Virtual surgical planning and three-dimensional printing for the treatment of comminuted zygomaticomaxillary complex fracture.

OBJECTIVE: the objective of the study is to evaluate the interest of advanced computer technology, including virtual surgical planning, three-dimensional modeling and pre-bended titanium plate and mesh in the treatment of comminuted zygomaticomaxillary complex fractures. MATERIAL AND METHODS: A total of 19 patients were included. In the study group (n=6) surgery was combined with preoperative planning including mirroring and bending of the titanium plates and mesh on a 3D model. In the control group (n=13) plates and mesh were bended on the patient during the surgery. Patient characteristics, clinical outcomes, orbital volumes, zygoma projection and complications were recorded. RESULTS: After surgery, the orbital volume and the zygoma projection variations between injured side and unaffected side were compared. Orbital volume variation was 2.1mL [1.5; 4.0] in the control group and 0.4mL [0.1; 1.0] in the study group. Zygoma projection variation was 0.2cm in the control group and 0.1cm in the study group. Orbital volume restoration (P=0.004) and zygoma symmetrisation (P=0.04) were significantly better when titanium plates and meshes were pre-bent on a stereolithographic model. CONCLUSION: This study confirms the interest of surgical planification using 3D models to improve treatment of midface trauma.

[Exclusive radiotherapy for a facial basal cell carcinoma with trigeminal ganglion involvement]. / Radiothérapie exclusive d'un carcinome basocellulaire de la face avec atteinte du ganglion de Gasser.

Basal cell carcinomas with symptomatic perineural invasion are rare entities. We report the case of a 60year-old man (with a grafted kidney), surgically treated in 2007 for a sclerodermiform basal cell carcinoma infiltrating the left nostril. Five years later, a painful left hemifacial hypoesthesia associated with an ulcus rodens of the nasolabial fold appeared. A biopsy confirmed a recurrence. MRI showed an enhancement of the trigeminal ganglion. The patient had a trigeminal perineural invasion secondary to a cutaneous basal cell carcinoma. He received a local intensity-modulated radiotherapy alone (70Gy in 33 sessions), administered from the skin tumour to the skull base. Three years after the end of treatment, the patient is in radiological and clinical remission, with partial recovery of the hypoesthesia. Evolution was marked by iterative corneal ulcers and decreased visual acuity. Modalities of treatment by surgery and/or radiation therapy and complications are poorly described in the literature.

[Central giant cell granuloma in children: Presentation of different therapeutic options]. / Granulome central à cellules géantes de l'enfant : présentation des différentes options thérapeutiques.

Central giant cell granuloma (CGCG) is a benign tumor that may be subdivided in a non-aggressive form and an aggressive form. In aggressive forms, tumor size and high recurrence risk need large surgical resections. In order to minimize surgical morbidity, especially in children, medical treatments acting on the tumor proliferation are currently being assessed: steroids (triamcinolone), anti-osteoclastic drugs (calcitonine, alendronate, denosumab), anti-angiogenic drugs (interferon α). However to date, there is no evidence for any superiority of medical over surgical treatment. Complete response is rarely obtained and additional surgery is often necessary to remove the tumor in case of tumor progression, to remove a remnant or to remodel bone. Moreover, these drugs have frequent local or systemic side effects such as osteonecrosis and growth deficiencies.