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Desbarats C, Derombise B, Trost O. [Effectiveness and interest of retrobulbar hyaluronidase injections in the treatment of blindness complicating facial hyaluronic acid injections: A literature review]. ANN CHIR PLAST ESTH 2024; 69:63-69. [PMID: 37980189 DOI: 10.1016/j.anplas.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 10/02/2023] [Accepted: 10/09/2023] [Indexed: 11/20/2023]
Abstract
INTRODUCTION Hyaluronic acid injections are becoming increasingly common among both the general public and the medical community, but they are not without risks. The occurrence of blindness, although rare, is a tragic event for both the patient and the practitioner. One of the treatments proposed in the literature is to inject hyaluronidase as close as possible to the site of ischemia, retrobulbarly. The aim of our study is to evaluate the effectiveness and potential benefits of retrobulbar hyaluronidase injections. MATERIALS AND METHODS A literature review was conducted using the PubMed database. Only articles addressing retrobulbar hyaluronidase injections for the treatment of blindness following hyaluronic acid injections were included. RESULTS We identified 12 case reports or series, comprising a total of 16 patients. Among these 16 patients, 3 regained their vision. Hyaluronidase was injected between 20minutes and 7days after the onset of the complication, with injected doses ranging from 3×150IU to 3×1500IU. DISCUSSION Literature reveals only 3 cases of successful treatment out of the 16 reported injections. The time interval before retrobulbar injection, as well as the dose and the experience of the injecting practitioner, may influence the success rate of this treatment. Other treatments, such as intravascular hyaluronidase injections, remain to be explored.
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Affiliation(s)
- C Desbarats
- Service de chirurgie maxillo-faciale et stomatologie, CHU-Hôpitaux de Rouen, hôpital Charles-Nicolle, 1, rue de Germont, 76031 Rouen cedex, France.
| | - B Derombise
- Service de chirurgie maxillo-faciale et stomatologie, CHU-Hôpitaux de Rouen, hôpital Charles-Nicolle, 1, rue de Germont, 76031 Rouen cedex, France
| | - O Trost
- Service de chirurgie maxillo-faciale et stomatologie, CHU-Hôpitaux de Rouen, hôpital Charles-Nicolle, 1, rue de Germont, 76031 Rouen cedex, France; Laboratoire d'anatomie, UFR Santé de Rouen, université de Rouen-Normandie, 22, boulevard Gambetta, 76000 Rouen, France; CETAPS, EA3832, Research Center for Sports and Athletic Activities Transformations, University of Rouen Normandy, Mont-Saint-Aignan, France
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Ben Slama N, Maquet C, Trost O, Leca JB. Pharyngeal flap in velopharyngeal insufficiency: Proposal of an algorithm in a series of 31 patients. J Stomatol Oral Maxillofac Surg 2023:101535. [PMID: 37307914 DOI: 10.1016/j.jormas.2023.101535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 06/09/2023] [Indexed: 06/14/2023]
Abstract
This study evaluated the results of a reproductible protocol indicating the need for a pharyngeal flap in children with cleft palate and velopharyngeal insufficiency (VPI). A retrospective review of all patients operated for a pharyngeal flap between 2010 and 2019 in our center was conducted. After exclusion of patients with primary VPI or residual fistulas, 31 patients' data were analyzed. Our main outcome measure was the improvement of the Borel Maisonny Classification (BMC) by at least 1 rank. Further analysis was made to evaluate the impact of age, type of cleft, and BMC before surgery on the gain in the velopharyngeal function. Of the 31 patients, success was achieved in 29 (93.5%, p<0.005). There was no significant correlation between age and gain in the velopharyngeal function (p = 0.137). There was no significant correlation between type of cleft and gain in the velopharyngeal function (p = 0.148). There was a significant correlation observed between the starting classification and gain in velopharyngeal function. The gain observed was greater as the initial velopharyngeal function was worse (p = 0.035). The use of an algorithm combining clinical assessment with a standardized classification of the velopharyngeal function proved to be a reliable tool for the indication of surgery in patients with VPI. A close follow up is essential in a multidisciplinary team.
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Affiliation(s)
- N Ben Slama
- Department of Oral and Maxillofacial Surgery, Rouen University Hospital, Rouen 76000, France.
| | - C Maquet
- Department of Otorhinolaryngology-Head and Neck Surgery, Rouen University Hospital, Rouen 76000, France
| | - O Trost
- Department of Oral and Maxillofacial Surgery, Rouen University Hospital, Rouen 76000, France; Laboratory of Anatomy, Faculty of Medicine-Pharmacy, Rouen-Normandie University, 22 Boulevard Gambetta, Rouen 76183, France
| | - J B Leca
- Department of Pediatric Surgery, Clinique Chirurgicale et Infantile, CHU Charles Nicolle, Rouen, France
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Derombise B, Ben Slama N, Desbarats C, Bastien AV, Trost O. Measurement of quality of life in orthognathic surgery using an original questionnaire: About a series of 123 cases. ANN CHIR PLAST ESTH 2023; 68:123-130. [PMID: 36642633 DOI: 10.1016/j.anplas.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 12/28/2022] [Indexed: 01/15/2023]
Abstract
INTRODUCTION The aim of this study was to measure changes in the quality of life of patients who had orthognathic surgery using an original questionnaire, designed for this purpose. MATERIAL AND METHOD This single-center retrospective study included all patients who had orthognathic surgery in our center between 2014 and 2019. An original questionnaire comprising 13 items in 4 domains was sent to patients postoperatively by email after telephone contact and obtaining their consent. Items were scored on a 5-point scale ranging from (-1), worse than before surgery, to (+3), better than before surgery. RESULTS All data were collected in a standardized way. In total, 123 patients responded. The mean score for all surgeries combined was +1.14, indicating an improvement in QOL considered to be "low to moderate". A total of 118 patients (95.9%) reported an improvement following surgery, including 18 patients (14.6%) who reported a marked improvement. The greatest improvement was observed for psychosocial aspects and morphology. CONCLUSION This study shows a positive effect of orthognathic surgery on patients' QOL, including self-perception, relationships with others, or functional aspects as mastication and breathing. We propose an original tool that is easy to use by patients to measure quality of life following orthognathic surgery.
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Affiliation(s)
- B Derombise
- Department of maxillofacial surgery and stomatology 1, Rouen Health UFR, CHU, Hospital of Rouen, 37, boulevard Gambetta, 76000 Rouen, France
| | - N Ben Slama
- Department of maxillofacial surgery and stomatology 1, Rouen Health UFR, CHU, Hospital of Rouen, 37, boulevard Gambetta, 76000 Rouen, France
| | - C Desbarats
- Department of maxillofacial surgery and stomatology 1, Rouen Health UFR, CHU, Hospital of Rouen, 37, boulevard Gambetta, 76000 Rouen, France
| | - A V Bastien
- Department of maxillofacial surgery and stomatology 1, Rouen Health UFR, CHU, Hospital of Rouen, 37, boulevard Gambetta, 76000 Rouen, France
| | - O Trost
- Department of maxillofacial surgery and stomatology 1, Rouen Health UFR, CHU, Hospital of Rouen, 37, boulevard Gambetta, 76000 Rouen, France; Anatomy Laboratory2, Rouen Health UFR, University of Rouen-Normandy, 22, boulevard Gambetta, 76083 Rouen cedex 1, France; Laboratory of medical informatics and knowledge engineering in e-Health, LIMICS 3, Inserm, University of Rouen-Normandy, Sorbonne University, Paris 13 University, 75006 Paris, France.
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Kerbrat JB, Miskowiak C, Trost O, Kerbrat A. Osteogenic distraction to treat solitary median maxillary central incisor (SMMCI) syndrome: a case report. Int J Oral Maxillofac Surg 2022; 51:1469-1472. [DOI: 10.1016/j.ijom.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 01/24/2022] [Accepted: 03/09/2022] [Indexed: 11/26/2022]
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Kerbrat A, Vinuesa O, Lavergne F, Aversenq E, Graml A, Kerbrat JB, Trost O, Goudot P. Clinical impact of two types of mandibular retention devices - A CAD/CAM design and a traditional design - On upper airway volume in obstructive sleep apnea patients. J Stomatol Oral Maxillofac Surg 2021; 122:361-366. [PMID: 34118470 DOI: 10.1016/j.jormas.2021.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/16/2021] [Accepted: 06/07/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE This pilot randomized crossover study evaluated the outcomes of two custom-made mandibular retention devices (MRDs), a computer-aided design (CAD)/computer-aided manufacturing (CAM) device (Narval CC™) and a non-CAD/CAM device (Narval™), on oropharyngeal airway volume in patients with obstructive sleep apnoea (OSA). METHODS 12 OSA patients were recruited from an University Hospital for MRD therapy with either CAD/CAM or non-CAD/CAM first. A cone-beam computed tomography evaluation (CBCT) and polysomnography assessment was performed during baseline assessment and at the end of each study period. RESULTS Upper airway volume increased significantly with the CAD/CAM device (7725 +/- 6540 mm3, p = 0.008) but not with the non-CAD/CAM device (3805 +/- 7806 mm3, p = 0.13). The CAD/CAM device was also associated with a significant decrease in AHI (mean AHI after treatment 9.4±6.7 events/h, p = 0.003) and oxygen desaturation index (mean ODI of ≥ 3%/h 11.9 ± 6.8, p = 0.011). Changes in AHI (14.7 +/- 11.7 events/h, p = 0.083) and ODI (15.5 +/- 19.2, p = 0.074) were not statistically significant with the non-CAD/CAM device. The vertical dimension of occlusion increased significantly following treatment with both MRD devices (both p = 0.003), but was significantly less pronounced with the CAD/CAM device (mean difference: -2.7 +/- 1.7 mm, p = 0.003). Final mandibular protrusion after titration was the same with both devices (85%, p = 0.317). CONCLUSION The CAD/CAM (Narval CCTM) device was associated with a significant increase in upper airway volume that may be caused by a lower degree of vertical separation between the jaws when compared to the non-CAD/CAM design.
