Paul Tessier ha creato negli anni 60 la chirurgia craniofacciale. Questa chirurgia richiede una perfetta collaborazione tra neurochirurgo, chirurgo maxillofacciale e anestesista-rianimatore pediatrico. La gestione di questi pazienti è svolta da equipe multidisciplinari al fine di adattare il trattamento ad ogni situazione. Per ragioni di pragmatismo, questo capitolo si limita all’esposizione di indicazioni e tecniche chirurgiche per le malformazioni più comuni dello scheletro craniofacciale: craniostenosi, facio-cranio-stenosi, ipertelorismo (e distopie orbitarie) e meningoencefalocele frontonasale.

Nasal glial heterotopia (NGH) is a rare benign tumor of the median line. We describe the case of a child presenting a lateral nasal mass. The characteristics of the prenatal ultrasound and the postnatal clinical examination argued in favor of a congenital hemangioma (CH). The MRI performed at 6 weeks of life suggested glial heterotopia. This diagnosis was confirmed by the pathological analysis. Congenital hemangiomas and nasal glial heterotopies have similar clinical presentations. Prenatal ultrasound diagnosis between NGH and CH is difficult. Fetal MRI is not yet highly specific for these two lesions, but it can eliminate an intracerebral connection in cases of NGH. Postnatal exams are more specific. Flow on the Doppler exam is rapid for CH and slow for NGH. On MRI, these two lesions appear as a hypersignal on T2-weighted sequences, but less intense for NGH than for CH. Distinguishing between NGH and CH can be difficult. This does not have a direct incidence on treatment because it is surgical in both cases.

INTRODUCTION:Congenital dacryocystoceles are rare and often misunderstood pathologies. Their treatment varies and consists in simple follow-up, lacrimal catheterization or endoscopic surgical drainage, depending on medical teams. The aim of our study was to discuss the place of endoscopic drainage in the treatment of congenital dacryocystocele. METHODS:We conducted a retrospective review on 18 cases of congenital dacryocystoceles taken in charge in a tertiary care center between 2009 and 2012. RESULTS:Thirteen newborns, including five bilateral cases, were taken in charge. The average age was 14.6 days. Six newborns presented with an acute dacryocystitis at the time of diagnosis. No respiratory complications were observed. Spontaneous drainage of the dacryocystocele was observed in 38.8% of the cases, occurring at 22 days of life on average. Endonasal endoscopic drainage was performed in 66.6% of the cases. No recurrence or complication was observed after surgery. After spontaneous drainage, one recurrence was observed. The mean follow-up period of these patients was 8.8 months. DISCUSSION:Spontaneous drainage is common. Conservative management may therefore be considered in absence of infection. In case of infection and/or persistence of dacryocystocele after 4 weeks of life, endonasal surgical drainage should be considered. Imaging of the facial structure should be performed before any surgical treatment.

Paul Tessier ha creato la chirurgia craniofacciale negli anni ′60. Questa chirurgia richiede una perfetta collaborazione tra neurochirurgo, chirurgo plastico o maxillofacciale e anestesista-rianimatore pediatrico. A scopo di pragmatismo, questo capitolo si limita all’esposizione delle indicazioni e delle tecniche chirurgiche delle malformazioni più comuni dello scheletro craniofacciale: le craniostenosi, le faciocraniostenosi, gli ipertelorismi (e le distopie orbitarie) e il meningoencefalocele frontonasale.

Introduction. Maxillary hypoplasia is a common sequela of cleft lip and palate. Its surgical treatment consists in a maxillary advancement by distraction or by conventional orthognathic surgery but morphological results are unpredictable. Our goal in this study was to see if the esthetical results (on the lip and the nose) of maxillary advancement were correlated to the preservation of lateral incisor space of the cleft side.Patients and method. This retrospective study included 38 patients operated between 2002 and 2013. Unilateral clefts were studied independently from bilateral clefts. Profile aesthetics was evaluated independently and subjectively by two surgeons and scored on an 8-point scale. The result was classified as "good" if the score was superior or equal to 6. The score was correlated to the following parameters: amount of maxillary advancement, upper incisor axis, preservation of the missing lateral incisor space.Results. In the "good result" group, the space of the lateral incisor was less often preserved. The nasolabial angle was more open and the upper central incisor axis more vertical. These results were more pronounced in bilateral clefts, but also found in unilateral clefts.Discussion. Under reservation of the subjective evaluation and of the small number of patients, it seemed that lateral incisor space closure improved the profile of patients treated by maxillary advancement for cleft lip and palate sequelae. (C) 2015 Elsevier Masson SAS. All rights reserved.

