[Implant insertion in distracted bone for reconstruction after gunshot injury]. / Pose d'implants en os distracté chez les patients reconstruits après traumatisme balistique.

Distraction osteogenesis is a tissue engineering technique with two clinical applications in maxillofacial surgery: alveolar distraction and basal bone distraction. Even if it appears to be a binding and major surgery, distraction osteogenesis applied to facial bone, and especially to the mandible, has the great advantage of producing a pluritissular reconstruction of ideal quality and quantity, suitable for the ultimate goal of dental implant rehabilitation management. This technique had some drawbacks due to technical constraints related to the material. Distraction osteogenesis is well placed in the armamentarium of reconstructive surgery techniques for bone defects caused by trauma or tumor. It allows rapid restoration of adequate physiological conditions for mandibular dental implant placement. We reviewed the various modifications of this technique.

[French innovations in aesthetic surgery of the face]. / Les innovations françaises en chirurgie esthétique de la face.

This article on French innovations in aesthetic surgery is a report mainly centered on the cervicofacial renovation surgery, with historic review and interviews of people who played a dominating role regarding anatomical works, invention and innovation of techniques, and their development. The main theme is the facial face-lift, which genesis dates back to the First World War, and to the surgery of the « gueules cassées ¼ with Morestin, father of the French plastic surgery. During the interwar years, plastic surgery techniques were developed by great French names such as Passot, Noël and Bourguet. The invention of the craniofacial surgery in the 1960s and historic anatomical works on the SMAS by Tessier and his team in the 1970s, allowed to clarify for everyone the various principles and indications of the face-lift, recently improved by Le Louarn and Besins. It is besides, in nasal aesthetic surgery, and still thanks to anatomical works, that Robin described in 1973 the technique of rhinoplasty by extramucous way, then developed by Jost, co-inventor with his master Redon of the aspirating drain tile.

Gunshot wounds: two cases of midface reconstruction by osteogenic distraction.

BACKGROUND: Reconstruction of the midface is a surgical challenge because of the aesthetic and functional implications that are characteristic of this area. METHODS: We describe two cases of reconstruction after gunshot wounds of the midface by a customized external ostegeognic device (OBL Laboratory). These two patients had mandibular reconstruction by osteogenic distraction by the same technic. RESULTS: Gunshot wounds cause considerable cutaneous, osseous and muscular damage. Reconstruction techniques have to reconstruct all those tissues. DISCUSSION: Reconstruction by osteogenic distraction allows the bone and soft tissues to be simultaneously expanded. This expansion decreases the patchwork effect of free flap reconstruction. An other advantage of reconstructing the soft tissues at the same time by osteogenic distraction is that subsequent bone grafts can be covered, reducing the risks of their exposure.

Gunshot wounds: reconstruction of the lower face by osteogenic distraction.

BACKGROUND: Although osteogenic distraction is a well-established technique, the distraction device still needs to be improved, miniaturized, and made lighter, more flexible, and more adaptable for mandibular reconstruction in adults with gunshot wounds. The authors successively used unidirectional and bidirectional devices, followed by a bone transporter with a horseshoe-shaped trammel. The trammel system was then replaced by an endless screw, and finally by a customized endless screw. METHODS: Eleven adult patients with gunshot injuries underwent mandibular reconstruction using osteogenic distraction with an external device. RESULTS: An average bone gain of 79 mm was achieved. No infectious complications were observed. The authors encountered equipment problems during the study, requiring a change of material. The mean duration of mandibular distraction was 3.5 months. CONCLUSIONS: Distraction of bone fragments facilitates the simultaneous expansion of soft tissues, avoiding free or pedicled myocutaneous flaps, for soft-tissue reconstruction. The alveolar ridge with the attached gum is also recreated by distraction, allowing dental reconstruction by osseointegrated implants.

[Nasolabial flap reconstruction of the columella]. / Le lambeau nasogénien en reconstruction de la columelle.

We report three cases of squamous cell carcinoma of the columella invading the sub-partitions. Wide resection raised the problem of several nasal esthetics sub-units. A chronological review of columella reconstruction procedures explained why the nasolabial fragment rarely used for partial rhinopoiesis, was appropriate in these three patients.

