Aim. Mandibular reconstructions with fibula free flap are commonly used in maxillo-facial surgery; termino-lateral mandibulectomy with reconstruction of the ramus and condylar unit is seldom used. Consequences on the temporomandibular joint remain unclear, and the type of reconstruction is still subject to controversy.Methods. Six patients were followed after terminal mandibulectomy, reconstructed with fibular free flap. Evaluations of the results were made on functional and radiological criteria.Results. No patient presented functional disturbances due to reconstruction. Remodeling of the neocondyle extremity was weak in adults but important in children, with modification of morphology and architecture of the condyle in children.Discussion. Preservation of the disc is recommended. Many techniques are described to improve congruence, preservation and remodeling of the free extremity of the fibula flap. All give similar results. It seems that the real determinant factors on the quality of the result are age, presence of the disc or not, previous surgery performed, with or without radiotherapy. (C) 2015 Elsevier Masson SAS. All rights reserved.

Sagittal split osteotomy of the mandible is the most frequently used method in orthognatic surgery. Osteosynthesis was performed with wires in the 1970s. The instability of fixation allowed condyle movements and there was no problem of condylar positioning. The drawback of this technique was that it required a strict intermaxillary fixation for 6 weeks. Osteosynthesis evolved in the 1980s to a rigid and semi-rigid fixation, with no longer any need for an intermaxillary fixation. But accurately determining the condyle position in the fossa is essential when using a rigid fixation, because no spontaneous adaptation is possible. Moreover, an improper condyle positioning is known to increase short term skeletal relapse, inadequate corrections, and a high incidence of temporomandibular joint dysfunctions. Many solutions have been proposed to solve the problem of condylar positioning: manual positioning technique at osteosynthesis, and mechanical or computer assisted devices to control condylar positioning. The repositionable and adjustable miniplates have also been designed to improve condyle positioning, with the possibility of peroperative adjustment. (C) 2014 Elsevier Masson SAS. All rights reserved.

Introduction. The temporalis muscle has been used for more than a century for facial reconstruction. But this flap cannot fill defects beyond the midline. Splitting the temporalis muscle in the plane of the tendon insertion allows lengthening the flap and crossing the midline.Technical note. The scalp incision is followed by a subcutaneous dissection, taking care to spare hair follicles and superficial temporal vessels. Then the temporalis muscle is detached by a strictly subperiosteal dissection and deep temporal pedicles are dissected and ligated. The flap is split in the plane of the insertion tendon up to its distal end.Discussion. This technique allows reconstructing cranio-facial defect beyond the midline with well-vascularized tissue. (C) 2013 Published by Elsevier Masson SAS.

Distraction osteogenesis is a tissue engineering technique with two clinical applications in maxillofacial surgery: alveolar distraction and basal bone distraction. Even if it appears to be a binding and major surgery, distraction osteogenesis applied to facial bone, and especially to the mandible, has the great advantage of producing a pluritissular reconstruction of ideal quality and quantity, suitable for the ultimate goal of dental implant rehabilitation management. This technique had some drawbacks due to technical constraints related to the material. Distraction osteogenesis is well placed in the armamentarium of reconstructive surgery techniques for bone defects caused by trauma or tumor. It allows rapid restoration of adequate physiological conditions for mandibular dental implant placement. We reviewed the various modifications of this technique. (C) 2012 Published by Elsevier Masson SAS.

