B. Laure

An arteriovenous fistula of the maxillary artery as a complication of Le Fort I osteotomy

INTRODUCTION The Le Fort I osteotomy, one of the most common techniques used to correct dento-midfacial deformities, is generally considered to be operatively safe. However, sometimes this procedure can lead to fatal vascular complications. MATERIALS AND METHODS This article describes a fifty-year-old woman with a giant facial venous malformation. The patient underwent a Le Fort I osteotomy in order to correct an open bite. The surgery was complicated by the development of an arteriovenous fistula (AVF) between the maxillary artery and the venous malformation, the diagnosis of which was made by ultrasound doppler. Neuroradiological embolisation process of the maxillary artery was performed in order to close the AVF. RESULTS The total fistula obliteration and a Class I occlusion were obtained. CONCLUSIONS The reported case suggests the necessity of a multidisciplinary process (involving both maxillofacial and neuroradiology teams) for the treatment of dento-midfacial deformities in relation to vascular malformations. This modality is the only way to guarantee minimization of morbidity (according to patients expectations).

Tessier number 4 bilateral orbito-facial cleft: a 26-year follow-up.

Orbito-facial number 4 clefts are the rarest craniofacial clefts and only a few cases have been reported. We report a case of a complete bilateral Tessier number 4 cleft, and our approach to surgical correction. We analyse the patients treatment plan over a 26-year follow-up period. We comment on the age at which the first surgical procedure is commonly performed with or without a primary bone graft, as well as the use of the facial plasty technique with interdigitating Z-plasty flaps and rotation-transposition flaps. Closure of the cleft can constitute an emergency when the patients globe is exposed.

Cemento-ossifying fibroma of the mandible.

INTRODUCTION Cemento-ossifying fibroma is a rare benign tumor most often discovered incidentally. CASE REPORT A 72-year-old patient was referred for a subclinical lesion of the mandible. The orthopantomogram showed a well-circumscribed radiolucent osteolytic image, 1 cm in diameter, on the mandibular angle. On CT, the single lesion had a tissue aspect with a peripheral halo without enhancement after contrast injection. A cortical lacuna on the lingual side was noted. Surgical enucleation of the lesion was performed. The pathological examination confirmed the ossifying fibroma. DISCUSSION/CONCLUSION Slow and progressive, cemento-ossifying fibroma is a rare benign tumor that reaches the maxilla and more frequently the mandible. The ossifying and cementifying fibromas are differentiated by their clinical, radiological, and histological findings. The authors discuss the pathogenesis and radiological signs guiding the choice of diagnostic and therapeutic methods. The treatment is surgical with an enucleation or wider resection with bone reconstruction for large fibromas.

Evaluation of skull strength following parietal bone graft harvest.

Background: Parietal bone grafts are commonly used in craniomaxillofacial surgery. The primary aim of this study was to quantify the loss of strength following monocortical parietal bone graft harvest. The secondary aim was to establish a correlation between strength and thickness of calvaria. Methods: Thirty fresh human cadaver heads (nonfrozen, unembalmed heads) were used for this study. Loss of strength was determined by comparing the maximum impact resistance of bone on the donor side versus the intact side, using a precalibrated pendulum Charpy impact testing machine. Thickness was measured using a surgical navigation system with optoelectronic tracking. Results: Loss of strength at the donor site was 36 percent (p = 0.0000000001) for a 40 percent loss of thickness. Although correlation between these two parameters is rather moderate (r = 0.46), it is highly significant (p < 0.0001). Conclusions: Although loss of strength is quite significant, serious complications at the donor site are rare. As shown in this study, these risks are nonnegligible. However, because of strong legal pressure, surgeons must carefully weigh the risks incurred by the patient against the expected benefits, whether immediate or deferred. Therefore, the patient should receive well-documented information before such monocortical parietal bone graft harvest is performed.

Coloration noire des os du crâne et de la face

INTRODUCTION We report the case of a patient with a craniofacial black bone disease. This was discovered accidentally during a coronal approach. CASE REPORT A 38-year-old patient was referred to our unit for facial palsy having appeared 10 years before. Rehabilitation of the facial palsy was performed with a lengthening temporal myoplasty and lengthening of the upper eyelid elevator. An unusual black color of the skull was observed at incision of the coronal approach. Subperiostal dissection of skull and malars confirmed the presence of a black bone disease. A postoperative history revealed minocycline intake (200mg per day) during 3 years. DISCUSSION This craniofacial black bone disease was caused by minocycline intake. The originality of this case is to see directly the entire craniofacial skeleton black. This abnormal pigmentation may affect various organs or tissues. Bone pigmentation is irreversible unlike that of the mouth mucosa or of the skin. This abnormal pigmentation is usually discovered accidentally.

