Gaoussou Toure

The procurement of allotransplants for ballistic trauma: a preclinical study and a report of two clinical cases.

Background: Maxillofacial trauma caused by severe ballistic injuries requires many steps of reconstruction and is often associated with disappointing results. The authors report on two clinical cases of facial allografting. Methods: After a preclinical anatomical study of 10 fresh cadavers, the authors performed allotransplantation of the lower two-thirds of the face in two patients in March and August of 2009. The grafts included all perioral muscles, facial nerves, parotid glands, the anterior region of the maxilla, and part of the mandible. The mandibular osteotomy included only the chin in one case, and the mandibular arch from one angle to the other in the second case. Results: The cadaveric study confirmed that relying only on the anastomoses between the facial and the maxillary artery for vascularization of the posterior part of the maxilla was unsafe. Periosteal vascularization seemed essential. The clinical results confirmed that complete revascularization from a single facial pedicle was possible: the first end-to-end arterial anastomosis to the left external carotid artery was sufficient for full perioperative revascularization of the flap and immediate reestablishment of bilateral venous flow. The facial appearance of both recipients improved gradually, with the development of changes in expression and the appearance of nasolabial folds. Preoperatively placed gastrostomies and tracheostomies were able to be removed in both patients within 6 weeks postoperatively. The procurement part of the operation was performed in 7 hours. Conclusion: Partial facial composite tissue allotransplantation of the lower two-thirds of the face along with parts of the maxilla and mandible (chin or entire-toothed mandible) is technically feasible, with a good cosmetic and functional outcome in typical cases of attempted suicide with rifles.

Relations of the facial nerve with the retromandibular vein: anatomic study of 132 parotid glands

BackgroundThe retromandibular vein (rmv) is an important anatomical element, in radiology to localise a tumor in the parotid gland in relation to the facial nerve, and in surgery as a landmark to dissect the facial nerve and its branches. The aim of this study was to give a precise description of the anatomic variations of the relations of the facial nerve with the rmv.MethodsOne hundred and thirty-two parotid glands have been dissected by pre-auricular route. The rmv, the facial nerve trunk and its branches have been dissected and described. The relations of the facial nerve with the rmv have been noted in each case.ResultsThe rmv was medial to the nerve in 65.2% and lateral in 13% to the nerve. In 6.8% the nerve was placed between a superficial and a deep venous plane.DiscussionMore variations were present in our description than in others. The situation of the rvm alone or associated with other anatomical elements is not a reliable landmark of the situation of a tumour either in the superficial part or in the deep part of the parotid gland in relation to the facial nerve. Some authors considered that the predictive value of these anatomical landmarks was near 65%.

Epidemiology and classification of dog bite injuries to the face: A prospective study of 108 patients

BACKGROUND Dog bites are considered to be septic injuries, and their location on the face, with its highly symbolic topography and important social functions, is particularly pertinent. In addition to specific medical aspects, such as their psychological impact, they are also of relevance in terms of child protection measures. In light of the far-reaching importance of this subject, we were prompted to carry out a prospective study, over 13 years, to identify risk factors. Our results highlight specific risk factors, and they may hence assist with the implementation of concrete primary prevention measures against dog bites. METHODS An information sheet was prepared and filled out during the intake of patients who had been bitten on the face. Data analysis was performed using Epi Info Version 6.04dfr software to find a correlation between the factors studied and the dog bite to the face. RESULTS Dog bites to the face represented 0.83% of the emergency admissions to our service. A considerable majority of these involved children, with 68.5% of patients <16 years of age, and 33.3% of patients aged between 2 and 5 years. The wounds were multiple and of variable severity. The type of dog involved was frequently a German Shepherd. Strikingly, 91.3% of bites had occurred in a single-parent environment. CONCLUSIONS Our study has determined that the fundamental factors that increase the probability of a dog bite to the face are as follows: the child being 2-5 years old, a single-parent context, and involvement of a German Shepherd-type dog.

