The first wave of COVID-19 did not cause longer wait times in head and neck cancer. Experience of a French expert center.

BACKGROUND: Head and neck cancers (HNC) have poor survival prognosis, as tumors are often diagnosed at advanced stages in patients consulting late. The first lockdown linked to the 1st wave of COVID-19 (Coronavirus Disease 2019) disrupted consultation schedules in France. OBJECTIVE: The principal aim of the present study was to analyze consultation wait time in HNC during and after lockdown, in our university expert oncology reference center, to disclose any increase in treatment wait time. METHODS: A single-center retrospective study included patients with a first diagnosis of HNC. Three groups were distinguished: "lockdown", "post-lockdown", and a "control" group (corresponding to a reference period 1 year earlier). Intervals between first oncologic consultation and multidisciplinary tumor board (FC-MTB) and between MTB and first treatment (MTB-T) were assessed. RESULTS: One hundred and seven patients were included in the control group, 60 in the lockdown group and 74 in the post-lockdown group. There was no increase in median FC-MTB interval (respectively 35, 29 and 28 days) between the lockdown and post-lockdown groups compared to the control group (respectively P=0.2298 and P=0.0153). Likewise, there was no increase in MTB-T interval (27, 20 and 26 days respectively) (P=0.4203). CONCLUSION: No increase in wait times was observed during the lockdown and post-lockdown periods in our center.

Significant decrease of facial cellulitis admissions during COVID-19 lockdown in France: A multicentric comparative study.

During the 2020 coronavirus pandemic, a lockdown was imposed in France during the first wave. An apparent decrease in incidence of cellulitis of odontogenic origin was noticed then. This study aimed to compare the incidence of cellulitis during this extraordinary period with the same period in 2018 and 2019, based on retrospective multicentric data. All maxillofacial surgery departments in French public hospitals were contacted. Responders were asked to include all patients admitted for the surgical drainage of a head and neck abscess of odontogenic origin during the first 2020 lockdown period, and in a similar time frame in 2018 and 2019 (control group), based on screening the French diagnostic and therapeutic classification of medical acts. We report a 44% significant nationwide decrease in the incidence of admissions for cellulitis. There were 187 patients in 2020 for 334 and 333 patients in 2018/2019 respectively. The reasons to explain this finding are hypothetical (organizational reasons leading to earlier management, patients' fear to seek for medical management, usual excess in surgical indications or concomitant decrease of non-steroidal anti-inflammatory drugs delivery). Whatever the explanation, it would be of great interest to find it out in order to improve the prevention of cellulitis.

Staged autogenous calvarial bone grafting and dental implants placement in the management of oligodontia: a retrospective study of 20 patients over a 12-year period.

Oligodontia demands multidisciplinary management due to its repercussions on dentofacial growth. To place implants to realize implant-borne fixed denture, preimplant surgery may be necessary if bone volumes are insufficient. Our aim was to assess bone increase following autogenic bone grafting and to discuss prosthetic options. Twenty patients followed for oligodontia, who underwent bone grafting, were treated from 2008 to 2019. Transversal and vertical bone levels were measured pre- and postoperatively to assess alveolar ridge augmentation. Mean horizontal grafting increase was 4.60 mm [standard deviation (SD) 0.79 mm], mean sinus lift increase was 9.95 mm (SD 2.35 mm). Mean implants placed per patient was 9, mean implants placed on grafted site was 5 per patient. Overall implant survival rate was 100%. All patients benefited from prosthetic procedures when it was planned to perform implant-borne fixed dentures. Within the framework of a complete treatment plan (involving paediatric dentistry, dentofacial orthopaedics, oral and maxillofacial surgery, and prosthodontics), autologous bone grafting combined or not with orthognathic surgery is fully adapted to patients with oligodontia. It allows reconstruction of favourable bone volumes for placement of implants to realize implant-borne fixed dentures, with high implant survival rates and great improvements to quality of life.

Match between therapeutic proposal in multidisciplinary tumor board and actual treatment in head and neck cancer.

OBJECTIVES: There are few published studies evaluating the quality and outcome of multidisciplinary tumor board (MDTB) decisions. The aim of the present study was to evaluate adherence to MDTB recommendations in head and neck cancer and to document reasons in case of discordance. MATERIAL AND METHODS: We included all patients with newly diagnosed head and neck cancer presented in our MDTB meetings between January 1st and December 31st, 2018, whatever the tumor site, histology type and TNM classification. MDTB recommendations were compared to actual treatment. Discordance was defined as treatment partially or entirely different from the treatment decision recorded in the MDTB minutes. RESULTS: Board decisions were made for 344 new patients. Complete treatment concordance rate was 91.6% (315/344 patients), with deviation in 29 patients. Reasons for deviation were complications of treatment in 10 cases, patient refusal in 8, and physician's decision in 4 cases. Five patients died before therapy initiation. Mean interval from board discussion to treatment was 21 days, and depended on type of treatment (range, 1 to 74 days). CONCLUSION: This study shows the importance of evaluating concordance between the protocol proposed in the MDTB and the treatment actually received, to identify factors for deviation and remedy them when possible.

