Adénome pléomorphe géant de la parotide

Introduction

Slow evolution pleomorphic parotid adenoma may be diagnosed late. These giant tumors have a functional, esthetic, and social impact. They raise prognostic issues because of the risk of degeneration. We present a case of a giant pleomorphic adenoma involving the parotid glands and try to explain the reasons for the diagnostic delay and describe therapeutic specificities.

Case report

A 54 year-old male patient consulted for swelling of the parotid region slowly evolving over the last 10 years. This lesion had been unsuccessfully treated by conventional methods. A painless 20 cm long plurinodular mass was located in the right lateral cervical region. Its consistence was heterogeneous. The CT scan revealed a heterogeneous tumor with hyperdense and hypodense areas without any associate lesions. A total conservative parotidectomy was performed; the anatomopathological examination confirmed the diagnosis of a pleomorphic adenoma, weighing 1.2 kg for a diameter of 19 cm, without malignant degeneration. The postoperative evolution was uneventful.

Discussion

The recommended treatment for giant parotid adenoma is total conservative parotidectomy. Besides its functional and esthetic impact, the giant parotid adenoma is at high risk of malignant degeneration. Documentation on the nature of the lesion, its evolutive potential, and an early surgical management could limit its incidence.     

Kyste osseux anévrismal de la mandibule

The aneurysmal bone cyst is a rare, expansive, osteolytic, pseudocystic lesion with an unknown etiology. It usually affects long bones and the spine. Two to 5 % of cases have mandibular localization (between 75 and 100 % present on the mandible) accounting for 1 % of all mandibular cysts. Less than 200 cases have been reported in English and French literature.     

Justification de l’ordre mandibule-maxillaire dans l’ostéotomie maxillomandibulaire

Introduction

Our aim was to study the reliability of sagittal split osteotomy and Le Fort I osteotomy respectively, and to try to judge objectively the impact of their order for the final result of bimaxillary osteotomy.

Patients and method

Fifty patients were included. For each we calculated the errors generated by sagittal split osteotomies on one hand and Le Fort I osteotomy on the other hand, by performing a peroperative splint after each osteotomy.

Results

After sagittal split osteotomies changes in the anteroposterior direction were present in 74% of cases with an average amplitude of 0.32 mm. They were less frequent in the transversal direction, 54% of cases, with a smaller amplitude (0.19 mm). After Le Fort I osteotomy, there was no difference in 92% of cases with an average error of 0.02 mm in the anteroposterior direction. No errors were observed in the transverse direction.

Discussion and conclusion

Le Fort I positioning is remarkably accurate contrary to the sagittal split. Using Le Fort I osteotomy first and mandibular sagittal split second has for drawback to perpetuate the errors of the sagittal split. The reverse order, beginning with the mandible, allows correction of sagittal split mistakes with the Le Fort I osteotomy. So it seems that the latter order is more logical and preferable.     

Fibrome desmoïde

Desmoplastic fibroma is a rare benign intraosseous neoplasms. They can affect the jaw. Posterior mandibular bone involvement is the most frequent localization. They are locally aggressive and recurrence is frequent. Radioclinical signs are not specific and the histological diagnosis may be difficult. Extended surgical removal is the recommended treatment.