Biomedical subjects
Publications and source records attributed to F Guilbert.
Mycetoma is a chronic granulomatous infection of the skin from which grains of the causative organism are eliminated via the sinus tracts. We report a rare case of cephalic mycetoma, which presented with an extensive involvement of the skull vault, base and an extradural granuloma. The diagnosis and treatment of the disease are discussed.
Firearm wounds are relatively frequent in civilian practice. Due to the variable power of the weapons involved, a wide range of maxillofacial lesions are encountered and classification is a difficult task. In order to predict the gravity of the lesions, we have drawn a classification scheme from our experience with maxillofacial injuries. The scheme was based on the kind of ammunition which gives a better classification than the type of weapon. Three main categories have been identified.
Due to the recent regulations generated by the diversity of infectious risks, autologous bone is the standard graft material in maxillofacial surgery. Although synthetic biomaterials can be useful, they remain insufficient in many situations. Among the many sites offering graft material, monocortical parietal bone which is accessible within the craniocephalic operative field has distinguishing characteristics due to its membranous embryological origin and its mode of direct ossification which does not include a cartilaginous stage. The proportion of cancellous bone per unit volume is much higher than in enchondral bone (iliac bone, ribs...). These factors are undoubtedly the source of its main qualities--very little resorption and excellent capacity for bony integration--motivating its increasingly widespread use over the past twenty years. We present our experience in a series of patients who underwent surgery between 1992 and 1997. Parietal bone was used for orthognathic, pre-implant or reconstruction surgery after trauma or carcinological trauma. We present a description of the surgical procedures together with morbidity results and compare our findings with those found in large series in the literature, particularly concerning rare neuromeningeal complications. We discuss indications for parietal grafts and their course at the receiver site.
The authors present a case report of a traumatic defect of the scalp involving all layers including galea and periost measuring 10 x 14 cm. The surgical repair of the scalp avulsion was obtained in 3 weeks using Continuous Skin Extension procedure with Kirschner pins threaded through the wound margins, held together with elastic bands. Traction forces were modified twice a week in our patient basis. No undermining was necessary. The authors analyse the benefits of this technic and describe the alternative surgical procedure. This technique is easy to handle, cheap, safe, and requires a single surgical step. Furthermore, it quickly allows the patient to proceed with his work.
Victims of facial trauma require global, and not exclusively surgical, management. We describe the psychological and psychiatric problems associated with facial trauma and emphasize the need for psychiatric care to complete surgical treatment in facial trauma.
A homogeneous series of 15 cases of diffuse cervical cellulitis originating in the oropharyngeal area were collected from December 1990 to April 1995. Despite early management, diffusion of the infectious processus was rapid with extension and development of severe mediastinal or pulmonary complications. When diffuse cervical cellulitis is suspected, early and adapted aggressive treatment must be initiated immediately: suppression of the causal factor, surgical exploration with repeated drainage depending on the clinical course assessed on CT scans, antibiotics effective against the aero-anaerobic flora. This aggressive attitude is required to avoid potentially severe morbidity. Anti-inflammatory drugs, taken alone or with unadapted antibiotics was implicated in 11 cases as a favoring factor.
PURPOSE: To better characterize congenital anophthalmos and microphthalmos in order to distinguish which patients need surgical treatment. MATERIALS AND METHODS: A retrospective study of 42 cases with congenital anophthalmos and microphthalmos over a 16 years period was performed. Seven anophthalmos, 20 microphthalmic globes with no associated colobomatous orbital cyst and 15 microphthalmic globes associated with colobomatous orbital cyst were observed. Complete history, pediatrical and ophthalmological examination, electrophysiological feature, oculo-cerebral imagery and karyotype on each of the patients were reviewed. RESULTS: Among all patients, lack of development of the lids was observed in 45% of cases. In our group of anophthalmos, 100% had micro-orbit. In our group of microphthalmic globes with no associated colobomatous orbital cyst, 30% had micro-orbit and in our group of microphthalmic globes associated with colobomatous orbital cyst, 6% had micro-orbit. 75% of patients had ocular anomalies and 39% had systemic anomalies, mostly on the face. Aetiology were found in 36% of cases. Visual evoked potentials and retinal electric feature were useful to better determine visual function. CONCLUSION: Expandable orbital prosthesis would appear to be the most effective therapy for certain cases of anophthalmos and microphthalmos with micro-orbit.
The complex embryology of the oculo-orbito-palpebral region is responsible for a number of heterogeneous clinicopathological situations, associating variable proportions of the three components of the malformation: micro-anophthalmia, microblepharism, micro-orbitism. Application of the double principle of skin expansion for the eyelids and distraction of the callus for the orbit, as early as possible (first year of life), is possible by means of a device which consists of a combination of an intraorbital expansion balloon, an antireflux valve to avoid effective pressure losses in the balloon, and an injection site for progressive filling of the expansion balloon. The response to these treatments is excellent for cases of simple microphthalmia and micro-orbitism; in complex craniofacial malformations, it generally only partially resolves the problem, but provides a precious complement to the quality of the final repair.
