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.

Modified technique used for sagittal splitting of the mandible.

Sagittal osteotomy of the mandible is the most common orthognathic surgery procedure. The drawbacks of this technique are: nerve disturbance, the common formations of a pre-angular notch after mandibular advancement, and the impossibility of lowering the mandibular angle bicortically. The goal of the described technique is to maintain the basal mandibular edge and the internal valve in one single piece. This split prevents unsightly notches appearing after mandibular advancement and it moves down the mandibular angle during counterclockwise rotation and does not increase the intergonial distance. It is especially indicated for skeletal class II cases.

Are postoperative intravenous antibiotics necessary after bimaxillary orthognathic surgery? A prospective, randomized, double-blind, placebo-controlled clinical trial.

Postoperative antibiotic prophylaxis is often administered intravenously, despite an increased morbidity rate compared with oral application. This study investigates whether a postoperative oral antibiotic regimen is as effective as incorporation of intravenous antibiotics after bimaxillary orthognathic surgery. 42 patients who underwent bimaxillary orthognathic surgery between December 2008 and May 2010 were randomly allocated to 2 placebo-controlled postoperative antibiotic prophylaxis groups. Group 1 received oral amoxicillin 500mg three times daily; group 2 received intravenous ampicillin 1g four times daily, during the first two postoperative days. Both groups subsequently took oral amoxicillin for three more days. Clinically, the infection rate was assessed in both study groups for a period of 6 weeks after the surgery. 9 patients (21.4%) developed infection. No adverse drug event was detected. No significant difference (p=0.45) was detected in the infection rate between group 1 (3/21) and group 2 (6/21). Age, type of surgical procedures, duration of the operative procedure, surgical procedure-related events, blood loss, and blood transfusion were all found not related to infection (p>0.05). Administration of more cost-effective oral antibiotic prophylaxis, which causes less comorbidity, can be considered to be safe in bimaxillary orthognathic surgery with segmentalizations.