Facial dog bites in children: A public health problem highlighted by COVID-19 lockdown.

BACKGROUND: Stay-at-home injunction during COVID-19 pandemic led to new dynamics in households and increased the risk of domestic accidents involving pets. The aim of the study was to demonstrate an increase of facial dog bites in children during first lockdown period in France, compared to the same period in 2018 and 2019. Secondary objective was to investigate the demographics and circumstances in which dog bites occurred. METHODS: A retrospective multicentric study was conducted nationwide. Patients under 18 years old managed in fifteen oral and maxillofacial surgery departments for a dog bite were included. RESULTS: Eighty-seven patients were included. A significant increase of the number of children managed for facial dog bite was noticed in 2020 (p=0.0005). The male-to-female ratio was significantly reversed in 2020 with more bites in girls than boys (p=0.02). In 2020, children were mostly bitten to cheeks (28.6 %), lips-and-chin region (26.2 %), and eyelids (23.8 %). Severe bites increased in 2020, in comparison with 2018 and 2019. Dog bites occurring while petting or playing significantly increased in 2020 (31 %) (p=0.03). CONCLUSION: The process leading to bites is highly dependent on the balance of dog-owner relationship. This was strongly disrupted during COVID-19 pandemic, resulting in the increase of dog bites in households. Regarding dog bites, face is the most vulnerable area in children. Its injury has lots of esthetic and functional consequences and maxillofacial surgeons have a key role to play in their prevention. Reminders of some of these management and prevention strategies are presented in this article.

Mental Nerves in the Lower Lip: Anatomical Basis for the Recovery of Sensation following Inferior Alveolar Nerve Damage.

BACKGROUND: Inferior alveolar nerve damage is one of the most common complications of surgery on the lower third of the face. It can have a significant psychological and social impact, and its evolution varies in terms of the duration and degree of recovery. In the literature, few studies adequately explain this phenomenon. The author therefore aims to establish the anatomical basis of recovery and its variability. METHODS: The author studied 60 mental nerves on 30 lips. A total of 25 lips were studied in situ, including five receiving an intraarterial injection of latex, whereas five lips were removed and dissected under transillumination. RESULTS: The author identified three types of intralabial distribution of the mental nerves: type I, absence of connections; type II, connections on the upper third of the lower lip; and type III, connections on the upper, middle, and lower thirds of the lower lip. Some cases also had a dominant side with more numerous fibers and a larger diameter than the contralateral side. CONCLUSIONS: Rapid or total recovery after inferior alveolar nerve damage is well known. The author's study showed the nerve map to repair nerve damage, and for the first time, to the author's knowledge, it highlighted the connections between the mental nerves in the lip. Types II and III allow the recovery of labiomental sensation.

Chondroblastic Osteosarcoma of the Mandible in a Patient on Risedronate: A Rare Case of Neoadjuvant Chemotherapy Failure.

Osteosarcoma of the jaw only represents 0.5-1% of tumors of the facial mass. Due to its rarity, clinical diagnosis is thus difficult. The guidelines for this pathology remain unclear, and the need for neoadjuvant chemotherapy is still debated. This case report aims to describe a rare case of chondroblastic osteosarcoma in a 50-year-old woman on risedronate treated by neoadjuvant chemotherapy. The tumor extended from the mandibular left first premolar to the mandibular right canine. An excisional biopsy was performed, leading to a diagnosis of chondroblastic osteosarcoma. Neoadjuvant chemotherapy was ineffective, as it did not result in the shrinkage of the tumor. A pelvi-mandibulectomy with fibula free flap reconstruction of the mandible was subsequently successfully performed followed by radiotherapy.

TNM Classification: Are Cancers With Extrinsic Tongue Muscle Involvement Systematically T4a?

