[Fatty tumors of the jaws]. / Tumeurs adipeuses des mâchoires.

Intraosseous lipoma is a benign tumor of the bone. It is mostly seen in the metaphyses of the long bones and calcaneus. There are few documented cases of intraosseous lipomas in the jaw. Clinically, the lesion is usually silent and radiologically it appears as a radiolucent area rarely including some radio-opacities. Diagnosis is based on clinical, radiological and histopathological features. Surgical removal of the lesion is the recommended treatment.

[Complications of head and neck skin expansion]. / Complications de l'expansion cutanée cervico-faciale.

INTRODUCTION: Skin expansion is a good solution for the reconstruction of head and neck defects. We assessed the complications of cervico-facial skin expansion technique to draft recommendations so as to minimize risks. METHODS: We made a retrospective study from 1990 to 2005. Complications were analyzed according to age, sex, etiology, area to reconstruct, location of the expander, expander volume and number, simultaneous single or repeated technique, type of expander, duration of expansion, and type of flap used for reconstruction. RESULTS: One hundred and thirty-nine tissue expanders were placed in 114 patients. The rate of complications was 60.4%. Age was not a risk factor (P=0.21; Fisher's exact test). The early complications were not related to the expander volume (P=0.32; Fisher's exact test). Infection was the most frequent complication (51.3%). Hypertrophic or large scars, retraction, or cording accounted for 32.4% of sequels. A rate of 6.5% of total and 6.5% of partial failure were recorded. Infection was the cause of 77.8% of total or partial failure. DISCUSSION: The complications of head and neck soft tissue expansion are often minor. The rate of reconstruction failure remains acceptable.

[Facial infantile aggressive fibromatosis: a frequent localization of an exceptional tumor!]. / La fibromatose agressive faciale chez l'enfant: une localisation fréquente d'une tumeur exceptionnelle !

INTRODUCTION: Although fibromatosis is considered as benign tumor, it can have significant morbidity, particularly when it occurs in the head and neck. Their propensity for infiltrative local growth with encroachment on vital structures and their tendency to recur make fibromatoses of the head and neck extremely challenging lesions. CASE REPORT: We report the case of a 10-year-old boy with desmoid fibromatosis of the upper lip. For this patient, the medical treatment has been decided to avoid a mutilating surgery. He had a good result with chemotherapy using methotrexate and vinblastine. DISCUSSION: According to the literature, surgery is the most common treatment of fibromatosis in the head and neck region. However, particularly in children, alternative modes of therapy must be considered because of the high recurrence rate and to avoid mutilating operations. Chemotherapy using methotrexate and vinblastine may be a reasonable choice.

[Pediatric mandibular ameloblastic fibro-odontoma]. / Fibrome odonto-améloblastique de l'enfant.

INTRODUCTION: Ameloblastic fibro-odontoma (AFO) is a very rare mixed odontogenic tumor (2% of all odontogenic tumors). It is considered as a non-extensive non-aggressive tumor but recurrence and malignant transformation remain possible. We report a voluminous AFO in a child. CASE REPORT: A 7-year-old boy presented with a right mandibular and facial swelling. The panoramic radiograph and CT scan revealed a voluminous unilocular radiolucent lesion (10 cm) with an impacted tooth that involved the ramus area and the angle of the right mandible. Enucleation and curettage was performed with a good outcome. There was no recurrence at ten months. DISCUSSION: This case is exceptional because of the young patient's age, the large tumor diameter, and the good outcome after ten months. This tumor occurs more often in the posterior region of the mandible and is frequently seen in the first two decades of life. The diagnosis is made on radio-clinical data and may be confirmed by histology. A surgical treatment with complete tumor removal is recommended to prevent recurrence.

[Mandibular fracture: a 10-year review of 685 cases treated in Charles-Nicolle Hospital (Tunis-Tunisia)]. / Particularités épidémiologiques et thérapeutiques des fractures de mandibule au CHU Charles-Nicolle de Tunis.

