Biomedical subjects
Publications and source records attributed to J L Beziat.
A 22-year-old white woman presented with a recurrent mass in her tongue that had originally been diagnosed as a fibrosarcoma. Review of the original specimen with new immunohistochemical staining showed that it was an inflammatory fibroblastic tumour.
Schwannoma of the foot is rare; only 12 cases have been reported. A schwannoma is a benign neurogenic tumour derived from Schwann cells. The diagnosis is often delayed because the symptoms are mainly those of compression disorders. We describe a 7cm schwannoma of the heel in a 30-year-old man. Ten years earlier a schwannoma was removed from the same site. The recurrent lesion was widely excised and a medial plantar flap was used to repair the heel.
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The aim of this study was to report a series of extracranial cephalic schwannomas. Fifteen patients with extracranial schwannomas treated between 1981 and 1999 are presented, and their clinical course during a median follow-up of 4.1 years is discussed. There is a female predominance. No specific factors have been identified. Their diagnosis is often delayed (median, 2.6 years). There is no predominant side. The orbit represents the most frequent location of schwannomas (26%). The trigeminal nerve is the most often affected (53%). Computed tomography and magnetic resonance imaging contribute to the diagnosis. Macroscopically, the schwannoma is a well-defined tumor of ovoid form and brownish color. It is formed of soft tissues and is fragmented easily. Diagnosis is often evident on microscopic examination. The only treatment is surgery. It consists of enucleation after opening the epineurium using an operating microscope, without interruption of the continuity of the nerve. The authors have observed only two relapses (the first two patients operated without a microscope). Total excision allows recovery. Nerve injuries have variable prognosis. It is necessary in juvenile populations to search for neurofibromatosis. All schwannomas required surgical treatment using an operating microscope to obtain total recovery.
Relapsing polychondritis is a rare and little known inflammatory disease. The case of a 29-year-old woman who presented with a one-year history of saddle nose is discussed in this article. After waiting for one year, rhinoplasty was decided, with a good result at the 18th month. We prefer to use a calvarial bone graft for this disease and to only operate under stable and minor conditions.
We report on our experience of the frontal sinus approach for removing olfactory groove meningiomas. Five tumors were operated on, one unilateral, four bilateral. Osteotomy of the anterior wall of the frontal sinus was performed with an oscillating saw without any burr hole. The posterior wall of the sinus was resected and the tumor was attacked along the plane of the anterior skull base. Ethmoidal blood supply was controlled at the initial stage of the operation, allowing avascular tumor debulking. Olfactory nerves, invaded by the tumor, usually cannot be spared. Tumor extensions towards the sella and the optic canals were removed without any brain retraction, nor opening of the sylvian fissure, nor dissection of the carotid arteries. The frontal sinus approach is technically easy to achieve. Osteotomy and reconstruction of the anterior wall of the frontal sinus are rapidly performed. When the frontal sinus is small, image guided surgery allows to delineate precisely its limits and the flap includes the calvarial outer layer, tangenitally cut from one supra-orbital canal to the other. Cosmetic result is perfect. The frontal sinus approach gives access to the medial part of the orbital roofs and to the central anterior skull base from the crista galli to the tuberculum sellae and the anterior clinoids. The frontal sinus approach represents an alternative to conventional craniotomies for tumors developed in the central anterior skull base, especially for olfactory groove meningiomas.
The buccinator muscle is a wide, flat quadrangular muscle. Its medial surface is covered by the oral mucosa. It receives its arterial blood supply from two main arteries: the facial and buccal arteries. A musculo-mucosal flap can be raised on the facial artery with or without the facial vein. In the case of absence of the facial vein, venous drainage is possible into the peri-arterial loose areolar tissue. A nasolabial skin incision facilitates facial artery identification and simplifies flap dissection in the loose areolar plane, superficial to the facial artery. The mean dimensions of the flap are 3.5 cm in width and 7 cm in length. The flap extends from the superior buccal sulcus to the inferior alveolar ridge. Its rotation enables reconstruction of the anterior and lateral floor of the mouth. The donor site is closed in two layers. The authors present a series of ten patients reconstructed with this flap after excision of a squamous cell carcinoma of the floor of the mouth. The results are excellent with perfect tongue function and no esthetic sequelae. The facial artery should be preserved during neck dissection, and the ipsilateral mandibular molar teeth must be extracted. Its simplicity and reliability makes this flap a useful alternative in floor of mouth reconstruction.
