Search

In the context of regenerative endodontics research with the development of biomaterials, this work aimed to develop and test a prototype biomimetic bioreactor of a human tooth. The bioreactor was designed to reproduce a shaped dental canal connected with a cavity reproducing the periapical region and irrigated through two fluidic channels intended to reproduce the apical residual vascular supply. A test biomaterial composed of polylactic acid/polycaprolactone-tannic acid (PLA/PCL-TA) was produced by electrospinning/electrospraying and calibrated to be inserted in a dental canal. This biomaterial was first used to evaluate its imbibition capacity and the oximetry inside the bioreactor. Then, Dental Pulp Stem Cells (DPSCs) were cultured on PLA/PCL-TA cones for 1-3 weeks in the bioreactor; afterward cell adhesion, proliferation, and migration were histologically assessed. Complete imbibition biomaterial was obtained in 10 min and oximetry was stable over time. In the bioreactor, DPSCs were able to adhere, proliferate and migrate onto the surface and inside the biomaterial. In conclusion, this bioreactor was used successfully to test a biomaterial intended to support pulp regeneration and constitutes a new in vitro experimental model closer to clinical reality.

Purpose Processed nerve allografts (PNA) are an alternative to nerve autografts to reconstruct the inferior alveolar nerve (IAN) when it is damaged. The purpose of this study was to report the results of IAN reconstruction using PNA in the context of aggressive benign mandibular pathology. Material and method A systematic literature review was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) statement through the MEDLINE (Pubmed) and SCOPUS (Elsevier) databases. Studies concerning reconstructive surgeries of IAN by PNA, performed at the same time as the surgical resection of the benign pathologies of the mandible were included. The following data were analyzed: gender and patient age, cause of mandibular resection, graft dimensions, sensory recovery at least 6 months after surgery according to the MRC scale, and adverse events related to the intervention. Results The initial search yielded 290 studies and 5 were included in the final review. A total of 33 patients underwent 36 IAN reconstructions; 14 patients were female (42.4%) and mean age was 30 years old. The mean length of graft used was 64.0 ± 9.1 mm. The most common pathology that led to nerve resection was ameloblastoma (52%). Among the reconstructions for which follow-up data were available, functional sensory recovery occurred in 92.9% of cases. Conclusion PNA are a reliable, safe, and effective alternative to nerve autografts for the rehabilitation of the IAN with 92.9% of functional recovery according to the reported literature, avoiding any comorbidity associated with the use of a donor site.

The present study aimed at assessing the epidemiology including demographic variables, diagnostic features, and management of ameloblastomas at several European departments of maxillofacial and oral surgery. The following data were recorded for each patient: gender, age, voluptuary habits, comorbidities, site, size, radiographic features, type, histopathological features, kind of treatment, length of hospital stay, complications, recurrence, management and complications of the recurrence. A total of 244 patients, 134 males and 110 females with ameloblastomas were included in the study. Mean age was 47.4 years. In all, 81% of lesions were found in the mandible, whereas 19% were found in the maxilla. Mean size of included ameloblastomas was 38.9 mm. The most frequently performed treatment option was enucleation plus curettage/peripheral ostectomy in 94 ameloblastomas, followed by segmental resection (60 patients), simple enucleation (46 patients), and marginal resection (40 patients). A recurrence (with a mean follow up of 5 years) was observed in 47 cases out of 244 ameloblastomas (19.3%). Segmental resection was associated with a low risk of recurrence (p = 0003), whereas enucleation plus curettage/peripheral ostectomy was associated with a high risk of recurrence (p = 0002). A multilocular radiographic appearance was associated with a high risk of recurrence (p < .05), as well as the benign solid/multicystic histologic type (p < .05). Within the limitations of the study it seems that the management of ameloblastomas will probably remain controversial even in the future. Balancing low surgical morbidity with a low recurrence rate is a difficult aim to reach.

Temporomandibular joint dysfunctions are a frequently occurring condition that can have a considerable impact on the quality of life. The treatment modalities vary according to the anatomical involvement and symptomatology of the patient. Conservative and surgical management is still controversial and has evolved significantly in recent decades. The temporomandibular joint prosthesis is one of them. Through improvements in material and case management, the joint prosthesis has gained in popularity and has moved from being a treatment of last resort to being part of standard management.Les dysfonctions de l’articulation temporo-mandibulaire sont une pathologie à incidence fréquente qui peut avoir un impact considérable sur la vie quotidienne. Leur traitement varie selon l’atteinte anatomique et la symptomatologie du patient. La prise en charge conservatrice et chirurgicale est encore controversée et a connu une évolution notable au courant des dernières décennies. Plus particulièrement, le remplacement prothétique de l’articulation, grâce à l’amélioration des matériaux et de la planification préopératoire, a gagné en popularité et est passé du traitement de dernier recours à un élément de la prise en charge standard.

