Bulky supernumerary bone of the falx cerebri: case report and literature review.

We present a rare case of ossification of the falx cerebri in a 25-year-old man, discovered incidentally on a craniofacial computed tomodensitometry (CT) scanner. This ossification presented a true cortico-medullary differentiation and pushed aside the right frontal lobe. There was no associated clinical manifestation.

Outpatient management of facial fractures in France: Current state.

Maxillofacial trauma is still very common in France with possible involvement of all face bones. Outpatient surgery is an axis strongly put forward by the public authorities. The aim of this study is to establish a current state in the outpatient management of facial fractures in France in 2019 before COVID infection. A closed and semi-open-ended questionnaire was sent to French hospitals treating facial fractures in order to evaluate current and possible future practices in terms of outpatient and perioperative management. Data extracted from the Program for giving Medical significance to Information Systems (PMSI) thanks to the Agency for Information on Hospital Care (ATIH) were also studied to obtain proportions of outpatient care by department. About the questionnaire 43 replies were received. Nasal fractures were the only type of fracture having a minimum average length of stay below 24hours (12.00±16.65) as well as an actual average length of stay (14.22±24.24). Concerning data extracted from the PMSI, 14510 stays were found. Currently only nasal fractures and zygomatic arch fractures requiring simple reduction without osteosynthesis are performed on an outpatient basis. Mandibular fractures could be performed as an outpatient procedure. Access to the operating room and organizational problems specific to each center are factors that limit the development of outpatient management of these facial fractures. Some incompressible parameters such as the monitoring required following the management of these fractures as well as the patients' comorbidities must be taken into account.

Does the quality of the presentation influence the outcome of a submitted manuscript? A plea for including "How to submit" in medical education.

INTRODUCTION: Our goal was to study the influence of the author's compliance with the Instructions for Authors for a submitted manuscript to a journal, on the final outcome of the submission. MATERIAL AND METHODS: 1200 consecutive submissions to the journal Surgical and Radiologic Anatomy have been evaluated and divided into four groups: A: Accepted, R: Rejected, I + : Instructions for Authors followed, I - : Instructions for Authors not followed. The quantity of manuscripts in the groups was measured and compared through statistical tests. We tried to determine if a specific category of authors was more likely to incorrectly follow the Instructions for Authors by verifying the lists of authors and the tables of contributions of co-authors. 322 (26.83%) manuscripts were accepted, 248 were I + , 74 were I - ; 878 (73.16%) were rejected, 526 were I + ; 352 were I - . RESULTS: The comparisons of the observed values and percentages showed significant differences between the groups. We could not identify a specific type of author associated with non-compliance with the Instructions for Authors. CONCLUSION: Most of the guidelines that have been published concern the preparation of the scientific contents of the manuscript (How to write), but the submission process (How to submit) has rarely been explained. We suggest including the rules of submitting a manuscript in graduate and post-graduate medical education.

Selective laryngeal reinnervation: can rerouting of the thyrohyoid nerve simplify the procedure by avoiding the use of a nerve graft?

PURPOSE: The objective of this study was to record the descriptive and metric anatomical characteristics of the thyrohyoid nerve with the aim of rerouting it in a selective laryngeal reinnervation procedure. METHODS: An anatomical study was performed on ten formalin-embalmed cadavers. The origin of the thyrohyoid nerve and the superior root of the ansa cervicalis, the location of the thyrohyoid nerve ending in the thyrohyoid muscle, and the recurrent laryngeal nerve were established. Then, a rerouting of the thyrohyoid nerve was performed. We measured the length of thyrohyoid nerve, the distance between the thyrohyoid nerve ending and the recurrent laryngeal nerve at the horizontal level of the cricothyroid joint before and after the rerouting, and the distance between the origin of the thyrohyoid nerve and the superior root of the ansa cervicalis. RESULTS: The thyrohyoid nerve was identified on both sides in all the cases. The average length of the thyrohyoid nerve was 27 mm. The end of the thyrohyoid nerve was found in 100% of the cases at the upper outer quarter of the thyrohyoid muscle. After the rerouting, an average reduction of 30% of the distance between the end of the thyroid nerve and the recurrent laryngeal nerve at the horizontal level of the cricothyroid joint was measured. CONCLUSION: The rerouting of the thyrohyoid nerve provided a reduction in the length of the nerve graft in laryngeal reinnervation. Moreover, the constancy of the thyrohyoid nerve and its characteristics make it a valuable anatomical base for laryngeal reinnervation and laryngeal innervated allotransplantation.

Rerouting the internal thoracic pedicle: a novel solution for maxillofacial reconstruction in vessel-depleted situations? A preliminary anatomic study.

