Characterization of the perinatal mandible growth pattern: preliminary results.

PURPOSE: The fetal development of the mandible is nowadays quite understood, and it is already known that craniofacial growth reaches its highest rate during the first 5 years of postnatal life. However, there are very few data focusing on the perinatal period. Thus, the present article is addressing this concern by studying the mandible morphology and its evolution around the birth with a morphometric method. METHODS: Thirty-one mandibles modelled in three dimensions from post-mortem CT-scans were analyzed. This sample was divided into two subgroups composed of, respectively, 15 fetuses (aged from 36 gestational weeks), and 16 infants (aged to 12 postnatal weeks). 17 distances, 3 angles, and 8 thicknesses were measured via the prior set of 14 landmarks, illustrating the whole mandible morphology. RESULTS: Although this methodology may depend on the image reconstruction quality, its reliability was demonstrated with low variability in the results. It highlighted two distinct growth patterns around birth: fetuses mandibles do not significantly evolve during the perinatal period, whereas, from the second postnatal weeks, most of the measurements increased in a homogeneous tendency and in correlation with age. CONCLUSIONS: The protocol developed in this study highlighted the morphologic evolution of the mandible around birth, identifying a different growth pattern from 2 postnatal weeks, probably because of the progressive activation of masticatory muscles and tongue. However, considering the small sample size, these results should be thorough, so identification and management of anatomic abnormalities could eventually be achieved.

[Lifting of the oval face--LOV: technical note]. / Lifting de l'ovale du visage--LOV: note technique.

OBJECTIVE: The authors describe a rejuvenation surgical technic of cervical area ptosis. It is called LOV for "Lifting of the Oval of Visage". LOV is realised under local anaesthesia, lasts about 40 minutes. In this study, post-operative results are evaluated after one year. MATERIAL AND METHODS: retrospective study with anonymous questionnaire measuring patient's satisfaction, operated between january 2011 and december 2011, by the same surgeon in the department. RESULTS: 43/45 questionnaires were analyzed, 40 females (93%) and 3 males (7%). Average age was 56 years, with a range of 51 years to 66 years. Our satisfaction ratings values after surgery were: very good: 32 (74.4%), good: 8 (18.6%), intermediate: 2 (4.6%), unsatisfied: 1 (2.3%), will not undergo LOV again: 1 (2.3%), would not recommend LOV to a friend: 2 (4.6%), recommend LOV to a friend: 37 (86%). The only complication (2.3%) was an unilateral hypoesthesia earlobe. CONCLUSION: LOV is simple and effective. It is a surgical alternative in the treatment of cervical area ptosis. Performed under local anesthesia, this short procedure responds to complaints of patients: safe rejuvenation and natural looking. Since 2008, LOV is performed in our department. Recruitment is most often "word of mouth", as confirmed by 86% of patients who would "recommend it to a friend". In cosmetic procedure, we should always keep in mind "a good result is measured to good patient satisfaction".

Characterization of the very young child's palatal vault growth pattern: how do its size and shape evolve?

AIM: This study aimed to characterise the palatal vault evolution during the first years of life, both in terms of shape and size. MATERIALS: The study sample was composed of 168 healthy children aged less than 4 years. Twenty-one measurements of distances and 6 angles were taken from 7 fixed landmarks set on the palatal vaults 3D surfaces reconstructed from CT-scans. To analyse only the shape evolution, the "sizefree" log-shape ratio of those measurements were computed and the global shape of the palatal vault and their transversal curve were plotted. Statistical analyses were performed to highlight the shape and size differences separately. CONCLUSION: The shape and size evolution of the palatal vault during the first years of life was not only correlated with deciduous dentition development. We assumed that the progressive orofacial muscles activation and tongue movements in the oral cavity may also explain these results as they induced strains on the palatal vault, warping it in various ways.

[Reoperation after orbital decompression for Graves' ophthalmopathy]. / Reprises chirurgicales après décompression orbitaire pour ophtalmopathie dysthyroïdienne.

INTRODUCTION: The aim of our study was to report the incidence of complications requiring early or late reoperation after bone and fat orbital decompression for Graves's ophthalmopathy. PATIENTS AND METHOD: We conducted a retrospective bicentric study in the Maxillofacial Surgery Departments of Marseille and Lyon. Ninety patients were selected from 2006 to 2010, accounting for 168 orbital decompressions. The surgical indication was morphological and functional for all patients. Several surgical techniques were used: bone and fat orbital decompression by trans-palpebral resection, two or three wall orbital decompression, malar valgization. RESULTS: Ten patients were reoperated for 12 revisions, two patients needed two revisions. There were four early revisions for two retro-orbital hematoma, one inadequate orbital decompression with persistent posterior compressive optic neuropathy, and one recurrent maxillary sinusitis with proptosis. The other eight revisions were carried out later for three cases of insufficient correction, four cases of proptosis relapse, and one for excessive correction with enophthalmos. All patients had satisfactory morphological and functional results despite revision surgery. DISCUSSION: Most reoperations are difficult to anticipate and their prevention is based on more or less specific recommendations. Patients should be informed of the risks and benefits and accept the possibility of reoperation. A systematic multidisciplinary consultation would standardize and improve the management of these patients, by detecting patients at risk of complications and thus reoperation.

