J. NEVEN, S. SICILIANO, H. REYCHLER
TRANSPORTING DISTRACTION OSTEOGENESIS USING THE MULTI-DIRECTIONAL EXTRA-ORAL DISTRACTOR (NORMED) FOR RECONSTRUCTING DISCONTINUITY MANDIBULAR DEFECTS. PRESENTATION OF TWO CASE REPORTS AND DISCUSSION.

Many options are available for mandibular reconstruction, including reconstruction plates, block grafts and free tissue transfer such as a fibular graft.
Distraction osteogenesis has proven also to be a reliable method for reconstructing missing segments of resected bone in both horizontal and vertical plane.
Two patients underwent a transport distracting osteogenesis using the Normed multi-directional extra-oral distractor for reconstructing the hard and soft tissues. The defects resulted from resection of squamous cell carcinoma. In both cases, we were able to obtain sufficient horizontal and vertical bone volume with attached gingival without the need of a free tissue transfer.

 
RICHTER M., LAURENT F.
MAXILLARY ANTERIOR STEP OSTEOTOMY FOR FACIAL REJUVENATION

Maxillary deficiency is frequently associated with pranasal flattening which hollowes the alar grooves and make the nose to appear more prominent.  This clinical signs give to the face a hard features and an aspect of premature ageing, especially if mandibular excess is present.  Maxillary anterior step osteotomy allows the creation of two strongs spurs which, after maxillary anterior repositionning masks the paranasal flatness.  This modification of the Le Fort I osteotomy is achieved during the same procedure and avoids autogenous bone grafts or synthetic implants.  The authors present the procedure on the base of clinical results which show the effect of rejuvenation of this surgical technic.

 
KARIMI A., MAHY P., REYCHLER H.
COMBINE OSSEOUS DISTRACTION WITH ORTHOGNATHIC SURGERY IN FIRST BRANCHIAL ARCH SYNDROME SEQUELAE'S CORRECTION

First branchial arch syndrome includes several head and neck anomalies, in particular mandibular hypoplasia. This hypoplasia (unilateral in 90% of cases) is often associated with panfacial asymmetry, mandibular retrognathia and dental malocclusion. As maxillar growth depends on mandible development, surgical treatment needs to consider both segments. Furthermore genioplasty may be useful in case of mental asymmetry. The case reported here concerns surgical treatment of first branchial arch syndrome where osseous distraction was combined to orthognathic surgery. Literature review on this particular subject is presented.

 
BOU SABA S. , SICILIANO S.
ORTHODONTIC AND ORTHOGNATHIC TREATMENT IN PATIENT WITH LIP PALATE CLEFT : UCL PHILOSOPHY

Patients affected by a cleft of lip and palate present many problems. A multidisciplinary team is demanded and necessary (ENT. Pediatrics, Maxillofacial surgeons, Plastic surgeons, orthodontists, Speech therapists, Psycologists, geneticiens, and dentists).

The role of the orthodontist is especially necessary during the first two decates of life.
 
During the permanent dentition the goals of the orthodontic treatment are :
- dental alignement
- bite stability
- occlusal and facial harmony

Because of skeletal dysmorphosis, especially maxillary hypoplasia owed to the cleft, orthodontic  procedures are very often associated with orthognathic surgery.
Actually in patients who follow our cleft repair protocol from the birth we perform an  osteogenetic distraction of upper maxillary in skeletal class III. The mean age is in children at about 10-11 years old after gingivoperiosteoplapsty and alveolar bone graft.
In older patients (not follow in our Department or in secondary cases) we prefer to do classic orthognathic surgery except if the dysmorphosis is so severe with a great over-jet and maxillary hypoplasia where we still use bone distraction. We don't perform the technique proposed by Posnick consisting in the advancement of the little fragments but we preserve the space of the cleft which is grafted by autologous bone. Further studies are necessary to confirm the benefits of distraction in young cleft patients.

