Ranula as the First Symptom of HIV Infection in Young Patients.

INTRODUCTION: Oral manifestations are often the earliest HIV signs. Salivary gland diseases are a common form of HIV expression. A ranula can occur in association with HIV. However, this manifestation is rarely considered as the disease sentinel sign. We present two cases of children consulting for a ranula, leading to the diagnosis of a previously unknown HIV infection. Case Reports. Two children, respectively, 5 and 13, were treated for a ranula by marsupialization. Relapse occurred in both cases, and thereafter, a ranula excision was performed. While the follow-up was uneventful, HIV infection was diagnosed during the patients' care. The only sign or symptom observed was the ranula. A routine HIV testing of ranula patients would have allowed earlier care. CONCLUSION: Routine HIV testing of patients with a ranula is justified and may be recommended, especially for children. Ranula excision associated with the sublingual gland resection is suggested in order to avoid recurrence.

Risk factors assessment in fibular free flap mandibular reconstruction.

INTRODUCTION: The fibular free flap (FFF) is the best choice method for mandibular reconstruction. However, the failure and the complications risk factors (RF) are not yet fully identified. This study aims to analyze these RF in order to improve the success rate. MATERIAL: This retrospective study includes all patients who benefited from a FFF mandibular reconstruction between the first of January, 2014 and the thirty-first of December, 2018 in the Department of Stomatology and Maxillofacial Surgery department of the CHU Saint-Pierre Hospital, Brussels, Belgium. RESULTS: Thirty patients benefited from this intervention. The overall success rate was 90%. Majority of the patients were men (67%) (mean age: 52 years). The main associated co-morbidities were: alcohol (50%), tobacco consumption (67%) and previous radiotherapy (20%). The mean operative time was 9,5hours. The morbidities rates at the receiving site (RS) and the donor site (DS) were respectively 43% and 30%. Infection and dehiscence of the RS were the main complications. Statistical analysis identified RF for RS infections: atherosclerosis and operative time; RS dehiscence (previous cervical dissection and secondary reconstruction); flap necrosis (ischemia time, rate of infection at the recipient site, history of radiation therapy, alcohol consumption, National Nosocomial Infection Surveillance score (NNISS), and history of cervical dissection); and DS morbidities (NNISS and dehiscence rate at the DS in the early period). CONCLUSION: The FFF mandibular reconstruction offers a significant success rate. Nevertheless, this study highlighted several failure and complications RF of the procedure. Previous neck dissection and radiotherapy, operative and the ischemia time, were RF associated with complication at the RS. Furthermore, the NNIS score and the dehiscence rate were also reported as RF for FFF necrosis.

[Ulcerations and erosions of the oral mucosa]. / Ulcérations et érosions de la muqueuse buccale.

Ulcerations and erosions of the oral mucosa are common and occur at any age. Their knowledge and recognition are essential to ensure optimal care at the earliest stage. Etiologies are numerous and the subject of different classifications. In this work, the authors address the most frequently encountered lesions, describing their main clinical presentations. A review of treatments is then proposed.

Les ulcérations et érosions de la muqueuse buccale sont fréquentes et surviennent à tout âge. Leurs connaissance et reconnaissance sont essentielles afin d'assurer une prise en charge optimale et la plus précoce possible. Les étiologies sont très nombreuses et font l'objet de différentes classifications. Dans ce travail, les auteurs abordent les lésions les plus fréquemment rencontrées, en décrivant leurs principales présentations cliniques. Une revue des traitements est ensuite proposée.

[Evolution of the indications of orthognathic surgery]. / L'évolution des indications de la chirurgie orthognatique.

Orthognathic surgery evolved over the last 30 years, which has reduced the morbidity of interventions and widened its field of indication. The management of dysmorphosis, obstructive sleep apnea syndrome, fracture sequelae and facial esthetics can be managed successfully thanks to these interventions, the scarring of which is almost absent.

