Idiopathic dilatation of the submandibular gland duct

Lithiasis and stenosis may cause salivary duct dilatation due to the increased pressure in the duct upstream of the obstruction. Idiopathic dilatations, also called megaducts, with no associated increase in pressure, have only been described in the parotid gland. The aim of this study was to describe the characteristics of submandibular duct dilatation unrelated to lithiasis, stenosis, or an imperforate duct, to report the existence of submandibular megaducts. This retrospective single-centre study included patients treated at La Conception University Hospital, Marseille, France, between 2007 and 2019. Patients with submandibular duct dilatation of ≥4 mm confirmed by magnetic resonance imaging sialography (sialo-MRI), who also underwent sialendoscopy to identify any associated stenosis, were included. Patients with lithiasis, stenosis, an imperforate ostium, or a history of trauma or surgery to the floor of the mouth were excluded. Five patients (three female, two male) aged 30-76 years with idiopathic duct dilatations in nine submandibular glands were included. The most commonly reported symptoms were submandibular swelling, pruritus, and discomfort, mostly outside mealtimes. Recurrence of symptoms after treatment was frequent. This study is novel in describing submandibular megaducts as opposed to dilatation caused by high pressure associated with stenosis, with confirmation by sialo-MRI and sialendoscopy.

Quality of life of patients irradiated for head and neck cancer and impact of rehabilitation with a removable dental prosthetic: 1-year follow-up study

Background

Head and neck cancer and its treatment cause significant functional, aesthetic, and social disabilities. These disabilities have a major impact on the quality of life of patients. When irradiation is required, removable dental prostheses are often the treatment of choice. This study investigated whether removable prosthetic rehabilitation improved patient function and aesthetics over the long term.

Material and Methods

In this prospective study, we assessed quality of life in 78 patients with the General Oral Health Assessment Index (GOHAI) questionnaire. Assessments were performed before, and 1 week, 3 months, 6 months, and 12 months after denture insertion. We evaluated whether quality of life was influenced by the type of removable prosthesis and the primary tumour location.

Results

We constructed mixed-effects linear regression models to identify correlates of the overall GOHAI score (GOAHI-add score) and the three domain-scores (functional, psychosocial, and discomfort/pain) in a longitudinal analysis over a 12-month follow-up. We compared scores (GOHAI-add score and domain-scores) in multivariate analyses between baseline (T0) and four post-insertion timepoints to determine significant changes.

Conclusions

We found that removable prosthetic rehabilitation had an influence on the evolution of quality of life. The psychosocial component scores increased steadily over the year and changed more significantly than the functional and discomfort-pain components. The mandibular location of the primary lesion had a negative influence on quality of life. The type of removable prosthesis did not influence the results.

Key words:Quality of life, head and neck cancer, GOHAI, dental prosthesis, radiotherapy.

What has the National Cancer Database taught us about oral cavity squamous cell carcinoma?

The wealth of data in the National Cancer Database (NCDB) has allowed numerous studies investigating patient, disease, and treatment-related factors in oral cavity squamous cell carcinoma (OCSCC); however, to date, no summation of these studies has been performed. The aim of this study was to provide a concise review of the NCDB studies on OCSCC, with the hopes of providing a framework for future, novel studies aimed at enhancing our understanding of clinical parameters related to OCSCC. Two databases were searched, and 27 studies published between 2002 and 2020 were included. The average sample size was 13,776 patients (range 356-50,896 patients). Four areas of research focus were identified: demographic and socioeconomic status, diagnosis, prognosis, and treatment. This review highlights the impact of age, sex, ethnicity, and socioeconomic status on the prognosis and management of OCSCC, describes the prognostic factors, and details the modalities and indications for neck dissection and adjuvant therapy in OCSCC. In conclusion, the NCDB is a very valuable resource for clinicians and researchers involved in the management of OCSCC, offering an incomparable perspective on a large dataset of patients. Future developments regarding hospital information management, review of data accuracy and completeness, and wider accessibility will help clinicians to improve the care of patients affected by OCSCC.

