Biomedical subjects
Publications and source records attributed to M Freidel.
Twelve cases of maxillo-facial fibrous dysplasia are presented, with a brief review of the condition. Only the complete excision of the lesion allows full healing, but it is rarely feasible, even with immediate reconstruction. The surgical abstention and partial excision keep many indications, but require a regular follow-up.
A case of lingual necrosis in a patient irradiated 3 years earlier for a tonsillar tumor is presented. Imputability to a post-radiology bilateral external carotid thrombosis is evoked, where the diagnosis of tumoral recurrence and Horton's disease have been ruled out. Cervical peridural nerve block allowed successful treatment of this lesion.
The authors report 3 cases (including 2 recurrences) of congenital median cervical clefts (fold and fistula). Based on a review of the literature, they recall the principal clinical features of these lesions. The modalities and results of surgical treatment are discussed: Z-plasty, musculocutaneous flaps, tissue expansion. The possibility of recurrence after Z-plasty during the first months of life emphasises the importance of regional hypoplasia in certain cases and requires tissue supplementation. The disturbance of mandibular growth may require genioplasty in adolescents.
43 patients with primary palatal clefts (53 clefts) were treated by secondary osteoplasty. In 85% of cases the graft enabled closure of the bucco-nasal fistula and alveolar continuity was reestablished in 98% of cases. Complications were minimal and did not generally affect the final result. The ideal age for the procedure would seem to be between 8 and 11 years, thereby allowing eruption of the canine under normal conditions and the production of a continuous dental arcade.
We report a new case of aggressive juvenile fibromatosis (A.J.F.) in a 20-month-old girl. The lesion affected the inferior border of the left mandible and the adjacent soft tissues. The child presented with a painless mass, which had grown over a period of 2 months. Radiographs and computed tomographic scan showed a multilacunar bone defect with subcutaneous and gingival involvement. A biopsy was performed, followed by a partial hemimandibulectomy and a costal graft. The surgical specimen measured 4 X 3 X 3 cm. The patient did well 1 year after surgery. 16 cases of A.J.F. have been reported; with ours, 14 are mandibular. A.J.F. is a locally aggressive lesion, which doesn't metastasize. It occurs chiefly in childhood and adolescence from 1 1/2 to 18 years (median 6.5 year-old). Duration of symptoms prior to presentation varies from a few weeks to months. Clinically, it is a firm nodule. Radiographs are non-specific, but 9 cases have poorly defined destruction of the mandibular inferior border. Following a block resection of the tumor (13 cases), there is no recurrence. In this review, we discuss the clinico-pathologic diagnosis of this impressive tumor which is compared with other mandibular fibrous tumors in children.
A relatively frequent disorder, hemi-mandibular hypertrophy is today well identified clinically and radiologically. Its expression varies from one case to another but it becomes stabilized at the end of growth. Its etiology is unclear and it can only be corrected surgically: the habitual inclination of the plane of occlusion leads to a bimaxillary action with a tridimensional effect. The results of these osteotomies performed at the same time is stable and dramatic. Although isolated osteotomy of the basilar excess has become a last resort procedure, isolated condylectomy is still an acceptable compromise in toothless patients. The diagnostic approach and result of surgical treatment are analyzed in light of a homogeneous series of 12 cases.
60 cases of maxillary sinus mucosal cyst diagnosed in patients with cardio-vascular pathology, are reported. Symptoms, histology and treatment are recalled. Surgical excision (or sinusoscopy) seems to be necessary in "high risk" patients (8.4% of asymptomatic infection).
Over the period extending from 1950 to 1978, the treatment of mandibular fractures at the CHU of Lyon followed a dual evolutionary course. On the one hand, fractures of the dental part of the bone were treated more and more often surgically via the endobuccal approach, by osteosynthesis using miniature screwed plates. On the other hand, fractures of the region of the condyle benefited from mechanotherapy according to professor Delaire's technique. These therapeutical trends have led to frank improvement in the outcome of these patients, both from the functional and esthetical points of view.
For more than 15 years, the maxillo-facial and stomatological center in Lyon has received approximately 100 cases of T.M.A.D.S. per year. The etiological basis of the symptomatology is muscular dysfunction due to malocclusion variable degree and duration. Simple radiological investigations complete the examination. Treatment aims at correcting the malocclusion, either by simple methods: dental occlusion and prosthesis, or by orthognathic orthodontic and surgical techniques. Surgery involving the temporo-mandibular joint is reserved for rare cases of condylar deformation which is often post-traumatic. Favorable results can be obtained in 85% of cases.
