This study aimed to assess occlusal stability following early orthognathic surgery. Complications, patient satisfaction, and correction of dysfunction were also assessed. Orthognathic surgery is considered early when it is performed before the end of growth. To this end, a retrospective study was conducted, involving patients aged between 11 and 16. In total, 51 patients were included (24 females and 27 males), with an average age of 14.7 years. The occlusal stability score at 3 years postoperatively was equal or superior to 8 in 76.5 % of the cases. The average occlusal stability score was 8.52/10 (SD = 2.17). Facial deformities recurred in seven patients (13.7 %). Three patients (5.8 %) required a second orthognathic surgery to correct facial deformity recurrence. Three patients (5.8 %) had bilateral partial sensory deficits of the inferior alveolar nerves. Two patients (3.9 %) had partial unilateral sensory deficits. Oral breathing significantly decreased from 54.9 % preoperatively to 25.5 % at 3 years postoperatively. Tongue position improved significantly at 3 years postoperatively, with 27.5 % of patients having a lower tongue versus 56.9 % during the preoperative period (p < 0.001). Our study revealed stable aesthetic and functional results at 3 years, as well as improved self-esteem and quality of life.

The chin is a major functional and aesthetic anatomical unit of the face. The correction of bony abnormalities is common in orthognathic surgery, but the management of the soft tissues is complex. This article describes a genioplasty technique focused on the soft tissue. The procedure improves the chin morphology in patients with a sharp lower lip-chin prominence angle or sagittal prominence of the chin soft tissue, with or without correction for bone malposition. Furthermore, this procedure can be performed on an outpatient basis. It can also be combined with conventional osteotomy.

OBJECTIVE:Transoral sialolithotomy (TSL) is the oldest technique used to remove submandibular stones. While it was initially limited to palpable and anterior stones, its indications have broadened. Although non-palpability has traditionally been considered a contraindication, our experience suggests TSL remains feasible in such cases. This study aimed to evaluate the efficacy and safety of TSL for non-palpable submandibular lithiasis. Secondary objectives were to identify distinguishing characteristics of non-palpable stones and factors associated with surgical success. METHODS:We conducted a retrospective, monocentric study at Conception University Hospital, Marseille, including all patients treated with TSL between April 2014 and January 2024. Demographic and clinical data were collected: stone laterality, size, location, palpability, multiplicity, operative time, and complications. Univariate and multivariate logistic regression analyses were used to assess factors influencing success. RESULTS:A total of 457 patients were included (380 with palpable stones, 77 with non-palpable). TSL achieved an 87% success rate for non-palpable stones, with a complication rate under 1%. Non-palpable stones were significantly smaller (mean 5.3 mm vs. 9 mm). Palpability was strongly associated with success (OR = 11.03 [2.95-55.00], p < 0.001). CONCLUSION:TSL is an effective and safe option for non-palpable submandibular stones. The absence of palpability alone should not exclude patients from this technique, even in the absence of sialendoscopy. However, patients should be informed of the increased risk of failure. Based on our surgical experience, systematic 3-D imaging, general anesthesia for deep gland exposure, and pressurized saline flushing improve the success of TSL in non-palpable stones. LEVEL OF EVIDENCE: 4:

Lithiasis and stenosis may cause salivary duct dilatation due to the increased pressure in the duct upstream of the obstruction. Idiopathic dilatations, also called megaducts, with no associated increase in pressure, have only been described in the parotid gland. The aim of this study was to describe the characteristics of submandibular duct dilatation unrelated to lithiasis, stenosis, or an imperforate duct, to report the existence of submandibular megaducts. This retrospective single -centre study included patients treated at La Conception University Hospital, Marseille, France, between 2007 and 2019. Patients with submandibular duct dilatation of >= 4 mm confirmed by magnetic resonance imaging sialography (sialo-MRI), who also underwent sialendoscopy to identify any associated stenosis, were included. Patients with lithiasis, stenosis, an imperforate ostium, or a history of trauma or surgery to the floor of the mouth were excluded. Five patients (three female, two male) aged 30-76 years with idiopathic duct dilatations in nine submandibular glands were included. The most commonly reported symptoms were submandibular swelling, pruritus, and discomfort, mostly outside mealtimes. Recurrence of symptoms after treatment was frequent. This study is novel in describing submandibular megaducts as opposed to dilatation caused by high pressure associated with stenosis, with confirmation by sialo-MRI and sialendoscopy.