Arterial vascularization of occipital scalp: mapping of vascular cutaneous territories and surgical applications

Although the vascular supply of the occipital region of the scalp is usually considered as depending on the occipital arteries, in our clinical experience the importance of the posterior auricular arteries seems to have been underestimated. Most of the authors consider that the occipital artery is the main artery to the vascular supply of this region. The role of the posterior auricular artery has not been clearly investigated. In order to describe the cutaneous territories of these two arteries, 20 occipital areas have been dissected after bilateral injection of coloured latex (40 occipital and 40 posterior auricular arteries studied), and 4 occipital areas have been dissected after selective injection of china ink in the occipital and posterior auricular arteries (4 occipital and 4 posterior auricular arteries injected). The occipital artery was deep from its origin to the arch constituted by the insertions of the trapezius and sternocleidomastoid muscles. Then the occipital artery was becoming superficial while ascending to the vertex. The cutaneous territory of the occipital arteries was paramedian and median (38% of the occipital area). The posterior auricular artery was superficial in the auriculomastoid sulcus and divided into three branches: auricular and mastoid as usually described and also a third terminal branch that we called “transverse nuchal artery”. The posterior auricular arteries supplied the major part of the occipital area of the scalp (62%).

Endoscopic resection of osteoma of the forehead

We report the one-year follow-up of a series of endoscopic removal of osteomas of the forehead to assess the feasibility of the technique, its functional results, and the satisfaction of the patients. Osteomas were resected in five patients (two women, three men, mean age 40 years, range 30 to 55) using an endoscopic technique. All operations were successful and did not require conversion to open operation. Operating time was 20 to 40 minutes (mean 30 minutes). All patients were discharged on the day of operation. There were no postoperative complications (haematoma, nerve injury, or infection), and no recurrence at the one-year follow-up visit. All patients were satisfied with the outcome and particularly with the cosmetic result. This series confirms the surgical feasibility of removal of osteomas of the forehead and its excellent outcome in functional results and patients’ satisfaction. Absence of extensive or visible scars, non-traumatic dissection, and magnification of anatomical structures are its most obvious advantages.

Anatomical study of the vascular territories of the maxilla: Role of the facial artery in allotransplantation

BACKGROUND Facial composite tissue allotransplantation has recently become a surgical option. The maxilla, which forms the upper jaw and plays an important role in facial allotransplantation, consists of the maxillary and facial arteries. The maxillary artery is located deep within the tissue and considered the main artery of the maxilla; however, the facial artery is easy to access. The objective of this study was to examine the territories of the maxillary and facial arteries within the maxilla. MATERIALS AND METHODS We excised and examined 22 maxillae. Of these, 18 were injected with latex and four with India ink. RESULTS We observed that the ascending palatine artery, which was collateral with the facial artery, vascularized the maxilla through its dorsal part. The facial artery vascularized the maxilla through its ventral part with the philtral and columellar branches of the superior labial artery. Therefore, the facial artery formed, through the nasal and palatine mucosa, an arterial circle with a dorsal and ventral pole. Angiosomes formed by both the facial and maxillary arteries were also observed. The India ink injected into the facial and maxillary arteries delineated specific territories for each artery. DISCUSSION This study allowed us to determine the anatomical structures that provide vascularization to the maxilla and describe their different forms. The whole of the maxilla was vascularized by the facial artery, despite the caution imposed by several studies on the removal of the facial artery alone. Indeed, the removal technique was found to be safer when it preserved the anastomoses between the facial and maxillary arteries. Therefore, previous clinical experience and our anatomical study definitively demonstrate that the facial artery vascularizes the maxilla.

Intraparotid Location of the Great Auricular Nerve: A New Anatomical Basis for Gustatory Sweating Syndrome.

