[Masticatory system and maxillofacial prosthesis: From pathology to function recovering]. / Appareil manducateur et prothèse maxillo-faciale : de la pathologie à la fonction retrouvée.

Maxillofacial prosthesis (MFP) can be defined as the art and science of esthetic and functional reconstruction of the facial bones, art because it uses hand-crafted and empirical rules, science because of its technical rigorism and its integration in medicine. MFP aims to multidisciplinary rehabilitate patients presenting with cutaneous and underlying structures defects, It also allows for functional speech and swallowing rehabilitation related to temporo-mandibular joint disorders. Whatever the origin, (traumatic, infectious ortumoral), surgical treatment of these TMJ disorders is usually not indicated in first-line. Functional treatment is often sufficient if started early in an observant patient. The aim of our article was to present the different types devices available for the rehabilitation of the masticatory system according to pathology. The first part will treat about the preservation of the TMJ range of motion in a preventive way. A second part will treat about the possibilities to recover the range of motion in a curative way. A third part will treat about mandibular reposition. At last, we will focus on the devices allowing for mandibular kinetic rehabilitation in adults and in a special pediatric case.

[Functional treatment of children subcondylar fractures: An axiographic assessment]. / Traitement fonctionnel des fractures sous-condyliennes de l'enfant : une évaluation axiographique.

INTRODUCTION: Subcondylar fractures are common in children. Occlusion disorders resulting from these fractures in deciduous or mixed dentition do not have as much impact as in adults due to alveolar adaption possibilities. Functional treatment allows for good functional results, but does not treat the dynamic shortening of the ramus. The objective of this study was to evaluate the axiographic condylar slope changes after subcondylar fracture in children. MATERIALS AND METHODS: A prospective study was conducted from 2010 to 2015, including all the under-18 patients presenting with a subcondylar fracture. Examination by mean of a Quick Axis axiograph measured the length of propulsion and the condylar inclination on both sides. The main evaluation criterion was the amount of condylar inclination decrease on the fractured side. RESULTS: Twelve patients (mean age: 10.42; 5-16) were included. Eleven children had a loss of condylar inclination on the fractured side without occlusion disorders at 33.2 months on average (3-144 months) after the initial trauma. Only one patient had symmetric axiographies without loss of condylar inclination on the fractured side. DISCUSSION: Dynamic shortening of the ramus on the side of the subcondylar fracture is consistent at short and medium terms in children. Surgical treatment may be the solution for avoiding this dynamic disorder of the mandible and should be evaluated.

[Double-barrel fibular free flap for mandibular reconstruction: beneficial alternative for dental implanted rehabilitation (5 cases)]. / Lambeau libre de péroné en double barre: intérêt du montage dans les reconstructions mandibulaires pour une réhabilitation prothétique sur implants (5 cas).

INTRODUCTION: As major loss of mandibular bone stock requires a vascularized transfer, fibula free flap reconstruction is considered to be the best free flap for its length and reliability. Its main advantage is to accept dental implants. Single or double-barrel reconstruction can be performed. Double-barrel reconstruction is generally preferred because the bone superposition offers enough height to allow dental implants. MATERIAL AND METHODS: We reviewed five selected cases of double-barrel fibula free flap adaptive mandibular reconstruction performed among a series of 11 oral rehabilitations with planned dental implants, focusing on the technical aspects. RESULTS: Today, dental rehabilitation has been achieved in three double-barrel fibula flaps. Details are reported concerning the implant step. DISCUSSION: In this perspective, we discuss the choice of the reconstructive technique in order to obtain adequate bone height. Early in our experience and for different reasons discussed in the text, we used a single barrel fibula flap. This technique provided sufficient height in some cases, but had to be completed by bone grafts in few patients. Our experience illustrates the usefulness of the double barrel technique which provide definitive bone height sufficient for dental implants. The double-barreled technique should be considered as the best solution.

[Bruxism, temporo-mandibular dysfunction and botulinum toxin]. / Bruxisme, syndrome algodysfonctionnel des articulations temporo-mandibulaires et toxine botulique.