The authors report a series of 13 extracranial cephalic schwannomas, treated between 1981 and 1998. Schwannomas are rare and benign tumors derived from Schwann cells. Cephalic sites represent 2.5% of all schwannomas. Their diagnosis is often delayed, because symptoms mainly consist of compression disorders. There is a female predominance. The age distribution is homogeneous. There are no risk factors. There is no predominant side. The orbit and jugular foramen are the most frequent sites. The trigeminal nerve is usually involved. CT scan and magnetic resonance imaging (MRI) specify the topography and characteristics of the tumor and can contribute to the diagnosis. Macroscopically, schwannoma is a well-demarcated, ovoid or spherical, brownish tumor, off-centered from the nerve. It is composed of soft, easily fragmented tissue. The diagnosis is often obvious on microscopic examination and rarely requires immunohistochemical confirmation. The only treatment is surgical. It consists enucleation after opening the epineurium, using on operating microscope, without disruption of the nerve. Total excision ensures recovery. The authors have observed only one recurrence (first patient operated without microscope). Compression disorders regress completely. Nerve injuries have a variable prognosis. Malignant transformation is exceptional. Type II neurofibromatosis must be excluded in young patients.
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The authors report a huge lymphangioma of the tongue in a sixty-seven years old female patient. The remarkable progression in dimensions of this lesion, leading to the inevitable protrusion of the tongue, led to the realization of an extended glossectomy, with a functional objective in mind. This simple procedure showed an excellent five years follow-up results. From this case report, the authors stress up on the etiopathogenic, pathological, clinical as well as therapeutic aspects of lingual lymphangioma.
Numerous routes of access to the medial basal structures of the cranium have been described, largely because of the wide variety of lesions observed in deep localizations. Access can be achieve via trans-sinusal, transfacial (trans-sphenoidal rhinoseptal, mediofacial or Lefort I), trans-oro-pharyngeal and numerous other routes. An examination of the principals involved, their development and the technical modalities demonstrate the advantages and disadvantages of each and their specific indications. Access is particularly interesting with the frontal trans-sphenoid, Lefort I osteotomy and trans-oro-pharyngeal routes. The simplicity of these non-mutilating routes provide an alternative to neurosurgical access. Their development depends on progress in imaging and microscopic surgery. Used alone or in combination, they can be an useful complement to a neurosurgical access.
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Cephalic localization of liposarcoma is exceptional. We report three cases, in an 87-year-old patient with liposarcoma of the tongue, a 78-year-old patient with multiple recurrent liposarcoma of the orbit and a 42-year-old patient with ethmoido-orbital liposarcoma of metastasis origin. These three cases and a review of the literature were the basis of a summary of the incidence, the anatomic classification and therapeutic options for this type of liposarcomas.
Three cases of osteochondroma of the mandibular condyle were observed with arthrosis type lesions. Based on a review of the literature, the epidemiologic, symptomatologic, pathologic and diagnostic characteristics of this rare benign tumour with facial localization are presented together with the therapeutic approach.
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A case of infra-sellar (sphenoidal nasopharyngeal) craniopharyngioma is reported. A 16 year-old girl presented with progressive nasal obstruction. CT and MR images showed a heterogeneous tumor originating from the sphenoid bone with no intra-cranial or supra-sellar extension. On a biopsy specimen, the histologic examination was consistent with a craniopharyngioma. The tumor was successfully removed via an inferior route using a Le Fort I maxillotomy. Plates and screws were used to achieve osteosynthesis. The post-operative course was uneventful and there was no residual tumor on post-operative CT. Craniopharyngiomas with strictly infra-sellar development are very rare. Up to now, 19 cases have been reported in the literature. This condition likely results from growth of embryonic remnants lying along the craniopharyngeal duct. Several surgical approaches have been proposed, most of those giving poor exposure to the clival and lateral tumorous extensions. Of particular interest in the authors' experience was the use of a Le Fort I maxillotomy which provided optimal exposure to the skull-base and facilitated radical excision. CT and MR studies have proved of upmost importance in delineating the area of bone to be removed at operation.
The authors use skull grafts obtained during the treatment of craniostenoses and sterilized by gamma radiation to reconstruct the orbital walls. They describe the practical modalities of this technique and report a series of 26 cases in which no incidents of complications were observed.
A case of osteosarcoma of the tongue is reported, with microscopic findings. The patient underwent chemotherapy, left hemiglossectomy, and neck dissection, followed by radiotherapy. Five years after initial therapy, he is still alive and well, with no evidence of recurrence.