Prevalence of anxiety and depressive disorders in facial trauma patients: A cross-sectional study

Background

To evaluate the prevalence of anxiety and depressive disorders in facial trauma patients admitted to the Ibn ROCHD University Hospital of Casablanca, we initiated this study. Indeed, facial trauma is damage that can have serious repercussions on the mental health of patients. However, there is little data in Morocco.

Methods

This was a cross-sectional study conducted at the Ibn Rochd University Hospital in Casablanca from January to April 2019 among facial trauma patients without a history of anxiety and depressive disorders, admitted to the Maxillofacial Surgery Department within 72 hours of the trauma. The patients' socio-demographic and clinical data were collected through a questionnaire, and then the Hospital Anxiety and Depression Scale (HADS) was applied to assess depression and anxiety. In addition to a descriptive analysis of the results, a multinomial regression analysis was performed to assess factors that might be associated with depression and anxiety.

Results

Among 50 facial trauma patients admitted to the Ibn Rochd University Hospital in Casablanca and included in our study, 11 had symptoms of anxiety (22%) and 12 had symptoms of depression (24%) according to the HADS classification. The mean HADS anxiety and depression subscale scores of the patients were 7.32±4.17 and 6.32±5.10, respectively. Although gender (OR = 2.28 [0.35; 5.70] females), marital status (OR = 3.30 [0.70; 12.70] singles), occupation (OR = 2.66 [0.58; 12.18] not employed), and circumstances of occurrence (OR = 3.66 [0.35; 15.70] public roads) increased the risk of anxiety in patients without anxiety (HADS score≤7); none of these factors was statistically associated with either anxiety or depression.

Conclusions

This cross-sectional study showed that the prevalence of anxiety and depression in victims of facial trauma is very high in Casablanca.

Key messages

The prevalence of anxiety and depression among facial trauma victims is very high. Gender, marital status, occupation, and circumstances of occurrence non-significantly increase the risk of anxiety and depression.

Orbital myeloid sarcoma misdiagnosed for subperiostal hematoma: a case report

BACKGROUND

Myeloid sarcoma is a solid tumor that consists of immature myeloid cells occurring at an extramedullary site. It can present before, concurrent with, or after the diagnosis of acute myeloid leukemia or other myeloproliferative diseases, and a proportion of patients never develop bone marrow infiltration. Only a few isolated cases of pediatric orbital myeloid sarcoma have been reported, and they are often associated with a high misdiagnosis rate.

CASE REPORT

We report a rare case of pediatric orbital myeloid sarcoma associated with blunt trauma in a 3-year-old Caucasian male patient, which was clinically and radiologically misdiagnosed for orbital subperiostal hematoma. The patient underwent a surgical intervention to drain the hematoma when an orbital mass was found. The microscopic, immunologic, and genetic features of the tumor and the myelogram were in favor of LAM2, and the patient was started with chemotherapy with a favorable evolution within 18 months follow-up.

CONCLUSION

Orbital myeloid sarcoma usually exhibits clinical and radiological features that can be easily misleading, especially if it happens de novo or as the first manifestation of acute myeloid leukemia. Only a few isolated cases have reported and proposed trauma as a trigger event of the onset of this type of tumor proliferation, but further investigations and evidence are needed to support this hypothesis.

Contralateral traumatic carotid cavernous fistula after a craniomaxillofacial fracture

Introduction

Carotid-cavernous fistula is an abnormal communication between the internal carotid artery, the external carotid artery or any of their branches and the cavernous sinus. This condition may occur spontaneously or after craniofacial trauma; in this case the fistula takes place on the same side as the craniofacial fracture and becomes symptomatic within a few weeks. The diagnosis is clinical; it must be evoked before any post-traumatic proptosis. Treatment must be started quickly to avoid visual or even vital complications.

Case presentation

We report the case of a 19 years old male patient who was admitted to the maxillofacial surgery department for osteosynthesis of a fracture of the left orbital roof after a traffic accident. The three-month's examination noted a right pulsatile proptosis with redness and decrease of the visual acuity. The cerebral MRI was in favor of a right sided direct CCF, which was confirmed by the arteriographie. The patient responded very well to embolization.

Discussion

Craniofacial trauma is a major cause of carotid cavernous fistula. When a patient has ophthalmic manifestations of vascular complications, early detection of CCF is important for preserving visual acuity. The diagnosis is mainly clinical based on the ophthalmological symptoms. CT and MRI scans show the indirect signs of the fistula. There are several types of invasive and non-invasive treatments. The evolution of the fistula is generally favorable and recurrence is not very frequent.

Conclusion

This case report is a documentation on an exceptional case of posttraumatic direct CCF occurring on the contralateral side of the skull base fracture.

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Posttraumatic carotid-cavernous fistula in a rare complication of craniofacial trauma.

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Contralateral CCF to the fracture side is even more exceptional.

