Reasons for failure of total temporomandibular joint replacement: a systematic review and meta-analysis.

The aim of this study was to evaluate the revision rate after total alloplastic temporomandibular joint replacement (TMJR) and determine whether there is a higher risk of revision surgery with stock or custom-fitted prostheses (the two most current TMJR prosthesis types). A systematic review was performed, with a search of PubMed, Google Scholar, and the Cochrane Library in November 2020. Overall, 27 articles were included in this study, describing Biomet and TMJ Concepts prostheses and including postoperative data on complications requiring a return to the operating room. A total of 2247 prostheses were analysed: 1350 stock Biomet prostheses and 897 custom-fitted TMJ Concepts and custom-fitted Biomet prostheses. The global revision rate was 1.19 per 100 prosthesis-years. The most common reason for revision was heterotopic bone formation. Stock prostheses appeared to have a lower risk of revision compared to custom prostheses: rate ratio 0.52 (95% confidence interval 0.33-0.81, P-value 0.003). Regarding causes of revision, the only significant difference between the types of devices was a higher rate of heterotopic bone formation for custom-made prostheses (P = 0.001). The results of this study revealed a low revision rate post TMJR revision, with stock devices even less prone to such risk. Nevertheless, these results can be explained by the fact that custom-made prostheses are more likely to be used for cases in which the anatomy is significantly abnormal or there is a history of multiple joint surgeries, which carry a greater risk of complications and heterotopic bone formation.

Posterior auricular artery helix root free flap-part I: radio-anatomical study.

Full-thickness defects of the distal nose are an ongoing surgical challenge. Among the available techniques, pre-auricular chondrocutaneous free flaps based on the superficial temporal artery (STA) have good aesthetic and functional outcomes. However they often require autologous venous grafts. The aim of this radio-anatomical study was to evaluate the feasibility of the helix root free flap based on the posterior auricular artery (PAA). Vascular lengths, diameters, and networks were investigated in flaps harvested from cadavers. The perfusion of the flaps was studied by injecting patent blue. Some flaps were also injected with contrast agent and studied by angiography and computed tomography. Ten flaps from seven fresh cadavers were dissected and analysed. The mean length of the PAA was 114.2 mm and the mean diameter was 2.2 mm. Perfusion was investigated in six flaps and considered good in three of these. The study results demonstrate the feasibility of PAA-based helix root free flaps. This alternative technique provides an 11 cm pedicle with vessels of appropriate calibre, facilitating any potential microsurgery. The scar is mostly hidden behind the ear. This PAA-based helix root free flap could be a reliable and promising single-stage procedure to repair complex defects of the alae nasi.

Long-term stability of basilar mandible osteotomy: Chin Wing.

The Chin Wing is a modified genioplasty extended along the basilar border and the angles of the mandible. This technique may be a better choice than standard genioplasty for correction of lip incompetence, retrogenia and high angle position associated with hyperdivergent cases. Our objective was to analyse the overall movement realized during surgery and the long-term stability of this procedure. Ten patients underwent a Chin Wing surgery from June 2018 to August 2019. All patients were operated on by the same surgeon. We performed a preoperative (PO), an immediate postoperative (POI), and an over 6 months postoperative (PO6) Cone Beam Computed Tomography (CBCT) for every patient. 3D reconstructions were performed for each CBCT with Proplan software. We were thus able to determine by subtractions acquired and resorbed bone volume. Some section plans were chosen in order to perform 2D measurements. The CBCT volume comparisons reveal a gain of 7.6cc between the PO and the POI, for a bone resorption of 2.5cc between POI and PO6 (33% of the volume gained). In 2D evaluation, we observe an average resorption of 1.7 mm corresponding to approximately 20% of the height gained, at the level of the mandibular angle. Given the low bone resorption we can consider Chin Wing stable over time. The important quantity of mobilized bone and the basilar rotational movement may explain over-standing aesthetic and functional outcome, compared to classical genioplasty.

Diagnostic performance of mobile cone beam computed tomography versus conventional multi-detector computed tomography in orbital floor fractures: a study on human specimens.

The aim of this study was to evaluate the diagnostic accuracy of mobile cone beam computed tomography (MCBCT) versus multi-detector computed tomography (MDCT) in orbital floor fractures. Twenty-four fresh cadaver heads were used, and one orbital floor was fractured for each head by transconjunctival approach. MDCT and MCBCT were performed on each of the heads. The images obtained were then analysed independently by eight evaluators. The radiological characteristics of the orbital floor fractures were visualized with good interpretation agreement between the two images. The location of the fracture and enophthalmos were identified in a comparable manner with strong agreement (κ=0.93 and κ=0.85, respectively). Measurements of fatty hernias and bone defects showed a strong correlation between the two imaging modalities (Pearson coefficient between 0.64 and 0.71 and between 0.67 and 0.71, respectively). The fracture limits and the presence of bone fragments, an intrasinus fatty hernia, and a fracture of the associated medial orbital wall were visualized in both examinations with good agreement (κ=0.68, κ=0.51, κ=0.57, and κ=0.46, respectively). The soft tissue study showed superiority for MDCT, with a κ<0.0009. MCBCT showed good diagnostic performance in the study of orbital floor fracture characteristics.

