Surgical management of odontogenic myxomas: A case series.

INTRODUCTION: Odontogenic myxoma is a relatively rare bone tumor involving exclusively the jaws. Despite its benign nature, odontogenic myxoma can exhibit aggressive, locally invasiveness and has a high potential of recurrence. Surgical treatment can be conservative of radical. The choice of surgical procedure is controversial, and there are no established guidelines. CASE SERIES PRESENTATION: We present a case series of three cases of odontogenic myxomas. This case series illustrates the variability of the radioclinical presentation of odontogenic myxoma and the resulting surgical management, ranging from simple enucleation to mandibular interruptive resection surgery with free flap reconstruction. DISCUSSION AND CONCLUSION: Through this case series, we highlighted and described decision criteria contributing to treatment choice and summarized this in an algorithm. Radiological tumor characteristics and also patient specific factors such as age need to be considered to make a personalized decision to each patient.

Contribution of anatomical criteria to surgical approach for treatment of bilateral coronoid hyperplasia.

INTRODUCTION: Bilateral coronoid hyperplasia is a rare condition characterized by a progressive and painless limitation of mouth opening. The treatment consists of coronoidectomy by intraoral or coronal approach. There is no recommendation in the literature on the choice of the surgical approach according to the importance of the hypertrophy. The objective of our study is to search for predictive anatomical criteria of each approach. MATERIAL AND METHODS: These anatomical criteria were evaluated from 3D CT facial reconstructions of 4 male patients aged 4 to 30 years retrospectively after their surgery. A single intraoral approach was used for cases 1 and 2 (group A), a double approach for cases 3 and 4 (group B). Same measurements were performed on 10 male case controls (group C). We performed a descriptive analysis of our results due to an insufficient number of patients. RESULTS: The average width of the coronal processes was much greater in group B, when a double approach was necessary, than in groups A and C. In groups A and B, the average height of the coronoid notch is low compared to group C when there is a need for a coronal approach. The width/TZS ratio is increased in group B compared to group C. DISCUSSION: In our study, 3 criteria could be informative for the choice of the surgical approach: the width at the superior end of the coronoid process, the width/TZS ratio and the height of the coronoid notch but additional data are needed to confirm our therapeutic options.

Myeloperoxydase and CD15 With Glycophorin C Double Staining in the Evaluation of Skin Wound Vitality in Forensic Practice.

Background: The determination of skin wound vitality based on tissue sections is a challenge for the forensic pathologist. Histology is still the gold standard, despite its low sensitivity. Immunohistochemistry could allow to obtain a higher sensitivity. Upon the candidate markers, CD15 and myeloperoxidase (MPO) may allow to early detect polymorphonuclear neutrophils (PMN). The aim of this study was to evaluate the sensitivity and the specificity of CD15 and MPO, with glycophorin C co-staining, compared to standard histology, in a series of medicolegal autopsies, and in a human model of recent wounds. Methods: Twenty-four deceased individuals with at least one recent open skin wound were included. For each corpse, a post-mortem wound was performed in an uninjured skin area. At autopsy, a skin sample from the margins of each wound and skin controls were collected (n = 72). Additionally, the cutaneous surgical margins of abdominoplasty specimens were sampled as a model of early intravital stab wound injury (scalpel blade), associated with post-devascularization wounds (n = 39). MPO/glycophorin C and CD15/glycophorin C immunohistochemical double staining was performed. The number of MPO and CD15 positive cells per 10 high power fields (HPF) was evaluated, excluding glycophorin C-positive areas. Results: With a threshold of at least 4 PMN/10 high power fields, the sensitivity and specificity of the PMN count for the diagnostic of vitality were 16 and 100%, respectively. With MPO/glycophorin C as well as CD15/glycophorin C IHC, the number of positive cells was significantly higher in vital than in non-vital wounds (p < 0.001). With a threshold of at least 4 positive cells/10 HPF, the sensitivity and specificity of CD15 immunohistochemistry were 53 and 100%, respectively; with the same threshold, MPO sensitivity and specificity were 28 and 95%. Conclusion: We showed that combined MPO or CD15/glycophorin C double staining is an interesting and original method to detect early vital reaction. CD15 allowed to obtain a higher, albeit still limited, sensitivity, with a high specificity. Confirmation studies in independent and larger cohorts are still needed to confirm its accuracy in forensic pathology.

Iatrogenic displacement of an impacted third maxillary molar in the parapharyngeal space: A case report.

