Twenty-four years of experience in management of complex mandibular fractures with low cost, custom-made mandibular external fixation: A 65-patient series.

INTRODUCTION: Ginestet introduced the first external device used to fix the mandible in 1936. In 1949, Morris introduced a biphasic fixation device. This "Joe Hall Morris fixation" design led to use of a self-crafted external fixator based on pins connected by a breathing tube filled with dental resin. The objective of this study was to present our surgical results with this device through a 65-patient series. METHODS: This retrospective study included all the patients who benefited from the self-crafted mandibular external fixator at our Oral and Maxillofacial department from 1995 to 2019. Sixty-five patients were allocated into two groups. There were 39 patients in the temporary stabilisation (TS) group and 26 in the bone healing (BH) group. Functional criteria were investigated, including mouth opening limitations and occlusal abnormalities. Aesthetic evaluation focused on skin healing, evaluated by both surgeon and patient. RESULTS: Twenty-three patients exhibited spontaneous bone healing during their immobilisation period and two patients developed a pseudoarthrosis in the BH group. Most TS group patients benefited from secondary management by bone graft, bone free flap, or distraction osteogenesis. Few complications were noted with our technique during the study period. CONCLUSION: Our self-crafted external fixation with Joe Hall Morris fixation style is a valuable option for external stabilisation of the lower third of the face.

[Temporomandibular joint septic arthritis with secondary condylar resorption]. / Arthrite septique temporomandibulaire avec résorption condylienne secondaire.

INTRODUCTION: Septic arthritis are serious infections rarely observed for the temporomandibular joint. They are mainly hematogenous or transmitted by contiguity. OBSERVATION: Our patient presents the case of an infection of the temporomandibular joint by maxillary sinusitis of dental origin further complicated by cerebral abscess and empyema. Initial treatment consisted of an endonasal and intraoral drainage, intravenous empirical antibiotic therapy, a close clinicoradiological monitoring, and rehabilitation following a long-term active physiotherapy. Furthermore, the patient reported the onset of a dental articulation disorder with a left side premature contact and right lateral open bite, corresponding to a significant left condylar resorption. DISCUSSION: This infectious disease is very rare for temporomandibular location; however, its general and functional outcome is determined by the precocity of the treatment. It is important to know the diagnosis and the associated symptoms even if they are not very specifically described. It is essential to consider the diagnosis when facing atypical pain of the temporomandibular joint associated with trismus.

[Temporomandibular joint disc surgery]. / Chirurgie discale de l'articulation temporo-mandibulaire.

Temporomandibular joint (TMJ) disorders are a common disease and may be responsible for major functional and painful repercussions. Treatment is not consensual. The literature highlights the role of conservative treatments (physiotherapy, analgesics, splints) in a first attempt. Minimally invasive surgical techniques (arthroscopy, arthrocentesis) have developed rapidly in recent decades. They have proven effective and reliable, especially in patients suffering from irreducible or reducible anterior disc dislocation or presenting with arthopathies. The goal of our work was to make an update about disk surgery.

Molecular alterations of bone quality in sequesters of bisphosphonates-related osteonecrosis of the jaws.

UNLABELLED: Compared to healthy bone, the intrinsic bone materials properties in the pre-existing lamellar bone are altered in jaw bone sequesters of bisphosphonates (BP)-related osteonecrosis. INTRODUCTION: The aim of this study was to evaluate the human jaw bone quality, especially intrinsic bone material properties among sequesters of osteonecrosis of the jaw (ONJ) induced by BP. METHODS: Bone sequesters were obtained from 24 patients suffering from ONJ following a BP treatment. Within BP-exposed bone samples, benign-BP and malignant-BP groups were distinguished in relation to the underlying disease: osteoporosis and bone metastases or multiple myeloma, respectively. Healthy cadaveric cortical jaw bone samples were used as controls. The physicochemical parameters of bone samples - mineral/organic ratio, relative proteoglycan content, crystallinity, monohydrogen phosphate content, and type-B carbonate substitution - were evaluated by Raman microspectroscopy. Representative Raman spectral features of bones control and BP-exposed bone sequesters were identified with the Partial-Least-Square Discriminant Analysis (PLS-DA). RESULTS: BP-exposed bone sequesters are characterized by a significant increase of mineral to organic ratio (+12 %) and a significant decrease of relative proteoglycan content (-35 %), thus regulating initial collagen matrix mineral deposition. Structural changes on mineral components are revealed by a significant decrease of both crystallinity (-2 %) and mineral maturation (-41 %) in the BP-exposed bone sequesters compared to healthy bones. These modifications were also observed distinctly in both benign-BP and malignant-BP groups. In addition, a shift of the phosphate ν1 band was highlighted by PLS-DA between bones control and BP-exposed bone sequesters, revealing a disruption of the apatitic phosphate environment in the jaw bone sequesters. CONCLUSIONS: The present data show that jaw bone quality can be altered with an overmineralization and ultrastructural modifications of apatitic mineral in bone sequesters of BP-related ONJ.

