Search

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.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.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.

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.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).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.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.

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.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.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.

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.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.

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.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).Postoperative relapse was seven times more frequent when the postoperative plane tilting was superior to +/-3.75 degrees in reference to the ideal plane.Postoperative occlusal plane tilting is a predictive factor of postoperative open bite relapse.

Proximal submandibular calculi are usually removed by transcervical submandibular sialadenectomy. The aim of this study was to show that intraoral removal of hilar submandibular calculi gives the same results with fewer complications than submandibulectomy.The surgical indication is assessed by palpability of the stone and confirmed by simple CT scan. The surgical procedure is performed under local or general anaesthesia. At the end of the procedure, the duct is controlled with a sialendoscope to remove remaining concretions. We prospectively followed 36 patients with a mean follow-up of six months (one to 36 months).The transoral removal of calculi was performed in 34 patients without any definitive neurological complication. The procedure failed in two patients with nonpalpable calculi. Two patients had a recurrence of symptoms due to small intraglandular calculi, which were evacuated later.The transoral removal of submandibular hilar calculi is a safe and reproducible procedure with less morbidity than submandibulectomy. It should be recommended for posterior palpable submandibular calculi.

Sialoendoscopy is a simple efficient mode of treatment for major salivary gland sialoliths and strictures.Sialendoscopy procedure requires specific devices, diagnostic and therapeutic sialendocopes, minigrasping forceps, wire baskets, lasers, balloons and stents. The sialendoscopy procedure is divided in three steps: the duct introduction step (through the papilla or through the duct wall); the diagnostic step (from main duct to third or fourth salivary division branches) and the therapeutic step (stone removal with a Dormia basket or miniforceps and stenosis balloon dilatation). The feasibility of stone removal depends on the size, the position, the mobility and the shape of the stone. The only contraindication is acute sialadenitis.Sialendoscopy complications are minor. Its success rate for stone removal is greater than 90%, and it has dramatically reduced the rate of sialadenectomy (to less than 5%).

A case of schwannoma of the cauda equina in which the initial manifestation was visual loss, due to papilledema, is described.A 56-year-old man presented a history of 1 month of progressively blurred vision. On examination, visual acuity was 20/1,000 due to bilateral papilledema without spinal symptoms or neurological signs. Brain computed tomography demonstrated a nonobstructive hydrocephalus. He underwent a ventriculoperitoneal shunt without improvement. One month later, he complained of disturbance while walking associated with lower back pain. A lumbar puncture revealed an increased opening pressure. Analysis of the cerebrospinal fluid demonstrated an elevated protein level (6.8 g/l). Spinal magnetic resonance imaging showed a neurinoma of the cauda equina. We performed complete surgical resection and the histopathology diagnosis was schwannoma. Neurological dysfunctions resolved except visual acuity due to bilateral optic atrophy.The association of papilledema and spinal tumor is an unusual but well-known phenomenon. Several theories have been proposed to explain the development of increased intracranial pressure in such cases but the exact physiopathology remains unknown.Spinal cord tumor should be considered when acute papilledema associated with normal brain computed tomography and high cerebrospinal fluid protein levels are encountered. Spinal magnetic resonance imaging should then be performed.

Orthognathic surgery is generally indicated for the treatment of maxillo-mandibular deformities. Surgery is performed to repair functional abnormalities, but also has a cosmetic impact.We conducted a retrospective study of 60 patients who underwent orthognathic surgery in 1996 and 1997 in order to assess patient perception of functional and cosmetic outcome. A questionnaire was sent to all patients one year after their surgery; 45 responded.We noted cosmetic, functional, and psychological changes. Patients considered that the changes were for the better. For functional abnormalities, 88.9% considered their occlusion had improved and 80% their chewing; 73.4% reported psychological improvement stating they had more self-confidence; 97.8% considered their cosmetic aspect had improved.This study enabled us to assess patients' perception of surgical outcome. It must be recalled that the patient basically decides to undertake surgery for cosmetic reasons while the surgeon proposes surgery to improve function. The psychological consequences of orthognathic surgery must be taken into account because the impact is considerable.

