[Mandibular advancement device and multidisciplinary consultation of sleep-disorders]. / Orthèse d'avancée mandibulaire et consultation pluridisciplinaire sur les pathologies du sommeil.

BACKGROUND: Multidisciplinary consultation of sleep-disorders can include recommendation of a mandibular advancement device (MAD) for some patients with obstructive sleep apnea syndrome (OSAS). AIM: To assess the outcomes of patients for whom an oral MAD was prescribed following multidisciplinary consultation for OSAS in a University Hospital Center. METHODS: All patients referred by hospital or community specialist who had visited this specialized service from December 2015 to December 2017 and to whom an MAD was prescribed were included in this study. The objective was to analyze their clinical course after this consultation and to assess the effectiveness of these devices in this population. RESULTS: In all, 184 patients were seen by the multidisciplinary consultation between December 2015 and December 2017. An MAD was offered to 148 patients and 70 of these went on to have one. Of these 52 of them received follow-up polygraphy (PG) with it in place. This confirmed effectiveness in 18 cases (decrease of at least 50% of the AHI. The average AHI went from 34.8/hr to 22.5/hr. Sixty-five of the 148 patients were lost to follow-up. CONCLUSION: After specialized consultation on sleep-disorders, only one-third of the patients to whom an OA was prescribed had polygraphic exam. OA was less effective than in equivalent series. Correctives measures (such as a multidisciplinary standard sheet) have been set up to ensure a close follow-up of patients.

The influence of orthognathic surgery on the perception of personality traits: A scoping review.

The purpose of this scoping review was to determine the current state of evidence regarding the influence of orthognathic surgery on the perception of personality traits in dysmorphic patients by laypersons. The MEDLINE database was searched for relevant studies using the search strategy: ("Personality"[Mesh]) AND ("Orthognathic Surgery"[Mesh] OR "Orthognathic Surgical Procedures"[Mesh]). A qualitative and quantitative synthesis of the results was performed. Descriptive statistics were used. The PRISMA-ScR guidelines were followed. Five studies, published between 2012 and 2018, remained after screening. Seventy-two dysmorphic patients and 12 class I control individuals were rated based on a total of 296 pre- and postoperative photographs or videos. The available data showed concordant results. Dysgnathic patients were more negatively perceived than class I patients for both aesthetic and personality dimensions. Compared to control class I patients, class II patients were perceived as more flexible, less confident, and less intelligent, whereas class III patients were characterized by dominance, aggressivity, and brutality. Dysgnathic patients showed an improvement in the postoperative ratings but did not reach the ratings attributed to the control class I group in most traits evaluated. This added understanding should help surgeons to counsel their patients in a realistic and reasonable manner.

Three-dimensional acquisition technologies for facial soft tissues - Applications and prospects in orthognathic surgery.

The management of patients with dento-maxillofacial deformities is based on assessments of the dental occlusion - facial skeleton - soft tissues triad. As societal demands and surgical practices have evolved, facial soft tissues have moved to the forefront of considerations in orthognathic surgery. Techniques are therefore required to analyze facial soft tissues objectively and reproducibly, for diagnosis, preoperative planning, and follow-up. Several technologies are currently capable of providing three-dimensional (3D) models of the face, either by 3D reconstruction of traditional computed tomography or cone beam computed tomography data, or directly by stereophotogrammetry, laser scanning or structured light scanning. Multimodal image registration techniques allow bone base, dental occlusion and facial soft tissue information to be combined in a 3D virtual patient. Three-dimensional cephalometric analysis of the facial skeleton and skin is now perfectly integrated in virtual planning and is gradually gaining in automation and accuracy. Photorealistic 3D simulations allow optimal soft tissue planning and facilitate physician-patient communication. Finally, these facial modeling techniques facilitate post-operative studies of soft tissues, which generally involve comparisons of volumetric data. There are many research avenues to pursue and technical improvements are to be expected, particularly through the development of big data and artificial intelligence approaches.

Artificial Intelligence: Applications in orthognathic surgery.

Artificial Intelligence (AI) applications have already invaded our everyday life, and the last 10 years have seen the emergence of very promising applications in the field of medicine. However, the literature dealing with the potential applications of IA in Orthognathic Surgery is remarkably poor to date. Yet, it is very likely that due to its amazing power in image recognition AI will find tremendous applications in dento-facial deformities recognition in a near future. In this article, we point out the state-of-the-art AI applications in medicine and its potential applications in the field of orthognathic surgery. AI is a very powerful tool and it is the responsibility of the entire medical profession to achieve a positive symbiosis between clinical sense and AI.

