Multicenter double-blind study of the efficacy and tolerance of roxithromycin versus erythromycin ethylsuccinate in acute orodental infection in adults. Odontogenic Infections Study Group.

A total of 194 patients with orodental infection were randomized either to roxithromycin 150 mg twice daily plus placebo or to erythromycin 1 g twice daily plus placebo for a mean duration of 8 days. The infections consisted of cellulitis, pericoronitis, and adenopathy, or any two in combination. In the 176 cases in which efficacy was evaluable, outcome was satisfactory in 94% and 91% of cases treated with roxithromycin and erythromycin, respectively (p = 0.45). Patients were evenly distributed with respect to demographic characteristics, diagnosis, and concomitant treatment. Surgery was performed in 63%, primarily for abscess formation in cellulitis (p less than 0.001); 18% of patients with an abscess did not undergo surgery. The success rate was identical irrespective of whether surgery was performed, including in those with an abscess. Tolerance was evaluated in 1986 patients. Unwanted effects, elicited by direct questioning, were reported in approximately 20% of cases per group (19% for roxithromycin and 21% for erythromycin). They consisted of mild gastrointestinal upsets which caused treatment to be withdrawn in eight cases (four per group). Thus, roxithromycin and erythromycin twice daily for orodental infection are similar in both efficacy and tolerance.

[Psychologic and psychiatric environment in the correction of facial dysmorphism]. / Environnement psychologique et psychiatrique dans les corrections des dysmorphies faciales.

Stomatologists well know that phenotype can reproduce a lot of abnormal genotype aspects, in facial growth. These vitiations are bound to abnormal behaviours during such functions as: deglutition, breathing, oral expression. It is important to know if "wrong para-functions" adopted in such praxies are psychologically significant. Very often, the psychiatrist only, will be able to confirm or oppose contra-indication about the surgical treatment of facial abnormalities in such special cases, known or unknown.

[Jaw block at maximal mouth aperture in subcondylar fractures in the very young child]. / Blocage bimaxillaire dans les fractures sous-condyliennes du très jeune enfant, en ouverture buccale maximale

In one case involving post-traumatic temporo-mandibular ankylosis, the authors suggest a means of bi-maxillary blockage at the maximum buccal aperture which they consider prevents this type of complication in very young children presenting with bicondylar fracture. The simplicity of this method, the possibility of carrying it out where the milk teeth are not yet complete, the fact that it is well-tolerated by the children it has been tried out on, make this, in their opinion, the procedure of choice.

[Induction alveolectomies and root malformations]. / Alvéolectomies d'induction et malformations radiculaires

In connection with 2 cases of dental retention due to radicular malformations, the authors draw attention to the following three points: 1. The diastema in which the retained tooth develops should exceed its mediodistal diameter. 2. The malformation of the root is not a counter-indication for induction alveolectomy: this triggers growth of the alveolar bone satellite of the tooth, following a process different from the usual mechanism of dental eruption. It could mean that the coronary portion, which is of epithelial origin, is rejected by its bony, connective tissue environment. 3. They would like diagnosis of dento-maxillary disharmony to be graded: --difficult to judge from X-rays alone; --dubious when abnormalities in the transverse diameter of the arches also contribute to crowding of the teeth.

[Unilateral post-fracture ankylosis and facial growth in infants: therapeutic considerations (author's transl)]. / Ankylose fracturaire unilatérale du petit enfant et croissance faciale. Propositions thérapeutiques.

Ankylosis of this type should be treated as early as possible. Resection of the ankylosed block should be avoided, and all that is required is reconstruction of a new condyle, subjacent to meniscal remnants that are usually present. As large as possible an inter-fragment space is obtained by forced lowering of the vertical branch, which is maintained in position by a blocking apparatus with a maximal molar gap. The validity of these principles is supported by the results in the case reported, after a lapse of 5 years.

[Etiological treatment of anterior vertical excess of the lower portion of the face]. / Un traitement étiologique des excès verticaux antérieurs de l'étage inférieur de la face (E.V.A. E.I.F.).

Antero-vertical excess of the lower third of the face is associated with dysfunction of the base of the tongue and widening of the goniac angle. This dysfunction forms part of a complex dynamic clinical picture: antero-vertical excess can complicate: -retrognathism -acceptable bone relations as shown by cephalometric measurements after correction of the goniac angle; -a true mandibular prognathism. Contrary to its reputation, we believe sagittal osteotomy of the rami to be the method of choice, because it permits: 1) correction of the goniac angle, 2) completion by an advancement or by a backing of the dental portion of the mandible. This technique is said to have a high relapse rate, no doubt due to disregard for the indispensable rehabilitation of lingual dynamics in the post-operative phase. With a follow-up of between one year and 6 years, we have seen no cases of relapse by following these rules: 1) Routine tongue modelling starting 6 months before the orthopaedic operation. 2) Kinesiorthophony to raise the usual positions of the base of the tongue.

