[Effectiveness and interest of retrobulbar hyaluronidase injections in the treatment of blindness complicating facial hyaluronic acid injections: A literature review]. / Efficacité et intérêt des injections rétrobulbaires de hyaluronidase dans le traitement des cécités compliquant une injection faciale d'acide hyaluronique : revue de la littérature.

INTRODUCTION: Hyaluronic acid injections are becoming increasingly common among both the general public and the medical community, but they are not without risks. The occurrence of blindness, although rare, is a tragic event for both the patient and the practitioner. One of the treatments proposed in the literature is to inject hyaluronidase as close as possible to the site of ischemia, retrobulbarly. The aim of our study is to evaluate the effectiveness and potential benefits of retrobulbar hyaluronidase injections. MATERIALS AND METHODS: A literature review was conducted using the PubMed database. Only articles addressing retrobulbar hyaluronidase injections for the treatment of blindness following hyaluronic acid injections were included. RESULTS: We identified 12 case reports or series, comprising a total of 16 patients. Among these 16 patients, 3 regained their vision. Hyaluronidase was injected between 20minutes and 7days after the onset of the complication, with injected doses ranging from 3×150IU to 3×1500IU. DISCUSSION: Literature reveals only 3 cases of successful treatment out of the 16 reported injections. The time interval before retrobulbar injection, as well as the dose and the experience of the injecting practitioner, may influence the success rate of this treatment. Other treatments, such as intravascular hyaluronidase injections, remain to be explored.

Measurement of quality of life in orthognathic surgery using an original questionnaire: About a series of 123 cases.

INTRODUCTION: The aim of this study was to measure changes in the quality of life of patients who had orthognathic surgery using an original questionnaire, designed for this purpose. MATERIAL AND METHOD: This single-center retrospective study included all patients who had orthognathic surgery in our center between 2014 and 2019. An original questionnaire comprising 13 items in 4 domains was sent to patients postoperatively by email after telephone contact and obtaining their consent. Items were scored on a 5-point scale ranging from (-1), worse than before surgery, to (+3), better than before surgery. RESULTS: All data were collected in a standardized way. In total, 123 patients responded. The mean score for all surgeries combined was +1.14, indicating an improvement in QOL considered to be "low to moderate". A total of 118 patients (95.9%) reported an improvement following surgery, including 18 patients (14.6%) who reported a marked improvement. The greatest improvement was observed for psychosocial aspects and morphology. CONCLUSION: This study shows a positive effect of orthognathic surgery on patients' QOL, including self-perception, relationships with others, or functional aspects as mastication and breathing. We propose an original tool that is easy to use by patients to measure quality of life following orthognathic surgery.

[Original three-dimensional reconstruction of a case of metopism associated with a unilateral complete absence of the left frontal sinus: Clinical interest and review of the literature]. / Représentation tridimensionnelle originale d'un cas de métopisme associé à une agénésie unilatérale complète du sinus frontal gauche : intérêt clinique et revue de la littérature.

Metopism (complete persistence of the metopic suture in adults) is a rare but not exceptional variation of the calvaria. Hypoplasia or aplasia of the frontal sinus may be associated without evident correlation. Nevertheless, a misdiagnosis of these variations may have clinical consequences, especially in a traumatic context. The aim of this paper was to report a case of metopism associated with a unilateral aplasia of the left frontal sinus, originally illustrated with 3D image fusion volume rendering reconstructions.

[Alfred-Louis-Dominique Richet (1816-1891): education, anatomy and surgery]. / Alfred-Louis-Dominique Richet (1816-1891) : pédagogie, anatomie et chirurgie.

Alfred-Louis-Dominique Richet was an anatomist and surgeon born in Dijon, France in 1816. He defended the teaching of clinical anatomy instead of descriptive anatomy, judged inappropriate to learn operative medicine. His name is associated with several anatomical structures that we cite in the present article.

[Étienne Destot (1864-1918): the first radioanatomist in Lyon, France]. / Étienne Destot (1864-1918) : l'anatomie radiographique.

