[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.

[Malar valgisation in narrow face patients]. / Intérêt de la valgisation fonctionnelle des malaires dans les faces étroites.

Most of the "narrow faces" are secondary to a maxillo-malar hypoplasia consecutive to chronic nasal obstruction. Functional malar valgisation by transmalar osteotomy allows a simple and safe correction of this dysmorphic aspect. Interpositional bone graft and osteosynthesis by miniplate avoid mucous inflammation, maxillary sinusitis and/or relapse observed with use of biomaterials. Correction of "narrow faces" by malar osteotomy is natural and long term results are stable. Functional and esthetic rhinoplasty is often associated. Our clinical experience in 15 cases is reported.

[Hard palate mucosal graft for posterior lamella repair]. / Greffe de fibro-muqueuse palatine en chirurgie palpébrale.

Several techniques have been proposed for posterior lamella repair. The ideal gaft should be easy and safe to harvest, be lined by mucosa and be rigid enough to support the lower lid against retraction. Hard palate mucosal grafts meet these criteria. The surgical procedure is done under local or general anaesthesia and a graft up to a 40 x 20 mm can be harvested. Paramedian and subperiostal harvest is recommended, local complications are less frequent (bleeding and sensory lesions) and the hard palate mucosa is of better quality at this site (thinner graft with fewer salivary glands but rigid enough due to the periostal layer). Donor site complications such as local bleeding can be reduced by meticulous surgical technique and local postoperative care such as compression using a mouthguard. The main indications for hard palate mucosal graft are lower eyelid reconstruction and management of lower eyelid retraction.

[Cavernous hemangioma of the nasal bones]. / Tumeur vasculaire caverneuse des os propres du nez.

Cavernous hemangioma of the nasal bones is a rare benign tumor. 31 cases have been published in the world literature. The tumor appears as a firm swelling involving the nasal bone, adjacent tissues are uninvolved. The CT scan is helpful in defining tumor characteristics and extent. In most cases surgery appears curative without major cosmetic deformation. We present a case of nasal bones hemangioma where a coronal flap approach was used for tumor resection and cranial bone grafts for reconstruction.

[Resection of maxillary nerve neurinoma in the pterygomaxillary fossa via Lefort I transmaxillary approach]. / Résection d'un neurinome du nerf maxillaire de la fosse ptérygo-maxillaire par voie trans-maxillaire de Lefort I.

Many approaches are used for resection of pterygomaxillary tumors. Le Fort I osteotomy allows a simple and safe access with a wide exposure of the central skull base. This observation presents the resection of a maxillary neurinoma through Lefort I osteotomy with success and no sign of recurrence with a 3 years follow up.

Discomallear and malleomandibular ligaments: anatomical study and clinical applications.

Phylogenesis, ontogenesis and anatomy show the existence of two discomallear and malleomandibular ligaments, arising from the first branchial arch and uniting the middle ear with the temporomandibular joint and to the mandible. The intra-articular discomallear ligament is the involuted tendon of the lateral pterygoid muscle on the primitive quadrato-articular joint. The malleomandibular ligament is the fibrous remnant of Meckel's cartilage. In the physiology of the temporomandibular joint, the discomallear ligament alone limits the anterior movement of the disc. Its stretching accompanies disco-condylar disunity, hyperlaxity and temporomandibular dislocation. The malleomandibular ligament, wrongly limited to its sphenomandibular part in classic anatomy, has no physiological role. However, it can be responsible for the dislocation of the ear ossicle chain after disarticulation or temporomandibular trauma. These two ligaments do not play any role in otological manifestations in dysfunction of the manducatory apparatus.

[Look and nasal ventilation]. / Regard et ventilation nasale.

Ophthalmic manifestations of nasal obstruction can involve palpebral, orbital and ophthalmic disturbances. They can be the consequence of: directly with the nasal obstruction because the orbital cavity drains partly in the nasal fossae: rings, lipoptosis, blepharochalasis, fat protrusions, aggravation of exophthalmy in Grave's disease, enophthalmia. Oral breathing: there are modifications in the shape of the palpebral fissure ("round eye") by stretching of the facial mask and modifications of the orbital rims ("sad eye") due to lack of naso-sinusal expansion, often associated to malocclusion, there is a biomechanical correlation between the dental occlusion and the orbital area because of the presence of the maxillary sinus. Every occlusal disorder have an influence on projections of the supra and infraorbital rims.

"Axial split osteotomy" of free fibular flaps for mandible reconstruction: preliminary results.

Vascularized free flaps are now considered the most appropriate choice for mandible reconstruction because they offer excellent cosmetic and functional results. Various techniques have been proposed. Free fibular flaps have numerous advantages in terms of versatility and contouring. Shaping can be achieved by wedge osteotomy with excellent results. However, this technique leads to bone loss and may be difficult in the later stages of the procedure. The purpose of this report is to describe a simple and safe flap-shaping method involving axial split osteotomy.