Robot-guided osteotomy in fibula free flap mandibular reconstruction: a preclinical study.

Various methods currently exist to guide fibular osteotomy positioning in fibula free flap mandibular reconstruction, but patient-specific navigation methods and cutting guides require experience, and may be time-consuming and/or expensive. This study describes a robot-guided osteotomy technique for mandible reconstruction using a fibula free flap according to virtual preoperative planning. The method was assessed on five 3D-printed models and a cadaveric model. The precision of the robot-guided osteotomy was evaluated by measuring the deviations between the lengths and angles of the fragments obtained and those of the virtual planning. The average deviation of the anterior and posterior crest lengths was 0.42 ± 0.29 mm for the 3D-printed models and 1.00 ± 0.53 mm for the cadaveric model. The average angle deviation was 1.90 ± 1.22° and 1.94 ± 0.69° for the 3D-printed and cadaveric models, respectively. The results of this preclinical study revealed that fibular osteotomy positioning guidance using a robot-positioned cutting guide may be a precise, easy-to-use technique that could be tailored for fibula free flap mandibular reconstruction.

Primary cheilorhinoseptoplasty using the Talmant protocol in unilateral complete cleft lip: functional and aesthetic results on nasal correction and comparison with the Tennison-Malek protocol.

Many surgical procedures used to treat patients with unilateral complete cleft lip do not include a complete primary rhinoseptoplasty, which is delayed until the end of growth as part of secondary surgery. Primary cheilorhinoseptoplasty using the Talmant technique has been performed at Lapeyronie University Hospital, Montpellier for 15 years. This retrospective study evaluated and compared the functional and aesthetic results obtained in such patients at 4-6 years after surgery with those obtained without primary rhinoseptoplasty in patients undergoing the Tennison-Malek technique. This study included a cohort of 60 children who presented a unilateral complete cleft lip: 29 were operated on with the Tennison-Malek technique and 31 with the Talmant technique. Three functional and 14 aesthetic criteria were evaluated. All functional criteria showed better results in the Talmant group: nocturnal nasal breathing (P < 0.001), incidence of closed rhinolalia (P = 0.0019), and presence of asymmetric nasal breathing (P < 0.001). Concerning the aesthetic results, all criteria evaluated on the frontal and basal photographs of each patient showed significantly better results in the Talmant technique group. The rate of satisfactory results was> 75% for 12 of the 14 criteria in the Talmant group, compared with none of the 14 criteria in the Tennison-Malek group.

Significant decrease of facial cellulitis admissions during COVID-19 lockdown in France: A multicentric comparative study.

During the 2020 coronavirus pandemic, a lockdown was imposed in France during the first wave. An apparent decrease in incidence of cellulitis of odontogenic origin was noticed then. This study aimed to compare the incidence of cellulitis during this extraordinary period with the same period in 2018 and 2019, based on retrospective multicentric data. All maxillofacial surgery departments in French public hospitals were contacted. Responders were asked to include all patients admitted for the surgical drainage of a head and neck abscess of odontogenic origin during the first 2020 lockdown period, and in a similar time frame in 2018 and 2019 (control group), based on screening the French diagnostic and therapeutic classification of medical acts. We report a 44% significant nationwide decrease in the incidence of admissions for cellulitis. There were 187 patients in 2020 for 334 and 333 patients in 2018/2019 respectively. The reasons to explain this finding are hypothetical (organizational reasons leading to earlier management, patients' fear to seek for medical management, usual excess in surgical indications or concomitant decrease of non-steroidal anti-inflammatory drugs delivery). Whatever the explanation, it would be of great interest to find it out in order to improve the prevention of cellulitis.

Could treatment with botulinum toxin protect against subsequent infection with COVID-19?

We report comparative results, over three months, of the impact of SARS-CoV2 in our patients injected with botulinum toxin for functional purposes, compared to the general population. Botulinum neurotoxin type A (BoNT/A) is known to block acetylcholine (ACh) as well as many other neuroreceptors and neuromodulators. The recent mention of a potential protective effect of nicotine in COVID 19, by blocking ACh, attracted our attention and guided the present study. Our results show a significant difference between the number of infected individuals in the general population and the number of patients injected with BoNT/A who showed signs of COVID 19.

