Facial dog bites in children: A public health problem highlighted by COVID-19 lockdown.

BACKGROUND: Stay-at-home injunction during COVID-19 pandemic led to new dynamics in households and increased the risk of domestic accidents involving pets. The aim of the study was to demonstrate an increase of facial dog bites in children during first lockdown period in France, compared to the same period in 2018 and 2019. Secondary objective was to investigate the demographics and circumstances in which dog bites occurred. METHODS: A retrospective multicentric study was conducted nationwide. Patients under 18 years old managed in fifteen oral and maxillofacial surgery departments for a dog bite were included. RESULTS: Eighty-seven patients were included. A significant increase of the number of children managed for facial dog bite was noticed in 2020 (p=0.0005). The male-to-female ratio was significantly reversed in 2020 with more bites in girls than boys (p=0.02). In 2020, children were mostly bitten to cheeks (28.6 %), lips-and-chin region (26.2 %), and eyelids (23.8 %). Severe bites increased in 2020, in comparison with 2018 and 2019. Dog bites occurring while petting or playing significantly increased in 2020 (31 %) (p=0.03). CONCLUSION: The process leading to bites is highly dependent on the balance of dog-owner relationship. This was strongly disrupted during COVID-19 pandemic, resulting in the increase of dog bites in households. Regarding dog bites, face is the most vulnerable area in children. Its injury has lots of esthetic and functional consequences and maxillofacial surgeons have a key role to play in their prevention. Reminders of some of these management and prevention strategies are presented in this article.

Defining a new aggressiveness classification and using NFATc1 localization as a prognostic factor in cherubism.

Cherubism is a rare genetic disease characterized by bilateral giant cell reparative granuloma of the jaws consisting of a fibrotic stroma with giant multinucleated cells (GMCs) and osteoclastic features. Cherubism severity is highly variable, and recurrence after surgery is the most important risk. Currently, there are no prognostic indicators. The aims of this study were to evaluate the osteoclastogenesis phenotype by histologic examination of nuclear factor of activated T cells 1 (NFATc1) localization and tartrate-resistant acid phosphatase (TRAP) activity and to correlate the results to disease aggressiveness to define prognostic indicators. Based on cherubism evolution 1 year after surgery, 3 classes of cherubism aggressiveness were identified: mild (group A), moderate (group B), and severe (group C). Histologically, in grade A and B cherubism lesions, GMCs were negative for both TRAP activity and NFATc1 nuclear localization. In contrast, in grade C cherubism lesions, GMCs were all positive for TRAP activity and NFATc1 nuclear localization and displayed osteoclast-like features. Other histopathologic findings were not different among the 3 groups. Our results establish that TRAP activity and NFTAc1 nuclear localization are associated with aggressive cherubism and therefore could be added to routine pathologic examination to aid in prognosis and management of the disease. The finding of NFATc1 nuclear localization in aggressive tumors supports the addition of anticalcineurin treatment to the therapeutic arsenal for cherubism.

Surgical anatomy of the preauricular anteroparotid approach for mandibular condyle surgery.

PURPOSE: The different surgical approaches used to treat mandibular condyle fractures are carried out in the periparotid skin area and can lead to facial nerve injury. We conducted a preauricular and anteroparotid surgical approach. Our main aim was to show the anatomical relationship between this approach site and the facial nerve branches, and to define cutaneous landmarks to locate the extraparotid facial nerve branches. METHOD: A 2-step dissection of 13 fresh human cadaver semi-heads was performed: a preauricular approach followed by a superficial parotidectomy to visualize the facial nerve. Its course and ramifications were studied and compared to cutaneous landmarks. The proximity of the facial nerve branches with the surgical approach site was observed. RESULTS: The approach allowed systematically visualising the zygomatic and/or buccal branches. No facial nerve branches were sectioned. In three cases (23 %), a nerve branch was visualized during the approach. The buccal and zygomatic branches were ramified in 77 % of cases. CONCLUSIONS: During our preauricular anteroparotid approach, the buccal and zygomatic branches were visualized but none was sectioned. Most often the approach was carried out between these two branches (46 % of cases). Cutaneous landmarks used were reliable to define a safe and nerve-free area for dissection. The buccal and zygomatic branches are very interesting because their high number of ramifications and anastomoses could serve as nerve relays in case of surgical lesion.

