[Cerebral thrombophlebitis: parotidectomy complication in a child]

INTRODUCTION

Onset of cerebral thrombophlebitis following parotidectomy in a child is reported.

OBSERVATION

A seven-year-old boy presenting apparently benign tumefaction in the right parotid gland area had undergone a conservative right total parotidectomy. The histological examination of the operative specimen suggested a diffuse neurofibroma as part of a clinical picture of Recklinghausen's neurofibromatosis. The immediate postoperative follow-up was marked by a pyramidal syndrome in the left hemibody, with the CT scan showing thrombophlebitis. After treatment combining an anticoagulant, a vasodilator and an antibiotic, the patient progressed toward partial recovery of left hemibody motor activity.

COMMENTS

This cerebral vascular accident is related to the angiodysplasia encountered in Recklinghausen's disease. Anticoagulants initialized rapidly are the only demonstrated therapy to improve the prognosis in this type of complication.

[Facial localizations of Buruli ulcers: two cases]

We report the first two published cases of a facial localization of Mycobacterium ulcerans ulcer (Buruli ulcer). M. ulcerans is the third most common mycobacteriosis, after leprosy and tuberculosis. Clinical manifestations involve large necrotic ulcerations with protruding edges, mainly localized on the limbs. Both of our patients, 9 and 45-year-old females, resided in endemic areas of Buruli ulcer in the Ivory Coast. The ulcers were located on the left zygomatic malar region in one patient and the submental region in the other. Treatment involved resection of the ulcer followed by total skin graft. Ulcer healing was observed after two months hospitalization in one patient. The other patient died.

[Retrospective analysis of 30 cases of mandibular ameloblastoma operated in the Ivory coast from 1992 to 2000]

OBJECTIVE

We analyzed a retrospective series of 30 cases of ameloblastoma operated in the Ivory coast from 1992 to 2000.

PATIENTS AND METHODS

The following techniques were used--temporary reconstructions via the endobuccal approach using a Peri prothesis in 27 cases and a resin coated Peri prosthesis in one;-- definitive reconstructions using iliac bone grafts in 3 cases and rib grafts in 14. These reconstructions were performed in a second operation via a cutaneous approach to replace the Peri prosthesis. Thirteen patients were lost to follow-up for this second phase. Mean follow-up ranged from 6 months to 13 months (mean 9.9 months).

RESULTS

Satisfactory outcome was acchevied when mouth opening was greater than 10 mm and patients with an acceptable cosmetic result no longer complained of mastication or phonation problems. There were four postoperative infections after bone graft reconstruction (two of them were immediate reconstruction). The resin coated Peri prosthesis led to a skin ulceration.

DISCUSSION

This study demonstrated the interest of mandibular reconstruction in undermedicalized countries where indications are dominated by reconstruction after resection for ameloblastoma. The large number of patients lost to follow-up before the second stage bone grafts points out the need for immediate reconstruction using autologous bone. Further study in a larger series would be needed to determine the cause of failure after immediate reconstruction.