[Nasal cavity mucosal melanoma with skin extension mimicking a malignant lentigo with mucosal extension]. / Mélanome muqueux des fosses nasales avec extension cutanée mimant un lentigo malin cutané d'extension muqueuse.

Mucosal melanoma is a rare malignant disease developed from melanocyte. We report the case of a patient with nasal cavity mucosal melanoma with a primary clinical and histological diagnosis of malignant lentigo with mucosal spreading. The presence of a c-Kit mutation, in a second lecture and the evolving nature of the lesion, reorientated the diagnosis of malignant lentigo to mucosal melanoma with skin extension. Extensive surgical resection and foramen free flap with costal graft reconstruction may have a local control of the disease. Yet, after one year, a regional evolution involving a parapharyngeal node was treated by stereotaxic radiotherapy. After 5 years, the patient was considered in clinical and radiological remission. Malignant lentigo with mucosal extension is a very rare situation, this diagnoses must be evoqued after setting mucosal melanoma diagnosis.

Arthrogryposis multiplex congenita and limitation of mouth opening: Presentation of a case and review of the literature.

Arthrogryposis multiplex congenita (AMC) is a rare entity gathering many diseases, isolated or included in more global syndromes. It affects symmetrically joints of lower limbs, back and maxillofacial area with temporomandibular joint (TMJ) impairment leading to deterioration of oral functions and mouth opening resulting in poor quality of life. Therapeutic strategy varies according to type and severity of impairment and could involve physical therapy and/or surgery. This article reported a case of AMC followed in our unit and highlighting various maxillo-facial impairments, especially restricted mouth opening and its consequences due to fibrotic TMJ and hypertrophic coronoid processes. We described our therapeutic approach based on surgery and postoperative physical therapy. A stable improvement of mouth opening was obtained, and patient's quality of life was increased. We performed a review of the literature and suggested a therapeutic management of mouth opening limitation in AMC.

Virtual surgical planning and three-dimensional printing for the treatment of comminuted zygomaticomaxillary complex fracture.

OBJECTIVE: the objective of the study is to evaluate the interest of advanced computer technology, including virtual surgical planning, three-dimensional modeling and pre-bended titanium plate and mesh in the treatment of comminuted zygomaticomaxillary complex fractures. MATERIAL AND METHODS: A total of 19 patients were included. In the study group (n=6) surgery was combined with preoperative planning including mirroring and bending of the titanium plates and mesh on a 3D model. In the control group (n=13) plates and mesh were bended on the patient during the surgery. Patient characteristics, clinical outcomes, orbital volumes, zygoma projection and complications were recorded. RESULTS: After surgery, the orbital volume and the zygoma projection variations between injured side and unaffected side were compared. Orbital volume variation was 2.1mL [1.5; 4.0] in the control group and 0.4mL [0.1; 1.0] in the study group. Zygoma projection variation was 0.2cm in the control group and 0.1cm in the study group. Orbital volume restoration (P=0.004) and zygoma symmetrisation (P=0.04) were significantly better when titanium plates and meshes were pre-bent on a stereolithographic model. CONCLUSION: This study confirms the interest of surgical planification using 3D models to improve treatment of midface trauma.

Surgical approach of ectopic maxillary third molar avulsion: Systematic review and meta-analysis.

Ectopic maxillary third molars (EMTM) are extracted mainly by the Caldwell-Luc technique but also by nasal endoscopy. There is currently no consensus on the treatment of this eruption and its management is heterogeneous and multidisciplinary. Two literature searches were performed with no time restrictions via Pubmed. In the first, we used the keywords "ectopic AND third molar" and in the second the keywords "dentigerous cyst AND ectopic third molar". For both articles, epidemiological, symptomatic, radiological and surgical data were recorded. Overall, 33 eligible articles were identified involving 39 cases of EMTM. 79% of patients were symptomatic. 87% of the teeth were associated with a dental cyst. In only 13% of cases was the location of the tooth in the sinus specified in the three planes of the space. Surgery was performed in 77% of patients by the Caldwell-Luc technique, by nasal endoscopy in 10% and by the Le Fort I approach in 3%. The indications for avulsion of EMTM are symptomatic patients or asymptomatic patients with an associated cyst. The intra-sinusal location of the tooth is not a factor in the choice of technique used, which depends rather on the individual skills of the surgeon. Although for a trained operator the Le Fort I osteotomy is an easy procedure, its interest in the treatment of EMTM is limited owing to the rare but potentially severe complications involved.