Current status of surgical planning and transfer methods in orthognathic surgery.

Since the advent of orthognathic surgery major efforts have been made to render these surgical procedures more reliable, accurate, reproducible, and shorter. Such improvements imply the enhancement of surgical planning (SP) techniques and optimization of SP transfer tools. Most widespread current SP methods are based on physical examination/anthropometric measurements combined with cephalometric analysis. Most surgeons currently use handmade acrylic surgical splints or sometimes freehand surgery as transfer tool. The emergence of virtual surgical planning (VSP) procedures gave birth to several modern transfer tools, such as computer-assisted design and manufactured (CAD/CAM) splints, CAD/CAM splints with extra-oral bone support, customized miniplates, and surgical navigation. This article classifies and describes these emerging transfer tools, therewith underlining their advantages and drawbacks.

[Stereophotogrammetry and facial surgery: Principles, applications and prospects]. / Photographie 3D en chirurgie de la face : principes, intérêts et perspectives.

The clinical examination of the face needs a reliable, objective and innocuous tool. Stereophotogrammetry for a medical use has been available for more than fifteen years but its popularity is still limited by a high cost. We hereby define the principles of stereophotogrammetry, its fields of application in facial surgery and the prospects, which might soon be offered by a wider access to this technique.

Chronic osteomyelitis of the mandible: A comparative study of 10 cases with primary chronic osteomyelitis and 12 cases with secondary chronic osteomyelitis.

INTRODUCTION: The purpose of this study is to compare a group of patients with Primary Chronic Osteomyelitis of the mandible (PCO) and a group with Secondary Chronic Osteomyelitis of the mandible (SCO) to support the classification of osteomyelitis of the jaws defined by Eyrich et al. MATERIAL AND METHODS: Medical records of patients with chronic osteomyelitis of the mandible were screened and relevant clinical data was recorded retrospectively. The patients were divided into two groups according the criteria proposed by Eyrich et al.: one group with PCO and one with SCO. Comparison was made between these two groups. RESULTS: Twenty-two patients were included, 10 in the PCO group, and 12 in the SCO group. The main differences between the two groups concerned the duration of the symptoms (100% of the cases in the PCO group lasted more than 2years, versus 8.3% in the SCO group, P<0.05), computed tomography images of bone sclerosis and bone hypertrophy (present in respectively 100% and 50% of the patients in the PCO group, vs. 36.4% and 0% in the SCO group, P<0.05), and the treatment (100% of surgical decortication and 80% of Nonsteroidal Anti-Inflammatory Drug or steroids use in the PCO group vs. 25% and 0% in the SCO group, P<0.05). DISCUSSION: The classification proposed by Eyrich et al. seems relevant according to the results of our study, PCO and SCO differing especially on the duration of the symptoms, the radiologic findings and the treatment and its outcomes.

[Temporo-mandibular joints and orthognathic surgery]. / Articulations temporo-mandibulaires et chirurgie orthognathique.

Temporo-Mandibular Joints (TMJ) and orthognathic surgery are closely linked. In the past, some authors have even described (with mixed results) the correction of some dysmorphosis through direct procedures on the TMJs. Nowadays, performing orthognathic surgery involves the TMJ in three different occasions: (1) TMJ disorders potentially responsible for dento-maxillary dysmorphosis, (2) effects of orthognathic surgery on TMJs, and (3) condylar positioning methods in orthognathic surgery. These three chapters are developed in order to focus on the close relationships between TMJ and orthognathic surgery. Some perspectives close this article.

Posterior mandibular widening secondary to advancement sagittal split osteotomy: A retrospective study.

INTRODUCTION: Patients sometimes spontaneously report a modification of the width of their lower face after an advancement bilateral sagittal split osteotomy (ABSSO). The main goal of our study was to assess the variation of the bigonial distance (BGD) before and after ABSSO in a group of patients. The second goal was to look for a possible relation between the variation of BGD and the amount of mandibular advancement. MATERIALS AND METHODS: We conducted a retrospective radiological study on patients who underwent an isolated ABSSO (Obwegeser-Dal Pont II type osteotomy) for a class II malocclusion in our department over a 26 months period. The measures were made on standardized frontal and lateral teleradiographies taken before, one day and one year postoperatively. RESULTS: Fifty patients (36 females, 14 males; mean age: 24) could be included. BGD was significantly increased one day (+9.8mm, P<10(-3)) and one year after surgery (+4mm, P<10(-3)). There was no relation between the amount of mandibular advancement and the increase of BGD. DISCUSSION: Our results suggest that ABSSO is responsible for posterior mandibular enlargement which must be taken into account during the aesthetic preoperative assessment. Further studies are mandatory to identify the risk factors for this phenomenon.