INTRODUCTION: The epidemiology and treatment of mandibular fracture vary from one country to another. The aim of this study was to present the current demographic pattern and treatment regimens of mandibular fractures in Tunisia. METHODS: The medical records and radiographs of 685 patients treated for mandibular fracture at the Maxillofacial and Plastic Surgery Department in the Tunis Charles-Nicolle Hospital between 1995 and 2004 were retrospectively studied. The relevant parameters were: age, sex, etiology, anatomical site of fracture, and treatment. RESULTS: The prevalence of mandibular fractures was higher in male patients (sex ratio 6:1). Traffic accidents were the main cause of these lesions (45%), followed by assault (22%). Angle fractures were the most common (24.8%) followed by parasymphyseal fractures (22.2%). The most frequent treatment was closed reduction with maxillo mandibular locking in 388 patients (56.6%). Transosseous wiring was the most commonly used method in open reductions. Tooth loss and neurological sensitive deficiency were the most common sequels. DISCUSSION: Our epidemiological data correlates to published data for developing countries. Analyzing this data can help to improve the management of maxillo-facial trauma in Tunisia. Therapeutic options vary according to the type of fracture but also depend on the economical status of the country.

[Columella defects: yet a challenge!]. / Les pertes de substance de la columelle : encore un défi !

The repair of nasal defects is thought to be the most ancient of facial reconstructive procedures, dating back to at least 3000 BC in India. In spite of the development of nasal reconstruction concepts, leading to remarkable esthetic and functional improvements, columella reconstruction is yet a contemporary challenge. Columella defects may result from trauma, infections, carcinoma resection, syphilis, bilateral cleft lip, etc. Maintaining symmetry, contour and function are essential for a successful columella reconstruction. Multiple factors help to determine the optimal repair method, including the size of the defect, its depth and location, and the strength of the underlying nasal framework. This article presents a range of techniques and discusses the application of these methods to specific columella defects. A chronological review of columellar reconstruction procedures used for this partial rhinoplasty is exposed.

[Fractured zygoma: a review of 356 cases]. / Les fractures de l'os zygomatique : à propos de 356 cas.

INTRODUCTION: Fractures of the zygomatic complex with its accompanying functional and esthetic deficits are a fairly common phenomenon in the practice of maxillofacial and plastic surgery. The purpose of this paper is to provide a review, based on collected data, on the topic of "fractured zygoma". The review is presented under the headings of epidemiology, fracture patterns, treatment modalities and complications. Throughout the paper comparison is made with published data from around the world. METHODS: A 10-year retrospective audit was undertaken of all hospitalized patients, at the department of maxillo facial and plastic surgery in Charles Nicolle Hospital (Tunisia), who had sustained a fractured zygoma from 1995 to 2004. RESULTS: A total of 356 fractures were sustained. Patients in the third decade of life (34%) recorded the highest incidence. The sex distribution is markedly higher for males than for females (9/1). Road traffic accidents (31%) were the predominant etiology. Tetrapod fractures (43.7%) were the most frequent type of fractures followed by zygomatic arch fractures (34.53%). Cases were managed by either closed or open reduction. Percutaneous reduction was the commonest technique employed. However, in unstable fractures necessitated open reduction, transosseous wiring was the most frequently employed fixation. Patients were followed-up routinely, for an average of nine months. Inferior orbital nerve dysfunctions were seen in 8.7% of cases. DISCUSSION: Epidemiological findings are similar to those reported in the literature. Males sustained more fractures than females and road traffic accidents were the commonest cause of zygomatic fractures. Open reduction and internal fixation is advocated for the unstable, markedly displaced or comminuted fractures.

[Epidemiology of maxillofacial traumatology in Tunis]. / Epidémiologie de la traumatologie maxillofaciale à Tunis.

INTRODUCTION: The aim of this study was to assess the epidemiology of maxillofacial trauma in Tunisia over a 10-year period. METHODS: This retrospective study was carried out between 1995 and 2004 on patients admitted for maxillofacial trauma in the department of maxillofacial and plastic surgery of the Charles-Nicolle Hospital in Tunis. The selected relevant parameters were: age, gender, etiology, time of trauma, type of fracture and associated lesions. RESULTS: A total of 1100 patient files were analyzed. The average age was 29 years and the sex-ratio was 6:1 in favor of men. The most common etiologies were: car crashes (39%), fights (28%) and domestic trauma (19%), occurred in the evening, on weekends and in the summer. The frequency increased in the evening, on weekends and in the summer. Mandibular fractures (62%) and zygomatic fractures (32%) were the most common trauma. Polytrauma occurred in 18% of the patients and cranial trauma in 10% of the cases. DISCUSSION: Epidemiological investigations results vary according to demographic and cultural regional specificities. Long-term collection of epidemiological data in maxillofacial surgery is a major issue to plan educational campaigns and therapeutic strategies. In Tunisia, driver education and observance of traffic regulations should be improved.

