[Composite midfacial flap vascularized by the facial artery: a preliminary anatomic study]. / Lambeau composite médiofacial vascularisé par l'artère faciale: étude anatomique préliminaire.

INTRODUCTION: Extended facial tissue defects are difficult to reconstruct because of the anatomical and functional complexity of the area. Recently, composite facial allotransplantation was used for reconstruction. This could be performed because of specific facial blood supply and its facial and maxillary anastomoses. Could a composite naso-labio-mental flap rely on the sole blood supply of a facial artery anastomosis? We performed an anatomic study of a naso-labio-mental composite flap vascularized by the facial artery. MATERIAL AND METHOD: The study relied on arteriographies made on cadaveric heads and in vivo. The following data was analyzed: caliber of facial and maxillary arteries, terminal branch of facial arteries, and vascular territories. RESULTS: Sixteen facial arteries and six maxillary arteries were studied. The mean facial artery caliber was 2.06 mm (1-3.2mm). The facial artery ended in the nasal area in 68.8% of the cases. The latero-nasal artery was always present; it was a branch of the facial artery in 66.7% of cases. The two facial arteries, when injected bilaterally, always allowed complete facial composite flap circulation. The nasal territory of the flap was not opacified by the homolateral facial artery in 16.7% of the cases. DISCUSSION: Both facial artery anastomoses are recommended as blood supply for composite midfacial flaps. Preoperative imaging should be used systematically to assess the vascular network before harvesting.

[Absence of the musculocutaneous nerve and its distribution from median nerve: About two cases and literature review]. / Absence du nerf musculocutané et distribution à partir du nerf médian : à propos de deux cas et revue de la littérature.

Musculocutaneous nerve arises mostly from the lateral cord of brachial plexus. Nevertheless, variations have been reported and, among them: the total absence of musculocutaneous nerve (from 1.4 to 15%), the absence of its passage through the coracobrachial muscle, its variable level of penetration as measured from the tip of the coracoid process, and its communicating branches with the median nerve. We report two cases of unilateral musculocutaneous nerve absence in a 66-year-old male and a 95-year-old female cadavers, on the right and the left side, respectively. The nerve fibers normally coming from musculocutaneous nerve emerged from the median nerve. The knowledge of this anatomical variation is important specially when performing plexus bloc or Latarjet's procedure.

[Tongue reconstruction with a bilateral infrahyoid flap innervated by Ansa Cervicalis after total glossectomy]. / Le lambeau infrahyoïdien bilatéral innervé par l'Ansa Cervicalis pour la reconstruction des glossectomies totales.

INTRODUCTION: Reconstruction after total glossectomy remains a functional challenge. It must provide a large volume to ensure adequate phonation and swallowing. We present the larynx sparing bilateral infrahyoid flap reconstruction procedure after total glossectomy. PATIENTS AND METHOD: Three patients managed for an epidermoid carcinoma of the tongue, classified T4N0, underwent total glossectomy. The tongue was reconstructed with a bilateral infrahyoid flap pedicled on two superior thyroid arteries and innervated by Ansa Cervicalis. RESULTS: Oral food intake was resumed after 8 to 20 days. No false route was observed. The muscular flap mobility was clinically satisfactory. It was assessed by EMG in one case. Esophageal transit confirmed the absence of stasis and false route for one patient. DISCUSSION: This short series proves the feasibility of bilateral innervated and pedicled infrahyoid flap procedure. It is an alternative to volumetric and functional reconstruction after total glossectomy. The indications are rare and restricted to patients without IIa nodal region invasion. Our results are still limited and need to be confirmed by a larger series and by a more systematic assessment.

A multirecurrent ameloblastoma metastatic to the lung.

INTRODUCTION: The ameloblastoma is a rare tumor of odontogenic epithelial origin. It is a neoplasm in which ameloblastic features are revealed by the primary growth in jaws and by any metastatic growth. Recurrences are usually local and distant metastases are rare. We present a case of a multirecurrent ameloblastoma of the mandible metastatic to the lung. OBSERVATION: We present a case of a mandibular malignant ameloblastoma in a 42-year old man with widespread pulmonary metastases. Some of these lesions were treated surgically. DISCUSSION: Ameloblastoma metastasis often occurs in the lung. The curative treatment is surgical. The results of palliative chemotherapy and radiotherapy are not always efficient.

