[Temporomandibular joint disorders: Physiotherapy and postural approaches]. / Dysfonction de l'appareil manducateur : approches rééducative et posturale.

Rehabilitation of temporomandibular joint dysfunctions has for a long time tried to treat symptoms: pain relief, joint kinetics restoration, disk re-capture by manual maneuvers. The authors present their own therapeutic approach, which is no longer limited to symptoms, but addresses the causes and identifies risk factors to prevent relapse.

Biomechanics of the weakened mandible: use of image correlation analysis.

Uninterrupted resection of mandibular bone is often necessary during maxillofacial operations for cancer. This weakens the mandible, and increases the risk of fracture. To our knowledge no biomechanical analysis has been made of deformations and strains that occur during chewing if this happens, so we have made such an analysis of the weakened mandible using a new technique: image correlation. Five fresh explanted human mandibles were prepared with black and white lacquer, and placed in a loading device that allowed replication of a physiological biting exercise. Calibrated pieces of bone were resected from the right body of each mandible. Images of the mandibular surface were recorded by 2 cameras and analysed with an algorithm to correlate them, which allowed us to confirm the distribution of strain on the body of the mandible, and to focus on the weak points. Before the bone was resected, we noted tensile strains on the alveolar border of the body, and compressive strains on the basilar border. The intensity of the strains in the posterior angle of the resected bony area then increased, with reduction in the height of the bone until fracture. The orientation of the fracture line started at the lower posterior angle of the resection area and spread in a lower posterior direction until it reached the basilar border of the mandible. Image correlation is a new technique for the study of mandibular biomechanics that provides accurate measurements on a wide bony surface with high definition images and without modification of the structure. Its application to weakened mandible provided reliable images of modifications to strains during simulated biting exercises.

[Techniques of anastomoses issue from vascular surgery and apply to maxillofacial microsurgery]. / Application des techniques d'anastomoses de chirurgie vasculaire à la microchirurgie maxillofaciale.

Vascular surgeons use an anastomosis technique that has proven its efficiency for a long time. This technique consists in an anastomosis with spatulated ended vessels designed with opposite obliquity. This anastomosis is closed by a continuous suture. Authors expose the results of this technique applied to microvascular surgery in facial reconstruction.

[Validating a loading protocol for weakened mandibular models]. / Validation d'un protocole de mise en charge des modèles mandibulaires fragilisés.

INTRODUCTION: The purpose of this study was to validate an experimental model of weakened synthetic mandible loaded in a device simulating masticatory forces by studying the reproducibility of the fracture threshold. MATERIALS AND METHODS: Both sides of five synthetic mandibles were weakened by progressive synthetic bone resection. The synthetic mandibles were submitted, after each resection, to static chewing exercises in the simulator. The threshold fracture was recorded. RESULTS: The fracture threshold mean resection height was 19.33 mm with a percentage of error of 6.72%. DISCUSSION: The low percentage of error allowed us to validate this experimental model. A comparison with other experimental or finite element models confirmed our protocol and results. We plan to apply this protocol to fresh weakened mandibles.

[Soft tissue myxoma of the face]. / Tumeurs myxoïdes des tissus mous de la face.

Myxoid tumors are a group of heterogeneous lesions with a voluminous myxoid matrix, which may affect any tissue in the body. The frequency of these tumors depends on their localization. On the face, the localization is most often osseous. In this case, they are odontogenic myxoma. Localization in facial soft tissues is very rare. These tumors are benign but with a high potential for local aggressiveness and recurrence. They must be treated surgically with radical exeresis and long-term follow-up.

[Suprafascial dissection of the radial forearm flap]. / Prélèvement suprafascial du lambeau antébrachial radial.

INTRODUCTION: The aim of this study was to assess the efficacy of dissection of radial forearm flap in a superficial plan above the deep fascia to prevent donor site problems. PATIENTS AND METHODS: Eighteen radial forearm flaps were used for orofacial reconstruction: 11 suprafascial flaps and seven infrafascial flaps. We compared in the two groups: flap failure, graft success, tendon adhesions, sensory nerve damage at donor site. RESULTS: We observed one case of flap failure in the infrafascial group and one case in the suprafascial group. With suprafascial elevation flap technique, we noted 100% of grafts integration without tendon adhesion. In infrafascial elevation flap technique, four out of seven patients had delayed healing. DISCUSSION: The suprafascial dissection of free radial forearm flap creates a superior graft recipient bed ensuring early and complete successful graft.

[Vegetable foreign body of the infratemporal fossa: a case report]. / Corps étranger végétal de la fosse infratemporale.

