C. Chossegros

Short retromandibular approach of subcondylar fractures: clinical and radiologic long-term evaluation.

OBJECTIVE The classic technique for open reduction of subcondylar fracture is the submandibular approach. The aim of this study was to evaluate long-term clinical and radiologic results of the short retromandibular approach to displaced subcondylar fractures. MATERIAL AND METHODS During a period of 66 months we performed a prospective study with a modified version of the retromandibular approach in 38 patients with displaced subcondylar fractures. In this article we describe clinical and radiologic results in 19 patients with follow-ups longer than 6 months (range, 6 to 66 months). Preoperatively all patients had malocclusion and radiology demonstrated displacement. RESULTS The retromandibular surgical approach was successful in all cases. Roughly 25 months after surgery, mouth opening was 43 mm with symmetric laterotrusive movements. Permanent marginal nerve palsy was never observed. CONCLUSIONS Our findings indicate that the short retromandibular approach is an easy and safe technique for displaced subcondylar fractures.

Sialendoscopie des glandes salivaires

INTRODUCTION Sialoendoscopy is a simple efficient mode of treatment for major salivary gland sialoliths and strictures. METHODS Sialendoscopy procedure requires specific devices, diagnostic and therapeutic sialendocopes, minigrasping forceps, wire baskets, lasers, balloons and stents. The sialendoscopy procedure is divided in three steps: the duct introduction step (through the papilla or through the duct wall); the diagnostic step (from main duct to third or fourth salivary division branches) and the therapeutic step (stone removal with a Dormia basket or miniforceps and stenosis balloon dilatation). The feasibility of stone removal depends on the size, the position, the mobility and the shape of the stone. The only contraindication is acute sialadenitis. DISCUSSION Sialendoscopy complications are minor. Its success rate for stone removal is greater than 90%, and it has dramatically reduced the rate of sialadenectomy (to less than 5%).

Note techniqueSialendoscopie des glandes salivairesSialendoscopy of the salivary glands

INTRODUCTION Sialoendoscopy is a simple efficient mode of treatment for major salivary gland sialoliths and strictures. METHODS Sialendoscopy procedure requires specific devices, diagnostic and therapeutic sialendocopes, minigrasping forceps, wire baskets, lasers, balloons and stents. The sialendoscopy procedure is divided in three steps: the duct introduction step (through the papilla or through the duct wall); the diagnostic step (from main duct to third or fourth salivary division branches) and the therapeutic step (stone removal with a Dormia basket or miniforceps and stenosis balloon dilatation). The feasibility of stone removal depends on the size, the position, the mobility and the shape of the stone. The only contraindication is acute sialadenitis. DISCUSSION Sialendoscopy complications are minor. Its success rate for stone removal is greater than 90%, and it has dramatically reduced the rate of sialadenectomy (to less than 5%).

L’ouverture buccale normale dans la population française adulte

INTRODUCTION: Limitation of mouth opening is a frequent symptom in the pathologies of the temporomandibular joint. The aim of this study is to establish normative basis for this criterion in the French population. MATERIALS AND METHODS: Maximal mouth opening was measured by an electronic goniometric device. Measurements were taken in 228 people (110 men and 126 women) aged between 18 to 84 years, representative of the French population. RESULTS: The average mouth opening is 50.7 7 mm, but it was greater in the male population. It was also greater in tall patients and in younger patients (under 50 years). DISCUSSION: Our study is original because it is based on normal subjects and because our population sample age is the same as that of the French population. Men have a greater mouth opening than women, but this can be due to the fact that they are taller. Mouth opening is wider in young subjects, under 50, because they are younger and because they are taller. Mouth opening is wider in tall patients, whatever their sex or their age.

Position paper from the IBRA Symposium on Surgery of the Head – The 2nd International Symposium for Condylar Fracture Osteosynthesis, Marseille, France 2012

