In-Brace versus Out-of-Brace Protocol for Radiographic Follow-Up of Patients with Idiopathic Scoliosis: A Retrospective Study.

The purpose of this retrospective study was to compare two standardized protocols for radiological follow-up (in-brace versus out-of-brace radiographs) to study the rate of curve progression over time in surgically treated idiopathic scoliosis (IS) patients after failed brace treatment. In-brace radiographs have the advantage that proper fit of the brace and in-brace correction can be evaluated. However, detection of progression might theoretically be more difficult. Fifty-one IS patients that underwent surgical treatment after failed brace treatment were included. For 25 patients, follow-up radiographs were taken in-brace. For the other 26 patients, brace treatment was temporarily stopped before out-of-brace follow-up radiographs were taken. Both groups showed significant curve progression compared to baseline after a mean follow-up period of 3.4 years. The protocol with in-brace radiographs was noninferior regarding curve progression rate over time. The estimated monthly Cobb angle progression based on the mixed-effect model was 0.5 degrees in both groups. No interaction effect was found for time, and patients' baseline Cobb angle (p = 0.98), and for time and patients' initial in-brace correction (p = 0.32). The results of this study indicate that with both in-brace and out-of-brace protocols for radiographic follow-up, a similar rate of curve progression can be expected over time in IS patients with failed brace treatment.

A new approach of crenellated fronto-orbital advancement for the management of trigonocephaly: Technical note.

Trigonocephaly is a craniosynostosis characterized by a premature fusion of the metopic suture associating a characteristic triangular head shape, with a frontal medial crest and hypotelorism. Various techniques have been described for its surgical treatment which is usually performed during the first year of life. However, there might be cases with a late referral, after the age of one year. One of the technical issues with a fronto-orbital advancement surgery in a child over one year of age is that there is a significant risk of persistent residual bone defects. This article describes a surgical technique of crenellated fronto-orbital advancement for correcting trigonocephaly in children over one year of age, allowing to reduce residual bone defects.

Emissary veins and pericerebral cerebrospinal fluid in trigonocephaly: do they define a specific subtype?

INTRODUCTION: The premature fusion of the metopic suture may be associated with the presence of emissary veins (EV) and abnormally large pericerebral cerebrospinal fluid (CSF) spaces which suggest an associated focal disturbance in CSF dynamics. The incidence of such findings and their potential significance in terms of management of the disease have not been fully elucidated. The aim of this study is to investigate whether these phenomena identify specific subtypes of trigonocephaly. In such a direction, we evaluated the volume of the pericerebral CSF spaces and their relationship to the morphology ("Ω," "V," or flat type) of the prematurely fused metopic suture and to the value of the interfrontal angle value on the grounds of computed tomographic (CT) scan examinations. METHOD: The preoperative brain CT scans of 74 children (52 boys, 22 girls) with trigonocephaly who had undergone fronto-orbital remodeling were evaluated. The volume of the pericerebral CSF spaces and the value of the interfrontal angle were calculated. The type of intracranial notch was studied and classified according to its shape on the preoperative CT scan: a groove "Ω," a ridge/"V" ridge or absent when flat and evidence of emissary veins related to the abnormally fused suture. RESULTS: Preoperatively, an endocranial metopic groove or ridge was seen in 70% of the children. Emissary veins were identified in 34 of 74 patients (45%), at a mean distance of 2.04 cm (1.18-2.94 cm) from the nasion. The presence of large pericerebral CSF spaces significantly correlated with the presence of EV (p < 0.05), with the "Ω" type (p < 0.05) and with interfrontal angles under 134° (p < 0.005). CONCLUSIONS: Metopic suture early fusion shows an association between EV, pericerebral CSF spaces, and the "Ω" groove appearance of the suture. This association identifies a specific subgroup in which the presence of emissary veins and large pericerebral CSF spaces is an indicator of local venous hypertension due to the sagittal sinus constriction within an osseous groove created by the abnormal suture fusion process. The implications for the surgical management and long-term results as compared to trigonocephalic children with small or absent normal peripheral spaces and EV are still to be determined.

[Neuropsychological consequences of craniosynostosis: Non-syndromic scaphocephaly]. / Le retentissement neuropsychologique de la craniosténose : cas de la scaphocéphalie non syndromique.

