AIM:This study aimed to characterise the palatal vault evolution during the first years of life, both in terms of shape and size. MATERIALS:The study sample was composed of 168 healthy children aged less than 4 years. Twenty-one measurements of distances and 6 angles were taken from 7 fixed landmarks set on the palatal vaults 3D surfaces reconstructed from CT-scans. To analyse only the shape evolution, the "sizefree" log-shape ratio of those measurements were computed and the global shape of the palatal vault and their transversal curve were plotted. Statistical analyses were performed to highlight the shape and size differences separately. CONCLUSION:The shape and size evolution of the palatal vault during the first years of life was not only correlated with deciduous dentition development. We assumed that the progressive orofacial muscles activation and tongue movements in the oral cavity may also explain these results as they induced strains on the palatal vault, warping it in various ways.

Introduction: The study aimed to evaluate the evolution of the respiratory status during sleep of OSAS children treated with a custom-made device combining maxillary expansion and mandibular advancement. Material and methods: Sleep studies were performed before and after the treatment for 103 children presenting an initial OSAS and Class II malocclusion. Sleep questionnaires were also addressed to parents several years after the end of the treatment to evaluate its long-term effects. Results: After nine months of treatment, the sleep breathing quality significantly improved: the Apnea/ Hypopnea Index systematically decreased <5. According to the sleep questionnaires results, 84% of the patients did not show any loud or troubled breathing several years after the end of the treatment. Discussion: Simultaneous maxillary expansion and mandibular advancement induced an increase of the oral space in the three spatial dimensions, helping in the significant improvement of the OSAS symptoms, with long-terms effects on the sleep breathing quality. (C) 2020 Elsevier Masson SAS. All rights reserved.

Prone positioning is an adjuvant therapy used to treat COVID-19 pneumonia complicated by acute respiratory distress syndrome. However, prolonged pressure on facial skin at the level of the bony structures may be responsible for facial pressure ulcers. In the context of severe COVID-19 pneumonia, we hypothesized that hypoxemia, microvascular injury and thrombosis can increase the risk of pressure ulcers. We described two cases in order to emphasize the risk of facial pressure ulcers as a result of prone positioning, so as to discuss their physiopathology and highlight the importance of appropriate preventive measures.

Entre 2010 et 2018, le numerus clausus des internes d’ophtalmologie a augmenté de près de 50 % (106 en 2010 vs 150 en 2018). Pour faire face à ce volume croissant d’étudiants en 3e cycle, le service d’ophtalmologie du CHU de Reims a mis en place dès mai 2015 des agréments avec l’ARS permettant à certains ophtalmologistes libéraux d’accueillir un interne au sein de leur structure le temps d’un semestre. Nous vous présentons ici le bilan de ces 3 ans et demi d’expérience.Deux questionnaires rétrospectifs ont été réalisés et complétés, l’un adressé à l’encadrant, l’autre à l’interne. Ils permettaient d’évaluer et de standardiser l’appréciation de l’expérience de stage des deux points de vue. Les volets suivants ont été explorés : accueil, pratique et progression médicale de l’interne, pratique et progression chirurgicale de l’interne, emploi du temps, relations internes/patients et conclusions respectives. Nous avons également demandé le nombre d’internes accueilli pour chaque établissement libéral, ainsi que les points positifs et négatifs du stage pour le maître de stage comme pour l’interne.Entre mai 2015 et octobre 2018, 12 internes du CHU de Reims ont réalisé un stage chez un des six ophtalmologistes libéraux accrédités en région Champagne-Ardenne. Les internes accueillis se répartissaient entre leur deuxième et huitième semestre d’internat. Sept internes ont réalisé leur premier ou deuxième stage d’ophtalmologie chez le praticien libéral. Les questionnaires permettaient de conclure à une expérience positive pour le maître de stage et pour l’interne, en particulier concernant la formation médicale et technique, le temps passé au bloc opératoire ainsi que les procédures chirurgicales réalisées.Devant l’augmentation du nombre d’internes en ophtalmologie et la limite des capacités de formation des stages hospitaliers, les stages chez les praticiens libéraux impliqués dans la pédagogie augmentent les capacités d’accueil mais apportent surtout une formation complémentaire au cursus hospitalier conventionnel des internes.Between 2010 and 2018, the quota for admission to ophthalmology residencies increased by 50 % (106 in 2010 vs 150 in 2018). In order to accommodate this increasing number of residents, the University Hospital of Reims formulated an agreement with the Regional Health Agency in May 2015 enabling certain ophthalmologists in the private sector to train a resident within their private practice for a semester. We will present the results of three and one half years of this experience.Two retrospective questionnaires were created and completed. One was addressed to the host supervisor, the other to the resident. Their objective was to evaluate and standardize the experience from both points of view. The following aspects were explored: the extent to which the environment was welcoming, the resident's clinical ability and progress, the resident's surgical ability and progress, time-management, resident-patient relations and respective assessments. We also requested information on the number of residents hosted by each private practice as well as the positive and negative aspects of the internship for both the supervisor and the intern.Between May 2015 and October 2018 (seven semesters), 12 residents from the University Hospital of Reims did an internship with one of the six proposed private sector ophthalmologists in the Champagne-Ardennes region. The residents were between their second and eighth semesters of professional training. Seven residents did their first or second semester of ophthalmology training in a private practice. The survey results led to the conclusion of a positive experience for both trainer and trainee regarding the progress made by the resident, both clinically and surgically.Given the growing number of ophthalmology residents and the limits of the training capacity of hospital-based residencies, private sector internships with practitioners actively involved in teaching increase the training capacity for residents and complement the conventional hospital training.

