Handcrafted firearm suicide: About the unusual use of a mole gun.

The body of a man was found in a workshop at the back of his home, a metal pipe embedded in his chest. In the immediate vicinity of the body, among various tools, was a machine containing a holster hit of lead shot evoking a mole-trap-type "taupe gun" (mole gun). The findings at the scene and the presence of a metal tube, sinkers, and a flock in the chest are in favour of the use of a homemade firearm. The autopsy and CT scan revealed atypical ballistic thoracic trauma responsible for a dilaceration of both the heart and thoracic aorta that caused the death. The autopsy also found a contused wound at the back of the skull without intracranial lesion, which may be due to the fall of the victim after the thoracic trauma. There is no other traumatic lesion and in particular no lesion of seizure, constraint, or defense. Toxicological analyses revealed the presence of alcoholic impregnation at the time of death. These findings, confronted with the expertise of a balistician, made it possible to understand how the victim used a mole gun to cause these lesions. A metal tube was used as a cannon to aim more surely at the heart but also as a means of triggering the propulsion mechanism of the trap without having to stretch out the arm. The tube, thinner than the barrel, had disengaged from its tip to be embedded with the lead shot in the chest of the victim.

Pathology diagnosis of an atypical thyroid cartilage lesion.

In forensic practice, laryngeal lesions are of particular interest for the pathologist, as they may sign foul play. We report the case of a decedent, whose body was found in an advanced state of putrefaction, at the bottom of a ledge, after a one-month disappearance. The face and neck were skeletised. The autopsy found multiple traumatic injuries. The hyoid bone was separated from the other laryngeal structures and seemed to be macroscopically normal. However, the thyroid cartilage had a thin notch at the base of the right upper horn. The nature of this notch was determined by microscopic examination: analysis showed incompletely ossified fibrous tissue, bordered by a line of enchondral ossification. We concluded that the notch was an old fracture, not concomitant with the polytrauma secondary to the fall that was the cause of death. This case shows that microscopic examination may allow the distinction between recent and old wound. Such a distinction is especially important in this context of polytrauma, where lesions could have been secondary to a fall, caused by a third party or unconnected with events.

[Mandibular fractures. Retrospective study of the experience of the Department of Maxillo-facial Surgery and Stomatology of the University of Poitiers Medical Center from 1978 to 1997]. / Les fractures mandibulaires. Etude rétrospective de l'activité du service de Chirurgie Maxillo-faciale et Stomatologie du CHU de Poitiers de 1978 à 1997.

Orthopedic or surgical repair is proposed for mandibular fractures, depending on schools and experience. We reviewed retrospectively 632 cases of mandibular fracture treated at the Poitiers University department of maxillofacial surgery between 1978 and 1997 to assess methods and outcome. We performed a global analysis and compared certain localizations with statistical tests. Different therapeutic protocols were used. The rate of complication was greater, for an equivalent initial lesion, with surgical compared with medical treatment. This was particularly true for fractures involving the jaw angle. There was no significant correlation between trauma-induced malocclusions and orthopedic or surgical preferences of the operators. Surgery did not lead to more sequelae than other techniques but did require a rigorous technique and surgical experience to limit complications. Joint fractures were associated with a high rate of complications, whatever the therapeutic method.

[Post-traumatic temporomandibular pain dysfunction syndrome and the problems raised by its imputation]. / Réflexions sur le SADAM posttraumatique et les problèmes soulevés par son imputabilité.

Direct, certain and total imputability of trauma as the cause of mandibular joint dysfunction is often difficult to establish. The theoretically obligatory conditions are rarely met, making the expert's opinion quite difficult to establish. The complexity of the pathophysiology involved in mandibular joint dysfunction confirms however the reality of this sequella. By determining the precise lesional or functional origin of the syndrome and the latent or patent nature of the prior status it is possible to ascertain intermediary situations.

[Facial reconstruction: the history of a challenge]. / La reconstruction faciale: histoire d'un défi.

In our society, there is a social, cultural and legal obligation to identify cadavers. If all other techniques fail to produce a presumed identity for a very deteriorated body, facial reconstruction can be the last resort. Historically, the first attempts in the XIXth century concerned famous men. Anatomists, anthropologists, and embryologists established the basic principles of the method. Paleontologists then tried to reconstruct the face of prehistoric men. For the first time in the XXth century, the Russian school, directly inspired by the American school began work concerning the victims of crimes. The development of photography, the discovery of X-rays and progress in imaging and data processing, then the development of the CT scan have all contributed to this still experimental method.

Identification by frontal sinus pattern in forensic anthropology.