PURPOSE: Microsurgical reconstruction in a vessel-depleted neck is a challenge due to the lack of reliable vessels in or nearby the host site. The use of the internal thoracic pedicle (ITP) by rib section or sparring is a limited option due to the small length of the pedicle of some flaps. However, in cardiac surgery, the internal thoracic artery (ITA) is widely used for myocardial revascularization, providing a long and versatile pedicle. We aimed at determining precise anatomical bases for the use of the ITP, approached by sternotomy and rerouted in the neck, as recipient vessels for free-flap facial reconstructions. METHODS: We performed a descriptive single centre anatomical study on 20 formalin-embalmed cadavers. The ITP was harvested on both sides from the emergence of the artery under the brachiocephalic vein to its terminal division. The level reached by the ITP in the cervicofacial area was described. Distal arterial and venous diameters, pedicle length and other parameters were measured. RESULTS: In at least 85% of the cases, the ITP reached the mandibular angle. The mean diameter at the distal extremity for the ITA was 2.36 ± 0.15, and 2.48 ± 0.19 mm for the committing vein. The mean length of the ITP was 177.3 mm. CONCLUSION: Rerouting the ITP towards the cervicofacial area could provide a reliable pedicle for free-flap reconstructions in patients with a vessel-depleted neck but it should be limited to selected patients. This novel solution for situations where current techniques are unfeasible warrants further clinical research.

Retraction force necessary to expose the mandibular neck in Risdon and high cervical anteroparotid transmasseteric approaches: an anatomic comparative study.

PURPOSE: The purpose of this anatomic study was to compare the retraction force necessary to expose the mandibular neck in the Risdon and the high cervical anteroparotid transmasseteric (HAT) approaches. METHODS: An anatomic study was performed on 18 formalin-embalmed cadavers. We performed a Risdon approach on the left side, and an HAT approach on the right side in all the cases. The subjects were placed in a normative frame and the force necessary to maintain a satisfactory exposure of the condyle was measured with a system of cables, pulleys, and mechanical dynamometer. The statistical comparison between the two sides was carried out using the Wilcoxon signed-rank test for paired series. RESULTS: In all the cases, the region of interest was exposed as in the operating room. In the Risdon approach, the mean force was 32 Newtons (4-47). In the HAT approach, the mean force was 19 Newtons (4-33). The difference was statistically significant (p < 0.001). The age, gender, and duration of conservation had no influence on the retraction force. CONCLUSION: In the HAT approach, the retraction of the soft tissues was significantly lower than in the Risdon approach. This study gave an additional explanation to the remarkable safety of the HAT approach. Our results were in favor of the generalization of this technique.

Unilateral complete articulated ossification of the stylohyoid apparatus: case report and review of the literature.

Anatomical variations of the stylohyoid apparatus are frequent. Two types can occur: an elongation of the stylohyoid ligament, from a long styloid process to a complete ossified structure connecting the skull base to the lesser horn of the hyoid bone, or the existence of supernumerary bones in the stylohyoid fibrous matrix, which sometimes resembles phalanges. These variations are in the majority of cases bilateral and symmetrical. The authors report the case of a 43-year-old male patient who presented with an unusual unilateral complete ossification of the stylohyoid apparatus, associated with vertebral and laryngeal calcifications. Original latest generation CT scan and three-dimensional MRI imagery are provided to illustrate this rare case.

Rating of French maxillofacial surgeons on their Google® business account: Current status and reflections for equitable communication.

INTRODUCTION: Online reputation is misattributed in France in academic publications. However, this phenomenon is growing. The objective of this study was to establish an inventory of the e-reputation of French maxillofacial surgeons through the opinions posted on their professional Google® account. MATERIAL AND METHODS: A descriptive study included all the surgeons registered on the list of the French National Medical Council in "maxillofacial surgery and stomatology". Data collection was carried out from February to April 2022. RESULTS: Among the 483 surgeons included, 61.1% had received at least one opinion, the number of per surgeon was 22.2. The average was 4.3/5. Among the 4433 written comments completing the review, 85% were positive. The average response rate of surgeons was 10% and was all the more important as the rating of the opinion was lower. Stomatology (65.3%), aesthetic surgery of the face (15.1%) and orthognathic surgery (14.5%) were the most commented maxillofacial procedures. DISCUSSION: The online image of French maxillofacial surgeons was very positive. However, faced with a defamatory or insulting comment, the surgeon found in an unbalanced situation where he could not respond without risking betraying medical. We recall some common-sense recommendations for managing one's e-reputation and some legislative adjustments for better regulation of these platforms, also considering legal and ethical aspects.

