Biomedical subjects
Publications and source records attributed to F Cheynet.
TMJ arthroscopy is a little invasive and of poor morbidity procedure of both investigation and treatment of temporomandibular pathology. A highly equipped operating room (double instrumentation) together with fine skill and proper knowledge of arthroscopic joint anatomy can easily prevent the rare complications described (articular, vascular, neurologic and otologic).
The authors report 3 cases of trauma induced false aneurysm (internal maxillary, external carotid and internal subpetrous carotid arteries) associated to closed mandibular fractures. These rare vascular complications of ill-defined pathogeny are often due to high speed facial impact. Clinical presentation is polymorphous (pseudo-parotidis, neurological deficit) and arteriography is the main step of the paraclinic investigation. The treatment essentially depend upon both the location and the evolutivity of the false aneurysm.
Condylar fracture are responsible for: homolateral TMJ disorders following discal apparatus lesions such as: disc displacement, discal lesion, osteoarthrosis of articular surfaces (condylar and temporal), contralateral TMJ disorders, more frequent, with destabilisation of the masticatory apparatus and decrease of ramus height or compensatory hypermobility. Functional treatment can prevent articular and muscular ankylosis. It is often indicated: non-displaced low undercondylar fractures or after surgery. Surgical reduction is indicated in two cases: displaced-low undercondylar fracture. The discal apparatus is intact and function usually excellent, displaced-high undercondylar fractures with 90 degrees head luxation. The bone reduction and contention must be associated to discal apparatus control. If dislocated or displaced, the apparatus should be replaced and sutured. Four factors are implicated in articular function: the fracture position, bone displacement (condylar head in or out of the glenoid fossa), discal apparatus integrity (the lower layer of the retrodiscal tissue is involved in bone regeneration especially in infants), and the quality of occlusion.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Arthroscopy is an interesting and enlarging technique that visualise the temporomandibular joint and allows surgical technics such as lysis and lavage, prediscal section, retrodiscal cauterisation, oblic protuberance cauterisation, disc suturing or shavering of the articular surfaces.
Diagnostic arthroscopy is reserved to patients who suffer from internal temporo-mandibular joint derangements resisting to conservative treatments. This technique allows an acute diagnostic approach to the intra-articular lesions of the superior compartment.
Metastatic tumors of oral cavity are uncommon. Mandibular localisation is the most frequent. Microscopic diagnosis and other metastatic localisations help the diagnosis we are reporting on. The report is on a case with prostatic and lung primitive tumors associated with gingivo-maxillary, femur and cutaneous metastasis.
In 7 cases of mandibular laterognathia caused by condylar hypertrophy, the authors specify the clinical and teleradiological features in adolescents. They emphasize the inadequacy of lateral teleradiography and of its measurements, and the need for three-dimensional investigation. In adolescents, secondary deformations, either spontaneous or therapeutic, are rare, and the treatment preferred is condylectomy based on the study of casts. The immediate results of this techniques are satisfactory. The long-term consequences on growth and temporomandibular pathology have been studied.
Posterolateral segmentary maxillary impaction osteotomy has a role to play in the treatment of gaps between the upper and lower jaws. It has several advantages, especially an uncomplicated postoperative period and the single-maxillary contention it provides. The indication must be established after an articulator assessment in order to take into account the mandibular protrusion caused by autorotation and to prevent a sagittal shift. Associated marginal glossectomy will frequently be required. Similarly, in case of vertical excess, genioplasty for vertical reduction will improve the facial balance. This technique may also be proposed as "pre-prosthetic surgery" in cases of egression in the premolar and molar areas, for which it has shown excellent results.
With reference to a case reported here, the authors emphasize the importance of reducing the length of the ramus of the jaw in rather exceptional forms of gaps between the upper and lower jaws with an increase in the posterior height of the face. This procedure provides more stable results and the patient's gums are no longer revealed when smiling.
The anatomical and physiological relation between temporal muscle and temporomandibular joint are well-knowed. The versatility of the temporo muscle-fascia flap must be stressed. The posterior temporal flap is a simply, reliable procedure, with low morbidity. This technique is probably the procedure of choice in discal replacement and in interposition arthroplasty for ankylosis.
Orbital hydatid cysts are extremely rare in France. The authors report two cases in young adults of North African origin, one being a recurrence. Echography and CT scan were the most useful paraclinical investigations. The cysts were surgically excised with difficulty via an anterior approach adapted to the localisation. After 5 years follow up, both patients survived, however, there was major visual loss (blindness, or requirement for enucleation), due to the delay in diagnosis.
We are yielding a case of recurring melanotic neuroectodermal tumor of infancy situated in the premaxilla, with a very quick evolution, haemorrhage, and which has precociously recurred after surgical removal. This tumor is studied on the paraclinical (CT scan, M.I.R.) and on the histological hand (immunohistochemical and ultra-microscopy). This observation is then compared with those of literature in which we find about 200 cases. The neurocristopathic histogenesis is actually doing the unanimity. The prognosis must now be quite reserved because of the recurrences (one case for six) and the possibility of malignant forms, some with metastasis.
Pure cancellous bone transplants constitute an alternative to the usual cortico-cancellous grafts used in certain cases for restoring interrupting substance loss (ISL) in the mandible. The greater number of surviving transplant cells, the rapid revascularization and more complete osteogenesis that are achieved cause indications for this type of graft to be particularly well adapted for cases where local repair conditions are precarious, such as bullet wound related sequelae. Indications for their utilization also extend to patient who have had benign tumors excised. The titanium-made receiving splint designed by Pr. Dumbach is particularly well adapted to this type of restoration; it provides for necessary functional stresses to be translated to the implant, allowing for the latter's incorporation, while controlling the direction of osteogenesis, thereby yielding excellent morphological and functional results.
The TMJ arthroscopy is an investigation method reserved for those who does not respond to non invasive treatments. The technical aspects of the puncture and the normal arthroscopic anatomy are studied.
Synovial chondromatosis of the temporo-mandibular joint is a rare and mild disorder. Three cases are reported, one with an histological aspect of chondrosarcoma. The evolution is favourable after removing the loose particles and the synovial tissues.
After a brief historical summary, the authors report twelve cases of familial form of cherubism and compare them with the other reports of the international literature, of which they make a review.