[Inflammatory granuloma of iliac bone harvest site: a rare complication of Horsley bone wax]. / Granulome inflammatoire du site de prélèvement osseux iliaque : une complication rare de la cire à os d'Horsley.

Bone wax or Horsley wax, which is used very frequently in bone surgery, is a non-absorbable mixture of beeswax (70%) and Vaseline. It permits the haemostasis of bone gaps by mechanical obstruction of bone pores containing blood capillaries. Complications due to this product are rare but sometimes quoted in literature. We report the case of a 17-year-old patient who, 10 months after surgery and after an asymptomatic period, presented an inflammatory granuloma at the scar of iliac bone harvest, which had been used as a maxillary graft. This complication necessitated a first exploratory and cleansing surgery, as well as a second surgery, which clarified the origin of the inflammation and made it possible to eliminate the wax remains. We think that bone wax should be used sparingly and with caution, firmly applied to the bleeding site without leaving any free particles.

[Zygomatic bone repositioning osteotomies]. / Ostéotomies de repositionnement de l'os zygomatique.

INTRODUCTION: The main morphological sequels of zygomatic bone fractures are lack of zygomatic projection and enopthalmia. They may be corrected by zygomatic osteotomy which is a difficult operation because of modified anatomic landmarks. Onlay bone or alloplastic grafts are preferred. TECHNICAL NOTE: Zygomatic osteotomies are performed through three surgical approaches: superior palpebral, sub-ciliary, and upper vestibular, followed by repositioning with osteosynthesis micro-plates. They allow reconstruction with an adequate projection in three dimensions. Surgery is usually associated with a bone graft of the orbital floor. DISCUSSION: Zygomatic osteotomy is a simple, reproducible technique, but it requires a good bone exposure. The esthetic results are satisfactory with an uneventful outcome. This surgical procedure is a good alternative to isolated techniques of autologous bone grafting or alloplastic material reconstruction which have sometimes disappointing and short lasting results due to graft resorption.

[The impact of low intensity pulsed ultrasound on mouse skull bone osteoblast cultures]. / Ultrasons pulsés de faible intensité (LIPUS): effets sur des cultures d'ostéoblastes crâniens de souris.

INTRODUCTION: Low intensity pulsed ultrasound (LIPUS) is one of the methods used to stimulate bone regeneration. This technique is still not well known or explained. The expression of several proteins (VEGF, IL-8, FGF-ß, IL-1 ß) or genes (ALP and OP) was increased after being exposed to weak ultrasounds, whereas IL-6 and TNF-α were not affected. The purpose of this study was to verify and understand the mechanisms involved in this stimulation, and more specifically to understand if the stimulation concerned only cellular differentiation factors or if it also affected transcription of stem cells into osteoblasts. MATERIALS AND METHODS: Cultures of mouse skull bone osteoblasts were exposed to pulsed ultrasounds of varying intensities during three consecutive days. The effect of this stimulation was assessed by counting cells and determining the number of bone nodules formed. We studied various genes participating in osteoblast proliferation or in the differentiation and transcription of osteoblasts, using reverse transcriptase PCR. RESULTS: The cellular proliferation of osteoblasts was increased after stimulation by low intensity pulsed ultrasound. The expression of various genes involved in differentiation and transcription of stem cells into osteoblasts was increased, especially after stimulating at 100 mW/cm(2). DISCUSSION: Low intensity pulsed ultrasound allows stimulation of bone proliferation in vitro by stimulating osteoblastic differentiation and transcription.

[Justification for the mandibular-maxillary order in bimaxillary osteotomy]. / Justification de l'ordre mandibule-maxillaire dans l'ostéotomie maxillomandibulaire.

INTRODUCTION: Our aim was to study the reliability of sagittal split osteotomy and Le Fort I osteotomy respectively, and to try to judge objectively the impact of their order for the final result of bimaxillary osteotomy. PATIENTS AND METHOD: Fifty patients were included. For each we calculated the errors generated by sagittal split osteotomies on one hand and Le Fort I osteotomy on the other hand, by performing a peroperative splint after each osteotomy. RESULTS: After sagittal split osteotomies changes in the anteroposterior direction were present in 74% of cases with an average amplitude of 0.32mm. They were less frequent in the transversal direction, 54% of cases, with a smaller amplitude (0.19mm). After Le Fort I osteotomy, there was no difference in 92% of cases with an average error of 0.02mm in the anteroposterior direction. No errors were observed in the transverse direction. DISCUSSION AND CONCLUSION: Le Fort I positioning is remarkably accurate contrary to the sagittal split. Using Le Fort I osteotomy first and mandibular sagittal split second has for drawback to perpetuate the errors of the sagittal split. The reverse order, beginning with the mandible, allows correction of sagittal split mistakes with the Le Fort I osteotomy. So it seems that the latter order is more logical and preferable.