Facial dog bites in children: A public health problem highlighted by COVID-19 lockdown.

BACKGROUND: Stay-at-home injunction during COVID-19 pandemic led to new dynamics in households and increased the risk of domestic accidents involving pets. The aim of the study was to demonstrate an increase of facial dog bites in children during first lockdown period in France, compared to the same period in 2018 and 2019. Secondary objective was to investigate the demographics and circumstances in which dog bites occurred. METHODS: A retrospective multicentric study was conducted nationwide. Patients under 18 years old managed in fifteen oral and maxillofacial surgery departments for a dog bite were included. RESULTS: Eighty-seven patients were included. A significant increase of the number of children managed for facial dog bite was noticed in 2020 (p=0.0005). The male-to-female ratio was significantly reversed in 2020 with more bites in girls than boys (p=0.02). In 2020, children were mostly bitten to cheeks (28.6 %), lips-and-chin region (26.2 %), and eyelids (23.8 %). Severe bites increased in 2020, in comparison with 2018 and 2019. Dog bites occurring while petting or playing significantly increased in 2020 (31 %) (p=0.03). CONCLUSION: The process leading to bites is highly dependent on the balance of dog-owner relationship. This was strongly disrupted during COVID-19 pandemic, resulting in the increase of dog bites in households. Regarding dog bites, face is the most vulnerable area in children. Its injury has lots of esthetic and functional consequences and maxillofacial surgeons have a key role to play in their prevention. Reminders of some of these management and prevention strategies are presented in this article.

Unilateral duplication of the acromioclavicular joint: case report and literature review.

Clavicle duplication is a rare anatomical variation of the scapular belt: only seven cases have been reported in the literature to date, and only one took note of the existence of a duplication of the acromioclavicular joint. Two hypotheses have been proposed to interpret this variation: genetic factors, or trauma occurred in the growth period. Clavicle duplication should not be mistaken for a quite frequent coracoclavicular joint widely described. The authors report the case of a left acromioclavicular joint duplication in a 51-year-old male patient presenting with left shoulder pain. This case was the first of literature providing 3D CT-scan images.

How to adapt orthodontic treatment for a patient with a general pathology? Review of the literature based on six scenarios that challenge the practitioner / Comment adapter le traitement orthodontique chez un patient porteur d'une pathologie générale ? Revue de la littérature à partir de six situations qui questionnent le praticien

Introduction: The democratization of access to orthodontic treatments and the development of orthodontics in adults lead more and more practitioners to take care of patients with various general pathologies. The aim of this literature review was to specify the recommendations governing orthodontic treatment in six specific situations: diabetes, patient at risk of endocarditis, haemophilia, osteopetrosis, epidermolysis bullosa and treatment with growth hormone. Material and Method: A review of the literature was carried out according to the PRISMA method from the PubMed database. The keywords used were, for diabetes: diabetic, diabetus mellitus, for infective endocarditis: endocarditis, for hemophilia : hemophilia, bleeding disorder, for the use of growth hormone: growth hormone, for epidermolysis bullosa: epidermolysis bullosa and for osteopetrosis: osteopetrosis, associated with the request « orthodontic ¼ or « tooth movement ¼. Results and Conclusion: None of these situations constituted an absolute contraindication to orthodontic treatment. However, if surgical procedures with potential for complications were necessary, a compromise should then be discussed in order to provide the best benefit/risk balance for patients.

Introduction: La démocratisation de l'accès aux traitements orthodontiques et le développement de l'orthodontie chez l'adulte amène de plus en plus les praticiens à prendre en charge des patients atteints de pathologies générales diverses. Le but de la présente revue de littérature était de préciser les recommandations encadrant les traitements orthodontiques dans six situations particulières : diabète, patient à risque d'endocardite, hémophilie, ostéopétrose, épidermolyse bulleuse et traitement par l'hormone de croissance. Matériel et méthode: Une revue de la littérature a été réalisée selon la méthode PRISMA à partir de la base de données PubMed. Les mots-clés utilisés étaient, pour le diabète : diabetic, diabetus mellitus, pour l'endocardite infectieuse : endocarditis, pour l'hémophilie : hemophilia, bleeding disorder, pour l'utilisation de l'hormone de croissance : growth hormone, pour les épidermolyses bulleuses : epidermolysis bullosa et pour l'ostéopétrose : osteopetrosis, associés à la requête « orthodontic ¼ ou « tooth movement ¼. Résultats et conclusion: Aucune de ces situations ne constituait une contre-indication absolue à un traitement orthodontique. Toutefois, si des actes chirurgicaux à potentiel de complications étaient nécessaires, un compromis devait alors être discuté afin d'apporter la meilleure balance bénéfice / risque pour les patients.

