Biomedical subjects

J F Chassagne

Publications and source records attributed to J F Chassagne.

At least 19 recordsLinked to original sources

PubMed1997

Post-operative brachytherapy: a prognostic factor for local control in epidermoid carcinomas of the mouth floor.

The aim of this study was to analyse the role of post-operative brachytherapy (BT) in a group of patients with a high risk of local relapse (positive or narrow surgical margins) for squamous cell carcinoma of the mouth floor (SCCFM). A comparison with post-operative external beam irradiation (EBI) in a group of patients with standard risk of local relapse for SCCFM with free margins is performed to estimate the benefit of BT. From 1979 to 1992, an initial group of 32 patients with SCCFM (12, T1-2; 20, T3-4x) received an Ir 192 low dose rate BT using plastic tubes (+EBI for 20 patients) after surgery with positive or close margins. BT was applied in one or two planes to the surgical scar. The mean dose of BT was 57 Gy (range: 50-60) for exclusive BT and 22 Gy (range: 15-30) when a boost was applied (mean EBI dose = 50 Gy). During the same period, 36 patients had post-operative external irradiation alone after satisfactory surgical resection. Excluding the post-operative margin, these two groups were comparable for other prognostic factors. The mean follow-up was 46 months (range: 5-145) with a minimum follow-up of 2 years. For BT and EBI groups, the 5-year results (Kaplan-Meier) were, respectively, overall survival 62% and 43%, local control 81% and 60% (P = 0.09) (log-rank) and severe complications 4/32 and 1/36. Post-operative BT achieves good local control for patients with narrow or positive margins by increasing the dose to the surgical scar, with good tolerance. Given these encouraging results, we confirm this treatment for these patients.

Brachytherapy↗

PubMed1995

A new three-dimensional treatment algorithm for complex surfaces: applications in surgery.

PURPOSE: Recent advances in computer technology enable automatic reconstruction of surface models using digitized contour lines and three-dimensional (3D) representation on a graphic terminal. This work was aimed at obtaining 3D reconstructions of facial bones to help guide oral surgery and complex dental implantology procedures. MATERIAL AND METHODS: The starting point was a computed tomographic examination. The limits of the cortical bone were automatically outlined and then digitized using a special computer program. The resulting data were then compiled for computer-aided design (CAD) purposes, and a virtual 3D model of the bone was mathematically computed. This model was next transferred to a computer program that piloted a CAD/computer-aided manufacture (CAM) machine that guided a laser stereolithography process. RESULTS: The early results of the use of 3D images, as well as solid models, for clinical and surgical purposes, indicate a high degree of reliability in morphologic diagnosis, determining the surgical procedure, and establishing the subsequent prognosis.

Algorithms↗

PubMed1995

[Surgery and curietherapy of keloids].

Postoperative irradiation of keloids allows a decrease of the recurrence rate by about 50%, compared to surgery alone. A review of the literature illustrates the benefits due to the irradiation, and describes the techniques available. The Iridium 192 interstitial brachytherapy, with per-operative implantation of the plastic tubes and immediate irradiation of 20 Gy at 5 mm depth, is detailed as used by French teams. The analysis of the published results allows to recommend this technique which is tailored to each clinical situation, safe, and easy to perform by the surgeon.

Brachytherapy↗

PubMed1995

[Temporomandibular joint luxation and Ehlers-Danlos disease. Apropos of a case].

First described by Tschernogobow in 1981, Ehlers-Danlos syndrome is usually observed in white males. Symptoms results from defective collagen synthesis. Diagnosis is based on clinical presentation. There are 9 different clinical groups. Maxillofacial manifestations are usually seen in type VIII Ehlers-Danlos syndrome. The clinical case presented here illustrates the problems involving the temporomandibular joints and focuses on an assessment of proposed therapeutic options.

Adolescent↗

PubMed1994

[Total reconstruction of the nose by osteocutaneous preformed forearm flap. Apropos of a case].