Tooth grinding and tooth clenching are unvoluntary mainly nocturnal habits that result in an hypertrophy of masseter and temporalis muscles with an unbalance between opening and closing muscles of the jaw and lead to an alteration of mandibular condyles movements and to hyper pressure in the temporo-mandibular joints (TMJ) which can generate severe pain. Intra muscular injections of botulinum toxin permit to restablish the balance between closing and opening muscles, to relieve pain, to treat masseteric hypertrophy with improvement of face outline and to recover a normal cinetic of temporo-mandibular joints. Moreover, botulinum toxin injections permit to quit habits of tooth grinding and clenching and one single session of injections is curative for 2/3 of the patients. There are no side effects apart from slight diffusion to superficial muscles of the face resulting in a "fixed" smile for about 6 to 8 weeks. So injections of botulinum toxin in masseter and temporalis muscles are an efficient treatment of bruxism and TMJ dysfunction, cheap with no lasting side effect.

[Orbital filling using a vascularized parietal bone graft: a case report of rehabilitation with an orbital graft of axial implants]. / Comblement orbitaire par greffe osseuse pariétale vascularisée: à propos d'un cas de réhabilitation par épithèse oculopalpébrale sur implants axiaux.

Orbital and intracranial complications of dental cellulitis are exceptional. The authors report such a case with orbital cellulitis and frontal abscess that dictated orbital exenteration with resection of the eyelids. Before realization of an implant supported epithesis, the orbit was filled with a prefabricated vascularized fascio-osseous parietal bone flap. This allowed placement of two extra-oral fixtures (Nobel biocare) in an antero-posterior axis. In some cases, preimplant orbital bone graft appears to be the only solution when implant placement in the orbital rim is impossible or contra-indicated. Indications, advantages and disadvantages of this technique will be discussed.

[Chondrosarcoma of the temporomandibular joint. Apropos of a case and review of the literature]. / Chondrosarcome de l'articulation temporo-mandibulaire. A propos d'un cas et revue de la littérature.

Chondrosarcomas of the temporo-mandibular joint are exceptional and have been previously reported in the literature in only seven cases. A case located in the temporal bone with extension in the infratemporal fossa and the cranial base is presented. Treatment consisted in a wide surgical resection combined with postoperative radiotherapy. The patient is alive with a follow-up of more than two years.

[Treatment of obstructive sleep apnea syndrome using a mandibular advancement prosthesis: review of the literature]. / Le traitement du syndrome d'apnées obstructives du sommeil par les prothèses mandibulaires d'avancée: revue de la littérature.

The treatment of OSAS with prosthetic devices displacing forward and lowering the mandible in order to increase the size of the pharyngeal airway is seldom used at present. Some recent publications attracted our interest and we deemed it of interest to review them. Our work is mostly concerned with objective results as assessed by polysomnography, and also with cephalometric changes caused by the device. In spite of equivocal results at polysomnography, which seldom met commonly accepted criteria of successful treatment, indiscutable therapeutic successes have been reported. Therefore, this simple, reversible and cheap devices could be advocated in cases of mild or moderate OSAS. However, their role in the therapeutic armamentarium of OSAS as well as their indications and efficacy need to be better assessed.

[Statistical study of mandibular resections]. / Etude statistique des résections mandibulaires.

A retrospective study of mandibular resections performed from 1980 to 1984 was conducted to evaluate age, sex, aetiology, etc. The number of mandibular resections appears to have declined at the Institute of Stomatology and Maxillofacial Surgery of the Pitié-Salpêtrière Hospital. Different factors are involved included early diagnosis, improved surgical techniques and better patient follow-up. Partial mandibular resections are increasingly performed (52% of the cases) compared with total resections. Finally, a better understanding of the pathologies involved, especially tumours, has led to an adaptation of the resection techniques to avoid extensive mutilations.

[Prosthetic treatment of mandibular pseudarthrosis using an articulated prosthesis]. / Traitement prothétique d'une pseudarthrose mandibulaire par prothèse articulée.

Two cases with complete loss of the tooth-bearing portion of the mandible were repaired with a prosthesis. This type of defect can involve the loss of a large number of teeth and aggression to the remaining teeth must be limited as much as possible. A two-part "articulated" prosthesis with two rings appears to be the best adapted system. This method takes into account the requirements of for additional conventional prostheses and thus makes it possible to save the remaining teeth.

