Strip pharyngoplasty as a secondary functional surgery for persistent velopharyngeal insufficiency in cleft palate.

Despite a satisfactory primary repair, velopharyngeal insufficiency (VPI) may be a sequel of soft palate clefts, resulting in hypernasality and phonation disorders. In order to increase the function of the pharyngeal flap during a secondary pharyngoplasty, we have developed a strip pharyngoplasty technique involving the middle constrictor muscle of the pharynx. This article describes the successive steps of the intervention and discuss its indications, advantages and limitations. Strip pharyngoplasty as a secondary functional surgery for persistent VPI after primary cleft palate repair is an attractive surgical procedure, particularly adapted to cases with defective muscle contraction by providing a muscle contingent in addition to the mucosal flap.

Surgical treatment outcomes of solitary fibrous tumors in the head and neck: A retrospective study.

The aim of this study was to better characterize head and neck solitary fibrous tumors (SFTs) and to evaluate surgical treatment. This retrospective study included patients who presented with head and neck SFTs. Clinical, radiological, and histological information and data regarding the treatments performed were collected. The risk of locoregional and distant metastases was calculated, and for orbital SFTs a specific classification was used. Overall, 34 patients were included. The majority of the SFTs were found in the oral cavity (n = 10), followed by the neck region (n = 8). The mean time to recurrence was 67.4 months. All patients underwent primary surgical resection. Recurrence was observed in five patients with a low risk of locoregional recurrence and distant metastasis. The treatment of choice is complete resection. Recurrence seems to be highly correlated with positive surgical margins. The safety margin should be increased when removing the lesion, and long-term follow-up should be performed.

Efficacy of Intra-Articular Injection of Botulinum Toxin Type A (IncobotulinumtoxinA) in Temporomandibular Joint Osteoarthritis: A Three-Arm Controlled Trial in Rats.

Temporomandibular disorders (TMD) are complex pathologies responsible for chronic orofacial pain. Intramuscular injection of botulinum toxin A (BoNT/A) has shown effectiveness in knee and shoulder osteoarthritis, as well as in some TMDs such as masticatory myofascial pain, but its use remains controversial. This study aimed to evaluate the effect of intra-articular BoNT/A injection in an animal model of temporomandibular joint osteoarthritis. A rat model of temporomandibular osteoarthritis was used to compare the effects of intra-articular injection of BoNT/A, placebo (saline), and hyaluronic acid (HA). Efficacy was compared by pain assessment (head withdrawal test), histological analysis, and imaging performed in each group at different time points until day 30. Compared with the rats receiving placebo, those receiving intra-articular BoNT/A and HA had a significant decrease in pain at day 14. The analgesic effect of BoNT/A was evident as early as day 7, and lasted until day 21. Histological and radiographic analyses showed decrease in joint inflammation in the BoNT/A and HA groups. The osteoarthritis histological score at day 30 was significantly lower in the BoNT/A group than in the other two groups (p = 0.016). Intra-articular injection of BoNT/A appeared to reduce pain and inflammation in experimentally induced temporomandibular osteoarthritis in rats.

Is panoramic radiography adequate for diagnosing coronoid process hyperplasia? A case series.

INTRODUCTION: The objective of this study was to compare the length ratios obtained on panoramic radiography and computed tomography (CT) to verify whether the former is adequate for diagnosing coronoid process hyperplasia. METHODS: A case series of patients with coronoid process hyperplasia was investigated. Length ratios between the coronoid process and condyle were measured on panoramic radiographs by using the Levandoski method and on CT scans by using the methods described by Tavassol et al. and Stopa et al. The mean length ratios obtained using the three measurement methods were compared. RESULTS: The mean length ratio measured with the Levandoski method was significantly lower than that measured with the method described by Stopa et al. (1.09 [0.09] vs. 1.21 [0.09]; P = 0.0001) and lower than that measured with the method described by Tavassol et al. (1.09 [0.09] vs. 1.34 [0.44]; P = 0.013). CONCLUSION: Panoramic measurement of the coronoid process by using the Levandoski method tended to underestimate the length ratio, emphasizing the importance of using a scanographic measurement method at the slightest doubt to confirm the diagnosis of coronoid process hyperplasia.

Comparison of chemical-induced temporomandibular osteoarthritis rat models (monosodium iodoacetate versus collagenase type II) for the study of prolonged drug delivery systems.

