Maxillary alveolar bone ridge width augmentation using the frame-shaped corticotomy expansion technique.

Maxillary alveolar ridge expansion performed by intercortical bone splitting is a seducing alternative surgical procedure for alveolar bone widening. The aim of this technique is to gain enough bone width to be able to place a dental implant simultaneously. This technique avoids a second surgical site for bone graft harvesting. However there are risks of surgical failure caused by unintended bone fracture during expansion and implant placement, or by insufficient bone widening for implant insertion. To limit these risks, we have published expansion techniques using various corticotomies. These corticotomies are achieved according to bone anatomy, most of them remote from implant position. Bone fractures are guided during the bone expansion and the implant placement, avoiding cortical bursting. Wider and safer bone movements can be achieved allowing to place the forecasted implant with adequate dimensions, axis, and cervical position on the bone ridge. Our technique increases the success rate of both the bone volume expansion and the dental implant placement, and improve the functional and aesthetic result of implant and prosthesis restoration. Four main types of bone expansion movement using corticotomies have been described: expansion with apical cortical hinge, cortical translation, bi-cortical osteotomy, and frame-shaped corticotomy. Our subject is the alveolar bone width augmentation with the frame- shaped corticotomy expansion technique, which allows to place an implant in a narrow and concave alveolar bone, with a straightened axis, without modifying its cervical position on the bone ridge arch. A series of 10cases with a 1 to 5year surgical follow-up is studied. Implants were all placed in the same stage and their supported prosthesis successfully made. Peculiarities and interest of this technique are discussed.

[Alveolar ridge augmentation with cortical osteotomies for dental implantation]. / Les ostéotomies corticales d'augmentation alvéolaire en chirurgie implantaire.

Cortical osteotomies allow alveolar ridge augmentation so as to place dental implants of adequate size, most often in one step. This technique is reliable and allows long-lasting prosthetic restoration, without need for a graft-harvesting site. We report an expansion technique, which combines various cortical alveolar osteotomies. It allows guiding bone fractures away from the implant site during the expansion procedure. The possibility of implant placement is enlarged because exposure risks for implants are limited. The technique also preserves cortical bone structure and resistance, while allowing a larger bone augmentation movement. The diameter, axis, and crestal emergence position are optimized, thus improving the biomechanical resistance of implant restoration. A better implant position and restoration of bone anatomy and volume, supporting the gingival alveolar mucosa, improve the esthetic and prosthetic result. This technique can be used if the ridge is very narrow with limited bone elasticity. We present the various osteotomies and basic surgical steps for transversal and even vertical alveolar ridge augmentation, as well as possible modifications and clinical results.

[Amniotic fluid embolism during curettage for a pregnancy arrest. Case report]. / Embolie amniotique lors d'un curetage pour une grossesse arrêtée. A propos d'un cas.

Amniotic fluid embolism is always a serious complication during the peripartum period. We report the case of an amniotic fluid embolism during curettage for a pregnancy arrest at 13 weeks. The diagnosis was confirmed by the presence of epithelial cells into the maternal blood.

[Maxillary ridge expansion for dental implant placement with alveolar corticotomy]. / L'expansion osseuse transversale pré-implantaire de la crête maxillaire par corticotomie alvéolaire.

UNLABELLED: Maxillary ridge transversal expansion is based on osseous plasticity obtained by corticotomy. It allows progressively for an adequate transversal intercortical diameter large enough to insert one or several dental implants. We present a pre-implant maxillary ridge transversal osseous expansion technique. SURGICAL TECHNIQUE: Surgery is carried out under local or general anesthesia. Infiltration of a local anesthetic with adrenaline reduces bleeding and facilitates dissection. One horizontal crestal and two vertical vestibular surgical incisions are made in the mucosa. The operating site is exposed by lifting a mucoperiostic flap. Two vertical osteotomies are performed 2mm away on either side of the future implant and one horizontal crestal osteotomy. A guided bone fracture following the osteotomy lines is performed with an osteotome. An alveolar bone flange with a superior hinge is thus obtained. If implant placement is immediately possible, the implant bed is made with the osteotomes and/or drill. An osseous graft is inserted in the intercortical space around the cervical implant area and in the corticotomy zones. The mucosa is sutured on a resorbable collagen membrane. DISCUSSION: The indications are maxillary crestal thickness ranging from 1.5 to 3mm. This technique allows gaining 4 to 5.5mm of thickness on a length of up to 40 mm. Implants are often placed during the same surgery. Morbidity is limited and aesthetic prosthetic results are satisfactory.

[The corrugator supercilii muscle. A review]. / Revue générale sur le muscle corrugator supercilii.

Corrugator supercilii is a facial, forehead and supra-orbital muscle. The frown glabellar wrinkles are mainly formed by repeated contractions of this muscle. These wrinkles will produce the picture of premature ageing even in a young person. Many treatments reduce or abolish the action of this muscle, enhancing the appearance of the glabellar area. We propose to review the recent material related to the anatomical characteristics of this muscle in order to build the necessary knowledge to optimize the result of these different treatments.