The vasodilator effect of anaesthetic agents on cutaneous vessels has often been investigated. In contrast, although subcutaneous tissue is concerned with metabolism and thermoregulation, the effects of anaesthesia on subcutaneous blood flow have not been well documented. The purpose of this study was to determine the magnitude of changes in cutaneous and subcutaneous blood flow during general anaesthesia in Man. Anaesthesia was induced with flunitrazepam in 15 patients before facial plastic surgery. Blood flow was estimated using heat thermal clearance (HC). Two HC sensors in different areas allowed the measurement of superficial and deep HC. Systolic (SABP), diastolic (DABP) and mean arterial blood pressure (MABP), heart rate (HR), and rectal and mean skin temperature were also recorded. After induction of anaesthesia, HR increased significantly (p less than 0.05) whereas SABP, DABP and MABP remained unchanged. The rectal-toe temperature gradient fell from 6.3 +/- 4.1 degrees C to 3.4 +/- 1.1 degrees C (p less than 0.01) suggesting a reduction in vasomotor tone. Superficial HC increased from 0.37 +/- 0.06 to 0.42 +/- 0.08 W.m-1.degrees C-1 (p less than 0.05) whereas deep HC decreased from 0.33 +/- 0.07 to 0.31 +/- 0.09 W.m-1.degrees C-1 (NS) and returned to the control value thereafter. Rectal temperature and mean skin temperature were unchanged. The changes in deep HC are similar to those previously observed in muscle during induction of anaesthesia. Our results show that anaesthesia mainly affects cutaneous blood flow, without any significant change in subcutaneous blood flow during the early phase of anaesthesia in human beings.
Explore the source record for details and available documents.
Two new cases of Cowden's disease observed in two young sisters are reported. The diagnosis was based on the clinical observation of oral mucosa lesions (gingival hyperplasia, papillomatosis, scrotal tongue). In one case, visceral manifestations in childhood were observed. Cowden's disease is a familial affection (autosomal dominant trait) characterized by association of oral mucosa and skin lesions and of multiple hamartomas involving glandular tissues. Clinical and familial history investigations are justified by the high risk of malignant tumors (breast carcinoma).
The authors review a uniform series of 15 cases of parotidectomized children aged below 10 years. From an etiological viewpoint, there were 6 different types of interventions, as 4 children had lymphangiomas, 2 had angiomas, 3 had tuberculous lymphadenopathy, 2 presented wounds in the area of the parotid, 1 had a pleomorphic adenoma, and there was 1 Ewing's sarcoma and 1 complex malformation of the hemiface. The analysis of such diverse cases provides an opportunity for precision in the indications, the technical procedures, and the outcome of parotidectomy performed in the child.
Two edentulous elderly women presented with benign but extensive tumors of middle third of face. The excision necessary for reasons of comfort and hygiene could not be envisaged unless the ineluctable vast palatine breach opened could be immediately repaired by surgery, any prosthetic solution being excluded. The use of a total temporal muscle flap, without zygoma section, provided an effective and comfortable solution to this both delicate and unusual problem. These cases illustrate the interest in the use of temporal muscle flaps in maxillofacial surgery, and their management for the repair of large palatine breaches.
A case is reported of progressive ossifying myositis (fibrodysplasia ossificans progressiva, Münchmeyer's disease) with onset at 16 years of age by a lesion of internal pterygoid with limitation of opening of mouth. Surgery to relieve ankylosis was followed by recurrence. Diagnosis was established only after the appearance of lesions in other regions (sternocleidomastoid, latissimus dorsi, lumbar muscles...). Clinical and paraclinical signs of this exceptionally rare disease are reviewed and diagnostic difficulties at onset of the disease discussed. Treatment of acute myositis episodes with diphosphonates delays passage to the ossification stage, allowing local surgery to be performed with less risk of relapse.
A 78 year old woman with a history of maxillary ameloblastoma from age of 38 years was found on routine examination to have a pulmonary image of the balloon release type. The lesion was atypical with respect to its clinical tolerance and slow progression. Pathology of several nodules removed by surgical lung biopsy confirmed the benign nature and identity of the maxillary and pulmonary lesions. The diagnosis was therefore pulmonary metastases from a benign ameloblastoma. The age of the patient and slow course of the lesion, combined with the absence of any functional disorder, was the basis for the decision not to operate on the pulmonary lesion. The concept of benign metastatic ameloblastoma is analyzed and findings compared with data in the literature.
Two cases of unfavorable course of epithelioma of nose are reported. Predisposing factors, anatomoclinical diagnostic features and treatment of these lesions are analyzed, and emphasis placed on the need for early, radical surgery to prevent such a course.
Principal features of histiocytosis X are discussed in relation to 5 cases treated in the department. Clinical signs are known. Bone scintiscans are of importance for evaluation of extension of the disease. Surgical treatment is the rule until more effective therapy becomes available and has a diagnostic rather than curative aim. The major problem remains the progressive dental mutilation.