Facial fractures in post-revolution Tunisia as violence indicator: About 476 cases

INTRODUCTION

On January 2011, Tunisia had known a revolution. To move from dictatorship to democraty project, the country suddenly fell into political instability, which was accompanied by a wave of social violence. Traumatology, and, particularly, maxilla-facial traumatology, is usually a reliable indicator of the degree of violence.

AIM

The aim of this study was to establish the epidemiological profile of facial fractures during the various phases of political transition through which Tunisia has passed since revolution (2012-2016).

PATIENTS AND METHODS

A retrospective cross-sectional study was conducted among all patients with facial fractures admitted to the department of Oral and Maxillo facial Surgery of University Hospital of Sahloul during five years (2012-2016). Fractures diagnosed late at the sequelae stage were excluded. Data of patients were recorded according to medical files, including cause of injury, age and gender, injury mechanisms and type of facial fracture.

RESULTS

During the period of the study, a total of 476 patients were identified, with a sex-ratio of 7.2 to 1, patients ranged in age from 1 year to 76-years-old with a mean age of 27 years. Assaults were the most common cause of injury (39.1%). Mandible was fractured in 257 cases (54.2%) followed by zygoma (116 cases, 24.4%), nasal bone (99 cases, 20.8%) and Orbital walls (98 cases, 20.6%).

DISCUSSION

The epidemiological profile of facial fractures in Tunisia has been changed since 2011. Facial fractures occur mainly after assaults, which are an indicator of increased social violence accompanying political instability present in our country.

Long-term therapeutic outcomes of facial arteriovenous malformations: A retrospective bi-centric study of 30 cases

INTRODUCTION

Among vascular malformations, arteriovenous malformations (AVM) are potentially the most invasive and destructive especially when located on the face. Their management is still subject to controversy and yet no consensus exists. Our aim was to report long-term therapeutic outcomes for patients with facial AVM managed either by embolization alone or by resection with/without preoperative embolization.

MATERIAL AND METHODS

A bi-centric retrospective study was carried out covering the period from 2001 to 2018 including 30 patients with a facial AVM. Outcomes were categorized as follows: with 1=controlled disease, 2=improved disease (residual, no expansion), 3=persistent or stable disease (neither improved nor worsened), and 4=recurrent or worsened disease.

RESULTS

The initial treatment modality was embolization (n=5, 16.7%), surgical resection (n=16, 53.3%), and surgical resection after embolization (n=9, 30%). The follow-up period ranged from 12 to 216 months with a median of 54.9 months. Taking all treatment modalities together, disease control was achieved in 60% of the cases. Disease control was achieved in 77.8% of the cases after embolization followed by surgery, in 68.7% after surgery alone and in none of the cases after embolization alone.

CONCLUSIONS

According to our results, optimal treatment is based on a combination of embolization followed by a well-conducted surgical treatment.

Facial plastic surgery and face recognition algorithms: Interaction and challenges. A scoping review and future directions

INTRODUCTION

Face recognition (FR) technology can be used in wide range of applications such as identity authentication, access control, and surveillance. Interests and research activities in face recognition have increased significantly over the past twenty years. Plastic surgery procedures can significantly alter facial appearance, thereby posing a serious challenge even to the state-of-the-art face matching algorithms. The purpose of this work was to detail the interaction between facial plastic surgery and facial recognition software and discuss the new challenges of this interaction.

MATERIAL AND METHODS

The authors critically reviewed the literature from January 2000 to September 2019, to identify articles reporting interactions between facial plastic surgery and facial recognition algorithms and discuss the new challenges of these interactions. Controlled vocabulary terms and keywords were used in the search strategy and two authors independently analyzed data. Factors included in the analysis were: Author, Journal, Year, Scope, Study design, Plastic surgery, Data (volume, origin and processing), Identification accuracy and Conclusion (interaction/challenge).

RESULTS

Forty-three research articles underwent data extraction and 28 articles were included in quantitative synthesis. Of the 28 articles, the most common study designs were experimental evaluation (n=15, 53,5%), Evaluation Study studies (n=7, 25%) and Review studies (n=4, 14,3%). Fifty percent of the articles have been published in the last 4 years (14 articles, 50%). Most of the study scope was informatics (64,3%). Only 10 articles were published in medical journals. Rhytidectomy (face lift) is the most challenging procedure for the FR algorithms. Data volume varied from 4 to 2878 subjects. The proposed algorithms provide at least 15 to 99% better identification performance. Among these, only two papers discuss the new challenges of the interaction between facial plastic surgery and Face Recognition Algorithms.

