognosis factors was performed on a surgical series of 34 of piriform sinus cancer, based on the use of a multivariate study according to the Cox model. The presentation is essentially didactic emphasizing the main points: how to collect data, what data to collect, and what judgment criterion to use. The authors detail the interpretation to be drawn from the analysis results using Cox model.