Introduction: The authors' main purpose was to simulate the behavior of a titanium mesh implant (TMI) used to reconstruct the orbital floor under the stress of a blunt trauma. Materials and methods: The orbital floor of a previously validated finite element model (FEM) of the human orbit was numerically fractured and reconstructed by a simplified TMI. Data from a CT scan of the head were computed with MICMICS (Materialise, Louvain, Belgium) software to re-create the skull's geometry. The meshing production, the model's properties management and the simulations of blunt traumas of the orbit were conducted on HYPERWORKS (R) software (Altair Engineering, Detroit, MI, USA). Some of the elements of the orbital floor were selected and removed to model the fracture; these elements were duplicated, their characteristics being changed by those of titanium to create a TMI covering this fracture. A 3D FEM composed of 640,000 elements was used to perform 21 blunt trauma simulations on the reconstructed orbit. Results: In 90.4% (19/21) of the tests conducted, the TMI, whether free from any bony attachment or screwed to the orbital rim, has tended to move in the orbit and/or to deform. Discussion: In the event of traumatic recurrence, which is not rare, TMIs may deform in a "blow-in" motion and threaten intra-orbital structures. (C) 2018 Published by Elsevier Masson SAS.

Introduction: Parotidectomy for benign tumours is usually performed after facial nerve trunk discovery through an anterograde approach (AA) of the nerve. More recently, a retrograde approach (RA) toward the facial nerve, which begins on the facial nerve branches and ends on the nerve trunk, has been described. A literature review of the RA was conducted to evaluate the RA and to compare it with AA. Methods: A literature review was conducted for the years 1980 through 2016. Nine studies out of 216 were included, including 558 parotidectomies and 370 RA. We studied the operative time (OT), the postoperative complications including facial paralysis (FP), tumour recurrences, and possibilities for reoperation. Results: Operative time was shorter in RA than in AA. Transitory FP significantly less frequent in RA than in AA in only one studies and not significantly in four studies. Incidence of Frey syndrome was similar in RA and AA. Tumour relapses were reported in 1.8% of cases with RA, comparable to AA. Conclusion: Retrograde parotidectomy is recommendable. OT was significantly shorter for the RA. The FP rate was lower for RA than for AA, but the difference was not significant. The recurrence rate appeared to be similar between RA and AA. Possibilities of reoperation were better after RA. (C) 2018 Elsevier Masson SAS. All rights reserved.

Introduction: The authors' main purpose was to develop a detailed finite element model (FEM) of the human orbit and to validate it by analyzing its behavior under the stress of blunt traumas. Materials and methods: A pre-existing 3D FEM of a human head was modified and used in this study. Modifications took into account preliminary research carried out on PubMed database. Data from a CT scan of the head were computed with Mimics (R) software to re-create the skull geometry. The mesh production, the model's properties and the simulations of blunt orbital traumas were conducted on Hyperworks (R) software. Results: The resulting 3D FEM was composed of 640 000 elements and was used to perform blunt trauma simulations on an intact orbit. A total of 27 tests were simulated. Fifteen tests were realized with a metallic cylinder impactor; 12 tests simulated a hit by a closed fist. In all the tests conducted (27/27), the orbital floor was fractured. Fracture patterns were similar to those found in real clinical situations according to the buckling and hydraulic theories of orbital floor fractures. Discussion: The similitude between the fracture patterns produced on the model and those observed in vivo allows for a validation of the model. This model constitutes, at the authors knowledge, the most sophisticated one ever developed. (C) 2018 Published by Elsevier Masson SAS.

