Purpose: The aim of this retrospective study was to analyze the characteristics of panfacial fractures and evaluate treatment results at the Maxillofacial, Stomatology and plastic surgery department at the AVICENNE mi...Purpose: The aim of this retrospective study was to analyze the characteristics of panfacial fractures and evaluate treatment results at the Maxillofacial, Stomatology and plastic surgery department at the AVICENNE military hospital over a period of 5 years. Patients and Methods: Forty eight patients with panfacial fractures were treated in Maxillofacial, stomatology and plastic surgery department of the AVICENNE Military Teaching Hospital between 2012 and 2017. The criteria for inclusion in the study were patients who had fractures of at least three of the four axial segments of the facial skeleton: frontal, upper midface, lower midface, and mandible. Results: 48 patients with panfacial fractures had a total of 116 subtypes of facial bone fractures. A total of seventeen (14.6%) LeFort II fractures in 16 (33.4%) patients were recorded, fifteen LeFort I fractures were recorded in 3 (6.2%) cases;seven (6%) LeFort III fractures were recorded in 5 (10.4%) cases, thirteen (11.2%) fractures of the NOF complex were recorded in 6 (12.5%) patients;sixteen (33.4%) patients had thirty eight (32.7%) fractures involving the mandible. Ten (8.6%) NOM (naso-orbito-maxilla) complex fractures occurred in 9 (18.7%) cases. 5 (10.4%) patients had a total of five (4.3%) CNEMFO (naso-ethmoido-maxillo-fronto-orbital) complex fractures. Our case series included five Comminuted premaxillary fractures and six Intermaxillary disjunctions. All 48 cases had facial deformities and thirty six had malocclusions. The treatment plan to reduce and fix the facial bone fractures was sequenced “Bottom up, Outside in”. Postoperative complications were reported, there were 5 cases whose malocclusions, 4 cases of zygomatic non-union or partial defects, 13 had enophthalmos and hypoglobus. Seven had scars from the trauma, 2 had lower eyelid ectropion, and 2 had temporal muscle atrophy. Conclusion: Panfacial fractures seem to be complex and difficult to treat, but with an organized and flexible approach, appropriate reduction of fractures is accomplishable, yet post-surgical complications mainly caused by soft tissue problems, including lacerations and asymmetries, can’t be easily avoided.展开更多
Introduction: Chondrosarcomas (CS) are malignant cartilaginous tumors of rare maxillary localization. Their evolution is generally slow in time. They have a high tendency for locoregional recurrence after surgical tre...Introduction: Chondrosarcomas (CS) are malignant cartilaginous tumors of rare maxillary localization. Their evolution is generally slow in time. They have a high tendency for locoregional recurrence after surgical treatment. Their prognosis depends on their degree of differentiation and the quality of resection. The authors report a clinical case of mesenchymal mandibular chondrosarcoma (MC), which is considered to be a subtype of CS, and specify the epidemiological, diagnostic, therapeutic and evolutionary features of this tumor. Case Report: A 73-year-old woman reported in February 2018 in our department complained of a slowly enlarging mass involving the right part of the lower jaw for the last 18 months. On examination a firm multilobular painful mass was palpated with cortical expansion, occupying the right side. A CT scan with 3D reconstruction was achieved and showed osteolysis lesions and cortical thickening. The mass biopsy for histological examination found a grade I well-differentiated bone chon-drosarcoma. We performed a hemi-mandibulectomy with complete resection of the tumor. The anatomopathologic examination of the resection specimen was in favour of a grade II mesenchymal chondrosarcoma. No radiotherapy was needed. The patient’s follow up was uneventful. Discussion: CS grading is the key to its management. Low grade CS (grades I and II) of the facial skeleton are luckily the most common, they are best treated with a local resection using 1.5 cm margins for bone and soft tissue. According to published literature, CS was historically considered as a radio resistant tumor. Radiotherapy and chemotherapy were therefore mainly reserved for high-grade tumors and for non-operable lesions. However, radical local surgery appears to be the treatment of choice for low grade chondrosarcoma. Conclusion: CS’s definitive diagnosis depends on appropriate radiographic evaluation along with adequate biopsy with meticulous histopathological examination and adjunctive immunohistochimical analysis. Neither chemotherapy nor radiotherapy is indicated as primary treatment. A long period follow-up should be advised as recurrence and metastasis are very frequent.展开更多
