[Maxillomandibular advancement surgery in severe OSAS]. / Le cas clinique du mois. Chirurgie d'avancée maxillo-mandibulaire dans le cadre d'un SAHOS sévère.

Obstructive Sleep Apnea Syndrome (OSAS) is a common underdiagnosed pathology. Its consequences are serious, especially in terms of quality of life and cardiovascular risk. This article describes the case of a patient having a severe OSAS. The conservative treatments as well as uvulopalatopharyngoplasty did not improve the symptomatology in an acceptable way. This clinical case illustrates the effectiveness of maxillomandibular advancement for patients with severe OSAS who respond poorly to conservative treatments.

Le Syndrome d'Apnées et d'Hypopnées du Sommeil (SAHOS) est une pathologie fréquente largement sous-diagnostiquée. Ses conséquences sont graves, notamment en termes de qualité de vie et de risque cardiovasculaire. Cet article décrit le cas d'une patiente souffrant d'un syndrome sévère d'apnées et d'hypopnées du sommeil, chez qui ni les traitements conservateurs ni l'uvulo-vélo-pharyngoplastie n'ont été efficaces. Ce cas clinique illustre l'efficacité de l'avancée maxillo-mandibulaire pour les patients atteints d'un SAHOS sévère, répondant mal aux traitements conservateurs.

[Sleep bruxism : state of the art and management]. / Bruxisme nocturne : actualités et prise en charge.

Although well studied since the 50's, bruxism remains a largely unknown pathology. Its origin is complex, mixing psychological as well as neurological, odontological and hypnic aspects. However, the few analyzes performed on this topic have allowed to set convincing etiopathological hypotheses, including central dysregulation of the dopaminergic system as well as of the neuro-masticatory system. To avoid harmful consequences as headaches, temporomandibular disorders and premature dental scuffs / fractures, it is mandatory to diagnose bruxism as early as possible. For this purpose, and in addition to anamnestic and clinical data, the practitioner can confirm diagnosis with polysomnography, including electromyographic study of masticatory muscles and audiovisual recording. Some orthodontic, pharmacological and psychological solutions have already proved efficient. Nevertheless, a better knowledge of causative neurobiological mechanisms would allow to foresee etiology-based treatments.

Le bruxisme reste, à l'heure actuelle, une pathologie relativement mal connue, bien que déjà étudiée depuis le début des années 50. Son origine est complexe, impliquant des composantes psychologiques, neurologiques, odontologiques et hypniques. Les quelques analyses réalisées à ce sujet ont, toutefois, permis de mettre en avant certaines hypothèses étiopathogéniques convaincantes, notamment un dérèglement central du système dopaminergique et du système neuromasticateur. Un diagnostic rapide de l'affection permettra de réduire ses complications (céphalées, désordres temporomandibulaires, abrasion et fractures dentaires prématurées). Au-delà de l'anamnèse et de l'examen clinique, le praticien pourra confirmer le diagnostic par polysomnographie, incluant une étude électromyographique des muscles masticateurs et un enregistrement audiovisuel. Certaines solutions orthodontiques, pharmacologiques et psychologiques ont déjà prouvé leur efficacité. Néanmoins, une meilleure connaissance des mécanismes neurobiologiques incriminés permettrait d'envisager un traitement étiologique.

Localized Piezoelectric Alveolar Decortication for Orthodontic Treatment in Adults: A Randomized Controlled Trial.

This randomized controlled trial aimed to evaluate the benefits and clinical outcomes of piezocision, which is a minimally invasive approach to corticotomy that is used in orthodontic treatments. Twenty-four adult patients presenting with mild overcrowdings were randomly allocated to either a control group that was treated with conventional orthodontics or a test group that received piezo-assisted orthodontics. The piezocisions were performed 1 wk week after the placement of the orthodontic appliances. Neither grafting material nor sutures were used. All patients were followed every 2 wk, and archwires were changed only when they were no longer active. The periods required for the completion of the overall orthodontic treatments were calculated, and the periodontal parameters were evaluated at baseline and at the end of the orthodontic treatment. Patient-centered outcomes were assessed with a visual analog scale; analgesic use following the procedures was also recorded. The patient characteristics were similar between the 2 groups. The overall treatment time was significantly reduced by 43% in the piezocision group as compared with the control group. In both groups, periodontal parameters (i.e., recession depth, pocket depth, plaque index, and papilla bleeding index) remained unchanged between the baseline and treatment completion time points. No increase in root resorption was observed in either group. Scars were observed in 50% of the patients in the piezocision group. Analgesic consumption was similar following orthodontic appliance placement and piezocision surgery. Patient satisfaction was significantly better in the piezocision group than in the control group. In these conditions, the piezocision technique seemed to be effective in accelerating orthodontic tooth movement. No gingival recessions were observed. The risk of residual scars might limit the indications for piezocision in patients with a high smile line (ClinicalTrials.gov NCT02590835).