Our study aimed to compare the biomechanical behaviour of mandibles with or without titanium miniplates when subjected to an impact after bone healing using a finite element model (FEM) of the human mandible. We simulated mandibular trauma on an FEM of a human mandible carrying or not two parasymphyseal miniplates and applying a concentrated force of 2000 N to four different areas, including the insertion area, the area straddling the edge of the miniplates and the adjacent bone, at a distance from the miniplates on the symphysis, and on the basilar border of the mandible below the miniplates. Then, we compared the Von Mises stress distributions between the two models. In the case of an impact on the miniplates, the maximum Von Mises stress occurred in two specific areas, on the cortical bone at the posterior border of the two miniplates at a distance from the impact, while in the model without miniplates, the Von Mises stresses were homogenously distributed in the impact area. The presence of titanium miniplates in the case of trauma affects the biomechanical behaviour of the mandible and could cause more complex fractures. We recommend informing patients of this potential risk.

Background:Photobiomodulation (PBM) may be prescribed after dental surgery to accelerate tissue healing and improve implant stability. The objective of this study is to evaluate the efficiency of LED-PBM on the dental implant osseointegration.Methods:A total of 48 implants (KontactTM) were inserted in 8 Yucatan minipigs (6 implants per minipig) divided into 2 groups (test and control). The test group received LED-PBM with a total energy of 124.2 J/cm2 delivered over 4 sessions (at day0, day+8, day+15 and day+28) lasting 12 minutes each. At day+28, all animals were sacrificed, and their mandibles removed to perform histologic and histomorphometric analysis. Implant osseointegration was evaluated using the computation of bone/implant contact (BIC) index and bone surface/total surface (BS/ TS) ratio. The groups were compared using Student's unpaired t test.Results:BIC index and BS/TS ratio were significantly higher within the test group as compared to the control group (P<0.01). Histologic observations on bone tissues demonstrated that LED-PBM may improve and accelerate dental implant osseointegration: 25% of dental implants analyzed within the test group were completely osseointegrated, versus 12.5% within the control group.Conclusion:This experimental study indicates that LED-PBM contributes to enhancing implant treatment outcomes.

Background. This study evaluated the success and survival rate of sandblasted and acid-etched dental implants according to the patient’s bone quality. Methods. A multicenter retrospective study was conducted in five clinical centers between 2016 and March 2019. A total of 407 implants (KONTACTTM S, Biotech Dental, France) placed in 229 patients (61.5±12.9 years old) were included. Bone quality, classified as types D1 to D4 (Misch classification), maximal insertion torque, and bone loss were measured. The implant survival rate was evaluated after one year for the overall cohort and for each bone quality. The overall survival rate after four years was also estimated with a Kaplan-Meier analysis. Results. After one year (12.8±9.6 months), eight implants were lost out of 407, representing an overall survival rate of 98%. It ranged from 100% for D1 to 89.7% for D4 (n=39), with significantly higher survival rates for D2 (n=93) and D3 (n=165) (98.9% and 98.2%, respectively) compared to D4. According to the Kaplan-Meier analysis, an overall survival rate of 96.5% was estimated after four years. An average maximal insertion torque of 45±12.6 N.cm and bone loss of 0.2±1.2 mm were measured. Conclusion. The high overall survival rate (98%), the average maximal insertion torque (45 N.cm), and the low marginal bone loss indicated good clinical results with acid-etched implants. Despite the relatively high survival rate for each bone quality, the significantly lower results in the D4 group highlight the expected benefits of bone quality-based implants and surgical protocols.

The trend towards patient-specific medical orthopedic prostheses has led to an increased use of 3D-printed surgical implants made of Ti6Al4V. However, uncertainties arise due to varying printing parameters, particularly with regards to the fatigue limit. This necessitates time-consuming and costly experimental validation before they can be safely used on patients. To address this issue, this study aimed to employ a stress-life fatigue analysis approach coupled with a finite element (FE) simulation to estimate numerically the fatigue limit and location of failure for 3D-printed surgical osteosynthesis plates and to validate the results experimentally. However, predicting the fatigue life of 3D components is not a new concept and has previously been implemented in the medical device field, though without experimental validation. Then, an experimental fatigue test was conducted using a proposed modification to the staircase method introduced in ISO 12107. Additionally, a FE model was developed to estimate the stress cycles on the plate. The stress versus number of cycles to failure curve (S-N) obtained from the minimum mechanical properties of 3D-printed Ti6AI4V alloy according to ASTM F3001-14 to predict the fatigue limit. The comparison between experimental results and fatigue numerical predictions showed very good agreement. It was found that a linear elastic FE model was sufficient to estimate the fatigue limit, while an elastic-plastic model led to an accurate prediction throughout the implant's cyclic life. The proposed method has great potential for enhancing patient-specific implant designs without the need for time-consuming and costly experimental regulatory testing.