Destot was born in Dijon, France, in 1864. He began his education in Burgundy, then he started his preclinical curriculum in Lyon, France, from 1884. He had to leave Lyon, and spent some times in Algeria to treat a tuberculosis. He came back in Lyon as a resident in 1886. Destot worked as an assistant in the laboratory of anatomy of Leo Testut in 1880. His thesis, in 1892, analyzed mortality in the departments of surgery of the Lyon hospitals. The polemical results he presented compromised his surgical career. He went on as prosector by Leo Testut, and then became electrician-physician in 1895 (electrotherapy and galvanotherapy). Étienne Destot of Lyon, France, developed in 1895 the first radiography room ever at the Hôtel-Dieu of Lyon, France. Wilhelm Röntgen discovered the X-rays in the same year, and Destot felt his discovery could revolutionize the approach of anatomy and traumatology. He studied wrist, ankle and calcaneus fractures, and described a new anatomy: "traumatic anatomy". For example, he focused on the posterior talar surface hollow in posterior tarsus fractures. He proposed the term of "thalamus" for this articular surface; this term is nowadays widely used by the clinicians. He introduced the term of "third malleolus" to describe the posterior part of the distal extremity of the tibia. He was the first author to analyze the normal and pathological movements of the scaphoid bone and the lunatum in wrist extension.

[Mandibular metastasis of a cutaneous melanoma or metachronous amelanotic melanoma of the oral cavity? A case report and literature review]. / Métastase mandibulaire d'un mélanome cutané ou mélanome achromique primitif métachrone de la cavité orale ? À propos d'un cas et revue de la littérature.

Primary and metastatic mandibular melanoma are extremely rare. We report the original case of a 55-year-old woman treated 16 years before for a cutaneous melanoma, and now presenting with a huge mandibular amelanotic melanoma. Was it an histologically different mandibular metastasis of the previous cutaneous melanoma, or a metachronous oral amelanotic melanoma?

[Can one harvest a long bone stick in the radial forearm flap? Original radioanatomical and NanoSPECT-CT Bioscan microvascular study]. / Peut-on prélever une grande baguette osseuse radiale dans le lambeau antébrachial radial composite ? Étude radio-anatomique et microscannographique originale.

OBJECTIVES: The composite radial forearm flap is a surgical option in the reconstruction of large traumatic or oncologic orofacial defects. Nevertheless, it has been criticized for its poor bone transport faculties that would make this flap insufficient in large osseous mandibular reconstructions, or for oral prosthetic rehabilitation with dental implants. What is more, the morbidity of the donor site has often been pointed. The aim of this radioanatomic study was to revisit the vascularization of the composite radial forearm flap, focusing on the bone stick. METHODS: A radioanatomic study was performed on seven upper limbs taken from fresh cadavers. First, the vessels were washed with a 40°C solution of potassium acetate. Then an intra-arterial injection of a mixture of lead oxide and agar-agar was performed. 3D-CT-scan examinations of the anatomical pieces were performed. In a second step, the flaps were harvested and analyzed with a Microscan examination (NanoSPECT-CT Bioscan(®), voxel 220 microns). Collateral branches of the radial artery to the bone and the skin were counted and classified. RESULTS: One radial diaphyseal artery was present in all the cases. The nutrient foramen took place at the anteromedial aspect of the diaphysis, between 45 and 65 % of the length of the bone. A dense anastomotic periosteal network was highlightened, supplied by one to four musculoperiosteal branches, and one to six fascio-periosteal arteries arising from the radial artery. A total of mean five osseous branches, and 12 cutaneous branches have been observed. CONCLUSIONS: The results of the present preclinical study suggested that a 16-cm bone stick could be harvested with an optimal vascular safety, without consideration for the morbidity at the donor site. The original approach in this study, relating anatomy to the preclinical imaging, allowed a precise visualization of the microvascularization of the soft and hard tissues. It opened a field of innovative research in plastic and reconstructive surgery.

Pharyngeal flap in velopharyngeal insufficiency: Proposal of an algorithm in a series of 31 patients.

