Revue de Stomatologie et de Chirurgie Maxillo-faciale

Published by Elsevier Masson
Print ISSN: 0035-1768
Publications
This retrospective study was conducted to analyze per and postoperative complications associated with third molar extraction. Our objective was to determine the appropriate moment for extraction. The study included 367 patients, selected randomly among the population treated between January 1992 and December 1996. A total of 1213 third molars were extracted: 603 under local anesthesia in 83 men and 136 women, mean age 24.9 years (range 11-70); 610 under general anesthesia in 44 men and 104 women, mean age 19.9 years (range 12-62 years). The patients were divided into three groups by age: 11-18 years, 19-30 years, and 31 years and over. Extractions were performed by senior (n=4) and junior (n=7) surgeons who used the same standard operative technique for all patients. The overall complication rate for extractions conducted under local anesthesia was 12.6% for lower third molars and 2% for upper third molars. The most frequent complication was secondary infection (3.6%) for the mandible and fracture of the tuberosity and bucco-sinus communication for the maxillary. The overall complication rate for extractions conducted under general anesthesia was 8.2% for lower third molars and 1.5% for upper third molars. Complications were more frequent, for the entire cohort, when the operator was less experienced, the subject was older, and the tooth was deeply embedded. These results are in agreement with data in the literature. Based on our experience, we propose extraction of third molars during adolescence when the x-ray indicates normal eruption cannot be expected due to lack of space or an abnormal position.
 
Surgery of the lacrimal appartus falls into the realm of a paradox: paradoxical because of the means employed to repair an excretory apparatus which is not absolutely indispensable; paradoxical because of the great difficulty encountered in assessing results in operated patients with: obstruction without weeping or; weeping without obstruction. The indication for operation is related to two factors: that of the act itself--valid in new lesions, debatable in old lesions, doubtful in relapses; that of the technique used, which in the authors' view is mainly a function of the state of the lacrimal sac. An objective analysis of a series of 102 cases strengthened the authors' opinions but with a feeling of circumspection tainted with deception.
 
The plastic qualities and vascular reliability of the frontal flap have been widely used for reconstruction of facial tissue. We revised the files of 105 patients who had undergone surgical repair of facial tissue loss with frontal flaps. The epidemiology, etiology of the repaired tissue loss and indications for frontal flap as well as the various techniques were analyzed: 66.7% of the patients were over 60 years of age; 74% had ambulatory surgical repair; 54.4% of the repaired tissue losses were situated in the nasal region; 80% of the losses were due to tumoral formations. The median flap was the most widely used (23.2%).
 
The authors describe the clinical and anatomical appearance of orbital fractures operated on in their centre, based on an analysis of a homogeneous series of 105 cases. They define their indications, operative technique and results.
 
On the basis of a routine study in 109 children of variations in pre-maxillary angulation, the authors feel that the pre-maxilla is a typical example of a basic osseous structure whose direction of growth is adapted to the muscular conditions which surround it.
 
We present an assessment of the dental and maxillofacial pathology in a medieval population in southwestern France. One hundred and ninety eight mandibles and 29 craniofacial complexes were analysed. Dental and periodontal infectious pathology predominated. Third molar agenesia was quite frequent, concerning 25% of the mandibles. Third molar eruption was almost constant and in a normal position. Condylar process degeneration concerned 6% of the population. Three cases of traumatic pathology were observed, one case of long mandible was noted, and two cases of hypertrophic inferior alveolar process. Dento-mandibular maladjustment was uncommon. No unwedging of the maxillo-mandibular bone basis was observed.
 
Malignant non-Hodgkin type lymphomas (MNHL) are relatively frequent tumors but their localisation in the salivary glands is rarely reported in the published literature. The authors describe 11 such cases, seen in the stomatology Department of the Salpêtrière Hospital in Paris over a period of 4 years, in which the MNHL was located in the salivary tissues (2 purely glandular, 1 of the mixed type, and 8 extranodal tumors). Treatment by multiple chemotherapy and radiotherapy demonstrated that survival, whatever the anatomical type or even the histological form, was improved in relation to that observed with tumors in other locations.
 