Accidental iatrogenic displacement of third molars in peripheral soft tissues is a major intraoperative complication, but is considered rare. A young women reported discomfort during mandibular lateral movements since she underwent the extraction her impacted third molars under general anesthesia, 2 years before. The clinical examination was not specific except for a laterality limitation of the right mandibular movements. The germ of 28 appeared radiologically encapsulated in the peripheral muscle tissues in the left parapharyngeal space and showed no signs of ankylosis. After measurement of the benefit-risk balance the surgical extraction of the foreign body has been successfully carried out. After 6 weeks the patient was able to regain bilateral symmetrical mandibular laterality movements. It appeared that tooth 28 was interfering with the movements of the manducatory function, either by obstructing the mandibular path, and/or by irritating the pterygoid muscles or other peripheral tissues .

Sequential Treatment of Extreme Maxillary Hypoplasia: A Historical Patient Report of an Edentulous Adult Patient With Ankyloglossia.

INTRODUCTION: The management of multiple dimensions in orthognathic surgery often requires careful planning. Too large discrepancies could require a sequential procedure to make alignment of the archs possible. REPORT OF CASE: The authors report a case of a 30-year-old partially edentulous man with severe maxillary hypoplasia caused by an untreated ankyloglossia. The transverse deficiency was estimated at more than 15 mm and the sagittal discrepancy shows a negative overjet of 11.5 mm. These wide deficits needed a 2-step surgery and the use of computed-aided design/computed-aided manufacturing. The first step was a palatal expansion by a fan-shaped Le Fort I osteotomy. The second step treated sagittal discrepancy and re-expanded the maxilla.At the end, the sagittal dimension got normal and the maxilla have been widened to almost 7 mm. CONCLUSION: Custom-made surgery is very useful for uncommon cases, in particular for toothless patients. It facilitates complex operations and allows precise results.

Massive bleeding after a tooth extraction: Diagnosis of unknown arteriovenous malformation of the mandible, a case report.

INTRODUCTION: Arteriovenous malformations (AVMs) are very rare. Only 5% of them occurs in the jaws but they can manifest with dramatic bleeding and be life-threatening. PRESENTATION OF CASE: We report the case of a 11-year-old healthy girl who presented a massive hemorrhage after extraction of the right mandibular first primary molar. This patient received a blood transfusion and was hospitalized in pediatric intensive care unit. CT angiography highlighted an AVM of the mandible. Treatment consisted in selective embolization. DISCUSSION: A review of the literature shows that the majority of AVMs of the jaws are often unknown until severe bleeding occurs during dental surgery. The low specificity of radiological signs on panoramic radiography makes the diagnosis particularly challenging. Their management requires an interdisciplinary approach. Selective embolization has a place of choice in the treatment of these complex pathologies. CONCLUSION: Although AVMs of the jaws are rare, they are frequently revealed through a massive hemorrhage during tooth extraction. Dentists have to suspect them when young patients present some clinical features, as spontaneous gingival bleeding, unexplained dental mobility, or facial asymmetry.

Cystathionine ß-synthase genetic variant rs2124459 is associated with a reduced risk of cleft palate in French and Belgian populations.

BACKGROUND: Orofacial cleft (OFC) is the most prevalent craniofacial birth defect. Genes involved in one-carbon, folate and vitamin B12 metabolisms have been associated with OFC but no study performed a concomitant assessment on genes involved in these three pathways. OBJECTIVE: We looked for potential genetic variants associated with OFC using an exhaustive gene panel of one-carbon metabolism. METHODS: We performed a case-control discovery study on children with OFC (236 cases, 145 controls) and their related mothers (186 cases, 127 controls). We performed a replication study on the top significant genetic variant in an independent group from Belgium (248 cases, 225 controls). RESULTS: In the discovery study on 'mothers', the CBS locus reached array-wide significance (p=9.13×10-6; Bonferroni p=4.77×10-3; OR 0.47 (0.33 to 0.66)) among the 519 haplotypes tested for their association with OFC risk. Within the CBS haplotype block (rs2124459, rs6586282, rs4920037, rs234705, rs234709), the rs2124459 was the most significantly associated with a reduced risk of OFC (p=1.77×10-4; Bonferroni p=2.00×10-2; OR 0.53 (0.38 to 0.74), minor allele). The rs2124459 was associated with a reduced risk of cleft palate (CP) (p=6.78×10-5; Bonferroni p=7.80×10-3; OR 0.40 (0.25 to 0.63)). In the 'children' group, the rs2124459 was associated with a reduced risk of CP (p=0.02; OR 0.61 (0.40 to 0.93), minor allele). The association between rs2124459 and reduced risk of CP was replicated in an independent children population from Belgium (p=0.02; OR 0.64 (0.44 to 0.93), minor allele). CONCLUSIONS: The CBS rs2124459 was associated with a reduced risk of CP in both French and Belgian populations. These results highlight the prominent involvement of the vitamin B6-dependent transsulfuration pathway of homocysteine in OFC risk and the interest for evaluating vitamin B6 status in further population studies.

