[Secondary cheiloplasty in the treatment of cleft lip and palates]. / La cheiloplastie secondaire dans le traitement des fentes labio-palatines.

In the course of treatment of cleft lip and palates, the quality of primary cheilo-rhinoplasty is essential to limit aesthetic and functional complications. This is why these primary reconstructions come under the domain of specialised centres with multidisciplinary teams. Unfortunately, residual imperfections often remain, especially in bilateral clefts, and secondary cheiloplasties represent for us a complex challenge. They aim at functional and aesthetic correction, and the choice of time is very random and depends largely on the psychological repercussions of the deformation in the child. It often occurs at the age of school entry and is combined with alveoloplasty. We then speak of alveolar transplantation with vestibulo and labio-plastie, the GPVP. Then we propose to combine all the resources of cosmetic surgery to improve the aesthetic and functional result of these children.

Two congenital cases of pigmented epithelioid melanocytoma studied by fluorescent in situ hybridization for melanocytic tumors: case reports and review of these recent topics.

The term 'pigmented epithelioid melanocytoma' (PEM) has recently been proposed as a nosological framework grouping lesions formerly known as animal-type melanomas, sporadic epithelioid blue nevi and Carney complex-associated epithelioid blue nevi. Congenital PEMs have been reported extremely rarely and their prognosis is poorly known. Four-color fluorescent in situ hybridization (FISH) for melanocytic lesions is a recent method developed to assess the malignant potential of ambiguous melanocytic lesions. Here we describe 2 cases of congenital epithelioid and strongly pigmented melanocytic lesions consistent with PEM. No BRAF gene mutation was found in the 2 cases. FISH for melanocytic lesions was also performed. The first case proved entirely negative, whereas the second one showed a positive zone with an extra copy of chromosome 6. The prognosis and management of PEM are discussed, with a review of the available data on the history, demographics, molecular alterations and histopathological aspects of this entity. PEM seems to represent a unique low-grade melanocytic tumor with a limited potential of metastasis to lymph nodes, but a favorable long-term clinical course. The published data about FISH for melanocytic tumors, and especially PEM, are reviewed. Four-color FISH may be a useful tool to assess more accurately the prognosis of these tumors.

Dynamic sorption of ammonium by sandy soil in fixed bed columns: Evaluation of equilibrium and non-equilibrium transport processes.

The release of excess nitrogen-containing compounds into groundwater is a major concern in aquifer recharge by the Soil Aquifer Treatment (SAT) process. Ammonium (NH(4)(+)) is one of the most nocive and common nitrogen compounds in wastewaters. In order to assess the risk of wastewater use for aquifer recharge, NH(4)(+)adsorption onto Souhil wadi soil sampled from the SAT pilot plant (Nabeul, Tunisia) was studied using laboratory columns experiments. Several experiments were conducted using aqueous synthetic solutions under different aqueous ammonium concentrations and flow rates. Furthermore, a real wastewater solution was used to test the effect of competitive cations contents on NH(4)(+) adsorption. Afterwards, the Hydrus-1D model was used in inverse mode to simulate the ammonium transport through the Souhil wadi soil. For the synthetic solutions, the adsorbed ammonium amount varied from 1 to 30.7 mg kg(-1) for aqueous ammonium concentrations between 4.9 and 36.4 mg L(-1). The linear isotherm model was found to be the most suitable for describing this adsorption. The flow rate decrease from 45 to 15 mL min(-1) induced an increase in the ammonium adsorption capacity by 49%. Indeed, the lesser the flow rate is, the longer the residence time and the higher the exchange between the aqueous solution and soil matrix. The use of wastewater instead of aqueous synthetic solution decreased about 7 times the Souhil wadi adsorption capacity of ammonium because of its relatively high concentrations of competitive ions such as calcium and magnesium. The use of the Hydrus-1D model showed that the chemical non-equilibrium model was the best to simulate the ammonium transport through the laboratory soil columns.

A case of primitive floor of the mouth paraganglioma in a child: an embryological theory unifying viscerocranium appended paragangliomas.

