Remplacement total de l’articulation temporo-mandibulaire par prothèse

Summary Introduction The temporomandibular joint (TMJ) may be the location for tumoral, post-traumatic, degenerative, inflammatory, or congenital diseases requiring a prosthetic replacement. We present a technical note for total TMJ replacement with a Biomet ® Microfixation prosthesis (Jacksonville, FL, USA). Technical note The preoperative data includes dental panoramic X-ray, MRI of the TMJ, and CT-scan (or cone beam) of the facial skeleton. The last two mentioned examinations allow three-dimensional reconstructions and stereo-lithographic models required for surgical planning. The prosthetic device includes a temporal ultra-high density polyethylene component and a mandibular chrome-coba…

Reconstruction de l’articulation temporomandibulaire assistée par ordinateur

Prosthetic replacement of TMJ is gradually becoming a common procedure because of good functional and aesthetic results and low morbidity. Prosthetic models available can be standard or custom-made. Custom-made prosthesis are usually reserved for complex cases, but we think that computer assistance for custom-made prosthesis should be indicated for each case because it gives a greater implant stability and fewer complications. Computer assistance will further enlarge TMJ prosthesis replacement indications.

Syndrome de la fissure orbitaire supérieure post-traumatique : mise au point

The traumatic superior orbital fissure syndrome is an uncommon complication of craniomaxillofacial trauma. The diagnosis is clinical and associates ophtalmoplegia (constantly at initial clinical examination), ptosis and anaesthesia of the forehead. Young men victim of road traffic accidents are most often affected. CT-scan usually shows facial and/or craniofacial fractures more or less spreading towards the superior orbital fissure. The absence of fracture seen at the X-rays does not eliminate the diagnosis. Initial management should be multidisciplinary (maxillofacial surgeons, ophthalmologists and neurosurgeons) and conducted early if possible. It combines high-dose corticosteroids and de…

Peroxisome proliferator-activated receptor alpha deficiency impairs regulatory T cell functions: Possible application in the inhibition of melanoma tumor growth in mice.

International audience; Regulatory T (Treg) cells are important to induce and maintain immunological self-tolerance. Although the progress accomplished in understanding the functional mechanism of Treg cells, intracellular molecules that control the mechanisms of their suppressive capacity are still on investigation. The present study showed that peroxisome proliferator-activated receptor-alpha deficiency impaired the suppressive activity of Treg cells on CD4(+)CD25(-) and CD8(+) T cell proliferation. In Treg cells, PPARα gene deletion also induced a decrease of migratory abilities, and downregulated the expression of chemokine receptors (CCR-4, CCR-8 and CXCR-4) and p27(KIP1) mRNA. Treg ce…

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 t…

Interest of studying the saliva metabolome, transcriptome and microbiome in screening for pancreatic cancer

Abstract Introduction Pancreatic cancer is a public health problem because its mortality rate is close to its incidence rate. If it were possible to detect this cancer before the onset of symptoms, 5-year survival could reach 75%. Numerous studies have attempted to accelerate the diagnosis to improve survival. Saliva presents interesting characteristics as a fluid for screening and diagnosis. Its many components provide a promising source of constitutive biomarkers with a specific signature of the disease. The aim of this work was to determine the interest of studying the metabolome, the transcriptome and the microbiome of saliva in screening for pancreatic cancer. Materials and methods A r…

VIH et noma au Burkina Faso

Summary Introduction Noma is a “gangrenous” disease beginning in gums and spreading to other parts of the face. It usually occurs in undernourished children with bad orodental hygiene. Its incidence in adults is increasing. HIV infection is very common in African countries. We had for objective to compare noma characteristics in patients with, or without, HIV. Material and methods This retrospective and descriptive study included patients managed for noma in our unit from January 1988 to December 2007. The clinical, epidemiological, and outcome data of patients treated for noma were compared according to HIV infection status. Results Two hundred and twelve patients were included and 14 (6.6…

Technique des membranes induites en chirurgie maxillo-faciale

Maxillofacial defects reconstruction represents a formidable challenge to achieve both functional and aesthetic goals. To succeed, numerous parameters must be taken into account: patient's general conditions, defect's location, width and type of the defect and eventual donor sites which can provide the tissues. Routine reconstructions include bone transplantation (autologous, homologous or heterologous), implantation of biomaterials and osteogenic distraction. The advantages of these techniques are evident, but they are usually limited by their complexity in patients with bad general health. The technique of induced membranes needs to be more known in maxillofacial surgery.