Introduction The potential drawbacks of surgical approaches to neck and base fractures of the mandibular condyle (visible scare, facial nerve injury) are still considered by many surgeons as a brake for open reduction and internal fixation. The aim of our study was to analyze the results in terms of access, scare quality and complications that could be noticed in a 12 years period of time with the use of the high sub-mandibular approach (HSMA) we first described in 2006 for the surgical treatment of neck and base fractures. Material and method All the files of patients operated on for condylar neck and base fractures approached by mean of a HSMA between January 2006 and December 2018 in our department and containing information concerning age, sex, type of fracture, kind of osteosynthesis material, operating time, name of the surgeon, postoperative complication linked to the approach, scare quality at 6 months follow-up at least were included. The skin incision and the dissection planes followed the original publication of Meyer et al. in 2006. Results 434 patients (sex ratio: 2.06, mean age: 32, 496 approaches) met the inclusion criteria. Following the AO classification, 21.2% of the fractures were classified as neck fractures and 78.8% as base fractures. 97.6% of all fractures were stabilized by mean of a 3D plate (TCP® plate, Medartis, Basel–CH), the remaining ones by mean of a combination of 1.2, 1.5 and 2.0 straight plates. Mean operating time was 40 minutes per side. Patients were operated on by senior surgeons in 71.7% of the cases and by trainees under supervision for the others. Concerning the complications linked to the approach, we noticed 11 (2.2%) temporary (0 definitive) paresis of the facial nerve, 1 (0.2%) hematoma and 1 (0.2%) abscess that both needed revision. Scare was hypertrophic or considered as unaesthetic by the patient in 5 cases (1%). Discussion The HSMA, if performed as initially described, is a safe and quick procedure compared to other cutaneous approaches. It gives access to all base fractures and to most of neck fractures. The very low rate of facial nerve complications is mainly explained by the plane by plane dissection making it very easy to avoid the facial nerve branches or to check them when encountered. The HSMA is particularly suited to the use of TCP plates as the upper holes of these plates, placed horizontally, are easy to reach from below. The HSMA is therefore still our preferred cutaneous approach to the condylar process.

Surgical site infections (SSI) occur in 1.4% to 33.4% of cases after orthognathic surgery. This type of complication is a major concern to surgical teams, but there is no consensus for the prevention and treatment of SSI in orthognathic surgery. The purpose of this descriptive study was to evaluate the severity and the consequences of postoperative infections. The charts of all the patients operated on by the orthognathic surgery team between January 2015 and July 2017 were collected. All types of orthognathic procedures (Le Fort I maxillary osteotomy, bilateral sagittal split mandibular osteotomy, and genioplasty) were screened, and patients diagnosed with SSI were included. Demographic data, timing and severity of the infection, as well as long-term complications were recorded. Five hundred and twelve patients were screened. Forty-one patients (8%) presenting with SSI were included. There were 18 men and 23 women. The site of the infection was mandibular for 38 patients (92.7%) and maxillary for 3 patients (7.3%). The average time between surgery and infection was 31.5 days. Twenty-four patients received isolated oral antibiotics for inflammatory cellulitic reaction (58.8%), 15 patients had a localized collection treated by incision and drainage under local anesthesia (36.6%), and 2 patients had an extensive collection requiring surgical drainage under general anesthesia (4.9%). Five patients (12.2%) needed hardware removal for plate loosening, and 2 patients (4.9%) developed chronic osteomyelitis. Infection following orthognathic surgery is easily treated most of the time with no long-term complications. In cases of patients with potential risk factors for severe infection, antibiotics may be given with curative intents.

Intrasaccular flow disrupter devices (ISFD) have opened up new ways to treat intracranial aneurysms but choosing the correct size of ISFD can be challenging. We describe the first use of 3D printing to assist in the choice of ISFD, and we report an illustrative case. We developed a technique that uses preoperative angiography to make a plastic model of the aneurysm. We tested the deployment of different sizes of intrasaccular flow disruptor on the 3D model under fluoroscopy. The best devices were then used as the first-line strategy to treat the patient. The preoperative 3D printing helped in the successful selection of a first-line ISFD, which was not the one recommended by the manufacturer. Three-dimensional printing can provide interesting information regarding the treatment of intracranial aneurysms using ISFD. Further studies are needed to fully assess its benefits.

INTRODUCTION: Odontoma is the most commonly diagnosed odontogenic tumor of the oral cavity. The objective of the present study was to assess the demographic variables, patterns, diagnostic features, and management issues of odontomas treated at several European departments of maxillofacial and oral surgery.MATERIALS AND METHODS: This study was conducted at 8 European departments of oral surgery between January 1, 2004, and December 31, 2018. Only patients with odontomas were included. The following data were recorded for each patient: gender, age, comorbidities, site, size of odontomas, radiographic features, type of odontoma, treatment of odontomas, treatment of associated teeth, complications, and recurrence.RESULTS: A total of 127 patients (70 male and 57 female patients) with odontomas were included. The mean age was 22 years; 71 odontomas were found in the mandible, whereas 56 in the maxilla. In the mandible, the most frequently involved subsite was the parasymphysis, while in the maxilla, the most common subsite was the upper incisor region. The mean size of included odontomas was 15.3 mm. On the whole, 62 complex odontomas, 50 compound odontomas, and 15 mixed-type odontomas were observed. Complete excision of the odontomas was performed in 121 patients. In 24 patients, the extraction of deciduous teeth was performed, and in 43 patients, one or more permanent teeth were removed. Finally, in 9 patients, a partial excision of the odontoma was performed. Recurrence was observed in 4 cases out of 127 patients.CONCLUSIONS: Dental practitioners should be aware of the distinct clinical and radiographic features of odontoma in order to perform an appropriate and early diagnosis. Conventional radiography, such as panoramic radiograph, is often sufficient technique for a diagnosis after clinical suspicion or for an incidental diagnosis to prevent later complications, such as impaction or failure of eruption of teeth.

