Biomedical subjects
Publications and source records attributed to F Souyris.
General anesthesia was obtained using a laryngeal mask in 53 patients with nasal fractures. The advantages of this procedure are: no need for curarization, easy removal, and awakening in the operating room. No complications were observed although orotracheal intubation was necessary in 3 patients.
Two children with bilateral congenital fistulae of the lower lip were treated by excision maintaining the fibers of the orbicular muscle. This condition is a rare, hereditary trait often associated with labial and palatine fissures. The etiology is different than other fistulae since the localization does not involve zones of junction between facial buds. On the basis of the embryology reported in the literature, it would appear that a morphogenic factor related to the position of the upper incisives might be involved.
The present study is a preliminary report on the use of hen's eggshell as a possible bone substitute. In the first part of the study, particles ranging from 400 microns to 600 microns in diameter were bioassayed in an intramuscular pouch in rodents. This material was found to be biocompatible, but appeared not to have osteoinductive capacities. In the second and third part of the study, this material was used as an interpositional graft material in critical-size defects of rat mandibles and rabbit skulls. At 2 months, a morphologic restoration was obtained using the graft, but the healing was only achieved by fibrous union. In the fourth part of the study, the material was experimented on as an onlay bone graft on rabbit mandibles. A 6-month follow-up of the implant confirmed its stability. In conclusion, the use of this safe and inexpensive material is suggested for filling limited bone defects in non-weight-bearing areas. The use of eggshell powder for bone augmentation may also be considered, after further studies, to assess its long-term stability.
Three different bone substitutes were implanted in a standardized nasal bone defect in 30 Wistar rats. The results were assessed at 2 months by macroscopic examination, contact radiography, and histologic analysis. Demineralized osseous implants sterilized by ethylene oxide induced bone formation in 90% of the the cases, as no heat-treated graft showed any bone formation. Coralline grafts were osteointegrated in 50% of the cases, but osteoconduction was not sufficient to achieve complete bone repair. This study implies that ethylene oxide sterilization does not impair biologic properties of demineralized grafts, but further studies on more evolved animal species are necessary before human implantation.
The use of bicoronal incisions has been sufficiently described in neurosurgery and craniofacial surgery including osteotomies and injuries. This approach provides excellent surgical access for nasal reconstruction with a very low rate of morbidity. A series of 11 patients, together with three case reports, illustrates the advantages and possible complications of this type of incision.
A case of gunshot wound of the brain associated with a scalp defect is presented. Repair of the scalp defect was primarily achieved by multiple rotation flaps. Successive complications occurred in the postoperative course related to wound breakdown and infection. The patient underwent a secondary reconstruction by a free forearm flap. Despite an infected recipient bed and poor general condition, the postoperative course was uneventful and the healing was complete within 1 month.
Goniopora lobata and polyphyllia talpina were tested in 10 sheep with a follow-up of 12 months. The reference material was a glass ceramic CAP 42. Different implantation sites are used: craniofacial and orthopaedic. A macro and microscopic postoperative study was performed at 3, 6, 9 and 12 months. The results show: (1) biocompatibility with bone and soft tissues; (2) disappearance, without colonisation, of Goniopora Lobata associated with complete bone regeneration at 12 months and (3) later resorption of polyphyllia talpina with a fibrous colonisation, without osseous transformation. The possibility of using these materials in cranio-maxillo facial surgery is discussed.
Popularized by Tessier in 1982, the calvarial bone graft has been used extensively in reconstructive techniques in the cranio-facial region. The authors present here their experience of nasal bone grafting using split skull grafts for post-traumatic reconstructions. Ten patients, with a total of 11 bone grafts harvested, were operated. Results are reported. The level of patient satisfaction has been high. We have had only 2 minor complications, 1 case of alopecia, corrected by a resection in local anesthesia, this inconvenient has never reported before in the literature, and another case of secondary displacement of the nasal bone graft, who required a second operation with a good result. Discussion is reported. Several methods have been used for nasal reconstruction as silicone implants and other bone donor site; but they have disadvantages like painful to the donor site, long hospitalizations, infections and extrusions, etc. The use of cranial graft has some advantages: first of all, it is less likely to resorb, because of its membranous origin, the donor site is in close proximity to the area to be grafted, there is almost no morbidity to the donor site. Recently two case reports describing major complications were published in the literature. A case of a superior sagittal sinus laceration reported by Cannella and Hopkins and a case of an intracerebral hematoma, reported by Leroy-Young. For these reasons it's important to follow strictly the surgical procedure described. We recommended this technique only to those surgeons who are experienced in cranio-facial surgery.