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CCF's complications can be both invalidating and life threatening.

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The prognosis depends on the etiology and the therapeutic delay.

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Before an exophthalmic and ocular redness, it is always necessary to think of a cavernous carotid fistula especially when there has been a recent trauma.

Nasal syringocystadenoma papilliferum in an elderly subject aggravated by Koebner's phenomenon after surgery: A case report

Syringocystadenoma papilliferum is a rare benign adnexal tumour of the sweat glands. It is considered an infantile tumour since it preferentially affects the newborn in 50% of cases and the child before puberty in 15–30% of cases. And its preferential location is the head and neck, but rare in the face. And the first line treatment remains surgery. We report here a case of Syringocystadenoma papilliferum in a nasal location in a 70 year old subject with a history of pemphigus vulgaris, treated by surgical excision, whose postoperative course was aggravated by Koebner phenomenon.

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Syringocystadenoma papilliferum is a rare benign adnexal tumour of the sweat glands, with preferential localisation in the head and neck.

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It is often present at birth and in early childhood before puberty, and rare in adults.

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The recommended management is surgery, but certain comorbidities may be responsible for Koebner's phenomenon.

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Koebner's phenomenon is the appearance of typical new skin lesions on wounded areas of otherwise healthy skin.

Repair of the orbital floor fractures: The endoscopic trans-maxillary approach as minimally invasive approach: A case-report

INTRODUCTION

The endoscopy in orbital surgery provides, similar to other surgical fields, the option of combining an extended view of the surgical field with minimally invasive approaches; also allows an excellent functional and esthetic results. Trans-maxillary endoscopy of the orbital floor offers excellent visualization of the posterior bony shelf and confirms that the implant rests securely in place.

PRESENTATION OF CASE

The authors report a ten years-old male child, reported to the oral and maxillofacial surgery department, Ibn Rochd university hospital, Casablanca, Morocco. The child was diagnosed for left orbital floor fracture, complaining of orbital trauma due to road accident. The injury occurred at the left orbit level. There was no general story of any disease.

DISCUSSION

In more than 40% of all the facial fractures parts of the orbital rim or/and the internal orbit are injured with a variety of fracture patterns. Accurate assessment is required in order to correct any bone defects or displacements. The surgical approaches have become more reduced offering better control of orbital pathological processes. Orbital lesions are precisely localized through imaging. Also, the approach decision depends on location, size and vascularization. No consensus exists regarding the timing of the repair, the repair technique and the optimal implant. In this case presentation, the defect on the orbital floor was extended by mobilization of the fragments. A combination of incisions was necessary due to the change in the dimensions of the defects intraoperatively and entrapment of orbital tissue by the placement of an implant.

CONCLUSION

The endoscopic approaches provide excellent visualization and safe from eyelid complications with no visible scar when secondary open fracture reduction is avoided. Also; the rate of postoperative complications are reduced: optic nerve injury, orbital apex injury.

Ameloblastoma giant: Diagnosis, treatment and reconstruction: A case report

INTRODUCTION

Ameloblastoma is a rare tumor, benign but rapidly extensive and prone to recurrence. Its management remains difficult and its treatment relies mainly on surgery. For giant ameloblastoma or in people with an advanced stage the gesture remains very mutilating.

PRESENTATION OF CASE

This is a 22 year old patient, the onset of the symptomatology dates back to 2 years ago with the appearance of a mandibular swelling that increased in size with dental mobility. this motivated the patient to consult a CT scan and a panoramic radiograph as well as a biopsy that objectified an ameloblastoma. He benefited from a surgical excision with reconstruction.

DISCUSSION

It is a rare tumor that mainly affects young people and especially males. It can be discovered by chance or generally in front of a mandibular swelling. Radiological examination is essential as well as biopsy to confirm the diagnosis. The treatment is surgical, which consists of an exeresis with safety margins. Reconstruction should be discussed especially for young healthy subjects.

CONCLUSION

Although ameloblastoma remains a benign tumor, it is a tumor that evolves rapidly and recurs a lot, which is why it is necessary to take care of it quickly with a radical treatment and a regular follow-up with the patients.

Squamous cell carcinoma during long term hydroxyurea treatment: A case report

BACKGROUND

Hydroxyurea (HU) is a ribonucleotide diphosphate reductase inhibitor that interferes with the S phase of cell replication and inhibits DNA synthesis, with limited or no effect on RNA or protein synthesis. The cutaneous side effects of hydroxyurea treatment are diverse and frequent. Squamous cell carcinoma is one of the most challenging side-effect.