TMJ related short-term outcomes comparing two different osteosynthesis techniques for bilateral sagittal split osteotomy.

OBJECTIVES: Bilateral sagittal split osteotomy (BSSO) is a morpho-functional surgery and post-surgical osteosynthesis may influence temporomandibular joint (TMJ) health. Our objective was to evaluate temporomandibular disorders (TMD) and TMJ symptoms after orthognathic surgery according to the type of osteosynthesis used in a population of patients with dentofacial deformities. MATERIALS AND METHODS: One hundred and eighty-three consecutive patients undergoing orthodontic and maxillofacial surgery treatment for correction of their malocclusion were recruited for a two-year period at Lille University Hospital. All patients had at least a mandibular BSSO using Epker's technique. Each patient was examined before and one year after orthognathic surgery. We compared osteosynthesis by miniplates fixed with monocortical screws (n=42) and the hybrid fixation with bicortical retro-molar screws used with miniplates (n=141). TMJ health was assessed by monitoring TMD signs and symptoms according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) and scores obtained from the "Jaw Pain Function" questionnaire. RESULTS: There was no significant difference in pre-operative and one year post-operative RDC/TMD assessments (p≥0.91) or JPF score (p≥0.29) between the two types of osteosynthesis. CONCLUSION: There was no difference in TMJ health between the two techniques of osteosynthesis after BSSO. CLINICAL RELEVANCE: In our experience the hybrid technique fixation affords many advantages and does not influence postoperative TMD compared with osteosynthesis by miniplates.

[3D-assisted mandibular reconstruction: A technical note of fibula free flap with preshaped titanium plate]. / Reconstruction mandibulaire par lambeau fibulaire : note technique de pré-conformation de plaques d'ostéosynthèse assistée en 3D.

The purpose of this technical note is to illustrate a simple and economical preoperative method for preshaping a reconstructive titanium plate in a fibula free flap (FFF) by using 3D printing of a virtually reconstructed mandible haptic model. The whole process consisted in creating a 3D model of the patient's mandible based on a CT-scan using a combination of free software (3Dslicer and ITK-snap), and simulating the surgical osteotomies and reconstruction, and print it as a guide for bending a reconstruction titanium plate. Reconstruction is performed using virtual cubes (1 to 3 cubes, according the number of FFF osteotomies). This virtual lab work is performed using 3D Builder® (Microsoft, Redmond) software. This technique allows obtaining an optimal plate application on the bony fragments. It facilitates reconstructive surgery with good functional (putting the patient back in an optimal dental occlusion based on the native maxilla) and aesthetic results. This technical note presents a simple and economical preoperative fabrication of a reconstructive plate through freeware and a low-cost 3D printer accessible to all surgeons.

Temporomandibular disorders in head and neck cancers: Overview of specific mechanisms and management.

Diagnosis classification system of Temporomandibular disorders (TMD) is based on the biopsychosocial model of pain. The pathogenesis is poorly understood, leading to difficulties in treating these multifactorial conditions. The predisposing factors are pathophysiological, psychological or structural processes that alter the masticatory system and lead to an increase in the risk of development of TMD. The purpose of this integrative review was then to point out the specific mechanisms of TMD in the oral oncologic context to optimize the TMJ functional results in the management of patients with oral oncologic conditions. We explored in this paper the role of Axis II assessment of the biopsychosocial model of pain, the involvement of mechanical concepts such as dental occlusion, mandibular condyle positioning and related-structures reconstruction, and the stomatognathic changes induced by radiation.

Temporomandibular Joint Ankylosis Following Mandibular Distraction Osteogenesis: A Dreadful Complication.

INTRODUCTION: Mandibular distraction osteogenesis (MDO) is an effective treatment for severe micrognathia, as it helps to avoid tracheostomy but has some adverse effects on the temporomandibular joint (TMJ). TMJ ankylosis is a serious condition leading to feeding difficulties and growth impairment, and could result in worse consequences in cases with micrognathia who already have limited growth potential. Here, we aimed to report on cases with TMJ ankylosis-a rare but devastating complication of MDO. In total, we described 3 syndromic cases with TMJ ankylosis that developed after MDO and reviewed the associated literature. MATERIAL AND METHODS: We retrospectively enrolled 3 patients who presented with TMJ ankylosis following MDO at the Oral and Maxillofacial Surgery Department of the University Hospital of Lille, France. RESULTS: All 3 patients had craniofacial syndrome with micrognathia. MDO was performed at least twice in each case, and the 3 patients developed subsequent TMJ ankylosis. They all presented with TMJ ankylosis and micrognathia in our Department. DISCUSSION: MDO leads to a certain amount of stress on the TMJ, and in cases with congenital TMJ deformation, such stress could lead to TMJ ankylosis. To our knowledge, 12 cases of TMJ ankylosis after MDO have been described in studies involving 309 patients while it is not reported in other publications. They were all syndromic patients. Thus, TMJ health should be carefully monitored during and after MDO to avoid TMJ ankylosis, and alternative treatments such as costochondral grafts should be considered.

