Significant decrease of facial cellulitis admissions during COVID-19 lockdown in France: A multicentric comparative study

During the 2020 coronavirus pandemic, a lockdown was imposed in France during the first wave. An apparent decrease in incidence of cellulitis of odontogenic origin was noticed then. This study aimed to compare the incidence of cellulitis during this extraordinary period with the same period in 2018 and 2019, based on retrospective multicentric data. All maxillofacial surgery departments in French public hospitals were contacted. Responders were asked to include all patients admitted for the surgical drainage of a head and neck abscess of odontogenic origin during the first 2020 lockdown period, and in a similar time frame in 2018 and 2019 (control group), based on screening the French diagnostic and therapeutic classification of medical acts. We report a 44% significant nationwide decrease in the incidence of admissions for cellulitis. There were 187 patients in 2020 for 334 and 333 patients in 2018/2019 respectively. The reasons to explain this finding are hypothetical (organizational reasons leading to earlier management, patients' fear to seek for medical management, usual excess in surgical indications or concomitant decrease of non-steroidal anti-inflammatory drugs delivery). Whatever the explanation, it would be of great interest to find it out in order to improve the prevention of cellulitis.

Botulinum toxin for ductal stenosis and fistulas of the main salivary glands

This study was performed to present the authors' experience with botulinum toxin therapy for salivary stenosis and salivary fistula in terms of the procedure, dosage, effectiveness, and complications. A retrospective study of all patients treated in the maxillofacial surgery department for salivary stenosis or fistula from January 2014 to September 2018 was performed. Intraglandular injections of incobotulinumtoxinA (Xeomin) were utilized. The frequency of relapse and the pain recorded before injection and at 3 months after each injection or fistula resolution were assessed. Swallowing dysfunction or any diffusion of toxin into the facial muscles was recorded. This study included 22 patients (mean age 53 years). Botulinum therapy was indicated for parotid duct stenosis in 14 patients, submandibular duct stenosis in four patients, and parotid fistula in four patients. The frequency of relapse (P =  0.0001) and pain level (P =  0.0001) decreased after botulinum therapy. The average duration of the botulinum effect was 4.50±2.00 months after the first injection. No complication was observed. Botulinum therapy with 100 IU of Xeomin proved effective at resolving salivary fistula. Botulinum therapy is an effective treatment for symptoms of salivary duct stenosis in patients for whom minimally invasive procedures have failed. Botulinum therapy can also be used for the treatment of salivary fistulas.

Temporomandibular Joint Regenerative Medicine

The temporomandibular joint (TMJ) is an articulation formed between the temporal bone and the mandibular condyle which is commonly affected. These affections are often so painful during fundamental oral activities that patients have lower quality of life. Limitations of therapeutics for severe TMJ diseases have led to increased interest in regenerative strategies combining stem cells, implantable scaffolds and well-targeting bioactive molecules. To succeed in functional and structural regeneration of TMJ is very challenging. Innovative strategies and biomaterials are absolutely crucial because TMJ can be considered as one of the most difficult tissues to regenerate due to its limited healing capacity, its unique histological and structural properties and the necessity for long-term prevention of its ossified or fibrous adhesions. The ideal approach for TMJ regeneration is a unique scaffold functionalized with an osteochondral molecular gradient containing a single stem cell population able to undergo osteogenic and chondrogenic differentiation such as BMSCs, ADSCs or DPSCs. The key for this complex regeneration is the functionalization with active molecules such as IGF-1, TGF-β1 or bFGF. This regeneration can be optimized by nano/micro-assisted functionalization and by spatiotemporal drug delivery systems orchestrating the 3D formation of TMJ tissues.

Active implant combining human stem cell microtissues and growth factors for bone-regenerative nanomedicine

AIMS

Mesenchymal stem cells (MSCs) from adult bone marrow provide an exciting and promising stem cell population for the repair of bone in skeletal diseases. Here, we describe a new generation of collagen nanofiber implant functionalized with growth factor BMP-7 nanoreservoirs and equipped with human MSC microtissues (MTs) for regenerative nanomedicine.

MATERIALS & METHODS

By using a 3D nanofibrous collagen membrane and by adding MTs rather than single cells, we optimize the microenvironment for cell colonization, differentiation and growth.

RESULTS & CONCLUSION

Furthermore, in this study, we have shown that by combining BMP-7 with these MSC MTs in this double 3D environment, we further accelerate bone growth in vivo. The strategy described here should enhance the efficiency of therapeutic implants compared with current simplistic approaches used in the clinic today based on collagen implants soaked in bone morphogenic proteins.

