[Treatment indications for hand agenesis or acquired loss: Standard technics versus allotransplantation (CTA)]. / Une main vous manque et... Indications thérapeutiques des agénésies et amputations de mains : plasties et prothèses versus allogreffes.

The new surgery thinking, in matter of hand loss, is made of two ways: without hand, there is no more functional abilities; homograft or allograft of hand is the best actual treatment. This is not true and we are able to get new functional abilities by other ways: without any treatment, we are able of spontaneous functional recovery. There are other treatments: the old operation of Krukenberg or new bionic prosthesis. This work is a recall of obvious or forgotten facts.

[Sequels of labial-alveolar-velopalatine clefts observed in charity missions. Analysis and management]. / Séquelles des fentes labioalvéolopalatovélaires en mission humanitaire. Analyse et prise en charge.

A lot of children with cleft lip and palate are not operated in the developing world, due to a lack of surgeons, hospitals, or simply because the condition is not considered as a priority. Charity missions give the opportunity to repair these malformations. Non-operated cleft lip and palate are the first problem, but our surgery may cause growth disturbances and sometimes a second operation is needed, more difficult than the first one in mission conditions. Repairing a cleft palate needs to be adapted to the type of cleft but also to the age of the child, a velopalatine pharyngoplasty can be performed in some cases.

[Neonatal surgery of cleft lip and palate: juridical aspects]. / Chirurgie néonatale des fentes labiopalatines: aspects juridiques.

Neonatal surgery of cleft lip and palate is a common practice fro many surgical teams. The modifications of the French Law in 2002 on patient's rights, the way judges decide how the law should be applied, and the modifications of the rules for health centres need an analysis of the juridical aspects of this surgery. First the bases of the Law are presented, then how the surgeon responsibility can be engaged is learned.

[Communicate? Transmission?]. / Communiquer? Transmettre?

Through our own experience and that of others authors - surgeons, mathematicians, philosophers - we consider methods, reality ant future of communication and transmission in plastic and reconstructive surgery. Open to criticism, communication is always revocable; registered in the future, transmission is not so easy to challenge. Subjects and means of communication and transmission - language and pictures - are discussed, provided that to allow citicism and to be closed to self-love. A matter of course is that truth must rise above self-vanity. Communication is devoted to all those who take care of patients, but also to patients themselves and their relatives: the best wisdom must be used here and, too, with medias where in communication must follow the simplest morality: don't act for yourself but for others. We have to teach that we must be impassioned of strictness, and accept to waste needfull time for research as for practice. We communicate with all who wish for it, but we transmit only to those we guess able to follow right and prudent practice. Spirit of surgery must overcome technical tips.

[Palatovelopharyngoplasty at the same time. Our experience in Philippines]. / Palatovélopharyngoplastie en un temps. Notre expérience aux Philippines.

After many surgical charity missions in the same hospital in the Philippines, we have evaluated the child's phonation being operated of cleft palate. We had bad results so we decided to do in the same time an Orticochéa pharyngoplasty and the closure of the palate. These patients were evaluated too, the results were improved.

[The treatment of cleft lip, cleft palate and other dysmorphisms: the ideal technic and therapeutic reality]. / A propos du traitement des fentes labio-palatines et autres dysmorphies: idéal technique et réalisme thérapeutique.

Good results in any surgical or orthodontic procedure require expert technique, well adapted to the problem and scrupulously executed. A technique that would achieve the best results can be described as "ideal" and can serve as a theoretical model for all similar cases. But, in dealing with apparently similar problems: cleft lips and palates, Class II or Class III cases... in reality, we are treating individual patients, none quite the same as any other. These differences derive from the varying characteristics of individual patients and from the varying and unpredictable responses of their tissues, and from their varying capacities to accommodate to and withstand insults, suffering, and the sensory-motor effects of their deformities and of the treatment they undergo, and, finally, from their variable readiness to submit to and to pay for treatment with their time and with their money. Any therapeutic technique must take into account these realities which sometimes oblige us to modify an ideal technique so that it will fit the specialized needs of a patient, an accommodation that can be defined as "therapeutic realism". When we ignore this reality, we risk the paradox of providing patients with technically ideal results that they find unsatisfactory or discover that what we thought was a technically mediocre outcome has delighted our patient: ultimately, it is the patient's judgment that determines the "therapeutic result" and is, in effect, the Final Evaluation of the technical result.

[The whole treatment of cleft lip and/or palate by the team of Dr. Chancholle in Toulouse]. / Prise en charge des fentes labio-palatines par l'équipe du docteur Chancholle à Toulouse.

Our choice in the treatment of the C.L.P. child is that the child is accepted by his parents and by Society as well as possible. In this way, the most important points are: to inform parents and Society of the ability of the child to a normal and satisfactory life. This information must be based upon the exact knowledge of what is really the cleft disease, its causes, and not only the genetic ones, the whole troubles induced by the cleft, local and general, and their treatment: by neonatal operation and, however was the choice of operative technic, by educative and reeducative means based on an exact knowledge of the modified physiology of the child: above all, sensory-motricity coordination and early speech-therapy before speech. The follow-up of the child at the difficult time of school admission, and cooperation between all the members of the team and the teachers.

[Ethics and best practice in the consulting management of children with cleft lip and palate, and their parents]. / Ethique et bonnes pratiques des consultations d'un enfant atteint de fente labiopalatine, et de ses parents.

Surgical treatment is only one part of the management of the child with cleft lip and palate. This paper exclusively focuses on other important aspects of this management. This includes the information and psychological supports of the parents, whether the cleft lip is diagnosed prenatally or at birth, the practical aspects of the consultation within the team of the different specialists involved (surgeon, anesthetist, dentist, orthodontist, speech therapist, otorhinolaryngologist, geneticist, child psychologist). The school teacher must also be concerned at the beginning of the first school year.