[The Léon [correction of Laurent] Guedj implant concept: simplification of the surgical phase in implantology]. / Concept implantaire C.L.G.: simplification de la phase chirurgicale en implantologie.

OBJECTIVE: We present a new self-drilling self-tapping dental implant that simplifies the operative technique and optimizes osseointegration. MATERIAL AND METHOD: The implant, the instrumentation, and the operative technique are described. An experimental study was conducted in a sheep with pathological and histomorphological analysis at three months. A clinical evaluation was also conducted in 18 patients who had 27 implants. RESULTS: The experimental study demonstrated good quality osseointegration, without bone necrosis. Three sectors were identified. Histomorphometric analysis demonstrated that mean bone contact reached 40% on cancellous bone and 65% on cortical bone. In the clinical series, one implant had to be removed due to a problem with gum healing. All the other implants were well tolerated. DISCUSSION: The advantage of this new technique is the use of the implant as the drilling instrument. Much time is saved. In addition, the bone-implant contact is better since the bone cavity is exactly adapted to the implant. The risk of bone lesion is reduced due to the smaller number of drillings.

[Mandibular fractures in sports. Retrospective study of 48 cases]. / Les fractures de la mandibule chez les sportifs. Etude rétrospective de 48 cas.

We present a retrospective study of 48 isolated mandibular fractures related to athletic activities. We studied patient age, sex, sport involved, mandibular location of the fracture and the therapeutic implication. The sex ratio was 4/1 and mean age 24 years. Rugby and cross-country biking were the more frequently involved sports (79%). We recall preventive measures. Miniplate osteosynthesis was used as often as possible in order to avoid intermaxillary fixation (IMF) (40%) or to limit the duration of IMF. This allowed early return to sport activities.

[Tools of the Internet in maxillofacial surgery and oral medicine. Practical applications]. / Les outils de l'Internet en chirurgie maxillo-faciale et stomatologie. Applications pratiques.

Internet has a wide range of functions applicable in the medical domain. Its use has had a clear impact on routine medical practice. The user can consult colleagues, send and receive multimedia files, order books from the library, access specialized reviews or worldwide scientific data on-line as well as publish results, and participate in forums, telephone or organize teleconferences in real time. Faced with the abundance of the available information flow and the methodological difficulty in extracting precisely useful data, the ordinary user can wander a long time in cyber-space before learning the skills required for efficient navigation. We recall here the fundamental principles of the Internet and describe the types of information the maxillofacial surgeon can use in his everyday practice. Certain unanswered questions are debated as well as certain difficulties related to the use of the Internet in its present state of development.

[Multiple lipoma of the tongue. Apropos of a case and review of the literature]. / Lipomes multiples de la langue. A propos d'un cas et revue de la littérature.

Lipomas are uncommonly located in the tongue and multiple forms are rare. We describe a case of multiple lipoma of the tongue in a female patient aged 60 years who also presented subcutaneous cervical lipoma. The literature on multiple lipomas is discussed.

[The Bimler method in the treatment of sagittal shift of the skeletal base in Class II division 1 malocclusion]. / Méthode de Bimler dans le traitement du décalage sagittal des bases osseuses des classes II, 1.

Inadequate sagittal development of the mandible (class II, division 1 malocclusion), is one of the most frequent in dentofacial malformations. We present the Bimler "gebissformer", removable and functional appliance and its tridimensional action. The treatment can be started during the deciduous dentition or in mixed dentition. Therapeutic results, increase of SNB angle, maxillary expansion, and reduction of the deep bite are presented. While therapeutic failure is observed in 30% of the cases (by absence of tissular response or poor patient compliance), the stability of the results in 70% of the remaining cases and its total inocuity make this appliance an interesting method of treatment.

[Treatment of fractures of the mandibular angle using miniplates attached through the transjugal approach]. / Traitement des fractures de l'angle mandibulaire par miniplaques vissées par voie transjugale.

We present 114 cases of mandibular angle fractures treated by screwed miniplates placed through a transbuccal incision with transbuccal trochar instrumentation. Usually patients were young men who suffered traffic accidents. The mean hospitalization time was 7 days. 94.5% of the patients healed without incident, no malocclusion complication was observed. Two postoperative hematomas required surgical drainage without healing complication. One non union required removal of the miniplate and maxillo-mandibular immobilization. 2 temporary postoperative hypoaesthesiae were observed. One patient presented a pericoronary infection of a third impacted molar, four months after surgery, but the fracture was healed. The comparison of the results with the others in the literature confirms the reliability of this technique.

