Biomedical subjects
Publications and source records attributed to T Piral.
The authors present an anatomical study of the nasolabial flap and buccinator flap on 12 cadavers. This study was illustrated by 2 clinical cases: a case of reconstruction of the philtrum with a superiorly based nasolabial flap and a case of reconstruction combining an inferiorly based nasolabial flap and an ipsilateral anteriorly based musculomucosal buccinator flap.
In a five and a half year-old child, a voluminous mandibular cyst was discovered by a dental check-up. The originality of this case consisted in the great volume of this asymptomatic lesion and the anterior localization in the mandible. Treatment was surgical, conserving the deciduous teeth and the underlying germs. The histopathological examination of the lesion confirmed the clinical and radiological aspects of follicular cyst. A regular clinical and radiologic surveillance was necessary until bone regeneration was complete, the risk of per and post-operative fracture being major.
The authors report two well documented cases of absent posterior tibial artery in patients undergoing free fibula transplant. The first patient was a 50-year-old woman treated by pelvimandibulectomy for squamous cell carcinoma, leaving a defect of the floor of the mouth. The second case was an 11-year-old child with Ewing sarcoma of the femoral metaphysis, in whom femoral reconstruction was performed by vascularized free fibula transplant. Based on these two cases, the authors describe their diagnostic and therapeutic approach designed to avoid risks associated with this anatomical variant. Absence of the posterior tibial artery can be confirmed by arteriography and duplex ultrasound. The authors propose duplex ultrasound as first-line investigation as this safe, noninvasive examination provides sufficient information in the majority of cases at a lower cost. In parallel, the various anatomical variants affecting the origin of leg arteries from the popliteal artery are classified into seven groups based on a phylogenetic and embryological study.
A well-documented case of absence of the posterior tibial a. is reported. We have studied 40 personal case-records of dissection of the arteries of the leg in fresh corpses. This study allowed classification of the origins of the leg arteries from the popliteal a. into 7 groups. Several findings emerged: 1) the peroneal a. is constant, for phylogenetic and embryologic reasons, 2) the posterior tibial a. is absent in 1 to 5% of cases [1, 2, 4, 6-8] (Fig. 4), in which case the vascularisation of the fibula remains as normal (the proximal epiphysis of the fibula is vascularised by the anterior tibial a., the diaphysis and the distal epiphysis by the peroneal a.). Other anatomic variations may be found: trifurcation of the popliteal a., origin of the anterior tibial a. from the peroneal a., absence of the anterior tibial a., aplasia of the terminal portions of both the anterior and posterior tibial aa. In practice, absence of the posterior tibial a. can be demonstrated by arteriography and doppler ultrasound. We are dubious about the indications for arteriography, which is not always a risk-free examination, and therefore prefer doppler examination with ultrasound, which supplies adequate information in the majority of cases.
Three cases of permanent constriction of the jaw are reported. One was a sequela after a noma, the second occurred in a child with arthrogryposis and the third was an inborn malformation. Each case raised specific problems for diagnosis and treatment. Mechanicotherapy is essential postoperatively and requires a specific electric apparatus to mobilize the joint.
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We observed the case of a young woman with haemangiopericytoma in the subtemporal fossa. Diagnosis problems and the access route were discussed. Good exposure was achieved at the price of minor aesthetic and functional impairment. The prognosis of these potentially malignant tumors is uncertain.
Digitalized imaging now allows determination the "medio-labyrinthic" plane to analyse cephalic symmetry. It is constructed from the two "vestibions", central points of the rings of lateral semi-circular canals. Reconstruction parallels this plane, passing through the vestibions provide vestibular orientation, with effective and constant coïncidence between right and left directions. That being obtained, it is easy to visualise orientation of the entire cephalic region in the three incidences of "vestibular space", and to work out sections parallels to the three vestibular planes, allowing analysis of the symmetry of the studied elements.