F. Siberchicot

Mandibular reconstruction using induced membranes with autologous cancellous bone graft and HA-βTCP: animal model study and preliminary results in patients

Providing an acceptable quality of life for patients after reconstruction of mandibular segmental defects is challenging because the surgical techniques available have limitations. The authors evaluated two-stage mandibular reconstruction in rabbits and provide preliminary results in humans. 21 rabbits underwent bilateral segmental mandibulectomy and the defect was filled with methylmethacrylate. The methylmethacrylate was removed after 4 weeks and an iliac autograft performed on the right-hand side and an autogenous graft with hydroxyapatite and triphasic calcium phosphate (HA-betaTCP) on the left-hand side. Four patients with severe mandibular osteoradionecrosis underwent a two-stage reconstruction. No clinical or paraclinical complications were noted. Hematoxylin-eosin-saffron staining revealed an induced membrane lining the cavity of all samples with dense vascularity. Decalcified, undecalcified and histomorphometric analysis showed new bone formation in the biomaterial and the autograft. Calcium uptake was higher inside the new cortical bone, notably at sites with HA-betaTCP. CT scans at 6 months showed that two patients had a favorable outcome with cortico-cancellous bone. Microscopic and immunochemical analysis confirmed the experimental data. This study demonstrates the feasibility of mandibular reconstruction using the induced membranes technique. This technique is efficient, and the results would be better in non-irradiated patients with good general health.

Septa within the sinus: effect on elevation of the sinus floor

Elevation of the sinus floor allows the correct number and length of oral implants to be placed. The sinus membrane is dissected blindly, usually by a crestal approach, but several internal configurations of the maxillary sinus or intrasinus septa can cause problems. We studied 150 sinuses from 40 male cadavers, and 35 randomised male patients by anatomical dissection and computed tomography. Forty-six subjects (61%) had no bony septa or had septa less than 4mm. Twenty-nine (39%) had bony septa of which seven were incomplete, one had a complete bony septum in each maxillary sinus, and 20 had symmetrical bony septa. We present the results of a study of bony intramaxillary sinus septa and the potential problems they can cause during elevation of the sinus floor.

Treatment of mandibular fractures with Michelet technique: manual fracture reduction without arch bars.

PURPOSE In our Bordeaux maxillofacial surgery unit, we have used the Michelet technique described for 40 years: manual fracture reduction and semi-rigid miniplate osteosynthesis fixation. No maxillomandibular fixation (MMF) with arch bars or with screws was used for reduction during osteosynthesis. The aim of this work was to evaluate results of this unknown manual reduction method. MATERIALS AND METHODS A total of 184 patients were reviewed. We recorded epidemiology of mandible fracture, clinical and radiologic evaluation before and after surgery, and treatment. Anatomic and functional manual reductions were the basic principle: manual maxillomandibular immobilization (functional) and manual fracture reduction (anatomic). In cases of condylar fractures without severe displacement, MMF with cortical bone screws was indicated (orthopedic treatment). Physiotherapy was also possible (functional treatment). RESULTS In all, 315 mandible fractures sustained by 184 patients were reviewed into the study. Of the patients, 80% were treated by osteosynthesis: 54% by osteosynthesis treatment alone, 26% by osteosynthesis and orthopedic treatments. The average time required for osteosynthesis or osteosynthesis and orthopedic treatment was 56 minutes. We observed 0.67% of disturbed occlusion, 0.67% of pseudarthrosis, and 0.67% of bilateral temporomandibular joint internal derangement. CONCLUSIONS Manual fracture reduction suppresses systematic MMF using arch bars during osteosynthesis of mandible fractures. Operating time and risk of complications are reduced. Functional results seem to be similar to that reported in the literature.

Results of oral implant-supported prostheses after mandibular vertical alveolar ridge distraction: a propos of 54 sites.

OBJECTIVE The aim of this study was to present retrospective long-term results of oral implant-supported prostheses after mandibular vertical alveolar ridge distraction. STUDY DESIGN Patients who had alveolar mandibular distraction before oral rehabilitation from 1999 to 2009 were retrospectively reviewed. RESULTS Fifty-four distractions were performed in 25 women and 12 men with a mean age of 51.7 years. Seventeen patients had bilateral distraction. Most of the distracted sites were posterior. Global major complications were major misdirection (3.7%), fracture (3.7%), and permanent alveolar nerve paresthesia (1 patient). All of the patients experienced osseous improvement. Mean height of the distraction was 11.7 mm. A total of 127 implants were inserted with survival and success rates, respectively, of 100% and 96.2% (mean follow-up of 62 months). All of the patients had satisfactory oral rehabilitation. CONCLUSIONS Mandibular alveolar vertical distraction could be a reliable and effective procedure with precise indications. A less complicated implant distractor may simplify the procedure.