CONCLUSION

In the context of advances in artificial intelligence, Internet connectivity and data integration, the purpose of this review is, to look forward to analyze the new interactions of facial plastic surgery and facial recognition algorithms, and to suggest avenues for future research and clinical application of this technology. Furthermore, to evaluate if plastic surgeons are prepared to discuss this technology with their patients. Plastic surgeons should be prepared to answer questions from patients about the fundamentals of facial recognition technology, and the potential effects of plastic surgery on facial recognition technology performance. Continued efforts are needed to provide scientifically rigorous data of facial biometric identification after facial plastic surgery and to include these notions in the routine consultation or consent process for patients seeking aesthetic facial surgery.

[Treatment of recurrent temporomandibular dislocation by displacement of the zygomatic arch: a modification of Gosserez and Dautrey's technique]

INTRODUCTION

Many methods have been reported for the surgical treatment of recurrent anterior temporomandibular dislocation. Most of these techniques are designed to limit the forward migration of the condylar head. The great number of surgical techniques experimented illustrates the difficulty to find a satisfactory method for the treatment of these recurrent dislocations.

TECHNICAL NOTE

We present a modification of Gosserez and Dautrey's surgical technique for the treatment of recurrent anterior temporomandibular joint dislocation.

DISCUSSION

The surgical technique is described and its indications are discussed.

[Ghost cell odontogenic carcinoma of the mandible]

INTRODUCTION

Ghost cell odontogenic carcinoma is a rare malignant tumor that occurs both in the mandible and maxilla. It has a variable non-specific clinical and radiological appearance. The authors report a mandibular case.

CASE REPORT

A 89-year-old man consulted for swelling of the left lower mandible and gums having developed over the previous 8 months. The lesion was 6cm long, ulcerative and budding, bleeding on contact. Radiological assessment revealed blurred contour osteolysis with extension to the mouth floor and sub-mandibular compartment. Histological examination of the surgical piece supported the diagnosis of ghost cell odontogenic carcinoma. The tumor recurred 2 months later and the patient died 6 months after surgery.

DISCUSSION

Ghost cell odontogenic carcinoma is a rare lesion. The patient was very old. Clinical and radiographic signs were unspecific. Histopathology proved the diagnosis. Evolution was unpredictable due to the wide spectrum of growth patterns. Extensive radical surgery is mandatory due to the high risk of recurrence.

[Eighteen cases of craniofacial fibrous dysplasia]

INTRODUCTION

Fibrous dysplasia or Jaffe Lischtenstein's disease is sporadic and rare bone affection, mainly observed in young adults. It is characterized by a bone maturation disorder that can affect one or several bones. Fibrous dysplasia is relatively rare in the craniofacial region, (only 20% of all locations). The authors analyzed the epidemiological, anatomoclinical and evolutive features of fibrous dysplasia in a Tunisian population.

MATERIAL AND METHOD

The authors retrospectively studied 18 cases of craniofacial fibrous dysplasia, diagnosed at the pathology department of the Sousse F. Hached hospital, beween1990 and 2005.

RESULTS

Most craniofacial dysplasia cases were monostotic (94% of cases). One case was polyostotic. The maxilla and the mandible were the most frequent locations (83.3%). The patients' mean age was 28.6 years, ranging from 6 to 30 years. The sex ratio was 3.5 in favor of women. Follow-up ranged from one month to 10 years with an average of 26.4 months. One case of sarcomatous transformation was observed.

DISCUSSION

The authors noted epidemiological discrepancies compared to what was usually reported, especially concerning the strong female predominance, the frequency of maxillary and mandibular locations and the predominance of monostotic presentations. Larger series are needed to validate these observations.

[Nasofrontal fistula and epidermoid cyst: a case study]

Nasofrontal fistulas, also called nasofrontal dermal sinuses, are very rare and found for the most part in children. This congenital malformation may be revealed by local infection or neuromeningitis, making this a serious disorder. We report one case of nasofrontal dermal sinus diagnosed in an 11-month-old girl, which was complicated by left fronto-orbital infection. Through this case, the authors stress the role of imaging methods in confirming the diagnosis and looking for associated cysts (dermoid and epidermoid).

[Epidemiological profile of salivary-glands tumors in a Tunisian teaching hospital]

INTRODUCTION

Salivary-glands tumors come in various presentations and the epidemiological data are variable. The aim of this retrospective study was to establish an epidemiological profile of salivary-glands tumors in a Tunisian teaching hospital and to compare it to published data.

PATIENTS AND METHODS

The study was made on 76 men and 80 women with a mean age of 43 years (five months to 85 years). Sixty percent of the tumors were parotid lesions, 16% were submandibular and 24% located on minor salivary glands. Eighty-four percent of parotid tumors were benign. Malignant-parotid tumors often affected men over 60 years of age. Most minor salivary-glands tumors were located on the palate.

DISCUSSION

Benign salivary-glands tumors, often have a parotid localization affect, more women in the Tunisian population. Contrary to the literature, in our series, malignant tumors were predominant in women.