The authors study the maxillofacial repercussions of choanal imperforation based upon 11 cases (8 unilateral and 3 bilateral). Skeletal abnormalities are defined using teleradiographic and tomographic techniques. The origin of these abnormalities is sought: malformations, deformities or sequelae of surgical treatment.
 
The use of osseointegrated implants to provide support for auricle prosthesis as been carried out by Tjellstrom. This method has provided the maxillofacial surgeon with another approach to the treatment of defect of the auricle. The principles and concepts of extra-oral osseointegrated implants are the same as those of the intra-oral application developed by Branemark 26 years ago. This simple and reliable method allow the attachment to splint bar fixated to three or two mastoid osseointegrated implants. This method represent an interesting possibility for the management of auricle defects. We report on our experience of 11 cases.
 
Neurothekoma is a rare benign tumor which must be distinguished from certain malignant tumors such as fibrohistiocyte tumors or plexiform cell tumors, neurotropic melanomas and clear-cell sarcoma. An 11-year-old girl consulted for a recurrent subcutaneous tumor of the chin which had been operated 4 months earlier. The resection was incomplete. A wider revision resection successfully stopped recurrence. The histology study established the diagnosis of neurothekoma due to the presence of mitosis atypia, cellular nodules, and extension to the hypodermis. Immunohistochemistry confirmed the diagnosis. Neurothekoma is a benign tumor observed in young women, mainly on the face. It occurs as a dermal cohesive mass without infiltration of the epidermis. The typical immunohistochemical pattern enables differential diagnosis with myxoid neurothekoma, melanocytic and nervous system tumors. Surgical resection is indicated.
 
Next to an anatomical come back authors describe different surgical technics they used for the rebuilding of the ear concha, after exeresis of basal cells epitheliomas: Post auricular island flap. Pretragian flaps superior pedicle. Post auricular flaps with a superior pedicle in two or one time. Clinical cases show what they said. To conclude, authors insist on the advantages of surgery: It allows, in the "conchal area" a protection of contiguous cartilage, in addition to a total check-up of the tumor. Surgical treatment can also be used to correct failures or resumption after radiotherapy.
 
The authors report a case of ameloblastoma occurring at the unusual age of 11 years. The surgical management is conservative. Complete and careful tumorectomy was performed without reconstruction. Complete spontaneous restitution was seen one year after the operation. No recurrence was seen and the patient may new be considered as cured, with a 6 year follow-up.
 
The authors study the gangrenous cellulitis epidemiology, about 11 cases in a series of 118 odontogenic cellulitis. They insist on the frequency of the gangrenous development in old patients, and the importance of an early adapted antibiotic therapy for the vital and functional prognosis. A large surgery procedure is also necessary. At last, the ulterior treatment is depending all the more on the general signs evolution, as the local aspect.
 
LAV/HTL VIII virus found in 1983, renamed HIV in 1986, is doing with many clinical manifestations among which AIDS is only ultimate one, and the more serious aspect of infection by the virus. At each stage of the disease, oro-facial manifestations can be encountered, often the first one. That emphasises for oral medicine the need of perfect knowledge of these clinical aspects concerning 111 patients, we will describe these clinical aspects and hygienical and preventive precautions we choose.
 
An investigation was done with N.-isopropyl-iodoamphetamine (123I AMP) in 20 patients: 10 patients with craniofacial injury and 10 patients without brain dysfunction or injury. Brain X ray computerized Tomography was normal. SPECT 123 I AMP detected functional defects related with traumatic impacts. Sensitivity is higher with SPECT than with CT Scan. The indications for the initial evaluation of head injury, and the relations with later sequelae i.e. post traumatic epilepsia and subjective syndrome are discussed.
 
The incidence of radicular cysts in 125 chronic periapical lesions was studied in 36 cases of periapical surgery (28.8%), and to 89 tooth extractions (71.2%). Histopathology revealed 18 radicular cysts (14.4%) and 107 lesions corresponding to chronic apical periodontitis (C.A.P.) or granulomas (85.6%). Cholesterol clefts, a fibrous capsule and presence of a cavity were more common in the cysts, significant differences being observed with respect to chronic apical periodontitis.
 