Fractura patológica de la mandíbula asociada a quiste radicular. Reporte de 3 casos clínicos / Mandibular pathologic fracture associated with radicular cyst. Report of three clinical cases

Introducción. El quiste radicular es el quiste más común de losmaxilares. Su tamaño puede variar desde una lesión que abarca el procesoalveolar hasta uno extenso que oblitera el espacio antral maxilar o causa unafractura patológica mandibular.Reporte de casos. Se reportan tres casos con fractura patológica mandibularasociados a quiste radicular ocurridos después de trauma facial. El diagnósticofue sugerido por un estudio clínico, radiografía panorámica y confirmadopor el estudio histopatológico de la pieza operatoria. El tratamientoconsistió en enucleación quística seguido por inmovilización de fragmentoscon osteosíntesis o bloqueo intermaxilar. El resultado clínico y radiológicoa corto plazo fue favorable.Discusión. Se discuten aspectos propios de la patología y su terapia.Conclusión. El éxito del tratamiento depende de una adecuada terapia enque sus principios más importantes son la remoción de la lesión medianteenucleación y una fijación estable(AU)

Introduction. Radicular cyst is the most common cyst ofthe oral cavity. It may range in size from a small periapical lesionto one that can obliterate the antral space or cause mandibularfracture.Case reports. We report three cases of radicular cyst complicatedby mandibular fracture that occurred after maxillofacial trauma.The diagnosis was strongly suggested by panoramic radiographyand confirmed by pathology examination of the operative specimen.Treatment consisted in cyst enucleation followed by immobilizationof fragments by osteosynthesis or maxillomandibular fixation. Theclinical and radiologic outcome was favorable.Discussion. The particularities and treatment are discussed.Conclusion. Treatment success is dependent on adequate therapy,the principles of which are removing the lesion and providing stablefixation(AU)

[Amniotic band syndrome and facial malformations]. / Maladie des brides amniotiques et malformations faciales.

Amniotic band syndrome (ABS) is a collection of fetal congenital malformations affecting mainly the limbs, but also the craniofacial area. The pathogenic mechanism is still unclear. The facial malformations in ABS are multiple, polymorphous, and asymmetric. The type and extent of facial defects depend on band location and time of onset. Defects may include a combination of facial cleft, cleft palate and lip, ocular lesions, and cranial malformations. The management of this disease must be multidisciplinary and the outcome depends on the gravity of malformations.

[Mandibular aggressive fibromatosis]. / Fibromatose agressive mandibulaire.

INTRODUCTION: Aggressive fibromatosis is a rare histologically benign fibrous tumor with a potential for locoregional aggression. Treatment is not well defined and several therapeutic approaches have been proposed. Surgical treatment is the reference, chemotherapy, radiotherapy and homonotherapy being proposed as complementary treatment or for inoperable tumors. CASE REPORT: A three-year-old patient underwent surgery for removal of a mandibular tumor. Pathology reported aggressive fibromatosis. The patient was given conservative treatment and was free of recurrence nine years after resection. DISCUSSION: Conservative surgery for aggressive mandibular fibromatosis appears to be preferable to radical mutilating surgery which would have a major impact on facial growth in children.

[Adenomatoid odontogenic tumor: two cases]. / La tumeur odontogénique adénomatoïde: deux cas.

