[Malar valgisation in narrow face patients]. / Intérêt de la valgisation fonctionnelle des malaires dans les faces étroites.

Most of the "narrow faces" are secondary to a maxillo-malar hypoplasia consecutive to chronic nasal obstruction. Functional malar valgisation by transmalar osteotomy allows a simple and safe correction of this dysmorphic aspect. Interpositional bone graft and osteosynthesis by miniplate avoid mucous inflammation, maxillary sinusitis and/or relapse observed with use of biomaterials. Correction of "narrow faces" by malar osteotomy is natural and long term results are stable. Functional and esthetic rhinoplasty is often associated. Our clinical experience in 15 cases is reported.

[Not Available]. / Avancement mandibulaire par greffon cartilagineux rétrocondylien.

Most of dentofacial abnomalies are due to mandibular retrognathisms. These abnomalies are surgically treated mostly by mandibular lenghtening with the help of the sagittal split osteotomy although other procedures could be used. Mandibular distraction and advancement of the receding lower jaw by retrocondylar cartilagenous graft are the two main alternatives. The retrocondylar cartilagenous graft has been introduced by Leon Dufourmentel in 1929. This procedure has strong anatomical and physiological basis and has to be better known because it is effective and respects the temporo-mandibular joint. The permanent advancement of the mandible is assured by a retrocondylar graft placed in the pretympanal and extra-articular space located between tympanal bone and retrocondylar venous plexus. All the mandibule retrognathisms should be treated through this approach, especially with associated obstruction sleep apnea syndrome.

[Impacted canine tooth and the eyebrow: the orbit-eyelid impact of occlusal dysfunction]. / Canine incluse et sourcil: conséquences orbito-palpébrales des dysfonctions occlusales.

The orbital region and the dental occlusion are biomechanicaly interdependant. The maxillary basal bone is located in the orbital region due to the presence of the maxillary sinus. Any trouble of the dental occlusion such as a retained canine can involve a lack of projection of the supra and the infra-orbital rim. This lack of projection of the infra-orbital rim is responsible of lower eyelid fat pad; the lack of projection of the supra-orbital rim is responsible of an eyebrow-forehead ptosis. Clinical variations can be observed according to the side of the preeminent eye.

[Whiplash lesions and temporomandibular joint disorders]. / Traumatisme cervical et dysfonctionnement de l'appareil manducateur.

Attributing dysfunction of the temporomandibular joint (TMJ) to whiplash injury is a difficult problem to solve. TMJ disorders do not seem to be secondary to direct articular trauma but rather caused by a postural disorder of the cervical spine. Occlusal disorders and stress further complicate the picture. Four clinical cases illustrate a new hypothetical approach.

[Hard palate mucosal graft for posterior lamella repair]. / Greffe de fibro-muqueuse palatine en chirurgie palpébrale.

Several techniques have been proposed for posterior lamella repair. The ideal gaft should be easy and safe to harvest, be lined by mucosa and be rigid enough to support the lower lid against retraction. Hard palate mucosal grafts meet these criteria. The surgical procedure is done under local or general anaesthesia and a graft up to a 40 x 20 mm can be harvested. Paramedian and subperiostal harvest is recommended, local complications are less frequent (bleeding and sensory lesions) and the hard palate mucosa is of better quality at this site (thinner graft with fewer salivary glands but rigid enough due to the periostal layer). Donor site complications such as local bleeding can be reduced by meticulous surgical technique and local postoperative care such as compression using a mouthguard. The main indications for hard palate mucosal graft are lower eyelid reconstruction and management of lower eyelid retraction.

[Basics of esthetic and functional cephalometric analysis of the profile]. / Bases fondamentales de l'analyse céphalométrique de profil fonctionnelle et esthétique.

We report a new cephalometric method for profile analysis, which uses strictly exobasicranial landmarks: 13 anatomic points, 9 bone points and 4 skin points. The analysis is based on phylogenetic, ontogenetic, anatomic and biomechanical data. Phylogenetic analysis reveals that the occipital plate belongs more to the cranial vault than the base of the skull. Embryology shows that on the midline the facial skull base ends at the spheno-occipital suture and that the overall skull base ends at the basion. The pre-maxillary fuses rapidly to the maxillary, while the pterygoid processes, which belong to the face and not the skull base, fusion very rapidly to the skull base. Revisiting the anatomy of the facial skull base shows that it is prolonged posteriorly medially to meast the synostosic creast and latterally to the glenoid fossae. Further anatomic analysis shows that the dentate and muscular part of the superior level of the facial mass correspond to equivalent parts of the inferior mandibular level. The biomechanical analysis reveals that the anterior pillar passes through the pre-maxillary, ending on the supra-orbital border and the glabella and as such belongs to the face. The posterior pillar follows the pterygoid process ending in the sphenoid. The glabella and these two pillars are taken into account in this new analysis technique.