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.

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.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.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.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.

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.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.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.

Lingual nerve damage is one of the main complications of mandibular third molar removal. In literature, the series published are heterogeneous so we have decided to study the importance of the lingual protection only during germectomies (wisdom teeth without root formation).We conducted a randomized prospective study in 300 germectomies, operated by the same skilled surgeon. These 300 third molar removals have been divided in two groups, one with lingual nerve protection and one without.Lingual nerve injuries following germectomies, with or without lingual protection was 0%.In germectomies, one can avoid lingual protection.

Infection is a rare complication after orthognathic surgery. A rate of 1% to 15% has been reported in the literature. We reviewed our experience.We reviewed retrospectively 60 mandibular osteotomies performed between 1998 and 1999. There were 41 women and 19 men, mean age 24 years. All were given antibiotic therapy using cefamandol 1500 mg preoperatively then 750 mg every 6 hours peroperatively and cefixime 400 mg/d postoperatively for 7 days. Patients were followed for at least 6 months after surgery.There were 10 infections (16% of the cases) involving a hematoma in 2 cases, adenitis in 1, osteitis on a cortical fragment in 2 and osteitis on implanted material in 5.We defined infection following orthognathic surgery as a collection or purulent fistula with either a high polynuclear count in the discharge fluid or a positive culture. Both soft tissue (for example infection of a perimandibular hematoma) or bone infections were equally considered. We found two types of risk factors: patient-related or procedure-related. Patient-related factors included smoking, paradontal status, and dental hygiene. The main procedure-related factor was duration of surgery. Measures of prevention include extraction of the wisdom teeth, interruption of smoking, preoperative scaling and careful dental care, rigorous operative technique, antibiotic therapy.

Genioplasty is one of the safest interventions in orthognathic surgery. We reviewed a series of 200 cases of genioplasty with or without other osteotomies and found 6 complications. We compared our findings with the rare data reported in the literature. We were able to distinguish: peroperative complications: atypical osteotomy, hemorrhage, soft tissue damage, injury to the mental nerve; postoperative complications: neurosensory deficits, hematoma, infection, secondary displacement, bone necrosis, mental ptosis, defective ossification, dental lesions, paradontal lesions, irregular mandibular contours. We present a discussion on means of prevention and treatment of these complications following genioplasty.

Posterior displacement of the temporo-mandibular joint disk is exceptional. The most typical clinical sign is sudden onset unilateral molar open bite. This lateral open bite is accompanied by a sensation of an intra-articular foreign body and more rarely by painful episodes. The joint sounds are not characteristic. Mouth opening is slightly limited. There is no consensus concerning treatment. Conservative treatment can be prescribed in cases with functional impairment. First line invasive techniques should be avoided.

Preprosthetic rehabilitation of the maxillary bone is sometimes difficult due to severe bone resorption in the posterolateral regions. The sinus lift with autogenous bony graft has given us satisfactory results since 1990 but requires a rigorous protocol before and during surgery to assure a lasting anchorage to the prosthesis. We describe morbidity and technical choices of this intervention in a series of 55 patients.

Surgery is sometimes indicated in cases of recurrent temporomandibular joint dislocation (luxation). Among the panel of available techniques, therapeutic arthroscopy with retrodiscal tissue and oblique protuberance coagulation has been used to prevent new episodes. Therapeutic arthroscopy was used for 6 patients. Outcome was considered to be satisfactory in 66% with a mean 3.1-year follow-up. This technique can be recommended as first line therapy when surgery is indicated. In case of failure, eminectomy is scheduled.

Orthodontic preparation before orthognatic surgery must straighten teeth alignment to enable correct adaptation of the upper and lower arches. It must also rectify dento-alveolar abnormalities partially responsible for the dysmorphosis and which can hinder smooth articulation of the bones. Thus before and after the operation, the orthodontist will have to prepare and monitor the surgical splints used in posterior deficiencies.

