[Bichat's buccal fat pad for reconstruction of posterior oral cavity defects]. / Le corps adipeux de la joue dans la reconstruction des pertes de substances postérieures de la cavité buccale.

Some losses of matter in the posterior area of the oral cavity require reconstruction with vascularized tissue to prevent retraction and a limited mouth opening. Bichat's fat pad or Bichat's fat ball is rarely used for oral mucosal reconstruction despite its proximity, easy availability, plasticity and simple use as a flap. Bichat's fat pad is resistant to lipolysis even in case of major weight-loss. It usually herniates in the exeresis site of a jugal tumor or intermaxillary commissure. When this is not the case, it can be obtained by a horizontal vestibular incision. The fat pad is unfolded and sutured without tension to the margin of the defect. The flap may be protected by a Bourdonnet dressing. Epithelialization begins 8 to 10 days after surgery. It is completed in the second or third week. The fat volume is variable, thus filling can only be applied to areas with loss of matter under 6cm. The technique is simple and quick. Postoperative evolution is usually uneventful; healing is quick as well as recovery of normal feeding function.

Localización intramandibular de un carcinoma adenoide quístico. Repaso de la literatura / Intramandibular location of an adenoid cystic carcinoma. Review of the literature

La revisión de 13 casos descriptos en la literatura permite actualizar nuestros conocimientos a propósito de los carcinomas adenoides quísticos intramandibulares. Esto tumores, en tanto mantengan esa condición, resultan raros; el diagnóstico puede determinarse por una zona radiolúcida ubicada en la parte distal de la rama horizontal o del ángulo de la mandíbula. El diagnóstico más generalmente propuesto es el de quiste odontogénico osteolítico. La exploración quirúrgica revela un tumor sólido, desmenuzable y de poca densidad, que comprime el nervio dentario inferior. La evolución es larga e insidiosa, caracterizada principalmente por metástasis pulmonares. El tratamiento consiste en efectuar una resección ósea. Su origen aún es desconocido; puede atribuirse a inclusiones ectópicas embriológicas o a una evolución maligna de quistes odontogénicos (AU)

Localización intramandibular de un carcinoma adenoide quístico. Repaso de la literatura / Intramandibular location of an adenoid cystic carcinoma. Review of the literature

La revisión de 13 casos descriptos en la literatura permite actualizar nuestros conocimientos a propósito de los carcinomas adenoides quísticos intramandibulares. Esto tumores, en tanto mantengan esa condición, resultan raros; el diagnóstico puede determinarse por una zona radiolúcida ubicada en la parte distal de la rama horizontal o del ángulo de la mandíbula. El diagnóstico más generalmente propuesto es el de quiste odontogénico osteolítico. La exploración quirúrgica revela un tumor sólido, desmenuzable y de poca densidad, que comprime el nervio dentario inferior. La evolución es larga e insidiosa, caracterizada principalmente por metástasis pulmonares. El tratamiento consiste en efectuar una resección ósea. Su origen aún es desconocido; puede atribuirse a inclusiones ectópicas embriológicas o a una evolución maligna de quistes odontogénicos

[Intra-mandibular location of a adenoid cystic carcinoma. Review of the literature]. / Localisation intra-mandibulaire d'un carcinome adénoïde kystique. Revue de la littérature.

An update review of the published data (13 références) concerning primary central mandibular adenoid cystic carcinoma is presented. Those tumors are exceptionally located within mandible: the diagnostic could be evocated in case of body or angle radiolucency of the mandible. The most frequent diagnosis appeared to be an osteolytic odontogenic cyst. Surgical analysis has shown a very friable and low density solid tumor next to mandibular nerve. This pathology has a quiet and long term development (mainly pulmonary metastasis many years later). The best treatment consisted in bone resection. Even though, his origin of this type of carcinoma is still unknown: a consistent hypothesis is made of ectopic embryologic inclusions or of neoplastic mutation of odontogenic cysts.

[Cancellous mandibular autografts and titanium mesh]. / Autogreffes spongieuses mandibulaires et maille en titane.

