Search

We retrospectively studied the cases of 19 patients suffering from low flow vascular malformations who were treated with Ethibloc sclerotherapy. Out of 10 venous angiomas, 5 entirely disappeared, 3 considerably decreased and 2 remained unaltered. Out of 7 cystic lymphangiomas, 7 were completely cured and in the 2 other cases, outcome was quite good. Post-treatment complications consisted in a local inflammatory reaction. This reaction occurred immediately and disappeared within a few days without after-effects. It materialized as an Ethibloc exteriorization among 5 patients suffering from venous angiomas and 3 patients suffering from lymphangiomas and as an inflammatory lump for 2 venous angiomas carriers and for 4 lymphangiomas carriers. This lump was located at the puncture point of the product and it was due to some Ethibloc residue. Fourteen of these local reactions spontaneously decreased; 5 of them required a surgical operation but in all cases, after-effects were minor. These satisfactory results (volume decreasing in 90% of the malformations) as well as the mildness of the side effects encourage to use Ethibloc in the treatment of low flow vascular malformations. In our experience, Ethibloc is particularly appropriate for the treatment of large lymphangiomas.

When a patient must undergo resection of part of the upper lip for the treatment of a cancer or following a traumatic defect of the upper hemilip, the surgeon is faced with the problem of reconstruction of a lip whose appearance and function must be as close as possible to the normal lip. The limits of the normal lip must be restored: the symmetry, equilibrium of the lips and position of the commissures must be maintained. The upper lip esthetic unit can be divided into subunits, as described by Burget and Menick. If a large part of a subunit is removed, replacement of the entire subunit rather than simple reconstruction of the defect often gives a better esthetic result (Burget). The best tissue for esthetic reconstruction of a full thickness defect of the upper lip is the lower lip. We apply Burget's principles to raise an Abbé flap, which is transferred in two stages. This approach is illustrated by 5 patients operated by this technique. Finally, this technique is compared to other techniques allowing reconstruction of the upper hemilip.

The goals of mandibular distraction are to restore a normal length but also a normal shape to the hypoplastic mandible. These two goals are related to the elongation vector which is itself related to the location of the cortictomy and of the device. Other factors influence this elongation vector. So it is impossible to precisely predict the elongation vector. With the monodirectional distraction device no modification can be made during the distraction time. With a bidirectional distraction device offering the possibility to modulate the angulation between the two elongation rods it is possible to adjust the elongation vector during distraction. Precise distraction gap modeling is possible. This is particularly important to correct anterior open-bite. This device was tested on animals (pigs).

A new case of this rarely described pathology is reported. It concerns a benign infiltrating lipomatosis, strictly located to the face. However, dento-musculo-squelettal structures are constantly involved, usually located to a hemiface. A young female patient has been followed up from her birth. Surgical procedures are reported. Diagnostic and therapeutic difficulties of this rare clinicopathologic entity are discussed.

A patient presented complex fractures of the face and skull with leg trauma after a traffic accident. Maxillofacial repair used sophisticated procedures: bone grafts, muscle flaps and multiple osteotomies. After reconstructing the mid face and the mandibular repair, bone implants were used to stabilize the maxillary prosthesis. The psychological and functions problems raised in this case are discussed considering the occupational and social outcome.

The nasal sequelae of unilateral cleft lip and palate are almost always present: more or less severe deformities, essentially consisting of nostril deformity and deviated septum. After an anatomical study of nasal deformities and the consequences of the primary procedures of cheiloplasty or cheilorhinoplasty, the authors review all of the most satisfactory technical aspects of secondary proposed in the literature. Five clinical cases illustrate the therapeutic strategy and the results.

The author scrutinises the evolution of orthognathic surgery for the last twenty years through the different parameters that participate to its origin; esthetic motivation, orthodontico-surgical collaboration, the limitation of widely used technics, a simple surgical solution, the spreading of rigid fixation, the interest of primary or secondary genioplasty, the consideration of ethnic differences,the usefulness of a maxillo-facial chain, the possible retreatment of failures and consideration for the stability of results.

We describe a method for fixation of condylar fractures using a Kirschner pin. A retromandibular approach is used. This protocol was evaluated in 12 consecutive patients.

We report a new case of aggressive juvenile fibromatosis (FJA) in a 20 months old girl. It was initially treated by hemimandibulectomy. A secondary reconstruction was performed with a fibular flap at the age of 9 years. FJA is a locally aggressive lesion which does not metastasize. It occurs chiefly in girls during childhood. Radiographs are non-specific (extensive osteolytic lesion). The clinicopathologic diagnosis is discussed with the other mandibular fibrous tumors in children.