This study evaluated the results of a reproductible protocol indicating the need for a pharyngeal flap in children with cleft palate and velopharyngeal insufficiency (VPI). A retrospective review of all patients operated for a pharyngeal flap between 2010 and 2019 in our center was conducted. After exclusion of patients with primary VPI or residual fistulas, 31 patients' data were analyzed. Our main outcome measure was the improvement of the Borel Maisonny Classification (BMC) by at least 1 rank. Further analysis was made to evaluate the impact of age, type of cleft, and BMC before surgery on the gain in the velopharyngeal function. Of the 31 patients, success was achieved in 29 (93.5%, p<0.005). There was no significant correlation between age and gain in the velopharyngeal function (p = 0.137). There was no significant correlation between type of cleft and gain in the velopharyngeal function (p = 0.148). There was a significant correlation observed between the starting classification and gain in velopharyngeal function. The gain observed was greater as the initial velopharyngeal function was worse (p = 0.035). The use of an algorithm combining clinical assessment with a standardized classification of the velopharyngeal function proved to be a reliable tool for the indication of surgery in patients with VPI. A close follow up is essential in a multidisciplinary team.

[Multiple ossifying trichilemmal cysts of the scalp: a familial case]. / Kystes trichilemmaux ossifiants multiples du cuir chevelu : un cas familial.

INTRODUCTION: The trichilemmal cyst, also called pilar cyst, is a dermal epithelial cyst originating from the pilar follicle. It usually occurs in the scalp. Hereditary and ossifying cases are rare. CASE REPORT: We report the case of a 61-year-old woman presenting with familial multiple trichilemmal cysts, located in the scalp. The histological examination after surgical exeresis confirmed the diagnosis. The trichilemmal cysts featured intra-cystic ossification. The wide dimension of the lesions dimension imposed an extensive surgical scalp exeresis. Reconstruction was performed with a flap after skin expansion. DISCUSSION: The trichilemmal cyst is a benign tumor of skin appendages with a slow outcome. Multiple locations may require an extensive surgical scalp exeresis and lead to a problematic reconstruction. Hereditary cases require familial follow-up to prevent such problems.

[Complications associated with sentinel lymph node biopsy for cutaneous melanoma. A retrospective study of 127 patients]. / Les complications liées à la technique du ganglion sentinelle dans le mélanome cutané. Étude rétrospective à partir de 127 cas.

BACKGROUND: Sentinel lymph node (SLN) biopsy for patients with cutaneous melanoma has become a routine procedure. Its purpose is to confirm the potential presence of micrometastases in the first lymph node basin. Therefore, staging of the melanoma can be determined. Somehow, only few studies assess the morbidity of this procedure. Our study was performed in order to list and analyze SLN biopsy-related complications in melanoma-affected patients. PATIENTS AND METHODS: This mono-institutional, retrospective study enrolled patients, operated on from May 2001 until August 2008, who had undergone SLN biopsy that found no metastatic colonization. Patients with positive SLN biopsy underwent subsequent completion lymph node dissection (CLND) and, therefore, were not included in this study. Thus, CLND-related complications did not interfere with SLN biopsy-related ones. Median follow-up was 19 months. RESULTS: One hundred and twenty-seven patients, 58 men and 69 women were evaluated. Nine patients (7,1%) were diagnosed with one complication. We noticed seven early complications occurring during the first month (four seromas, one lymphocele, one infection with dehiscence of wound, one deep veinous thrombosis) and two late complications occurring beyond this period (one neuroma, one cicatricial bridle). Four (44%) among these complications arose in the groin. CONCLUSION: SLN biopsy is known as a simple and minimally invasive surgical technique. Somehow, some potentially severe complications may arise. These must be clearly explained to obtain the patient's informed consent prior to surgery.

Osteogenic distraction to treat solitary median maxillary central incisor (SMMCI) syndrome: a case report.

Solitary median maxillary central incisor (SMMCI) syndrome is a rare developmental disorder characterized by a single symmetrical maxillary central incisor. Only a small number of cases with comprehensive dental treatment have been reported in the literature. No surgical treatment has been proposed before. We report the case of an 8-year-old girl who presented SMMCI syndrome associated with an Angle class II occlusion and a maxillary transverse deficiency. After the failure of two rapid maxillary expansions, a surgical option was proposed: osteogenic maxillary distraction. The distraction, associated with multi-bracketed fixed orthodontic treatment, created enough space to place a prosthetic central incisor without dental extractions. Osteogenic distraction is an interesting option to treat patients with SMMCI.

[Sentinel node procedure in head and neck cutaneous melanoma]. / Ganglion sentinelle dans les mélanomes cutanés de l'extrémité cervicocéphalique.

