[The management of extra-oral implants. Anachronisms and paradoxes]. / Prise en charge des implants extra-oraux. Anachronismes et paradoxes.

Used in France for ten years and in Sweden since 1977. Extra-Oral Implants (EOI) represent one of the new therapeutic approach of facial defects treatment by maxillo-facial prostheses fixed on implants and of some transmission deafnesses. Audiologic applications are free of charges for the patient but not the prosthetic applications; the authors note this paradox and some other anachronisms. Finally the authors wonder why Extra-Oral implantology is a "correct" science and why Intra-Oral Implantology remains absent from the Administrative texts as if it was a sort of doubtful therapy without scientific principles.

[Implant-supported prosthesis. The significance of endosseous and peri-osseous implants]. / Epithèses implanto-portées. Intérêt des implants endo et juxta-osseux.

The new extra-oral of Farmand (EPITEC system) is a plate-implant. This concept is really different from the Brånemark's implant and the use of EPITEC system give the authors opportunity of a first assessment. It seems that if, of course, Brånemark system is still the reference, the EPITEC system certainly has a real interest in thin osseous implantation areas.

[Bone-anchored implants: comparison of the techniques and values of endo- and juxta-bone implants]. / Les épithèses implanto-portées: technique et intérêt comparés des implants endo et juxta-osseux.

Extra-oral implants have been used for well-defined application for nearly 20 years; for tupoorting maxillo-facial prostheses and for bone anchored hearing aids (BAHA). In both of these applications, the bone-anchored prostheses support transcutaneous abutments. It is the junction between the implant and the abutment which ensures, given certain preconditions, the permanent percutaneous connection (PPC). The authors describe the two types of implants currently in use-intra- and juxta-osseous implants. They then give a brief description of the two techniques. The advantages and disadvantages of each system are summarised, as well as the conditions required for permanent survival of a PPC.

[Maxillofacial prosthesis fixed on endosseous implants. Apropos of 15 cases]. / Prothèses maxillo-faciales fixées sur implants endo-osseux. A propos de quinze cas.

In the light of 15 cases of craniofacial defects due to trauma of carcinomas, the authors propose a new approach of the indications for craniofacial prostheses. Progress in materials (silicons) and treatments of maxillo-facial defects (titanium implants) have renewed the interest in maxillo-facial prostheses in maxillo-facial surgery. The advantages and disadvantages of classical methods of prosthesis fixation (on glasses or adhesives) and modern techniques of extra-oral implants (Swedish) are cause of the recent interest for prostheses in plastic surgery. New implants (German) and easier techniques induce a growing interest for extra-oral implants.

[Contribution of computerized cisternography using hydrosoluble contrast media or CT transit to the diagnosis of post-traumatic cerebrospinal rhinorrhea]. / Apport de la cisternographie computérisée aux hydrosolubles, ou transit scanner, au diagnostic des rhinorrhées cérébro-spinales post-traumatiques.

Based on a series of 100 cases, the authors present the value of CT transit in craniofacial traumatology. This examination, systematically performed in cases of fistulogenic fracture, is able to confirm or exclude the presence of an osteomeningeal breach, which is often difficult to detect during the immediate post-traumatic period. CT transit also allows precise localisation of the breach, which guides the operative procedure.

[Pectoralis major muscular flap in thoracic substance loss following mediastinitis. Apropos of 7 cases]. / Le lambeau musculaire de grand pectoral dans les pertes de substance thoracique après médiastinite. A propos de sept cas.

Mediastinitis is a rare complication but can occur after any form of cardiac surgery via midline sternotomy. Despite early diagnosis, management in intensive care and appropriate treatment, the prognosis remains severe. Progression towards a chest wall defect, exposing a sternal flap is not uncommon and requires reconstructive surgery because of the potential life-threatening risk. Among the techniques currently used, the authors emphasize the value of pectoralis major myoplasty centered on perforating vessels derived from the internal mammary artery according to the technique described by Nahai in 1982. They have performed this procedure in 7 patients with a high-risk context, always using a single muscle, and also assessed its technical simplicity, low morbidity, absence of obvious functional handicap associated with the aesthetic aspects by means of regular review with a mean follow-up of 18 months.

[Facial paralysis. Treatment of upper eyelid occlusion by inclusion of a concealed gold plate]. / Paralysie faciale. Traitement de l'occlusion palpébrale supérieure par inclusion d'une plaque d'or protégée.

