[An artificial salivary gland. Indications. Technical note concerning installation]. / La glande salivaire artificielle. Indications.--Note technique de mise en place.

Idiopathic or iatrogenic aptyalism is responsible for disabling odontostomatological symptoms and constitutes a predisposing factor for bucco-dental complications. Drug treatment designed to stimulate the salivary parenchyma is doomed to failure in cases of severe, irreversible alteration of the glandular acini. The only available treatment is palliative consisting of buccal artificial salivation. Two modalities of endobuccal administration of artificial saliva have been developed: prosthesis-reservoir and "artificial salivary gland". The "artificial salivary gland" consists of a system connecting an external reservoir to the buccal cavity via a catheter implanted over part of its path. The artificial saliva stored in the reservoir is advanced mechanically as far as the mouth where it is released according to an adjustable flow rate. The insertion of a medical silicone catheter is an outpatient procedure with a simple postoperative course. Under normal conditions, one millilitre of saliva solution per hour is sufficient to ensure satisfactory humidification of the buccal mucosa. Dysfunction of the system is generally due to a mechanical problem and any consequent alterations are treated as required. The indications for "artificial salivary gland" must be reserved to semi-urgent cases with severe aptyalism and as a therapeutic relay in the context of global management of the aptyalic patient. This new modality of administration could be extended to other diseases requiring endobuccal drip treatment.

[Hypercondylia and lateral deviations of the mandible (author's transl)]. / Les hypercondylies et latéro-déviations mandibulaires.

Hypercondylia is a relative rare, benign affection presenting as asymmetry of the lower facial region with laterognathia, dental articulation disorders, and minimal functional effects on the temporomandibular joints. These clinical manifestations, confirmed by the presence of lesions of the condylar region on radiological examination, vary as a function of the directional axis and course of the hyperplasia. Various distinct and sometimes extremely different radioclinical pictures can therefore be distinguished. Therapy aims at re-establishing facial harmony and restoring altered dental articulation. Whereas minor anomalies can be corrected by orthodontic or prosthetic treatment associated with plastic surgery, severe abnormalities require major reconstructive surgery as determined by orthopedic investigations.

[Posterior hypsomaxilla: diagnostic and therapeutic considerations]. / Hypsomaxillie postérieure: considérations diagnostiques et thérapeutiques.

Posterior maxillary excess is a well individualized dento-alveolar anomaly which distorts the maxillary occlusal plane and induces clockwise rotation of the mandible. The dysmorphosis issued from is a skeletal open bite syndrome without dento-labial dysharmony. Surgico-orthodontic combined management is the adequate therapeutic procedure, on the following stages: during youth, a dento-facial orthopedic treatment is attempted to control posterior alveolar growth; pre-surgical alignment of teeth by orthodontic means correcting sagittal and transversal dental dystopies; surgical correction of the sole posterior hypsomaxilly is carried out by SCHUCHARDT osteotomy. In case of associated maxillary anomalies, LEFORT I osteotomy is indicated, mobilising the hole maxillary plate; post-surgical orthodontic affinement of final occlusion. When no orthodontic treatment had been effectuated, the prosthodontist will act for obtaining maximal dental intercuspidation; the plastic surgeon will harmonize facial profile, if needed.

[Labial incompetence. Therapeutic considerations of esthetic and functional deficits]. / Inocclusion labiale. Considérations thérapeutiques des déficits esthétiques et fonctionnels.

The lips constitute an anatomic, physiologic and aesthetic specific entity which is integrated between nasal and chin areas. Inocclusion of the lips at rest forms an anomaly which affects mandibular growth, lip function and facial morphology. This vertical labial dysharmony implies on one hand an architectural skeletal unbalance at inferior third of the face, mostly associated with dento-alveolo-maxillary disturbance, on the other hand a disorder of oro-facial muscular behaviour. The treatment's aim is the restoration of a spontaneous lip seal at rest. It will be institute as early as growth-hood using functional orthopaedic devices. In adolescent and adult, the correction of existing dento-alveolar dysharmonies by orthodontic means will be completed, if necessary, by surgical procedures either orthognathic correcting retrognathism or maxillary anterior alveolar hyperplasia with dental extrusion, or morphologic to achieve elongation of congenital upper short lip or elevating of lower lip attracted towards the chin. Orthopaedic and morphologic analyses are necessary to locate the site of the responsible anomalies and indicate particular surgical technics relative to the magnitude of functional and aesthetic repercussion.