Utility of decellularised urinary bladder extracellular matrix in full mucosalisation of a post-oncological maxillectomy defect

This report highlights the utility of MatriStem Surgical Matrix Thick UBM™ (rebranded as Gentrix® ACell, Inc), a decellularised urinary bladder extracellular matrix in the reconstruction of a post-oncological maxillectomy defect. In utilising this biological construct to serve as a biological dressing, our patient underwent complete mucosalisation of his surgical site without the development of an oroantral fistula and with adequate maxillary vestibule to allow for definitive oral rehabilitation with a removable partial denture.

Facial pressure ulcers in COVID-19 patients undergoing prone positioning: How to prevent an underestimated epidemic?

Prone positioning is an adjuvant therapy used to treat COVID-19 pneumonia complicated by acute respiratory distress syndrome. However, prolonged pressure on facial skin at the level of the bony structures may be responsible for facial pressure ulcers. In the context of severe COVID-19 pneumonia, we hypothesized that hypoxemia, microvascular injury and thrombosis can increase the risk of pressure ulcers. We described two cases in order to emphasize the risk of facial pressure ulcers as a result of prone positioning, so as to discuss their physiopathology and highlight the importance of appropriate preventive measures.

Surgical reconstruction of the foramen tympanicum: What is known and how we do it

Defects affecting the anterior wall of the tympanal bone can result from trauma, infection, neoplasm or previous local surgery. An anatomic variation, namely the persistence of the foramen tympanicum, can also be encountered. When symptomatic, surgical reconstruction may be indicated. The aim of this study was to identify the surgical treatments of symptomatic foramen tympanicum found in the literature and detail our innovative reconstruction technique. A bibliographic research was conducted in PubMed database in March 2020, without time limitation. Papers dealing with surgical management of a foramen tympanicum were included. Data collected were the publication date, the number of patients, their age and gender, the symptoms and the surgical treatment performed. We report, in addition, the case of a symptomatic persistent foramen tympanicum in a 30-year-old man with a follow-up of 18-months. A total of 17 studies (n=23 patients) were included for analysis. The main reconstruction techniques were, in equal proportion, cartilage graft (30%) and insertion of a titanium mesh (30%). We carried out an iliac crest bone graft using a preauricular approach on a patient suffering from chronic tinnitus and fullness in the left ear resulting from a persistent foramen tympanicum, confirmed by clinical and radiological examinations. It allowed the complete resolution of symptoms and no complication such as temporomandibular ankylosis occurred. Based on the review of the literature, we believe this technique has the advantage of providing durable reconstruction thanks to osseointegration.

Repair of gauge earlobe medium defect

Defects due to earlobe gauging are becoming more and more frequent. Many techniques have been described to repair major defects but very few papers exist about medium defects. The aim of this article is to describe a simple surgical technique to repair medium deformations, based on two opposite crescents on the anterior and posterior sides of the earlobe. It gives a harmonious result to the overall shape of the earlobes with a natural curve along the inferior border which is the most difficult part of this surgery.

Facial necrotising fasciitis following rhytidectomy

Rhytidectomy is the most common surgical procedure used to rejuvenate the appearance of the aging face and neck. Necrotising fasciitis is a rapidly progressing, life-threatening, bacterial infection of the skin, the subcutaneous tissue, and the fascia. We report a case of necrotising fasciitis of the face caused by a group A streptococcal infection after rhytidectomy on a healthy female patient. An abscess on her hand that had been caused by an infection related to a venous catheter had provided a potential entry for the pathogen, and treatment combined both surgical debridement and antibiotics. The operation had resulted in large tissue losses around the ears, which we treated by healing by second intention.

