J.M. Foletti

Transoral approach for Stensen's duct lithiasis

Extracorporeal lithotripsy (ECL) and interventional sialendoscopy are the classical treatments for Stensens duct salivary stones, but some cases cannot be treated using these techniques. Another technique is now available, transoral Stensens duct approach.

Update on orbital decompression as emergency treatment of traumatic blindness

INTRODUCTION Blindness is a rare and severe complication of craniofacial trauma. The management of acute orbital compartment syndrome (AOCS) is not well defined and there is no standard treatment. Our objective was to find indications for orbital decompression, the best time for treatment, and the appropriate techniques. MATERIALS AND METHODS A literature review was made from articles published between 1994 and 2014 in the PubMed database, on the emergency treatment of AOCS. RESULTS 59 of the 89 patients treated surgically for AOCS presented with significant improvement of visual acuity (VA) after orbital decompression. The delay between trauma and surgery was short. A lateral canthotomy with inferior cantholysis (LCIC) was the most frequently used technique. DISCUSSION AOCS with a risk of visual impairment must be decompressed in emergency, at best in the 2 hours following trauma, most often by LCIC to have the best chance of recovering VA. Adjuvant medical treatment (acetazolamide, mannitol, corticosteroids) should not delay surgery. Postoperative corticosteroid therapy is not indicated, especially in patients with severe head trauma.

Abord combiné des lithiases parotidiennes. Note technique

INTRODUCTION Sialendoscopy, extracorporeal lithotripsy and transoral removal are the usual treatments for parotid lithiasis. These techniques cannot treat all the patients. In fact, removal of lithiasis bigger than the ductal diameter and situated in the middle or posterior third of the duct may fail with such techniques. For this reason the combined approach has been developed. Our technical note describes this procedure. TECHNICAL NOTE Preoperative check-up needs an ultrasound or a CT scan of the parotid region. The procedure is conducted under general anesthesia. It begins with the localization of the lithiasis with help of the sialendoscope light visible through the skin. A face lift approach is performed giving access to the SMAS that is opened over the lithiasis and the transilluminated area. A window is opened on the duct and the lithiasis is removed. Proximal duct permeability is assessed with the sialendoscope. The different layers are sutured and a suction drainage is left in place. DISCUSSION Combined approach is indicated in case of failure of conservative techniques. It provides good results in removal of lithiasis located in the posterior or middle thirds of the duct. Its morbidity is low. It can avoid performing a parotidectomy and lowers the risk of facial palsy. In case of failure, botulinum toxin injection may be indicated.

Transoral Stensen's Duct Approach: A 22-case retrospective study.

INTRODUCTION Parotid gland duct lithiasis is preferentially managed using minimally-invasive techniques such as sialendoscopy and lithotripsy. However, these 2 techniques cannot remedy all obstructions and other techniques such as the Transoral Stensens Duct Approach (TSDA) may sometimes be helpful. MATERIAL AND METHODS A retrospective study of patients treated with TSDA was conducted to evaluate this procedure between 2006 and 2013. Criteria for inclusion were: failures for lithiases (22 patients and 28 lithiases) treated with sialendoscopy and/or lithotripsy for parotid gland duct obstruction. Mean follow-up was 47.4 months. Pain intensity, swelling and occurrence of infectious episodes were evaluated immediately and after middle-term and long-term follow-up (up to 36 months). RESULTS The best results were obtained for anterior lithiasis, with an 87.5% immediate success rate. Morbidity was low with 2 transient facial nerve upper buccal branch palsies and 2 post-operative stenoses. DISCUSSION TSDA is an easy-to-perform and safe technique that can be recommended in cases of sialendoscopy or lithotripsy failure for anterior-third parotid duct lithiasis. Even if this technique has shown limitations for more posterior lithiases, or other causes of obstruction (stenosis, megaduct), it requires no specific material and may be useful. It may avoid an external combined approach or a parotidectomy.

Endoscopic treatment of mandibular condylar fractures in live minipigs: benefits of the operative learning curve.

Endoscopic treatment of mandibular condyle fractures is a minimally invasive technique that avoids the complications of open reduction and internal fixation. We have used live minipigs as an animal model for learning and training the technique. Fourteen condylar fractures were created, reduced, and internally plated in 7 minipigs using an endoscopic approach by a surgeon with no previous experience of the technique. The mandibles were reduced and fixed successfully in each animal. Operating time was reduced as the surgeon became more familiar with the technique. Minipigs are useful as a model for the endoscopic approach to the treatment of mandibular condylar fractures. Surgeons have the opportunity to train and gain surgical endoscopic experience before treating patients.

Ranulas à expression cervicale. Mise au point

INTRODUCTION Ranula is a pseudocyst of the sublingual gland, often of unknown etiology. In few cases, it can extend to the neck when passing through the mylohyoid muscle. Diagnosis is not always easy as other cervical cystic lesions may have the same clinical aspect. Some ranulas recur after removal. The aim of our study was to conduct a review about plunging ranulas, with a focus on the most useful paraclinical exams and the most effective treatment. MATERIAL AND METHODS A review of the literature has been conducted in the PubMed database between 2015 and 2010 using following keywords: plunging ranula, recurrent plunging ranula. RESULTS Thirteen articles reporting 37 cases of plunging ranulas have been selected. Among these cases, 3 recurred. Paraclinical exams consisted in US, CT scan and MRI. Main reported treatment was sublingual gland removal, sometime associated with marsupialization. DISCUSSION The most useful paraclinical exam is CT scan. Total sublingual gland removal is the most efficient treatment.

