[Reconstruction of lip isocele]. / Reconstruction isocèle des lèvres.

The surgical treatment of labial carcinoma must allow the complete excision of the tumor. This must be performed by using an immediate reconstruction procedure with respect of the lip function and with a satisfying aesthetic result. To achieve this goal, we choose the isosceles lip reconstruction, according with Meyer's advancement flap technique, described in 1965. By using this method we can restore up to the 2/3 of the lower or upper lip and also the lip commissure, after malignant tumor surgery. For total lip reconstruction, we have to combine this method with an Abbe-Estlander flap. Our paper presents this original lip reconstruction technique and analyses the results obtained. We especially base our conclusions on functional tests, but also on aesthetical considerations. We underline the interest of this choice of surgical procedure, permitting its adaptation to all cases of lip reconstruction, with immediate possibility of reconstruction, usually in one stage, without compromising either the function or the aesthetic aspect of the reconstructed lip.

Optic- and computer-aided surgery.

Optic- and computer-aided surgery is a new, original tool for the diagnosis of dismorphies, both in its conception (digitalization of a Moiré pattern on the body) and in its applications (predominantly surgical, for legal medicine and didactic purposes). By means of this three-dimensional (3D) method of measurement by digitalized Moiré, the forms of the body in general and those of the face in particular can be studied and quantified with a high degree of accuracy. This precision in the geometrical analysis of its forms is achieved by combining the latest developments in optics and computer technology. This article presents the current state of the authors' research in the 3D synthesis and manipulation of the human image.

[Conservative otoplastic modelling: early operative indication]. / Modelage otoplastique conservateur: précocité de l'indication opératoire.

The authors presents their philosophy and their experience in the field of otoplasty in young children. The modelling and conservative characteristic of the surgical procedure, used for over 6 years, allows surgery on children as young as 3 years old. They detail the different operative steps underlining the rarity of the complications, the natural results achieved and the stability of these results with the child growth.

[OCAS (Optic and computer aided surgery)]. / OCAS (Optic and computer aided surgery).

OCAS is a new, original tool for the diagnosis of dismorphies, both in its conception (digitalisation of a moiré pattern on the body) and in its applications (predominantly surgical, for legal medicine and didactic purposes). By means of this new 3D method of measurement by digitalised moiré, the forms of the body in general, and those of the face in particular, can be studied and quantified with a high degree of accuracy. This precision in the geometrical analysis of its forms is achieved by combining the very latest developments in optics and computer technology. The authors present the current state of their research in the 3D synthesis and manipulation of the human image.

[Peribuccal esthetic surgery]. / Chirurgie esthétique péribuccale.

This paper concerns the procedures of remodelling the peribuccal area for aesthetic purposes; these techniques may be planned in isolation or as a complement to a face-lift. In our hands these interventions are helpful firstly to correct and excessively deep nasolabial fold and sublabial crease using dermis or fascia grafts. Secondly, are designed to correct the contour of the upper lip either by smoothening the fine vertical folds, excising a fine strip of skin along the cupid's bow associated with dermabrasion or by diminishing the labial height resecting a buffalo-horn shaped cutaneous strip at the nasal vestibular sill and at the base of the columella. The philtrum is sculptured by dissecting the philtral columns. The medial philtral depression is maintained using translabial mattress sutures. Furthermore the upper and lower lips themselves are able to be augmented by means of dermal or fascia grafts or on the contrary thinned by resecting an appropriate horizontal strip of vermilion or mucous membrane, without any lesion of the orbicularis muscle. To eliminate the sadness of sagging buccal angles, we model the subcutaneous tissue of the labial commissure.

[Alar and columellar refinement in rhinoplasty]. / Finition alaire et columellaire dans la rhinoplastie.

This paper emphasizes the value of surgical techniques of nasal sculpturing with special attention to the structural details in primary and secondary rhinoplasty to achieve a perfect aesthetic as well as functional result. The marginal resection of the alae and the columella allows the appropriate reduction adapting the nostril contour to the new proportions of the nose at the end of a rhinoplasty or to equalize the height of the alar rim in cases of harelip nose. In order to perfect the nasal contour, we also introduce cartilaginous onlays into the anterior part of the columella emphasizing the lobulo-columellar double-angle in a harmonious profile. In case of moderate fibrocicatricial retraction of the alar border, a vestibular advancement flap is dissected through the inter-cartilaginous incision and a thin cartilage graft fills the loss of tissue as a spacer. It is then held in place using transalar mattress sutures. Important losses of alar tissue necessitating composite graft are not especially considered in the paper which essentially concerns refinement procedures. The finesse of the latter seems to be indispensable to adapt the alar-tip-columellar complex to the bony structures of the nose and to ensure the harmonious equilibrium of the rhinoplasty.

The solution in functional rehabilitation after destruction of the larynx: the tracheostoma closed.

A bayonet-shaped airway allowing free respiration and undisturbed deglutition was reconstructed in 2 young women who had undergone tracheotomy and radiotherapy for thyroid carcinoma. The laryngeal vestibule, glottis, and subglottis had been destroyed, and the air passages were closed. An external gutter and an anterior tracheal wall were created in a multistage procedure. In 1 patient, the hypopharynx and upper esophageal segment were reconstructed with bilateral pectoralis major musculocutaneous flaps, which disfigured the breast. The two displaced nipple-areola complexes were properly repositioned using skin expanders and island flap transfer, and the breast was remodeled with prostheses. Our results suggest that this method of laryngotracheal reconstruction may also be applied in laryngectomized patients in whom only part of the epiglottis and the aryepiglottic folds remain. Although the procedure is lengthy and difficult, it is recommended for extensive lesions in fully cooperative patients.

[Intubation or tracheotomy in severe subglottic laryngitis]. / Intubation ou trachéotomie dans les laryngites sous-glottiques sévères.

A retrospective study to assess safety of nasotracheal intubation for subglottic laryngitis in children was conducted in 44 cases treated in the Intensive Care Unit of Hôpital Bretonneau, France between 1971 and 1981. Intubation had been performed in 40 children, and immediate tracheotomy in the other 4. The course of the affection was favorable in 37 (92,5%) of intubated children, secondary tracheotomy being necessary in only 3 cases. A mean duration of 84 hours of intubation was sufficient in 24 children, a total mean duration of 180 hours being required in the 13 other cases. The catheter employed in the 3 tracheotomized children with morbilous laryngitis was too large, and laryngeal stenosis developed in 2 of them. These findings demonstrate that when a catheter of correct size (1/2 size below that indicated by the weight and age of the child) is employed, nasotracheal intubation for severe subglottic laryngitis is a safe procedure.