Objectives: Facial surgery for cosmetic purposes aims to improve the physical appearance and self-image of normal individuals. The aim of the guidelines is to answer questions related to legislation, patient evaluation and motivations, relevance and risk assessment, patient information and patient follow-up. Methodology: Analysis and synthesis of the medical literature through research of bibliographic databases in French and English from 2000 to 2017. Research and use of guidelines from evaluation agencies and academic societies. Drafting of guidelines with indications on levels of evidence. Results: 24 guidelines with levels of evidence B (scientific presumption), C (low level of evidence) or EO (expert opinion) were selected to answer the questions. Cosmetic facial surgery must be performed by certified, qualified professionals in authorized structures. It must follow certain specific rules as well as a charter and code of ethics so as to enforce the rules of practice. (C) 2019 Elsevier Masson SAS. All rights reserved.

Introduction: With more than 270 million spectators, football - or soccer - is the most popular sport in the world. International football events generate many risky situations, including hooliganism and are an opportunity to analyze the incidence and the particularities of associated trauma. We sought to underline the potential rapid and brutal increase in maxillofacial trauma during a world-class competition. Material and methods: A retrospective multicenter study of the epidemiology of maxillofacial traumas during the UEFA 2016 Cup was conducted. All the medical data from each UEFA 2016 World Cup matches from 10 June 2016 to 10 July 2016 were collected. Only the maxillofacial traumas requiring a surgery under general anesthesia and a hospitalization were included. Results: 11 patients from 3 different cities were included. The main etiology was interpersonal violence (7/11), followed by road accidents (3/11). Open reduction with internal fixation of a mandibular fracture was the most performed surgery (9/11). Patients were 18 to 50 year-old, with an average age of 30.6 years. Discussion: This study underlines the violence of riots between "ultra" supporters during the 2016 UEFA cup. We noticed an upsurge of maxillofacial trauma severe enough to require a surgery under general anesthesia. Hooligan behaviors should be known by every practitioner dealing with trauma care, and may requires transitional adjustment of public health policy. (C) 2019 Published by Elsevier Masson SAS.

Mandibular dental anterior crowding is a common multi-factorial phenomenon. The involvement of the lower third molar remains unclear. These pending questions led us to conduct a literature review to evaluate the impact of the lower third molar on mandibular dental anterior crowding. Twelve articles were selected, published from 1974 to 2014. Four studies were prospective. Sample size ranged from 30 to 9044. The average age was 20.56 years old. Seven studies considered patient with orthodontic treatment. The studies compared two to four groups. Studying tools were radiographs, casts and clinical examinations. Little's irregularity index, TSALD and Ganss ratio were used. In total, 83% of articles (n = 10/12) did not find any significant relationship between lower third molar and mandibular dental anterior crowding. However, methods and designs of these studies being questionable, a definite conclusion on the impact of mandibular third molar on mandibular dental anterior crowding cannot be set.

The fetal development of the mandible is nowadays quite understood, and it is already known that craniofacial growth reaches its highest rate during the first 5 years of postnatal life. However, there are very few data focusing on the perinatal period. Thus, the present article is addressing this concern by studying the mandible morphology and its evolution around the birth with a morphometric method.

Introduction: Orbital haematomas threaten the visual prognosis, but no treatment guidelines have been proposed. Antithrombotics could affect their prognosis and treatment. This study aimed to evaluate the effect of antithrombotics in the management of orbital haematomas and to suggest a standardised protocol. Material and methods: We conducted a retrospective study by sending a standardised questionnaire to 20 French maxillofacial surgery university departments to collect all the cases of orbital haematoma. Results: Twenty-five cases from 10 centres were collected, including five patients treated with anticoagulant and one patient treated with dual antiplatelet. Antithrombotics increased the risk of amaurosis and ocular disorders significantly. Surgery was performed for 66.7% of patients treated with antithrombotic and for 89.5% of other patients. Surgical delay was longer in patients treated with antithrombotic. Surgical drainage was used in most of the cases, whereas canthotomy with inferior cantholysis was the least-used technique. Conclusion: Antithrombotics appear to worsen the functional prognosis of orbital haematomas. A surgical management of orbital haematoma in patients treated with antithrombotics is not contraindicated. Surgical delay must be shortened as much as possible. A lateral canthotomy with inferior cantholysis seems to be an appropriate solution. (C) 2018 Elsevier Masson SAS. All rights reserved.