[Chondrosarcoma of the upper jaw. Apropos of a clinical case]. / Chondrosarcome du maxillaire supérieur. A propos d'un cas clinique.

Initially it has been a tendency to place chondrosarcoma in the general category of osteogenic sarcoma. Jaffe et Lichtenstein claimed that the concept of chondrosarcoma as a separate entity has a firm clinical and histological basis. Chondrosarcomas may arise in peripheral long and flat bones. The maxillary location is very rare, it represents about 0,7% of the whole body. 40 well documented instances are yet counted in the literature. Reporting a personnal case, the author proceeds to a comparative study between the three varieties of maxillary sarcomas, evokes the special histogenesis in this location, he reminds the interest of bone electrocoagulation as curative treatment, and discusses the difficulty in making a prognosis 3 years after surgery without local recurrence or metastasis in this case.

[Therapeutic coordination in a case of maxillofacial dysmorphosis with enamel decay]. / Coordination thérapeutique dans un cas de dysmorphose maxillo-faciale avec adamantose délabrante

The collaboration of various specialists is an understandable procedure for rational management of patients presenting complex dento-maxillo-facial abnormalities. The establishement of precise diagnosis and the chronologic execution of the hole therapeutic programm will be co-ordinate by one person which is responsible of the treatment towards the patient. Providing with these principles, the author exposes the case of a patient who presents an uncommun micrognatia associated with dental dystrophies. Anatomic diagnosis, etio-pathogenesis, the treatment of the lesions and the prognosis, are all as many problems which are better approached by medico-surgical team, researching to acheive the best results.

[Multiple cancers of the oral cavity. An unusual association of an epidermoid carcinoma of the mucosa with a bone carcinoma of salivary origin]. / Cancer multiple de la cavité buccale. Association rare d'un carcinome épidermoïde de la muqueuse à un carcinome intra-osseux d'origine salivaire

Multiple cancers cannot be considered as accidentally discovered curiosities. They have their own characteristics and differ from multifocal cancers or those secondary to a primary cancer. The authors describe the rare case of a patient suffering from two different types of cancer of the oral cavity; the first one was an epidermoid carcinoma of the upper alveolar mucosa, the second a salivary carcinoma of both epidermoid and glandular type situated within the bone of the mandible. A comparative study was carried out on the muco-epidermoid tumour and the adenosquamous carcinoma which proved the separate indentity of the second cancer. The galloping development of the adenosquamous carcinoma raises the problem of the effect of the primary cancer on the development of the second.

[Corticotomy. A rapid method for correction of incisor malpositions]. / La corticotomie. Moyen de correction rapide des malpositions incisives

Since the studies of Bell and Cadenat about dento-alveolar revascularization after alveolar osteotomies, orthodontic surgery knows new developments. The surgical correction of isolated incisal malpositions by interalveolar corticotomies with immediate repositionning of dento-osseous segments, represents actually a rapid therapeutic method in comparison with orthodontic treatment or combined surgico-orthodontic procedure. The authors present a study upon 31 corticotomies performed these last two years. They clear the usual indications, note the importance of the pre-operative planning, expose their technique, finally they give an idea about the value of this procedure.

[Early functional surgery as a component of interceptive treatment of developing dysmorphosis in adolescents]. / La chirurgie fonctionnelle précoce composante de la thérapeutique interceptive d'une dysmorphose évolutive de l'adolescent.

