[Dental avulsions and blood coagulation disorders]. / Avulsions dentaires et coagulophaties.

INTRODUCTION: We performed a retrospective study of tooth removal for patients with coagulation disorders. MATERIAL AND METHOD: The study included 67 patients divided into 3 groups according to their coagulation disorder. The first group included 31 patients with a congenital disorder, the second 19 patients receiving anticoagulant therapy, and the third 16 patients with an acquired disorder. The same surgical procedure was used for all patients: alveoli regulation, socket preparation with resorbable oxycellulose dressing, and sutures with separate stitches. Biological glue and celluloid splints were not used. Depending on the severity of the coagulation disorder, factor VIII or concentrated von Willebrand factor or Desmopressine was administered for patients in the first group. If possible, low-molecular-weight heparin replaced oral anticoagulation for patients in the second group. Platelet concentrates were administered for 2 of the patients in the third group. RESULTS: Postoperative bleeding was noted in 4 patients in the first group, 2 in the second and 2 in the third. DISCUSSION: We have abandoned the use of biological glue and celluloid splints. The rate of bleeding in the first and second group was similar to that reported in the literature. We were unable to find any comparable report for the third group.

[Radiographic anomalies and obstructive sleep apnea syndrome]. / Anomalies téléradiographiques et syndrome d'apnées obstructives du sommeil.

BACKGROUND: The purpose of this study was to identify the particular cranio-facial pattern observed in patients with obstructive sleep apnea syndrome and to search for possible correlations between morphological anomalies and disease severity. MATERIAL AND METHODS: The study group included 49 dentate patients, mean age 47.7 years suffering from obstructive sleep apnea syndrome. Most of the patients were overweight. RESULTS: Typical features observed in these patients were a short craniospinal field, a retro-maxillary, a retro-mandibula, antero-inferior vertical excess of the face, and class II malocclusion. No correlation between severity of obstructive sleep apnea syndrome and craniofacial morphology could be identified. DISCUSSION: These results are in agreement with data in the literature. The absence of a morphological correlation appears to be related to the type of patients studied (overweight). Indeed, two categories of sleep apnea patients have been identified: obese patients who have few or no anomalies of the facial skeleton and thin patients with characteristic open bite class II malocclusion.

[Progressive hemifacial atrophy in the young patient: surgical problems in children]. / L'atrophie hémifaciale progressive du sujet jeune: difficultés chirurgicales chez l'enfant.

Parry-Romberg syndrome is characterized by a limited progressive hemifacial atrophy. For young patients, the surgeon has to deal with two tendencies: the patient's growth and the course of the syndrome. When managing such an unpredictable disease, the surgeon has to make a guess about the future course of the structural movements. We reviewed our experience and analyzed the different surgical possibilities for reconstructive surgery for Parry-Romberg syndrome.

[Orthognathic surgery with missing teeth]. / La chirurgie orthognathique avec pertes dentaires.

Orthognathic surgery in patients with missing teeth can be divided into two categories. In the first case after tooth loss, specially designed bridging is required using the prosthesis already in place. In the second case in patients with congenital deficiencies, usually sequellae of cleft palate, there is a wider range of therapeutic options which are discussed on the basis of observed cases.

[Cervicofacial cellulitis of dental origin and tracheal intubation]. / Cellulites cervico-faciales d'origine dentaire et intubation trachéale.

OBJECTIVES: To evaluate the difficulty of intubation in relation with the localisation and spread of cervico-facial cellulitis of odontogenic origin and to recognize the optimal technique of intubation in such circumstances. STUDY DESIGN: Prospective clinical open study. PATIENTS: Hundred patients, including 16 children, undergoing surgical drainage of a cervico-facial cellulitis of odontogenic origin under general anesthesia were studied. METHODS: Difficulty of intubation was evaluated with the following four criteria: active mouth opening in the awake patient, Mallampati's classifying system, presence of trismus, clinical and radiological control of localisation and extension of the cellulitis (mandibular, maxillar or mouth floor). In case of a foreseen difficult intubation, a fibrescope was used in the awake patient. Otherwise the endotracheal tube was inserted after administration of propofol (3 mg.k-1) and alfentanil (10 to 20 micrograms.kg-1). A Cormack's grading was performed during intubation. RESULTS: Mouth opening depended on the localisation of the cellulitis. Trismus occurred more often with mandibular than maxillary localisations. Trismus and a Mallampati's class > 2 were associated with difficulty in intubation (Cormack's grade > 2), except in maxillary localisations. CONCLUSIONS: The localisation of cellulitis of odontogenic origin is responsible for the difficulty grade of intubation. Awake fibreoptic intubation should be systematically performed in patients with a floor of the mouth cellulitis to reduce the risk of rupture of the abscess by a laryngoscope blade. As trismus associated with mandibular localisations is not relieved by general anaesthesia, awake fibreoptic endotracheal intubation should be preferred.

[Maxillary ossifying fibroma: apropos of 3 cases]. / Fibrome ossifiant maxillaire: à propos de trois cas.

Three cases of ossifying fibroma of the maxilla are reported in two young females and in one child. The characteristic of this benign fibro-osseous tumour are described. The authors insist on the necessity of a confrontation between the clinical, the radiological and the histopathological aspects of this tumour to establish a diagnostic.

[Infectious temporomandibular arthritis. Apropos of a case in an adult]. / Arthrite infectieuse temporo-mandibulaire. A propos d'un cas chez l'adulte.

Imagery revealed osteitis of the base of the skull in a 37-year-old patient with infectious arthritis of the temporomandibular joint. The characteristics of this rare pathology were recalled from a review of the literature.

[Indications and role of surgery in painful dysfunction syndromes of the masticatory apparatus]. / Indications et place de la chirurgie dans les syndromes algo-dysfonctionnels de l'appareil manducateur.

Among the numerous causes of facial neuralgias, the painful dysfunction syndrome of the manducatory apparatus corresponds to a frequent etiology whose thorough study carried out by a multidisciplinary team over about 500 cases allowed their splitting into several evolutive clinical forms. At present, a number of these forms which are particularly painful, require a disk surgery (dislocation reduction, perforation suture, etc.) and if necessary an articular facet surgery (modelling condylectomy, surfacing, etc.). This study specifies the indications and prognosis for these surgical operations.

[Arthrotomy for the permanent displacement of the temporomandibular meniscus. A coagulation-retraction technic of the posterior meniscal frenum]. / Arthrotomie pour déplacement permanent du ménisque temporo-mandibulaire. Technique de la coagulation-rétraction du frein méniscal postérieur.

An original technique for surgical treatment by arthrotomy for permanent closed lock of the temporo-mandibular joint is described. This technique uses the temporo-meniscal compartment approach. The superior belly of the posterior meniscal attachment is dissected and retracted by a diathermy coagulation. Advantages of this technique are compared to the usual techniques of meniscopexy and meniscorrhaphy using a suture. The indications are proposed.