[Psychological effects of orthognatic surgery and postoperative dissatisfaction: presentation of a research protocol]. / Effets psychologiques de la chirurgie orthognatique et insatisfaction postopératoire : présentation d'un protocole de recherche.

INTRODUCTION: The causes of postoperative dissatisfaction in orthognathic surgery are difficult to grasp. The aims of our study are to analyze the effects of orthognathic surgery on self-esteem, body image, psychological morbidity, and quality of life. We also want to assess the combined effects of these factors on postoperative dissatisfaction, and to study the interest of personality assessment (especially neuroticism) as a predictive factor of dissatisfaction. METHOD: Three hundred patients candidates for maxillo-mandibular osteotomy will be included in the study. They will answer a questionnaire assessing self-esteem, body image, psychological morbidity, quality of life, and personality. The evaluation will be conducted preoperatively and postoperatively at 3 months and at 1 year. The degree of satisfaction will be measured postoperatively. EXPECTED RESULTS: The results should help evaluate the psychological effects of orthognathic surgery and identify predictors of postoperative dissatisfaction, and especially the role of neuroticism.

Orthognathic surgery improves quality of life and depression, but not anxiety, and patients with higher preoperative depression scores improve less.

This study assessed quality of life (QoL), depression, and anxiety before and after orthognathic surgery and identified risk factors for poorer postoperative outcome. This multicentre prospective study included 140 patients from five French medical centres. We assessed patients before surgery (T1), 3 months after surgery (T2), and 12 months after surgery (T3). We assessed the severity of the orofacial deformity, physical, psychological, social, and environmental QoL (WHOQOL-BREF), and depression and anxiety (GHQ-28). Risk factors for poorer outcome were identified using linear mixed models. Between baseline and 12 months, there was significant improvement in psychological and social QoL and in depression (although below the norms reported in the general population), but not in anxiety. Physical QoL was poorer in patients who were younger, who had a mild orofacial deformity, and who were depressed. Psychological QoL was poorer in younger patients and in depressed patients. Social QoL was poorer in patients who were single, who had a mild orofacial deformity, and who were depressed. Although orthognathic surgery provides a moderate improvement in psychological and social QoL, the systematic screening and treatment of depression could further improve QoL after surgery because it is a major predictor of poor QoL in this population.

[Reconstruction of complex tissue loss of the medial canthus]. / Reconstruction des pertes de substance complexes du canthus interne.

The medial canthus is an anatomic and surgical entity. Reconstruction after cancerological resection is complex. The purpose of this article is to report a reconstruction technique for massive loss of tissue of the medial canthus which was applied in 2 patients with 2 years follow-up. Anatomic reconstruction was achieved. Each element of the canthus was restored: skin using Mustardé temporojugal and frontal flaps, conjunctive using a palatine mucosal graft, lacrimal canal using conjuctivo-rhinostomy, the medial canthal ligament using a fascia lata graft and transnasal canthopexia. Both patients developed an ectropion which required revision surgery. At 2 years, the functional outcome is good. Reconstruction allowed adapted social life and the cancer was controlled successfully.

[Stability of grafts and implants after bone grafting of the maxillary sinus. Retrospective analysis of 44 patients]. / Stabilité du greffon et des implants après greffe osseuse du sinus maxillaire.

OBJECTIVES: We assessed the reliability of maxillary bone grafting and implant stability, comparing our results with reports in the literature. MATERIAL AND METHODS: This retrospective series included 44 patients who underwent maxillary sinus bone grafting between 1998 and 2002. An analogous graft was used for 31 patients and a combination autologous-bone substitute graft for 13. One hundred twelve dental implants were positioned at the grafting site (2.5 implants per graft). We assessed recipient site morbidity, bone graft integration and stability, and stability of the implants. RESULTS: Bone grafting was successful in 97.8% of patients. There was one failure. Two of the 112 implants failed. DISCUSSION: Our results are comparable with those in the literature. This study demonstrated the reliability of maxillary bone grafting with equivalent results using autologous bone and combination autologous bone-bone substitute.

[Reconstruction of complex loss of maxillary substance using a vascularized fibular flap after arteriovenous fistulization with a saphenous loop]. / Reconstruction d'une perte de substance complexe du maxillaire par transfert de fibula vascularisé après réalisation d'une fistule artério-veineuse par boucle vasculaire saphène.

INTRODUCTION: When major loss of bone stock requires a vascularized transfer, the poor quality of the receiver vessels may require complementary lengthening of the vascular pedicle. This can be achieved with venous bypasses or by preparing the recipient site with a vascular loop. We have used this later approach successfully in a patent with major tissue loss involving the maxillary bone. CASE REPORT: A 39-year-old man presented total loss of the maxillary tissues due to a firearm wound. A free fibular flap was considered. Due to the limited length of the fibular pedicle, and the scar tissue in the area of the vascular anastomoses, reconstruction was performed in two phases: first preparation of the recipient site with a saphenous loop then fifteen days later transfer of the fibular flap. DISCUSSION: This technique is an alternative to venous bypass which increases the risk of postoperative thrombosis. The objectives of the vascular loop are to position the anastomoses in a healthy area and to achieve end-to-end anastomoses. This technique has been described basically for the treatment of post-traumatic tissue loss of the limbs, but can be applicable for the face, particularly after radiation.