[The orthognathic surgery so called « early ¼]. / La chirurgie orthognathique qualifiée de « précoce ¼.

Some young patients with a significant skeletal shift with a strong morpho-aesthetic and psychological impact may require surgical correction during their growth. A good understanding of facial growth, the different treatment options and the effects of surgery on the post-operative growth pattern will allow the practitioner to use the technique most suited to each of his patients and improve long-term treatment outcomes. So-called « interceptive ¼ surgery may therefore be considered in cases of severe skeletal dysmorphism of secondary or functional origin. It will lead to early normalization with the immediate consequence of breaking the « dysmorpho-dysfunctional ¼ spiral.

[First-line surgery : indications, advantages and drawbacks]. / La chirurgie de première intention : indications, avantages et inconvénients.

First-line surgery offers an additional option in our orthodontic treatment arsenal. Unlike the classic three-stage orthodontic-surgical protocol, it aims to correct the skeletal discrepancies during stage one in order to restore a favorable functional environment and enable orthodontic occlusal correction during a second stage. In some cases of maxilla-mandibular malformation, and for specific indications, it involves eliminating presurgical orthodontic preparation or reducing it to a minimum. From the orthodontic point of view, it reduces overall treatment time, facilitates treatment following surgery and speeds up tooth displacement. On the patient's side, it makes for rapid esthetic improvement and a radically enhanced quality of life. The use of anchorage devices, surgical splints or set-ups makes it possible to offset the drawbacks of this technique such as postsurgical occlusal instability or restrictive treatment planning.

Position paper from the IBRA Symposium on Surgery of the Head--the 2nd International Symposium for Condylar Fracture Osteosynthesis, Marseille, France 2012.

BACKGROUND: This is a position paper from the 2nd International Bone Research Association (IBRA) Symposium for Condylar Fracture Osteosynthesis 2012 was held at Marseille, succeeding the first congress in Strasbourg, France, in 2007. The goal of this IBRA symposium and this paper was to evaluate current trends and potential changes of treatment strategies for mandibular condylar fractures, which remain controversial over the past decades. METHODS: Using a cross-sectional study design, we enrolled the consensus based on the panel of experts and participants in the IBRA Symposium 2012. The outcomes of interest were the panel and electronic votes on management of condylar base, neck and head fractures, and panel votes on endoscopic and paediatric condylar fractures. Appropriate descriptive and univariate statistics were used. RESULTS: The consensus derived from 14 experts and 41 participant surgeons, using 12 case scenarios and 27 statements. The experts and participants had similar decision on the treatment of condylar base, neck and head fractures, as well as similar opinion on complications of condylar fracture osteosynthesis. They had a parallel agreement on using open reduction with internal fixation (ORIF) as treatment of choice for condylar base and neck fractures in adults. Endoscopic approaches should be considered for selected cases, such as condylar base fractures with lateral displacement. There was also a growing tendency to perform ORIF in condylar head fractures. The experts also agreed to treat children (>12 years old) in the same way as adults and to consider open reduction in severely displaced and dislocated fractures even in younger children. Nevertheless, non-surgical treatment should be the first choice for children <6 years of age. The decision to perform surgery in children was based on factors influencing facial growth, appropriate age for ORIF, and disagreement to use resorbable materials in children. CONCLUSIONS: The experts and participating surgeons had comparable opinion on management of condylar fractures and complications of ORIF. Compared to the first Condylar Fracture Symposium 2007 in Strasbourg, ORIF may now be considered as the gold standard for both condylar base and neck fractures with displacement and dislocation. Although ORIF in condylar head fractures in adults and condylar fractures in children with mixed dentition is highly recommended, but this recommendation requires further investigations.

Third molar extraction with massive hemorrhage treated by embolization.

Impaction of the third molar is relatively frequent in oral and maxillofacial surgery, and its removal is a usual operation with mostly unremarkable outcome. We report a case of bleeding that occurred after a left upper third molar extraction, which necessitated in emergency an angiography with embolization.

Dental occlusion and postural control in adults.

We studied the influence of a dental occlusion perturbation on postural control. The tests were performed in three dental occlusion conditions: (Rest Position: no dental contact, Maximal Intercuspal Occlusion: maximal dental contact, and Thwarted Laterality Occlusion: simulation of a dental malocclusion) and four postural conditions: static (stable platform) and dynamic (unstable platform), with eyes open and eyes closed. A decay of postural control was noted between the Rest Position and Thwarted Laterality Occlusion conditions with regard to average speed and power indexes in dynamic conditions and with eyes closed. However, the head position and stabilization were not different from those in the other experimental conditions, which means that the same functional goal was reached with an increase in the total energetic cost. This work shows that dental occlusion differently affects postural control, depending on the static or dynamic conditions. Indeed, dental occlusion impaired postural control only in dynamic postural conditions and in absence of visual cues. The sensory information linked to the dental occlusion comes into effect only during difficult postural tasks and its importance grows as the other sensory cues become scarce.

Long-term radiological findings following reconstruction of the condyle with fibular free flaps.

AIM: Fibular bone grafts are considered as one of the best choices for reconstruction of the condyle. However, little data are available on bone remodelling after such reconstruction. The purpose of this study was to evaluate the long-term radiological outcome. PATIENTS AND METHODS: Eleven patients underwent condylar reconstruction with a free fibular transplant. In all cases the end of the fibular graft was placed into the glenoid fossa under the intact temporomandibular joint (TMJ) disc. Evaluation consisted of digital width and length measurement of the end of the fibula on panorex studies. RESULTS: Remodelling of the end of the neocondyle was found and consisted of rounding off and narrowing of the end of the transplant. CONCLUSION: The most likely explanation for these changes is the fact that the TMJ disc was preserved.