Biomedical subjects
Publications and source records attributed to D Goga.
Morbidity of cancer treatments is well-known. Postradiation sarcomas have been reported though the relative risk is considered to be low. We report a case of osteogenic sarcoma of the face occurring 13 years after irradiation and chemotherapy of bilateral retinoblastoma. In this case chemotherapy, irradiation in the first years of life and retinoblastoma increased the risk of postradiation sarcoma.
Reconstruction of facial skin defects after cancer surgery or trauma with conventional flaps can give a poor cosmetic result when a thick flap is used to replace thin skin. The thickness of the flap can be a disadvantage to replacing a thin skin. Defatting the flap can resolve these situations, using the principle of Colson's flap. This operative procedure is safe, and improves the cosmetic results. The authors report a series of 21 full-thickness skin defects located at the junction of two or three regional units. The defects were repaired with total or partial undermining flap (frontal, nasoiabial, cheek flaps). The viability of these reconstructions was perfect and the cosmetic results fairly esthetic in comparison with conventional flaps.
A case of chondroblastoma of the temporomandibular area in a 56 years old female patient is presented. We proposed a discussion about clinical, histological diagnosis and therapy.
Nowadays, the place of psychiatrist is currently admitted in facial plastic surgery, but is still discussed in reconstructive surgery. This page will stress the importance of a cooperation between surgeon and psychiatrist, preoperatively in orthognathic surgery. After a brief review of literature, we will try to precise when psychiatrist's advice would help, preoperatively, maxillofacial surgeon. On the other end, we will see that psychiatrist having in charge patients with major facial deformity can head them to undergo a reparatrice surgery. A clinical case will end this paper.
Seven cases of primary skin neuroendocrine carcinoma or Merkel cell tumours with cervico-facial localization are reported. The poor prognosis of these tumours is essentially due to the potential for local recurrence and the frequency of locoregional and visceral metastasis. Surgical treatment is required but rarely sufficient to control the disease. Complementary radiotherapy, when performed early, can reduce the rate of locoregional recurrence. Lymph node resection is important to determine prognosis but has not been proven to improve outcome. In addition, parotid metastasis appears to result from blood stream dissemination and has a very poor prognosis. Exclusive radiotherapy may be discussed in such cases.
Actually, oral medicine and maxillo-facial surgery are really moving. There is no detail's study of the different aspects of our specialty, so we had like to realise a "picture" of our activity in the private sector in 1993. In this evaluation, an answering has been sent to the whole professional. Per 37.2% of answers have been received. The aim of this article is describing you the oral medicine and maxillo-facial surgery population following, in 4 points: old and sex demography; university and post-university formation; surgical or no activity repartition; exercises and installations.
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Clinical and radiological involvement of the temporomandibular joint (TMJ) in rheumatoid arthritis (RA) varies greatly in the literature. Clinical and tomographic (sagittal plane) examination of the TMJ was performed in 26 patients with RA and 26 control subjects. Sixty-one per cent of the RA group had physical signs in the TMJ, compared with 42% in the control group (NS). Sixty-nine per cent of the RA group had erosive or cystic lesions of the TMJ compared with 31% of control subjects (P < 0.01). The clinical dysfunction score did not correlate with the tomographic TMJ score in patients with RA. It was found that a wide range of tomographic abnormalities occurs in patients with RA and in patients without the disease, and that there are no tomographic abnormalities specific for RA; however, the incidence of erosions and cysts of the mandibular condyle are significantly higher in patients with RA (P < 0.01), and should suggest the diagnosis. It was also found that there is no correlation between the clinical and tomographic findings of the TMJ in RA, and that the intensity of destructive lesions of the TMJ on tomography in RA is well correlated to the severity of the disease (evaluated with clinical and laboratory features).
Direct coronal computed tomography (CT) of the temporomandibular joint (TMJ) was performed in 26 patients with rheumatoid arthritis (RA) and 26 control subjects. Erosions and cysts of the mandibular condyle had a significantly higher frequency in the RA group than in the control group (p < 0.05) but there was no significant difference in the incidence of other abnormalities. Bone changes were bilateral in RA. A wide range of CT abnormalities was present in patients with RA and in the control group. There are no CT abnormalities specific for RA, but the incidence of erosions and cysts of the mandibular condyle was significantly higher in the RA group and should suggest the diagnosis.
Bony substitutes are in fashion in maxillofacial surgery. They are used to fill bony cavities, in bony reconstruction to give shape-lines and re-create area of support or to fill bony defects. Then their use is frequently crowned by success in general surgery, it is not the same thing in maxillofacial surgery because of the usual impossibility to fulfil a requirement to biomaterial utilisation: the watertight. Furthermore, they don't have yet, for the most part, an essential quality: malleability. In our experience, their use are frequently disappointing because of postoperative infections and we stay faithful to the autograft bone. However it is highly probable that these biomaterials will take an importance more and more considerable when these problems will be overcame.
