[The "two positions" lipoabdominoplasty]. / Plastie abdominale en deux positions.

BACKGROUNDS: Lipoabdominoplasty is a way to improve morphological outcomes by treating the areas not accessible to resection during classical abdominoplasty, especially hips. However, patients can present a lateral and posterior fat extension, not accessible to an anterior liposuction. This situation is managed by a first step with liposuction in the prone position. The aim of this study was to determine whether lipoabdominoplasty performed in two positions increases morbidity compared with lipoabdominoplasty in supine position only. METHODS: This was a retrospective study of 137 patients who underwent lipoabdominoplasty between 2009 to 2013. Eighty-five patients underwent a one position lipoabdomynoplasty and 52 a two positions lipoabdomynoplasty. Medical records were reviewed to collect data regarding patient demographics, operative technique, volume of liposuction and complications. RESULTS: The posterior liposuction has significantly increased the length of procedure (mean: 43.3 minutes). The volume of liposuction was significantly higher when the procedure was performed with prone and supine position (2789.6 mL versus 1373.8 mL, P<0.001). There was no significant difference between the two groups regarding complications and blood loss. CONCLUSION: Lipoabdominoplasty in two positions is an effective technique with the same morbidity as a lipoabdominoplasty in supine position only. The procedure finds its indication, between classic abdominoplasty and bodylift, for patients with lateral and posterior fat extension without posterior skin excess.

[Morphological evaluation of genioplasty associated with orthognathic surgery]. / Évaluation morphologique des génioplasties associées à la chirurgie orthognathique.

INTRODUCTION: The maxillo-mandibulary dysphormias are frequently associated with morphological abnormalities of the chin. Their correction in the sagittal and transverse planes can benefit both morphologically and functionally. The purpose of this study was to evaluate the morphological benefit of the osseous genioplasty associated with orthognathic surgery depending on the type of technique used, as well as complications occurred. PATIENTS AND METHODS: We identified patients who underwent osseous genioplasty associated with orthognathic surgery in our department between 2004 and 2010. For each patient Angle class, type of osteotomy, genioplasty and postoperative complications were recorded. The morphological results were evaluated by a group of surgeons and a group of observers using standardized photographs. RESULTS: Of the 203 facial osteotomies performed during this period, 101 osseous genioplasties were made. In most cases, there was a height reduction associated with advancement of the chin. The morphological results were considered as satisfactory all evaluators alike (3.92). The best results were obtained in height reductions with advancement techniques as sliding genioplasty (4.03) and jumping divided genioplasty (4.19). Five patients (5.9%) had a postoperative complication. This was especially one mental nerve injury and two dental mortifications. No default of consolidation or necrosis or hematoma of mouth floor have been reported. CONCLUSION: Osseous genioplasty is a safe, reliable procedure with morphological satisfactory outcome, in combination with orthognathic surgery. The best results were obtained with cases of height reduction with advancement of the chin, especially the original technique of the jumping divided genioplasty.

[Which treatment for the malar bags?]. / Existe-t-il un traitement approprié aux poches prémalaires ?

The treatment of malar bags is known to be particularly difficult; although it is not the most frequent palpebral anomaly justifying a surgical recourse, this problem cannot be ignored. It is important to distinguish their minor forms and to be able to analyze them in order to propose the best to our patients. We review the literature concerning this subject. The various surgical techniques are discussed and we present five of our cases. Even taking into account its various evolutions, the standard lower eyelid blepharoplasty can correct neither the ptosis nor the excess of orbicularis oculi muscle, which appear to be the main components of the malar bag. Publications, precisely mentioning malar bags or festoons, analyzing their physiopathology or their treatments, are few. We discuss the current data of the literature and on the results obtained in our experiment, and the surgical techniques suggested for their treatment. All the techniques suggested for the malar bags remain local or regional approaches. Results obtained with those techniques do not seem effective to us: although it has not been specifically proposed for the treatment of malar bags, the midface sub-periosteal lift, combining a skin flap lower eyelid dissection and a subperiosteal malar dissection, seems to be able to correct the lowest part of the orbicularis oculi muscle due to its concentric action and its major vertical vector of traction. This study underlines the importance of clinical analysis of the malar bags to appreciate the contribution of each element. So the surgeon will be able to choose the most adapted treatment, which is most often a midface sub-periosteal lift associated with a blepharoplasty.

