Biomedical subjects
Publications and source records attributed to P Caix.
The anatomy of the abdominal wall describes the superficial and extra peritoneal planes: skin, fat and muscles. Inguinal and lumbar anatomy are excluded. Phylogenetic, embryologic and comparative anatomy allow better integration of evolution, growth, and congenital syndromes. Classical anatomy is adapted to modern aspects, more useful for plastic surgeons.
Our large experience of shotgun injuries to the face emphasizes the need for a reappraisal of primary treatment for this poorly documented topic. The medical records of 165 patients, treated at our institution between january 1st, 1982 and december, 31st 1996 for such an injury, were reviewed. Almost all cases were exclusively self-inflicted lesions. The guns were mainly twelve-gauge and occasionally 16 or 20-gauge. Close range wounds in an heterogeneous area--soft-tissue, mandible, muscles of the tongue and floor of the mouth, oral and nasal cavities, maxilla and paranasal sinuses--caused massive damage. A topographic classification based on the soft-tissue and bone loss is reported. After initial management (including securing the airway and control of bleeding), conservative debridement of all devitalized tissues and stabilization of the fractures were performed. As soon as possible, bone and soft tissue reconstruction was undertaken using local or distant flaps. However, immediate definitive reconstructive procedures were scarcely [corrected] used and only in particular cases. We believe that a carefully planned reconstruction schedule is required to achieve satisfactory appearance and function.
Radical neck dissection was the golden standard of treatment for cervical nodes in head and neck tumors. From the seventies, the preservation of the spinal accessory nerve has become increasingly popular in order to improve the functional result of the neck dissections. The aim of this study was to assess the degree of functional disability associated with each type of neck dissection and the value of anatomical references for dissection of the spinal accessory nerve. One hundred twenty seven patients were evaluated 1 month and 1 year after radical, functional or supraomohyoid neck dissection with a questionnaire and a physical examination. Anatomical measurements of the spinal accessory nerve were performed in 20 patients. We found considerable or severe shoulder dysfunction in 7%, 34% and 51% respectively of patients in whom supraomohyoid, functional and radical neck dissections were performed. Furthermore 49% of patients having undergone a radical neck dissection had little or no symptoms. Sacrifice of the spinal accessory nerve in radical neck dissection may lead to shoulder dysfunction. A functional disability may also be associated, although in a less extent, with any neck dissection in which the spinal accessory nerve is dissected and placed in traction. There is a large variation in the degree of functional disability and pain in patients with similar neck dissections. The course of the spinal accessory nerve in the neck makes it particularly vulnerable to injury during the dissection near the sternocleidomastoid muscle and in the posterior cervical triangle.
The osteocutaneous fibular free flap is one of the most useful flap for complex mandibular reconstruction. The authors summarize the surgical technique, giving a pre, per and postoperative strategy.
The fibula osteocutaneous free flap now has a recognized place in the therapeutic arsenal of microsurgical mandibular reconstructions. Based on a review of the literature and their own experience, the authors propose a preoperative and intraoperative strategy adapted to reconstructions of mandibular defects. The place of complementary investigations, the site of the skin flap, the choice of osteotomy, the type of fixation, and spatialisation of the skin flap are presented. They conclude on the excellent plastic and vascular qualities of the fibula flap in complex mandibular reconstructions.
The aim of this study was to assess the reconstruction of floor of the mouth defects after cancer surgery. The medical records of 140 patients treated between January 1st, 1987 and December 31st, 1995 were reviewed. Ninety-six patients had primary reconstruction: there were 82 cutaneous or osteomyocutaneous flaps and 14 microsurgical transfers. Among these patients 15 had titanium mandibular reconstruction plates. The reconstruction procedures and postoperative follow-up were evaluated. Healing by first intention is appropriate for superficial soft tissue defects. The nasolabial flap is used only for small mucosal defects. A forearm flap should be the first choice treatment for large soft tissue defects owing to its plasticity and reliable vessels. Segmental mandibular resections often imply mandibular reconstruction. Titanium plates may be used alone or with a cutaneous flap. Tolerance of plates after radiotherapy is very good and they are an effective method of reconstruction for fragile patients.
Soft tissue sarcomas of the head and neck account for less than 1% of all malignant neoplasms in this region. A significantly increased risk of treatment failure is associated with high histologic grade, leading to an aggressive treatment. The medical records of 17 patients with soft tissue sarcomas of the head and neck were reviewed. They were divided into two groups according to age: 13 adults and 4 children. The former underwent wide surgical excision with postoperative radiotherapy in some cases and possibly chemotherapy. The 2 and 5 years survivals were 54% and 46% respectively. The latter, with rhabdomyosarcoma, underwent multimodality treatment (chemotherapy, surgery, radiotherapy). The 2 years survival was 50%. The mainstay of treatment of soft tissue sarcomas of the head and neck in adults remains surgery. Patients with incomplete resection or high grade tumour should receive more aggressive treatment (surgery and postoperative radiotherapy). The use of systemic chemotherapy has showed no statistically significant improvement in local control or survival. However, for rhabdomyosarcoma in children, chemotherapy is an essential part of treatment.
The aim of this study was to assess the use of titanium mandibular reconstruction plates after cancer surgery. The medical records of 36 patients were reviewed. The mean follow-up was 22 months. All patients had primary reconstruction of the mandible with Leibinger titanium plates. Thirty patients underwent postoperative radiotherapy with the plate in the field. The mean dose was 60 Grays over 6 weeks and the overdosage into tissues was reduced to 5%. Thirty patients (83%) had retained the plate at 6 months and no sign of osteomyelitis was found in any patient. Quality of speech and deglutition were satisfactory in 63% and 94% of the patients respectively; sixty-six p. cent of them found their cosmetic appearance good or excellent. The overall success rate of the technique was 74%. This technique did not excessively prolong operating time unlike microvascular transfer. Plates are an effective method of primary reconstruction in patients with advanced cancer and uncertain long-term survival. Tolerance of plates after radiotherapy is outstanding. Speech, deglutition and facial contour are immediately restored and further bone reconstruction is feasible.
