Orthognathic surgery improves quality of life and depression, but not anxiety, and patients with higher preoperative depression scores improve less.

This study assessed quality of life (QoL), depression, and anxiety before and after orthognathic surgery and identified risk factors for poorer postoperative outcome. This multicentre prospective study included 140 patients from five French medical centres. We assessed patients before surgery (T1), 3 months after surgery (T2), and 12 months after surgery (T3). We assessed the severity of the orofacial deformity, physical, psychological, social, and environmental QoL (WHOQOL-BREF), and depression and anxiety (GHQ-28). Risk factors for poorer outcome were identified using linear mixed models. Between baseline and 12 months, there was significant improvement in psychological and social QoL and in depression (although below the norms reported in the general population), but not in anxiety. Physical QoL was poorer in patients who were younger, who had a mild orofacial deformity, and who were depressed. Psychological QoL was poorer in younger patients and in depressed patients. Social QoL was poorer in patients who were single, who had a mild orofacial deformity, and who were depressed. Although orthognathic surgery provides a moderate improvement in psychological and social QoL, the systematic screening and treatment of depression could further improve QoL after surgery because it is a major predictor of poor QoL in this population.

[Psychological effects of orthognatic surgery and postoperative dissatisfaction: presentation of a research protocol]. / Effets psychologiques de la chirurgie orthognatique et insatisfaction postopératoire : présentation d'un protocole de recherche.

INTRODUCTION: The causes of postoperative dissatisfaction in orthognathic surgery are difficult to grasp. The aims of our study are to analyze the effects of orthognathic surgery on self-esteem, body image, psychological morbidity, and quality of life. We also want to assess the combined effects of these factors on postoperative dissatisfaction, and to study the interest of personality assessment (especially neuroticism) as a predictive factor of dissatisfaction. METHOD: Three hundred patients candidates for maxillo-mandibular osteotomy will be included in the study. They will answer a questionnaire assessing self-esteem, body image, psychological morbidity, quality of life, and personality. The evaluation will be conducted preoperatively and postoperatively at 3 months and at 1 year. The degree of satisfaction will be measured postoperatively. EXPECTED RESULTS: The results should help evaluate the psychological effects of orthognathic surgery and identify predictors of postoperative dissatisfaction, and especially the role of neuroticism.

[Hyperactivity of the muscles of the lip and chin and indications for surgery to reduce it]. / Dysfonctionnement des muscles labio-mentonniers et indications de la chirurgie d'affaiblissement.

Hyperactivity of the muscles controlling the lower lip and chin (muscles of the chin, buccinator, orbicularis, etc.) can be demonstrated at different levels of the muscular complex and may act as an elastic force against the mandibular alveolar process. Dysfunction in this region may lead to reduction of the alveolar bone quantity, reducing the tooth-bone equilibrium. If this balance is disturbed, periodontal lesions, a lower incisal crowding and a retrognathic mandibular process may result. Surgery to correct overactivity of the chin muscles is described here step by step. Resection of the muscles may be undertaken on a greater or lesser scale and striation of the muscle may also allow reduction of muscular strength. Reducing the muscular activity creates a better environment for the development of the mandible and its alveolar process. Depending on the clinical situation, these techniques can be associated with genioplasty, bone graft and/or mandibular orthognathic surgery.

[Proposal for a classification of Class II Division 1: contribution of Delaire's analysis]. / Proposition d'une classification des classes II division 1: contribution de l'analyse de Delaire.

Class II division 1 dental malocclusions are present in various forms depending on the site, direction and degree of discrepancy between the arches. The ability to recognize the origin of the malocclusion is essential to decide how, and when it is necessary to treat. In this study, the Delaire's analysis was performed for 111 individuals with a Class II division I malocclusion; a classification of these cases is proposed, according to the presence or the absence of a skeletal discrepancy. In 87% of the cases, a Class II division 1 dental malocclusion was associated with a Class II skeletal discrepancy (50% maxillary prognathism, 23.5% normal maxillary relationship and 13.5% maxillary retrognathism). The lines of the cranial base, the shape and size of the mandible varied considerably. In only 6% of cases, the dental malocclusion was associated with a skeletal Class I relationship, and in 7% of cases with a Class III relationship: it was often related to retruded mandibular teeth. It was shown that Class II division 1 dental malocclusions may result from differing causes: therefore, the identification of their etiology seems essential to provide the best possible treatment, at the right period in time.

[Labioglossopexy in Pierre Robin syndrome. Our experiences apropos of 70 cases]. / La labio-glossopexie dans le syndrome de Pierre Robin. Notre expérience à propos de 70 cas.

Pierre Robin syndrome is typically characterized by glossoptosis and retrognathia associated with cleft palate, respiratory and deglutition disturbances. Two morphological tendencies arise out of this 70-patient series, 50 of whom were managed with the same therapeutical regimen, which included labioglossopexy and was associated with only one case of death: "deforming" type Pierre Robin syndrome most commonly follows a favorable course with respect to both function and facial deformations, provided labioglossopexy is carried out sufficiently early. Indeed, this surgical operation allows for prompt restoration of normal function, thereby limiting the dysfunction-deformation vicious circle. This form of Pierre Robin syndrome may find its origin in the embryo's abnormal amniotic environment. "Malformation"-associated Pierre Robin syndrome often presents with combined anomalies, respiratory disturbances that may evolve into severe airway problems, impaired deglutition and abnormal brain development; in most cases, labioglossopexy will dramatically improve the immediate state of the child, although long-term prognosis as regards malformation is rather guarded.