Osteocutaneous radial forearm free flap for anterior cranial base reconstruction: Technical note.

The reconstruction of anterior skull base defects after carcinologic surgery is challenging. Large defects can require the use of autologous free tissue transfer. Currently, most reconstructions use soft-tissue flaps. We describe the use of an osteocutaneous radial forearm free flap to reconstruct a large defect secondary to a malignant paraganglioma extending into the anterior cranial fossa and both orbits. The surgical resection required endonasal and transcranial approaches. We reconstructed the defect with a free osteocutaneous radial forearm flap. We laid the bone flap across the defect, resting on the orbital roof on each side, and sutured the soft component to the edge of the dura. The pedicle was funnelled from the craniotomy to a prepared cervicotomy and the micro-anastomoses were performed onto the facial artery and two satellite veins. Potential indications and major drawbacks of this technique are briefly discussed. Osteocutaneous radial forearm free flaps can be a valuable reconstructive option for patients with a large defect of the anterior skull base, needing both rigid support and a watertight closure.

Impact of the COVID-19 lockdown on the epidemiology of maxillofacial trauma activity: a French multicentre comparative study.

The coronavirus disease 2019 (COVID-19) outbreak has had a major impact on medical and surgical activities. A decline in facial trauma incidence was noticed during the lockdown period. The aim of this study was to evaluate the decline in maxillofacial trauma in France during this particular period. A retrospective multicentre comparative study was initiated in 13 major French public hospital centres. The incidence of facial trauma requiring surgery during the first month of lockdown was compared to that during equivalent periods in 2018 and 2019. Differences in the types of trauma were also analysed. Thirteen maxillofacial departments participated in the study. A significant decline in maxillofacial trauma volumes was observed when compared to equivalent periods in 2018 and 2019 (106 patients compared to 318 and 296 patients, respectively), with an average reduction of 65.5% (P=0.00087). The proportion of trauma due to sports and leisure was reduced when compared to reports in the literature. As a consequence, in the context of a pandemic, the material and human resources related to this activity could be reallocated to the management of other pathologies that cannot be postponed.

In-house 3D treatment planning for mandibular reconstruction by free fibula flap in cancer: Our technique.

Planning of free fibula flaps for mandibular reconstruction improves the quality of conformation and reduces the operating time. Many methods based on modeling and 3D printing have been described with excellent results, but planning and production of custom-made guides and/or plates are often time-consuming and expensive. In this article, we describe our 3D printing-assisted free fibula flap planning method, routinely performed exclusively by the surgical team in less than 72hours, compatible with urgent cancer management. Fibula and mandible models were printed by using preoperative CT data. The mandibular resection, the length of fibula and the number of osteotomies and their angles were planned on the printed models. Titanium fixation plates were then conformed on the printed model and sterilized prior to surgery and templates were made to guide fibula osteotomies. Preliminary analysis based on 7 cases shows a reduction of conformation time with good clinical and radiological results. This 3D printing-assisted planning technique is simple, cost-effective and readily reproducible, allowing mandibular reconstruction with good cosmetic and functional results.

Repair of gauge earlobe medium defect.

Defects due to earlobe gauging are becoming more and more frequent. Many techniques have been described to repair major defects but very few papers exist about medium defects. The aim of this article is to describe a simple surgical technique to repair medium deformations, based on two opposite crescents on the anterior and posterior sides of the earlobe. It gives a harmonious result to the overall shape of the earlobes with a natural curve along the inferior border which is the most difficult part of this surgery.

Hooliganism and maxillofacial trauma: The surgeon should be warned.

INTRODUCTION: With more than 270 million spectators, football - or soccer - is the most popular sport in the world. International football events generate many risky situations, including hooliganism and are an opportunity to analyze the incidence and the particularities of associated trauma. We sought to underline the potential rapid and brutal increase in maxillofacial trauma during a world-class competition. MATERIAL AND METHODS: A retrospective multicenter study of the epidemiology of maxillofacial traumas during the UEFA 2016 Cup was conducted. All the medical data from each UEFA 2016 World Cup matches from 10 June 2016 to 10 July 2016 were collected. Only the maxillofacial traumas requiring a surgery under general anesthesia and a hospitalization were included. RESULTS: 11 patients from 3 different cities were included. The main etiology was interpersonal violence (7/11), followed by road accidents (3/11). Open reduction with internal fixation of a mandibular fracture was the most performed surgery (9/11). Patients were 18 to 50 year-old, with an average age of 30.6 years. DISCUSSION: This study underlines the violence of riots between "ultra" supporters during the 2016 UEFA cup. We noticed an upsurge of maxillofacial trauma severe enough to require a surgery under general anesthesia. Hooligan behaviors should be known by every practitioner dealing with trauma care, and may requires transitional adjustment of public health policy.