[Head and neck cellulitis caused by a broken anesthesia needle]. / Cellulite cervicofaciale sur bris d'aiguille d'anesthésie.

INTRODUCTION: Third molar extraction is one of the most common surgical procedures in oral and maxillofacial surgery. Infectious complications can be estimated at 3.6% after local anesthesia. OBSERVATION: A 39-year-old female patient, presenting with important swelling of the face and neck after extraction of teeth 28 and 38 after local anesthesia. Clinical and radiographic data led to the diagnosis of facial cellulitis due to a foreign body on the sub angulo-mandibular region. Drainage under general anesthesia was performed and a fragment of anesthesia needle was removed. One month after surgery, the patient was considered cured. DISCUSSION: Breaking an anesthesia needle is a rare accident, which can occur during oral surgery under local anesthesia. Respecting the rules of good practice is essential in preventing this type of complication, especially since forensic rules for dental and oral surgery are becoming stricter.

[Botulinum toxin A: analgesic treatment for temporomandibular joint disorders]. / Toxine botulinique de type A : traitement antalgique des dysfonctions de l'appareil manducateur.

INTRODUCTION: Pain, along with clicking, sub-luxation, and blocking, is one of the main symptoms for patients presenting with temporomandibular joint disorders. We assessed the effectiveness of botulinum toxin A (BOTOX(®), Allergan) as analgesic treatment for temporomandibular joint disorders. PATIENTS AND METHOD: Twenty-six patients with chronic pain linked to temporomandibular joint disorders were prospectively assessed. Botulinum toxin A was injected in masseter and temporalis muscles. Follow-up parameters, at one and three months, were: measuring mouth opening and diduction, muscle tenderness and pain using a visual analogue scale. RESULTS: There was a significant (P<0.0001) decrease of pain, an increased mouth opening, and diduction at three months. Seventy percent of the patients felt less muscle tenderness. The patient felt his psychological state had improved and so did his family. DISCUSSION: Botulinum toxin A significantly decreases pain and improves movements of patients presenting with temporomandibular joint disorders. The effects are prolonged three months after the injection.

[Retrospective study of two years of surgery for temporomandibular joint pain dysfunction syndrome]. / Etude rétrospective de deux années de chirurgie du Sadam.

BACKGROUND: Assessment of temporomandibular joint (TMJ) surgery is a controversial topic. We analyzed our long-term surgical results in a set of patients who underwent TMJ surgery in our unit from January 1995 through December 1996. We used a simple methodology based on 4 criteria: pain, mouth opening, type of feeding and patient satisfaction. MATERIAL AND METHODS: We reviewed 21 operated patients who had been managed by an orthodontist after surgery. The post-surgical follow-up was 4 years. Patient age at surgery ranged from 14 to 51 years; the sex ratio was 1/9 M/F. Seventeen patients suffered a closed-lock, 2 had fibrous ankylosis of the disc. Fifteen patients underwent bilateral TMJ arthrotomy with joint fixation and, very often, mandibulo-condylar-plasty to counteract the bony compression inside the joint. We rated outcome as "very good" if four factors were found: resolution or improvement of pain, more than 40 mm post-surgery mouth opening or at least 10 mm improvement for patients with less than 40 mm post-surgical mouth opening, normal feeding, subjective satisfaction rated as very or quite good. Outcome was thus rated as very good (4 factors), quite good (3 factors), good (2 factors), poor (1 factor), failure (0 factors). RESULTS: Resolution of pain was achieved in 55% of the patients with an improvement in the others. All patients recovered normal feeding. Mouth opening remained limited for two patients. Subjective patient satisfaction was very or quite good in 80% of the cases. Outcome was rated very good in 9 patients, quite good in 7, and good in 5. There were no patients with poor outcome or failure. Analysis of the good outcome group showed that 3 had experience a post-surgery trauma, one had not complied with rehabilitation therapy, and one suffered from undiagnosed rheumatoid polyarthritis. CONCLUSION: According to the literature, TMJ surgery is an effective means of treating pain and reducing dysfunction. We obtained good and stable outcome in patients who participated in our postoperative follow-up. The TMJ is a fragile joint particularly susceptible to trauma.