INTRODUCTION: Sentinel lymph node (SLN) biopsy is frequently discussed in the management of cutaneous melanoma, especially in head and neck localizations where SLN biopsy is much more demanding. The benefits of SLN protocol are not proved yet. The aim of our study was to present our experience of SLN biopsy in head and neck cutaneous melanoma. PATIENTS AND METHODS: This retrospective study included all patients managed for head and neck malignant melanoma from 2002 to 2006. We reviewed the technique, implementation and difficulties of the procedure, postoperative outcome, and complications. RESULTS: Nineteen patients were included. An average of 2.2 lymph nodes were localized per patient using lymphoscintigraphy. Biopsy was impossible for one patient because the deep spinal node was not found. An average of 1.2 nodes was biopsied per patient. One patient presented with micrometastases. Another presented with lymphorrhea. DISCUSSION: Sentinel node biopsy is widely performed in the management of cutaneous melanoma but remains an option for these indications in the last update of the French Society of Dermatology. SLN biopsy is difficult to implement because of the complexity of head and neck lymphatic system.

[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).

Clinical impact of two types of mandibular retention devices - A CAD/CAM design and a traditional design - On upper airway volume in obstructive sleep apnea patients.

OBJECTIVE: This pilot randomized crossover study evaluated the outcomes of two custom-made mandibular retention devices (MRDs), a computer-aided design (CAD)/computer-aided manufacturing (CAM) device (Narval CC™) and a non-CAD/CAM device (Narval™), on oropharyngeal airway volume in patients with obstructive sleep apnoea (OSA). METHODS: 12 OSA patients were recruited from an University Hospital for MRD therapy with either CAD/CAM or non-CAD/CAM first. A cone-beam computed tomography evaluation (CBCT) and polysomnography assessment was performed during baseline assessment and at the end of each study period. RESULTS: Upper airway volume increased significantly with the CAD/CAM device (7725 +/- 6540 mm3, p = 0.008) but not with the non-CAD/CAM device (3805 +/- 7806 mm3, p = 0.13). The CAD/CAM device was also associated with a significant decrease in AHI (mean AHI after treatment 9.4±6.7 events/h, p = 0.003) and oxygen desaturation index (mean ODI of ≥ 3%/h 11.9 ± 6.8, p = 0.011). Changes in AHI (14.7 +/- 11.7 events/h, p = 0.083) and ODI (15.5 +/- 19.2, p = 0.074) were not statistically significant with the non-CAD/CAM device. The vertical dimension of occlusion increased significantly following treatment with both MRD devices (both p = 0.003), but was significantly less pronounced with the CAD/CAM device (mean difference: -2.7 +/- 1.7 mm, p = 0.003). Final mandibular protrusion after titration was the same with both devices (85%, p = 0.317). CONCLUSION: The CAD/CAM (Narval CCTM) device was associated with a significant increase in upper airway volume that may be caused by a lower degree of vertical separation between the jaws when compared to the non-CAD/CAM design.

[Joseph-Guichard Duverney (1648-1730). Doctor, teacher and researcher in the 17th and 18th centuries]. / Joseph-Guichard Duverney (1648-1730). Médecin, anatomiste et chercheur aux xviie et xviiie siècles.

Duverney was a leader in the field of research and education, because he worked as a physician, as a surgeon and he led many scientific works. To Peltier, he was the first academic professor of surgery. His wonderful career was explained by his heavy interest in knowledge. He became one of the main actors of the scientific revolution of the 17th century, especially concerning the methods of investigation in the medical science. He had so much fear for imperfect purposes, that many scientists of his century called him the Master. The only work he published about the anatomy and physiology of the ear and audition, was a world success, and is still amazing today. During about 50 years, Duverney allowed many advances in the field of osteology, otology, embryology, respiratory and circulatory physiology, but also provided competent pupils as Winslow, Sénac, Petit, Dionis, Valsalva. Duverney is still frequently cited by veterinary and dentists for many descriptions in animal anatomy. He died at the age of 82 years, and worked for the service of science until his death. His legacy consists of many works, some have been used by his pupils to highlight all the benefits he gave to the scientific community.

Management of an extended bone-invasive basal cell carcinoma of the median forehead.

