A. Picard

Feasibility of magnetic activation of a maxillofacial distraction osteogenesis, design of a new device

PURPOSE Distraction osteogenesis is a technique of bone lengthening which uses the bones natural healing process. Current devices for craniofacial distraction require a transmucosal or transcutaneous activator and are associated with numerous complications. The aim of this study was to evaluate the feasibility of a rodless magnetic activation device that could be used in craniofacial distraction. METHODS The method is based on the torque applied between two unaligned permanent magnets. This torque depends on magnet size, shape, composition, magnetization and distance between the two magnets. Using a configuration close to that which would be applied in actual distraction osteogenesis (in terms of the distance between the two magnets), we performed an analytical study and evaluated the results. RESULTS We observed good agreement between the model and the experimental results, finding that the transmitted force value is comparable to the force required in mandibular distraction. Thus, we proposed a design of a new distracting device consisting of a cylindrical permanent magnet diametrically magnetized and fixed to an endless screw along its main axis. Activation of the distraction motion is achieved through interaction of the first magnet with a second cylindrical magnet whose magnetization is orthogonal to its main axis and to the devices endless screw. CONCLUSION This preliminary study demonstrates that magnetic activation for mandibular osteogenic distraction is feasible and that device size is not a constraint. We propose a prototypic device.

TMJ arthritis is a frequent complication of otomastoiditis

INTRODUCTION Septic arthritis of the temporomandibular joint (TMJ) is a rare condition known to result in significant morbidity if diagnosis is delayed. Acute otomastoiditis is a typical complication of acute otitis media but few cases of acute otomastoiditis complicated with TMJ arthritis have been reported in the international literature. Furthermore, otomastoiditis reports and studies rarely analyzed TMJ CT scans. The aim of this study was to determine the incidence of TMJ arthritis in acute otomastoiditis, based on the analysis of CT scans. MATERIALS AND METHODS We conducted a prospective study from 2014 to 2015, including all consecutive pediatric patients admitted to the Pediatric Otolaryngology department for acute otomastoiditis. A craniofacial injected CT scan was performed in all patients. The imagery was prospectively blind analyzed by two independent investigators screening for the criteria of TMJ arthritis. Finally, during the long-term follow-up we noted the number of patients presenting a clinical TMJ ankylosis. RESULTS We included 45 patients. The analysis showed 15 patients with TMJ effusion. Of those, 6 (13.33%) had an abscess and 2 clinical ankyloses. CONCLUSION This study showed a high rate of TMJ arthritis complicating otomastoiditis. Our results demonstrate that systematic TMJ analysis in the CT scan of patients with otomastoiditis is essential.

Congenital fibroblastic connective tissue nevi: Unusual and misleading presentations in three infantile cases

Fibroblastic connective tissue nevi (FCTN) are benign skin conditions characterized by bland spindle cells infiltrating the reticular dermis and the upper subcutis with preservation of adnexal structures. A subset of FCTN expresses CD34, which may cause difficulties in the differential diagnosis, in particular with dermatofibrosarcoma (DFSP). We aim to study clinical and histological main features of congenital FCTN to better understand their heterogeneity.

Phenotypic spectrum of Tessier facial cleft number 5

INTRODUCTION Craniofacial clefts belong to the most disfiguring and rare congenital malformations of the face and among these, orbito-facial clefts constitute approximately 0.22 % of the cases with Tessier cleft number 5 being the least common. Our aim was to define the phenotypic spectrum for this subgroup to improve clinical management. METHODS Our study group consisted of four patients which were treated at two different cleft centers. Retrospective chart review and anatomical analysis were conducted for each patient based on clinical evaluation and imaging studies. Morphological anomalies including soft tissue, bone and oral components were recorded. RESULTS Based on our analysis and literature review, we could define two subtypes of Tessier facial cleft number 5. (1) Medial clefts are the more severe subtype, creating a significant soft tissue and bone defect that runs vertically, through the eyelid, infraorbital rim, maxillary sinus and cheek. They have the poorer esthetic and functional prognosis, due to orbital dystopia and absence of lower eyelid. (2) Lateral clefts are a less severe subtype characterized by the presence of a vertical furrow of the cheek running laterally to the maxillary sinus. CONCLUSIONS We identified two subtypes of facial cleft number 5 which require an individualized surgical management.

Diagnostic criteria in Pai syndrome: results of a case series and a literature review

Pai syndrome was originally described as the association of a midline cleft lip, midline facial polyps, and lipoma of the central nervous system. However, only a few patients present with the full triad, and most exhibit a wide spectrum of phenotypic variability. The aim of this study was to phenotypically delineate Pai syndrome and to propose new criteria to facilitate a clinical diagnosis in the future. The study cohort consisted of seven case patients and an additional 60 cases diagnosed with Pai syndrome identified in a literature review. Only 23 of 67 patients presented the full triad as historically described by Pai et al. (1987). A congenital facial midline skin mass was always encountered, particularly affecting the nasal structures (60/67). A midline facial cleft was reported in 45 of 67 patients and a pericallosal lipoma in 42 of 67 patients. The proposed definition of Pai syndrome is the association of (1) a congenital nasal and/or mediofrontal skin mass and/or a mid-anterior alveolar process polyp as a mandatory criterion, and at least one of the following criteria: (2) midline cleft lip and/or midline alveolar cleft, and/or (3) a pericallosal lipoma or interhemispheric lipoma in the case of corpus callosum dysgenesis.

Speech evaluation after intravelar veloplasty. How to use Borel-Maisonny classification in the international literature?

OBJECTIVE Comparing functional outcomes after velar repair appeared to be difficult because of the absence of international standardized scale. Moreover most of the studies evaluating speech after cleft surgery present multiple biases. The aim of our study was to assess speech outcomes in a homogeneous group of patients, and to define an equivalence table between different speech scales. MATERIALS AND METHODS Patients with isolated cleft lip and palate (CLP), operated in our unit by the same senior surgeon were included. All patient were operated according to the same protocol (cheilo-rhinoplasty and intravelar veloplasty at 6 months, followed by a direct closure of the hard palate at 15 months). Speech evaluation was performed after 3 year-old and before the alveolar cleft repair. Borel-Maisonny scale and nasometry were used for speech evaluation. RESULTS Twenty-four patients were included: 17 unilateral CLP and 7 bilateral CLP. According to the Borel-Maisonny classifications, 82.5% were ranged phonation 1, 1-2 or 2b. Nasometry were normal in almost 60% of cases. CONCLUSIONS This study showed the efficiency of our protocol, and intravelar veloplasty. Moreover we proposed an equivalence table for speech evaluation scale.

Familial lumps of the lower jaw

Familial lumps of the lower jaw J. Bouaoud *, A. Picard , A. Joly , R.H. Khonsari a,b,c a Service de chirurgie maxillofaciale et plastique, hôpital universitaire Necker-Enfants Malades, Assistance publique–Hôpitaux de Paris, 149, rue de Sèvres, 75015 Paris, France b CRMR MAFACE, 149, rue de Sèvres, 75015 Paris, France c Université Paris-Descartes, 12, rue de l’École-de-Médecine, 75006 Paris, France