Usefulness of the orbitofrontomalar approach associated with bone reconstruction for frontotemporosphenoid meningiomas.

Seven cases of frontotemporosphenoid meningioma are reported. The principles of the orbitofrontomalar approach and of reconstruction of the orbital cone and of the frontomalar region with an orbitotemporal prop are discussed.

[Value of the orbito-fronto-temporo-malar approach in the excision of various meningiomas of the sphenoidal crest]. / Intérêt de la voie d'abord orbito-fronto-temporo-malaire dans l'exérèse de certains méningiomes de l'arête sphénoïdale.

The authors describe the use of orbito-fronto-temporo-malar for sphenoidal meningiomas. The resection is followed by bone reconstruction. They discuss the advantages and indications for this approach and reconstruction.

[The morphogenesis of the temporomandibular joint considered in its phylogenic aspects in vestibular orientation]. / La morphogenèse de l'articulation temporo-mandibulaire considérée sous son aspect phylogénique en orientation vestibulaire.

Comparative phylogenic movements of skull points can be obtained using vestibular orientation and skulls from various mammals after reducing the bimediocondyle distance to approximately 100 mm (as in man). With this method, the condyle is seen to move backwardly and rise in a very thin bony area which will be covered by the increasing volume of the encephalus. A "mandibulocerebral" index of less than 100 is a criteria of humanoid species. A part posterior to the fixed zone in primate which will become the temporal condyl in man is eroded by the mandibular condyle. The tympanum migrates upwardly and posteriorly in primates and turns forwardly in man, contributing to limit the glenoid cavity posteriorly. The anterior limit to mandibular propulsion in primates is the intercanine bite; this disappears in man as does the post-glenoid apophysis which is reduced to a tubercle with no limiting effect. In man, function of the temporomandibular joint depends on its more delicate construction than in primates. The major humanoidizing processes alone, i.e. posterior movement of the jaws and their reduced volume, bipedism, and amplification of the cerebral volume, are sufficient to explain this situation which results from the effect of phylogenic evolution.

[Superior external approach to the pterygomaxillary fossa and its extensions]. / Voie d'abord supéro-externe vers la fosse ptérygo-maxillaire et ses extensions.

Access to the pterygomaxillary fossa is obtained with difficulty, classical approaches to this lateral craniofacial cross-roads being either narrow or mutilating. In some affections it is justifiable to use a scalp approach with temporary displacement of the zygomaticomalar block, this providing an excellent view of the region.

[Condylar osteochondroma. Presentation of a new case (author's transl)]. / Ostéochondrome condylien. Présentation d'une nouvelle observation.

The histopathogenesis and course of the lesion are discussed on the basis of a new case of osteochondroma. It would seem to be of low grade activity. At all events, presenting as hypercondylism, the only logical treatment is condylectomy via a pre-auricular approach which is adequate other than for very large tumours.

[Intravenous sedation in implantology]. / Sédation intraveineuse en implantologie.

Local or block anesthesia can be used satisfactorily in many implant procedures. However, when advanced implant techniques or pre-prosthetic reconstruction surgery of the maxillofacial bones are required, local or regional anesthesia is insufficient. The "day-hospital" concept is a rational approach which meets the requirements for anesthesia and deep sedation with criteria for patient safety and comfort while guaranteeing optimal operating conditions. Intravenous sedation, both "conscious" and "deep" sedation, is a very well adapted form of anesthesia for implant recipients. Local or block anesthesia is enhanced or reinforced prior to surgery by the intravenous administration of a sedative and anxiolytic agent (single-drug concept), such as a benzodiazepine, associated or not with a morphinomimetic agent and an antihistaminic substance (multiple-drug concept). The main goal is to maintain spontaneous respiration while obtaining postoperative amnesia of the entire procedure. Mandatory use of a pulse oximeter has greatly contributed to improved safety of intravenous sedation, essentially indicated for operations not lasting more than 2 and a half hours in patients in good general health (scoring 1 or 2 in the American Society of Anesthesiology (ASA) classification) and with a low risk of postoperative complications. This concept requires an adapted technical facility. The operating theatre should have all the equipment necessary for cardiovascular, neurological and respiratory emergency care. The postoperative recovery room should also be equipped with cardiovascular monitoring devices and be able to accommodate an intensive care unit. Under these strict rules, short duration surgical procedures (< 150') can be performed : 1) with the best conditions of medical safety, 2) with improved operating conditions for the implant surgeon (the patient responds immediately to vocal orders when necessary) while asepsis is maintained as easily as with general anesthesia, 3) with better conditions for postoperative care and patient comfort (the anesthetist is continuously present). 4) better psychological conditions for the patient who will be discharged the same day, 5) with total amnesia of the entire surgical procedure, 6) elimination of a usually disproportionately long hospitalization. Day hospitalization also helps contain health care costs by cutting out the need for overnight care and accommodation. We underline the safety of current intravenous sedation techniques and present two series of data related to the use of this technique by an anesthetist and an operating surgeon in a day hospital from 1986 to 1995.

