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1.
J Craniomaxillofac Surg ; 46(9): 1408-1420, 2018 Sep.
Article in English | MEDLINE | ID: mdl-30001885

ABSTRACT

OBJECTIVE: SARME is often considered to be the only available treatment for significant or severe maxillary transverse palatal deficiencies (MTD) in skeletally-mature patients. Despite this observation, the aim of our study was to assess a new type of maxilla distraction osteogenesis. Using two innovative tools, we performed selective expansion: the site to be widened and the amount of increase were both pre-selected. Patients were treated in a single maxillomandibular procedure. Our study focuses primarily on the extent of osseous widening. STUDY DESIGN: Post-expansion computed tomography data from 55 non-syndromic patients were included in a prospective study and analyzed in two planes for transverse skeletal widening. Of the 55 patients, 16 underwent isolated posterior distraction for severe posterior endognathia (group I), and 39 were treated in both segments (group II). Diastemas and anterior spaces permitted resolution of crowding and patients with a small, narrow, tapering arch were given a more rounded form. All patients underwent a complete Le Fort I with down fracture. Two novel devices were used: first, an adjustable distractor to achieve an angular opening; and secondly, in group II, new modular plates interlocked for osteosynthesis to provide stability and anterior expansion. RESULTS: In group I, analysis of the width of the gain showed significant posterior values decreasing from back to front, a result never achieved with the SARME procedure. The mean osseous gain at first molars was 7.1 mm. When anterior space was required in group II, it was created as wide as needed (mean 4.2 mm, at canine level) with good preservation of the 1st molar space gain (mean 6.8 mm). CONCLUSION: Total Le Fort I osteotomy associated with two innovative devices provides a new, segmental and adaptable approach for transverse distraction osteogenesis. We demonstrate a good match with the dental enlargement required. All patients were managed in a single orthognathic procedure for all the anomalies to be treated. Long-term results show good stability.


Subject(s)
Malocclusion/therapy , Orthognathic Surgical Procedures , Palatal Expansion Technique/instrumentation , Adolescent , Combined Modality Therapy , Equipment Design , Female , Humans , Male , Osteogenesis, Distraction , Osteotomy, Le Fort , Prospective Studies , Tomography, X-Ray Computed , Treatment Outcome , Young Adult
2.
J Craniofac Surg ; 28(8): 2093-2097, 2017 Nov.
Article in English | MEDLINE | ID: mdl-29019820

ABSTRACT

BACKGROUND: The overlapping bone flap genioplasty, described by Tessier, was developed to treat major retrognathia or long and retruded chins. For 15 years, we have used a modified version of this technique to avoid its drawbacks. The aim of this article is to describe our modification and evaluate the long-term morphologic and radiologic outcomes. PATIENTS AND METHOD: The authors included every split-overlapping genioplasty performed in our department between 2004 and 2014. Demographics, surgical data, and complications were recorded. Radiologic bone resorption was evaluated comparing preoperative, day-1 postoperative, and year-1 postoperative cephalometric x-rays. Morphologic outcomes were evaluated on standardized pre- and postoperative views using an analogic Likert scale. SURGICAL TECHNIQUE: The main modification of the procedure consists in separating the posterior cortex of the transplant using a reciprocating saw. After overlapping the reduced transplant onto the mandible, the posterior cortex is used as an apposition graft to soften the labiomental crease. RESULTS: Forty-seven patients were analyzed during this period. In 44 patients, the procedure was combined with mandibular and/or maxillary osteotomy. The average reduction of symphysis height was 5 mm, and the average pogonion advancement was 4.3 mm. After 1 year, we recorded 7% average bone resorption. No major complications (nerve injury, hematoma, among others) were reported. Morphologic outcomes were deemed satisfactory or very satisfactory in the vast majority of cases. CONCLUSION: Split-overlapping genioplasty is a safe and reliable procedure with stable, long-lasting outcomes. This versatile technique is particularly useful for the correction of a massive symphysis or high and retruded chins.


Subject(s)
Bone Resorption , Chin , Genioplasty , Mandibular Osteotomy , Maxillary Osteotomy , Postoperative Complications , Retrognathia/surgery , Adolescent , Adult , Bone Resorption/diagnosis , Bone Resorption/etiology , Cephalometry/methods , Chin/diagnostic imaging , Chin/surgery , Female , France , Genioplasty/adverse effects , Genioplasty/methods , Glycosides , Humans , Male , Mandibular Osteotomy/adverse effects , Mandibular Osteotomy/methods , Maxillary Osteotomy/adverse effects , Maxillary Osteotomy/methods , Middle Aged , Outcome and Process Assessment, Health Care , Postoperative Complications/diagnosis , Postoperative Complications/prevention & control , Pregnanes , Radiography/methods , Retrognathia/diagnosis , Surgical Flaps
3.
J Plast Reconstr Aesthet Surg ; 69(5): 700-5, 2016 May.
Article in English | MEDLINE | ID: mdl-26923660