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Affiliation(s)
- A Kerbrat
- Resident, Service de Stomatologie et de Chirurgie Maxillo-faciale de la Pitié Salpétrière, 81 Boulevard de l'hopital, 75013 Paris, France.
| | | | - F Lavergne
- ResMed Science center - Saint-Priest, France
| | - E Aversenq
- ResMed Science center - Saint-Priest, France
| | - A Graml
- ResMed Science center, Munich, Germany
| | - J B Kerbrat
- Chief of the department of Orthodontics, Service de Stomatologie et de Chirurgie Maxillo-faciale de la Pitié Salpétrière, France
| | - O Trost
- Professor,Chief of the Service de Stomatologie et de Chirurgie Maxillo-faciale du CHU de Rouen, France
| | - P Goudot
- Professor, Chief of the Service de Stomatologie et de Chirurgie Maxillo-faciale de la Pitié Salpétrière, France
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Landart C, Trost O, Moizan H. [Atypical actinomycosis revealed by distant dermatological disorders: Report of an unusual case and literature review]. Rev Med Interne 2020; 42:210-213. [PMID: 33303221 DOI: 10.1016/j.revmed.2020.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 11/15/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Dermatological manifestations of actinomycosis are classical, most often related to Actinomyces israelii. In most of the cases, they occur near to the primary focus, and in the cervicofacial area. Systemic dissemination with cutaneous distant metastasis is rare, most often related to A. israelii, too. We report an original case of upper limb actinomycosis associated with an oral localisation and due to an unusual bacteria. CASE REPORT A 49-year-old man was referred to the Department of dermatology for a skin lesion of the left hand and wrist. Biopsies revealed actinomycosis related to A. meyeri. Dental primary focus was identified and treated. Although the patient was lost sight of, dental eradication and prolonged antibiotics therapy allowed cutaneous improvement. DISCUSSION We report an atypical case of cutaneous actinomycosis due to an Actinomyces meyeri dental infection occurring in an immunocompetent, smoking adult, with poor oral hygiene. The literature review revealed only 4 well-documented cases of cutaneous A. meyeri infections distant to dental primary focus. All of patients were males, immunocompetent, with a history of poor oral hygiene. The prognosis is favourable with adequate treatment (antibiotic therapy and surgical treatment to eradicate dental infectious entry points).
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Affiliation(s)
- C Landart
- Service de chirurgie maxillo-faciale et stomatologie, CHU de Rouen, université de Rouen Normandie, 1, rue de Germont, 76000 Rouen, France; Centre de soins dentaires, CHU de Rouen, 2, rue Guillaume-Lecointe, 76140 Le Petit-Quevilly, France
| | - O Trost
- Service de chirurgie maxillo-faciale et stomatologie, CHU de Rouen, université de Rouen Normandie, 1, rue de Germont, 76000 Rouen, France; Laboratoire d'anatomie, UFR de santé de Rouen, université de Rouen Normandie, 22, boulevard Léon-Gambetta, 76000 Rouen, France; Inserm, université de Rouen Normandie, université de la Sorbonne, université de Paris 13, Laboratory of medical informatics and knowledge engineering in e-Health, LIMICS, 75006 Paris, France.
| | - H Moizan
- Centre de soins dentaires, CHU de Rouen, 2, rue Guillaume-Lecointe, 76140 Le Petit-Quevilly, France
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Desbarats C, Adnot J, Bastien AV, Trost O. [Langerhans cell histiocytosis revealed by a temporomandibular joint disorder: Report of a case and review of the craniofacial expressions]. Rev Med Interne 2019; 41:50-53. [PMID: 31474430 DOI: 10.1016/j.revmed.2019.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 07/17/2019] [Accepted: 08/15/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Langerhans cell histiocytosis (HL) is a rare disease that can affect all tissues. Oral manifestations such as mucosal ulcer and tooth mobility are often the first signs of the disease. We report a rare case of mandibular condyle unifocal HL mimicking a temporomandibular joint disorder. CASE REPORT A 44-year-old patient presented with a left temporomandibular disorder with painful left preauricular swelling. The imaging assessment found a bone lesion of the left mandibular condyle. A curettage with biopsy was used to diagnose HL. Six months later, the patient had no more pain. DISCUSSION The craniofacial clinical expressions of HL mainly concern the bones, which can cause: pain, swelling, fracture, compression of noble organs. The other sites are: oral cavity, skin, lymph nodes, or eyes. Isolated forms are generally benign, and their treatment is discussed between abstention and non-aggressive surgery.
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Affiliation(s)
- C Desbarats
- Service de chirurgie maxillo-faciale et stomatologie, centre hospitalo-universitaire de Rouen, 1, rue de Germont, 76000 Rouen, France
| | - J Adnot
- Service de chirurgie maxillo-faciale et stomatologie, centre hospitalo-universitaire de Rouen, 1, rue de Germont, 76000 Rouen, France
| | - A V Bastien
- Service de chirurgie maxillo-faciale et stomatologie, centre hospitalo-universitaire de Rouen, 1, rue de Germont, 76000 Rouen, France
| | - O Trost
- Service de chirurgie maxillo-faciale et stomatologie, centre hospitalo-universitaire de Rouen, 1, rue de Germont, 76000 Rouen, France; Laboratoire d'anatomie, faculté de médecine de Rouen, 22, boulevard Gambetta, 76000 Rouen, France; Institut national de la santé et de la recherche médicale (Inserm), LIMICS UMR-1142, 76000 Rouen, France.
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Ben Slama N, Adnot J, Trost O. Management of an extended bone-invasive basal cell carcinoma of the median forehead. J Stomatol Oral Maxillofac Surg 2019; 121:296-299. [PMID: 31325622 DOI: 10.1016/j.jormas.2019.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 07/02/2019] [Accepted: 07/08/2019] [Indexed: 10/26/2022]
Abstract
We report the case of a 35-year-old male patient managed for extended basal cell carcinoma of the median forehead, invading the frontal bone. Bone reconstruction was performed by a splitting of calvaria and skin reconstruction was performed using two frontal flaps dissected into complete vascular island, covering a skin defect of about 8cm in diameter (including safety margins). Wound healing was achieved after 4 weeks despite a median area of suffering and a temporary leak of cerebrospinal fluid of favorable evolution. The result at 5 years was excellent, with the patient's return to normal daily life and total satisfaction.
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Affiliation(s)
- N Ben Slama
- Department of Oral and Maxillofacial Surgery, Rouen Normandy University, 1, rue de Germont, 76031 Rouen, France
| | - J Adnot
- Department of Oral and Maxillofacial Surgery, Rouen Normandy University, 1, rue de Germont, 76031 Rouen, France; LIMICS UMR-1142,French National Institute for Health (INSERM), 76000 Rouen, France
| | - O Trost
- Department of Oral and Maxillofacial Surgery, Rouen Normandy University, 1, rue de Germont, 76031 Rouen, France; LIMICS UMR-1142,French National Institute for Health (INSERM), 76000 Rouen, France; Laboratory of Anatomy, Rouen Faculty of Medicine, Rouen Normandy University, Rouen, France.
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Adnot J, Desbarats C, Joly LM, Trost O. Nasomaxillary fracture: Retrospective review of 11 consecutive patients and literature review. J Stomatol Oral Maxillofac Surg 2019; 120:534-539. [PMID: 30862536 DOI: 10.1016/j.jormas.2019.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 03/04/2019] [Accepted: 03/05/2019] [Indexed: 12/01/2022]
Abstract
PURPOSE Nasomaxillary fractures can be mistaken for fractures confined to the nasal bones, resulting in inappropriate treatments that jeopardize patient outcomes. Our purpose here was to provide information on nasomaxillary fractures via a retrospective study and literature review. MATERIAL AND METHODS We retrospectively collected clinical, computed tomography (CT), therapeutic, and outcome data in consecutive patients managed for unilateral impacted nasomaxillary fractures at our centre over a 5-year period (2013-2017). Long-term outcomes were further assessed by administering scoring tools for subjectively assessed cosmesis, nasal obstruction, and pain during a telephone interview. RESULTS The 11 included patients had a mean age of 33.4 years. The clinical manifestations included nasal asymmetry in all 11 patients and infra-orbital rim step-off deformity in 9 patients. Consistent CT findings were involvement of the nasal bone, canine pillar, and anterior maxillary bone; and presence of blood within the maxillary sinus. The treatment in 8 patients consisted in open reduction and internal fixation via the intraoral approach, with or without an added infra-orbital approach; 1 patient was managed by endonasal reduction and 2 patients declined reduction. Almost 1 year after surgery, the cosmetic outcome was good (mean score, 22/25) and few patients reported nasal obstruction (mean score, 3.6/20) or pain (mean score, 1.6/10). CONCLUSION Nasomaxillary fracture is a specific entity that must be differentiated from nasal bone fracture. Open reduction and internal fixation via the intraoral approach, with an added infra-orbital approach if needed, provides good outcomes.