La chirurgie orthognatique a connu une évolution au cours des 30 dernières années qui a eu pour conséquence de diminuer la morbidité des interventions et d'élargir son champ d'indication. La prise en charge des dysmorphoses, du syndrome d'apnées obstructives du sommeil, des séquelles de fractures et de l'esthétique de la face peut être gérée avec succès grâce à ces interventions dont la sanction cicatricielle est quasiment absente.

[Chronic maxillary rhinosinusitis of dental origin: report of 2 cases]. / Rhinosinusites chroniques maxillaires d'origine dentaire : à propos de 2 cas.

Chronic maxillary rhinosinusitis of dental origin represents approximately 5 % of chronic maxillary rhinosinusitis. The diagnosis of this pathology is often delayed and mainly based on endoscopy and medical imaging. Its treatment is complex and requires the involvement of several teams. This article discusses two cases of chronic maxillary rhinosinusitis secondary to dental treatment. A literature review on the epidemiology, diagnosis, treatment and complications are also introduced.

Should older head and neck patients be treated differently?

OBJECTIVES: Growing life expectancy is resulting in an increasing number of elderly patients with upper aero digestive tract tumor. The objective of this study was to assess the appropriateness of aggressive curative treatment for these older patients. PATIENTS AND METHODS: Patients over the age of 70 years, with head and neck squamous cell carcinoma (HNSCC) of the oral cavity, pharynx or larynx, primarily treated in our department between 2005 and 2007, were assessed retrospectively at 36 months' follow-up. Demographics, comorbidity and treatment strategies and their associated morbidity and mortality were reviewed. RESULTS: Thirty-two males and 12 females with a median age of 77 years (range, 70-88 yrs) were given curative treatment. The majority presented with a least one comorbidity. Seven had a history of myocardial ischemia, 15 of chronic obstructive bronchopathy, and 10 of type-2 diabetes; 17 were under treatment for arterial hypertension, four had chronic renal insufficiency, and two had cirrhosis. Nine patients received radiation therapy alone; 18, concomitant chemoradiotherapy; 14, surgery with adjuvant chemoradiotherapy; three were treated by salvage surgery after failure of radiation therapy. In the 44 patients, there were 12 deaths: seven from recurrence, two from treatment complications, one from MI, one from peritonitis and one from pneumonia. At 36 months' follow-up, 32 of the 44 patients were alive. CONCLUSION: HNSCC is a serious disease that often necessitates aggressive treatment. All patients who are medically eligible should receive curative treatment, without age being an exclusion criterion. Taking comorbidity into account, on the other hand, enables treatment options to be optimized.

[Orthodontics, orthognatic surgery and their functional environment]. / Orthodontie, chirurgie orthognatique et environnement fonctionnel.

Dento-dental and dento-maxillary dysharmonies and maxillo-mandibular dysmorphologies are impairments that can be treated either by orthodontics and surgery, or with a combination of orthodontics and orthognatic surgery. Respiration, deglutition, phonation and succion play a predominant role in the occurrence of maxillofacial dysmorphologies. Contributing factors to such impairments include upper airway function disorders such as respiration, deglutition, phonation, sucking. Abnormal functions must be extensively studied in management of maxillofacial patients in order to achieve stable results and to avoid relapses.

[Management of patient with sleep apnea syndrome]. / Prise en charge du syndrome des apnées du sommeil.

Obstruction sleep apnea (OSA) syndrome is a frequent problem observed in 2% of females and 4% of male patients. It is considered as a public health problem regarding its high neuropsychological and cardiovascular morbidity. Precipitating factors include male gender, high blood pressure, obesity and maxillofacial morphological abnormalities. Even if Continuous Positive Airway Pressure (CPAP) is the treatment of choice in OSA, stomatological orthesis and bimaxillary advancement surgery give excellent results and keep place within our therapeutic arsenal. Multidisciplinary management of SAOS patients enables us to deliver adequate and adapted therapy to each patient.