PURPOSE: In the Union for International Cancer Control classification, extrinsic muscle involvement in oropharyngeal cancers is systematically defined as a T4a tumor, although the term extrinsic may incorrectly imply that these muscles are outside the tongue. Our aim was to describe the topography of extrinsic tongue muscles and show that their involvement in oropharyngeal cancers does not always correspond to T4a staging. METHODS: This cadaveric study was based on dissections of the tongues of ten healthy subjects. Dissections were carried out using sections, and careful macroscopic examination with a 3.5-diopter magnifying glass allowed the identification of muscles from their origin to their termination. Imagery and histology were excluded to stay as close as possible to the clinical evaluation. RESULTS: The sample comprised seven men and three women, with a mean age 82 years. In all the ten cases, the extrinsic muscles were located at the periphery of the tongue. The genioglossus was the only deep extrinsic muscle, extending to the periphery and under the mucous membrane of the tongue. As a result, a T1 tumor can invade the mucous membrane and affect the extrinsic muscles without transforming into a T4a tumor. CONCLUSION: As extrinsic tongue muscles are peripheral and submucosal, the use of the term "deep" is erroneous, as is the systematic usage of extrinsic muscles to define T4a oropharyngeal cancers. This study attempts to explain this error, which is recurrent in the different editions of the Union for International Cancer Control and American Joint Committee on Cancer.

Distribution of the maxillary artery in the deep regions of the face and the maxilla: Clinical applications.

Composite tissue allotransplantation of the face has led to renewed interest in the vascularization of the maxilla. The maxillary artery, which is deep within the tissue and difficult to access, is considered the main artery of the maxilla. The objective of this study was to describe the distribution of the maxillary artery in the deep regions of the face and maxilla. Twenty-four maxillae were studied, of which 20 were injected with latex and four with India ink. The maxillary artery in the pterygopalatine fossa gave rise to the sphenopalatine artery, infraorbital artery, descending palatine artery, and posterior superior alveolar artery in all 24 cases. The posterior superior alveolar artery gave rise to a periosteal branch and an intraosseous branch (in the wall of the maxillary sinus) in 18 cases. The branch passed through part of the wall and the entire wall in eight and ten cases, respectively, and anastomosed at the anterior nasal spine and the infraorbital foramen. The descending palatine artery presented as a single trunk in four cases, a greater palatine artery and a lower palatine artery in 18 cases, and four branches in two cases. Intraosseous and periosteal anastomoses were found along with anastomosis through the incisive foramen, which were obstructed in three cases. The vascular territories were studied. The maxillary artery created an intraosseous and periosteal anastomotic network, explaining the supply pathways during different surgical procedures, risk of hemorrhage with orthognathic surgery (Le Fort type I) in a sinus lift for preimplant surgery, and the vascular territories.

Vascular and Nerve Relations of the Marginal Mandibular Nerve of the Face: Anatomy and Clinical Relevance.

BACKGROUND: The marginal mandibular nerve of the facial nerve is frequently injured during corrective and cosmetic surgery. Recent or emerging techniques such as the injection of filler materials, botulinum toxin, allotransplantation of composite tissues of the face, placement of chin implants, and submental cryolipolysis require in-depth knowledge of this nerve. The studies to date are not in agreement regarding the number of branches of the marginal mandibular nerve and its relationship with the vasculature and other nerves. METHODS: This study involved 62 half-heads from cadavers. RESULTS: In 22.6 percent of the cases, the marginal mandibular nerve of the facial nerve was a single branched entity and lateral to the pedicle, with respect to the facial artery and the facial vein. In 16 cases (29 percent), the marginal mandibular nerve had two branches. In 12.9 percent of the cases, the marginal mandibular nerve gave rise to three branches. In 17 cases (35.48 percent), the marginal mandibular nerve gave rise to between four and more than 10 branches, thereby forming a plexus at its end. Analysis of this collection of cases revealed that the marginal mandibular nerve was more consistently lateral to the facial vein than to the facial artery. The marginal mandibular nerve exhibited connections with other branches of the facial nerve and branches of the trigeminal nerve. CONCLUSIONS: The facial vein had a more consistent relationship with the marginal mandibular nerve than the facial artery. This study provides the anatomical bases of substitution, proprioception, and clinical variations in injuries of the marginal mandibular nerve and in their prognosis.

