[Sclerosing polycystic adenosis of the parotid gland : surgical treatment of an extensive lesion of deep tissue without superficial damage]. / Adénose sclérosante polykystique de la parotide : traitement chirurgical d'une lésion extensive du lobe profond sans atteinte superficielle.

Sclerosing polycystic adenosis (SPA) is a rare benign epithelial lesion of the salivary glands, of unknown etiology, mainly affecting the parotid gland. We report the first clinical case of SPA involving the deep parotid gland with extension in the parapharyngeal space and the masticatory region. It has been resected by an external parotidectomy approach exclusively, despite the median extension of the lesion. The objective of this article is to complete the small series of cases described in the literature, and to update the knowledge of this rare disease.

L'adénose sclérosante polykystique (SPA) est une lésion épithéliale bénigne rare des glandes salivaires, d'étiologie inconnue, atteignant principalement la glande parotide. Nous rapportons le premier cas clinique de SPA dont l'origine est le lobe profond de la parotide et qui envahit la région masticatrice et l'espace parapharyngé. Elle a été réséquée par une voie d'abord externe de parotidectomie, exclusivement, malgré l'extension médiane de la lésion. L'objectif de cet article est de compléter la petite série de cas décrits dans la littérature, et d'actualiser les connaissances de cette pathologie rare.

Evolution in the management of oropharyngeal squamous cell carcinoma: systematic review of outcomes over the last 25 years.

The treatment of oropharyngeal squamous cell carcinoma (SCC) has evolved over the last 25years, from open surgery to combined chemoradiotherapy, and now to the development of minimally invasive procedures, but evidence for the best treatment is lacking. We therefore did a systematic search of the MEDLINE database for studies published between 1992 and 2017 that reported oncological or functional outcomes, or both. Predefined inclusion and exclusion criteria were used for screening and selection, and 45 studies were chosen. Only one was a randomised controlled trial, all the rest were prospective or retrospective case series. The heterogeneities in their characteristics made meta-analysis impossible and only qualitative analysis was feasible. We found no conclusive evidence to suggest the advantage of one therapeutic approach over another, so we still cannot offer patients the "ideal" treatment. We have, however, raised the possibility of there being two different entities: human papillomavirus (HPV)-positive and HPV-negative disease.

Dental prosthetic reconstruction of osseointegrated implants placed in irradiated bone.

Nineteen patients who were treated for oncologic pathology by surgery and radiotherapy (average dose = 57 Gy) received prosthetic reconstruction with 53 implants placed in the residual mandible or maxilla and/or replacement bone graft. Implants were placed within a minimum period of 5 months after radiotherapy. The healing period before placement of the prosthesis also was at least 5 months. Two to six implants were placed as a function of tooth loss and required prosthetic design. Prostheses included both removable and fixed restorations. Two implants were lost as a result of osseointegration failure. Fifteen implants in six patients could not be followed throughout the study because of patient expiration. Patients were followed up to 68 months and for an average of 38 months. No osteoradionecrosis phenomenon was seen in this study. However, caution is urged in placing implants in irradiated bone because of the potential for osteoradionecrosis. Patients should be carefully selected and a strict therapeutic protocol should be followed.

[A case of very late malignant degeneration of pleomorphic adenoma]. / Un cas de dégénérescence maligne très tardive d'un adénome pléomorphe.

Incomplete excision of a pleomorphic adenoma exposes to a high risk of recurrence and tumor spread, making secondary surgery more difficult or a malignant transformation with a poor vital prognosis likely. Three histological types of pleomorphic adenomas can be observed when the tumor undergoes a transformation, namely the carcinoma ex-pleomorphic adenoma, the true malignant mixed tumor and the benign metastasizing mixed tumour.

[Combination of successive free transplants and osseointegrated implants in the reconstruction of the upper jaw]. / Association de transplants libres successifs et d'implants ostéo-intégrés dans la reconstruction d'un maxillaire supérieur.

Various free flap transfers can be associated to reconstruct a defect after resections in the head and neck region. The use of these flaps can be synchronous (one-stage surgery) or metachronous (two-stage surgery) in order to correct or improve secondary residual deformities. A two-stage use of free flaps, first with an osteocutaneous scapular flap and second with a fascial radial forearm flap, is reported after total maxillectomy. The osteocutaneous scapular flap was used to restore function (swallowing, chewing, speech and cheek projection) and the radial forearm flap to improve esthetic facial morphology. Minor ancillary procedures were subsequently necessary to achieve the final result (brow lift, tarsal straightening and facial lift).

[Prosthetic dental rehabilitation on osseointegrated implants placed in irradiated mandibular bone. Apropos of 50 implants in 17 patients treated over a period of 5 years]. / Réhabilitation prothétique dentaire sur implants ostéointégrés placés dans l'os mandibulaire irradié. A propos de 50 implants chez 17 patients traités sur une période de 5 ans.

The authors report on their experience with prosthetic dental rehabilitation of 17 patients after surgery and radiotherapy for oncologic diseases of the oral cavity. 50 implants were inserted either in the mandibular residual bone or in a bone graft. These implants were inserted at least 5 months after radiotherapy, and functionally loaded at least 5 months after implanting. Depending on the degree of edentation, 2 to 6 implants were necessary to allow for a functional removable or fixed denture. 2 implants were lost because of lack of osseointegration and 10 were lost because of death of 4 patients. The longest observation period was 56 months and the mean observation time was 29 months. Not any osteoradionecrosis occurred : nevertheless, implantation in irradiated bone must remain a carefully planned operation in selected patients with a rigourous therapeutic protocol.