Twenty-four years of experience in management of complex mandibular fractures with low cost, custom-made mandibular external fixation: A 65-patient series.

INTRODUCTION: Ginestet introduced the first external device used to fix the mandible in 1936. In 1949, Morris introduced a biphasic fixation device. This "Joe Hall Morris fixation" design led to use of a self-crafted external fixator based on pins connected by a breathing tube filled with dental resin. The objective of this study was to present our surgical results with this device through a 65-patient series. METHODS: This retrospective study included all the patients who benefited from the self-crafted mandibular external fixator at our Oral and Maxillofacial department from 1995 to 2019. Sixty-five patients were allocated into two groups. There were 39 patients in the temporary stabilisation (TS) group and 26 in the bone healing (BH) group. Functional criteria were investigated, including mouth opening limitations and occlusal abnormalities. Aesthetic evaluation focused on skin healing, evaluated by both surgeon and patient. RESULTS: Twenty-three patients exhibited spontaneous bone healing during their immobilisation period and two patients developed a pseudoarthrosis in the BH group. Most TS group patients benefited from secondary management by bone graft, bone free flap, or distraction osteogenesis. Few complications were noted with our technique during the study period. CONCLUSION: Our self-crafted external fixation with Joe Hall Morris fixation style is a valuable option for external stabilisation of the lower third of the face.

A modified method for a customized harvest of fibula free flap in maxillofacial reconstruction.

Mandibular reconstruction using computer-aided design/computer-aided manufacturing cutting guides is currently a common procedure. However, inaccurate positioning of the cutting guide onto the fibular bone may result in osteosynthesis difficulties or imprecision in the reconstruction. A novel way to improve the stability of the cutting guides may be to add pillars in order for them to be suspended from the fibula, avoiding soft tissues interactions. We present the case of a 39-year-old male who needed mandibular reconstruction after a self-inflicted ballistic injury. We designed a customized cutting guide which included a set of 8 pillars allowing a suspension of the cutting guide 8 millimeters above the bone level. The pillars were perpendicular to one another, and allowed the operator to screw the cutting guide to the bone. The orthogonal position of the pillars enabled real stability during the osteotomies. In the operator experience, the length of the pillars was too important, and led to incomplete osteotomies, and the whole device was too bulky. However, with adaptations in the size of the pillars and the size of the whole device, this solution could be useful in cutting guide design to avoid impairments due to the soft tissues surrounding the fibula.

A simple, no-cost method for 3D printed model identification.

3D printed models are often very similar in shape and can be inadvertently switched if the related patient is not identified correctly. Here, we present a free and simple method to imprint letters and numbers in a 3D model. CT scan data were used to create an STL file of a patient's mandible. We then used Blender software to modify it with numbers and letters. We chose to imprint a series of four letters and numbers on our 3D models. We chose representative letters and numbers of the Latin alphabet. Six models were printed with an Up plus 2 - easy 120 3D printer with different character sizes and shape to evaluate the readability. All models were printed without any failures. Regarding readability, 2 mistakes were made among ten readers. The favourite extrusion depth was 3 mm, and the largest model was preferred. Identification can be done at different times and by different means, but identifying the 3D model during its creation is safer. Moreover these identified 3D models could be saved in the digital patient medical file. The identification location should take into consideration the future indication of the 3D printed medical model. We recommend that 3D identification should be done using at least 7.5mm high, with a depth of 3mm. Our method allows easy, fast and free 3D text. This 3D text identification printing method may be a first step towards the legal use of 3D printed models made within the hospital.

Improvement in quality of life after botulinum toxin injection for temporomandibular disorder.