A discordance in the shape and relation between dental arches may be corrected by functional orthopaedics. Discovered in the adolescence, the dysgnathia has yet run its course and it remains just a bit of growth power, this situation justifies to recourse to interceptive surgery, meant for facilitation of oral reeducation and thus harmonisation of residual facial growth. This "functional surgery" is composed of tongue myoplasty, functional genioplasty and the early corrective orthopaedic surgery which is defined by its association with immediate reeducation. It is characterized by its benignity and stability of its results if occlusal and functional surroundings are equilibrated. Moreover, its profits by residual growth power which became well guided, and assures improvement of immediate postoperative results, if needed.

[Secondary sliding of the mandible after sagittal osteotomy of the ascending ramus]. / Réflexions sur les glissements secondaires de la mandibule après ostéotomie sagittale des branches montantes.

Thus in the area of prognathism, modifications would seem to develop during the first three months after deblocking:-true recurrences are rare and would appear to be avoidable by careful technique;-secondary sliding shoud not be the source of too much anxiety, being the result of spontaneous attempts at equilibrium and are of little aesthetic consequence. Our statistics indicate that sagittal osteotomy of the ascending rami gives 82% good results. This would agree with statistics generally found in the literature.

[Therapeutic principles in angioma of the mandible: applications in relation to a clinical observation (author's transl)]. / Attitude thérapeutique face à un angiome mandibulaire. Réflexions à propos d'un cas clinique.

When confronted with a case of angioma of the mandible, treatment should be directed towards two main areas:--to stop blood loss. Ligature of the external carotid can be life-saving, but it does not prevent the formation of nearby anastomotic vessels which refill, more or less rapidly, the external carotid axis. Ligature make embolization impossible by femoral way. A by-pass operation to improve permeability is also dangerous if not impossible. Ligature should be reserved only for those cases in which there is an immediate threat to life. On the contrary, embolization is necessary before surgery. --to treat the angioma. As radiotherapy is not effective or is dangerous, surgical treatment is necessary; either by a conservative operation or by radical resection. All these facts are illustrated dramatically by the case reported.

[Therapeutic approach to post-radiation xerostomia. A reservoir prosthesis and an artificial salivary gland]. / Approche thérapeutique de la xérostomie post-radique. Prothèse réservoir et "glande salivaire artificielle".

Radiation-induced xerostomia is an incapacitating sequela of salivary gland irradiation in patients receiving tumoricidal X-ray therapeutical doses for cancer of the upper respiratory and gastrointestinal tracts. All stimulant type therapeutics available are powerless to bring back wetness into the mouth of patients with asialia. Replacement therapy constitutes the only alternative for symptomatic treatment. Artificial salivary gland sprays have a proven unsustained, short-lasting efficacy. The administration of an oral mucine-containing salivary emollient solution drip, presented either in the form of an oral or external container, constitutes an original symptomatic treatment regimen, the efficacy of which has been established. The authors here review the concept and methodology of their palliative treatment protocol against chronic asialia.

[A therapeutic approach using dental implants in an irradiated area. The experiences of the René Huguenin Center]. / Approche thérapeutique implantaire dentaire en terrain irradié. Expérience du Centre René Huguenin.

A therapeutic trial was conducted with six patients who were in remission after cancer therapy for at least two years. Twenty-four implants were performed in irradiated maxillary bone after local and general paraimplantation preparation using adjuvant hyperbaric oxygenotherapy. All implants integrated the bone within a minimal delay of nine months. All patients were fitted with a removable dental prosthesis which was anchored magnetically or with implant conjunction bars. Despite the limited number of implants and the short observation period, the results have been promising, in agreement with previous reports. These findings emphasize the importance of adjuvant hyperbaric oxygenotherapy and the need for good conditions in paraimplantation tissue. Although this technique demonstrates that dental implantation in irradiated tissue is possible, the risk of secondary failure has not been determined. In strictly selected cancer patients with reasonably healthy irradiated tissue, implantation can be proposed by a fully multidisciplinary team of specialists.