BACKGROUND: Scaphocephaly increases the rate of some modifications of cognitive and mood profile in a manner that remains to be elucidated. OBJECTIVE: We aimed to describe the impact of scaphocephaly on neuropsychological profile and more particularly on the executive functions. PATIENTS AND METHODS: An experimental group of 19 children older than 5 years, operated on for scaphocephaly, was compared with a control group of 10 children operated on for trigonocephaly, using IQ tasks, attention tasks and mood scales. A group of 6 children from 2 to 4 years old, operated on for scaphocephaly, and a group of 6 children with non-operated scaphocephaly are also described. RESULTS: Both the experimental group and the control group showed unchanged IQ, whereas attention deficit and anxiety disorder were more frequent in the experimental group. Cognitive profiles differed between groups, with a higher rate of impaired inhibitory control of visual processing in the scaphocephaly group, contrasting with a higher rate of impaired auditory verbal working memory in the trigonocephaly group. Comparable profiles were also found in groups of younger or non-operated children with scaphocephaly. CONCLUSIONS: Many children with scaphocephaly must cope with a specific neuropsychological profile throughout development. This study suggests the interest for these children and their families of specific follow-up in reference centers.

Sagittal suture craniosynostosis or craniosynostoses? The heterogeneity of the most common premature fusion of the cranial sutures.

BACKGROUND: Scaphocephaly is usually defined as the deformation of the skull resulting from the premature fusion of the sagittal suture. It is the most common type of craniosynostosis, and can be easily recognized on simple clinical examination. Its pathophysiology is easy to understand and to confirm on neuroradiological examination. In contrast, surgical indications are still somewhat controversial, the dispute mainly concerning therapeutic versus esthetic objectives. In recent years, however, several studies have challenged these basic and relatively simplistic interpretations of the pathophysiology of the condition. MATERIALS AND METHODS: To assess the heterogeneity of scaphocephaly, we reviewed cases of scaphocephaly operated on at the Hôpital Femme-Mère-Enfant, Lyon University Hospital, France during a 10-year period (2008-2017) and performed a review of the literature on scaphocephaly and sagittal suture closure. RESULTS: During the 10-year period, 401 children were operated on for a scaphocephaly at the Hôpital Femme Mère Enfant, Lyon University Hospital. Mean age at surgery was 1.14 years, for a median 0.7 years (range, 4 months to 8. 5 years). Several subtypes could be distinguished according to morphology, intracranial findings on imaging, patient age, and etiology associated to the sagittal synostosis. Two main surgical techniques were used to correct the malformation, depending on patient age, type of deformation and the surgeon's preference: cranial vault remodeling with occipital pole widening, with the patient in a prone position, and parietal enlargement with or without forehead remodeling, in dorsal decubitus. CONCLUSIONS: The complexity and heterogeneous nature of sagittal synostoses depend on different pathogenic mechanisms leading to and interfering with the skull abnormalities: abnormalities of CSF dynamics, possibly associated with systemic alterations, accounting for the varied postoperative morphological and functional course, in terms of cognitive impairment and late complications (notably intra-cranial pressure elevation). However, the real impact of such heterogeneous clinical presentations on surgical indications and surgical results remains to be elucidated.

[Psychological support for children operated on for craniosynostosis and their family. Some thoughts for the craniofacial surgeon]. / Suivi psychologique des enfants opérés de craniosténoses et de leurs proches. Quelques éléments de réflexions pour le chirurgien craniofacial.

What is the impact on child and family when they receive a diagnosis of craniostenosis? And what is the impact of surgery? What is the role of the clinical psychologist in accompanying the child and family, especially during hospital stay and surgery time? We present a few thoughts that help understand the psychological processes at work in case of craniostenosis, giving a little hint of the impact on the life of the child and family - which surgeons, preoccupied by more technical questions, sometimes tend to overlook.

[Secondary surgeries for facial osteotomies: 10 cases]. / Chirurgies secondaires dans le cadre des ostéotomies de la face : 10 cas.

