[The tongue flap in palatal defect reconstruction]. / Le lambeau de langue dans la reconstruction des pertes de substances du palais.

INTRODUCTION: A palatal defect with bucconasal fistula often follows exeresis of palatal tumors. It cannot be directly sutured. Several techniques have been used to cure such defects: palatal obturator, free, or local flaps. TECHNICAL NOTE: The tongue pediculated flap is an easy, safe, and reliable surgical option to reconstruct palatal defects. The tongue flap is a double-layer muscular and mucosal flap that requires two surgeries. During the first, the flap is harvested on the tongue and partially sutured on the anterior portion of the palatal defect. During the second, the pedicle is freed from the tongue and sutured to the posterior portion of the palatal defect. Between these two surgeries the patient is fed through a nasogastric tube. DISCUSSION: The tongue flap is easy and reproducible. It can be recommended in mediopalatal defects after cancer palatal surgery. Its esthetical and functional results are excellent. It is an alternative to palatal obturator, which are not well tolerated in the long run. Similar but uneven results are obtained with free flaps. Free flaps do not require a second surgery but are more difficult to implement in developing countries.

[Medical and dental digital photography. Choosing a cheap and user-friendly camera]. / Photographie numérique médicale et dentaire. Le choix d'un appareil photo simple et économique.

INTRODUCTION: Digital photography is more and more important in our everyday medical practice. Patient data, medico-legal proof, remote diagnosis, forums, and medical publications are some of the applications of digital photography in medical and dental fields. A lot of small, light, and cheap cameras are on the market. The main issue is to obtain good, reproducible, cheap, and easy-to-shoot pictures. TECHNICAL NOTE: Every medical situation, portrait in esthetic surgery, skin photography in dermatology, X-ray pictures or intra-oral pictures, for example, has its own requirements. For these reasons, we have tried to find an "ideal" compact digital camera. The Sony DSC-T90 (and its T900 counterpart with a wider screen) seems a good choice. Its small size makes it usable in every situation and its price is low. An external light source and a free photo software (XnView((R))) can be useful complementary tools. The main adjustments and expected results are discussed.

[Occlusal plane orientation and postoperative anterior open bite relapse]. / Orientation du plan d'occlusion et récidive postopératoire des béances antérieures.

INTRODUCTION: Most published data on relapse in open bite maxillo-mandibular deformities give raw results but do not suggest any specific therapy. Indeed, their authors compare the various osteotomy techniques but without identifying risk factors for relapse (dysfunctional or architectural). We studied the predictive value of occlusal plane tilting, in the long-term relapse of open bite maxillo-mandibular deformity. MATERIAL AND METHOD: Fifty patients were included between 1996 and 2007. For each patient, Delaire cephalometric analysis was performed on preoperative, immediate and late postoperative teleradiographs. Immediate real postoperative occlusal plane tilting was analyzed and compared with "ideal" theoretical occlusal plane tilting (calculated with Delaires' analysis). The patients were classified in two groups: one with slight discrepancy between these two planes (+/-3.75 degrees) and one with large discrepancies between these two planes (greater than 3.75 degrees or lesser than 3.75 degrees). RESULTS: Postoperative relapse was seven times more frequent when the postoperative plane tilting was superior to +/-3.75 degrees in reference to the ideal plane. DISCUSSION: Postoperative occlusal plane tilting is a predictive factor of postoperative open bite relapse.

Prognostic molecular markers with no impact on decision-making: the paradox of gliomas based on a prospective study.

This study assessed the prognostic value of several markers involved in gliomagenesis, and compared it with that of other clinical and imaging markers already used. Four-hundred and sixteen adult patients with newly diagnosed glioma were included over a 3-year period and tumour suppressor genes, oncogenes, MGMT and hTERT expressions, losses of heterozygosity, as well as relevant clinical and imaging information were recorded. This prospective study was based on all adult gliomas. Analyses were performed on patient groups selected according to World Health Organization histoprognostic criteria and on the entire cohort. The endpoint was overall survival, estimated by the Kaplan-Meier method. Univariate analysis was followed by multivariate analysis according to a Cox model. p14(ARF), p16(INK4A) and PTEN expressions, and 10p 10q23, 10q26 and 13q LOH for the entire cohort, hTERT expression for high-grade tumours, EGFR for glioblastomas, 10q26 LOH for grade III tumours and anaplastic oligodendrogliomas were found to be correlated with overall survival on univariate analysis and age and grade on multivariate analysis only. This study confirms the prognostic value of several markers. However, the scattering of the values explained by tumour heterogeneity prevents their use in individual decision-making.