CASE PRESENTATION

The authors report the case of a healthy 59-year-old woman on long-term therapy with Hydroxyurea 500 mg daily for essential thrombocytosis, presented with a painless slow-growing lesion of the jaw that had persisted and increased in size for six months, the appearance of the lesion is correlated to the administration of the hydroxyurea treatment. Clinical examination revealed a large nodular lesion 4 × 4 cm with irregular borders of the right cheek, infiltrated into underlying tissue, the lesion extending to the free border of the right lower eyelid without sensory disturbances or diplopia. The surgery was indicated. The surgical procedure had the aim of the restoration of the anatomic landmarks after a large excision of the tumor and reconstruction of full-thickness eyelid defect with a local flap under general anesthesia.

CONCLUSION

Maxillofacial surgeons must be aware of the side effects of hydroxyurea including facial cancer, ulceration, etc. Rigorous follow-up of patients on hydroxyurea is required.

Locoregional anesthesia for removal osteosynthesis hardware from healed corpus mandibularis fractures: A descriptive study of a series of 40 cases

INTRODUCTION

Locoregional anesthesia represents a very interesting modality for the removal of osteosynthesis hardware of the corpus mandibularis. Several procedures have been described, but each is dedicated to a single mandibular segment.

MATERIAL AND METHODS

The surgical records of 40 patients treated with rigid internal fixation after maxillofacial traumas were reviewed. Study variables included age, sex, site and number of plates, time of plate removal, reasons for plate removal, and postoperative.

RESULTS

Our study enrolled 40 patients, 45% of whom had single-focal plate placement and 55% of whom had bifocal plate placement. 66% of the patients with bifocal plate placement had the plates removed during the same operation. The average operative time was 45 min for bifocal and 28 min for single-focal approaches. Postoperative complications were observed only for the truncal analgesia procedure of the inferior alveolar nerve at the mandibular foramen. Anesthesia failure was reported in 2 patients.

DISCUSSION

Various locoregional anesthetic procedures are used to remove mandibular body plates but each has its indication depending on the mandibular segment being treated. Factors that can lead to failure of locoregional anesthesia are dominated by the state of inflammation at the site and patient anxiety which can be minimized by premedication with anxiolytics.

CONCLUSION

Locoregional anesthesia for removal of osteosynthesis hardware of the corpus mandibularis remains a good anesthetic method that is performed in good conditions when it is done in compliance with standards. Its use avoids the usual risks and complications that can occur under general anesthesia.

Parotid swelling revealing an unusual pathological state: HIV and ewing sarcoma

Swelling of the parotid region is a frequent reason for consultation and the first clinical sign of both benign and malignant parotid tumors.

These parotid tumors represent 80 % of tumors of the main salivary glands. They present a highly variable clinical and radiological picture and are known to have a wide histological diversity. Some histological types are rare entities found in the parotid gland, such as Ewing's sarcoma and lymphoepithelial cyst, the latter of which is often associated with HIV co-morbidity, and therefore requires careful and adequate therapeutic attitudes and strategies.

We report two cases of parotid swelling revealing unusual pathologies: HIV and Ewing's sarcoma.

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Swelling of the parotid region is a frequent reason for consultation.

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Some histological types are rare entities found in the parotid gland.

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The pathological examination of the surgical specimen provides a definitive diagnosis.

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Age can be a concealing element, therefore a careful medical attitude is the key.

Unusual cervicofacial localization of two subcutaneous tuberculous cold abscesses in an immunocompetent subject

Introduction

Subcutaneous tuberculous cold abscesses represent a rare form of extra-pulmonary tuberculosis and their cervicofacial localization is exceptional. The management of this unusual form and location is medico-surgical and must be adapted to avoid progression to complications.

Case report

We report the case of a double cervicofacial localization of subcutaneous tuberculous cold abscesses in an immunocompetent patient followed for pulmonary tuberculosis who benefited from a surgical drainage of the two abscesses with anti-tuberculosis treatment with good clinical evolution.

Discussion

The diagnosis of subcutaneous tuberculous cold abscesses is based on a combination of anamnestic, clinical and paraclinical findings. Cold abscesses are most commonly described in patients with disseminated tuberculosis or during human immunodeficiency virus infection, but they may also occur in immunocompetent subjects. Monofocal localization is the most common and the association of several localizations is unusual. The treatment is medical-surgical, combining surgical drainage with anti-tuberculosis treatment.

Conclusion

Subcutaneous tuberculous cold abscesses should be considered in the presence of any stubborn collection occurring in a context of tuberculosis infection. Early diagnosis is the best guarantee of a cure without complications.

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Subcutaneous tuberculous cold abscess is a rare presentation of extra-pulmonary tuberculosis.

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Cervico-facial localization is exceptional.

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The association of two locations is unusual.

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The diagnosis requires the comparison of a set of anamnestic, clinical and paraclinical arguments.

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The therapeutic management must be adapted to avoid the evolution towards complications.

Seborrheic keratosis of the cheek simulating squamous cell carcinoma

INTRODUCTION

Seborrheic keratoses are benign tumours that occur electively on the head, neck and trunk. It can be confused on its clinical appearance with other skin tumours and it is the histological examination that establishes the diagnosis. We report a case of seborrheic keratosis simulating squamous cell carcinoma.

