Some young patients with a significant skeletal shift with a strong morpho-aesthetic and psychological impact may require surgical correction during their growth. A good understanding of facial growth, the different treatment options and the effects of surgery on the post-operative growth pattern will allow the practitioner to use the technique most suited to each of his patients and improve long-term treatment outcomes. So-called « interceptive » surgery may therefore be considered in cases of severe skeletal dysmorphism of secondary or functional origin. It will lead to early normalization with the immediate consequence of breaking the « dysmorpho-dysfunctional » spiral.

BACKGROUND:Postural control is classically described as being based on the visual, vestibular, and proprioceptive musculo-articular sensory systems. The influence of mandibular proprioception on postural stabilization remains controversial. Most previous studies analyzed how postural stability is influenced by partial changes in mandibular proprioception (dental occlusion and jaw position).RESEARCH QUESTION:In the present experiment, we asked whether drastic mandibular changes, resulting from orthognathic surgery (including dental, joint and muscular efferents), modify postural control.METHODS:The analyzes were performed in 22 patients tested before, and 2.5 months, after orthognathic surgery for treatment of dysmorphic jaws. Experiments were performed under 4 experimental conditions: 2 visual conditions: Eyes Open (EO) and Eyes Closed (EC), and 2 occlusal conditions: Occlusion (OC: mandible positioned by the contact of the teeth), and Rest Position (RP: mandible positioned by the muscles without tooth contact). The analyses focused on head orientation in the frontal plane and on postural stabilization in a static task, consisting of standing upright.RESULTS:The results show that, 2.5 months after orthognathic surgery, head orientation in the frontal plane was improved, since patient's external intercanthal lines became closer to the true horizontal line when they were tested EC and in OC condition. Postural responses, based on the wavelet transformation data, highlight an improvement in maintaining an upright stance for all the tested sensory conditions. However, such improvement was greater in the EC and RP conditions.SIGNIFICANCE:These results show, for the first time, that after drastic mandibular changes, the weight of proprioceptive cues linked to the mandibular system may be so enhanced that it may constitute a new reference frame to orient the head in space, in darkness, and improve static postural stabilization, even in the presence of visual cues.

Le contrôle postural est classiquement décrit comme étant basé sur les informations visuelles, vestibulaires et proprioceptives musculo-articulaires. L’influence de la proprioception mandibulaire sur la stabilisation posturale reste controversée. Dans cette étude, nous avons analysé les conséquences de changements drastiques de la proprioception mandibulaire suite à une chirurgie orthognatique (modification de position des mâchoires qui implique l’articulation des dents, l’articulation temporo-mandibulaire et les muscles) sur le contrôle postural. Les analyses ont été effectuées chez 22 patients testés avant et 10 semaines après chirurgie orthognatique, avec un examen photographique et un examen sur plateforme stabilométrique dans 4 conditions déterminées par la vision et l’occlusion : les yeux étaient ouverts ou fermés et la mandibule était en occlusion (dents en contact) ou au repos (positionnée par les muscles, sans contact dentaire). Nous avons étudié l’orientation de la tête dans le plan frontal et la stabilisation posturale dans une tâche posturale statique consistant à tenir debout. Les résultats montrent qu’après chirurgie orthognatique, l’orientation de la tête dans le plan frontal est améliorée lorsque les tests sont réalisés en conditions yeux fermés et dents en occlusion. De plus, la stabilisation posturale est améliorée dans toutes les conditions expérimentales. Cette amélioration est plus importante en condition yeux fermés et repos mandibulaire. Ces résultats montrent, pour la première fois, que des changements mandibulaires drastiques sont susceptibles d’augmenter le poids des informations proprioceptives mandibulaires de telle sorte quelles peuvent constituer une nouvelle référence pour orienter la tête dans l’espace dans l’obscurité et améliorer la stabilisation posturale même en présence d’informations visuelles.