[276 cases of horizontal infrahyoid myocutaneous flap]. / Le lambeau musculocutané infrahyoïdien à palette cutanée horizontale : à propos de 276 cas.

INTRODUCTION: The infrahyoid myocutaneous flap was described by Wang et al. in 1986. The horizontal design of the skin paddle is a modification of this technique allowing for a smaller scar. We have been systematically using this modified technique for 10 years. We had for aim to describe the interest of the horizontal infrahyoid myocutaneous flap for cervicofacial carcinology. PATIENTS AND METHODS: A horizontal infrahyoid myocutaneous flap procedure was performed in 276 cervicofacial carcinology patients for lesions of the mouth floor, the mandibular gum, the oropharynx and the tongue between March 1997 and March 2007. RESULTS: No complications were observed in 252 patients. No patient presented with total flap necrosis. DISCUSSION: Modifying the infrahyoid myocutaneous flap technique with a horizontal design of the skin paddle does not modify the reliability of the flap and prevents more extensive scars. The main indications of this technique are defects of the mouth floor, the tongue and the oropharynx.

[Head and neck reconstruction with antebrachial flap concerning 100 patients]. / La reconstruction par lambeau antébrachial au niveau de la sphère cervicofaciale : revue d'une série de 100 cas.

We studied the files of head and neck reconstruction with antebrachial flap used in 100 patients between May 1996 and March 2007 in the department of Maxillofacial Surgery of the CHU of Bordeaux. Flap harvesting and vascular anastomosis were performed by the same operator. Antebrachial flap was used to cover the defect after resection of head and neck cancer in 89 patients and after shotgun injuries of the face in 11 patients. This flap, by its smoothness and its plasticity, makes it possible to rebuild all the oral cavity localizations, even the most complex, by covering the defects without blocking deglutition and enunciation. It brings to the patient a better quality of life by decreasing the functional after-effects that can be seen with the traditional myocutaneous flaps. This flap is highly reliable, not requiring specific care after the operation as other micro-surgeries, which simplifies the postoperative quality of life of the aged and debilitated patients.

Anatomical landmarks for maxillary nerve block in the pterygopalatine fossa: A radiological study.

INTRODUCTION: The aim of this study was to describe the anatomical landmarks for maxillary nerve block in the pterygopalatine fossa. The risk of injury to the skull base and maxillary artery was assessed. METHODS: This retrospective study was based on the analysis of 61 consecutive computed tomography angiographies obtained from patients suffering from different pathologies. Anatomical relationships between optic canal (OC), foramen rotundum (FR), inferior orbital fissure (IOF) and puncture point (PP) were assessed. A "maxillary section" was virtually carried out on the CTs, following a plane passing through PP, IOF and FR in order to mimic the anaesthesia needle route. RESULTS: No gender difference was observed except for the PP-OC distance that was longer in men. The mean PP-IOF distance was of 31.9 (± 0.7mm). PP-OC (43.9±0.5) and PP-FR (44.2±0.7) distances increased significantly with the patients height (PP-FR=17.25+0.16×height (cm); PP-OC=20.54+0.13×height (cm)). The route to the skull base was curved, with an angle of 168±1.6° at the FR level. The angle to reach the OC was greater than 7°. DISCUSSION: With a 35-mm needle length, the probability to reach the IOF was high (79%), while the risk to injure the skull base (2%) and the optical nerve (0%) was low. Artery injuries were only found in 13% of cases. Therefore, a 35-mm needle length allows for the best efficacy/risk ratio in maxillary nerve block.

Sentinel lymph node biopsy for head and neck Merkel cell carcinoma: a preliminary study.

INTRODUCTION: A retrospective preliminary study assessed the feasibility of sentinel lymph node biopsy (SLNB) in the management of Merkel cell carcinoma (MCC) of the head and neck. PATIENTS AND METHODS: Twelve patients with stage I or II head and neck MCC underwent SLNB over a 4-year period. RESULTS: Only 1 of the 12 patients had a positive SLNB. The sentinel node was not identified in 3 patients. Two of the 8 patients with negative SLNB showed regional lymph node recurrence within 2years. One patient died during follow-up. CONCLUSION: Merkel cell carcinoma is an uncommon but highly aggressive pathology; management protocols have been based on small series. The role of SLNB in the management of MCC remains to be defined.

