Sequential Treatment of Extreme Maxillary Hypoplasia: A Historical Patient Report of an Edentulous Adult Patient With Ankyloglossia.

INTRODUCTION: The management of multiple dimensions in orthognathic surgery often requires careful planning. Too large discrepancies could require a sequential procedure to make alignment of the archs possible. REPORT OF CASE: The authors report a case of a 30-year-old partially edentulous man with severe maxillary hypoplasia caused by an untreated ankyloglossia. The transverse deficiency was estimated at more than 15 mm and the sagittal discrepancy shows a negative overjet of 11.5 mm. These wide deficits needed a 2-step surgery and the use of computed-aided design/computed-aided manufacturing. The first step was a palatal expansion by a fan-shaped Le Fort I osteotomy. The second step treated sagittal discrepancy and re-expanded the maxilla.At the end, the sagittal dimension got normal and the maxilla have been widened to almost 7 mm. CONCLUSION: Custom-made surgery is very useful for uncommon cases, in particular for toothless patients. It facilitates complex operations and allows precise results.

[Two experimental models for wound vitality evaluation in forensic pathology: A clinical prospective non-interventional study and an animal model]. / Présentation de deux modèles expérimentaux pour l'étude de la vitalité des plaies en pathologie médico-légale : une étude clinique prospective non interventionnelle et un modèle animal.

AIM OF THE STUDY: In forensic pathology, wound age evaluation allows to determine if a wound was inflicted before or after death, and to date wounds of different ages. This dating is performed in conventional histopathology by observing inflammatory cells and hemorrhage at the wound site. However, these criteria seem to show low sensitivity and/or specificity. The aim of our study was to compare two models of wound vitality evaluation: a human surgical model, and a porcine experimental model; using these histological criteria. PATIENTS AND METHOD: In the two human (n=38) and porcine (n=11) models, three wounds were performed at regular time-lapse before devascularization/sacrifice, and a control wound after devascularization/sacrifice. The main evaluation criteria were the presence of interstitial hemorrhage and the number of interstitial polymorphonuclear neutrophils at 10 high power fields. RESULTS: In the two models, the number of polymorphonuclears neutrophils was significantly higher in vital wounds compared to the post-devascularization/sacrifice wounds (P<0.001), with a very low sensitivity (human model: 4.3%; porcine: 47%). Hemorrhagic infiltration was more frequent in vital wounds (human: P<0.001; porcine: P=0.01), with a low specificity (human: 48%; porcine: 54%). DISCUSSION AND CONCLUSION: This first study confirms, in the two models, the limitations of conventional histopathology in wound vitality evaluation. The next step will be testing several immunohistochemical markers in the two models.

Juvenile trabecular ossifying fibroma: A case of extensive lesion of the maxilla.

INTRODUCTION AND IMPORTANCE: Juvenile trabecular ossifying fibroma is a rare benign tumor of childhood affecting the facial bones rarely described in literature. Its aggressive growth and high tendency of recurrence make it a real challenge for diagnosis and care. CASE PRESENTATION: This article presents a case of an extensive juvenile trabecular ossifying fibroma of the maxilla in a 14-year-old boy, which required surgical intervention with immediate bone reconstruction using an autogenous graft (iliac crest). No recurrence has been found after two and a half years of follow-up. CLINICAL DISCUSSION: Common symptoms of juvenile trabecular ossifying fibroma include painless swelling, facial asymmetry, jaw deformity and teeth displacement. Differential diagnosis should consider other forms like psammomatoid ossifying fibroma, osteofibrous dysplasia, fibrous dysplasia, ameloblastoma, odontoma, or even poorly differentiated carcinoma. CONCLUSION: Currently, there is no recommendation or consensus for the treatment of juvenile trabecular ossifying fibroma. The objective of treatment is also to preserve growth and development and conserve the nervous structure and the function, as mastication, vision. Early diagnosis and appropriate care are essential to prevent morphological and functional defects in young patients. Regular and long-term follow-up is essential due to the high recurrence rate.

Surgical management of odontogenic myxomas: A case series.

INTRODUCTION: Odontogenic myxoma is a relatively rare bone tumor involving exclusively the jaws. Despite its benign nature, odontogenic myxoma can exhibit aggressive, locally invasiveness and has a high potential of recurrence. Surgical treatment can be conservative of radical. The choice of surgical procedure is controversial, and there are no established guidelines. CASE SERIES PRESENTATION: We present a case series of three cases of odontogenic myxomas. This case series illustrates the variability of the radioclinical presentation of odontogenic myxoma and the resulting surgical management, ranging from simple enucleation to mandibular interruptive resection surgery with free flap reconstruction. DISCUSSION AND CONCLUSION: Through this case series, we highlighted and described decision criteria contributing to treatment choice and summarized this in an algorithm. Radiological tumor characteristics and also patient specific factors such as age need to be considered to make a personalized decision to each patient.

