A. Gallucci

Update on orbital decompression as emergency treatment of traumatic blindness

INTRODUCTION Blindness is a rare and severe complication of craniofacial trauma. The management of acute orbital compartment syndrome (AOCS) is not well defined and there is no standard treatment. Our objective was to find indications for orbital decompression, the best time for treatment, and the appropriate techniques. MATERIALS AND METHODS A literature review was made from articles published between 1994 and 2014 in the PubMed database, on the emergency treatment of AOCS. RESULTS 59 of the 89 patients treated surgically for AOCS presented with significant improvement of visual acuity (VA) after orbital decompression. The delay between trauma and surgery was short. A lateral canthotomy with inferior cantholysis (LCIC) was the most frequently used technique. DISCUSSION AOCS with a risk of visual impairment must be decompressed in emergency, at best in the 2 hours following trauma, most often by LCIC to have the best chance of recovering VA. Adjuvant medical treatment (acetazolamide, mannitol, corticosteroids) should not delay surgery. Postoperative corticosteroid therapy is not indicated, especially in patients with severe head trauma.

Coronoïdectomie intra-orale : note technique

INTRODUCTION Among the skeletal causes of limited mouth opening, uni- or bilateral coronoid process hypertrophy, or Langenbeck disease, is the most frequent. It can be associated with an osteochondroma or a coronoid-malar bone conflict and is then called Jacob disease, an unilateral pathology. Treatment rests on coronoidectomy in both cases. This technique is illustrated via two cases, one Langenbeck and one Jacob disease. TECHNICAL NOTE A transoral approach was performed. After subperiosteal dissection, the coronoid process was cleared. The process was than severed at its base by means of a burr, freed from its temporal muscular fibers and removed. Mouth opening improved peroperatively. The surgical procedure was completed by active long-term physiotherapy beginning immediately after surgery. DISCUSSION Transoral coronoidectomy is a simple, quick and safe procedure. Extra-oral approaches present a high risk of facial nerve injury. In our first case, mouth opening improved from 24 to 36 mm after bilateral coronoidectomy and to 40 mm after physiotherapy. In our second case, mouth opening improved from 22 to 38 mm after unilateral coronoidectomy and to 43 mm after one year physiotherapy. Long-term post-operative physiotherapy is mandatory to get and maintain good results.

Bioactive glass 45S5 ceramic for alveolar cleft reconstruction, about 58 cases

BACKGROUND Secondary alveolar bone grafting in patients with clefts lip and palate is usually performed with iliac crest bone harvesting, however using bone substitute allow to avoid harvesting morbidity. The purpose of our study was to assess if the use of a bioactive glass ceramic is an acceptable alternative to iliac crest bone harvesting in alveolar clefts treatment. METHODS A prospective study including all patients who have benefited of alveolar grafting by GlassBONE™ (Noraker, France), a synthetic resorbable bioactive glass 45S5 ceramic was conducted. The patients underwent clinical assessments and imaging check-up by dental panoramic radiography and CBCT. RESULTS Fifty-eight graftings were performed. The mean age at the time of the graft was 7.6 years. Hospitalization, social eviction and antalgic consumption were reduced. Bone continuity was achieved in 63.8% of the cases. Bilateral cleft and dental agenesia increased grafting failure. In the subgroup of 25 patients with isolated unilateral cleft without dental agenesis, 80% had bone continuity at one year. We noted 10.3% of alveolar fistula recurrence. CONCLUSION The use of GlassBONE™ in alveolar grafts simplifies the surgery procedure and the postoperative management, and ensures satisfactory mucosal healing, tooth eruption and bone continuity in two thirds of the followed grafts.

52e Congrès de la SFSCMFCOArthropathie temporomandibulaire après infiltration cortisonique in situTemporomandibular joint arthropathy in situ steroid injection

INTRODUCTION Temporomandibular disorders (TMDs) affect the masticatory muscles and the temporomandibular joints (TMJs). TMDs most often result from occlusal and/or muscular disorders and are then called primary or idiopathic TMDs. Less frequently, TMDs are related to local (trauma, infection) or general (rheumatoid arthritis) causes and are then called secondary TMDs. A little known iatrogenic cause of secondary TDM is the osteoarthritis that may be induced by intra-articular cortisone injections. We report one case of condylar lysis that occurred after one single intra-articular cortisone injection. OBSERVATION A 62-years-old woman consulted for a long-lasting TMD on the left side manifesting itself through pain and noise. She benefited one year before from an intra-articular injection of cortisone by her rheumatologist for repeated closed lock of her left TMJ. Physical examination showed limited mouth opening with deviation on the left side. Lateral movements on the right side were impossible. The panoramic X-ray showed a condylar lysis on the left side that was on the CT scan. MRI additionally showed an anteriorly displaced and severely reshaped disc and an articular inflammation without intra-articular effusion. DISCUSSION TMJ osteoarthritis secondary to unique or repeated intra-articular steroid injections are little-known. They are clinically expressed as typical TMDs and characterized on X-rays by condylar lysis and inflammation. Intra-articular injections of steroids are not totally harmless and other treatments must be preferred.