Long-term outcome after surgical treatment of temporomandibular joint ankylosis is not always satisfactory in children. Interposition of a temporalis muscle flap is insufficient to ensure good functional results if the surgical procedure is not followed by careful active and passive physiotherapy. The results can be evaluated only after the child has grown.

Self-controlled gymnastics in SADAM relaxes the masticator muscles, allows precise assessment of occlusion and helps the patient acquire occlusion-conscience. The technique is entirely patient controlled.

Moebius syndrome is a congenital bilateral palsy of the sixth and seventh cranial nerves. It results a total absence of facial expression and a severe strabismus. Social life is greatly disturbed. Other anomalies may be associated, especially other cranial palsies and Poland syndrome. The etiology of this syndrome isn't clearly established. Stem necrosis secondary to a vascular deficiency is often admitted. We report two observations. We emphasize the importance of a complete maxillo-facial treatment including maxillo-mandibular anomaly. Both patient underwent orthognathic surgery. The first one for class II and the second for class III anomaly. One patient underwent a facial reanimation by temporal muscle transfer. Orthognathic surgery must be realized prior to facial reanimation. A correction of the strabismus is possible. Moebius syndrome is a rare (200 observations) but very severe malformation. Maxillofacial surgery is able to improve the morphological and relational aspect of Moebius syndrome.

The authors report a case of penetration of an odontogenic keratocyst into the skull base. There is significant controversy about what is the optimum surgical treatment for the odontogenic keratocyst. Diagnosis, mode of growth and recurrence of keratocyst are still a great deal of interest. This paper reports the recent advances in the subject.

From a review of the literature and a clinical case, we demonstrate the value of ultrasonographic monitoring of mandibular distraction according to the Ilizarov's protocol. Unlike X rays, sonography offers early and reliable pictures of the ossification process. The ultrasonic image matches the histological aspect obtained in the course of experiment. A more accurate monitoring of the regenerating area is thus made possible.

Objective: To assess the efficiency of corticosteroids and preoperative acute normovolaemic haemodilution (PANHD) in reducing postoperative inflammation after maxillofacial surgery., Study Design: Randomized clinical trial., Patients: Thirty-two patients scheduled to undergo maxillary osteotomy for facial dysmorphia were randomized into four groups of eight (PANHD or not; corticosteroids or not)., Methods: PANHD decreased haematocrit to 30%. In the corticosteroid groups, methylprednisolone 1.5 mg.kg-1 was given intravenously at the beginning of surgery (after PANHD in haemodiluted group), and after surgery, 1.5 mg.kg-1 iv daily for three days. Postoperative inflammation was assessed with an X-Ray technique (radiotelemetry) providing data on tissue thickness (extent of facial oedema), and by measurement of plasma concentrations of four acute phase proteins during the first postoperative week., Results: No change in facial oedema and in acute phase proteins occurred with PANHD. Corticosteroids decreased postoperative oedema and acute phase proteins., Conclusion: Corticosteroids decrease postoperative inflammation after maxillofacial surgery but not PANHD.

The Abbe-Estlander flap is a full-thickness lip-switch flap rotated from mid lower lip to fill defects of the upper lip. In 1872, Estlander emphasized the importance of this flap. Abbe, in 1898, was the first to switch a lower lip flap into the upper lip for a cleft deformity. The lip-switch flap is an arterialized flap, based on the constant inferior labial artery. This flap is widely used to repair the defects from cancer and traumatism or in repair of the cleft lip deformities.

The gastro-omental flap consists of a patch taken from the greater curvature of the stomach and the bordering omentum. It is based on the right gastro epiploic vessels and is used as a free flap for intraoral reconstruction after resection of oral carcinoma. Twenty patients underwent gastro-omental flap. The operative technique is described. The evaluation consisted in questioning, chemism on the salivary flow and biopsies. There is no morbidity related with the donor site. The gastro-omental flap avoids post irradiation xerostomia. Oral irritation and bleeding of the flap may occur.

A case of extreme macroglossia was observed in a patient with amyloid disease and dysglobulinaemia. A medial diamond-shaped glossectomy was required to reduce the size of the tongue. The details of the surgical and anaesthetic procedure are presented. This type of surgery, greatly appreciated by the patient, can only be undertaken after careful preparation. The reported cases are rare and the indication for surgery is difficult due to the unpredictable nature of the local and general clinical course of the disease.

