Search

Large series of cauda equina tumors in adults are seldom reported. This French series retrospectively reviews 231 cases collected for the congress of the Societe Francaise de Neurochirurgie in 1996. The authors first analyze this series and then discuss the pertinent literature. Schwannoma was the most frequent benign tumor in this series, followed by ependymoma. Very few malignant tumors were recorded; these were usually malignant neurinomas nearly always in neurofibromatosis patients. Some other rare tumors were also recorded, including paragangliomas. This series confirms the importance of the pretherapeutic neurological status in functional prognosis. All schwannomas can be cured, while ependymomas and paragangliomas may recur after a very long delay. Surgery must be as complete as possible, since adjuvant therapies are proven to have little efficacy. This type of tumor requires very long follow-up. Prognosis is good for hemangioblastomas. Sphincter dysfunctions carries a poor prognosis and may appear after primary surgery, more often after treatment of recurrences.

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.

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.

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.

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.

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.

Recurrence is a major problem after release of temporomandibular joint ankylosis. Early physiotherapy and choice of interpositional material are important in preventing recurrence. Currently, the most used technique is gap arthroplasty associated with coronoidectomy, temporalis muscle flap interposition and reconstruction of the condylar unit with a costochondral graft. Full-thickness skin graft interposition, using the technique described by PopescuVasiliu, can also be used. This retrospective review of 31 patients confirms the reliability of full-thickness skin graft interposition. Results were successful in 90% of the 20 patients with follow-up longer than one year.

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.

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.

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.

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.

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.

We are yielding a case of recurring melanotic neuroectodermal tumor of infancy situated in the premaxilla, with a very quick evolution, haemorrhage, and which has precociously recurred after surgical removal. This tumor is studied on the paraclinical (CT scan, M.I.R.) and on the histological hand (immunohistochemical and ultra-microscopy). This observation is then compared with those of literature in which we find about 200 cases. The neurocristopathic histogenesis is actually doing the unanimity. The prognosis must now be quite reserved because of the recurrences (one case for six) and the possibility of malignant forms, some with metastasis.

Trapdoor fractures of the floor of the orbit were first described in 1965 by Soll and Poley. The authors discuss the pathology and pathogenic theories for these lesions and present 8 cases. The diagnosis is essentially clinical and is frequently supported by computed tomography when it is performed rapidly. The surgical procedure is designed to release the herniated tissues by lowering the orbital floor so as not to aggravate the constrictive lesions. These fractures constitute surgical emergencies and their prognosis depends on the nature of the tissues incarcerated.

Injury to the face as a result of firearm wounds differs as a function of whether the injury was due to a bullet or lead shot. In the first case treatment is usually that of a mandibular or maxillary comminuted fracture and is principally orthopedic. In the case of hunting guns the damage is considerable and requires reconstitution of soft tissue with the use of a distant flap (purely cutaneous or musculo-cutaneous), bone repair, when necessary, being by costal or iliac grafts.

Statistical analysis of data from patients with mandibular fractures produced results in agreement with etiologic and pathologic findings in all previous studies. The possible use of miniaturized plate and screws osteosynthesis is discussed. Results of the study indicate a good prognosis for mandibular body fractures but a more reserved prognosis for bicondylar fractures.

This study concerns 3 cases of malignant syndrome due to neuroleptics. Our aim is to clarify the nature of this syndrome and to attempt to delimit it from malignant hyperthermia. The etiology suggests that its occurence should increase with the growing use of very active neuroleptics. It consists clinically of an extrapyramidal syndrome with hypertonicity, akinesia, tremor and with a neuro-vegetative syndrome of which the main sign is hyperthermia. On the basis of physiopathology it is attempted to explain, in the light of fresh data, the extrapyramidal signs, the hyperthermia and the rise in the OPK Etiological treatment has, however, proved disappointing.

