[Odontogenic keratocyst related to a Gorlin syndrome: a case report]. / Kératokystes odontogènes dans le cadre d'un syndrome de Gorlin: à propos d'un cas clinique.

We are reporting here, the case of a 9 years old boy with Gorlin syndrome diagnosis. Current knowledge on this syndrome is reviewed.

Treatment of vascular malformations of the mandible: a description of 12 cases.

This study evaluated the treatment of intraosseous vascular malformation of the mandible. We analysed the medical records of 12 patients treated at the Salpêtrière Hospital (Paris, France) for vascular malformation of the mandible between 1965 and 1996. There were six male and six female patients, with a mean age of 16 years. The mean follow-up time was ten years. The treatment was surgery (enucleation or resection) or interventional radiology (arterial embolization or transosseous transcutaneous embolization). There are several indications for treatment, including age, and the size and type of vascular malformation (active or passive).

[Fortuitous discovery of a voluminous mandibular cyst in a child]. / Découverte fortuite d'un volumineux kyste mandibulaire chez un enfant.

In a five and a half year-old child, a voluminous mandibular cyst was discovered by a dental check-up. The originality of this case consisted in the great volume of this asymptomatic lesion and the anterior localization in the mandible. Treatment was surgical, conserving the deciduous teeth and the underlying germs. The histopathological examination of the lesion confirmed the clinical and radiological aspects of follicular cyst. A regular clinical and radiologic surveillance was necessary until bone regeneration was complete, the risk of per and post-operative fracture being major.

[Free fibula transplant and practical approach in the absence of posterior tibial artery. A report of 2 cases]. / Transplant libre de péroné et attitudes pratiques en cas d'absence d'artère tibiale postérieure. A propos de deux cas.

The authors report two well documented cases of absent posterior tibial artery in patients undergoing free fibula transplant. The first patient was a 50-year-old woman treated by pelvimandibulectomy for squamous cell carcinoma, leaving a defect of the floor of the mouth. The second case was an 11-year-old child with Ewing sarcoma of the femoral metaphysis, in whom femoral reconstruction was performed by vascularized free fibula transplant. Based on these two cases, the authors describe their diagnostic and therapeutic approach designed to avoid risks associated with this anatomical variant. Absence of the posterior tibial artery can be confirmed by arteriography and duplex ultrasound. The authors propose duplex ultrasound as first-line investigation as this safe, noninvasive examination provides sufficient information in the majority of cases at a lower cost. In parallel, the various anatomical variants affecting the origin of leg arteries from the popliteal artery are classified into seven groups based on a phylogenetic and embryological study.

Absence of the posterior tibial artery: implications for free transplants of the fibula.

A well-documented case of absence of the posterior tibial a. is reported. We have studied 40 personal case-records of dissection of the arteries of the leg in fresh corpses. This study allowed classification of the origins of the leg arteries from the popliteal a. into 7 groups. Several findings emerged: 1) the peroneal a. is constant, for phylogenetic and embryologic reasons, 2) the posterior tibial a. is absent in 1 to 5% of cases [1, 2, 4, 6-8] (Fig. 4), in which case the vascularisation of the fibula remains as normal (the proximal epiphysis of the fibula is vascularised by the anterior tibial a., the diaphysis and the distal epiphysis by the peroneal a.). Other anatomic variations may be found: trifurcation of the popliteal a., origin of the anterior tibial a. from the peroneal a., absence of the anterior tibial a., aplasia of the terminal portions of both the anterior and posterior tibial aa. In practice, absence of the posterior tibial a. can be demonstrated by arteriography and doppler ultrasound. We are dubious about the indications for arteriography, which is not always a risk-free examination, and therefore prefer doppler examination with ultrasound, which supplies adequate information in the majority of cases.

[Arteriovenous malformation of the mandible. Apropos of a case in a 6-year-old child]. / Malformation artério-veineuse de la mandibule. A propos d'un cas chez l'enfant de 6 ans.

Arteriovenous malformations of the mandible are uncommon. Though characteristic clinical and radiological presentations are well described, management in the case of children is still a matter of debate. We report a mandibular angioma in a 6-year-old girl which was treated with superselective embolization. This method is the treatment of choice for mandibular arteriovenous malformations in children because of the low complication rate and the preservation of healthy tissue. When the malformation continues to develop despite repeated embolizations, surgical treatment may be necessary.

[Hemangiopericytoma of the infra-temporal fossa. Apropos of a clinical case]. / Hémangiopéricytome de la fosse infra-temporale. A propos d'un cas clinique.

We observed the case of a young woman with haemangiopericytoma in the subtemporal fossa. Diagnosis problems and the access route were discussed. Good exposure was achieved at the price of minor aesthetic and functional impairment. The prognosis of these potentially malignant tumors is uncertain.

[Rhinorrhea of parotid origin. Apropos of a case]. / Une rhinorrhée d'origine parotidienne. A propos d'un cas.

The authors report a case of a post-traumatic salivary fistula originating in the parotid gland, evacuating into the maxillary sinus and revealed by rhinorrhea. The mechanism and treatment of the fistula were analyzed.

[mandibular reconstruction by free bone flaps with micro-anastomosis. Our current indications]. / Reconstruction mandibulaire par lambeaux libres osseux micro-anastomosés. Nos indications actuelles.