[Mandibular angle and orthodontic treatment. Apropos of the possible therapeutic inversion of the direction of rotation of mandibular growth]. / Angle mandibulaire et traitement orthopédique. A propos de l'inversion thérapeutique possible du sens de la rotation de croissance mandibulaire.

The spontaneous and therapeutic modifications of the mandibular angle suggest that the rotations of growth described by Björk are not inevitable but are due to lingual dysfunction, particularly involving the pharyngeal part. Adequate treatment can modify the widening and narrowing of this angle.

[Scanning radiographic evaluation of cleft lip and palate]. / Bilan scannographique dans les fentes labio-maxillaires.

The works of Paul Tessier, M.D., have shown the frequent association of facial and cranial clefts. After studying eleven cases of cleft palate which could be associated to encephalic anomalies, we conclude that we cannot systematize an evaluation by CAT-scan for low and isolated cleft palates. On the other hand, as soon as an association exists with: a psychomotor deficit (even slight); neurologic symptoms; a participation of the eye or the socket, the scanner evaluation becomes necessary.

[Reposition osteoplasty of the median process in bilateral labiomaxillary clefts]. / Ostéoplastie de reposition du bourgeon médian dans les fentes labio-maxillaires bilatérales.

Twenty two bilateral cleft lips accompanied by a premaxilla protusion and associated with cleft palates have been operated according to the technic called "Premaxilla Reposition Osteoplasty". This operation must follow the cheiloplasty. It is often preceeded by an orthopedic appliance, used to make place for the premaxilla. The main goals are: to normalize the incisors level in relation with the one of the decidual canines and molars; to obtain a synostosis of premaxilla and lateral parts of the cleft maxilla osteous ridges; to close the residual vestibular and palatal hiatus. The good results observed in twenty cases have made easier the complementary orthodontic or surgical treatments.

[Genioplasty in adolescence]. / Les génioplasties de l'adolescent.

Different possible types of genioplasty in adolescence are envisaged: pure subtraction, conjugated subtraction, apposition, addition and in particular transfer for correction of the facial asymmetry of temporomandibular ankylosis sequelae. It is difficult to predict results and it is necessary to remain within a known framework in which esthetic and psychologic demands must occupy a very important place.

[Lingual vascular malformations, their consequences on the growth of the inferior facial plane. The integration of orthodontic embolization]. / Les malformations vasculaires linguales, leurs conséquences sur la croissance de l'étage inférieur. Le complément orthopédique de l'embolisation.

Lingual vascular malformations are usually benign, but have repercussions on the growth of the maxillo-mandibular unit in the child. The improvement in the vascular problems at puberty leads the authors to prefer a conservative form of treatment, hence the important role of embolization techniques. These techniques should be followed by the fitting of a lingual guide appliance, similar to the "mono-block" designed by Pierre Robin. This orthesis forces the child to modify incorrect movements due to the volume of the angiomatous tongue and gradually teaches him to automatize the new motor images created based on the dynamics of a virtually normal tongue, within the 6 months following embolization.

[Preoperative potentiation of immune defenses or postoperative antibiotic therapy?]. / Potentialisation pré-opératoire des défenses immunitaires ou antibiothérapie post-opératoire?

A clinical study was conducted during the postoperative period in adolescents to compare efficacy of two regimens by objective (temperature, edema) and subjective (pain) criteria. half had received preoperative immunotherapy and the other half conventional postoperative antibiotic treatment. Operations were germectomy of a wisdom tooth and maxillary osteotomy. Results were submitted to statistical analysis and data obtained from the objective and particularly subjective parameters studied led to the routine introduction of preoperative immunotherapy for these operations.

[Analysis of lesions from mandibular fractures in children. Therapeutic methods (author's transl)]. / Bilan lésionnel des fractures mandibulaires de l'enfant. Modalités thérapeutiques adoptées à l'Hôpital Bretonneau.

A statistical analysis was conducted in 22 recent cases of fracture and 4 cases of post-fracture ankylosis treated in the "Hôpital Bretonneau" over the last 5 years. The results demonstrated the frequency of often unrecognized associated condylar lesions (19 of 22 cases of recent fracture). They also emphasized the need to avoid conventional bimaxillary blocking, which when required should be conducted with the "open mouth", in cases of high or severe lesions of the mandibular condyles. Reconstruction of the condylar head involves re-insertion of the meniscular cap associated with regain of function, rather than conservation at any price of the condylar head, even recovered with its "fertile" cartilage.

