Biomedical subjects
Publications and source records attributed to P Laudenbach.
The authors present a case of a giant cell tumor of the mandibular condyle, which is a very rare condition. Clinical history and symptoms suggested a disease of the ear. There was a destruction of the cortex of the condyle an invasion of the joint cavity, and an erosion of the adjacent temporal bone.
A schedule for radiological exploration of the temporomandibular joint is proposed which is simple, easily reproducible from one subject to another, under any circumstances, and which employs a restricted number of projections. It can also be used for complete examination of the dental arches, the mandible, and the total face, a series which cannot be dissociated either physiologically or pathologically.
Radiological examination of maxillofacial injuries, though difficult in patients with multiple lesions, should be rigorously conducted and be as complete as possible, depending on the results of clinical investigation. Initially, it must include at least the basic cranial projections: profile, high anteroposterior, Worms, low anteroposterior, and finally Blondeau. Secondarily, or immediately in less severe or isolated maxillofacial injuries: multiple anteroposterior projections by discontinuous scanning for better analysis of fracture lines or disjunctions, computed tomography in three planes, a panoramic radiograph, and particular projections depending on clinical findings and results of initial radiological examination. The CI scan, rapidly becoming more perfected, is essential in skull injuries with brain damage.
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Biopsies of the labial accessory (144 cases) or principal (4 cases) salivary glands were performed in 139 patients with clinically and biologically confirmed Sjögren's syndrome, and 9 patients with rheumatoid arthritis alone to act as control. Confirmation of diagnosis was obtained in both isolated cases (31 p. cent) and those with associated collagen disease (69 p. cent). Histological lesions were classified in 3 stages of increasing severity. Stage I cases had ectasia of several distal canals which, in the absence of significant lymphocytic reactions, permitted early diagnosis. In stage II, a typical appearance was noted: abundant nodular or diffuse lymphocytic infiltration with an increase in numbers of ectasias. In stage III of acini destruction, the dominant feature was diffuse peri- and intralobular sclerosis and only rare lymphocytes. Is, therefore, distal canal dilation the most reliable diagnostic sign of the syndrome, which has been shown by ultrastructural studies to arise from massive destruction, followed by anarchic regeneration, of myoepithelial cells that ensure canal contractility. These 3 histologically-defined stages generally correlate well with those normally employed to grade sialographic images (stage I, initial, showing miliary filling defects; stage II with larger rounded areas and penetration of the contrast medium into tissues around the canal; stage III demonstrating the "dead tree" appearance together with lack of contrast medium extension beyond Stenon's duct and its main branches). However, certain discordances were noted, histological signs sometimes preceding sialographic modifications. Biopsy of accessory salivary glands could be the most simple, reliable method for confirming diagnosis of Sjögren's syndrome in its early stages.
Clinical and radiological results of an antirejection therapy based on the local action of a thyroid hormone, thyrocalcitonin, were studied. A double action was noted as it may stop the rhyzalase, and, more particularly, it reestablishes normal alveolodental relationships. Immunological factors are discussed. The therapeutic mode of action is emphasized as being a new method of local treatment.
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Two univitelline twin sisters developed Gougerot-Sjögren's syndrome at 30 years of age. Immunity disorders were more significant in the sister with the more severe disorder, as demonstrated by sialography and scintigraphy. Among the immunological tests practiced, emphasis is placed on antinuclear antibody assay in the saliva, the authors finding no mention of this test in the published literature. Of particular interest is the negative result of histological examination of the accessory salivary glands, this contrasting with the close relationship between immunity and sialographic disturbances. The identical nature of the two sisters was confirmed by a study of the HLA systems, but this did not demonstrate the presence of the B8 marker, classically correlated with Gougerot-Sjögren's syndrome.
A clinical experimental study involving human grafts (heterochronic and heterogenic homografts) was carried out after different techniques (isolation, preservation, decontamination, freezing-thawing cycles of grafts). Surgical application then the clinical and radiological course were followed up over a period of up to 4 years. Some pulp specimens were examined histologically. Clinical, radiological and histological correlation was envisaged in order to offer hypotheses, in particular immunological, with regard to the course of the process.
Though it is not unusual to observe sub-mylohyoidal mandibular cavities in relation to the submaxillary or sublingual (Stafnes cavities) salivary lobules, it is extremely rare to see an intramandibular salivary cyst in the region of the incisors. The salivary origin of the cyst was established after demonstrating amylase in the cyst fluid contents. The radiological diagnosis could have been a globulomaxillary cyst (usually noted between the incisor and canine teeth), a peridontal cyst from a live tooth, or a keratocyst (epidermoid cyst). This could be a salivary form of a globulomaxillary cyst.
Had markedly anarchic dietary behaviour with alternating anorexia and bulimia, or even self-induced vomiting. These disturbances in dietary behaviour fall within the context of an unusual neurotic syndrome, predominantly hysterical. There were also menstrual problems, most often amenorrhoea. The physiopathological relations between these symptoms and signs may be envisaged as follows: the initial psychological problems explain the dysorexia; the menstrual difficulties are related at one and the same time to the psychological problems and the dysorexia; the latter is responsible for the parotidomegaly and for disturbances in carbohydrate and lipid metabolism.
Radium therapy at the age of 3 years for an embryonic rhabdomyosarcoma of the paranasal fold resulted in severe cutaneous lesions but also relatively limited disturbances of growth of the corresponding maxilla: inclusion of the underlying canine and version of neighbouring teeth, very incomplete development of the nearest dental roots, absence of air filling of the maxillary sinus. The relatively slight nature of these developmental disturbances is certainly related to the techniques of interstitial radium therapy developed and used at the Gustave Roussy Institute. Routine orthodontic study of the cases of children surviving after treatment of a malignant tumor of the face would undoubtedly offer even more precise information concerning therapeutic indications.
Signs of a fracture of the mandible and a submaxillary hematoma were present in a patient wounded by a bullet. Selective carotid arteriography by femoral catheterization revealed the presence of sectioning of the facial artery at its origin and underlying external carotid stenosis. Hemorrhagic complications or aneurysm formation could have occurred if the lesion had not been demonstrated. Though arteriography is not without risks, it is irreplaceable for investigating cervicofacial injuries when a vascular lesion is suspected.
The authors describe ten patients with calculi in various regions of the submandibular gland, who were operated upon using the buccal approach, and review the different therapeutic procedures available. Though removal of the submandibular gland is a mutilating operation and has many sequelae when operated upon through the submandibular approach, it is still, surprisingly, the standard operative procedure for removal of posterior calculi, even though Delaire had already expressed his logical preference for the buccal approach, 23 years ago. This procedure was used in the 10 cases reported here and results were very good, and there were no sequelae. A strict operative technique is necessary, including general anaesthesia and dissection of Wharthon's duct along its whole length as the essential factors.
Postoperative analgesia by the use of acupuncture was attempted in 88 cases after stomatological operations, of which 60 were for impacted wisdom teeth. During the three years of clinical study of this method it has become simplified; from being applied before, during, and after operation, acupuncture is now used exclusively postoperatively without apparent effects on the analgesia obtained. The results appear to be extremely favourable in relation to those obtained under routine conditions after operation without acupuncture.
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