[Squamous cell carcinomas of the ear: factors of gravity and surgical treatment, about 30 cases]

INTRODUCTION

Squamous cell carcinomas (SCC) of the ear are known for their aggressiveness. The aim of this study was to investigate factors of gravity while freeing the therapeutic requirements.

PATIENTS AND METHODS

This is a retrospective study of 28 patients (30 ears) operated for SCC. The characteristics of the lesion, the presence of metastasis, treatment modalities and histologic findings were collected. Local recurrences and metastasis are identified with a mean follow-up time of 37months (17-110months).

RESULTS

The lesion size was less than 2cm in 19 cases (63.3%) and greater than or equal to 2cm in 11 cases (36.7%). Macroscopic resection margins were 5, 7 or 10mm. The resections were histologically incomplete in 4 cases (13%) requiring further surgery. Six cases had local recurrence (20%): three with pulmonary or lymph node metastases (10%) and one death (3.3%). In these 6 cases of recurrence, the surgical margins were 6.3mm on average, the initial lesion measured always greater than 2cm (100%). Three quarters of incomplete resections have recurrent despite a surgical revision in healthy margin.

CONCLUSION

Our study confirms the data of literature, namely the pejorative character of a lesion greater than 2cm and incomplete resection. The HAS recommendations seem minimal regarding the ear. In case of injury by more than 2cm and with a proximal location on the ear pinna, only amputation of the ear allows satisfactory cancer control.

Frohse's arcade is not the exclusive compression site of the radial nerve in its tunnel

INTRODUCTION

The radial tunnel is a musculo-aponeurotic furrow which extends from the lateral epicondyle of humerus to the distal edge of the supinator muscle. The superficial head of the supinator muscle forms a fibrous arch, the arcade of Frohse (AF), which is the most common site of compression of the radial nerve motor branch. The latter is less commonly compressed by the adjacent muscular structures. This tunnel syndrome might be worsened with repeated pronation and supination of the forearm. The double object of that work was: (1) to define the radial nerve anatomic landmarks, (2) to determine the anatomical relationship of the radial nerve main trunk and branches to the peripheral osseous and muscular structures in the anterior aspect of the elbow joint in order to identify which of these conflicting elements are likely to cause a compressive neuropathy.

MATERIAL AND METHODS

The study design involved the dissection of 30 embalmed cadaveric upper limbs. Anatomic and morphometric investigations of the radial nerve, its terminal and motor branches were carried out. The presence of adhesions between radial nerve and joint capsule, tendons and aponeurotic expansions of epicondylar muscles and supinator arch was investigated. All measurements were taken in both pronation and supination of the forearm.

RESULTS

Neither macroscopic radial compressive neuropathy at the level of the supinator arch nor adhesions between the radial nerve and the joint capsule were found. In four cases (13%), dense fibrous tissue surrounded the radial nerve supply to extensor carpi radialis brevis (ECRB). The fibrous arch of the supinator muscle arose in a semi-circular manner and was noted to be tendinous in 87% of the extremities and of membranous consistency in the remaining 13%. The length of the AF averaged 25.9 mm. The angle formed by the radial shaft and the supinator arch was 23 degrees. Neither fibrous structures nor adhesions of the deep branch of the radial nerve (DBRN) along its course through the supinator muscle were observed.

DISCUSSION

Anatomic studies have revealed a variable rate of occurrence of a tendinous AF, which range from 30 to 80% (87% in our study) according to authors. It is reported to be a predisposing factor to the development of chronic entrapment neuropathy of the DBRN, especially if it is thick and provides a narrow opening for passage of the DBRN. The tendinous consistency of the supinator arch is believed to develop in adults, in response to repeated rotary movements of the forearm. Repetitive pronation and supination of the forearm induces compression of the radial nerve and its branches between two inextensible structures. The fibrous AF and the proximal end of the radius (radial head and radial tubercle). This condition is aggravated by the supinator muscle repeated activity. Repetitive compression might then promote histological changes in radial tunnel content and progressive development of a local fibrous zone. We also observed that the radial nerve supply to ECRB could be entrapped between the superolateral aspect of the ECRB and the superior edge of the supinator muscle.

Interaction between Candida agglutinins and antifungal agents

Antifungal agents alter the function and morphology of Candida cell membranes and cell walls. We observed that brief (30 minute) exposure to either amphotericin B or clotrimazole inhibited the agglutination of Candida blastoconidia by murine bronchoalveolar lavage fluid. This inhibition required continuous drug presence. Neither amphotericin nor clotrimazole inhibited Candida agglutination by concanavalin A or pooled human serum. These results demonstrate that antifungal drugs can produce rapid changes in the surface characteristics of some fungi.