[Intermaxillary fixation: technique and benefit for piezosurgical sagittal split osteotomy]. / Blocage maxillomandibulaire: technique et intérêt dans le clivage sagittal piézoélectrique.

INTRODUCTION: The aim of this study was to assess piezosurgical sagittal split osteotomy with peroperative inter maxillary fixation. MATERIAL AND METHOD: We studied 25 bimaxillary osteotomies, 50 sagittal split osteotomies performed with this technique. It included both maxillomandibular fixation during all the split osteotomy and performing split osteotomy in five steps. For each case, we noted the type of dysmorphia, the size of split osteotomy and the time required for surgery, along with common data such as sex, age, etc. The data was compared to results of a previous series of patients also operated with Piezosurgery but without peroperative maxillomandibular fixation. RESULTS: Using peroperative maxillomandibular fixation during piezosurgical bilateral sagittal osteotomy decreases the length of surgery by 33%, allows 9 times out of 10 for complete splitting, including the basilar edge, has no adverse effect especially on orthodontic material. DISCUSSION: Piezosurgery is a great progress for orthognatic surgery because of its precision and ability to preserve soft tissues. But it requires modification of the usual technique for mechanical section. Using peroperative inter maxillary fixation during ultrasonic splitting is a remarkably effective and easy technical modification.

Ultrasonic osteotomy as a new technique in craniomaxillofacial surgery.

Ultrasound osteotomy is a new surgical technique used in dentistry to section hard tissues without damaging adjacent soft tissues. It was hypothesized that this could also be useful in craniofacial and orthognathic surgery. An ultrasonic device was employed in the following craniofacial surgical procedures: 144 Le Fort I osteotomies, 140 palatal expansions after Le Fort I osteotomies and 140 bilateral sagittal osteotomies; 2 Le Fort III osteotomies for treatment of Crouzon syndrome in two patients; 12 cases of unicortical calvarial bone grafting; removal of superior orbital roof in 25 cases of craniofaciostenosis; removal of external wall of the orbit in 10 cases of orbital cavity tumour; removal of anterior and posterior walls of the frontal sinuses in four cases of orbital cavity tumour. Integrity of soft tissues and surgical time were evaluated. Functional results were good without any soft-tissue damage being observed, but the overall operative time was increased. Ultrasound osteotomy is a new technical procedure that is advantageous for bone cutting in multiple situations, with minimal to no damage in adjacent soft tissues such as brain, palatal mucosa and the inferior alveolar nerve.

Inflammatory myofibroblastic tumour of the tongue: a case report.

A 22-year-old white woman presented with a recurrent mass in her tongue that had originally been diagnosed as a fibrosarcoma. Review of the original specimen with new immunohistochemical staining showed that it was an inflammatory fibroblastic tumour.

[Upper eyelid congenital coloboma, aethiology pathogenesis and management]. / Colobome congénital de la paupière supérieure, étiologie physiopathologie et prise en charge.

Coloboma of the upper eyelid is a rare congenital disease. It is defined as an agenesis of the eyelid free edge. Multiple patho-physiological theories exist about its etiology. The surgical therapeutic management of this malformation is clearly codified. We illustrate the presentation by two cases treated in the Groupement Hospitalier Nord of Lyon University Hospital.

Trans-sinusal frontal approach for olfactory groove meningiomas.

The authors report on their experience with the trans-sinusal frontal approach in removing olfactory groove meningiomas. Six tumors were operated on by the trans-sinusal frontal approach, using a bicoronal incision; two tumors developed on one side, and there were four bilateral olfactosellar tumors. Osteotomy of the anterior wall of the frontal sinus was performed with an oscillating saw without any burr hole. The posterior wall of the sinus was resected and the tumor was attacked through a real subfrontal route along the plane of the anterior skull base. Ethmoidal blood supply was controlled at the initial stages of the operation, allowing avascular tumor debulking. Olfactory nerves, invaded by the tumor, were removed along with the tumor. Tumor extensions toward the sella and the optic canals were removed without brain retraction, opening of the Sylvian fissure, or dissection of the carotid arteries. All patients made a good neurologic recovery; intellectual impairment disappeared within 1 month, and visual acuity normalized within 2 weeks. Olfactory nets were preserved on the contralateral side in unilateral tumors. The trans-sinusal frontal approach is technically easy and safe to achieve. Osteotomy and replacement of the anterior wall of the frontal sinus are rapidly performed. When the frontal sinus is small, imageguided surgery allows precise deliniation of its limits and the free bone flap, including the calvarial outer layer, tangentially cut from one supraorbital canal to the other. The cosmetic result is perfect, as the normal contour of the forehead is maintained without any scar or visible burr hole. The trans-sinusal frontal approach gives access to the orbital roofs and to the central anterior skull base from the crista galli to the tuberculum sellae and the anterior clinoid processes. The trans-sinusal frontal approach represents an alternative to conventional craniotomies for tumors developed in the central anterior skull base, especially for olfactory groove meningiomas, whatever their size.

