How accurate is computer-assisted mandible gunshot wound management by patient-specific distraction device? Preoperative planning versus postoperative outcomes.

Gunshot wounds of the lower face are a challenge for the surgeon. Customized distraction osteogenesis (DO) is a well-established procedure for managing facial gunshot wounds. However, differences between the preoperative planning and postoperative outcomes are often noted. This multi-centre, retrospective study was performed to analyse the differences between the planning and outcomes for the lower third of the face, in patients undergoing the computer-assisted repair of mandible gunshot wounds using patient-specific distraction devices. Different planes and points were defined, and two distances (anteroposterior and intercondylar lengths) and an angle (inter-mandible body angle) were measured on the preoperative planning models and the postoperative models obtained from the computed tomography data. Twelve patient cases that met the study eligibility criteria were included. A significant difference between the planning and postoperative outcome was found for the anteroposterior length (6.6 mm shorter than the preoperative planning; P = 0.003). The differences in intercondylar length (P = 0.116) and inter-mandible body angle (P = 0.121) were not significant. This study revealed a difference between the planning and outcomes. Various factors such as scar tissue and muscle forces limit distraction and therefore lead to under-correction with insufficient projection.

Risk factors for lower border notching after bilateral mandibular sagittal ramus advancement: three-dimensional evaluation.

Bilateral sagittal split osteotomy (BSSO) mandibular advancement can cause mandibular lower border notching (MLBN). The objective of this study was to calculate the incidence of MLBN and identify risk factors. This single-centre, retrospective study was performed between January 2018 and November 2020, in the Maxillofacial Surgery Department, Centre Hospitalier Universitaire, Caen. Patients who underwent BSSO advancement and had cone beam computed tomography (CBCT) scans obtained preoperatively, immediately postoperative (within 1 week), and late postoperative (≥1 year) were included. Measurements were made on the CBCT images. A total of 113 patients (226 operated sides) were enrolled. Mean age at the time of surgery was 17 years; 66.4% of patients were female and 33.6% were male. MLBN was observed on 35 operated sides (15.5% of sides). Advanced age (P = 0.002) and the degree of mandibular advancement (P = 0.008) were determined to be risk factors for developing MLBN. Sex, the operated side, third molar removal, and genioplasty were not associated with an increased occurrence of MLBN. Older patient age at the time of surgery and the requirement for a large advancement should be taken into consideration by the surgeon in order to reduce the risk of MLBN by using a modified BSSO procedure or bone grafting.

Significant decrease of facial cellulitis admissions during COVID-19 lockdown in France: A multicentric comparative study.

During the 2020 coronavirus pandemic, a lockdown was imposed in France during the first wave. An apparent decrease in incidence of cellulitis of odontogenic origin was noticed then. This study aimed to compare the incidence of cellulitis during this extraordinary period with the same period in 2018 and 2019, based on retrospective multicentric data. All maxillofacial surgery departments in French public hospitals were contacted. Responders were asked to include all patients admitted for the surgical drainage of a head and neck abscess of odontogenic origin during the first 2020 lockdown period, and in a similar time frame in 2018 and 2019 (control group), based on screening the French diagnostic and therapeutic classification of medical acts. We report a 44% significant nationwide decrease in the incidence of admissions for cellulitis. There were 187 patients in 2020 for 334 and 333 patients in 2018/2019 respectively. The reasons to explain this finding are hypothetical (organizational reasons leading to earlier management, patients' fear to seek for medical management, usual excess in surgical indications or concomitant decrease of non-steroidal anti-inflammatory drugs delivery). Whatever the explanation, it would be of great interest to find it out in order to improve the prevention of cellulitis.

Impact of the COVID-19 lockdown on the epidemiology of maxillofacial trauma activity: a French multicentre comparative study.

The coronavirus disease 2019 (COVID-19) outbreak has had a major impact on medical and surgical activities. A decline in facial trauma incidence was noticed during the lockdown period. The aim of this study was to evaluate the decline in maxillofacial trauma in France during this particular period. A retrospective multicentre comparative study was initiated in 13 major French public hospital centres. The incidence of facial trauma requiring surgery during the first month of lockdown was compared to that during equivalent periods in 2018 and 2019. Differences in the types of trauma were also analysed. Thirteen maxillofacial departments participated in the study. A significant decline in maxillofacial trauma volumes was observed when compared to equivalent periods in 2018 and 2019 (106 patients compared to 318 and 296 patients, respectively), with an average reduction of 65.5% (P=0.00087). The proportion of trauma due to sports and leisure was reduced when compared to reports in the literature. As a consequence, in the context of a pandemic, the material and human resources related to this activity could be reallocated to the management of other pathologies that cannot be postponed.

