[Pre-implantation bone graft coffering technique for posterior mandibular edentulism: between onlay grafting and regeneration]. / Technique du coffrage en greffe osseuse préimplantaire mandibulaire postérieure : entre apposition et régénération.

BACKGROUND: Pre-implant placement posterior mandibular bone grafts remain a challenge for maxillofacial surgeons. We present a coffering technique we prefer using in this localization. SURGICAL PROCEDURE: This original technique involves creating a sagittal mandibular groove in which a graft harvested from the retromolar region is wedged vertically, after being sharpened in a bone mill. Reconstruction of the alveolar region itself is achieved by filling up the space between this vestibular coffer and the residual alveolar ridge with particulate bone graft from the bone mill. RESULTS: A hundred patients were operated with this technique by the same team from 2005 to 2010. The treatment failed for four patients at 3 post-operative months. No alteration of inferior alveolar nerve was observed. DISCUSSION: This coffering technique seems to be fully adequate in case of a posterior mandibular atrophy with a narrow ridge and sufficient bone height. This technique has several assets. Guided bone regeneration is associated with the use of exclusively autologous bone grafts. It may be performed under local anesthesia. The donor site is close, and the regenerated bone is of good quality. Implant placement must be achieved from 4 to 6 months after graft surgery. The drawbacks of the technique are related to donor site possibilities, and to the alveolar ridge height. Morbidity is low.

Long-term stability of basilar mandible osteotomy: Chin Wing.

The Chin Wing is a modified genioplasty extended along the basilar border and the angles of the mandible. This technique may be a better choice than standard genioplasty for correction of lip incompetence, retrogenia and high angle position associated with hyperdivergent cases. Our objective was to analyse the overall movement realized during surgery and the long-term stability of this procedure. Ten patients underwent a Chin Wing surgery from June 2018 to August 2019. All patients were operated on by the same surgeon. We performed a preoperative (PO), an immediate postoperative (POI), and an over 6 months postoperative (PO6) Cone Beam Computed Tomography (CBCT) for every patient. 3D reconstructions were performed for each CBCT with Proplan software. We were thus able to determine by subtractions acquired and resorbed bone volume. Some section plans were chosen in order to perform 2D measurements. The CBCT volume comparisons reveal a gain of 7.6cc between the PO and the POI, for a bone resorption of 2.5cc between POI and PO6 (33% of the volume gained). In 2D evaluation, we observe an average resorption of 1.7 mm corresponding to approximately 20% of the height gained, at the level of the mandibular angle. Given the low bone resorption we can consider Chin Wing stable over time. The important quantity of mobilized bone and the basilar rotational movement may explain over-standing aesthetic and functional outcome, compared to classical genioplasty.

Assessing the incidence of nerve injuries according to different mandibular osteotomies including Wing osteotomies.

We use currently 3 types of new mandibular osteotomies (a shortened Bilateral Sagittal Split Osteotomy (BSSO), associated or not with Chin Wing or Mini Wing). Chin osteotomy is a modified genioplasty extended along the basilar border and the angles of the mandible. These osteotomies are associated with a risk of inferior alveolar nerve (IAN) damage. We prospectively studied 113 consecutive patients operated on by the same surgeon who underwent one of the following procedures: (1) isolated BSSO, (2) BSSO with a Chin Wing, (3) BSSO with a Mini Wing, (4) isolated Chin Wing. We analyzed rates of IAN damage and impact on the patients' life by using a subjective questionnaire administered at the patient's 1 year follow up appointment between June 2018 and August 2019. Sixty-seven patients underwent isolated BSSO, 24 BSSO with Mini Wing, 13 BSSO with Chin Wing, and 9 Chin Wing only. Our analysis reveals that nerve damage is greater in the BSSO group associated with Chin Wing (50% vs. 21.6%; p=0.006). However, there is no significant difference between nerve damage in the Mini wing group and the isolated BSSO group (27.1% vs. 21.6%; p=0.432). In the isolated Chin Wing group, the inferior alveolar nerve damage rate was 11%. There is no significant difference between the groups with regard to the impact of the nerve damage on the patients' life. In case of BSSO with concomitant Wing osteotomy, we conclude that Mini Wing osteotomies cause less nerve related morbidity than Chin Wing.

The intermediate length BSSO: Finding the balance between the classical and short designs.

Bilateral Sagittal Split Osteotomy (BSSO) is performed in orthognathic surgery to treat cases of dento-skeletal malformation. We present a shorter BSSO variant that allows for the realization of all orthognathic movements. This line respects the basilar rim and allows to modify the position of the mandibular angles. The splitting is more natural, separating the mandible into two anatomical subunits: the rising branch and the horizontal branch. This variant layout may also be associated with Chin Wing genioplasty.

Mini wing osteotomy: A variant of chin wing osteotomy.

The mini wing is a variant of the chin wing osteotomy. Its design extends from the chin region to the horizontal branch of the mandible as in a traditional chin wing. However, the posterior most cut ends on the upper part of the mandibular notch. It corresponds to a shortened chin wing that respects the basilar edge of the mandible. Its advantage is the capacity to associate it with a bilateral sagittal split osteotomy (BSSO) in the global management of dento-skeletal deformity. There is no contraindication to the realization of a mini wing. Contrarily to the traditional chin wing, a very low positioned inferior alveolar nerve (IAN) is not a contraindication to the mini wing.

Chin wing: Technical note.