OBSERVATION

A 62-year-old woman consulted for a budding right jugal lesion that had been evolving for 6 months. Clinical examination found a right jugal budding lesion with crusts on its surface, pedunculated, surrounded by a hyperpigmented halo at its base, firm to palpation, painless and non bleeding on contact. An initial biopsy of the lesion for histological examination confirmed the diagnosis, followed by complete surgical excision.

DISCUSSION

Seborrheic keratoses are benign tumours that occur mainly in subjects over 50 years of age. They occur electively on the trunk, head and neck. Its clinical aspect is generally typical but sometimes misleading, as found in our case; only histology allows to make the diagnosis of certainty.

Synovial sarcoma of the maxillary sinus and chest wall: An exceptional association of two synchronous rare locations, Case report

INTRODUCTION

Synovial sarcoma is a malignant tumour of mesenchymal origin with an aggressive character and a rare cervicofacial location. Its management is multidisciplinary in order to improve prognosis and survival.

CASE REPORT

We report the case of two rare and synchronous localizations of monophasic synovial sarcoma of the maxilla and chest wall in a 58-year-old woman, whose management was based on exclusive chemotherapy.

DISCUSSION

The cervicofacial location of synovial sarcoma represents 3% of all locations in the body. Its clinical and radiological manifestations are aspecific. Its diagnosis is based on a combination of histological and genetic arguments. Its therapeutic management depends on the tumour stage and prognostic factors.

CONCLUSION

Early diagnosis of cervicofacial synovial sarcoma allows to avoid a mutilating procedure for the patient and to improve the long-term prognosis by a good control of the tumour.

Well-differentiated liposarcoma of the cheek misdiagnosed for lipoma: A case report

INTRODUCTION

Liposarcoma is the most common sarcoma entity and accounts for 17% to 30% of soft tissue sarcomas. There are several histological types including well-differentiated liposarcoma. This paper aims to underline the interest of immunohistochemical and cytogenetic studies to diagnose well-differentiated liposarcoma and to show the delicacy of performing a surgical procedure in the cheek area.

CASE PRESENTATION

The authors report the case of a 48-year-old female patient who presented with the recurrence of a right jugal mass initially diagnosed as a lipoma on the resection specimen. The patient was reoperated 5 years later and further immunohistochemical and cytogenetic studies confirmed the diagnosis of well-differentiated jugal liposarcoma.

DISCUSSION

Sarcomas are rare malignant tumors of mesenchymal origin, arising from connective and supporting tissues. It should be noted that certain MRI features can distinguish liposarcoma from lipoma. Conventional histology and immunohistochemistry are the basic means for the diagnosis and classification of liposarcomas. However, molecular biology can add to the pathologist's analysis and rule out differential diagnoses Liposarcoma of the maxillofacial region has a better prognosis compared to other parts of the human body.

CONCLUSION

This paper underlines the interest of complementary immunohistochemical and cytogenetic studies to differentiate well-differentiated liposarcoma from lipoma as well as the potential for local recurrence of liposarcomas.

Lingual primary tuberculosis mimicking malignancy

INTRODUCTION

The constant increase in the incidence of tuberculosis, as long as the emerging global resistance to antituberculous drugs warrants an increased awareness of the possibility of Mycobacterium Tuberculosis in persistent lesions of the oral cavity. Lingual tuberculosis is a rarely described entity of extra pulmonary tuberculosis. It usually presents as a non-healing chronic mucosal lesion that may mimic malignant lingual neoplasms.

CASE REPORT

In the present paper, we report a rare presentation of lingual tuberculosis in a 36 years old woman, which was clinically suspected as an extensive malignant fissure of the tongue. The diagnosis was confirmed by tongue biopsy and the patient responded well to the antitubercular chemotherapy.

DISCUSSION

lingual tuberculosis is a rare clinical and pathological entity of extrapulmonary tuberculosis. Only a few cases have been reported around the world, and in each one of them, a unique clinical form has been described. This variability of clinical presentations can allude to several pathological conditions including malignancy.

CONCLUSION

This case report is a documentation of a unique clinical and radiological presentation of lingual tuberculosis; it also highlights the importance of considering tuberculosis in the differential diagnosis of chronic tongue lesions.

Cutaneous adenoid cystic carcinoma of lower eyelid: Case report of a rare malignant entity

INTRODUCTION

cutaneous adenoid cystic carcinoma is a rare epithelial tumor with slow development, it is most often described in the scalp; palpebral involvement is very rare. And is accompanied by local aggressiveness and frequent recurrence. The aim of this work is to discuss the management and the interest of a close surveillance of adenoid cystic carcinoma.

CASE PRESENTATION

The authors report a case of palpebral cystic adenoid carcinoma in a 65-year-old patient who underwent surgical excision followed by reconstruction of the loss of substance.