[The Internet in oral medicine and maxillofacial surgery]. / Internet en stomatologie et chirurgie maxillo-faciale.

The authors give an Internet short historical record, then describe the different services offered and the possible applications for oral and maxillo-facial surgery. Electronic-mail (E-mail) provides the ability to compose, send and receive messages through the computer and allows exchanging informations with colleagues around the world. Programs, files and graphics can be transferred from one computer to another. The "news groups" are interesting in various subjects and allow a team work. We find several hundred sites about maxillo-facial surgery. These sites present a medical department, diagnosis problems or therapeutic solutions, medical press. Any information submitted is insecure and could be observed by a third party while in transit. Internet potential (educational benefits, digital access to medical literature, online consultation service) is mentioned in the end of the article.

[A superiorly pedicled nasobuccal flap. Its value in the reconstruction of posterior-superior loss of substance of the oral mucosa]. / Lambeau naso-génien à pédicule supérieur. Intérêt dans la reconstruction des pertes de substance postéro-supérieures de la muqueuse buccale.

Superiorly based nasolabial flap is an interesting solution for reconstruction of moderate size maxillary defects. The operative technique and its results are described. Advantages (reliability in flap vascularity, versatility, easiness of elevation) and limits of this procedure for closure maxillary defects are mentioned. Then they are compared to the other reconstructive maxillary techniques.

[Cephalometric study of changes in the upper airways after orthognathic surgery. Significance in the management of obstructive sleep apnea syndromes. Apropos of 43 cases]. / Etude céphalométrique des modifications des voies aériennes après chirurgie orthognathique. Intérêt pour la prise en charge des syndromes d'apnée obstructive du sommeil. A propos de 43 cas.

The aim of this work was to study long-term airways space changes after maxillomandibular osteotomy in order to assess benefit of this surgery in case of obstructive sleep apnea syndrome. Preoperative and postoperative cephalometric airway spaces evaluation of 43 patients (who did not have obstructive sleep apnea) was done. Analysis revealed no charge in velopharyngeal space, lingual-pharyngeal augmentation in case of mandibular advancement. Hyoid bone position was not modified by osteotomy. Signification and interest of this finding for patients with obstructive sleep apnea are discussed through literature data.

[The value of lidocaine-prilocaine cream in the surgery of detached ears]. / Intérêt de la crème de lidocaïne-prilocaïne dans la chirurgie des oreilles décollées.

The possibility to obtain a skin anaesthesia using only an ointment may be very usefull for outpatient surgery. Recently available in France, the lidocaine-prilocaine cream give an interesting local anaesthesia. We have used this new presentation as skin preparation before otoplasty for 10 patients. As the local anaesthesia injections are then performed without pain, the comfort of the patient is greatly improved. Furthermore, it is easy to sue and without side-effect. The main disadvantage consists in the action delay of one hour, with the necessity to ask the patient to come earlier.

[Reconstruction of the orbit floor using a resorbable polydioxanone (PDS degree) cup. Analysis of a series of 71 cases]. / Reconstruction du plancher de l'orbite par cupule résorbable de polydioxanone (PDS degree). Analyse d'une série de 71 cas.

A 71 patients series is presented, concerning primary orbital floor reconstruction by a polydioxanone cup (PDS degree) which has been used for five years. The technical data and surgical procedure are exposed. No infection either intolerance manifestation has been observed until the materiel was resorbed. Two early displacements of the implant are reported, due to a technical fault during the insertion of the cup. Only one late enophtalmy was observed for a patient with a large orbital floor defect. The loss a the rigidity of the polydioxanone seems to be relatively fast (probably 2-3 months) and leads to contraindicate its use in cases of large osseous traumatic defects. In all other cases, this surgical technique seems to be very useful.

Squamous odontogenic tumor. Report of three cases including the first extraosseous case.

Squamous odontogenic tumor is a distinct entity-separate from the more aggressive ameloblastoma. Only 33 squamous odontogenic tumors have been reported since the first description in 1975. We report three additional cases including the first completely extraosseous case.

[Condylar retrusion in the algo-dysfunctional syndrome of the mastication apparatus]. / La rétrocondylie facteur de syndrome algo-dysfonctionnel de l'appareil manducateur (SADAM).