Management of patients with inherited bleeding disorders in oral surgery: A 13-year experience.

INTRODUCTION: The management of patients with inherited bleeding disorders in oral surgery requires the systematic evaluation of bleeding risk and the setting up of an adequate treatment protocol by the referring haematologist, defining a replacement therapy and a recommended length of hospital stay. The purpose of this study was to determine the bleeding risk associated with oral surgery for each type of inherited bleeding disorder and to evaluate the efficacy of the treatment protocols set up in our tertiary care center. MATERIALS AND METHODS: We included all patients with an inherited bleeding disorder, managed in our oral and maxillofacial surgery department with a treatment protocol set up by our local Haemophilia Treatment Centre for an oral surgical procedure. RESULTS: Between January 2006 and December 2018, 295 treatment protocols were set up for the management of patients with haemorrhagic risk in oral surgical procedures. Of these, 203 were scheduled to take place in our department. A total of 180 oral surgical procedures for 147 patients were included. The incidence of bleeding complications in our study was 4.44% (8 out of 180) with a significantly higher risk in patients with haemophilia, the mean time to onset of bleeding was 11 days. DISCUSSION: The use of a treatment protocol for the management of patients with inherited bleeding disorders in oral surgery seems effective. Our rate of bleeding complications was comparable to data in the literature, and often lower.

Preauricular anteroparotid transmasseteric approach of the mandibular condyle: The natural evolution after cervical dissections? An anatomical feasibility study.

The purpose of this study was to evaluate the reliability and reproducibility of a novel approach for base and neck fractures of the mandible. An anatomical study was conducted on 22 given to Science subjects. A rhytidectomy-like approach was performed, followed by a transmasseteric anteroparotid dissection. Measures were taken of the incision length and bone exposure at every step. The identification of a ramus of the facial nerve during dissection was noted. The subjects were classified according to their facial adiposity. A correlation coefficient was measured between incision length and bone exposure as well as morphotype and bone exposure. Statistical analysis was carried out using the Pearson method for linear correlation, and Chi2 test for further analysis. Adequate condylar exposure was always achieved in the area of interest (i.e. in the main localization of base and neck fractures). There was no correlation between the length of the cranial cutaneous backcut and the bone exposure horizontally (p = 0.3296) or vertically (p = 0.8382). There was no correlation between the total length of the incision and the bone exposure horizontally (p = 0.5171) or vertically (p = 0.8404). There was a significant correlation between the subjects' facial adiposity and the bone exposure horizontally and vertically (p<0.005). This approach allowed adequate bone exposure to the mandible base and neck, with a possible 90° angulation of instruments for optimal bone fixation. The incidence of facial nerve rami identification during dissection was similar to other approaches. The scarring was hidden. These results allowed us to propose this approach in a clinical study.

CT-scan imaging of iron marked chorda tympani nerve: anatomical study and educational perspectives.

The chorda tympani nerve (CTN) is the last collateral branch of the facial nerve in its third intraosseous portion just over the stylomastoid foramen. After a curved course against the medial aspect of the tympanum where it is likely to be injured in middle ear surgery, CTN reaches the lingual nerve in the infratemporal fossa. Knowledge of CTN topographic anatomy is not easily achieved by the students because of the deep location of this thin structure. The aim of this study was to assess the spatial relationships of the CTN in the infratemporal fossa. Therefore, ten nerves were dissected in five fresh cadavers. All the nerves were catheterized with a 3/0 wire. After a meticulous repositioning of surrounding structures, standard X-ray and CT scan examinations were performed with multiplanar acquisitions and three-dimensional surface rendering reconstructions. Ventral projection of the CTN corresponded to the middle of the maxillary sinus. Lateral landmark was the mandibular condyle. The CTN was present and unique in all the dissections. The average length of the nerve, as measured on CT scans, was 31.8 mm (29-34, standard deviation of 1.62); the anastomosis of the CTN to the lingual nerve was located at a mean 24.9 mm below the skull base (24-27, standard deviation of 0.99), approximately in the same horizontal plane as the lower part of the mandibular notch. The acute angle opened dorsally and cranially between CTN and LN measured mean 63.2° (60-65, standard deviation of 1.67). Three-dimensional volumetric reconstructions using surface rendering technique provided realistic educational support at the students' disposal.

Do mandibular miniplates increase the risk of complex fracture in facial trauma recurrence? Case series.