Head and neck bone sarcomas are very uncommon tumors. Therefore, treatment modalities are not clearly established. The medical record of 12 patients with bone sarcoma of the jaw were reviewed. Six patients with osteosarcoma underwent primary chemotherapy followed by wide surgical resection, radiation therapy or combined radiosurgical treatment. The 2 and 5 years survivals were 66% and 40% respectively. Five patients with chondrosarcoma were treated by wide surgical resection alone or combined with postoperative radiotherapy and possibly chemotherapy. All patients were alive; the mean follow-up was 9 years. One patient had Ewing's tumor. Osteosarcoma and chondrosarcoma in head and neck patients have a high rate of local recurrences. Surgery is the mainstay of treatment. Patients with voluminous tumors and high-grade lesions should receive postoperative radiotherapy. The role of chemotherapy has not been defined.
Since the first description in 1970, by F. X. Michelet, of the use of the mini plate system in maxillo-facial surgery, if the fundamental principles remain the same, the equipment has been constantly improved. The plates have been modified in structure and shape, the screws becoming self-tapping and self-drilling and finally self-breaking. The head of the screw has diminished to the point of not going over the level of the plate. The ancillary material is now more performing and easier to use. The authors have presented 3 years ago a new self breaking screw of which they now explain the technical and biomechanical bases, the necessities and the indications insisting on the numerous advantages of this system.
The authors present a new technique of face lift via a temporal approach which allows them to perform a "Total SMAS Lift" of the supra- and infra-zygomatic region. They use the passage on the deep side of the superficial layer of the temporal fascia, which avoids damage to the frontal branch of the facial nerve. Undermining of the periorbital area is performed under the muscle, but above the periosteum of the malar bone. This technique is situated between the subcutaneous face lift and the superiostal mask-lift. This technique can also be combined with a frontal or cervico-facial lift. This "Total SMAS Lift" is essentially indicated in patients with early ptosis of the cheek, the peri-orbital area ant the naso-labial folds and the aesthetic results are gratifying.
The authors report a new technique for the reconstruction of upper eyelid full thickness tissue losses in preserving the inferior edge. They describe a myo-cutaneous inferior eyelid flap which has been preliminarily expanded before transposition. An anatomical study has demonstrated vascularization and innervation of the myo-cutaneous eyelid flap which will remain active. A clinical case presentation confirms a good aesthetic but also functional result with a transferred active orbicularis muscle which allows the regain of a dynamic upper eyelid.
The use of combined craniofacial resection is well established for tumors of the ethmoid bone and the anterior aspect of the base of the skull. Mobilization of the medial fronto-orbital ridge improves the transbasal approach and can be performed with a monobloc bone flap. We describe an en bloc bifrontal craniotomy including the supraorbital ridges and the nasal bones. This provides a wider angle of approach to the anterior aspect of the base of the skull than any other method and avoids retraction of the frontal lobes. This type of bone flap procedure can be performed after a wide periosteal dissection in the coronal area of the scalp alone, without facial skin incision.
We report an unusual case of eating dystonia induced by attempts to bite into hard food and resulting in prolonged jaw opening spasms. Mastication was severely impeded. Simultaneous bilateral electromyogram (EMG) of the masticatory muscles during mastication of hard food showed an abnormal prolonged activity in the anterior digastrics with an abnormal cocontraction of these muscles during contraction of the jaw-closers and a prolonged inhibition of the jaw-closers until the hard bolus was softened. This action dystonia seems to be triggered when more than a certain pressure is exerted on the peridontal mechanoreceptors and could result from a defective central command control of their sensory inputs. Local injections of botulinum toxin had little effect.
Authors present a Barraquer-Simons syndrome case. After a quick historical account, they look at the study of the clinical case. They present the different treatments undertaken in order to correct the two different types of anomaly of this syndrome: these are complementary treatments because they consist in taking the fat in excess in the lower half of the body and reinject it in the face. The different etiopathogenic hypothesis are tackled. To conclude, authors insist on the excellent result obtained after a lipo-aspiration: but they notice a near disappearance of the reinjected fat at the face after 4 years. Anyway, lipo-filling can be renewed without risks for the patient and can be an interesting palliative solution.
Cerebral SPECT studies with N-isopropyl-iodo-amphetamine (123I) (IMP) were performed in patients who had suffered cranio-facial trauma, with and without loss of consciousness (LOC). The results were compared with computed tomography (CT). Nine out of ten of those with LOC had normal CT scans and evident photopaenia in IMP studies. It is clear that IMP SPECT scans complement CT in the investigation of patients who have suffered cranio-facial trauma.
Fifteen patients underwent surgery for retromandibular parotid, pharyngeal, or posterior tongue tumors. Surgical approach to the pterygomaxillary fossa, parapharyngeal space, and posterior tongue was performed by external cervical incision and lateral stair-step mandibulotomy. After resection of the tumors, the mandibular segments were replaced and secured with miniplates. The plates were removed after six weeks whenever postoperative radiation therapy was planned. By reflecting the ascending ramus, this method provides excellent exposure of the concerned areas. It makes unnecessary both incision of the lower lip and intermaxillary fixation with arch bars, thus allowing a quick resumption of oral feeding. A review of 15 patients demonstrated satisfactory results for mandibular function and morphologic appearance, with minimal complications.