Roman Hossein Khonsari

Severe facial rubber bullet injuries: Less lethal but extremely harmful weapons

UNLABELLED Less-lethal rubber-bullet weapons are designed to induce blunt injuries that incapacitate violent individuals. AIM AND SCOPE We intend to study the functional and aesthetic impairments and the cost in terms of social health resulting from rubber-bullet facial trauma. MATERIALS AND METHODS We retrospectively collected all the facial trauma cases caused by mass-appeal, less-lethal guns followed up in two French university hospitals since the year 2000. We did not consider the facial injuries caused by professional, less-lethal, rubber or plastic bullet guns. CONCLUSION We showed that mass-appeal, less-lethal rubber-bullet guns induce severe traumas with irreversible functional consequences and long-term social implications. Victims of facial rubber-bullet traumas should be managed like high-energy trauma patients and benefit from extremely careful primary wound care.

Clues on Balo's concentric sclerosis evolution from serial analysis of ADC values.

Balòs sclerosis is considered a rare variant of multiple sclerosis characterized by demyelination with concentric rings. Advanced magnetic resonance studies allow nowadays early diagnosis and prompt treatment. However, the pathophysiology of lesion evolution is still matter of debate, as detailed in our literature review. Based on a clear-cut Balòs lesion analysis, we describe early changes in DWI and ADC values within the different layers, favoring the concept of a centrifugal growth.

Shaping the fibula without fumbling: the SynpliciTi customised guide-plate.

Systems designed to reposition bone in free flap operations optimise morphological results and reduce ischaemic time. We describe SynpliciTi (OBL, Châtillon, France), a new approach to reconstruction of the jaw using fibular flaps, which is based on customised drilling guides and titanium plates obtained by direct manufacturing after reversed planning, in a fully digital process. We used Surgicase 5.0 (Materialise, Leuven, Belgium) to make a 3-dimensional operating plan of the final positions of the bony segments and osteotomy planes. Three or more non-aligned titanium screws were placed in ideal positions on each segment of the virtually reconstructed jaw according to accessibility, and quantity and quality of bone. We also planned dental implants where required and designed 1.5 mm thick plates based on these screw positions.

Les céramiques phosphocalciques synthétiques dans l’alvéoloplastie secondaire

INTRODUCTION Bone substitutes are rarely used in the reconstruction of cleft lip and palate. The graft material of choice is cancellous bone, harvested in the hip or tibia. Tibial harvesting may lead to postoperative morbidity, or even complications. This has lead surgeons to develop alternative solution. We present a secondary alveolar bone grafting technique using synthetic calcium phosphate ceramics. OBSERVATION A patient presenting with a complete unilateral cleft lip and palate was treated by alveolar bone grafting at the age of nine years, using a mixture of autologous bone, harvested on the operative field, and particles of biphasic calcium phosphate (BCP); the graft was included in a platelet rich plasma (PRP) gel. The patient was followed up for eight years after the procedure. No sign of early or late infection was observed. At the end of facial growth, the cuspid had erupted correctly in a safe periodontal environment. Sequential X-rays showed complete filling of the initial bone defect, progressive resorption of ceramics, and spontaneous eruption of the cuspid. DISCUSSION In this long-term follow-up report, the use of BCP mixed with autologous bone did not interfere with dental eruption or maxilla growth. A second bone-harvesting site was thus avoided. BCP could be a suitable alternative to autologous bone graft for secondary alveoloplasty.

Ostéotomie de Le Fort 1 en fer à cheval

INTRODUCTION Performing Le Fort I impaction osteotomy can be compromised or impossible. The intranasal volume of the lower turbinates prevents an important maxillary impaction. In this case, horseshoe osteotomy is an alternative. SURGICAL TECHNIQUE The first step is to lower the inferior edge of the pyriform aperture and the anterior floor of the nasal fossae with a bur. The palatine alveolar wall is cut through resection of the maxillary sinus anterior and lateral walls. The maxillary dental arch may be impacted without freeing the vomer or cutting through lateral walls of the nasal fossa, after having dissected the palatine fibrous mucosa and disjoined the pterygomaxillary suture. DISCUSSION This technique has mainly been used in pre-implantation surgery to lower the maxillary crest in edentulate patients, and to increase the crestal height after bone grafting without modifying the position of the hard palate. It is a good alternative to the usual Le Fort I osteotomy for important impactions when the alveolar bone height is sufficient.

