Modification of the pedicled osteomuscular dorsal scapula flap to include a skin paddle.

This article describes a reliable surgical alternative for the repair of wide oromandibular defects that require bone and soft tissues, which was applied in two patient cases. While microvascular free flap transfer, especially the fibula flap, is the gold standard for mandibular reconstruction, this reconstruction is challenging in patients with a vessel-depleted neck and/or severe arteriosclerosis. The pedicled osteomuscular dorsal scapular (OMDS) flap is a surgical alternative to free flap transfer in this clinical setting. The technique described involves harvesting of the OMDS flap to include a skin paddle, which is often required to close wide oral mucosal defects.

Efficacy of cognitive behavioral therapy on aggressive behavior in children with attention deficit hyperactivity disorder and emotion dysregulation: study protocol of a randomized controlled trial.

BACKGROUND: Attention deficit hyperactivity disorder (ADHD) is frequently associated with emotional dysregulation (ED). ED is characterized by excessive and inappropriate emotional reactions compared to social norms, uncontrolled and rapid shifts in emotion, and attention focused on emotional stimuli. Few studies have evaluated non-pharmacological interventions to improve ED in children with ADHD. The current randomized controlled trial assesses the efficacy of a cognitive behavioral therapy (CBT) intervention compared with a theater-based intervention (TBI) in children with ADHD and ED. METHODS: Sixty-eight 7- to 13-year-old children with ADHD and ED will be recruited and randomly assigned to the CBT or TBI group. CBT aims to reduce ED by teaching anger management strategies. TBI seeks to reduce ED by improving emotion understanding and expression through mimics and movement. In both groups, children participate in 15 1-h sessions, and parents participate in 8 sessions of a parent management program. The primary outcome measure is the change in the "Aggression" sub-score of the Child Behavior Checklist (CBCL). Secondary outcome measures include overall impairment (Children's Global Assessment Scale, Strengths and Difficulties Questionnaire), personality profile (Hierarchical Personality Inventory for Children), executive function (Behavioral Rating Inventory of Executive Function), quality of life (Kidscreen-27), parental stress (Parenting Stress Index, 4th edition), parental depression (Beck Depression Inventory-II), and impact of child disorders on the quality of the family life (Parental Quality of Life and Developmental Disorder). DISCUSSION: Children with ADHD and ED are at risk of functional impairment and poor outcomes and have specific therapeutic needs. This randomized controlled trial wants to assess non-pharmacological treatment options for this population. TRIAL REGISTRATION: Clinicaltrials.gov. NCT03176108 . Registered on June 5, 2017.

[Anatomical characteristics of the superficial temporal venous system and implications in microsurgery]. / Caractéristiques anatomiques du système veineux temporal superficiel et implications en microchirurgie.

INTRODUCTION: The superficial temporal vessels remain underused in microsurgery, the superficial temporal vein (STV) being reported as inconstant. The aim of this study was to precise the anatomical characteristics of the superficial temporal venous system by means of a cadaveric anatomical study and a doppler-ultrasound study on healthy subjects. MATERIALS AND METHODS: In order to study the anatomical variations of the STV and its different branches in the temporo-parietal area, 10 hemifaces of bodies donated to science were injected with latex and dissected. A doppler-ultrasound study of the superficial temporal venous system was also performed on 10 healthy subjects in order to assess the median diameter of the STV. RESULTS: A common temporo-parietal trunk was found on all the bodies dissected, with a mean number of 1,6 [1-3] venous affluents. The STV preceded systematically the superficial temporal artery (STA) in the pre-auricular area. The arterio-venous relationships were in contrast highly variable above that area. The diameter of the STV presented major interindividual variations, with a median diameter of 1,3mm [0,5-2]. CONCLUSION: The superficial temporal vessels can be easily identified in the pre-auricular area. With a mean harvestable length of 6,5cm and a mean diameter of 1,3mm, the parietal branch of the STV presents a caliber sufficient for the realization of the anastomoses.

Incidence and morphology of the incisive suture in CT scanning of young children and human fetuses.

