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ABSTRACT: The aneurysmal bone cyst is a rare, expansive, osteolytic, pseudocystic lesion with an unknown etiology. It usually affects long bones and the spine. Two to 5 % of cases have mandibular localization (between 75 and 100 % present on the mandible) accounting for 1 % of all mandibular cysts. Less than 200 cases have been reported in English and French literature.
Revue de stomatologie et de chirurgie maxillo-faciale 10/2009; 110(6):329-34. · 0.35 Impact Factor
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ABSTRACT: Metastatic disease of the jaws is unusual and accounts for 1 to 4% of oral cavity malignancies. Jaw metastases from the gastrointestinal (GI) tract usually evolve from adenocarcinoma of the esophagus, colon, and rectum. Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the GI tract defined by a positive C-Kit (CD117). These tumors are thought to arise from Cajal cells in GI tract walls, essential for intestine motor function. The small intestine harbors only 30% of GIST. After reviewing the literature, no case of jaw metastases from GIST was found. The purpose of this study was to report the first case of mandibular metastases arising from a stromal tumor of the ileum.
A 68-year-old man presented with a painful swelling in the parasymphysis and left molar mandibular area having grown progressively for 3 weeks. The oral mucosa was macroscopically normal. The orthopantomograph showed radiolucency. A CT-Scan revealed an irregular osteolytic lesion with invasion of soft-tissues. Biopsy proved a stromal tumor. A complete CT-Scan analysis revealed an ileum tumor. Biopsies and immunochemistry proved an ileum stromal tumor. All tumoral cells expressed the C-Kit in the ileum and the mandible. The patient was treated with imatinib but died 11 months after the diagnosis.
The prevalence of GIST is low but the true incidence may be higher because of under-diagnosis. To our knowledge, this is the first well-documented case report of jaw metastasis from ileum GIST. GIST should be included in the differential diagnosis of intramandibular tumor in patients with prior or current non-oral malignancy.
Revue de Stomatologie et de Chirurgie Maxillo-faciale 12/2008; 109(6):399-402. · 0.25 Impact Factor
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ABSTRACT: Facial reconstruction technique can be simple or complicated. The choice of performing a flap is made according to several criteria. Since its first description the submental flap has been used in several indications. The aim of this article was to document maxillofacial surgeons on this flap technique. ANATOMY: The submental artery is a major branch of the facial artery. This artery runs medial to the mandible and ends next to the mandibular symphysis. The submental artery supplies the submandibular lymph nodes, submandibular salivary gland, mylohyoid and digastric muscles, and the skin of the chin. The submental vein drains the tissues of the chin as well as the submandibular region.
The integrity of the facial artery is a sine qua none condition before performing this flap. It is important that the submandibular gland and the submental vessels be well exposed. The anterior belly of the homolateral digastric muscle must be included in the flap. The donor side is closed after a large subcutaneous dissection of the neck and chin.
The pedicled submental flap is indicated in defects of the oral cavity and the lower two-thirds of the face.
The submental flap is relatively easy to raise. This flap avoids dyschromia and provides soft-tissues presenting with the same quality as that of the tissue surrounding the defect. Sequels on the donor side are minor. DISADVANTAGES: The submental flap is not indicated if a submental neck dissection is needed or in case of intraoral/frontal reconstruction with bearded skin. The submental flap is a simple and reliable procedure, with good aesthetics results and minor sequels.
Revue de Stomatologie et de Chirurgie Maxillo-faciale 07/2007; 108(3):210-4. · 0.25 Impact Factor
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ABSTRACT: The technique used for reconstruction of a cervicofacial defect depends on the extent of the tissue loss. Locoregional or free flaps are commonly used for this type of reconstruction. The type of flap used depends on donor site availability and morbidity. The aim of this technical note was to present appropriate use of the fascia temporalis flap in maxillofacial surgery. ANATOMIC BASIS: The superficial fascia temporalis lies just under the scalp. Blood is supplied via the superficial temporal artery which widely irrigates this anatomic region. Venous blood is drained by the superficial temporal vein and the posterior auricular vein.
First, the skin flap is drawn after determining the required size and length of the vascular pedicle. The T or Y incision enables complete exposure of the superficial fascia temporalis and the temporal vessels. The superficial fascia temporalis fascia is then resected at the desired size and easily dissected from the deep temporal fascia via the avascular plane. This dissection is easily achieved manually using a compress.
This flap can be used in the auricular region, for commissural reconstruction to ensure facial motricity, for eyelids defects, for defects in the frontal or zygomatic area and for defects of the palate or labial or cheek mucosa.