On two equations about brain volume, cranial capacity and age.

AIM: We decided to study the relationship between brain volume and cranial capacity and the relationship between brain volume and age on a series of CT from healthy adults. METHODS: Fifty-eight healthy volunteers (27 women, 31 men, age range 18-95 years) were examined using our imaging protocols. The volunteers had no present or past neuropsychiatric illness and no abuse of alcohol or illicit drugs. RESULTS: Mean intracranial volume was 1,384.6 cm(3) (standard deviation = 135.27, range 1,106-1,656) and mean brain volume was 1,201.0 cm(3) (standard deviation = 142.52, range 791-1,500). Linear regression between brain volume and cranial capacity yielded this formula: brain volume = 182.3 + 0.7 × cranial capacity. Multivariate analysis yielded a relationship between cranial capacity, brain volume and age as follows: brain volume = 396.5-3.5 × age + 0.7 × cranial capacity. CONCLUSION: This study could be supplemented by the collection of data such as, the size of the individuals in order to study the relationship between size of the brain and stature because this relation remains unclear.

Treatment of mandibular fractures with Michelet technique: manual fracture reduction without arch bars.

PURPOSE: In our Bordeaux maxillofacial surgery unit, we have used the Michelet technique described for 40 years: manual fracture reduction and semi-rigid miniplate osteosynthesis fixation. No maxillomandibular fixation (MMF) with arch bars or with screws was used for reduction during osteosynthesis. The aim of this work was to evaluate results of this unknown manual reduction method. MATERIALS AND METHODS: A total of 184 patients were reviewed. We recorded epidemiology of mandible fracture, clinical and radiologic evaluation before and after surgery, and treatment. Anatomic and functional manual reductions were the basic principle: manual maxillomandibular immobilization (functional) and manual fracture reduction (anatomic). In cases of condylar fractures without severe displacement, MMF with cortical bone screws was indicated (orthopedic treatment). Physiotherapy was also possible (functional treatment). RESULTS: In all, 315 mandible fractures sustained by 184 patients were reviewed into the study. Of the patients, 80% were treated by osteosynthesis: 54% by osteosynthesis treatment alone, 26% by osteosynthesis and orthopedic treatments. The average time required for osteosynthesis or osteosynthesis and orthopedic treatment was 56 minutes. We observed 0.67% of disturbed occlusion, 0.67% of pseudarthrosis, and 0.67% of bilateral temporomandibular joint internal derangement. CONCLUSIONS: Manual fracture reduction suppresses systematic MMF using arch bars during osteosynthesis of mandible fractures. Operating time and risk of complications are reduced. Functional results seem to be similar to that reported in the literature.

Result of maxillomandibular fixation using intraoral cortical bone screws for condylar fractures of the mandible.

PURPOSE: Treatment of mandibular condylar fractures is not standardized. The maxillomandibular cortical bone screw fixation technique carries many advantages. The aim of this work was to evaluate this technique for routine method. MATERIALS AND METHODS: Fifty patients treated by maxillomandibular fixation (MMF) by use of cortical bone screws from 2004 to 2006 were retrospectively analyzed. In our maxillofacial surgery unit in Bordeaux, France, our indication is to treat extra-articulated fractures without severe displacement by MMF. RESULTS: The mean time required for MMF was 13 minutes, and fixation occurred after a mean of 16 days. Screw removal was performed after a mean of 26 days, and this required local anesthesia. Of the patients, 48 had good occlusion. Two patients had persistent lateral cross bites. Two patients had mandible deviation when they opened their mouths, and mouth opening was limited in one patient. Two patients had temporomandibular joint pain. CONCLUSIONS: MMF screws have more advantages and fewer disadvantages than arch bars when closed treatment has been selected as the treatment of choice.