From the oracle of Delphi to magnetic resonance imaging, the anatomist's dissecting gaze has always been accompanied by a connective reading, nourishing subjectivity. The face offered to view has thus been the subject since Aristotle (and probably before without any written record of it being kept) of multiple interpretations, becoming a standard throughout the ages. A whole vocabulary emanates from it: metoposcopy, prosopology, physiognomony, phrenology, organology, morphopsychology, amphibology… which punctuated the beyond of the gaze. It is this story, focused on the frontal region, which will be mentioned, with the excesses it may have caused. Invitation to educate the surgical perspective.

Le front est le casque protecteur du cerveau, si l’on se réfère à l’étymologie du mot calvaria. Détruit, il convient de le reconstruire ; en priorité son infrastructure osseuse, quand bien même l’on peut vivre sans elle, dès lors que les autres tissus (peau, muscle, aponévrose, méninge) sont intègres. Chantier chirurgical complexe dont il sera fait mention quand la multiplicité des techniques décrites témoigne de leur imperfection et que jusqu’à présent la meilleure restauration d’un tissu manquant impose sa substitution par le même tissu. Invitation à inventer une véritable chirurgie régénératrice.

From the oracle of Delphi to magnetic resonance imaging, the anatomist's dissecting gaze has always been accompanied by a connective reading, nourishing subjectivity. The face offered to view has thus been the subject since Aristotle (and probably before without any written record of it being kept) of multiple interpretations, becoming a standard throughout the ages. A whole vocabulary emanates from it: metoposcopy, prosopology, physiognomony, phrenology, organology, morphopsychology, amphibology... which punctuated the beyond of the gaze. It is this story, focused on the frontal region, which will be mentioned, with the excesses it may have caused. Invitation to educate the surgical perspective.

The forehead is the protective helmet of the brain, if we refer to the etymology of the word calvaria. Destroyed, it must be rebuilt; priority is given to its bone infrastructure, even though we can live without it, as long as the other tissues (skin, muscle, aponeurosis, meninge) are intact. Complex surgical project which will be mentioned when the multiplicity of techniques described demonstrates their imperfection and until now the best restoration of a missing tissue requires its replacement by the same tissue. Invitation to invent a true regenerative surgery. (c) 2024 Published by Elsevier Masson SAS.

Robotic assistance can help in physically guiding the drilling trajectory during zygomatic implant positioning. A new robot-assisted strategy for a flapless zygomatic implant placement protocol is reported here. In this protocol, a preoperative computed tomography scan is used to plan the surgical path. After surface registration, the ROSA robot (Zimmer Biomet Robotics) guides several steps, which are performed with shared control. The surgeon performs the drilling and tapping, guided by the robotic arm, which is positioned according to the planned trajectory. Placement of the zygomatic implant is done manually. Immediate intraoperative 3D verification is performed by cone beam computed tomography (flat-panel detector, Medtronic O-arm II). Four zygomatic implants were placed in the case patient according to the flapless protocol, with a mean vector error of 1.78 mm (range 0.52-4.70 mm). A screw-retained temporary prosthesis was placed on the same day. No significant complications were observed. The application of this robotassisted surgical protocol, which guarantees a very high degree of precision, may reduce inaccuracies in the positioning of zygomatic implants that could deviate from the surgeon's plan. This appears to be a potentially safe flapless surgery technique. Drill slipping on the crest or on the maxillary wall is the main source of error in this procedure, emphasizing the usefulness of the assisted surgical