Stabilité du greffon et des implants après greffe osseuse du sinus maxillaire : Étude rétrospective de 44 cas

Objectif Objectiver la fiabilite de la technique de greffe osseuse du maxillaire et la stabilite de l’implantation apres greffe, en effectuant une comparaison de nos resultats a ceux de la litterature. Materiel et methodes Nous avons mene une etude retrospective a partir de 44 cas de greffe osseuse du sinus maxillaire, operes entre 1998 et 2002. Le greffon etait autologue dans 31 cas, et un melange d’os autologue et de biomateriau dans 13 cas. Cent douze implants ont ete poses sur les sites greffes, avec une moyenne de 2,5 implants par greffes. L’evaluation a porte sur la morbidite du site receveur, l’integration et la stabilite du greffon osseux ainsi que la stabilite du systeme implantaire sur greffe. Resultats Le taux de reussite des greffes est de 97,8 %. Il y a eu un seul echec, tous les autres cas ont pu etre implantes. Sur les 112 implants poses, 2 ont ete perdus. Discussion Nos resultats sont comparables a ceux de la litterature. Cette etude objective la fiabilite de la technique de greffe osseuse au sinus maxillaire, et l’equivalence des resultats entre greffe autologue et biomateriaux associes a l’os autologue.OBJECTIVES We assessed the reliability of maxillary bone grafting and implant stability, comparing our results with reports in the literature. MATERIAL AND METHODS This retrospective series included 44 patients who underwent maxillary sinus bone grafting between 1998 and 2002. An analogous graft was used for 31 patients and a combination autologous-bone substitute graft for 13. One hundred twelve dental implants were positioned at the grafting site (2.5 implants per graft). We assessed recipient site morbidity, bone graft integration and stability, and stability of the implants. RESULTS Bone grafting was successful in 97.8% of patients. There was one failure. Two of the 112 implants failed. DISCUSSION Our results are comparable with those in the literature. This study demonstrated the reliability of maxillary bone grafting with equivalent results using autologous bone and combination autologous bone-bone substitute.

Reconstruction d’une perte de substance complexe du maxillaire par transfert de fibula vascularisé après réalisation d’une fistule artério-veineuse par boucle vasculaire saphène

Introduction Lorsqu’une perte de substance osseuse importante necessite un transfert vascularise, la mauvaise qualite des vaisseaux receveurs impose parfois un geste complementaire d’allongement du pedicule vasculaire. Ce geste peut etre realise soit par des pontages veineux soit en preparant le site receveur par une boucle vasculaire. Nous avons utilise avec succes cette derniere technique chez un patient presentant une importante perte de substance pluri-tissulaire maxillaire. Observation Un homme de 39 ans presentait une perte de substance complete du maxillaire a la suite d’un traumatique balistique. Un lambeau libre de fibula etait envisage. Compte tenu de la longueur limitee du pedicule peronier et du caractere cicatriciel de la zone d’anastomoses vasculaires, la reconstruction a ete realisee en 2 temps : d’abord la preparation du site receveur par une boucle saphene, puis 15 jours plus tard le transfert proprement dit. Discussion Cette technique est une alternative aux pontages veineux qui augmentent de maniere significative le risque de thrombose post-operatoire. Les objectifs de la boucle vasculaires sont d’une part de placer les anastomoses vasculaires en territoire sain et d’autre part de les realiser en termino-terminal. Cette technique a surtout ete decrite dans le traitement des pertes de substance post-traumatique des membres, mais elle est applicable a la face notamment en territoire irradie.

Facial resurfacing with split-thickness skin grafts in Xeroderma Pigmentosum variant

Xeroderma Pigmentosum (XP) is a rare systemic disease which is transmitted through an incomplete sex-linked recessive gene. As a result of this, exposure to the ultraviolet (UV) rays of the sun causes malignant skin lesions. One of the most effective treatment options for the malignant lesions is full-face resurfacing with skin grafts. These grafts should be harvested from areas that have not been affected by UV exposure or have at least been minimally affected. The authors present a patient with XP whose face was resurfaced by split-thickness skin grafts taken from the buttocks.

Launois–Bensaude syndrome involving the orbits

BACKGROUND We report the first description of a Launois-Bensaude syndrome involving the orbit. CASE REPORT Launois-Bensaude syndrome was diagnosed in a 70-year-old-man who presented with severe bilateral proptosis (Hertel value 26mm). We performed a bilateral transpalpebral orbital decompression by resection of intraorbital fat without bone removal. The surgery was uneventful. The volume of resected orbital fat was 16cc in both sides. Proptosis reduction was 7mm. Postoperative Hertel values were 19mm in both eyes. CONCLUSION The proptosis was managed successfully. Orbital lipectomy lead to minimal sequelae and, may be repeated if necessary in this case.

Long-term Assessment of Suturectomy in Trigonocephaly and Anterior Plagiocephaly

Introduction: Techniques for treating trigonocephaly and anterior plagiocephaly have evolved from the initial suturectomy technique to frontal cranioplasty. The authors evaluated the suturectomy technique in adolescent patients with these craniosynostoses, by carrying out a retrospective, long-term assessment at the end of growth. Methods: Patients with anterior plagiocephaly or trigonocephaly were included. All had undergone coronal or metopic suturectomy with bilateral orbitofrontal bandeau resection between 1997 and 2005. The primary endpoint was the Whitaker classification. The secondary endpoints were anthropometric measurement, assessments of the bone defects on computed tomography scan, and the comments of patients and their relatives concerning the final skull outcome. Patients with anterior plagiocephaly also attended an ophthalmological consultation. Results: Seventeen patients were included in the study: 8 with anterior plagiocephaly and 9 with trigonocephaly. Mean age at the time of surgery was 6.91 months. Mean age at the time of craniofacial consultation was 14 years. Fourteen patients (82%) were classified as Whitaker Class III and IV, corresponding to poor esthetic results and persistent bone defects. Seven patients requested further surgery. Conclusion: This study shows that suturectomy seems to yield poor esthetic results in the long term and patients should be followed up throughout adolescence to correct any craniofacial deformities.