Physiological Psychology

Afota F., Raybaud H., Bozec A., Abid S., Savoldelli C.

Introduction : Peri implantitis can be identified by classic clinical and radiographic signs. The aim of this case was to show an original exophytic lesion appeared 8 years after the implantation in the mandibular symphysis. Observations : The patient has been implanted on symphyseal site 8 years ago. The lesion was exophytic and located around mobile implant in right mandible. First curative surgical resection was performed under local anesthesia, combined with explantation of mobile implants. Histhopathological exam identified a giants cells granuloma. A second surgical removal was necessary under general anesthesia because of a severe recurrence. Discussion : The goal of this clinical case was to emphasize the possible correlation between inflammatory peri implantits context and giants cells granuloma. Others techniques could be used to manage this case.

Bayet K., Sifi Y., Gondolfini M., Gellee T., Levy-Bohbot A., Levy M., Touboul A., Guez P., Alantar A.

Introduction: The increasing number of cardiovascular and/or neurological patients with polypathologic backgrounds has led practitioners to adapt the technical platform. The objective is to evaluate the indications of one-day hospitalization (ODH) in oral surgery set up in 2013 in the Max Fourestier Hospital (Nanterre), a comparative prospective study is carried out in 2014 and 2015. Material and methods: The evaluation criterion is the rate (%) of local or general perioperative complications requiring intervention or full hospitalization of patients at risk for oral surgery with ODH. Results: Sixty-eight interventions were performed, mainly dental extractions, root planning and biopsies. 52% of patients were women. Cardiovascular diseases (36%) were the majority. 20.58% of the included patients had a complication taken up by the practitioner or managed by the day hospitalization service. This rate of complications was statistically significantly different ( χ 2  = 9.89, P  = 5%, NDF = 1) from the control group (3.80%). Discussion: The highest complication rate in polypathologic patients, confirms the indications of ODH. No conversion to full hospitalization was necessary thus this study shows that ODH allows a safe intake taking charge avoiding a full hospitalization of higher cost.

Melka A., Barthélémy I., Cousson P., Devoize L., Dang N.P.

Introduction: Florid osseous dysplasia is a rare benign pathology, characterized by a multifocal extension, and possibly affecting the four maxillo-mandibular quartors. It is often a fortuitous discovery, and only becomes symptomatic when the lesions are voluminous, deforming mandible or maxillary, or when secondary infections occur. Observation: A 45-year-old African patient is referred for diagnosis of a florid osseous dysplasia. Mandibular lesions are revealed by a CBCT scan. As the patient is asymptomatic, an annual follow-up was established. Six months later, the patient shows neuropathic pain signs on the right side of the chin and the inferior lip: the inferior alveolar nerve seems to be affected. A surgical treatment is then proposed to the patient. Discussion: Affection of the alveolo-dental nerve due to florid osseous dysplasia has never yet been reported in literature. However, our patient showed neuropathic pain symptoms, with no sign of infection, and the CBCT revealed a great proximity of the nerve and the lesions. The surgery was a success: removing the calcified masses has allowed us to amend the neuropathic pain. We can then suppose that the bone lesions were directly responsible for our patient's pain symptoms. Conclusion: Florid osseous dysplasia lesions, when close to the inferior alveolar nerve, can cause a nerve illness, by compression, on its intracanal trajectory or by its foramen.

Bercault B., Fenelon M., Catros S., Marteau J., Fricain J.

Observation: An 82-year-old patient treated with the antihistamine ebastine (Kestin ® ) for allergic rhinitis presented for gingival pain. The diagnosis of mucous membrane pemphigoid was suspected after a positive pinch test. Blood examinations highlighted AC anti-PBGA2, and the gingival biopsy showed an epithelioconjunctival delamination and the presence of anti-IgA antibody and C3 deposition along the basal of the membrane. Topical corticosteroid administration was initiated. The symptoms improved but elevated IgA and C3 levels persisted. He underwent a complete remission on cessation of ebastine treatment. Commentary: Mucous membrane pemphigoid is an autoimmune disease whose origin remains unclear. The aim of the treatment is to decrease the symptoms, but full recovery of the patients is exceptional. We report here a clinical case with symptom resolution because of the ebastine withdrawal. Ebastine can thus be suspected as a cause if a patient presents with oral symptoms of mucous membrane pemphigoid.

Lodi G.

Doustkam A., Riemenschneider-Chillès S.