INTRODUCTION: Adenomatoid odontogenic tumor, initially referred to as adenoameloblastoma, is a rare and benign odontogenic tumor. No recurrence has been reported after enucleation-resection. CASE REPORTS: We report two cases of adenomatoid odontogenic tumor, which illustrate the radiological and anatomic features of this tumor. They occurred in two 21 and 14 years-old teenagers who presented gingival swelling. The panoramic radiographs showed a radiolucent lesion with an impacted tooth. Enucleation-resection was performed with good outcome. DISCUSSION: The clinical, radiological and histological features of adenomatoid odontogenic tumor are distinct from those of ameloblastoma. It affects most commonly patients in the second decade of life predominantly females. This tumor is frequently misdiagnosed as other odontogenic cysts or tumors. We discuss the anatomoclinical features and the histogenesis of this rare tumor.

[Primary malignant melanoma of the nasal cavity presenting as a large tumor of the cheek]. / Mélanome malin des fosses nasales révélé par une tuméfaction jugale.

INTRODUCTION: Malignant melanoma of the nasal cavity is a rare tumor usually causing unilateral nasal obstruction and nasal bleeding. Diagnosis is achieved with immunohistochemistry analysis. Surgery is proposed for curative treatment. CASE REPORT: We report the case of a 60-year-old man with a malignant melanoma of the nasal cavity revealed by an important tumor of the cheek. Epistaxis and nasal obstructive syndrome occurred later. Because of the tumor stage, palliative chemotherapy was performed but the patient died 4 months after the diagnosis. DISCUSSION: This clinical presentation of malignant melanoma of the nasal cavity, related to local spreading, is exceptional. CT scan and MRI are essential for tumor staging and therapeutic decision-making. Prognosis remains poor.

Lipomatous hemangiopericytoma (adipocytic variant of solitary fibrous tumor) of the orbit. A case report with review of the literature.

Hemangiopericytoma (HPC) of the orbit is a rare tumor presenting with slowly progressive proptosis, ocular motility impairment and visual loss. In 1995, a newly variant of HPC termed lipomatous hemangiopericytoma (LHPC), was described. Only two cases arising in the orbit have been previously reported. The authors describe another case of orbital LHPC and discuss the clinicopathologic features, including the immunohistochemical staining profile and ultrastructural appearance of this distinctive tumor, and briefly discuss the relationship between HPC and solitary fibrous tumor of soft tissue, a neoplasm with many clinical and pathologic similarities.

[Mesenchymatous chondrosarcoma of the superior maxillary bone. A case report]. / Chondrosarcome mésenchymateux de l'os maxillaire supérieur. A propos d'un cas.

The authors report a new case of mesenchymal chondrosarcoma (MCS), occurring in the upper jaw bone of a 19 year-old woman. Radiographic picture in the bone shows an aggressive osteolytic tumor suspect of malignancy. An incisional biopsy was practiced and the histologic examination has confirmed the diagnosis of MCS. Treatment have consisted of a large resection of maxilla with additional irradiation therapy. The postoperative course was marked by recurrence of the lesion one year later.

[Maxillo-mandibular osteotomy]. / Les ostéotomies maxillo-mandibulaires.

The authors present their experience of maxillo-mandibular osteotomies performed at the Charles Nicolle Hospital in Tunis. The objective of this paper is to describe the preliminary steps (clinical, radiographic, photographic, modelling, cephalometric) in order to obtain a precise diagnosis of the dysmorphosis. They use Burstone's cephalometric analyses which allow evaluation of the relations between soft tissues which do not correspond to the relations of bony and dental displacement. They also present several clinical cases, the pre-operative steps and, most importantly, Burstone's cephalometric analyses demonstrating that, after osteotomies, the cephalometric values for soft tissues approach normal values. Complete analysis of the naso-maxillary profile may correct the motivation for consultation in some cases. The indication for Lefort I osteotomy is sometimes more appropriate than rhinoplasty. Preoperative orthodontic preparation is often required. Functional rehabilitation is necessary to adapt the orofacial muscles to the new shapes of the dental arch and to prevent recurrence.

[An African disease: noma]. / A propos d'une maladie africaine: le noma.

Cancrum oris, formerly a fatal disease, is seen in poor regions of Africa. The starting point of the disease is acute ulceronecrotic gingivitis which results in an extensive gangrenous plaque destroying, from inside working outwards, the dental arch, the maxilla and all of the soft tissues of the face. At the stage of sequelae, the therapeutic problem is twofold: functional and morphological. It is based on a panoply of technical procedures of surgical reconstruction.