Use of a 3-Dimensional Custom-Made Porous Titanium Prosthesis for Mandibular Body Reconstruction With Prosthetic Dental Rehabilitation and Lipofilling.

Reconstruction of mandibular substance loss by a free flap is a widely used technique. This technique suffers from several disadvantages, including the presence of a second intervention site and a substantial frequency of complications. We have undertaken a custom-made 3-dimensional reconstruction (using computer-aided design and manufacturing) with prosthetic dental rehabilitation and esthetic improvement by lipomodeling of the face. A 50-year-old woman presented with a massive recurrence of an ameloblastoma of the right hemimandible. A cervical approach was used to resect the mandible well away from the tumor site. In light of her refusal to undergo reconstruction by a fibula free flap, reconstruction was performed using a custom-made porous titanium device with dental prosthetic rehabilitation, followed by lipomodeling of the face. The reconstruction was achieved without the occurrence of any complications. The implant-supported prosthetic dental implantation and the lipofilling resulted in functionally and esthetically satisfactory outcomes. Three-dimensional mandibular reconstruction with a custom-made porous titanium device and lipofilling yielded satisfactory results. Fitting of the dental prosthesis was undertaken at an early stage as it did not require osseointegration, although there was a need to overcome difficulties linked with the seal and the stability of the dental prosthesis and titanium support. The duration of patient follow-up was 18 months.

Arterial Vascularization of the Mandibular Condyle and Fractures of the Condyle.

BACKGROUND: Despite substantial displacements, fractures of the mandibular condyle rarely lead to necrosis. This illustrates the negligible role of the inferior alveolar artery in intraosseous supply to the condyle, and led to this systematization of its arterial vascularization. METHODS: Forty-two temporomandibular joints from nonembalmed cadaveric specimens were studied following injection of latex (n = 32) or India ink (n = 10). RESULTS: The intraosseous branches of the inferior alveolar artery that lead to the condyle were inconstant and often rudimentary. In this study, the arteries that consistently led to the condyle were the superficial temporal artery, the deep posterior temporal artery, and arterial branches leading to the lateral pterygoid muscle emanating directly from the maxillary artery. These arteries, along with the transverse facial artery and the masseteric artery (when they participated in condoyle vascularization), formed a quadrangle around the mandibular condyle. After India ink injection, the pterygoid muscle was the most strongly colored muscle, thus indicating substantial vascularization. CONCLUSIONS: Although there is a lack of consensus in the literature regarding the constancy and proportions of the arteries participating in vascularization of the condyle, the superficial temporal artery, the maxillary arterial branches leading to the lateral pterygoid muscle, and the deep posterior temporal artery were constant in this study. This study shows the important role of the lateral pterygoid in the vascularization of the condyle. In case of a fracture with substantial displacement, the vascularization emanating from the superficial temporal artery and the lower alveolar artery is ruptured or compromised.

Lacrimal Apparatus Procurement in Face Transplantation.