[Severe diffuse facial cellulitis]. / Les cellulites faciales graves diffuses.

Twenty cases of severe cervicofacial infections among 184 cases of cellulites treated in 1991 and 1992 at the Lille University Hospital were investigated. Outcome was compared with results reported in the literature. Outcomes were similar and emphasized the critical nature of this type of infection which caused 7 deaths in our series and severe anatomic and functional sequelae. All patients (n = 20) were given anti-inflammatory drugs prior to surgery. The correlation between disease severity and use of anti-inflammatory drugs would appear to be an established fact. Criteria predicting severity were identified in order to obtain a score for high or low risk and to better adapt the medical and surgical management strategy.

[Facial volume and its global position in vestibular orientation, in adults and during growth]. / Volume facial et sa position globale en orientation vestibulaire, chez l'adulte et durant la croissance.

Two sagittal surfaces were defined on the dry skull of 96 youngs and 51 adults Caucasian subjects in vestibular orientation. The surface of the face and the surface of the "total face" (by including the buccodental and mandibular surfaces) were measured with a planimeter. From the longest maxillary and zygomatic distances, the volume of two ellipsoids were calculated. The radius of a sphere corresponding to this volume was then deducted. Each sphere was then positioned taking the vestibular coordinates, corresponding to the barycenter of the sagittal surface, as the center. The ontogenetic evolution of these two points showed a curve similar to that of all the points in the splanchnocranium of man. Quantitative results are given for volumes and calculated data. The two facial spheres were then positioned relative to two known spheres in the neurocranium. The quadrilaterals drawn between the 4 centers denote a phylogenic constancy of the directions when compared with the results observed in man and those obtained in anthropoïds.

[Indications for selective embolizations in maxillofacial pathology]. / Indications des embolisations sélectives en pathologie maxillo-faciale.

There has been remarkable progress in the therapy of maxillofacial disorders, mainly as a result of the development of Djinjian and Merland's techniques for the exploration and selective embolization of the region supplied by the external carotid artery. These methods facilitate management of bone and skin angiomas and help to resolve problems of therapeutic arteriography for orofacial tumors. Two particularly hypervascular types of tumor: nasopharyngeal angiofibroma and carotid glomus tumor, as well as the hemorrhagic complications of facial epitheliomas, are conditions in which extremely useful data is obtained. Post-traumatic arteriovenous fistula can be treated by introducing inflatable balloons that are releasable or linked to a catheter. Acute severe epistaxis following injury responds to emergency embolization of the external carotid artery branches.

[Rotation flap from the anterior tonsillar pillar for the reconstruction of the intermaxillary commissure and posterior portion of the cheek]. / Lambeau de rotation du pilier antérieur de l'amygdale pour reconstruire la commissure intermaxillaire et la partie postérieure de la joue.

A modified technique is presented, which is based on Kazanjian and Hynes' methods using a lateral pharyngeal flap, and which provides a simple means of repair of loss of mucosal substance from the intermaxillary area or the posterior two-thirds of the cheek.

[Mandibular condyle lacunae. A report on three cases (aneurysmal cyst, granuloma eosinophil and metastasis) (author's transl)]. / Lacunes condyliennes mandibulaires. A propos de 3 observations (kyste anévrismal, granulome éosinophile et métastase).

Three cases of rare cystic tumors of the mandibular condyles are described: One case concerned a young 17-year-old girl with pain and joint crepitation due to an aneurysmal cyst. In the second case the presence of pain and a swelling led to the discovery of an eosinophil granuloma, with similar lesions in two other locations. A mandibular metastasis from a bronchial epithelioma was present in the third case.