Inclusion of a gold plate to oppose the action of the levator muscle has been proposed for a long time in the treatment of superior palpebral paralysis. Long-term ulceration of the overlying skin has generally led to the abandonment of this technique. The simultaneous insertion, in front of the gold plate, of a conchal cartilage graft, which is subsequently reinhabited, overcomes this disadvantage. This is a simple, rapid, reversible, effective procedure which is indicated essentially in longstanding or recent permanent facial paralysis, but also as temporary treatment while waiting for the results of suture, graft or anastomosis of the facial nerve.

[Forum on tissue expansion. Value of cutaneous expansion for the covering of synthetic materials used in cranioplasty. Apropos of a case]. / Forum: l'expansion tissulaire. Intérêt de l'expansion cutanée pour la couverture de matériaux synthétiques de cranioplastie. A propos d'une observation.

The authors present a case of cover of synthetic material by expanded skin. In a context of post-sepsis revision, this cover proved to be of excellent quality, superior to normal scalp. The specific characteristics of tissue expansion may possible explain, in this context, the superiority of the expanded skin. The authors intend to adopt a similar therapeutic approach is such a situation should arise in the future.

[Treatment of incisional hernia of the abdominal wall by the skin lacing technique. Apropos of 30 cases]. / Traitement des éventrations de la paroi abdominale par la technique du laçage à la peau. A propos de trente observations.

The treatment of large incisional hernias is often difficult, as reflected by the many surgical techniques proposed and the high recurrence rate. Since 1983, the authors have used a skin lacing procedure in these large hernias which frequently tend to recur. This report was based on the study of 30 consecutively patients operated by this method between 1983 and 1989. The objective results evaluated clinically in terms of the quality of the abdominal wall after more than two years of follow-up appear to argue in favour of this little known technique which combines simplicity, rapidity and reliability. Based on their experience, the authors believe that this method has a place in the therapeutic arsenal for abdominal wall repair as, in some cases, it can resolve the difficult problem of treatment of large, recurrent incisional hernias regardless of the patient's age.

[Rhinophyma. The value of progressive dermabrasion]. / Rhinophyma. Intérêt de la dermabrasion progressive.

After briefly summing up the nosology of rhinophyma, the authors report their experience with the surgical correction of this nasal disease, on the basis of eight cases. They explain their reasons for giving up dermasection and preferring dermabrasion.

[Therapeutic attitude in extensive cutaneous lesions in Recklinghausen's disease]. / Attitude thérapeutique dans les lésions cutanées étendues de la maladie de Recklinghausen.

Based on our experience with von Recklinghausen's disease, we present two cases characterized by highly developed skin tumors. One of these cases is unique in the literature. After describing these two cases, we review the different sites of the disease and discuss the limitations of surgery. Particular attention is paid to surgical palliation for patients with end-stage tumors.

[Reconstruction of the vermilion border after vermilionectomy. Apropos of 16 cases]. / Reconstruction du vermillon après vermillonectomie. A propos de 16 cas.

The authors are concerned with 16 recently operated cases, and express their renewed interest in vermilionectomy in the management of precancerous states affecting the vermilion, immediately followed by reconstruction with a mucous advancement flap. After describing the method, the authors stress the benefits afforded by the method from both oncologic and prophylactic viewpoints. Functional and esthetic results are excellent.

[Post-traumatic surgery of the corpus cavernous]. / Chirurgie réparatrice post-traumatique des corps caverneux.

Basing their study on the early observation of a case of corpus cavernous fracture and referring themselves to a recent literature review, the authors agree that only surgical management and repair of the fractured tunica albuginea may hopefully provide fast recovery without sequelae. In case of delayed diagnosis, the operation will depend upon erection quality, functional impairement at intercourse, as well as upon the individual's psyche. Complete loss of erection capacity is the most ominous complication.

[Reconstruction of the commissural vermillion by a bifid tongue flap. Its application to gunshot wounds of the lips]. / Reconstruction du vermillon commissural par lambeau bifide de langue. Application aux délabrements balistiques.

Reconstruction of the vermilion border in three patients with maxillofacial bullet wounds was by use of a tongue flap. The interest of a bifid flap is stressed, this providing a border capable of allowing almost normal opening of the mouth, and possessing the advantage of its removal from the ventral surface giving an appearance close to that of the uninjured commissural vermilion.