Pure cancellous bone transplants constitute an alternative to the usual cortico-cancellous grafts used in certain cases for restoring interrupting substance loss (ISL) in the mandible. The greater number of surviving transplant cells, the rapid revascularization and more complete osteogenesis that are achieved cause indications for this type of graft to be particularly well adapted for cases where local repair conditions are precarious, such as bullet wound related sequelae. Indications for their utilization also extend to patient who have had benign tumors excised. The titanium-made receiving splint designed by Pr. Dumbach is particularly well adapted to this type of restoration; it provides for necessary functional stresses to be translated to the implant, allowing for the latter's incorporation, while controlling the direction of osteogenesis, thereby yielding excellent morphological and functional results.

[Trap-door fractures of the orbit floor. Apropos of 8 cases]. / Les fractures en trappe du plancher orbitaire. A propos de 8 observations.

Trapdoor fractures of the floor of the orbit were first described in 1965 by Soll and Poley. The authors discuss the pathology and pathogenic theories for these lesions and present 8 cases. The diagnosis is essentially clinical and is frequently supported by computed tomography when it is performed rapidly. The surgical procedure is designed to release the herniated tissues by lowering the orbital floor so as not to aggravate the constrictive lesions. These fractures constitute surgical emergencies and their prognosis depends on the nature of the tissues incarcerated.

[Köle's operation]. / L'opération de Köle.

Kole's operation combines segmental alveolar osteotomy of lower incisor-canine region with a reduction mentoplasty. The procedure usually provides a reduction in height of mentum, sometimes with an advancement, and involves ablation of an intermediate bone fragment. Ablation of lower border as described by Kole too frequently results in an esthetically poor chin. Insertions of platysma and digastric muscles are untouched. The inferior segmental osteotomy separates the lower incisor-canine region, which is displaced upwards or upwards and backwards after extraction of premolars, displacement being maintained by interposition of bone detached during mentoplasty. A reduction glossectomy is almost constantly associated. The best indication for Kole's operation is anterior gaps with or without proalveoli. It is often combined with segmental or total surgery to maxilla. Results are generally stable, especially after mentoplasty, but from the dental aspect pulp mortifications are not rare.

[Repair of loss of facial substance due to firearm injury]. / A propos de la réparation des pertes de substance faciales par coup de feu.

Injury to the face as a result of firearm wounds differs as a function of whether the injury was due to a bullet or lead shot. In the first case treatment is usually that of a mandibular or maxillary comminuted fracture and is principally orthopedic. In the case of hunting guns the damage is considerable and requires reconstitution of soft tissue with the use of a distant flap (purely cutaneous or musculo-cutaneous), bone repair, when necessary, being by costal or iliac grafts.

[The place of composite flaps in maxillofacial surgery]. / Place des lambeaux composites en chirurgie maxillo-faciale.

The preferred composite flap is the musculocutaneous flap from pectoralis major for repair of loss of mucocutaneous substance due to cancer or injury. In rare indications the musculocutaneous flap from sternocleidomastoid muscle is used. When loss of bone substance combined with a cutaneous or mucosal defect has to be corrected use is made of the bone-muscle-skin flap from pectoralis major to include the 5th rib, or the bone-muscle-skin flap from sternocleidomastoid to include internal portion of clavicle. Reliability on use of these two flaps has led to their application in surgery for mandibular osteoradionecrosis. In addition to allowing repair of bone continuity, the vascular and cellular capacities of the flap provide colonization and rehabilitation of the borders of lost substance with live tissue, as shown by subsequent bone remodelling. Results of statistical analysis of 50 cases are presented.

[Computed tomography in imaging in maxillofacial surgery]. / Apport de la tomodensitométrie dans l'imagerie en chirurgie maxillo-faciale.

The improved definition and good visualization of soft tissues provided by high resolution computed tomography imaging greatly exceeds results of conventional tomography investigations. It is irreplaceable for tumoral lesions, particularly of the facial region, when not only the tumor but its degree of extension are perfectly identified. In orbital injuries it is the only imaging procedure capable of visualizing the orbital contents and its relation with the fracture line.

[Current treatment of osteoradionecrosis]. / Le traitement actuel de l'ostéoradionécrose.