Study of medical education in 3D surgical modeling by surgeons with free open-source software: Example of mandibular reconstruction with fibula free flap and creation of its surgical guides.

INTRODUCTION: Benefits of 3D printing techniques, biomodeling and surgical guides are well known in surgery, especially when the same surgeon who performed the surgery participated in the virtual surgical planning. Our objective was to evaluate the transfer of know how of a neutral 3D surgical modeling free open-source software protocol to surgeons with different surgical specialities. METHODS: A one-day training session was organised in 3D surgical modeling applied to one mandibular reconstruction case with fibula free flap and creation of its surgical guides. Surgeon satisfaction was analysed before and after the training. RESULTS: Of 22 surgeons, 59% assessed the training as excellent or very good and 68% considered changing their daily surgical routine and would try to apply our open-source software protocol in their department after a single training day. The mean capacity in using the software improved from 4.13 on 10 before to 6.59 on 10 after training for OsiriX® software, from 1.14 before to 5.05 after training for Meshlab®, from 0.45 before to 4.91 after training for Netfabb® and from 1.05 before and 4.41 after training for Blender®. According to surgeons, using the software Blender® became harder as the day went on. DISCUSSION: Despite improvement in the capacity in using software for all participants, more than a single training day is needed for the transfer of know how on 3D modeling with open-source software. Although the know-how transfer, overall satisfaction, actual learning outcomes and relevance of this training were appropriated, a longer training including different topics will be needed to improve training quality.

Use of the 3D surgical modelling technique with open-source software for mandibular fibula free flap reconstruction and its surgical guides.

INTRODUCTION: Tridimensional (3D) surgical modelling is a necessary step to create 3D-printed surgical tools, and expensive professional software is generally needed. Open-source software are functional, reliable, updated, may be downloaded for free and used to produce 3D models. Few surgical teams have used free solutions for mastering 3D surgical modelling for reconstructive surgery with osseous free flaps. We described an Open-source software 3D surgical modelling protocol to perform a fast and nearly free mandibular reconstruction with microvascular fibula free flap and its surgical guides, with no need for engineering support. PROCEDURE: Four successive specialised Open-source software were used to perform our 3D modelling: OsiriX®, Meshlab®, Netfabb® and Blender®. Digital Imaging and Communications in Medicine (DICOM) data on patient skull and fibula, obtained with a computerised tomography (CT) scan, were needed. The 3D modelling of the reconstructed mandible and its surgical guides were created. CONCLUSIONS: This new strategy may improve surgical management in Oral and Craniomaxillofacial surgery. Further clinical studies are needed to demonstrate the feasibility, reproducibility, transfer of know how and benefits of this technique.

Three-dimensional surgical modelling with an open-source software protocol: study of precision and reproducibility in mandibular reconstruction with the fibula free flap.

Very few surgical teams currently use totally independent and free solutions to perform three-dimensional (3D) surgical modelling for osseous free flaps in reconstructive surgery. This study assessed the precision and technical reproducibility of a 3D surgical modelling protocol using free open-source software in mandibular reconstruction with fibula free flaps and surgical guides. Precision was assessed through comparisons of the 3D surgical guide to the sterilized 3D-printed guide, determining accuracy to the millimetre level. Reproducibility was assessed in three surgical cases by volumetric comparison to the millimetre level. For the 3D surgical modelling, a difference of less than 0.1mm was observed. Almost no deformations (<0.2mm) were observed post-autoclave sterilization of the 3D-printed surgical guides. In the three surgical cases, the average precision of fibula free flap modelling was between 0.1mm and 0.4mm, and the average precision of the complete reconstructed mandible was less than 1mm. The open-source software protocol demonstrated high accuracy without complications. However, the precision of the surgical case depends on the surgeon's 3D surgical modelling. Therefore, surgeons need training on the use of this protocol before applying it to surgical cases; this constitutes a limitation. Further studies should address the transfer of expertise.

