[Morel-Lavallée syndrome and post-traumatic nodular fat necrosis: Two post-traumatic complications mimicking cellulitis]. / Syndrome de Morel-Lavallée et cytostéatonécrose : deux complications post-traumatiques simulant une dermo-hypodermite infectieuse.

BACKGROUND: Dermal and subcutaneous inflammation following direct trauma is initially evocative of soft-tissue infection. However, two differential diagnoses must be considered: Morel-Lavallée syndrome and post-traumatic nodular fat necrosis. PATIENTS AND METHODS: Case 1: a 51-year-old woman fell off her motorbike and had dermabrasions on her right and left tibial ridges that rapidly developed into dermo-hypodermitis of the entire limb. There was no improvement after 3 weeks of antibiotics. The patient was apyretic. She had a soft, non-inflammatory tumefaction on the inner aspect of her left knee. Ultrasound revealed subcutaneous collection in both legs. The surgeons confirmed a diagnosis of Morel-Lavallée syndrome and drained the two collections. Progress was good and the patient healed without major consequences. Case 2: following a fall on her stairs, a 40-year-old woman presented dermabrasions and haematomas on her left leg. Antibiotic therapy failed to prevent the progression of dermo-hypodermitis. The patient remained apyretic and there was no inflammatory syndrome. A CT scan showed thickening of a subcutaneous fat and fluid collection, resulting in diagnosis of post-traumatic nodular fat necrosis. Management was surgical and the outcome was good. DISCUSSION: These two cases show two post-traumatic cutaneous complications: Morel-Lavallée syndrome and post-traumatic nodular fat necrosis. Morel-Lavallée syndrome occurs after tangential trauma next to richly vascularized tissue. Post-traumatic nodular fat necrosis is defined as necrosis of adipocytes. In both cases, diagnosis is confirmed by imagery (Ultrasonography, tomography). CONCLUSION: Our two case reports show that inflammatory presentation of both Morel-Lavallée syndrome and post-traumatic nodular fat necrosis can lead to diagnostic and therapeutic errors while a surgical procedure is necessary since tissue necrosis can occur.

[Congenital midline cervical cleft]. / Fente cervicale médiane congénitale.

INTRODUCTION: The midline cervical cleft is a rare congenital anomaly of the anterior part of the neck. CASE: We report the case of a 9-year old girl, presenting a congenital midline cervical cleft who underwent corrective surgery at the age of 7 months. Currently, outome is quite satisfactory two years post-operatively; no recurrence has developed. DISCUSSION: We discuss the clinical manifestation of this anomaly, the embryology, the surgical treatment and the clinical course. In its complete form, this rare disorder presents as a subcutaneous midline vertical cervical cord, associated with a cutaneous cleft. The cutaneous cleft consists of an ulceration with an overhanging cutaneous fibromatous protuberance which prolongs downwards to a blind-ended sinus tract. The embryologic mechanism is not formally established, but the majority of the authors agree on the imperfect midline fusion of the paired branchial arch tissue by anomaly of mesodermisation. Surgical treatment is required and must be carried out in the first month of the life in order to avoid neck and mandible functional and morphological disorders. Surgery involves complete excision of the cutaneous ulceration and subjacent fibrous cord followed by site closure using multiples "Z" plasties. Long postoperative monitoring is needed due to the frequency of the recurrence.

Gout of the temporomandibular joint: pitfalls in diagnosis.

Gout is a frequent benign disease that rarely affects the temporomandibular joint (TMJ) alone. When it does, the disease is usually confined to the joint space and leads to pain and limitation of jaw opening (acute gout). The case described in this report is atypical in so far as it extended beyond the joint capsule into the pterygoid muscle and destroyed the head of the mandible, the temporal bone and the greater wing of the sphenoid bone. This clinical behaviour in combination with the radiographic appearance created the appearance of a benign but osteolytic lesion. The clinical, radiographic and biological features of gout in the TMJ are reviewed and treatment options are discussed.

[Cervical ganglioneuroma. Review, apropos of a case]. / Ganglioneurome cervical. Mise au point, à propos d'un cas.

We describe a case of cervical ganglioneuroma, an uncommon benign tumor which develops slowly, predominantly in females and infants. Ganglioneuromas have a neuroectodermic origin and are localized along the sympathetic trunk. Most are unmasked fortuitously by palpation or by high serum catecholamine levels proportional to tumor size. After radiographic exploration and surgical excision, a pathologic study of the surgical specimen is required to identify this very differentiated tumor stemming from the neural crest.

[Axillary lymphadenectomy by lipo-aspiration and endoscopic picking. Apropos of 72 cases]. / Le curage axillaire par lipo-aspiration et prélèvement endoscopique. A propos de 72 cas.

Axillary lymphadenectomy is part of breast cancer treatment. It has two aims: prognosis and treatment. The high morbidity rate of conventional lymphadenectomy is unacceptable in conservative treatment of small tumors. Therefore we developed a new technique combining liposuction and endoscopic picking. So we are able to perform a conservative axillary lymphadenectomy with the same efficiency for prognosis and treatment with a near to zero morbidity. We report here our experience of 72 cases in endoscopic lymphadenectomy.

Endoscopic axillary lymphadenectomy after liposuction.

In breast cancer treatment axillary lymphadenectomy remains essential and necessary because of its role in prognosis and in treatment. Lymphatic nodal involvement is the most important finding for prognosis and indicates the necessity of adjuvant chemotherapy. Axillary lymphadenectomy decreases the risk of local and/or regional recurrence, but it does not modify the survival rate. Unfortunately, axillary lymphadenectomy has a high morbidity rate, despite all improvements made in the last decades. The conventional surgical technique removes the intact axillary content, preserving large vascular and nervous elements, but destroys a certain amount of small arteries, veins, lymphatics and nerves. This leads to complications such as lymphorrhea and edema, hypoaesthesia, shoulder stiffness, pain, deformity of the axilla, long and unaesthetic scars and the most disabling of all, arm swelling.