[Reconstruction of the interruptive loss of substance of the mandible].
Explore the source record for details and available documents.
Biomedical subjects
Publications and source records attributed to F Cheynet.
Explore the source record for details and available documents.
Trapdoor fractures of the floor of the orbit were first described in 1965 by Soll and Poley. The authors discuss the pathology and pathogenic theories for these lesions and present 8 cases. The diagnosis is essentially clinical and is frequently supported by computed tomography when it is performed rapidly. The surgical procedure is designed to release the herniated tissues by lowering the orbital floor so as not to aggravate the constrictive lesions. These fractures constitute surgical emergencies and their prognosis depends on the nature of the tissues incarcerated.
Explore the source record for details and available documents.
Injury to the face as a result of firearm wounds differs as a function of whether the injury was due to a bullet or lead shot. In the first case treatment is usually that of a mandibular or maxillary comminuted fracture and is principally orthopedic. In the case of hunting guns the damage is considerable and requires reconstitution of soft tissue with the use of a distant flap (purely cutaneous or musculo-cutaneous), bone repair, when necessary, being by costal or iliac grafts.
The preferred composite flap is the musculocutaneous flap from pectoralis major for repair of loss of mucocutaneous substance due to cancer or injury. In rare indications the musculocutaneous flap from sternocleidomastoid muscle is used. When loss of bone substance combined with a cutaneous or mucosal defect has to be corrected use is made of the bone-muscle-skin flap from pectoralis major to include the 5th rib, or the bone-muscle-skin flap from sternocleidomastoid to include internal portion of clavicle. Reliability on use of these two flaps has led to their application in surgery for mandibular osteoradionecrosis. In addition to allowing repair of bone continuity, the vascular and cellular capacities of the flap provide colonization and rehabilitation of the borders of lost substance with live tissue, as shown by subsequent bone remodelling. Results of statistical analysis of 50 cases are presented.
Kole's operation combines segmental alveolar osteotomy of lower incisor-canine region with a reduction mentoplasty. The procedure usually provides a reduction in height of mentum, sometimes with an advancement, and involves ablation of an intermediate bone fragment. Ablation of lower border as described by Kole too frequently results in an esthetically poor chin. Insertions of platysma and digastric muscles are untouched. The inferior segmental osteotomy separates the lower incisor-canine region, which is displaced upwards or upwards and backwards after extraction of premolars, displacement being maintained by interposition of bone detached during mentoplasty. A reduction glossectomy is almost constantly associated. The best indication for Kole's operation is anterior gaps with or without proalveoli. It is often combined with segmental or total surgery to maxilla. Results are generally stable, especially after mentoplasty, but from the dental aspect pulp mortifications are not rare.
The improved definition and good visualization of soft tissues provided by high resolution computed tomography imaging greatly exceeds results of conventional tomography investigations. It is irreplaceable for tumoral lesions, particularly of the facial region, when not only the tumor but its degree of extension are perfectly identified. In orbital injuries it is the only imaging procedure capable of visualizing the orbital contents and its relation with the fracture line.
Conventional treatment of osteoradionecrosis of mandible is by antibiotics combined if necessary with a hemimandibulectomy. A method is proposed which reduces bone excision to infected and necrotic tissue while respecting mandibular continuity. The bone remaining is covered by a flap taken from a distant region. Five cases treated in this way are reported. When mandibular continuity has to be interrupted to suppress infected foci, immediate repair is performed using an osteo-musculo-cutaneous flap, and six cases treated by this method are reported. A part from their mechanical covering and reconstructing roles these well vascularized flaps improve vitality of tissues they enclose, including the mandibular bone.
Specific features of Delaire's operation when compared with Rosenthal's inferior pedicle pharyngoplasty are described, and phonetic results obtained in a recent series of 10 patients operated upon using the former procedure reported. The excellence of these results is emphasized.