INTRODUCTION: Limited amplitude of mouth opening due to a foreign body in the infratemporal fossa is a rare event. We report a trismus due to a foreign body of vegetable origin located in the infratemporal fossa. OBSERVATION: A 44-year-old female patient presented with a left endobuccal wound made by an oak branch. Limited amplitude of mouth opening was noted on clinical examination. A first CT scan did not reveal any foreign body. Despite an adequate treatment, the patient presented with acute cellulitis. A second CT scan revealed a parapharyngeal and masticatory compartment collection. One month after drainage, the patient spontaneously rejected the vegetable foreign bodies. An MRI better investigated the lesional diagnosis and the patient underwent surgery for the third time. DISCUSSION: Discovering foreign bodies in the infratemporal fossa is unusual. CT scan is a useful but limited tool if foreign bodies are small and/or of weak density. MRI is the reference examination.

[Outcome of oral implants after autogenous bone reconstruction]. / Devenir des implants après chirurgie préimplantaire.

INTRODUCTION: The purpose of this study was to evaluate the implant placement outcome in edentulous patients prosthetically rehabilitated after autogenous bone graft. MATERIAL AND METHOD: Between 2002 and 2006, 75 patients underwent graft surgery, only 64 patients (mean age of 53.8 years) had a complete treatment. Calvarial bone grafts were used in 41 cases, mandible bone in 13 cases, and iliac bone in 13 cases. Grafting techniques were onlay and inlay grafts in the maxilla combined or not with LeFort I osteotomies, and onlay or interposed bone graft in the mandible. Twelve patients presented with complications, wound dehiscence in seven cases and infection in five cases. Twenty-two patients presented with perforation of the sinus mucosa in the course of sinus lift. RESULTS: Three hundred and seventy-nine implants were inserted in 64 patients, 295 in the maxilla and 84 in the mandible. Fifteen implants failed (3.95%), 13 before loading and two after, 10 maxillary implants (3.38%), and five mandibular implants (5.95%). The global implant survival was 96.05% with a mean background of 23.6 months, 88.37% after sinus lift, 83.33% after apposition graft in the mandible and 88.64% in the maxilla. DISCUSSION: These results correlate to current published data.

[Maxillofacial metastasis of a cholangiocarcinoma]. / Métastase maxillofaciale d'un cholangiocarcinome.

OBSERVATION: A 64-year-old woman with a history of cholangiocarcinoma, presented with painful cheek-swelling and ulcerated lesion of the lower jaw. There were lytic bone lesions of the mandible. Histological examination revealed cholangiocarcinoma metastasis. Surgery was impossible because of the primitive tumor's extension. The patient then received palliative treatment with radiotherapy - and chemotherapy. She died 13 months after the initial diagnosis. DISCUSSION: Maxillofacial metastasis generally occur in the mandible. Although adenocarcinomas are often observed, cholangiocarcinoma has never been reported as maxillofacial metastasis. The prognosis of cholangiocarcinoma is bad because of a usually late diagnosis.

[Perception of maxillofacial surgery and stomatology in France]. / Perception de la chirurgie maxillofaciale et de la stomatologie en France.

INTRODUCTION: The authors wanted to know how stomatology and maxillofacial surgery were perceived by general practitioners, dentists, and the patients. A study was made on the model of two studies made in 1994 and 2005 in Great Britain and one in 1996 in the United States. MATERIAL AND METHOD: Four thousand and one hundred and fifty questionnaires were mailed. Six hundred and ninety-three to general practitioners, 690 to dental practitioners, and 2770 to the public. Practitioners were chosen randomly, in equal number in each of 22 administrative regions of metropolitan France. RESULTS: One hundred and fifteen physicians answered (16.6%), 130 dentists answered (18.8%). The practitioners sent back 180 questionnaires completed by their patients (6.5%). These results, higher than the ones reported in the above-mentioned studies, allowed determining the perception of maxillofacial surgery and stomatology in France. This study showed that we are, in the eye of the public, specialists of temporomandibular joint disorders, fractures of the face, but also of orthognatic surgery, cleft lip and palate, cancer of the oral cavity, and implantology. This study also showed that maxillofacial surgeons are the major referents for odontologists whereas they remained less acknowledged by general practitioners. DISCUSSION: The maxillofacial surgeon is in France the main correspondent of odontologists; he still has to convince general practitioners and the global population to be acknowledged as the surgeon of the "face". Our results correlate to published international data.

[Non-surgical management of parotid gland and duct injuries: interest of botulinum toxin]. / Prise en charge non chirurgicale des plaies de la glande parotide et du canal de Stenon: intérêt de la toxine botulinique.

