[Intraosseous arteriovenous malformations]. / Les malformations artérioveineuses intra-osseuses.

Intraosseous arteriovenous maxillomandibular malformations are rare. The diagnosis is primarily clinical (children with pulsatile osseous tumefaction, bleeding at cingulum), completed with imaging techniques (TDM and/or MRI). Arteriography is indicated only at the time of therapeutic management. The evolution may vary greatly (four levels: quiescence, expansion, destruction, decompensation) and usually evolves because of hormonal changes or trauma. Radiotherapy and vascular ligatures are no longer recommended. The best treatment is direct or transarterial embolization. Surgical resection, when feasible, must be thorough. It is indicated in case of failure or recurrence after embolization.

[Anaplastic thyroid carcinoma: aggressive radical resection and cervical reconstruction. A case report]. / Chirurgie d'exérèse élargie et reconstruction cervicale pour cancer anaplasique de la thyroïde. A propos d'un cas.

STUDY AIM: Anaplastic carcinoma of the thyroid is a rare but highly malignant tumor. The goal of this study was to present the case of a patient who underwent a multimodal treatment and to analyze prognosis factors. PATIENT AND METHODS: We present the case of a patient treated in 1996 for an anaplasic thyroid carcinoma with cervical cutaneous invasion. The initial surgical procedure was a total thyroidectomy extended to the anterior cervical skin associated to bilateral neck dissection. The patient underwent a differed reconstruction with musculocutaneous latissimus dorsi flap. Management was then supplemented by radiotherapy and chemotherapy. RESULTS: This patient is free of tumor 9 years after this multimodal management. She does not present any functionary sequela and plastic results of the reconstruction is considered as very satisfactory. CONCLUSION: Anaplastic carcinoma is one of more aggressive neoplasm affecting humans. This case report suggests that multimodality therapy, including surgery, chemotherapy and radiotherapy may offer hope for long-term survival. A musculocutaneous latissimus dorsi flap is a reliable solution to cover this large cervical defect.

[Cheek defect reconstruction with a vertical translation flap: nine cases]. / Reconstruction jugale par lambeau à translation verticale: neuf cas.

INTRODUCTION: Cheeks are frequently the sites of common skin tumors. Surgery is the common treatment of those lesions and the operative defect can be important. The aim of this study was to present reconstruction of lateromedial cheek defects with a vertical translation flap. PATIENTS AND METHODS: Nine patients (three women and six men) with a mean age of 46 years (21-74) were included. The defect was located in the medial part of the cheek in all cases with a mean diameter of 5 cm (4-6). The incision was made between the cheek, lateral nasal area, upper and lower lips, and chin aesthetic units. Then the flap was vertically translated and the upper end was fixed to the adjacent periosteum. The average follow-up was four years. RESULTS: In all cases the defect was covered and there was no case flap necrosis. In one case a postoperative paresia of the marginal ramus was noted and two patients presented with minor ectropion without lagopthalmia. DISCUSSION: In our experience this type of flap is indicated in large cheek defects without extension to nasal ala, upper lip, and lower eyelid.

[Detection of the sentinal node by lymphoscintigraphy in squamous-cell carcinoma of the oral cavity: a prospective study of 31 patients]. / Détection du ganglion sentinelle par lymphoscintigraphie dans les cancers epidermoïdes de la cavité buccale: étude prospective de 31 patients.

INTRODUCTION: This study aimed at evaluating the relevance of sentinel node detection by lymphoscintigraphy in patients diagnosed with squamous-cell carcinoma of the oral cavity in the absence of neck adenopathy. PATIENTS AND METHODS: A prospective study was carried out in 31 patients diagnosed with T1 to T3 squamous-cell carcinoma of the oral cavity without any clinically detectable neck adenopathy. A lymphoscintigraphy was performed the day before surgery. All patients underwent sentinel lymph node biopsy guided by a gamma-ray detecting probe and modified neck dissection. Pathologic evaluation of the sentinel lymph node included, in addition to the standard protocol, immunohistochemical analysis and thin sections of E stained preparations. RESULTS: In 3 patients, the lymphoscintigraphy failed to detect any sentinel lymph node. In the remaining group of 28 patients, 20 patients showed a negative sentinel node concordant with a histologically negative neck dissection. In 5 patients, a positive lymph node was found although the rest of the neck dissection was negative. In 3 patients, sentinel lymph node was found to be negative but other neck nodes were positive. The overall sensitivity of lymphoscintigraphy in our study was 62%. DISCUSSION: Surprisingly, the results of our study do not support the clinical usefulness of sentinel lymph node detection as a reliable and accurate staging method in patients with oral squamous cell carcinoma. We observed that lymphoscintigraphy was not a reliable method for detecting micrometastases in patients diagnosed with a squamous-cell carcinoma of the oral cavity without clinical evidence of neck matastases.