[Osteoradionecrosis and dental implants]. / Ostéoradionécrose sur implants dentaires.

INTRODUCTION: Osteoradionecrosis (ORN) is a severe complication of radiation therapy (RT). A triggering factor is frequently present. It is often a dental, periodental, or surgical traumatism. We report the case of a bilateral ORN: the first lesion appeared 3months after the end of RT around the osteosynthesis plate and was treated by mandibular resection. The second lesion appeared 40months after RT on the opposite side, due to peri-implantitis. Dental implants had been inserted 10years before cancer therapy. No case of ORN in post-implantation RT had been previously reported. CASE REPORT: A 75-year-old woman was admitted for a squamous cell carcinoma of the right cheek extending to the intermaxillary commissure, the maxillary tuberosity, the soft palate, the lingual junction, and the vestibule up to the second premolar area. There was no suspicious lymph node. She had undergone dental implant procedure 15 and 10 years before, respectively, one in the second premolar position of the right maxilla and four in the premolar and molar left mandible area. All of them were osseo-integrated and charged. A trans-mandibular buccopharyngectomy with modified radical neck dissection was performed, completed by RT. The total dose of irradiation was 65Gy in the oral cavity and 45Gy on cervical and supraclavicular areas. Delayed mucosal healing was observed on the right mandible and ORN appeared in this area 3months after the end of irradiation. Mandibular resection was necessary. Later, the right maxillary implant was lost, and multiple dental extractions were required. Forty months after RT, peri-implantitis was observed on the left side of the mandible, complicated by ORN and pathological fracture. No surgical reconstruction could be performed because of the patient's age and state. The patient was carrying a complete removable maxillary prosthesis on latest follow-up. DISCUSSION: This was the first case of ORN on dental implants placed before RT. RT is a risk factor of implant failure, a relatively rare and unpredictable event. Most often, it causes implant loss and exceptionally ORN. In our case, ORN was bilateral. The first lesion was probably due to surgical trauma. The second one, on the opposite side, was caused by peri-implantitis. Irradiation overdose on the alveolar mandibular ridge, close to the implant, may have been the cause. In our case, there was no severe pain, and slow evolution led to a pathological fracture.

Influence of gender and menstrual cycle on volatile sulphur compounds production.

The menstrual cycle has been pointed out as a factor influencing halitosis. However, this relationship has not yet been clarified. The aim of this study was to evaluate the influence of gender and the menstrual cycle on the production of volatile sulphur compounds (VSC) in women (n=14) across the menstrual cycle, and in men (n=17). Volunteers in good oral and general health were submitted to the evaluation of VSC, salivary flow, cortisol and anaerobic bacteria counts in saliva. Data were compared among groups by Analysis of Variance (alpha=5%). VSC was higher in the menstrual and premenstrual phases when compared with men and the follicular phase (p<0.05). Salivary flow was lower in the menstrual and premenstrual phases when compared with men and the follicular phase (p<0.05). Salivary cortisol was higher in the menstrual phase in comparison with men and the premenstrual and follicular phases (p<0.05). Total salivary protein was higher in men when compared to women (p<0.05) with no differences among menstrual phases (p>0.05). Levels of anaerobic micro-organisms, however, were not different among groups (p>0.05). In conclusion, the production of VSC is influenced by menstrual cycle and protein concentration and salivary flow might be involved in this process.

Aetiology and incidence of facial fractures sustained during sports: a prospective study of 140 patients.

A prospective study was carried out involving patients presenting with facial fractures sustained during sports. One hundred and forty patients were admitted to the Pitié-Salpêtrière University Hospital of Paris between March 1998 and March 2000, accounting for 13.3% of all patients with facial bone fractures. The ratio of males to females was 7.2:1 and the mean age was 28.5 years. The majority of accidents occurred during soccer (25.0%), followed by rugby (15.0%), and as a consequence of collisions between players (50.7%). The majority of the injuries involved the mandible (34.4%), the zygomatic bone (23.4%) and the nasal bone (15.6%). The sporting activities were classified as either contact or non-contact sports. Frontal sinus, central midface and LeFort fractures were seen more often in vehicular sports such as mountainbiking and skiing. The authors stress the importance of preventive measures, including the use of protective equipment, periodic sports medical check-ups and personal discipline.

[Halitosis in 1999]. / L'halitose en 1999.

Bad breath is a major concern to the general population and a source of an important profit industry world wide. Between 50 and 60 per cent of the population suffer from chronic halitosis. This can have consequences for private or professional life. Reasons can imply many specialities: ENT, gastro-enterology, pneumology, hepatology, genetics and psychiatry (a high percentage of the patients who come to the clinic with a primary complaint of halitosis do not have a detectable problem). Nevertheless, 85% are stomatological and are explained by the release of volatile sulfur compounds. These substances have a very offensive odor in very low concentrations. A specialized device called a halimeter is available to measure the volatile sulphur compounds in mouth air but in practice the objective assessment of malodor is still best performed by the organoleptic method. A careful examination can determine the patient's problem in most cases. Initial treatment strategy should focus on the exact cause and on oral hygiene. In addition to the usual recommendations, the daily use of tongue cleaners is very beneficial. Other than etiologic therapy, masking can be achieved by oral care products (mouth rinses, toothpastes, chewing gums) which contain metal ions, especially zinc, that inhibit odor formation because of its affinity to sulphur compounds.

[Eckelt's technic: an evaluation of the access route used at Salpêtrière Hospital]. / Technique d'Eckelt: évaluation de la voie d'abord utilisée à la Salpêtrière.

AIM: We report a prospective study undertaken to investigate the morbidity connected with the approach of lag screw osteosynthesis for the treatment of subcondylar fractures in the department of Maxillo-Facial Surgery at the Salpêtrière University Hospital. METHOD: 24 patients have been operated between November 1997 and December 1998. We estimated the accessibility, the size and quality of scars the satisfaction index, and the complication rate. RESULTS: The average size of scars was 3 cm (2.5-4). Their quality was satisfactory, except for an hypertrophic and an invaginated one. The satisfaction index was always excellent and often superior to the surgeon one. COMPLICATIONS: three paresis in the mental territory of the facial nerve regressive in three months, a salivary fistula regressive in three weeks, an hematoma and a subcutaneous infection. These different criteria improved during the study. CONCLUSION: The approach is not free of risks but these ones seem to decrease with surgeon's experience.

[Diffuse cervical cellulitis apropos of 15 cases]. / Cellulites cervicales diffuses à propos de 15 cas.

A homogeneous series of 15 cases of diffuse cervical cellulitis originating in the oropharyngeal area were collected from December 1990 to April 1995. Despite early management, diffusion of the infectious processus was rapid with extension and development of severe mediastinal or pulmonary complications. When diffuse cervical cellulitis is suspected, early and adapted aggressive treatment must be initiated immediately: suppression of the causal factor, surgical exploration with repeated drainage depending on the clinical course assessed on CT scans, antibiotics effective against the aero-anaerobic flora. This aggressive attitude is required to avoid potentially severe morbidity. Anti-inflammatory drugs, taken alone or with unadapted antibiotics was implicated in 11 cases as a favoring factor.