Orthognathic surgery, now well known to the general public, is becoming increasingly successful. It is the most predictable approach to the treatment of dento-maxillo-facial deformities. As with plastic surgery the number of indications increasing the number of difficult cases follows as well as the searching for perfection. The aim of these treatments must be triple and take into account the functional elements of the face, the dental occlusion and the aesthetic objectives of the patient and therapists. Orthognathic surgery procedures having become quite bearable patients who feel that the result is not up to their requirement easily require a reoperation to achieve their objective. PATIENTS AND METHODS: We studied 10 cases of facial redone osteotomies from 4 different surgeons. We looked at the initial indication, the type of surgery, the initial orofacial functions, the delay of the reoperation, the technique of redo and the result. RESULTS AND DISCUSSION: Like other authors, we found that there are surgeries and at-risk patients. The patients who were re-operated all had at least one of the three negative factors: OSAS, lingual dysfunction, oral ventilation. We have not been able to highlight an overall frequency of surgical resumption in the studied literature which is poor about reoperations after osteotomies of the face.

Alteration of facial growth after radiotherapy: orthodontic, surgical and prosthetic rehabilitation.

Most patients treated in childhood with radiotherapy for head and neck tumors develop craniofacial alterations related to impaired growth of the irradiated regions. These deformities have a significant functional and aesthetic impact, generating physiological and social troubles. The therapeutic solutions are mostly surgical and multidisciplinary. In this article, we describe the orthodontic and surgical care of a teenager treated with radiotherapy for a bilateral retinoblastoma at the age of 8 month and a half. The patient presented growth defects of the middle third of the face. These growth deficiencies are at the origin of significant aesthetic and physical disorders. Moreover, the three-dimensional skeletal abnormalities and the histological changes of these irradiated tissues make surgical management of the cases complex and specific.

[Management of impacted cuspid--July 2015]. / Prise en charge d'une canine incluse--juillet 2015.

The French Society of Stomatology, Oral and Maxillofacial Surgery (SFSCMFCO) together with the Medical Society of Dento-Maxillofacial Orthopedics has drawn up in 2015 a new practice guideline concerning the management of one or several impacted cuspids. As the previous ones, this guideline is based on a rigorous French Heath Regulation Authorities type methodology. It is thus intended to become a major reference in its field. We report hereafter the short version of the text in the same way it has been presented during the 2015 French National Congress of the SFSCMFCO in Lyon - France. Each of these recommendations is marked A, B or C according to a decreasing evidence based rating scale. Lacking any evidence-based data, the recommendation is considered as an expert opinion (AE). The full text of this guideline is available on the website of the SFSCMFCO at the following address: http://www.sfscmfco.fr/; "Recommandations de bonnes pratiques" section. A patient information sheet is also proposed by the working group. Happy reading.

[Orthodontic treatment in children suffering from obstructive sleep apnea]. / Traitement orthodontique chez l'enfant porteur d'un syndrome d'apnées obstructives du sommeil.

The obstructive sleep apnea syndrome (OSAS) may affect children, especially those with dentofacial disharmonies. Dentofacial orthopedic (DFO) treatments carried out in those patients must take this condition into account and can, in selected cases, improve or even treat the OSAS. The goal of our work was to report our experience about DFO treatments of children affected by OSAS in the department of maxillofacial surgery of Femme-Mère-Enfant hospital of university hospitals of Lyon, France.

[Diagnosis and management of ankyloglossia in young children]. / Diagnostic et prise en charge de l'ankyloglossie chez le jeune enfant.

Ankyloglossia is a common condition. Its prevalence is between 3.2% and 4.8% depending on the series and is largely underestimated given the fact of non-diagnosis when the symptoms are limited. It is defined as a short lingual frenulum resulting in a limitation of the lingual mobility. It is due to a defect in cellular apoptosis embryogenesis between the floor of the mouth and tongue. The result is a fibrous and short lingual frenulum. Several classifications were used to make the diagnosis. However, these are the clinical implications, particularly on food and primarily breastfeeding in the baby and phonation in older children that will motivate the management. This is surgical and different techniques are available: infants before the age of 6 months and when the lingual frenulum is still a fine cellular membrane, frenotomy is recommended. Frenectomy with or without frenoplasty is indicated for the older child. The surgery is simple, the results are good and rapidly improving grievances. Complications are rare. Finally, speech therapy is important when there are implications for phonation.