The chin may be concerned by morphological abnormalities in its various dimensions. Classical genioplasty techniques can be used to correct these but have some disadvantages. The "chin wing", described by Triaca, is a technique of genioplasty extended to the mandibular angles, considering the mandibular basilar border as an anatomical unit, thus achieving a better harmonious functional and aesthetic result. The preoperative assessment included a mandibular Cone Beam to evaluate the position of the inferior alveolar nerve. The procedure was performed under general anesthesia. The periosteal dissection was limited to the osteotomy area and mental nerves were protected. The osteotomy observed a modification of its orientation in front of the mental foramen to become parallel to the basilar border, which was interrupted at the level of the mandibular angle. The spaces created were filled with bone grafts and maintained by a symphysary plate. Chin wing genioplasty both improves the function and aesthetic of the face because it considers the mandibular basilar border as an entire anatomical unit. It can be performed independently of any procedure to modify the bone bases. Nowadays, chin wing remains a challenging technique hardly performed.

INTRODUCTION:The ameloblastic fibro-odontoma (FOA) is a rare benign tumor representing 1-3% of odontogenic tumors. The FOA affects young patients before the age of 20. Surgical treatment allows usually for recovery. Recurrence and malignant transformation are possible. OBSERVATION:A 3-year-old patient, with no medical and surgical history, was referred for a painless swelling of the right cheek progressing for several months. Radiographic examination showed a large mixed lesion. Buccal and lingual cortices were blown out. Surgical resection was performed under general anesthesia. Microscopically, the lesion consisted of dental tissue composed of mature dentin and enamel and of an epithelial component. These elements allowed for the diagnosis of ameloblastic fibro-odontoma. The postoperative course was uneventful. DISCUSSION:The management of this 3-year-old patient was delayed due to late consultation. The size of the lesion, that included all dental structures of sector 4, was big considering the very young age of the patient. The primary conservative surgical treatment allowed for preservation of teeth and of the inferior alveolar nerve, the only sequelae being the removal of the germ of the tooth no 44 directly involved in the tumor.

Les variations anatomiques des axes artériels du membre supérieur ne sont pas rares. Elles sont à connaître afin d’adapter au mieux les techniques chirurgicales et de limiter leur morbidité. L’artère ulnaire superficielle est, après les variations d’origine de l’artère radiale, la deuxième variation la plus retrouvée à ce niveau. Sa présence peut amener à modifier le cours d’interventions, notamment pour en faire le pédicule nourricier de lambeaux antébrachiaux lors de chirurgies reconstructrices. Les auteurs présentent le cas d’une artère ulnaire superficielle révélée en peropératoire lors du prélèvement d’un lambeau libre antébrachial radial, ainsi qu’une revue de leurs cas afin d’évaluer la fréquence de cette variation et la corréler aux données de la littérature.The anatomical variations of arterial axes of the upper limb are not uncommon and must be known to allow for safe surgical procedures and in order to limit the morbidity of these procedures. The superficial ulnar artery represents, after the variations in origin of the radial artery, the second most frequent variation in this area. When present, reconstructive procedures may be modified, especially when harvesting forearm free flaps, in order to choose this vessel as nourishing pedicle. The authors present the case of a superficial ulnar artery revealed intraoperatively while harvesting a radial forearm free flap, and a review of their cases in order to assess the frequency of this variation, and correlate it to literature.

INTRODUCTION:The aim of our study was to analyse a series of patients suffering from temporomandibular joint (TMJ) chondromatosis treated in 2 departments of stomatology and maxillofacial surgery (University hospitals of the Conception in Marseille and of Caen) and to make a general review of this disease.MATERIAL AND METHODS:We conducted a retrospective study including all the patients treated for a TMJ chondromatosis in one of these 2 departments. Following parameters were analyzed: sex, ages at discovery and at surgery, symptoms, side, imaging, histology, recurrence and any other events considered as relevant.RESULTS:Fourteen patients could be included: 85.7 % were women. Average age at diagnosis was 40.14 (σ = 13.82; IC95: 32.90-47.38) (41 for women [σ = 14.74; IC95: 33.28-48.72] and 35 years for men [σ = 5.66, IC95: 27.16-42.84]). Average age at surgery was 40.86 (σ = 14.18; IC95: 33.43-48.28). There was no predominance of side; 57.14 % of the patients had a joint syndrome, 57.14 % a tumor syndrome, 28.57 % had pain and 14.29 % had headaches. Panoramic X-ray was informative in 3 cases only. CT scan showed intra-articular calcifications in half of the cases only but arthrosic modifications in all the cases. Magnetic resonance imaging (MRI) constantly showed intra-articular cartilage fragments. When histology was performed, it found the synovial to be normal in one case and multiple nodules with clear cartilaginous differentiation in another case. One patient suffered from a second contralateral localization 10 years later.DISCUSSION:Chondromatosis has a slow evolution and is asymptomatic for a long time. MRI allows to evoke the diagnosis and to locate precisely the osteochondromas. Diagnosis is confirmed by histology that highlights a synovial metaplasia and more or less calcified chondromas. The main differential diagnosis to be eliminated because of prognostic reasons is the synovial chondrosarcoma. Treatment consists in surgical removing of the chondromas. Evolution is usually favorable.