[PEEK customized implant for skull esthetic reconstruction]. / Reconstruction esthétique de la voûte crânienne par implant sur mesure en PEEK.

INTRODUCTION: Craniotomies provide unsightly sequels. Conservative methods for the removed bone, autologous graft, or use of surgical cement do not always allow restoring cranial symmetry. A customized PolyEtherEtherKetone (PEEK) implant may then be used. This implant is made from 3D CT reconstruction. The PEEK material is biocompatible, conformable, strong enough to protect the brain. TECHNICAL NOTE: The authors report a case of aesthetic reconstruction of a large cranial defect using a customized PEEK implant. Balloon scalp expansion was performed before implant placement. DISCUSSION: The aesthetic results are satisfactory, the postoperative short and simple. PEEK is a good alternative to titanium implants for customized implants; it is easier to use and lighter. This customized implant is well suited to correct unsightly sequels of craniotomy.

[Vade mecum for a surgical humanitarian mission]. / Vade-mecum du chirurgien en mission humanitaire.

Humanitarian surgical missions provide cares in developing countries and in difficult conditions. Preparation of these missions is a mandatory step for both technical and human points of view. Before the departure, care must be taken to accomplish all the administrative (visa application, valid passport…) and the medical formalities (mandatory and recommended vaccinations). The aim of this article is to present a helpful vade mecum allowing any surgeon, especially the juniors, to prepare a humanitarian mission abroad.

Integrated silicon-based nanoplasmonic sensor.

The concept of an integrated nanoplasmonic sensor implemented on a silicon substrate is presented. Developed experimental setup based on rotation of linearly polarized light provides intensity detection between two orthogonal polarizations of a He-Ne laser beam. This optical configuration yields to a sensitivity improvement and noise reduction, resulting in a resolution of 4x10(-5) Refractive Index Units. Proposed methodology is promising for the application in portable nanoplasmonic multisensing and imaging.

Intensity based surface plasmon resonance sensor using a nanohole rectangular array.

We show high resolution measurements of a surface plasmon resonance (SPR) sensor based on a rectangular nanohole array in a metal film. This SPR setup uses balanced intensity detection between two orthogonal polarizations of a He-Ne laser beam, which allows for sensitivity improvement, noise reduction and rejection of any uncorrelated variation in the intensity signal. A bulk sensitivity resolution of 6.4 x 10(-6) RIU is demonstrated. The proposed methodology is promising for applications in portable nanoplasmonic multisensing and imaging.

[Tooth abscess: management in the field]. / Abcès dentaires: diagnostic et prise en charge sur le terrain.

Tooth abscess can be diagnosed based solely on clinical findings. No additional studies are required. Abscess can be treated using a few basic instruments.

[The tongue flap in palatal defect reconstruction]. / Le lambeau de langue dans la reconstruction des pertes de substances du palais.

INTRODUCTION: A palatal defect with bucconasal fistula often follows exeresis of palatal tumors. It cannot be directly sutured. Several techniques have been used to cure such defects: palatal obturator, free, or local flaps. TECHNICAL NOTE: The tongue pediculated flap is an easy, safe, and reliable surgical option to reconstruct palatal defects. The tongue flap is a double-layer muscular and mucosal flap that requires two surgeries. During the first, the flap is harvested on the tongue and partially sutured on the anterior portion of the palatal defect. During the second, the pedicle is freed from the tongue and sutured to the posterior portion of the palatal defect. Between these two surgeries the patient is fed through a nasogastric tube. DISCUSSION: The tongue flap is easy and reproducible. It can be recommended in mediopalatal defects after cancer palatal surgery. Its esthetical and functional results are excellent. It is an alternative to palatal obturator, which are not well tolerated in the long run. Similar but uneven results are obtained with free flaps. Free flaps do not require a second surgery but are more difficult to implement in developing countries.

Preliminary results on the impact of simultaneous palatal expansion and mandibular advancement on the respiratory status recorded during sleep in OSAS children.