[Sphenoido-nasopharyngeal craniopharyngioma. A case with radical excision by Le Fort I-type maxillotomy]. / Crâniopharyngiome sphénoïdo-naso-pharyngé. Un cas avec exérèse radicale par maxillotomie de Le Fort I.

A case of infra-sellar (sphenoidal nasopharyngeal) craniopharyngioma is reported. A 16 year-old girl presented with progressive nasal obstruction. CT and MR images showed a heterogeneous tumor originating from the sphenoid bone with no intra-cranial or supra-sellar extension. On a biopsy specimen, the histologic examination was consistent with a craniopharyngioma. The tumor was successfully removed via an inferior route using a Le Fort I maxillotomy. Plates and screws were used to achieve osteosynthesis. The post-operative course was uneventful and there was no residual tumor on post-operative CT. Craniopharyngiomas with strictly infra-sellar development are very rare. Up to now, 19 cases have been reported in the literature. This condition likely results from growth of embryonic remnants lying along the craniopharyngeal duct. Several surgical approaches have been proposed, most of those giving poor exposure to the clival and lateral tumorous extensions. Of particular interest in the authors' experience was the use of a Le Fort I maxillotomy which provided optimal exposure to the skull-base and facilitated radical excision. CT and MR studies have proved of upmost importance in delineating the area of bone to be removed at operation.

[Frontal sinus approach to olfactory groove meningiomas]. / Voie trans-sinusienne frontale pour les méningiomes de la gouttière olfactive.

We report on our experience of the frontal sinus approach for removing olfactory groove meningiomas. Five tumors were operated on, one unilateral, four bilateral. Osteotomy of the anterior wall of the frontal sinus was performed with an oscillating saw without any burr hole. The posterior wall of the sinus was resected and the tumor was attacked along the plane of the anterior skull base. Ethmoidal blood supply was controlled at the initial stage of the operation, allowing avascular tumor debulking. Olfactory nerves, invaded by the tumor, usually cannot be spared. Tumor extensions towards the sella and the optic canals were removed without any brain retraction, nor opening of the sylvian fissure, nor dissection of the carotid arteries. The frontal sinus approach is technically easy to achieve. Osteotomy and reconstruction of the anterior wall of the frontal sinus are rapidly performed. When the frontal sinus is small, image guided surgery allows to delineate precisely its limits and the flap includes the calvarial outer layer, tangenitally cut from one supra-orbital canal to the other. Cosmetic result is perfect. The frontal sinus approach gives access to the medial part of the orbital roofs and to the central anterior skull base from the crista galli to the tuberculum sellae and the anterior clinoids. The frontal sinus approach represents an alternative to conventional craniotomies for tumors developed in the central anterior skull base, especially for olfactory groove meningiomas.

[Solitary fibrous tumor of the orbit: Possibly recurrent in the long-run]. / Les tumeurs fibreuses solitaires de l'orbite : une entité pouvant récidiver à long terme.

Solitary fibrous tumor (SFT) is a rare etiology of progressive unilateral exophthalmia. The tumor is of mesenchymal origin and it is usually well defined. But recurrences can occur despite of complete surgical resection. Metastases have been observed. Tumors of the SFT spectrum are considered as benign or low-grade malignant. Histological features do not currently allow any prognosis. The most important prognostic factor is complete surgical resection. Craniofacial approaches provide a good view of the tumor extensions and orbital contents. Recurrent tumors must be surgically removed when possible. Complementary treatments have not proved effective. A very long-term follow-up is mandatory.

Patient-controlled analgesia in orthognathic surgery: evaluation of the relationship to anxiety and anxiolytics.