[Comparison between closure and absence of closure after removal of fully impacted mandibular third molar: a prospective randomized study]. / Comparaison entre fermeture et absence de fermeture du site d'avulsion des troisièmes molaires mandibulaires incluses: étude prospective randomisée.

UNLABELLED: We prospectively and randomly assessed the absence of surgical wound closure on the patient's postoperative outcome when removing impacted mandibular third molars. MATERIAL AND METHOD: Patients were randomized in 2 groups: the "open group" (O) and the "closed group" (C). We considered the postoperative perimandibular edema, postoperative pain, and limitation of mouth opening at preoperative time, Day2, and Day7. The same physician performed all preoperative (D0) and postoperative measures (D2, D7). RESULTS: Fifty-four patients (27 female and 27 male patients) were included in the study. Ninety-nine cases of impacted mandibular third molars were studied. The statistical analysis revealed a significantly more important postoperative edema in Group C at D2 (P<0.0001) and at D7 (P<0.0001). Postoperative mandibular pain was significantly greater in Group C at D2 (P<0.05) but not at D7 (P>0.05). The decrease of mouth opening was significantly more important in Group C at D2 and at D7 (P<0.05). DISCUSSION: Our prospective randomized study data suggests a significant improvement of postoperative outcome when the mucoperiosteal flap was not sutured after removal of impacted third molars.

[When should an orthoptic evaluation be prescribed in the management of orbital floor fracture? A prospective study of 47 fractures]. / Quand demander un examen orthoptique dans la prise en charge des fractures du plancher de l'orbite ?

INTRODUCTION: We evaluated the indication of orthoptic evaluation for the management of orbital floor fractures in a prospective series. MATERIAL AND METHOD: Forty-seven patients presenting with an orbital floor fracture were included in our prospective study. Consultations in orthoptics and maxillo-facial surgery were regularly carried out. Diplopia and motility were systematically assessed as well as a coordimetric examination according to Hess-Lees's technique. RESULTS: Nineteen percent of coordimetric motility disorders were observed among asymptomatic patients, after trauma. No diplopia or clinical motility disorder were observed 1 and 2 months after trauma, and coordimetric examinations came back to normal 2 and 3 months after trauma respectively for non-operated (26) and operated (21) patients. CONCLUSIONS: An orthoptic evaluation is necessary for the management of orbital floor fractures to diagnose the type of diplopia, motility disorders, and to indicate a coordimetric examination if diplopia is present. We suggest this orthoptic evaluation for patients presenting with diplopia between 5 and 10 days following trauma, 1 month after trauma for non-surgical treatment and 2 months after trauma for surgical treatment.

[Role of PET-CT with 18-FDG in the management of UADT squamous-cell carcinomas: a retrospective study of 43 cases]. / Intérêt de la TEP-TDM au 18-FDG dans la prise en charge des cancers des VADS : étude rétrospective de 43 cas.

INTRODUCTION: The aim of our retrospective study was to evaluate the role of PET-CT in the management of upper-aerodigestive tract (UADT) squamous-cell carcinomas. MATERIAL AND METHODS: Our study included 43 patients with UADT squamous-cell carcinomas having undergone PET-CT for: initial staging (n=20), diagnosis of recurrent disease (n=16), and response to treatment (n=7). RESULTS: PET-CT diagnosed distant metastases missed by conventional imaging in four patients (20%) in initial staging, four patients (25%) in diagnosis of recurrent disease, and two patients (29%) in response to treatment. Overall, PET-CT induced a shift in the management of 10 patients (28%). DISCUSSION: Our study and other publications suggest that PET-CT should be used in: initial staging in Stage III and IV; detection of recurrent disease; and evaluation of treatment response.

[The horizontal infrahyoid myocutaneous flap: surgical technique]. / Le lambeau musculocutané infrahyoïdien à palette cutanée horizontale. Technique chirurgicale.

The infrahyoid myocutaneous flap technique was described by Wang in 1986, the skin pad being orientated vertically. Its blood supply comes from the superior thyroid artery. This flap consists of the sternohyoid muscle, the sternothyroid muscle, and the superior belly of the omohyoid muscle. The harvesting of a horizontal skin flap does not modify its reliability and avoids additional scars. The donor site anatomy and flap vascularization are briefly described as well as the flap features and harvesting technique.