[A complete intermediate temporomandibular joint prosthesis. Evaluation after 6 years]. / Prothèse totale intermédiaire d'articulation temporo-mandibulaire (A.T.M.). Bilan après 6 ans.

Since 1983 we have inserted more than 100 temporomandibular joint prostheses. A review after 6 years allows the respective indications to be listed and the complications to be studied in 72 insertions involving 62 cases suitable for analysis. The prosthesis is a total intermediary prosthesis forming an unsealed cupula composed of 2 halves--a mandibular portion and a temporal portion. Insertion of the prosthesis requires preliminary facial nerve dissection then osteotomy of the mandibular condyle and its subsequent drilling to allow the screwing in of the prosthesis. The prosthesis was used in traumatology, in condylar and high sub-condylar fractures, in the event of failure of functional treatment, in malformation syndromes, in tumors and, finally, in degenerative pathology. 13 prostheses were removed. A study of the probable causes of complications shows a predominance of technical problems related to inaccurate positioning of the prosthesis, in that it was not placed in the axis of the condyle, or that inadequate bicortical support was present. In our opinion, these complications do not question the conception of the prosthesis but rather indicate that it is necessary to perfect the insertion technique while taking advantage of improvements in the prosthesis which are currently under study.

[Reconstruction of the temporomandibular joint and its alternatives]. / La reconstruction de l'articulation temporo-mandibulaire (A.T.M.) et ses alternatives.

Reconstruction of the temporomandibular joint is always quite problematic. --Use of a prosthesis. Many prostheses have been propounded to deal with the operational problems. As, in our opinion, these seem not to meet the usual orthopaedic surgery requirements, we developed a totally intermediate prosthesis with non-sealed cupula. The use of this prosthesis, whenever feasible, provides the solution for the problems with which we have to contend during reconstruction surgery in traumatology and degenerative or tumoral disease. Nonetheless, its use remains limited to adults. --Utilization of biological material: following numerous attempts made with the conventional osteocartilagenous grafts (metatarsal, rib), we believe that the proper orientation, walking in Chang's footsteps, is toward the use of the head of the second metatarsal bone as a microanastomotic transfer. It seems to us that this technique must be used in children, particularly those with malformation syndromes or ankylosis.

[Computerized tomography in the diagnosis of craniomandibular disorders: radiological-surgical comparison]. / Application de la scanographie au diagnostic des désordres cranio-mandibulaires: confrontations radio-chirurgicales.

Among 500 C.T. scan of temporomandibular joint (T.M.J.), examined since 1982 by bilateral direct sagittal method (Department of Radiology, Pr. A. TREHEUX, C.H.U. Nancy-Brabois), the authors have retained 14 cases of patients with symptoms related to dysfunction of the T.M.J. cured by surgery (Department of Maxillo Facial Surgery, Pr. STRICKER, C.H.U. Nancy). These cases were chosen among hundred patients annually examined by C.T. scan, for various diseases (dysfunctions of the T.M.J., traumatisms, infections, inflammatory diseases...). These correlations between radiology and surgery about 26 T.M.J. (2 patients underwent surgery only on one side) were: an accuracy with surgical findings for 19 cases (76%); in 6 cases (23%), a meniscus anteriorly displaced, non detected by C.T. scan was found by surgery; 2 cases of meniscus perforations (one in the frontal plane, the other sagittal) were surgical findings; in 1 case, a displacement was under-valued by C.T. scan; in 3 cases, arthrosic changes (1 case of REITER syndroma) were characterized by C.T. scan. The authors emphasize the value and the limits of evaluation of the internal derangements of the T.M.J. with direct sagittal C.T.

[The CT scanner and the temporomandibular joint. Anatomo-radiologic comparisons. Apropos of 14 cases of algodysfunctional of the manducator system]. / Scanner et articulation temporo-mandibulaire (ATM). Confrontations anatomo-radiologiques. A propos de 14 cas de syndrome algo-dysfonctionnel de l'appareil manducateur (SADAM).

Among 500 CT scan of temporomandibular joint (TMJ), examined since 1982 by bilateral direct sagittal method (Department of Radiology, Pr. A. TREHEUX, CHU Nancy-Brabois), the authors have retained 14 cases of patients with symptoms related to TMJ's dysfunction cured by surgery (Department of Maxillo Facial Surgery, Pr STRICKER, CHU Nancy). These cases were chosen among hundred patients annually examined by CT scan, for various diseases (TMJ's dysfunctions, traumatisms, infections, inflammatory diseases...). These correlations between radiology and surgery about 26 TMJ (2 patients underwent surgery only on one side) were: an accuracy with surgical findings for 19 cases (76%); in 6 cases (23%), a meniscus anteriorly displaced, non detected by CT scan was found by surgery; 2 cases of meniscus perforations (one in the frontal plane, the other sagittal) were surgical findings; in 1 case, a displacement was under-valued by CT scan; in 3 cases, arthrosic changes (1 case of Reiter syndrome), were characterized by CT scan. The authors emphasize the value and the limits of evaluation of the internal derangements of the TMJ with direct sagittal CT.

