[Temporomandibular joint disorders: current concepts for conservative management]. / Dysfonction de l'articulation temporo-mandibulaire: concepts actuels pour le traitement conservateur.

The temporomandibular joint is subject to repeated stress. The overloading of the compensation system leads to dysfunction, which manifests itself in the form of muscular and articular damage. Pain, joint noises and limitation of mouth opening are the most frequent reasons for a temporomandibular dysfunction (TMD) consultation. The diagnosis is mainly clinical. The therapeutic concepts are still controversial. The aim of this article is to offer a management strategy based on evidence through the analysis of literature reviews.

L'articulation temporo-mandibulaire est sujette à des contraintes répétées. La surcharge du système de compensation engendre une dysfonction qui se manifeste par des atteintes musculaires et articulaires. La douleur, les bruits articulaires et la limitation de l'ouverture buccale sont les motifs les plus fréquents pour une consultation de dysfonction temporo-mandibulaire (DTM). Le diagnostic positif est essentiellement clinique et les concepts thérapeutiques sont controversés. Le but de cet article est de proposer une prise en charge basée sur l'évidence et l'analyse de revues de la littérature.

[Temporomandibular joint dysfunctions: evolution in patient care]. / Dysfonction de l'articulation temporo-mandibulaire: modification de la prise en charge.

Temporomandibular joint dysfunctions are a frequently occurring condition that can have a considerable impact on the quality of life. The treatment modalities vary according to the anatomical involvement and symptomatology of the patient. Conservative and surgical management is still controversial and has evolved significantly in recent decades. The temporomandibular joint prosthesis is one of them. Through improvements in material and case management, the joint prosthesis has gained in popularity and has moved from being a treatment of last resort to being part of standard management.

Les dysfonctions de l'articulation temporo-mandibulaire sont une pathologie à incidence fréquente qui peut avoir un impact considérable sur la vie quotidienne. Leur traitement varie selon l'atteinte anatomique et la symptomatologie du patient. La prise en charge conservatrice et chirurgicale est encore controversée et a connu une évolution notable au courant des dernières décennies. Plus particulièrement, le remplacement prothétique de l'articulation, grâce à l'amélioration des matériaux et de la planification préopératoire, a gagné en popularité et est passé du traitement de dernier recours à un élément de la prise en charge standard.

The Mandibular Ramus: An Alternative Donor Site for Secondary Alveolar Bone Grafting in Clefts of the Alveolus.

The authors describe the use of the mandibular ramus as an autologous bone graft material for secondary alveolar bone grafting in cleft patients. This technique represents a safe and effective alternative to currently used donor sites. Furthermore, it allows to minimize patient discomfort, so that they can be treated as outpatients.

Complex Tracheocarinal Reconstructions Using Extrathoracic Muscle Flaps as Airway Substitutes.

BACKGROUND: Extrathoracic muscle flaps can be used as airway substitutes for the closure of complex bronchopleural or tracheoesophageal fistulas or in the context of tracheocarinal reconstructions after resection for centrally localized tumors in order to alleviate excess anastomotic tension. METHODS: Evaluation of all patients undergoing tracheocarinal reconstructions with extrathoracic muscle flap patches as airway substitutes in our institution from 1996 to 2016. RESULTS: A total of 73 patients underwent tracheocarinal reconstructions using extrathoracic muscle flap patches as airway substitutes for the closure of bronchopleural fistulas (n = 17) and complex tracheoesophageal fistulas (n = 7), or in the context of airway reconstructions after carinal resections in combination with pneumonectomy/sleeve lobectomy for centrally localized lung tumors (n = 36) and noncircumferential tracheal resections for tracheal disease processes (n = 14). The size of airway defects replaced by muscle patches ranged from 2 × 2 to 8 × 4 cm and was at most 40% of the airway circumference. The postoperative 90-day mortality was 8.2% and was only observed after right-sided pneumonectomy. Complications at the airway reconstruction site occurred in 8 patients (10%): 4 airway dehiscence (5%) with uneventful healing after reoperation (n = 2) or temporary stenting (n = 2) and 4 airway stenosis (5%) that required repeated bronchoscopy and stenting. Overall, 63 of 67 surviving patients (94%) revealed intact airways without further bronchoscopic interventions or tracheal appliance during follow-up. CONCLUSIONS: Extrathoracic muscle flaps used as airway substitutes are an interesting and sometimes life-saving option to close difficult tracheocarinal airway defects or to reduce anastomotic tension in the context of complex tracheocarinal surgeries.

Vacuum-assisted closure device for the management of infected postpneumonectomy chest cavities.

BACKGROUND: Infected postpneumonectomy chest cavities may be related to chronic postpneumonectomy empyema or arise in rare situations of necrotizing pneumonia with complete lung destruction where pneumonectomy and pleural debridement are required. We evaluated the safety and efficacy of an intrathoracic vacuum-assisted closure device (VAC) for the treatment of infected postpneumonectomy chest cavities. METHOD: A retrospective single institution review of all patients with infected postpneumonectomy chest cavities treated by VAC between 2005 and 2013. Patients underwent surgical debridement of the thoracic cavity, muscle flap closure of the bronchial stump when a fistula was present, and repeated intrathoracic VAC dressings until granulation tissue covered the entire chest cavity. After this, the cavity was obliterated by a Clagett procedure and closed. RESULTS: Twenty-one patients (14 men and 7 women) underwent VAC treatment of their infected postpneumonectomy chest cavity. Twelve patients presented with a chronic postpneumonectomy empyema (10 of them with a bronchopleural fistula) and 9 patients with an empyema occurring in the context of necrotizing pneumonia treated by pneumonectomy. In-hospital mortality was 23%. The median duration of VAC therapy was 23 days (range, 4-61 days) and the median number of VAC changes per patient was 6 (range, 2-14 days). Infection control and successful chest cavity closure was achieved in all surviving patients. One adverse VAC treatment-related event was identified (5%). CONCLUSIONS: The intrathoracic VAC application is a safe and efficient treatment of infected postpneumonectomy chest cavities and allows the preservation of chest wall integrity.