PURPOSE: Incisive suture is a suture classically described on the oral face of the palate in fetuses and young children. The aim of our study was to describe the evolution of the incisive suture in human fetuses and to evaluate the incidence of this suture in a population of young children under 4 years, to determine if there is a possibility of improving the anterior growth of the maxilla, by stimulation of this suture. METHODS: One hundred and thirty CT scan images of patients aged from birth to 48 months have been studied and nine fetal palates aged from 18 to 26 weeks of development, have been scanned using high-resolution X-ray micro-computed tomography RESULTS: The CT scan images of patients showed that an incisive suture was present in 33/130 cases (25,4%). All the patients with a suture were under 2 years old. The fetal palate study showed that the suture was present in the inferior aspect of the palate (oral cavity) in all cases. The incisive suture increased from 18 to 24 weeks. At 26 weeks it stopped growing although the intercanine length increased. Considering the closure of the suture in a vertical plane, our study on fetuses has shown that the incisive suture is closing from its superior side (nasal side) to its inferior side. CONCLUSIONS: Considering all these results it appears to us that the incisive suture is partially ossified after birth, it cannot be stimulated by orthodontic appliances.

Anatomic study of the arterial territories of the face depending on the external carotid artery branches.

AIM OF THE STUDY: Blood supply of the skin of the face is mainly provided by 3 branches of the external carotid artery: facial artery (FA), superficial temporal artery (STA) and transverse facial artery (TFA) which is a branch of the STA. The aim of the study was to describe the arterial territories of the skin of the face depending on the external carotid branches. MATERIAL AND METHODS: After dissection of the first two centimeters of these arteries on one side, we performed an injection of India ink of different colors in the arteries in order to describe the arterial territories (angiosomes) of the face on 24 embalmed cadavers. RESULTS: The lips and the tip of the nose were vascularized in most cases by the FA. The STA vascularizes the temporal and frontal areas and a part of the auricle. The buccal area blood supply is coming from the FA with a participation of the TFA which is variable (10/24 cases), and the zygomatic area blood supply is coming from the STA with a participation of the TFA (9/24 cases). CONCLUSIONS: Variations in the angiosomes of the face have to be considered in reconstructive surgery, and in face transplantation.

Surgical implications of the anatomic situation of the mandibular canal for mandibular osteotomies: a cone beam computed tomographic study.

PURPOSE: In bilateral sagittal split osteotomy (BSSO), the risk of lesion of the inferior alveolar nerve (IAN) is important. The aim of this study was to investigate the situation of the IAN in the area of the BSSO in preoperative 158 CBCT. METHODS: The situation of the mandibular canal (MC) has been studied in six coronal sections (one section each 4 mm) from the proximal root of the second mandibular molar. The height of the MC related to the height of the mandible, and the horizontal distance between the MC and the lateral cortical plate related to the mandibular width have been determined in each section. The cancellous bone width has been measured allowing to determine a cancellous bone ratio. RESULTS: The variability of the MC was high, depending mainly on the cancellous bone ratio which was higher when the IAN was deep. When a third molar was present, the MC was lower in the area of the third molar. CONCLUSIONS: To decrease the risk of injuring the IAN in BSSO, the evaluation of the cancellous bone ratio by a preoperative CBCT may be proposed to adapt the surgical technique to the anatomy.

The transverse facial artery and the mandibular condylar process: An anatomic and radiologic study.

INTRODUCTION: In surgical approaches to condylar fractures, there is a risk of damage to the transverse facial artery (TFA) which may in turn account for impaired blood supply to the temporomandibular joint (TMJ). In order to investigate the risk of damage to the TFA, and prevent lesions to this artery resulting from TMJ surgical procedures, we studied the distance between the TFA and the head of the condylar process. METHODOLOGY: A dissection study was conducted on 10 fresh cadavers (20 condylar specimens dissected), involving fifty CT scans of the face with intravenous contrast. Vertical distance from the TFA to the top of the mandibular condyle head and distance from the TFA to the lateral aspect of the mandibular condyle were measured. RESULTS: The lateral aspect of the mandibular condyle is vascularized by branches emanating from the superficial temporal artery (STA) and the TFA. The TFA was located 1.84 ± 0.6 cm below the condylar process of the mandible and ran 1.09 ± 0.54 mm lateral to the head of the mandibular condyle. DISCUSSION: In order to spare the TFA in fractures involving the condylar neck, surgical approaches to the condyle should preserve the uppermost 2 cm of the lateral surface of the condyle during dissection. Due to the necessity for periosteal elevation of the lateral surface of the condyle in condylar head fractures, it is possible to spare the TFA, running lateral to the condylar neck, and the medial condylar surface in order to leave the branches that derive from the maxillary artery (MA) intact.

