Inferior alveolar nerve repositioning surgical techniques and outcomes - a systematic review.

Inferior alveolar nerve (IAN) lateralization (IANL) or transposition (IANT) are both techniques allowing for dental implant placement in posterior atrophic mandibles. The aim of this study was to systematically review the implant survival rate and the complications associated with IAN reposition techniques with simultaneous implant placement in atrophic posterior mandibles. This systematic review was conducted following PRISMA guidelines (Preferred Reporting Items for Systematic review and Meta-Analysis). The review was designed to answer the following PICO question: Is IAN repositioning (I) a safe and efficient technique (O) to treat patient looking for fixed dental rehabilitation of an atrophic posterior mandible (P). Thirty-three articles were reviewed, including a total of 899 patients, and approximately 950 IAN repositioning procedures. Dental implant survival rate ranged between 86.95% and 100% with a mean dental survival rate of 90.16%. Among the 269 patients who underwent IANT, there were 93% immediate neurosensory disturbance, and 15% persistent neurosensory disturbance. Among the 350 patients who underwent IANL, there were 93% immediate neurosensory disturbance, and 6% persistent neurosensory disturbance. IANT and IANL are reliable techniques allowing safe dental implant placement in atrophic posterior mandible with high patient satisfaction. IANL seems to cause less persistent neurosensory disturbances compared to IANT. The level of evidence is poor due to the high number of bias present in the included studies. IAN neurosensory disturbance assessment should be better homogenized in order to increase comparability.

Lipofilling of the lower eyelids: A craniofacial tool to postpone the facial advancement in craniofacial syndromes.

PURPOSE: Many genetic diseases are responsible for a defect in the growth of the maxilla. Craniofacial syndromes such as Crouzon syndrome or Apert syndrome are typically associated with a major hypoplasia in the midface responsible for exophthalmos, leading to palpebral malocclusion and frequent corneal complications. Several treatments have been used to manage ocular protection in craniofacial syndromes such as tarsorrhaphy, a fronto-orbital advancement and/or a Lefort III osteotomy with or without distraction. We describe a new approach as a waiting solution to relieve exophthalmos: the autologous fat grafting of the lower eyelids. MATERIAL AND METHODS: Children operated from lipofilling of the lower eyelids at the Referral Center for craniosynostosis of Femme-Mère-Enfant Hospital in Lyon, were included. All the patients suffered from midface hypoplasia and exophthalmos with insufficient eyelid closure responsible of multiples episodes of keratitis and corneal ulcerations. RESULTS: Four children were included: three suffered from Crouzon Syndrome and one suffered from Apert Syndrome. The fat was reinjected at the level of the infraorbital rim, the nasolabial fold or the palpebrojugal fold, in the different planes, according to the patients' needs. Six months after surgery, a second surgery was performed for the patients whose lagophtalmos persisted. Six months after the second procedure, the results are satisfactory with a good eyelid closure. CONCLUSION: The lipofilling, well used in pediatric surgery to restore facial symmetry, can also be used, as a waiting solution or complement to treat complicated exophtalmos with visual prognosis involved in congenital craniofacial syndromes.