[Gene MGMT and oligodendrogliomas. Fundamental data and short review of the literature]. / Gène MGMT et oligodendrogliomes. Données fondamentales et brève revue de la littérature.

MGMT (O6 methyl guanine methyl transferase) is a gene involved in DNA repair. Its mechanism of action is to remove alkyl groups created by alkylating chemotherapy and therefore induces chemoresistances. Recent studies show that this gene expression seems to be related to the promoter's methylation, which could predict a possible chemosensitivity. The study of MGMT could be of some therapeutic and prognostic interest. Few series of oligodendrogliomas have been published and their results appear to be controversial. This is probably due to both tumour heterogeneity and multiple parameters associated with chemosensitivity. To date, it thus appears difficult to choose the adjuvant treatment according to the sole status of MGMT.

"Axial split osteotomy" of free fibular flaps for mandible reconstruction: preliminary results.

Vascularized free flaps are now considered the most appropriate choice for mandible reconstruction because they offer excellent cosmetic and functional results. Various techniques have been proposed. Free fibular flaps have numerous advantages in terms of versatility and contouring. Shaping can be achieved by wedge osteotomy with excellent results. However, this technique leads to bone loss and may be difficult in the later stages of the procedure. The purpose of this report is to describe a simple and safe flap-shaping method involving axial split osteotomy.

Full-thickness skin graft interposition after temporomandibular joint ankylosis surgery. A study of 31 cases.

Recurrence is a major problem after release of temporomandibular joint ankylosis. Early physiotherapy and choice of interpositional material are important in preventing recurrence. Currently, the most used technique is gap arthroplasty associated with coronoidectomy, temporalis muscle flap interposition and reconstruction of the condylar unit with a costochondral graft. Full-thickness skin graft interposition, using the technique described by Popescu & Vasiliu, can also be used. This retrospective review of 31 patients confirms the reliability of full-thickness skin graft interposition. Results were successful in 90% of the 20 patients with follow-up longer than one year.

Is lingual nerve protection necessary for lower third molar germectomy? A prospective study of 300 procedures.

Lingual nerve damage is one of the most common complications of lower third molar removal. However evaluation of the factor involved in these lesions is difficult since most previous series are heterogeneous. The purpose of this prospective randomized study was to ascertain the impact of lingual nerve protection in a homogeneous series including only patients undergoing third molar germectomy (i.e. removal of the developmental bud prior to anchoring of the roots in the jaw). Data from a total of 300 germectomy procedures were included in this study. All procedures were performed by the same experienced surgeon randomly with or without lingual nerve protection. No lingual nerve injury was observed after third molar germectomy regardless of whether or not lingual nerve protection was used. Lingual nerve protection is unnecessary for lower third molar germectomy.

Short retromandibular approach of subcondylar fractures: clinical and radiologic long-term evaluation.

OBJECTIVE: The classic technique for open reduction of subcondylar fracture is the submandibular approach. The aim of this study was to evaluate long-term clinical and radiologic results of the short retromandibular approach to displaced subcondylar fractures. MATERIAL AND METHODS: During a period of 66 months we performed a prospective study with a modified version of the retromandibular approach in 38 patients with displaced subcondylar fractures. In this article we describe clinical and radiologic results in 19 patients with follow-ups longer than 6 months (range, 6 to 66 months). Preoperatively all patients had malocclusion and radiology demonstrated displacement. RESULTS: The retromandibular surgical approach was successful in all cases. Roughly 25 months after surgery, mouth opening was 43 mm with symmetric laterotrusive movements. Permanent marginal nerve palsy was never observed. CONCLUSIONS: Our findings indicate that the short retromandibular approach is an easy and safe technique for displaced subcondylar fractures.

Comparison of different materials for interposition arthroplasty in treatment of temporomandibular joint ankylosis surgery: long-term follow-up in 25 cases.