DISCUSSION

Cutaneous cystic adenoid carcinoma of the eyelids remains a very rare entity that must be evoked in front of a nodular cutaneous palpebral tumor that progresses slowly. An early diagnosis and a complete excision guarantee a better prognosis.

CONCLUSION

Adenoid cystic carcinoma, because of its local aggressiveness and its capacity to recur despite satisfactory surgical removal, requires long-term surveillance. Its surgery may be responsible for functional and aesthetic sequelae.

Parotid lymphoepithelial cysts revealing HIV infection in a 12-year-old girl: A case report

INTRODUCTION

and importance: benign lymphoepithelial cysts are benign lesions consisting of one or more cysts of the salivary glands or neck regions that occur in 3-6% of patients with positive HIV serology. The objective of this work is to discuss the link between HIV and benign lymphoepithelial cysts.

CASE PRESENTATION

The authors report a case of benign lymphoepithelial parotid cysts in a 12-year-old girl who underwent a partial parotidectomy. HIV serology was performed in the patient and all her family and was positive only in the girl.

CLINICAL DISCUSSION

Benign lymphoepithelial lesions of the parotid gland represent the main parotid pathology associated with HIV infection. They may be the first clinical manifestation of the virus. Diagnosis is often difficult, in most cases after surgical excision and histopathological evaluation of the mass. Treatment options include observation, highly active antiretroviral therapy (HAART), aspiration, sclerotherapy, and surgery.

CONCLUSION

Because of the close relationship between parotid lymphoepithelial cysts and HIV infection, it is important to perform HIV serology in any patient with these types of cysts.

Cervicofacial cellulitis on vascular malformation: About two case reports

Cervicofacial cellulitis is a brutal and dreadful disease that poses a serious problem in terms of therapeutic management. Most often, these cellulitides occur either in a fragile environment or after inappropriate initial management. We report two (02) observations of cervicofacial cellulitis in patients with vascular malformation of the face. In both cases, the patients were previously diagnosed with a facial vascular malformation and presented with secondary cervicofacial cellulitis homolateral to the vascular malformation. The diagnosis of cellulitis was made by clinical and biological elements and confirmed by imaging (CT). This comorbidity remains a rare entity, and almost not reported in the literature; their management remains however complex and must be integrated with multidisciplinary consultations.

Mucoepidermoid carcinoma of the retromolar trigone in an elderly female: A case report

Tumors of the retromolar trigone area represent 12% of neoplasms of the oral cavity, and of which squamous cell carcinoma represents the main histological type. Mucoepidermoid carcinoma (MEC) of the accessory salivary glands is a rare entity, representing less than 5% of head and neck cancers, and 10% of all salivary gland tumors; its biological characteristics are very diverse, correlated to the histological grade of the tumor. This tumor has an excellent outcome after surgical management, with a prognosis related to the histological grade of the tumor. The authors reported a case of low-grade mucoepidermoid carcinoma, arising in the left retromolar trigon, in an 83-year-old woman who was treated by surgical removal of the tumor with a 1.5 cm border.

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Mucoepidermoid carcinoma (MEC) of the accessory salivary glands is a rare entity.

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Its biological characteristics are very diverse, correlated to the histological grade of the tumor.

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This tumor has an excellent outcome after surgical management; with a prognosis related to the histological grade of the tumor.

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We reported a case of low-grade mucoepidermoid carcinoma, arising in the left retromolar trigon, in an 83-year-old woman, treated by surgical resection.

Bone choristoma of the gingiva: A case report

INTRODUCTION

Bone choristoma is a benign tumor with normal histology and ectopic location. This paper aims to report a rare case of bone choristoma in the maxillary gingival location.

OBSERVATION

The authors report a case of a 39-year-old woman, with a history of maxillary full edentulousness, who consulted for a slight pain evolved for about six months, triggered by movements on the lesion. Clinical examination found growth at the level of the right maxillary gingival alveolar ridge. Surgical biopsy was indicated and performed under local anesthesia. The histological examination of the excisional specimen concluded at a bone choristoma. The patient had a good evolution after the surgical removal.

CONCLUSION

Choristoma is a rare and benign condition. The management is surgical.