The benefit of bilateral inferior alveolar nerve block in managing postoperative nausea and vomiting (PONV) after mandibular osteotomy.

INTRODUCTION: The purpose of our study was to evaluate the benefit of bilateral inferior alveolar nerve block (BIANB) in managing postoperative pain, nausea and vomiting and opioid and antiemetic consumption in mandibular osteotomy. MATERIAL AND METHODS: 51 patients operated for bilateral sagittal split osteotomy (BSSO) were included in this prospective randomized controlled, double-blind, superiority trial. In the first group (n = 25), standard protocol was applied (general anesthesia and postoperative multimodal analgesia). The second group (n = 26) received bilateral inferior alveolar nerve block anesthesia at the start of surgery in addition to routine protocol. Postoperative monitoring was conducted every 4 h over the first 24 h and targeted the following criteria: postoperative nausea and vomiting (PONV), the visual analog scale (VAS) for pain, consumption of morphine (cumulative dose) and antiemetic agents, need for removal of guiding elastics. RESULTS: PONV was significantly lower in the BIANB group (15.4 % VS 40 %, p = 0.049), as were mean VAS scores for pain (1 VS 1.57, p = 0.045) and medians of morphine bolus (8 [6-16] VS 5.5 [1-8], p = 0.033). We found no significant difference in incidence of guiding elastic removal, and antiemetic consumption. DISCUSSION: The use of BIANB in BSSO improved postoperative patient comfort in terms of PONV and pain. Furthermore, it led to a decrease in opioid consumption. In conclusion, it is an additional therapeutic means of improving patients' postoperative comfort.

Repair of gauge earlobe medium defect.

Defects due to earlobe gauging are becoming more and more frequent. Many techniques have been described to repair major defects but very few papers exist about medium defects. The aim of this article is to describe a simple surgical technique to repair medium deformations, based on two opposite crescents on the anterior and posterior sides of the earlobe. It gives a harmonious result to the overall shape of the earlobes with a natural curve along the inferior border which is the most difficult part of this surgery.

Alveolar distraction osteogenesis of a fibula free flap in maxillary reconstruction.

In maxillary reconstruction, it is challenging to obtain satisfactory maxillary projection and to optimizate the dental implant-prosthetic rehabilitation. We report a case of sagittal distraction of a fibula free flap used to reconstruct maxilla after a ballistic trauma. Distraction began seven days after implantation of the device. The distraction protocol was 0.9mm per day during a total period of 2 months. Cone beam computed tomography acquisitions were performed at 3 months after the end of the distraction. The distractor device was removed 5 months after the end of the distraction protocol to allow bone consolidation. A satisfactory total distraction of 7mm was obtained with an esthetic variation of the projection of the upper lip and closure of the nasolabial angle.

[Palato velar fistulae in cleft palate]. / La fistule palatine ou vélaire dans les fentes.

Palatal fistulas after primary closure of a cleft palate are extremely variable ranging from 15 to 35%. When they are symptomatic, these fistulas affect feeding (nasal regurgitation to liquids, discharge, bad smells) and phonation (hypernasality that can hinder the precise assessment of velar incompetence). First of all, it is important to analyze the cause of the fistula, it helps to avoid early recurrences. The correction must apply to respect the 2 mucosal planes (nasal mucosa and oral mucosa), the only guarantee of surgical success. Different techniques are usually described: lingual flap, lifting of all palatal mucosa, flap hinge, blaster, FAMM. In all cases, postoperative care plays a key role in the success of the surgical correction.

The significance of computer-assisted surgery in avoiding double-barrel fibula grafts in reconstruction of the horizontal mandibular ramus.

It is recognized that the mandibular reconstruction with free flap allows for both functional and aesthetic restoration. The flap must be used for reconstruction of a smooth lower mandibular contour and also the alveolar bone to allow dental rehabilitation. The double-barrel fibula free flap does respond well to these imperatives, but it increases risk of vascular complications. To overcome these risks, we propose a single-barrel fibula free flap, positioned at the alveolar level and a customized 3D implant, designed by computer-assisted surgery, at the basilar level. The interest of the single-barrel fibula associated with a customized 3D implant compared to the double-barrel fibula free flap is twofold: it decreases the vascular risks associated with the plication of the second pedicle and allows patients to have a pedicle of greater length. It also allows them to have a good cortical bone placed in the alveolar bone to rehabilitate the mastication function.

The role of telemedicine in the management of maxillofacial trauma in emergency departments - preliminary results.