[The scanner and the temporomandibular joint; anatomic-radiologic comparisons. Apropos of 26 cases of masticatory apparatus pain-dysfunction syndrome]. / Scanner et articulation temporo-mandibulaire (ATM); confrontations anatomo-radiologiques. A propos de 26 cas de syndrome algo-dysfonctionnel de l'appareil manducateur (SADAM).

Among 500 CT scan of temporomandibular joint (TMJ), examined since 1982 by bilateral direct sagittal method (Department of Radiology, Pr. A. Treheux, C.H.U. Nancy-Brabois), the authors have retained 14 cases of patients with symptoms related to TMJ's dysfunction cured by surgery (Department of Maxillo Facial Surgery, Pr. Stricker, C.H.U. Nancy). These cases were chosen among a hundred of patients annually examined by CT scan, for various diseases (TMJ's dysfunctions, traumatisms, infections, inflammatory diseases...) These correlations between radiology and surgery about 26 TMJ (2 patients underwent surgery only on one side) were: an accuracy with surgical findings for 19 cases (76%); in 6 cases (23%), a meniscus anteriorly displaced, non detected by CT scan was found by surgery; 2 cases of meniscus perforations (one in the frontal plane, the other sagittal) were surgical findings; in 1 case, a displacement was under-valued by CT scan; in 3 cases, arthrotic changes (1 case of Reiter syndrome) were characterized by CT scan. The authors emphasize the value and the limits of evaluation of the internal derangements of the TMJ with direct sagittal CT.

[Computerized tomography of sagittal sections. A noninvasive alternative in the exploration of temporomandibular joint dysfunction]. / Tomodensitométrie en coupes sagittales. Une alternative non invasive dans l'exploration des dysfonctionnements de l'articulation temporo-mandibulaire.

Important advances in the use of CT scan imaging for exploration of the temporomandibular joint include the obtaining of direct sagittal section images and the possibility of surveillance. This avoids the need for more invasive and painful techniques such as arthrography. The position of the meniscus can be determined from either direct or indirect signs and bone structures and muscles are particularly clearly demonstrated. This technique can be used while awaiting more widespread availability of NMR apparatuses for meniscal exploration.

[The influence of the masticatory muscles on craniofacial growth. A microsurgical study in the rat]. / L'effet des muscles masticateurs sur la croissance cranio-faciale. Etude micro-chirurgicale chez le rat.

Possible influence of masticatory muscles on facial growth was investigated in the rat by the formation of several experimental groups: excision of right masseter muscle of right temporal muscle, of both masseter muscles, of both temporal muscles and of both masseter and temporal muscles, section of inferior maxillary nerve and masseter transplantation. Results demonstrated that overall masticatory muscles provided equilibrium of masticatory function, any rupture of this equilibrium producing effects on mandibular growth and that of the facial mass.

[Reconstruction of the temporomandibular joint with a total intermediate prosthesis]. / Reconstruction de l'articulation temporo-mandibulaire par prothèse totale intermédiaire.

A method for reconstruction of temporomandibular joint is proposed using an intermediary prosthesis and non-sealed cupula. This prosthesis respects the cranial articular slope and provides twofold mobility at the cupular level, which approaches physiological conditions and allows reproduction of buccal opening and closing movements as well as lateralization. A strict surgical procedure is essential when inserting the prosthesis, particular care being necessary in the approach to the facial nerve and control of its temporofacial contingent until above the zygomatic arch. Indications for this procedure are discussed in relation to injuries and tumoral, degenerative and malformatory lesions.

[Protocol of mandibular reconstruction]. / Protocole de reconstruction mandibulaire.

Conventional methods for reconstruction of the mandible require an adequately vascularized receiving bed and total absence of cutaneous and mucosal fluid loss. These conditions are rarely attained during immediate reconstructive surgery and secondary operations are very often of doubtful outcome because of previous infection. A part from the treatment of small post-traumatic loss of substance by means of iliac or costal bone grafts, it is suggested that free osteo (musculo) cutaneous grafts be used for other cases. The flap preferred is one from the anterior iliac crest pediculated on the deep iliac circumflex vessels.

[Management of Pierre-Robin syndrome]. / La prise en charge du syndrome de Pierre Robin.

Pierre Robin syndrome continuously raises problems of intensive care that are difficult to surmount. A peak has to be overcome, the date of which varies as a function of the severity of the affection, following which the infant remains a neonate at high risk. Intensive care of these infants during the neonatal period involves avoidance of the sequence of disturbances provoked by the disorders of ventilation and deglutition. Surveillance of biological variables, feeding and the fight against glossoptosis are mainly the concern of medical procedures: from orthostatic nipples to continuous gastric feeding, from procubitus to intubation with assisted ventilation, and including pharyngeal catheters and physiotherapy. Surgery is required only exceptionally at this stage, mainly in the form of hyomandibulopexy.

[Musculocutaneous flaps in maxillofacial surgery]. / Les lambeaux myocutanés en chirurgie maxillo-faciale.

The principal general characteristics of musculocutaneous flaps are described. Originally indicated for repair of wounds and reconstructive surgery following operation for cancer, they are now employed to treat post-radiotherapy lesions, burn sequelae, and even facial asymmetry. The principal clinical features of the most commonly applied flaps are discussed with a view to defining their maxillofacial applications more precisely.