[Horizontal V-Y advancement flap for lower eyelid reconstruction in young patients]. / Le lambeau d'avancement horizontal en V-Y dans les reconstructions des pertes de substances non transfixiantes de la paupière inférieure chez le sujet jeune.

PURPOSE: The reconstruction of lower eyelid defects is a complex issue because of the thinness of eyelid tissues and the need for protection of the globe. The surgery must address two requirements: a functional goal, avoiding eyelid malposition, and a cosmetic goal, limiting aesthetic compromises. In young patients, direct closure is rarely possible if the defect is superior to 1cm. The horizontal V-Y advancement flap is a simple and reliable method but is hardly ever reported. The purpose of this study is to review the surgical technique and report our experience with this flap in the reconstruction of younger patients. PATIENTS AND METHODS: Nine patients, 5 men and 4 women, with a mean age of 54 years, underwent a lower eyelid reconstruction by horizontal V-Y advancement flap between 2011 and 2014. In every case, the initial pathology was a basal cell carcinoma and the surgical margins were uninvolved. The mean diameter of the surgical defect was 1.9 centimeters and the average procedure duration was 40 minutes. RESULTS: All patients were managed as outpatients. Functional and aesthetic results were judged satisfactory or very satisfactory by all the patients and their surgeon. No flap necrosis and no ectropion or scleral show were reported. In one patient, lower lid edema lasted until the third postoperative month. CONCLUSION: The horizontal V-Y advancement flap enables to repair lower eyelid defects using nearby skin of similar characteristics. Aesthetic results are very satisfactory, and scars, concealed in the eyelid creases, are nearly invisible in the long term. The lack of tension on the eyelid margin limits the risk of eyelid position. This simple and reliable one-step procedure, possible under local anesthesia, is appropriate for young, active patients, limiting the cosmetic sequelae and social ramifications.

[Mandibular reconstruction by composite musculocutaneous flap in glossopelvimandibular excisions]. / La reconstruction mandibulaire par lambeau musculo-cutané composé dans les exérèses glosso-pelvi-mandibulaires.

Results of 14 mandibular reconstruction by a composite muscular flap of the pectoralis major and trapezium muscles during widespread glossopelvimandibular excisions are described. The technique employed is outlined, emphasis being placed on the need to observe strict precautions during removal and application of the bone component, to avoid accidental avulsion during reconstruction which could compromise the musculoperiosteal vascularization of the graft. Results are sufficiently encouraging for this type of reconstructive surgery to be proposed in all cases where mandibular repair is necessary after interruption of continuity.

[Sliding osteosynthesis: a new technique for transverse palatal distraction osteogenesis associated with advancement and/or impaction Le Fort I osteotomy]. / L'ostéosynthèse coulissante: une nouvelle technique de distraction transversale associée à une ostéotomie de Le Fort 1, d'avancée et/ou d'impaction.

BACKGROUND: The orthopedic and surgically assisted maxillary expansion is often followed by maxillary advancement osteotomy. The posterior width gain is often small. The expansion is often more extended anteriorly. It impairs posterior correction. The authors describe a new device, ensuring both transversal and sagittal maxillary correction in a single procedure. MATERIAL AND SURGICAL TECHNIQUE: The sliding internal fixation device is in titanium, 0.8mm thick. It is made up of two plates (Deltex(®), Paris cedex 15, France): an inferior plate with a 45°-angulated slide, a superior plate with a spur. The surgical technique is a Le Fort 1 segmented osteotomy. The distractor is activated between the fifth and 10th postoperative day. Contention is maintained for 1 year after the end of activation. DISCUSSION: This sliding osteosynthesis technique allows stabilizing the advancement and/or impaction as well as transversal expansion for large transversal deficits in adult patients. This technique avoids performing a second procedure.

[An adjustable distractor for transverse maxillary distraction osteogenesis]. / Un distracteur modulable pour la distraction transversale du maxillaire.