Various approaches have been proposed for surgical treatment of displaced condylar fractures included submandibular approach, preauricular approach, rhytidectomy approach or intraoral approach. Since 1992, we used a short retromandibular approach to treat displaced subcondylar fractures with a miniplate. When open reduction and osteosynthesis are required, the retro-mandibular approach is an easy and safe technique for displaced condylar fractures. The aim of this article was to describe the short retro-mandibular approach. Indications for surgical treatment, surgical approach and techniques of osteosynthesis for condylar fractures are discussed.

A 15 patients series is presented concerning complications following the use of silicone orbital floor implants. The more frequent complications are inferior eyelid swelling, pain and ocular dystopia. Complications may occur very belatedly, 10 years for a patient, 9 years for an other. The mean delay from insertion to removal for complication of the implant is 4.3 years. Sinus troubles are found in 70% patients that may indicate a relationship between sinusal pathology and complications observed. The CT study is described. Precautions in insertion of the implant are given. Suggestions are done to prevent such complications.

A madreporic coral graft was used for orbital floor reconstruction following facial trauma. This report presents a multicentric study of 83 patients with a follow-up period of 15 to 24 months. The results of this study indicate no significant rejection or infection opposed to so many synthetic implants outcome. The radiological follow-up demonstrates a partially resorption of the implant within about 2 years and its replacements by new bone. Coral implant was used to correct enophthalmos or diplopia due to enlarged orbital dimensions. It was technically easy to insert and its anatomic shape does not require to be fashioned before use. Its inflexibility allows to bridge large bone defects and this implant should be considered as an attractive alternative to autogenous grafts, avoiding a second surgical site, in reconstructing orbital floor fractures.

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.

Edentulism is often reported after treatment for malignancy of oral cavity. The resulting deformities from loss of teeth and bone create a "social invalid" with difficulties in articulation and mastication. Prosthetic rehabilitation was difficult because of two problems: the risk of osteoradionecrosis development and local anatomic modifications. The introduction of osseointegrated implants improved results of oromandibular reconstruction. A preliminary report of nineteen Branemark implants of seven patients is reported here. Implants have been in place and functioning for a period of one to four years. No major complication occurred and osseointegration permitted good oral rehabilitation. Placement of osseointegrated implants in osteomyocutaneous flaps and in irradiated bone is discussed.

Inferior alveolar nerve lateralisation is a new technique. Mostly indicated in implantology, the techniques described are partial and located at the anterior part of the nerve, near the foramen mentalis. The authors describe a technique of total inferior alveolar nerve lateralisation, from the lingulae mandibulae to the foramen mentalis. Total lateralisation technique can be used in dental prosthesis (in mandibular posterior edentulism when the alveolar bone is reduced and when the prosthesis compresses the nerve in the foramen region), in implantology (when terminal implant restitution is needed), or in benign tumors (when the horizontal branch of the mandible is resected).

Recurrence is the main problem in temporo-mandibular joint ankylosis treatment. Two therapy are used against this, physiotherapy and surgical joint interposition. Following ankylosis removal, many materials can be interposed but, for us, fullthickness skin graft using Popescu and Vasiliu technique seems to be the best and simplest one. This retrospective study of 31 cases, 20 with long-term follow-up, shows that good results are obtained using this skin graft, with 90% successful rate.

In literature, the authors demonstrate that progressive distraction osteogenesis, according to the Ilizarov method, is applicable to the mandible. Mandibular distraction is achievable through external approach or through oral approach. Further experimental and clinical studies will be necessary to define the most stable apparatus and the best indications that are currently hemifacial microsomia and facial asymmetry associated with T.M.J. ankylosis.

Cranio-mandibular disorders include muscular and articular signs. Articular pathology is the only one that need to be structurally studied. Paraclinic indications are based upon physical examination. Bone structure can be explored with tomography or CT scan and intra-articular structures can be explored with M.R.I. or arthrography. Two pathologies have then been found with an excessive frequency, disc displacements and juvenile osteoarthrosis.