[Functional and esthetic cephalometric analysis of the profile]. / Analyse céphalométrique de profil fonctionnelle et esthétique.

We report a new cephalometric method for profile analysis, which uses strictly exobasicranial landmarks: 13 anatomic points, 9 bone points and 4 skin points. The analysis is based on phylogenetic, ontogenetic, anatomic and biomechanical data. The face is comprised between a new exobasicranial plane represented by the Nasion-Glenion (Na-Gl) and the classical mandibular plane. These two planes form the angle of facial divergence. Orthogonal projection of the axis of the maxillary incisors and the axis of facial growth on the new basicranial plane is then performed. The upper and lower levels of the facial mass are divided sagittally by four vertical anatomic planes perpendicular to the Francfort plane, accounting for the facial skin profile (cutaneous facial plane), the anterior and posterior facial pillars (premaxillary and postmaxillary planes), and the craniospinal postural plane. The ideal occlusion plane is undistinguishable from the curve of Spee. This new cephalometric method for functional and esthetic profile analysis enables simple rapid and efficient study of the main facial and cervical structures.

[Resection of maxillary nerve neurinoma in the pterygomaxillary fossa via Lefort I transmaxillary approach]. / Résection d'un neurinome du nerf maxillaire de la fosse ptérygo-maxillaire par voie trans-maxillaire de Lefort I.

Many approaches are used for resection of pterygomaxillary tumors. Le Fort I osteotomy allows a simple and safe access with a wide exposure of the central skull base. This observation presents the resection of a maxillary neurinoma through Lefort I osteotomy with success and no sign of recurrence with a 3 years follow up.

Discomallear and malleomandibular ligaments: anatomical study and clinical applications.

Phylogenesis, ontogenesis and anatomy show the existence of two discomallear and malleomandibular ligaments, arising from the first branchial arch and uniting the middle ear with the temporomandibular joint and to the mandible. The intra-articular discomallear ligament is the involuted tendon of the lateral pterygoid muscle on the primitive quadrato-articular joint. The malleomandibular ligament is the fibrous remnant of Meckel's cartilage. In the physiology of the temporomandibular joint, the discomallear ligament alone limits the anterior movement of the disc. Its stretching accompanies disco-condylar disunity, hyperlaxity and temporomandibular dislocation. The malleomandibular ligament, wrongly limited to its sphenomandibular part in classic anatomy, has no physiological role. However, it can be responsible for the dislocation of the ear ossicle chain after disarticulation or temporomandibular trauma. These two ligaments do not play any role in otological manifestations in dysfunction of the manducatory apparatus.

[Look and nasal ventilation]. / Regard et ventilation nasale.

Ophthalmic manifestations of nasal obstruction can involve palpebral, orbital and ophthalmic disturbances. They can be the consequence of: directly with the nasal obstruction because the orbital cavity drains partly in the nasal fossae: rings, lipoptosis, blepharochalasis, fat protrusions, aggravation of exophthalmy in Grave's disease, enophthalmia. Oral breathing: there are modifications in the shape of the palpebral fissure ("round eye") by stretching of the facial mask and modifications of the orbital rims ("sad eye") due to lack of naso-sinusal expansion, often associated to malocclusion, there is a biomechanical correlation between the dental occlusion and the orbital area because of the presence of the maxillary sinus. Every occlusal disorder have an influence on projections of the supra and infraorbital rims.

[Ophthalmic manifestations of masticulatory system dysfunctions]. / Manifestations ophtalmologiques des dysfonctionnements de l'appareil manducateur.

Temporomandibular joint dysfunctions may involve ophthalmic symptoms such as orbital pain, asthenopia, or anisocoria. These ophthalmic manifestations may be the first signs or the complications of masticatory system dysfunctions. Treatment of these ophthalmic symptoms begins with treatment of the temporomandibular joint dysfunctions.