Neoadjuvant polychemotherapy in locally advanced Merkel cell carcinoma

Background. A 72-year-old man presented with a Merkel cell carcinoma (MCC) of the left cheek with concomitant nodal spread. A 61-year-old man presented with an MCC of the right thigh with rapid nodal recurrence.Investigations. Skin biopsy samples proved the MCC nature of the neoplasm in both patients. Staging procedure included clinical and radiological investigations.Diagnosis. Advanced stage II MCC.Management. Neoadjuvant cisplatin, etoposide and cyclophosphamide (EPC) regimen led to local control in the first patient and allowed curative surgery associated with adjuvant radiation therapy. Complete remission was maintained for 32 months. The second patient was treated by surgery plus radiation therapy. Nodal and cutaneous recurrences were treated with a neoadjuvant EPC regimen leading to a 5-year complete remission.

Reconstruction of lateral mandibular defects with dynamic bridging plates

The principle of mandibular reconstruction by dynamic bridging plates in association with a bone graft is based on the double bridge reconstruction method. However, the plate can be used alone. Our aim was to report the long-term results of this treatment for mandibular lateral defects in fragile patients. From 1993 to 1999, 38 consecutive patients had primary reconstructions with bridging plate for lateral mandibular defects. Their mean age was 58.4 years (26-86) and the mean follow-up was 50 months (6-89). Excluding removal of plates for local recurrences, the overall success rate was 78%. Plates were removed after a mean of 20.4 months (1-66). No plates fractured. Dynamic bridging plates allow an immediate and efficient reconstruction with reduced operating time and compare favourably with conventional plates. They can also be used as a stand-by for patients who are to have a delayed free flap reconstruction.

A multirecurrent ameloblastoma metastatic to the lung.

INTRODUCTION The ameloblastoma is a rare tumor of odontogenic epithelial origin. It is a neoplasm in which ameloblastic features are revealed by the primary growth in jaws and by any metastatic growth. Recurrences are usually local and distant metastases are rare. We present a case of a multirecurrent ameloblastoma of the mandible metastatic to the lung. OBSERVATION We present a case of a mandibular malignant ameloblastoma in a 42-year old man with widespread pulmonary metastases. Some of these lesions were treated surgically. DISCUSSION Ameloblastoma metastasis often occurs in the lung. The curative treatment is surgical. The results of palliative chemotherapy and radiotherapy are not always efficient.

Result of Maxillomandibular Fixation Using Intraoral Cortical Bone Screws for Condylar Fractures of the Mandible

PURPOSE Treatment of mandibular condylar fractures is not standardized. The maxillomandibular cortical bone screw fixation technique carries many advantages. The aim of this work was to evaluate this technique for routine method. MATERIALS AND METHODS Fifty patients treated by maxillomandibular fixation (MMF) by use of cortical bone screws from 2004 to 2006 were retrospectively analyzed. In our maxillofacial surgery unit in Bordeaux, France, our indication is to treat extra-articulated fractures without severe displacement by MMF. RESULTS The mean time required for MMF was 13 minutes, and fixation occurred after a mean of 16 days. Screw removal was performed after a mean of 26 days, and this required local anesthesia. Of the patients, 48 had good occlusion. Two patients had persistent lateral cross bites. Two patients had mandible deviation when they opened their mouths, and mouth opening was limited in one patient. Two patients had temporomandibular joint pain. CONCLUSIONS MMF screws have more advantages and fewer disadvantages than arch bars when closed treatment has been selected as the treatment of choice.

Le lambeau musculocutané infrahyoïdien à palette cutanée horizontale. Technique chirurgicale

The infrahyoid myocutaneous flap technique was described by Wang in 1986, the skin pad being orientated vertically. Its blood supply comes from the superior thyroid artery. This flap consists of the sternohyoid muscle, the sternothyroid muscle, and the superior belly of the omohyoid muscle. The harvesting of a horizontal skin flap does not modify its reliability and avoids additional scars. The donor site anatomy and flap vascularization are briefly described as well as the flap features and harvesting technique.

Étiologies des pertes de substance des lèvres

Resume La reparation des levres ne peut s’envisager qu’apres avoir bien determine les caracteristiques de la perte de substance donnees par l’etiologie de celle-ci. Les etiologies traumatiques restent dominees par les accidents de la voie publique associees le plus souvent a des atteintes sous-jacentes. Les morsures de chien restent l’apanage de l’enfant et posent toujours le probleme de leur septicite. Les brulures necessitent d’attendre que l’organisme delimite lui-meme les tissus viables. Les traumatismes balistiques vont entrainer des degâts majeurs ou la reparation fonctionnelle des levres sera souvent tres difficile. Les tumeurs des levres, essentiellement malignes, entrainent une chirurgie d’exerese large dont les marges sont dictees par l’etude anatomopathologique. Elles posent, bien sur, le probleme d’eventuels evidements cervicaux et sont dominees en frequence par les carcinomes epidermoides.