Biomedical subjects
Publications and source records attributed to R Gola.
Diagnostic arthroscopy is reserved to patients who suffer from internal temporo-mandibular joint derangements resisting to conservative treatments. This technique allows an acute diagnostic approach to the intra-articular lesions of the superior compartment.
Traumatic ptosis is most often secondary to a fasciomuscular lesion of the levator system. Less frequently, it results from the paralysis of the levator muscle due to an injury to the third pair of cranial nerves. This ptosis is observed in comminuted orbital fractures or fractures of the base of the skull involving the orbital apex, and it is then associated with oculomotor paralysis. In favorable cases seen early, repairing surgery of the levator system produces excellent results. When associated with ophthalmoplegia or corneal anesthesia, neurogenic ptosis requires a watch and wait policy.
Eyelid involution affects all the tissues of the lid, including the tarsotendinous band and the levator muscle. Dermatochalasis can be complicated by ptosis, entropion or ectropion, which must be taken into account during assessment and treatment.
An empty orbital cavity is always unesthetic-looking, but several plastic surgery procedures exist to attenuate the cosmetic damage. In case of exenteration affecting periorbital tissues and cavities, spontaneous epithelialization is preferable than a split skin graft. Except for rare cases, where it is indicated to preserve the conjunctivae and eyelids, covering up may be realized with minimal scarring using two flaps, one superficial jugotemporal, and the other deep mid-frontal.
The anatomical and physiological relation between temporal muscle and temporomandibular joint are well-knowed. The versatility of the temporo muscle-fascia flap must be stressed. The posterior temporal flap is a simply, reliable procedure, with low morbidity. This technique is probably the procedure of choice in discal replacement and in interposition arthroplasty for ankylosis.
The severity of entropion depends on trichiasis which is perpetuated by orbicularis spasm, creating a vicious cycle. The therapeutic approaches are based on the aetiopathogenesis. Congenital entropion is essentially treated by infraciliary cutaneomuscular resection. The various components of involutional (senile) entropion, horizontal and vertical retraction, orbicularis dyskinesia, are treated respectively by tissue reduction, reinforcement of retractore and myoplasties. In cicatricial entropion, chondro-mucosal or fibromuscular graft is the technique of choice for correcting insufficiency of the tarsoconjunctival plane or its curvature. It is also the best solution for the correction of trichiasis or distichiasis.
Orbital hydatid cysts are extremely rare in France. The authors report two cases in young adults of North African origin, one being a recurrence. Echography and CT scan were the most useful paraclinical investigations. The cysts were surgically excised with difficulty via an anterior approach adapted to the localisation. After 5 years follow up, both patients survived, however, there was major visual loss (blindness, or requirement for enucleation), due to the delay in diagnosis.
The TMJ arthroscopy is an investigation method reserved for those who does not respond to non invasive treatments. The technical aspects of the puncture and the normal arthroscopic anatomy are studied.
Synovial chondromatosis of the temporo-mandibular joint is a rare and mild disorder. Three cases are reported, one with an histological aspect of chondrosarcoma. The evolution is favourable after removing the loose particles and the synovial tissues.
Repair of mutilated lacrimal passages should be adapted to the anatomy and physiology. Whenever possible, this should be performed as an emergent operation and come in as part of an overall therapeutic strategy. Repair methods used are simple end-to-end approximation of permeable segments, in case of limited lesions, and use of arterial grafts or of adjacent, nasal or saccular mucous flaps, in case of extended lesions. When reconstruction is not feasible owing to the extent of the lesions or to failure of the repair methods, tear derivation is carried out directly via the lacrimal sac or nasal fossa, by means of intermediate flaps (primarily nasal mucosa) or indwelling drains. Objectively, the functional outcome of repair is hard to assess, as tearing can, by no means, be considered a clinical criterion of obstruction, in the same way as lack of tearing is not a criterion of permeability. Only dacryography or, when possible, postoperative scintigraphy of the lacrimal passages allow for an objective evaluation of the results. Thus, although satisfactory results are the rule, long-term objective observation often leads to mitigating feelings.
Rhinoseptoplasty is proposed to preserve the integrity of the ridge of the nose and its natural appearance. It is patterned on Maurel's procedure (1940). After mobilization of the bony root of the nose, the resection of a strip of the nasal septum just under the "keystone" allows pushing the nose back into the facial structures. Besides its simplicity, the advantages of this method include: the integral preservation of the ridge of the nose, the controlled reduction of the profile. and the relative autonomy of the tip of the nose. The indications for this type of rhinoplasty are mainly restricted to straight noses with a mild, harmonious osteocartilaginous hump.
The congenital blepharoptosis is the most frequent palpebral abnormality. The anatomical, physiological and clinical aspects of the congenital blepharoptosis are successively discussed. Clinical and anatomopathological studies support the hypothesis of a myogenic basis for congenital genuine blepharoptosis and the hypothesis of a neurogenic basis for the ptosis with synkinetic phenomena. The different surgical methods are then described and their results compared.
Drugs with a short elimination half-life should display fewer side effects than longer acting drugs in the treatment of sleep disturbances due to their smaller tendency to accumulate, especially in the elderly. This hypothesis could be confirmed in a double blind study of zopiclone versus flurazepam.
Several plastic surgical procedures can attenuate the unsightly effects of a disinhabited empty orbit. Only the imperatives of follow-up or very poor general status can still justify spontaneous epithelialisation, which we prefer to split skin graft. In other cases, apart from the exceptional indications of preservation of the eyelids and conjunctival sac, closure by flap is the technique of choice: temporo-frontal flap in cases of simple exenteration and temporo-jugal for the superficial plane and medio-frontal for the deep plane in radical exenterations. In young adults, when the resection is limited to the orbit, after flap closure, conjunctival reconstruction by means of a mucosal graft can be attempted without preliminary temporalis muscle transposition, as the orbital cavity is filled spontaneously and sufficiently by fibrous tissue.
A rhinoplasty technique is proposed to maintain the integrity of the nasal ridge and to retain the natural appearance of the nose. It is derived from Maurel's technique (1940). After global mobilisation of the bony canopy, the resection of a band of nasal septum immediately under the keystone allows displacement of the nose deeper within the face. The advantages of this method, apart from its simplicity, are: preservation of the entire bony ridge, controlled reduction of the profile, relative autonomy of the nasal tip. The indications for this rhinoplasty are essentially confined to straight noses with moderate and harmonious osteocartilaginous kyphosis.
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In connection with three observations, we discuss clinical and biological characteristics of "acquired haemophilia". We insist on therapeutics problems: in all the cases corticosteroid and or immunosuppressive drugs are indicated: haemorrhagic accidents treatment depend on the clinical state severity and on the inhibitor concentration: indications of substitutive therapy, plasmapheresis and activated concentrate are considered.
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