The objective of the present study was to assess the epidemiology including demographic variables, diagnostic features, and the management of odontogenic keratocyst (OKCs) at several European departments of maxillofacial and oral surgery. This study is based on a systematic computer-assisted database that allowed the recording of data from treated OKCs. The following data were recorded for each patient: gender, age, voluptuary habits, comorbidities, site, size, radiographic features, treatment of OKCs, length of hospital stay, complications, recurrence, management and complications of eventual recurrence. A total of 405 patients, 249 male and 156 female, with 415 OKCs (407 sporadic and 8 syndromic lesions) were included in the study: 320 lesions were found in the mandible, whereas 95 were found in the maxilla. In the mandible, the most frequently involved subsite was the angle, whereas in the maxilla it was the molar region. The most frequently performed treatment option was enucleation plus curettage/peripheral ostectomy in 204 OKCs (recurrence rate, 9%). Decompression without residual cystectomy (recurrence rate, 66%), marsupialization with residual enucleation with the use of Carnoy's solution (recurrence rate, 50%), decompression with residual cystectomy (recurrence rate, 43%), and simple enucleation (recurrence rate, 24%) were the treatment options with the highest recurrence rates. An appropriate management of odontogenic keratocysts should be individualized, taking into consideration clinical and radiological findings, as well as patients’ age and comorbidities.

INTRODUCTION: The aim of the present article was to review and depict the main radiological features of odontogenic keratocysts (OKCs), thus helping the differential diagnoses from other odontogenic cysts and neoplasms. EVIDENCE ACQUISITION: A review of articles published between January 2000 and October 2020 using Medline and the MeSH Term "odontogenic keratocyst" in combination with the following terms "imaging," "radiology," "panoramic radiograph," and "computed tomography," was performed. EVIDENCE SYNTHESIS: Radiographically, OKCs are well-defined unilocular or multilocular radiolucencies bounded by corticated margins. Most lesions are unilocular; instead, multilocular OKCs represent about the 30% of cases, mainly involving the posterior mandible. When, particularly in large lesions, OKCs display a multilocular presentation with adjacent satellite cysts (daughter cysts) a "soap-bubble appearance" can be recognized. DISCUSSION: Panoramic radiograph and CT still play an important role in the diagnosis and treatment planning of OKCs. Unfortunately, it may not be easy to differentiate OKCs from other odontogenic lesions, especially when they are small and unilocular. CONCLUSIONS: Histopathological findings are still necessary to obtain a definitive diagnosis.

Artificial Intelligence (AI) applications have already invaded our everyday life, and the last 10 years have seen the emergence of very promising applications in the field of medicine. However, the literature dealing with the potential applications of IA in Orthognathic Surgery is remarkably poor to date. Yet, it is very likely that due to its amazing power in image recognition AI will find tremendous applications in dento-facial deformities recognition in a near future. In this article, we point out the state-of-the-art AI applications in medicine and its potential applications in the field of orthognathic surgery. AI is a very powerful tool and it is the responsibility of the entire medical profession to achieve a positive symbiosis between clinical sense and AI.

3D-printing is part of the daily practice of maxillo-facial surgeons, stomatologists and oral surgeons. To date, no French health center is producing in-house medical devices according to the new European standards. Based on all the evidence-based data available, a group of experts from the French Society of Stomatology, Maxillo-Facial Surgery and Oral Surgery (Societe Francaise de Chirurgie Maxillofaciale, Stomatologie et Chirurgie Orale, SFSCMFCO), provide good practice guidelines for in-house 3D-printing in maxillo-facial surgery, stomatology, and oral surgery. Briefly, technical considerations related to printers and CAD software, which were the main challenges in the last ten years, are now nearly trivial questions. The central current issues when planning the implementation of an in-house 3D-printing platform are economic and regulatory. Successful in-house 3D platforms rely on close collaborations between health professionals and engineers, backed by regulatory and logistic specialists. Several large-scale academic projects across France will soon provide definitive answers to governance and economical questions related to the use of in-house 3D printing.

This study aimed to demonstrate an association between the occurrence of surgical site infection (SSI) after orthognathic surgery and penicillin allergy and to assess whether other factors could be associated with the occurrence of SSI. A 10-year monocentric retrospective study was conducted to identify possible risk factors for SSI in orthognathic surgery. Bivariate analyses were performed using Fisher, Student, or Wilcoxon tests and multivariate analyses using logistic regression. Two hundred and sixty-six patients were included, and 3.5% had SSI. Bivariate analyses revealed a significant association between SSI and age at surgery (p = 0.01), penicillin allergy (p = 0.02), and postoperative antibiotic therapy by Clindamycin (Dalacine®) (p = 0.02). Multivariate analyses confirmed the association between the occurrence of SSI and treatment with Clindamycin (Dalacine®) or Clindamycin (Dalacine®) and Metronidazole (Flagyl®) postoperatively (p = 0.04). Antibiotic therapy with Clindamycin (Dalacine®) seems to be associated with a higher rate of SSI, and the mandible was the only site affected by SSI.

