[Mandibular osteotomy, a simpler and safer method of osteosynthesis]. / Ostéotomie mandibulaire, une méthode plus simple et plus sûre d'ostéosynthèse.

Bilateral sagittal split osteotomy (BSSO) is a surgical procedure to treat mandibular malpositions. However, this surgery is associated with a risk of recurrence. Osteosynthesis techniques may be the cause of early recurrences. This study aims to demonstrate the efficiency and stability of osteosynthesis with two bicortical screws placed with a transjugal approach. We included patients who benefited from a BSSO alone, between May 2020 and August 2021. We performed the osteosynthesis using two bicortical screws placed with a transjugal approach. All the patients underwent lateral X-rays before the surgery, one week after and minimum six months after the intervention. These medical images allowed to study the mandibular movements during the intervention and the osteosynthesis stability. Twenty-five patients benefited from a BSSO alone. Patients obtained a satisfactory occlusal result. The results showed good stability of the two fragments, after surgery, during the studied period (average follow up of 8 months). Two bicortical screws osteosynthesis placed with a transjugal approach is a simple, effective and stable method for osteosynthesis in case of BSSO.

Les ostéotomies sagittales bilatérales mandibulaires (OSBM) sont des procédures chirurgicales utilisées pour traiter les malpositions mandibulaires. Toutefois, cette chirurgie présente un risque de récidive. Les techniques d'ostéosynthèse pourraient être la cause de récidives précoces. Cette étude vise à démontrer l'efficacité et la stabilité de l'ostéosynthèse à l'aide de deux vis bicorticales placées par voie transjugale. Nous avons inclus les patients ayant bénéficié d'une OSBM seule, entre mai 2020 et août 2021. Nous avons réalisé les ostéosynthèses à l'aide de deux vis bicorticales placées par voie transjugale. Tous les patients ont réalisé des clichés radiologiques de profil avant l'intervention, une semaine après et minimum six mois après. Ces imageries ont permis d'étudier les mouvements mandibulaires durant l'intervention et la stabilité de l'ostéosynthèse. Vingt-cinq patients ont bénéficié d'une OSBM seule. Les patients ont obtenu un résultat occlusal satisfaisant. Les résultats ont montré une bonne stabilité des deux fragments après la chirurgie durant la période étudiée (en moyenne, recul de 8 mois). En conclusion, l'ostéosynthèse à l'aide de deux vis placées par voie transjugale est une méthode simple, efficace et stable d'ostéosynthèse d'OSBM.

Individualized Prophylactic Neck Irradiation in Patients with cN0 Head and Neck Cancer Based on Sentinel Lymph Node(s) Identification: Definitive Results of a Prospective Phase 1-2 Study.

PURPOSE: This prospective, nonrandomized, interventional phase 1-2 study investigated the individualization of elective node irradiation in clinically N0 head and neck squamous cell carcinoma by sentinel lymph node (SLN) mapping with single-photon emission computed tomography/computed tomography (SPECT/CT) and its impact on tumor control and radiation-related toxicity. METHODS AND MATERIALS: Forty-four patients with clinically N0 head and neck squamous cell carcinoma treated with definitive (chemo-)radiation therapy were imaged with SPECT/CT after 99mTc nanocolloid injection around the tumor. The neck levels containing up to the 4 hottest SLNs were selected for prophylactic irradiation. A comparative virtual planning was performed with the selection of neck levels based on the current international guidelines. Regional control was monitored as a function of the selected volume. Dosimetric data for the organs at risk were compared between the plans. Normal tissue complication probability (NTCP) rates were derived for xerostomia, dysphagia, and hypothyroidism to predict the clinical benefit and correlated to quality-of-life (QoL) assessments at 6 months. RESULTS: Sixteen percent of patients presented unpredicted lymphatic drainage, and 48% drained unilaterally. The nodal clinical target volume based on lymphoscintigraphy was smaller than the nodal clinical target volume based on international guidelines by a factor of 2 (P < .0001). After a median follow-up of 46 months, only 1 patient experienced a regional relapse in a nonirradiated area. Significant median dose reductions to organs at risk were observed, particularly to contralateral salivary glands in patients with unilateral drainage (14.6-28.1 Gy) and to the thyroid gland in all patients (22.4-48.9 Gy). Median NTCP reductions were observed for xerostomia (0.3% to 13.7%), dysphagia (1.7% to 10.8%), and hypothyroidism (14.0% to 36.1%). QoL at 6 months was improved, particularly in patients irradiated unilaterally. CONCLUSIONS: Neck SLN mapping with SPECT/CT individualizes and reduces the elective nodal target volumes without compromising the regional control. The NTCP rates were reduced and favorable QoL were observed in all patients, particularly in the case of unilateral irradiation.

Congenital Unilateral Zygomatico-Maxillo-Mandibular Fusion.

Congenital fusion of the jaws (syngnathia) is a rare and severe disorder. The authors report a case of bony fusion of the left mandible with the maxilla and zygomatic complex in a 5-day-old male who was not able to feed and open his mouth normally. Early surgery was performed to release the bony fusion on the tenth day of life. The authors present a new technique based on the intraoperative use of 3-dimensional surgical guides.

SPECT/CT lymphoscintigraphy of sentinel node(s) for superselective prophylactic irradiation of the neck in cN0 head and neck cancer patients: a prospective phase I feasibility study.

BACKGROUND: Clinically node negative HNSCC patients have a risk ranging between 18 and 45% of occult metastases, making prophylactic irradiation mandatory. Selective irradiation of nodal target volume based on international guidelines is practice. Anyway, about half the tumours lying in an anatomical subsite known to potentially drain bilaterally effectively do so, leading to unnecessary large volume irradiation. Moreover, 15% of the tumours show drainage outside of predicted basin, increasing the risk for potential geographical misses. Three-dimensional SPECT/CT lymphoscintigraphy (LS) of sentinel node(s) may help to individualize nodal target volume selection. This prospective phase I study explores its feasibility and the dosimetric impact. METHODS: Ten cN0 HNSCC patients eligible for definitive radiotherapy were imaged with SPECT/CT after 99mTc nanocolloid injection around the tumour. The neck levels containing up to four hottest nodes were identified and selected for prophylactic irradiation (CTVn-LS) by volumetric modulated arc therapy. A comparative virtual planning was performed with volumes selected according to international guidelines (CTVn-IG). RESULTS: Migration was observed in all patients (one with gamma probe only). 2.9 sentinel nodes were detected per patient on average. In some patients, accurate localization was difficult when not using thermoplastic mask for SPECT/CT. CTVn-LS was totally encompassed by CTVn-IG in all patients but one (unpredicted drainage in retropharyngeal level). On average, CTVn-LS and related planning target volumes were two times smaller than IG ones. This led to significant dose decrease in identified organs at risk as well as remaining volume at risk. CONCLUSIONS: SPECT/CT LS is a promising tool to individualize prophylactic node CTV in cN0 HNSCC patients eligible for definitive radiotherapy. Oncological safety must be confirmed by ongoing phase II study.