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Affiliation(s)
- J Adnot
- Department of oral and maxillofacial surgery, Rouen university hospital, 1, rue de Germont, 76000 Rouen, France.
| | - C Desbarats
- Department of oral and maxillofacial surgery, Rouen university hospital, 1, rue de Germont, 76000 Rouen, France
| | - L-M Joly
- Emergency unit, Rouen university hospital, 1, rue de Germont, 76000 Rouen, France
| | - O Trost
- Department of oral and maxillofacial surgery, Rouen university hospital, 1, rue de Germont, 76000 Rouen, France; Laboratory of anatomy, Rouen faculty of medicine, 22, boulevard Léon-Gambetta, 76000 Rouen, France; French national institute for health (inserm), LIMICS UMR-1142, 76000 Rouen, France
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Adnot J, Moizan H, Trost O. Dental implants in a patient with left mandibular fibrous dysplasia: Two-year outcomes on the normal and affected sides. J Stomatol Oral Maxillofac Surg 2019; 120:575-578. [PMID: 30763781 DOI: 10.1016/j.jormas.2019.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 01/15/2019] [Accepted: 02/01/2019] [Indexed: 01/07/2023]
Abstract
Dental rehabilitation raises specific challenges in patients with mandibular fibrous dysplasia. We report the 2-year post-operative outcomes on the normal and affected sides in a 64-year-old female with focal left mandibular fibrous dysplasia and bilateral posterior edentulism. On the left, bone shaving of the lesion to restore sufficient vertical height was followed by the insertion of two dental implants. Three dental implants were inserted into the normal bone on the right. Dental prostheses were added 6 months later. Two years after the first procedure, no complications had been recorded and the patient reported similar high satisfaction for both sides. This comparison of outcomes of dental implants inserted into dysplastic versus normal bone in the same patient suggests that dental implants may constitute a valid option for managing edentulism in selected patients with fibrous dysplasia, provided appropriate precautions are taken.
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Affiliation(s)
- J Adnot
- Oral and Maxillofacial surgery department, Rouen university hospital, 1, rue de Germont, 76031 Rouen, France.
| | - H Moizan
- Odontology department, Rouen university hospital, 1, rue de Germont, 76031 Rouen, France
| | - O Trost
- Oral and Maxillofacial surgery department, Rouen university hospital, 1, rue de Germont, 76031 Rouen, France; Laboratory of anatomy, Rouen faculty of medicine, 22, boulevard Léon-Gambetta, 76031 Rouen, France; French national institute for health (Inserm), LIMICS UMR-1142, 76031 Rouen, France
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Adnot J, Gemival P, Trost O. Maxillary metastasis from a hepatocellular carcinoma: Report of an uncommon presentation and literature review. J Stomatol Oral Maxillofac Surg 2018; 119:503-505. [PMID: 29981859 DOI: 10.1016/j.jormas.2018.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 06/04/2018] [Accepted: 07/02/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Oral metastases from hepatocellular carcinoma (HCC) are very rare, and predominate in the mandible. We report an exceptional case of maxillary metastasis revealing HCC. CASE REPORT A 56-year-old man with a previous medical history of alcohol abuse presented to our department with a 3-week evolving oral mass. Physical examination showed a left maxillary tumor. The biopsy revealed a HCC and a multi-metastatic HCC with portal thrombosis and a pulmonary embolism was discovered following a CT-scan. A state of advanced malnutrition contraindicated sorafenib chemotherapy. Thus, external irradiation was proposed, without success. The patient subsequently died 50 days later. DISCUSSION Maxillary HCC metastases are extremely rare. The average age of HCC jaw metastases appearance in patients has been reported to be approximately 57 years, men are more affected than women are, and the mean life expectancy is 12 months following the diagnosis. These patients require palliative treatment. Local recurrences occur very early after possible surgery, and expose the patient to life-threatening bleeding.
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Affiliation(s)
- J Adnot
- Department of oral and maxillofacial surgery, Rouen university hospital, 1, rue de Germont, 76031 Rouen, France
| | - P Gemival
- Department of anatomic pathology, Rouen university hospital, 1, rue de Germont, 76031 Rouen, France
| | - O Trost
- Department of oral and maxillofacial surgery, Rouen university hospital, 1, rue de Germont, 76031 Rouen, France; Laboratory of anatomy, Rouen faculty of medicine, 22, boulevard Léon-Gambetta, 76031 Rouen, France; French National Institute for Health (Inserm), LIMICS UMR-1142, 76031 Rouen, France.
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Crampon F, Duparc F, Grignon B, Trost O. Advances in anatomical bases for head and neck surgery. Surg Radiol Anat 2018; 40:607. [PMID: 29752483 DOI: 10.1007/s00276-018-2037-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- F Crampon
- Laboratory of Anatomy, Faculty of Medicine, Rouen University, 22 boulevard Gambetta, 76183, Rouen, France.,Department of ENT Surgery, Rouen University Hospital, 1 rue de Germont, 76031, Rouen, France
| | - F Duparc
- Laboratory of Anatomy, Faculty of Medicine, Rouen University, 22 boulevard Gambetta, 76183, Rouen, France.
| | - B Grignon
- Department of Medical Imaging, Nancy University Hospital, 29 Avenue du Maréchal de Lattre de Tassigny, 54035, Nancy, France
| | - O Trost
- Laboratory of Anatomy, Faculty of Medicine, Rouen University, 22 boulevard Gambetta, 76183, Rouen, France.,Department of Oral and Maxillofacial Surgery, Rouen University Hospital, 1 rue de Germont, 76031, Rouen, France
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Gerlach J, Jörres A, Trost O, Hole O, Vienken J, Courtney J, Gahl G, Neuhaus P. Side Effects of Hybrid Liver Support Therapy: TNF-α Liberation in Pigs, Associated with Extracorporeal Bioreactors. Int J Artif Organs 2018. [DOI: 10.1177/039139889301600807] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
During acute liver failure, hybrid liver support therapy could serve as a bridge to liver transplantation. In this desired temporary use, immune competent cell responses, such as the production of cytokines, might be of limiting relevance. We have investigated the Tumor Necrosis Factor-α (TNF) liberation in two models using pigs, connected with an extracorporeal bioreactor with homologous hepatocytes: TNF liberation was measured in arterial plasma during a 4 day perfusion time in untreated animals, model (i), and during short term perfusion of hepatectomized pigs in model (ii). Animals four days after catheter implantation in model (i) had TNF values of < 5 pg/ml. After connecting the system without hepatocytes, TNF rose to 9.7 ± 2 within 120 min and rose further to 32.6 ± 6 pg/ml within 4 hours after filling the system with the homologous hepatocytes. After 24 hours of continuous perfusion and during four days of perfusion, the TNF levels were lowered to baseline levels. In model (ii), TNF rose to 220 ± 130 pg/ml within 180 min and decreased to 110 ± 10 pg/ml within six hours, whereas controls without hepatocytes showed mean levels with a maximum of 120 ± 20 pg/ml. In both models, there was no correlation between TNF levels and clinical abnormalities such as fever or shock symptoms. There is evidence for an activation of blood cells during experimental extracorporeal hybrid support. No typical side effects were, however, observed. Thus, TNF mediated extracorporeal cell activation does not appear to limit the application of homologous hybrid liver support therapy.
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Affiliation(s)
- J. Gerlach
- Department of Surgical Clinic, Freie Universität Berlin - Germany
| | - A. Jörres
- Department of Nephrology, Freie Universität Berlin - Germany
| | - O. Trost
- Department of Surgical Clinic, Freie Universität Berlin - Germany
| | - O. Hole
- Department of Surgical Clinic, Freie Universität Berlin - Germany
| | - J. Vienken
- Department of Akzo AG, Wuppertal - Germany, University of Strathclyde, Glasgow - UK
| | - J.M. Courtney
- Department of Bioengineering Unit, University of Strathclyde, Glasgow - UK
| | - G.M. Gahl
- Department of Nephrology, Freie Universität Berlin - Germany
| | - P. Neuhaus
- Department of Surgical Clinic, Freie Universität Berlin - Germany
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Side W, Muraine M, Gueudry J, Retout A, Guichard B, Batut C, Trost O. [Total traumatic dislocation of the globe with transection of the optic nerve]. J Fr Ophtalmol 2017; 40:e347-e348. [PMID: 28987447 DOI: 10.1016/j.jfo.2016.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 08/08/2016] [Indexed: 11/18/2022]
Affiliation(s)
- W Side
- Service d'ophtalmologie, CHU Charles-Nicolle, 1, rue de Germont, 76000 Rouen, France.
