O. Trost

Comparison of fresh and Thiel’s embalmed cadavers according to the suitability for ultrasound-guided regional anesthesia of the cervical region

IntroductionUltrasound-guided punctures are a new technique in anesthesia. However, training in these techniques requires conditions resembling real life as far as possible for learning purposes. Several models are available, but none associates realistic anatomy and lifelike sensations of the passage of fascias. The aim of our study was to compare fresh and Thiel’s embalmed cadavers for ultrasound-guided punctures.MethodsEight fresh cadavers and eight Thiel’s embalmed cadavers were investigated. The cervical region was scanned with an ultrasound probe. Age, sex and body mass index (BMI) were recorded. Visibility of he structures, including sternocleidomastoid (SCM) muscle, anterior and middle scalene muscles, thyroid gland, nerve and the needle, was evaluated as 0 (not visible or bad visibility) or 1 (good visibility). The feeling (“pop”) of passing the fascias was noted as 0 (not felt) or 1 (felt). The possibility of nerve displacement with the needle, the difficulty of intraneural injection and the possibility of nerve penetration and nerve swelling were all recorded as 0 (not possible) or 1 (possible).ResultsThe two groups were comparable in terms of sex, age and BMI. Visibility of the SCM muscle and the needle was better in the Thiel group. Moreover, the “pop” feeling and nerve swelling were significantly more frequently present in the Thiel group. There was no significant difference in terms of the other results between the two groups.ConclusionsCadavers embalmed according to Thiel’s method should be recommended for ultrasound-guided punctures as a realistic and lifelike model.

Open reduction and internal fixation of low subcondylar fractures of mandible through high cervical transmasseteric anteroparotid approach.

PURPOSE The aim of the present study was to evaluate the functional and radiologic results of low subcondylar fracture fixation with modus TCP plates (Medartis, Basel, Switzerland) using a high cervical transmasseteric anteroparotid approach. MATERIALS AND METHODS A prospective study was designed, enrolling all minimum-aged 15-year-old echomorphology patients presenting with displaced low subcondylar fracture with occlusion disturbances during a 41-month period. All fractures were fixed with modus TCP plates using high cervical transmasseteric anteroparotid approach. All patients underwent immediate physiotherapy and a 6-week liquid and semiliquid feeding period. Clinical and radiologic examinations were performed at 1 week and 1, 3, and 6 months. A total of 35 patients presenting with 38 fractures were enrolled with a mean follow-up of 17 months. RESULTS All fractures had healed at 6 months in the correct anatomic position in 73.7%. Occlusion was deemed normal in 80% of the patients. The mandibular movement was normal in 97.1%, with the mouth opening up to 40 mm, mean lateral movement of 11 mm without a difference between the 2 sides, and a mean protrusion of 12 mm. Minimal asymmetry remained in 15.6%. No facial palsy occurred, including no transient facial palsy. Complications consisted of 1 infection and 1 plate fracture requiring surgical revision. CONCLUSIONS Low subcondylar fracture fixation with modus TCP plates using a high cervical transmasseteric anteroparotid approach is a safe and reproducible procedure providing excellent functional results. This procedure has been routinely performed in our department.

Posterior perilunate carpal dislocation associated with a multifragmentary distal radius fracture

Dorsal perilunate wrist dislocations are rare. Associated carpal bones or radial styloid process fractures can occur and be included in the current classifications. The authors report an unusual association of dorsal perilunate wrist dislocation with a multifragmentary distal radius fracture. Such traumatic entity has never been previously described. Poor functional outcome may justify the inclusion of associated complex forearm bone fractures in wrist dislocation classifications.

[Third molar surgery under general anesthesia: a review of 180 patients].

BACKGROUND Third molar surgery is an important part of the activity in a maxillofacial surgery department. This common activity is often under-evaluated by patients who forget its surgical aspect. The aim of this study was to evaluate our practice, and especially complications, with special consideration given to medicolegal aspects. MATERIALS AND METHODS All the patients operated between September 2004 and July 2006 were enrolled in a retrospective study. This population is described, with the indications, follow-up, and complications. RESULTS One hundred and eighty patients were reviewed (sex-ratio 1, mean age 27 years). The most frequent indications were impaction and pain. The mean duration of hospitalization was 1.7 days and temporary disability, one week. Local infection occurred in 8%; there was neurological complication in 2% for the inferior alveolar nerve, and 1% for the lingual nerve. These were all transient cases. DISCUSSION Third molar surgery is an important and profitable part of the activity in a maxillofacial surgery department. Standardized information is necessary even if the rate of complications remains low.