ABSTRACT

BACKGROUND AND AIM: Persistent postsurgical pain (PPP) has been reported by patients following various surgeries. Body contouring procedures are being performed more frequently, but no data are available regarding the effects of these procedures. Long-term disability occurring after performing "functional" procedures on healthy subjects is a particular concern. The aim of this study was to describe the risk factors, prevalence, characteristics, and effects of persistent pain after body contouring procedures. METHODS: Patients who underwent body contouring surgery (e.g., abdominoplasty, lower body lift, medial thigh lift, brachioplasty, and abdominal liposuction) between January 1 2009 and December 31 2013 were included in this retrospective, monocentric cohort study. Pain evaluation was performed using a visual analog pain scale (VAS) and the Douleur Neuropathique 4 (DN4) questionnaire. Major risk factors previously identified in the literature were evaluated. RESULTS: The study included 199 patients. Pain was reported by 42 patients (21%). Seventy-one percent (n = 30) of these 42 patients presented with neuropathic pain. Risk factors that were significantly associated with PPP were acute postoperative pain (p = 0.0003), medical history of bariatric surgery (p = 0.002), longer period of hospitalization (p = 0.04), depressive status during the operative period (p = 0.03), substantial stress before surgery (p = 0.03), and major complications after surgery (p = 0.03). CONCLUSION: Persistent chronic pain is frequent after body contouring procedures. Preemptive approaches and early postoperative diagnosis are important measures that can be used to limit the effects of this complication on the patient's quality of life.


Subject(s)
Chronic Pain/epidemiology , Chronic Pain/etiology , Cosmetic Techniques/adverse effects , Pain, Postoperative/epidemiology , Pain, Postoperative/etiology , Abdominoplasty/adverse effects , Adult , Aged , Arm/surgery , Bariatric Surgery/adverse effects , Depression/complications , Female , Humans , Length of Stay , Lipectomy/adverse effects , Male , Middle Aged , Neuralgia/epidemiology , Neuralgia/etiology , Pain Measurement/methods , Prevalence , Retrospective Studies , Risk Factors , Thigh/surgery
5.
Int Orthod ; 13(3): 320-31, 2015 Sep.
Article in English, French | MEDLINE | ID: mdl-26277457

ABSTRACT

BACKGROUND: Surgically assisted rapid maxillary expansion (SARME) is usually considered the gold standard for maxillary transverse expansion in adults. However, a second surgical procedure is needed in cases of associated sagittal or vertical discrepancies. We describe the use of two new innovative devices for the correction of discrepancies in all dimensions during a single surgical procedure, thus reducing treatment duration. MATERIAL: We report the case of a 21-year-old female patient, referred to our department for skeletal Class III malocclusion associated with right-side laterognathism and transverse maxillary deficiency. The patient underwent one-stage surgery, using sliding osteosynthesis plates and an adjustable bone-borne distractor. Pre-surgical orthodontics consisted in leveling and aligning the mandibular arch; maxillary leveling was initiated 3 months before surgery. Postoperative palatal distraction combined with orthodontic finishing enabled complete correction of dental and bony discrepancies after 3 months. CONCLUSION: In our experience, treatment of transverse, sagittal and vertical discrepancies has been possible in a single surgical procedure, using two innovative techniques: sliding osteosynthesis and an adjustable bone distractor. Two years post-surgery, the correction is stable in all dimensions.


Subject(s)
Malocclusion, Angle Class II/therapy , Maxilla/surgery , Osteogenesis, Distraction/instrumentation , Osteotomy, Le Fort/methods , Palatal Expansion Technique , Bone Plates , Equipment Design , Facial Asymmetry/surgery , Facial Asymmetry/therapy , Female , Follow-Up Studies , Humans , Malocclusion, Angle Class II/surgery , Osteogenesis, Distraction/methods , Osteotomy, Le Fort/instrumentation , Osteotomy, Sagittal Split Ramus/methods , Palatal Expansion Technique/instrumentation , Treatment Outcome , Young Adult
6.
J Plast Reconstr Aesthet Surg ; 67(12): 1659-62, 2014 Dec.
Article in English | MEDLINE | ID: mdl-25193398

ABSTRACT

BACKGROUND: The Antia-Buch flap is a sophisticated one-stage procedure using two chondrocutaneous flaps to reconstruct the ear helix. Because tissue laxity is largely conferred by the inferior flap, relative to the less mobile superior flap, chondrocutaneous resection of scapha is required for closure. This results in loss of ear height and limits morphologic outcome. We describe a modification of the Antia-Buch flap, which may avoid such drawbacks. PATIENTS AND METHOD: We conducted a retrospective review of patients (n = 15), each undergoing our modified Antia-Buch flap between 2010 and 2014. All procedures were performed under local anesthesia as outpatient procedures. Data on magnitude of resections, procedure durations, related complications, and aesthetic outcomes were collected. RESULTS: The mean size of resection was 25 mm (range, 20-30 mm). The modification improved the mobility of the upper chondrocutaneous flap, eliminating the need to resect the scapha. All wounds healed uneventfully, with no skin necrosis. The morphologic outcome was satisfactory or very satisfactory in all patients, preserving the shape, height, and width of the ear. CONCLUSIONS: Our modification changes the upper flap from an advancement flap to a transposition flap, enhancing its mobility and preempting the resection of the scapha. Thus, anatomic landmarks, aesthetic subunits of the pinna, and ear height are maintained for highly satisfactory morphologic results. LEVEL OF EVIDENCE: 4.