Temporomandibular joint prosthesis. The temporomandibular joint can be affected by end-stage pathology such as arthritic disease, trauma, ankylosis. The main debilitating symptoms results in limited mouth opening and pain. TMJ prosthesis is recommended for disease resulting in an anatomical modification and aims at restoring joint function with pain relief. Despite its initial history of health scandals, prosthetic replacement for end-stage TMJ disease is gradually becoming a common procedure because of good functional results and low morbidity. Significant advances have been made in the design of the temporomandibular joint prostheses during the last decades, specially thanks to the use of 3D printing. The indications should be further clarified and extended.Prothèses d’articulation temporo-mandibulaire. L’articulation temporo-mandibulaire peut être le siège de pathologies telles que l’arthrose, les séquelles de trau¬matisme ou l’ankylose. Les principaux symptômes inva¬lidants sont la limitation de l’ouverture buccale et la douleur. La prothèse d’articulation temporo-mandibulaire s’adresse aux pathologies entraînant une modification anatomique. Son but premier est de restaurer la fonction de l’articulation en soulageant la douleur. Malgré son histoire initialement émaillée de scandales sanitaires, le remplacement prothétique pour les pathologies avancées de l’articulation temporo-mandibulaire est progressive¬ment devenu une intervention courante, grâce à de bons résultats fonctionnels et une morbidité faible. D’impor¬tantes avancées ont été réalisées dans la conception des prothèses durant les dernières décennies, notamment grâce à l’apport de l’impression 3D. Ses indications doivent encore être précisées et étendues.

International audience; An important component of tissue engineering (TE) is the supporting matrix upon which cells and tissues grow, also known as the scaffold. Scaffolds must easily integrate with host tissue and provide an excellent environment for cell growth and differentiation. Human amniotic membrane (hAM) is considered as a surgical waste without ethical issue, so it is a highly abundant, cost-effective, and readily available biomaterial. It has biocompatibility, low immunogenicity, adequate mechanical properties (permeability, stability, elasticity, flexibility, resorbability), and good cell adhesion. It exerts anti-inflammatory, antifibrotic, and antimutagenic properties and pain-relieving effects. It is also a source of growth factors, cytokines, and hAM cells with stem cell properties. This important source for scaffolding material has been widely studied and used in various areas of tissue repair: corneal repair, chronic wound treatment, genital reconstruction, tendon repair, microvascular reconstruction, nerve repair, and intraoral reconstruction. Depending on the targeted application, hAM has been used as a simple scaffold or seeded with various types of cells that are able to grow and differentiate. Thus, this natural biomaterial offers a wide range of applications in TE applications. Here, we review hAM properties as a biocompatible and degradable scaffold. Its use strategies (i.e., alone or combined with cells, cell seeding) and its degradation rate are also presented.

Lymphomas are rare pathologies in the oral cavity, representing only 3.5% of malignant tumors. Their typical topography is Waldeyer's lymphatic ring and approximately 8% of all non-Hodgkin lymphomas are mucosa associated lymphoid tissue (MALT) lymphomas. The authors report a rare case of mandibular gingival MALT lymphoma, which developed around an extraosseous dental root canal overfill. This atypical, case of lymphoma indicates that practitioners have to be vigilant and perform a biopsy every time they are confronted with a suspicious chronic lesion in the oral cavity.

International audience; Defects affecting the anterior wall of the tympanal bone can result from trauma, infection, neoplasm or previous local surgery. An anatomic variation, namely the persistence of the foramen tympanicum, can also be encountered. When symptomatic, surgical reconstruction may be indicated. The aim of this study was to identify the surgical treatments of symptomatic foramen tympanicum found in the literature and detail our innovative reconstruction technique. A bibliographic research was conducted in PubMed database in March 2020, without time limitation. Papers dealing with surgical management of a foramen tympanicum were included. Data collected were the publication date, the number of patients, their age and gender, the symptoms and the surgical treatment performed. We report, in addition, the case of a symptomatic persistent foramen tympanicum in a 30-year-old man with a follow-up of 18-months. A total of 17 studies (n=23 patients) were included for analysis. The main reconstruction techniques were, in equal proportion, cartilage graft (30%) and insertion of a titanium mesh (30%). We carried out an iliac crest bone graft using a preauricular approach on a patient suffering from chronic tinnitus and fullness in the left ear resulting from a persistent foramen tympanicum, confirmed by clinical and radiological examinations. It allowed the complete resolution of symptoms and no complication such as temporomandibular ankylosis occurred. Based on the review of the literature, we believe this technique has the advantage of providing durable reconstruction thanks to osseointegration.

Background/Aims Management of maxillofacial trauma in the geriatric population poses a great challenge due to anatomical variations and medical comorbidities. The aim of this study was to analyze the management variables, timing, and outcomes of facial fractures in elderly patients (aged 70 years or more) at several European departments of oral and maxillofacial surgery. Materials and Methods This study was based on a systematic computer-assisted database that allowed the recording of data from all geriatric patients with facial fractures from the involved maxillofacial surgical units across Europe between 2013 and 2017. Results A total of 1334 patients were included in the study: 665 patients underwent closed or open surgical treatment. A significant association (P lt .005) was found between the presence of concomitant injuries and a prolonged time between hospital admission and treatment. The absence of indications to treatment was associated with comorbidities and an older age (P lt .000005). Conclusions Elderly patients require specific attention and multidisciplinary collaboration in the diagnosis and sequencing of trauma treatment. A prudent attitude may be kept in selected cases, especially when severe comorbidities are associated and function is not impaired., Peer-reviewed manuscript: [http://smile.stomf.bg.ac.rs/handle/123456789/2528]

