Bilateral submandibular duct relocation for chronic sialorrhea: a 15 years of experience in children with a neurological disorder

Background: Chronic sialorrhea is a troublesome condition for children with neurological disorders that affect swallowing. Various surgical procedures for reflecting drooling cases are helpful. Some of them could be followed by complications or lead to over–dryness of the mouth. This article aims to highlight the safety and effectiveness of bilateral submandibular duct relocation (BSDR) on fifteen years of experience. Material and methods: A retrospective chart review identified 25 patients with chronic sialorrhea who underwent BSDR. Clinical and demographic data were reviewed. Surgical outcomes were assessed with both Wilkie and Brody's criteria and the Teacher drooling (TDS) scale. Results: The mean age of children was 11.7 years. They had neurological disorders and dribbled saliva with an average of 4.28 according to the TDS which falls to an average of 1.12 after surgery. By referring to Wilkie and Brody's criteria, 88% of the results have been labelled as excellent and good for the others. Conclusion: Our 15 years of experience in managing neurologically impaired children with profuse drooling illuminates and supports our trend for BSDR without sublingual gland excision. This surgical procedure is safe, and effective against drooling, protects oral health, and provides a high rate of success

Infraorbital nerve disturbance secondary to long-term cosmetic filler nodule migration at the lower eyelid

Background: Injectable fillers are widespread for antiaging non-invasive treatment. Whereas complications are difficult to manage, basically those of permanent fillers such as Bio-Alcamid. These complications could occur years later and far from the injected site, such as nodule migration. This article aims to highlight the delayed one-set nodules migration diagnosis for each patient with periorbital complaints when a history of cosmetic treatment such as polyalkylimide (Bio-Alcamid®) injection was reported. We also emphasize the knowledge of the product, sometimes given by the patient or predictable on ultrasound findings, to perform effective and efficient treatment. Case presentation: A 32-year-old woman had presented for paresthesia of the right cheek. The clinical examination revealed a palpable but not visible painless nodular and firm mass at the level of the infraorbital nerve emergence, and it was mobile and not pulsatile. A thorough medical history detected a malar injection about four years ago with polyalkylimid. Surgical treatment was performed to extract a well-encapsulated transilluminated lesion located beneath the orbicularis muscle without any adherence to adjacent structures, mainly the infraorbital nerve. Histopathological findings corroborated with a migrated nodule. Conclusion: Polyalkylimide injection in the cheek may give rise to leakage of hydrogel droplets in the lower eyelid, leading to nodule formation in the long term. The hardness of the capsule surrounding the hydrogel and the existence of these nodules between the infraorbital nerve and the orbicular muscle could lead to intolerable paresthesia. Corticosteroid injections are widely administered to manage delayed non-inflammatory granuloma related to filler injections. However, they are inefficient on polyalkylimide nodules where surgical excision remains the mainstay approach

Clinical characteristics and management of odontogenic necrotizing fasciitis: a retrospective study

Background: Life-threatening illnesses like necrotizing fasciitis (NF) from dental origin arise suddenly and unexpectedly as a result of the debilitating condition and frequent self-medicating behaviour. This article aims to report the medical and therapeutic characteristics of 15 patients while discussing risk factors, pathogenetic mechanisms and management of this disease. Method: From 2012 up to 2022, a retrospective chart study of patients with odontogenic NF was carried out. Demographic, medical and therapeutic data were collected and analysed, using the Excel program. Results: Fifteen patients were identified with retrievable medical records. There was a male predominance, and the age ranged from 13 to 82 years with a majority over 40 years. Preadmission delay was ≤4 days in 40% of patients with self-medication of non-steroid anti-inflammatory drugs. 53.85% of patients had previous dental treatment without antibiotic coverage. Rheumatoid arthritis was the predominant comorbidity followed by diabetes mellitus and anaemia. Multispace involvement was found in 73.33% of patients. Preoperative computed tomography was performed for 60% of patients. Conclusion: Prompt and efficient treatment is required for NF, a polymicrobial odontogenic infection that is lethal even in healthy people. Self-medication and debilitating condition should be considered. Early diagnosis and therapy may reduce mortality and morbidity

