Revue de stomatologie et de chirurgie maxillo-faciale
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Local or block anesthesia can be used satisfactorily in many implant procedures. However, when advanced implant techniques or pre-prosthetic reconstruction surgery of the maxillofacial bones are required, local or regional anesthesia is insufficient. The "day-hospital" concept is a rational approach which meets the requirements for anesthesia and deep sedation with criteria for patient safety and comfort while guaranteeing optimal operating conditions. ⋯ Under these strict rules, short duration surgical procedures (< 150') can be performed : 1) with the best conditions of medical safety, 2) with improved operating conditions for the implant surgeon (the patient responds immediately to vocal orders when necessary) while asepsis is maintained as easily as with general anesthesia, 3) with better conditions for postoperative care and patient comfort (the anesthetist is continuously present). 4) better psychological conditions for the patient who will be discharged the same day, 5) with total amnesia of the entire surgical procedure, 6) elimination of a usually disproportionately long hospitalization. Day hospitalization also helps contain health care costs by cutting out the need for overnight care and accommodation. We underline the safety of current intravenous sedation techniques and present two series of data related to the use of this technique by an anesthetist and an operating surgeon in a day hospital from 1986 to 1995.
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Facial manifestations due to giant cell arteritis are analysed about 102 cases. The whole facial vascular territories are involved, so we have many manifestations. Diagnosis depends on artery biopsy with Doppler aid.
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The authors report a giant cell arteritis case associating trismus and hemifacial oedema in a febrile context. After spontaneous regression of other manifestations, the apparition of more typical signs allowed to associate the diagnosis of temporal arteritis, later confirmed histologically. ⋯ The examination of facial, temporal and internal maxillary arteries has a good negative predictive value in this pathology. It would be useful in therapeutic supervision.
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Rev Stomatol Chir Maxillofac · Jan 1995
[Cervicofacial involvement of primary cutaneous neuroendocrine carcinomas or Merkel cell tumors: therapeutic considerations].
Seven cases of primary skin neuroendocrine carcinoma or Merkel cell tumours with cervico-facial localization are reported. The poor prognosis of these tumours is essentially due to the potential for local recurrence and the frequency of locoregional and visceral metastasis. Surgical treatment is required but rarely sufficient to control the disease. ⋯ Lymph node resection is important to determine prognosis but has not been proven to improve outcome. In addition, parotid metastasis appears to result from blood stream dissemination and has a very poor prognosis. Exclusive radiotherapy may be discussed in such cases.