[Our physiotherapy treatment of articular fractures of the mandibular condyle]. / Notre prise en charge kinésithérapique des fractures condyliennes articulaires.

Physical therapy greatly contributes to improved function of the injured temporomandibular joint, particularly after trauma. In our unit, we use the Delaire rehabilitation method for patients presenting a fracture of the mandibular condyles. This method involves active mobilization, first with assistance, then with facilitation, and finally against resistance. A rehabilitation session starts with a preparation of the teguments and muscles associated with relaxation exercises. The joint is first mobilized by assisted movements if needed. When unassisted motion becomes possible, propulsion, diduction and open-close exercises are then performed with neuromuscular facilitation. When sufficient amplitudes have been achieved, the program proceeds with opposed exercises. By inducing propulsion and diduction (lateral pterygoid muscle) movements, physical therapy stimulates regeneration of the condylar unit, thus facilitating optimal functional rehabilitation. Posture and passive motion methods, which in our opinion are poorly adapted to the temporomandibular joint, are used little in our unit. Since condylar regeneration is controlled by functional factors, the lateral pterygoid muscle is an important element. Good functional outcome, and the absence of ankylosis, depends directly on the quality of active rehabilitation.

[Retrospective study of two years of surgery for temporomandibular joint pain dysfunction syndrome]. / Etude rétrospective de deux années de chirurgie du Sadam.

BACKGROUND: Assessment of temporomandibular joint (TMJ) surgery is a controversial topic. We analyzed our long-term surgical results in a set of patients who underwent TMJ surgery in our unit from January 1995 through December 1996. We used a simple methodology based on 4 criteria: pain, mouth opening, type of feeding and patient satisfaction. MATERIAL AND METHODS: We reviewed 21 operated patients who had been managed by an orthodontist after surgery. The post-surgical follow-up was 4 years. Patient age at surgery ranged from 14 to 51 years; the sex ratio was 1/9 M/F. Seventeen patients suffered a closed-lock, 2 had fibrous ankylosis of the disc. Fifteen patients underwent bilateral TMJ arthrotomy with joint fixation and, very often, mandibulo-condylar-plasty to counteract the bony compression inside the joint. We rated outcome as "very good" if four factors were found: resolution or improvement of pain, more than 40 mm post-surgery mouth opening or at least 10 mm improvement for patients with less than 40 mm post-surgical mouth opening, normal feeding, subjective satisfaction rated as very or quite good. Outcome was thus rated as very good (4 factors), quite good (3 factors), good (2 factors), poor (1 factor), failure (0 factors). RESULTS: Resolution of pain was achieved in 55% of the patients with an improvement in the others. All patients recovered normal feeding. Mouth opening remained limited for two patients. Subjective patient satisfaction was very or quite good in 80% of the cases. Outcome was rated very good in 9 patients, quite good in 7, and good in 5. There were no patients with poor outcome or failure. Analysis of the good outcome group showed that 3 had experience a post-surgery trauma, one had not complied with rehabilitation therapy, and one suffered from undiagnosed rheumatoid polyarthritis. CONCLUSION: According to the literature, TMJ surgery is an effective means of treating pain and reducing dysfunction. We obtained good and stable outcome in patients who participated in our postoperative follow-up. The TMJ is a fragile joint particularly susceptible to trauma.

[The management of anterior transversal mandibular deficiencies by distraction osteogenesis. Preliminary results and report of 3 cases]. / Prise en charge des déficits transversaux antérieurs de la mandibule par ostéodistraction symphysaire. Résultats préliminaires à propos de trois cas cliniques.

During the last ten years, osteodistraction genesis appeared as being a treatment of some maxillo-facial transversal deficiencies. A new technique have been develop in Lille Maxillo-Facial Department (Pr Ferri, France). This new technique is used in cases of mandibular hyposymphysis, which induce most of the time a mandibular incisor crowding. This distraction osteogenesis performed after sagittal osteotomy of the mandibular symphysis and associated with orthodontic treatment is a solution to avoid teeth extractions. Other treatments could be used to solve anterior mandibular teeth crowding but they have disadvantages: teeth slicing, teeth extraction or orthodontic teeth tilting. This new technique is performed with intra oral-device, small enough to be placed under mandibular periosteum. Three patients have been treated by this technique, they got a stable result. In these three cases, alveolar and basal bone is present. So for us, symphysis osteogenesis distraction appears to be an alternative treatments to mandibular incisor crowding.