Whether to conserve or remove miniplates, widely used in oral and maxillofacial surgery, has not been agreed on in the literature. Complications such as pain, infection, and screw exposure or loosening have already been largely described. We present the consequences of a trauma recurrence on a mandible with miniplates. The data of 13 patients who had a mandibular fracture previously surgically treated with miniplates (ten mandibular fractures and three mandibular osteotomies) were analysed. All the patients were male; the average age was 32 years (range, 20–64 years). The mechanism of the second trauma was assault in most of the cases. The average time between the first osteosynthesis and the new fracture was 35 months (range, 6–128 months). The fractures occurred at a distance from the miniplates in all the cases except two. No plate fracture was reported. We hypothesised that miniplates reinforced the underlying bone, protecting it from fractures, and transmitted the forces to areas anterior or posterior to the miniplates or to the condyle. Thus, the risk of mandible trauma recurrence should be taken into account in the indication of plate removal, and the biomechanical consequences of the conservation of the miniplates should be studied.

International audience; Ectopic maxillary third molars (EMTM) are extracted mainly by the Caldwell-Luc technique but also by nasal endoscopy. There is currently no consensus on the treatment of this eruption and its management is heterogeneous and multidisciplinary. Two literature searches were performed with no time restrictions via Pubmed. In the first, we used the keywords "ectopic AND third molar" and in the second the keywords "dentigerous cyst AND ectopic third molar". For both articles, epidemiological, symptomatic, radiological and surgical data were recorded. Overall, 33 eligible articles were identified involving 39 cases of EMTM. 79% of patients were symptomatic. 87% of the teeth were associated with a dental cyst. In only 13% of cases was the location of the tooth in the sinus specified in the three planes of the space. Surgery was performed in 77% of patients by the Caldwell-Luc technique, by nasal endoscopy in 10% and by the Le Fort I approach in 3%. The indications for avulsion of EMTM are symptomatic patients or asymptomatic patients with an associated cyst. The intra-sinusal location of the tooth is not a factor in the choice of technique used, which depends rather on the individual skills of the surgeon. Although for a trained operator the Le Fort I osteotomy is an easy procedure, its interest in the treatment of EMTM is limited owing to the rare but potentially severe complications involved.

Introduction: Central giant-cell granuloma (CGCG) is a rare mandibular tumor. The originality of this case lies in its clinical presentation, with a delay in treatment despite a significant aesthetic impact. Observation: An 8-year-old boy whose chin had been swelling for three (3) months was referred to have a consultation. The medical imaging examination revealed a well-defined osteolytic lesion of about 3 cm and round in shape. The lesion was surgically treated by enucleation. The anatomopathological examination provided evidence of a CGCG. Conclusion: Postoperative period was aesthetically acceptable, there were no nervous or dental lesions and no relapse at the 6-month follow-up.

Introduction 3D printing seems to have more and more applications in maxillofacial surgery (MFS), particularly since the release on the market of general use 3D printers several years ago. The aim of our study was to answer 4 questions: 1. Who uses 3D printing in MFS and is it routine or not? 2. What are the main clinical indications for 3D printing in MFS and what are the kinds of objects that are used? 3. Are these objects printed by an official medical device (MD) manufacturer or made directly within the department or the lab? 4. What are the advantages and drawbacks? Methodology Two bibliographic researches were conducted on January the 1st, 2017 in PubMed, without time limitation, using “maxillofacial surgery” AND “3D printing” for the first and for the second “maxillofacial surgery” AND “computer-aided design” AND “computer-aided manufacturing” as keywords. Articles in English or French dealing with human clinical use of 3D printing were selected. Publication date, nationality of the authors, number of patients treated, clinical indication(s), type of printed object(s), type of printing (lab/hospital-made or professional/industry) and advantages/drawbacks were recorded. Results Two hundred and ninety-seven articles from 35 countries met the criteria. The most represented country was the People's Republic of China (16% of the articles). A total of 2889 patients (10 per article on average) benefited from 3D printed objects. The most frequent clinical indications were dental implant surgery and mandibular reconstruction. The most frequently printed objects were surgical guides and anatomic models. Forty-five percent of the prints were professional. The main advantages were improvement in precision and reduction of surgical time. The main disadvantages were the cost of the objects and the manufacturing period when printed by the industry. Discussion The arrival on the market of low-cost printers has increased the use of 3D printing in MFS. Anatomic models are not considered to be MDs and do not have to follow any regulation. Nowadays, they are easily printed with low-cost printers. They allow for better preoperative planning and training for the procedures and for pre-shaping of plates. Occlusal splints and surgical guides are intended for the smooth transfer of planning to the operating room. They are considered to be MDs and even if they are easy to print, they have to follow the regulations applying to MDs. Patient specific implants (custom-made plates and skeletal reconstruction modules) are much more demanding objects and their manufacturing remains nowadays in the hands of the industry. The main limitation of in-hospital 3D printing is the restrictive regulations applying to MDs. The main limitations of professional 3D printing are the cost and the lead time. 3D printed objects are nowadays easily available in MFS. However, they will never replace a surgeon's skill and should only be considered as useful tools.