Alström syndrome is an autosomal recessive disorder characterized by cone-rod dystrophy, obesity, hearing impairment, and diabetes caused by insulin resistance. By reviewing the charts of eight patients followed for periods of 2 to 22 years, we established the natural history of this syndrome during childhood. Five patients, in four families, were seen between the ages of 3 weeks and 4 months with a dilated cardiomyopathy, a previously unrecognized feature of the syndrome. Photophobia and nystagmus were first documented in the eight patients between the ages of 5 months and 15 months. In all patients, electroretinography initially showed a severe cone impairment with mild (2/8) or no (6/8) rod involvement. Electroretinograms, obtained again at ages 9 to 22 years for four patients, revealed extinguished rod-and-cone responses. Obesity developed during childhood in seven patients, in at least three of them before age 2 years. Hearing impairment (5/8) and diabetes/glucose intolerance (4/8) were diagnosed at the end of the first decade or during the second decade. This constellation of features should facilitate early diagnosis of the syndrome.
The paradental cyst is an odontogenic inflammatory cyst (WHO classification, 1992). It has been rarely described in the french literature and includes: The inflammatory paradental cyst which occurs on the buccal or distal aspects of an erupted third mandibular molar or of a canine (first description by Main in 1970); the mandibular infected buccal cyst which occurs on the buccal surface of the mandibular second or first molar in children around 6-8 years of age with an associated history of inflammatory signs (Stoneman and North, 1993). The histological features are the same as those of the radicular cyst. Prognosis is excellent after enucleation. This paper present an additional case report of a paradental cyst located on a second mandibular molar.
The lateral region of the face is often exposed to trauma and may also be the site of tumor localization. Exeresis may lead to major tissue loss. We report several surgical techniques, from the most simple to more complicated, available for facial repair. Neighboring regions in the frontal or temporal area are used but a submental flap may also be useful.
Fractures or the medial wall of the orbit are uncommon and clinical signs are often discreet. This report was focused on isolated fractures of the medial wall of the orbit. Blow-out trauma is usually the cause. In these cases the clinical signs ranged from simple ecchymosis to blindness by haematoma of the orbital cone. Computed tomography is a major tool for diagnosis and making therapeutic indications for these fractures. Treatment depends on the oculomotor involvements as measured by forced duction tests.
This is the first case report of an exceptional maxillary infection due to Scedosporium prolificans. This recently discovered fungus was identified in the sinus. In the literature, it has been observed at different locations. Identification requires careful sample taking for mycology and pathology studies emphasizing the importance in maxillary surgery. This pathogenic fungus is very invasive, particularly in immunodepressed or immunocompromised patients. Therapeutic modalities vary with the patient's immune status.
A malignant xanthogranuloma located in the mandible presented as a tumefaction of the alveolar crest with labiomental hypoaesthesia in a 52-years-old woman. The patient was treated with combined chemoradiotherapy and remained in complete remission for 14 years. Epidemiologic features (age, sex, race) of this tumour are discussed in light of the 24 cases reported in the literature. Histology features and possible treatment protocols as well as observed results are discussed. Five-year survival rate in malignant cervicofacial xanthogranulomas is estimated at 48%.
Different techniques can be used to repair paralytic labial commissurae. Ideally, microsurgical procedures or dynamic suspension methods can correct kinetic paralysis but in certain patients (elderly subjects, poor general health, precarious postsurgical rehabilitation) such procedures may represent an excessively aggressive procedure. We therefore used static suspension of the paralytic labial commissurae based on desepidermization of a nasogeneal flap. This simple technique is easy to perform and is our method of choice for static suspension because the flap pulls the paralysed commissurae upward and doubles the tissue cover, helping overcome buccinator incompetence.
Merkel cell tumours are exceptional and usually occur in exposed areas of the face or limbs. These tumours are related to small-cell bronchogenic cancer. The case reported here demonstrates the relationship between these two cancers since the diagnosis of Merkel cell tumour of the gingival mucosa, initially made in a patient with no other presenting signs other than the stomatological lesions, was corrected six weeks later when the buccal lesion was found to be a metastasis of small-cell bronchogenic cancer. This observation is in agreement with the retrospective study reported by the Institute of Stomatology of the Salpêtrière hospital published in 1992 and presented at the XXIVth congress of the French Society of Cervicofacial Cancerology.
Rhabdomyosarcoma is a malignant tumour of striated muscles. It is usually encountered in children and rarely in adults. In this study we compared sex ratios, aetiologic factors, different localizations, development stages, modes of extension and treatment as well as prognosis in children and adults with cervicofacial localizations. The differences observed led to the conclusion that cervicofacial rhabdomyosarcomas in children and adults are two very different pathological entities.
A brief review of the lingual nerve anatomy is followed by an examination of the consequences of injury to the lingual nerve during mandibular wisdom tooth extraction on sensibility and sensorial activities. The circumstances of such injury are described as a function of the position of the tooth together with means of prevention. The clinical course of injury to the lingual nerve is unpredictable and varies over time and in quality of recovery. No prognosis can be made before a reasonable delay of 18 months to 2 years. Prevention remains the best treatment and consists of using a flexible bar to protect the nerve during the operation. Rate of legal disability compensation is estimated at 2 to 5%.