Satisfaction and complications after lower body lift with autologous gluteal augmentation by island fat flap: 55 case series over 3 years.

BACKGROUND: Major weight loss causes body deformities. Lower circumferential dermolipectomy with autologous gluteal augmentation by a fat island flap can restore a part of the body contour, but this procedure is associated with a high incidence of complications. The aim of this study was to analyse the benefit/risk ratio and the patients' satisfaction. METHODS: All patients who underwent this procedure at the Nancy University Hospital over a 3-year period (between January 2010 and 2013) were reviewed; the complications were analysed and the patients' satisfaction rated. RESULTS: A total of 55 patients were included with a mean age of 41.0 years. The average body mass index of the patients was 28.2 kg/m² with a mean weight of 76.8 kg at the time of the procedure and a mean weight reduction of 49.6 kg. The mean operative time was 4.85 h. The average hospital stay was 6.1 days. The average haemoglobin loss was 3.0 g/dl, and 12 (21.8%) patients required a blood transfusion. Of the total number of patients, 22 (40%) developed at least one complication, including six (10.9%) major complications. Fifty-two patients answered the questionnaire; 49 (94.2%) patients would go through this procedure again. The overall satisfaction was rated as excellent by 29 (55.8%) patients and as pleasing by 22 (42.3%). The outcome was judged as excellent or pleasing for the abdomen by 29 (55.8%) and 20 (38.35%) patients, respectively, and for the buttocks by 17 (32.7%) and 29 (55.8%) patients, respectively. The quality of life was rated better after than before the intervention by 49 (94.2%) patients. CONCLUSION: Despite a high complication rate, the majority of patients confirmed that they would opt for this procedure again, showing an improvement in their quality of life with an aesthetic and functional benefit. LEVEL OF EVIDENCE: III.

Liposuction-assisted medial brachioplasty after massive weight loss: an efficient procedure with a high functional benefit.

BACKGROUND: Brachioplasty frequently offers functional benefits but results in poor aesthetic scars and a relatively high complication rate. The authors describe the complications and risk factors inherent in liposuction-assisted medial brachioplasty and assess patient satisfaction with the functional and aesthetic benefits. METHODS: A 5-year retrospective study was performed that included all patients who underwent liposuction-assisted medial brachioplasty. Complications were reviewed and analyzed by aesthetic and nonaesthetic categories, and patient satisfaction was rated. RESULTS: Sixty-six patients were included (mean age, 44.4 years). The average body mass index was 30.2 kg/m; mean weight reduction was 50.72 kg. Thirty-seven patients (56.1 percent) developed at least one complication, including six (9.1 percent) with a nonaesthetic complication versus 31 (47.0 percent) with an aesthetic complication. Complications were significantly associated with a longer operative time (p = 0.015), 233 minutes in the complication group versus 164 minutes in the no-complication group. Fifty-three patients answered the questionnaire. Forty-six (86.8 percent) stated that they would undergo this intervention again. Overall satisfaction was reported as excellent for 12 patients (22.6 percent) and pleasing for 24 (45.3 percent). All patients rated the functional outcome superior or equal to the aesthetic outcome. Quality of life was estimated to be better after than before the intervention for 41 patients (77.4 percent). CONCLUSIONS: Liposuction-assisted medial brachioplasty is a safe and efficient technique. It offers a functional benefit with a low nonaesthetic complication rate. Despite the inherent scars, the majority of patients would undergo this intervention again because of an important satisfaction rate and improvement in quality of life. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

Particular catastrophic antiphospholipid syndrome, on the sole surgical site after breast reduction.

