Objectives: Treatment by sclerotherapy has been suggested as a first-line treatment of low-flow vascular malformations. This study reports our experience in treating low-flow vascular malformations by ultrasound-guided sclerosis with polidocanol foam at the Vascular Medicine Department in Grenoble, France.Design: Retrospective single-centre consecutive series.Materials and methods: Between January 2006 and December 2009, we analysed the complete records of patients with symptomatic low-flow vascular malformations of venous, lymphatic or complex type (Klippel-Trenaunay syndrome, KTS) treated by ultrasound-guided sclerosis. The therapeutic indication was always validated by the Consultative Committee for vascular malformations of the University Hospital of Grenoble. All vascular malformations were classified according to the Hamburg Classification. The sclerosing agent was polidocanol used as foam.Results: A total of 24 patients between 7 and 78 years were treated (19 venous malformations, three KTSs and two venous-lymphatic malformations). The concentrations of polidocanol used ranged from 0.25% to 3%. The average number of sessions was 2.3 (1-16). After a median follow-up at 5 months after the last session, 23 out of 24 patients reported a decrease in pain; in nine cases (37.5%), over 50% reduction in size was observed, and in 14 cases (58.3%), a reduction of less than 50% of the original size was obtained. Two minor side effects were reported.Conclusions: Treatment by ultrasound-guided sclerosis using polidocanol foam seems to be well tolerated and can improve the symptoms of low-flow malformations without the risks of more aggressive sclerosing agents, such as ethanol. (C) 2010 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

Aims: Sclerotherapy has been suggested as a treatment for slow-flow vascular malformations and especially venous malformations. This article reports on our experience of echosclerotherapy using polidocanol foam in slow-flow malformations at the Vascular Medicine Department of Grenoble University Hospital. Materials and methods: This is a single-centre retrospective study of the medical records of a continuous series of all patients presenting with a symptomatic slow-flow venous, or veno-lymphatic or Klippel-Trenaunay-syndrome (KTS)-type complex vascular malformation treated by echosclerotherapy between January 2006 and December 2009. The therapeutic indication was always validated beforehand by the Grenoble University Hospital multidisciplinary committee for vascular malformations. All of the vascular malformations were classified according to the Hamburg Classification. Polidocanol foam was the sclerosing agent used. Results: 24 patients from 7 to 78 years were treated (19 venous malformations, 3 KTS and 2 veno-lymphatic malformations). The concentrations of polidocanol used ranged from 0.25 to 3%. The mean number of sessions was 2.3. After a median follow-up of 5 months after the last visit, 23 patients of the 24 reported a decrease in pain; in 9 cases, a reduction of more than 50% in the initial volume was achieved, and in 58.3% a reduction of less than 50% in the initial volume. Two cases of minor adverse side effects were reported. Conclusions: Echosclerotherapy with polidocanol foam appears to be well tolerated, improves the symptoms of slow-flow malformations and does not carry the risks of more aggressive sclerosing agents such as ethanol.

Central-facial mutilations, located within the nose lips and chin triangle, require great quality repairs regarding morphology and function. Plastic surgery history affords the ideas evolution in this field crossing over nose and lips reconstructions, which were the subject of successive reports within our society, in 1994 (nose reconstruction) and 2002 (lips reconstruction). Now a day, following this progress, the plastic surgeon has a large choice of reliable techniques. His choice is dictated by a precise evaluation of the limits of the substance loss to repair, according to a (mapping) classification of the nose-lip and chin triangle. This classification defines three units (nose-labial, bilabial and chin-labial) as reflexion bases to the therapeutic indications. This anatomical and surgical approach was built starting from a retrospective study of 195 central-facial mutilations caused by ballistic damage and dog bites. The results evaluation makes possible to carry out a reflexion on the potential indications regarding allograft as a therapeutic alternative to the traditional reconstructions of this territory.

Les mutilations centrofaciales, sises au sein du triangle nasolabio-mentonier, requièrent des réparations morphofonctionnelles de grande qualité. L’histoire de la chirurgie plastique rend compte de l’évolution des idées dans ce domaine, recoupant celle de la rhinopoïèse et de la chéiloplastie, qui ont fait l’objet de rapports successifs au sein de notre Société, en 1994 (Rhinopïèse) et en 2002 (Chéiloplastie). Héritiers de ces progrès, le plasticien a en sa possession, à ce jour, un éventail de techniques fiables dans la mesure où son choix est dicté par une évaluation précise des limites de la perte de substance à réparer, selon une sectorisation du triangle nasolabio-mentonnier. Cette classification définit trois sous-ensembles, nasolabial, bilabial et labiomentonnier comme base de réflexion aux indications thérapeutiques. Cette approche antomochirurgicale s’est construite à partir d’un inventaire rétrospectif de 195 dossiers de mutilations centrofaciales par dégâts balistiques et morsures de chien. Une évaluation des résultats permet de mener une réflexion sur les indications potentielles d’allogreffes comme alternative thérapeutique aux reconstructions traditionnelles au niveau de ce territoire.