Although T.M.J. dysfunction-pain syndrome is a multicausal affection, it is obvious that occlusal disturbance is one of the greater etiologic factors. In order to evaluate the role of condylar position in the glenoid fossa, a statistical study has been made on a 16 patients series. These patients presented an uni- or bilateral T.M.J. dysfunction-pain syndrome without arthrosis, ankylosis or traumatologic deformation. The vertical and horizontal relationships of the mandibular condyle to the temporal were quantitatively evaluated from lateral tomographs. Pain and clicking were noted (Y or N) for each of the 32 T.M.J. Condylar position doesn't seem to have any relation with clicking, which is present in cases of meniscus anterior displacement. On the contrary, condylar horizontal retrusion is statistically connected with pain (p less than 0.05) even if one can see condylar retroposition without pain. On the other hand, vertical changes in condylar position cannot be connected with pain. The importance of condylar retrusion in the pain-group can surely be related to inflammatory histologic injuries at the level of the posterior disc attachment. Then, in these cases, the etiologic treatment must be focused on anterior mandibular release by orthodontics, prosthetics or orthognathic surgery.

[Diffuse sclerosing osteomyelitis of the mandible. Apropos of a case followed for more than 10 years]. / Ostéomyélite sclérosante diffuse de la mandibule. A propos d'un cas suivi sur plus de 10 ans.

Diffuse sclerosing osteomyelitis (DSO) is a well-known chronic osseous disease. However, the diagnosis can be difficult as it has been observed for a case which is presented with more than 10 years survey. The clinical, radiographic, scintigraphic, histologic and bacteriologic aspects are discussed. The treatment can be made by various medical or surgical methods. None of these is completely efficient, even if good results could be observed in some cases. The prognosis seem to be at least uncertain. The real etiology is probably infection, but has never been proved.

[Transjugal osteosynthesis by compression miniscrew in sagittal ramus osteotomy]. / Ostéosynthèse trans-jugale par mini-vis à compression dans les ostéotomies sagittales des branches montantes.

The transjugal osteosynthesis technique of the Obwegeser-Dalpont type is used for treatment by sagittal osteotomy of ascending rami. The material used is a direct compression mini-screw derived from that described by Michelet-Champy. Principles underlying all types of osteosynthesis (rigidity, solidity, miniaturization, according to the authors) are discussed and advantages and inconveniences of their material compared with those of other existing procedures. Two clinical cases are presented as an illustration.

[Modifications to the skin profile following facial osteotomy]. / Modifications du profil cutané consécutives aux ostéotomies faciales.

Soft tissue changes resulting of maxillary and/or mandibular osteotomies need to be evaluated with a great accuracy for a better prediction of the post-operative profile. As the aesthetic result seems to be most important for our patients, it is necessary to study the relations between the displacements of characteristic cutaneous points and hard structures below, osseous or dental. Then, a retrospective statistical computerized study was performed on 45 patients who underwent facial osteotomies at least three months before. The vertical and horizontal positions of 14 osseous or dental landmarks and 16 cutaneous points were recorded. Corresponding displacements were calculated for each of these, but only six cutaneous and 9 osseous displacements were selectionned for this study. A first correlation research was made, with determination of the lineary regression equations, when it was possible. Then a multivariate study was performed for each cutaneous point, with determination of multiple regression equations. Comparison between the two methods of prediction shows a S.D. over 2 mm for the simple regression versus a S.D. of about 1 mm for the multiple regression. On the other hand, it seems that it is possible to predict the horizontal displacements with the first method without important error. But the vertical displacements cannot be evaluated with good prediction, and particulary the stomion movements. It will be necessary to consider other parameters to obtain better correlation coefficient. But it is obvious that one can join together different groups of patients for a soft tissue changes study with the same results than after separation of those. In fact, the soft tissue reactions are the same although the surgical procedures are different.

[Value of the surgical treatment of subcondylar fractures. Apropos of a comparative study of 24 cases of luxation-fractures treated by to-and-fro osteosynthesis or by active protrusive mobilization]. / Intérêt du traitement chirurgical des fractures sous-condyliennes. A propos d'une étude comparative de 24 cas de luxations-fractures traitées par ostéoxynthèse en "va et vient" ou par mobilisation active en propulsion.

Regarding the bad results of the orthopaedic treatment of subcondylar dislocated mandibular fractures, the authors present a comparative study of two series of twelve patients: one (group "A") with orthopaedic treatment; the other one (group "B") with surgical treatment by "up and down" pinning via a temporal approach. The results of surgical treatment seem to be better than those of orthopaedic treatment, as it can be seen in some other papers. The choice of the surgical technique of osteosynthesis and the indications are then discussed. It seems to be necessary to improve the specific instrumentation for wider indications an better results.