Gain of exposure provided by extended incision in lateral rhinotomy approach: A cadaveric study.

OBJECTIVE: To assess the gain of exposure provided by extensions of the lateral rhinotomy (LR) incision, including subciliary extension, lip-splitting extension, or both (Weber-Fergusson incision), by comparing the surgical field obtained with every incision. The final goal is to better delineate the indications of each approach. MATERIALS AND METHODS: Prospective study on fresh frozen specimens. A LR incision was first performed, and then extended by subciliary and/or lip-splitting incisions. The exposure of the anterior facial skeleton and of the deep retromaxillar spaces (pterygopalatine fossa and infratemporal fossa) were assessed. The distance between the nasal bone and the most lateral part of the exposure was measured. RESULTS: Dissection was performed on 4 specimens, with 7 LR. Three LR incisions were extended with subciliary incision, 3 with lip-splitting incision, and 4 with Weber-Fergusson incision. LR incision alone gave only limited access to the lateral orbital rim, the zygomatic arch and the maxillary tuberosity. Both subciliary and lip-splitting incisions gave access to the lateral orbital rim and to the zygomatic arch, but only upper lip incision provided a good access to the maxillary tuberosity. Weber-Fergusson did not significantly increase the surgical field obtained with lip-splitting extension alone. The exposure of the deep retromaxillar spaces was the same in all cases. CONCLUSION: LR incision with lip-splitting extension provided an optimal access to the anterior facial skeleton and to the maxillary tuberosity. In terms of exposure, it was equivalent to Weber-Fergusson approach. The exposure of deep spaces was the same regardless of the incision.

Groin reconstruction using a pedicled anterolateral thigh flap.

INTRODUCTION: This article describes an attractive approach to the reconstruction of the groin after loss of substance: the skin, subcutaneous tissue and fascia of the rectus abdominis and oblique muscles were reconstructed using an anterolateral thigh flap based on a proximal vascular pedicle. CLINICAL CASE REPORT: A 70-year-old female with a strangulated inguinal hernia that had been neglected for eight days presented initially with intestinal necrosis and necrotizing infection of the abdominal wall in the right groin. After debridement of necrotic tissue, reconstructive surgery was necessary. We opted for an anterolateral thigh flap based on a proximal vascular pedicle. DISCUSSION: In this case, there was a major loss of substance that included the rectus abdominis fascia below the level of the arcuate line. This situation required a fascial reconstruction of the abdominal wall; a defect of this size would typically require synthetic mesh for closure. The anterolateral thigh flap allowed us to avoid the use of foreign material by repairing the defect with a pedicle flap including fascia lata and the quadriceps aponeurosis. CONCLUSION: The use of an anterolateral thigh flap based on a proximal vascular pedicle seems to be a simple straightforward solution for reconstruction of the skin and fascia of the inguinal region.

[Motor nerves of the face. Surgical and radiologic anatomy of facial paralysis and their surgical repair]. / L'innervation motrice de la face. Anatomie chirurgicale et radiologique des paralysies faciales et de leur réparation chirurgicale.

Motor innervation of the face depends on the facial nerve for the mobility of the face, on the mandibular nerve, third branch of the trigeminal nerve, which gives the motor innervation of the masticator muscles, and the hypoglossal nerve for the tongue. In case of facial paralysis, the most common palliative surgical techniques are the lengthening temporalis myoplasty (the temporal is innervated by the mandibular nerve) and the hypoglossal-facial anastomosis. The aim of this work is to describe the surgical anatomy of these three nerves and the radiologic anatomy of the facial nerve inside the temporal bone. Then the facial nerve penetrates inside the parotid gland giving a plexus. Four branches of the facial nerve leave the parotid gland: they are called temporal, zygomatic, buccal and marginal which give innervation to the cutaneous muscles of the face. Mandibular nerve gives three branches to the temporal muscles: the anterior, intermediate and posterior deep temporal nerves which penetrate inside the deep aspect of the temporal muscle in front of the infratemporal line. The hypoglossal nerve is only the motor nerve to the tongue. The ansa cervicalis, which is coming from the superficial cervical plexus and joins the hypoglossal nerve in the submandibular area is giving the motor innervation to subhyoid muscles and to the geniohyoid muscle.