Botulinum toxin for ductal stenosis and fistulas of the main salivary glands

This study was performed to present the authors' experience with botulinum toxin therapy for salivary stenosis and salivary fistula in terms of the procedure, dosage, effectiveness, and complications. A retrospective study of all patients treated in the maxillofacial surgery department for salivary stenosis or fistula from January 2014 to September 2018 was performed. Intraglandular injections of incobotulinumtoxinA (Xeomin) were utilized. The frequency of relapse and the pain recorded before injection and at 3 months after each injection or fistula resolution were assessed. Swallowing dysfunction or any diffusion of toxin into the facial muscles was recorded. This study included 22 patients (mean age 53 years). Botulinum therapy was indicated for parotid duct stenosis in 14 patients, submandibular duct stenosis in four patients, and parotid fistula in four patients. The frequency of relapse (P =  0.0001) and pain level (P =  0.0001) decreased after botulinum therapy. The average duration of the botulinum effect was 4.50±2.00 months after the first injection. No complication was observed. Botulinum therapy with 100 IU of Xeomin proved effective at resolving salivary fistula. Botulinum therapy is an effective treatment for symptoms of salivary duct stenosis in patients for whom minimally invasive procedures have failed. Botulinum therapy can also be used for the treatment of salivary fistulas.

Mucoceles of the anterior ventral surface of the tongue and the glands of Blandin-Nuhn: 5 cases

INTRODUCTION

Mucoceles are cystic diseases of the oral mucosa. The most common are ranula and mococeles of the lower lip. Blandin and Nuhn mucoceles, which develop at the ventral side of the tongue, are rare benign lesions. They are often misdiagnosed and sometimes confused with ranula. The recommended treatment is a complete surgical excision of the gland.

PATIENTS AND METHODS

We describe 5 clinical cases managed in service between 2009 and 2016. Clinical cases are presented in order to detail their clinical history, paraclinical and treatment.

RESULTS

The clinical appearance is a longitudinal swelling of the ventral surface of the tongue, parallel to the frenulum. The volume of the swelling is variable; it is normally around 30 × 10 mm. The paraclinical (ultrasound, CT, MRI, or ponction) could be performed. CT showed an cyst located on the ventral surface of the tongue, with liquid density. Blandin and Nunh mucocele were strictly anechogenic. MRI confirms the liquid content of this cyst (low T1signal, high T2signal and no post-contrast-enhanced). The resection of Blandin and Nuhn glands should respect the sublingual gland, the lingual nerve and the lingual veins in the mouth floor.

CONCLUSION

This study demonstrates that Blandin and Nuhn mucoceles must be understood and recognised to propose complete excision of the Blandin and Nuhn gland and avoid recurrence.

Hooliganism and maxillofacial trauma: The surgeon should be warned

INTRODUCTION

With more than 270 million spectators, football - or soccer - is the most popular sport in the world. International football events generate many risky situations, including hooliganism and are an opportunity to analyze the incidence and the particularities of associated trauma. We sought to underline the potential rapid and brutal increase in maxillofacial trauma during a world-class competition.

MATERIAL AND METHODS

A retrospective multicenter study of the epidemiology of maxillofacial traumas during the UEFA 2016 Cup was conducted. All the medical data from each UEFA 2016 World Cup matches from 10 June 2016 to 10 July 2016 were collected. Only the maxillofacial traumas requiring a surgery under general anesthesia and a hospitalization were included.

RESULTS

11 patients from 3 different cities were included. The main etiology was interpersonal violence (7/11), followed by road accidents (3/11). Open reduction with internal fixation of a mandibular fracture was the most performed surgery (9/11). Patients were 18 to 50 year-old, with an average age of 30.6 years.

DISCUSSION

This study underlines the violence of riots between "ultra" supporters during the 2016 UEFA cup. We noticed an upsurge of maxillofacial trauma severe enough to require a surgery under general anesthesia. Hooligan behaviors should be known by every practitioner dealing with trauma care, and may requires transitional adjustment of public health policy.

Retrograde approach for parotid benign tumours: A review

INTRODUCTION

Parotidectomy for benign tumours is usually performed after facial nerve trunk discovery through an anterograde approach (AA) of the nerve. More recently, a retrograde approach (RA) toward the facial nerve, which begins on the facial nerve branches and ends on the nerve trunk, has been described. A literature review of the RA was conducted to evaluate the RA and to compare it with AA.

METHODS

A literature review was conducted for the years 1980 through 2016. Nine studies out of 216 were included, including 558 parotidectomies and 370 RA. We studied the operative time (OT), the postoperative complications including facial paralysis (FP), tumour recurrences, and possibilities for reoperation.