| | - M Muraine
- Service d'ophtalmologie, CHU Charles-Nicolle, 1, rue de Germont, 76000 Rouen, France
| | - J Gueudry
- Service d'ophtalmologie, CHU Charles-Nicolle, 1, rue de Germont, 76000 Rouen, France
| | - A Retout
- Service d'ophtalmologie, CHU Charles-Nicolle, 1, rue de Germont, 76000 Rouen, France
| | - B Guichard
- Service de chirurgie maxillo-faciale stomatologie, CHU Charles-Nicolle, 1, rue de Germont, 76000 Rouen, France
| | - C Batut
- Service de chirurgie maxillo-faciale stomatologie, CHU Charles-Nicolle, 1, rue de Germont, 76000 Rouen, France
| | - O Trost
- Service de chirurgie maxillo-faciale stomatologie, CHU Charles-Nicolle, 1, rue de Germont, 76000 Rouen, France
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Bastien AV, Adnot J, Moizan H, Calenda É, Trost O. Secondary surgical decompression of the inferior alveolar nerve after overfilling of endodontic sealer into the mandibular canal: Case report and literature review. J Stomatol Oral Maxillofac Surg 2017; 118:389-392. [PMID: 28893717 DOI: 10.1016/j.jormas.2017.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 08/09/2017] [Accepted: 09/04/2017] [Indexed: 11/27/2022]
Abstract
The authors report the case of a 43-year-old woman who underwent endodontic treatment of the right second mandibular molar with substantial extrusion of endodontic material into the mandibular canal. The patient presented at the Department of Oral and Maxillofacial Surgery with a persistent total anaesthesia of the lower lip and chin after two months. 2D panoramic view and 3D CT-scan examination highlighted the overfilling into the mandibular canal with a more than 50% stenosis of the canal and a consequently significant compression of the dental pedicle. A surgical decompression of the inferior alveolar nerve was performed through an inferior vestibular approach, using PiezoSurgery®. The tooth was conserved. After a period of 8days, paraesthesia of the lower lip and chin appeared. Thermoalgic sensitivity was recovered at 1month. At 3months postoperatively, the patient had recovered protopathic and epicritic sensitivity. Dental prosthetic rehabilitation was finally achieved one year postoperatively. The authors discuss the physiopathology of nervous injuries during dental procedures, and further strategies in the case of persistent neurologic disorders.
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Affiliation(s)
- A-V Bastien
- Department of Oral and Maxillofacial Surgery, University Hospital of Rouen, Charles-Nicolle Hospital, 1, rue de Germont, 76031 Rouen, France
| | - J Adnot
- Department of Oral and Maxillofacial Surgery, University Hospital of Rouen, Charles-Nicolle Hospital, 1, rue de Germont, 76031 Rouen, France
| | - H Moizan
- Department of Odontology, University Hospital of Rouen, Saint-Julien Hospital, rue Guillaume-Lecointe, 76140 Le Petit-Quevilly, France
| | - É Calenda
- Department of Anesthesiology, University Hospital of Rouen, Charles-Nicolle Hospital, 1, rue de Germont, 76031 Rouen, France
| | - O Trost
- Department of Oral and Maxillofacial Surgery, University Hospital of Rouen, Charles-Nicolle Hospital, 1, rue de Germont, 76031 Rouen, France; Laboratory of Anatomy, Faculty of Medicine of Rouen, Rouen University, 22, boulevard Gambetta, 76000 Rouen, France; French National Institute for Health, Inserm, LIMICS UMR-1142, University of Rouen, 76000 Normandy, France.
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Eliezer M, Crampon F, Adnot J, Duparc F, Trost O. [Original three-dimensional reconstruction of a case of metopism associated with a unilateral complete absence of the left frontal sinus: Clinical interest and review of the literature]. Morphologie 2017; 101:97-100. [PMID: 28528795 DOI: 10.1016/j.morpho.2017.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 04/24/2017] [Accepted: 04/24/2017] [Indexed: 06/07/2023]
Abstract
Metopism (complete persistence of the metopic suture in adults) is a rare but not exceptional variation of the calvaria. Hypoplasia or aplasia of the frontal sinus may be associated without evident correlation. Nevertheless, a misdiagnosis of these variations may have clinical consequences, especially in a traumatic context. The aim of this paper was to report a case of metopism associated with a unilateral aplasia of the left frontal sinus, originally illustrated with 3D image fusion volume rendering reconstructions.
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Affiliation(s)
- M Eliezer
- Service de chirurgie maxillofaciale et stomatologie, hôpital Charles-Nicolle, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France
| | - F Crampon
- Service de chirurgie maxillofaciale et stomatologie, hôpital Charles-Nicolle, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France; Laboratoire d'anatomie, UFR mixte de médecine et de pharmacie de Rouen, 22, boulevard Léon-Gambetta, 76000 Rouen, France
| | - J Adnot
- Service de chirurgie maxillofaciale et stomatologie, hôpital Charles-Nicolle, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France
| | - F Duparc
- Laboratoire d'anatomie, UFR mixte de médecine et de pharmacie de Rouen, 22, boulevard Léon-Gambetta, 76000 Rouen, France
| | - O Trost
- Service de chirurgie maxillofaciale et stomatologie, hôpital Charles-Nicolle, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France; Laboratoire d'anatomie, UFR mixte de médecine et de pharmacie de Rouen, 22, boulevard Léon-Gambetta, 76000 Rouen, France.
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Crampon F, Eliezer M, Choussy O, Hardy H, Trost O. A pathognomonic CT of the parotid gland. ACTA ACUST UNITED AC 2014; 116:e1-2. [PMID: 25458593 DOI: 10.1016/j.revsto.2014.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 10/06/2014] [Indexed: 10/24/2022]
Affiliation(s)
- F Crampon
- Department of oral and maxillofacial surgery and multidisciplinary federation of cervicomaxillofacial oncology, university hospital of Rouen, Charles-Nicolle hospital, 1, rue de Germont, 76031 Rouen, France
| | - M Eliezer
- Department of radiology, university hospital of Rouen, Charles-Nicolle hospital, 1, rue de Germont, 76031 Rouen, France
| | - O Choussy
- Department of oral and maxillofacial surgery and multidisciplinary federation of cervicomaxillofacial oncology, university hospital of Rouen, Charles-Nicolle hospital, 1, rue de Germont, 76031 Rouen, France
| | - H Hardy
- Department of oral and maxillofacial surgery and multidisciplinary federation of cervicomaxillofacial oncology, university hospital of Rouen, Charles-Nicolle hospital, 1, rue de Germont, 76031 Rouen, France
| | - O Trost
- Department of oral and maxillofacial surgery and multidisciplinary federation of cervicomaxillofacial oncology, university hospital of Rouen, Charles-Nicolle hospital, 1, rue de Germont, 76031 Rouen, France.
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Trost O, Hardy H, Péron JM, Trouilloud P. [Current Nomina Anatomica for oral and maxillofacial surgery]. ACTA ACUST UNITED AC 2014; 115:287-92. [PMID: 25444243 DOI: 10.1016/j.revsto.2014.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 07/15/2014] [Accepted: 09/12/2014] [Indexed: 12/01/2022]
Abstract
Using the international organonymy is mandatory as well for daily clinical practice as for research and teaching our students. The international organonymy, Nomina Anatomica, is in Latin. A rather unsuccessful attempt at using a French version of the international organonymy in clinical practice has been made in France. Eponyms have been systematically contraindicated; the definitions of general anatomy are applied, as well as a systematic Gallicization of the Latin terminology. Despite a stringent observance of these rules, some terms remain inappropriate because they are misleading or inaccurate. Furthermore, using this language used worldwide remains uneasy in daily clinical practice. We had for objective to focus on the main anatomical terms used routinely in oral and maxillofacial surgery, and to justify their use in clinical practice, research, and education.
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Affiliation(s)
- O Trost
- Service de chirurgie maxillo-faciale et stomatologie, Fédération pluridisciplinaire de chirurgie cancérologique et réparatrice cervico-maxillo-faciale, CHU-hôpitaux de Rouen, hôpital Charles-Nicolle, 1, rue de Germont, 76031 Rouen, France.
| | - H Hardy
- Service de chirurgie maxillo-faciale et stomatologie, Fédération pluridisciplinaire de chirurgie cancérologique et réparatrice cervico-maxillo-faciale, CHU-hôpitaux de Rouen, hôpital Charles-Nicolle, 1, rue de Germont, 76031 Rouen, France
| | - J-M Péron
- Service de chirurgie maxillo-faciale et stomatologie, Fédération pluridisciplinaire de chirurgie cancérologique et réparatrice cervico-maxillo-faciale, CHU-hôpitaux de Rouen, hôpital Charles-Nicolle, 1, rue de Germont, 76031 Rouen, France
| | - P Trouilloud
- Laboratoire d'anatomie, UFR de médecine, 7, boulevard Jeanne-d'Arc, 21000 Dijon, France
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De Taddéo A, Collin B, Hardy H, Guichard B, Trouilloud P, Trost O. [Can one harvest a long bone stick in the radial forearm flap? Original radioanatomical and NanoSPECT-CT Bioscan microvascular study]. ANN CHIR PLAST ESTH 2014; 59:170-6. [PMID: 24485328 DOI: 10.1016/j.anplas.2013.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 12/23/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The composite radial forearm flap is a surgical option in the reconstruction of large traumatic or oncologic orofacial defects. Nevertheless, it has been criticized for its poor bone transport faculties that would make this flap insufficient in large osseous mandibular reconstructions, or for oral prosthetic rehabilitation with dental implants. What is more, the morbidity of the donor site has often been pointed. The aim of this radioanatomic study was to revisit the vascularization of the composite radial forearm flap, focusing on the bone stick. METHODS A radioanatomic study was performed on seven upper limbs taken from fresh cadavers. First, the vessels were washed with a 40°C solution of potassium acetate. Then an intra-arterial injection of a mixture of lead oxide and agar-agar was performed. 3D-CT-scan examinations of the anatomical pieces were performed. In a second step, the flaps were harvested and analyzed with a Microscan examination (NanoSPECT-CT Bioscan(®), voxel 220 microns). Collateral branches of the radial artery to the bone and the skin were counted and classified. RESULTS One radial diaphyseal artery was present in all the cases. The nutrient foramen took place at the anteromedial aspect of the diaphysis, between 45 and 65 % of the length of the bone. A dense anastomotic periosteal network was highlightened, supplied by one to four musculoperiosteal branches, and one to six fascio-periosteal arteries arising from the radial artery. A total of mean five osseous branches, and 12 cutaneous branches have been observed. CONCLUSIONS The results of the present preclinical study suggested that a 16-cm bone stick could be harvested with an optimal vascular safety, without consideration for the morbidity at the donor site. The original approach in this study, relating anatomy to the preclinical imaging, allowed a precise visualization of the microvascularization of the soft and hard tissues. It opened a field of innovative research in plastic and reconstructive surgery.