[Nasal injuries during labor and in early childhood. Etiopathogenesis, consequences and therapeutic options]. / Traumatismes du nez périnataux et de la petite enfance. Etiopathogénie, conséquences et principes thérapeutiques.

Childhood and perinatal nasal traumatisms involve an anterior septal deviation or an anterior septal lysis. These complications induce a soft nasal tip. Nasal obstruction et oral ventilation are responsible for the development of facial and occlusal sequelae. A better knowledge of anatomy and physiopathology of nasal traumatisms is needed for an earlier treatment.

[Ophthalmic manifestations of nasal obstruction]. / Manifestations ophtalmiques orbito-palpébrales de l'obstruction nasale.

Ophthalmic manifestations of nasal obstruction can involve palpebral, orbital and ophthalmic disturbances. They can be the consequence of -Direct contact with the nasal obstruction because the orbital cavity drains partly in to the nasal fossae: rings, lipoptosis, blephaochalasis, fat protrusions, aggravation of exophthalmy in Grave's disease. -Oral breathing: there are modifications in the shape of the palpebral fissure (round eye) by stretching of the facial mask and modifications of the orbital rims (sad eye) due to a lack of naso sinusal expansion, often associated with malocclusion. -A biomechanical correlation between the dental occlusion and the orbital area because of the presence of the maxillary sinus. Every occlusal disorder has an influence on projections of the supra-and infraorbital rims.

[A new cephalometric analysis of the profile. 1. Anatomic bases, cephalometry]. / Une nouvelle analyse céphalométrique de profil. I: Bases anatomiques, céphalométrie.

Through a revision of the classical anatomy of the exocranial skull base, the authors present of a new exobasicranial plan in cephalometry, the Nasion-Glenion (or Porion plane). The median part of the base devoted to ventilation goes from the Nasion to the spheno-occipital synchondrosis, joining two essentially cartilaginous sites. The lateral parts, with manducatory functions, extend from supra-orbital rim to glenoid fossa and are mainly membranous. Pterygoid processes belong to the facial squeleton. Dental and growth axes are projected on the new exobasicranial base. Facial structures are analyzed in four planes, perpendicular to Francfort plane (facial cutaneous plane, premaxillary plane, postmaxillary plane, craniocervical plane).

"Axial split osteotomy" of free fibular flaps for mandible reconstruction: preliminary results.

Vascularized free flaps are now considered the most appropriate choice for mandible reconstruction because they offer excellent cosmetic and functional results. Various techniques have been proposed. Free fibular flaps have numerous advantages in terms of versatility and contouring. Shaping can be achieved by wedge osteotomy with excellent results. However, this technique leads to bone loss and may be difficult in the later stages of the procedure. The purpose of this report is to describe a simple and safe flap-shaping method involving axial split osteotomy.

[Complications of nasal obstruction in children]. / Conséquences de l'obstruction nasale chez l'enfant.

The author reviews the morphogenetic and functional consequences of oral breathing in childhood.

[Etiopathogenesis of nasal obstruction in children]. / Etiopathogénie de l'obstruction nasale chez l'enfant.

The author lists the dysmorphic and dysfunctional causes of nasal obstruction in the child.

[Functional and esthetic rhinoplasty in orthognathic surgery]. / La rhinoplastie fonctionnelle et esthétique en ODMF.

The author presents a surgical rhinoplasty, aiming at functional and aesthetic purposes, in dentofacial orthopedics.

[Conservative forehead facelift. Design and preliminary results]. / Lifting frontal conservateur. Conception et résultats préliminaires.

The digastric occipitofrontalis muscle, as described in classical anatomy text books, does not exist. The epicranial aponeurosis or galea aponeurotica receives the occipitalis muscle on its deep surface and the frontalis muscle on its superficial surface. This revised anatomy of the concept of the frontal cutaneo-musculo-aponeurotic unit, combining skin, galea and frontalis muscle (frontal CMAU) is the basis for a new forehead facelift which corrects ageing of the forehead, essentially related to recession of the forehead and relaxation of the galea. The essential advantage of this new facelift is preservation of the frontalis muscle which plays a fundamental role not only in forehead expression, but also in support and elevation of the eyelids. The absence of any direct procedure on the frontalis muscle decreases the extent of skin resection and avoids or minimizes sensory or motor neurological complications.