[Sclerosing polycystic adenosis of the parotid gland : surgical treatment of an extensive lesion of deep tissue without superficial damage]

Sclerosing polycystic adenosis (SPA) is a rare benign epithelial lesion of the salivary glands, of unknown etiology, mainly affecting the parotid gland. We report the first clinical case of SPA involving the deep parotid gland with extension in the parapharyngeal space and the masticatory region. It has been resected by an external parotidectomy approach exclusively, despite the median extension of the lesion. The objective of this article is to complete the small series of cases described in the literature, and to update the knowledge of this rare disease.

Evolution in the management of oropharyngeal squamous cell carcinoma: systematic review of outcomes over the last 25 years

The treatment of oropharyngeal squamous cell carcinoma (SCC) has evolved over the last 25years, from open surgery to combined chemoradiotherapy, and now to the development of minimally invasive procedures, but evidence for the best treatment is lacking. We therefore did a systematic search of the MEDLINE database for studies published between 1992 and 2017 that reported oncological or functional outcomes, or both. Predefined inclusion and exclusion criteria were used for screening and selection, and 45 studies were chosen. Only one was a randomised controlled trial, all the rest were prospective or retrospective case series. The heterogeneities in their characteristics made meta-analysis impossible and only qualitative analysis was feasible. We found no conclusive evidence to suggest the advantage of one therapeutic approach over another, so we still cannot offer patients the "ideal" treatment. We have, however, raised the possibility of there being two different entities: human papillomavirus (HPV)-positive and HPV-negative disease.

[A case of very late malignant degeneration of pleomorphic adenoma]

Incomplete excision of a pleomorphic adenoma exposes to a high risk of recurrence and tumor spread, making secondary surgery more difficult or a malignant transformation with a poor vital prognosis likely. Three histological types of pleomorphic adenomas can be observed when the tumor undergoes a transformation, namely the carcinoma ex-pleomorphic adenoma, the true malignant mixed tumor and the benign metastasizing mixed tumour.

[Combination of successive free transplants and osseointegrated implants in the reconstruction of the upper jaw]

Various free flap transfers can be associated to reconstruct a defect after resections in the head and neck region. The use of these flaps can be synchronous (one-stage surgery) or metachronous (two-stage surgery) in order to correct or improve secondary residual deformities. A two-stage use of free flaps, first with an osteocutaneous scapular flap and second with a fascial radial forearm flap, is reported after total maxillectomy. The osteocutaneous scapular flap was used to restore function (swallowing, chewing, speech and cheek projection) and the radial forearm flap to improve esthetic facial morphology. Minor ancillary procedures were subsequently necessary to achieve the final result (brow lift, tarsal straightening and facial lift).

Dental prosthetic reconstruction of osseointegrated implants placed in irradiated bone

Nineteen patients who were treated for oncologic pathology by surgery and radiotherapy (average dose = 57 Gy) received prosthetic reconstruction with 53 implants placed in the residual mandible or maxilla and/or replacement bone graft. Implants were placed within a minimum period of 5 months after radiotherapy. The healing period before placement of the prosthesis also was at least 5 months. Two to six implants were placed as a function of tooth loss and required prosthetic design. Prostheses included both removable and fixed restorations. Two implants were lost as a result of osseointegration failure. Fifteen implants in six patients could not be followed throughout the study because of patient expiration. Patients were followed up to 68 months and for an average of 38 months. No osteoradionecrosis phenomenon was seen in this study. However, caution is urged in placing implants in irradiated bone because of the potential for osteoradionecrosis. Patients should be carefully selected and a strict therapeutic protocol should be followed.

[Prosthetic dental rehabilitation on osseointegrated implants placed in irradiated mandibular bone. Apropos of 50 implants in 17 patients treated over a period of 5 years]

The authors report on their experience with prosthetic dental rehabilitation of 17 patients after surgery and radiotherapy for oncologic diseases of the oral cavity. 50 implants were inserted either in the mandibular residual bone or in a bone graft. These implants were inserted at least 5 months after radiotherapy, and functionally loaded at least 5 months after implanting. Depending on the degree of edentation, 2 to 6 implants were necessary to allow for a functional removable or fixed denture. 2 implants were lost because of lack of osseointegration and 10 were lost because of death of 4 patients. The longest observation period was 56 months and the mean observation time was 29 months. Not any osteoradionecrosis occurred : nevertheless, implantation in irradiated bone must remain a carefully planned operation in selected patients with a rigourous therapeutic protocol.

[Free antebrachial flap with radial pedicle. I. Theoretic considerations and indications in maxillofacial reconstruction]

The authors detail the anatomical, physiological, and clinical considerations of the free forearm flap. These characteristics determine the many indications of this flap in the maxillofacial surgical reconstruction. Contraindications are quasi inexistent. The second part of this work analyses the surgical and microsurgical operative technique use for the authors. All different parts of this work are discussed upon a deep review of the recent literature.

[The role of microsurgery in the reconstruction of loss of substance of soft tissue in the maxillofacial region]

Reconstruction of oncological defects in the maxillofacial region still remains a real surgical challenge due to the complexity and the tridimensional aspect of these defects responsible for heavy functional impairment. Microsurgery allowing the transfer of free flaps gives the surgeon the opportunity to adapt a specific reconstruction to each defect and to reinsert the patient in a quasi normal social life. These reconstruction technics are routinely used in many centers; they must be integrated in our therapeutic arsenal and in the training of the maxillofacial surgeon. Seven years ago, we incorporated microsurgical reconstruction in our therapeutical concepts and today, it seems to us important to share our experience of microsurgical reconstruction in the field of soft tissues defects in the maxillofacial region.

[Esthetic IMZ implant for a central incisor]

Replacement of a missing incisor with an osseo-integrated implant, presents a difficult prosthetic problem for the practitioner because of the obliqueness of the implant and its diameter smaller than the tooth to be reconstructed. Therefore, a topographic and aesthetic pre-estimation is highly desirable. The patient whose treatment is described hereafter, presents large diastemas permitting to set the missing tooth in several locations. The various options are simulated on a study model and recorded by a silicone or resin index. This index is cut out so that the implant site is clearly defined and it presents a guide rod indicating the direction of the alveolar bone. The optimal site is selected during the surgical procedure with the most favorable index depending on the residual bone. After the implant is released, the location impression, is taken using asymmetric transfer allowing a strict positioning of the implant's replica and its thread. In order to prevent the making of a triangular-shaped crown, a false transfixed core removable is built over the intramobile component of the IMZ as well as pa periodontal ring. The latter is independent and maintained by the intramobile component. It compensates the difference in diameter between the implant and the natural tooth to be reconstructed. Its finely polished but asymmetric internal aspect prevents the rotation of the device. The volume of this device is controlled by a silicone index made on the preestimation model. Both pieces are cast in gold and assembled on the implant with a positioning indes. Parallel proximal grooves increase the friction of the core and a ceramo-metal crown is built in the conventional fashion. It is temporally cemented, and periodically removed and cleansed. The absence of gingical sulcus provides an aesthetic result similar to a bridge component.