The Pentoxifylline, Tocopherol and Clodronate protocol (PENTOCLO) showed promising results for jaw osteoradionecrosis (ORN) management. However, the clinical and radiological improvements are often delayed, leading to unwanted long-term treatment, with potential loss of opportunity for more radical surgical treatments. Our objective was to assess the diagnosis performance of 18F-FDG PET/CT to early predict ORN response to the PENTOCLO protocol.All patients from our center who were treated with the PENTOCLO protocol and with a 18F-FDG PET/CT performed at diagnosis and three months after the end of antibiotherapy were retrospectively included. The PENTOCLO protocol was always combined with prior appropriate antibiotherapy for six weeks. The healing endpoint was divided into healing, stability or worsening, according to the combination of clinical and radiological assessments at the date of last follow-up. For each patient, the difference between the maximal standardized uptake value (ΔSUVmax) of the ORN lesion at three months and baseline were computed. Diagnostic performance of 18F-FDG PET/CT was evaluated by sensitivity, specificity and the area under the receiver operating characteristic curve (ROC-AUC) of ΔSUVmax.24 patients were included with an average follow-up of 29.3 months. The healing, stability and worsening rate were 25%, 62.5% and 12.5% respectively. The AUC for discriminating worsening vs stability or healing was 0.92 (IC95 [0.81–1.00]). A ΔSUVmax greater than or equal to 0 was predictive of a worsening with a sensitivity and specificity of 84 and 66% respectively.18F-FDG PET/CT imaging could be useful for early prediction of PENTOCLO treatment resistance with appropriate antibiotherapy.

Genioplasty is commonly performed as part of facial feminization surgery. Commonly addressed areas in facial feminization surgery include the chin. According to some authors, 100% of patients request genioplasty surgery in order to feminize their faces. Specific genioplasty techniques (involving generally reduction surgery) applied to transgender patients have been rarely described in the literature. Objective: We aimed to carry out a review of the literature to update the current knowledge on this subject while achieving a comprehensive synthesis of the available surgical techniques for reduction genioplasty in trans Male to Female patients. Conclusion: Reduction genioplasty is frequently performed in facial feminization surgery. Multiple surgical techniques for chin feminization have been described in the existing literature. Reduction genioplasty requires combined work in the sagittal and transverse planes so as to obtain a harmonious result. However, no comparative study on the different surgical techniques has as yet been conducted. Patient satisfaction or surgical complications (which tend to be rare) cannot be related to any specific surgical technique.

Introduction: Whether to conserve or remove titanium miniplates after rigid internal fixation of mandibular fractures still remains controversial. Miniplates could affect the biomechanical behaviour of the mandible in case of trauma, and therefore cause more complex fractures. Materials and methods: An experimental study, consisting in simulating a mandibular trauma, was designed in order to compare the fractures caused by an impact on the mandible in the presence or absence of an internal fixation. We simulated an impact on the right parasymphysis region in 10 post-mortem human subjects, according to the Charpy impact test method at an impact speed of 7.4 m/s, using a 5 kg test impactor. Results: In the control group, the fracture lines were vertical and straight, without comminution. In the miniplate group, the fractures occurred close to the miniplates (4 cases) and under the miniplates (one case). The fracture lines were more complex, even comminuted in 2 cases. Thus, miniplates impacted the biomechanical behavior of the mandible, resulting in more complex fractures. Conclusion: Our experimental study highlighted the impact of the presence of miniplates on the mandible in case of trauma, and the risk of causing more complex fractures. We therefore recommend further investigations to determine if titanium miniplates should be systematically removed after bone healing, in patients with a higher risk of trauma in relation with previous assault injuries, alcohol or substance abuse, the practice of fighting or contact sport/activities, and soldiers. (c) 2022 Elsevier Masson SAS. All rights reserved.