INTRODUCTION: The posterior skeletal widening in conventional distractions (Surgical Assisted Rapid Maxillary Expansion) is often modest, in contrast with a predominant anterior expansion. Until recently, it was not possible to consider transverse palatal distraction osteogenesis and Le Fort I impaction or advancement in the same procedure, as the osteosynthesis plates impeded maxillary anterior opening. We developed new sliding osteosynthesis plates allowing to perform an advancement or impaction Le Fort I osteotomy associated with a low-resistance bipartite palatal distraction osteogenesis. We had for aim to describe the device and to determine its clinical applications. MATERIAL: This new palatal distractor is made up of two independent stainless steel jacks allowing for an adjustable distraction in the anterior or posterior area as needed. Bone-borne and tooth-borne versions are available. DISCUSSION: This new distractor can be adjusted sagittally. The distraction can be angular or parallel, and the distraction mode can be modified during post-operative distraction. This device should be adapted to all clinical presentations. It can be used in combination with sliding osteosynthesis to perform a Le Fort 1 osteotomy and at the same time a complete correction of vertical, horizontal, and sagittal deficiencies.

[Peroperative use of a silicone occlusal block for palatal and lingual support in orthognathic surgery]. / Utilisation per-opératoire d'un bourrelet occlusal en silicone à appui palatin et lingual en chirurgie orthognatique.

We present an alternative to acrylic occlusal wafers in orthognatic surgery. We propose using a silicone wafer that is easier to position preoperatively.

[Primary oral syphilis. A sometimes difficult diagnosis]. / Syphilis primaire buccale. Un diagnostic parfois difficile.

There recently treated cases of primary buccal syphilis are reported. The lesions are discussed, with the aid of photographs, and overall symptomatology described with the aim of providing permanent training of the young. A review of primary, secondary and tertiary syphilis is followed by a summary of diagnostic criteria and therapy.

[Christ-Siemens-Touraine syndrome. Completed management is unrelated to the number of years]. / Syndrome de Christ-Siemens-Touraine. Le complet n'attend pas le nombre des années.

The authors report a case of anhidrotic ectodermal dysplasia (A.E.D.) or Christ-Siemens-Touraine syndrome, which was completely edentated and fitted with prostheses at school age for two reasons: for nutritional reasons, as the child was unable to eat under normal physiological conditions; and for psychological and cosmetic reasons.

[Complex odontoma and composite odontoma. Apropos of 2 cases]. / Odontomes complexes et odontomes composés. A propos de deux observations.

Two cases of odontoma are reported, one lesion being a compound odontoma and the other a complex odontoma, the latter provoking facial pain combined with rhino-sinusal allergic phenomena. These two cases are used as a basis for an update classification of odontomas.

[Unfavorable effects induced by mandibular surgery in Class II malocclusions]. / Effets disgracieux induits par la chirurgie mandibulaire des classes II.

The sagittal split ramus osteotomy is probably the most frequently used procedure for correction of mandibular skeletal dento-facial deformities. In the 30 years since the procedure was introduced, a number of complications has been reported: unfavorable fracture during surgery, paresthesia or anesthesia and relapse. The literature seems to be very poor concerning the esthetical and morphological complications of the sagittal split ramus osteotomy; especially when treating Class II dento-facial deformity frequently associated with a genioplasty. The purpose of this study was to determine and analyze the esthetical complications occurring after mandibular surgery in patients with Class II dento-facial deformities: Pre-angular notches, Widening of the bi-angular distance, The unaesthetic effects of the associated genioplasty, Class III like "dento-facial deformities", Plates and screws visibility. Each of those complications has been analyzed to find a preventive treatment.

[Wide excision in cancer of the tongue: the choice of approach, modalities of reconstruction]. / Les vastes exérèses dans les cancers de la langue: le choix d'une voie d'abord, les modalités de la reconstruction.

Surgical treatment of extensive carcinoma of the tongue requires reconsideration at the present time: firstly, because the efficacy of other therapeutic measures is rapidly suppressed by the size of the tumors, and there is not theoretical reason for excluding extensive surgery, and secondly, because esthetic and functional sequelae of these bloody treatments have been totally modified by the introduction of new reconstructive techniques. Based on a series of 16 cases treated during a one-year period, the conditions for surgery of vast malignant tongue tumors (T3, T4, N indifferent) are analyzed, and findings emphasize the need for a wide approach. Clear exposure is obtained, the continuity of the mandibular arch is conserved, and effective anatomical and functional reconstruction obtained of tissues sacrificed by the musculocutaneous flaps.