The aesthetic outcome of a well-planned and executed vascularized composite tissue face allotransplant is unquestionable; however, complete functional restoration is necessary. The authors studied the possibility of restoring tear duct function in face transplant recipients. They also examined the technical specifics and feasibility of incorporating a lacrimal drainage apparatus into facial allografting. The authors performed a standardized face vascularized composite allograft on 4 hemi-faces (2 fresh cadavers). On one side of the face, a soft tissue myocutaneous alloflap was raised. They attempted to incorporate the nasolacrimal apparatus into the allograft to develop and describe an efficient harvest method. On the contralateral side, an osteocutaneous alloflap was raised with the midface and mandible. The authors describe 2 techniques to incorporate the lacrimal drainage system. The authors retrieved the graft in a consistent and replicable fashion within conventional alloflap retrieval times. The authors successfully incorporated the entire nasolacrimal drainage system into the conventional soft tissue-only myocutaneous alloflap by transforming it into a modified mini-osteomyocutaneous alloflap. They demonstrated that the contralateral conventional bi-maxillary osteocutaneous alloflap procedure, as an alternative comparative technique, provided another means to restore lacrimal drainage. In conclusion, surgically harvesting the nasolacrimal apparatus is technically feasible in vascularized composite tissue allotransplantation. Before translating this to a clinical setting, further dissections are necessary to explore the technical specifics of how to insert the harvested nasolacrimal apparatus into the recipient to restore a conduit for tear drainage. This study is the first step towards a fully functioning lacrimal drainage system in face transplant recipients.

Epidemiology of facial fractures in the elderly.

Facial fractures are considered more common in young individuals. However, they are also increasing in the aging population. Investigation of the characteristics of such fractures is important so as to be able to devise preventive measures and specifications for their proper treatment. We carried out a descriptive retrospective epidemiological study. The information was taken from a database of medical files of patients over 65 years of age in the setting of the emergency ward. Patient information was included for 157 patients aged 65 to 100 years. Two-thirds of the individuals with facial trauma were women. Twenty-eight had a prior history of cognitive impairment. For half of the cases, the trauma occurred at their place of residence, while accidents and falls in public areas were not uncommon. The most frequent site for the fractures was the middle third of the face. These facial fractures were serious in light of their location, as well as the associated skeletal and intracranial lesions. The number of such fractures can be expected to increase with time. Their hospital cost is higher than with younger individuals. Preventative measures need to be devised and the treatment should be all-encompassing.

Plasma Cell Granuloma of the Jaw and the Infratemporal Fossa: A Clinical Case.

Plasma cell granuloma or inflammatory pseudotumor (IPT) is diagnosed by a process of elimination. The precise etiology is unknown, although it can occur after a bout of periodontal infection. This report describes the various stages of progression for this ailment. A 49-year-old woman with no noteworthy medical history presented with a recurrent periodontal abscess accompanied by progressive and severe destruction of the right maxilla. There was invasion of the infratemporal fossa and very tight trismus. Histologic examination indicated a reactive plasma cell granuloma. IPT is an entity recognized by the World Health Organization. A triggering infectious or inflammatory factor is often present. In the maxilla, progression is very aggressive. Treatment relies on corticotherapy, with or without radiotherapy, and administration of cyclosporine.

The styloauricular muscle: clinical relevance and literature review of this rare muscle.

PURPOSE: In humans, the styloauricularis is a rare muscle extending from the tragal cartilage of the auricle to the styloid process. When it contracts, by bearing on the styloid process, it increases the cephalo-auricular angle. It can be a landmark for the facial nerve. We report a case with bilateral presence of the styloauricularis. METHODS: Bilateral presence of the styloauricularis was discovered during routine dissection of the head and neck. RESULTS: In the presented case, styloauricularis muscles arose from the cartilage of the external acoustic meatus on both sides of the head, crossing halfway along the facial nerve trunk and inserting the styloid process. Both muscles were vascularized by a branch of the posterior auricular artery, and innervated by the facial nerve. CONCLUSIONS: The ventral auricular muscle, formed by the auricular parotid and the styloauricular muscles, is a muscle that lowers and abducts the auricle in animals. There is generally considered to be no equivalent for these muscles in humans, however, this bilateral case reveals evidence to the contrary. There is a dearth of scientific literature about the styloauricularis. The study of this muscle demonstrated the usefulness of comparative anatomy in understanding its action in increasing the cephalo-auricular angle.

Intraparotid Location of the Great Auricular Nerve: A New Anatomical Basis for Gustatory Sweating Syndrome.

