Disabling hearing loss after Lefort I osteotomies in patients with history of Eustachian tube dysfunction: An unknown complication.

INTRODUCTION: The aim of this study was to determine the predisposing factors of this deafness after orthognathic surgery for a population with no history of cleft palate. MATERIAL AND METHODS: All patients with significant auditory symptoms after orthognathic surgery performed in the department of Craniomaxillofacial surgery in the Croix Rousse Hospital, Lyon, France, since 2012 were included in the study. The exclusion criterion was a history of cleft palate. Bone movements performed during orthognathic surgery were analyzed. An audiometric assessment, including Pure Tone Audiometry and tympanometry, was performed at day 30 (D30), day 60 (D60) and day 90 (D90). RESULTS: Six patients were included in the study. All patients were women with a mean age of 33.5 years and suffered from class III skeletal deformities. The average hearing loss was 40 dB at D30, 20 dB at D60 and 5 dB at D90 with sometimes differences between the two ears. Five patients had a type C tympanogram suggesting Eustachian tube dysfunction and one patient had a type B tympanogram. All patients benefited from maxillary advancement of 5 mm on average. DISCUSSION: This study allows to conclude that female patients with a history of allergy or catarrhal tubal deafness are at risk of deafness after orthognathic surgery. These patients must be informed of this complication before surgery and be reassured about its reversibility.

Bilateral dermoid cysts of the upper lip.

Dermoid cysts are benign tumors found throughout the body. They are either congenital or acquired. Derived from both ectoderm and mesoderm, they are often diagnosed in childhood. Dermoid cysts of the head and neck region account for less than 10% of all dermoid cysts. The most common locations of the cysts are the periorbital region and the neck. We expose the case of a 47-year-old man who presented with bilateral dermoid cysts of the upper lip. Only 1 case of unilateral dermoid cyst of the upper lip is referenced in the literature. Authors report the first case of bilateral dermoid cysts and discuss its possible origins.

[The nose, an orthodontic-surgical marker]. / Le nez, marqueur orthodontico-chirurgical.

INTRODUCTION: Inthe quest for a universal marker to describe the physiological function of facialmechanics, the author has found nasal ventilation at rest to be a major factor to beborne in mind. MATERIALS AND METHODS: Factors related to embryology, anatomyand respiratory physiology, along with analysis of the literature in the relevantareas, now enable us to view the nose in a different light. CONCLUSION: The authorconcludes that nasal ventilation at rest constitutes a mandatory objective in theperformance of all types of therapy.

Sensitivity of the inferior lip and chin following mandibular bilateral sagittal split osteotomy using Piezosurgery.

BACKGROUND: Bimaxillary osteotomy, including bilateral sagittal split osteotomy, is the most commonly performed orthognathic surgical intervention in Europe and the United States. Neurosensory perturbation in the territory of the inferior alveolar nerve is a reported adverse effect of bilateral sagittal split osteotomy. Piezosurgery is a relatively new technique that allows bone to be cut while preserving soft tissues, including nerves. The purpose of this study was to assess inferior alveolar nerve function through clinical neurosensory testing after bilateral sagittal split osteotomy using Piezosurgery. METHODS: Between February and September of 2004, 20 patients (40 sides) presenting with dentoskeletal deformities underwent bimaxillary osteotomy, including bilateral sagittal split osteotomy. The Mectron Piezosurgery device was used to perform all sagittal splits, with distraction being performed between the two bone valves. The inferior alveolar nerve was evaluated both objectively with clinical neurosensory testing, including pin-prick sensation, light touch sensation, and two-point discrimination tests, and subjectively at the following time points: preoperatively; at days 5, 7, and 10, postoperatively; and at the second month postoperatively. RESULTS: The anatomical integrity of the inferior alveolar nerve was respected in all cases. Observed normal results for the different tests at 10 days were 90, 82, and 70 percent, respectively, for pin-prick sensation, light touch sensation, and two-point discrimination. By computing scores for different clinical neurosensory tests, the authors observed between 75 and 80 percent complete neurosensory recuperation as early as the second postoperative month. CONCLUSIONS: Piezosurgery used for bilateral sagittal split osteotomy allows prompt recovery of inferior alveolar nerve neurosensory function within 2 months. No comparison is possible with the results using the standard technique for bilateral sagittal split osteotomy.