RESULTS

Operative time was shorter in RA than in AA. Transitory FP significantly less frequent in RA than in AA in only one studies and not significantly in four studies. Incidence of Frey syndrome was similar in RA and AA. Tumour relapses were reported in 1.8% of cases with RA, comparable to AA.

CONCLUSION

Retrograde parotidectomy is recommendable. OT was significantly shorter for the RA. The FP rate was lower for RA than for AA, but the difference was not significant. The recurrence rate appeared to be similar between RA and AA. Possibilities of reoperation were better after RA.

Impact of antithrombotic treatment in orbital haematoma

INTRODUCTION

Orbital haematomas threaten the visual prognosis, but no treatment guidelines have been proposed. Antithrombotics could affect their prognosis and treatment. This study aimed to evaluate the effect of antithrombotics in the management of orbital haematomas and to suggest a standardised protocol.

MATERIAL AND METHODS

We conducted a retrospective study by sending a standardised questionnaire to 20 French maxillofacial surgery university departments to collect all the cases of orbital haematoma.

RESULTS

Twenty-five cases from 10 centres were collected, including five patients treated with anticoagulant and one patient treated with dual antiplatelet. Antithrombotics increased the risk of amaurosis and ocular disorders significantly. Surgery was performed for 66.7% of patients treated with antithrombotic and for 89.5% of other patients. Surgical delay was longer in patients treated with antithrombotic. Surgical drainage was used in most of the cases, whereas canthotomy with inferior cantholysis was the least-used technique.

CONCLUSION

Antithrombotics appear to worsen the functional prognosis of orbital haematomas. A surgical management of orbital haematoma in patients treated with antithrombotics is not contraindicated. Surgical delay must be shortened as much as possible. A lateral canthotomy with inferior cantholysis seems to be an appropriate solution.

Extracorporeal lithotripsy of salivary gland stone: A 55 patients study

Sialolithiasis are the most frequent salivary gland disease, mainly affecting the submandibular gland. With the advent of minimally invasive techniques, total salivary gland removal should not be considered as the first-line treatment anymore. Extracorporeal Shock Wave Lithotripsy (ESWL) is an alternative to surgery preserving the gland. The objective of our retrospective study was to evaluate the efficiency of ESWL on pain and obstructive syndrome in patients suffering from sialolithiasis. The global result felt by the patients was also considered. All patients treated between October 2009 and July 2016 for sialolithiasis by ESWL in our department were included. They were divided into two groups according to the concerned gland: a parotid gland (PG) and a submandibular gland (SMG) group. Our retrospective telephone questionnaire consisted in 4 questions about their symptomatology before and after ESWL, including pain self-evaluation before and after treatment. They were finally asked to evaluate the global result of the ESWL treatment: excellent, good, mean, or poor. In total, 55 patients were included in this study, 38 patients in PG group and 17 patients in SMG group. We observed a decrease of pain and obstructive syndrom after ESWL procedure in both groups. Better results were found on the obstructive syndrome in the PG group. Very few side-effects were reported by patients. Given that it has very few side effects, ESWL can easily be considered as first line treatment for sialolithiasis to avoid heavier treatments such as surgery. It should be the first-line treatment for symptomatic parotid sialolithiases. The treatment of symptomatic submandibular sialolithiases depends on the topography of the lithiasis.

CT scan assessment in salivary gland lithiasis diagnosis

INTRODUCTION

The aim of the study was to assess computed tomography (CT) scan efficiency for the diagnosis of salivary lithiasis.

METHODS

Patients who were included were all the patients who consulted in our department for main salivary gland (submandibular and parotid) obstruction symptoms between June 2014 and December 2016. A CT scan without injection was prescribed for all of them. The 163 patients were divided into two groups after the CT scan: patients with and without lithiasis. During surgery, we confirmed the presence or absence of the lithiasis previously diagnosed on the CT scan. The patients were divided in two groups: case and control groups. For statistical analysis, the sensitivity, specificity, and the negative and positive predictive values of the preoperative CT scan were calculated.