Subject(s)
Carcinoma, Basal Cell/surgery , Carcinoma, Squamous Cell/surgery , Cartilage/surgery , Dermatologic Surgical Procedures/methods , Ear Auricle/surgery , Ear Neoplasms/surgery , Surgical Flaps , Adult , Aged , Aged, 80 and over , Ambulatory Care , Anesthesia, Local , Humans , Male , Middle Aged , Operative Time , Retrospective Studies
7.
JAMA Facial Plast Surg ; 15(6): 428-33, 2013.
Article in English | MEDLINE | ID: mdl-23989114

ABSTRACT

IMPORTANCE: Otoplasty procedures usually involve cartilage sparing, with stitches or cartilage scoring. These techniques have been widely reviewed in the literature. The technique reported in this study requires neither stitches nor rasping but rather a complete separation of the helix and antihelix, with nontransfixing incisions to break the cartilaginous springs. OBJECTIVES: To evaluate the technical details, aesthetic results, and complications in a series of otoplasty procedures involving cartilage splitting without stitches. DESIGN, SETTING, AND PARTICIPANTS: We conducted a retrospective review of patients who underwent otoplasty procedures between January 2004 and September 2010, by the same senior surgeon. MAIN OUTCOMES AND MEASURES: File data on complications, recurrences, and revision rates were collected. An aesthetic evaluation of the postoperative results was conducted by a panel of 3 plastic surgeons and 3 lay observers. RESULTS: Our series included 58 patients, with a mean age of 16 years. No recurrences were reported. Six patients (10%) experienced minor complications. No revisions were needed. No chondritis or skin necrosis was noted. The aesthetic results were very good for 36 patients (62%) by the plastic surgeons and 39 patients (68%) by lay observers. The remaining aesthetic results were judged as good. CONCLUSIONS AND RELEVANCE: The Jost otoplasty procedure described herein requires no nonabsorbable sutures to bend the cartilage, avoiding many complications. The technique is safe, reliable, and reproducible, with predictable and permanent outcomes. It is also useful for secondary otoplasty after failed Stenström or Mustarde otoplasty. LEVEL OF EVIDENCE: 4.


Subject(s)
Cosmetic Techniques , Ear Cartilage/surgery , Adolescent , Adult , Child , Esthetics , Female , Follow-Up Studies , Humans , Male , Middle Aged , Outcome Assessment, Health Care , Patient Satisfaction/statistics & numerical data , Postoperative Complications , Retrospective Studies , Young Adult
8.
Plast Reconstr Surg ; 121(4): 1240-1248, 2008 Apr.
Article in English | MEDLINE | ID: mdl-18349642

ABSTRACT

BACKGROUND: The management of severe postpregnancy musculoaponeurotic laxity remains a challenge for plastic and reconstructive surgeons. Several techniques have been proposed, but there is no consensus on the best treatment. The authors report the validity of their abdominoplasty method. METHODS: From May of 1995 to May of 2006, a retrospective chart review was conducted on 52 women who underwent the authors' abdominoplasty technique. The average age was 39 years (range, 25 to 60 years). They had an average of 3.2 children (range, two to six). The average preoperative body mass index was 23.5 (range, 20 to 31.5). None of the patients included had preexisting medical conditions. The posterior rectus fascia was released and plicated at the midline. A resorbable mesh was used to reinforce the plication and to reduce the tension of the traction. RESULTS: Follow-up ranged from 6 months to 11 years, with an average of 54 months. Complications included a bladder injury in one patient during posterior fascia release and epigastric bulging in one woman immediately after extubation. The local complications were seromas in two patients, skin flap necrosis in one smoking patient, and umbilical necrosis in one patient. Four patients required minor scar revision and liposuction under local anesthesia. There were no cases of systemic complications. No incidence of infection, dehiscence, or extrusion of the mesh was noted. All patients were completely satisfied. CONCLUSION: The release and plication of the posterior rectus sheath associated with the use of submuscular resorbable mesh is a long-lasting and reliable procedure in multiparous women with severe myoaponeurotic laxity.


Subject(s)
Abdomen/surgery , Muscular Diseases/surgery , Plastic Surgery Procedures/methods , Surgical Mesh , Adult , Biocompatible Materials , Female , Humans , Middle Aged , Pregnancy , Retrospective Studies , Severity of Illness Index , Time Factors
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