Is non-operative management of severe blunt splenic injury safer than embolization or surgery? Results from a French prospective multicenter study.

PURPOSE OF THE STUDY: The management of the severe blunt splenic injuries remains debated. The aim of this study is to evaluate the morbidity and mortality of splenic injury according to severity and management (surgery, embolization, non-operative management [NOM]). METHODS: A prospective multicenter study was conducted including patients aged 16 years and older with diagnosed splenic injury. We evaluated severity according to the AAST classification, the presence of hemoperitoneum or a contrast blush on initial CT scan. The initial hemodynamic status, patients co-morbidities, the ISS (injury severity score), management and morbidity were also noted. RESULTS: Between May 2010 and May 2012, 91 patients were included. Thirty-seven patients (41%) had mild splenic injury (AAST I or II and a small hemoperitoneum) while 54 patients (59%) had severe splenic injury (AAST III or greater). The management included 18 splenectomies (20%), 15 embolizations (16%). Among 67 patients undergoing NOM without initial embolization, five (7%) developed secondary bleeding, five required surgery and nine underwent secondary embolization. No patient died and morbidity was 44% (n=40), 13% for mild injuries vs. 65% for severe injuries (P<0.01). For severe injuries, total morbidity was 58% after NOM, 73% after embolization and 70% after surgery. Specific morbidity related to the management was 10% after NOM vs. 47% after embolization (P=0.02). Specific morbidity after surgery was 15%. CONCLUSION: Embolization, because of its important specific morbidity, should not be performed as a prophylactic measure, but only in presence of clinical or laboratory signs of bleeding.

Keys for microRNA expression profiling of single rat hypothalamic nuclei and multiplex sequencing strategies.

Integrative research has taken on the challenge of addressing questions in physiology by using novel knowledge and novel techniques. Recently, small and long non-coding RNAs have emerged as key regulators of gene expression, while next-generation sequencing technologies have revolutionized the characterization of genomes and gene expression. For a decade, it has been known that microRNAs (miRNAs) are RNAs of 18-24 bases that regulate gene expression in mammals. Here, we first describe the nature of miRNAs and the advantages of high-throughput sequencing technologies for establishing miRNA expression profiles. The hypothalamus harbours a dozen specialized areas or nuclei, the sampling of which is required to establish physiologically relevant miRNA expression profiles. MicroRNA expression profiling from single animals is also important for investigating potential genetic or epigenetic differences between individuals. Establishing a large number of miRNA expression profiles of individual hypothalamic nuclei of single rats at a cost compatible with laboratory finance can be achieved by using tagged cDNA libraries constructed from purified small RNAs and a multiplex sequencing strategy. We continue this report by surveying specificities of the different strategies that are used at present for constructing tagged cDNA libraries and provide a comparative analysis of miRNA expression profiles from hypothalamic arcuate nuclei of seven male Wistar rats.

[Comparison of the Latissimus dorsi insertions on the iliac crest in chimpanzee (Pan troglodytes) and in man]. / Étude comparative des insertions du Latissimus dorsi sur la crête iliaque chez l'homme et dans le chimpanzé (Pan troglodytes).

INTRODUCTION: Comparing to other primates, one of the most important specificities of the human anatomy are consequences of bipedalism. Although bone consequences are well known (lumbar lordosis, horizontal position of the foramen magnum, lengthening of the lower limbs, reduction of the pelvis, specialization of the foot), consequences of our locomotion on the Latissimus dorsi are still unclear. MATERIALS AND METHODS: One dissection of a chimpanzee Latissimus dorsi (Pan troglodytes) has been performed and compared to 30 human Latissimus dorsi dissections (10 fresh cadavers and 20 formoled cadavers). In each dissection, the existence of direct muscular insertions on the iliac crest has been investigated and the constitution of the thoracolumbar fascia has been described. RESULTS: In chimpanzee dissection, a muscular direct insertion of the Latissimus dorsi was present on the iliac crest of 9 cm long. The TLF was made of the superficial and the deep fascias of the Latissimus dorsi and the superficial fascia of the erector spinae muscles which was deeper. In man, there was no direct muscular insertion of the Latissimus dorsi in 90 % of cases, the TLF was constituted the same way. CONCLUSION: This study suggests that the Latissimus dorsi has been separated from the iliac crest in man during the evolution because of the permanent bipedalism and that it stayed inserted on the iliac crest in chimpanzee because of the brachiation.