A variety of interposition materials have been used to prevent recurrence after arthroplasty in treatment of temporomandibular joint ankylosis. The purpose of this retrospective study of our experience was to compare the different materials (skin, temporal muscle, homologous cartilage) used for interposition arthroplasty over a period of 22 years. A total of 25 patients (32 joints) with at least 3 years of follow-up were included. Good results were achieved in 92% of cases using total full thickness skin graft and 83% of cases using temporal muscle flap. Homologous cartilage gave poor results.

Clinical results of therapeutic temporomandibular joint arthroscopy: a prospective study of 34 arthroscopies with prediscal section and retrodiscal coagulation.

Thirty-four therapeutic temporomandibular arthroscopies were done during a 24-month period for patients with debilitating joint disorders (mainly disc displacements with or without reduction) who had not responded to non-invasive treatment. Lysis and lavage with prediscal section and retrodiscal coagulation were the techniques used. Analysis of the results indicated subjective improvement of pain in 71% of cases, noise in 78%, jaw opening in 88% and diet in 97% and objective evidence of disappearance of noise in 29% and improvement of jaw opening in 94% (mean 9.24 mm). In jaw opening, improvement was highly significant, compared with the preoperative results, P < 0.01. We conclude that temporomandibular arthroscopy is safe and indicated in disc displacements and joint luxation if medical treatment has failed.

Posterior disk displacement of the TMJ: MRI evidence in two cases.

Posterior disk displacement is a rare temporomandibular joint (TMJ) disorder. The main clinical sign is sudden molar open-bite (jaw locked in the open position). This may be accompanied by a sensation of intra-articular foreign body and more rarely joint pain. Joint sounds are unremarkable. Mouth opening may be slightly impaired. Hypothetically, like anterior disk displacements, posterior disk displacements can be classified as either reducible or nonreducible. A definitive diagnosis requires magnetic resonance imaging (MRI). There is no consensus concerning treatment. A conservative course of treatment can be successful in patients with functional impairment and should always be attempted before irreversible, invasive therapy.

[Temporomandibular staphylococcal arthritis]. / Arthrite temporo-maxillaire à staphylocoque.

Two cases of temporo-mandibular joint infection with several blood cultures positive for Staphylococcus aureus are reported. Positive diagnosis depended on the importance of the pain and trismus, as well as the lack of abscess formation. The rapid development of ankylosis requires treatment to be started as soon as the first signs appear.

[Intramedullary spinal cord metastasis: is there a place for surgery? Case report and review of literature]. / Métastases intramédullaires de cancers viscéraux: quelle place pour la chirurgie? Revue de la littérature à propos d'un cas.

BACKGROUND AND PURPOSE: The usual onset of intramedullary spinal cord metastases at an advanced stage of cancer disease explains that surgical removal of such lesions is rarely performed. We tried to define the place for surgery in the management of such lesions. METHODS: We report the observation of a 52-year-old male patient presenting with a metastasis of the conus medullaris revealing a lung cancer. Surgical excision of the lesion led to pain relief and improvement of bladder dysfunction. We present a review of pertinent literature. RESULTS: Surgery allows histological diagnosis in case of isolated, revealing tumor. In other selected cases, radical removal of intramedullary metastases could improve the quality and comfort of life although it does not seem to affect the duration of survival.

[Orbito-maxillo-facial rehabilitation with osteointegrated prostheses]. / Réhabilitation orbito-maxillo-faciale par prothèses ostéo-intégrées.

This investigation was conducted to evaluate 20 cases of implant-retained prosthetic rehabilitation (mean follow-up of 35 months). Ear, nose, orbit and complex defects of the face have been restored. Our main indication was reconstruction in cancer patients after tumor surgery (n = 14). Rehabilitation was also performed in traumatic disorders (n = 3) and congenital aural malformations (n = 3). Fifty seven titanium fixtures have been implanted with an integration success rate of 98%. We also report 6 cases of maxillary or mandibulary functional rehabilitation. The use of osteointegrated implants to provide support for maxillo-facial prosthesis is a new and valuable technique when reconstructive plastic surgery is not envisageable.

[Intracranial penetration of the mandibular condyle: report on three cases (author's transl)]. / Pénétration intracrânienne du condyle mandibulaire. A propos de trois cas.

Three cases of intracranial penetrations of the mandibular condyle condyle are reported, the published literature reviewed, and therapy discussed. Often unrecognized during initial examinations, they are diagnosed when the patient is seen several months later with permanent constriction of the jaws. Frontal and sagittal tomographic examinations should therefore be performed in the articular region in all cases when it is involved in injuries. Orthopedic reduction gives good results in recent injuries, long-standing cases with temporomandibular ankylosis requiring sub-condylar resection by the pre-auricular approach.