BACKGROUND: Gustatory sweating syndrome (also known as Frey syndrome or auriculotemporal nerve syndrome) is thought to result from a lesion of the auriculotemporal nerve. A lesion of this nerve can lead to aberrant regeneration of nerve fibers to the sweat glands and blood vessels. The occurrence of signs outside the region of the auriculotemporal nerve prompted the author to search for another anatomical basis for this syndrome. METHODS: The author dissected 46 great auricular nerves from their origin to the parotid gland and in the infratemporal fossa. The author investigated the different connections of the great auricular nerve with the facial nerve and the auriculotemporal nerve. RESULTS: The great auricular nerve was found to essentially be a parotid nerve. There was a set of intraparotid nerve connections on 14 of the 46 half-heads that were dissected. The author was able to discern three types of parotid great auricular nerve connections, which he designates as either type 1, connection with the trunk of the facial nerve and its branches; type 2, connection with the auriculotemporal nerve; or type 3, connection with the auriculotemporal nerve and the facial nerve with the formation of an intraparotid nerve circle. CONCLUSIONS: Having clearly established the nerve connections of the great auricular nerve, the author believes that it is primarily this nerve that is responsible for gustatory sweating syndrome. This allows for a better understanding of the sympathetic nervous system features and the manifestation of the syndrome outside the region of the auriculotemporal nerve.

Epidemiology and classification of dog bite injuries to the face: A prospective study of 108 patients.

BACKGROUND: Dog bites are considered to be septic injuries, and their location on the face, with its highly symbolic topography and important social functions, is particularly pertinent. In addition to specific medical aspects, such as their psychological impact, they are also of relevance in terms of child protection measures. In light of the far-reaching importance of this subject, we were prompted to carry out a prospective study, over 13 years, to identify risk factors. Our results highlight specific risk factors, and they may hence assist with the implementation of concrete primary prevention measures against dog bites. METHODS: An information sheet was prepared and filled out during the intake of patients who had been bitten on the face. Data analysis was performed using Epi Info Version 6.04dfr software to find a correlation between the factors studied and the dog bite to the face. RESULTS: Dog bites to the face represented 0.83% of the emergency admissions to our service. A considerable majority of these involved children, with 68.5% of patients <16 years of age, and 33.3% of patients aged between 2 and 5 years. The wounds were multiple and of variable severity. The type of dog involved was frequently a German Shepherd. Strikingly, 91.3% of bites had occurred in a single-parent environment. CONCLUSIONS: Our study has determined that the fundamental factors that increase the probability of a dog bite to the face are as follows: the child being 2-5 years old, a single-parent context, and involvement of a German Shepherd-type dog.

Surface anatomy of the parotid duct and its clinical relevance.

The trajectory of the parotid duct (PD) makes it vulnerable to injuries during facial trauma and facial rejuvenation procedures. The PD is usually represented as a straight line, although its description in the literature varies. Our objective was to study the trajectory of the PD and to define reliable cutaneous landmarks. We dissected 35 human cadaver half-heads. We defined three points: point I where the PD crossed a line (line 2) between point T (the intertragal incisura) and point C (the corner of the mouth), point S for the top of the PD, and point B where the PD penetrated the buccinator muscle. We measured the distance (D) between points T and C, the distance (d1) between points T and I, and the distance (d2) between points T and B. We also determined the height (h) of the orthogonal line between point S and line 2. We noted that for all of the half-heads that we examined, the PD followed a curved trajectory between points I and B above line 2. Point I was located 1/3 of the way along distance D. Point B was tangential to line 2, and was located 2/3 of the way along distance D. The average height measurement (h) was 1.4 cm. We demonstrated that the PD follows a curved trajectory from the 1/3 mark to the 2/3 mark along distance D, the top of this curve being 1.5 cm above the line TC.

Anatomical study of the vascular territories of the maxilla: role of the facial artery in allotransplantation.