Coronoid process hyperplasia is one of a large number of disorders affecting the stomatognathic system and causing mandibular hypomobility. It is characterized by an excessive coronoid process growing to such an extent that it impinges on the posterior portion of the zygomatic bones. Despite the low prevalence of this condition, it should be considered as a possible diagnosis in patients with painless, progressive, and chronic restriction of mouth opening. The diagnosis is based on clinical signs in association with radiographic examinations. Coronoidectomy is the only treatment option for this condition along with early postoperative physical therapy. This article presents the case of a patient with bilateral coronoid process hyperplasia, who was initially diagnosed as having bilateral temporomandibular joint disorders. The patient underwent months of physiotherapy and bite-appliance therapy without any improvement in mouth opening. FinalIy, he was referred to La Timone Hospital for a proper diagnosis and, consequently, effective treatment.

L’étude des liens entre articulations temporomandibulaires (ATM), manducation et ventilation et l’implication de ces deux fonctions dans la genèse des dysfonctions temporomandibulaires (DTM) primaires et dans certaines dysmorphies dentofaciales a été initiée en France, il y a plus de 30ans, par le Professeur Raymond Gola. Une fois critiquée, la faiblesse de la littérature scientifique dans ce domaine l’originalité des ATM au sein de l’appareil manducateur est rappelée avec son potentiel d’adaptation aux contraintes biomécaniques très variées selon l’âge et les activités manducatrices durant la journée. Mais la biomécanique de l’appareil manducateur ne s’arrête pas la nuit et les positions de la mandibule et de la tête durant le sommeil doivent être étudiées soigneusement. En cas de ventilation orale nocturne (VON) et de bouche ouverte, la position prédominante de sommeil (générant des forces faibles mais de longue durée) peut s’avérer délétère pour le complexe condylo-discal, pour les muscles environnants et pour les rapports occlusaux. Certaines désunions condylo-discales et malocclusions asymétriques trouvent ainsi leur origine dans cette longue portion de vie qu’est le sommeil, d’autant plus que la VON entraîne avec elle tout un cortège parafonctionnel (langue basse, dyspraxie labio-linguale, exacerbation du bruxisme de sommeil…). Le but de ce travail était de partager notre expérience multidisciplinaire impliquant orthodontistes, chirurgiens maxillo-faciaux, ORL, allergologues, orthophonistes, kinésithérapeutes et radiologues, dans l’étude des conséquences biomécaniques faciales de la ventilation orale nocturne.

Congenital deformities of the mandibular ramus and of the temporo-mandibular joint are treated by surgery since the early 20th century. However, morphological and functional results are often disappointing, accounting for iterative operations. Today, a clear consensus concerning the type of intervention to be proposed, and at what age it should be carried out does not yet exist. For mild cases, "conventional" orthognathic or osteogenic distraction procedures seem to work well, especially if they are carried out at the end of growth. In severe cases, it is often necessary to proceed in several surgical steps, usually starting with a chondrocostal graft, especially when interceptive surgery, performed before the end of growth, is preferred in order to improve the patient's quality of life.

The ameloblastic fibro-odontoma (FOA) is a rare benign tumor representing 1-3% of odontogenic tumors. The FOA affects young patients before the age of 20. Surgical treatment allows usually for recovery. Recurrence and malignant transformation are possible.A 3-year-old patient, with no medical and surgical history, was referred for a painless swelling of the right cheek progressing for several months. Radiographic examination showed a large mixed lesion. Buccal and lingual cortices were blown out. Surgical resection was performed under general anesthesia. Microscopically, the lesion consisted of dental tissue composed of mature dentin and enamel and of an epithelial component. These elements allowed for the diagnosis of ameloblastic fibro-odontoma. The postoperative course was uneventful.The management of this 3-year-old patient was delayed due to late consultation. The size of the lesion, that included all dental structures of sector 4, was big considering the very young age of the patient. The primary conservative surgical treatment allowed for preservation of teeth and of the inferior alveolar nerve, the only sequelae being the removal of the germ of the tooth no 44 directly involved in the tumor.