[Cost-benefit evaluation of spinal cord stimulation treatment for failed-back surgery syndrome patients]. / Evaluation coût/bénéfice du traitement des lombosciatalgies post-operatoires par stimulation médullaire.

BACKGROUND AND PURPOSE: Spinal cord stimulation is a well-known treatment of rigorously selected failed-back surgery syndrome patients. Efficacy levels over 50% of pain relief have been reported in long-term studies. The objective of this multicenter prospective evaluation was to analyze the cost to benefit ratio of spinal cord stimulation treatment for failed back surgery syndrome patients. METHODS: Nine hospitals (pain evaluation and treatment centers) were involved in the study. Forty-three patients were selected and implanted between January 1999 and January 2000. For each patient, pre- and post-operative evaluations (6, 12 and 24 months after implantation) were performed to assess pain relief and economical impact on pain treatment costs. RESULTS: After 24 months, mean 60% pain relief was achieved as assessed with the neuropathic pain score using a Visual Analog Scale (success rate=70%), whereas low-back pain was moderately reduced (29%). The Oswestry Disability questionnaire score was improved by a mean 39%. Costs of pain treatment (medication, consultation, other) are reduced by a mean 64% (1705 Euro) per patient per year. CONCLUSIONS: This study confirms a clear analgesic effect on neuropathic sciatalgia, and moderate attenuation of low-back pain. One particular interest of this study is the medico-economic prospective evaluation showing that the initial cost of the implanted device is compensated by a significant, early, and stable reduction in the cost of associated pain therapies.

[Recovery of maxillary tooth sensibility after Le Fort I osteotomy]. / Récupération de la sensibilité dentaire maxillaire après ostéotomie de Le Fort I.

INTRODUCTION: Upper alveolar nerves, when injured during Le Fort I osteotomies, alter maxillary tooth sensitivity. We had for aim to analyze post-operative maxillary tooth sensitivity recovery. MATERIAL AND METHODS: We conducted a prospective study in a series of patients having undergone Le Fort I osteotomy, with, or without mandibular osteotomy or intermaxillary disjunction (IMD). The direction and range of displacement of the maxillary bone were recorded. One tooth in each alveolar sector (incisivocanine, premolar, molar) was tested with an electric stimulator for each patient. The tests were performed before (D-1), and after surgery (D2 or day+2, D+15, M2 (or month +2), M3, and M6). RESULTS: Twenty-two patients were included. Among the tested teeth, 91.9 % were sensitive at D-1. At D2, only 12.7 % of teeth were sensitive. At D15, M2, M3, and M6, the sensitivity was respectively 33.3 %, 43.1 %, 50 %, and 61.8 %. The recovery of sensitivity was faster in young patients (under 35 years of age) and for upper middle and superior alveolar nerves. There was no difference regarding the direction of maxillary movement. DISCUSSION: Among the teeth that were sensitive before surgery, 87.3 % had not regained sensitivity at D2. The recovery of sensitivity increased at D15. A great displacement of the maxillary bone was an aggravating factor for loss of tooth sensitivity.

[Is orthognathic surgery an alternative for mandibular osteopetrosis?]. / Ostéopétrose mandibulaire: la chirurgie orthognatique est-elle possible ?

INTRODUCTION: Osteopetrosis is a metabolic bone disease that leads to bone malformation and bone healing disorders. We report the case of a patient who underwent orthognathic surgery to treat a class III skeletal malocclusion. OBSERVATION: A 21-year-old patient had presented with osteopetrosis in his childhood, which had been treated by bone marrow transplantation. He presented with esthetic and functional sequels, a class III skeletal malocclusion, lateral mandibular deviation, and dental agenesis. This dysmorphism was corrected by bimaxillar osteotomy. The postoperative outcome was uneventful, with satisfactory and stable healing. DISCUSSION: The patient's lesions where after-effects of his disease, but the bone structure is normal, because osteopetrosis regressed after bone marrow transplantation. There is no risk for the consolidation. Osteopetrosis, even when treated by bone marrow transplantation, is not a contraindication for maxillomandibular osteotomy.