BACKGROUND: Paragangliomas are unusual tumors in the head and neck originating from the paraganglia or glomus cells of neural crest origin. METHODS: We describe the first case of a primitive paraganglioma of the floor of the mouth presenting in childhood. RESULTS: Complete surgical removal was performed after embolization of the left lingual artery. There was no evidence of either persistent or recurrent disease 5 years after surgery. The embryologic and anatomic origins of head and neck paragangliomas are reviewed. CONCLUSIONS: An embryologic theory based on the common neural crest origin and migration pathways of both autonomic viscerocranium appended ganglias and paragangliomas is proposed that unifies the topographically heterogeneous group of viscerocranium-appended paragangliomas.

[Hemifacial microsomia. Embryological and clinical approach]. / Microsomies hémifaciales. Approche embryologique et clinique.

Hemifacial microsomia is an otomandibular dysplasia which includes congenital malformations affecting the jaw and ear apparatus. The knowledge of normal embryonic development is a prerequisite for optimal clinical management of those malformations. The development of craniofacial structures is a multi-step process, which involves many developmental events ranging from the migration of neural crest cells from the neural folds of the young neurula embryo to molecular signaling interactions that coordinate outgrowth and patterning of the facial primordia. Our current knowledge of craniofacial development is limited, but the use of animal developmental models will contribute significantly to our understanding of human otomandibular dysplasias. In this review we discuss both the classical and current aspects of otomandibular development. A clinical approach to hemifacial microsomia is proposed. Current pathogenetic hypotheses of hemifacial microsomia and also mandibulofacial dysostosis are reviewed.

[The importance of early surgery in preventing the esthetic sequelae of cervicofacial mucocutaneous hemangiomas in children]. / Intérêt de la chirurgie précoce dans la prévention des séquelles esthétiques des hémangiomes cutanéo-muqueux cervico-faciaux de l'enfant.

Infants with cutaneous hemangiomas are classically managed medically, well-defined surgery being planned for esthetic correction at the age of 8 to 10 years. We present a series of 65 cases of early surgery in children with head and neck cutaneous or mucosal hemangiomas where irreversible and unesthetic scars were predictable. The surgical procedure was simple and the cosmetic result was better than could be expected after late surgery, limiting psychological consequences. In our opinion, the abstention rule should be changed. A multidisciplinary check-up at 2 years to identify cases with a predictably unesthetic scar after complete resolution of the angioma would help select cases where early surgical correction, taking advantage of the exceptional quality of skin in these young children, would be most beneficial.

[Progressive hemifacial atrophy in the young patient: physiopathologic hypotheses, diagnosis and therapy]. / L'atrophie hémifaciale progressive du sujet jeune: où en sommes-nous des hypothèses physiopathologiques, diagnostiques et thérapeutiques?

Parry-Romberg syndrome is characterized by a limited progressive hemifacial atrophy. Since its first description in 1825, this syndrome has aroused interrogation and reflection about is pathophysiology, its variable clinical expression and its progression. The first part of this focuses on the different hypotheses advanced to date to explain this type of atrophy. We then recall the different steps for clinical diagnosis and treatment. Management of such an unpredictable disorder is particularly difficult. Because of the uncertain pathophysiology, medical therapy has not been very successful. Palliative reconstruction surgery remains the only possibility. We present three cases illustrating this review of progressive hemifacial atrophy.

[Progressive hemifacial atrophy in the young patient: surgical problems in children]. / L'atrophie hémifaciale progressive du sujet jeune: difficultés chirurgicales chez l'enfant.

Parry-Romberg syndrome is characterized by a limited progressive hemifacial atrophy. For young patients, the surgeon has to deal with two tendencies: the patient's growth and the course of the syndrome. When managing such an unpredictable disease, the surgeon has to make a guess about the future course of the structural movements. We reviewed our experience and analyzed the different surgical possibilities for reconstructive surgery for Parry-Romberg syndrome.

Description of cutaneous excision and suture using a mathematical model.