[Chronic diffuse osteomyelitis of the mandible. Apropos of a case]. / Ostéomyélite mandibulaire diffuse chronique. A propos d'un cas.

The incidence of osteomyelitis of the jaw has declined. Outcome is favorable with antibiotic therapy and surgery. We report a case in a women who experienced an unfavorable course with massive progressive diffusion, complicated by neoplastic conversion.

[Fibrous dysplasia: management of a severe case of pseudo-leontiasis ossea]. / Dysplasie fibreuse: prise en charge d'un cas extrême de pseudo leontiasis ossea.

We report the case of a 75-year-old woman who consulted for suppurative gingivitis and maxillary deformation with slow progression and associated severe joint disorder. The patient suffered both esthetic prejudice and functional impairment. Clinical signs and radiographic findings suggested the diagnosis of fibrous dysplasia, in its leontiasis ossea form, rarely reported in the literature. Primum non nocere guided our management. Abstention, a simple remodeling resection, or extensive resection and reconstruction would have been inappropriate in this elderly patient. We opted for an orthognatic attitude in spite of the vascular risk inherent in the orthodontic preparation and the osteotomy on an abnormal dystrophic bone. Outcome was satisfactory.

[Orthognathic surgery with missing teeth]. / La chirurgie orthognathique avec pertes dentaires.

Orthognathic surgery in patients with missing teeth can be divided into two categories. In the first case after tooth loss, specially designed bridging is required using the prosthesis already in place. In the second case in patients with congenital deficiencies, usually sequellae of cleft palate, there is a wider range of therapeutic options which are discussed on the basis of observed cases.

[Indications and role of surgery in painful dysfunction syndromes of the masticatory apparatus]. / Indications et place de la chirurgie dans les syndromes algo-dysfonctionnels de l'appareil manducateur.

Among the numerous causes of facial neuralgias, the painful dysfunction syndrome of the manducatory apparatus corresponds to a frequent etiology whose thorough study carried out by a multidisciplinary team over about 500 cases allowed their splitting into several evolutive clinical forms. At present, a number of these forms which are particularly painful, require a disk surgery (dislocation reduction, perforation suture, etc.) and if necessary an articular facet surgery (modelling condylectomy, surfacing, etc.). This study specifies the indications and prognosis for these surgical operations.

[Treatment of osteo-dural injuries of the anterior segment of the skull base through the trans-lesion approach. Apropos of 25 cases surgically treated by a dual neurosurgical and maxillofacial team]. / Traitement des brèches ostéo-durales de l'étage antérieur de la base du crâne par voie trans-lésionnelle. A propos de 25 cas opérés en double équipe neurochirurgicale et maxillo-faciale.

The authors describe a technique of mobilisation of the frontal sinus using the fractures of anterior and posterior walls. The translesional approach is adapted to cranio-facial borders surgery of traumatisms. It's a skull base approach which minimizes the cerebral retraction and enables or perfect viewing of the top of the ethmoid. The advantages, drawbacks and indications are discussed about 25 cases.

[Adenoid cystic carcinoma of the salivary glands. Apropos of 52 cases]. / Carcinomes adénoïdes kystiques des glandes salivaires. A propos de 52 observations.

52 cases of adenoid cystic carcinoma of the salivary glands are reported according to the age of the patient, to the localisation near an osseous structure or in soft tissues, to the histologic grade, to the therapeutic management, viz the surgical or radiotherapy treatment, correlated to the survival. It is worthy to notice that the localisations to the palate have a better prognosis than the localisations in soft tissues. Cribriform histologic grade in the same way have a better involvement than basaloid grade, but worse than tubular grade. Effectiveness of radiotherapy does not appear clearly in our study, unlike the observations of some authors.

[In unipolar depression does the response to the dexamethasone suppression test predict a symptomatic recurrence after clinical cure?]. / Dans la dépression unipolaire, la réponse au test de freination à la dexaméthasone après guérison clinique prédit-elle une rechute symptomatique?

We assessed the length and the quality of the remission of 13 unipolar endogenous depressed DST nonsuppressors before treatment in a 2-year prospective study. During this period, we recorded stressful life events. Persistent dexamethasone non-suppression after treatment and complete clinical recovery correlated highly with early clinical relapse. All six nonnormalizers but only one normalizer were rehospitalized within the following two years for a major depressive relapse. Persistent DST nonsuppression was unrelated to any impact of drug discontinuation, to the occurrence of stressful life events or to the length of illness-free intervals in the patient's prior course of illness. Persistent DST non-suppression appears to have a significant prognostic value.