[Distraction osteogenesis for the premaxillary reconstruction. Report of 3 cases]. / Reconstruction du prémaxillaire par distraction ostéogénique. A propos de trois cas cliniques.

Reconstructing the premaxillary is well-known for being difficult and usually requires a bone implant, in grafts or flaps. This technique has a high morbidity rate and its middle or long term results remain uncertain. Thanks to their experience and to the results they achieved in mandible and maxillary osteogenic distraction, the authors suggest applying the principle of distraction osteogenesis to the premaxillary reconstruction. Three patients have been treated: first, two hypoplasias of the premaxillary, sequelae of a cleft palate and of a former traumatic loss of teeth; secondly one premaxillary defect following a gunshot wound. The first two were women, the other one was man, all adults. For premaxillary distraction, an intraoral extramucosa device is made-up for each individual case before the surgical operation itself and after an orthognathic analysis. The surgical operation consists in a classical segmental maxillary osteotomy which respects the palatal periosteum, and also in fitting a distractor device with transmucosa screws into the palatal bone. In each of the three cases, with a follow-up from 24 to four months, the reconstruction of the premaxillary by distraction osteogenesis is considered satisfactory and stable as regards both bone and soft tissues. This achieves particularly a very good expansion of the fibrous mucosa of the palate which makes it possible to re-insert false teeth, with or without implants into the bone. The principle of distraction osteogenesis applied to premaxillary reconstruction has shown, in our cases, very good functional and aesthetic results. Yet the techniques we used are simple and have a low morbidity rate; secondly the distraction device is easy to design and little expansive.

[Mandibular distraction osteogenesis and dental rehabilitation by osseointegrated implants. A case report] ]. / Distraction ostéogénique mandibulaire et prothèse sur implants. A propos d'un cas clinique.

The authors report a case of mandibular reconstruction by distraction osteogenesis. The patient presented an interrupting mandibular defect secondary to a gunshot injury. The distraction osteogenesis permitted the reconstruction of the mandible without bone grafts or flaps. The attached gingiva on the alveolar ridge was also recreated by the distraction and allowed a dental rehabilitation by osseointegrated implants.

[The management of extra-oral implants. Anachronisms and paradoxes]. / Prise en charge des implants extra-oraux. Anachronismes et paradoxes.

Used in France for ten years and in Sweden since 1977. Extra-Oral Implants (EOI) represent one of the new therapeutic approach of facial defects treatment by maxillo-facial prostheses fixed on implants and of some transmission deafnesses. Audiologic applications are free of charges for the patient but not the prosthetic applications; the authors note this paradox and some other anachronisms. Finally the authors wonder why Extra-Oral implantology is a "correct" science and why Intra-Oral Implantology remains absent from the Administrative texts as if it was a sort of doubtful therapy without scientific principles.

[Implant-supported prosthesis. The significance of endosseous and peri-osseous implants]. / Epithèses implanto-portées. Intérêt des implants endo et juxta-osseux.

The new extra-oral of Farmand (EPITEC system) is a plate-implant. This concept is really different from the Brånemark's implant and the use of EPITEC system give the authors opportunity of a first assessment. It seems that if, of course, Brånemark system is still the reference, the EPITEC system certainly has a real interest in thin osseous implantation areas.

[Intramuscular capillary-venous angioma extending into the infratemporal fossa. Apropos of a case]. / Angiome capillaro-veineux intra-musculaire étendu à la fosse infra-temporale. A propos d'un cas.

A rapidly growing tumor in the temporal area extended into the infratemporal fossa. Imaging findings favored a hypervascularized meningo-sarcoma type extracranial tumor, but the pathology report on the surgical specimen confirmed the diagnosis of capillaro-venous angioma. The therapeutic approach was preoperative hyperselective embolization then access via the temporal and infra-temporal fossa for simple tumor exeresis. Mature angiomas and access via the infra-temporal fossa are reviewed.

[Reconstruction of the vermilion border after vermilionectomy. Apropos of 16 cases]. / Reconstruction du vermillon après vermillonectomie. A propos de 16 cas.