The surgical notebooks (1945-1959) of General Gustave Ginestet are the last direct testimony of the quintessential period in which autoplastic techniques were used, before their twilight, favored by the advent of axial pedicle flaps, musculocutaneous flaps and later free flaps. They summarize all the refinements of the experience accumulated at the National Center for Reconstructive Surgery (Centre Medico-Chirurgical Foch-Suresnes). They appear to be more informative than the various books of the time, which were intended for an experienced public or for those benefiting from a companionship, thus eluding a certain number of precautionary advice, which are undoubtedly tacit but essential to obtain a successful operation in the hypothesis of their current use. This paper aims to establish the principles of historical surgical techniques and to integrate them into the management of patients in therapeutic impasse. One hundred and seven clinical situations requiring tissue displacement were analyzed by reconstructed region and by type of flap used. This technical view of the past, as close as possible to the daily practice of a famous reconstructive surgery center, does not offer absolute methodological or technical precepts. From the surgical notebooks studied, the only thing that emerges is a rigorous approach that allows us to contain a permanent doubt and an experimental process. This notion of constant evolution of the autoplastic practice, guided by its errors, intuitions and beliefs, highlights the importance of a surgical culture, which, with a humanistic approach, must be nourished by the paths of the past. (c) 2022 Elsevier Masson SAS. All rights reserved.

Introduction. - Paul Tessier was a leading French oculoplastic surgeon who took part in several surgical missions in Iran to manage victims of the Iraq-Iran conflict in the late 1980's and early 1990's. Methods. - We collected the records of 322 patients who underwent surgical procedures for the management of wartime injuries by Paul Tessier's team in Iran from 1990 to 1993. We also report one of the most representative cases of orbital reconstruction performed by Tessier. Results. - Mean age at the time of trauma was 20.65 +/- 7.04 years (range: 2--62). Craniofa-cial CT-scans were available for 54 patients. The bones of the upper third of the face and the orbital contents were affected in 124/322 patients (38.50%). Soft-tissue lesions of the upper third included 13 frontal lacerations (4.04%), 60 orbital injuries (18.63%) and 95 uni-or bilat-eral enucleations (29.50%). Thirty-nine uni-or bilateral lid injuries (12.11%) and 8 tear duct injuries (2.48%) were reported. A specific case of orbital reconstruction using antero-internal and posterior iliac bone grafts was reported as a representative example of Tessier's techniques. Conclusion. - This study highlights the challenges of orbital reconstruction in wartime injuries and provides insights on the work of one of the most renowned surgeons in this field. (c) 2022 Elsevier Masson SAS. All rights reserved.

Les carnets opératoires (1945–1959) du médecin-général Gustave Ginestet constituent un ultime témoignage direct, de la période de quintessence de l’utilisation des techniques autoplastiques, avant leur crépuscule favorisé par l’avénement des lambeaux à pédicule axial, musculo-cutanés puis libres. Ils condensent tous les raffinements que l’expérience a permis d’accumuler dans ce qui était le Centre national de chirurgie réparatrice (centre médico-chirurgical Foch-Suresnes). Ils apparaissent plus informatifs que les différents traités de l’époque destinés alors à un public expérimenté ou bénéficiant d’un compagnonnage, éludant ainsi un certain nombre de conseils précautionneux sans doute tacites mais essentiels pour obtenir un succès opératoire dans l’hypothèse de leur utilisation actuelle. Ce travail cherche alors à établir les principes de techniques chirurgicales historiques et à les intégrer dans la prise en charge de patients en impasse thérapeutique. Cent sept situations cliniques nécessitant des déplacements tissulaires ont été analysées par région reconstruite et par type de lambeaux utilisés. Ce regard technique sur le passé, au plus près de la pratique quotidienne d’un centre de chirurgie réparatrice réputé, n’offre pas de préceptes méthodologiques ou techniques absolus. Des carnets opératoires étudiés, ne transparaît qu’une rigueur permettant de contenir un doute permanent et un tâtonnement expérimental. Cette notion d’évolutivité constante de la pratique autoplastique, guidée par ses erreurs, ses intuitions et ses croyances met en exergue l’importance d’une culture chirurgicale qui, par un regard humaniste, doit se nourrir des cheminements du passé.

