[Tooth extraction in hemophiliacs and patients with von Willebrand's disease. Therapeutic proposals apropos of 26 cases]. / Les extractions dentaires chez les hémophiles et les porteurs de la maladie de Willebrand. Propositions thérapeutiques à propos de 26 observations.

Extensive bleeding is an important complication of dental extractions in haemophiliacs. Based on 26 case reports, the different therapeutic possibilities are discussed. When general or regional anaesthesia is required, protocols can be proposed for coagulation factor supplementation or even treatment with Minirin. In cases with local anaesthesia, substitution is not required. The importance of mandatory local haemostatic measures combined with antifibrinolytic treatment is emphasized.

Macrostomia, ectropion, atrophic skin, hypertrichosis: another observation.

We report on a boy with bilateral ectropion, ocular hypertelorism, bulbous nose, macrostomia with thin lips, abnormal ears, hypertrichosis of the forehead, neck and back, atrophic skin with hypoplastic nipples. Cause and inheritance are unknown.

[Labioglossopexy in Pierre Robin syndrome. Our experiences apropos of 70 cases]. / La labio-glossopexie dans le syndrome de Pierre Robin. Notre expérience à propos de 70 cas.

Pierre Robin syndrome is typically characterized by glossoptosis and retrognathia associated with cleft palate, respiratory and deglutition disturbances. Two morphological tendencies arise out of this 70-patient series, 50 of whom were managed with the same therapeutical regimen, which included labioglossopexy and was associated with only one case of death: "deforming" type Pierre Robin syndrome most commonly follows a favorable course with respect to both function and facial deformations, provided labioglossopexy is carried out sufficiently early. Indeed, this surgical operation allows for prompt restoration of normal function, thereby limiting the dysfunction-deformation vicious circle. This form of Pierre Robin syndrome may find its origin in the embryo's abnormal amniotic environment. "Malformation"-associated Pierre Robin syndrome often presents with combined anomalies, respiratory disturbances that may evolve into severe airway problems, impaired deglutition and abnormal brain development; in most cases, labioglossopexy will dramatically improve the immediate state of the child, although long-term prognosis as regards malformation is rather guarded.

[Prognostic and therapeutic aspects of lympho-epithelial lesions of the parotid. Apropos of 8 cases]. / Aspects pronostiques et thérapeutiques des lésions lympho-épithéliales de la parotide. A propos de 8 observations.

The so-called benign lympho-epithelial lesion (BLEL) of the parotid is a rare condition. Its diagnosis is based on histology. For a long time there have been problems with its classification and prognosis: classification since certain cases may be classified as Sjögren's syndrome or as a precursor of the latter, prognosis there may be recurrence, contralateral involvement or progression to non-hodgkin's lymphoma. The authors discuss these factors in 8 cases and propose total parotidectomy with facial nerve preservation as the treatment of choice.

[The place of mandibular condylectomy in surgery of temporomandibular joint dysfunction]. / Place de la condylectomie mandibulaire dans la chirurgie du dysfonctionnement temporo-mandibulaire.

Mandibular condylectomy is one of the methods to which one must sometimes resort when treating temporomandibular joint dysfunction. As emphasized by Merville, this is the conventional method used whenever dealing with condylar hypertrophy , as well as in certain grade-III cases with deep bite. However, another interesting indication for it is the horizontal configuration of the occlusal plane, leading to pain and/or luxation. This type of surgical joint operation presents no risk whatsoever, provided the meniscus is respected.

[Orthognathic surgery of the edentulous: a particular form of preprosthetic surgery]. / La chirurgie orthognathique de l'édenté: une certaine forme de chirurgie préprothétique.

It is not unusual to find patients who have lost posterior teeth or who are totally toothless, approaching our dental surgeon colleagues in cases of difficulties, and even prosthetic impossibility, nearly always associated or in relation with skeletic maxilo-mandibular imbalance. Orthognatic surgery of the toothless should thus satisfy the essential need for prosthesis but should also re-establish the unbalanced facial architecture which can be the only guarantee of a stable result. This therefore requires true pre-prosthetic surgery in which clinical analysis, cranial-facial architectural analysis and great care in making the provisional and final prosthesis, constitute the essential stages of diagnosis and therapy.