Arthropathie temporomandibulaire après infiltration cortisonique in situ

INTRODUCTION Temporomandibular disorders (TMDs) affect the masticatory muscles and the temporomandibular joints (TMJs). TMDs most often result from occlusal and/or muscular disorders and are then called primary or idiopathic TMDs. Less frequently, TMDs are related to local (trauma, infection) or general (rheumatoid arthritis) causes and are then called secondary TMDs. A little known iatrogenic cause of secondary TDM is the osteoarthritis that may be induced by intra-articular cortisone injections. We report one case of condylar lysis that occurred after one single intra-articular cortisone injection. OBSERVATION A 62-years-old woman consulted for a long-lasting TMD on the left side manifesting itself through pain and noise. She benefited one year before from an intra-articular injection of cortisone by her rheumatologist for repeated closed lock of her left TMJ. Physical examination showed limited mouth opening with deviation on the left side. Lateral movements on the right side were impossible. The panoramic X-ray showed a condylar lysis on the left side that was on the CT scan. MRI additionally showed an anteriorly displaced and severely reshaped disc and an articular inflammation without intra-articular effusion. DISCUSSION TMJ osteoarthritis secondary to unique or repeated intra-articular steroid injections are little-known. They are clinically expressed as typical TMDs and characterized on X-rays by condylar lysis and inflammation. Intra-articular injections of steroids are not totally harmless and other treatments must be preferred.

Complications dues aux vis de blocage maxillo-mandibulaires

L e blocage maxillo-mandibulaire est utilisé dans le traitement des fractures de la mandibule, en chirurgie orthognathique et en reconstruction. Il peut être effectué à l’aide de vis de blocage, technique décrite en 1989 [1]. Ces vis permettent une mise en place plus simple et plus rapide que les arcs traditionnels, tout en préservant la muqueuse buccale et le confort du patient. Elles limitent également le risque d’accident d’exposition au sang, en diminuant les manipulations. Par ailleurs, leur retrait est simple et rapide [2]. Ces vis présentent malgré tout des inconvénients. La stabilité obtenue est moindre qu’avec un blocage sur arcs [3]. Elles ont un coût plus élevé que les arcs [2]. Elles présentent également un risque élevé de lésion des racines dentaires qui va de 0,9 à 17 % selon les études et persiste malgré l’arrivée de nouvelles vis sans forage. C’est à l’occasion d’une revue des patients du service traités avec ces vis en 2013 dans le cadre d’une évaluation de nos pratiques que nous avons souhaité rappeler le risque de lésion dentaire inhérent à la pose de ces vis et les moyens de les prévenir. Trois cas de fractures dentaires ont été observés dans le service suite à la mise en place de vis de blocage.

ÉditorialComplications dues aux vis de blocage maxillo-mandibulairesIntermaxillary fixation screws complications

L e blocage maxillo-mandibulaire est utilisé dans le traitement des fractures de la mandibule, en chirurgie orthognathique et en reconstruction. Il peut être effectué à l’aide de vis de blocage, technique décrite en 1989 [1]. Ces vis permettent une mise en place plus simple et plus rapide que les arcs traditionnels, tout en préservant la muqueuse buccale et le confort du patient. Elles limitent également le risque d’accident d’exposition au sang, en diminuant les manipulations. Par ailleurs, leur retrait est simple et rapide [2]. Ces vis présentent malgré tout des inconvénients. La stabilité obtenue est moindre qu’avec un blocage sur arcs [3]. Elles ont un coût plus élevé que les arcs [2]. Elles présentent également un risque élevé de lésion des racines dentaires qui va de 0,9 à 17 % selon les études et persiste malgré l’arrivée de nouvelles vis sans forage. C’est à l’occasion d’une revue des patients du service traités avec ces vis en 2013 dans le cadre d’une évaluation de nos pratiques que nous avons souhaité rappeler le risque de lésion dentaire inhérent à la pose de ces vis et les moyens de les prévenir. Trois cas de fractures dentaires ont été observés dans le service suite à la mise en place de vis de blocage.