Isabelle Barthélémy

Etiology, distribution, treatment modalities and complications of maxillofacial fractures

Purpose: This study evaluated the trends and factors associated with maxillofacial fractures treated from 1997 to 2007 in the Oral and Maxillofacial Surgery Department of the Clermont-Ferrand University Hospital. Material and Methods: This study included 364 patients of which 82% were men and 45%, 20-29-years old. The etiology, anatomical distribution, treatment modality and complications of maxillofacial fractures were examined. Results: Overall, interpersonal violence, traffic accidents and falls were the most common mechanisms of injury. There was a decreasing trend in traffic accidents and increasing one in falls as a cause of fracture over the 11-years period of this study. Young male patients were preferentially victim of interpersonal violence and traffic accidents, while middle-aged ones were of falls and work-related accidents. Middle-aged female patients were preferentially victim of traffic accidents and interpersonal violence, while older ones were of falls. And the number of fractures per patient varied according to the mechanism of injury: low after work-related accidents and high after traffic accidents. About two-third of fractures involved the mandible. Most of these mandibular fractures were treated by osteosynthesis with or without intermaxillary fixation, with the proportion of the latter increasing over time. There were very few postoperative infections and only in mandible. Conclusions: Maxillofacial fractures predominantly occur in young men, due to interpersonal violence. There is nevertheless an increasing trend in falls as a cause of fracture, especially in female patients, consistent with the increasing trend in presentation of older people. Most maxillofacial fractures involve the mandible and there is an increasing trend in treating these fractures by osteosynthesis without intermaxillary fixation. Antibiotic prophylaxis associated with dental hygiene care can be indicated to prevent postoperative infections. Key words:Maxillofacial fractures, Epidemiology, Trends, Influencing factors, Fall, Age, Gender, Antibiotic prophylaxis.

Bilateral cervical chondrocutaneous remnants: a familial observation

Cervical chondrocutaneous remnants are extremely rare, and fewer than 40 unilateral, and only 11 bilateral, forms have been reported. The clinical and ultrasonographic criteria have been well characterised. Several associated anomalies may accompany the remnants and patients should therefore be investigated further. The treatment of choice is complete excision to confirm the diagnosis. Histological investigations define this lesion as heterotopic, composed of normal skin and fat with a strip of cartilage running through the middle. The embryological origin is not clear. We report what is to our knowledge the first familial form in 6 members of a Libyan family all of whom had unilateral or bilateral forms. We focus specifically on a 10-year-old girl with bilateral chondrocutaneous remnants who was admitted to our department.

Cervicothoracic Subcutaneous Emphysema and Pneumomediastinum After Third Molar Extraction.

Third molar extraction is one of the most common interventions in dental and maxillofacial surgery. Complications are frequent and well documented, with swelling, pain, bleeding, infection, and lingual or alveolar nerve injury being the most common. This report describes a case of subcutaneous extensive emphysema and pneumomediastinum that occurred 4 days after extraction of an impacted right mandibular third molar. The management and etiology of this case and those reported in the literature are discussed.

Computer-assisted planning and navigation for the treatment of true hemifacial hyperplasia.

FIGURE 2. Patient and three-dimensional computed tomography scan views 2 months after operation; note that, although the bones are almost symmetric, soft tissue enlargement persists. To the Editor: True hemifacial hyperplasia (THFH), classified in 1962 by Rowe, is a developmental anomaly, defined as a unilateral variable enlargement of all hemifacial tissues, bounded by the frontal bone superiorly (not including the eye); the border of the mandible inferiorly; the facial midline medially; and the ear, including the pinna, laterally. We present the surgical steps to symmetrize midface and low-face in 1 procedure. These associations have not been previously reported and were made possible by the assistance of virtual planning and navigation system. A 34-year-old woman complained of right hemiface abnormal shape worsening since birth. Clinical examination reported bigger ear, thick and fleshy soft tissues with normal skin and hairs, hemi-tongue enlargement with hypertrophic papilla ending abruptly at the midline, chin deviation to the left side, malocclusion with an anterior open bite, distortion of dental arches and spacing between teeth, and no restriction of temporomandibular joint movement neither maxillary midline deviation. Panoramic radiography and computed tomography scan showed a complete enlargement of right hemimandible, maxillar, and zygoma (Fig. 1). Cephalometric analysis indicated a class III skeletal jaw relationship with a retrusive maxilla, protrusive mandible, and concave soft tissue profile. A technetium-99m methylenediphosphonate single-photon emission computed tomography revealed an increased focal activity in the upper extremity of the right condyle. Data were consistent with the diagnosis of THFH. The presurgical planning consisted of mirroring the left threedimensional reconstruction on the right side, including the orthognathic surgical plane in the virtual treatment and drawing cut lines for right condylectomy, coronoidectomy, mandibuloplasty, and zygomaplasty. Using the navigation system during the surgery, condyle was resected with disk preservation using a preauricular incision, zygoma was reduced from 4-mm length and fixed in a more medial and posterior position through a subciliar, and intraoral

Virtual Surgery Planning and Three-Dimensional Printing Template to Customize Bone Graft Toward Implant Insertion

Premaxillary tooth loss and bone deficiency or atrophy often occur in facial trauma. Onlay bone graft and implants have so far been the best means of restoring function and esthetic appearance. Void space between the graft and the jaw bone, over projection and mucosal trauma can cause mucosal dehiscence, bone exposure, or resorption and can compromise implant survival. Virtual surgical planning using 3-dimensional printing technology has improved the efficiency of craniofacial surgery. The drawbacks of this technology are its cost and time-consuming preparation. However, the democratization of high-performance 3-dimensional printing and open-source software have enabled surgeons to master the procedure. The authors applied this innovative technology to customize bone graft for insertion of a premaxillary implant. It enabled us to custom-make the bone graft on the template and to perfectly embed the graft in the gap with a reduce operating time and a good osteointegration.