Mycoplasma pneumoniae induced rash and mucositis (MIRM) is a distinct entity of erythema multiforma spectrum. Observation: we report a case of a 19-year-old man hospitalised for multiple mucosal eruptions and hyperthermia for three days, in context of a pro-T lymphoblastic leukemia in complete cytological and molecular remission. Discussion: MIRM is a skin split of 0% – 10% body surface area, at least two mucosal sites involved, few skins including vesiculobullous or atypical targets and evidence of atypical pneumonia. Identification of MP is essential for the correct diagnosis of MIRM and even more differentiation of EM associated with herpes simplex virus and drug-associated. Conclusion: MIRM has a good prognosis with rare recurrence and seldom complications.

Conventional three-dimensional (3D) printing techniques have been growing in importance in the field of reconstructive surgery. Three-dimensional bioprinting is the adaptation of 3D printing techniques to tissue engineering, through the use of a bio-ink containing living cells and biomaterials. We hereby describe the principles of bioprinting, its main current limitations, and the prospects of this technique. A PubMed/MEDLINE search was performed. A total of 40 publications were included. To date, most of the tissues have been printed with promising results in vitro (e.g., skin, cartilage, and muscle). The first animal studies are promising for small-scale defects. Vascularization issues are the main limitation to printing large constructs. Once the barrier of vascularization is overcome, printing organs and composite tissues of any size could be possible, opening the doors for personalized medicine based on medical imaging. Printing custom-made autologous grafts or flaps could minimize donor site morbidity and maximize the morphological results. Considering the potential future applications of bioprinting in the field of reconstructive surgery, one has to be aware of this tool, which could drastically change our practice.

Introduction Maxillofacial surgery plays an important role in humanitarian surgery because this specialty includes common procedures such as facial reconstruction after burns, facial clefts or Noma's sequelae, which do not require complex infrastructures and thus can be carried out in sub-optimal conditions. Nevertheless, there is a mortality rate during those missions and few studies evaluating their rate and circumstances have been published. The aim of our study was threefold: to study the deaths reported during humanitarian missions, to analyze the circumstances of those deaths, and to determine the risk factors in order to propose possible adaptations in operative indications and therapeutic attitudes so that those mortalities may be avoided in the future. Material and method We evaluated the early deaths (between day 0 and day 8) observed among 3,494 patients operated on during humanitarian missions conducted between 2007 and 2018 in Africa and Asia by the charity organization "Les Enfants du Noma" (EDN). Information (patient, type of surgery, circumstances of death) was collected from the medical files and by questioning the medical teams who took part in the missions. Results Five deaths were recorded from 2007 to 2018, representing a mortality rate of 0.14%. The deceased were between 1 and 20 years of age and the deaths occurred between the day of the surgical procedure and the third post-operative day. The causes of death were as follows: two cases of respiratory failure due to mucous plugs (one in the endotracheal tube and one in the tracheotomy canule), one cardio-respiratory failure, one bilateral tension pneumothorax and one peritonitis from several duodenal perforations. Discussion In order to minimize the risks of lethal complications, it is important to identify as early as possible certain high-risk situations, to ensure the adequacy of the means available, and to establish an indication for surgery by a concerted discussion among the surgeons and anesthetists involved. One of the general limitations of humanitarian missions is the lack of resuscitation facilities and the lack of availability of further exams. Rites, beliefs, superstitions, gri-gri and ancestral practices often hold a prominent place in these cultures. The absence of well-kept medical records (including personal and family histories), language barriers, large volumes of patients to manage, the inexperience of first-time teams, the lack of knowledge of the terrain and local health conditions, and an inability to empathize with patients, limit the quality of preoperative assessment and sometimes lead to poor decisions.

Resume Introduction L’osteochimionecrose des maxillaires (ONM) est une exposition osseuse ischemique, chronique, d’incidence croissante. Elle est principalement liee aux bisphosphonates en contexte carcinologique, ainsi qu’au denosumab. L’ONM est reputee de resolution longue et incertaine. Les recommandations internationales suggerent de traiter les ONM de maniere symptomatique en premiere intention. L’indication d’un geste chirurgical, potentiellement lourd, est souvent delicate a poser concernant des patients fragiles et a l’esperance de vie souvent limitee. Pourtant, le traitement chirurgical semble permettre un taux eleve de remission clinique. Les delais moyens de remission postoperatoires, lorsqu’ils sont indiques dans les etudes, sont disparates. Le but de cette etude etait de preciser les delais de guerison des ONM apres prise en charge chirurgicale. Methode Une etude retrospective a ete realisee au service de chirurgie maxillo-faciale et stomatologie du CHU de Besancon (France) de janvier 2006 a septembre 2015 chez tous les patients operes pour une ONM de stades 2 et 3. La guerison etait definie comme une cicatrisation muqueuse complete et l’absence de symptomes. Ont principalement ete notes le nombre et le type d’interventions chirurgicales realisees et la duree entre la derniere intervention et la guerison. Ces donnees ont ete comparees a une revue exhaustive de la litterature sur la base de donnee Pubmed avec les mots cles « osteonecrosis » AND « jaw » AND « surgery » AND « management ». Seuls les articles mentionnant les delais de guerison ont ete retenus. Resultats Concernant l’etude retrospective monocentrique, les dossiers de 23 patients correspondaient aux criteres d’inclusion. Quinze pour cent des patients ont beneficie de plusieurs interventions chirurgicales sous anesthesie generale. Vingt pour cent des patients presentaient un stade 3 et 80 % un stade 2. Vingt-cinq interventions ont ete realisees sur 23 sites chez 20 patients. Le taux de guerison immediat apres chirurgie etait de 35 %. A 6 mois postoperatoires, la guerison concernait 57 % des sites traites. Vingt pour cent des patients etaient decedes. Le taux de guerison etait stable au bout de 6 mois postoperatoires. Concernant la revue de la litterature, 7 articles ont repondu aux criteres d’inclusion. La duree moyenne de guerison postoperatoire etait de 60,7 % a 6 mois, de 71,1 % a 12 mois et de 69,5 % a 18 mois. Discussion Notre etude permet d’estimer que le taux de succes du traitement chirurgical des ONM est compris entre 57 et 60,7 % a 6 mois et que ce taux de succes etait optimise de l’ordre de 10 % a 12 mois puis stable a 18 mois post operatoire. Les ONM de notre serie etaient liees partiellement ou totalement a d’autres molecules que les bisphosphonates dans 70 % des cas : 50 % concernaient le denosumab seul ou associe et 35 % incriminaient une association avec les molecules anti-angiogeniques, bevacizumab essentiellement.

