The coverage of soft-tissue defects concerning the front of the knee and the proximal lower leg is a complex procedure. The reverse flow anterolateral thigh flap represents a good solution for this defects, especially when the coverage surface is large-sized and a free flap is not appropriate regarding the difficulty of the process. Flap retrograde vascularization is based on the anastomosis between the descending branch of the circumflex femoral artery and lateral superior genicular artery. It is an easy solution with low morbidity. The authors have chosen this flap to cover soft-tissue defect of anterior knee from two patients with total knee prothesis. (C) 2015 Elsevier Masson SAS. All rights reserved.

The birth of a child with a cleft lip, whether or not in association with a cleft palate, is a traumatic event for parents. This prospective, multidisciplinary and multi-centre study aims to explore the perceptions and feelings of parents in the year following the birth of their child, and to analyse parent–child relationships. Four inclusion centres have been selected, differing as to the date of the first surgical intervention, between birth and six months. The aim is to compare results, also distinguishing the subgroups of parents who were given the diagnosis in utero and those who were not.

Avec une fréquence moyenne de 1/800 naissances en France, les fentes labiomaxillo- palatines (FLMP) sont parmi les malformations congénitales les plus fréquentes. Elles posent des problèmes fonctionnels, esthétiques, psychologiques et socio-familiaux qui doivent être pris en charge par une démarche interdisciplinaire. Dans cette équipe, le chirurgien-dentiste doit, avec ses restaurations prothétiques, compenser certaines séquelles et déficiences. Selon la sévérité du cas et le succès des traitements, la restauration d’usage peut se limiter à remplacer une incisive latérale manquante, comme elle peut nécessiter la mise en oeuvre de traitements globaux impliquant un arsenal chirurgico-prothétique beaucoup plus conséquent.

With an average frequency of 1/800 births in France, labio-maxillo-palatal clefts (LMPC) are among the most frequent congenital malformations. They raise functional, esthetic, psychological and socio-familial problems that must be managed with an interdisciplinary approach. Within the medical team, the dentist must, by way of prosthetic restorations, compensate for certain sequelae and deficiencies. According to the severity of the case and the success of the treatments, the typical restoration can be limited to replacing the missing lateral incisor, or the restoration may require undertaking comprehensive treatments involving a much more specialized arsenal of surgical and prosthetic procedures.

Le type et l’importance d’une Fente Labio-Maxillo-Palatine (FLMP) interviennent dans sa réhabilitation. Seuls les centres qualifiés prennent en charge ces traitements qui, en complément de la chirurgie, nécessitent une succession d’étapes thérapeutiques multidisciplinaires. Il est évident que les centres de compétence, en fonction des besoins, de leur expérience et de leurs moyens, défendent des avis d’école. Il est néanmoins possible de se référer à un « canevas » qui situe les objectifs communs à toute équipe et qui présente l’ensemble des situations cliniques. Ce « canevas », qui identifie les différentes phases thérapeutiques, situe la contribution de l’orthodontie.

Only competent centres are able to provide the full range of multi-disciplinary specialized therapies that cleft lip and palate rehabilitation requires. Despite some detail differences in conducting treatment, the agreed centres produced consensual treatment philosophy and observe equivalent therapeutic schemes. These sequences, to which orthodontics invariably contributes, are designed to favour the normal outcome of facial development and functions.

Labio-maxillary-palatal clefts, which are caused by fetal nasal buds failing to fuse with the maxillary bud, disrupt the ensemble of the structures that support and interact with the nose and upper jaw creating a rupture of balance that becomes an increasingly exacerbating vicious circle. In correcting these defects practitioners must effect a compromise between the need to re-unite separated parts – under as little tension as possible – and the need to preserve the interrupted potential for growth in the affected facial region. They must carry out this compromise in the double sense of topography and chronology.Adhering to this therapeutic philosophy, the Nancy protocol closely associates orthopedic preparation and surgical treatment of patients to obtain: high quality morphology, an unblocked, sufficiently broad maxilla, correct nasal breathing, velo-pharyngeal competence. We use a tibial periosteal graft to repair the oral cleft as an important element of our procedures.

Les fentes labio-maxillo-palatines, qui résultent d’un défaut de fusion entre bourgeons nasaux, et bourgeon maxillaire, désorganisent l’ensemble des structures d’appui et d’animation, créant une rupture d’équilibre qui consacre un cercle vicieux d’aggravation. Leur réhabilitation est le fruit d’un compromis entre la rééquilibration par réunion des berges sous une tension minimale des parties molles et la préservation du potentiel de croissance résiduel de la région interrompue.

The question of final-phase treatment and prosthetic rehabilitation is posed for the young adult patient who has followed a program of surgical, orthopedic, and orthodontic work aimed at achieving a functional, aesthetic balance. When a toothless space has been maintained or recreated between the proximal teeth of each fragment, two solutions are at hand for the expert odontologist: implantology, or traditional joint prosthesis. Four problems are evoked here to describe the difficulties related to this therapeutic decision: confrontation of the banks, residual osseous defect, teeth bordering the cleft, and the odontologist's role in the overall responsibility for the patient. The choice of the final surgical and prosthetic context induces a multifactor analysis, and must be integrated early on, as part of a multidisciplinary therapeutic strategy. Psychological acceptance is thereby favored, along with the rational search for a durable, aesthetic result.

The actual gold standard of Botulin A toxin (BoTx A) batches qualification is the mouse lethality assay. With this assay it is nevertheless impossible to set a therapeutic value unit.Aims. - The goat of this research was to study the effects of BoTx A increasing concentrations on glutamatergic rat neurons.Experimental procedure. - We studied the glutamate release with increasing concentrations of BoTx A. We also studied the BoTx A target cleavage with a western blot technique.Results. - Our results proved that it is possible to establish a dose-response - like curve of BoTx A effects on glutamate release. Moreover the cleavage of the target protein was visible for the same toxin concentrations that inhibited the glutamate release.Conclusion. - This technique could be the first step toward a new way of setting a better pharmaceutical profile for toxin batches. (C) 2008 Publie par Elsevier Masson SAS.