Iatrogenic displacement of an impacted third maxillary molar in the parapharyngeal space: A case report.

Accidental iatrogenic displacement of third molars in peripheral soft tissues is a major intraoperative complication, but is considered rare. A young women reported discomfort during mandibular lateral movements since she underwent the extraction her impacted third molars under general anesthesia, 2 years before. The clinical examination was not specific except for a laterality limitation of the right mandibular movements. The germ of 28 appeared radiologically encapsulated in the peripheral muscle tissues in the left parapharyngeal space and showed no signs of ankylosis. After measurement of the benefit-risk balance the surgical extraction of the foreign body has been successfully carried out. After 6 weeks the patient was able to regain bilateral symmetrical mandibular laterality movements. It appeared that tooth 28 was interfering with the movements of the manducatory function, either by obstructing the mandibular path, and/or by irritating the pterygoid muscles or other peripheral tissues .

Contribution of anatomical criteria to surgical approach for treatment of bilateral coronoid hyperplasia.

INTRODUCTION: Bilateral coronoid hyperplasia is a rare condition characterized by a progressive and painless limitation of mouth opening. The treatment consists of coronoidectomy by intraoral or coronal approach. There is no recommendation in the literature on the choice of the surgical approach according to the importance of the hypertrophy. The objective of our study is to search for predictive anatomical criteria of each approach. MATERIAL AND METHODS: These anatomical criteria were evaluated from 3D CT facial reconstructions of 4 male patients aged 4 to 30 years retrospectively after their surgery. A single intraoral approach was used for cases 1 and 2 (group A), a double approach for cases 3 and 4 (group B). Same measurements were performed on 10 male case controls (group C). We performed a descriptive analysis of our results due to an insufficient number of patients. RESULTS: The average width of the coronal processes was much greater in group B, when a double approach was necessary, than in groups A and C. In groups A and B, the average height of the coronoid notch is low compared to group C when there is a need for a coronal approach. The width/TZS ratio is increased in group B compared to group C. DISCUSSION: In our study, 3 criteria could be informative for the choice of the surgical approach: the width at the superior end of the coronoid process, the width/TZS ratio and the height of the coronoid notch but additional data are needed to confirm our therapeutic options.

Myeloperoxydase and CD15 With Glycophorin C Double Staining in the Evaluation of Skin Wound Vitality in Forensic Practice.

Background: The determination of skin wound vitality based on tissue sections is a challenge for the forensic pathologist. Histology is still the gold standard, despite its low sensitivity. Immunohistochemistry could allow to obtain a higher sensitivity. Upon the candidate markers, CD15 and myeloperoxidase (MPO) may allow to early detect polymorphonuclear neutrophils (PMN). The aim of this study was to evaluate the sensitivity and the specificity of CD15 and MPO, with glycophorin C co-staining, compared to standard histology, in a series of medicolegal autopsies, and in a human model of recent wounds. Methods: Twenty-four deceased individuals with at least one recent open skin wound were included. For each corpse, a post-mortem wound was performed in an uninjured skin area. At autopsy, a skin sample from the margins of each wound and skin controls were collected (n = 72). Additionally, the cutaneous surgical margins of abdominoplasty specimens were sampled as a model of early intravital stab wound injury (scalpel blade), associated with post-devascularization wounds (n = 39). MPO/glycophorin C and CD15/glycophorin C immunohistochemical double staining was performed. The number of MPO and CD15 positive cells per 10 high power fields (HPF) was evaluated, excluding glycophorin C-positive areas. Results: With a threshold of at least 4 PMN/10 high power fields, the sensitivity and specificity of the PMN count for the diagnostic of vitality were 16 and 100%, respectively. With MPO/glycophorin C as well as CD15/glycophorin C IHC, the number of positive cells was significantly higher in vital than in non-vital wounds (p < 0.001). With a threshold of at least 4 positive cells/10 HPF, the sensitivity and specificity of CD15 immunohistochemistry were 53 and 100%, respectively; with the same threshold, MPO sensitivity and specificity were 28 and 95%. Conclusion: We showed that combined MPO or CD15/glycophorin C double staining is an interesting and original method to detect early vital reaction. CD15 allowed to obtain a higher, albeit still limited, sensitivity, with a high specificity. Confirmation studies in independent and larger cohorts are still needed to confirm its accuracy in forensic pathology.

Liposuction-assisted medial brachioplasty after massive weight loss: an efficient procedure with a high functional benefit.