Introduction: Tooth movements require a stable base. The most stable endo-buccal base is bone, thus temporary bone-anchoring techniques have been well developed to date. Literature review of different bone-anchoring techniques reveals limitations in their regular use, particularly when it comes to mini-screw stability. The purpose of this paper is to present a reliable temporary bone-anchoring technique pushing the limits of orthodontic treatments. Technique: The device is made of one to two micro-screws connected to a steel or titanium molybdenum alloy (TMA ® ) wire going through one or two loops. The device is then inserted into the bony base after a mucoperiosteal incision. The connecting arm, which emerges through the mucosa, is then connected to the teeth to be pulled in a direct or indirect manner. Comments: This device provides advantages in terms of reliability, versatility of orthodontic movements, simplicity in terms of protocol installation and removal, and poses no anatomical risk. Conclusion: This is an orthodontic surgical technique that provides a real benefit to the patient.

Ordioni U., Campana F., Catherine J., Lan R.

Introduction: Canalicular adenoma (CA) is a benign tumor that develops in the accessory salivary glands. Observation: We reported a case of CA of the upper lip in a 61-year-old man. Discussion: The clinical diagnosis of CA is difficult, and a lot of possible differential diagnoses exist, including benign or malignant salivary tumors. Thus, the diagnosis may be challenging and must rely on histological examination findings. The treatment is surgical in nature and the prognosis is excellent.

Leturc T., Chaux-Bodard A., Paulus C.

Introduction:  Oronasal fistula have several etiologies. Most of the time, the origin is congenital associated with cleft lip and patate patients, or it can be acquired after trauma, infection, neoplasm, postsurgical complications or radio and chemonecrosis. Excepted for palatal obturators, their treatment is surgical and may use different intraoral flaps. Observation: A 9-year-old girl was sent to consult presenting an oronasal fistula as a sequela of a cleft lip and palate, initially treated in Kosovo (Albania). This was an anterior midpalate fistula, large around 2 cm, functionnaly responsible of a nasal speech and food reflux in the nasal airways. The closure has been done with a tongue flap. Commentary: Most of the oronasal fistulae secondary to a cleft palate are managed with palatal rotational flaps. Nevertheless, they cannot be used in some cases, especially when the fistula size is too large, the localization too anterior and with already scarred palatal tissues around. Then, tongue flap may represent a reliable alternative. Conclusion: The tongue flap allowed a complete closure of the oronasal fistula, with a very good tolerance from the child. It shows its interest into the list of the numerous existing oral flaps. However, considering the discomfort of this technique, it must be done in selected cases, with compliant patients.

Bontemps L., Poulain C., Landru M., Hoang L.

Trisomy 18 and osteogenesis imperfecta are serious diseases with multiple systemic complications. Osteogenesis imperfecta is usually associated with dentinogenesis imperfecta. Observation : A young woman consulted for dental care, with the family suspecting multiple caries because of yellow spots on her teeth. Medical history revealed trisomy 18 associated with osteogenesis imperfecta. The patient was quite uncooperative, even with tooth brushing at home. We provided care after the completion of clinical and radiographic examinations. The colorations were due to amelogenesis imperfecta. Discussion : The association between osteogenesis imperfecta and amelogenesis imperfecta has not been described in the literature. Moreover, the presence of an extra abnormality in tooth structure was a delicate situation for the family. This case suggests the link between amelogenesis imperfecta and osteogenesis imperfecta. Conclusion : This case is the first description of the association of amelogenesis imperfecta and osteogenesis imperfecta.

Bercault B., Catros S., Marteau J., Fricain J.

Observation: A 44-year-old patient was deferred for consultation for vesicles and whitish papules a few millimeters in diameter on the tongue. Painful inflammatory attacks and phases of mitigation alternated with each other. The clinical test results were all normal. The pathological examination indicated a lymphangiomatous component caused by inflammation. A CO2 laser treatment was successfully initiated. Regular monitoring revealed no recurrence at the 12-month follow-up. Comments: Cystic lymphangioma is an early-stage benign tumor. Their occurrence in adults is rare. The case presented was atypical by the context and appearance of the lesions. The treatment of cystic lymphangioma in the oral cavity is surgical in nature, which consists of a complete removal of the cysts to avoid recurrences. Other treatments can be proposed: laser, sclerotherapy, ablation, and radiofrequency cauterization. Conclusion: Cystic lymphangioma in adults is rare. The malformations are sometimes difficult to diagnose. There is no evidence-based treatment but laser vaporization is an option for microcystic forms.

Alande C., Fénélon M., Catros S., Fricain J.

Introduction: Necrotizing sialometaplasia is an inflammatory, rare and benign pathology, affecting particularly minor salivary glands. Observations: A case of deep and persistent ulceration of the oral floor associated with sensitivity disorders is reported. Three biopsies were realized, each concluding to a nonspecific ulceration. Local treatments by triamcinolone injections and laser CO 2 were tested. After 18 months of follow-up, a partial regression of the lesion was observed and the patient did not have any sensitivity disorders. Comments: This ulceration was clinically evocative of malignant neoplasia, which was reversed by histology. Others causes of ulceration were excluded on clinical and biological arguments. By elimination, a diagnosis of necrotizing sialometaplasia of the sublingual gland was made. Conclusion: Only one case of necrotizing sialometaplasia of sublingual gland has already been published. The case described here is exceptional due to the low prevalence of the lesion and the chronic ulcer evolution.

