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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.

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

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

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

In four cases, the authors analyse the medical and legal factors which lead the expert to his conclusions in french law, concerning temporo-mandibular joint dysfunction after whiplash injury indemnification. An uncertain direct link between the injury and the damage together with the patient's dental prior state to the accident, lead to retain an incomplete legal imputability. The compensation awarded to the victim will consist of an overvalued extra-patrimonial damage which will eventually be able to balance a low physiological deficit price.

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

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

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

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

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

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

The TMJ arthroscopy is an investigation method reserved for those who does not respond to non invasive treatments. The technical aspects of the puncture and the normal arthroscopic anatomy are studied.

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.

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.

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.

A 49-year old man developed myositis of the left masticatory muscles followed by myositis of the right supinator longus; these two lesions were histologically confirmed. Blood and bone marrow eosinophilia was present. Cure was obtained with systemic corticosteroids. Only one similar case was found in the literature. These cases differ from the various localized or focal forms of myositis as well as from eosinophilic polymyositis. Despite some similarities with masseteric myopathies in animals, no hypothesis can be formulated concerning the cause of the disease.

Results of 104 arthrotomography scans with contrast of temporomandibular joints of 71 patients are used to define normal arthrography criteria (15.4% of cases). Reducible anterior displacements represented 28.8% of cases, non-reducible displacements 40.4%, perforations 12.5% (5.8% associated with a reducible luxation, 6.7% with a non-reducible luxation). The failure rate was 2.9%. Arthrography provides important information on articular morphology and dynamics, the state and position of the meniscus and of the posterior brake, and the state of the joint capsule. Performed by an experienced operator it possesses few complications.

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.

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.

Specific features of Delaire's operation when compared with Rosenthal's inferior pedicle pharyngoplasty are described, and phonetic results obtained in a recent series of 10 patients operated upon using the former procedure reported. The excellence of these results is emphasized.

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.

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.

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.

This analysis of replies to a questionnaire raises three questions: Is surgery indicated in the treatment of this syndrome? What are the factors on which the indication for surgery should be based? If surgery is indicated what type of operation should be performed? Complications of surgery are discussed.

In spite of the considerable technical progress made over the last few years, no type of irradiation used at the present time for treating malignant tumors in the maxillofacial region can protect the patient from the always dreaded appearance of a secondary osteoradionecrosis of the maxillomandibular bones. Extablished osteoradionecrosis is not a "true" necrosis of these bones but a particularly severe osteitis which evolves in bone, which is pathological because it has been irradiated, and is surrounded by tissues which are also pathological for the same reason. Very high doses of antibiotics, comparable to those used in the treatment of osteomyelitis, mandibular resection by the endobuccal route, and the possibility of treating perimaxillomandibular tissues by reconstructive surgery, have completely transformed the prognosis of this dreaded affection, which is being increasingly prevented by daily fluoride applications applied locally.

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.

Primitive malignant lymphomas involving salivary glands are rarely observed. Among the cases, the parotid gland is more often affected than the submandibular. A case of sublingual gland lymphosarcoma is reported here with clinical-pathological "staging" established according to Ann arbor classification extended to non Hodgkin's lymphomas (stage I). Histological data suggest a case of "Diffuse Histiocytic "lymphoma" (D. H. L.) in Rappaport's Classification. Treatment regimen was chosen in conformity with current concepts; that is simple excision of the sublingual gland, followed; that is simple excision of the sublingual gland, followed by radiation therapy and chemotherapy (C.V.P.). After one year, the patient is still free of relapse. However, at the present time no definite prognosis can be ventured.

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.

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.

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.

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.