Management of mandibular condylar fractures in patients with atrophic edentulous mandibles.

INTRODUCTION: Treatment of condylar fractures in patients with atrophic edentulous mandibles is a peculiar field that has been little considered in the literature. The aim of the study was to assess the demographic and clinical variables as well as management and outcome of mandibular condylar fractures in edentulous patients with atrophic mandibles that were treated at several European departments of oral and maxillofacial surgery. METHODS: The data of all patients with fractures of the atrophic edentulous mandible from the involved maxillofacial surgical units across Europe between January 1, 2008, and December 31, 2017. Only patients that were diagnosed with condylar fractures of the edentulous atrophic mandible were included. RESULTS: A total of 52 patients met the inclusion criteria and were included in the study: 79% of patients reported one or more comorbidities. Thirty-four unilateral neck or subcondylar fractures, 9 bilateral neck or subcondylar condylar fractures, 7 unilateral head condylar fractures, and 2 bilateral head condylar fractures were diagnosed. No treatment was performed in 37 cases, whereas in 4 patients a closed treatment was decided, and 11 patients underwent open reduction and internal fixation. Outcome was considered to be satisfying in 48 patients, with no complications. CONCLUSIONS: The golden rule still remains that the diagnosis of a subcondylar or neck fracture in an edentulous patient should constitute an indication for open reduction and internal fixation. However, an appropriate choice of management options has to be individualized on a case by case basis, also depending on the patient consent.

Does the repetition over a short time of a microsurgical suture improve its reliability?

Our hypothesis was that immediate repetition of a microsurgery-suturing task will improve its execution and outcome. This was an experimental animal study. Ten surgeons were divided into two groups of five surgeons. Each performed two end-to-end carotid anastomoses on the same rat, one after the other. The anastomosis was evaluated by the surgeon and an instructor. The primary endpoint was permeability. The outcome was evaluated using an objective and subjective assessment grid yielding 1 to 3 points per item. The total scores for each of the 10 surgeons were used to compare the anastomosis of carotid 1 versus 2, using the ratings given by the surgeon and the instructor. Twenty anastomoses were performed, but 1 rat died intraoperatively, leaving 18 anastomoses for evaluation. No significant differences were found on the main endpoint of permeability, with all anastomoses being permeable. The surgeon's self-assessment was significantly better for the second carotid artery (P=0.05), but this was not confirmed by the proxy assessment (instructor). The analysis by subgroups-morning versus afternoon-found the second carotid anastomosis was significant better in the self-assessment and proxy assessment for the morning group (P<0.001, P=0.024). There was no significant difference in clamping times. The immediate repetition of a microsurgical procedure seems to favor its execution, which leads us to propose that the more difficult or important anastomosis should be done after an easier or less important one during complex surgeries. LEVEL OF EVIDENCE: 2B.

Surgical approach of isolated fracture of the anterior wall of the frontal sinus: The upper eyelid incision.

Fractures of the frontal sinus are classified according to the topography (anterior wall, posterior wall or both), the displacement, and the presence of associated lesions (wound, nasofrontal duct injury, rhinorrhea). Isolated fractures of the anterior wall require surgical management, if the displacement is over 4 mm, to restore the forehead symmetry, to maintain the sinus ventilation and to avoid long-term complications (sinusitis, mucocele, meningitis…). Coronal incision is commonly performed but less invasive techniques are more and more used. We describe a technique of reduction and fixation of isolated anterior wall fractures by upper eyelid incision, allowing a good exposure of the lower portion of the frontal sinus, with a limited scar.

[Giant cementifying fibroma of the maxillary sinus. Apropos of a case]. / Fibrome cémentifiant géant du sinus maxillaire. A propos d'un cas.

The case of a patient presenting with a gigantiform fibrous cementoma of the maxillary sinus is described. The diagnostic, the treatment and the histologic classification of the cementifying tumours is reviewed in light of the present literature.

[Frontal sinus osteoma in a skull found in the archeological excavations at the old Louvre]. / Mise en évidence d'un ostéome du sinus frontal sur un crâne provenant des fouilles archéologiques du vieux Louvre.

A skeleton dating 8th-9th centuries exhumed from the Napoleon square at the Louvre, presents a voluminous ivory or benign osteomata at its frontal sinus. Anthropological and pathological studies give matter to introduce this osteomata on the morphological and demographic problematica ot the benign tumours.

[Prostaglandins and benign mastopathies (author's transl)]. / Prostaglandines et mastopathie bénigne.

During both phases of their menstrual cycle, women who suffer from benign mastopathies evidence hormonal deficiency, which is total although of variable magnitude, as shown by oestradiol (E2) and progesterone (p) plasma levels. by contrast, these women show a concomitant and large rise of prostaglandin E2 (PGE2) plasma level. An oestrogen directed PGE2 synthesis by the mammary epithelium is likely to occur. The patients whose mammary thermography displays PG synthesis can be cooled by the administration of PG synthesis inhibitors. They show a steroid deficiency which is more or less pronounced without having any marked imbalance of the E2-P ratio. By contrast, patients who exhibit no thermographic response show a marked relative rise in oestrogen during both phases of the menstrual cycle. The significance of PG synthesis and relatively raised oestrogen levels will be discussed in relationship to the risk of breast cancer.

Benign breast disease: studies of prostaglandin E2, steroids, and thermographic effects of inhibitors of prostaglandin biosynthesis.

Plasma levels of estradiol (E2), prostaglandin (PG)E2, and progesterone (P) were measured in both phases of the menstrual cycle in 22 women with benign mastopathies and in 5 normal women. In both phases of the cycle, PGE2 blood levels were significantly higher in patients with benign mastopathies than in normal women. In contrast, the plasma levels of both steroids were lower in patients than in controls. An estrogen-directed synthesis of PGE2 is proposed. In 10 patients, breast thermogenic response to inhibitors of PG biosynthesis (aspirin and indomethacin) revealed a cooling effect in 4 cases, a partly positive response in 3 cases, and no response in 3 cases. The 7 cases with positive responses also had a deficiency of variable magnitude of both steroids without an unbalanced P/E2 ratio. In contrast, patients with a negative thermographic response manifested very low levels of progesterone and a low P/E2 ratio. The significance of patients' unresponsiveness to inhibitors of PGE2 biosynthesis is discussed, as well as the implications with regard to breast cancer.