Whether to conserve or remove miniplates, widely used in oral and maxillofacial surgery, has not been agreed on in the literature. Complications such as pain, infection, and screw exposure or loosening have already been largely described. We present the consequences of a trauma recurrence on a mandible with miniplates. The data of 13 patients who had a mandibular fracture previously surgically treated with miniplates (ten mandibular fractures and three mandibular osteotomies) were analysed. All the patients were male; the average age was 32 years (range, 20-64 years). The mechanism of the second trauma was assault in most of the cases. The average time between the first osteosynthesis and the new fracture was 35 months (range, 6-128 months). The fractures occurred at a distance from the miniplates in all the cases except two. No plate fracture was reported. We hypothesised that miniplates reinforced the underlying bone, protecting it from fractures, and transmitted the forces to areas anterior or posterior to the miniplates or to the condyle. Thus, the risk of mandible trauma recurrence should be taken into account in the indication of plate removal, and the biomechanical consequences of the conservation of the miniplates should be studied.

A simple method to locate mandibular foramen: preliminary radiological study.

INTRODUCTION: The position of mandibular foramen is variable at the medial aspect of mandibular ramus. Nevertheless its location is useful for the oral and maxillofacial surgeon in orthognatic surgery, especially in vertical ramus osteotomy (VRO) procedure. The aim of our study is to analyse the position of mandibular foramen in order to provide simple and reliable surgical landmarks. MATERIALS AND METHODS: A radio-anatomical study was undertaken on normal mandibular panoramic X-ray examinations. Precise reproductions were outlined on tracing paper. Original orthonormal landmark was designed using posterior border of the ramus, mandibular incisure and anterior border of the ramus. All these elements are visible in the patient in VRO. Measurements of the position of mandibular foramen in horizontal and vertical dimensions were then performed with a ruler by two independent observers: l (width of mandibular branch), x (distance between posterior border of the ramus and mandibular foramen), h (height of mandibular branch) and y (distance between sigmoid notch and mandibular ramus). x/l and y/h ratios were calculated in order to minimise magnifications and image distortions due to the imaging process. RESULTS: Forty-six panoramic X-rays were analysed, including 24 male and 22 female specimens (sex-ratio 1.1/1) with the mean-age 21 years. In vertical dimension, y/h ratio was distributed on a gaussian mode with a peak around 0.30-0.35, mandibular foramen was located around the midpoint of the inferior two-thirds and the superior third of the ramus, preferentially under this point. In horizontal dimension, x/l ratio observed the same model with a peak around 0.35; mandibular foramen was located around the midpoint of the anterior two-thirds and the posterior third of the ramus, preferentially in front of this point. Mandibular foramen was situated in the ventral and inferior two-thirds of the ramus without difference according to the side, sex or age. DISCUSSION: Posterior and superior thirds of the ramus constitute a "safety zone" where mandibular foramen is unlikely to be found. This area can be used by the oral and maxillofacial surgeon in vertical ramus osteotomy of the mandible with low inferior alveolar nerve morbidity probability.

Open reduction and internal fixation of low subcondylar fractures of mandible through high cervical transmasseteric anteroparotid approach.

PURPOSE: The aim of the present study was to evaluate the functional and radiologic results of low subcondylar fracture fixation with modus TCP plates (Medartis, Basel, Switzerland) using a high cervical transmasseteric anteroparotid approach. MATERIALS AND METHODS: A prospective study was designed, enrolling all minimum-aged 15-year-old echomorphology patients presenting with displaced low subcondylar fracture with occlusion disturbances during a 41-month period. All fractures were fixed with modus TCP plates using high cervical transmasseteric anteroparotid approach. All patients underwent immediate physiotherapy and a 6-week liquid and semiliquid feeding period. Clinical and radiologic examinations were performed at 1 week and 1, 3, and 6 months. A total of 35 patients presenting with 38 fractures were enrolled with a mean follow-up of 17 months. RESULTS: All fractures had healed at 6 months in the correct anatomic position in 73.7%. Occlusion was deemed normal in 80% of the patients. The mandibular movement was normal in 97.1%, with the mouth opening up to 40 mm, mean lateral movement of 11 mm without a difference between the 2 sides, and a mean protrusion of 12 mm. Minimal asymmetry remained in 15.6%. No facial palsy occurred, including no transient facial palsy. Complications consisted of 1 infection and 1 plate fracture requiring surgical revision. CONCLUSIONS: Low subcondylar fracture fixation with modus TCP plates using a high cervical transmasseteric anteroparotid approach is a safe and reproducible procedure providing excellent functional results. This procedure has been routinely performed in our department.