Introduction. Our objective was to evaluate the contribution of bilateral inferior alveolar nerve block (BIANB) in patients before mandibular sagittal osteotomy for postoperative pain management, consumption of opioids, treatment of nausea and vomiting.Materials and methods. We included 30 patients undergoing mandibular sagittal osteotomy in a prospective, randomized, double blind study. The first group of patients (n = 14) underwent a standard procedure (general anesthesia with postoperative morphine treatment). The second group of patients (n = 16) underwent BIANB before surgery, in addition to the standard procedure. The post-surgical management was evaluated every four hours for the first 24 hours, according to the following criteria: postoperative nausea and vomiting (PONY), visual analogue scale (VAS) assessment of pain, consumption of morphine (cumulative dose) and antiemetic drugs, and need for releasing inter-maxillary blockage.Results. PONV was significantly less frequent in the second group (6.3% versus 42.9%, P=0.031). The frequency of releasing inter-maxillary blockage and the consumption of antiemetic drugs were not significantly different in the two groups. The mean VAS pain score was significantly lower in the second group (1.6 versus 0.9 avec P=0.045). There was no significant difference in cumulative morphine requirements between the two groups at 24 hours.Discussion. BIANB during mandibular osteotomy increases the patient comfort by decreasing PONV and improving postsurgical analgesia. (C) 2012 Published by Elsevier Masson SAS.

Objectives. Treatment of oronasal fistulae in cleft patients remains a surgical challenge because of its high failure rate. The authors report the results of an aggressive surgical technique using the total elevation of palatal mucoperiosteum, even for small fistulae.Methods. This approach was used on twelve consecutive patients, from five to 33 years of age, presenting with a Pittsburgh classification type IV palatal fistulae. The surgical procedure was total elevation of the hard palate mucoperiosteum starting from the dental sulcus combined with sealed double layer sutures. Clinical and Photographical control was made at least 6 months after to detect a possible relapse.Results. The success rate was 100%. No relapsing fistula was observed with follow-up ranging from 6 to 36 months.Discussion. This technique allows wide exposure and safe closure of the nasal layer. It is simple and leaves no raw bone surface exposed and no additional scar. The authors think it can be used in all type W fistulae less than 1 cm wide. Several other surgical techniques have been described to close palatal fistulae: local turnover flaps, pedicled flaps from adjacent oral tissue, tongue flaps, tissue expansion, and even free flaps. Obturator prostheses have also been used. The technique we report, even if more aggressive, seems to be more reliable with fewer relapse and sequelae. (C) 201.1 Elsevier Masson SAS. All rights reserved.

Introduction. The free fibula flap is the most commonly used flap for mandibular reconstruction thanks to its multiple advantages. Its main drawback is the thin width of the boric section. The "double barrel'. fibula flap is a solution to this problem allowing reconstruction of both basilar and alveolar ridges for a stable prosthetic dental rehabilitation. The authors wanted to assess its use, in France, to evaluate its reliability, and to determine its indications.Patients and methods. The authors sent a questionnaire to the 25 French Maxillo-Facial University Hospital Departments. Questions concerned the surgical technique, its indications, and the operative results, between January 2002 and December 2007.Results. Out of the 18 teams who answered, 16 used a free fibula flap for mandibular reconstruction but only seven used the double barrel technique, for a total of 24 double barrel reconstructions. Only one total necrosis was reported. The indications for double barrel fibula flap were nearly all for corpus reconstruction and the operating overtime was less than one hour.Discussion. The international literature review analysis gives results which compare to French ones, with a weak rate of necrosis despite the intermediate rectangular ostectomy. This technique may be recommended especially since it does not increase the operative time much and it irnproves dental restoration. (C) 2011 Published by Elsevier Masson SAS.

Introduction. Horsley wax (R) is an efficient bone haemostatic agent commonly used in bone surgery. But it is non resorbable and surgeons should be aware of possible complications, which can appear many years later.Observation. We report three cases of foreign body granulomas due to bone wax. A 14-years-old female patient with an Aped syndrome underwent Le Fort III osteotomy and distraction osteogenesis; 3 years later, an inflammatory granuloma appeared in the temporal area. A 23-years-old female patient, traffic accident casualty, complained about pain in the hip 1 year after undergoing cervical spine surgery with iliac bone graft. A 35-years-old female patient underwent rhinoplasty with anterior nasal aperture surgery. She presented with an inflammatory reaction requiring several subsequent surgeries.Discussion. Using Horsley wax (R) must be performed according to recommendations so as to prevent inflammatory or infectious complications, and to allow good bone healing. Surgeons must mention its use in the surgical report to avoid a delayed diagnosis in case of complications. There are alternatives to bone wax but they are less effective. (C) 2011 Elsevier Masson SAS. All rights reserved.

