[The Bimler method in the treatment of sagittal shift of the skeletal base in Class II division 1 malocclusion]. / Méthode de Bimler dans le traitement du décalage sagittal des bases osseuses des classes II, 1.

Inadequate sagittal development of the mandible (class II, division 1 malocclusion), is one of the most frequent in dentofacial malformations. We present the Bimler "gebissformer", removable and functional appliance and its tridimensional action. The treatment can be started during the deciduous dentition or in mixed dentition. Therapeutic results, increase of SNB angle, maxillary expansion, and reduction of the deep bite are presented. While therapeutic failure is observed in 30% of the cases (by absence of tissular response or poor patient compliance), the stability of the results in 70% of the remaining cases and its total inocuity make this appliance an interesting method of treatment.

[Decision strategies in orthognathic surgery. Part 1: The predominance of functional factors in the choice of osteotomy sites. A theoretical study]. / Stratégie de la décision en chirurgie orthognathique. 1ère partie: prédominance des facteurs fonctionnels dans le choix des sites d'ostéotomie. Etude théorique.

Most of the scientific papers concerning facial osteotomies are focused on the surgical procedures. However, the most important thing to consider is how to go to the right indication and not how to do it. By an only morphological approach, as we can do with dental casts and cephalometric studies, it is obvious that we forget the functional factors. They nevertheless are essential to consider. Their knowledge permits understanding the physiopathology of the deformity and avoiding the postsurgical relapses. The main five factors concern: the dentoalveolar corridor, between tongue and orbicularis oris muscle, the facial bone growth modeling by functional matrix, the relations between upper incisors, lower incisors and lips, the posterior airway and the rest position of the tongue, the vertical muscular balance. Surgery has to normalize the abnormal function which is at the origin of the abnormal morphology. For this reason, maxillary surgery is better than mandibular surgery for the correction of a Class III deformity. Moreover, the transversal and vertical dimensions are always to be considered at the light of the functional parameters. Most of cases of dentofacial deformities are to be treated by bimaxillary osteotomies, including often transversal and/or vertical modifications. When the anatomical sites of these surgical procedures are determined, then we have to make an aesthetic facial profile simulation to validate the total amount of the bone displacements (cf. Part 2).

[The premaxilla and facial growth 68 years later]. / Prémaxillaire et croissance faciale 68 ans après.

The thesis of Dr Etienne Cadenat on the embryology of cleft-lip dates from 1924. From this epoch onwards it was demonstrated that the human premaxilla had a specific development not corresponding to that of other mammals, in whom the suture between the pre- and post- maxilla is active and participates in the sagittal, transversal and vertical growth of the maxilla. Numerous studies have been undertaken to verify that the human premaxilla does in fact exist, and several have gone as far as to conclude in its non-existence. The author restudied the question from the histologic angle, and showed that the zone of union between premaxilla and maxilla did not contain any histologic elements that could identify a growth suture. Indeed, the spatial orientation of this suture would not allow anteroposterior growth. It can be concluded that the human premaxilla does exist but its specificity has again been demonstrated.

[Reconstruction of the mouth floor with nasolabial flap after cancer resection. Report of 81 cases]. / Reconstruction du plancher buccal par lambeau nasogénien après exérèse pour cancer. A propos de 81 cas.

The authors report functional results in a series of 81 patients with carcinoma of the floor of the mouth treated by surgical resection and reconstruction by nasolabial flap. The study confirms the literature concerning advantages and limits of such a flap. With regards to others techniques of reconstruction, nasolabial flap is still perfectly usefull in reconstruction of T2 T3 carcinomas of the floor of the mouth.

[Decision strategy in orthognathic surgery. Part 2: The esthetic choice in orthognathic surgery--practical applications]. / Stratégie de la décision en chirurgie orthognathique. 2e Partie: Le choix esthétique en chirurgie orthognathique--application pratique.

Even if the functional factors are the most important in the decision, we have always to remember the need of our patient concerning aesthetic improvement. At this moment, the traditional approach based upon morphologic cephalometric analysis (which are frequently discordant) must be substituted by an aesthetic approach. The goal is to obtain a realistic 3D-imaging of the face as it will be after surgery. But it cannot really be achieved yet and we are obliged to work on lateral X-ray cephalograms. The most important at this stage of the decision is not to make a static aesthetic evaluation. It is on the contrary to perform a prospective simulation of the new profile line, as accurate as possible, based upon statistical correlations between soft- and hard-tissues changes. Even if there are some technical problems, even if the results are not currently good enough, the aesthetic prospective analysis allows validation or modulation of the initial functional surgical indication. We can compare for instance the aesthetic results of different amounts of displacements in bimaxillary surgery. Meanwhile, it is sure that the result depends also on the precision of the surgical procedure and on the good functional re-equilibration which is essential for the stability.

[Trans-zygomatic approach to the temporomandibular joint]. / Abord transzygomatique de l'articulation temporo-mandibulaire (A.T.M.).