[Implant-borne prosthetic rehabilitation in patients with cleft lip and palate: A retrospective study on 43 patients]. / Réhabilitation implanto-portée des patients porteurs de fentes labio-alvéolo-palatines : étude rétrospective sur 43 patients.

INTRODUCTION: Implant-borne rehabilitation in cleft lip and palate patient are aimed to allow for good orofacial functions, stable occlusion, and adequate support for the naso-labial region. The goal of our study was to evaluate the functional and esthetic results of the implant-born dental rehabilitation of the cleft lip and palate patients in our department. MATERIAL AND METHODS: Our retrospective study concerned patients operated between 1995 and 2010 in our department. All included patients suffered from a cleft alveolus and lip, with or without cleft palate. Dental implants were placed in the bone-grafted alveolus and the end of growth and at distance from the bone graft procedure. Criteria of implant survival and implant-borne rehabilitation success were defined. RESULTS: A total of 78 implants were placed in 43 patients between 1995 and 2010. Two implants were lost (implant survival rate: 97.4%). Despite this loss, all the patients could be rehabilitated with good functional and esthetic results. DISCUSSION: Implant-borne rehabilitation is a reliable solution for prosthetic rehabilitation in patients with cleft lip and palate. This solution allows for avoiding removable prosthesis and dental mutilation.

[Our experience about the use of resorbable plates in the treatment of craniostenosis]. / Notre expérience de l'utilisation des plaques résorbables dans le traitement des craniosténoses.

INTRODUCTION: The use of resorbable plates increases for craniosynostosis surgery. This material, based on polymere (PLA, PGA) can replace steel wire and non resorbable plates. A few studies present surgical results about the use of this material with a long follow-up. We present our ten years experience of using resorbable material for craniosynostosis treatment in children. METHODS: Between 2002 and 2012, we operated 283 craniosynostosis (98 scaphocephalies, 55 trigonocephalies, 79 plagiocephalies et 51 craniofaciostenoses). Among these surgeries, 211 were realized with resorbable material (plates and screws). Different criteria were observed: the esthetic result, the infection rate, the re-intervention, the bone defects and the inflammatory granuloma. RESULTS: Among the 211 craniosynostosis, we found 62 plagiocephalies, 66 scaphocephalies, 50 trigonocephalies, 33 craniofaciostenoses. All the reconstructions were realized with the same resorbable material (Macropore by Medtronic). The rate of complications was low: one scar infection without participation of material for two patients (0.9%), a pseudo-meningocele for two patients (0.9%), epilepsy for four children (1.8%) and bone defect for 15 (7%). We observed no granuloma for these patients. CONCLUSION: Our experience of ten years using resorbable material is very satisfactory. This material permits to realize solid and esthetic reconstructions with a low rate of infection without dangerous reaction for children in young age.

Cranial vault expansion with the split bone flap technique in shunt-related craniosynostosis.

INTRODUCTION: Shunt-related craniosynostosis causing craniocerebral disproportion represents a particular complication of the treatment of hydrocephalus. When the modification of the shunt opening pressure does not improve the symptomatology, surgery for correction of craniocerebral disproportion is indicated. We present the results and advantages of the split bi-frontal bone technique that is a modification of the previous used frontal bone advancement technique. PATIENTS AND METHODS: We retrospectively reviewed 5 patients with iatrogenic craniosynostosis treated in our institution from 1995 to 2012. A splitting bi-frontal bone flap that is left floating posteriorly was performed to increase the cranial volume. RESULTS: All patients were cured. This technique increases the volume of the skull favoring the expansion of the brain and allows good cosmetical results. No perioperative complications were reported. DISCUSSION: The fact that the brain has a more appropriate volume allows the disappearance of the clinical symptomatology related to the split ventricle syndrome. The advantage is the respect of the fronto-orbital shape in children and adults with the same results of the classic frontal advancement in terms of volume expansion. The study of cerebral blood flow confirms the increase of the cerebral blood perfusion and the improvement of the regional cerebral blood flow in borderline regions. We preconize, for the treatment of slit ventricle syndrome, the bi-frontal split technique in children and adults for its efficacy, the low rate of complications and the respect of aesthetical constraints.

[Orthognathic surgery for patients with cleft lip and palate]. / Chirurgie orthognathique dans le cadre des fentes.