Conventional treatment of osteoradionecrosis of mandible is by antibiotics combined if necessary with a hemimandibulectomy. A method is proposed which reduces bone excision to infected and necrotic tissue while respecting mandibular continuity. The bone remaining is covered by a flap taken from a distant region. Five cases treated in this way are reported. When mandibular continuity has to be interrupted to suppress infected foci, immediate repair is performed using an osteo-musculo-cutaneous flap, and six cases treated by this method are reported. A part from their mechanical covering and reconstructing roles these well vascularized flaps improve vitality of tissues they enclose, including the mandibular bone.

[Current trends in the treatment of mandibular osteoradionecrosis. Use of a sternocleidomastoid osteomyocutaneous flap]. / Tendance actuelle dans le traitement des ostéo-radio-nécroses de la mandibule. Utilisation d'un lambeau ostéo-musculo-cutané sterno-cléido-mastoïdien.

An osteomusculocutaneous flap using the clavicle, and pedunculated on the sternocleidomastoid muscle, was used in two patients to repair loss of post-radicular mucosa and bone substance. Healing of mucosa and bone consolidation was obtained with evidence of production of bone callus on radiography. The hypothesis advanced to explain this reconstruction of necrosed mandible is the presence of the new vascular supply.

[Sequelae of condylar fractures in the experience of the department and that of medical expertise]. / Les séquelles des fractures condyliennes à travers l'éxpérience du service et l'expertise médicale.

Statistical analysis was conducted on findings in 104 cases of fractures in the condylar region and 25 patients examined to determine degree of incapacity as a result of these types of fracture. Data obtained illustrated the adverse effects of ascending ramus shortening, and the improvement obtained after surgical restoration of its height whenever this was indicated. Long-term follow up surveillance is also necessary after high subcondylar fractures with impaction of the ascending ramus because of the risk of external temporomandibular ankylosis.

[A technic for osteotomy of the malar bone]. / Une technique d'ostéotomie du malaire.

On the basis of the results of osteotomy of the malar in malunion of facial fractures, the authors suggest the use of this operation in the correction of maxillary malformations including faulty development of the cheeks. Two cases are described.

[Facial cellulitis of dental origin]. / Cellulite de la face d'origine bucco-dentaire.

A case of facial cellulitis of dental origin associating a retropterygoidal necrosis, a retro-orbital abscess and a cervicofacial cellulitis is reported. No related risk factors were found in this 28 year old man. Bacteriological analyses showed a mixed bacterial flora and the presence of candida. Direct examination favoured an anaerobic germ infection. However the culture and identification of theses germs were impossible. The clinical circumstances together with the results of facial computed tomography tended to make the diagnosis of an anaerobic cellulitis highly probable. The diagnostic and therapeutic managements are reviewed.

[One-stage surgical treatment of temporo-mandibular ankylosis and its facial deformity]. / Traitement chirurgical en un temps d'une ankylose temporo-mandibulaire et de sa déformation faciale.

A patient with temporomandibular ankylosis was treated by resection of the ankylosed block followed by lengthening of the ascending ramus by an endoprosthesis. The place of the latter in the treatment of such lesions and the deformities that result from them is analyzed. Emphasis is laid on the value of displacement of the superior arch by a Le Fort I osteotomy in the correction of facial asymmetry in cases of laterognathia due to a mandibular development defect.

[External temporomandibular ankylosis]. / L'ankylose temporo-mandibulaire externe.

The predominant aetiology in 24 cases of temporomandibular ankylosis treated surgically since 1976 was trauma. Among the patients operated upon for post-traumatic ankylosis one anatomoclinical form could be identified characterized by an external block attaching the condylar neck to the zygomatic bone, and an internal joint by movement of the head or part of the condylar head. A favorable prognosis can be given in this type of lesion as resection of the block does not modify the height of the ascending ramus.

[The dangers of Trauner's operation]. / Les écueils de l'opération de Trauner.

The technique described by Trauner for using retro-condylar cartilaginous implants is outlined, and the complications observed indicated. External or inferior luxation of the implant leads to recurrence of the deformity, whereas no inconvenience is caused by the opening of the joint. These pitfalls led to the use of a modified technique in which the cartilaginous implant is introduced into the supra-meniscal cavity of the temporo-mandibular joint.