Assessing the incidence of nerve injuries according to different mandibular osteotomies including Wing osteotomies.

We use currently 3 types of new mandibular osteotomies (a shortened Bilateral Sagittal Split Osteotomy (BSSO), associated or not with Chin Wing or Mini Wing). Chin osteotomy is a modified genioplasty extended along the basilar border and the angles of the mandible. These osteotomies are associated with a risk of inferior alveolar nerve (IAN) damage. We prospectively studied 113 consecutive patients operated on by the same surgeon who underwent one of the following procedures: (1) isolated BSSO, (2) BSSO with a Chin Wing, (3) BSSO with a Mini Wing, (4) isolated Chin Wing. We analyzed rates of IAN damage and impact on the patients' life by using a subjective questionnaire administered at the patient's 1 year follow up appointment between June 2018 and August 2019. Sixty-seven patients underwent isolated BSSO, 24 BSSO with Mini Wing, 13 BSSO with Chin Wing, and 9 Chin Wing only. Our analysis reveals that nerve damage is greater in the BSSO group associated with Chin Wing (50% vs. 21.6%; p=0.006). However, there is no significant difference between nerve damage in the Mini wing group and the isolated BSSO group (27.1% vs. 21.6%; p=0.432). In the isolated Chin Wing group, the inferior alveolar nerve damage rate was 11%. There is no significant difference between the groups with regard to the impact of the nerve damage on the patients' life. In case of BSSO with concomitant Wing osteotomy, we conclude that Mini Wing osteotomies cause less nerve related morbidity than Chin Wing.

How useful is intraoperative cone beam computed tomography in maxillofacial surgery? An overview of the current literature.

Intraoperative imaging is increasingly used by surgeons and has become an integral part of many surgical procedures. This study was performed to provide an overview of the current literature on the intraoperative use of cone beam computed tomography (CBCT) imaging in maxillofacial surgery. A bibliographic search of PubMed was conducted in March 2020, without time limitation, using "intraoperative imaging" AND "maxillofacial surgery" AND "cone beam computed tomography" as key words. Ninety-one articles were found; after complete reading, 16 articles met the eligibility criteria and were analysed. The results showed that the majority of the indications were related to maxillofacial trauma, particularly zygomaticomaxillary complex fractures. Final verification with intraoperative CBCT before wound closure was the most common use of this device. However, innovative uses of intraoperative CBCT are expanding, such as CBCT coupling with mirror computational planning, and even the combined use of initial intraoperative CBCT acquisition with navigation. Immediate, fast, and easy evaluation of bone repositioning to avoid the need for further surgical revision is the main advantage of this technique. Imaging quality is comparable to that of multi-slice computed tomography, but with lower radiation exposure. Nevertheless, CBCT is still not widely available in maxillofacial centres, probably because of its cost, and perhaps because not everyone is aware of its advantages and versatility, which are reported in this review.

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.

De l'histoire des chirurgiens cachés derrière nos instruments du quotidien. Partie 4 : la rhinoplastie.

Many surgical instruments are named after their inventors, acclaimed surgeons of the past, because of their discoveries and their contributions in the field of surgical techniques. However, these daily reminders of history of surgery are often forgotten by the modern practitioners. We propose to review, through a selection of instruments, short biographies of these precursors. This fourth original article will focus on the inventors of rhinoplasty instruments: Joseph, Killian, Aufricht, Cottle and Claoué.

Gingival Mucosa-Associated Lymphoid Tissue (MALT) lymphoma developed around a mandibular extraosseous dental root canal overfilling: A case report.

Lymphomas are rare pathologies in the oral cavity, representing only 3.5% of malignant tumors. Their typical topography is Waldeyer's lymphatic ring and approximately 8% of all non-Hodgkin lymphomas are mucosa associated lymphoid tissue (MALT) lymphomas. The authors report a rare case of mandibular gingival MALT lymphoma, which developed around an extraosseous dental root canal overfill. This atypical, case of lymphoma indicates that practitioners have to be vigilant and perform a biopsy every time they are confronted with a suspicious chronic lesion in the oral cavity.

Surgical reconstruction of the foramen tympanicum: What is known and how we do it.