Les résultats histologiques décrivent fréquemment une marge significativement moindre que la marge d’excision clinique et chirurgicale. L’objectif principal de notre étude était d’évaluer le degré de rétraction cutanée survenant après exérèse de tumeurs cutanées de la face et après fixation dans le formol. Les objectifs secondaires étaient d’évaluer le rôle potentiel du type tumoral, de l’âge, du genre, de l’IMC, du tabac, de l’alcool, du phototype, du photo-vieillissement et de la localisation selon les sous-unités anatomiques de la face. Nous avons inclus prospectivement tous les patients consentants admis pour exérèse de tumeurs cutanées de la face, entre le 01/06/17 et le 31/10/17, dans le département universitaire de chirurgie maxillo-faciale et stomatologie à l’hôpital Nord de Marseille. Une fiche standardisée a été utilisée pour recueillir les différents paramètres étudiés. Nous avons comparé les mesures de la pièce d’exérèse et de la lésion tumorale avant exérèse, après exérèse et avant fixation, et après 24 h de fixation dans le formol. Nous avons inclus 100 pièces opératoires de tumeurs cutanées de la face, principalement des carcinomes basocellulaires (CBC) (61 %). La rétraction cutanée moyenne de la pièce opératoire avant exérèse et après fixation dans le formol était de 12,8 % en longueur et de 11,2 % en largeur (p < 0,001) ; celle de la tumeur était de 10,3 % et 9,7 % respectivement (p < 0,001). Ainsi, la rétraction de la marge dépourvue de tumeur était plus élevée (15,3 % en longueur et 12,7 % en largeur). La majorité de la rétraction avait lieu après excision de la pièce opératoire, le formol n’ayant pas d’effet significatif sur le degré de rétraction. La rétraction était plus faible pour les CBC que pour les carcinomes épidermoïdes (CE) en longueur (9,7 % vs 13,1 %, p < 0,001) et en largeur (7,2 % vs 17 %, p = 0,006). Il n’était pas trouvé d’association significative et pertinente entre le degré de rétraction cutanée et l’âge, le genre, l’IMC, le tabac, l’alcool, le phototype, le photo-vieillissement et la localisation anatomique. Avec 100 pièces opératoires, notre étude de la rétraction cutanée constitue la plus grande cohorte de tumeurs cutanées de la face, l’étude avec l’effectif le plus important n’atteignant que 67 pièces. Nous retrouvons des degrés de rétraction conformes à ceux précédemment publiés. La fixation dans le formol n’a pas d’influence sur la rétraction cutanée, la rétraction principale survenant juste après excision de la peau. Nous soulignons cependant une forte différence de rétraction selon le type tumoral, probablement liée à des propriétés histologiques et bio-élastiques différentes du tissu tumoral et péri-tumoral des CBC et des CE. Le degré de rétraction cutanée est un paramètre important qu’il faut avoir à l’esprit lors de l’interprétation des comptes-rendus histologiques et plus précisément des marges tumorales.

Introduction: Inferior alveolar nerve (IAN) lesions related to endodontic treatments can be explained by the anatomical proximity between the apices of the mandibular posterior teeth and the mandibular canal. The aim of this article is to review the management of inferior alveolar nerve lesions due to endodontic treatments and to establish a therapeutic flow chart. Methods: A review of publications reporting IAN damage related to endodontic treatment over the past 20 years has been conducted, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist; it combines an electronic search of the Pubmed (R) and Google Scholar (R) databasis. Forty-two full-text articles corresponding to 115 clinical cases have been selected. Two personal clinical cases were additionally reported. Results: IAN lesions due to endodontic treatments require urgent management. Early surgical removal of the excess of endodontic material, in contact with the nerve allows the best recovery prognosis (72 h). Beyond this delay, irreversible nervous lesions prevail and a medical symptomatic treatment, most of the time with pregabalin, must be/can be carried out. A delayed surgical procedure shows some good benefits for patients. However, the healing prognosis remains poorly predictable. (C) 2018 Elsevier Masson SAS. All rights reserved.