[An obturator prosthesis in a patient with perfect dentition. Functional, esthetic approach]. / Prothèse obturatrice chez une patiente parfaitement dentée. Approche fonctionnelle, esthétique.

A prosthesis was implanted immediately after operation for a velo-palatal tissue defect in an active young female patient in order to avoid function, psychological and social complications involved with this mutilation. The three classical steps of the process were performed: immediate implantation of the prosthesis, temporary prosthesis, definitive prosthesis. Anchoring to the teeth maintained the prosthesis in position. A functional print is always needed to obtain perfect closure. A metallic bridge links the retention part and the obstructive part. The device is effective, discrete, functional and well-tolerated by the patient.

[Complex reconstruction of the lower lip. Apropos of various cases]. / Reconstruction complexe de la lèvre inférieure. A propos de quelques cas.

Preservation of buccal cavity relations raises problems when treating extensive defects of lower lip. After a review of anatomical features, several case reports are presented to illustrate the advantages and inconveniences of three interventions for labial reconstruction.

[Mandibular fractures. Our patient enrollment during the past 2 years]. / Fractures mandibulaires. Notre recrutement au cours de ces deux dernières années.

The method of patient referral; the patient's physical predisposition, the localization and the treatment undertaken for the different mandibular fractures seen by SOS Face over the past two years were analyzed. The 312 mandibular fractures were used to reevaluate the commonly accepted statistics concerning these parameters.

[The role of muscle rehabilitation in the treatment of temporomandibular joint pain-dysfunction syndrome]. / Rôle de la rééducation musculaire dans le traitement des syndromes algo-dysfonctionnels des articulations temporo-mandibulaires.

Physiotherapy in association with mechanotherapy provides a functional treatment for T.M. algo-dysfunctional syndromes. The authors review the indications for this treatment and distinguish two varieties requiring different treatments: syndromes with a defect in propulsion and a limitation of mouth opening and syndromes with hyperpropulsion and subluxation.

[The value of MRI in the management temporomandibular joint algo-dysfunctional syndromes. Preliminary study]. / Intérêt de l'I.R.M. dans la prise en charge d'un syndrome algo-dysfonctionnel des articulations temporo-mandibulaires (S.A.D.A.M.). Etude préliminaire.

The authors report their initial conclusions regarding the value of M.R.I. in the investigation of temporo-mandibular joint dysfunction. This examination was performed for all varieties of symptomatology: musculo-ligamentary, menisco-ligamentary or meniscal. A detailed examination technic is given. M.R.I. enables meniscal abnormalities to be demonstrated: morphological and positional abnormalities (reducible and irreducible anterior luxations) and structural abnormalities similar to those seen in meniscal pathology within the knee joint.

[Reconstruction following anterior sulco-mandibulectomy. The advantages and disadvantages of different procedures. Apropos of 85 cases]. / Reconstruction après pelvi-mandibulectomie antérieure. Avantages et inconvénients des différents procédés. A propos de 85 cas.

A retrospective study was conducted on 85 case-reports of patients with epithelioma of anterior and anterolateral region of floor of mouth operated upon in the Stomatology and Maxillofacial Surgery Clinic of Salpêtrière hospital, Paris. An update review of recent advances in surgery for reconstruction of floor of mouth is completed by results of study of the case-reports showing evolution of ideas related to functional results and to vital prognosis (as function of tumoral stage).

[Prophylaxis of infectious complications in maxillo-facial surgery. Value of cefazolin. (A review of 400 cases)]. / Prophylaxie des complications infectieuses dans les interventions de chirurgie maxillo-faciale. Intérêt de l'utilisation de la céfazoline. (A propos de quatre cents cas).

The value of short-term prophylaxis with antibiotics in maxillo-facial surgery and plastic facial surgery is studied. 200 patients were included in the study and compared to 200 controls who were given the usual systematic antibiotic therapy, with a different antibiotic, for more than 6 days. 400 case-reports were thus retrospectively analyzed. The results show that when the surgical procedure lasts for less than three hours, short-term prophylaxis with antibiotics is more effective than the usual systematic antibiotic therapy given for more than 6 days.