This work was carried out over a year on all the wounded patients picked up by the S.A.M.U. 42. Out of 502 interpretable alcoholemic tests 353 positive tests were found (of which 222 were greater than 0.80 g.l-1). The law of July 1978 had no influence on the figures. Thursday is the day when the greatest number of positive alcohol tests were recorded. There is no significant difference between the nocturnal and diurnal results. Pedestrians had an average alcohol blood level which was higher than drivers of automobiles or two wheeled vehicles. Alcoholic excess is found especially in the rural "plain" areas. The unemployed constitute the professional category with the highest alcholemia. Women are more reasonable in their libations. Alcohol is an important factor in the clumsiness which is the origin of worksite accidents. Alcohol encourages suicide attempts. It would seem according to this work that alcoholemia is higher in the region of Saint-Etienne than the national average.

The preferred composite flap is the musculocutaneous flap from pectoralis major for repair of loss of mucocutaneous substance due to cancer or injury. In rare indications the musculocutaneous flap from sternocleidomastoid muscle is used. When loss of bone substance combined with a cutaneous or mucosal defect has to be corrected use is made of the bone-muscle-skin flap from pectoralis major to include the 5th rib, or the bone-muscle-skin flap from sternocleidomastoid to include internal portion of clavicle. Reliability on use of these two flaps has led to their application in surgery for mandibular osteoradionecrosis. In addition to allowing repair of bone continuity, the vascular and cellular capacities of the flap provide colonization and rehabilitation of the borders of lost substance with live tissue, as shown by subsequent bone remodelling. Results of statistical analysis of 50 cases are presented.

Teleradiographic examinations were conducted pre- and postoperatively and one year after resection of the body (5 cases) or angle (10 cases) of the mandible for mandibular protrusion in 15 patients. Clinical results of these operations appeared to be very stable, but teleradiographic modifications were observed constantly after one year. Resection of the body has little effect on the position of the ascending rami, whereas angle resection usually results in parasitic movements in this region, their pre-operative condition being re-established in practically all cases. Following shortening of the body there is an almost constant drop in the symphysial region. These movements appear to arise from activity of masticatory and suprahyoid muscles, with an accessory role being played by the tongue.

Two cases of intracranial penetration of the mandibular condyle are described, reports on similar cases in the published literature reviewed, and current therapeutic methods outlined. These penetrating injuries are often unrecognized during initial investigations, the patients presenting with temporomandibular ankylosis several months later.

The predominant aetiology in 24 cases of temporomandibular ankylosis treated surgically since 1976 was trauma. Among the patients operated upon for post-traumatic ankylosis one anatomoclinical form could be identified characterized by an external block attaching the condylar neck to the zygomatic bone, and an internal joint by movement of the head or part of the condylar head. A favorable prognosis can be given in this type of lesion as resection of the block does not modify the height of the ascending ramus.

A patient with temporomandibular ankylosis was treated by resection of the ankylosed block followed by lengthening of the ascending ramus by an endoprosthesis. The place of the latter in the treatment of such lesions and the deformities that result from them is analyzed. Emphasis is laid on the value of displacement of the superior arch by a Le Fort I osteotomy in the correction of facial asymmetry in cases of laterognathia due to a mandibular development defect.

Two cases of temporo-mandibular joint infection with several blood cultures positive for Staphylococcus aureus are reported. Positive diagnosis depended on the importance of the pain and trismus, as well as the lack of abscess formation. The rapid development of ankylosis requires treatment to be started as soon as the first signs appear.

Statistical analysis was conducted on findings in 104 cases of fractures in the condylar region and 25 patients examined to determine degree of incapacity as a result of these types of fracture. Data obtained illustrated the adverse effects of ascending ramus shortening, and the improvement obtained after surgical restoration of its height whenever this was indicated. Long-term follow up surveillance is also necessary after high subcondylar fractures with impaction of the ascending ramus because of the risk of external temporomandibular ankylosis.

Three cases of intracranial penetrations of the mandibular condyle condyle are reported, the published literature reviewed, and therapy discussed. Often unrecognized during initial examinations, they are diagnosed when the patient is seen several months later with permanent constriction of the jaws. Frontal and sagittal tomographic examinations should therefore be performed in the articular region in all cases when it is involved in injuries. Orthopedic reduction gives good results in recent injuries, long-standing cases with temporomandibular ankylosis requiring sub-condylar resection by the pre-auricular approach.