The authors report two recent cases of intractable luxation of the temporomandibular joint which was initially overlooked due to the neurologic or geriatric context. Open reduction was performed. The literature is reviewed and the different aetiological forms of the long standing luxations are presented together with the different treatments proposed.
A case is reported of necrosis of the columella nasi due to prolonged intubation in a 21-year-old road traffic accident patient. He was intubated by the nasal route because of combined head and facial injuries. The necrosis was discovered during surgery for repair of the bony facial injuries. As the patient was in a poor condition, the lesion was not immediately repaired, and the necrotic area was only removed. Definitive repair was carried out four and a half months later, with closure of the oronasal communication with an intravelar veloplasty. Such maxillofacial complications of prolonged endotracheal intubation are rare. They are related to prolonged vascular compression by the tube. Such accidents must be recognized without any delay by carefully examining patients.
Carotid-cavernous fistulas are unusual complications of facial traumas but this life-threatening complication requires a rapid diagnosis. Noninvasive procedures as ultrasounds will confirm the diagnosis and are helpful to demonstrate hemodynamic conditions of the fistula. Angiography remains the main radiologic examination and embolization is now the preferred method of treatment. Surgical treatment will only be required after failure of the interventional radiology.
Congenital segmental amputations are difficult to correct. Free interposition bone grafts with growth centers were tried experimentally by many investigators even at the beginning of this century. Attempts at clinical application of this principle, however, were mostly failures. More recently, with the advent of microsurgical techniques, new hope has arisen. In particular, toe transfers in children have confirmed the survival of such growth centers, as these transfers could be found to grow normally [1]. The transfer of vascularized epiphysis with its growth plate has been shown in animal limbs to achieve a rate of growth comparable with the normal site. Originally, two donor sites were used with acceptable results in children. These were the superior epiphysis of the fibula and the iliac crest. So far, in most clinical applications, they have been used as appositional transfers. However, a growth problem occurring at the donor site has proved to be quite crippling.
336 patients have been operated for protruding ears. 140 of them have a long term postoperative follow-up. The anterior partial chondrotomies are opposed to the other surgical procedures and give the opportunity for a comparative and retrospective study. Surgical indications and procedures, use of antibiotics, postoperative follow-up, and complications are studied. 95% of results are good or very good whatever the surgical procedure. The authors remain the posterior and anterior access for partial chondrotomy.
In four cases, the authors analyse the medical and legal factors which lead the expert to his conclusions in french law, concerning temporo-mandibular joint dysfunction after whiplash injury indemnification. An uncertain direct link between the injury and the damage together with the patient's dental prior state to the accident, lead to retain an incomplete legal imputability. The compensation awarded to the victim will consist of an overvalued extra-patrimonial damage which will eventually be able to balance a low physiological deficit price.
On the basis of 3 cases, we try to demonstrate the dominating role of model surgery in the patient's motivation, the surgical indication and the cooperation with orthodontists. This is achieved with a perfectly reproducible and didactic surgery. The use of color wax and of the TARG are the two deciding elements of this work.
In a retrospective study, we compared monocortical internal fixation versus bicortical screwing in the treatment of the mandibular fractures. Between 1983 and 1985, 40 patients underwent bicortical screw plate osteosynthesis and 46 were treated with the monocortical screw plate technique. The results are favorable to bicortical screwing, as regards both infection and pseudarthrosis. Monocortical screwing caused fewer occlusal disorders than bicortical screwing. Best on the increased amount of complications we decided to abandon the using of monocortical in favour with bicortical plates.
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After a ten year clinical experience of coral implants in Cranio-Facial Surgery, the authors can precise the up to date indications. 55 patients received coral inlays. Two varieties of coral have been used, Goniopora and Polyphylla, demonstrating complementary properties. Filling of bony defects and volumetric increase specially held our attention. Coral may be discussed versus autologous bony grafts in very circumscribed indications.