 
D. DEQUANTER, G. ANDRY, PH. LOTHAIRE AND R. DERAEMAECKER
Department of Surgery, Institut Jules Bordet.
WIDE SURGERY AND RECONSTRUCTION FOR MINOR SALIVARY GLAND TUMORS

AIM : Limited excision is one of the main factors leading to recurrence of minor salivary gland tumor (1-6). Our aim is to perform large resections with immediate reconstruction in order to provide local control, as well as to achieve better cosmetical and functional results.
MATERIAL & METHOD : Four consecutive patients suffering from minor salivary gland tumors of the upper aerodigestive tract are reported : two adenoid cystic carcinoma (one of the lateral oropharyngeal mucosa, one of the retromolar area), one terminal duct adenocarcinoma (base of tongue), one mucoepidermoid carcinoma (floor of the mouth). Two radial forearm free-flaps, a trapezius myocutaneous pedicled flap (including an adjacent osseous part of the scapula) and a sternocleidomastoid muscular pedicled flap were respectively used for reconstruction. Additional external radiation was used for three patients (60 cGy), the 71 years old patient with the retromolar location was not irradiated.
RESULTS : Postoperative course were uneventfull and the ability to chew and swallow was rapidly restored (11 days, mean ; range : 10 to 25. days) in each case. Two patients, locally controlled, with adenoid cystic CA died : one from brain metastases (2 years), the other with pulmonary metastases (8 years).
One patient is alive with a recurrent tumor of the pterygomaxillary fossa (without trismus so far) 16 years after the original operation, the other patient is free of recurrent disease at the base of the tongue but has been recently operated (with success) for 2 pulmonary metastases 60 months after initial surgery.
CONCLUSIONS : For minor salivary gland carcinoma of the head and neck, large resection with immediate reconstruction afford fast recovery and long lasting locoregional control. Additional radiotherapy is feasible.

 
C. LAROCHE, H. ABBAR
MODIFICATIONS DU COMPLEXE NASO-LABIAL APRES OSTEOTOMIE DE LEFORT I

L'ostéotomie de Lefort I entraîne des répercussions sur les tissus mous naso-labiaux qui d'après de nombreux auteurs sont prévisibles mais mal quantifiables car multifactorielles. Ces modifications sont en général considérées comme défavorables. Après un bref rappel de l'anatomie de la région naso-labiale et de la morphogénèse du pré-maxillaire, notre étude tente de recenser les différents facteurs intervenant, de décrire les processus entraînant ces déformations et d'en déduire des techniques chirurgicales établies.
Douze patients regroupés en vecteur spécifique de mouvement ont bénéficié d'une ostéotomie de Lefort I. La technique de fermeture était un repositionnement musculaire sans fermeture en VY. L'étude des tissus mous a été réalisée avec photographies et céphalométries avant l'intervention et au moins un an après.
Nous concluons qu'en respectant l'équilibre architectural cranio-facial des patients, et en repositionnant la musculature naso-labiale de façon adaptée, ces modifications après ostéotomie de Lefort I sont soit favorables dans la majorité des cas, soit défavorables mais limitées dans les autres cas.

 
I. PONIKELSKY, C. VERVAET, E. DEROUX, A. BALON-PERIN, R. GLINEUR
IMPACT OF ORTHODONTIC AND SURGICAL TECHNIQUES ON MAXILLARY TRANSVERSAL EXPANSION. OBTAINED BY TRANSPALATAL DISTRACTION

Inadequate transversal development of the maxilla is a frequently observed problem in orthodontics.
In adolescents and adults, the preferred therapeutic attitude consists of a transversal expansion surgically assisted by transpalatal distraction.

Clinical studies show that the transversal expansion obtained by transpalatal distractor (TPD) is greater at the level of the canines than at the level of the molars.  Nevertheless, if a pterygomaxillary disjunction is carried out, and the TPD is placed at the level of the first molars, the expansion of the segments would be more parallel.

The orthodontic or bone anchors may modulate the antero-posterior gradient of the transversal expansion obtained by the transpalatal distractor.