Resume Introduction L’arthrocentese de l’articulation temporomandibulaire associee a un lavage intra-articulaire et, plus recemment, a l’injection intra-articulaire d’un agent pharmacologique a ete developpee a partir des annees 1990 et est largement utilisee de nos jours pour le traitement des dysfonctions temporomandibulaires (DTM). Le but de notre travail etait de repondre a 3 questions : 1. Les lavages intra-articulaires sont-ils efficaces dans le traitement des DTM ? 2. Quels sont les agents pharmacologiques injectables actuellement utilises en complement de ces lavages et ces injections sont-elles utiles ? 3. Quelle est la place de ces traitements dans la prise en charge des DTM ? Materiel et methodes Une recherche bibliographique a ete realisee dans la banque de donnees PubMed avec les mots cles « arthrocentesis » et « temporomandibular joint ». Les 27 articles parus entre 1991 et 2016, indiquant les criteres d’inclusion des patients et evaluant de maniere objective les resultats cliniques obtenus (ouverture buccale, bruits articulaires, douleur), ont ete selectionnes. Les agents pharmacologiques, quand ils etaient utilises, etaient notes. Resultats 1. Tous les auteurs concluaient a l’efficacite du lavage intra-articulaire. Aucun facteur pronostique de l’efficacite de l’arthrocentese n’a ete demontre. 2. Les principaux agents pharmacologiques utilises etaient les corticoides, l’acide hyaluronique, les morphiniques et le plasma riche en plaquettes. La superiorite du protocole avec injection ne faisait pas l’unanimite aupres de tous les auteurs. Tous les auteurs ayant compare les protocoles avec et sans injection complementaire concluaient a une superiorite des protocoles avec injection et ce, quel que soit l’agent utilise. 3. L’indication majoritaire de ces traitements etait les DTM resistants aux traitements non invasifs. Discussion De nombreuses etudes ont prouve l’efficacite du lavage intra-articulaire dans le traitement des DTM resistants aux traitements non invasifs. L’interet de l’adjonction d’un agent pharmacologique n’est pas clairement demontre. Les mecanismes d’action ne sont pas tous elucides. Aucune superiorite d’un agent pharmacologique par rapport a un autre ne peut etre affirmee. La methodologie des etudes est tres souvent defectueuse : criteres d’inclusion peu precis, duree de suivi courte, facteurs de confusion non pris en compte, peu de comparaison entre plusieurs agents pharmacologiques.

INTRODUCTION: The progressive aging of European population seems to determine a change in the epidemiology, incidence and etiology of maxillofacial fractures with an increase in the frequency of old patients sustaining craniofacial trauma. The objective of the present study was to assess the demographic variables, causes, and patterns of facial fractures in elderly population (with 70 years or more).MATERIALS AND METHODS: The data from all geriatric patients (70 years or more) with facial fractures between January 1, 2013, and December 31, 2017, were collected. The following data were recorded for each patient: gender, age, voluptuary habits, comorbidities, etiology, site of facial fractures, synchronous body injuries, Facial Injury Severity Score (FISS).RESULTS: A total of 1334 patients (599 male and 735 female patients) were included in the study. Mean age was 79.3 years, and 66% of patients reported one or more comorbidities. The most frequent cause of injury was fall and zygomatic fractures were the most frequently observed injuries. Falls were associated with a low FISS value (PCONCLUSIONS: This study confirms the role of falls in the epidemiology of facial trauma in the elderly, but also highlights the frequency of involvement of females, and the high frequency of zygomatic fractures.