Rhinophyma is an hypertrophy of the nose occurring primarily in man, as from 40 years, secondary of an hyperplasy and a fibrosis of sebaceous glands. This pathology is particularly unesthetic and sometimes responsible of nasal obstruction. The treatment of this pathology is primarily surgical and the purpose of all techniques is to carry out a decortication. The authors describe one case of surgical treatment of rhinophyma by hydrodissection using Versajet (R). After having presented the other possibilities of surgical technics for the treatment of this pathology, the authors compare the advantages and drawbacks of this new technique compared to those described in the international literature. (C) 2008 Elsevier Masson SAS.

Benign cartilaginous tumors are a rare entity in jaw bones. The histogenesis is still discussed but an embryological hypothesis is suggested. Chondroma, osteochondroma, chondroblastoma and chondromyxoid fibroma are the main benign maxillary cartilaginous tumors.

INTRODUCTION:The Poncet-Spiegler cylindroma (PSC) is a benign annexal cutaneous tumor which preferentially develops on the scalp, neck, or forehead. Localizations may be isolated or multiple and often affect the young adult. The lesions grow progressively. When the scalp is completely involved, it presents as a "turban tumor". Treatment is surgery and may be difficult when the tumor is extended. We report the management of turban tumor. OBSERVATION:A 25 year-old female patient was first treated by partial scalp nodule exeresis and histology documented a PSC. She was lost to follow-up. But 9 years later, she was managed for a turban like PSC. The treatment was a complete scalp exeresis and secondary reconstruction with a skin graft. Follow-up was uneventful with a progressive functional and cosmetic improvement and after 2 years, there was no relapse. DISCUSSION:As for most tumors, management depends on the size of the PSC. An aggressive surgical treatment must be considered if the PSC is extended. In case of turban tumor, total scalp exeresis and secondary reconstruction with a skin graft is recommended.

Benign bone forming tumors typically produce dense bone (osteoma, enostosis) or osteoid tissue (osteoid osteoma, osteoblastoma). Even though these four lesions have distinct characteristics, it is sometimes difficult to tell them apart and to rule out malignant bone forming lesions such as osteosarcoma. The first line treatment is surgical exeresis.

Benign cartilaginous tumors are a rare entity in jaw bones. The histogenesis is still discussed but an embryological hypothesis is suggested. Chondroma, osteochondroma, chondroblastoma and chondromyxoid fibroma are the main benign maxillary cartilaginous tumors.

Rhinophyma is an hypertrophy of the nose occurring primarily in men, from the age of 40, secondary to hyperplasia and fibrosis of sebaceous glands. This pathology is particularly unsightly and sometimes responsible of nasal obstruction. The treatment of this pathology is primarily surgical and the purpose of all techniques is to carry out a decortication. The authors describe one case of surgical treatment of rhinophyma by hydro-dissection using Versajet. After having presented the other possibilities of surgical technics for the treatment of this pathology, the authors compare the advantages and drawbacks of this new technique compared to those described in the international literature.

The Poncet-Spiegler cylindroma (PSC) is a benign annexal cutaneous tumor which preferentially develops on the scalp, neck, or forehead. Localizations may be isolated or multiple and often affect the young adult. The lesions grow progressively. When the scalp is completely involved, it presents as a "turban tumor". Treatment is surgery and may be difficult when the tumor is extended. We report the management of turban tumor.A 25 year-old female patient was first treated by partial scalp nodule exeresis and histology documented a PSC. She was lost to follow-up. But 9 years later, she was managed for a turban like PSC. The treatment was a complete scalp exeresis and secondary reconstruction with a skin graft. Follow-up was uneventful with a progressive functional and cosmetic improvement and after 2 years, there was no relapse.As for most tumors, management depends on the size of the PSC. An aggressive surgical treatment must be considered if the PSC is extended. In case of turban tumor, total scalp exeresis and secondary reconstruction with a skin graft is recommended.