Patients with cleft lip and palate frequently develop dento-facial deformity requiring orthognatic surgery. The origin of this deformity is therapeutic and surgeons are currently trying to prevent this iatrogenicity. The maxillary dento-facial deformity in these patients is a retrognathia with infragnathia, associated with endognathia, obliquity of the occlusal plane, with deviation of the superior incisive midline in case of unilateral clefts. The difficulties in the treatment of these skeletal deformities are due to the palatal, labial, and pterygomaxillary scar tissue. Orthognathic surgery is most of the time bimaxillary with a 3-dimensional movement of the jaws including maxillary advancement. The aims of surgery are occlusal, esthetic, and functional improvement. The first step is gingivoperiosteoplasty (ideally performed during childhood), orthodontic treatment including, if necessary, transversal maxillary distraction to obtain enough space to replace the lateral incisor; extraction of premolars should be avoided if possible. Planning and performing the treatment are difficult for the orthodontist and for the surgeon. Maxillary advancement by distraction may be an interesting alternative to prevent partial relapse. Obtaining normal oro-facial functions are required for a stable result. These should be monitored after the primary treatment by the whole staff, surgeons, speech therapist, and orthodontists. Performing Le Fort 1 osteotomy is more difficult than in other patients because of scar fibrosis than needs to be released.

[High oblique sagittal split osteotomy]. / Clivage sagittal oblique court.

INTRODUCTION: Bilateral sagittal split osteotomy has become the standard mandibular surgery for the treatment of dental and facial deformities, even for small ones. The morbidity must be as low as possible. TECHNICAL NOTE: We describe a technique with reduced split surfaces, with an oblique bone section rather than a split. The bone is cut complete, on the posterior edge of the ramus, following an oblique line from above the lingula downward and laterally towards the supra-angular region. DISCUSSION: This section preserves the inferior alveolar nerve. It greatly decreases the risk of neurological sequels. Most mandibular movements are possible except for important advancement and elongation of the ramus.

Hypodontia due to ectodermal dysplasia: rehabilitation with very early dental implants.

INTRODUCTION: Anhidrotic ectodermal dysplasia is a rare disease combining hypodontia, hypotrichosis, and hypohidrosis. The quality of life is greatly impaired very early, with major difficulty for feeding and the drawbacks of usual dental prostheses. Early implant placement is a therapeutic alternative. It is usually performed in areas of stable growth, such as the mandibular symphysis. We report the case of very early implant placement in a child presenting with hypodontia related to ectodermal dysplasia. CASE PRESENTATION: A 6-year-old male patient was treated with maxillary and mandibular implant-borne prosthetic rehabilitation. Five implants were placed in the mandible and seven in the maxilla. The esthetic and functional outcome was satisfactory, improving the quality of life. DISCUSSION: Very early implant-borne prosthetic rehabilitation is an alternative, which could become a first line treatment. It restores oro-facial functions allowing for a better development of maxillo-facial bones. This alternative is not without risks. But is it acceptable to wait until teenage with an inadequate removable prosthesis, because growth is not completed?

[Hypodontia due to ectodermal dysplasia: rehabilitation with very early dental implants]. / Hypodontie d'une dysplasie ectodermique: traitement par implantologie très précoce.

INTRODUCTION: Anhidrotic ectodermal dysplasia is a rare disease combining hypodontia, hypotrichosis, and hypohidrosis. The quality of life is greatly impaired very early, with major difficulty for feeding and drawbacks of usual dental prostheses. Early implant placement is a therapeutic alternative. It is usually performed in areas of stable growth, such as the mandibular symphysis. We report the case of very early implant placement in a child presenting with hypodontia related to ectodermal dysplasia. CASE PRESENTATION: A 6-year-old male patient was treated with maxillary and mandibular implant-borne prosthetic rehabilitation. Five implants were placed in the mandible and seven in the maxilla. The esthetic and functional outcome was satisfactory, improving the quality of life. DISCUSSION: Very early implant-borne prosthetic rehabilitation is an alternative, which could become a first line treatment. It restores oro-facial functions allowing for a better development of maxillo-facial bones. This alternative is not without risks. But is it acceptable to wait until teenage with an inadequate removable prosthesis, because growth is not completed?