["Renal dwarfism". Its impact on dental development and on maxillary growth]. / Le "nanisme rénal". Son retentissement sur l'évolution dentaire et la croissance maxillaire.

Children with terminal renal failure require iterative dialysis while awaiting kidney graft, and these have to be repeated over a period of years until a suitable graft presenting histocompatibility with the receiver is found. This has a considerable growth retardation effect (-3 to -6 SD, according to the age at onset of terminal failure). Two features appear to be paradoxical in these children. 1) In spite of a high carbohydrate diet and generally poor oral hygiene, they present a low prevalence of caries, probably related to modified salivary components. The only objective finding is an increase in salivary urea levels. 2) In spite of harmonious hypotrophy, no particular encumbrance of the dental arch is observed. Alveolar growth, contemporary with dental eruption, is sufficient to compensate possible hypotrophy of maxillary bone bases.

[Recurrent infectious parotiditis in the child (author's transl)]. / Les parotidites infectieuses récidivantes de l'enfant.

On the basis of 18 cases of recurrent parotiditis in the child, the authors offer the current review of this condition: clinical features, radiological features, bacteriological features, course. They emphasize the importance of precise technique during sialography, which must include straight and lateral films. The progress of this condition is characterised by recurrences. These may be avoided by prolonged and appropriate antibiotic therapy. The improvement which takes place at puberty is of etiopathogenic significance. Bucco-dental septis, constantly present, is one of the causes favourising infectious parotiditis in child.

[Current flora of mandibular osteomyelitis]. / Flore actuelle des ostéomyélites mandibulaires.

1) Blood-borne osteomyelitis may have a dental portal of entry. This results in a bacteraemia or septicaemia due to organisms other than staphylococci. In such cases, osseous lesions occur at a distance from the initial dental site. 2) As far as antibiotic treatment is concerned:--It must be begun early but not prematurely, i.e. bacteriological studies should be undertaken before antibotic therapy is started, possibly to be later changed in the light of laboratory results.--It should be combined, with a preference for two antibiotics which result in a bactericidal combination, as soon as the responsible organism is identified.--It should be given in high dosage, in view of the problem of diffusion of the antibiotic to the centre of the necrotic bone lesion.--It should be prolonged, based upon clinical, laboratory and radiological findings.

[Capdepont dysplasia and vertical excess of the lower half of the face. Genetic syndrome or fortuitous association?]. / Dysplasie de Capdepont et excès vertical de l'étage inférieur. Syndrome génétique ou association fortuite?

The study of an Algerian family revealed that four of the seven children presented dentinogenesis imperfecta associated with an anomaly of the facial skeleton (maxillary hypoplasia, anterior expansion of skeletal origin due to widening of the angle of the gonion). This type of association and its very unusual type of transmission (no doubt recessive) leads to a discussion of genetic mechanisms of these syndromes.

[Possibility of a relationship between the development of keratocysts of the maxilla and dental eruption]. / Possibilité d'une relation entre le développement de kérato-kystes des maxillaires et l'éruption dentaire.

On the basis of two cases, the problem is raised of the pathogenesis of kerato-cysts. The possibility of some sort of "induction" by factors which are involved in provoking eruption of the teeth is suggested by the clinical cases described.

[The systemic environment and dental development. From the clinical to the molecular approach]. / Environnement systémique et développement dentaire. De la clinique à l'approche moléculaire.

Clinical observation of patients with disordered phosphocalcium metabolism has demonstrated that dyschromia and/or dental dysplasias systematically accompany such disorders. A certain action of this steroid on dental buds has been demonstrated after analysis of the effects of experimental vitamin D deficiency in the rat: vitamin D would seem to control the behaviour of cells undergoing differentiation and also after this process is complete. Dentinogenesis and amelogenesis would appear principally to be affected. Two proteins, calbindins D-9K and -28K, may constitute the molecular mediators of this ameloblastic regulation.

[Cauhépé-Fieux syndrome. Interception in the deciduous dentition of mid-face hypoplasia]. / A propos du "syndrome de Cauhépé-Fieux". L'interception en denture lactéale des hypoplasies de l'étage moyen.

Inadequate transverse development of the milk dentition alveolar arcade (Cauhepe-Fieux syndrome) may have important effects on the constitution of facial architecture and in the medium term require orthognathic surgery. The acquisition of dental arcade contact on deglutition is only possible after normalization of the dimensions of the arch of the palate. The recommended suture inducing prosthesis should obligatorily include intercalating molar plates designed to overcome inadequate occlusion during treatment (on average 9 months). Both stimulation of growth at the level of the intermaxillary suture in this age group, and the stability of the results obtained, have been demonstrated after a period of follow up of more than 10 years taking into account the cybernetic aspects of the studies carried out by Professor Petrovic.