The articular eminence of the temporal bone may be removed and resect without modifying substantially joint function. Such temporal resection allows for complete exploration and renders surgical treatments easier. The technique which is described here has been carried out on over one hundred patients with a follow-up period spanning 5 years or less. Indications are specified and the approach of interest seems to be complementary to the conventional lateral approach of the temporomandibular joint.

[The value of mandibular kinesiography and of T-scanning in the diagnosis and treatment of algo-dysfunctional syndrome of the temporomandibular joint]. / Intérêt du mandibular kinesiograph (MKG) et du T-scan dans le diagnostic et le traitement du syndrome algo-dysfonctionnel de l'articulation temporo-mandibulaire (A.T.M.).

The application of T-Scan and kinesiographic techniques in combination with electromyography is of great value to the clinician for substantiating certain clinically hard-to-evidence factors, such as chronology and strength of contact points, muscular activity, or certain mandibular movements. The utilisation of these methods is of benefit for diagnosis, treatment and objective patient follow-up.

[Arthroscopy of temporomandibular joint dysfunctions]. / Arthroscopie dans les dysfonctionnements de l'articulation temporo-mandibulaire (A.T.M.).

The arthroscopy of the T.M.J. is a mean of diagnosis and treatment of some lesions but it cannot claim to bring about the diagnosis or the treatment of all lesions. After the experience resulting from 29 cases, the value of this technic among the element of diagnosis and treatment is discussed.

[The role of the temporal muscle in the temporomandibular joint. Surgical applications]. / Rôle du muscle temporal dans l'articulation temporo-mandibulaire. Applications chirurgicales.

The temporal muscle is involved as a musculo-tendinous brake in working to block the dislocation. The reconstitution or the addition of this brake can be realised by the shortening of the horizontal fibres or by advancing the articular eminence realising an arthroplasty and an increase in the action of the temporal brake.

Evaluation of gingival microcirculation by a laser-Doppler flowmeter. Preliminary results.

Up to now, only qualitative studies have been performed on gingival microcirculation whereas quantitative methods have been used in animal experiments, by the injection of microspheres for instance. The authors had the opportunity of using a Laser-Doppler Flowmeter (LDF) which had already served to explore the cutaneous microvascular blood flow. At first, it was necessary to modify an occlusal splint for good immobilisation of the probe on the gingival mucosa. Then they made a study on twenty healthy students with measurements of red cell velocity in superficial maxillary gingival mucosa. Each subject was tested twice at an interval of one-month. A statistical analysis shows very good reproducibility of the tests, especially for the pulsative velocity, despite a rather high variability between the subjects. The haemodynamic parameters (heart rate, systolic or diastolic blood pressure) do not seem to have a significant influence on the values obtained. The LDF is a very good instrument for the evaluation of gingival microvascular flow, as has been demonstrated for cutaneous microcirculation. A wide range of applications can be considered for this sensitive and harmless technique.

[The value of miniature compression screws in maxillofacial surgery]. / Intérêt des mini-vis à compression en chirurgie maxillo-faciale.

According to the well-known principle of compression, a new kind of screw has been developed. It is a development of the miniaturized Michelet-Champy osteosynthesis device which we have used for the last 10 years in maxillofacial surgery. These traction-screws were initially elaborated for rigid stabilization after sagittal ramus osteotomies such as Obwegeser-Dal Pont. Usually, three screws are inserted at each side, via a transjugal approach. It is then possible to remove the intermaxillary fixation device at the end of the surgical procedure. However, these screws are also useful in other cases: for other kinds of mandibular osteotomies (visor osteotomy for instance), in traumatology (oblique mandibular or condylar fractures) or for fixation of onlay bone grafts on the facial structures. When iliac bone grafts, which are essentially cancellous bone are used, it is possible to use a small metallic ring to avoid penetration of the head of the screw into the graft. The screws can be inserted by a cutaneous punctiform incision when it is impossible to pass the screwdriver through the buccal incision. In all cases, this material is particularly easy to insert, allows good fixation, permits a solid interosseous compression, and is particularly well tolerated. The main drawback is the difficulty of choosing the right length of the screws because only two lengths are available at the present time. Despite this problem, these mini traction-screws seem to be useful for maxillofacial surgeons.

[Modifications in the vertical position of the stomion in facial osteotomies and osseous genioplasties]. / Modifications de la position verticale du stomion dans les ostéotomies faciales et génioplasties osseuses.

A retrospective statistical analysis is made on 45 patients who have undergone a facial osteotomy. The authors study the vertical changes of the stomion on pre- and post-operative lateral cephalograms. Considering the bad initial results, it has been necessary to create subdivisions on the surgical procedure and to work on homogeneous groups. The results of this study led to the following conclusions: the stomion follows the vertical displacement of the maxilla on an approximative ratio of 1/3, with rather great variations between the subjects; the functional osseous genioplasties, specially with vertical displacement, are not accompanied by significant vertical changes in the position of the stomion. Furthermore, it is obvious that it is necessary to use a "multivariable" method for a better prevision of the cutaneous changes after facial osteotomies, specially for the lips. Indeed, vertical soft tissue changes are the result of the interactions of many vertical and horizontal surgical squelettal displacements.

