[Maxillary dysmorphoses and their treatment with total osteotomy].
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Biomedical subjects
Publications and source records attributed to J C Vigneul.
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Primary radiological examinations after maxillofacial injuries are often poorly performed. Statistical analysis of 25 case-reports of patients with these injuries enabled the essential projections to be defined in order to establish a rapid diagnosis. A new type of panoramic apparatus for maxillary exploration enables films to be taken with the patient recumbent.
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Four cases of solitary maxillary cysts are reported, and our current knowledge of these rare lesions reviewed. Their diagnosis should be suspected whenever bone lacunae are detected, that are not the result of dental disorders. Surgical exploration demonstrates the presence of a cavity that is almost always unilocular, and contains blood-stained fluid, or is completely empty in some cases. Curettage may be employed but filling by a bone graft is not necessary. No recurrence occurs, in contrast to those present in the long bones, and bone repair is rapid after curettage. Though of a probable dystrophic nature, their true significance is still unknown.
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Basal-cell epitheliomas are of primary importance when discussing a case of multiple naevi. Two factors have to be considered to explain therapeutic failures: --Firstly, the very active local malignancy of these basal-cell epitheliomas; --Secondly, the long delay in applying drastic treatment such as wide excision and immediate repair, and the danger arising from divergent therapy because of lack of a common decision between the various specialists concerned: dermatologist, ophthalmologist, radiotherapist, and plastic or maxillofacial surgeon.
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The two essential problems posed by craniofacial trauma are assessed in the light of 70 collected cases. Firstly, the "time" of treatment. Immediate surgery by two teams, neurosurgical and maxillofacial, may be justified in the presence of craniocerebral lesions. This occurs rarely. The cranial problem is often explored during the first 3 or 4 days and with the exception of certain cases of immediate or delayed coma, maxillofacial treatment may be undertaken early. The treatment of cerebrospinal fluid fistulae remains controversial. Secondly, the surgical technique. Accent is placed upon two points which are still discussed : cutaneous phase and bone phase in open trauma ; reconstruction of the cranial level and the facial mass by fixation using plates or steel wire, bone grafts or inert materials, with in particular surgery for fractures of the floor of the orbit in all cases. A number of clinical cases suggest that suitability of eclectism in this surgical approach to craniofacial trauma.