Prenatal Diagnosis of a Melanotic Neuroectodermal Tumor of Infancy (MNTI): A Case Report With a Favorable Outcome After Chemotherapy Failure and Incomplete Resection.

We present the case of a woman referred to our department at 34 weeks of pregnancy with a fetal ultrasonographic scan showing a mass that had developed within the right maxilla with invasion of the orbit. A retrospective examination showed that this tumor had been present since the 12th week of pregnancy. At 39+4 weeks of gestation, a boy was born. He presented a black firm aspect in the maxilla. A computed tomographic scan and magnetic resonance imaging revealed a soft tissue swelling over the right maxilla, extending into the orbit but without invasion of the globe. Surgical biopsy confirmed a melanotic neuroectodermal tumor of infancy. The pathologic examination did not show any neuroblast-like component on the hematoxylin eosin saffron staining. Because of the extension and the size of the lesion, neoadjuvant chemotherapy was carried out. At day 21, the patient received 1 cycle of low-dose cyclophosphamide and vincristine, 2 cycles of etoposide and carboplatin, and thereafter 1 cycle of cyclophosphamide, adriamycin, and vincristin because the lesion kept growing. After stabilization of the size of the tumor, at 4 months, a maxillectomy and partial resection of the orbital floor and lateral orbital wall was performed on the patient. As a complete resection would have required orbital exenteration, surgery was performed deliberately incomplete leaving a macroscopic residue (R2). At 2.5 years of follow-up, the patient showed complete remission with no lesions evident on magnetic resonance imaging.

Fat graft transfer in children's facial malformations: a prospective three-dimensional evaluation.

INTRODUCTION: Autologous fat grafting for volume augmentation in soft tissues has grown in popularity in the paediatric plastic surgery community, despite a lack of quantifiable evidence of graft survival and predictable outcomes for child patients. The objective of this study is to quantify, through an objective method, the rate of survival of fat grafting in children's reconstructive surgery. METHODS: Clinical evaluation of all children was performed under standardised conditions in a prospective fashion with a 1-year follow-up. All patients, under 18 years of age, were photographed with a three-dimensional imaging system. Data were analysed with three-dimensional analysing software to quantify the volume improvements postoperatively and during the follow-up. RESULTS: Eleven children were included and followed up for 12 months. The mean age was 7.4 years. The mean amount of fat grafted was 13 cm3. At the end of the follow-up, the mean survival rate of the fat grafted was 40%. Complementary fat grafts were needed in 27% of the cases. No significant complications occurred. CONCLUSION: Until now, the literature has failed to provide objective evidence of fat survival in children. This study, using three-dimensional data, showed a 40% survival of grafted fat. The use of three-dimensional photographs and analysis has great clinical potential for surgical planning and follow-up.

[Aesthetic blepharoplasty]. / Blépharoplasties esthétiques.

Suzanne Noël, a pioneer of aesthetic surgery in Europe, first published her results with cosmetic blepharoplasty in 1926, in a book entitled: "The social role of aesthetic surgery". Paul Tessier further expanded the range and surgical possibilities of blepharoplasty by incorporating lateral canthopexies and underlying the importance of the craniofacial skeleton. Other authors in the 20th century brought their own technical refinements to this operation, such as the transconjunctival route, and various fat preserving modifications as well as lipostructure. The aim of this paper was to review the surgical approach to blepharoplasty, according to both historical and currently used protocols (including data gathered by questionnaires sent to eight French and foreign plastic surgical teams). A new perspective is proposed regarding the analysis of different morphological and ageing subtypes. The indication for individual surgical techniques stems from an accurate analysis of each patient according to anatomical categories. Pre-operative records before any orbito-palpebral surgery should include a full orthoptic and ophthalmological assessment, as well as high-quality medical photographs. An increasing emphasis has developed recently upon the use of autologous fat harvested locally (septofat advancement), or from a distant site (lipostructure).