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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.

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.

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.

Conventional treatment of osteoradionecrosis of mandible is by antibiotics combined if necessary with a hemimandibulectomy. A method is proposed which reduces bone excision to infected and necrotic tissue while respecting mandibular continuity. The bone remaining is covered by a flap taken from a distant region. Five cases treated in this way are reported. When mandibular continuity has to be interrupted to suppress infected foci, immediate repair is performed using an osteo-musculo-cutaneous flap, and six cases treated by this method are reported. A part from their mechanical covering and reconstructing roles these well vascularized flaps improve vitality of tissues they enclose, including the mandibular bone.

The technique involves transposition at the site of the angle of resection via an intrabuccal approach of the horizontal ramus at its various stages. The technique is dependable and is indicated whenever correction of the malformation requires mass displacement of the dental arcade. It is preferable to sagittal split of the ascending ramus since it is more precise and less dangerous as far as the neurovascular bundle is concerned.

Two cases of mandibular angiodysplasia associated with hemorrhagic phenomena were treated surgically, by conservation resection in one patient and conservative surgery following embolization in the other. External carotid artery ligature is a useless and even risky procedure, whereas surgery should be preceded by tumoral embolization whenever possible. Prognosis, according to the classification proposed by Merland, depends upon whether active vascular malformations, mainly represented by arteriovenous fistulae, are present, or whether the lesions are inactive vascular malformations or with slowed circulation.

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.

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.

It is proposed to alter the classification of laterognathy due to excessive unilateral development of the mandible into hypercondyly and mandibular hemihypertrophy. Two forms are distinguished: those with occlusal modifications and those with conserved occlusal ratios and compensatory skeletal deformities usually involving the two stages. Treatment of laterognathy with occlusal deformity is usually by condylectomy--a simple operation with rapid results and excellent articular tolerance. Treatment of those forms with marked skeletal deformity is usually by condylectomy combined with a Lefort I of occlusal adaptation, surgery for the basilar border being difficult and aleatory except in the region of the chin.

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.

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.

An osteomusculocutaneous flap using the clavicle, and pedunculated on the sternocleidomastoid muscle, was used in two patients to repair loss of post-radicular mucosa and bone substance. Healing of mucosa and bone consolidation was obtained with evidence of production of bone callus on radiography. The hypothesis advanced to explain this reconstruction of necrosed mandible is the presence of the new vascular supply.

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.

The technique described by Trauner for using retro-condylar cartilaginous implants is outlined, and the complications observed indicated. External or inferior luxation of the implant leads to recurrence of the deformity, whereas no inconvenience is caused by the opening of the joint. These pitfalls led to the use of a modified technique in which the cartilaginous implant is introduced into the supra-meniscal cavity of the temporo-mandibular joint.

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.

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.

On the basis of the results of osteotomy of the malar in malunion of facial fractures, the authors suggest the use of this operation in the correction of maxillary malformations including faulty development of the cheeks. Two cases are described.

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.

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.

The improved definition and good visualization of soft tissues provided by high resolution computed tomography imaging greatly exceeds results of conventional tomography investigations. It is irreplaceable for tumoral lesions, particularly of the facial region, when not only the tumor but its degree of extension are perfectly identified. In orbital injuries it is the only imaging procedure capable of visualizing the orbital contents and its relation with the fracture line.

Kole's operation combines segmental alveolar osteotomy of lower incisor-canine region with a reduction mentoplasty. The procedure usually provides a reduction in height of mentum, sometimes with an advancement, and involves ablation of an intermediate bone fragment. Ablation of lower border as described by Kole too frequently results in an esthetically poor chin. Insertions of platysma and digastric muscles are untouched. The inferior segmental osteotomy separates the lower incisor-canine region, which is displaced upwards or upwards and backwards after extraction of premolars, displacement being maintained by interposition of bone detached during mentoplasty. A reduction glossectomy is almost constantly associated. The best indication for Kole's operation is anterior gaps with or without proalveoli. It is often combined with segmental or total surgery to maxilla. Results are generally stable, especially after mentoplasty, but from the dental aspect pulp mortifications are not rare.