Extracorporeal septorhinoplasty: Technical note.

Severe nasal septal deformities can be responsible for functional and aesthetic impairments. Correction of these deformities can be difficult and restoring perfect nasal shape and function is still challenging. Classical techniques can, sometimes, lead to disappointing results or relapse. In this article, the aim was to describe the different techniques of extracorporeal septorhinoplasty and fixation of the neoseptum. Three techniques are mainly used: "crisscross" suture, "U-shaped" suture and anterior septal reconstruction to fix the neoseptum after extracorporeal remodeling. All these techniques are technically demanding, especially concerning keystone area management; but, if well performed, could give satisfactory functional and aesthetic outcomes. We therefore think that extracorporeal septorhinoplasty should really improve our results concerning functional and aesthetic aspects in case of severe anterior or caudal septum deviation.

Mandible extensive intra osseous destructive lesion, a diagnostic challenge.

Intraosseous verrucous carcinoma of the mandible is a rare situation often confused with chronic osteomyelitis. Despite the low aggressively of the tumor, prognosis is poor because of delayed diagnosis. We report 3 cases, from three different hospitals, initially diagnosed with a chronic osteomyelitis of the mandible after wisdom extraction. Imaging, bacteriological and histological samples supported each time this interpretation. The 3 patients worsened with intraosseous extension of the lesions and outflow of whitish and purulent debris. Only extensive resection with mandibulectomy allow the pathologists to identify the tumor. Adjuvant radiotherapy or radiochemiotherapy followed the surgery. One patient is in clinical remission. In front of mandible lesion resistant to antibiotic therapy and sequestrum resection, atypical squamous cell carcinoma must be evoked. MRI and CT-scan are not able to distinguish osteomyelitis and intraosseous verrucous carcinoma. Presence of whitish lysed and debris of keratin must draw the attention. Firm evidence must be provided to the pathologist but samples should be wide and thick.

Are routine microbiological samplings in acute dental infections justified? Our 10-year real-life experience.

PURPOSE: Most patients with severe odontogenic infections are successfully treated with large spectrum probabilistic antibioc therapy, drainage of the collections and tooth treatment or extraction and are discharged home before antibiotic sensitivity results were available. The investigators hypothesized whether bacteriological sampling should be systematically performed in the management of patients with severe odontogenic infections. METHODS: The investigators implemented a prospective observational study. The sample was composed of patients managed between January 2004 and December 2014 for severe odontogenic infection based on three criteria: hospital admission, intravenous antibiotic therapy, tooth extraction and collections drainage under general anesthesia. The predictor variable was the results of bacteriological sampling, culture and sensitivity. The outcome variable was antibiotic therapy adaptation according to antibiotic sensitivity results. RESULTS: The sample was composed of 653 patients; 386 (59%) were male and 267 (41%) female, with a mean age of 37 years (range 18-88); 378 (58%) patients had been receiving oral antibiotics before admission to hospital, for a mean duration of 4.1 days (range 1 - 30). About 535 (81.9%) patients had swabs taken during surgery. Microorganisms were observed in 477 (89.1%) patients but in 377 (70.5%) they were polymorphic oropharyngeal flora. After culture, at least one antibiogram was obtained for 91 (17%) patients and the results led to antibiotic therapy being adapted in 23 (4.3%) patients. CONCLUSION: The results suggest that bacteriological analysis had an impact on evolution in less than 5% of patients. Future studies will focus on the patients for whom the bacteriological analysis is essential.

[Osteoid osteoma of zygomatic bone: Case report and literature review]. / Ostéome ostéoïde du corps de l'os zygomatique : à propos d'un cas et revue de la littérature.

INTRODUCTION: Osteoid osteoma is a benign osseous tumor affecting mainly young men. Although it develops essentially in long bones, some cases occurring in face, mainly in mandible, were related. To our knowledge, only one single case was described in zygomatic bone. OBSERVATION: A 71-year-old man consulted for a right periorbital pain evolving since months with night recrudescence. The pain was not relieved by standard analgesics. Clinical examination was strictly normal. CT scan showed a low-density bone lesion surrounded by a peripheral osseocondensation line within the body of the right zygoma with intense uptake at bone scintigraphy. The patient benefited from surgical excision of the lesion. Pain stopped immediately. Histological examination assessed an osteoid osteoma. DISCUSSION: Zygomatic localization and late occurrence are rare concerning osteoid osteomas. Many ways of management have been reported but surgical excision remains the gold standard.