Deux cas d’histiocytose sinusale ganglionnaire cervicale de Destombes-Rosai-Dorfman

Resume Introduction L’histiocytose sinusale de Destombes-Rosai-Dorfman est une pathologie rare. Sa localisation est ubiquitaire, mais la forme la plus classique reste ganglionnaire cervicale. Observation Nous presentons 2 cas d’histiocytose sinusale ganglionnaire de Destombes-Rosai-Dorfman. Les patients etaient âges respectivement de 9 et 30 ans. Ils ont presente tous les deux une polyadenopathie cervicale bilaterale avec un syndrome compressif cervical dans le premier cas. Le diagnostic de certitude histologique a ete fait grâce a la mise en evidence d’une emperipolese histiocytaire dans le premier cas et dans le second cas par immuno-histochimie. Le traitement a consiste dans les deux cas…

Tuberculosis of the temporomandibular joint.

Summary Introduction Extrapulmonary and extra-spinal tuberculosis (TB) is rare, even in countries where the disease is endemic. Ten percent of these localizations are cervico-facial. Involvement of the temporomandibular joint (TMJ) is very unusual. We present the features of such a case. Review We looked for patients managed for TMJ TB in 2 Maxillofacial Surgery departments and in 1 Pneumology & Phthisiology Department since 1992. The second part of the study was a literature review. One case was found in our departments and 15 other cases were found in published data. Most patients were women with mean age of 39.9 years (5 to 68). Pre-auricular swelling was the predominant functional sign,…

Reconstruction faciale complexe sur mesure : un cas de remplacement total de l’articulation temporo-mandibulaire, de l’arcade zygomatique et du zygoma

Resume Introduction Le remplacement total prothetique de l’articulation temporo-mandibulaire (ATM) est devenu une intervention courante, mais ce remplacement prothetique se cantonne habituellement a l’ATM. Nous presentons le cas d’une reconstruction prothetique complexe sur mesure etendue l’articulation et les structures osseuses voisines. Observation Un patient de 57 ans, multi-opere pour une dysplasie fibreuse crânio-faciale droite, presentait une recidive d’ankylose de l’ATM droite et une perte de substance osseuse latero-faciale droite complexe. Nous sommes intervenus pour proceder a une reconstruction incluant l’ATM, l’arcade zygomatique et le zygoma a l’aide d’une prothese sur mesure …

Prothèses totales des articulations temporomandibulaires

The temporomandibular joint (TMJ) is probably the most complex human joint. As in all joints, its prosthetic replacement may be indicated in selected cases. Significant advances have been made in the design of TMJ prostheses during the last three decades and the indications have been clarified. The aim of our work was to make an update on the current total TMJ total joint replacement. Indications, contraindications, prosthetic components, advantages, disadvantages, reasons for failure or reoperation, virtual planning and surgical protocol have been exposed.

Résultats fonctionnels après reconstruction de l’articulation temporo-mandibulaire par prothèse totale (2e partie)

Resume Introduction Les pathologies de l’articulation temporo-mandibulaire (ATM) sont habituellement traitees medicalement. La gravite de l’atteinte et le retentissement fonctionnel peuvent justifier une reconstruction partielle ou totale. Nous avons evalue nos resultats apres reconstruction de l’ATM par prothese totale Biomet Microfixation® (Jacksonville, FL, Etats-Unis). Patients et methode Nous avons revu les dossiers des patients reconstruits entre 2009 et 2012 par une prothese totale d’ATM. L’ouverture buccale initiale et postoperatoire, l’occlusion dentaire initiale et postoperatoire, l’intensite des douleurs pre- et postoperatoire sur une echelle verbale simplifiee allant de 0 (absen…

Peri-oral symptoms of immunodepression caused by COVID-19 infection

Étude radio-anatomique tridimensionnelle de l’artère faciale et de ses perforantes cutanées

Cicatrices chéloïdes de la tête et du cou

A keloid scar is a benign proliferative lesion of dermic collagen. It is predominant in black skin patients. It is most commonly located on the head and neck. Skin trauma and a genetic predisposition may be responsible for the keloid scar. Nevertheless, the pathogenesis of keloid scar is still unclear, and no currently available treatment is 100% effective. The authors had for aim to review the current data on keloid scar pathogenesis and treatment for an optimal management of this condition.

Intra-mandibular adenoid cystic carcinoma.

Intra-mandibular localization of adenoid cystic carcinoma is rare. This tumor is characterized by progressive local, regional, and distant aggressiveness. We reviewed the latest data on this rare type of cancer with a small number of reported cases, alack of consensus for its treatment, and its bad prognosis.