Mathematical models are being developed at a fast rate in industry thanks to computer technology; they are used to simulate motion and deformation over time to test materials and objects in a virtual manner. These modeling techniques are being developed in medicine, but they remain, at this time, in the domain of biomechanical research. We report a mathematical model for cutaneous excision and suture, which we have used to predict the deformations and tensions that result when using four different forms of excision. The results are expressed in numerical and graphic form. The results obtained corresponded with our experience in dermatologic surgery. Uses and limits of this model are discussed.

Branchio-oculo-facial syndrome with cleft lip and bilateral dermal thymus.

OBJECTIVE: The objective of this study was to demonstrate that the branchiooculo-facial (BOF) syndrome is a cervicocephalic neural crest maldevelopment. RESULTS: Using an embryologic study, we linked the clinical features and the level of the neural crest deficiency. We report here two cases of BOF syndrome with a particular branchial cleft presenting as bilateral supernumerary thymus glands on the surface of the skin; one of the cases was associated with tetralogy of Fallot. One patient underwent lip reconstruction at 4 months, combined with excision of bilateral auricular pits and superior labial fistula. The other patient had a surgical correction of the tetralogy of Fallot, and at 2 months, the two stages of the lip reconstruction were performed, combined with bilateral auricular pit excision. Both patients have shown normal developmental patterns to date. CONCLUSION: The BOF syndrome must be considered as a neurocristopathy at different levels, with a tiny mesencephalo-prosencephalic lesion and a severe rhombencephalic lesion that includes seven consecutive hindbrain segments, from rhombomere 2 to rhombomere 8.

Cervicofacial hemangioma and a minor sternal malformation: inclusion in PHACES syndrome?

Hemangiomas are frequent in childhood, but those associated to dysmorphic anomalies are rare. We report a young girl with hemangiomas of the face, neck, and upper trunk, severe laryngeal dyspnea, and sternal atrophic skin without sternal nonunion, probably corresponding to a minor form of PHACES syndrome.

[Use of iterative expansion in the early surgical treatment of complex nevi of the head in children]. / Utilisation des expansions itératives dans le traitement chirurgical précoce des naevus complexes céphaliques de l'enfant.

Extensive of congenital pigmented nevi to the face in an infant is an indication for early exeresis to prevent the risk of degeneration. Search for the best esthetic result has led many authors to healthy skin to a maximum, often relying on tissue expansion. The aim of this study was to present the combination of two expansion techniques, prosthetic expansion and differed natural expansion. Five infants with congenital pigmentary nevi extending to more than 50% of a facial anatomic unit were treated. Total treatment was achieved in all patients with three or four procedures. By combining different expansion techniques early treatment can be proposed with good esthetic results and moderate cost.

[Infra-orbital nerve block in early primary cheiloplasty]. / Bloc des nerfs sous-orbitaires dans les cheiloplasties primaires précoces.

A prospective study have studied the effect of infraorbital block during anesthesia in infants with a cleft lip. The study was conducted during the year 1994, in the hospital Necker Enfants-malades. During this period 51 cleft lip surgery were performed. Anesthesia for infants with cleft lip using bilateral infraorbital block is a safe, simple and quick technique, and result in a good longlasting analgesia, seems to decrease the risk of respiratory depression, and allows an immediate and comfortable awakening.

[Congenital giant blue nevus. Apropos of a case]. / Naevus bleu congénital géant. A propos d'un cas.

A case of a three years old girl showing a congenital giant blue nevus, in the neck and the occipital region, is presented. The giant blue nevus was associated to an important cutaneous nevomatosis. The treatment has consisted of an surgical excision of an surgical excision of the main lesion, and operative continuations have been simple. The literature study showed 11 cases of congenital giant blue nevus and demonstrate the high risk of malignancy, and the importance of an early surgical treatment.

Surgical treatment of large cutaneous lesions of the back in children by concentric cutaneous mobilization.