The management of temporomandibular joint (TMJ) ankylosis requires complete removal of the ankylosed block and the prevention of recurrence. For this purpose, the ramus?condyle unit can be reconstructed with a second metatarsal free flap. This article reports the use of this flap in a young patient treated for left TMJ ankylosis, post costochondral graft for the treatment of hemifacial microsomia. Data from the 10-year follow-up are reported. The glenoid fossa was reconstructed with a graft of the second metatarsal base, enabling the juxtaposition of two cartilaginous joint surfaces, with the aim of optimizing the functional result and preventing the recurrence of ankylosis. At the 10-year follow-up after this surgery, there was no recurrence of the ankylosis and no articular disorder, and the morphological result was satisfactory. Bone fixation was stable over the 10-year period and the metatarsal head was still in place. Quantitative measurements obtained by computed tomography scan did not show any growth of the second metatarsal free flap compared to the right unaffected condylar process.

La fente labio-alvéolo-palatine, qui puise son origine aux stades les plus précoces de l’embryogenèse, impose une prise en charge continue qui ne s’achèvera qu’à l’âge adulte au prix d’une signature cicatricielle indélébile. Avec son triple retentissement esthétique, fonctionnel et psychologique quand, à l’étage céphalique, formes et fonctions sont intimement liées. C’est ce déroulé dans le temps de sa prise en charge thérapeutique qui est ici évoqué, invitant le lecteur pédiatre, après avoir pris connaissance des actuels fondamentaux en matière de syndrome fissuraire, à intégrer l’équipe pluridisciplinaire qui en assume le traitement, en ajoutant son regard distancié au regard que les enfants, les parents et les thérapeutes spécialistes portent sur cette malformation.

L’analyse rétrospective des échecs d’une technique chirurgicale invite à porter regard autocritique sur ses propres pratiques. Elle permet de remettre en cause certains faits établis, de retrouver les signes jusqu’alors passés inaperçus, annonciateurs cependant de ces complications, de s’interroger sur les effets de mode, d’inscrire un acte chirurgical lourd dans une autre dimension spatio-temporelle, de repenser les indications et améliorer les réalisations. Plus de 200 lambeaux libres osseux (crête iliaque et fibula) utilisés en dix années dans un même service pour reconstruire la mandibule ont été, à travers le suivi des patients pendant trois ans, analysés. Le taux d’échec est mesuré à 28 %. Ce chiffre élevé recouvre en fait toute une série de complications survenant parfois à long terme. Cinq remises en cause alimentent ce chapitre de discussion : de l’ambiguïté de la littérature au savoir-faire chirurgical, elles invitent à garder à l’esprit la dimension biologique de tout geste chirurgical. Evidence de la primauté d’une clinique que la technologie a tendance à marginaliser.

The authors proposed here a retrospective analysis of a surgical procedure they performed for long time. It allows to put into questions some established principles, to find some unkwown datas which could be important to predict complications. It is also interesting to discuss about the use of indication and choice of the flaps along years of reconstructive surgery history in the way to improve protocoles and management of those large reconstruction. During ten years in one maxillofacial surgery departement, more than 200 bone free flaps (essentially fibula and iliac crest) have been used for mandibular reconstruction and analyse with a three years follow-up. The global failure rate is estimated as 28 % included all various complications from fistulas to infections. Five different points are discussed from the ambiguity of the reported studies to the way of doing of such surgery. It is also pointed out the importance of the biological dimension of all surgical procedures and the place of clinical figures regarding of the technical processes which usually forget the main clinical purpose. (C) 2021 Elsevier Masson SAS. All rights reserved.

Lower lip and chin reconstructions are challenging, since satisfactory aesthetic and function outcomes in the mouth region are difficult to achieve 1 Baker S. Reconstruction of the lip. in: Baker S.R. Swanson N.A. Local Flaps in Facial Reconstruction. Mosby, St. Louis1995: 389-396 Google Scholar . Although various techniques for lower lip and chin reconstruction have been described, some cannot be applied in patients with disease recurrence, the failure of previous procedures, or a history of radiotherapy. These particularly unfavorable conditions rule out the use of an additional free flap, due to the lack of donor sites or recipient vessels. The pedicled flaps (deltopectoral, latissimus dorsi, and pectoralis major flaps) used as a second-line procedures are associated with a retractile healing process, resulting in cervical flexion deformity and worsened lip incompetence. In situations lacking a conventional solution, the historical bipedicled scalp flap 2 Dufourmentel L.An attempt to reconstruct an entire lower jaw by means of grafts of skin, mucosa and bone. La Restauration maxillo-faciale: revue pratique de chirurgie et prothèse spéciales, consacrée à l'étude des lésions traumatiques de la face, des maxillaires, des dents, et à leur traitement.... March1919. Available onhttps://gallica.bnf.fr/ark:/12148/bpt6k65199722/f5.itemFrench version with iconographieshttps://gallica.bnf.fr/ark:/12148/bpt6k65199722English version without iconography. Google Scholar may therefore be a valuable option.

