[Tibial bone harvesting technique for filling maxillary bone gaps in implantology]. / Prélèvement osseux tibial pour comblement osseux maxillaire en implantologie.

We present an easy and quick technique of tibial bone grafting that can be used in maxillary bone losses, specially in implantology. The surgical technique is performed under general anaesthesia. A 1.5 cm skin incision is made on the anteromedial side of the tibia. Then the bone marrow can be approached through a cortical window drilled with a motorized trephine. At this stage, a disposable bone aspirator is used to collect the cancellous bone. At the end of the procedure, the periosteum, the subcutaneous tissues and the skin are sutured in three layers. The quantity of harvested cancellous bone varies from 18 to 30 cc. The procedure duration is about twenty minutes. The complication rate is low and the patients are able to walk a few hours after the procedure. They leave the hospital on the day after. Tibial bone harvesting is an alternative technique that can be chosen in cases with large bone defects. This tibial graft can be recommended because of its low morbidity, the quality of the bone and the short time duration of the procedure. Some details must be pointed out. A medial tibial surgical approach is for us better than a lateral approach because of its lower morbidity and because the bone is more superficial. The use of a motorized trephine is important to lift precisely the cortical bone window and because it is less traumatic than the hand trephine. The disposable bone aspirator is an excellent option to pick-up bone marrow with a minimum loss of bone material and in a shorter time.

Nasal cocaine abuse and centrofacial destructive process: report of three cases including treatment.

We report 3 new cases of a centrofacial destructive process associated with chronic nasal abuse of cocaine. This complex first described in 1988 is a rare entity involving sinonasal tract necrosis after cocaine abuse. Of special interest in this report is a male patient with columella and lip involvement instead of the more usual rhinopalatal destruction. This cocaine abuse complex should be included in the differential diagnosis of centrofacial midline destructive processes in young patients as the first diagnostic possibility. We suggest a management strategy for these patients.

Survival evaluation of treatment modality in squamous cell carcinoma of the oral cavity and oropharynx.

The treatment of squamous cell carcinoma of the mouth and oropharynx continues to change. In this primary report, we compared the results obtained by combined surgery and radiation therapy, or either modality alone. Other methods such as brachytherapy, or hyperfractionated radiotherapy, were not included in our protocols. A statistical analysis of the 3- and 5-year survival rates in relation to location and size of the primary tumour, stage at initial presentation, treatment modality and recurrence, was carried out in 88 patients with squamous cell carcinoma of the oral cavity or oropharynx. The overall survival rate was 73.8% at 3 years and 66.3% at 5 years. Size of tumour and stage at presentation were significant when P value was adjusted by site. Survival was significantly associated with type of treatment (combined approach obtained superior results), location of primary tumour, and recurrence. The type of neck dissection did not show any effect. Therapeutic modality used, stage, and location of primary tumour significantly influenced survival. A more selective combined initial treatment according to site and stage (distribution) is recommended.

[Oral, mandibular and oropharyngeal reconstruction with a pedicled trapezius flap]. / Reconstruction orale, mandibulaire et de l'oropharynx avec le lambeau pédiculé de trapezius.

Reconstruction of large defects of the oral cavity (with or without jaw defects) and the oropharynx is one of the most important challenges in reconstructive maxillofacial surgery. Many reconstruction techniques have been proposed although none has provided total satisfaction. For each patient, accurate evaluation is required to choose the optimal solution. In this study, we reviewed our indications and results with the trapezius flap (with or without spina scapulae for lower jaw reconstruction). We review suggested indications, the technique we applied and results obtained over the past five years after an initial experience of fifteen years. The advantages and disadvantages of this technique are evaluated an indications suggested.

Parotidectomy technique in the treatment of parotid tumours (an analysis of 70 cases).

A study of seventy different cases of parotid tumours, using subtotal as opposed to total parotidectomy in the treatment of benign tumours. In malignant tumours total parotidectomy was used, together with postoperative radiotherapy, as a standard procedure. The accurate meaning of subtotal parotidectomy is defined, comparing its indications as opposed to total parotidectomy. Preoperative biopsy is performed as a diagnostic procedure, and as a reference for the surgical decision. A new dissecting retractor is presented.