Mathieu Laurentjoye

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.

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.

Facial vein variation: implication for facial transplantation.

Philippe Caix, MD, PhD Mathieu Laurentjoye, MD Department of Oral and Maxillofacial Surgery Centre Hospitalio-Universitaire Bordeaux, France Department of Anatomy Université de Bordeaux Bordeaux, France Sir: T anterior facial veins ensure the venous drainage of the face and have been used as main venous pedicles for facial transplantations. The facial vein starts at the medial angle of the eye like the angular vein. Then, it runs obliquely behind the facial artery, crosses over the body of the mandible, and drains into the internal jugular vein through the thyrolinguofacial trunk. At the end of its course, the facial vein joins the retromandibular vein coming from the parotid gland establishing an anastomosis between external and internal jugular veins. We studied the course of 660 facial veins in 330 patients who underwent computed tomography angiography. There were 195 men and 135 women, with a mean age of 54.5 years, and none of them had a history of head or neck surgery. We report 2 cases with facial vein variations. The first case was a 42-year-old woman with bilateral variation of the facial vein, which drained into the jugular system through the parotid gland (Figs. 1 and 2). It could be a retromandibular ending of the facial vein. The vessels were connected with the parotid gland. The frequency of the variation was 0.3%. The second case was a 42-year-old man with unilateral variation of the right facial vein. The contralateral facial vein and facial arteries were normal. The frequency of the unilateral variation was 0.3%. To our knowledge, this is the first description of bilateral variation, whereas a unilateral facial vein variation has already been reported in 4 cases. In 2001, Peuker et al1 first described this phenomenon in an anatomically dissected cadaver. In 2004, Renshaw et al2 found one case of facial vein draining into the temporal vein in a color Doppler ultrasound study conducted in 100 patients, with a frequency of 1%. More recently, Lohn et al3 found during anatomical dissections the variation in 2 cases, with a frequency of 2%. Among the 4 previously published cases, 2 cases presented the variation on the right side of the face and 2 cases were not documented, so that no conclusion can be drawn about any predominance of one side over the other. Variations are rare with a rate ranging between 0.3% and 2%. However, anatomical variations of the facial veins and arteries are of great importance for facial transplantations because they are the main vascular pedicles that will be connected to the patient. A good arterial inflow and venous outflow are essential for the free flap survival. Several authors recommend preoperative investigations in a brain-dead donor before performing any facial transplantation.2–4 The aim is to identify any anatomical vascular variation, allowing surgeons to adapt the dissection during facial flap harvesting.

Lambeau composite médiofacial vascularisé par l’artère faciale : étude anatomique préliminaire

INTRODUCTION Extended facial tissue defects are difficult to reconstruct because of the anatomical and functional complexity of the area. Recently, composite facial allotransplantation was used for reconstruction. This could be performed because of specific facial blood supply and its facial and maxillary anastomoses. Could a composite naso-labio-mental flap rely on the sole blood supply of a facial artery anastomosis? We performed an anatomic study of a naso-labio-mental composite flap vascularized by the facial artery. MATERIAL AND METHOD The study relied on arteriographies made on cadaveric heads and in vivo. The following data was analyzed: caliber of facial and maxillary arteries, terminal branch of facial arteries, and vascular territories. RESULTS Sixteen facial arteries and six maxillary arteries were studied. The mean facial artery caliber was 2.06 mm (1-3.2mm). The facial artery ended in the nasal area in 68.8% of the cases. The latero-nasal artery was always present; it was a branch of the facial artery in 66.7% of cases. The two facial arteries, when injected bilaterally, always allowed complete facial composite flap circulation. The nasal territory of the flap was not opacified by the homolateral facial artery in 16.7% of the cases. DISCUSSION Both facial artery anastomoses are recommended as blood supply for composite midfacial flaps. Preoperative imaging should be used systematically to assess the vascular network before harvesting.