INTRODUCTION: The study aimed to evaluate the evolution of the respiratory status during sleep of OSAS children treated with a custom-made device combining maxillary expansion and mandibular advancement. MATERIAL AND METHODS: Sleep studies were performed before and after the treatment for 103 children presenting an initial OSAS and Class II malocclusion. Sleep questionnaires were also addressed to parents several years after the end of the treatment to evaluate its long-term effects. RESULTS: After nine months of treatment, the sleep breathing quality significantly improved: the Apnea/Hypopnea Index systematically decreased ≤5. According to the sleep questionnaires results, 84% of the patients did not show any loud or troubled breathing several years after the end of the treatment. DISCUSSION: Simultaneous maxillary expansion and mandibular advancement induced an increase of the oral space in the three spatial dimensions, helping in the significant improvement of the OSAS symptoms, with long-terms effects on the sleep breathing quality.

[Mandible dislocation: diagnosis and reduction technique "in the field"]. / La luxation de mandibule: diagnostic et technique de "réduction sur le terrain".

Diagnosis of temporomandibular joint dislocation can be achieved based on clinical findings. No complementary studies are required. Reduction can be performed without specific equipment in remote areas.

[Medical and dental digital photography. Choosing a cheap and user-friendly camera]. / Photographie numérique médicale et dentaire. Le choix d'un appareil photo simple et économique.

INTRODUCTION: Digital photography is more and more important in our everyday medical practice. Patient data, medico-legal proof, remote diagnosis, forums, and medical publications are some of the applications of digital photography in medical and dental fields. A lot of small, light, and cheap cameras are on the market. The main issue is to obtain good, reproducible, cheap, and easy-to-shoot pictures. TECHNICAL NOTE: Every medical situation, portrait in esthetic surgery, skin photography in dermatology, X-ray pictures or intra-oral pictures, for example, has its own requirements. For these reasons, we have tried to find an "ideal" compact digital camera. The Sony DSC-T90 (and its T900 counterpart with a wider screen) seems a good choice. Its small size makes it usable in every situation and its price is low. An external light source and a free photo software (XnView((R))) can be useful complementary tools. The main adjustments and expected results are discussed.

Facial pressure ulcers in COVID-19 patients undergoing prone positioning: How to prevent an underestimated epidemic?

Prone positioning is an adjuvant therapy used to treat COVID-19 pneumonia complicated by acute respiratory distress syndrome. However, prolonged pressure on facial skin at the level of the bony structures may be responsible for facial pressure ulcers. In the context of severe COVID-19 pneumonia, we hypothesized that hypoxemia, microvascular injury and thrombosis can increase the risk of pressure ulcers. We described two cases in order to emphasize the risk of facial pressure ulcers as a result of prone positioning, so as to discuss their physiopathology and highlight the importance of appropriate preventive measures.

[Transverse maxillary deficiency: interest in the management of chronic nasal obstruction]. / Disjonction intermaxillaire : intérêt dans la prise en charge de l'obstruction nasale chronique.

OBJECTIVES: To describe the surgical orthodontic technique of correcting transverse maxillary deficiency associated with nasal obstruction and malocclusion. SURGICAL PROCEDURE: The surgical-orthodontic correction of transverse maxillary deficiency consists in an incomplete Le Fort I procedure, without down-fracture, associated with a sagittal palatal osteotomy. This procedure is called SARE (Surgically Assisted Rapid Expansion). A pre-fabricated orthodontic appliance is cemented to premolars and molars prior to the surgical procedure. The patient activates the appliance allowing a 1 mm widening a day up to 10 mm. A stabilisation phase is mandatory to avoid early relapse of the correction. This phase involves ossification of the midline osteotomy site. RESULTS: A 22 year old female consulted for a chronic nasal obstruction. Previous treatments, medical and surgical (septoplasty) did not improve her symptoms. She presented with a typical transverse maxillary hypoplasia. She underwent a surgery with the technique described above. Nasal patency improvement was noted on the first post-operative day. This was confirmed by comparing pre and post-operative rhinomanometry. An orthodontic treatment followed for several months to stabilize the result. DISCUSSION AND CONCLUSION: Main advantages of this surgical intervention are to correct both the dental malocclusion and the nasal obstruction by widening the nasal floor and the maxillary arch. Post-operative period is mostly uneventful. It can take up to six months to achieve a good result that is why a strong collaboration has to exist between the surgeon, the orthodontist and the patient.

Finite element analysis of the human orbit. Behavior of titanium mesh for orbital floor reconstruction in case of trauma recurrence.