Orbital varix: A rare case of unilateral exophthalmos, case report

The etiologies of unilateral exophthalmos are multiple, rarely represented by an intra- or extra-conical vascular mass. Orbito-palpebral varixes are rare (2% of orbital masses) and represent a main cause of unilateral intermittent exophthalmos, often of an inflammatory nature. We report a Case of right orbito-palpebral varix in a 65-year-old adult, with no particular history, evolving for 2 years. The ophthalmological examination showed a right palpebral mass, extended to the right external canthus, with palpebral collateral circulation, moderate right ptosis with exophthalmos, non-axial, non-pulsatile, without thrill, painless, without complication, without visual deficit. A vascular mass was suspected and MRI revealed a right orbito-palpebral varix with temporal extension, confirmed by ANGIO-MRI. The latter also allowed to search for a cerebral venous malformation, an encephalocele or a bone defect, associated and also to eliminate differential diagnoses (tumor, arteriovenous fistula …). Color Doppler ultrasound in the proclive position confirmed the diagnosis of orbital varices. A preventive low-dose anticoagulant treatment was started to avoid thrombosis, with therapeutic abstention in the absence of complications. A rigorous monthly follow-up in consultation is ensured. Orbito-palpebral varices are characterized by an extensive posterior intra-orbital character, often during their evolution and imposes a strict surveillance. In Case of complication (thrombosis, hemorrhage, pain, compressive signs of the optic nerve), surgical removal or sclerosis of the varix can be envisaged with disappointing results (recurrence, hemorrhage).

Parotid Ewing's sarcoma: Extra-skeletal uncommon condition

Introduction

The parotid gland is a very rare location of Ewing's sarcoma. Its clinical and radiological manifestations are atypical. Its management is based on a multidisciplinary approach to improve prognosis and survival.

Discussion

The diagnosis of parotid Ewing's sarcoma is determined by a combination of genetic and histological criteria. Its local aggressiveness and high metastatic potential require prompt and appropriate management. Many prognostic features affect its management, the most important is the TNM staging.

Conclusion

Limited cases of parotid Ewing's sarcoma have been published in the literature. This small number of reported cases is the only way to study its characteristics.

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The parotid gland is a very rare location of Ewing's sarcoma.

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The diagnosis of parotid Ewing's sarcoma is determined by a combination of genetic and histological criteria.

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Many prognosis features affect its management, the most important is the TNM staging.

Chronical rhino-orbital mucormycosis in an immunocompetent host: A case report

Mucormycosis is an opportunistic fungal infection caused by molds within the order Mucorales. The rhino-orbital-cerebral localization is the most frequent. It is a destructive, necrotizing and potentially fatal disease. The treatment involves aggressive surgical debridement combined with antifungal drugs. The course is quickly fatal in the event of delayed diagnosis and / or treatment. This infection usually affects immunocompromised and diabetic patients, but cases of mucormycosis in immunocompetents are increasingly reported. Chronic mucormycosis is extremely rare and affects both immunocompromised and immunocompetent patients, its clinical evolution is nonspecific and its treatment is not standardized. We report the case of a destructive rhino-orbital and pulmonary involvement in a 59 years old immunocompetent patient who presented a right periorbital edema associated and a vision loss and a notion of nasal obstruction and progressive onset headache four months before admission. Her condition progressed with rapidly extensive necrosis. She underwent extensive surgical resection but soon succumbed to multiple organ failure. The diagnosis of mucormycosis was confirmed post mortem on the excisional piece. The purpose of this article is to draw attention to chronic mucormycosis in the immunocompetent and to emphasize the importance of early diagnosis and adequate management of this fatal infection.

Scorfuloderma of cheek (a cutaneous tuberculosis colliquativa cutis): Case report

Introduction

Scrofuloderma is the most common form of cutaneous tuberculosis. The facial location is unusual and requires special care.

Discussion

The diagnosis of cutaneous tuberculosis is difficult due to the polymorphism of the anatomo-clinical pictures as well as the difficulty of isolating the causal agent. The combination of a range of clinical and paraclinical arguments justifies starting antibacillary treatment.

Conclusion

Tuberculosis is endemic disease in our country; this endemicity is attested by the multiple cases of cutaneous tuberculosis reported in the literature.

SURGICEL mimicking a recurrence of a temporomandibular joint chondrosarcoma

INTRODUCTION

The hemostatic agents have increased the bleeding complication in many surgeries. The SURGICEL is a preparation of oxidized cellulose regenerated from alpha-cellulose in an organic solvent, this product has the characteristic of resorbing without having a reaction of foreign body in 4-8 weeks.

CASE PRESENTATION

We report the case of a patient operated on for a chondrosarcoma of the right temporomandibular joint with normal postoperative consequences, nevertheless after 3 months, the patient consulted again for the same symptomatology. To rule out tumor recurrence, magnetic resonance imaging has been requested; which showed a lesion well limited in T1 hypointense and heterogeneous in T2. During the surgical revision, we discover the presence of a reworked fibrous material, this material was the surgicel used for hemostatic purposes during the first surgery.

DISCUSSION

Hemostatic agents significantly reduced bleeding complications. But some authors are observed that some substances can persisted after 8 weeks of using, clinical manifestations depend of operative site. The diagnosis is suspected behind an imaging resonance aspect of a lesion well limited in T1 hypointense and heterogeneous in T2, but the discovery of a reworked fibrous materiel when the revision can confirm it.