Biangular fractures of the mandible

Summary Introduction Bifocal fractures of the mandible often associate the angle and condyle or symphysis. Little data is available on biangular fractures. The authors had for aim to study their characteristics and to suggest an adapted management. Material and methods We retrospectively reviewed the records of patients operated on for a biangular fracture from January 2005 to December 2009. The impact of a third molar was evaluated using Pell and Gregory's and Shiller's classifications. Results Six hundred and forty patients underwent surgery for a mandibular fracture, seven of whom (1.1%) for biangular fractures. The patients’ mean age was 27.6 years. Patients were predominantly men (85.7…

Reconstruction of large mandibular and surrounding soft-tissue defects using distraction with bone transport.

Reconstruction of large bone and soft-tissue defects of the inferior third of the face is possible using various surgical techniques. Patients who require these procedures need to be in good general health, may have sequelae linked to donor sites, and require several interventions to achieve good aesthetic and functional results. The aim of this study was to report outcomes in patients with large mandibular and soft-tissue defects treated using osteogenic distraction with bone transport. Between 2001 and 2008, 14 patients had distraction with bone transport. Most patients were men (92.1%). The mean age was 43.1 years. The average mandibular bone reconstruction was 13.6 cm. The mean duration…

Une forme pagétoïde de pseudomélanome d’Ackerman secondaire à un naevus congénital dans l’enfance : à propos d’un cas

Resume Introduction Le pseudomelanome d’Ackerman est une tumeur benigne presentant des similitudes avec des lesions malignes. Il survient classiquement chez l‘adulte a la suite de l’exerese incomplete d’un naevus commun acquis. Son incidence varie de 0,3 a 27 % selon les etudes. Nous presentons ici un cas clinique pediatrique de forme pagetoide de pseudomelanome d’Ackerman apparu dans les suites de l’exerese d’un naevus congenital. Cas clinique L’exerese d’un naevus congenital localise au niveau du thorax a ete realisee sur une patiente de 9 mois. L’analyse histologique a conclu a un naevus commun acquis d’exerese complete. A sept mois post-operatoires, deux autres lesions cutanees sont app…

Traumatic atlanto-axial rotatory subluxation after surgical correction of prominent ears: Case report and review of the literature

International audience; Corrective surgery of prominent ears may be justified for social or aesthetic reasons during childhood or adulthood. Post-operative complications occur in approximately 0 to 8.4% of cases. This case describes a rare atlanto-axoid rotatory subluxation after bilateral surgical correction of prominent ears under general anesthesia. Orthopedic treatment was done after two months of medical roaming outside of our center. The one-year post-operative clinic consultation and radiological exam were normal. Only the psychological impact of the episode remained. Traumatic atlanto-axial rotatory subluxation is a rare complication but should be considered after post-operative tor…

Capillary measurement of lactate and glucose for free flap monitoring.

Summary Background It is reported that the salvage rate of free flaps is inversely related to the time interval between the onset of pedicle impairments and their clinical recognition. Monitoring of free flaps is therefore of major importance and clinical monitoring remains the most used technique because of lack of low-cost and non-invasive techniques. The authors suggested an efficient, simple and cheap technique to detect early thrombotic events in monitoring free flaps with skin paddle. Methods In this multicentre prospective study, measurements of capillary glucose and lactate in the flaps were done. These parameters were compared to standardized clinical monitoring during the first fi…

Le lambeau ostéo-fascio-cutané antébrachial radial dans la reconstruction maxillo-faciale

Resume Introduction Les pertes de substance maxillo-faciales souvent pluritissulaires relevent d’une reconstruction par lambeaux composites. Le lambeau osteo-fascio-cutane antebrachial radial (LOFCAR) est l’un des moins utilise. Nous presentons nos resultats de reconstruction maxillo-faciale avec ce lambeau. Patients et methode Nous avons repris les dossiers des patients reconstruits par LOFCAR entre 2009 et 2011. Les pertes de substance mandibulaires ont ete classees selon la classification HCL, les maxillaires selon celle de Cordeiro-Santamaria. Les resultats fonctionnels (deglutition et elocution) ont ete analyses a partir du sixieme mois. Resultats L’âge moyen des dix patients etait de …

Kystes trichilemmaux ossifiants multiples du cuir chevelu : un cas familial

Resume Introduction Le kyste trichilemmal, egalement appele kyste pilaire, est un kyste epithelial dermique developpe aux depens du follicule pileux. Le cuir chevelu est la localisation la plus frequente de cette lesion. Les cas ossifiant et familiaux sont rares. Observation Nous rapportons un cas de kystes trichilemmaux multiples du cuir chevelu, decouverts chez femme de 61 ans ayant des antecedents familiaux. Le diagnostic a ete confirme par l’histologie de la piece operatoire. Les kystes trichilemmaux se caracterisaient par remaniements intrakystiques, sous forme d’ossification. L’etendue des lesions a necessite une exerese chirurgicale elargie du cuir chevelu. La reconstruction a ete fa…