Background: Gustatory sweating syndrome (also known as Frey syndrome or auriculotemporal nerve syndrome) is thought to result from a lesion of the auriculotemporal nerve. A lesion of this nerve can lead to aberrant regeneration of nerve fibers to the sweat glands and blood vessels. The occurrence of signs outside the region of the auriculotemporal nerve prompted the author to search for another anatomical basis for this syndrome. Methods: The author dissected 46 great auricular nerves from their origin to the parotid gland and in the infratemporal fossa. The author investigated the different connections of the great auricular nerve with the facial nerve and the auriculotemporal nerve. Results: The great auricular nerve was found to essentially be a parotid nerve. There was a set of intraparotid nerve connections on 14 of the 46 half-heads that were dissected. The author was able to discern three types of parotid great auricular nerve connections, which he designates as either type 1, connection with the trunk of the facial nerve and its branches; type 2, connection with the auriculotemporal nerve; or type 3, connection with the auriculotemporal nerve and the facial nerve with the formation of an intraparotid nerve circle. Conclusions: Having clearly established the nerve connections of the great auricular nerve, the author believes that it is primarily this nerve that is responsible for gustatory sweating syndrome. This allows for a better understanding of the sympathetic nervous system features and the manifestation of the syndrome outside the region of the auriculotemporal nerve.

Plasma Cell Granuloma of the Jaw and the Infratemporal Fossa: A Clinical Case

Plasma cell granuloma or inflammatory pseudotumor (IPT) is diagnosed by a process of elimination. The precise etiology is unknown, although it can occur after a bout of periodontal infection. This report describes the various stages of progression for this ailment. A 49-year-old woman with no noteworthy medical history presented with a recurrent periodontal abscess accompanied by progressive and severe destruction of the right maxilla. There was invasion of the infratemporal fossa and very tight trismus. Histologic examination indicated a reactive plasma cell granuloma. IPT is an entity recognized by the World Health Organization. A triggering infectious or inflammatory factor is often present. In the maxilla, progression is very aggressive. Treatment relies on corticotherapy, with or without radiotherapy, and administration of cyclosporine.

The styloauricular muscle: clinical relevance and literature review of this rare muscle

PurposeIn humans, the styloauricularis is a rare muscle extending from the tragal cartilage of the auricle to the styloid process. When it contracts, by bearing on the styloid process, it increases the cephalo-auricular angle. It can be a landmark for the facial nerve. We report a case with bilateral presence of the styloauricularis.MethodsBilateral presence of the styloauricularis was discovered during routine dissection of the head and neck.ResultsIn the presented case, styloauricularis muscles arose from the cartilage of the external acoustic meatus on both sides of the head, crossing halfway along the facial nerve trunk and inserting the styloid process. Both muscles were vascularized by a branch of the posterior auricular artery, and innervated by the facial nerve.ConclusionsThe ventral auricular muscle, formed by the auricular parotid and the styloauricular muscles, is a muscle that lowers and abducts the auricle in animals. There is generally considered to be no equivalent for these muscles in humans, however, this bilateral case reveals evidence to the contrary. There is a dearth of scientific literature about the styloauricularis. The study of this muscle demonstrated the usefulness of comparative anatomy in understanding its action in increasing the cephalo-auricular angle.

Surface anatomy of the parotid duct and its clinical relevance.

The trajectory of the parotid duct (PD) makes it vulnerable to injuries during facial trauma and facial rejuvenation procedures. The PD is usually represented as a straight line, although its description in the literature varies. Our objective was to study the trajectory of the PD and to define reliable cutaneous landmarks. We dissected 35 human cadaver half‐heads. We defined three points: point I where the PD crossed a line (line 2) between point T (the intertragal incisura) and point C (the corner of the mouth), point S for the top of the PD, and point B where the PD penetrated the buccinator muscle. We measured the distance (D) between points T and C, the distance (d1) between points T and I, and the distance (d2) between points T and B. We also determined the height (h) of the orthogonal line between point S and line 2. We noted that for all of the half‐heads that we examined, the PD followed a curved trajectory between points I and B above line 2. Point I was located 1/3 of the way along distance D. Point B was tangential to line 2, and was located 2/3 of the way along distance D. The average height measurement (h) was 1.4 cm. We demonstrated that the PD follows a curved trajectory from the 1/3 mark to the 2/3 mark along distance D, the top of this curve being 1.5 cm above the line TC. Clin. Anat. 28:455–459, 2015.