Excision of large cutaneous lesions of the back, such as giant nevi in children, represents a major surgical challenge. Actually, many authors use tissue expanders. Recently, we have proposed, through a better evaluation of the biomechanical properties of the skin, a natural expansion mode using the postoperative tension. This expansion is natural and delayed. In the back the natural expansion can be created by concentric excision, which takes maximum advantage of the possibilities of cutaneous mobilization of the back. The concentric excision has been used in 12 children presenting with cutaneous lesions of the back involving more than 30 percent of the dorsal anatomic unit. Nine patients underwent total excision; two patients were treated in one stage, four patients in two stages, and three patients in three stages. Three patients could not have total excision. The follow-up was uneventful, except in one patient who presented with wound dehiscence. The follow-up was 1 to 2 years and showed a modest scar widening (< 4 mm) in three patients, moderate widening (> 4 min, < 7 mm) in three patients, and significant widening (> 10 mm) in three patients. The systematization of the cutaneous mobilization for each region of the back has allowed us to optimize the utilization of peripheral normal tissue in the surgical treatment of large cutaneous lesions of the back. In some circumstances, the gain in tissue has been superior to that we usually obtain with skin expanders and with lesser cost, lesser pain, and fewer risks.

[Early functional surgery as a component of interceptive treatment of developing dysmorphosis in adolescents]. / La chirurgie fonctionnelle précoce composante de la thérapeutique interceptive d'une dysmorphose évolutive de l'adolescent.

A discordance in the shape and relation between dental arches may be corrected by functional orthopaedics. Discovered in the adolescence, the dysgnathia has yet run its course and it remains just a bit of growth power, this situation justifies to recourse to interceptive surgery, meant for facilitation of oral reeducation and thus harmonisation of residual facial growth. This "functional surgery" is composed of tongue myoplasty, functional genioplasty and the early corrective orthopaedic surgery which is defined by its association with immediate reeducation. It is characterized by its benignity and stability of its results if occlusal and functional surroundings are equilibrated. Moreover, its profits by residual growth power which became well guided, and assures improvement of immediate postoperative results, if needed.

[Complex facial nevus in children treated by combination of prosthetic and deferred natural expansions]. / Naevus complexe facial de l'enfant traité par combinaison des expansions prothétique et naturelle différée.

Congenital pigmented naevi of the face in children represent indications for early excision and the search for the best aesthetic result has led the authors to prefer the use of skin expansion techniques. The case presented here illustrates the combined use of two expansion techniques: prosthetic expansion and natural differed expansion. This procedure gives good cosmetic results at a moderate overall cost.

Dog ear: true and false. A simple surgical management.

The rise of the utilization of tissue expanders and procedures like liposuction have brought us a better understanding of the biomechanical properties of the skin as a living organ. This understanding has helped us to appreciate better the etiopathology of a dog ear deformity and to utilize the same properties for its correction by simple methods and thus avoid complex plasties and additional scars.

[Use of deformities in the treatment of facial skin defects in children: "deforming resections". Report of 35 cases]. / L'utilisation des déformations dans le traitement des pertes de substance cutanées faciales de l'enfant: "les exérèses déformantes". A propos de 35 cas.

Spontaneous resolution of deformities after excision of facial skin lesions has been known and used for a long time by plastic surgeons. The resorption mechanism of deformity is based on natural skin expansion, and seems to be directly related to the action of the muscles of facial expression and their skin relations. Natural expansion has been shown to be effective in children. Between 1990 and 1994 excision of skin lesions, including congenital nevi, leading to postoperative deformity of the cheek, labial commissure, nose, eyelid and forehead, was performed on 35 patients, aged from 3 month to 12 years. The average follow-up is 24 months. For 26 patients (74%), natural resorption was observed 4 or 6 weeks later with good aesthetic results. For 6 patients (17%), the deformity persisted 3 or 6 months later, but did not require any further surgery. For 3 patients (9%), a second operation was necessary. Using the skins natural capacity for expansion in the treatment of facial skin defects in children is a method of reconstruction which has already been used for excision in enforced position. The platysma and muscles of facial expression by their action on skin mobilisation, allow natural expansion. A better knowledge of cutaneous biomechanical properties enables plastic surgeons to find an alternative to other classical methods.

[The significance and role of speech therapy in rehabilitation after lip surgery]. / Intérêt et place de l'orthophonie dans la rééducation après chirurgie labiale.

Post-operative functional rehabilitation of the orofacial region has greatly benefited from progress in orthophony. Technical know-how in pediatric patients can be adapted to the specific requirements of postoperative rehabilitation in children.