[Histopathology of odontogenic cysts]. / L'histopathologie des kystes odontogènes.

Odontogenic cysts present problems of diagnosis, radiology and histopathology. This review of the literature considers the current system of classification and reveals a level of agreement with regard to the major categories of cysts. The term "developmental odontogenic cyst" embraces primordial cysts (or odontogenic keratocysts), gingival cysts (newborn and adult), lateral periodontal cysts, eruption and dentigerous cysts and odontogenic calcified cysts (Gorlin cysts). "Inflammatory odontogenic cyst" includes: the radicular cysts and its etiological variance, residual cysts, inflammatory collateral cysts, periodontal cysts and inflammatory follicular cysts. Clinical symptoms are not in themselves sufficient to differentiate between several of the different categories. A combination of clinical and histopathological evidence is essential if a definitive diagnosis is to be achieved and the risk of carcinoma eliminated. Developmental or inflammatory cysts arise from cells involved in the development of the dental organ.

[The 3 palatine fibromucous membranes. Their role in maxillary growth. Therapeutic role in surgery of the palatine shelves]. / Les trois fibro-muqueuses palatines. Leur rôle dans la croissance du maxillaire. Déductions thérapeutiques dans la chirurgie des divisions palatines.

The palatine fibromucosa is not the same throughout the various regions of the palatine vault and its role differs in maxillary growth. On can in fact distinguish: --the fibromucosa of the "palatine lamellae", thin and smooth, which occupies only the median and posterior portion of the vault, opposite the nasal fossae. Its importance derives from the fact that it covers the medio-palatine and palatino-vomerian suture complex, which has an essential role in transverse, vertical and also sagital maxillary growth; --the palatine maxillary fibromucosa, thick and striated, which surrounds the above as far as the gingiva. It plays a major role in transverse and vertical maxillary growth. In fact, it would appear that it possesses autonomous growth potential; --the "gingival" fibromucosa, smooth, which is located at the alveolar level (from the palatine maxillary to the gingivo-dental border) and is involved in the structure of the latter. A good understanding of the anatomical and physiological aspects of these three fibromucosae has a therapeutic relevance, in particular, in subjects suffering from congenital velo-palatine defects (isolated or associated with a labio-maxillary defect).

[Fracture injuries of the mandibular arch. A repair technic]. / Les ouvertures traumatiques de l'arche mandibulaire. Une technique de réparation.

The authors describe a technique for reduction of external lateral displacement of the posterior portions of the mandibular arch following unifocal or multifocal fractures. To achieve reduction they use a basilar wire transfixing the floor of the mouth and stretched between two horizontal branches, most often combined with a symphyseal osteosynthesis. This study of ten cases demonstrates the good functional and cosmetic results obtained with this method.

[Changes in the posterior vertical dimension of the face. Etiopathogenic factors, architectural criteria and therapeutic aspects]. / Les altérations de la dimension verticale postérieure de la face. Facteurs étiopathogéniques, critères architecturaux et aspects thérapeutiques.

The ramus of the mandible appears with the cephalic hominisation phenomenous during phylogenesis and determines the vertical posterior height of the face. Among the three skeletal units that form it, the condylar one is responsible of this height and of the level of the posterior part of the occlusal plane. So, all congenital, constitutional or acquired diseases concerning this unit, give a change of the vertical posterior height of the face. The excess troubles ar essentially represented by the condylar hyperplasia, usually unilateral and treated by condylectomy. The vertical posterior insufficiency may be unilateral or bilateral. The former looks like a mandibular asymmetry whereas the latter looks like an anterior vertical excess with or without a Class II malocclusion. If the condyle is absent or T.M.J. destroyed like in ankylosis, the authors use the costo-chondral graft to repair it. But in condylar hypoplasia, they use a vertical osteotomy of the ramus for lengthening the ramus. The three-dimensional architectural analysis is very useful for studying the vertical posterior height of the face and his changes.

