Biomedical subjects
Publications and source records attributed to P Goudot.
The authors relate the case of two patients of 61 and 64 years old, each one having a high latero-cervical tumor, arching the soft palate, developed from the right vagus nerve and which was a chromaffin paraganglioma. After a recall about the APUD system tumors and the "paraganglioma" concept, they relate their observations at state of the vagal paraganglioma histology, pathology and treatment.
A case of cholesteatoma of the ethmoid extending to the orbit is reported. These cholesteatomas of facial sinuses are rarely reported, those documented involving localization in maxillary or frontal, or ethmoido-frontal or ethmoido-maxillary sinuses. Primary perisinusal cholesteatomas of embryonic origin must be distinguished from the rarer secondary iatrogenic or post-traumatic lesions. Histopathology allows distinction between epidermoid cysts and cholesterol type granulomas. Treatment is by surgery using a wide approach.
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A case of post-traumatic false aneurysm of a segment of the zygomato-malar artery is used as a basis for a discussion of this fairly rare complication of facial injuries and the complementarity of angiographic examinations and surgical exploration findings.
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Fossil mandibles from the "La Chapelle-aux-Saints" Man and Cro-Magnon "old man" are considered to be representative of Neanderthal and Cro-Magnon era. Radiographic studies of such mandibles - including C. T. Scan and panoramic views in common use in maxillofacial surgery - allowed the authors to make useful comments: the mandibular canals are nearly similar to those in Modern Man and quite different from those in Pongidae; the imaging was of adequate quality for a good evaluation of fossil internal structures.
Electrophysiological studies of the rather strange, enigmatic, likely vestigial omohyoid muscle led the authors to point out the dual nature of its two bellies. Electromyographically, the inferior belly with a nearly constant activity may be opposed to the superior belly with intermittent activity. Motor nerve stimulation combined with electromyographic study demonstrated the superior belly to be supplied by the ansa cervicalis while the inferior belly is supplied by the accessory nerve. Based on these findings, anatomical studies conducted with histological examination were consistent with this double innervation.
A two years old girl developed orbital infection secondary to dental trauma. Computed tomographic scanning of the orbit shows subperiosteal abcess in the medial orbital wall and proptosis of left globe. Teeth removal, appropriate antibiotics and surgical drainage are essential for preservation of vision.
A case of cutaneous salivary fistula is presented. A 42-year-old man had a recurrent inflammatory parotid disease which disappeared with the expulsion of the calculus. The authors note the rarity of this evolution in the literature and suggest a protocol of treatment.
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46 cases of acquired immunodeficiency syndrome permit the authors to detail the particular aspects of the oral and facial lesions in AIDS. In patients at risk, a lymphadenopathic syndrome is thought to represent a prodromic phase of the illness. The authors insist upon the differences between the classic Kaposi's sarcoma and that associated with the AIDS (mean age and initial sites of tumor). One third of these sarcomas is completed by a digestive candidiasis. The review of the literature reveals squamous cell carcinoma and Burkitt's lymphoma with the AIDS. We must be aware of early diagnosis and transmission factors in the individuals at risk with tumors and opportunistic infection.
Results are reported of the use of 93 musculocutaneous flaps, distinction being drawn between those used for secondary reconstruction and those employed during surgical excision. Secondary flaps were used to close 19 pharyngostomies, 10 orostomies, and 2 necrotic skin lesions, and for reconstruction of a circular pharyngectomy. Large radiation doses had been given in 29 of these 32 patients. Treatment was a total failure in 3 cases, and was partially ineffective in 5 patients, with the need for alternative surgery. Flaps obtained during initial surgery (57 cases) included 33 patients treated by radiation. Partial healing was obtained in 5 cases but the treatment was unsuccessful in 4 cases: all on previously radiated tissue. Unfavourable factors are mainly previous radiation and the hypopharyngeal site of loss of substance. Indications for the different types of flap are discussed.
The authors preferred the term of "fracture of the posterior arch of the axis", rather than the restrictive terms of bipedicular or bi-isthmic fractures commonly referred to in the literature. It was possible, from 34 cases to joint out 4 different figures of fractures of the posterior arch of axis: isthmus, body and articular process, pedicle and lamina. From this classification it is possible to get indications for surgical treatment, as some of those fractures need internal fixation and others not. On completing Xrays study with research of instability between C2-C3 it's possible to fix a standard management for those fractures. --at first reduction for many patients, then --immobilisation by a minerva cart in mostly cases --or surgical approach and internal fixation in case of diastasis or of bad reduction --anterior arthrodesis if needed (anterior instability) --or both posterior fixation and anterior arthrodesis.
The value of short-term prophylaxis with antibiotics in maxillo-facial surgery and plastic facial surgery is studied. 200 patients were included in the study and compared to 200 controls who were given the usual systematic antibiotic therapy, with a different antibiotic, for more than 6 days. 400 case-reports were thus retrospectively analyzed. The results show that when the surgical procedure lasts for less than three hours, short-term prophylaxis with antibiotics is more effective than the usual systematic antibiotic therapy given for more than 6 days.
Surgical treatment of post-traumatic major loss of substance of the palate is reviewed, injuries in the series studied resulting from projectiles. The extensive loss of substance excludes the use of a mucous reservoir and skin grafts have to be employed. Free micro-anastomotic flaps represent a marked progress, as rapid results can be obtained, but these are not always totally effective. Pedicular flaps may have to be used, either of regional origin (cheek, neck, forehead, pectoral region) or from other zones (abdomen, internal surface of the arm). This allows effective, durable obturation of the palatine breach, and the application of the mobilized tissue to associated lesions that, because of the etiology, are almost always present.
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