[Improving the esthetic results and patient satisfaction in orthognatic surgery]. / Améliorer le résultat esthétique et la satisfaction du patient en chirurgie orthognatique.

The objectives of dental and maxillary defect management have changed over the last decade. Occlusal improvement is required, but it is expected to come with a good esthetic result for patients, especially for adults, and mentioned or not preoperatively. Thus, the maxillofacial surgeon must include complementary data in his therapeutic scheme, beyond the one provided by the cephalometric analysis. This chapter was drafted in pluridisciplinary mode to this end. A psychological approach and post-operative satisfaction are crucial factors that were studied prospectively (MD Battini and Courtois) and are a part of this chapter. Esthetic labial standard are also described, based on the results of a retrospective study (MD Hardy, Laure and Goga). Doctor Belhaouari presents solutions to embellish lips with filling products, initially or later. Finally, the complementary surgical techniques that can be used during orthognatic surgery are listed: lipofilling, rhinoplasty, surgery of mandibular angles, apposition of piriform aperture.

[Temporal lift]. / Lifting temporal.

UNLABELLED: The temporal lift belongs to the traditional face lift which is in fact temporo-cervico-facial. It also forms part of the face lift "upper part of the face" which is in fact temporo-frontal. It is to say that it relates to a junction zone between the superior and inferior part of the face. OBJECTIVES: In a first part the authors recall the essential anatomical data including the eyebrow, the Charpy's fat pad, the galea and the temporoparietal fascia, the nerves (temporo-facial branch of the facial nerve and supra-orbital nerve) and the veins (sentinel vein). Then they expose the various surgical techniques (galeapexy, endoscopic temporal lift, brow lift, facial threads, standard fixing Endotine forehead, botulinic toxin. This makes it possible to define in a more precise way the indications and counterindications of the temporal lift. CONCLUSION: The indications of the temporal lift are the lateral ptosis of the tail of the brow. On the other hand, the total ptosis requires a frontal lift. In this case one can associate a concomitant blepharoplasty. The temporal lift is frequently carried out in a way combined with a cervico-cheek lift. The prospects for technical progress to improve perenniality of an isolated temporal gesture are large and will allow us to widen the indications.

[Frontal muscular balance and botulinum toxin]. / Balance musculaire frontale et toxine botulique.

A good knowledge of the anatomy of the muscles of upper third of the face and their function, a good understanding of the famous Frontal Muscular Balance, to consider the anatomic and histological modifications induced by ageing in the cutaneous layer and the muscular function of the underlying "peaucier muscles", are essential for a better approach and for an easy and safe use of botulinum toxin, remarkable product, and for avoiding its operator-dependent risks.

[Complications of laser facial resurfacing]. / Complications des abrasions du visage par laser.

Laser resurfacing is a burn of the superficial skin layers: it's a controlled burn in its depth, that can destroy epidermis and the dermis superficial part, but not deeper for avoiding healing complications. All complications and the normal postoperative follow-up can be explained by the fact that laser resurfacing is a burn of the dermis and epidermis, with the destruction, partial or total, of their components. It's essential to understand the normal postoperative process and complications to avoid them and to treat them in the beginning. Infection, persistent erythema, pigmentation troubles like hyperpigmentation or depigmentation and demarcation surrounding the resurfacing area, healing troubles like hypertrophic scarring, keloids, excess of skin retraction are the main complications. Careful preoperative explanation of laser-resurfacing follow-up will help the patient adjust more easily to postoperative care.

Shave excision and phenol peeling of generalized verrucous epidermal nevus.

BACKGROUND: Generalized verrucous epidermal nevus is a disorder characterized by papulokeratotic and verrucous plaques involving a large area of the skin. This disease has been associated with a number of malformations including osseous, neurological, and ophthalmologic anomalies. OBJECTIVE: To report clinical and histologic features of verrucous epidermal nevus that developed in association with osseous anomalies, and the surgical technique employed. METHODS: Treatment consisted of razor blade shaving using a dermatome, followed by phenol peeling on the pigmented areas of the face. RESULTS: The described procedure resulted in a cure of the verrucous epidermal nevus with good cosmetic outcome. CONCLUSION: Generalized verrucous epidermal nevus can be successfully managed by surgical excision using a razor blade mounted on a dermatome.

[Failure and problems: apropos of a cranioplasty]. / Echec et problèmes: à propos d'une crânioplastie.

The authors report a case of post-traumatic cranioplasty associated with various complications. They stress the difficulties in managing this type of reconstruction when a vast cerebral defect is associated with ventriculo-peritoneal by-pass.

[Inguinal island flap for covering trochanteric bedsores]. / Lambeau inguinal en îlot pour la couverture des escarres trochantériennes.

Trochanteric bedsores are a serious condition because of the danger of osteoarthritis of the coxofemoral joint, which is a source of septicemia, and also because of the difficulty of covering them with skin owing to the mobility of the bone and the absence of skin laxity in the area. The authors suggest a new technique of closure after local preparation providing a clean "surgical" defect. They use a groin island flap raised in the Japanese "retrograde" manner (i.e. laterally to medially). This technique is of course the fruit of the authors' experience of the microsurgery. The distal portion of the flap is drawn, corresponding to the size of the defect (round shape). The proximal portion contains the vessels surrounded by subcutaneous and protected by a de-epithelialized triangle of skin with a distal base. The flap is passed through a subcutaneous tunnel between the femoral trigone and the trochanteric area to be covered. The donor site is closed by approximation of the edges after they have been undermined. The authors discuss the others possible surgical managements: 1) local flaps (transposition flap, Z plasties, are unsuitable; 2) the double S-rotation flap had the drawback of creating a large undermined area and leaving a scar on the trochanteric region; 3) simple GER-type muscle flaps are not advisable because the transposed muscle always indergoes a fibrous involution so that the graft provides insufficient protection; 4) myocutaneous flaps, and especially fascia lata myocutaneous flap, offer better indication, because of muscle only acts as a vascular pedicle for the skin flap. The only drawback is the relative defect resulting from raising the flap. The authors conclude that the groin island flap offers the following advantages; a skin material which is more than efficient; ideal vascularization; perfect corverage without undue tension of the trochanteric surface; an interesting training for the plastic surgeon performing microsurgical reconstruction.