129 patients, who had oral cavity or oropharyngeal carcinoma underwent excision with intraoperative histopathologic examination. Thanks to this method, the number of satisfying resections has increased from 25% to 75%. Whatever the quality of the surgical excision may be, postoperative radiotherapy improves the prognosis.
 
Les crânes sont stabilisés dans le céphalostat et orientés selon le plan de Francfort. Figure 2. Points céphalométriques et angles sélectionnés pour l'étude.
The aim of this study was to compare cephalometric norms of complete medieval skulls (n=35) with contemporary skulls (n=41), all from the same region, taking five craniofacial measures. The medieval skulls were from different sites and tombs from southwestern France and contemporary skulls were those of students from the Faculty of Dental Surgery, Toulouse. A lateral cephalometric radiograph of each skull was obtained. All the skulls had to contain teeth and all anatomical reference points required for inclusion in the study. Cephalometric points were selected by inspection. The angles were chosen to evaluate the sagittal maxillo-mandibular relation, the cranial base flexion and the vertical dimension. Results showed that the ANB angle was wider in the medieval skulls (4.11 degrees vs 2.41 degrees ) but no significant difference for the cranial base flexion and the vertical dimension could be found between the two populations. We suggest there is no significant change in cephalometric norms over a period of approximately 800 years. Changes in lifestyle, diet, environment and populations intermixing do not appear to significantly affect cephalometric norms, although such factors are thought to affect dental occlusion.
 
The authors describe 13 cases of hypertrophic sialosis and discuss possible mechanisms which could explain their appearance. In spite of different etiologies there is uniformity in the reactions produced. The authors therefore compared the clinical findings with those reported from animal experiments in which such lesions were artificially produced. Whether the processes of cellular hyperplasia and hypertrophy observed are related to an autonomic nervous system disorder, is open to question.
 
13 Converse scalping flaps have been done in the past 3 years. 11 cases were for nasal reconstruction, at least half nose which is its main indication including 4 after gun shot wounds and 7 for invasive skin cancers. The preference of this flap is discussed versus the other processes for reconstruction: median forehead flap whatever its design, Washio or orther fronto-auricular flaps, free flaps. Lining and framework repair are done in the same operation than cover when usefull. 2 other clinical cases illustrate other areas than nose where the Converse flap can be employed.
 
During the ten last years, 13 neural tumors of the tongue have been observed in the department of stomatology and maxillo-facial surgery of Salpêtrière Hospital Paris (Prof. J.M. Vaillant): 4 amputation neuromas, 5 benign schwannomas, 1 malignant schwannoma, 2 neurofibromas and 1 multiple endocrine syndrome type III. The authors analyze the clinical and histological data from these case-reports; they point out difficulties encountered in the diagnosis, and the prognostic problems brought up by such infrequent lesions.
 
Morbidity of cancer treatments is well-known. Postradiation sarcomas have been reported though the relative risk is considered to be low. We report a case of osteogenic sarcoma of the face occurring 13 years after irradiation and chemotherapy of bilateral retinoblastoma. In this case chemotherapy, irradiation in the first years of life and retinoblastoma increased the risk of postradiation sarcoma.
 
We report the clinico-pathologic characteristics of 13 cases of Laugier-Hunziker disease, consisting of the presence of oral melanotic macules associated or not to longitudinal nail pigmentation. The presence of regular acanthosis, basal pigmentation without increase in the number of melanocytes and the presence of melanophages in subepidermal connective tissue have been the most constant histopathological characteristics. The term "essential cutaneo-mucous hyperpigmentation" as synonym of Laugier-Hunziker disease is proposed.
 
Previous studies in patients with Down's syndrome have revealed signs of major anomalies of base of skull. A cephalometric radiography study was conducted to determine extent of these anomalies by quantitative methods. Skull morphology and structure were investigated in two groups of patients with Down's syndrome in whom cytogenetic analysis had demonstrated the presence of an extra chromosome in group G. The first group included 100 patients of both sexes aged between 9 and 30 years, the second group consisted of 33 patients aged 5 to 19 years. A matched control group was also studied. Cephalometric analysis (Björk, Delaire) showed shortening of anterior segment of base of skull in patients with Down's syndrome, as well as an increase in angle of base of skull when compared with controls, the differences being statistically significant.
 