RESULTS

A total of 163 patients with a salivary obstructive syndrome were included. On the CT scans, we found lithiases (hyperdense images) in 157 glands ("CT scan⊕" group), and we found no lithiasis in 6 glands ("CT scan" group). In the "CT scan⊕" group, 203 lithiases were present. During surgery, we found and removed lithiases in 155 patients (case group), and 8 patients had no lithiases (control group). The overall sensitivity, specificity, positive predictive value, and negative predictive values of the CT scan for the detection of lithiasis were 100%, 75%, 99%, and 100%, respectively. The specificity of CT scans for the lithiasis located in the anterior and middle third of the duct was 100%.

DISCUSSION

According to our study, the CT scan is very efficient in diagnosing salivary main gland lithiases in patients with an obstructive syndrome.

Double palatal flap for oro-nasal fistula closure

INTRODUCTION

The management of oral fistula to the nose depends on its etiology, its size and its location. Here, we describe a simple technique, inspired by the ones initially developed by Bardach for cleft palates repair. The surgical alternatives are discussed.

TECHNICAL NOTE

The double palatal flap is a simple technique, allowing closure in a single session of a central or centro-lateral palate fistula. The key of this technique is the dissection between nasal and palate mucous layers, providing a sufficient amount of laxity to close the defect without tension.

DISCUSSION

The double palatal flap can cover centro-lateral palate mucosal fistulae. It provides both aesthetic and functional results in a single stage. Reliability, simplicity and quickness are its main advantages. Outcomes are usually simple; Velar insufficiency may occur, that can be corrected by speech therapy.

Treatment of salivary stones by intraductal pneumatic lithotripsy: A preliminary presentation of the StoneBreaker with sterile bag covering

INTRODUCTION

Sialendoscopy has changed the management of obstructive sialadenitis. Nowadays, minimally invasive techniques evolve to preserve salivary gland function. Intraductal lithotripsy allows stones fragmentation and retrieval without opening the salivary duct. We report our experience with the StoneBreaker (SB), a new lithotripter with improvement using a sterile bag that permits reuse of the SB without passing to sterilization.

TECHNICAL NOTE

The non-sterilized SB was used into a sterile camera sleeve in 5 patients, 3 submandibular lithiases and 2 parotid lithiases. Technique and outcomes were described with a review of the literature. An explanatory video of the procedure was performed.

DISCUSSION

Complete fragmentation was achieved and all fragments were extracted without any ductal damage. Utilization of the sterile sleeve did not change the SB efficiency and the procedure duration. The use of a sterile bag allowed several consecutive procedures with a single non-sterilized handpiece. However, the gas cartridge change may be more delicate when more than 80 impacts are needed. Patients remained symptoms and stones free one month after surgery.

Use of 3D orbital reconstruction in the assessment of orbital sexual dimorphism and its pathological consequences

INTRODUCTION

Surrounded by a variety of structures including the facial sinuses and the brain, the human orbit displays unique anatomical features. It is known that orbital volume correlates with age and sex. The aim of this study was to evaluate sexual dimorphism of orbital volume relative to the size of the skull, and to establish criteria for gender determination.

METHODS

Orbital volume was measured from 3D models of the orbits. The volumes were expressed in relation to the centroid size of the skull, to ensure that any sexual dimorphism in orbital volume was not simply due to a difference in skull size. Thirty-three male and 42 female subjects were included in the study.

RESULTS

The volume of both orbits were significantly higher in men than in women (P=0.0001). The right, left and total orbital volumes relative to the centroid skull size were also significantly higher in men than women (P<0.05). The method was repeatable and reproducible. A test of gender determination was developed, with a precision of 77.3%.

DISCUSSION

This is the first study showing a sexual dimorphism in orbital volume relative to skull size. This difference in volume could explain the greater predisposition to myopia in women and their more frequent need for orbital decompression in thyroid orbitopathies.

[Combined approach for parotid lithiases: A 9 cases retrospective study]

INTRODUCTION

Minimally invasive techniques (MIT), including sialendoscopy, extracorporeal lithotripsy and intraoral approach, have to be preferred in parotid stones removal. In case of MIT failure, a combined intra- and extra-oral approach can be achieved. The aim of our study was to evaluate the efficacy and the complications of these combined approaches.