Purpose Bilateral sagittal split osteotomy (BSSO) is frequently used to treat Class II malocclusion for functional and esthetic purposes, with expected changes in the profile. The goal of this study was to assess transversal changes in mandibular advancement by comparing 3-dimensional (3D) photogrammetric modifications and 2-dimensional (2D) radiographic enlargement. Materials and Methods A cohort study was conducted of patients who underwent an isolated advancement BSSO (Obwegeser-Dal Pont II type) for a Class II malocclusion. All patients had 3D photogrammetric and 2D radiographic evaluations before and after surgery. Frontal cephalograms were used to measure the evolution of bigonial distance (BGD) and 3D photographs were used to measure the evolution of cutaneous BGD (CBGD). Results Fourteen patients were included. Mean mandibular advancement was 6 mm. BGD (+6.1 mm; P Conclusion This 2D and 3D analysis of transversal modifications shows that advancement with the BSSO is responsible for marked lower third facial enlargement. This parameter must be taken into account during the preoperative esthetic assessment to ensure the provision of pertinent information to the patient and the consideration of complementary surgical correction.

Introduction Maxillary transverse deficiency (MTD) is a common facial disharmony that may need surgical assisted rapid palatal expansion (SARPE). The aim of this study was to present our SARPE technique and to report about our experience. Materiel and Method Medical records of all class III patients who underwent SARPE in our department from 2010 to 2015 and for whom a follow-up of at least 1 year was available, were included in a retrospective study. The technique consisted, after short orthodontic preparation allowing for divergence of the upper central incisors, in a complete Le Fort I osteotomy without down fracture, and medial sagittal submucosal separation of the hard palate under general anesthesia in an inpatient procedure. Teeth-supported distracters were sealed preoperatively while bone-supported devices were inserted peroperatively. Activation of the distracter was allowed from day 2 at the rate of 2 × 0.25 per day during 4 days and 2 × 0.5 mm per day the following days. Distracters were left in place for about 4 months. Orthodontic treatment resumption was allowed from the second month. The initial malocclusion, the amount and type (parallel or angular) of distraction that was needed, the type of distracter used, the amount of distraction obtained, the per- and postoperative complications and the clinical stability of the end result were analyzed. Results The records of 23 patients (18 women, 5 men – average age: 25.4 years, extremes: 16–55 years) could be included. MTD was isolated in 6 cases, associated with a maxillary retrognathism in 5 cases, with a mandibular prognathism in 6 cases, and with both in 6 cases. The average amount of distraction needed was 7.2 mm (range: 4–12), parallel in 20 cases and angular in 3 cases. The distracters were bone-supported (Rapid Palatal Expander®, KLS Martin Group, Tuttlingen, Germany) in 3 patients and custom-made tooth-supported in 20 patients. The average amount of distraction obtained at the level of the distracter cylinder was 7.7 mm (range: 5–13). We noted 2 cases of palatal fibromucosa perforations, 1 case of posterior excess of distraction, 1 case of nasal septum deviation, 1 case of iatrogenic necrosis of tooth No.°11, 1 case of naso-genial sulcus hematoma, 1 case of intraoperative mobility of tooth No.°21, 5 cases of asymmetric distraction. Seventeen patients needed a second orthognathic procedure and 22 had stable Class I occlusion after removal of appliances at 18 months follow-up on average. Discussion SARPE is a quite safe procedure that allows for transverse coordination without dental extraction. Transverse discrepancies greater than 4 mm are for us clear indications for SARPE. When a sagittal discrepancy is associated, we prefer performing SARPE first and correcting the sagittal plane in a second operation. The recent development of Le Fort I sliding osteosynthesis plates opens the way to one time correction and the development of double-action distracters fitted out with 2 cylinders will be helpful for performing angular distractions.

Introduction Unilateral coronal synostosis (UCS) is a complex craniosynostosis, combining malformations of the upper (frontal bone, orbito-naso-frontal bandeau (ONFB) ) and the middle thirds of the face. In our centre, the surgical correction consists in the repositioning of the ONFB in front of the zygomaticofrontal suture on the affected side. Defects in the corrections have been observed post-operatively for some patients with a persistent asymmetry in the side walls of the orbits. The purposes of our study were to perform an analysis of the frontal process of zygoma (FPZ) in children affected by UCS using preoperative CT-scans and to consider the modification of surgical techniques in order to achieve a better ONFB repositioning and thus, better symmetry. Material and method The preoperative CT-scans of 13 children with UCS who underwent corrective surgery in our department from 2005 to 2016, were analyzed. After the selection of 6 morphological points in 2 and 3 dimensions using planning software, the sutures constituting the coronal arch and the sagittal distances between the coronal plane and the zygomaticofrontal sutures were analyzed. We compared the measurements on the pathological side to the healthy side, the non-affected side being the reference side. The patients included were those for whom the lack of symmetry between the healthy side and the affected side was more than 2 mm. Statistical analyses were carried out using a Student t-test. Results Of the 13 children, 10 (1 day to 42 months old) met the inclusion criteria. The mean sagittal distance between the coronal plane and the healthy zygomaticofrontal suture was 33.8 mm ± 5.43 mm [range: 25.9: 40.9] [median: 34.3]. On the pathological side, the distance was 28.75 mm ± 4.76 mm [range: 20.8: 36.3] [median: 29.55], (p = 0.04). Discussion There is a significant asymmetry between the FPZ on the healthy and the pathological sides in children affected by UCS. This asymmetry is variable, therefore justifying a personalized surgical correction whichtakes into account not only the shape of the ONFB but also the degree of asymmetry of the FPZ. A prospective study with immediate preoperative CBCT image acquisition and long-term clinical and radiological follow-up, will be our next step.