Introduction. Temporomandibular joint (TMJ) dysfunction associates pain, limited mouth opening and joint noise. Failures of conservative treatments may lead to arthroscopy. The aim of our study was to evaluate the current interest of arthroscopy in the treatment of TMJ dysfunction.Material and methods. Using the keywords "TMJ'' and "Arthroscopy'', 1668 articles were found in the Sciencedirect database. We selected 17 papers published between September 2012 and May 2016. Six questions were asked: (1) what treatment should be given to patients suffering from TMJ dysfunction? (2) What treatment should be performed for TMJ disorders when conservative treatments failed? (3) Does Wilkes staging change the surgical indication? (4) What has to be done in case of arthroscopy failure? (5) Can disc position be improved after surgery? (6) Should the disc position be improved?Results and discussion. (1) Conservative treatment should always be considered in first intention (2) In case of conservative treatment failures, surgery can be proposed, beginning with the less invasive one (3) Whatever the Wilkes stage, treatment should begin by the less invasive one (4) In case of arthroscopy failure, TMJ arthrotomy can be indicated (5) Disc position may be improved in the long term but it is complex to obtain (only one paper) (6) there is no evidence that disk has to be repositioned. (C) 2016 Elsevier Masson SAS. All rights reserved.

Temporomandibular joint (TMJ) dysfunction associates pain, limited mouth opening and joint noise. Failures of conservative treatments may lead to arthroscopy. The aim of our study was to evaluate the current interest of arthroscopy in the treatment of TMJ dysfunction.Using the keywords "TMJ" and "Arthroscopy", 1668 articles were found in the Sciencedirect database. We selected 17 papers published between September 2012 and May 2016. Six questions were asked: (1) what treatment should be given to patients suffering from TMJ dysfunction? (2) What treatment should be performed for TMJ disorders when conservative treatments failed? (3) Does Wilkes staging change the surgical indication? (4) What has to be done in case of arthroscopy failure? (5) Can disc position be improved after surgery? (6) Should the disc position be improved?(1) Conservative treatment should always be considered in first intention (2) In case of conservative treatment failures, surgery can be proposed, beginning with the less invasive one (3) Whatever the Wilkes stage, treatment should begin by the less invasive one (4) In case of arthroscopy failure, TMJ arthrotomy can be indicated (5) Disc position may be improved in the long term but it is complex to obtain (only one paper) (6) there is no evidence that disk has to be repositioned.

First-line surgery offers an additional option in our orthodontic treatment arsenal. Unlike the classic three-stage orthodontic-surgical protocol, it aims to correct the skeletal discrepancies during stage one in order to restore a favorable functional environment and enable orthodontic occlusal correction during a second stage. In some cases of maxilla-mandibular malformation, and for specific indications, it involves eliminating presurgical orthodontic preparation or reducing it to a minimum. From the orthodontic point of view, it reduces overall treatment time, facilitates treatment following surgery and speeds up tooth displacement. On the patient's side, it makes for rapid esthetic improvement and a radically enhanced quality of life. The use of anchorage devices, surgical splints or set-ups makes it possible to offset the drawbacks of this technique such as postsurgical occlusal instability or restrictive treatment planning.

Le contrôle postural est classiquement décrit comme étant basé sur les systèmes sensoriels visuel, vestibulaire et proprioceptif musculo-articulaire. La proprioception de la sphère oro-faciale pourrait également participer à ce contrôle, en particulier par l’influence qu’elle exerce sur la posture de la tête. Dans cette étude, nous avons abordé la question des relations entre proprioception mandibulaire et posture suite à une chirurgie orthognathique qui présente potentiellement des conséquences sur la proprioception liée à l’occlusion, aux muscles masticateurs et au ligament dento-alvéolaire. Les tests ont été réalisés avant et après chirurgie orthognatique chez 11 patients, au délai post-opératoire de 2,5 mois. Afin d’apprécier le poids supplémentaire de l’occlusion dentaire et des informations sensorielles disponibles, les tests ont été effectués dans deux conditions occlusales (occlusion, inocclusion) et deux conditions visuelles (yeux ouverts et yeux fermés). L’analyse a porté sur l’inclinaison de la tête et sur les données posturographiques. Les résultats montrent qu’après la chirurgie, l’orientation de la tête devient plus proche du plan horizontal chez le sujet testé yeux fermés. Les données posturographiques montrent une amélioration de la stabilisation posturale, en particulier lorsque les patients sont testés dans des conditions d’inocclusion, les yeux ouverts comme les yeux fermés. Ces résultats témoignent d’une influence notable de la proprioception mandibulaire sur l’orientation de la tête et la stabilisation posturale suite à une chirurgie orthognathique, vraisemblablement par modification des récepteurs proprioceptifs musculaires et occlusaux.