The chin may be concerned by morphological abnormalities in its various dimensions. Classical genioplasty techniques can be used to correct these but have some disadvantages. The "chin wing", described by Triaca, is a technique of genioplasty extended to the mandibular angles, considering the mandibular basilar border as an anatomical unit, thus achieving a better harmonious functional and aesthetic result. The preoperative assessment included a mandibular Cone Beam to evaluate the position of the inferior alveolar nerve. The procedure was performed under general anesthesia. The periosteal dissection was limited to the osteotomy area and mental nerves were protected. The osteotomy observed a modification of its orientation in front of the mental foramen to become parallel to the basilar border, which was interrupted at the level of the mandibular angle. The spaces created were filled with bone grafts and maintained by a symphysary plate. Chin wing genioplasty both improves the function and aesthetic of the face because it considers the mandibular basilar border as an entire anatomical unit. It can be performed independently of any procedure to modify the bone bases. Nowadays, chin wing remains a challenging technique hardly performed.

[Esthetic reconstruction of the superior hemilip using the Abbé technique modified by Burget. Apropos of 5 cases]. / Reconstruction esthétique de l'hémilèvre supérieure selon la technique d'Abbé modifiée Burget. A propos de cinq cas.

When a patient must undergo resection of part of the upper lip for the treatment of a cancer or following a traumatic defect of the upper hemilip, the surgeon is faced with the problem of reconstruction of a lip whose appearance and function must be as close as possible to the normal lip. The limits of the normal lip must be restored: the symmetry, equilibrium of the lips and position of the commissures must be maintained. The upper lip esthetic unit can be divided into subunits, as described by Burget and Menick. If a large part of a subunit is removed, replacement of the entire subunit rather than simple reconstruction of the defect often gives a better esthetic result (Burget). The best tissue for esthetic reconstruction of a full thickness defect of the upper lip is the lower lip. We apply Burget's principles to raise an Abbé flap, which is transferred in two stages. This approach is illustrated by 5 patients operated by this technique. Finally, this technique is compared to other techniques allowing reconstruction of the upper hemilip.

[Congenital infiltrating lipomatosis of the face. Presentation of a new clinical case]. / Lipomatose congénitale infiltrante de la face. Présentation d'un nouveau cas clinique.

A new case of this rarely described pathology is reported. It concerns a benign infiltrating lipomatosis, strictly located to the face. However, dento-musculo-squelettal structures are constantly involved, usually located to a hemiface. A young female patient has been followed up from her birth. Surgical procedures are reported. Diagnostic and therapeutic difficulties of this rare clinicopathologic entity are discussed.

[The keratocyst or epidermoid cyst: the current state of understanding apropos of a case with intracranial involvement]. / Le kératokyste ou kyste épidermoïde: état actuel des connaissances à propos d'un cas d'extension intra-crânienne.

The authors report a case of penetration of an odontogenic keratocyst into the skull base. There is significant controversy about what is the optimum surgical treatment for the odontogenic keratocyst. Diagnosis, mode of growth and recurrence of keratocyst are still a great deal of interest. This paper reports the recent advances in the subject.

[Secondary rhinoplasty for unilateral cleft lip and palate. Review of the literature and 50 clinical cases]. / Rhinoplastie secondaire des fentes labio-palatines unilatérales. Revue de la littérature et expérience de 50 cas cliniques.

The nasal sequelae of unilateral cleft lip and palate are almost always present: more or less severe deformities, essentially consisting of nostril deformity and deviated septum. After an anatomical study of nasal deformities and the consequences of the primary procedures of cheiloplasty or cheilorhinoplasty, the authors review all of the most satisfactory technical aspects of secondary proposed in the literature. Five clinical cases illustrate the therapeutic strategy and the results.

[Mammaplasty with an L-shaped scar and a pre-established design. Apropos of 80 cases]. / Plastie mammaire à cicatrice en L et à dessin pré-établi. A propos de 80 cas.

Over recent years, surgeons have tried to reduce the reduction mammaplasty scar. In this context, we use a surgical technique described by J.P. Chavoin, privileging "the remaining breast". Three advantages of this surgical method are derived from its technical choices: a superior dermal pedicle for preservation of the areolar nipple complex, preoperative drawing and finally a short incision with an inverted L scar. A retrospective study of 80 patients with 27 months of follow-up defines the advantages and disadvantages of this technique. Discomfort, indications, quality of results are evaluated with charts. Preoperative drawing and technique are described. This study shows this to be a reliable technique with good and constant results. Lastly, its indication is described in comparison with other techniques designed to achieve. Its preferential indication is moderately severe hypertrophy (500 g), which represents the majority of patients consulting us, but it can also be used in severe hypertrophy or even gigantomastia. Reduction of asymmetry also constitutes a good indication, facilitated by rigorous skin drawing based on precise anatomical landmarks. In addition to its broad indications, its advantages are marked vascular safety, rapid execution, constant results, while preserving the median part of the thorax from any scars.

[An experimental study of a new bidirectional distraction appliance]. / Expérimentation d'un nouveau distracteur bidirectionnel.

The goals of mandibular distraction are to restore a normal length but also a normal shape to the hypoplastic mandible. These two goals are related to the elongation vector which is itself related to the location of the cortictomy and of the device. Other factors influence this elongation vector. So it is impossible to precisely predict the elongation vector. With the monodirectional distraction device no modification can be made during the distraction time. With a bidirectional distraction device offering the possibility to modulate the angulation between the two elongation rods it is possible to adjust the elongation vector during distraction. Precise distraction gap modeling is possible. This is particularly important to correct anterior open-bite. This device was tested on animals (pigs).