Le kyste synovial de l'articulation temporomandibulaire

OBSERVATION

A 30-year-old patient presented with a left painful pre-auricular tumefaction for one year. CT-scan suggested the diagnosis of temporomandibular synovial cyst or first branchial cleft cyst. This was confirmed by surgery.

DISCUSSION

Temporomandibular synovial cysts are rare, the etiology is not documented. Revealing symptoms are those mentioned above. The common treatment is surgery.

Kyste dermoïde de la langue : aspects en imagerie d’un kyste géant

Dermoid cysts of the oral cavity are rare and most commonly involve the floor of mouth. Intralingual dermoid cysts are extremely rare and usually large at the time of diagnosis in adult patients. We report the case of 6 year old girl with macroglossia and swallowing and respiratory difficulties due to a giant intralingual dermoid cyst. Ultrasonography showed a large cystic intralingual lesion. MRI allowed accurate evaluation of the size, the extension and the relationship of the cystic mass with adjacent structures, the fat component of the cystic mass confirmed the dermoid origin. This case illustrates the diagnostic contribution of US and MRI in this disease.

[Pterygoïdien hydatid cyst]

INTRODUCTION

The cervico-facial hydatid cyst is rare. It accounts for 1% echinococcisis locations and usually involves the salivary gland and the thyroid. Pterygoid muscle involvement is exceptional.

CASE REPORT

We report the case of a patient presenting a hydatid cyst of the pterygoid muscle. The patient presented a non specific progressive tumor syndrome.

DISCUSSION

This case illustrates the importance of CT scans. Surgery is always required. We emphasize the risk of complications when the diagnosis is missed.

[Mandibular odontogenic carcinosarcoma: a case report]

The last W.H.O classification of odontogenic tumors (1992) individualized a new entity called odontogenic carcinosarcoma. We report a case in which we encountered some difficulties to establish the diagnosis. The patient J.Z., a 26 year-old woman was operated on for a left mandibular tumor corresponding, histologically, to an ameloblastic fibrosarcoma. One year later, we noted a submandibular swelling considered as a local recurrence. After resection, the pathologic examination diagnosed a lymph node metastasis from the same tumor. We decided to observe the patient. Three years post operatively, metastatic lymph nodes appeared, involving a double-component tumor: ameloblastic fibrosarcoma and malignant ameloblastoma. These features allowed the diagnosis of odontogenic carcinosarcoma. We insist on difficulties of the diagnosis and the necessity of radical resection of the tumor with neck dissection.

[Giant cell lesions of the maxilla disclosing primary hyperparathyroidism]

We report 2 cases of giant-cell lesions of the maxilla in two female patients aged 42 and 22 years. The initial diagnosis was giant-cell tumor and giant-cell repair granuloma. The diagnosis of brown tumor was established at discovery of primary hyperparathyroidism. We emphasize the importance of searching for hyperparathyroidism in patients with a giant-cell lesion of the maxilla.

[Neurosarcoma of the submandibular gland arising in a pleomorphic adenoma. Apropos of a case]

A 71-year-old woman consulted for a tumor of the right submandibular gland that had been present for 4 years and had rapidly increased in size during the last two months. Histological examination of frozen sections and immunohistochemistry concluded to a poor differentiated sarcoma probably a neurosarcoma with residual pleomorphic adenoma component. In spite of wide resection, local recurrences with nodes and lung metastases occurred leading to the death of the patient. We think interesting to report this unusual salivary tumor and to discuss its pathological features.

[Post-traumatic adenoid cystic carcinoma of the lacrimal gland]

A young 17-year-old man was injured on the external orbital canthus and developed a tumefaction which remained stable. After 2 years the tumefaction with exophthalmia and visual troubles. Radiological investigations suggested two diagnosis: Organized hematoma or a lacrimal gland tumor. Surgical exploration found an apparently benign tumor but histologically it was a cystic adenoid carcinoma.

[Thymic cyst in the neck. Apropos of a case]

Cervical thymic cyst is an uncommon lesion. It is usually diagnosed after cervicotomy for lateral swelling of the neck. We present a case in a 12-year-old boy. Clinical diagnosis was cystic hygroma, but computed tomography revealed extension of the cyst to the anterior mediastinum, suggesting its thymic origin. Successful excision was performed through a neck incision alone. There has been no recurrence of the cyst nor immune deficiency within a 2-year follow-up. Pathogenesis and diagnostic modalities are discussed.

[Osteochondroma of the mandibular condyle. Apropos of a case]

The authors report a case of mandibular condyle osteochondroma on a 33 years-old woman, similar to osteocartilaginous exostosis of the long bones. The lesion was revealed by a facial asymmetry and a change of the occlusion. The diagnosis was performed on the computed-tomography examination and histopathology. The removal of the lesion has conserved the condyle without recurrence after 20 months following-up. The authors remind the uncommonly location of osteochondroma in the facial skeleton and discuss the histogenesis of this lesion in its mandibular condyle site.