This flap can be raised rapidly and easily without any specific requierment. The flap is reliable and allows a long pedicle. The superficial fascia temporalis is thin and easily remodeled. The scar at the donor site is masked by the hair. DRAWBACKS: This flap may not be available in the event of previous trauma or surgery with a high risk of injury to the temporal vessels. This flap is not suitable in patients with prior irradiation exposure or malformatve disease (Franceschetti's syndrome, hemifacial atrophy etc.). Facial palsy due to facial nerve injury, sensorial disorders or local alopecia can develop post-operatively. For reconstruction of the lower third of the face, other flaps should be preferred.
Revue de Stomatologie et de Chirurgie Maxillo-faciale 05/2007; 108(2):120-7. · 0.25 Impact Factor
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ABSTRACT: IntroductionThe technique used for reconstruction of a cervicofacial defect depends on the extent of the tissue loss. Locoregional or free flaps are commonly used for this type of reconstruction. The type of flap used depends on donor site availability and morbidity. The aim of this technical note was to present appropriate use of the fascia temporalis flap in maxillofacial surgery.Anatomic basisThe superficial fascia temporalis lies just under the scalp. Blood is supplied via the superficial temporal artery which widely irrigates this anatomic region. Venous blood is drained by the superficial temporal vein and the posterior auricular vein.Surgical techniqueFirst, the skin flap is drawn after determining the required size and length of the vascular pedicle. The T or Y incision enables complete exposure of the superficial fascia temporalis and the temporal vessels. The superficial fascia temporalis fascia is then resected at the desired size and easily dissected from the deep temporal fascia via the avascular plane. This dissection is easily achieved manually using a compress.IndicationsThis flap can be used in the auricular region, for commissural reconstruction to ensure facial motricity, for eyelids defects, for defects in the frontal or zygomatic area and for defects of the palate or labial or cheek mucosa.AdvantagesThis flap can be raised rapidly and easily without any specific requierment. The flap is reliable and allows a long pedicle. The superficial fascia temporalis is thin and easily remodeled. The scar at the donor site is masked by the hair.DrawbacksThis flap may not be available in the event of previous trauma or surgery with a high risk of injury to the temporal vessels. This flap is not suitable in patients with prior irradiation exposure or malformatve disease (Franceschetti's syndrome, hemifacial atrophy etc.). Facial palsy due to facial nerve injury, sensorial disorders or local alopecia can develop post-operatively. For reconstruction of the lower third of the face, other flaps should be preferred.RésuméIntroductionDans les pertes de substance molle cervicofaciales, le type de reconstruction dépend de la zone défectueuse. À partir d'une certaine taille, cette reconstruction est réalisée grâce à des lambeaux locorégionaux ou à distance. Cependant, la morbidité liée aux sites donneurs peut conduire à proposer un type de lambeau plutôt qu'un autre. Nous rappelons dans cette note technique la place du lambeau de fascia temporal superficiel pédiculé dans la reconstruction des pertes de substance molle en chirurgie maxillofaciale.Bases anatomiquesLe fascia temporal superficiel constitue l'un des plans de couverture crânienne avec le cuir chevelu, le fascia préaponévrotique, l'aponévrose temporale profonde et le quatrième plan, le muscle temporal. La vascularisation artérielle de la région est assurée par un réseau dense qui provient principalement de l'artère temporale superficielle et le drainage veineux se fait par les veines temporales superficielles et auriculaires postérieures.Technique chirurgicaleLa voie d'abord peut être en « Y » ou en « T » avec une partie hémicoronale verticale préauriculaire prolongée selon l'axe des vaisseaux temporaux superficiels. Pour découvrir la face superficielle du fascia temporal superficiel, le décollement des lambeaux de scalp impose une dissection difficile et artificielle au bistouri à lame au ras des follicules pileux, afin d'emporter le plan veineux. Dans la région préauriculaire, les vaisseaux sont repérés dans le tissu cellulo-adipeux. La face superficielle étant exposée, la levée du lambeau se fait par une incision des contours à la demande, avec ligature manuelle ou mécanique des branches vasculaires les plus importantes en convergeant vers le pédicule. La pleine épaisseur du fascia temporal superficiel est utilisée, incluant tous les tissus situés entre les follicules pileux et le périoste. Le décollement de la face profonde est aisé, s'effectuant dans un plan classiquement avasculaire et facilement clivable, grâce à une compresse.IndicationsIl peut être indiqué dans les pertes de substance du pavillon auriculaire, la réanimation de la commissure labiale, les reconstructions conjonctivopalpébrales ou du sourcil, les pertes de substance cutanées ou sous-cutanées frontomalaires et les pertes de substance de la muqueuse palatine, labiale ou jugale.Contre-indicationsIl peut être contre-indiqué en cas d'antécédent chirurgical ou traumatologique ayant altéré la vascularisation régionale, d'antécédent d'irradiation ou d'une malformation (syndrome de Franceschetti, atrophie hémifaciale etc.).AvantagesIl s'agit d'un lambeau dont la levée est relativement facile, rapide, fiable et ne requérant aucune technicité particulière. Il a un grand arc de rotation à partir du conduit auditif externe et grâce à sa finesse, il est facilement pliable. La cicatrice est peu visible.InconvénientsIls sont souvent liés au site donneur : une paralysie de la branche frontale du nerf facial, troubles sensitifs du site donneur et une alopécie en bande. Il est recommandé de lui préférer d'autres types de reconstructions dans les pertes de substance du tiers inférieur de la face.