BACKGROUND: Although patient-controlled analgesia' (PCA) use has been reported in oral and maxillofacial surgery,(8) it has not been evaluated for use in orthognathic surgery. In this study, we evaluated the relationship between age, gender, and preoperative anxiety and postoperative morphine intake after orthognathic surgery in the PCA environment. STUDY DESIGN: Fifty-one patients (34 female, 17 male) underwent orthognathic surgery. Patients' anxiety was evaluated preoperatively. All patients received morphine-based postoperative PCA. Relationship between preoperative anxiety and postoperative visual analog scale (VAS) and 24 hour morphine intake was evaluated. Patients were randomly grouped according to whether preoperative oral anxiolytics were prescribed. RESULTS: Age and VAS were correlated, as well as preoperative anxiety score and postoperative morphine intake (P < .05). Female patients receiving anxiolytics before surgery had less morphine consumption than those who did not. CONCLUSION: Preoperative anxiety directly influences postoperative PCA morphine intake. Anxiolytics preoperatively seem to reduce the need for postoperative analgesics.

[What is Piezosurgery? Two-years experience in craniomaxillofacial surgery]. / Qu'est-ce que la Piezosurgery? Intérêten chirurgie craniomaxillofaciale. A propos de deux ans d'expérience.

INTRODUCTION: Piezosurgery is a new surgical technique used in dentistry to section hard tissues without damaging adjacent soft tissues. We hypothesized that such a device could also be useful in craniofacial and orthognathic surgery. MATERIAL AND METHOD: An ultrasonic device (Mectron) was employed in different craniofacial surgical procedures: a) to perform 144 Le Fort I osteotomies, 140 palatal expansions after Le Fort I osteotomies, and 134 bilateral sagittal osteotomies; b) to perform a Le Fort III osteotomy for treatment of Crouzon syndrome in 2 patients; c) to perform 5 segmental osteotomies and 3 osteotomies of the inferior edge of the mandible for facial asymmetry; d) to perform 12 cases of unicortical calvarial bone grafting; e) to remove the superior orbital roof in 20 cases of craniofaciostenosis and the frontal bone in 5 cases; f) to remove the external wall of the orbit or the anterior and posterior wall of the frontal sinuses in 10 cases of orbital cavity tumors; g) to approach the skull base through the frontal sinuses in 4 cases. Integrity of soft tissues and surgical time were evaluated. RESULTS: Analysis of the results showed that Piezosurgery: a) allows very precise cutting; b) avoids bone cutting using an osteotome; c) spares soft tissue such as brain, dura-mater, palatal mucosa, and the inferior alveolar nerve; d) increases the time of bone cutting but not the overall operative time because of the absence of soft tissue protection. DISCUSSION: Piezosurgery is a new technical procedure, which can be advantageous for bone cutting in many situations, sparing adjacent soft tissues such as brain, palatal mucosa, and the inferior alveolar nerve from any damage. The device's lack of power appears to be a minor problem compared with the advantages.

[Craniofacial approach for orbital tumors and ultrasonic bone cutting]. / Voies d'abord craniofaciales des tumeurs orbitaires et découpe osseuse ultrasonique.

BACKGROUND: Removal of orbital tumors is a difficult problem. The goal of this study was to evaluate the advantages of the craniofacial approach to remove such tumors and to evaluate ultrasonic bone cutting during the procedure. METHOD: The authors reviewed their experience with 57 tumors of the posterior cavity using lateral craniofacial and frontal transsinus approaches. Orbital osteotomies were performed with mechanical instruments or piezoelectric bone surgery as a minimally invasive surgery. For each case, the quality of bone cutting and soft tissue damage were evaluated. RESULTS: Craniofacial approaches are simple and fast. Under the microscope, they provide a good view of the entire posterior orbital cavity. Using Piezosurgery, the functional results are good with no soft tissue damage. These advantages balance with the increased operative time required by ultrasonic bone cutting. CONCLUSION: This study shows the advantages of craniofacial approaches for removal of posterior orbital tumor. Moreover, the present preliminary report introduces and demonstrates the utility of piezoelectric bone surgery in craniofacial approaches for orbital tumors.

[Is Delaire's cephalometric analysis flexible? A quantified study]. / L'analyse céphalométrique de Delaire est-elle élastique? Une étude chiffrée.

INTRODUCTION: Delaire's architectural analysis is a tool used in the maxillofacial field. Its use requires identifying landmarks teleradiographically in order to map appropriate lines dependent on these points. We studied the elasticity of the analysis. MATERIAL AND METHOD: The C0 line technique was used to vary individually the spatial position of specific landmarks and lines. The consequences on the position of the Me point and the slope of the occlusal plane were tabulated. RESULTS: Modifying the special position of the studied landmarks did not affect the final map drawn by the analysis, proving that Delaire's analysis has a certain degree of elasticity. It was noted however that the F4 line might be the determining factor. DISCUSSION: After the mathematical and geometrical demonstration, the question is raised of whether or not there is an ideal and single craniofacial architecture for a given patient, taking into consideration the elasticity of the analysis and the problem of positioning the F4 line.