CONCLUSION

the absence of degradation of the surgicel can clinically mimic a superinfection or even tumor recurrence; imaging guide the diagnosis but only the surgical revision can confirm it.

Restorative management of human bite injuries to the face: Case series

Facial skin wounds are common problems seen and treated by emergency centers around the world. Among all wounds, cat and dog bites are frequently seen. Human bite injuries are both deceptive and difficult in their presentation and management. The injuries have a disfiguration effect with possible psychological impact on the patient. The aim of this paper is to compare experience with human bites of the face in our surgical unit, with other similar trials in term of reasons for the circumstances of injuries, age, and sex of the patients, site of injury, pan-time between consultation and treatment, incidence of infection and surgical management. Data in terms of age, gender distribution, circumstances of injury, location of injuries, evolution of surgical management and complications were recorded. We report here a series of 10 cases of human bite wounds to the face, admitted to our department, and treated with different reconstruction procedures.

The deltopectoral flap in full-thickness cheek defect: A case report

Introduction

Defects caused after tumor resection should be closed with flaps that match the neighboring cheek's skin.

Presentation of case

the authors report a patient diagnosed with squamous cell carcinoma and its management. A 50-year-old man patient presented with a painless slow swelling in the left cheek, which had increased in size in the last four months, tobacco smoking, and alcohol intake for 15 years. Clinical examination revealed left cheek swelling without any lymph nodes at the palpation.

Discussion

Reconstruction of the full-thickness is a real challenge. The deltopectoral flap offers several advantages despite the increasing use of microvascular reconstruction; technically is a simple and reliable flap that is preferred for the reconstruction of large through-and-through defects after resection of oral carcinoma. Preoperative planning of flap and early recognition of issues can avoid postoperative complications.

Conclusion

This reconstruction technique was demonstrated in large, full-thickness defects involving the cheek.

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Reconstruction of through-and-through defects of the head and neck is a challenge.

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The deltopectoral flap is used despite the increasing use of microvascular reconstruction.

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Technically is a simple and reliable flap that is preferred for the reconstruction of large defects after resection of oral carcinoma.

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The main treatment of surgical management of head and neck tumors is to achieve a satisfactory functional and aesthetic results.

Melanoma of the oral cavity: A silent killer

Melanoma of the mouth is a rare entity of cancer. It has a bad prognosis. We report two cases of mouth melanoma. In the first case, 68 years old man developed a mandibular gingival tumor. Head and neck MRI scans showed an aggressive tumor process in the mouth with bone extension and in the deep spaces. The patient was free of cervical lymph nodes. The second case is a 75-years-old male with heavy tobacco smoke. The man felt a burgeoning mass on the right palate. The neck palpation found a firm mobile non-tender mass at the left upper jugular region. The anatomopathological study of the biopsies assigned both cases to malignant melanoma. Because of the rarity and delays in diagnosis, case reports are an invaluable source of information.

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Melanoma of the mouth is a rare entity of cancer with a bad prognosis.

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Tobacco and alcohol use are two of the most important risk factors for oral cavity and oropharyngeal cancers.

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Maxillofacial surgeons and physicians who treat oral lesions must be conscious of the need for early diagnosis of melanoma.

Cavernous Sinus Thrombosis related to Orbital Cellulitis Serious Complication to Prevent: a case report and literature review

Introduction

The authors report a case which aims to underline the importance of multidisciplinary management and rapid diagnosis of orbital cellulitis, for an adequate treatment of ocular damages and related complications, to prevent serious and permanent sequelae and avoid a fatal prognosis.

Presentation of case

A 61-year-old female reported to the oral and maxillofacial surgery department after she was dragged around for two months. She presented with a right facial swelling and orbital apex syndrome including proptosis, ophthalmoplegia and ptosis.

Discussion

Complications of orbital cellulitis may be limited to the orbit, such as subperiosteal or orbital abscess, optic neuritis, blindness, or intracranial such as meningitis, sinus cavernous thrombosis, cerebral abscess and even death.

Conclusion

Maxillofacial surgeons must be aware of this complication in a multidisciplinary context to adopt adequate treatment as soon as possible.

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Orbital cellulitis is a rare ophthalmic disease due to pansinusitis with hard maxillofacial management.

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Cavernous sinus thrombosis is a rare but highly fatal complication of orbital cellulitis.

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Early and appropriate treatment can improve the bad prognosis of this condition and avoid visual sequelae.

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Maxillofacial surgeons must be aware of this complication in a multidisciplinary context to adopt adequate treatment as soon as possible.

Lipofilling as an aesthetic restorative technique for the facial hemiatrophy of Parry-Romberg syndrome: An analysis of 27 cases

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Progressive haemifacial atrophy, also known as Parry-Romberg syndrome.

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Lipofilling provides an option for voluminous flaps, improving skin quality and preserving the natural contours of the face.

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Fat reinjection is a simple, efficient and reproducible procedure.