Dérivation des canaux de Wharton dans le traitement du bavage. Technique chirurgicale

Introduction : Le bavage est secondaire à une altération de la musculature oro-faciale responsable d’une accumulation excessive de la salive au niveau du plancher antérieur qui entraîne sa fuite hors de la bouche. Il n’est pas généralement accompagné d’une hypersalivation. Matériel et méthodes : Sept patients porteurs d’un handicap psychomoteur présentant un bavage chronique et sévère, dont les thérapeutiques médicales ont abouti à l’échec, étaient candidats à une dérivation bilatérale des canaux de Wharton. Ce procédé était efficace sans aucune morbidité. Discussion : La prise en charge du bavage est multidisciplinaire. La chirurgie est indiquée après échec du traitement médical. Nous décrivons la technique de dérivation des canaux de Wharton et nous faisons l’état de l’art actuel sur les différents moyens chirurgicaux en précisant leurs avantages et leurs inconvénients

Surgical correction of the webbed neck: an alternative lateral approach

Objective: The webbed neck deformity or pterygium colli is the number one symptom of the Turner syndrome that leads the patient to consult a doctor. Various but rare surgical approaches have been described to correct this deformity. We reviewed our experience with the surgical correction of the pterygium colli.Methods: Through five clinical cases, we describe the surgical technique with a lateral approach which provides a better control of the operative site, allows for the excision of the underlying trapezial fascial web, thus preventing recurrence seen in the posterior approach, and restores a normal hairline. Results: No postoperative wound infection occurred. No recurrence was observed through 24 months. Three patients developed hypertrophic scars.Conclusion: The lateral approach associated with an advanced flap and a Z-plasty is an effective technique for correction of this neck deformity. The presence of a multidisciplinary team, formed with maxillofacial and plastic surgeons, endocrinologists and psychologists, is required to treat these patients allowing reintegration into society and family

Le fibrome non ossifiant mandibulaire : différences par rapport aux localisations orthopédiques et implications thérapeutiques

Introduction : Le fibrome non ossifiant est une tumeur bénigne très rare au niveau mandibulaire, pouvant simuler une pathologie maligne. Il s’observe généralement chez l’enfant et au niveau des os longs. Observation : Il s’agit d’un enfant âgé de 12 ans ayant consulté pour une tuméfaction mandibulaire évoluant progressivement depuis un an. La tuméfaction est associée à une mobilité dentaire sans trouble sensitif, ni adénopathie cervicale. Les signes radiologiques sont en faveur d'une pathologie agressive. La biopsie a révélé un fibrome non ossifiant. Un traitement chirurgical conservateur a été réalisé. Discussion : Contrairement aux localisations orthopédiques, le fibrome non ossifiant mandibulaire ne présente pas de signes radiologiques pathognomoniques. Les signes radiologiques du fibrome ossifiant mandibulaire peuvent faire suspecter une lésion maligne. Une biopsie préopératoire est obligatoire pour éviter une chirurgie mutilante

A histologic variant of ameloblastoma: the acanthomatous type

Introduction: Ameloblastoma is the most common aggressive benign odontogenic tumor of the jaws. This kind of tumor arises from dental embryonic remnants. Clinical case: We report a case of acanthomatous ameloblastoma of the mandible occurring in a 79-year-old male patient. Through this case, we describe clinical and radiological findings in ameloblastoma, discuss different variants of this tumor, and emphasize the histological diagnosis. Discussion: Among the various types of aggressive benign odontogenic tumors, acanthomatous ameloblastoma represents a subtype of the solid multicystic ameloblastoma with specific microscopic features. Its course is controversial. Conclusion: Although the diagnosis of acanthomatous ameloblastoma is based on histologic features, dentists and oral surgeons should consider this possibility in patients with an aggressive tumoral process