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Affiliation(s)
- A De Taddéo
- Laboratoire d'anatomie, faculté de médecine, 7, boulevard Jeanne-d'Arc, 21000 Dijon, France
| | - B Collin
- Plateforme d'imagerie préclinique, centre de lutte contre le cancer Georges-François-Leclerc, 1, rue du Professeur-Marion, 21000 Dijon, France
| | - H Hardy
- Service de chirurgie maxillo-faciale et stomatologie, hôpital Charles-Nicolle, CHU-hôpitaux de Rouen, université de Rouen, 1, rue de Germont, 76000 Rouen, France
| | - B Guichard
- Service de chirurgie maxillo-faciale et stomatologie, hôpital Charles-Nicolle, CHU-hôpitaux de Rouen, université de Rouen, 1, rue de Germont, 76000 Rouen, France
| | - P Trouilloud
- Laboratoire d'anatomie, faculté de médecine, 7, boulevard Jeanne-d'Arc, 21000 Dijon, France
| | - O Trost
- Service de chirurgie maxillo-faciale et stomatologie, hôpital Charles-Nicolle, CHU-hôpitaux de Rouen, université de Rouen, 1, rue de Germont, 76000 Rouen, France.
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de Taddéo A, Zwetyenga N, Trouilloud P, Trost O. Étude radio-anatomique tridimensionnelle de l’artère faciale et de ses perforantes cutanées. ANN CHIR PLAST ESTH 2014; 59:22-8. [DOI: 10.1016/j.anplas.2013.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 10/25/2013] [Indexed: 12/15/2022]
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Trost O, Peron JM. Re: "Treatment of low subcondylar fractures--a 5-year retrospective study". Int J Oral Maxillofac Surg 2013; 42:1596-7. [PMID: 24094670 DOI: 10.1016/j.ijom.2013.08.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 08/26/2013] [Indexed: 11/28/2022]
Affiliation(s)
- O Trost
- Department of Oral and Maxillofacial Surgery, University Hospital of Rouen, Ch. Nicolle Hospital, 1 rue de Germont, F-76000 Rouen, France.
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Duvernay A, Henault B, Danino M, Trost O, Dalac S, Aubriot-Lorton MH, Zwetyenga N. Les complications liées à la technique du ganglion sentinelle dans le mélanome cutané. Étude rétrospective à partir de 127 cas. ANN CHIR PLAST ESTH 2012; 57:151-7. [DOI: 10.1016/j.anplas.2011.12.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2011] [Accepted: 12/14/2011] [Indexed: 12/01/2022]
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Mommers XA, Trost O, Zwetyenga N. Temporomandibular joint total replacement using Biomet® prostheses: a prospective study. Int J Oral Maxillofac Surg 2011. [DOI: 10.1016/j.ijom.2011.07.652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Taddeo AA, Trost O, Zwetyenga N. Osseo-cutaneous radial forearm free flap: radio-anatomical study and clinical applications. Int J Oral Maxillofac Surg 2011. [DOI: 10.1016/j.ijom.2011.07.1033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Roche M, Duvernay A, Dalac S, Malka G, Zwetyenga N, Trost O. [Sentinel node procedure in head and neck cutaneous melanoma]. ACTA ACUST UNITED AC 2011; 112:6-10. [PMID: 21269653 DOI: 10.1016/j.stomax.2010.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2008] [Revised: 12/17/2010] [Accepted: 12/17/2010] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Sentinel lymph node (SLN) biopsy is frequently discussed in the management of cutaneous melanoma, especially in head and neck localizations where SLN biopsy is much more demanding. The benefits of SLN protocol are not proved yet. The aim of our study was to present our experience of SLN biopsy in head and neck cutaneous melanoma. PATIENTS AND METHODS This retrospective study included all patients managed for head and neck malignant melanoma from 2002 to 2006. We reviewed the technique, implementation and difficulties of the procedure, postoperative outcome, and complications. RESULTS Nineteen patients were included. An average of 2.2 lymph nodes were localized per patient using lymphoscintigraphy. Biopsy was impossible for one patient because the deep spinal node was not found. An average of 1.2 nodes was biopsied per patient. One patient presented with micrometastases. Another presented with lymphorrhea. DISCUSSION Sentinel node biopsy is widely performed in the management of cutaneous melanoma but remains an option for these indications in the last update of the French Society of Dermatology. SLN biopsy is difficult to implement because of the complexity of head and neck lymphatic system.
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Abstract
All our colleagues are unanimous: the anatomists were the most prestigious teachers of their preclinical curriculum. Our prestige, our durable impact on young students are partially based upon the fact that anatomy is the most "medical" discipline among all the lectures given in the first year(s) of medical curriculum. But the respect of our students is due in a large way to the quality of our educational methods based on lectures at the blackboard with pieces of chalk. A long preparation is required to achieve excellence and provide lectures melting science and art, inviting students to learn and understand with pleasure the human body on which they will practice up to date medicine. Training of anatomists requires long preparation in their own institutes as well as in common sessions organized at the Saints-Pères Institute of Anatomy of Paris, a mythic place of anatomy in France.
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Affiliation(s)
- O Trost
- Inserm U-887 "motricité-plasticité ", laboratoire d'anatomie, faculté de médecine, université de Bourgogne, 7, boulevard Jeanne-d'Arc, 21000 Dijon, France.
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Trost O, Charon-Barra C, Soichot P, Moreau G, Trouilloud P, Malka G. Lymphome B mandibulaire isolé révélé par une anesthésie du nerf alvéolaire inférieur. ACTA ACUST UNITED AC 2009; 110:101-4. [DOI: 10.1016/j.stomax.2008.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2008] [Revised: 10/12/2008] [Accepted: 11/13/2008] [Indexed: 10/21/2022]
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Kadlub N, Trost O, Duvernay A, Parmentier J, Wirth C, Malka G. Traitement orthopédique des fractures extra-articulaires de la région condylienne de la mandibule : étude rétrospective de 39 fractures unifocales. ACTA ACUST UNITED AC 2008; 109:301-5; discussion 305-6. [DOI: 10.1016/j.stomax.2008.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2008] [Revised: 04/10/2008] [Accepted: 05/20/2008] [Indexed: 10/21/2022]
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Trost O, Kadlub N, Cheynel N, Benkhadra M, Malka G, Trouilloud P. [Contribution of the posterior auricular artery in the vascularization of the facial nerve in prestylian space: anatomical study and surgical applications]. Morphologie 2008; 92:171-5. [PMID: 18845467 DOI: 10.1016/j.morpho.2008.07.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2008] [Accepted: 07/29/2008] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The aim of our study was to establish a systematization of collateral branches originating from posterior auricular artery to facial nerve in prestylian space. MATERIALS AND METHODS Thirty posterior auricular arteries were studied on 15 fresh cadavers after selective patent blue injection. We observed subsequent colouration of facial nerve. Number and topography of collateral branches were highlighted. RESULTS Posterior auricular artery supplied facial nerve in 67%. Collateral branches dedicated to facial nerve could be classified into three types: type 1 corresponded to one artery in prestylian space, type 2 to several branches in prestylian space; finally type 3 featured several branches originating from posterior auricular artery in prestylian space on the one hand, in superficial retroauricular area on the other hand. CONCLUSION Posterior auricular artery is the main blood supply to facial nerve in prestylian space. In most of the cases, branches to facial nerve originate deeply in parotid space. Nevertheless nervous branches may originate from superficial retroauricular segment of posterior auricular artery. Their damage during surgical procedures as bat ear surgery can cause definitive facial nerve palsy.
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Affiliation(s)
- O Trost
- Laboratoire d'anatomie, faculté de médecine, université de Bourgogne, and Service de chirurgie maxillo-faciale et stomatologie, hôpital Général, CHU de Dijon, 3, rue du Faubourg-Raines, 21033 Dijon, France.