Minimally invasive techniques (MIT), including sialendoscopy, extracorporeal lithotripsy and intraoral approach, have to be preferred in parotid stones removal. In case of MIT failure, a combined intra- and extra-oral approach can be achieved. The aim of our study was to evaluate the efficacy and the complications of these combined approaches.A retrospective study has been conducted on patients treated between 2006 and 2015. All adult patients presenting with one or more parotid stones and in whom TMI failed have been included. Age and sex of the patients, number, size and location of the stones, result of the procedure, occurrence of pain, swelling, or infection have been recorded.Nine patients were included (mean age: 56). Mean follow-up was 48 months. Eighty-eight percent of patients had an unique stone. Nine stones were extracted by combined approach. Mean diameter of the stones was 8.5mm and 33% of them were located at the junction between middle and posterior third of parotid duct. All the patients suffered preoperatively from daily retention symptoms, such as pain (55%) and swelling (100%). Two patients had an infectious complication (duct and/or gland infection). Seventy-five percent (9/12) of stones were removed. Complications consisted of 1 fistula, 1 facial paresis, 3 recurrences. Seven of 9 patients (77%) had a total relieve after surgery.Surgical combined approaches for parotid stones removals are indicated after failure of MIT when symptoms affect quality of life.

Introduction: Salivary duct stenosis is the second most common cause of obstructive pathology after lithiases, and it primarily affects the parotid gland. Salivary duct stenosis is treated with drug therapy and/or sialendoscopy. If unsuccessful, surgical removal of the gland is indicated, but it is associated with a high risk of facial morbidity. The aim of this study is to evaluate the clinical efficacy of an alternate treatment, botulinum toxin, in salivary duct stenosis. Material and methods: In a preliminary retrospective study from January 2011 to December 2014, six patients with parotid duct stenosis received 50 IU of botulinum toxin in three injections in the parotid gland. The frequency of relapses and the intensity of pain and swelling were recorded before and after treatment. The onset of action and duration of efficacy were also assessed. Results: Four of six patients showed a decrease in the frequency of swelling episodes and greater pain relief during the first year of treatment, but to a lesser extent after 2 years. The mean duration of efficacy was 3.5 months with an interval between two injections of 5.7 months. Only one parotidectomy had to be performed. No major side effects were observed, with only one case of local infection at the injection site. Conclusion: Botulinum toxin appears to be a viable alternative in treating salivary duct stenosis before resorting to surgical gland removal. (C) 2017 Published by Elsevier Masson SAS.

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: Minimally invasive techniques (MIT), including sialendoscopy, extracorporeal lithotripsy and intraoral approach, have to be preferred in parotid stones removal. In case of MIT failure, a combined intra- and extra-oral approach can be achieved. The aim of our study was to evaluate the efficacy and the complications of these combined approaches.Materials and methods: A retrospective study has been conducted on patients treated between 2006 and 2015. All adult patients presenting with one or more parotid stones and in whom TMI failed have been included. Age and sex of the patients, number, size and location of the stones, result of the procedure, occurrence of pain, swelling, or infection have been recorded.Results: Nine patients were included (mean age: 56). Mean follow-up was 48 months. Eighty-eight percent of patients had an unique stone. Nine stones were extracted by combined approach. Mean diameter of the stones was 8.5 mm and 33% of them were located at the junction between middle and posterior third of parotid duct. All the patients suffered preoperatively from daily retention symptoms, such as pain (55%) and swelling (100%). Two patients had an infectious complication (duct and/or gland infection). Seventy-five percent (9/12) of stones were removed. Complications consisted of 1 fistula, 1 facial paresis, 3 recurrences. Seven of 9 patients (77%) had a total relieve after surgery.Discussion: Surgical combined approaches for parotid stones removals are indicated after failure of MIT when symptoms affect quality of life. (C) 2016 Elsevier Masson SAS. All rights reserved.

Introduction: The management of oral fistula to the nose depends on its etiology, its size and its location. Here, we describe a simple technique, inspired by the ones initially developed by Bardach for cleft palates repair. The surgical alternatives are discussed. Technical note: The double palatal flap is a simple technique, allowing closure in a single session of a central or centro-lateral palate fistula. The key of this technique is the dissection between nasal and palate mucous layers, providing a sufficient amount of laxity to close the defect without tension. Discussion: The double palatal flap can cover centro-lateral palate mucosal fistulae. It provides both aesthetic and functional results in a single stage. Reliability, simplicity and quickness are its main advantages. Outcomes are usually simple; Velar insufficiency may occur, that can be corrected by speech therapy. (C) 2017 Published by Elsevier Masson SAS.