Hypoglossal-facial anastomosis, tricks and trade

Total removal of difficult tumours at the skull base left behind a traumatized facial nerve previously aggressed by the tumour. Reanimation of the nerve was mandatory in order to recover functional and cosmetic results. Despite an additional XII[th] cranial nerve morbidity, hypoglossal-facial nerve anastomosis was still a gold standard to reach this goal. The authors present their experience in managing 11 cases of facial nerve reanimation after skull base tumour resection by using the descending branch of the hypoglossal nerve as axon donator for direct facial anastomosis. Outcome of facial reanimation according to House-Brackmann classification was good [grade I, II and III] in 5 cases, mild [grade IV] in 3 cases and bad [grade IV and V] in 3 cases. Hemi tongue atrophy occurred in none of our patients. Hypoglossal-facial nerve anastomosis using the descending branch of the XII[th] cranial nerve is an effective procedure to reanimate the facial nerve without additional morbidity. Early reanimation of the facial nerve is the key to offer resumption of normal life for these patients who had already undergone a major neurosurgical procedure

Surgical correction of chin deformities: indications and technique

The prominent position of the chin between the head and neck makes of it an essential component of the equilibrium and aesthetic of the face. It has a rather conscious impact on the subject personality and affects his relation with his peers. The horizontal osteotomy in genioplasty is a simple, reliable and rapid technique allowing an accurate three-dimensional repositioning of the chin including advancement, posterior, and transverse displacement, and chin height reduction. Indications of this procedure are variable. It is performed as an isolated cosmetic genioplasty, or as a part of a profiloplasty surgery or surgery for correction of a maxillomandibular dysmorphosis. The authors describe their technique and discuss its benefits and disadvantages with emphasis on patient selection and knowledge of technical details

analyse esthetique faciale in chirurgie orthognathique

This article describes the analysis of facial esthetics in orthognathic surgery. The conditions of the clinical evaluation are reminded, and faces are classified with priority to the vertical dimension, in well-balanced, short and long faces. Each type of face is studied in both frontal and lateral views. The importance of the clinical evaluation as an essential diagnostic tool is overemphasized

Traitement chirurgico-orthodontique d'une face longue avec beance: a propos d'un cas

This article describes the surgical and orthodontic treatment of a long face syndrome with an open bite. Leveling the arches, torquing buccally the upper incisors and correcting the transverse dimension were achieved through sixteen months of pre-surgical orthodontics. Surgery consisted of a Le Fort I maxillary impaction in the posterior part, and a genioplasty. Post-surgical orthodontics for six months detailed and finished the occlusion. This combined surgical and orthodontic approach resulted in an optimal facial esthetics, a functional occlusion and a stable result