[Evaluation of the mid-term results of trident osteotomy using orthodontic goniometry]. / Appréciation du résultat à moyen terme de l'ostéotomie en trident par la goniométrie orthodontique.

The authors study a series of twenty patients who underwent a "trident" maxillary osteotomy for transversal deficiency. They try to have a good evaluation of the exact value of the inter-molar distance after one year, in comparison with the expected value on the plaster casts before operation. Furthermore, they measure the axial modifications of the first molar, which consists in vestibulo or linguo version. For this study, they use a simple method which is called "orthodontic goniometry" and give a great precision. The transversal augmentation seems to be quite stable, with only fifteen per cent lost in the measured intermolar distance. But there are dental axial changes in eighty per cent of the patients. The most common modification consist in vestibular inclination, without damage for the result. But in thirty per cent of the cases, a palatal inclination is observed, with deterioration of the results. This is a good reason for maintaining a palatal contention during at least six months after surgery.

[Transjugal osteosynthesis by compression miniscrew in sagittal ramus osteotomy]. / Ostéosynthèse trans-jugale par mini-vis à compression dans les ostéotomies sagittales des branches montantes.

The transjugal osteosynthesis technique of the Obwegeser-Dalpont type is used for treatment by sagittal osteotomy of ascending rami. The material used is a direct compression mini-screw derived from that described by Michelet-Champy. Principles underlying all types of osteosynthesis (rigidity, solidity, miniaturization, according to the authors) are discussed and advantages and inconveniences of their material compared with those of other existing procedures. Two clinical cases are presented as an illustration.

[Treatment of buccal mucosa lesions with the carbon dioxide laser]. / Traitement des affections de la muqueuse buccale par le laser à gaz carbonique.

The authors report their experience of the use of the CO2 laser in oral pathology, based on 109 patients treated in 136 sessions. The indications of this type of therapy are reviewed and details of the technic and results are given. The CO2 laser is specially useful in cases of dysplasia and cavernous hemangiomas; it guarantees the quality of the intervention, and avoids post-operative discomfort for the patients. Future prospects of this method are promising.

[Modifications to the skin profile following facial osteotomy]. / Modifications du profil cutané consécutives aux ostéotomies faciales.

Soft tissue changes resulting of maxillary and/or mandibular osteotomies need to be evaluated with a great accuracy for a better prediction of the post-operative profile. As the aesthetic result seems to be most important for our patients, it is necessary to study the relations between the displacements of characteristic cutaneous points and hard structures below, osseous or dental. Then, a retrospective statistical computerized study was performed on 45 patients who underwent facial osteotomies at least three months before. The vertical and horizontal positions of 14 osseous or dental landmarks and 16 cutaneous points were recorded. Corresponding displacements were calculated for each of these, but only six cutaneous and 9 osseous displacements were selectionned for this study. A first correlation research was made, with determination of the lineary regression equations, when it was possible. Then a multivariate study was performed for each cutaneous point, with determination of multiple regression equations. Comparison between the two methods of prediction shows a S.D. over 2 mm for the simple regression versus a S.D. of about 1 mm for the multiple regression. On the other hand, it seems that it is possible to predict the horizontal displacements with the first method without important error. But the vertical displacements cannot be evaluated with good prediction, and particulary the stomion movements. It will be necessary to consider other parameters to obtain better correlation coefficient. But it is obvious that one can join together different groups of patients for a soft tissue changes study with the same results than after separation of those. In fact, the soft tissue reactions are the same although the surgical procedures are different.

[Rational surgical treatment of mandibular retrognathism]. / Traitement chirurgical rationnel des rétrognathies mandibulaires.

The authors expose their approach in the surgical treatment of mandibular retrognathism. They study the anomalies in the transverse, vertical and sagittal directions. They increase the transverse size of the maxilla by the mean of an original technique ("trident" osteotomy) recently described. Also they show several technical procedures about incisions, osteotomies and osteosynthesis.

[Value of the surgical treatment of subcondylar fractures. Apropos of a comparative study of 24 cases of luxation-fractures treated by to-and-fro osteosynthesis or by active protrusive mobilization]. / Intérêt du traitement chirurgical des fractures sous-condyliennes. A propos d'une étude comparative de 24 cas de luxations-fractures traitées par ostéoxynthèse en "va et vient" ou par mobilisation active en propulsion.

Regarding the bad results of the orthopaedic treatment of subcondylar dislocated mandibular fractures, the authors present a comparative study of two series of twelve patients: one (group "A") with orthopaedic treatment; the other one (group "B") with surgical treatment by "up and down" pinning via a temporal approach. The results of surgical treatment seem to be better than those of orthopaedic treatment, as it can be seen in some other papers. The choice of the surgical technique of osteosynthesis and the indications are then discussed. It seems to be necessary to improve the specific instrumentation for wider indications an better results.