MATERIALS AND METHODS

A retrospective study has been conducted on patients treated between 2006 and 2015. All adult patients presenting with one or more parotid stones and in whom TMI failed have been included. Age and sex of the patients, number, size and location of the stones, result of the procedure, occurrence of pain, swelling, or infection have been recorded.

RESULTS

Nine patients were included (mean age: 56). Mean follow-up was 48 months. Eighty-eight percent of patients had an unique stone. Nine stones were extracted by combined approach. Mean diameter of the stones was 8.5mm and 33% of them were located at the junction between middle and posterior third of parotid duct. All the patients suffered preoperatively from daily retention symptoms, such as pain (55%) and swelling (100%). Two patients had an infectious complication (duct and/or gland infection). Seventy-five percent (9/12) of stones were removed. Complications consisted of 1 fistula, 1 facial paresis, 3 recurrences. Seven of 9 patients (77%) had a total relieve after surgery.

DISCUSSION

Surgical combined approaches for parotid stones removals are indicated after failure of MIT when symptoms affect quality of life.

[Congenital malformations of the temporo-mandibular joint and the mandibular ramus: Grafting vs distraction osteogenesis]

Congenital deformities of the mandibular ramus and of the temporo-mandibular joint are treated by surgery since the early 20th century. However, morphological and functional results are often disappointing, accounting for iterative operations. Today, a clear consensus concerning the type of intervention to be proposed, and at what age it should be carried out does not yet exist. For mild cases, "conventional" orthognathic or osteogenic distraction procedures seem to work well, especially if they are carried out at the end of growth. In severe cases, it is often necessary to proceed in several surgical steps, usually starting with a chondrocostal graft, especially when interceptive surgery, performed before the end of growth, is preferred in order to improve the patient's quality of life.

[De novo (type 3) primary intraosseous carcinoma of the jaws]

INTRODUCTION

Primary intraosseous carcinoma (PIOC) of the jaws is a rare epidermoid carcinoma from epithelial origin and initially strictly localized within the bone. Histologically, type 3 PIOC (PIOC3) is a de novo primary intraosseous carcinoma. Because of the rarity of this illness, we propose an analysis of a personal case and a revue of the literature.

MATERIAL AND METHODS

Two search engines (Pubmed^®, Sciencedirect^®) were questioned over the period 1976-February 2016 by using following keywords carcinoma, intraosseous, jaws, squamous cell carcinoma. Articles reporting proven PIOC3 and mentioning a precise treatment were selected.

RESULTS

Thirty articles concerning 54 patients (sex ratio: 2.4; mean age: 56.8; extreme: 24-78) met the inclusion criterions. The most common symptoms were swelling (53%), pain (44.9%) and infra-alveolar nerve paresthesia (30.6%). The time to diagnosis was 13 weeks. Classification of Zwetyenga et al. showed more than 80% of T2 and T3 stages. The lesions were predominantly mandibular (85.2%) and posterior. Less than a third of patients had lymph node and 10% had distant metastasis. Treatment consisted mostly in a combination of surgery and radiotherapy. With a mean follow-up of 74.8 months, 70.8% were in remission with no evidence of recurrence. We report the case of a 58-year-old patient, with no medical history, complaining since several months about periodontitis with teeth mobility in the right mandibular area. The panoramic X-ray showed a bone lysis at the place of tooth No. 46. In the absence of alveolar healing after extraction and antibiotherapy, a biopsy was made that diagnosed a differentiated keratinizing squamous cell carcinoma. CT scan and MRI showed a mandibular cortical bone loss with involvement of adjacent structures and lymphadenopathy in the ipsilateral IB area. The patient was treated with a combination of chemotherapy and surgery. Postoperative chemo- and radiotherapy is still going on.

DISCUSSION

The PIOC3 is a rare tumor, mainly arising in males around 50. Diagnosis should be evoked in the presence of painful swelling and nervous symptoms. The time to diagnosis is long. Tumors are usually seen at late stages. Treatment classically combines surgery and radiotherapy.