Fraser syndrome (cryptophthalmos-syndactyly syndrome) is a rare autosomal recessive malformation disorder. The first description of the syndrome was reported by George Fraser in 1962. Diagnosis is based on the major and minor criteria established by van Haelst et al. in 2007. Unilateral or bilateral cryptophthalmos, syndactyly, unilateral renal agenesis, and genital anomalies are the most frequent anomalies. Several maxillofacial, oro-dental, ear-nose-throat, hormonal, and anorectal disorders are reported. Cardiac malformations and musculoskeletal anomalies are uncommon. The syndrome is related to mutations in three different genes (FRAS1, FREM2, and GRIP1) resulting in failure of the apoptosis program and disruption of the epithelial-mesenchymal interactions during embryonic development. Prenatal diagnosis is based on the detection of renal agenesis and laryngeal atresia, together with a family history. Most foetuses with severe anomalies are terminated or are stillborn. All patients or pregnancies with a diagnosis of Fraser syndrome should be referred to expert centres. A collaborative approach including anaesthetists, ENT specialists, maxillofacial surgeons, and geneticists is necessary for the management of this syndrome. In vivo and in vitro research models are available to better understand the underlying aetiology.

HAL is a multi-disciplinary open access archive for the deposit and dissemination of scientific research documents, whether they are published or not. The documents may come from teaching and research institutions in France or abroad, or from public or private research centers. L’archive ouverte pluridisciplinaire HAL, est destinée au dépôt et à la diffusion de documents scientifiques de niveau recherche, publiés ou non, émanant des établissements d’enseignement et de recherche français ou étrangers, des laboratoires publics ou privés. Characterisazion of bifid, fibrous and fine zygomaticus muscles with ultrasound elastography R. Ternifi, P. Pouletaut, F. Charleux, Stéphanie Dakpé, Sylvie Testelin, Bernard Devauchelle, Salem Boussida, Jean-Marc Constans, S. Bensamoun

Mandibular osteoradionecrosis (mORN) is a severe complication of head and neck irradiation. International consensus on the management of mORN is currently lacking. The present study sought to evaluate the effectiveness and benefits of early reconstructive surgery (resection of the diseased bone and immediate reconstruction with a free flap) in treatment-refractory mORN. A single-center retrospective study was carried out of operations performed in a French university medical center between 2003 and 2013 inclusive. For each patient, the surgical modalities and postoperative outcomes were recorded. A total of 55 operations (19 marginal resections and 36 segmental resections) were performed, and the overall success rate was 92.3%. Relative to marginal resections, segmental resections were associated with longer operating times (440±62min vs. 531±72min, respectively; P<0.05 in Student’s t-test), a longer length of hospital stay (16.5±6.5 days vs. 25.6±11.3 days, respectively; P<0.05), and a higher complication rate (26.3% vs. 63.9%, respectively; P<0.05 in Fisher’s test). Given the unpredictable progression of treatment-refractory mORN and the risk–benefit ratio observed here, the value of early reconstructive surgery with curative intent should be reassessed.

(2019). Development of a new MR elastography protocol to measure the functional properties of facial muscles. Computer Methods in Biomechanics and Biomedical Engineering: Vol. 22, 44th Congress of the Société de Biomécanique, pp. S317-S319.