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Trost O, Duvernay A, Parmentier J, Malka G. Re: Reconstruction of bony mandibular and maxillary defects with one single transfer of a free fibula osteocutaneous flap. J Plast Reconstr Aesthet Surg 2008; 61:1385; author reply 1386-7. [PMID: 18691953 DOI: 10.1016/j.bjps.2008.03.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2008] [Accepted: 03/30/2008] [Indexed: 10/21/2022]
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Trost O, Cheynel N, Benkhadra M, Kahn JL, Malka G, Trouilloud P. [Trapezio second metacarpal joint: anatomical study and clinical matters]. Morphologie 2008; 92:78-81. [PMID: 18809349 DOI: 10.1016/j.morpho.2008.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
INTRODUCTION An unusual dislocation of the column of the thumb associated with a fracture of the base of the second metacarpal inspired an anatomical study of the trapeziosecond metacarpal joint. MATERIALS AND METHODS Forty-five dissections of the palmar aspect of trapeziometacarpal joint aimed at focusing on palmar ligaments and tendons reinforcing the joints. RESULTS Trapeziosecond metacarpal joint is a constant little diarthrosis reinforced by a palmar ligament stressed between the crest of the trapezium and the base of the second metacarpal. The tendon of flexor radialis carpi muscle is an active link due to strong vinculae to trapezium bone and distal attachment to the bases of both second and third metacarpals. CONCLUSION The connections between the trapezium and the base of the second metacarpal bone play a role in the treatment of thumb instability and their mechanical importance is illustrated in our original clinical observation.
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Affiliation(s)
- O Trost
- Laboratoire d'anatomie, faculté de médecine, université de Bourgogne, 7, boulevard Jeanne-d'Arc, 21000 Dijon, France.
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Danino MA, Trost O, Malka G, Garrido I, Jebrane A, Dalac S. [Study of variations between surgeons regarding inguinal lymph node clearance in melanoma]. Ann Dermatol Venereol 2008; 135:142-4. [PMID: 18342100 DOI: 10.1016/j.annder.2007.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2007] [Accepted: 06/15/2007] [Indexed: 11/29/2022]
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Trost O, Danino A, Benoît L, Dalac S, Labruère-Chazal C, Trouilloud P, Malka G. La pratique des curages ganglionnaires est-elle harmonieuse? Analyse rétrospective de 330 cas. ANN CHIR PLAST ESTH 2007; 52:555-8; discussion 559-10. [PMID: 17481793 DOI: 10.1016/j.anplas.2007.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2005] [Accepted: 03/14/2007] [Indexed: 11/23/2022]
Abstract
AIM The aim of our study was to make evident the huge variability in lymph node dissection practice. MATERIAL AND METHODS Therefore a retrospective study was conducted on 330 patients assessed for cervical, axillary or groin dissections. In each case the authors collected the primary diagnosis and clinical stage indicating lymph node clearance, identity of the surgeon and the pathologist, surgical technique including skin incision and landmarks of tissue removal, size of the clearance, and number of lymph nodes removed. Correlations between diagnosis, surgeon's or pathologist's identity, size of the clearance and number of nodes were analyzed using non-parametric tests. RESULTS Standardized procedures as axillary dissections occurred few differences between surgeons. In groin or cervical dissections statistical differences were made evident with great technical variability. There was a positive correlation between size of the piece of lymphadenectomy and number of lymph nodes removed. CONCLUSION Standardized procedures as axillary dissections provide few variations. Cervical and especially groin dissections should be harmonized, published and taught harmoniously in schools of surgery. So the expression "regional lymph node clearance" would mean.
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Affiliation(s)
- O Trost
- Service de chirurgie maxillofaciale, plastique, esthétique et réparatrice, chirurgie de la main, CHU de Dijon, 3, rue du Faubourg-Raines, BP 1519, 21033 Dijon, France.
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Abu El-Naaj I, Trost O, Tagger-Green N, Trouilloud P, Robe N, Malka G, Peled M. Péri-implantite ou carcinome épidermoïde? ACTA ACUST UNITED AC 2007; 108:458-60. [PMID: 17624383 DOI: 10.1016/j.stomax.2007.04.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2006] [Revised: 08/24/2006] [Accepted: 04/01/2007] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Squamous cell carcinoma developed around dental implants has seldom been described. It simulates peri-implantitis. The authors present two cases and a literature review. CASE REPORTS A 70 year-old woman presented with an exophytic tumor developed around dental implants placed in the anterior part of the mandible. Panoramic X-rays showed major osteolysis, especially around the distal abutment implants. A 72 year-old patient, smoker, presented with chronic lichen planus; he was carrying two implants supporting an overdenture with ball-attachments, placed 15 years before. He presented with an ulcerated symphyseal tumor, bone loss around implant in position 43. The implant had been spontaneously pushed out. In both cases the diagnosis was squamous cell carcinoma. DISCUSSION Few cases of squamous cell carcinoma developed around dental implants have been reported. They initially mimic peri-implantitis. The carcinogenic role of the implant has never been established. Another hypothesis is the migration of malignant cells, originating from a mucosal tumor, through the sulcus. Risk factors for squamous cell carcinoma (smoking or alcohol consumption, precancerous lesions) are an indication for a permanent follow-up. Biopsies will prove the diagnosis.
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Affiliation(s)
- I Abu El-Naaj
- Department of Oral and Maxillofacial Surgery, Rambam Medical Center, Technion Faculty of Medicine, Haifa, Israel
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Trost O, Gradel J, Danino A, Malka G. [Socioeconomic adjustment in young cleft lip-palate patients]. Rev Stomatol Chir Maxillofac 2007; 108:383-7. [PMID: 17681569 DOI: 10.1016/j.stomax.2007.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2007] [Accepted: 06/15/2007] [Indexed: 05/16/2023]
Abstract
INTRODUCTION The aim of our study was to evaluate socioeconomic adjustment of young adults after treatment for cleft lip and palate. MATERIALS AND METHODS A retrospective study was made including patients born from 1975 to 1986 and followed-up in our department. The investigation was based on response to a questionnaire that partly replicated a national survey of social and economic life in the population (standard of living survey Burgundy, Insee France 1999). The control group was constituted by individuals taken from a regional probability sample of households. This report covered education, employment, and marriage. RESULTS 41 patients were enrolled in this retrospective study and compared to 972 young adults. There was a significant delay in the independence process, regarding housing and marriage. Patients remained in normal limits concerning employment. However the patients' education history showed a significant delay, and a higher rate of vocational courses. DISCUSSION The independence process showed a significant delay in cleft lip-palate patients, as well as education history. Nevertheless the final socioeconomic adjustment was similar to that of the general population.
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Affiliation(s)
- O Trost
- Service de chirurgie maxillofaciale et de stomatologie, chirurgie plastique, esthétique et réparatrice, chirurgie de la main, CHU de Dijon, 3, rue du Faubourg-Raines, BP 1519, 21033 Dijon, France
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Trost O, Kadlub N, Abu El-Naaj I, Danino A, Trouilloud P, Malka G. Traitement chirurgical des fractures du condyle mandibulaire de l'adulte en France en 2005. ACTA ACUST UNITED AC 2007; 108:183-8. [PMID: 17459440 DOI: 10.1016/j.stomax.2006.09.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2006] [Accepted: 09/12/2006] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The authors had for aim to present the latest trends in the surgical management of mandibular condylar fractures in France, in 2005. MATERIAL AND METHODS One hundred maxillofacial surgeons were questioned on the surgical management of condylar fractures and indications. Results were presented at the 41st Congress of Stomatology and Maxillofacial surgery. RESULTS The overall reply rate was 70%. Condylar fractures are generally managed in teaching hospitals. Open reduction and fixation was deemed appropriate in low subcondylar fractures in 76% of the cases, in 10% for diacapitular fractures. Therapeutic details and indications were a matter of huge variability. DISCUSSION This survey highlighted the absence of any consensus as far as condylar fractures are concerned. It seems that the higher the fractures are, the lesser they are approached.
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Affiliation(s)
- O Trost
- Service de chirurgie maxillofaciale et stomatologie, plastique, esthétique et réparatrice, chirurgie de la main, CHU de Dijon, 3, rue du Faubourg-Raines, BP 1519, 21033 Dijon, France.
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El Khatib K, Kadlub N, Trost O, Danino AM, Malka G. [Dynamic external traction system for management of distal displaced fractures of the head of the proximal phalanx]. ACTA ACUST UNITED AC 2007; 26:21-5. [PMID: 17418765 DOI: 10.1016/j.main.2007.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2006] [Revised: 01/15/2007] [Accepted: 01/26/2007] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Phalangeal fractures are generally underestimated injuries, but result in pain, stiffness, instability, degenerative arthritis and loss of finger function. Treatment varies from open reduction with internal fixation giving perfect anatomical reduction but a risk of side effects, to orthopaedic treatment with variable results. Unstable fractures must be fixed rigidly to minimize joint immobilization. It is this concept of solid fixation and early mobilization, which directed us in the choice of dynamic external distraction in the management of these fractures. MATERIAL AND METHOD The authors present a prospective study of twelve patients treated for unstable fractures of the proximal interphalangeal joint by closed reduction and dynamic external distractor, we describe this simple device created with pins and rubber bands and examine the functional clinical results. RESULTS The average follow-up period was 7.5 months. We only noted one pin-track infection. Three patients complained of pain at postoperative follow up. In this series, the total active motion varied from 70 degrees to 120 degrees (average 94.16 degrees), the mean lack of extension was 5.6 degrees (from 0 to 15 degrees). Ten patients had good mobility and were satisfied. DISCUSSION Different traction devices for the management of displaced intraarticular phalangeal fractures have been reported. Most of them are complex to construct and expensive. The traction system is simple to assemble, economical and it allows early active motion of the affected digits. We consider that it is an effective mode of treatment for the management of complex intraarticular phalangeal fractures.