BACKGROUND: Facial composite tissue allotransplantation has recently become a surgical option. The maxilla, which forms the upper jaw and plays an important role in facial allotransplantation, consists of the maxillary and facial arteries. The maxillary artery is located deep within the tissue and considered the main artery of the maxilla; however, the facial artery is easy to access. The objective of this study was to examine the territories of the maxillary and facial arteries within the maxilla. MATERIALS AND METHODS: We excised and examined 22 maxillae. Of these, 18 were injected with latex and four with India ink. RESULTS: We observed that the ascending palatine artery, which was collateral with the facial artery, vascularized the maxilla through its dorsal part. The facial artery vascularized the maxilla through its ventral part with the philtral and columellar branches of the superior labial artery. Therefore, the facial artery formed, through the nasal and palatine mucosa, an arterial circle with a dorsal and ventral pole. Angiosomes formed by both the facial and maxillary arteries were also observed. The India ink injected into the facial and maxillary arteries delineated specific territories for each artery. DISCUSSION: This study allowed us to determine the anatomical structures that provide vascularization to the maxilla and describe their different forms. The whole of the maxilla was vascularized by the facial artery, despite the caution imposed by several studies on the removal of the facial artery alone. Indeed, the removal technique was found to be safer when it preserved the anastomoses between the facial and maxillary arteries. Therefore, previous clinical experience and our anatomical study definitively demonstrate that the facial artery vascularizes the maxilla.

Midterm clinical and tomodensitometric evaluation of cortical bone repair using bone substitute and allogenic membrane protection in the areas of cortical bone harvesting in the parietal cranium in preimplant reconstructive surgery.

The authors present their clinical and computed tomographic findings in a series of 13 cases of monocortical bone harvesting, in the setting of preimplant reconstructive surgery, with the harvest sites filled with granular bovine bone substitute, which had an additional coverage using a collagen membrane. These patients were compared with a control group of 6 patients who had not received any cranial bone reconstruction during the initial harvesting. Clinical and computed tomographic evaluations of the repaired parietal cortical bone harvest sites were performed to study the contour of the cortical bone harvest sites in relation to the surrounding soft tissue. Among the 13, there were no clinical cases of infection or allergic reaction. Midterm results of the parietal cortical bone reconstruction using granular bone substitute with overlying protective biodegradable membrane show that this method of reconstruction of the cranium after cranial bone harvesting resulted in significantly improved clinical outcomes.

The procurement of allotransplants for ballistic trauma: a preclinical study and a report of two clinical cases.

BACKGROUND: Maxillofacial trauma caused by severe ballistic injuries requires many steps of reconstruction and is often associated with disappointing results. The authors report on two clinical cases of facial allografting. METHODS: After a preclinical anatomical study of 10 fresh cadavers, the authors performed allotransplantation of the lower two-thirds of the face in two patients in March and August of 2009. The grafts included all perioral muscles, facial nerves, parotid glands, the anterior region of the maxilla, and part of the mandible. The mandibular osteotomy included only the chin in one case, and the mandibular arch from one angle to the other in the second case. RESULTS: The cadaveric study confirmed that relying only on the anastomoses between the facial and the maxillary artery for vascularization of the posterior part of the maxilla was unsafe. Periosteal vascularization seemed essential. The clinical results confirmed that complete revascularization from a single facial pedicle was possible: the first end-to-end arterial anastomosis to the left external carotid artery was sufficient for full perioperative revascularization of the flap and immediate reestablishment of bilateral venous flow. The facial appearance of both recipients improved gradually, with the development of changes in expression and the appearance of nasolabial folds. Preoperatively placed gastrostomies and tracheostomies were able to be removed in both patients within 6 weeks postoperatively. The procurement part of the operation was performed in 7 hours. CONCLUSION: Partial facial composite tissue allotransplantation of the lower two-thirds of the face along with parts of the maxilla and mandible (chin or entire-toothed mandible) is technically feasible, with a good cosmetic and functional outcome in typical cases of attempted suicide with rifles.