OBJECTIVE: To compare two agents that can induce a rat model of temporomandibular joint osteoarthritis (TMJOA) by chemical induction: monosodium iodoacetate (MIA) and collagenase type 2 (Col-2). We wished to ascertain the best agent for assessing drug-delivery systems (DDSs). METHOD: Male Wistar rats underwent intra-articular injection with MIA or Col-2. They were manipulated for 30 days. The head withdrawal threshold (HWT), immunohistological assessment, and positron emission tomography (PET) were used to evaluate the relevance of our models. RESULTS: For both the MIA and Col-2 groups, pain persisted for 30 days after injection. Change in the HWT showed that Col-2 elicited a strong action initially that decreased progressively. MIA had a constant action upon pain behavior. Histology of TMJ tissue from both groups showed progressive degradation of TMJ components. CONCLUSIONS: MIA and Col-2 induced orofacial pain by their local chemical action on TMJs. However, based on a prolonged and greater sustained effect on the pain threshold, persistent histological changes, and imaging results, MIA appeared to be more suitable for creation of a rat model of TMJOA for the study of DDSs.

3D printing for orbital volume anatomical measurement.

PURPOSE: The aim was to develop a method for reproducible orbital volume (OV) measurement in vivo based on 3D printing. METHODS: Twelve orbits were obtained from dry skulls of the Human Anatomy Department of Lille University. Computer tomography (CT) slice images of these orbits were transformed into stereo-lithography (STL) format and 3D-printed. Bone openings were closed using either putty and cellophane after printing (3D-Orb-1) or at the printing stage in silico using MeshMixer (3D-Orb-2). The results were compared with those of the conventional water-filling method as a control group (Anat-Orb). RESULTS: The observers reported a mean orbital volume of 21.3 ± 2.1 cm3 for the open-skull method, 21.2 ± 2.4 cm3 for the non-sealed 3D-printing method, and 22.2 ± 2.0 cm3 for the closed-print method. Furthermore, the intraclass correlation coefficients (ICCs) showed excellent intra-rater agreement, i.e., an ICC of 0.994 for the first observer and 0.998 for the second, and excellent interobserver agreement (ICC: 0.969). The control and 3D-Orb-1 groups show excellent agreement (ICC: 0.972). The 3D-Orb-2 exhibits moderate agreement (ICC: 0.855) with the control and appears to overestimate orbital volume slightly. CONCLUSION: Our 3D-printing method provides a standardized and reproducible method for the measurement of orbital volume.

The inception of a hospital-based dental emergency department in a precarious region decreases the incidence of severe cellulitis of odontogenic origin.

INTRODUCTION: Although most localized odontogenic infections can be managed successfully without complications, some can cause extensive morbidity through the onset of cervicofacial cellulitis. The management of these more severe infections generally requires emergency treatment, including surgical treatment under general anesthesia, and prolonged length of hospital stay. MATERIAL & METHODS: In this work, we assessed the impact of the provision of a hospital-based dental emergency department on the regional incidence of severe odontogenic cellulitis in a socioeconomically precarious region. Monthly case rates of odontogenic cellulitis treated between January 2010 and December 2019 at the hospital-based dental emergency department of Lille Medical University Hospital were collected. RESULTS: The mean number of monthly severe odontogenic cellulitis cases treated under general anesthesia was significantly higher before than after the inception of the hospital-based dental emergency service [14.07 (5.83) vs 8.79 (4.42); p<0.0001]. Conversely, the monthly mean number of collected odontogenic cellulitis cases treated under local anesthesia was significantly lower before the emergency service was set up [22.42 (12.73) vs 43.32 (23.41); p<0.0001]. CONCLUSION: The provision of a hospital-based dental emergency department resulted in a decrease in severe dental infections in a region with high indices of socioeconomic precarity, morbidity and mortality. Greater accessibility to dental care allows for the rationalization of care through more precocious and fewer burdensome procedures.

Classification of pedicle ossification after maxillofacial reconstruction with bony free flap: An observational study.

INTRODUCTION: Maxillofacial reconstruction with bony free flap is a classical technique. However, pedicle ossification after such reconstruction is a misunderstood complication that is rarely reported in the literature. It is usually manifested as trismus, neck pain, and hard swelling, but it is predominantly asymptomatic and, thus, mainly incidentally discovered at a later stage. The aim of our study is to propose a classification for pedicle ossification based on both radiological features and vascular calcification progression. We also describe a case of metachronous ossification after two fibula free flap procedures. MATERIAL & METHODS: Our observational study includes all patients from our unit who underwent maxillofacial reconstruction with bony free flap from 2003 to 2018. We collected all cases of pedicle ossifications identified during the follow-up and described the radiological status of each one to categorise them in different groups and propose a classification scheme for the same. RESULTS: Radiological and histological analysis showed a progressive three-step evolution of pedicle ossification, starting from the media, progressing into the lumen, and then reaching completion in the extravascular region. The final stage was observed in all symptomatic patients. CONCLUSION: Pedicle ossification is a progressive process that passes through three successive histological stages that may be associated with factors such as smooth muscle cell phenotype modification [1]. This complication may lead to more severe clinical symptoms and may require surgery for removal of the calcification.