Defects affecting the anterior wall of the tympanal bone can result from trauma, infection, neoplasm or previous local surgery. An anatomic variation, namely the persistence of the foramen tympanicum, can also be encountered. When symptomatic, surgical reconstruction may be indicated. The aim of this study was to identify the surgical treatments of symptomatic foramen tympanicum found in the literature and detail our innovative reconstruction technique. A bibliographic research was conducted in PubMed database in March 2020, without time limitation. Papers dealing with surgical management of a foramen tympanicum were included. Data collected were the publication date, the number of patients, their age and gender, the symptoms and the surgical treatment performed. We report, in addition, the case of a symptomatic persistent foramen tympanicum in a 30-year-old man with a follow-up of 18-months. A total of 17 studies (n=23 patients) were included for analysis. The main reconstruction techniques were, in equal proportion, cartilage graft (30%) and insertion of a titanium mesh (30%). We carried out an iliac crest bone graft using a preauricular approach on a patient suffering from chronic tinnitus and fullness in the left ear resulting from a persistent foramen tympanicum, confirmed by clinical and radiological examinations. It allowed the complete resolution of symptoms and no complication such as temporomandibular ankylosis occurred. Based on the review of the literature, we believe this technique has the advantage of providing durable reconstruction thanks to osseointegration.

The influence of orthognathic surgery on the perception of personality traits: A scoping review.

The purpose of this scoping review was to determine the current state of evidence regarding the influence of orthognathic surgery on the perception of personality traits in dysmorphic patients by laypersons. The MEDLINE database was searched for relevant studies using the search strategy: ("Personality"[Mesh]) AND ("Orthognathic Surgery"[Mesh] OR "Orthognathic Surgical Procedures"[Mesh]). A qualitative and quantitative synthesis of the results was performed. Descriptive statistics were used. The PRISMA-ScR guidelines were followed. Five studies, published between 2012 and 2018, remained after screening. Seventy-two dysmorphic patients and 12 class I control individuals were rated based on a total of 296 pre- and postoperative photographs or videos. The available data showed concordant results. Dysgnathic patients were more negatively perceived than class I patients for both aesthetic and personality dimensions. Compared to control class I patients, class II patients were perceived as more flexible, less confident, and less intelligent, whereas class III patients were characterized by dominance, aggressivity, and brutality. Dysgnathic patients showed an improvement in the postoperative ratings but did not reach the ratings attributed to the control class I group in most traits evaluated. This added understanding should help surgeons to counsel their patients in a realistic and reasonable manner.

Three-dimensional acquisition technologies for facial soft tissues - Applications and prospects in orthognathic surgery.

The management of patients with dento-maxillofacial deformities is based on assessments of the dental occlusion - facial skeleton - soft tissues triad. As societal demands and surgical practices have evolved, facial soft tissues have moved to the forefront of considerations in orthognathic surgery. Techniques are therefore required to analyze facial soft tissues objectively and reproducibly, for diagnosis, preoperative planning, and follow-up. Several technologies are currently capable of providing three-dimensional (3D) models of the face, either by 3D reconstruction of traditional computed tomography or cone beam computed tomography data, or directly by stereophotogrammetry, laser scanning or structured light scanning. Multimodal image registration techniques allow bone base, dental occlusion and facial soft tissue information to be combined in a 3D virtual patient. Three-dimensional cephalometric analysis of the facial skeleton and skin is now perfectly integrated in virtual planning and is gradually gaining in automation and accuracy. Photorealistic 3D simulations allow optimal soft tissue planning and facilitate physician-patient communication. Finally, these facial modeling techniques facilitate post-operative studies of soft tissues, which generally involve comparisons of volumetric data. There are many research avenues to pursue and technical improvements are to be expected, particularly through the development of big data and artificial intelligence approaches.

The high sub-mandibular approach: Our experience about 496 procedures.

INTRODUCTION: The potential drawbacks of surgical approaches to neck and base fractures of the mandibular condyle (visible scare, facial nerve injury) are still considered by many surgeons as a brake for open reduction and internal fixation. The aim of our study was to analyze the results in terms of access, scare quality and complications that could be noticed in a 12 years period of time with the use of the high sub-mandibular approach (HSMA) we first described in 2006 for the surgical treatment of neck and base fractures. MATERIAL AND METHOD: All the files of patients operated on for condylar neck and base fractures approached by mean of a HSMA between January 2006 and December 2018 in our department and containing information concerning age, sex, type of fracture, kind of osteosynthesis material, operating time, name of the surgeon, postoperative complication linked to the approach, scare quality at 6 months follow-up at least were included. The skin incision and the dissection planes followed the original publication of Meyer et al. in 2006. RESULTS: 434 patients (sex ratio: 2.06, mean age: 32, 496 approaches) met the inclusion criteria. Following the AO classification, 21.2% of the fractures were classified as neck fractures and 78.8% as base fractures. 97.6% of all fractures were stabilized by mean of a 3D plate (TCP® plate, Medartis, Basel-CH), the remaining ones by mean of a combination of 1.2, 1.5 and 2.0 straight plates. Mean operating time was 40minutes per side. Patients were operated on by senior surgeons in 71.7% of the cases and by trainees under supervision for the others. Concerning the complications linked to the approach, we noticed 11 (2.2%) temporary (0 definitive) paresis of the facial nerve, 1 (0.2%) hematoma and 1 (0.2%) abscess that both needed revision. Scare was hypertrophic or considered as unaesthetic by the patient in 5 cases (1%). DISCUSSION: The HSMA, if performed as initially described, is a safe and quick procedure compared to other cutaneous approaches. It gives access to all base fractures and to most of neck fractures. The very low rate of facial nerve complications is mainly explained by the plane by plane dissection making it very easy to avoid the facial nerve branches or to check them when encountered. The HSMA is particularly suited to the use of TCP plates as the upper holes of these plates, placed horizontally, are easy to reach from below. The HSMA is therefore still our preferred cutaneous approach to the condylar process.