文摘Purpose: The aim of this retrospective study was to analyze the characteristics of panfacial fractures and evaluate treatment results at the Maxillofacial, Stomatology and plastic surgery department at the AVICENNE military hospital over a period of 5 years. Patients and Methods: Forty eight patients with panfacial fractures were treated in Maxillofacial, stomatology and plastic surgery department of the AVICENNE Military Teaching Hospital between 2012 and 2017. The criteria for inclusion in the study were patients who had fractures of at least three of the four axial segments of the facial skeleton: frontal, upper midface, lower midface, and mandible. Results: 48 patients with panfacial fractures had a total of 116 subtypes of facial bone fractures. A total of seventeen (14.6%) LeFort II fractures in 16 (33.4%) patients were recorded, fifteen LeFort I fractures were recorded in 3 (6.2%) cases;seven (6%) LeFort III fractures were recorded in 5 (10.4%) cases, thirteen (11.2%) fractures of the NOF complex were recorded in 6 (12.5%) patients;sixteen (33.4%) patients had thirty eight (32.7%) fractures involving the mandible. Ten (8.6%) NOM (naso-orbito-maxilla) complex fractures occurred in 9 (18.7%) cases. 5 (10.4%) patients had a total of five (4.3%) CNEMFO (naso-ethmoido-maxillo-fronto-orbital) complex fractures. Our case series included five Comminuted premaxillary fractures and six Intermaxillary disjunctions. All 48 cases had facial deformities and thirty six had malocclusions. The treatment plan to reduce and fix the facial bone fractures was sequenced “Bottom up, Outside in”. Postoperative complications were reported, there were 5 cases whose malocclusions, 4 cases of zygomatic non-union or partial defects, 13 had enophthalmos and hypoglobus. Seven had scars from the trauma, 2 had lower eyelid ectropion, and 2 had temporal muscle atrophy. Conclusion: Panfacial fractures seem to be complex and difficult to treat, but with an organized and flexible approach, appropriate reduction of fractures is accomplishable, yet post-surgical complications mainly caused by soft tissue problems, including lacerations and asymmetries, can’t be easily avoided.
文摘Introduction: Chondrosarcomas (CS) are malignant cartilaginous tumors of rare maxillary localization. Their evolution is generally slow in time. They have a high tendency for locoregional recurrence after surgical treatment. Their prognosis depends on their degree of differentiation and the quality of resection. The authors report a clinical case of mesenchymal mandibular chondrosarcoma (MC), which is considered to be a subtype of CS, and specify the epidemiological, diagnostic, therapeutic and evolutionary features of this tumor. Case Report: A 73-year-old woman reported in February 2018 in our department complained of a slowly enlarging mass involving the right part of the lower jaw for the last 18 months. On examination a firm multilobular painful mass was palpated with cortical expansion, occupying the right side. A CT scan with 3D reconstruction was achieved and showed osteolysis lesions and cortical thickening. The mass biopsy for histological examination found a grade I well-differentiated bone chon-drosarcoma. We performed a hemi-mandibulectomy with complete resection of the tumor. The anatomopathologic examination of the resection specimen was in favour of a grade II mesenchymal chondrosarcoma. No radiotherapy was needed. The patient’s follow up was uneventful. Discussion: CS grading is the key to its management. Low grade CS (grades I and II) of the facial skeleton are luckily the most common, they are best treated with a local resection using 1.5 cm margins for bone and soft tissue. According to published literature, CS was historically considered as a radio resistant tumor. Radiotherapy and chemotherapy were therefore mainly reserved for high-grade tumors and for non-operable lesions. However, radical local surgery appears to be the treatment of choice for low grade chondrosarcoma. Conclusion: CS’s definitive diagnosis depends on appropriate radiographic evaluation along with adequate biopsy with meticulous histopathological examination and adjunctive immunohistochimical analysis. Neither chemotherapy nor radiotherapy is indicated as primary treatment. A long period follow-up should be advised as recurrence and metastasis are very frequent.
