[Atypical actinomycosis revealed by distant dermatological disorders: Report of an unusual case and literature review]. / Actinomycose atypique révélée par des lésions cutanées à distance : à propos d'un cas et revue de la littérature.

INTRODUCTION: Dermatological manifestations of actinomycosis are classical, most often related to Actinomyces israelii. In most of the cases, they occur near to the primary focus, and in the cervicofacial area. Systemic dissemination with cutaneous distant metastasis is rare, most often related to A. israelii, too. We report an original case of upper limb actinomycosis associated with an oral localisation and due to an unusual bacteria. CASE REPORT: A 49-year-old man was referred to the Department of dermatology for a skin lesion of the left hand and wrist. Biopsies revealed actinomycosis related to A. meyeri. Dental primary focus was identified and treated. Although the patient was lost sight of, dental eradication and prolonged antibiotics therapy allowed cutaneous improvement. DISCUSSION: We report an atypical case of cutaneous actinomycosis due to an Actinomyces meyeri dental infection occurring in an immunocompetent, smoking adult, with poor oral hygiene. The literature review revealed only 4 well-documented cases of cutaneous A. meyeri infections distant to dental primary focus. All of patients were males, immunocompetent, with a history of poor oral hygiene. The prognosis is favourable with adequate treatment (antibiotic therapy and surgical treatment to eradicate dental infectious entry points).

Dental implants in a patient with left mandibular fibrous dysplasia: Two-year outcomes on the normal and affected sides.

Dental rehabilitation raises specific challenges in patients with mandibular fibrous dysplasia. We report the 2-year post-operative outcomes on the normal and affected sides in a 64-year-old female with focal left mandibular fibrous dysplasia and bilateral posterior edentulism. On the left, bone shaving of the lesion to restore sufficient vertical height was followed by the insertion of two dental implants. Three dental implants were inserted into the normal bone on the right. Dental prostheses were added 6 months later. Two years after the first procedure, no complications had been recorded and the patient reported similar high satisfaction for both sides. This comparison of outcomes of dental implants inserted into dysplastic versus normal bone in the same patient suggests that dental implants may constitute a valid option for managing edentulism in selected patients with fibrous dysplasia, provided appropriate precautions are taken.

Management of patients with sickle cell disease in oral surgery. Literature review and update.

Sickle cell disease, the most common genetic disease in the world, is a chronic hemolytic disease that can be complicated by severe vaso-occlusive pain crises resulting in tissue necrosis and even death. Due to its increasing incidence, oral surgeons will inevitably be faced with the management of these patients. To limit the risk of crises, our goal is to share recommendations for the management of sickle cell patients in oral surgery. The vaso-occlusive crises (VOC), heart attacks and chronic anemia endured by these patients cause chronic lesions in various organs. Complications include retinal disease, avascular necrosis, priapism, neurological involvement (cerebrovascular accident), cardiomyopathy, lower limb ulceration, renal and hepatic dysfunction, and cardiopulmonary disease. These complications inevitably lead to an increase in mortality rate. Thorough knowledge of this pathology is essential for the management of these patients in oral surgery. Management strategies include prevention and diagnosis of oral lesions related to sickle cell disease and its treatment, as well as methods of preparation and execution of oral surgery procedures. We suggest guidelines for the management of these complications and implementation of preoperative, intraoperative and postoperative surgical protocols for both practitioners and patients.

Secondary surgical decompression of the inferior alveolar nerve after overfilling of endodontic sealer into the mandibular canal: Case report and literature review.

The authors report the case of a 43-year-old woman who underwent endodontic treatment of the right second mandibular molar with substantial extrusion of endodontic material into the mandibular canal. The patient presented at the Department of Oral and Maxillofacial Surgery with a persistent total anaesthesia of the lower lip and chin after two months. 2D panoramic view and 3D CT-scan examination highlighted the overfilling into the mandibular canal with a more than 50% stenosis of the canal and a consequently significant compression of the dental pedicle. A surgical decompression of the inferior alveolar nerve was performed through an inferior vestibular approach, using PiezoSurgery®. The tooth was conserved. After a period of 8days, paraesthesia of the lower lip and chin appeared. Thermoalgic sensitivity was recovered at 1month. At 3months postoperatively, the patient had recovered protopathic and epicritic sensitivity. Dental prosthetic rehabilitation was finally achieved one year postoperatively. The authors discuss the physiopathology of nervous injuries during dental procedures, and further strategies in the case of persistent neurologic disorders.