Condylar resorption after orthognathic surgery: A systematic review.

INTRODUCTION: Condylar resorption after orthognathic surgery (CROS) represents a progressive alteration of shape and volume of the mandibular condyle. It is a known factor of surgical relapse. The aim of this systematic review was to discuss the physiopathology, mechanisms, risk factors, diagnosis and treatment of this disease. MATERIALS AND METHODS: A systematic review of the literature was performed on the Pubmed database from 1970 to 2014, using following terms: ("orthognathic surgery") AND ("condylar resorption" OR "progressive condylar resorption" OR "idiopathic condylar resorption" OR "condylar atrophy" OR "condylolysis"). Papers were included according inclusion and exclusion criterias. RESULTS: The search leaded to 32 articles. Seventeen were included. CROS was a condylar remodeling secondary to an imbalance between mechanical stress applied to the temporomandibular joints (TMJ) and the host adaptive capacities. It mainly occurred in 14 to 50years old women with pre-existing TMJ dysfunction, estrogen deficiency, class II malocclusion with a high mandibular plane angle, a diminished posterior facial height and a posteriorly inclined condylar neck. Mandibular advancement superior to 10mm, counterclockwise rotation of the mandible and posteriorly condylar repositioning were associated with an increased risk of CROS. DISCUSSION: Treatment consists in re-operation in case of degradation of the occlusal result after an inactivity period of at least 6 months. Condylectomy with allogenic or autologous reconstruction is an alternative. Prevention is crucial and requires at-risk patient information.

[Reconstruction assisted by 3D printing in maxillofacial surgery]. / Reconstruction assistée par l'impression 3D en chirurgie maxillofaciale.

INTRODUCTION: 3-dimensional models (3D) appeared in the medical field 20 years ago. The recent development of consumer 3D printers explains the renewed interest in this technology. We describe the technical and practical modalities of this surgical tool, illustrated by concrete examples. TECHNICAL NOTE: The OsiriX(®) software (version 5.8.5, Geneva, Switzerland) was used for 3D surface reconstruction of the area of interest, the generation and export of ".stl" file. The NetFabb(®) software (Basic version 5.1.1, Lupburg, Germany) provided the preparation of ".stl" file. The 3D-printer was an Up plus 2 Easy 120(®) (PP3DP, Beijing Technology Co. TierTime Ltd., Chine). The printer used fused deposition modeling. The softwar Up!(®) allowed the 3d impression as required. RESULTS: The first case illustrated the value of 3D printing in the upper (frontal sinus and orbital roof). The second case concerned the preconfiguration of the osteosynthesis material for a complex fracture of the midface through the "mirroring" system. The third case showed the conformation of a prereconstruction for segmental mandibulectomy. DISCUSSION: Current 3D-printers are easy to use and represent a promising solution for medical prototyping. The 3D printing will quickly become undeniable because of its advantages: information sharing, simulation, surgical guides, pedagogy.

Periodontal management in orthognathic surgery: early screening of periodontal risk and its current management for the optimization of orthodontic and surgical treatments.

Orthodontic preparation for orthognathic surgery requires correcting mal-occlusions and coordination of arcades. In addition to improving the aesthetics, these treatments can ensure the achievement and sustainability of prosthetics and/or implants. Nevertheless, periodontal structures are easily damaged. Orthodontic displacement can only be applied in the absence of inflammation or weakened periodontal structure. An early detection of periodontal risk should be achievable by prescribers of a surgical-orthodontic treatment. Simplified periodontal examination, with easily detectable warning signs, will help to identify the periodontal risk. Although periodontal treatment follows current "non invasive" trend, some procedures remain necessary to prevent and/or remedy periodontal defects or diseases, such as mineral periodontal reinforcement corticotomy. It is essential that the patient meets all the practitioners to plan and assess the extent of the constraints necessary to optimize results, before starting orthodontic treatment combined with orthognathic surgery. Any periodontal complication (even minor) will be considered as a failure, regardless of good aesthetic and functional results.

[Giant ameloblastoma of the mandible]. / Améloblastome géant mandibulaire.