Extracorporeal lithotripsy of salivary gland stone: A 55 patients study

Sialolithiasis are the most frequent salivary gland disease, mainly affecting the submandibular gland. With the advent of minimally invasive techniques, total salivary gland removal should not be considered as the first-line treatment anymore. Extracorporeal Shock Wave Lithotripsy (ESWL) is an alternative to surgery preserving the gland. The objective of our retrospective study was to evaluate the efficiency of ESWL on pain and obstructive syndrome in patients suffering from sialolithiasis. The global result felt by the patients was also considered. All patients treated between October 2009 and July 2016 for sialolithiasis by ESWL in our department were included. They were divided into two groups according to the concerned gland: a parotid gland (PG) and a submandibular gland (SMG) group. Our retrospective telephone questionnaire consisted in 4 questions about their symptomatology before and after ESWL, including pain self-evaluation before and after treatment. They were finally asked to evaluate the global result of the ESWL treatment: excellent, good, mean, or poor. In total, 55 patients were included in this study, 38 patients in PG group and 17 patients in SMG group. We observed a decrease of pain and obstructive syndrom after ESWL procedure in both groups. Better results were found on the obstructive syndrome in the PG group. Very few side-effects were reported by patients. Given that it has very few side effects, ESWL can easily be considered as first line treatment for sialolithiasis to avoid heavier treatments such as surgery. It should be the first-line treatment for symptomatic parotid sialolithiases. The treatment of symptomatic submandibular sialolithiases depends on the topography of the lithiasis.

Endodontic related inferior alveolar nerve injuries: a review and a therapeutic flow chart

INTRODUCTION Inferior alveolar nerve (IAN) lesions related to endodontic treatments can be explained by the anatomical proximity between the apices of the mandibular posterior teeth and the mandibular canal. The aim of this article is to review the management of inferior alveolar nerve lesions due to endodontic treatments and to establish a therapeutic flow chart. METHODS A review of publications reporting IAN damage related to endodontic treatment over the past 20 years has been conducted, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist; it combines an electronic search of the Pubmed® and Google Scholar® databasis. Forty-two full-text articles corresponding to 115 clinical cases have been selected. Two personal clinical cases were additionally reported. RESULTS IAN lesions due to endodontic treatments require urgent management. Early surgical removal of the excess of endodontic material, in contact with the nerve allows the best recovery prognosis (72h). Beyond this delay, irreversible nervous lesions prevail and a medical symptomatic treatment, most of the time with pregabalin, must be/can be carried out. A delayed surgical procedure shows some good benefits for patients. However, the healing prognosis remains poorly predictable.

Upper aerodigestive tract cancer and oral health status before radiotherapy: A cross-sectional study of 154 patients

OBJECTIVES We aimed to determine primarily the oral health status of patients with upper aerodigestive tract cancer before radiotherapy, and secondarily the prevalence of risk factors for poor oral status. METHODS A cross-sectional study was conducted in Marseille University hospital. Assessment criteria were the Decay, Missing and Filled (DMF) Index and periodontal status. RESULTS One hundred and fifty-four patients, mean age 60.9years, were included. The most common sites of primary tumors were the larynx (28.6%) and oral cavity (26.6%). Current or past smokers accounted for 80.5% of patients and 67% were alcohol abusers. Most patients (83.8%) did not have xerostomia. They ate three meals a day (61%), with sugar consumption in 40%. The median number of daily tooth brushings was 2, with a manual toothbrush (81.2%). Few patients used dental floss or interproximal brushes. Individual DMF index was 17.6 (D=2.3, M=9.3, F=6.0) and was higher in patients with xerostomia and alcohol abusers (P=0.01). Osseous level was 62.3% and 57.8% of patients had osseous infections, which were more common with poor hygiene (P=0.04). Most patients (85.7%) had periodontal disease, but incidence did not significantly differ according to risk factors. DISCUSSION The DMF index was higher in presence of periodontal disease and osseous infections. Alcohol and xerostomia were associated with a high individual DMF index and osseous infections were more frequent in patients with poor hygiene. Patients with upper aerodigestive tract cancer are at high risk of osteoradionecrosis if they do not receive dental treatment before radiotherapy.

A case of bilateral megaducts: Diagnostic and treatment methods

INTRODUCTION The pathology of the saliva glands comprises both tumoral and obstructive disorders. The latter include lithiasis, stenosis and megaduct. In this paper, we describe a clinical case of bilateral megaduct, a rare pathology, using sialo-MRI imaging and a conservative diagnostic-cum-therapeutic technique, sialendoscopy with dilation followed by catheterization. CLINICAL CASE Our female patient presented oversized parotids with an unsightly deformation of the face (parotid ducts visible beneath the skin) and itchy cheeks, from which she had suffered for several years. Sialo-MRI revealed bilateral hypertrophied parotid saliva glands. We opted to perform diagnostic sialendoscopy to explore the branches of the salivary gland system and found ducts shaped like strings of sausages associated with mucous plugs. The treatment procedure was combined with rinsing of both parotid ducts in physiological serum followed by initiation of antibiotic-corticotherapy within the saliva ducts and, lastly, by placement of transpapillary drains, which were left in place for 10 days. Immediately following the procedure, the patient felt a considerable improvement regarding both local discomfort and her cheek deformation. Postoperative control at 10 weeks by sialo-MRI confirmed the reduction of the dilation of the salivary ducts. At 3 months, the patient continued to display a marked clinical improvement despite her saliva retaining a thick consistency. She no longer suffered from pruritis or deformation of the cheeks. DISCUSSION Sialendoscopy could become the reference treatment tool since it is both efficient and conservative. Duration of her postoperative catheterization remains to be defined.