Use of omental free flap for craniofacial reconstruction in unfavorable wound bed: A case report.

INTRODUCTION: The omental free flap is an effective tool for craniofacial reconstruction. However it is generally under-utilised by a large number of practitioners. This paper's goal is to increase awareness of this free flap's accessibility and to demonstrate that it can be an attractive option for reconstructive surgery. CLINICAL REPORT: This article outlines the details of a 57-year-old patient who required coverage of a fronto-parietal wound with dura mater exposure. After previous failed conventional free flap attempts, a procedure using the omental free flap was finally performed on this severe wound. The omentum was harvested via a 8cm laparotomy and anastomosed to the temporal vessels. The final result was successful, with a favorable aesthetic result. DISCUSSION: The omental free flap has many advantages: the pedicle length is long, it allows coverage of a large wound, it can be applied to a wound bed previously irradiated and infected, it has a low morbidity rate to the donor site, the surgical technique of harvesting is easy, the aesthetic result is satisfactory. However, the absence of skin slice is a disadvantage of the omental free flap because it makes monitoring difficult and it requires a skin graft in a second procedure. Laparoscopic harvest of omentum free flaps is a safe and effective tool in the reconstructive armamentarium. Every maxillofacial and plastic surgeon should aim to master and use this method as a legitimate option in some infrequent but appropriated cases.

New innovative method relating guided surgery to dental implant placement.

INTRODUCTION: Companies selling dental implant guided systems mostly offer similar surgical guides. The purpose of this paper is to present an innovative-guided surgery system which originality lies in its guidance device, and to report the author's experience in using this system for dental implant surgery. TECHNICAL PROTOCOL: Two parallel tubes on either side of the drilling axis guide the successive drills and the implant placement. As a result of the lateral guidance, there is no friction of the drills on the surgical guide, which would damage it or contaminate the drilling hole with particles torn out from the guide. No radiological guide is needed during the radiographic examination stage. No successive diameter reduction tubes are requested. This guide can be used for all brands of implants. DISCUSSION: In our experience, 67 implants (31 titanium and 36 zircon implants) were placed in 35 patients with guided surgery system. Multiple clinical cases were treated with this system: 'one-stage' or a 'two-stage' surgical protocol, with flap and flapless surgical techniques, and with delayed or immediate loading. Clinical cases treated revealed good implant placement with planning. The widely open design of this guide allows irrigation and practitioner's sight control under conditions comparable to those of operations performed without surgical guide. CONCLUSION: This dental implant guided system appears to be a significant advance in the field of implant surgical guides.

Tessier number 4 bilateral craniofacial cleft associated with amniotic band syndrome: 22 years of follow-up.

Tessier clefts are a very rare entity. Number 4 Tessier cleft is describe like an orbito-facial cleft with trajectory between the lower eyelid and the lip. We report management of a bilateral number 4 Tessier cleft with amniotic band syndrome with 22 years of follow-up. After reviewing literature, we talk about difficulty to manage these kinds of rare Tessier clefts.

[Contribution of botulinum toxin to maxillo-facial surgery]. / Apport de la toxine botulique en chirurgie maxillo-faciale.

Botulinum toxin has a wide range of use in maxillo-facial surgery due to its action on muscles, on the glandular system, and against pain. It already has been given several market authorizations as indicated for: blepharospasm, spasmodic stiff neck, and glabellar lines. Furthermore, several studies are ongoing to prove its effectiveness and usefulness for many other pathologies: treatment of pain following cervical spine surgery; action on salivary glands after trauma, hypertrophy, or hyper-salivation; analgesic action (acknowledged but still being experimented) on neuralgia, articular pain, and keloids scars due to its anti-inflammatory properties. Botulinum toxin injections in the cervico-facial area are more and more used and should be to be correctly assessed.