[Prosthetic rehabilitation with dental implant in cleft lip and palate: a ten-year retrospective study]. / Réhabilitation implantaire des fentes labiopalatines: étude rétrospective sur dix ans.

INTRODUCTION: Two problems need to be faced during cleft lip and palate surgical treatment to gain a functional and esthetic result: restoration of the maxillary bone defect and the missing lateral incisor tooth, which may be replaced by an implant. The aim of our study was to demonstrate that it is possible to successfully place a dental implant after obtaining adequate bone graft volume. PATIENTS AND METHOD: 12 consecutively treated patients were studied, 7 with unilateral and 5 with bilateral clefts, mean age 21.5 years, with an average follow-up of 5.5 years (range: 1-10 years). Various types of autogenous or alogenous bone grafts were performed to provide adequate bone volume for immediate or secondary implant placement. We studied the number of bone grafts needed to reach this target, and the number of implants placed, focusing on lateral incisor tooth replacement. RESULTS: Enough cleft bone volume for the implant was obtained in 9 out of 12 cases (75%). All endosseous implants placed in bone graft were successfully restored, 8 out of them for lateral incisor. Some surgical cases are described. DISCUSSION: Global improving of cleft lip and palate surgical treatment by implantology is now feasible. Maxillary defect bone grafting, often in several stages, is strictly necessary to place an implant but also to obtain a good cosmetic result in cleft repair. Length, direction, and cervical implant position have to be considered too. Reconstruction of mucosal anatomy also contributes to the end result.

[Modified subcutaneous mastectomy. Apropos of 916 cases]. / Les mammectomies sous-cutanées modifiées. A propos de 916 observations.

Modified subcutaneous mastectomy was described by one of us in 1968; its approach, the dissection of the gland, plastic reconstruction of shape and volume are completely different from the subcutaneous mastectomy performed by plastic surgeons. 3 different time periods were studied to explain clearly evolution in the technic and indications. During many years retrospective studies made it possible to build a procedure according to the new diagnostic means for infraclinical breast cancer and to the constant improving prosthetic material. Therefore our indications for modified subcutaneous mastectomy are as following: suspicious mastopathies are the best indications with a performing choice of the radiologic images which require histologic control some evolutive or evoluated mastopathies some small infiltrating tumors developing in a highly dystrophic glandular surrounding. The numerous in situ cancers accompanying them argue for this choice. some big phyllod tumors or phyllod's recurrences.

[mandibular reconstruction by free bone flaps with micro-anastomosis. Our current indications]. / Reconstruction mandibulaire par lambeaux libres osseux micro-anastomosés. Nos indications actuelles.

The frequency with which difficulties were encountered in the reconstruction of the continuity of the mandible led us to attempt to systematize our indications. Although grafts, composite pedicle flaps and prosthetic guides still have their appropriate applications. Local conditions are more and more frequently amenable to free flaps. The factors guiding our choice are presented in detail: physical conditions, etiology and anatomy of the defect. In addition, the reason for choosing the type of free flap--iliac crest, fibula or external brachial--is discussed.

[Post-traumatic enophthalmos]. / Enophtalmies post-traumatiques.

Based on 8 cases, the authors study the mechanisms involved in post-traumatic enophthalmos and demonstrate that they result from an increase in orbital volume. There are no grounds to suggest that the disappearance of orbital fat is involved.

[Experimental study of an axial vascularized pedicle flap induced in rats]. / Etude expérimentale d'un lambeau à pédicule vasculaire axial induit chez le rat.

The authors report an experimental study about induced flaps in rats. The aim of this study is to determine that neoangiogenesis can be formed from surgically introduced pedicle. Two main groups were studied: in the first one the arteriovenous pedicle was be anastomased at its distal end, in the other, an arteriovenous loop was created microsurgically. In both groups we obtained good results and the flaps stayed alive. Neoangiogenesis from the surgically introduced axial pedicle was observed. The prospects in human pathology are interesting to consider, for the surgeon might be liberated from the narrow anatomic limits imposed by vascular territories, by creating a suitable flap anywhere in the body.

[Changes in the nasal pyramid in osteotomy of the maxilla]. / Etude des modifications de la pyramide nasale au cours des ostéotomies du maxillaire supérieur.

The correction of dento-facial deformities with Lefort I osteotomy are always accompanied by changes in soft tissue and skeleton. But, in many cases there is also modification of the low floor of the nose and profile changes. This clinical experience has been confirmed in the Laboratory on cadavre experimentation. Three deplacements have been studied: advancement of maxilla, inferior repositioning of maxilla and superior repositioning of maxilla. Often, Lefort I osteotomy is a complex association of these movements; modifications are also function of soft tissue. Operation must necessary provide theses technical modification for a real adaptation of the surgery. The surgical technique must therefore be adapted in order to obtain the best aesthetic result.