Minimally invasive versus standard approach in LeFort 1 osteotomy in patients with history of cleft lip and palate.

OBJECTIVE: Compare literature-reported efficiency and complications of the standard maxillary advancement surgery with those of a minimally invasive mucosal approach in patients with CL/P requiring Le Fort 1 osteotomy. DESIGN: Meta-analysis vs. retrospective analysis of 18 consecutive cases. SETTING: Department of maxillofacial surgery at a tertiary-level public general hospital. PARTICIPANTS: The meta-analysis encompassed Medline, Embase and Cochrane, years 1990 to 2014, inclusive. The local series concerned all squeletally mature adolescents with non-syndromic CL/P who underwent orthognathic surgery between 30 April 2004 and 27 January 2012. INTERVENTIONS: Minimally invasive approach and perioperative orthodontics including intermaxillary fixation for 3 months after surgery. MAIN OUTCOME MEASURE(S): Assessment of complications. Standard lateral cephalograms were taken before surgery, then <1 week and 12 months after surgery. Delaire's cephalometric analysis was performed and the position of the maxilla was recorded. RESULTS: There were no significant differences between the literature and our series regarding sex and type of deformity (P=0.634 and 0.779, respectively). The mean horizontal and vertical relapse rates were 0.61 and 1.17mm (vs. 1.29 and 1.48mm in the meta-analysis) and the overall complication rate was 22.2% (vs. 12.76% but P=0.271). There was a significant difference regarding the palatal fistula rate (0 here vs. 21.43% in meta-analysis, P=0.028). CONCLUSIONS: The minimally invasive approach showed trends toward less relapse and less complications than conventional approaches. This technique seems adapted to the management of patients with CL/P sequelae. Other benefiting groups are underway.

[Upper eyelid congenital coloboma, aethiology pathogenesis and management]. / Colobome congénital de la paupière supérieure, étiologie physiopathologie et prise en charge.

Coloboma of the upper eyelid is a rare congenital disease. It is defined as an agenesis of the eyelid free edge. Multiple patho-physiological theories exist about its etiology. The surgical therapeutic management of this malformation is clearly codified. We illustrate the presentation by two cases treated in the Groupement Hospitalier Nord of Lyon University Hospital.

[Hemostatic absorbable gel matrix for severe post-traumatic epistaxis]. / Gels hémostatiques résorbables et épistaxis post-traumatiques sévères.

INTRODUCTION: The management of traumatic epistaxis is an important issue for maxillofacial trauma patients, because of their frequency and severity. We assessed a single use sterile hemostatic gel matrix (surgiflo© [SF], Floseal © [FS]) available for this indication. MATERIALS AND METHODS: Ten patients were managed between 2008 and 2012 by the same surgeon. The following data was documented for each patient: gender, age, mechanism of trauma or type of surgery, characteristics of epistaxis, the various hemostatic techniques used before using SF, and its effectiveness. The primary endpoint was SF effectiveness compared with usual techniques. The secondary endpoint was the evaluation of patient comfort compared to other hemostatic methods, using a visual analogue scale (VAS). RESULTS: In nine out of ten cases, epistaxis was controlled after endonasal instillation of SF after failure of wicking, or double balloon catheter in first line treatment, or use of SF directly as first line treatment. The mean post procedure VAS was: 7/10 for wicking (eight patients), 9.3/10 for the double balloon catheter (three patients), 3.2/10 for SF (ten patients). DISCUSSION: Our study highlights the effectiveness of hemostatic gel matrix in the management of post-traumatic epistaxis compared to usual methods. It also pointed out better patient comfort. A prospective comparative study on a larger cohort of patient would support the legitimacy of SF as first-line treatment for severe posttraumatic epistaxis.