Standardization of a device for continuous observation of local flow in tissue.

As our experimental set-up for continuous recording of local blood flow in the cerebral cortex of a laboratory animal with chronically implanted miniature thermistors (based on the heat clearance principle) gave satisfactory results for routine tests of pharmacological agents during anoxia, hypoxia, hypercapnia, etc., experiments, we intended to standardize the apparatus, to increase accuracy, to facilitate calibration and to enhance flexibility with respect to the operator. The exponential aspect in the thermistor resistance/temperature characteristic is linearized by applying a logarithmic converter in the thermistor amplifier. Calibration to the centigrade temperature scale is performed by a three digit numerical adaptation of two thermistor constants determined in a thermostatic-cryostatic bath (zero and slope). A heating power measuring circuit is provided so that the dissipation constant of the thermistor implanted in tissue can be obtained and the thermal conductivity of the tissue can be estimated. Linearity of the relation between cooling of the heated thermistor and local flow, for small cooling values as they are registered in vivo, is still being investigated.

Assessment of the in vivo recording of local cerebral blood flow using a thermistor device.

In order to obtain a continuous measurement of local blood flow in the cerebral cortex of a laboratory animal using chronically implanted sensors, we have developed a device based on the heat clearance principle. Flow information is obtained from temperature measurement by means of two thermistors one of them being heated at a defined level above ambient tissue temperature; as such, cooling of the heated thermistor caused by convection phenomena in its vicinity, can be related to local perfusion rate. In a first step "in vitro" measurements were performed in order to study the behaviour, sensitivity and reliability of the device; a physical model was established explaining the results. In this paper we describe "in vivo" tests in the rabbit's brain cortex with the miniature thermistors (0.5 mm diameter) chronically implanted (at the cortical surface). Results are correlated with oxygen tension measurements using (smaller) pO2 electrodes inserted into the cortical tissue. We have observed that all sensors are well tolerated by the animals who remain symptom free. Test experiments, inducing a well known physiological effect on local blood flow, such as arterial clamping, inhalation of CO2 gas mixtures, etc., are performed. The phenomena during induced anoxic anoxia are also shown. These preliminary investigations are essential in order to attempt by future experiments the establishment of a correlation between "in vivo" recorded flow signals and the "in vitro" measured characteristics.

A standardized 'in vivo' model for the study of experimental arterial thrombosis: description of a method.

A method for "in vivo" induction and registration of arterial platelet thrombosis has been developed and standardized in a branch of the mesenteric artery of the white Wistar rat. It consists in local deendothelialization by electrical current. Thrombus induction is performed by topical superfusion with ADP; when the superfusion is discontinued the thrombus disappears but can again be induced reproducibly by renewal of the ADP superfusion after a time interval not exceeding 15 minutes. Registration of the thrombotic phenomenon is made possible by microprojection of the investigated arterial segment. An appropriate optoelectronic device allows the on-line derivation of discriminating parameters. Off-line storage and processing of the experimental data by computer is provided. The method is automatized and can easily be applied to other species of laboratory animals.

A thermistor device for the continuous recording of mass transport velocity in tissue based on the heat clearance principle.

A method for the recording of mass transport velocity in tissue, related to the relative local mass flow, has been developed. It is based on the heat clearance principle, applied in the continuous mode. Thermistors are used as temperature sensors; heating is performed by a high frequency square wave, thus avoiding an additional heating coil. The cooling of the heated thermistor, with as a reference a non-heated one, is related to the local mass transport velocity. A test equipment has been built for the calibration of the device and a set of results have been obtained in test fluids with a thermal conductivity approaching the one of brain tissue (glycerin and water). A mathematical model has been set up which gave results consistent with the recorded data. From this model significant parameters could be derived which, introduced in a compensation circuit, may be used in order to linearize the relation between the measuring value and the velocity variable. In vivo results in the brain cortex of the rabbit have been obtained.