The solitary maxillomandibular bone cyst is a benign bone lesion with a nontumoral osteolysis and a progressive growth potential. It is considered as a pseudocyst because of the absence of epithelium and accounts for 1% of bone cysts. Most facial solitary bone cysts are observed in the mandible, especially in the corpus, and in young patients. Its etiopathogeny is unknown. The solitary bone cyst is asymptomatic. It is often discovered accidentally by radiolucent lacuna. Adjacent teeth vitality is preserved. The differential diagnosis is that of mandibular radiolucent lacuna etiologies. The diagnosis is confirmed by the surgical approach. Treatment is based on wall cavity curettage. It is usually relatively benign but the issue is discussed in publications because of the up to 26% of recurrence, requiring radiographic follow-up. (C) 2009 Elsevier Masson SAS. All rights reserved.

Le chérubisme est un processus extensif kystique atteignant surtout la mandibule, dont le diagnostic est souvent fait devant un faciès joufflu chez l’enfant. Il existe des cas familiaux et des cas de novo. Les cas autosomiques dominants de la maladie sont liés à la mutation de l’exon 9 de SH3BP2. Le traitement est essentiellement chirurgical associant curetage des kystes et chirurgie modelante. Un nouvel espoir thérapeutique repose sur les thérapies anti-TNF.

The solitary maxillomandibular bone cyst is a benign bone lesion with a nontumoral osteolysis and a progressive growth potential. It is considered as a pseudocyst because of the absence of epithelium and accounts for 1% of bone cysts. Most facial solitary bone cysts are observed in the mandible, especially in the corpus, and in young patients. Its etiopathogeny is unknown. The solitary bone cyst is asymptomatic. It is often discovered accidentally by radiolucent lacuna. Adjacent teeth vitality is preserved. The differential diagnosis is that of mandibular radiolucent lacuna etiologies. The diagnosis is confirmed by the surgical approach. Treatment is based on wall cavity curettage. It is usually relatively benign but the issue is discussed in publications because of the up to 26% of recurrence, requiring radiographic follow-up.

Cherubism is an extensive cystic-like growth mostly affecting the mandible. It is often diagnosed because of a swollen lower half of the face in children. There are familial and de novo cases. The autosomal dominant cases are related to exon 9 -SH3BP2 mutation. The treatment is mainly surgical combining cyst curettage and modeling resections. Anti-TNF therapy could be a new treatment option.

Cherubism is an extensive cystic-like growth mostly affecting the mandible. It is often diagnosed because of a swollen lower half of the face in children. There are familial and de novo cases. The autosomal dominant cases are related to exon 9 -SH3BP2 mutation. The treatment is mainly surgical combining cyst curettage and modeling resections. Anti-TNF therapy could be a new treatment option.

Introduction. Sinus pericranii is rare midline cranial venous anomaly. It should be diagnosed radiologically. We report an asymptomatic case in a six-year female patient.Case report. The patient consulted for a congenital asymplomatic bluish mediofrontal swelling. The complaint was strictly esthetic. A color US and MR angiography allowed diagnosing a sinus pericranii. Simple surveillance was decided because of a limited esthetic prejudice and the absence of any functional disorder.Discussion. Sinus pericranii is a communication between extra- and intracranial venous systems. Its diagnosis is suspected when a subcutaneous mass is located on the scalp close to the midline, the volume of which change with the head's position. It is confirmed by MRI, which usually shows a drainage in the superior sagittal sinus. Surgical treatment is a complex procedure and rarely indicated. A simple follow-up is often proposed because of the usual absence of complications. (C) Elsevier Masson SAS. All rights reserved.

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.

Introduction. Since 1996, vascular anomalies are classified either as tumors or malformations. Infantile hemangioma is the most common vascular tumor. It is an endothelial cellular proliferation, stimulated after birth (10th day) which then slow involves. Congenital hemangioma is a different kind of hemangioma develops prenatally appearing fully grown at birth. Rapidly involuting congenital hemangioma (RICH) generally involutes spontaneously while non involuting congenital hemangioma (NICH) usually requires a surgical procedure. The clinical and radiological aspects of these two tumors differ significantly at birth. Most congenital hemangiomas detected at antenatal ultrasonography, due to their cephalic localization and their size (up to 10 cm) are RICH.Material and methods. We report on five vascular tumors detected in utero during the second and third trimesters, and after birth.Results. There were three boys and two girls. The average size of the RICH was 5 em (1.8-10 cm). Four were cephalic and one on a lower limb. A doppler examination was available in three patients, and showed fast-flow in two. Prenatal magnetic resonance imaging was available in three patients.Discussion. The diagnosis of RICH can be suspected on the antenatal ultrasonography. Fast-flow on the doppler examination confirms the diagnosis. It is advisable to repeat the ultrasonography every two to four weeks to reevaluate the possibility of delivery and the fetal cardiac status. In the event of a prenatal vascular tumor the differential diagnosis also includes other congenital tumors. Magnetic resonance imaging would be indicated if there is any doubt about malignancy. Regular follow-up is necessary during the first months to confirm the diagnosis. RICH regress rapidly while the size of malignant tumors increases. A biopsy is necessary to obtain histopatholgical proof. (C) 2007 Elsevier Masson SAS. All rights reserved.

