Biomedical subjects
Publications and source records attributed to P Goudot.
An unexpected finding on histology in a 73 years old patient was an isolated suborbital plexiform neurofibroma. Since this tumor is specific for von Recklinghausen's disease, the diagnosis was that of a minor form of the disease. The different cephalic manifestations of von Recklinghausen's disease are reviewed.
Despite a thorough examination it is not always possible to detect the primary cancer responsible for malignant cervical adenopathy. In the vast majority of cases the metastases arise from an epidermoid carcinoma of the upper respiratory or digestive tract. A possible diagnostic, but also therapeutic procedure is exploratory cervicotomy with extemporaneous examination. The prognosis is poor, both locally (glandular involvement) and generally (metastatic spread).
Prevention against the transmission of the HIV must be universal today, which means that it applies to all patients. Blood, tissues, the CSF are infected, but nasal secreta, tears and saliva are not contaminated unless they contain blood. The statistical risk of an HIV serological conversion when making an injection is an estimate of 0.1 to 0.3%, one hundred times less than with the hepatitis B virus. The best protection for maxillofacial surgeons, who are very exposed by the manipulation of objects (needle, wires) and by considerable projections of blood (rotary motor) is not a systematic HIV serological test for all patients, but goggles with side screens, a double pair of gloves and the use of an antiseptic acting on the HIV in case of staining.
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In the case of a total loss of teeth, a conventional understanding of descriptive anatomy is no longer sufficient. It does not take into account: The principles of osteo-architecture allowing the distribution of different types of bone structure (Haversian, spongy, papyracious) to be understood; The mechanisms of bone resorption; The new anatomical relationships created by such resorption.
The temporomandibular joint (TM joint) is a synovial joint with two condylar surfaces and an intra-articular cartilaginous disc. Its development has two origins. Its physiology is complex and intimately related to dental occlusion, which is why we talk about the temporomandibular and dental joint. Recent neurophysiological data allow a better approach to TM joint dysfunction. The lateral pterygoid muscle plays decisive role in the pathogenesis of TM joint dysfunction.
Physiotherapy in association with mechanotherapy provides a functional treatment for T.M. algo-dysfunctional syndromes. The authors review the indications for this treatment and distinguish two varieties requiring different treatments: syndromes with a defect in propulsion and a limitation of mouth opening and syndromes with hyperpropulsion and subluxation.
64 patients with extra-nodal maxillo-facial NHL were seen between 1969 and 1989. These rare tumours (1 to 4% of stomatological tumours) tended to occur more often in men (60% of cases) between the ages of 40 and 70. Bony involvement was common (maxillary and mandibular involvement), though more rarely the salivary glands or mucosa were involved, presenting as a swelling with lysis of underlying bone. Highly malignant varieties (85% of cases) were most commonly encountered. The treatment remains medical, involving chemotherapy (C.H.O.P. or high dose methotrexate) and gives an actuarial survival rate of 50% at 3 years.
Based on 8 cases, the authors study the mechanisms involved in post-traumatic enophthalmos and demonstrate that they result from an increase in orbital volume. There are no grounds to suggest that the disappearance of orbital fat is involved.
The rare case reported here was a mandibular metastasis of a malignant melanoma located in the nape of the neck and surgically removed. 4 years later, occurred a fibrosarcomatous mandibular tumour without local recurrence. The metastatic nature of this tumour was difficult to prove by means of immunohistochemical and ultrastructural methods. This case illustrated the eventuality of a desmoplastic change in metastasis of a common malignant melanoma. The histogenesis of this rare type of melanoma was discussed.
A rare case of primary central squamous-cell carcinoma of the mandible is reported. Etiology, pathogenesis, clinical features and differential diagnosis are discussed.
The case reported here illustrates a rare variety of hereditary osteodysplasia, the pyknodysostosis. The patient, a 34-years-old man, had an history of prior fractures. He took medical advice for a mandibular osteitis consecutive to a tooth extraction. The clinical examination detected a dwarfism accompanied by cranial deformities and abbreviated terminal phalanges of the fingers. The histological study was performed on the mandibular sequestrum and on the adjacent bone. Besides of chronic osteitis, it exhibited an intense osteo-condensation with changes in collagen frame by polarized lumen. As to the 2 molars implanted in the sequestrum, they were ankylosed because of the loss of periodontal ligament. About this case, the differential diagnosis with osteopetrosis and cleidocranial dysostosis and the pathogenesis of the disease are discussed.
In a series of 570 pleomorphic adenomas of main and accessory salivary glands, we found 48 recurrences (8.04%). These recurrences occurred between several months and 19 years after surgical treatment. They were more frequently noted in parotid tumors. Comparatively to a control series, in recurrent tumors myxoid structures were more frequent than epithelial structures, as demonstrated by immuno-markings (anti-protein S 100 and anti-vimentin sera). Besides, in these tumors, extracapsular myxoid expansions were commonly seen. The proliferative potential of myoepithelial cells which are the main cellular component of myxoid areas, is thus suggested as a mainly factor of recurrence of pleomorphic adenomas.
1 case of circumscribed myositis ossificans of the temporal muscle is reported in a 21 years-old man. The initial complaint was a sudden non traumatic swelling. Roentgenography showed a characteristic feature: peripheral radio-opacity around a non-opacified area. Under microscope, we could find 3 zones: a central fibroblastic area, an intermediate zone with immature osteoid bone, a peripheral zone with mature lamellar bone. In addition, we used histoenzymological and electron microscopical methods. The difficulties of diagnosis, the pathogenesis and the prognosis of this disease were also discussed.
A large cyst of mandibular angle was surgically removed in a 20 years-old woman. This cyst was discovered during childhood and was associated with a branchial para-mandibular cyst. It was histologically lined either with a malpighian epithelium with sebaceous islands or with a ciliated cylindrical epithelium. Because of its topography, its association with a branchial cyst and its histological feature quite similar to that of a cyst of thyroglossal duct, this cyst was thought to represent a simplified salivary ectopy composed only of a cystic secretory duct without any salivary parenchyma.
The authors report their initial conclusions regarding the value of M.R.I. in the investigation of temporo-mandibular joint dysfunction. This examination was performed for all varieties of symptomatology: musculo-ligamentary, menisco-ligamentary or meniscal. A detailed examination technic is given. M.R.I. enables meniscal abnormalities to be demonstrated: morphological and positional abnormalities (reducible and irreducible anterior luxations) and structural abnormalities similar to those seen in meniscal pathology within the knee joint.
We report two cases of mechanical limitation of buccal opening. CT scanning of bone anomalies diagnosed on standard radiography allowed to define malformation of the coronoid piston on the one hand, and the temporo-malar groove on the other: a combination of Langenbeck's and Jacob's disease in one case and Langenbeck's disease in the other. Coronoidectomy, systematically bilateral, demonstrated these morphological anomalies together with formation of coronoido-malar neo-arthrosis.