Clinical and CT scan abnormalities of the temporomandibular joint in rheumatoid arthritis have been little studied in the literature. The temporomandibular joint was examined clinically and by CT scan in 26 patients with rheumatoid arthritis and 26 controls. In the rheumatoid arthritis group, 61.2% of patients had physical signs of temporomandibular disease as compared with 42.3% of the controls. 88.4% of rheumatoid arthritis had erosive or geodic lesions of the temporomandibular joint by CT scan as compared with 57.6% of the controls (p less than 0.05). The temporomandibular clinical score was not correlated with CT scan score in rheumatoid arthritis. CT scan score was correlated with the number of basic drugs used, rheumatoid factor levels and radiological scores of the hands and cervical spine. The authors feel that the only CT scan abnormalities specific to rheumatoid arthritis consist of erosive and geodic lesions of the mandibular condyle, that there is no correlation between clinical and CT scan abnormalities of the temporomandibular joint in rheumatoid arthritis and that the extent of destructive lesions of the temporomandibular joint by CT scan in rheumatoid arthritis is closely correlated with the severity of the disease.
Direct coronal computed tomography (CT) examination of the temporomandibular joint (TMJ) was performed in 26 patients with rheumatoid arthritis (RA) and 26 control subjects. Changes in condylar shape, erosions and cysts of the mandibular condyle and condylar head resorption were more frequent among the RA group than the control group. Only the erosions and cysts of the mandibular condyle had a significantly higher frequency in the RA group than in the control group (p less than 0.05). Bone changes were bilateral in RA. Coronal view of the CT examination allow a clear visualization of the osseous elements of the TMJ but a control group is absolutely necessary to affirm with certainty the rheumatoid origin of the bone changes. The erosions and cysts of the mandibular condyle and their bilateral nature are the most specific features of RA on TMJ.
Injuries, osteomyelitis, tumors are responsible of large skull defects. Their management is difficult. Three post traumatic and post infectious defects were repaired with an osteoperiostic flap taken from the internal face of the femur. A large defect due to the removal of a metastatic tumor was repaired with an iliac osseous flap. The choice of the donor site depends on the defect size (the femur provides a flap of 13 cm x 8 cm, the iliac bone a flap of 17 x 17 cm). The three head injured patients had a range of six previous unsuccessful surgical attempts using polymerised material or bone grafts. The post operative course in the post traumatic patients was uneventful, the domestic result good, the periostic consolidation less than three months. The free flap seems a good method for the management of risky cases.
Rybka's flap is an island myocutaneous sliding flap, based on the lower portion of the nasalis muscle. It takes advantage of a constant and reliable arterial pedicle. It presents an aesthetic advantage, respecting natural creases lines. It does not take the place of the other tip reconstruction methods, but it must belong to them on account of its trumps.
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The medial canthus is a surgical entity. The anatomical features are defined from a dissection of eight orbital regions. The pathways of carcinological invasion and the anatomical barriers are considered. The conclusions are discussed in the light of the data reported in the literature.
Surgical exeresis and radiation therapy are effective means of treatment for facial carcinomas. In some areas that are difficult to manage (nose, ears, periorbital region), the respective importance of both approaches is discussed. We report on the retrospective study of 309 patients seen after a skin carcinology consultation in which a dermatologist, a surgeon and a radiotherapist were associated. These 309 patients, with a mean age of 73 years, presented with 375 carcinomas, i.e. 246 basal-cell (BC) and 119 epidermoid (EC) carcinomas. The most frequent sites were the nose (33.8% of BC), the inner canthus (12.7% of BC), the lower lip (23.8% of EC) and the ear (15.6% of EC). Management mainly consisted of surgery (50.8%) then Curie therapy (37%). The rate of recurrence was the same (10.5%) after surgery and radiation therapy. The study of the results leads us to advocating surgery for carcinomas of the ear (due to the occurrence of radiation necrosis in every third case after radiation therapy) and Curie therapy for carcinomas of the lower lid (except the inner canthus) because of recurrence in every second case treated with surgery. We currently prefer surgery for carcinomas of the lower lip (radiodermatitis in 11.8% of cases) and Curie therapy for the nose (lower rate of recurrence than with surgery). However, in the last two cases, the proposals for treatment should be confirmed by randomized studies. Thus facial carcinomas of the skin surrounding the orifices of the face and/or those that affect patients who are difficult to treat must be seen during a skin carcinology consultation by a dermatologist, a surgeon and a radiotherapist working together.(ABSTRACT TRUNCATED AT 250 WORDS)
The authors report a retrospective study of 47 cases of carcinoma of the medial canthal area which were operated on between 1982 and 1987. Patient age and the histological frequency of basal cell carcinoma were similar to those of studies previously reported. Local extension must be evaluated at the initial clinical examination and computed tomography can be very useful. Frozen section for histopathologic study should be done if there is the least doubt. The surgical treatment and different methods of local reconstruction are discussed.