Salivary fistulas and sialoceles are rare complications of post-traumatic or postoperative parotid gland and duct injuries. Local injections of type A botulinum toxin represent a new and effective treatment for complications of these injuries, which is less invasive, stressful and lengthy than conventional methods. The authors report five cases in which three salivary fistulas and two sialoceles were successfully treated by botulinum toxin injections. The therapeutic protocol is described; it allows simple management of these complications and use of smaller doses than those described in the literature for treatment of sialoceles. The authors recommend use of botulinum toxin injections in first intention for management of salivary fistulas and sialoceles.

[Osteosynthesis of the temporal articular tubercle]. / L'osteosynthèse du tubercule articulaire temporal.

This technical note stresses the interest of the temporal articular tubercle osteosynthesis in zygomatic bone fractures. An impaction of the zygoma can lead to valgus of the temporal bone's zygomatic process with diastasis in the temporal articular tubercle. If the frontal and maxillary processes are comminuted, osteosynthesis of the temporal articular tubercle allows recovering the initial projection of the zygomatic bone. The adequate alignment of the sphenozygomatic suture is also reliable for an anatomical reduction of the fracture.

[Otophyma, zygophyma and giant rhinophyma: a rare association]. / Otophyma, zygophyma et rhinophyma géant : une association rare.

A patient, 64-year-old, is referred for the treatment of a giant rhinophyma. He refused any treatment during eight years. The interest of this case report is the size and the weight of the rhinophyma, the obstruction of the nasal airways and the resulting social disturbance. This exceptional clinical rhinophyma was associated with an otophyma, a zygophyma and ophthalmic disease. To our knowledge, this clinical presentation has never been reported before. The management of the rhinophyma and the otophyma was surgical excision, secondary healing followed by a full thickness skin graft associated to a fullface mechanical dermabrasion.

[Lingual nerve injury during removal of the lower third molar: importance of early intervention]. / Lésions du nerf lingual lors de l'extraction d'une dent de sagesse inférieure.

INTRODUCTION: Lingual nerve injury is one of the most important complications after removal of a lower third molar. CASE REPORT: We report two cases of this complication in our experience. In the first case, lingual nerve injury was repaired immediately and the patient recovered total tongue sensitivity. In the second case, lingual nerve exploration was not undertaken and the patient developed complete tongue anesthesia. DISCUSSION: Opinions are quite different about the delay before exploration of an injured lingual nerve. However, absence of sensory improvement incited us to undertake surgical exploration of the nerve. Due to the degenerative lesion of the damaged nerve, timing of repair before three months seems preferable. In young patients, early repair, and good quality nerve suture without tissue loss improve sensitive recovery of the tongue.

[Transconjunctival inferior blepharoplasty]. / La blépharoplastie inférieure par voie conjonctivale.

The transconjunctival approach is the appropriate standard for lower eyelid blepharoplasty in patients presenting with lower eyelid herniated fat without excess skin. A transconjunctival incision is made approximately 2 mm below the tarsal border and extended inferiorly following a plane posterior to the orbital septum. No conjunctival suture is necessary. Although transconjunctival blepharoplasty diminishes the occurrence of postoperative complications when compared to the transcutaneous method and constitutes a more comfortable option for the patient, we always recommend a preoperative test of the eyes. Patients must be informed of the risk of amaurosis.

[Nicardipine-induced gingival hyperplasia: case report]. / Hyperplasie gingivale induite par la nicardipine.

Several types of therapeutic agents may induce gingival hyperplasia. An unusual case induced by nicardipine, a calcium antagonist, is presented. The other drugs concerned are: several anticonvulsants, cyclosporin, and several other calcium antagonists. In the majority of patients for whom drug discontinuation or substitution is not possible, and for whom prophylactic measures have failed, surgical excision of gingival tissue remains the only treatment option.

[Complications of orthognathic surgery. Apropos of a series of 84 patients]. / Complications de la chirurgie orthognathique. A propos d'une série de 84 patients.

BACKGROUND: Patients demand satisfactory functional and esthetic results from orthognatic surgery. The aim of this study as to assess adverse outcomes after orthognatic surgery. PATIENTS AND METHODS: We retrospectively reviewed 84 patients who underwent maxillary (22.6%), mandibular (29.8%) or bimaxillary (38.1%) osteotomy in 1997. We re-examined 76 of these patients at a mean 21 months follow-up. Data were recorded for the preoperative, early postoperative, secondary postoperative and late postoperative periods. RESULTS: Infectious complications occurred in 2% of the cases of maxillary surgery. For mandibular surgery there were 10.5% infectious complications including 83% that resolved spontaneously, 3.5% neurological complications and 1.7% temporomandibular joint complications. DISCUSSION: Maxillary osteotomy has proven reliable. Major adverse outcome is infrequent but serious. Adverse outcomes in mandibular surgery are more common but less problematic.