In the bilateral total labio-maxillary cleft the premaxilla is sometimes very protrusive at the completion of facial growth. This kind of malposition cannot be treated by orthodontics. Surgical repositioning of the premaxilla with simultaneous bilateral alveolar maxillary bone graft is done before the revision of lip and nose. Its goal is the reconstruction of a solid and harmonious dental and maxillary arch, closure of bucconasal fistulas, improvement of facial profile by closure of nasolabial angle. The authors describe the operation technique and illustrate it by two cases.

Bone cell conduction can occur within hydroxyapatite, a biocompatible, bioactive, synthetised ceramic material, when it is placed in contact with bone tissue. Results of experimental and clinical studies on maxillary osteotomy incisional lines have confirmed these properties, the quality and stability of the results and the good tolerance of this biomaterial making it a product of choice as a substitute of iliac bone grafts, when no longer indicated in this context.

The serrato-costal free flap provides a large costal flap vascularized by a digitation of the serratus anterior muscle supplied by the dorsal thoracic artery. The flap is easy and rapid to raise with low morbidity. The repair obtained is functionally very satisfactory, but does not allow insertion of an implant. Six cases are reported. The indications of this technique of mandibular reconstruction are discussed.

Bilateral hyperplasia of the coronoid processes of the mandible is not frequent and concerns most always males between the ages of 14 and 16. The restricted opening movement is caused by impingement of the process on the medial and anterior surfaces of the zygomatic arch. The diagnostic is made by a good radiography. The treatment is surgery by intraoral approach. The coronoid processes are removed on the two sides with postoperative physiotherapy. The results are good and permanent.

Hemangioma of the nasal tip (Cyrano nose) is a cavernous or capillary cavernous form. Its development is related to immaturity. It occurs in infants a few days after birth, and increases with regularity. The natural outcome is favorable, and the angioma decreases in most cases after 5 or 6 years of age. Due to the location and the aesthetic prejudice involved, the parents often ask for early surgical treatment. A study of 4 cases and a literature review indicate the surgical intervention should take place later, ie one should wait and only operate on the sequelae resulting from the development of the hemangioma. Late surgical treatment led to resection of the remaining lesion and to repair of the nasal tip.

With regard to medicolegal problems, semantics are of considerable importance: indeed, depending on whether we call grafting or transplantation of an organ the operation that takes a living organ to reimplant it in the same person or the operation that takes a living organ from a donor to reimplant it in a recipient, the issues raised are completely different. The transposition of a dental organ does not raise any particular problems apart from the technical requirements to be met; there is no special problem of prevention or ethics to be taken into consideration. The problem is a completely different one when it means taking a living organ from a living or dead subject and reimplanting it in another subject. All measures decreed from the point of view of law and regulations that are dictated by considerations of prevention and ethics must then be strictly applied.

The authors expand their method of cephalometric simulation, which was designed for maxillofacial surgeons performing orthognathic surgery. This method has been developed to make up for the insufficiencies of the usually available cephalometric simulations, ie. poor legibility and the lack of data that may be necessary for surgery. The authors only deal with CS on profile teleradiographs at the end of the orthodontic preparation. This method utilizes models cut out of colored polyester and representing the profile of the maxillary and mandible. All the possible movements of the skeletal parts can also be simulated and the analysis of their direction and amplitude is possible, as is, more importantly, the influence of vertical movements of the maxillary on the mandible due to the mandibular autorotation phenomenon. This method is essential to accurately assess the degree of differential impaction or egress of the mandible in the region of the incisors and of the molars, according to the accompanying movements of the mandible moving around the condyle. Examples illustrate the use of this simulation method in the various types of orthognathic surgery. Finally, the authors point out the limitations of the method and the complementary usefulness of anteroposterior cephalometric simulation and of gnathologic simulation on casts, in particular for osteotomies for the transverse direction and for asymmetria.

One case of connective-tissue tumor with a lymphomatous appearance, secondary to chronic sinusitis with a dental origin, is reported. The main ophthalmological syndromes associated with a dental and/or sinusal involvement are described.

Swallowing dysfunction is the main cause of drooling in cerebral palsy. Medical treatment is inefficient. Surgical treatment involves neurectomy, translocation of the salivary duct or salivary gland resection. Following this, reeducation is advisable. Indications are based on the degree of drooling and on the degree of histories mental retardation. The authors present 2 case histories of drooling in patients with cerebral palsy treated by submandibular gland resection and parotid duct ligation.