MicroRNA expression profiling of hypothalamic arcuate and paraventricular nuclei from single rats using Illumina sequencing technology.

MicroRNAs (miRNAs) finely tune messenger RNA (mRNA) expression. As the brain is a highly heterogeneous tissue, physiologically relevant miRNA expression profiling greatly benefits from sampling brain regions or nuclei. MiRNA expression profiling from individual samples is also important for investigating potential differences between animals according to their physiological and pathophysiological status. We have punched the arcuate (ARC) and paraventricular (PVN) nuclei from the hypothalamus of seven male Wistar rats and used them to establish a novel method for the characterization of the miRNA expression profile of individual rat brain nuclei. The identity of the ARC and PVN samples was checked for proopiomelanocortin and arginine vasopressin mRNA expression, respectively. Individual cDNA libraries were constructed from purified RNAs between 16 and 26 bases, using barcoded adapters. Libraries were multiplexed and sequenced using Illumina technology to a read depth >10(5). The ARC and PVN profiles displayed similar expression from a set of more than 210 miRNA genes. Expression was high or moderate for about twenty miRNAs that may be used to define a common ARC/PVN prototype profile of male Wistar rats. These miRNAs included seven of the eight genes of the let-7 family, the two miR-7 genes, miR-9 gene and 5' copy of the three miR-30 loci. Our method shows that the ARC and PVN from a single rat are accessible for miRNA digital characterization. This method will allow miRNA transcriptome characterization for any rat brain substructure or nuclei that can be microdissected.

[The chin fat pad]. / Le corps adipeux du menton.

The chin fat pad is poorly described in anatomic publications. To improve its knowledge, we performed 10 dissections, we studied 10 CT Scanners and ten RMN from patients without mental scar, and we performed a CT scanner of this area in a man at rest and during the lips protraction. A histological study has been performed comparing the chin fat pad with the subcutaneous fat and the buccal fat pad. The chin fat pad was cylindric, measuring 20 mm long, 7,5 mm wide and 4 mm high. It became thinner during the lips protraction. The histological study revealed a lot of fibrous septa. It was more similar to the subcutaneous fat than to the buccal fat pad.

CT scan study of the mandibular nerve intra-mandibular path.

INTRODUCTION: It is mandatory to know the anatomic path of the mandibular nerve and its intra-mandibular connections for numerous odontology, stomatology, and maxillofacial surgical procedures. We present a computed tomography study of the mandibular nerve intra-mandibular path. PATIENTS AND METHOD: The computed tomography of 14 mandibles was performed (vestibulo-lingual cross-section) and four landmarks were defined behind the mental foramen. At each landmark, we measured the distance between the alveolar canal and the two cortical layers in the vestibulo-lingual plane, and the distance between the alveolar canal and the alveolar crest, and the inferior border of the mandible in the vertical plane. RESULTS: In the vestibulo-lingual plane, the mandibular nerve is located close to the vestibular cortical layer, then to the lingual cortical before it exits. In the crestal plane, it is located at the superior third of the inferior border of the mandible. DISCUSSION: In spite of anatomical variability, there is a globally common path which means that the utmost caution should be taken by performing systematic imaging before undertaking any surgery close to the nerve.

[Galactosemia associated with Rogers syndrome in a 10-month-old infant]. / Galactosémie congénitale associée à un syndrome de Rogers chez une petite fille de 10 mois.

Galactosemia and congenital Rogers syndrome or thiamine-responsive megaloblastic anemia are 2 rare inherited metabolic diseases. The combination of the 2 diseases has never been reported in the literature. We describe the case of an infant followed for congenital galactosemia since the age of 8 days, with thiamine-responsive megaloblastic anemia diagnosed at the age of 10 months. Galactosemia's symptoms occur in the first 2 weeks of life with severe liver disease. Total eviction of the galactose allows complete regression and prevention of early symptoms but does not prevent late complications. Rogers syndrome associates megaloblastic anemia, deafness, and diabetes mellitus that begin in childhood. Supplementation with thiamine allows regression of anemia and prevents the onset of diabetes at least until adolescence.