[A free forearm flap in reconstructive maxillofacial surgery. Surgical technic and results of 40 clinical cases]. / Le lambeau antébrachial libre dans la chirurgie réparatrice maxillo-faciale. Technique opératoire et résultats de 40 cas cliniques.

The authors report their experience of microsurgical reconstruction of the maxillofacial region with the radial forearm flap in 40 patients. After a brief historical and anatomical description, the cases are presented and specific considerations on the author's operative technique are detailed. The discussion on the advantages and the disadvantages of this flap ends the paper.

[Antebrachial free flap with radial pedicle. II. Surgical technique]. / Le lambeau libre antébrachial à pédicule radial. II. Technique opératoire.

The authors detail the anatomical, physiological, and clinical considerations of the free forearm flap. These characteristics determine the many indications of this flap in the maxillofacial surgical reconstruction. Contraindications are quasi inexistent. The second part of this work analyse the surgical and microsurgical operative technique use for the authors. All different parts of this work are discussed upon a deep review of the recent literature.

[Free antebrachial flap with radial pedicle. I. Theoretic considerations and indications in maxillofacial reconstruction]. / Le lambeau libre antébrachial à pédicule radial. I. Considérations théoriques et indications dans la reconstruction de la région maxillo-faciale.

The authors detail the anatomical, physiological, and clinical considerations of the free forearm flap. These characteristics determine the many indications of this flap in the maxillofacial surgical reconstruction. Contraindications are quasi inexistent. The second part of this work analyses the surgical and microsurgical operative technique use for the authors. All different parts of this work are discussed upon a deep review of the recent literature.

[The role of microsurgery in the reconstruction of loss of substance of soft tissue in the maxillofacial region]. / Le rôle de la microchirurgie dans la reconstruction des pertes de substance des tissus mous de la région maxillo-faciale.

Reconstruction of oncological defects in the maxillofacial region still remains a real surgical challenge due to the complexity and the tridimensional aspect of these defects responsible for heavy functional impairment. Microsurgery allowing the transfer of free flaps gives the surgeon the opportunity to adapt a specific reconstruction to each defect and to reinsert the patient in a quasi normal social life. These reconstruction technics are routinely used in many centers; they must be integrated in our therapeutic arsenal and in the training of the maxillofacial surgeon. Seven years ago, we incorporated microsurgical reconstruction in our therapeutical concepts and today, it seems to us important to share our experience of microsurgical reconstruction in the field of soft tissues defects in the maxillofacial region.

[Mandibular reconstruction using a pedicled osteomyocutaneous flap of the latissimus dorsi]. / Reconstruction mandibulaire par lambeau ostéomyocutané pédiculé de grand dorsal.

The authors report their experience with reconstruction of loss of mandibular substance due to wide or complicated resections for cancer. A series of 8 reconstructions using a latissimus dorsi osteo-myocutaneous pediculated flap and the 10th rib helped to define the advantages and disadvantages of this form of complex flap. Since a latissimus dorsi pediculated flap has classically been used in maxillo-facial reconstruction, an osteo-myocutaneous flap, including a portion of the 10th rib, is naturally appropriate for the reconstruction of a major loss of substance involving the mandible and related structures. The separation technique and trans-cervical transposition are described. The advantages of this form of flap are the ease with which it may be detached and the reliability of the vascular pedicle. The principal disadvantages are the relatively large volume, the difficulty in dissociating the cutaneous layer from the bony layer and the difficulties involved in the fixation of the bone graft to a prosthetic plate. Problems with rehabilitation are also discussed.

[Esthetic IMZ implant for a central incisor]. / Programmation esthétique d'un implant IMZ pour incisive centrale.

Replacement of a missing incisor with an osseo-integrated implant, presents a difficult prosthetic problem for the practitioner because of the obliqueness of the implant and its diameter smaller than the tooth to be reconstructed. Therefore, a topographic and aesthetic pre-estimation is highly desirable. The patient whose treatment is described hereafter, presents large diastemas permitting to set the missing tooth in several locations. The various options are simulated on a study model and recorded by a silicone or resin index. This index is cut out so that the implant site is clearly defined and it presents a guide rod indicating the direction of the alveolar bone. The optimal site is selected during the surgical procedure with the most favorable index depending on the residual bone. After the implant is released, the location impression, is taken using asymmetric transfer allowing a strict positioning of the implant's replica and its thread. In order to prevent the making of a triangular-shaped crown, a false transfixed core removable is built over the intramobile component of the IMZ as well as pa periodontal ring. The latter is independent and maintained by the intramobile component. It compensates the difference in diameter between the implant and the natural tooth to be reconstructed. Its finely polished but asymmetric internal aspect prevents the rotation of the device. The volume of this device is controlled by a silicone index made on the preestimation model. Both pieces are cast in gold and assembled on the implant with a positioning indes. Parallel proximal grooves increase the friction of the core and a ceramo-metal crown is built in the conventional fashion. It is temporally cemented, and periodically removed and cleansed. The absence of gingical sulcus provides an aesthetic result similar to a bridge component.

[Fine-needle puncture of salivary gland tumors]. / La ponction à l'aiguille fine des tumeurs des glandes salivaires.

Fine needle aspiration cytology of major salivary glands is easy to perform at a low cost. Its predictive value is 100% for malignancy. Its main indications are: the diagnosis of inflammatory lesions, of malignant growths (either epithelial or lymphoma or metastases) and the follow-up of benign lesions which are not immediately amenable to surgery.