Paul Tessier fue el creador de la cirugía craneofacial en la década de 1960. Esta cirugía requiere una colaboración perfecta entre el neurocirujano, el cirujano maxilofacial y el anestesista-reanimador pediátrico. El tratamiento de estos pacientes lo realizan equipos pluridisciplinarios para adaptarlo a cada situación. Con un afán de pragmatismo, este artículo se limita a la descripción de las indicaciones y de las técnicas quirúrgicas de las malformaciones más frecuentes del esqueleto craneofacial: las craneoestenosis, las faciocraneoestenosis, los hipertelorismos (y distopias orbitarias) y los meningoencefaloceles frontonasales.

We are exposing the case of a 22 year-old patient presenting a wound of the right cheek, with a palsy of the right corner of the mouth. He has been sent to us 6 days after the trauma for secondary exploration. A section of the buccal branch of the right facial nerve with a 1 cm gap has been brought out. We have bypassed the loss of substance with a collagen absorbable biological conduit. The 6-months clinical and electromyographic follow-up has shown a clear improvement of the function of the orbicularis oris, as well as its reinnervation by the buccal branch of the right facial nerve. (C) 2014 Elsevier Masson SAS. All rights reserved.

A 4 year-old female patient was treated for persistent right-sided dacryocystitis and xerostomia. MRI was performed to screen for a dry syndrome; which resulted in the diagnosis of agenesis of the parotid and submandibular glands as well as lacrimal duct malformation. An MRI of each parent was normal. The mother's history revealed 4 days of pyrexia during the 8th week of amenorrhea. This was an isolated case, with no family history, characterized by a febrile episode during pregnancy at the period of main salivary gland genesis. Epigenetic mechanisms could be implicated.

Les dacryocystocèles congénitales sont des pathologies rares et souvent méconnues. Leur traitement consiste, selon les équipes, en une simple surveillance, un sondage des voies lacrymales ou un drainage chirurgical par voie endonasale. L’objectif principal de cette étude est de discuter la place du drainage chirurgical par voie endonasale dans la prise en charge de cette pathologie en période néonatale. Il s’agit d’une étude rétrospective portant sur 18 cas de dacryocystocèles congénitales prises en charge dans un centre hospitalier universitaire tertiaire entre juin 2009 et février 2012. Treize nouveau-nés ont été pris en charge, dont 5 cas bilatéraux. L’âge moyen était de 14,6 jours. Six nouveau-nés présentaient une complication infectieuse au moment du diagnostic. Aucune complication respiratoire n’a été observée. Un drainage spontané de la dacryocystocèle a été observé dans 38,8 % des cas survenant en moyenne à 22 jours de vie. Un drainage chirurgical par voie endonasale a été réalisé dans 66,6 % des cas. Aucune récidive ni complication n’a été observée après traitement chirurgical. Après drainage spontané, une récidive a été observée. Le suivi moyen de ces patients était de 8,8 mois. Le drainage spontané est fréquemment observé. En l’absence de complication infectieuse initiale, un traitement conservateur peut de ce fait être proposé. En cas d’infection et/ou de persistance de la dacryocystocèle après 4 semaines de vie, un drainage chirurgical par voie endonasale doit être réalisé. Une imagerie du massif facial est nécessaire avant tout traitement chirurgical. Congenital dacryocystoceles are rare and often misunderstood pathologies. Their treatment varies and consists in simple follow-up, lacrimal catheterization or endoscopic surgical drainage, depending on medical teams. The aim of our study was to discuss the place of endoscopic drainage in the treatment of congenital dacryocystocele. We conducted a retrospective review on 18 cases of congenital dacryocystoceles taken in charge in a tertiary care center between 2009 and 2012. Thirteen newborns, including five bilateral cases, were taken in charge. The average age was 14.6 days. Six newborns presented with an acute dacryocystitis at the time of diagnosis. No respiratory complications were observed. Spontaneous drainage of the dacryocystocele was observed in 38.8% of the cases, occurring at 22 days of life on average. Endonasal endoscopic drainage was performed in 66.6% of the cases. No recurrence or complication was observed after surgery. After spontaneous drainage, one recurrence was observed. The mean follow-up period of these patients was 8.8 months. Spontaneous drainage is common. Conservative management may therefore be considered in absence of infection. In case of infection and/or persistence of dacryocystocele after 4 weeks of life, endonasal surgical drainage should be considered. Imaging of the facial structure should be performed before any surgical treatment.

European Annals of Otorhinolaryngology, Head and Neck Diseases - Vol. 128 - N° 3 - p. 159-161

Let M be a topological G2-manifold. We prove that the space of infinitesimal associative deformations of a compact associative submanifold Y with boundary in a coassociative submanifold X is the solution space of an elliptic problem. For a connected boundary ∂Y of genus g, the index is given by ∫∂Yc1(νX)+1−g, where νX denotes the orthogonal complement of T∂Y in TX|∂Y and c1(νX) the first Chern class of νX with respect to its natural complex structure. Further, we exhibit explicit examples of non-trivial index.