Revue de Stomatologie et de Chirurgie Maxillo-faciale. 108(2):120-127.
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ABSTRACT: IntroductionFacial reconstruction technique can be simple or complicated. The choice of performing a flap is made according to several criteria. Since its first description the submental flap has been used in several indications. The aim of this article was to document maxillofacial surgeons on this flap technique.AnatomyThe submental artery is a major branch of the facial artery. This artery runs medial to the mandible and ends next to the mandibular symphysis. The submental artery supplies the submandibular lymph nodes, submandibular salivary gland, mylohyoid and digastric muscles, and the skin of the chin. The submental vein drains the tissues of the chin as well as the submandibular region.TechniqueThe integrity of the facial artery is a sine qua none condition before performing this flap. It is important that the submandibular gland and the submental vessels be well exposed. The anterior belly of the homolateral digastric muscle must be included in the flap. The donor side is closed after a large subcutaneous dissection of the neck and chin.IndicationsThe pedicled submental flap is indicated in defects of the oral cavity and the lower two-thirds of the face.AdvantagesThe submental flap is relatively easy to raise. This flap avoids dyschromia and provides soft-tissues presenting with the same quality as that of the tissue surrounding the defect. Sequels on the donor side are minor.DisadvantagesThe submental flap is not indicated if a submental neck dissection is needed or in case of intraoral/frontal reconstruction with bearded skin. The submental flap is a simple and reliable procedure, with good aesthetics results and minor sequels.RésuméIntroductionLa reconstruction des pertes de substance de la face nécessite une technique plus ou moins simple. Le choix d'un lambeau dépend de plusieurs critères. Depuis sa première description le lambeau sous-mental a été utilisé dans plusieurs indications. Le but de cet article est de décrire la réalisation de ce lambeau pour qu'il trouve sa place en chirurgie maxillofaciale.Rappels anatomiquesL'artère sous-mentonnière est une branche constante de l'artère faciale se terminant à proximité de la symphyse mandibulaire par un plexus sous-dermique s'anastomosant avec son homologue controlatérale. Elle donne des collatérales destinées aux structures de toute la région. Le drainage veineux régional est assuré par la veine sous-mentonnière constante.Technique de prélèvementLa palpation du pouls de l'artère faciale est un préalable. La dissection du lambeau commence par la dissection et une bonne exposition de la glande sous-mandibulaire afin d'exposer les vaisseaux sous-mentaux et faciaux. Le ventre antérieur du muscle digastrique homolatéral est inclus dans le lambeau. La fermeture du site donneur se fait après un décollement sous-cutané cervical et réalisation d'un angle cervicomentonnier, en deux plans.IndicationsLe lambeau sous-mental pédiculé est indiqué en chirurgie maxillofaciale dans les pertes de substance intraorales et pertes de substance cutanées des deux tiers inférieurs de la face.AvantagesIl s'agit d'un lambeau relativement simple à prélever. Les dyschromies et la différence de texture entre ce lambeau et les tissus environnants sont très nettement atténuées et les séquelles liées au site donneur sont faibles.InconvénientsIl ne peut être effectué en cas de nécessité d'un évidement sous-mental. Le caractère pileux peut limiter certaines reconstructions. Le lambeau sous-mental est fiable, versatile, évite les dyschromies et expose à peu de séquelles. Sa place est toute trouvée en chirurgie maxillofaciale.
Revue de Stomatologie et de Chirurgie Maxillo-faciale. 108(3):210-214.