Ganglion sentinelle dans les mélanomes cutanés de l’extrémité cervicocéphalique

INTRODUCTION Sentinel lymph node (SLN) biopsy is frequently discussed in the management of cutaneous melanoma, especially in head and neck localizations where SLN biopsy is much more demanding. The benefits of SLN protocol are not proved yet. The aim of our study was to present our experience of SLN biopsy in head and neck cutaneous melanoma. PATIENTS AND METHODS This retrospective study included all patients managed for head and neck malignant melanoma from 2002 to 2006. We reviewed the technique, implementation and difficulties of the procedure, postoperative outcome, and complications. RESULTS Nineteen patients were included. An average of 2.2 lymph nodes were localized per patient using lymphoscintigraphy. Biopsy was impossible for one patient because the deep spinal node was not found. An average of 1.2 nodes was biopsied per patient. One patient presented with micrometastases. Another presented with lymphorrhea. DISCUSSION Sentinel node biopsy is widely performed in the management of cutaneous melanoma but remains an option for these indications in the last update of the French Society of Dermatology. SLN biopsy is difficult to implement because of the complexity of head and neck lymphatic system.

Extraction des dents de sagesse sous anesthésie générale : à propos de 180 patients

BACKGROUND Third molar surgery is an important part of the activity in a maxillofacial surgery department. This common activity is often under-evaluated by patients who forget its surgical aspect. The aim of this study was to evaluate our practice, and especially complications, with special consideration given to medicolegal aspects. MATERIALS AND METHODS All the patients operated between September 2004 and July 2006 were enrolled in a retrospective study. This population is described, with the indications, follow-up, and complications. RESULTS One hundred and eighty patients were reviewed (sex-ratio 1, mean age 27 years). The most frequent indications were impaction and pain. The mean duration of hospitalization was 1.7 days and temporary disability, one week. Local infection occurred in 8%; there was neurological complication in 2% for the inferior alveolar nerve, and 1% for the lingual nerve. These were all transient cases. DISCUSSION Third molar surgery is an important and profitable part of the activity in a maxillofacial surgery department. Standardized information is necessary even if the rate of complications remains low.

Contribution de l'artère auriculaire postérieure à la vascularisation du nerf facial dans l'espace préstylien : étude anatomique et conséquences chirurgicales

INTRODUCTION The aim of our study was to establish a systematization of collateral branches originating from posterior auricular artery to facial nerve in prestylian space. MATERIALS AND METHODS Thirty posterior auricular arteries were studied on 15 fresh cadavers after selective patent blue injection. We observed subsequent colouration of facial nerve. Number and topography of collateral branches were highlighted. RESULTS Posterior auricular artery supplied facial nerve in 67%. Collateral branches dedicated to facial nerve could be classified into three types: type 1 corresponded to one artery in prestylian space, type 2 to several branches in prestylian space; finally type 3 featured several branches originating from posterior auricular artery in prestylian space on the one hand, in superficial retroauricular area on the other hand. CONCLUSION Posterior auricular artery is the main blood supply to facial nerve in prestylian space. In most of the cases, branches to facial nerve originate deeply in parotid space. Nevertheless nervous branches may originate from superficial retroauricular segment of posterior auricular artery. Their damage during surgical procedures as bat ear surgery can cause definitive facial nerve palsy.

Alfred-Louis-Dominique Richet (1816–1891) : pédagogie, anatomie et chirurgie

Alfred-Louis-Dominique Richet was an anatomist and surgeon born in Dijon, France in 1816. He defended the teaching of clinical anatomy instead of descriptive anatomy, judged inappropriate to learn operative medicine. His name is associated with several anatomical structures that we cite in the present article.

Article originalExtraction des dents de sagesse sous anesthésie générale : à propos de 180 patientsThird molar surgery under general anesthesia: A review of 180 patients

BACKGROUND Third molar surgery is an important part of the activity in a maxillofacial surgery department. This common activity is often under-evaluated by patients who forget its surgical aspect. The aim of this study was to evaluate our practice, and especially complications, with special consideration given to medicolegal aspects. MATERIALS AND METHODS All the patients operated between September 2004 and July 2006 were enrolled in a retrospective study. This population is described, with the indications, follow-up, and complications. RESULTS One hundred and eighty patients were reviewed (sex-ratio 1, mean age 27 years). The most frequent indications were impaction and pain. The mean duration of hospitalization was 1.7 days and temporary disability, one week. Local infection occurred in 8%; there was neurological complication in 2% for the inferior alveolar nerve, and 1% for the lingual nerve. These were all transient cases. DISCUSSION Third molar surgery is an important and profitable part of the activity in a maxillofacial surgery department. Standardized information is necessary even if the rate of complications remains low.

Articulation du trapèze avec le second métacarpien : étude anatomique et intérêts cliniques

INTRODUCTION An unusual dislocation of the column of the thumb associated with a fracture of the base of the second metacarpal inspired an anatomical study of the trapeziosecond metacarpal joint. MATERIALS AND METHODS Forty-five dissections of the palmar aspect of trapeziometacarpal joint aimed at focusing on palmar ligaments and tendons reinforcing the joints. RESULTS Trapeziosecond metacarpal joint is a constant little diarthrosis reinforced by a palmar ligament stressed between the crest of the trapezium and the base of the second metacarpal. The tendon of flexor radialis carpi muscle is an active link due to strong vinculae to trapezium bone and distal attachment to the bases of both second and third metacarpals. CONCLUSION The connections between the trapezium and the base of the second metacarpal bone play a role in the treatment of thumb instability and their mechanical importance is illustrated in our original clinical observation.