We report the case of a 35-year-old male patient managed for extended basal cell carcinoma of the median forehead, invading the frontal bone. Bone reconstruction was performed by a splitting of calvaria and skin reconstruction was performed using two frontal flaps dissected into complete vascular island, covering a skin defect of about 8cm in diameter (including safety margins). Wound healing was achieved after 4 weeks despite a median area of suffering and a temporary leak of cerebrospinal fluid of favorable evolution. The result at 5 years was excellent, with the patient's return to normal daily life and total satisfaction.

[Langerhans cell histiocytosis revealed by a temporomandibular joint disorder: Report of a case and review of the craniofacial expressions]. / Histiocytose langerhansienne révélée par un désordre de l'appareil manducateur : rapport d'un cas et revue de la littérature des atteintes crâniofaciales.

INTRODUCTION: Langerhans cell histiocytosis (HL) is a rare disease that can affect all tissues. Oral manifestations such as mucosal ulcer and tooth mobility are often the first signs of the disease. We report a rare case of mandibular condyle unifocal HL mimicking a temporomandibular joint disorder. CASE REPORT: A 44-year-old patient presented with a left temporomandibular disorder with painful left preauricular swelling. The imaging assessment found a bone lesion of the left mandibular condyle. A curettage with biopsy was used to diagnose HL. Six months later, the patient had no more pain. DISCUSSION: The craniofacial clinical expressions of HL mainly concern the bones, which can cause: pain, swelling, fracture, compression of noble organs. The other sites are: oral cavity, skin, lymph nodes, or eyes. Isolated forms are generally benign, and their treatment is discussed between abstention and non-aggressive surgery.

Cricoid cartilage and esophagus: CT scan study of the dynamic variability of their relative positions.

INTRODUCTION: Cricoid pressure occludes the esophagus (E) by compressing it between the cricoid cartilage (CC) and the body of the sixth cervical vertebra (C6). This technique is used to prevent passive regurgitation during the induction of anesthesia in patients at high risk for regurgitation. Failures of this technique had been described and a possible displacement of the E relative to the CC had been reported, but there is no study about displacement during antero-posterior movements of the head. AIM: The aim of our study was to evaluate the displacement of the CC relative to the cervical E, during flexion and extension movements of the head. MATERIALS AND METHODS: We retrospectively studied X-ray computed tomography (CT) images of 21 patients with suspected cervical trauma. Patients were in the supine position. In the first series of images, the head was positioned at maximal flexion by means of a support placed under the external occipital protuberance. In the second series of images, the head was maintained in extension by means of a support placed under the shoulders. Each position was obtained as far as possible within the limits of pain and restricted movement. In flexion and extension, we used the lowest slice from the cricoid cartilage. The variables measured were: diameters of CC (CD) and E (OD), left and right lateral displacements of E. RESULTS: A total of 13 CT were analyzed. CD and OD as well as OD/OC ratios did not vary significantly in flexion and extension. We noticed 61.5 and 92.3% (respectively in flexion and in extension) of left or right displacement: 23% of patients presented right displacement in both flexion and extension; 38.5% of patients did not present any right displacement in flexion or in extension; 61.5% of patients presented left displacement in both flexion and extension. More generally, almost 92% of patients presented displacement either in flexion or extension, or both. DISCUSSION: In our study, it can be seen that the E is clearly displaced with regard to the CC, that this displacement is favored by extension. Only 2/13 patients have an "over than 3 mm" displacement in extension whereas 5/13 in flexion. So, even if there are more displacements in extension, they are inferior to 3 mm and may not be considered as significant considering the occlusion of E. According to our results, the extension position of the head produces more displacement of the E but should preserve the containment of the cricoid pressure if we consider the thickness of the E wall.

[Long is the road...]. / "Du pain sur les planches"...

All our colleagues are unanimous: the anatomists were the most prestigious teachers of their preclinical curriculum. Our prestige, our durable impact on young students are partially based upon the fact that anatomy is the most "medical" discipline among all the lectures given in the first year(s) of medical curriculum. But the respect of our students is due in a large way to the quality of our educational methods based on lectures at the blackboard with pieces of chalk. A long preparation is required to achieve excellence and provide lectures melting science and art, inviting students to learn and understand with pleasure the human body on which they will practice up to date medicine. Training of anatomists requires long preparation in their own institutes as well as in common sessions organized at the Saints-Pères Institute of Anatomy of Paris, a mythic place of anatomy in France.