Maxillomandibular advancement as the initial treatment of obstructive sleep apnoea: Is the mandibular occlusal plane the key?

Maxillomandibular advancement (MMA) can be effective for managing obstructive sleep apnoea (OSA); however, limited information is available on the predictor surgical variables. This study investigated whether normalization of the mandibular occlusal plane (MOP) was a determinant factor in curing OSA. Patients with moderate or severe OSA who underwent MMA were evaluated by preoperative and postoperative three-dimensional (3D) scans and polysomnograms. The postoperative value of MOP and the magnitude of skeletal advancement were the predictor variables; change in the apnoea-hypopnoea index (AHI) was the main outcome variable. Thirty-four subjects with a mean age of 41±14years and 58,8% female were analysed. The Epworth Sleepiness Scale (ESS) was 17.4±5.4 and AHI was 38.3±10.7 per hour before surgery. Postoperative AHI was 6.5±4.3 per hour (P<0.001) with 52.94% of the patients considered as cured, and 47.06% suffering from a mild residual OSA with ESS 0.8±1.4 (P<0.001). 3D changes revealed a volume increase of 106.3±38.8%. The mandible was advanced 10.4±3.9mm and maxilla 4.9±3.2mm. MOP postoperative value was concluded to be the best predictor variable. Treatment planning should include MOP normalization and a mandibular advancement between 6 and 10mm. The maxillary advancement would depend on the desired aesthetic changes and final occlusion.

[Current evaluation of a self-snapping screw system in traumatologic and orthodontic surgery]. / Bilan actuel du vissage auto-cassant en chirurgie traumatologique et orthognathique.

Since the first description in 1970, by F. X. Michelet, of the use of the mini plate system in maxillo-facial surgery, if the fundamental principles remain the same, the equipment has been constantly improved. The plates have been modified in structure and shape, the screws becoming self-tapping and self-drilling and finally self-breaking. The head of the screw has diminished to the point of not going over the level of the plate. The ancillary material is now more performing and easier to use. The authors have presented 3 years ago a new self breaking screw of which they now explain the technical and biomechanical bases, the necessities and the indications insisting on the numerous advantages of this system.

[The value of a previously expanded musculo-cutaneous flap of the lower eyelid for the reconstruction of a full thickness loss of tissue substance of the upper eyelid]. / Intérêt d'un lambeau musculo-cutané de paupière inférieure préalablement expansé pour la reconstruction d'une perte de substance de pleine épaisseur de la paupière supérieure.

The authors report a new technique for the reconstruction of upper eyelid full thickness tissue losses in preserving the inferior edge. They describe a myo-cutaneous inferior eyelid flap which has been preliminarily expanded before transposition. An anatomical study has demonstrated vascularization and innervation of the myo-cutaneous eyelid flap which will remain active. A clinical case presentation confirms a good aesthetic but also functional result with a transferred active orbicularis muscle which allows the regain of a dynamic upper eyelid.

[Barraquer-Simons syndrome and facial lipo-filling. Apropos of a case]. / Syndrome de Barraquer-Simons et lipofilling facial. A propos d'un cas.

Authors present a Barraquer-Simons syndrome case. After a quick historical account, they look at the study of the clinical case. They present the different treatments undertaken in order to correct the two different types of anomaly of this syndrome: these are complementary treatments because they consist in taking the fat in excess in the lower half of the body and reinject it in the face. The different etiopathogenic hypothesis are tackled. To conclude, authors insist on the excellent result obtained after a lipo-aspiration: but they notice a near disappearance of the reinjected fat at the face after 4 years. Anyway, lipo-filling can be renewed without risks for the patient and can be an interesting palliative solution.