[Methods for the evaluation of abnormalities of the bony chin with a view toward surgical correction]. / Moyens d'évaluation des anomalies du menton osseux en vue d'une correction chirurgicale.

The bony chin is not placed in its position by chance. As with the other skeletal pieces of the face, it is controlled by the major laws of craniofacial morphologic and functional equilibrium. Clinical evaluation of anomalies of position of the bony chin in the three spatial planes is not sufficiently precise, and craniofacial structural and architectural analysis is an essential aid for determining origin of the mental dystopia and surgical remedial means. The aim of the latter is to restore the bony chin to its position of craniofacial equilibrium, the only way to obtain a stable functional result.

[Limited mandibular osteoradionecrosis. Early conservative surgical treatment]. / Les ostéoradionécroses mandibulaires limitées. Traitement chirurgical conservateur précoce.

Nine patients with early phase mandibular osteoradionecrosis received conservative treatment involving closure with mucosal and periosteal graft. Early intervention and the limited nature of the osteoradionecrosis are the two fundamental elements for a successful outcome to this conservative therapy, thus avoiding progression to an extensive form requiring interruption mandibulectomy.

[Solitary bone cyst. A case of dual mandibular and humeral location]. / Le kyste osseux solitaire. Une observation à double localisation mandibulaire et humérale.

Among cystic lesions of maxilla the solitary bone cyst always raises diagnostic and etiopathogenic problems. Typically observed as single lesions in maxilla, reports have been published of multiple localizations. Similitudes with solitary cyst of long bones have even been underlined, but no reports exist in the literature of the double localization: maxillary and extra-maxillary. A young man presented mandibular and humeral lesions possessing characteristics of solitary bone cysts.

[Butel's hip screw-plate in osteosynthesis of fractures of the upper end of the femur. Apropos of 241 osteosyntheses (100 true cervical fractures and 141 fractures of the trochanter)]. / La vis-plaque B.H.P. dans l'ostéosynthèse des fractures de l'extrémité supérieure du fémur. A propos de 241 ostéosynthèses (100 fractures cervicales vraies et 141 fractures du massif trochantérien).

Butel's hip plate was used for osteosynthesis of 241 fractures of upper end of femur (100 true cervical - 141 trochanteric and subtrochanteric fractures). Results for true cervical fractures were assessed as satisfactory in 89.5% of cases, with only 3 pseudarthroses and 4 cases of femoral head necrosis (2 septic, 2 aseptic), a total complication rate of 7.5%. These clinical results confirm the value of screw fixation at several cephalic anchorage sites (demonstrated biomechanically) in true cervical fractures. Results in trochanteric and subtrochanteric fractures were rated as satisfactory in 86.9% of cases, complications including 2 ruptures of plate, 1 sepsis and 4 early loosening of plate. The latter sequela was avoided by an improved choice of indication for the procedure and by substitution of this compound material (screw-plate) for a monobloc piece ("anti-loosening cervicocephalic screw apparatus"), in compound fractures of trochanter.

[The tongue in facial hemihypertrophy]. / La langue dans les hémihypertrophies faciales.

As reported by Gorlin, Pindborg and Cohen, hemifacial hypertrophy is not an affection sui generis, but one that presents different aspects and is of varied etiology. The presence of a tumor must be excluded initially. The hemifacial lesion may be congenital, and form part of a diffuse affection involving the whole of one side of body including hard and soft tissues such as the tongue. Because of their role in cephalic organogenesis, an alteration in cells of neural crests appears to be at the origin of this form but the authors consider that the initial lesion develops at a much earlier stage. The lesion may be tissue-orientated: nervous as in the case of Recklinghausen's neurofibromatosis; vascular as in diffuse angiodysplasias such as the Klippel-Trenaunay-Weber syndrome. Here again the tongue participates in the expression of the disease. Finally, hemifacial hypertrophy may be secondary to a bone lesion as found in more or less diffuse fibrous osteopathies or possibly hypercondylar disorders, the absence of a tongue lesion being a diagnostic factor.