Ankylosis of the temporomandibular joint was treated by resection of the ankylosed block and arthroplasty with an osteo-cartilage graft from the rib. The main feature was attaching the cartilage to the bony surface and the appearance of enchondral ossification. The value of this method is discussed.

The authors report on 40 cases using acrylic-metal prosthesis after ablative cancer surgery and compare them with the literature. The long-term complications (prosthesis extrusion or infection) are important, but the short-term follow-up (3 months) is more than 80% of success, any material used. The prosthesis keep a physiological position to the mandible, against scar sequelae. The use of soft tissue closure without post-operative radiotherapy increase the success of a simple-used and low-priced device of mandibular reconstruction.

TMJ arthroscopy is a little invasive and of poor morbidity procedure of both investigation and treatment of temporomandibular pathology. A highly equipped operating room (double instrumentation) together with fine skill and proper knowledge of arthroscopic joint anatomy can easily prevent the rare complications described (articular, vascular, neurologic and otologic).

The authors report 3 cases of trauma induced false aneurysm (internal maxillary, external carotid and internal subpetrous carotid arteries) associated to closed mandibular fractures. These rare vascular complications of ill-defined pathogeny are often due to high speed facial impact. Clinical presentation is polymorphous (pseudo-parotidis, neurological deficit) and arteriography is the main step of the paraclinic investigation. The treatment essentially depend upon both the location and the evolutivity of the false aneurysm.

Arthroscopy is an interesting and enlarging technique that visualise the temporomandibular joint and allows surgical technics such as lysis and lavage, prediscal section, retrodiscal cauterisation, oblic protuberance cauterisation, disc suturing or shavering of the articular surfaces.

In 7 cases of mandibular laterognathia caused by condylar hypertrophy, the authors specify the clinical and teleradiological features in adolescents. They emphasize the inadequacy of lateral teleradiography and of its measurements, and the need for three-dimensional investigation. In adolescents, secondary deformations, either spontaneous or therapeutic, are rare, and the treatment preferred is condylectomy based on the study of casts. The immediate results of this techniques are satisfactory. The long-term consequences on growth and temporomandibular pathology have been studied.

With reference to a case reported here, the authors emphasize the importance of reducing the length of the ramus of the jaw in rather exceptional forms of gaps between the upper and lower jaws with an increase in the posterior height of the face. This procedure provides more stable results and the patient's gums are no longer revealed when smiling.

Metastatic tumors of oral cavity are uncommon. Mandibular localisation is the most frequent. Microscopic diagnosis and other metastatic localisations help the diagnosis we are reporting on. The report is on a case with prostatic and lung primitive tumors associated with gingivo-maxillary, femur and cutaneous metastasis.

Diagnostic arthroscopy is reserved to patients who suffer from internal temporo-mandibular joint derangements resisting to conservative treatments. This technique allows an acute diagnostic approach to the intra-articular lesions of the superior compartment.

Posterolateral segmentary maxillary impaction osteotomy has a role to play in the treatment of gaps between the upper and lower jaws. It has several advantages, especially an uncomplicated postoperative period and the single-maxillary contention it provides. The indication must be established after an articulator assessment in order to take into account the mandibular protrusion caused by autorotation and to prevent a sagittal shift. Associated marginal glossectomy will frequently be required. Similarly, in case of vertical excess, genioplasty for vertical reduction will improve the facial balance. This technique may also be proposed as "pre-prosthetic surgery" in cases of egression in the premolar and molar areas, for which it has shown excellent results.

Synovial chondromatosis of the temporo-mandibular joint is a rare and mild disorder. Three cases are reported, one with an histological aspect of chondrosarcoma. The evolution is favourable after removing the loose particles and the synovial tissues.

After a brief historical summary, the authors report twelve cases of familial form of cherubism and compare them with the other reports of the international literature, of which they make a review.