Exclusive Functional Treatment for Mandibular Condylar Fractures.

PURPOSE: Despite the frequency of condylar fractures, no consensus has been reached regarding treatment alternatives (ie, operative vs nonoperative). The purpose of the present study was to describe functional treatment without intermaxillary fixation of condylar fractures and summarize the treatment outcomes. PATIENTS AND METHODS: We designed a retrospective case series and enrolled patients with condylar fractures with malocclusion. The primary outcome was treatment success, assessed at the end of 6 weeks. We recorded 5 parameters to assess treatment success, including a stable return to the initial occlusion, lateral excursion of more than 7 mm, centered protrusion of more than 4 mm, centered mouth opening of more than 35 mm, and painless mandibular mobilization. If all 5 parameters were met, treatment was deemed a success. Treatment failure was defined as meeting less than all 5 parameters. We used numbers and percentages for these nominal qualitative variables (healing criterion absent or present). Two prognostic variables (ie, fracture type and age range), stratified by treatment success, were compared using the Fisher exact test for patients presenting with all healing criteria. RESULTS: We included 30 patients with a median age of 33 years. Of the 30 patients (34 fractures), 15 had low subcondylar fractures (44.1%), 12 had high subcondylar fractures (35.3%), and 7 had head condylar fractures (20.5%). At the last consultation, 21 patients (70%) had exhibited all the criteria defining treatment success. A significant difference was found in the success rate when stratified by age (P = .002) in favor of the younger patients. Also, high subcondylar and head fractures were associated with a better success rate. CONCLUSIONS: Exclusive functional treatment showed promising results and should be considered for cooperative patients, avoiding the risks of surgery and the discomfort with intermaxillary fixation.

Nanofat and Platelet-Rich Plasma injections used in a case of severe acne scars.

BACKGROUND: Acne is a common chronic inflammatory disease, which can result in permanent scarring. Different types of treatments have been used in order to treat acne scars. However, esthetic results have proved variable. Furthermore, none of these treatments has had an impact on the underlying inflammatory process. OBJECTIVE: The main purpose of this case-report is to suggest a new potential therapy for acne scar management combining esthetic filling with an anti-inflammatory and a regenerative action. METHODS: A Platelet rich plasma (PRP) and Nanofat mixture was injected into the pathological dermis in order to treat and fill severe acne scars. RESULTS: After a one- year follow-up, skin elasticity had improved, scar reduction and a reversal of the inflammation process had been observed. CONCLUSIONS: PRP and Nanofat could represent a new and promising therapeutic approach in the treatment of the inflammatory scarring process in severe acne.

Oral and maxillofacial surgery: what are the French specificities?

PURPOSE: Oral and maxillofacial surgery has expanded rapidly over the past century. Recognition in France has grown since the first face transplantation in the world performed by Professor Bernard Devauchelle. This speciality, which seems to correspond to a narrow scope of services, actually involves oral, plastic, reconstructive, and cosmetic surgeries of the face. French training for maxillofacial surgeons differs from the Anglo-Saxon course of study. After examining surveys carried out in Great Britain, the United States, and Brazil, the perception of this speciality in the general public and among regular correspondents (general practitioners and dental practitioners) was ascertained. MATERIALS AND METHODS: More than 4,000 questionnaires were sent to health care workers and patients attending dental practices. The returned questionnaires concerning recognition of this profession in France were analyzed. Evaluating awareness of maxillofacial surgery among practitioners and the public was of particular interest because it can overlap with several other specialities (ear, nose, and throat; plastic surgery; odontology). The questionnaire included the 20 items used in other similar studies so the results could be compared. RESULTS: Several fields of expertise were identified in maxillofacial surgery, in particular traumatology, surgery for facial birth defects, and orthognathic surgery. Moreover, dental practitioners were found to be the most regular correspondents of maxillofacial surgeons compared with general practitioners. Compared with Anglo-Saxon and Brazilian peers, French recognition of maxillofacial surgery was better. CONCLUSION: Despite encouraging results, maxillofacial surgery remains a somewhat obscure speciality for health care workers and the general public. Better awareness is necessary for this speciality to become the reference in facial surgery.

Fat microinfiltration autografting for facial restructuring in HIV patients.

INTRODUCTION: Antiretroviral drugs used to treat HIV infection are closely associated with faciocervical and peripheral lipodystrophies. There are several options for surgical treatment of facial lipodystrophy, one of these was described by S. R. Coleman in 1994, the technique of fat transplantation. MATERIAL AND METHODS: A retrospective study of 23 seropositive patients is presented, who were treated according to Coleman's technique. The surgical procedure was evaluated by clinical and CT analysis. The longest follow-up was 3 years. RESULTS: The technique was well tolerated from both a clinical and psychological point of view. 74% were successful. Multiple fat transplantation procedures were required to obtain a satisfactory result for the remaining patients. No complications were observed. DISCUSSION: Coleman's method is very simple. It is performed without using any biomaterial. There are aesthetic and social benefits for the patients. A limitation of this procedure is that some patients do not have enough fat at the donor site. CONCLUSION: The results of this procedure after a maximum of 3 years postoperatively have been positive. However, there is a need of long-term experience with this method.

[Masticatory apparatus disorder: how can rehabilitation treatment help?] / Dysfonction de l'appareil manducateur : apport de la prise en charge rééducative.

INTRODUCTION: The temporomandibular joint is highly adaptive and masticatory apparatus disorders (MAD) can occur when its ability to adapt is overwhelmed. Occlusal etiologies were long pinpointed as the sole culprits. However, a consensus now exists which minimizes their involvement. It is recognized that the etiology of MAD is multifactorial, combining occlusal problems, parafunctions, postural anomalies, orofacial dyspraxia and stress. MATERIALS AND METHODS: In this article, the authors review the role of physiotherapy in managing these pathologies. RESULTS: While it remains essential to treat the symptoms in order to relieve pain, optimum treatment requires the underlying pathogenic mechanisms to be identified. Rehabilitation treatment, therefore, offers a physiotherapy-based approach providing an etiological solution. By reeducating function, physiotherapy produces lasting results. DISCUSSION: Given the multifactorial nature of MAD etiologies, maxillofacial rehabilitation is an indispensible ally for odontologists or orthodontists adopting a multidisciplinary approach in their treatment of this disorder.