New technologies have over the past forty years become widespread across all domains of basic and applied research particularly in health-related fields. Telemedicine is a form of remote medical practice using information and communication technologies. It connects one or more health professionals with other health professionals or with patients. Within the framework of emergencies in maxillofacial surgery, requests received for specialist advice often pertain to procedures to be followed for facial wounds, bites, burns, maxillofacial bone trauma or facial cellulitis. These requests for specialist advice were previously made by phone between emergency physicians and maxillofacial specialists, with exchange of patient photos by text messaging, which raised security issues. We collaborated with the Telehealth Normandy Health Cooperation Group (GCS TSBN) for the implementation of a mobile application using the "Therap-e" telemedicine platform. This platform links together websites and remote health professionals via the Internet. Physicians communicate over a mobile network or from a health institution, in online or offline mode, synchronously or asynchronously, using any medium (tablet, PC, Mac, smartphone). This scheme both ensures secure transmission of personal and clinical data (especially facial photographs) and records specialist advice in patient medical records. The purpose of tele-expertise applications in an emergency context is to provide a solution to the demographic problems facing healthcare professionals and to rise to the growing challenges surrounding quality and security issues.

Management of nasopharyngeal teratomas associated with cleft palate.

Nasopharyngeal teratomas are rare tumours, responsible for a high birth mortality rate from acute respiratory distress. Palatine localization can lead to an embryopathogenic mechanical obstacle responsible for a cleft palate. The aim of this study was to update current knowledge concerning the management of this rare pathological association. We conducted a multicentre, retrospective study by case analysis. The inclusion criteria were patients of any age under care for a nasopharyngeal teratoma associated with a velopalatine cleft. The diagnosis of the teratoma was confirmed by histological analysis. Seven cases were included in the study: three cases from the University Hospital of Lille, one from the University Hospital of Caen, one from of the University Hospital of Toulouse, and two from of the University Hospital of Amiens. Approximately 30% of patients experienced acute respiratory distress at birth, necessitating oro- or nasotracheal intubation. The surgical excision was performed in the first 5 months of life for all patients and in a single operative time for 70%. There was no recurrence. Therapeutic management of nasopharyngeal teratomas associated with cleft palate at birth is multidisciplinary and is based on surgical excision. In the absence of other associated pathologies, the prognosis is favourable.

Management of patients with sickle cell disease in oral surgery. Literature review and update.

Sickle cell disease, the most common genetic disease in the world, is a chronic hemolytic disease that can be complicated by severe vaso-occlusive pain crises resulting in tissue necrosis and even death. Due to its increasing incidence, oral surgeons will inevitably be faced with the management of these patients. To limit the risk of crises, our goal is to share recommendations for the management of sickle cell patients in oral surgery. The vaso-occlusive crises (VOC), heart attacks and chronic anemia endured by these patients cause chronic lesions in various organs. Complications include retinal disease, avascular necrosis, priapism, neurological involvement (cerebrovascular accident), cardiomyopathy, lower limb ulceration, renal and hepatic dysfunction, and cardiopulmonary disease. These complications inevitably lead to an increase in mortality rate. Thorough knowledge of this pathology is essential for the management of these patients in oral surgery. Management strategies include prevention and diagnosis of oral lesions related to sickle cell disease and its treatment, as well as methods of preparation and execution of oral surgery procedures. We suggest guidelines for the management of these complications and implementation of preoperative, intraoperative and postoperative surgical protocols for both practitioners and patients.

Cholesterol granuloma of the maxilla.

Intra-osseous cholesterol granuloma (CG) is a rare and benign lesion. Very few cases of CG of the jaws have been described in the literature. CG of the jaws seems to be due to the accumulation of cholesterol of hematogenous origin in odontogenic cysts. We report on one case of CG of the maxilla treated by surgical enucleation in a 46-year-old man who presented an asymptomatic swelling of the maxilla.

A rare location for a common tumor: Lingual lipoma.

Lipomas are the most common benign tumors in human body but their occurrence in the oral cavity is very rare. They present as a slow growing, yellowish submucosal and painless mass. The treatment consists of a simple surgical excision. The histopathologic examination confirms the diagnosis. We present a case of tongue lipoma.

Tessier number 4 bilateral craniofacial cleft associated with amniotic band syndrome: 22 years of follow-up.

Tessier clefts are a very rare entity. Number 4 Tessier cleft is describe like an orbito-facial cleft with trajectory between the lower eyelid and the lip. We report management of a bilateral number 4 Tessier cleft with amniotic band syndrome with 22 years of follow-up. After reviewing literature, we talk about difficulty to manage these kinds of rare Tessier clefts.

Study of the mechanical reliability of an S-shaped adjustable osteosynthesis plate for bilateral sagittal split osteotomies. Study on 15 consecutive cases.