The frequency with which difficulties were encountered in the reconstruction of the continuity of the mandible led us to attempt to systematize our indications. Although grafts, composite pedicle flaps and prosthetic guides still have their appropriate applications. Local conditions are more and more frequently amenable to free flaps. The factors guiding our choice are presented in detail: physical conditions, etiology and anatomy of the defect. In addition, the reason for choosing the type of free flap--iliac crest, fibula or external brachial--is discussed.

[Scanner-guided puncture biopsy of a lesion occupying the pterygo-maxillary fossa]. / Ponction biopsie guidée sous scanner d'un processus occupant la fosse ptérygo-maxillaire.

A 26-year old male patient was referred to us for impaired mouth opening. Actually, Mr. B. has been followed up for SADAM for 2 years at different hospital services. In view of the ineffectiveness of the treatments administered (occlusal releasing gutter, antiinflammatory agents) and due to occurrence of severe episodes of earache refractory to conventional analgesics, we request that a CT-scan be obtained to evidence the process invading the pterygopalatine fossa. ENT examination and scanner-guided needle biopsy are performed to enable anatomopathological analysis and diagnosis.

[The diagnostic importance of different imaging technics in temporomandibular joint dysfunction]. / Apport diagnostique des différentes techniques d'imagerie dans les dysfonctionnements des articulations temporo-mandibulaires.

Various imaging techniques enable to explore the Temporo-mandibular joints (T.M.J.). The physicians prescribing them, must be perfectly aware of the informations they provide as well as their costs, for a judicious formulation of their indications. Conventional radiography is absolutely necessary and, most of the time, sufficient, since it simply permits to evaluate the bony structures. An orthopantomogram and modified Schüller views of each T.M.J., "open mouth" and "closed mouth" will be performed. Conventional tomograms are no longer indicated. They will be abandoned for Computed Tomograms. This examination permits, at a relatively low cost, to analyse a bony abnormality and explore the muscular soft tissues. It may also be possible to assess the meniscus, its position and displacement when the mouth is opened. In fact, if a meniscal or articular pathology is considered, which could result in surgical or endoscopic procedure, it is absolutely necessary to perform: -either an arthro-tomography, with contrast material, -or a magnetic resonance examination. The latter provides perfect anatomical and pathological informations of the joint and meniscus, in an atraumatic fashion for the patient. Its only contraindication is in the cost of the examination. It will be possible to look for a dislocation, a malformation or a structural alteration of the meniscus which could result in a perforation, a rupture of the posterior frenulum, adhesions or joint extravasation. A necrosis or early osteochondritis of the condyle will be ruled out.

[Changes in the nasal pyramid in osteotomy of the maxilla]. / Etude des modifications de la pyramide nasale au cours des ostéotomies du maxillaire supérieur.

The correction of dento-facial deformities with Lefort I osteotomy are always accompanied by changes in soft tissue and skeleton. But, in many cases there is also modification of the low floor of the nose and profile changes. This clinical experience has been confirmed in the Laboratory on cadavre experimentation. Three deplacements have been studied: advancement of maxilla, inferior repositioning of maxilla and superior repositioning of maxilla. Often, Lefort I osteotomy is a complex association of these movements; modifications are also function of soft tissue. Operation must necessary provide theses technical modification for a real adaptation of the surgery. The surgical technique must therefore be adapted in order to obtain the best aesthetic result.

[Genioplasty, indications and therapeutic methods in dento-maxillary malformations]. / Les génioplasties, indications et modalités thérapeutiques dans les dysmorphoses dento-maxillaires.

Genioplasty constitutes an adjunctive surgical procedure used in adult plastic surgery of the facial profile. It is used after dental malocclusion has been corrected and facial morphological features have been reassessed (soft tissue changes consecutive to maxillary osteotomy should be previously analyzed by cephalometry). Genioplasty permits achieving a modification of the chin point in the three planes. The authors describe several types of genioplastic operations, depending on the aim.

[The value of projection genioplasty using silicone endoprostheses]. / Intérêt des génioplasties de projection par endoprothèses en silicone.

Use of a silicone menton endoprosthesis appears to be a seductive alternative to menton osteotomy for profile reconstructions of a certain type, whether pure or associated with orthognathic treatment. A strict surgical technique is essential, particularly a limited incision and median and low situated positioning. The advantages and inconveniences of this procedure are described and the need for very selective choice of patients emphasized.

[Necrotizing sialometaplasia. Apropos of a case. Diagnostic and therapeutic problems]. / Sialométaplasie nécrosante. A propos d'un cas. Problèmes diagnostique et thérapeutique.

The authors a rare case of necrotizing sialometaplasia localised in the palate. This case is interesting because of the diagnostic problems raised by the clinical and radiological appearance of the lesion. The case report is completed by a review of the literature.

Postero-lateral expansion osteotomy of maxilla. A case report.

The posterior-maxillary osteotomy introduced by Schuchardt was designed to close skeletal anterior open bite. Also, it can be used to reduce a posterior cross bite. But in this latter case, the most important problem is the difficulty in expanding the maxilla because of the relative inelasticity of the palatal mucosa. This paper reports on the result obtained by a surgical expansion technique without orthodontic treatment. The use of a local soft tissue flap is necessary; the anteroposterior part of the palatal incision is placed contralaterally to the bone incision. A palatal appliance is used for the retention of the palatal flap.