Objective:Dysfunctional swallowing may cause transverse occlusal disorders. The speech re-education of dysfunctional swallowing aims to correct or prevent the recurrence of occlu­sal disorders. The main objective was to test the dynamic palato­graphy as a diagnosis and quantification tool of the dysfunctional swallowing.Material and methods:The study was prospective and descriptive. Twelve average 23.5 years old women with a clinical dysfunctional swallowing have been included between January and May 2014. None was aware of presenting an atypical swallowing or dento-facial dysmorphism of class II. The dynamic palatography device measured the pressure force of the language on the palate during the lingual rest, swallowing saliva and water. Parameters measured were the duration and magnitude of support of the tongue on the palate.Results:Dynamic palatography showed a trend to predominant anterior contact during rest position (25%), and lower position of the language with little contact during swallo­wing of saliva and water.Discussion:Palatography results are consistent with the clinical diagnostic criteria of atypical swallo­wing. Our palatography tool has the advantage of being unobtrusive in the mouth compared to other pre existing systems. This device should be tested on larger patient popu­la­tions and could enable monitore atypical swallowing rehabili­ta­tion efficiency. The palatography could complete the swallo­wing assessment and be a monitoring and rehabilitation tool in real time.

La chirurgie de première intention constitue une option supplémentaire pour nos traitements. Contrairement au protocole orthodontico-chirurgical classique en trois étapes, elle vise à corriger le décalage squelettique dans un premier temps, pour restituer un environnement fonctionnel favorable et permettre, dans un second temps, de corriger orthodontiquement l’occlusion du patient. Elle consiste, dans certains cas de dysmorphies maxillo-mandibulaires et pour des indications qui lui sont spécifiques, à supprimer ou réduire à minima la préparation orthodontique pré-chirurgicale. D’un point de vue orthodontique, elle permet de réduire la durée globale du traitement, facilite le traitement ultérieur à la chirurgie et accélère le déplacement dentaire. Du point de vue du patient, elle permet une amélioration esthétique rapide et une qualité de vie radicalement améliorée. L’utilisation de moyens d’ancrages, de gouttières chirurgicales ou de set-up permet de pallier les inconvénients de cette technique que peuvent être une occlusion post-chirurgicale instable, ou une planification étroite du plan de traitement.

BackgroundThis is a position paper from the 2nd International Bone Research Association (IBRA) Symposium for Condylar Fracture Osteosynthesis 2012 was held at Marseille, succeeding the first congress in Strasbourg, France, in 2007. The goal of this IBRA symposium and this paper was to evaluate current trends and potential changes of treatment strategies for mandibular condylar fractures, which remain controversial over the past decades.MethodsUsing a cross-sectional study design, we enrolled the consensus based on the panel of experts and participants in the IBRA Symposium 2012. The outcomes of interest were the panel and electronic votes on management of condylar base, neck and head fractures, and panel votes on endoscopic and paediatric condylar fractures. Appropriate descriptive and univariate statistics were used.ResultsThe consensus derived from 14 experts and 41 participant surgeons, using 12 case scenarios and 27 statements. The experts and participants had similar decision on the treatment of condylar base, neck and head fractures, as well as similar opinion on complications of condylar fracture osteosynthesis. They had a parallel agreement on using open reduction with internal fixation (ORIF) as treatment of choice for condylar base and neck fractures in adults. Endoscopic approaches should be considered for selected cases, such as condylar base fractures with lateral displacement. There was also a growing tendency to perform ORIF in condylar head fractures. The experts also agreed to treat children (>12 years old) in the same way as adults and to consider open reduction in severely displaced and dislocated fractures even in younger children. Nevertheless, non-surgical treatment should be the first choice for children <6 years of age. The decision to perform surgery in children was based on factors influencing facial growth, appropriate age for ORIF, and disagreement to use resorbable materials in children.ConclusionsThe experts and participating surgeons had comparable opinion on management of condylar fractures and complications of ORIF. Compared to the first Condylar Fracture Symposium 2007 in Strasbourg, ORIF may now be considered as the gold standard for both condylar base and neck fractures with displacement and dislocation. Although ORIF in condylar head fractures in adults and condylar fractures in children with mixed dentition is highly recommended, but this recommendation requires further investigations.