[Management of patients with bradykinin-mediated angioedema in oral and maxillofacial surgery]. / Prise en charge des patients atteints d'angiœdèmes bradykiniques en chirurgie orale et maxillo-faciale.

Bradykinin-mediated angioedema (AE) is a rare disease characterized by recurrent cutaneous or mucosal angioedema. This hereditary or acquired disease is of rapid installation, non-pruritic, usually painless and can affect the face, lips, larynx, gastrointestinal tract or extremities. When the affected area involves the upper respiratory tract, laryngeal angioedema can lead to imminent death by asphyxia. This is the reason for the high mortality rate (30 %) in undiagnosed or improperly managed patients. High-risk situations in oral and maxillofacial surgery procedures should be identified preoperatively. Short-term prophylaxis must be carried-out prior to any procedure that may trigger an attack. A multi-site reference center (CREAK) has been created to help clinicians to manage this disease. This article reviews the pathophysiologic mechanisms, the clinical presentations, the possible treatments, the acute strategies for attacks and different prophylactic possibilities in oral and maxillofacial surgery.

[Mastoid bone graft in implantology. A case report]. / Greffe d'os mastoïdien en implantologie orale. À propos d'un cas.

INTRODUCTION: In implantology, autogenous bone remains currently a useful-material to rebuild horizontal and vertical osseous defects. Usually, it is the needed osseous volume that indicates the grafting procedure, intraoral one for small and middle volume and extraoral one for severely atrophied jaws. The originality of this case report is to show an alternative to usual grafting procedure borrowed from ENT surgeons: osseous mastoid graft. TECHNICAL NOTE: A 63-year-old patient with maxillary sinus pathology underwent during same surgical time maxillary sinus curetting and osseous grafting to finalize the dental treatment. DISCUSSION: Mastoid cortical bone is a source of bone usable in oral implantology. Its use has been proved to be reliable in oto-surgery. Mastoid bone harvesting implies the presence of ENT surgeon; it is nevertheless interesting to know this site from a biological point of view and because of its functional and economical aspects.

[Evaluation in clinical practice of the quality of life of patients with VADS cancer: an ethical justification or a fad?]. / Evaluation en pratique clinique de la qualité de vie des patients atteints de cancers des V.A.D.S.: une démarche éthique justifiée ou un effet de mode?

Now that the treatment of head and neck cancer has been perfectly standardized and the complications and sequelae are well known, many authors have started to investigate health-related quality of life (QoL). The use of generic and cancer-specific QoL instruments remains limited to the field of research, but can this approach be transposed to clinical oncology? This study was designed to answer this question by identifying the ethical problems related to QoL assessment. The methodology used is based on a questionnaire survey of a cohort of 40 volunteer patients, conducted some time after their initial treatment in order to optimally assess their expectations and questions in relation to these aspects. The validity of the instrumental approach cannot be guaranteed due to conceptual limits, and the sociocultural level and cognitive state of the target population. A more subtle approach to QoL assessment in routine clinical practice would consist of a mixed approach harmoniously combining quantitative and qualitative aspects based on questionnaire and interview.

[Committee on cancer of the upper aerodigestive tract and survey on buccodental aspects. Report of 164 teams]. / Comité de cancérologie des VADS et prise en compte des aspects bucco-dentaires. Enquête auprès de 164 équipes.

BACKGROUND: Head and neck cancer occupies an important place in the field of oncology in France (8%). Patient management requires a wide diversity of treatment modalities and must be based on a multidisciplinary approach. MATERIALS AND METHODS: This clinical ethics study was based on analysis of a national survey of current practise in public and private hospital structure. A 28-questions anonymous questionnaire was send to 164 practitioners caring for these patients from the stage of diagnosis and evaluated the modalities of dental treatments and the related ethical aspects. RESULTS: The competence of the various practitioners in their respective fields is undeniable, but there is a lack of multidisciplinary collaboration. The absence of an oral practitioner is a serious problem and can reduce the patient's chances of cure. DISCUSSION: The oral practitioner must participate in head and neck cancer committees at all steps of treatment in order to provide curative, preventive care and prosthetic rehabilitation, thereby contributing to improvement of the quality of life of these patients.