A 20-year-old woman treated with vitamin K antagonist for antiphospholipid syndrome (APS) (pulmonary embolisms at age 15) was admitted for breast reduction after bridging therapy. At 2 days post-surgery haematomas appeared on the surgical site and anticoagulant therapy was withheld. She developed a skin and breast necrosis leading to the diagnosis of catastrophic APS. Despite medical treatment (anticoagulant therapy, corticosteroids and intravenous immunoglobulins) and surgery, necrosis continued. After 2 weeks of negative-pressure wound therapy (V.A.C.(®) Therapy™) the patient improved, mammary tissues were alive, well vascularised and budding. Breast reconstruction was then initiated. Artificial dermis graft (MatriDerm(®) 2 mm) was applied, and 3 weeks later the apposition of split-thickness skin graft on it. Six months later, results of the surgery were good and the patient was satisfied.

Relational development in children with cleft lip and palate: influence of the waiting period prior to the first surgical intervention and parental psychological perceptions of the abnormality.

BACKGROUND: The birth of a child with a cleft lip, whether or not in association with a cleft palate, is a traumatic event for parents. This prospective, multidisciplinary and multi-centre study aims to explore the perceptions and feelings of parents in the year following the birth of their child, and to analyse parent-child relationships. Four inclusion centres have been selected, differing as to the date of the first surgical intervention, between birth and six months. The aim is to compare results, also distinguishing the subgroups of parents who were given the diagnosis in utero and those who were not. METHODS/DESIGN: The main hypothesis is that the longer the time-lapse before the first surgical intervention, the more likely are the psychological perceptions of the parents to affect the harmonious development of their child. Parents and children are seen twice, when the child is 4 months (T0) and when the child is one year old (T1). At these two times, the psychological state of the child and his/her relational abilities are assessed by a specially trained professional, and self-administered questionnaires measuring factors liable to affect child-parent relationships are issued to the parents. The Alarme Détresse BéBé score for the child and the Parenting Stress Index score for the parents, measured when the child reaches one year, will be used as the main criteria to compare children with early surgery to children with late surgery, and those where the diagnosis was obtained prior to birth with those receiving it at birth. DISCUSSION: The mental and psychological dimensions relating to the abnormality and its correction will be analysed for the parents (the importance of prenatal diagnosis, relational development with the child, self-image, quality of life) and also, for the first time, for the child (distress, withdrawal). In an ethical perspective, the different time lapses until surgery in the different protocols and their effects will be analysed, so as to serve as a reference for improving the quality of information during the waiting period, and the quality of support provided for parents and children by the healthcare team before the first surgical intervention. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT00993993.

[Prosthetic and surgical options in the rehabilitation of the after-effects of alveolar clefts]. / Choix chirurgico-prothétiques dans la gestion alvéolaire des séquelles de fentes labio-maxillo-palatines.

The question of final-phase treatment and prosthetic rehabilitation is posed for the young adult patient who has followed a program of surgical, orthopedic, and orthodontic work aimed at achieving a functional, aesthetic balance. When a toothless space has been maintained or recreated between the proximal teeth of each fragment, two solutions are at hand for the expert odontologist: implantology, or traditional joint prosthesis. Four problems are evoked here to describe the difficulties related to this therapeutic decision: confrontation of the banks, residual osseous defect, teeth bordering the cleft, and the odontologist's role in the overall responsibility for the patient. The choice of the final surgical and prosthetic context induces a multifactor analysis, and must be integrated early on, as part of a multidisciplinary therapeutic strategy. Psychological acceptance is thereby favored, along with the rational search for a durable, aesthetic result.

[Measurement of botulinum toxin activity: towards a new cellular culture assay?]. / Dosage de l'activité toxine botulique : vers un nouveau dosage sur culture cellulaire ?

UNLABELLED: The actual gold standard of Botulin A toxin (BoTx A) batches qualification is the mouse lethality assay. With this assay it is nevertheless impossible to set a therapeutic value unit. AIMS: The goal of this research was to study the effects of BoTx A increasing concentrations on glutamatergic rat neurons. EXPERIMENTAL PROCEDURE: We studied the glutamate release with increasing concentrations of BoTx A. We also studied the BoTx A target cleavage with a western blot technique. RESULTS: Our results proved that it is possible to establish a dose-response - like curve of BoTx A effects on glutamate release. Moreover the cleavage of the target protein was visible for the same toxin concentrations that inhibited the glutamate release. CONCLUSION: This technique could be the first step toward a new way of setting a better pharmaceutical profile for toxin batches.