Background Facial feminization surgery (FFS) includes several osseous modifications of the forehead, mandible and chin, procedures which require precision in order to provide the patient with a satisfactory result. Mispositioned osteotomies can lead to serious complications and bad aesthetic outcomes. Surgical cutting guides are commonly used in plastic and maxillofacial surgery to improve safety and accuracy. Yet, there is no report in the literature on the clinical application of cutting guides in FFS. Objectives The aim of this paper is to assess the safety and accuracy of custom surgical cutting guides in FFS procedures. Methods A prospective follow-up of forty-five patients regarding FFS with preoperative virtual planning and 3D custom-made surgical guides for anterior frontal sinus wall setback, mandibular angle reduction and/or osseous genioplasty was conducted. Accuracy (superimposing preoperative data on postoperative data by global registration with a 1 mm margin of error), safety (intradural intrusion for the forehead procedures and injury of the infra alveolar nerve for chin and mandibular angles) and patient satisfaction were assessed. Results A total of 133 procedures were documented. There was no cerebrospinal fluid leak on the forehead procedures nor any infra alveolar nerve or tooth root injury on both chin and mandibular angle operations (safety, 100%). Accuracy was 90.80 % on the forehead (n=25), 85.72% on the mandibular angles (n=44) and 96.20% on the chin (n=26). An overall satisfaction of 94.40% was recorded. Conclusions Custom-made surgical cutting guides could be a safe and accurate tool for forehead, mandibular angles and chin procedures for FFS.

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Background: Despite a re-increase in the incidence of tuberculosis, extranodal location on head and neck remains rare. Clinical symptomatology is non-specific and even data from paraclinical explorations often pose the problem of differential diagnosis with tumor pathology. Methods: We report a series of 29 cases of extranodal tuberculosis collected over a period of 32 years [1986-2018] in ENT department of the military hospital of Tunis. Results: Rhinosinusopharyngeal involvement was predominant (45%) followed by glandular involvement (14%). Diagnosis was histopathological in most cases. Concomitant pulmonary tuberculosis was detected in two cases and spinal lumbar in one case. Treatment was medical in all cases. Conclusion: Clinical presentation of extranodal tuberculosis is various and non-specific. Neoplastic pathology is the main differential diagnosis. However, diagnosis should be systematically raised in endemic countries. Treatment is essentially medical.