Les carcinomes basocellulaires (CBC) de la face et du cou nécessitent des chirurgies qui peuvent être délabrantes, notamment quand une reprise chirurgicale est nécessaire du fait d’une exérèse initiale incomplète. L’objectif était d’identifier les facteurs associés aux EI de CBC dans ces localisations. Etude rétrospective réalisée sur tous les cas de CBC de la face et du cou ayant nécessité une reprise chirurgicale sur l’année 2018 dans 3 CHU d’une même ville. Les facteurs analysés étaient: l’âge, le sexe, l’antécédent de carcinome cutané, la localisation tumorale, le type histologique, l’opérateur (chirurgien/dermatologue), le lieu de l’intervention, les principales comorbidités et la prise d’antiagrégants plaquettaires (AAP) ou anticoagulants. Sur 652 cas de CBC de la face et du cou opérés chez 652 patients, 123 (19 %) ont nécessité une reprise chirurgicale. L’âge moyen des patients était de 71 ans, 54,5 % étaient des hommes. La majorité des interventions était réalisée sous anesthésie locale (86%) et en ambulatoire (76 %) et52 patients sur 123, étaient sans antécédent de carcinome cutané. Des biopsies avaient été effectuées chez 35 patients (28 %) avant l’exérèse de la lésion. Ces interventions étaient réalisées par des chirurgiens dans 80 % des cas. Les CBC nécessitant une reprise étaient sur le nez (55 cas, 45 %) les tempes (14 cas, 11 %) et les oreilles (12 cas, 10 %). Les CBC étaient infiltrants chez 84 sujets (68 %), nodulaires chez 27 patients (22 %), sclérodermiformes chez 5 patients (4 %) et superficiels chez 5 patients (4%). 38 patients (31 %) étaient sous AAP. Des comorbidités cardiaques étaient observées chez 63 patients (51 %). Une maladie neurodégénérative n’était notée que chez 2 sujets. Une série préalable a montré un taux d’EI qui n’était que de 180 (4,6 %) pour 3911 CBC opérés sur la totalité du corps. Comme dans notre travail, la localisation au nez et aux oreilles, ainsi que les types histologiques sclérodermiformes et infiltrants étaient les facteurs associés aux EI les plus fréquents. Comme les limites cliniques de ces tumeurs sont souvent difficiles à évaluer, la précision du repérage macroscopique des marges serait moins bonne. Ces localisations sont aussi techniquement plus difficiles à opérer ce qui explique l’implication des chirurgiens. La connaissance du type histologique par biopsie préalable semble mieux «guider» la délimitation des marges. La prise d’AAP et d’anticoagulants n’avait jamais été décrite mais le risque hémorragique associé peut inciter à économiser sur la taille de l’exérèse ainsi que l’état général comme en atteste le facteur « comorbidités cardiaques ». Ces résultats méritent d’être vérifiés par un travail d’envergure mais incitent déjà à améliorer la formation des chirurgiens à la lecture « anatomique » des lésions et à favoriser les biopsies préalables pour identifier les types histologiques nécessitant un geste large.

Background To assess the risk of postoperative SARS-CoV-2 infection during the COVID-19 pandemic. Methods The CONCEPTION study was a cohort, multidisciplinary study conducted at Conception University Hospital, in France, from March 17th to May 11th, 2020. Our study included all adult patients who underwent minor surgery in one of the seven surgical departments of our hospital: urology, digestive, plastic, gynecological, otolaryngology, gynecology or maxillofacial surgery. Preoperative self-isolation, clinical assessment using a standardized questionnaire, physical examination, nasopharyngeal RT‐PCR and chest CT scan performed the day before surgery were part of our active prevention strategy. The main outcome was the occurrence of a SARS-CoV-2 infection within 21 days following surgery. The COVID-19 status of patients after discharge was updated during the postoperative consultation and to ensure the accuracy of data, all patients were contacted again by telephone. Results A total of 551 patients from six different specialized surgical Departments in our tertiary care center were enrolled in our study. More than 99% (546/551) of included patients underwent a complete preoperative Covid-19 screening including RT-PCR testing and chest CT scan upon admission to the Hospital. All RT-PCR tests were negative and in 12 cases (2.2%), preoperative chest CT scans detected pulmonary lesions consistent with the diagnosis criteria for COVID-19. No scheduled surgery was postponed. One patient (0.2%) developed a SARS-CoV-2 infection 20 days after a renal transplantation. No readmission or COVID-19 -related death within 30 days from surgery was recorded. Conclusions Minor surgery remained safe in the COVID-19 Era, as long as all appropriate protective measures were implemented. These data could be useful to public Health Authorities in order to improve surgical patient flow during a pandemic.