The authors report forensic cases from the literature, as well as two personal homicide cases, of identification through comparison of frontal sinus radiographs. A general discussion about identification using frontal sinus X-rays is presented, pointing out the reliability of the method, in reference to the uniqueness of the frontal sinus in humans, but also some difficulties, especially in reference to the distance, orientation and angle of the X-ray technique.

[The value of the accountability of results in oral medicine and maxillofacial surgery]. / Place de l'obligation de résultat en stomatologie et chirurgie maxillo-faciale.

As far as his/her patients are concerned, the physician is usually only accountable for the means used. Only exceptionally will he/she claim forthcoming results and, consequently, be held liable in case of lack thereof, even though no fault may be retained against him/her. In stomatology and maxillofacial surgery, the risk inherent to such a commitment touches primarily on three areas: prostheses, orthodontia, and plastic surgery, the latter being nondevoid of ambiguity as to how it should be differentiated from repair surgery. Risk may be limited by applying special vigilance when giving information to the patient.

[Cervicofacial arterial lesions. An unusual case and a review of the literature]. / Lésions artérielles cervico-faciales. Une observation particulière, revue de la littérature.

A patient with a bullet wound developed an initially unrecognized vascular lesion revealed after five weeks by a cataclysmic hemorrhagic complication during drainage attempts. Literature on cervicofacial ballistic injuries is reviewed and the practical attitude to adopt with these lesions discussed.

[Maxillofacial sequelar manifestations of Silverman's syndrome]. / Les manifestations maxillo-faciales séquellaires du syndrome de Silverman.

The Silverman's syndrome or "child abuse syndrome" consist in several symptomes whose about 50% are maxillo-facial ones. These which are must often unknown at the initial stage, are responsible for an after effect syndrome, involving very significant nasal, oral, labial and buccal lesions. The anomalies of facial growth are the results of chronic lesions of cartilagenous septum and of nose bone area. A better understanding of this syndrome should held to diagnose it as quickly as possible. Indeed children are endangered by a lack of protective measures.

[Schwannoma of the pterygomaxillary fossa, excision by transmandibular approach]. / Schwannome de la fosse ptérygo-maxillaire, exérèse par voie transmandibulaire.

Primary tumors of the pterygomaxillary fossa are rare and difficult to approach surgically. A case of a schwannoma is reported, extirpation being through a transmandibular approach using an osteotomy-osteosynthesis procedure.

[Conservation of the mandible by osteotomy-osteosynthesis in "trans-mandibular" oropharyngectomy. 34 case reports]. / La conservation de la mandibule par ostéotomie-ostéosynthèse dans lóro-pharyngectomie "trans-mandibulaire". A propos de 34 observations.

Trans-mandibular oropharyngectomy was performed in 34 patients, as initial treatment in 20 cases and following tumoral recurrence after radiotherapy in the other 14 cases. Results indicate that mandibular conservation is possible when bone is not affected by the neoplastic process and when an oropharyngoplasty ensures perfect covering of the mandible. The site of choice for osteotomy-osteosynthesis appears to be the parasymphysial region, as this provides a very satisfactory route of approach, the mental nerve and innervation of the lip are respected, it is situated outside of the irradiation field (before or after surgery), and there are no dental articulation complications.

[Ligation of the external carotid in the parotid space. Its surgical significance]. / La ligature de la caroide externe dans la loge parotidienne. Son intérêt chirurgical.

The classical procedure of external carotid artery ligature in the carotid sulcus presents certain difficulties: The subdiagastric lymph nodes and branches of farabeuf's venous trunk must be avoided, and major nerves and vessels, including the hypoglossal nerve, internal carotid artery, and internal jugular vein, identified and protected. An approach to the external carotid artery at its entry into the parotid space, as employed in parotidectomy, avoids such problems due to major anatomical elements. This technique appears to be simpler, less restrictive, and more rapidly accomplished than the classical method of ligature, when its objective, the most frequent one, is arrest or prevent ion of hemorrhage in the region supplies by the internal maxillary artery.

[Treatment of florid oral papillomatosis. Apropos of 10 cases]. / Le traitement de la papillomatose orale floride. A propos de 10 observations.

Florid oral papillomatosis is a well defined, not exceptionally observed clinical entity of unknown pathogenesis. The exuberant lesions are characterized by their benign appearance on histology, but this is usually associated with a marked capacity for progression and recurrence and a tendency for epitheliomatous degeneration. Based on a review of cases in the published literature and a series of ten patients treated personally, it would appear that radiation therapy should be formally excluded, and that the treatment of choice is by wide excision associated, whenever possible, with reconstructive surgery.