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Affiliation(s)
- K El Khatib
- Service de chirurgie maxillofaciale et chirurgie plastique, hôpital Général, CHU de Dijon, 3, rue du Faubourg Raines, 21033 Dijon cedex, France.
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Kadlub N, Trost O, Dalac S, Berriolo A, Ponelle T, Malka G, Danino A. [Evaluation of a method to reduce the number of sentinel nodes removed in melanoma patients: prospective study]. ANN CHIR PLAST ESTH 2006; 52:24-7. [PMID: 17126981 DOI: 10.1016/j.anplas.2006.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2005] [Accepted: 09/22/2006] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Since 1992, sentinel node (SLN) biopsy was generally applied to melanoma for carcinologic staging. Literature points out an increase of nodes removed for each procedure. It means to a high cost for this procedure and it wanders from the defining concept of SLN. The aim of our study was to evaluate whether, we can minimize number of SLN removed, without influencing the reliability of carcinologic staging. MATERIAL AND METHODS We conducted a prospective study about 50 patients with stage one melanoma. For each patient, the SLN was identified with hand-held gamma probe technique. We removed only the hottest and all nodes greater than 70% of the hottest. We analysed the characteristics of melanoma, the success rate of this procedure, how many nodes have been removed and how many have had micro-metastases. This result was compared to two main studies with chi(2) test. RESULTS The success rate of this technique was 100%. We dissected 1,3 SLN for each patient, with 22% positive SLN. Statistical analyse pointed out a better selectivity of our study, rate of pathological positivity and recurrence was alike. DISCUSSION Our technique decreasing number of removed SLN is reliable. A minimal number of nodes doesn't distort sensitivity of carcinologic staging, and reduce cost of the procedure.
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Affiliation(s)
- N Kadlub
- Service de chirurgie maxillofaciale et plastique, hôpital général, CHU de Dijon, 3, rue Faubourg-Raines, 21000 Dijon, France.
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Trost O, Trouilloud P, Danino A, Malka G. O.248 Anteroparotid transmasseteric approach of mandibular subcondylar fractures. A prospective study. J Craniomaxillofac Surg 2006. [DOI: 10.1016/s1010-5182(06)60275-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Abstract
UNLABELLED Many methods of treatment have been proposed for fractures of the neck of the fifth metacarpal ranging from early mobilization to various surgical techniques. The aim of this retrospective study was to evaluate the functional results and the costs of closed as opposed to open treatment (Foucher's K-Wire technique). MATERIALS AND METHODS We conducted a retrospective study on all fractures without rotational deformity and with a palmar angulation less than 40 degrees C. Details of the patients, the fractures, functional results and the cost of management were analyzed. RESULTS The functional results were similar between the two groups, but surgical treatment increased the cost of treatment to 1100 euros. CONCLUSIONS We advocate the use of closed treatment for these fractures. The functional results are the same as with surgical management, but the costs are much reduced.
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Affiliation(s)
- N Kadlub
- Service de chirurgie plastique, main et maxillofacial, 3, rue Faubourg-Raines, 21000 Dijon, France.
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Galliot-Repkat C, Cailliod R, Trost O, Danino A, Collet E, Lambert D, Vabres P, Dalac S. The prognostic impact of the extent of lymph node dissection in patients with stage III melanoma. Eur J Surg Oncol 2006; 32:790-4. [PMID: 16822643 DOI: 10.1016/j.ejso.2006.04.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2006] [Accepted: 04/05/2006] [Indexed: 12/01/2022] Open
Abstract
AIMS To analyse disease-free and overall survival in 67 melanoma patients who underwent dissection for clinically apparent regional lymph node metastases, taking into account the total number of excised lymph nodes. METHODS After a median follow-up time of 16 months, 47 recurrences were observed and 43 patients died. The median disease-free and overall survival intervals were 14 and 24 months respectively. RESULTS Multivariate analyses revealed that the number of excised lymph nodes had a significant impact on overall survival (P=0.036) but not on disease-free survival (P=0.97). Extranodal growth was the only statistically significant prognostic factor both for disease-free (P=0.005) and overall (P=0.038) survival. Age, nodal basin, primary tumor ulceration, tumor thickness and number of positive lymph nodes were not significant prognostic factors. CONCLUSIONS Our results suggest that the total number of lymph nodes excised in the dissection has impact on overall survival of stage III melanoma patients and should be considered in clinical assays.
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Affiliation(s)
- C Galliot-Repkat
- Department of Dermatology, University Hospital, 2 Boulevard Marechal de Lattre de Tassigny, F-21033 Dijon, France.
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Trost O, Abu-El Naaj I, Danino A, Kadlub N, Trouilloud P, Malka G, Peled M. [Deep lobe parotid gland lipoma: an extremely rare entity. A case report]. ANN CHIR PLAST ESTH 2006; 51:239-42. [PMID: 16519982 DOI: 10.1016/j.anplas.2005.12.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2005] [Accepted: 12/09/2005] [Indexed: 11/24/2022]
Abstract
The incidence of lipoma in the parotid gland is very low, and lipomas in the deep lobe of the parotid are extremely rare and seldom considered in the differential diagnosis of deep lobe parotid gland tumours. A deep lobe parotid gland lipoma is presented and discussed.
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Affiliation(s)
- O Trost
- Service de chirurgie maxillofaciale, plastique, esthétique et réparatrice, chirurgie de la main, CHU de Dijon, 3, rue du Faubourg-Raines, BP 1519, 21033 Dijon, France.
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Robe N, Trost O, Kadlub N, Danino A, Trouilloud P, Abu El Naaj I, Malka G. [Dynamic distraction and early reeducation in proximal interphalangeal joint fractures: preliminary results of a 15 patients' prospective series]. ANN CHIR PLAST ESTH 2006; 51:195-8. [PMID: 16488524 DOI: 10.1016/j.anplas.2005.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2005] [Accepted: 12/09/2005] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The authors present early results of the treatment of interphalangeal fractures with external dynamic distractor and early reeducation. PATIENTS AND METHODS Fifteen proximal interphalangeal fractures were treated with a "do-it-yourself" external distracter. Distraction was performed with rubber band or steel stitches. Patients sustained immediate self-mobilization and physiotherapy. Total duration of the treatment was 45 days. RESULTS Thirteen patients had good results with normal mobility after three months and recovered 80% of their controlateral force. Algodystrophia occurred in one case with poor functional results. One late management led to severe interphalangeal rigidity. CONCLUSION External distraction is a safe and economical treatment providing good early results with few complications. Long-term follow-up is necessary to make this procedure a standard-of-care in the management of proximal interphalangeal fractures.
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Affiliation(s)
- N Robe
- Service de chirurgie maxillofaciale, plastique, esthétique et réparatrice, chirurgie de la main, CHU de Dijon, 3, rue du Faubourg-Raines, BP 1519, 21033 Dijon, France
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Trost O, Kadlub N, Trouilloud P, Malka G, Danino A. Calciphylaxie : une complication grave et méconnue de l'insuffisance rénale chronique terminale. À propos de deux cas. ANN CHIR PLAST ESTH 2005; 50:746-50. [PMID: 16243422 DOI: 10.1016/j.anplas.2005.08.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2005] [Accepted: 08/25/2005] [Indexed: 10/25/2022]
Abstract
Calciphylaxis presents like subcutaneous lesions with livedo reticularis leading to necrotic and painful ulcers, predominantly in the lower limbs and the abdomen. They initially simulate dermohypodermitis. Biology reveals secondary hyperparathyroidism, phosphocalcic metabolism abnormalities and state of hypercoagulability. Histological signs are constant: calcifications in the media of small and sub-cutaneous arteries, intimal hyperplasia and intravascular thrombosis. This complication occurs in 4% of end-stage renal disease patients. Its prognostic is awful with a rate of mortality of 60% due to sepsis. Treatment is based upon the normalization of phosphocalcic rates and local debridement.
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Affiliation(s)
- O Trost
- Service de chirurgie maxillofaciale, plastique, esthétique et réparatrice, chirurgie de la main, CHU de Dijon, 3, rue du Faubourg-Raines, BP 1519, 21033 Dijon, France.
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El Khatib K, Danino A, Trost O, Jidal B, Malka G. [Use of nasolabial flap for mouth floor reconstruction]. ANN CHIR PLAST ESTH 2005; 50:216-20. [PMID: 15896896 DOI: 10.1016/j.anplas.2005.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2004] [Accepted: 02/25/2005] [Indexed: 11/22/2022]
Abstract
SUBJECT Oral cavity cancers represent 30% of the cephalic extremity tumors. Their resection requires in the majority of the cases a reconstruction by soft tissue. The reconstruction must be simple by bringing some reliable, hairless, thin, resistant tissue to radiation therapy, with a limited morbidity and an acceptable scar ransom. PURPOSE The purpose of our study is to define the place and the limits of nasolabial flap in the reconstruction of the anterior floor of the mouth after tumoral resection compared to the other surgical and microsurgical techniques. MATERIAL AND METHOD We retrospectively studied patients with oral cancerous lesions of the anterior floor of the mouth reconstructed by nasolabial flap between 1997 and 2002. The patients benefited from a surgical resection of the tumor by respecting the safety margins, with an immediate reconstruction allowing the restoring of the oral functions. We tried to describe the limits of this flap and discussed its modalities of vascularization. RESULTS Fifty-three flap procedures were performed on 47 patients; forty-one have received a unilateral and 6 a bilateral nasolabial flap. The majority of tumors were squamous cell carcinomas (50 cases). The average age of patients were 64.8 years (45-78 years) with 40 men (75%) and 13 women (25%). A radical neck lymph nodes dissection with facial artery ligation was realized for 21 patients (15 ipsilateral and 3 bilateral) without affecting the outcome. As complications, we noted one complete necrosis and two partial necrosis of the flap, two postoperative wound complications with dehiscence as well as a massive local recurrence of initial tumor in one patient. CONCLUSION The nasolabial flap represents a simple functional and morphological option to other pedicled or microsurgically anastomosed flaps for the reconstruction of intermediate-sized mouth floor defects.
