[Sternal pseudarthrosis in irradiated patients. Repairing by the pectoralis major myocutaneous flap].
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Biomedical subjects
Publications and source records attributed to M Freidel.
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Maxillofacial injuries due to sporting activities represent approximately 10% of all cases of injury admitted to the University Hospital Center, Lyon, France, and more than half of these occur in football or rugby players. The causes of these accidents (blows against another player, the ground, the field equipment or the game accessories) are discussed. Lesions are generally simple in young, fit adults and results of surgical treatment satisfactory, apart from the rare cases of facial disruption. Preventive measures include examination for aptitude for sporting activities, adequate referring of games and the wearing of helmets, masks and inter-maxillary protective bars.
Washio's temporo-retro-auricular flap was used to repair point of nose in three children and one ala nasi amputated by dog bites. Details of the technique are presented and long-term results discussed. Despite two inconveniences--dyschromia and relative stenosis of nares--this method compares favorably with other surgical procedures and over the time has proved to be one worth recommending.
The maxillofacial prosthesis for surgical treatment of loss of bony, dental or mucosal substance in children has the advantage of allowing postponement of therapy until growth is terminated or any other favorable period. In addition, the temporary reconstitutions possible by their use often provide, apart from esthetic results, an effective action physically and mentally on the mainly labile growth.
On the basis of two cases, the problem is raised of the pathogenesis of kerato-cysts. The possibility of some sort of "induction" by factors which are involved in provoking eruption of the teeth is suggested by the clinical cases described.
A patient with intramandibular angioma and arteriovenous fistula (high output arterial angiodysplasia) required 4 separate hyperselective embolizations and a surgical excision. The problems of embolization, surgical technique and indications for operation of this happily rare, serious vascular malformation are analyzed.
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Fibrinogen glue of human origin was used in 44 patients. Indications are of two types: as a glue mainly for dermoepidermoid grafts but also to assist mucosal suturing and bone obturation, and for hemostasis after extractions in patients with coagulation disorders (hemophilia, cirrhosis, leukemia). Positive results were obtained, particularly in hemophilic patients, the incidence and severity of secondary hemorrhage appearing to diminish.
We report the observation of a 78 year old patient who had a plexiform ameloblastoma since the age of 38. A systematic pulmonary radiographic examination revealed multiple dense nodules like "cannon ball secondaries". However the histology of these pulmonary nodules, obtained by open lung biopsy, was identical with the primary tumour and showed no evidence of malignancy. The dispersion to the lungs was probably explained by inhalation of tumour cells, itself favoured by 8 surgical curettages. The progress of these pulmonary lesions was as slow as the primary tumour. No therapeutic trial was attempted on the grounds of age, perfect clinical tolerance and the absence of any known therapeutic protocol which would be active.
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Common features in two patients with chronic suppurative lesions of the maxillofacial region from vegetable foreign bodies were : foreign body origin of the accident ; chronic nature of the suppuration (7 and 23 months respectively) ; multiple operations by different surgical teams ; radiotransparency of the foreign bodies. Positive signs on CT scanning can confirm the diagnosis, but cannot exclude it when normal images are obtained. The number and localization of wood fragments may limit the value of the scan, and fistulography and xeroradiography may then provide confirmation of the diagnosis. Operative treatment may be difficult due to fragmentation of the wood into multiple pieces, a possible source of recurrence of infection.
Three patients with mandibular ameloblastomas were treated by hemimandibulectomy followed by immediate reconstruction by a single-block mandibular homograft prepared at a distance from the operating field and taken from the bone section removed after visual and radiologic control of total tumoral separation. This procedure is simpler and more economic, rapid and reliable that conventional reconstruction using rib or iliac homografts. It is indicated for those limited cases of ameloblastoma or benign bone tumors which, even though possessing similar prognoses by their site (coronal...) or their tendency for recurrence and thus requiring interruptive resection, are sufficiently small to ensure total tumor excision and the recovery of a sufficiently thick bone piece for an ideal homograft. The procedure is of particular interest in the elderly and/or debilitated patients, and may be useful after abusive hemimandibulectomy.
Steinert's disease is a myotonic dystrophy associated with diffuse visceral involvement. A severe hereditary disorder, it is characterised from a maxillo-facial standpoint by a special dysmorphism which the authors emphasize in the light of one case. They then suggest that a wider study of this condition might be envisaged.
A 26-year-old man presenting no clinical manifestations apart from the intermittent flow of nasal secretions into the mouth was found to have a double fistulous tract at the level of the upper central incisors. Fistulography confirmed the presence of a fistula. The nosological place of this congenital lesion remains to be defined.
An reversible daylight color film associated with 3 filters was used for slide reproduction from radiographs. This simple, rapid, and low-cost technique appears to be particularly suitable for iconographic reproduction for teaching purposes.
It is exceptional for surgery to become necessary after the use of miniaturized plate and screws. When it is required it is because of faulty reduction or contention, mucosal disunion or an infective focus, or a combination of these factors. Surgery provides good final results, but 2 to 4 supplementary months of immobility are needed, and it can be avoided by respecting the indications and practical necessities of this method.
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Temporomandibular dysfunction is a relatively frequent disorder, affecting mainly young women, that remains a poorly recognized entity. Clinical symptoms usually associate pain and cracking of the jaw, frequently accompanied by limitation of opening of the mouth. Occlusal injury is the cause of the dysfunction in every case. Two panoramic radiographs, one in the usual terminal occlusion and the other with the mouth open, provide evidence of the amount of condylar movement and the morphology of the condyles. Active mandibular movements provide muscular re-education. The inhibitors of occlusion (palatine plate to increase incisor elevation or covering plate) have the objective of reducing muscle spasm. Treatment of the cause of the disorder is based on occlusal rehabilitation, surgery of the temporomandibular joint being doomed to failure as it attacks the consequences and not the origin of the occlusal dysfunction.