[How I explore a dento-maxillofacial dysmorphosis]. / Comment j'explore une dysmorphose dento-maxillo-faciale.

Dento-maxillofacial dysmorphoses represent a considerable area of maxillofacial surgery. Their incidence has constantly been on the rise since the beginning of the century. This can be explained by variations in the food and society habits.We will first discuss the various causes (congenital and environnemental) and the pathophysiology of these disorders. Then, we will separate them according to the skeletal and Angle's classifications. We will examine the predictive criteria of these dysmorphoses from the youngest age and consider their clinical and cephalometrical diagnosis. We will envisage their functional and aesthetic consequences and expose the preventive options. Finally, we will describe the orthodontic and surgical treatment available today and conclude that surgery remains the gold standard by restoring the conventional axis.

Les dysmorphoses dento-maxillo-faciales (DDM) occupent un volet important de la chirurgie maxillo-faciale. Elles constituent un problème en constante progression depuis le début du siècle, s'expliquant notamment par des modifications des habitudes alimentaires et sociétales (1). Nous discuterons les diverses causes, congénitales et environnementales, ainsi que les aspects physiopathologiques de ces affections et ferons le point sur leur classification grâce à la classe squelettique et la classe dentaire d'Angle. Nous discuterons des critères prédictifs de ces dysmorphoses dès le plus jeune âge ainsi que de leur diagnostic clinique et céphalométrique. Nous détaillerons leurs conséquences esthétiques et fonctionnelles et exposerons les mesures préventives visant à éviter leur développement. Enfin, nous évoquerons la thérapeutique à la fois orthodontique et chirurgicale que nous pouvons actuellement proposer pour restaurer les fonctions masticatoires, phonétiques et respiratoires tout en harmonisant le tiers inférieur de la face.

[Upper airway's 3D analysis of patients with obstructive sleep apnea using tomographic cone beam]. / Analyse tridimensionnelle de la voie aérienne supérieure des patients atteints d'un syndrome d'apnées et d'hypopnées obstructives du sommeil par la technique du Cone Beam.

The progress of medical imaging over the last decades has led to a better understanding of the upper airway structure in sleep-disordered patients. The Obstructive Sleep Apnea Syndrome (OSA) is attributed to a functional narrowing of the upper airway, particularly of the oropharynx, during sleep. This narrowing is multifactorial. We have shown that in 60% cases, the maxilla (nasal pyramid) seems too narrow. A mandible retroposition may also play a dominant role in 30% of the cases. Both scenarios can be combined. Cone Beam Computed Tomography (CBCT) is a new medical imaging technique that permits to visualize the upper airway with less ionizing radiation than the conventional scanner. To date, only five authors have performed an upper airway's 3D analysis of sleep apnea patients with cone beam. A better understanding of the affected segment of the upper airway should help refine treatment options.

Acromegaly and sleep apnea: cephalometric evaluations.

Lateral teleradiography is a standard and quick examination. It has enabled us to define differences as regards to the craniofacial morphology between 20 acromegalic patients and 20 control subjects. The height of the mandibular ramus (from the posterior condyle point to the gonion point) increases significantly with the acromegalic patient and the cranial base angle (basion-superior tuberculum sellae-M point) is more extended. As acromegalic patients are more subject to sleep apnea (30% prevailing), the relationship between the amount of sleep apnea and hypopnea (AHI) in an acromegalic patient and his bone, tissue and hormone factors has been researched, in order to act on the causes of sleep apnea. It has emerged that confronting craniofacial bones and soft tissues factors enables a good prediction of the apnea and hypopnea index. Of course, we can find again the potential action of growth hormone (GH) but only in fifth place in importance order. The tongue, which increases in volume with the GH impact, is in a too short "lingual enclosure" (reduced length of the mandibular horizontal branch).