Induction chemotherapy is now frequently included in therapeutic protocol for carcinoma of oral cavity and oropharynx. Frequency of objective responses and predictive factors for favorable responses to therapy were evaluated in 135 patients. In 45% of cases an objective tumoral regression was noted (with 6% total regression). Combined CDDP-5 FU produced responses in 65% of cases, whereas the combinations of CDDP-BLM-VCR-MTX and of CDDP-BLM-VDS produced values of 35 and 41% respectively. Small tumors (T1, T2) regressed better during chemotherapy than extensive tumors (T3, T4) (16 and 34% respectively). The tumor implantation site was a predictive factor: tumors of the tonsillar region not extending to base of tongue regressed in 74% of cases as against 35% for lesions of base of tongue. In contrast, histologic type and degree of glandular involvement were not important predictive factors. These findings suggest that induction chemotherapy for carcinoma of oropharynx or oral cavity is feasible and that predictive factors of response to treatment are size and site of tumor and type of chemotherapy.
 
In our center, carcinomas of the tonsillar region are most often treated by radiotherapy. The aim of this retrospective study was to assess the therapeutical results obtained for such tumors over a period of ten years. From 1976 to 1986, 137 patients with carcinoma of the tonsillar area were exclusively treated by radiotherapy. The mean age of the patients was 54.3 years. 120 male and 17 female patients were included in the study. 63% of the patients had T3 or T4 tumors, while 53% had N2 or N3 adenopathies at enrollment (1979 TNM classification). All the patients had transcutaneous irradiation done either exclusively (121 cases) or in combination with curietherapy (16 cases). 61 patients had induction chemotherapy. Local control of the tumor was obtained in 59% of patients (79/137), and attained 92%, 71%, 58% and 16% for the T1, T2, T3 and T4 groups, respectively. The 5 year survival rate was 34%. 12 patients developed distal metastases. 9 patients developed another type of cancer. Elements of prognosis were tumor size and nodal status. Age, sex and histological differentiation were not determinant prognostic factors.
 
Osteosarcoma, the second most frequent primary malignant bone tumor, is usually found in long bones: femur, tibia or humerus with only 6 to 7% of cases occurring in the jaws. Patients with osteosarcoma of the mandible usually complain of a swelling, which can be painful or not, accompanied by paresthesia of one of the trigeminal nerve branches in about 20% of cases. We report a case of chondroblastic osteosarcoma of the mandible affecting a 33-year-old woman with 14 years follow-up illustrating the difficulties of a rapid diagnosis. The prognosis of osteosarcoma of the mandible relies on its histological grade and the amount of time elapsing from diagnosis to treatment onset. The treatment of choice is radical surgery providing a 5-year survival rate up to 80%. The definitive surgical treatment is usually performed only after several interventions because operative-room pathology cannot be obtained due to the necessity of decalcification. In order to avoid multiple resections, an interim bridging with a reconstructive plate with a condylar head can be proposed before definitive graft reconstruction. The prognosis of osteosarcoma of the mandible is better than that of long bones. Chemotherapy or radiotherapy, which are very efficient for osteosarcoma in general, do not change the prognosis of osteosarcoma of the mandible.
 