Les fentes cervicales médianes congénitales sont des malformations qui concernent la « bande médiane » du cou. Elles résultent d’une anomalie de fusion des arcs branchiaux sur la ligne médiane et sont exceptionnelles. Une centaine de cas sont rapportés dans la littérature. Nous en décrivons une observation chez un petit nourrisson. Les auteurs rapportent le cas d’un nourrisson de sexe féminin adressé à l’âge de 4 mois suite à la découverte néonatale d’une anomalie cervicale médiane atypique. L’aspect a fait évoquer une fente cervicale médiane. Après un bilan malformatif (radiographies du rachis cervical et de la mandibule, échographie cervicale, IRM cervicale, écho-cardiographie), une chirurgie correctrice a été réalisée à 9 mois. Les suites ont été simples. Les fentes cervicales médianes congénitales sont reconnais-sables dès l’inspection de l’enfant tant leur aspect est typique. Ceci en permet le diagnostic précoce. La forme complète comporte: une bride verticale médiane sous-cutanée sterno-mentale, une fente cutanée longitudinale ulcérée à fond granuleux, une formation molluscoïde fibromateuse médiane surmontant la fente et un trajet fistuleux borgne sus-sternal à la partie inférieure de la fente. La bride est l’élément le plus constant des formes partielles. Le plus souvent isolées, l’association à des fentes labio-glosso-mandibulaires ou à des cardiopathies congénitales a cependant été décrite. L’évolution spontanée en l’absence de traitement se fait vers un retentissement esthétique et fonctionnel cervico-facial parfois important (limitation de l’extension du cou avec attitude en flexion, perturbation de la croissance mandibulaire). Ces complications et séquelles potentiellement graves soulignent l’intérêt d’un diagnostic précoce, néonatal, permettant une chirurgie correctrice dans les premiers mois de vie. Les techniques chirurgicales sont discutées et le plus souvent basées sur l’exérèse de l’ensemble des tissus anormaux et la reconstruction par plasties en « Z ». Une surveillance doit être instituée au long cours de façon à dépister les récidives éventuelles et à s’assurer du bon déroulement de la croissance mandibulaire.

Introduction. Cleft lip and palate (CLP) patients often present with a class [I] malocclusion in connection with a three dimensional maxillary hypoplasia. Twenty-five to 60% of these patients require a maxillary advancement. Two solutions are possible: orthognathic surgery and maxillary distraction. The purpose of this study was to evaluate the complications of the maxillary distraction in CLP patients.Materials and methods. Data was collected from the records of patients treated at out Surgery Unit between 2000 and 2007. Among the eight patients (four male and four female), five presented a bilateral CLP, two a unilateral CLP and one a unilateral cleft lip associated to a soft palate cleft. The average age at surgery was 17 years old. All had a Le Fort 1 osteotomy with a pterygomaxillary disjunction. The first two patients had external distractors and the six following internal ones. After a seven-day latency, activation was led to the rate of 1mm per day twice. The period of consolidation was four months on average. The maxillary advancement varied between 7 and 19 mm with an average of 12.6 mm. The average follow-up was four years.Results. We encountered difficulties and/or complicationsin seven patients: one intraoperatively haemorrhage, one avulsion of a tooth fixed at the pterygoid process during the osteotomy, three device failures, two cases of significant pains during activation, one dissociation of the dental anchorage of an external system, two labial ulcerations and one maxillary sinusitis by migrationof the 18.Discussion. Difficulties of maxillary distraction in CLP patients are very frequent. The majority is related to the distractors and did not interfere with the final result. But this frequency must be taken into account in the indication and in the choice of the material. Two types of complications can occur during distraction: those related to the osteotomy and those related to the material. The complications related to the osteotomy are in connection with the cicatricial ground of the CLP. They are not specific of the distraction. We especially managed complications related to the material. The social benefit of the internal distractors is undeniable, but the design of certain models must be reexamined to improve their tolerance (C) 2008 Elsevier Masson SAS. All rights reserved.

Primary nasal deformity is characterized by apparent prolabio-columellar skin shortness due to alar cartilage dislocation worsened by lack of muscular support. The secondary deformation retains part of the initial deformity, sometimes even worsened by the primary lip repair. Multiple surgical lengthening techniques were used in nasal defect correction, suggesting both technical complexity and unsatisfactory results. Indeed, columellar insufficiency has more to do with abnormal columello-apical skin distribution due to alar mispositioning than an effective lack of skin. Secondary correction by open rhinoplasty allowing careful cartilage reconstruction of the nose tip seems to be widely accepted. However, the nasal defect can be limited by performing a primary intervention focusing on two principles: columellar lengthening by early alar repositioning and simultaneous lip and nose repair. (C) 2007 Elsevier Masson SAS. All rights reserved.