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Affiliation(s)
- K El Khatib
- Service de chirurgie plastique, chirurgie maxillofaciale et stomatologie, hôpital militaire d'instruction Mohammed-V, 10100 Rabat, Maroc.
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Trost O, Danino AM, Kadlub N, Labruere C, Lepine J, Rombi H, Malka G. Diminution de la douleur au site donneur d'une greffe de peau mince par infiltration locale de ropivacaïne (Naropeine®) : résultats d'une série prospective de 30 patients. ANN CHIR PLAST ESTH 2005; 50:309-13. [PMID: 15913878 DOI: 10.1016/j.anplas.2005.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2004] [Accepted: 03/16/2005] [Indexed: 11/23/2022]
Abstract
AIM The aim of this study was to evaluate the benefits and risks of local infiltration in split-thickness skin grafts donnor site with ropivacaine (Naropein. MATERIALS AND METHODS Therefore a prospective study was conducted enrolling 30 patients assessed for split skin grafts to cover muscular flaps, burn areas or primary tumor sites. Donnor site surface ranged from 50 to 200 cm(2). Patients were randomized into two groups: with or without infiltration. Critters of inclusion were age over 18 y.o., donnor site surface below 200 cm(2), no neurological or psychiatic pathology, no contra-indication to ropivacaine. All grafts were performed under general anaesthesia, using Lagrot's razor to take 0.2 to 0.4 mm thickness skin bands. Donnor sites dressings were standardized, associating a corticoid fat dressing (Corticotulle strongly and occlusively contained with an elastic band (Elastoplast. Dressings were removed after three weeks. Immediate and late post-operative pain were evaluated using analogic visual scale (EVA) and need of analgesics during the hospitalisation in our Institution. Side-effects were collected. RESULTS Thirty patients were enrolled in this prospective study. They were mean aged 37 years old, sex ratio was 1/1. Donor site surface was mean 157 cm(2) and graft thickness 0.35 mm. There was a significant difference in immediate and late post-operative pain between both groups. Ropivacain reduced pain for the same oral analgesics use during 36 to 48 post-operative hours. No difference was noticed after 48 hours. No side-effects were noticed. CONCLUSION Infiltration of split skin grafts donnor site with ropivacain improves postoperative pain during 48 hours. This is a safe and efficient method to improve comfort in addition to a standardized occlusive dressing. It has become a standard routine in our Institution.
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Affiliation(s)
- O Trost
- Service de chirurgie plastique et maxillofaciale, CHU de Dijon, France
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Trost O, Danino AM, Dalac S, Hervé C, Moutel G, Malka G. La recherche du ganglion sentinelle dans le mélanome malin cutané de bas stade est-elle réellement peu invasive ? ANN CHIR PLAST ESTH 2005; 50:113-7. [PMID: 15820596 DOI: 10.1016/j.anplas.2004.11.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2004] [Accepted: 11/10/2004] [Indexed: 11/25/2022]
Abstract
AIM The aim of this study was to analyze outcome in patients enrolled in sentinel node biopsy procedure in early-staged cutaneous melanoma. MATERIAL AND METHODS Therefore a prospective study was conducted enrolling patients presenting with early-staged cutaneous melanoma. Our study focused on age and sex, duration from diagnosis to treatment, duration of hospitalization, dressing care and work inability in current follows. Duration from scintigraphy to surgery was analyzed and compared to sensibility of the procedure. What is more we observed rate and kind of complications and economical consequences, increasing duration of dressing care and work inability. The authors aimed at evaluating costs of SLN procedure including hospitalization, lymphoscintigraphy, general anaesthesia, costs of dressings, inability and overcosts of complications. RESULTS Forty-five patients were enrolled in our study (sex-ratio 1/2) mean aged 60 years old. Duration from diagnosis to treatment was mean 36 days. Sensibility of the procedure was excellent in trunk and limbs cases, lower in head and neck. In current cases patients were mean hospitalized three days, underwent 20 days of dressings and work inability depended on further interferon treatment. Complications occurred in 25% as seroma or local infections requiring antibiotherapy. Duration to healing was then 45 days increasing inability. Global costs of SLN procedure were significantly higher than previous wait and watch policy. CONCLUSION SLN biopsy is an expensive and invasive procedure with a high rate of complications. It defers melanoma treatment, only way to gain survival.
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Affiliation(s)
- O Trost
- Service de chirurgie plastique et maxillofaciale, CHU de Dijon, 3, rue du Faubourg Raines, 21033 Dijon, France.
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Trost O, Danino AM, Kadlub N, Dalac S, Hervé C, Malka G. Ganglion sentinelle dans le mélanome malin de bas stade : état des lieux en France en 2003. ANN CHIR PLAST ESTH 2005; 50:99-103. [PMID: 15820594 DOI: 10.1016/j.anplas.2004.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2004] [Accepted: 11/04/2004] [Indexed: 11/26/2022]
Abstract
AIM The aim of this study was to establish the status of sentinel lymph node (SLN) biopsy procedure in cutaneous melanoma in France in 2002. MATERIAL AND METHODS This study was based upon the statistics of the main French melanoma centers. A short questionnary was sent to Head Physician by email. The authors asked for the global attitude as far as SLN was concerned, number of cutaneous melanoma diagnosed during year 2002 and of SLN procedures performed, critters of inclusion and postoperative management in each case. Abstension could be argued in a free item. Answers were sent back by email. RESULTS The authors collected 22 answers coming from overall territory; 64% performed SLN procedure (14 centers), 36% applied "wait and watch" policy. Staffs performing SLN diagnosed a mean of 101 (8-400) melanoma and biopsied a mean of 21 (0-53) sentinel nodes. The others diagnosed a mean of 151 (15-250) melanoma. Patients were enrolled for Breslow thickness upper to 1.5 mm in 71%, to 1 mm in 29%. Ulceration was a critter of inclusion in 93% (21 staffs), 100% enrolled patients whose tumor presented signs of regression. SLN was performed for primary sites located overall body in 71%, only in limbs and trunk in 29%. Positive node lead to regional lymph node clearance, then observation or interferon protocol. Negative node lead to "wait and watch policy" in 14%, different interferon protocols according to Breslow thickness in 86%. CONCLUSION SLN procedure is not homogenous in France. France is divided as far as SLN is concerned. If 64% are performing SLN, more than 50% of the new melanoma are not included in the trial.
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Affiliation(s)
- O Trost
- Service de chirurgie plastique et maxillofaciale, CHU de Dijon, 3, rue du Faubourg-Raines, 21033 Dijon, France
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Trost O, Danino AM, Dutronc Y, Dalac S, Lambert D, Malka G. Is sentinel node biopsy beneficial in melanoma patients? A report on 200 patients with cutaneous melanoma (EJSO 2002; 28: 673--678). Eur J Surg Oncol 2003; 29:699. [PMID: 14511622 DOI: 10.1016/s0748-7983(03)00145-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Gerlach J, Jörres A, Trost O, Hole O, Vienken J, Courtney JM, Gahl GM, Neuhaus P. Side effects of hybrid liver support therapy: TNF-alpha liberation in pigs, associated with extracorporeal bioreactors. Int J Artif Organs 1993; 16:604-8. [PMID: 8225652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
During acute liver failure, hybrid liver support therapy could serve as a bridge to liver transplantation. In this desired temporary use, immune competent cell responses, such as the production of cytokines, might be of limiting relevance. We have investigated the Tumor Necrosis Factor-alpha (TNF) liberation in two models using pigs, connected with an extracorporeal bioreactor with homologous hepatocytes: TNF liberation was measured in arterial plasma during a 4 day perfusion time in untreated animals, model (i), and during short term perfusion of hepatectomized pigs in model (ii). Animals four days after catheter implantation in model (i) had TNF values of < 5 pg/ml. After connecting the system without hepatocytes, TNF rose to 9.7 +/- 2 within 120 min and rose further to 32.6 +/- 6 pg/ml within 4 hours after filling the system with the homologous hepatocytes. After 24 hours of continuous perfusion and during four days of perfusion, the TNF levels were lowered to baseline levels. In model (ii), TNF rose to 220 +/- 130 pg/ml within 180 min and decreased to 110 +/- 10 pg/ml within six hours, whereas controls without hepatocytes showed mean levels with a maximum of 120 +/- 20 pg/ml. In both models, there was no correlation between TNF levels and clinical abnormalities such as fever or shock symptoms. There is evidence for an activation of blood cells during experimental extracorporeal hybrid support. No typical side effects were, however, observed. Thus, TNF mediated extracorporeal cell activation does not appear to limit the application of homologous hybrid liver support therapy.
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Affiliation(s)
- J Gerlach
- Surgical Clinic, Universitätsklinikum Rudolf Virchow, Freie Universität Berlin, Germany
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