[TMJ arthroscopy. A review]

INTRODUCTION

Temporomandibular joint (TMJ) dysfunction associates pain, limited mouth opening and joint noise. Failures of conservative treatments may lead to arthroscopy. The aim of our study was to evaluate the current interest of arthroscopy in the treatment of TMJ dysfunction.

MATERIAL AND METHODS

Using the keywords "TMJ" and "Arthroscopy", 1668 articles were found in the Sciencedirect database. We selected 17 papers published between September 2012 and May 2016. Six questions were asked: (1) what treatment should be given to patients suffering from TMJ dysfunction? (2) What treatment should be performed for TMJ disorders when conservative treatments failed? (3) Does Wilkes staging change the surgical indication? (4) What has to be done in case of arthroscopy failure? (5) Can disc position be improved after surgery? (6) Should the disc position be improved?

RESULTS AND DISCUSSION

(1) Conservative treatment should always be considered in first intention (2) In case of conservative treatment failures, surgery can be proposed, beginning with the less invasive one (3) Whatever the Wilkes stage, treatment should begin by the less invasive one (4) In case of arthroscopy failure, TMJ arthrotomy can be indicated (5) Disc position may be improved in the long term but it is complex to obtain (only one paper) (6) there is no evidence that disk has to be repositioned.

Orofacial manifestations of scleroderma. A literature review

INTRODUCTION

Scleroderma is a rare disease of the connective tissue (50 to 200 patients/1 million people; 60,000 patients in France). We conducted a literature review about the orofacial manifestations of scleroderma that have been little studied.

MATERIAL AND METHODS

The 45 articles found in 6 different databases by using the keywords "scleroderma", "systemic sclerosis", "oral medicine", "face" and published between 1944 and 2016 were selected, for a total of 328 patients.

RESULTS

A total of 1187 orofacial manifestations of scleroderma were identified, occurring mainly in women (84.5%) with a mean age of 40.2 years, 10 years on average after the first manifestation of the disease. The main ones were limitation of mouth opening (69.8%), widening of the periodontal ligament (67.3%), xerostomia (63.4%), telangiectasia (36.2%) and bone lesions (34.5%). Dental root resorptions, pulp and nose calcifications were also reported but with no evident link with scleroderma.

DISCUSSION

Orofacial manifestations of scleroderma are probably more common than reported. They mostly affect women with a mean age of 40. The most common oral manifestations are limitation of mouth opening, widening of the periodontal ligament and xerostomia. Because of the handicap they may be responsible for, these manifestations must be detected early in order to prevent from functional impairments and from dental and periodontal lesions.

[Acute decompensation of os odontoideum in the elderly. Case report]

Os odontoideum is a lesion of the second cervical vertebra, usually revealed by a neurological decompensation due to a neck injury in young adults. We report the exceptional case of an os odontoideum decompensation in a 81-year-old patient, who became quadriplegic after a fall. Subsequent surgical treatment resulted in complete neurological recovery. Os odontoideum can decompensate at all ages, and the authors recommend preventive surgical treatment in cases of instability, including in the elderly.

[Riga-Fede disease: traumatic ulceration of the tongue in an infant]

INTRODUCTION

Riga-Fede disease is rare. It is an oral mucosal ulceration due to repetitive dental trauma. We report the case of an infant for whom a quick diagnosis prevented many complications.

OBSERVATION

A 45-day-old infant was brought to our consultation for pain during baby-bottle intake, preventing feeding. Oral examination revealed ulceration on the ventral surface of the tongue, associated next to a mandibular incisor present at birth. Pain stopped immediately after dental extraction of the supernumerary tooth. The infant could be fed again without any problem. The ulceration healed in less than three months.

DISCUSSION

The diagnosis of Riga-Fede disease is strictly clinical. The early diagnosis in our case allowed for a quick management and normal feeding before there was any somatic consequence. Dental trauma is the most frequent cause of Riga-Fede disease. Treatment is conservative (polishing, resin) except in case of supernumerary teeth or excessive mobility. In these cases, extraction is indicated. The pathological diagnosis is required only when there is no healing after appropriate management fails, to look looking for another diagnosis.