BACKGROUND: Brachioplasty frequently offers functional benefits but results in poor aesthetic scars and a relatively high complication rate. The authors describe the complications and risk factors inherent in liposuction-assisted medial brachioplasty and assess patient satisfaction with the functional and aesthetic benefits. METHODS: A 5-year retrospective study was performed that included all patients who underwent liposuction-assisted medial brachioplasty. Complications were reviewed and analyzed by aesthetic and nonaesthetic categories, and patient satisfaction was rated. RESULTS: Sixty-six patients were included (mean age, 44.4 years). The average body mass index was 30.2 kg/m; mean weight reduction was 50.72 kg. Thirty-seven patients (56.1 percent) developed at least one complication, including six (9.1 percent) with a nonaesthetic complication versus 31 (47.0 percent) with an aesthetic complication. Complications were significantly associated with a longer operative time (p = 0.015), 233 minutes in the complication group versus 164 minutes in the no-complication group. Fifty-three patients answered the questionnaire. Forty-six (86.8 percent) stated that they would undergo this intervention again. Overall satisfaction was reported as excellent for 12 patients (22.6 percent) and pleasing for 24 (45.3 percent). All patients rated the functional outcome superior or equal to the aesthetic outcome. Quality of life was estimated to be better after than before the intervention for 41 patients (77.4 percent). CONCLUSIONS: Liposuction-assisted medial brachioplasty is a safe and efficient technique. It offers a functional benefit with a low nonaesthetic complication rate. Despite the inherent scars, the majority of patients would undergo this intervention again because of an important satisfaction rate and improvement in quality of life. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

Satisfaction and complications after lower body lift with autologous gluteal augmentation by island fat flap: 55 case series over 3 years.

BACKGROUND: Major weight loss causes body deformities. Lower circumferential dermolipectomy with autologous gluteal augmentation by a fat island flap can restore a part of the body contour, but this procedure is associated with a high incidence of complications. The aim of this study was to analyse the benefit/risk ratio and the patients' satisfaction. METHODS: All patients who underwent this procedure at the Nancy University Hospital over a 3-year period (between January 2010 and 2013) were reviewed; the complications were analysed and the patients' satisfaction rated. RESULTS: A total of 55 patients were included with a mean age of 41.0 years. The average body mass index of the patients was 28.2 kg/m² with a mean weight of 76.8 kg at the time of the procedure and a mean weight reduction of 49.6 kg. The mean operative time was 4.85 h. The average hospital stay was 6.1 days. The average haemoglobin loss was 3.0 g/dl, and 12 (21.8%) patients required a blood transfusion. Of the total number of patients, 22 (40%) developed at least one complication, including six (10.9%) major complications. Fifty-two patients answered the questionnaire; 49 (94.2%) patients would go through this procedure again. The overall satisfaction was rated as excellent by 29 (55.8%) patients and as pleasing by 22 (42.3%). The outcome was judged as excellent or pleasing for the abdomen by 29 (55.8%) and 20 (38.35%) patients, respectively, and for the buttocks by 17 (32.7%) and 29 (55.8%) patients, respectively. The quality of life was rated better after than before the intervention by 49 (94.2%) patients. CONCLUSION: Despite a high complication rate, the majority of patients confirmed that they would opt for this procedure again, showing an improvement in their quality of life with an aesthetic and functional benefit. LEVEL OF EVIDENCE: III.

Simulations of the consequences of tongue surgery on tongue mobility: implications for speech production in post-surgery conditions.

BACKGROUND: We studied the ability of a three-dimensional (3D) biomechanical model of the oral cavity to predict the consequences of tongue surgery on tongue movements, according to the size and location of the tissue loss and the nature of the flap used by the surgeon. METHOD: The core of our model consists of a 3D biomechanical model representing the tongue as a finite element structure with hexahedral elements and hyperelastic properties, in which muscles are represented by specific subsets of elements. This model is inserted in the oral cavity including jaw, palate and pharyngeal walls. Hemiglossectomy and large resection of the mouth floor are simulated by removing the elements corresponding to the tissue losses. Three kinds of reconstruction are modelled, assuming flaps with low, medium or high stiffness. RESULTS: The consequences of these different surgical treatments during the activation of some of the main tongue muscles are shown. Differences in global 3D tongue shape and in velocity patterns are evaluated and interpreted in terms of their potential impact on speech articulation. These simulations have been shown to be efficient in accounting for some of the clinically observed consequences of tongue surgery. CONCLUSION: Further improvements still need to be done before being able to generate patient-specific models easily and to decrease the computation time significantly. However, this approach should represent a significant improvement in planning tongue surgery systems and should be a very useful means of improving the understanding of muscle behaviour after partial resection.