INTRODUCTION: The main challenge during the osteosynthesis of a bilateral sagittal split osteotomy (BSSO) is to take into account the correct position of the condyle. Adjustable plates can be used to fine-tune the final occlusion without changing the osteosynthesis. A new type of adjustable plate is presented in this article. The aim is to assess the mechanical reliability of this system during the surgery and during the healing period, thanks to a preliminary prospective on 15 consecutive cases. MATERIAL AND METHODS: The bridge of the plate studied here has an "S"-shape and can be bent in two different planes. Fifteen patients presenting a maxilla-mandibular disharmony have been operated on with this device. Clinical results were evaluated three months postoperatively and the mechanical reliability of the device was studied prospectively from teleradiographies of 15 patients operated on in our department. RESULTS: This study shows good results, with respect to the mechanical reliability of this S-shaped adjustable plate, three months postoperatively corresponding to the bone-healing period. Radiographic observations did not show any significant displacement at the osteosynthesis site. DISCUSSION: This preliminary study shows the mechanical reliability of this new S-shaped adjustable plate. Its semi-rigid character may allow for certain condyle position adaptability. No plate fracture was reported for this 15 patient series. These encouraging results have to be confirmed on a larger series.

Autologous Adipose Tissue Graft to Treat Hypertensive Leg Ulcer: A Pilot Study.

BACKGROUND: Adipose tissue is an abundant source of mesenchymal stem cells, called adipose-derived stem cells, which have anti-inflammatory and trophic effects to enhance overall tissue repair. OBJECTIVE: To determine the healing effects of autologous adipose tissue graft on hypertensive leg ulcers. METHODS: Prospective pilot study in 1 French dermatology department. Ten patients with a hypertensive leg ulcer were enrolled from April 2013 to June 2015. The primary end point was the wound closure rate at each follow-up visit. The secondary end points were wound characteristics, pain assessment and adverse events. RESULTS: One patient, the only smoker, was lost to follow-up at month 5 (M5). For the 9 non-smokers, wound surfaces constantly and significantly decreased: the median wound closure rate was 73.2% at M3 and 93.1% at M6, p < 0.001. The median wound closure rate of the 10 patients was 63.2% at M3, p < 0.001. Percentages of fibrin and necrosis decreased, granulation tissue increased significantly. Pain rapidly and significantly decreased. No recurrence or adverse event was observed. CONCLUSION: Our data suggest that autologous adipose tissue grafting induces pain relief and promotes wound healing with a good skin quality. Large prospective controlled randomized studies are required to confirm these results.

Cheiloplasty associated to a palatal obturator in a preterm infant with a cleft lip and palate.

INTRODUCTION: Preterm infants are commonly treated by non-invasive ventilation (NIV) and nasal continuous positive airway pressure (CPAP), which are associated with fewer complications than nasotracheal intubation. In preterm infants with a cleft lip and palate, this method of respiratory management is difficult or impossible to perform because of air leakage through the cleft defect. CASE: We report a male infant who was born at 29 weeks of gestation with a left complete unilateral cleft lip and palate. Birth weight was 900 grammes. Because of the cleft, we have any problems to ventile this infant. We decide to close the cleft prematurely on day 17 after multidisciplinary discussion. DISCUSSION: NIV cannot be performed with the usual equipment in very premature infants with a cleft lip and palate because of air leakage through the cleft defect. Very few studies report pre term infant with cleft lip and palate and his difficulties of ventilation. This is the first case reported to perform cheiloplasty on a 900g preterm infant.

[Information quality in general public French-speaking websites dedicated to oral cancer detection]. / Qualité de l'information des sites francophones destinés au public pour le dépistage des cancers oraux.

INTRODUCTION: The goal set by the French highest national authorities in the 2014-2019 Cancer Plan is to "heal more sick persons by promoting early diagnosis through screening". Screening requires information. Nowadays, Internet allows for access to information "in one click". The aim of our study was to evaluate the quality of information found on the Internet. MATERIALS AND METHODS: Several sites dedicated to oral cavity cancer screening were selected on Google. The quality of health information found in these sites was evaluated by the DISCERN questionnaire. The quality of decision support provided by the sites was evaluated by the IPDAS checklist. RESULTS: Twenty-seven sites were selected. The average DISCERN score was 25.1/75 (15/75 to 40/75). Eighteen sites (66.6%) had very poor, 8 sites (29.6%) had poor and 1 site had average information quality. IPDAS scores ranged from 11.1 to 38.1. Eight sites (29.6%) had less than 20%, 14 sites (51.9%) had between 20 and 30% and 5 sites (18.5%) had 30% or more validated criteria. No site achieved the pass mark. DISCUSSION: The quality of general public French-speaking website dedicated to oral cancer detection is very bad. The role of health professionals such as general practitioners and head and neck surgeons, remains essential.