INTRODUCTION: The authors' main purpose was to simulate the behavior of a titanium mesh implant (TMI) used to reconstruct the orbital floor under the stress of a blunt trauma. MATERIALS AND METHODS: The orbital floor of a previously validated finite element model (FEM) of the human orbit was numerically fractured and reconstructed by a simplified TMI. Data from a CT scan of the head were computed with MICMICS (Materialise, Louvain, Belgium) software to re-create the skull's geometry. The meshing production, the model's properties management and the simulations of blunt traumas of the orbit were conducted on HYPERWORKS® software (Altair Engineering, Detroit, MI, USA). Some of the elements of the orbital floor were selected and removed to model the fracture; these elements were duplicated, their characteristics being changed by those of titanium to create a TMI covering this fracture. A 3D FEM composed of 640,000 elements was used to perform 21 blunt trauma simulations on the reconstructed orbit. RESULTS: In 90.4% (19/21) of the tests conducted, the TMI, whether free from any bony attachment or screwed to the orbital rim, has tended to move in the orbit and/or to deform. DISCUSSION: In the event of traumatic recurrence, which is not rare, TMIs may deform in a "blow-in" motion and threaten intra-orbital structures.

Development and validation of an optimized finite element model of the human orbit.

INTRODUCTION: The authors' main purpose was to develop a detailed finite element model (FEM) of the human orbit and to validate it by analyzing its behavior under the stress of blunt traumas. MATERIALS AND METHODS: A pre-existing 3D FEM of a human head was modified and used in this study. Modifications took into account preliminary research carried out on PubMed database. Data from a CT scan of the head were computed with Mimics® software to re-create the skull geometry. The mesh production, the model's properties and the simulations of blunt orbital traumas were conducted on Hyperworks® software. RESULTS: The resulting 3D FEM was composed of 640 000 elements and was used to perform blunt trauma simulations on an intact orbit. A total of 27 tests were simulated. Fifteen tests were realized with a metallic cylinder impactor; 12 tests simulated a hit by a closed fist. In all the tests conducted (27/27), the orbital floor was fractured. Fracture patterns were similar to those found in real clinical situations according to the buckling and hydraulic theories of orbital floor fractures. DISCUSSION: The similitude between the fracture patterns produced on the model and those observed in vivo allows for a validation of the model. This model constitutes, at the authors knowledge, the most sophisticated one ever developed.

Retrograde approach for parotid benign tumours: A review.

INTRODUCTION: Parotidectomy for benign tumours is usually performed after facial nerve trunk discovery through an anterograde approach (AA) of the nerve. More recently, a retrograde approach (RA) toward the facial nerve, which begins on the facial nerve branches and ends on the nerve trunk, has been described. A literature review of the RA was conducted to evaluate the RA and to compare it with AA. METHODS: A literature review was conducted for the years 1980 through 2016. Nine studies out of 216 were included, including 558 parotidectomies and 370 RA. We studied the operative time (OT), the postoperative complications including facial paralysis (FP), tumour recurrences, and possibilities for reoperation. RESULTS: Operative time was shorter in RA than in AA. Transitory FP significantly less frequent in RA than in AA in only one studies and not significantly in four studies. Incidence of Frey syndrome was similar in RA and AA. Tumour relapses were reported in 1.8% of cases with RA, comparable to AA. CONCLUSION: Retrograde parotidectomy is recommendable. OT was significantly shorter for the RA. The FP rate was lower for RA than for AA, but the difference was not significant. The recurrence rate appeared to be similar between RA and AA. Possibilities of reoperation were better after RA.

Hooliganism and maxillofacial trauma: The surgeon should be warned.

INTRODUCTION: With more than 270 million spectators, football - or soccer - is the most popular sport in the world. International football events generate many risky situations, including hooliganism and are an opportunity to analyze the incidence and the particularities of associated trauma. We sought to underline the potential rapid and brutal increase in maxillofacial trauma during a world-class competition. MATERIAL AND METHODS: A retrospective multicenter study of the epidemiology of maxillofacial traumas during the UEFA 2016 Cup was conducted. All the medical data from each UEFA 2016 World Cup matches from 10 June 2016 to 10 July 2016 were collected. Only the maxillofacial traumas requiring a surgery under general anesthesia and a hospitalization were included. RESULTS: 11 patients from 3 different cities were included. The main etiology was interpersonal violence (7/11), followed by road accidents (3/11). Open reduction with internal fixation of a mandibular fracture was the most performed surgery (9/11). Patients were 18 to 50 year-old, with an average age of 30.6 years. DISCUSSION: This study underlines the violence of riots between "ultra" supporters during the 2016 UEFA cup. We noticed an upsurge of maxillofacial trauma severe enough to require a surgery under general anesthesia. Hooligan behaviors should be known by every practitioner dealing with trauma care, and may requires transitional adjustment of public health policy.