Born at the late 19th century, Suzanne Noël achieved, despite prejudices, to become at the same time the first female cosmetic surgeon and an influential feminist activist. Trained as a dermatologist by Professor Brocq, she first became fascinated by rejuvenation surgery during her studies by meeting Sarah Bernardh, who had undergone a facelift in the United States. As a surgeon, she mainly performed procedures under local anaesthesia in her salon, where she maintains worldly relations with her women clients. As an activist, she founded feminist clubs all over the world since 1923, under the aegis of a still flourishing organization: "Soroptimist International", which provided assistance in the field to women in need. She successively lost her first husband, then her single daughter and her second husband to be 46 years old, widowed, indebted and without any medical license. Their personal difficulties are not foreign to what she advocates: the women's emancipation by achieving economic independence. Suzanne Noel's journey is a singular paradox on the relationship between the earliest days of cosmetic surgery and feminist ideology. She structured the controversy within the various thinking movements at that time: does embellishing a woman serve her cause? Provocative but necessary question for thinking the surgical act. Suzanne Noël, as a liberal feminist, however, supported the idea that cosmetic surgery could be a transitional solution to integrate a working environment in which there was significant discrimination in women's employment.

Background: Head and neck mucosal melanoma (HNMM) is aggressive and rare, with a poor prognosis because of its high metastatic potential. The two main subtypes are sinonasal (sinonasal mucosal melanoma [SNMM]) and oral cavity (oral cavity mucosal melanoma [OCMM]). Consensual therapeutic guidelines considering the primary tumour site and tumour-node-metastasis (TNM) stage are not well established. Material & methods: Patients with HNMM from the prospective national French Rare Head and Neck Cancer Expert Network database between 2000 and 2017 were included. Clinical characteristics, treatment modalities, outcomes and prognostic factors were analysed. Results: In total, 314 patients were included. The 5-year overall survival (OS) and progression-free survival (PFS) rates were 49.4% and 24.7%, respectively, in the surgery group; no long-term survivors were observed when surgery was not feasible. Moreover, even after surgery, a high recurrence rate was reported with a median PFS of 22 months. In multivariate analysis, Union for International Cancer Control (UICC) stage and tumour site correlated with PFS and OS. Postoperative radiotherapy (PORT) improved the PFS but not OS in patients with small (T3) SNMM and OCMM tumours. Nodal involvement was more frequent in patients with OCMM (p < 10(-4)), although, as in SNMM, it was not a significant prognostic predictor. Conclusion: Even early HNMM was associated with poor oncologic outcomes due to distant metastases despite surgical resection with clear margins. Lymph node metastases had no impact on the prognosis, suggesting treatment de-escalation in cervical node management. PORT might be useful for local control. (C) 2019 Elsevier Ltd. All rights reserved.

Mandibular osteoradionecrosis (ORN) is one of the most serious complications of radiotherapy of the head and neck, and is characterised by hypoxia, hypovascularisation, and hypocellularity. Periosteal free flaps have intrinsic osteogenic, and extrinsic neoangiogenic, properties that are related to the periosteum. Our objective was to present our experience with the use of periosteal free flaps in the treatment of ORN (Notani class I or II) that are refractory to conservative management or have a large area of bone (≥2 cm) exposed. We organised a single-centre, retrospective study between 2003 and 2013 and describe the management of 11 patients (4 women and 7 men) who were being treated for refractory mandibular ORN. Thirteen periosteal free flaps were used: inner femoral condylar periosteum (n = 4), iliac crest (n = 1), external brachial with humeral periosteum (n = 1), and forearm with radial periosteum (n = 7). During follow-up we found three acute complications (haematoma, partial necrosis, and total vascular necrosis) that required immediate construction of a second periosteal free flap. There were also two chronic complications (fistula and post-traumatic fracture). With only one progressive lesion identified, the ORN was stopped in 11/12 patients. Two examples of osteoconduction were identified on postoperative images at six months and two years. Because of its osteoconductive and neoangiogenic capacities, the periosteal free flap seems to offer a real biological dimension to the treatment of ORN, and its efficiency favours its early revascularisation.