INTRODUCTION:Since 1996, vascular anomalies are classified either as tumors or malformations. Infantile hemangioma is the most common vascular tumor. It is an endothelial cellular proliferation, stimulated after birth (10th day) which then slow involves. Congenital hemangioma is a different kind of hemangioma develops prenatally appearing fully grown at birth. Rapidly involuting congenital hemangioma (RICH) generally involutes spontaneously while non involuting congenital hemangioma (NICH) usually requires a surgical procedure. The clinical and radiological aspects of these two tumors differ significantly at birth. Most congenital hemangiomas detected at antenatal ultrasonography, due to their cephalic localization and their size (up to 10 cm) are RICH.MATERIAL AND METHODS:We report on five vascular tumors detected in utero during the second and third trimesters, and after birth.RESULTS:There were three boys and two girls. The average size of the RICH was 5 cm (1.8-10 cm). Four were cephalic and one on a lower limb. A doppler examination was available in three patients, and showed fast-flow in two. Prenatal magnetic resonance imaging was available in three patients.DISCUSSION:The diagnosis of RICH can be suspected on the antenatal ultrasonography. Fast-flow on the doppler examination confirms the diagnosis. It is advisable to repeat the ultrasonography every two to four weeks to reevaluate the possibility of delivery and the fetal cardiac status. In the event of a prenatal vascular tumor the differential diagnosis also includes other congenital tumors. Magnetic resonance imaging would be indicated if there is any doubt about malignancy. Regular follow-up is necessary during the first months to confirm the diagnosis. RICH regress rapidly while the size of malignant tumors increases. A biopsy is necessary to obtain histopatholgical proof.

The development of in vivo microdialysis has made it possible to monitor cutaneous free flaps in maxillo-facial surgery. A microprobe inserted in the free flap dermis collects a microdialysate enabling measurement of dermal metabolites such as glucose, lactate, pyruvate, or glycerol. The monitoring curves are predictive of ischemia-related tissue injury. Hourly measurements provide a reliable method for early diagnosis of venous or arterial thrombosis. Revision surgery can then be undertaken if needed to repair microanastomoses before clinical alteration. This technique has been compared with validated flaps monitoring systems such as temperature probe, transcutaneous oxygen tension monitoring, and laser Doppler flowmetry. Microdialysis has several advantages: objective measurements, different curves for venous and arterial thrombosis, early diagnosis. Accessibility to oral cavity or pharyngeal flaps requires careful clinical analysis (microprobe fixation, anatomy and choice of flap).

Bisphosphonates have been recently associated with bone necrosis of jaws.Five patients were treated, two males and three females. All patients received bisphophonates and chemotherapeutic agents, two for multiple myeloma and three for breast cancer with bone metastasis. Bisphophonates were discontinued. None of the patients had received radiotherapy to the head and neck. The localization was mandibular in four patients and the maxillary area in one with oro-antral fistula. Histological and microbiological studies were performed.Histopathology demonstrated osteonecrosis and ruled out detectable neoplastic disease of the jaws. Four biopsies showed Actinomycosis. Four patients underwent sequestrectomy, but the mucosa did not heal.Two mechanisms are involved: the antiangiogenic effect of bisphophonates has recently been described in vivo; as bone mineralization increases, accumulation of microdamage is observed in animals studies. Only the jaws are affected by bone necrosis, suggesting a possible trophism for bisphosphonate uptake? Other risks factors have been found: cancer, use of chemotherapeutic agents or corticosteroids, renal failure, Actinomycosis infection. The only effective treatment is dental prevention before starting treatment.

Le chérubisme est un processus extensif kystique atteignant surtout la mandibule, dont le diagnostic est souvent fait devant un faciès joufflu chez l’enfant. Son déterminisme familial est anciennement connu. Récemment identifiée, la mutation de l’exon 9 de SH3BP2 permet d’identifier les cas autosomiques dominants de la maladie. Les auteurs rapportent le cas d’un enfant de 14 ans, de grade I, de diagnostic tardif. Une recherche génétique familiale, faite à Berlin, n’a pas retrouvé la mutation du gène candidat. À côté des cas familiaux dominants, on retrouve des cas sporadiques, parfois liés à une néo-mutation identifiée du gène codant pour SH3BP2. Le cas présenté a des antécédents familiaux de troubles de l’homéostasie osseuse et dentaire qui peuvent argumenter l’hypothèse d’un mode de transmission autosomique récessif ou d’un autre gène candidat. Cherubism is an extensive kystic process of the mandibula. The diagnosis is often established in children presented swelling of the jaws. The familial determinism of cherubism is well-known, and recently autosomal dominant cases have been described with detection of the exon 9 - SH3BP2 mutation. We describe the case of a 14-year-old boy with grade I cherubism diagnosed late. The familial genomic analyze conducted in Berlin was negative for the recently identified candidate gene. Apart from dominant cases cherubism sometimes occurs sporadically, some of the cases resulting from a neomutation of the candidate gene. The present case with familial bone homeostasis and dental disorders is an argument for the recessive transmission hypothesis or for another candidate gene.