[Mandibular mechanics in temporomandibular joint pain-dysfunction syndrome]. / La mécanique mandibulaire dans le SADAM.

There are several reasons for perturbed mandibular mechanics in SADAM: craniofacial architecture anomalies, malocclusions, lingual dyspraxia, postural disorders. SADAM diagnosis and therapeutics should be conducted by a pluridisciplinary team.

[Infectious temporomandibular arthritis. Apropos of a case in an adult]. / Arthrite infectieuse temporo-mandibulaire. A propos d'un cas chez l'adulte.

Imagery revealed osteitis of the base of the skull in a 37-year-old patient with infectious arthritis of the temporomandibular joint. The characteristics of this rare pathology were recalled from a review of the literature.

[A report on mandibular fractures in children (author's transl)]. / A propos des fractures mandibulaires de l'enfant.

The review of 192 cases of mandibulars fractures in childhood (between 10 days to 15 days old) demonstrates two important points: --the frequency of condylar fractures (110) but a low rate of temporo-mandibular ankylosis (2 cases); --a way to perform osteosynthesis with iron wire (5/10 degrees) through holes drilled with a hand perforator, that prevents follicular damages.

[Contrast arthrography of the temporomandibular joint]. / L'arthrographie opaque de l'articulation temporo-mandibulaire.

Seventy-four temporomandibular arthrographic examinations, mostly involving paracentesis of the menisco-condylar compartment, provided the means for visualizing normal and pathologic aspects of both reducible and non-reducible meniscal dislocations, and of perforations. Findings included distension of the bilaminar zone and adhesions. Post modeling condyloplasty status was noted. At present, arthrography seems to be the most reliable test, as well as being the easiest to perform and the least expensive one for visualizing menisco-condylar abnormalities.

[Intra-masseter metastasis of a gastric adenocarcinoma]. / Métastase intra-massétérine d'un adénocarcinome gastrique.

We report a case of metastasis in the masseter muscle secondary to stomach carcinoma. Second neoplastic invasion in skeletal muscle is an exceptional phenomenon. And this frequency is paradoxical against corporeal muscular mass. Immune hypothesis is conjure up for explain this fact. Symptoms are not specific and the diagnosis is not often recognized. However, systematic postmortem investigation is positive in one per cent of the cases. Consequently, every painful and nodular induration involved in carcinoma supervision must do perform a systematic biopsy.

Craniofacial behavior of sutures in young rabbits postimmobilization.

Although sutures have been identified as being important growth sites of the craniofacial complex, some points are still debated. The aim of our work was to analyze coronal suture response after immobilization in 24 New Zealand White rabbits. This immobilization was induced by an adhesive that bridged the coronal suture under investigation. Contrary to the reports of several authors, our procedure did not promote craniostenosis. The sutural space remains present even if it appears considerably reduced. Our cytometric examination clearly demonstrates that growth reduction localized on the external cortex of the calvaria whereas the internal cortex have a subnormal evolution. These findings favor a different evolving profile of both tables of the calvaria. They also suggest that one should be very careful before considering this procedure, as it may induce craniostenosis.

[Closure of anterior oro-nasal communications, sequelae of cleft palate, using a retro-incisal flap]. / Fermeture des communications bucco-nasales antérieures, séquellaires de fente palatine, par lambeau rétro-incisif.

The persistence of a residual communication between mouth and nose, is an important sequela a after primary closing of cleft palate. This retrospective study reports twenty-one cases of a new technique (retro-incisive flap) used for closing this residual communication. This flap is an easy and reliable method with an 85% success rate, so we recommend it as the first choice in this indication.

[Orthognathic surgery of the atrophic upper jaw. A proposal for a single-stage treatment. Le Fort I osteotomy with bone grafts and implants]. / Chirurgie orthognathique du maxillaire supérieur atrophique. Une proposition de traitement en un temps. L'ostéotomie de Lefort I avec greffe osseuse et implants.

We report an osteotomy technique for the maxilla using an iliac graft and simultaneous implantation for correction of atrophic class III dysmorphosis of the maxilla. The advantages and disadvantages of this technique are discussed on the bases of a 3-year experience.