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Physical appearance and psychological well-being should be considered as a part of the general management.

Introduction

The aim of this paper is to present our experience using autologous fat transplantation for facial augmentation and to evaluate the effectiveness of lipofilling in different regions of the face for the reconstruction and aesthetic improvement of the facial contouring.

Case presentation

Data in term to the age, gender distribution, harvest and injection sites, degree of satisfaction with post-surgical facial, and complications were recorded.

Discussion

Progressive haemifacial atrophy, also Known as Parry Romberg's disease, is a common craniofacial disease that conventionally affects the subcutaneous tissue on one side of the face. We report here a series of 27cases of hemifacial atrophy (Parry-Romberg syndrome), admitted to our department, and treated with lipofilling in conformity with Coleman's guidelines. The volume of fat grafting was assessed by an attempt to reach symmetry with the controlateral side within a single procedure.

Conclusion

All patients claimed that they were satisfied or very satisfied with the aesthetic results and affirmed that it had a positive psychological impact on their daily life.

Central Giant cell tumor of jaw bone in child: A case report

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Giant cyst tumor of the jaw is rare and less common in childhood.

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The clinical behavior is very diverse.

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The main treatment for giant cell tumors is surgical excision.

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Follow-up is necessary to reveal recurrence.

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A major complication of surgical removal of the large cyst is iatrogenic fracture of mandible.

Introduction

Central giant cell tumors (CGCTs) bones are uncommon benign bone tumors in the jaw.

Presentation of case

The authors report a pediatric patient who was diagnosed with an aggressive central giant cell cyst of the mandible and its management. The CGCT usually occurs in adolescents patients from 5 to 10 years of age. An 8-year-old female patient presented with progressive non-pulsatile swelling of the mandible. Intraoral examination revealed mobility of teeth, associated with gingival swelling.

Discussion

Common sites of giant cell tumors are the epiphysis of the long bones. Giant cell tumors accounted for 4–7% of all primary bone tumors. The mandible localization is exceptional, the main treatment for giant cell tumors is surgical excision and different surgical approaches had been reported in the literature thus depending on the size of the cyst, localization, and experience of the surgeon.

Conclusion

Giant cyst tumor of the jaw is rare and less common in childhood. The clinical behavior is very diverse. The main treatment is surgical removal and follow-up to reveal recurrence.

Rehabilitation of facial palsy by the lengthening temporalis myoplastie: A case report

Introduction

The lengthening temporalis myoplasty (LTM) is defined as a transfer of the entire temporal muscle from the coronoid process to the labial commissure reinserted into the orbicularis muscle.

Presentation of case

a 60-year-old man with grade III longstanding facial paralysis of the right hemi-face secondary to a right total parotidectomy. The surgery was performed for the rehabilitation of the right hemi-facial side by the lengthening temporalis myoplasty. The follow-up was favorable with improvement of the facial dynamics.

Discussion

Surgical management of the longstanding facial palsy is a real challenge. The lengthening temporalis myoplasty offers several advantages; technically is a simple. This technique was demonstrated in severe neglected facial palsy and is performed when there is a definitive complete, or almost complete, loss of the facial nerve and the trigeminal is preserved. Effective rehabilitation through training and physical therapy is necessary to optimize results.

Conclusion

Facial palsy should no longer be permanent, surgical techniques as lengthening temporalis myoplasty with early postoperative physiotherapy leads to good results. Preoperative planning and early recognition of issues can avoid postoperative complications.

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The value and contribution of temporal muscle lengthening myoplasty as a surgical technique in the long neglected facial palsy.

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Longstanding Facial palsy should no longer be permanent.

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The main treatment of surgical management of neglected facial plasy is to achieve a satisfactory functional and aesthetic results.

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Effective rehabilitation through training and physical therapy is necessary to optimize results.

An early orbital metastasis from breast cancer: A case report

INTRODUCTION

Orbital metastases from solid cancers are infrequent or underestimated, since they represent only 1-13% of tumors of the orbit. They are even less frequent in breast cancer and are rarely diagnosed. We report a case of an early diagnosed orbital metastasis from breast cancer to an extra ocular muscle.

CASE REPORT

We report the case of a 33-year-old female patient who presented, following the diagnosis of her breast cancer, headache, a progressive decrease in visual acuity of the right eye and diplopia. Brain imaging revealed a tissue process at the expense of the internal rectus muscle, which biopsy pointed to a secondary lesion of breast cancer.

DISCUSSION

Extraocular muscles are rarely infiltrated by metastasis from distant sites. They are mostly asymptomatic and suggest a systematic spread of the disease. The treatment is generally palliative and the prognosis is generally poor.

CONCLUSION

Orbital metastases from breast cancer are certainly rare but are associated with significant morbidity. In order to make a precise diagnosis and offer an appropriate treatment, healthcare professionals must remain vigilant in the face of any ophthalmological symptoms.