Jouan R., Faure F., Robin O.

Purpose: Eagle syndrome is a rare symptomatic clinical and radiological entity. It is characterized by an elongation of the styloid process or calcification of the stylohyoid ligament, and it typically causes head and neck pain, odynophagia, otalgia, or headache. Observation: The first case dealt with an elongation of the left styloid by 46 mm, and the second case dealt with a calcification of the right stylohyoid ligament at the lesser horn of the hyoid bone. In both cases, cervical rotation caused a vagal episode by the compression of the carotid arteries. Both cases were treated surgically, the first with an intrabuccal procedure and the second by cervicotomy. Both patients have shown no postoperative recurrence of their symptoms. Conclusion: Eagle syndrome, although rare, should be considered when patients describe pain symptoms with no identified etiology in the head and neck area. A simple additional diagnostic procedure such as a computed tomography (CT) scan or an orthopantomogram can easily show a long styloid process or calcified stylohyoid ligament and their anatomical relations, in particular, any vascular relations. The use of piezosurgery decreases intraoperative risks in the mastoid cut of styloid process.

Carrozzo M.

Desmyttere M., De Boutray M., Levallois B., Torres J., Fauroux M.

Introduction: Pycnodysostosis, or Toulouse Lautrec's disease, is a rare lysosomal genetic disease with an autosomal recessive transmission, and it is classified as one of the osteo-chondro-dysplasias (ICD-10). Patients with pycnodysostosis manifest with several clinical features, including osteosclerosis, bone fragility, short stature and acro-osteolysis of the distal phalanges. Maxillofacial symptoms mainly associate a lack of maxillary and mandibular growth, open mandibular angle, and significant dental crowding. Observations: This work presents the case of two sisters suffering from pycnodysostosis as part of a family affected by it (mother and maternal aunt also affected). The first patient has received regular monitoring and oral care. The second one suffered from spontaneous mandibular osteomyelitis, which was difficult to treat and cure. Discussion: Oral symptoms of this disease make maintaining oral hygiene difficult and predispose to tooth decay and periodontal disease. The most common complications are mandibular osteomyelitis and pathological fractures. Pycnodysostosis must be differentiated from osteopetrosis and cleidocranial dysplasia. Conclusion: These cases illustrate the difficulty of managing the patients suffering from pycnodysostosis, whose treatment may be difficult.

Nemsi H., Tellili N., Bouanene I., Tlili M., Khenfir F., Khalfi M.S., Amor F.B.

Introduction: Considering the close proximity of the third molar roots and the mandibular canal, also the location of the lingual nerve and its anatomic variations, both nerves may be injured during extraction. The aim of this observational study was to optimize a classification of the relationship between the third molar and its neuroanatomical environment, mandibular canal and lingual bone plate, which is inspired from the neurological risks involving cone beam CT (CBCT) images, and to apply this classification to our sample. Materials and methods: A retrospective, observational study was performed involving 100 CBCT (171 mandibular third molars). Two medical doctors, qualified in human anatomy, independently evaluated all CBCT using coronal oblique sections. The classification was approved by agreement between both observers. After that, it was applied to our sample by one of them. The SPSS software, version 21.0 (SPSS ® Inc., Chicago, Illinois, USA) was used for the statistical analysis. Results: The final consensual classification presented three Classes (A, B, L) with their four subclasses (from 1 to 4). The rare cases found in our sample were grouped separately under the name of “uncommon”, and were divided into four specific subclasses. The status of the lingual bone plate was assessed by the presence or the absence of a fenestration or a cortical thinning. In the current study, when the mandibular canal presented a direct contact with the third molar with a reduced calibre, lingual course was the most frequent anatomical situation in both genders (males 66.7%/females 70.5%). There is not a significant correlation between the proximity of the third molar to the mandibular canal neither with age nor with gender. In contrast, the proximity to the third molar is significantly associated with the course of the canal. The highest significance was found with the lingual course. Statistical analysis showed a nonsignificant correlation between the status of the lingual bone plate and the age then the gender. Discussion and conclusion: The use of the proposed classification (NRC) could be a support for clinical practice. We suggested a common language among operators and during collaboration with radiologists in order to facilitate the clinical discussion and to correlate the surgery outcomes to the CBCT classes for more adjustment of the surgical procedures.