The authors are concerned with 16 recently operated cases, and express their renewed interest in vermilionectomy in the management of precancerous states affecting the vermilion, immediately followed by reconstruction with a mucous advancement flap. After describing the method, the authors stress the benefits afforded by the method from both oncologic and prophylactic viewpoints. Functional and esthetic results are excellent.

[Epidermoid carcinoma of the lip. The contribution of surgery. Apropos of 429 cases]. / Carcinome épidermoïde de la lèvre. Apport de la chirurgie. A propos de 429 cas.

The surgical treatment of epidermoid carcinoma of the lip too rarely resorts to pluri-disciplinary confrontation, although all the possible techniques, i.e. surgery, curietherapy and radiation therapy, are effective. Curietherapy still is the choice method for large lesions, due to the quality of its aesthetic and functional results. The lymph node areas of N0 patients are neglected but should not be so, because the secondary evolution of an adenopathy has a poor prognosis. All the T2 and T3 patients with no general contraindication should undergo cervical exploration.

[Rhinophyma. The value of progressive dermabrasion]. / Rhinophyma. Intérêt de la dermabrasion progressive.

After briefly summing up the nosology of rhinophyma, the authors report their experience with the surgical correction of this nasal disease, on the basis of eight cases. They explain their reasons for giving up dermasection and preferring dermabrasion.

[Submental endotracheal intubation in craniomaxillofacial trauma. Technical note]. / Intubation sous-mentale en traumatologie cranio-maxillo-faciale. Note technique.

Submental intubation is a new technique of oroendotracheal intubation in patients with facial fracture requiring jaw control, associated with skull base fracture. First described by Altemir in 1986, the simplicity of this procedure and its minimal scar traces lead the authors to prefer it to tracheostomy in patients who do not need endotracheal intubation for more than 48 hours.

[Mandibular reconstruction of gunshot wounds by progressive bone distraction. Report of five cases]. / Reconstruction mandibulaire par distraction osseuse progressive chez les traumatisés par arme de chasse. A propos de cinq cas.

Five adult patients with gunshot wound defect underwent bilateral mandibular lengthening by an extraoral device. All patients presented with interrupting mandibular defect of 50 to 100 mm. Distraction of bone fragments led to mandibular reconstruction without bone grafting and simultaneous expansion of soft tissues, avoiding free or pedicled myocutaneous flaps for soft tissue reconstruction of the lower third of the face. Mandibular distraction also recreated the alveolar ridge with its attached mucosa which is equivalent to the gingiva. It can be used for dental rehabilitation by osseointegrated implants. Avoiding the morbidity and functional problems of classical flaps, mandibular distraction accelerates facial reconstruction, and social reinsertion of these patients.

[A new application of extraoral implants: the permanent percutaneous electrical connection. Apropos a case]. / Une nouvelle application des implants extra-oraux: la connexion électrique percutanée permanente. A propos d'un cas.

The principle of EOI is an implant fixed to the bone supporting a percutaneous abutment. Placed through the skin, the abutment allows a permanent communication between inside and outside of the organism. A rigorous very precise surgical protocol has allowed good results of the technique for over 20 years and shown the reliability of this two-piece device. This surgical protocol and device concept have been used by the authors to design a percutaneous electrical connector experimented in a rabbit model since 1996. A percutaneous electrical connector called PEP (percutaneous electrical plug) directly steming from the Sweden and German extra oral implants as been design for human applications. Authors describe the surgical placement and loading of there first PEP, under Huriet law, in an otologic application: the treatment of sever, drug-resistant tinnitus by electrical stimulation of the internal ear. The anatomical implantation area of these new extra-oral implants is retro-auricular. So the implants placements should be realized by ENT and maxillo-facial surgeons.

[Psychological profile of suicide using firearms to the face. Review of the literature. Our experiences at the university hospital center at Caen]. / Profil psychologique des suicidés de la face par arme à feu. Revue de la littérature. Notre expérience au CHU de Caen.

We studied the psychological feature of subjects who attempted suicide with firearms. This retrospective study included 36 cases of "facial suicide" treated at the Caen University Hospital since 1981 and data in the literature. An analysis of the different parameters showed in several cases, that this population is different from the others, particularly hospitalized drug overdose suicide patients. Two notions were particularly remarkable in these patients: history of patients psychiatric disorders were very rare and recurrent suicide attempts.