A case of lingual necrosis in a patient irradiated 3 years earlier for a tonsillar tumor is presented. Imputability to a post-radiology bilateral external carotid thrombosis is evoked, where the diagnosis of tumoral recurrence and Horton's disease have been ruled out. Cervical peridural nerve block allowed successful treatment of this lesion.

Aspiration biopsy by fine needle from the major salivary glands has been studied. To evaluate this form of biopsy, 34 patients with salivary gland enlargement were examined. By this technic, 29 has confirmative histology. The method proved complication free and accurate. The safety of this biopsy form has been proven. The accuracy of this method may be high, particularly, for the most common benign mixed tumor. Thus this procedure is suggested for initial examination of all lesions of the salivary gland.

Twelve cases of maxillo-facial fibrous dysplasia are presented, with a brief review of the condition. Only the complete excision of the lesion allows full healing, but it is rarely feasible, even with immediate reconstruction. The surgical abstention and partial excision keep many indications, but require a regular follow-up.

Three cases of intra-mandibular salivary tumors are presented. Two patients died (one with local recurrence, the other with metastasis). 69 cases have been reported in the literature. The lesions present as a progressive swelling of the mandible, with a frequent nervous involvement. The histologic diagnosis is difficult. Mucoepidermoid tumors are the more frequent (71%) but all salivary tumors can be found. An aggressive clinical behavior with local recurrences and/or metastasis (more than 30%) justify a radical treatment.

The authors present 10 cases of anterior vertical insufficiency of maxillary origin. They analyse the principal clinical and radiological elements of this syndrome. They discuss possible therapy involving Lefort I lowering osteotomy with bone grafting and possible mandibular surgery.

The gastro-omental flap is centered around the midportion of the greater curve of the stomach, with the attached omentum. The flap is based on the right gastro-epiploïc pedicle. The size of the mucosal patch is adaptable. This flap offers several practical advantages: great plasticity (including the omentum), large length and size of the pedicle, mucus secretion which may improve xerostomia, and less morbidity. Disadvantages include the propensity for excessive mucus production (needing tracheotomy), the requirement for an abdominal operation, and the possibility of peptic ulceration (no case reported in the literature). Seven patients have been treated, with a good result. This flap is suitable for repair of complex soft-tissue defects after extensive cancer surgery.

Since Wassmund in 1927, the Le Fort I osteotomy became a popular procedure in maxillo-facial surgery. Review of the literature is presented with a series of 50 homogenous patients. The authors show that they are few complications of this operation although theoretically may look numerous. The intra and post-operative haemorrhages are infrequent and never alter the vital prognosis. The bony necrosis disappeared since the last technical improvements. The secondary displacement remains a problem which seems less important actually because of the use of plates and screws, and the improved surgeon's skill. So, the Le Fort I osteotomy become a reliable surgery since indications and technical points are respected.

Gore-Tex* or polytetrafluoroethylene was used successfully in 30 cases of orbital fractures in order to make good a loss of substance of less of 1.5 cm. The advantages and disadvantages of the product are discussed. Its value in relation to traditional bone grafting is also defined.

Conventional therapy for fractures of the atrophied mandibular arch in edentulous patients, employing surgery followed by the insertion of a prosthesis, gives unsatisfactory results due to the frequency of early or late complications. A strictly surgical approach has therefore been adopted in the maxillofacial Surgical Unit in Lyon. The procedure involves systematic freeing of the fracture lines and their contention, after as complete an anatomical reduction as possible, by means of wire sutures, a miniature plate and screw, or even a rib graft in cases of marked mandibular atrophy. Consolidation without complications can be obtained, followed by the insertion of a prosthesis after a short period of time.

A relatively frequent disorder, hemi-mandibular hypertrophy is today well identified clinically and radiologically. Its expression varies from one case to another but it becomes stabilized at the end of growth. Its etiology is unclear and it can only be corrected surgically: the habitual inclination of the plane of occlusion leads to a bimaxillary action with a tridimensional effect. The results of these osteotomies performed at the same time is stable and dramatic. Although isolated osteotomy of the basilar excess has become a last resort procedure, isolated condylectomy is still an acceptable compromise in toothless patients. The diagnostic approach and result of surgical treatment are analyzed in light of a homogeneous series of 12 cases.