BACKGROUND This is a position paper from the 2nd International Bone Research Association (IBRA) Symposium for Condylar Fracture Osteosynthesis 2012 was held at Marseille, succeeding the first congress in Strasbourg, France, in 2007. The goal of this IBRA symposium and this paper was to evaluate current trends and potential changes of treatment strategies for mandibular condylar fractures, which remain controversial over the past decades. METHODS Using a cross-sectional study design, we enrolled the consensus based on the panel of experts and participants in the IBRA Symposium 2012. The outcomes of interest were the panel and electronic votes on management of condylar base, neck and head fractures, and panel votes on endoscopic and paediatric condylar fractures. Appropriate descriptive and univariate statistics were used. RESULTS The consensus derived from 14 experts and 41 participant surgeons, using 12 case scenarios and 27 statements. The experts and participants had similar decision on the treatment of condylar base, neck and head fractures, as well as similar opinion on complications of condylar fracture osteosynthesis. They had a parallel agreement on using open reduction with internal fixation (ORIF) as treatment of choice for condylar base and neck fractures in adults. Endoscopic approaches should be considered for selected cases, such as condylar base fractures with lateral displacement. There was also a growing tendency to perform ORIF in condylar head fractures. The experts also agreed to treat children (>12 years old) in the same way as adults and to consider open reduction in severely displaced and dislocated fractures even in younger children. Nevertheless, non-surgical treatment should be the first choice for children <6 years of age. The decision to perform surgery in children was based on factors influencing facial growth, appropriate age for ORIF, and disagreement to use resorbable materials in children. CONCLUSIONS The experts and participating surgeons had comparable opinion on management of condylar fractures and complications of ORIF. Compared to the first Condylar Fracture Symposium 2007 in Strasbourg, ORIF may now be considered as the gold standard for both condylar base and neck fractures with displacement and dislocation. Although ORIF in condylar head fractures in adults and condylar fractures in children with mixed dentition is highly recommended, but this recommendation requires further investigations.

Posterior Disk Displacement of the TMJ: MRI Evidence in Two Cases

ABSTRACT Posterior disk displacement is a rare temporomandibular joint (TMJ) disorder. The main clinical sign is sudden molar open-bite (jaw locked in the open position). This may be accompanied by a sensation of intra-articular foreign body and more rarely joint pain. Joint sounds are unremarkable. Mouth opening may be slightly impaired. Hypothetically, like anterior disk displacements, posterior disk displacements can be classified as either reducible or nonreducible. A definitive diagnosis requires magnetic resonance imaging (MRI). There is no consensus concerning treatment. A conservative course of treatment can be successful in patients with functional impairment and should always be attempted before irreversible, invasive therapy.

Transoral approach for Stensen's duct lithiasis

Extracorporeal lithotripsy (ECL) and interventional sialendoscopy are the classical treatments for Stensens duct salivary stones, but some cases cannot be treated using these techniques. Another technique is now available, transoral Stensens duct approach.

Fractures de l’orbite de l’enfant

The aim of this article is to review data concerning paediatric orbital fractures. These fractures exhibit strong specificities because they occur in a growing face. Due to the craniofacial growing pattern and the peumatization of paranasal sinuses, there are differences in the anatomical location of orbital fracture with the age: before the age of seven they are mostly orbital roof and after seven they involve the orbital floor. The clinical diagnosis is confirmed with a computed tomography scan (CT scan), gold standard for the imaging in the orbital fractures. The magnetic resonance imaging (MRI) offers a better soft-tissue depiction and is useful when clinical data are not consistent with CT scan findings. The orbital fractures in children are rarely operated. In emergency the main surgical indications are the trap-door fracture involving the ocular muscles and the compressive haematomas. We hypothesize that the periosteum more likely than the bony structure is involved in the responsible trap-door fractures: the thickness and the elasticity of the periosteum leads to reposition the floor or the medial wall of the orbit to its initial position.

Exérèse endobuccale des lithiases submandibulaires postérieures : 36 cas

INTRODUCTION Proximal submandibular calculi are usually removed by transcervical submandibular sialadenectomy. The aim of this study was to show that intraoral removal of hilar submandibular calculi gives the same results with fewer complications than submandibulectomy. PATIENTS AND METHODS The surgical indication is assessed by palpability of the stone and confirmed by simple CT scan. The surgical procedure is performed under local or general anaesthesia. At the end of the procedure, the duct is controlled with a sialendoscope to remove remaining concretions. We prospectively followed 36 patients with a mean follow-up of six months (one to 36 months). RESULTS The transoral removal of calculi was performed in 34 patients without any definitive neurological complication. The procedure failed in two patients with nonpalpable calculi. Two patients had a recurrence of symptoms due to small intraglandular calculi, which were evacuated later. DISCUSSION The transoral removal of submandibular hilar calculi is a safe and reproducible procedure with less morbidity than submandibulectomy. It should be recommended for posterior palpable submandibular calculi.

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. (Plast. Reconstr. Surg. 108: 332, 2001.)