Magnetic Resonance Sialography of Bilateral Stafne Bone Cavities

Stafne bone cavities (SBCs) are mandibular radiolucent lesions with challenging differential diagnoses. Many radiologic methods have been proposed to visualize the presence of salivary gland tissues inside the cavities. This report describes a case of bilateral angular mandibular radiolucent cavities located below the mandibular nerve canal. Magnetic resonance (MR) imaging showed continuity between the submandibular glands and the tissue herniated into the cavities. The ductal system of the 2 submandibular glands was evaluated using MR sialography. MR sialography depicted opacification of the glandular ductal system distinct from the contents of the cavities up to its primary branches, confirming the diagnosis of SBC. MR sialography visualized the submandibular gland ducts and the presence of salivary gland tissue inside the mandibular cavities with precise topographic information. This technique does not involve cannulation or injection of contrast agents and does not expose a patient to radiation. MR sialography is a valuable addition to the common imaging procedures used in the investigation of SBCs.

Lower jaw reconstruction and dental rehabilitation after war injuries: The experience of Paul Tessier in Iran in the late 1980s

Iraq-Iran war resulted in more than 400,000 people requiring prolonged medical care in Iran. An international team of prominent reconstructive surgeons led by Paul Tessier, the founder of craniofacial surgery, was invited to Iran during the war by official organizations entitled to support war victims. This team provided up-to-date oral and maxillofacial rehabilitation to patients with severe trauma defects in the lower third of the face. We collected the medical notes of 43 patients operated on by the Tessier team in Iran in the 1980s (files property of AFCF). The parameters we collected were: age of the patient, nature of the trauma (when available), previous procedures, number of implants placed (mandibular and maxillary), associated procedures (bone grafts, soft-tissue procedures, orthognathic surgery). A protocol based on soft-tissue rehabilitation using local flaps, parietal or iliac bone grafts and implant placement 6 months later was used in all patients. Paul Tessiers approach emphasizes the importance of keeping high standards of care in difficult situations and maintaining standard protocols.

Paul Tessier facial reconstruction in 1970 Iran, a series of post-noma defects

BACKGROUND Paul Tessier was a pioneering plastic surgeon who founded craniofacial surgery and had an international influence in the field of reconstructive surgery. We reviewed his techniques in the reconstruction of post-noma defects in Iran in the late 1970s. PATIENTS AND METHODS We studied a series of 23 patients operated on by Tessier from 1974 to 1978 in Iran (property of Association Française des Chirurgiens de la Face). They all suffered from noma in childhood with major facial defects. RESULTS Ten suffered from simple lip and cheek defects, nine also from nose defects and four from extensive facial defects. Abbe flaps were used in 15 patients to reconstruct the lips completed by commissuroplasty in six patients. Nose defects were reconstructed with nasofrontal flaps (ten cases). The outer cheek was reconstructed with a rotation flap (four cases), or with a frontotemporal flap (six cases). The inner cheek was reconstructed using a Barron-Tessier myocutaneous flap (ten cases). Of the 23 patients, partial flap necrosis occurred in five cases. CONCLUSIONS Tessier was a pioneering plastic surgeon who used local flaps to reconstruct these important facial defects. He had a high rate of success, although nowadays local flaps are commonly replaced by free flaps.

Three-Dimensional Reconstructions From Computed Tomographic Scans on Smartphones and Tablets: A Simple Tutorial for the Ward and Operating Room Using Public Domain Software

Handling 3-dimensional reconstructions of computed tomographic scans on portable devices is problematic because of the size of the Digital Imaging and Communications in Medicine (DICOM) stacks. The authors provide a user-friendly method allowing the production, transfer, and sharing of good-quality 3-dimensional reconstructions on smartphones and tablets.

Ostéome du sinus maxillaire associé à une mucocèle

INTRODUCTION Maxillary sinus osteomas are rare benign tumours with a poorly documented clinical evolution. Their craniofacial localization may be part of a syndrome. We report a case of maxillary sinus osteoma associated to a mucocele and a cyst probably of dental origin, with no sign of associated Gardner syndrome. CASE REPORT A 52-year-old woman consulted for chronic maxillary sinusitis and an oral vestibular fistula. The CT-scan suggested a mucocele with reactive bone formation. Macroscopically, a pediculated bone tumour was found next to a mucocele, and to a cyst probably of dental origin. The anatomopathological examination led to a diagnosis of cancellous osteoma. DISCUSSION Several hypotheses have been made on the etiology of sinus osteomas. When identified, screening for Gardners syndrome should be implemented because of the associated risk for colic malignancy.