La position de la langue et les forces qu'elle exerce sur son environnement dentaire et osseux seraient responsables d'un certain degre de dysmorphose. Il n'existe cependant pas d'outil utilisable en clinique qui permette de verifier la realite des forces exercees par la langue sur le palais. Nous avons mis au point un prototype constitue d'un palais artificiel en resine rigide incluant des capteurs de pression et nous rapportons l'etude de faisabilite sur des sujets sains. Les capteurs permet - tent effectivement de monitorer des differences visibles de fonc - tionnement entre differentes «manoeuvres» lors de la deglu ti tion d'une gorgee d'eau. L'outil sera maintenant adapte pour une etude clinique comparant des sujets avec et sans dys fonction linguale

La section des nerfs alvéolaires supérieurs lors de l’ostéotomie de Le Fort I entraîne habituellement une perte de la sensibilité des dents maxillaires. Le but de notre étude a été d’analyser la cinétique de récupération de la sensibilité dentaire postopératoire. Une étude prospective a été menée chez des patients opérés pour ostéotomie de Le Fort I isolée, associée à une ostéotomie mandibulaire ou à une disjonction intermaxillaire (DIM). Les mouvements effectués au cours de l’intervention ont été notés. Une dent par secteur alvéolaire (incisivo-canin, prémolaire, molaire, au mieux) a été testée pour chaque patient à l’aide d’un testeur électrique. Les tests ont été effectués en préopératoire (j1), à j2, j15, M2 (+2 mois), M3 et M6 postopératoires. Vingt-deux patients ont été inclus. À j1, 91,9 % des dents testées étaient sensibles, à j2, 12,7 % des dents étaient sensibles. À j15, M2, M3 et M6, les pourcentages de dents sensibles étaient respectivement de 33,3 %, 43,1 %, 50 % et 61,8 %. La récupération sensitive a été significativement plus rapide et plus complète chez les patients âgés de moins de 35 ans et au niveau des dents situées dans le territoire des nerfs alvéolaires supérieur et moyen. Il n’a pas été noté de différence significative en fonction des mouvements effectués. Parmi les dents sensibles à j1, 87,3 % ne l’étaient plus à j2. La récupération sensitive des dents atteintes s’effectue dès j15. Une grande amplitude de mouvement semble être un facteur aggravant. Upper alveolar nerves, when injured during Le Fort I osteotomies, alter maxillary tooth sensitivity. We had for aim to analyze post-operative maxillary tooth sensitivity recovery. We conducted a prospective study in a series of patients having undergone Le Fort I osteotomy, with, or without mandibular osteotomy or intermaxillary disjunction (IMD). The direction and range of displacement of the maxillary bone were recorded. One tooth in each alveolar sector (incisivocanine, premolar, molar) was tested with an electric stimulator for each patient. The tests were performed before (D-1), and after surgery (D2 or day + 2, D + 15, M2 (or month +2), M3, and M6). Twenty-two patients were included. Among the tested teeth, 91.9 % were sensitive at D-1. At D2, only 12.7 % of teeth were sensitive. At D15, M2, M3, and M6, the sensitivity was respectively 33.3 %, 43.1 %, 50 %, and 61.8 %. The recovery of sensitivity was faster in young patients (under 35 years of age) and for upper middle and superior alveolar nerves. There was no difference regarding the direction of maxillary movement. Among the teeth that were sensitive before surgery, 87.3 % had not regained sensitivity at D2. The recovery of sensitivity increased at D15. A great displacement of the maxillary bone was an aggravating factor for loss of tooth sensitivity.