Customized three-dimensionally printed mandibular external fixator.

The advent of customized three-dimensional (3D) printing allows the affordable manufacturing of sophisticated medical devices, thereby providing swift and simple solutions to specific needs in modern healthcare. Meanwhile, certain devices such as industrial mandibular external fixators (EFs) have become less and less available from medical device companies because of decreased indications. What is more, their handling is often complex. The authors report, step by step, the original design and uneventful clinical use of a 3D-printed, customized mandibular EF. This device was designed together with a positioning and drilling guide for the fixation of a septic mandibular pseudarthrosis. It provided an adequate and satisfactory balance between lightness and rigidity. A simple, accurate and safe placement of the EF was achieved thanks to the skin-supported positioner and drilling guide, thereby making the procedure minimally invasive and time-efficient. To our knowledge, this is the first reported clinical use of a 3D-printed, customized mandibular EF to date. Because such 3D technology is becoming increasingly available to a large number of surgeons, the authors believe that the present innovation could become an alternative to reusable standard EFs.

[About history of surgeons hidden behind our daily surgical instruments: Scissors]. / De l'histoire des chirurgiens cachés derrière nos instruments du quotidien. Partie 3 : ciseaux.

Many surgical instruments are named after their inventors, acclaimed surgeons of the past, because of their discoveries and their contributions in the field of surgical techniques. However, these daily reminders of history of surgery are often forgotten by the modern practitioners. We propose to review, through a selection of instruments, short biographies of these precursors. This third original article will focus on the inventors of modern scissors: Mayo, Metzenbaum, Stevens and Lister.

[About history of surgeons hidden behind our daily surgical instruments: Retractors]. / De l'histoire des chirurgiens cachés derrières nos instruments du quotidien. Partie 2 : écarteurs.

Many surgical instruments are named after their inventors, acclaimed surgeons of the past, because of their discoveries and their contributions in the field of surgical techniques. However, these daily reminders of History of Surgery are often forgotten by the modern practitioners. We propose to review, through a selection of instruments, short biographies of these precursors. This second original article will focus on the inventors of modern retractors: von Langenbeck, Farabeuf, Leriche, Gillies and Tessier.

The intermediate length BSSO: Finding the balance between the classical and short designs.

Bilateral Sagittal Split Osteotomy (BSSO) is performed in orthognathic surgery to treat cases of dento-skeletal malformation. We present a shorter BSSO variant that allows for the realization of all orthognathic movements. This line respects the basilar rim and allows to modify the position of the mandibular angles. The splitting is more natural, separating the mandible into two anatomical subunits: the rising branch and the horizontal branch. This variant layout may also be associated with Chin Wing genioplasty.

Mandible extensive intra osseous destructive lesion, a diagnostic challenge.

Intraosseous verrucous carcinoma of the mandible is a rare situation often confused with chronic osteomyelitis. Despite the low aggressively of the tumor, prognosis is poor because of delayed diagnosis. We report 3 cases, from three different hospitals, initially diagnosed with a chronic osteomyelitis of the mandible after wisdom extraction. Imaging, bacteriological and histological samples supported each time this interpretation. The 3 patients worsened with intraosseous extension of the lesions and outflow of whitish and purulent debris. Only extensive resection with mandibulectomy allow the pathologists to identify the tumor. Adjuvant radiotherapy or radiochemiotherapy followed the surgery. One patient is in clinical remission. In front of mandible lesion resistant to antibiotic therapy and sequestrum resection, atypical squamous cell carcinoma must be evoked. MRI and CT-scan are not able to distinguish osteomyelitis and intraosseous verrucous carcinoma. Presence of whitish lysed and debris of keratin must draw the attention. Firm evidence must be provided to the pathologist but samples should be wide and thick.