To analyze arteriovenous malformations (AVMs) of maxillo-mandibular arcades seen in our department since 1977, and to determine adequate treatment. Fourteen AVMs were reviewed to determine their revelation, their semiology, the treatment applied and the results that could be obtained. All these lesions were true AV shunts involving bone with or without soft tissue extension. Eight patients belonged to the pediatric population. Six lesions were maxillary and 8 mandibular. All lesions were revealed during or after puberty by local swelling, pain, mass effect or bruit. Hemorrhage was the most frequent (71%) symptom. Teeth instability was detected in all these patients and was origin of the bleeding. The lesions were suspected clinically and confirmed radiologically. Angiography analyzed properly the architecture of the lesion (4 arteriovenous fistulas). Embolization was the clinical treatment in all patients: particles helped to stabilize the acute situations but failed to offer stable results, necessitating complementary embolizations and/or surgery (hemimandibulectomy in 2 patients). The use of acrylic glue (Histoacryl), injected percutaneously (5 patients), or transarterially in the AVM (4 patients)) provided cure in 6 of these lesions (43%) and long term stabilization for all the other AVMs. Teeth extraction could be performed thereafter in good conditions. Antibiotics and anti-inflammatory treatment helped to stabilize the evolutive risk of these lesions. Embolization is the therapy of choice in these lesions. Appropriate use of glue offers a high rate of cure and/or clinical stabilizations and avoids unneeded surgery.
 
Ultrasonography of the temporomandibular joint is a non-invasive, low cost, easy to perform examination. Despite promising results, further improvements in reliability can be expected with technological progress. We report our experience with 140 explorations which we hope incite interest of other researchers in this technique.
 
Study of 1,488 cases of facial injuries treated in the Department of Maxillofacial surgery of the Montpellier Teaching Hospital Centre, led the authors to draw certain conclusions with regard to causes one the one hand and secondly the individuals involved. Road accidents were by far the largest cause, accounting for 70.2% of facial wounds. Domestic accidents took second place at 13%, followed by brawls and attacks as well as work accidents (each approximately 5%).
 
The aim of this survey was to study the prevalence of tooth decay, to assess oral hygiene control, to analyze the different risk factors for caries in orthodontics, and to determine recommendations. We studied 155 patients managed in the unit, for three months and 19 days. The main indicators used were: the DMF index; Loe and Silness's gingival index, and Silness and Loe's plate index. The plate index ranged between 0.08 and 2.4, with a mean of 1.12 ± 0.48; the gingival index ranged between 0 and 2, with a mean of 0.67 ± 0.43; the DMF index ranged between 0 and 21, with a mean of 5.77 ± 4.52. The orthodontist has a major role to play in the prevention of caries before and after treatment. Recommendations and patient information should be adapted to risk for dental caries.
 
Sialometria or measurement of salivary fluid is an important test for the patients with glandular disfunction. Biological parameters are being studied which may influence the results of the unstimulated salivary flow measurements. Sialometria test, which was carried on 159 healthy subjects of a population (81 male and 79 females), studies habits (tobacco), age, sex, corporal weight, environmental factors, oral exploration (caries, lack of teeth and fillings) We found less salivary fluid in the elderly subjects (p = 0.0001), in women (p = 0.045) and with missing teeth (p = 0.0001). We did not find any variation respecting smoking habit, or corporal weight. Before carrying out the salivary resting flowmetry we ought to bear in mind the variations respecting sex, age and number of teeth missing when interpreting a resting flowmetry.
 
Squamous cell carcinomas of the oral cavity were treated in 157 patients by surgery as first-line (104) or salvage (53) treatment. Postoperative irradiation delivered either for locally advanced tumors (stade III-IV) or for unfavorable histological data (nodal or surgical margins involvement). The retrospective study with a mean time of follow-up of 2.5 years shows a loco-regional control rate of 75% statistically influenced by histological nodal status (p < 0.01). Cumulative and cause specific survival rates at 5 years are 41.1% and 57.2% respectively. T stage was found to be a prognostic factor of survival (p < 0.01) as bone involvement (p < 0.05). Surgical margins are influent on local control and survival only in absence of radiation.
 