BACKGROUND: Temporomandibular disorders (TMDs) cause chronic pain and interfere with quality of life (QoL). Botulinum toxin is one of the treatment modalities popularly used for TMDs. The primary objective of this retrospective study was to evaluate improvement in QoL after botulinum toxin injections in patients with TMD. METHODS: Twenty-eight patients diagnosed with TMD were included in this study. In accordance with the Research Diagnostic Criteria for Temporomandibular Disorders, all patients had myofascial pain. They received botulinum toxin A (BTX-A) injections in temporalis and masseter muscles. QoL was measured using a French translated version of the validated Oral Health Impact Profile-14 (OHIP-14) and a second questionnaire, which was an adaptation of the temporomandibular joint replacement QoL questionnaire (TMJ-QoL). Patients answered both questionnaires and a visual analogue scale (VAS) before the injection, at 1 month after the injection and at 3 months after the injection. Relationship between QoL and factors such as bruxism, age, sex and body mass index (BMI) were also evaluated. RESULTS: All patients reported significant improvements in QoL (OHIP-14 and TMJ-QoL) and VAS Scores at 1 and 3 months after BTX-A injections (P < 0.0001). A significant moderate positive correlation was noted between TMJ-QoL before BTX-A injections and BMI (P = 0.016). CONCLUSION: Overall, QoL in patients with TMD improved significantly at 1 and 3 months after BTX-A injections. BTX-A injection in masticatory muscles of patients with TMD can be a useful supportive therapy to control pain and improve QoL.

Sialolithiasis removal under general anesthesia: A descriptive retrospective study in the maxillofacial surgery department in Lille University Hospital.

INTRODUCTION: Since the beginning of the use of sialendoscopy and extracorporeal lithotripsy, recommendations have changed. The purpose of this retrospective study was to evaluate the efficiency of our treatment protocol, without a lithotripter, under general anaesthesia in the Stomatology and Maxillofacial Surgery Department of Lille University Hospital. The secondary goals were to evaluate patient tolerance and satisfaction. MATERIALS AND METHODS: All patients treated with sialendoscopy alone, sialendoscopy with a combined surgical approach or a transoral approach (TOA) (sialolithotomy) between January 2013 and December 2015 were included. Efficiency was judged by the number and size of the extracted calculi compared to those found on the preoperative CTS, the symptoms mentioned during the one month postoperative examination and the recurrence within 6 months (telephone follow-up). Success was attained when the calculus was completely eliminated and the patient was symptom free after one month and without recurrence through six months. On the other hand, failure was attained when the calculus could not be completely removed, there was remaining debris, the patient was still symptomatic after one month or if there was a recurrence before six months. RESULTS: The sialendoscopy success rate was 78.57% for the submandibular gland and 92.3% for the parotid gland. We had a 100% success rate with the combined approach for the parotid gland, we had a 96.7% success rate with TOA and we had a 100% success rate with TOA assisted with sialendoscopy. CONCLUSION: Our results conform with the literature and prompt us to suggest a protocol without a lithotripter.

Three-dimensional printed haptic model from a prenatal surface-rendered oropalatal sonographic view: a new tool in the surgical planning of cleft lip/palate.

Three-dimensional (3D) ultrasound has significantly improved prenatal screening and perinatal care in the area of cleft lip/palate and other deformities, providing essential preoperative information to the surgical team. However, current 3D reconstruction modalities are limited primarily to display on a two-dimensional surface. In contrast, a 3D printed haptic model allows both the surgeon and the parents to develop a better understanding of the anatomy and the surgical procedure through the ability to interact directly with the printed model. The production of a 3D printed haptic model of cleft lip and palate obtained from a surface-rendered oropalatal sonographic view is presented here. The development of this 3D printed haptic model will allow the surgical team to perform preoperative planning with a highly accurate medical model, and it therefore represents a new tool in the management of cleft lip/palate. It also provides better prenatal information for the parents.

Spasmodic torticollis after orthognathic surgery.

The treatment of malocclusions can involve orthognathic surgery. Although orthognathic surgery is a safe surgical procedure, low incidences of many complications have been reported such as infections, hemorrhage, nerve injuries, temporomandibular disorders (TMDs), and psychological problems. There are no reports in the literature of orthognathic surgery being associated with postural disorders although the link between dental occlusion and postural disorders is highlighted in numerous recent publications. This report describes the case of a young, healthy patient who presented with sustained spasmodic torticollis following orthognathic surgery. In addition, the physiopathological aspects of this atypical condition are discussed.

How to produce pre-shaped rigid arch bars using low-cost 3D printing technology - A technical note.

Numerous oral and maxillofacial procedures in dentate patients begin with the fixation of occlusions. While several techniques exist to perform mandibulo-maxillary fixation, many surgeons use arch bars in common practice. In cases of severe craniofacial traumas or jaw malformations, such as temporomandibular joint ankylosis, it may be impossible to use rigid arch bars. This technical note reports on the development of a technique to produce pre-shaped rigid arch bars using 3D printing technology. We take the case of a patient who presents Le Fort 1, Le Fort 2 and Le Fort 3 fractures as well as a central palatine disjunction, an angular mandibular fracture and bilateral zygomatic fractures. We specify the indications and limitations of this technique.