[Orthognathic surgery of the edentulous: a particular form of preprosthetic surgery]. / La chirurgie orthognathique de l'édenté: une certaine forme de chirurgie préprothétique.

It is not unusual to find patients who have lost posterior teeth or who are totally toothless, approaching our dental surgeon colleagues in cases of difficulties, and even prosthetic impossibility, nearly always associated or in relation with skeletic maxilo-mandibular imbalance. Orthognatic surgery of the toothless should thus satisfy the essential need for prosthesis but should also re-establish the unbalanced facial architecture which can be the only guarantee of a stable result. This therefore requires true pre-prosthetic surgery in which clinical analysis, cranial-facial architectural analysis and great care in making the provisional and final prosthesis, constitute the essential stages of diagnosis and therapy.

[The 3 palatine fibromucous membranes. Their role in maxillary growth. Therapeutic role in surgery of the palatine shelves]. / Les trois fibro-muqueuses palatines. Leur rôle dans la croissance du maxillaire. Déductions thérapeutiques dans la chirurgie des divisions palatines.

The palatine fibromucosa is not the same throughout the various regions of the palatine vault and its role differs in maxillary growth. On can in fact distinguish: --the fibromucosa of the "palatine lamellae", thin and smooth, which occupies only the median and posterior portion of the vault, opposite the nasal fossae. Its importance derives from the fact that it covers the medio-palatine and palatino-vomerian suture complex, which has an essential role in transverse, vertical and also sagital maxillary growth; --the palatine maxillary fibromucosa, thick and striated, which surrounds the above as far as the gingiva. It plays a major role in transverse and vertical maxillary growth. In fact, it would appear that it possesses autonomous growth potential; --the "gingival" fibromucosa, smooth, which is located at the alveolar level (from the palatine maxillary to the gingivo-dental border) and is involved in the structure of the latter. A good understanding of the anatomical and physiological aspects of these three fibromucosae has a therapeutic relevance, in particular, in subjects suffering from congenital velo-palatine defects (isolated or associated with a labio-maxillary defect).

[The use of free forearm flaps in oropharyngeal neoplastic surgery. Our experience with 52 cases]. / Utilisation du lambeau libre antébrachial dans la chirurgie carcinologique oro-pharyngée. Notre expérience à propos de 52 cas.

The authors report their experience in the management of a series of 52 patients treated in Nantes for repair of loss of substance in the bucco-pharyngeal cavity, using a free antebrachial flap. Its fundamental value is to provide a very fine, supple cutaneous sheet of large surface area, which is particularly adapted to bucco-pharyngeal cancer surgery by limiting as much as possible the anatomical and functional sequelae and thereby allowing much larger resections to be carried out. After a review of the anatomy, a study of the indications, precautions and results obtained in this series is presented.

[Fracture injuries of the mandibular arch. A repair technic]. / Les ouvertures traumatiques de l'arche mandibulaire. Une technique de réparation.

The authors describe a technique for reduction of external lateral displacement of the posterior portions of the mandibular arch following unifocal or multifocal fractures. To achieve reduction they use a basilar wire transfixing the floor of the mouth and stretched between two horizontal branches, most often combined with a symphyseal osteosynthesis. This study of ten cases demonstrates the good functional and cosmetic results obtained with this method.

[Lateral cysts and fistulae of the neck. Apropos 70 cases]. / Kystes et fistules latéraux du cou. A propos de 70 cas.

Anomalies of branchial origin, amygdaloid cysts and fistulae of 1st, 2nd and 3rd slits are not rare cervical affections. Their histology is characteristic: cylindrical epithelium for fistulae and malpighian epithelium with lymphoid masses for cysts. Excision must be completed by an approach route that is sufficiently wide to avoid recurrence and vascular-neural lesions of the neck.

[Hematic cyst of the masseter. Apropos of 2 cases]. / Le kyste hématique du masséter. A propos de 2 observations.

An isolated swelling of the masseter raises an aetiopathogenic problem which may be encountered by any stomatologist. There are a number of diagnostic possibilities, in particular tumours. The authors report two cases with a special clinical picture: hematic cyst of the masseter. Treatment is surgical: excision via an endobuccal approach. Histological examination of the operative specimen reveals vascular dystrophy.

[The tongue in facial hemihypertrophy]. / La langue dans les hémihypertrophies faciales.

As reported by Gorlin, Pindborg and Cohen, hemifacial hypertrophy is not an affection sui generis, but one that presents different aspects and is of varied etiology. The presence of a tumor must be excluded initially. The hemifacial lesion may be congenital, and form part of a diffuse affection involving the whole of one side of body including hard and soft tissues such as the tongue. Because of their role in cephalic organogenesis, an alteration in cells of neural crests appears to be at the origin of this form but the authors consider that the initial lesion develops at a much earlier stage. The lesion may be tissue-orientated: nervous as in the case of Recklinghausen's neurofibromatosis; vascular as in diffuse angiodysplasias such as the Klippel-Trenaunay-Weber syndrome. Here again the tongue participates in the expression of the disease. Finally, hemifacial hypertrophy may be secondary to a bone lesion as found in more or less diffuse fibrous osteopathies or possibly hypercondylar disorders, the absence of a tongue lesion being a diagnostic factor.