The fragmentation of salivary stones by extracorporeal shockwave lithotripsy (ESWL) has been described since the 1990s. We wanted to assess its effectiveness through a retrospective study. We reviewed the files of 1571 patients (801 women and 770 men, from 6 to 85 years of age) treated by ESWL between 1995 and 2010 for 1031 submandibular (65.6%) and 540 parotid gland sialolithiasis (34.4%). The treatment consisted in one or several sessions of ESWL distributed over 3 to 24 months. Three thousand to 6000 shockwaves were delivered by session, if there was no hemostatic disorder or infection. Ultrasound control examinations were performed regularly and systematically. An average of six sessions was necessary. All the lithiases were fragmented, 1056 (67.2%) totally and 515 (32.8%) partially with residual fragments from 1 to 6mm in size. After treatment, 1446 patients (92%) were asymptomatic and 125 (8%) continued to present salivary symptoms, without residual fragments on ultrasound examination in 82% of the cases. The main adverse reaction was infection (628 patients, 40%) resolved thanks to antibiotic treatment or extraction of fragments under local anesthesia. Developed for 20 years, LEC is an excellent alternative to conventional surgery as long as indications are respected. It seems very effective, but its drawbacks are the length of management and the difficulty of ultrasound localization of calculi, which requires an experienced operator.
 
We report our experience in 16 patients with a three-staged forehead flap, described by Millard (1974) and Burguet (1992) for nasal reconstruction. We wanted to determine whether the three-stage procedure improves the quality of the final aesthetic result. Sixteen patients underwent forehead flap nasal reconstruction between June 2002 and February 2005. Reconstruction was performed in three stages, a first stage for the transfer of the forehead flap on the nose, a second stage where the pediculized forehead flap was thinned (day 15) and a third stage for division of the pedicle (day 30). The quality of the final aesthetic result of nasal reconstruction was evaluated 6 months postoperatively, by the patient (patient's satisfaction with the nasal reconstruction [4 points]) and by the surgical team according to the thickness of the flap (3 points), integration of the scars (1 point), color of the flap (1 point) and the redefinition of the natural contour of the nose (1 point). A final 10-point score was used to assess the quality of the result: very good (score above 8), good (score from 7 to 8), average (score from 5 to 7) and poor (score less than 5). Sixteen nasal reconstructions were followed to completion. Outcome was considered very good in ten (62.5%), good in three (18.7%) and fair in three (18.7%). Use of the three-stage procedure for forehead flap nasal reconstruction improved the contour of the flap by aggressive defatting of the still pediculized flap, and thus improving the final aesthetic result. Traditionally two stages are used for frontal flaps, with pedicle division at the first stage. This refinement must not be excessive because of the risk of necrosis, the frontal flap often requiring latter defatting. In the three-stage technique thinning is performed at the second stage on a vascularised, bipediculized flap, which makes it possible to obtain the desired refinement without excessive vascular risk.
 
In this study, primary we present briefly the main anatomic elements that concern the tongue as also the clinical and other structures of the cancer of the oral cavity. Simultaneously, we notice our experience from the use of the tongue flap in 16 patients with cancer of the floor of the oral cavity. This procedure is simple, easy, brief and it does not cause aesthetic problems to patients. It is also emphasized that this method does not create functional disabilities to the rest part of the tongue, with result the patients not have disturbances in speech, in chewing or in swallowing.
 
Investigation in 16 patients attending the stomatology outpatients clinic over the last 18 years has enabled definition of a particular radioclinical entity that has been named "idiopathic bilateral salivary megacanal". This generally parotid affection occurs in patients between 50 and 60 years, the onset usually being by an episode of sialodochitis. In addition to these inflammatory attacks there is the persistence of a bilateral "salivary ejaculation" from the ostia of the principal glands, sometimes after manual expression of a mucoid plug. Sialography shows dilatation of canals, the appearance being very suggestive for Stensen's duct, which becomes sinuous, enrolled and segmented. Dilatation is bilateral and affects the total length of the duct. The problem arises as to whether etiopathogenicity is from parietal canalar dysplasia or a constitutional anomaly of the nerve plexus comparable with that described in congenital megacolon. The latter hypothesis is plausible but requires confirmation from histopathology. The always benign course of the disease justifies conservative therapy only: oral antibiotics and canal massage several times a day, with a neostomy only when absolutely necessary.
 
Top-cited authors
Cyrille Chossegros
  • Aix-Marseille Université
Miguel Penarrocha
  • University of Valencia
Jose V Bagan
  • University of Valencia
Vera Sempere
  • University of Valencia
Francois Cheynet
  • Aix-Marseille Université