Systematic review of studies on drug-delivery systems for management of temporomandibular-joint osteoarthritis.

INTRODUCTION: Temporomandibular-joint osteoarthritis (TMJOA) management is a major challenge. Minimally invasive therapies (based mainly on injections) have been developed to increase local efficacy and limit adverse systemic effects. However, the requirement for repeat injections due to a short duration of action and expensive healthcare costs have pushed researchers to develop, via tissue engineering, drug-delivery systems (DDSs). In this literature systematic review, we aim to provide an overview of studies that tested DDSs on a TMJOA model. MATERIAL AND METHODS: We searched on PubMed for articles published from November 1965 to March 2021 on DDSs using a TMJOA model. We highlighted the different DDSs and the active molecule employed. Route of drug administration, model type, test duration, and efficacy duration were assessed. To evaluate the quality of each study, a protocol bias was tested using QUADAS-2™. RESULTS: Of the 10 studies that were full text-screened, four used a poly(lactic-co-glycolic acid)-based delivery system. The other DDSs employed chitosan-based hydrogels, microneedles patches, nanostructured lipid carriers, or poloxamer micelles. Hyaluronic acid, nonsteroidal anti-inflammatory drugs, and analgesics were used as active molecules in five studies. The main way to administer DDSs was intra-articular injection and the most used model was the rat. DISCUSSION: Various DDSs and active molecules have been studied on a TMJOA model that could aid TMJOA management. Further works using longer test durations are necessary to validate these advances.

A Systematic Review of Rat Models With Temporomandibular Osteoarthritis Suitable for the Study of Emerging Prolonged Intra-Articular Drug Delivery Systems.

PURPOSE: Development of minimally invasive therapies for temporomandibular joint osteoarthritis (TMJOA) has focused on drug intra-articular injections to avoid the systemic adverse effects experienced when these substances are administered orally. Therefore, we performed a systematic review to answer the question "Which method of induction of a TMJOA-related pain model in rats leads to prolonged painful symptoms, allowing the best assessment of a sustained drug delivery system?" MATERIALS AND METHODS: Following the PRISMA guidelines, we searched MEDLINE for papers published from 1994 to July 2020 on a TMJ arthritis model using rats. We identified the means of pain induction and of nociception assessment. We assessed protocol bias using an adaptation of the QUADAS-2 tool. Animal selection, the reference standard method of pain assessment, applicability of a statistical assessment, and flow and timing were assessed. RESULTS: Of the 59 full papers we reviewed, 41 performed no pain assessment after the first 7 days following induction of the TMJ-related pain model. We eventually identified 18 long-term TMJOA-related pain models. Pain was induced by injection of toxic substances, most commonly Freund's complete adjuvant (50 µg per 50 µl), formalin at various concentrations, or monosodium iodoacetate (0,5 mg per 50 µl), into the TMJ, or by physical methods. Few studies reported data on pain after 21 days of follow-up. Heterogeneity of induction methods, pain assessment methods, and flow and timing biases precluded a meta-analysis. CONCLUSIONS: Given that pain is 1 of the main symptoms of TMJOA, experimental study protocols should include long-term pain assessment.

Lateral Pterygoid Muscle Biometric Modifications in Pterygoid Process Fractures Associated With Mandibular Fractures.

PURPOSE: Pterygoid process fractures (PPFs) are classically associated with Lefort fractures but can also be encountered in association with other facial fractures such as mandibular fractures. The aim of this study was to estimate the frequency of PPFs associated with mandibular fractures and identify factors associated with PPF. MATERIALS AND METHODS: We conducted a retrospective cross-sectional study using computed tomography scanning of patients having a mandibular fracture between November 2018 and April 2020. PPFs were classified using the classification by An et al. Volume, length, and width of both lateral pterygoid muscles have been evaluated by using an image processing software. Study population has been divided into 2 groups: fracture of pterygoid process or the absence of PPF. To evaluate the implication of lateral pterygoid muscle in the pathophysiology of PPF, we compared lateral pterygoid muscle volume, its maximal length, and width between both groups. Patients with bilateral fractures were excluded from this analysis. RESULTS: About 304 patients with at least 1 mandibular fracture have been included in this study. About 18 patients presenting an association of mandibular fracture and PPF were finally selected. About 83.33% of the patients were concerned by a fracture of the posterior part of the mandible. The PPF was classified as type IIA by the classification of An et al for 94.4% of patients. The lateral pterygoid muscle volumes were significantly larger on the side of the PPF (P = .02). However, there were no significant differences in the maximum length (P = .49) and width (P = .1) of lateral pterygoid muscle. CONCLUSIONS: Our study showed an association between mandibular fractures (mainly ipsilateral posterior) and isolated PPF through a lateral pterygoid muscle volume increase.