Hyposalivation is a serious complication during radiotherapy (RT) and it is one of the major risk factors for the presence of candidiasis. The aim of this study was to evaluate the salivary hypofunction during the different stages of RT, analysing its connection with the presence of candidiasis.A retrospective study was performed in 83 patients who had been diagnosed with head and neck tumours and who were undergoing RT treatment. Their salivary function was clinically analysed throughout the course of the RT treatment (before, during and after treatment) by means of the whole saliva test (WST), both unstimulated (WST-I) and stimulated (WST-II), and its relationship with candidiasis was evaluated using culture-based methods.The WST-I before RT was 37.24 ± 17.36 mm and the WST-II was 60.70 ± 30.98 mm, with 47% of patients testing positive for candidiasis. The prevalence of candidiasis increased up to 55.8% during RT and it returned to similar pre-RT levels at the end of treatment (45.2%). A statistical significant relationship was found between low WST-I and candidiasis in the 1st (13.58 vs 20.78 mm), 3rd (18.06 vs 24.36 mm), 6th (16.83 vs 24.5) and 12th (16 vs 28.74 mm) months after RT; and this relationship was also detected for WST-II in the 1st (24.73 vs 41.26 mm) and 3rd (27.71 vs 39.91 mm) months after RT. Female sex was identified as an independent associated risk factor for mild hyposalivation before RT (OR = 6.50, CI: 95% 1.77–23.93, p = 0.005) and glandular hypofunction (OR = 3.01, CI: 95% 1.12–8.10, p = 0.029).There is a clear relation between hyposalivation and the presence of candidiasis during and after RT. Larger studies must be performed in order to further elucidate this effect.

The frequency of midface and frontobasal fractures has increased over the past 40 years despite the improvement and stringent regulation implemented on modern safety equipment (belts, helmets…). This observation might be correlated with the progress of radiodiagnosis tools. Literature was reviewed according to Prisma guidelines. We searched for reviewed articles, published between January 2000 and December 2017, through Medline (Pubmed) online databases and ScienceDirect, using the following MeSH Keywords: "Le Fort classification", "Le Fort fracture", "Frontobasal fracture", "skull base fracture", "Midface Fractures". Among 652 patients with frontobasal fractures, 125 (19.1%) were associated with a Le Fort fracture. 59 (9%) were associated with Le Fort III fracture, 51 (7.8%) with Le Fort II fracture and 15 (2.3%) with Le Fort I fracture. When frontobasal fractures were associated with midfacial fractures, we found 18 cerebrospinal fluid leaks (11.8 %) and 19 cases of meningitis (12.5 %). When only the frontobasal area was involved, there were 6 cerebrospinal fluid leaks (4.3 %) and 6 meningitis (4.3 %). Our results highlight a regular association between Le Fort fractures and frontobasal fractures for stages II and stage III of Le Fort fractures and also found a higher rate of neuro-septic complication. Further research shall investigate treatment and monitoring recommendations fitting modern epidemiology of craniofacial traumatology.

During the 2020 coronavirus pandemic, a lockdown was imposed in France during the first wave. An apparent decrease in incidence of cellulitis of odontogenic origin was noticed then. This study aimed to compare the incidence of cellulitis during this extraordinary period with the same period in 2018 and 2019, based on retrospective multicentric data. All maxillofacial surgery departments in French public hospitals were contacted. Responders were asked to include all patients admitted for the surgical drainage of a head and neck abscess of odontogenic origin during the first 2020 lockdown period, and in a similar time frame in 2018 and 2019 (control group), based on screening the French diagnostic and therapeutic classification of medical acts. We report a 44% significant nationwide decrease in the incidence of admissions for cellulitis. There were 187 patients in 2020 for 334 and 333 patients in 2018/2019 respectively. The reasons to explain this finding are hypothetical (organizational reasons leading to earlier management, patients' fear to seek for medical management, usual excess in surgical indications or concomitant decrease of non-steroidal anti-inflammatory drugs delivery). Whatever the explanation, it would be of great interest to find it out in order to improve the prevention of cellulitis.

Whether to conserve or remove miniplates, widely used in oral and maxillofacial surgery, has not been agreed on in the literature. Complications such as pain, infection, and screw exposure or loosening have already been largely described. We present the consequences of a trauma recurrence on a mandible with miniplates. The data of 13 patients who had a mandibular fracture previously surgically treated with miniplates (ten mandibular fractures and three mandibular osteotomies) were analysed. All the patients were male; the average age was 32 years (range, 20–64 years). The mechanism of the second trauma was assault in most of the cases. The average time between the first osteosynthesis and the new fracture was 35 months (range, 6–128 months). The fractures occurred at a distance from the miniplates in all the cases except two. No plate fracture was reported. We hypothesised that miniplates reinforced the underlying bone, protecting it from fractures, and transmitted the forces to areas anterior or posterior to the miniplates or to the condyle. Thus, the risk of mandible trauma recurrence should be taken into account in the indication of plate removal, and the biomechanical consequences of the conservation of the miniplates should be studied.