INTRODUCTION: Giant ameloblastomas are more common in developing countries. They raise a serious problem of management. We present the case of one of the largest ameloblastoma ever reported. CASE REPORT: A 48-year-old Congolese female patient was referred for mandibular swelling having begun 23 years before and now inducing severe functional disorders. A cephalic CT scan revealed a multicystic mass, 30×18×10cm in size, with a typical "soap bubble" presentation, and with thinned and inflated cortical bone. The treatment was sub-total segmental mandibulectomy with immediate reconstruction using a fibular free flap, modeled on the sampling site by four ostectomies. The pathological examination confirmed the diagnosis of a benign follicular and plexiform ameloblastoma. The excess of soft tissue was treated with a right commissuroplasty on the 15th postoperative day. There was no complication. DISCUSSION: Radical treatment followed by immediate reconstruction using a free flap is the treatment of choice for giant mandibular ameloblastomas, when considering immediate functional and esthetic benefits. This is a prime concern for patients with a difficult access to health care and for whom long-term follow-up is not feasible.

[Reoperation after orbital decompression for Graves' ophthalmopathy]. / Reprises chirurgicales après décompression orbitaire pour ophtalmopathie dysthyroïdienne.

INTRODUCTION: The aim of our study was to report the incidence of complications requiring early or late reoperation after bone and fat orbital decompression for Graves's ophthalmopathy. PATIENTS AND METHOD: We conducted a retrospective bicentric study in the Maxillofacial Surgery Departments of Marseille and Lyon. Ninety patients were selected from 2006 to 2010, accounting for 168 orbital decompressions. The surgical indication was morphological and functional for all patients. Several surgical techniques were used: bone and fat orbital decompression by trans-palpebral resection, two or three wall orbital decompression, malar valgization. RESULTS: Ten patients were reoperated for 12 revisions, two patients needed two revisions. There were four early revisions for two retro-orbital hematoma, one inadequate orbital decompression with persistent posterior compressive optic neuropathy, and one recurrent maxillary sinusitis with proptosis. The other eight revisions were carried out later for three cases of insufficient correction, four cases of proptosis relapse, and one for excessive correction with enophthalmos. All patients had satisfactory morphological and functional results despite revision surgery. DISCUSSION: Most reoperations are difficult to anticipate and their prevention is based on more or less specific recommendations. Patients should be informed of the risks and benefits and accept the possibility of reoperation. A systematic multidisciplinary consultation would standardize and improve the management of these patients, by detecting patients at risk of complications and thus reoperation.

[Multiple facial squamous cell carcinomas in a child, revealing a xeroderma pigmentosum]. / Xeroderma pigmentosum révélé par des carcinomes épidermoïdes multiples de la face chez un enfant.

BACKGROUND: Squamous cell carcinoma of the skin is very rare in children. One of its most common risk factors is xeroderma pigmentosum (XP), an autosomal recessive disease characterized by defective cellular DNA repair, and hypersensitivity to ultraviolet radiation. CASE REPORT: We report a case of XP in a 7-year-old black African boy, revealed by squamous cell carcinomas of the inferior lip and upper left eyelid. DISCUSSION: In sub-Saharan regions, the early diagnosis of XP is difficult because of its uncommon occurrence on black skin and black skin specificities. The strong sun radiation in the tropics and a late diagnosis make XP treatment challenging. Thus, prevention in patients' families is mandatory.

[Severe vascular complications of Le Fort I osteotomy]. / Complications vasculaires graves de l'ostéotomie de Le Fort I.

INTRODUCTION: Le Fort I osteotomy is a common orthognathic procedure. This surgery presents risk of severe vascular complications because of local anatomy. The aim of our study was to collect data on vascular complications of Le Fort I osteotomies performed in our department, describe the diagnostic and therapeutic aspects, and discuss prevention. PATIENTS AND METHODS: A retrospective analysis was made on the files of patient having undergone Le Fort 1 osteotomy, between 1998 and 2007. Severe vascular complications were recorded, defined as postoperative hemorrhagic or ischemic complications severe enough to require a specific procedure. RESULTS: Nine hundred and sixteen patient files were included (39% male and 61% female patients, mean-age: 24.42 years; range: 13 to 59 years). Five patients presented with severe hemorrhagic complication. There was no ischemic complication. Three hemorrhagic episodes occurred in the immediate postoperative phase. In two cases, delayed hemorrhagic complication occurred, diagnosed as a pseudo-aneurysm by angiography. These were treated by hyperselective embolization. DISCUSSION: Vascular complications of Le Fort I osteotomies are rare (0.55% in our series). They are most frequently hemorrhagic complications.