The authors report the case of a 28-year-old woman in whom multiple surgical reconstructions were performed to cure an extensive radiation necrosis of the nose. In 1980, after the failure of a dorsalis pedis free flap and of a free groin flap, success was obtained with a free lateral mammary flap. But defatting, bone grafting and modelling produced partial necrosis of the flap. Finally, total nasal reconstruction was achieved in 1983 with a pedicled osteocutaneous forearm flap. To secure the transfer, the flap was first modelled by folding directly on the donor site. The advantages of this procedure are a lower risk of postoperative infection and a fewer number of secondary surgical stages needed to achieve the reconstruction. The reliability of the forearm flap and the simplicity of the procedure advocate its use in difficult reconstructions of the nose, when others techniques could not give better results.

Adult↗

PubMed1992

[Bone substitutes and infection in maxillofacial surgery].

Bony substitutes are in fashion in maxillofacial surgery. They are used to fill bony cavities, in bony reconstruction to give shape-lines and re-create area of support or to fill bony defects. Then their use is frequently crowned by success in general surgery, it is not the same thing in maxillofacial surgery because of the usual impossibility to fulfil a requirement to biomaterial utilisation: the watertight. Furthermore, they don't have yet, for the most part, an essential quality: malleability. In our experience, their use are frequently disappointing because of postoperative infections and we stay faithful to the autograft bone. However it is highly probable that these biomaterials will take an importance more and more considerable when these problems will be overcame.

Biocompatible Materials↗

PubMed1992

[Traumatic rupture of the levator tendon of the upper eyelid].

We report on two cases of traumatic desinsertion of levator aponeurosis. After a blunt trauma diagnosis between levator aponeurosis desinsertion and neurogenic ptosis is important in planing the treatment: early surgery for the first and foregoing for the later.

Adult↗

PubMed1992

[The first- and second-arch syndrome. A treatment analysis and plan].

There is a very great lesion staging in these syndromes, and a great number of procedures have been described, according to the age and severity of the lesions. The initial assessment is therefore important, since it allows classifying these malformations according to their severity in key sectors. Scheduling the treatment in time must take account of: growth, the necessity to perform successive operations in one region, since no operation must hinder a subsequent one. It is essential to determine the optimum time for bone reconstruction. An early treatment with a conventional bone graft, without any intrinsic growth potential, condemns the reconstructed region to immobility, therefore to a progressive degradation of the result in time and to successive corrections. Early reconstruction is justified only if the available reconstruction means allow the reconstructed area to grow, either naturally or with the aid of orthopaedic stimulation. Some means seem to be available to date. A choice must therefore be made between: delayed morphological surgery, early functional surgery. Considering the extent of the means implemented, this is reserved for severe cases. The other great problem is the reconstruction of the auricle, which most often requires a series of operations scheduled over 2 years. The middle ear may not be operated if the lesions are unilateral. The other malformations, including macrostomia, muscular and neural abnormalities, involvement of the eyelids, sometimes require correction, which must fit in a repair schedule that must be established as soon as possible and must take account of the predictable procedures in order to prevent them from hindering each other.

Abnormalities, Multiple↗

PubMed1992

[Osteosarcomas of the mandible].

On the base of 3 cases of mandibular osteosarcoma, the current role of surgery is specified. The most often used procedure is Rosen's protocol, which includes: preoperative chemotherapy, radical surgery with reconstruction, and postoperative chemotherapy. The key element is the pathological study of the surgical specimen. This will determine the response of the tumor to preoperative chemotherapy and, by comparing the histology of the initial biopsy specimen to that of the surgical specimen, will be used as a basis to select the postoperative chemotherapy. For this type of tumor, chemotherapy has completely substituted for radiation therapy, which is no longer used in the initial treatment. Prophylactic lung radiation therapy has also been given up due to the risks of pulmonary fibrosis entailed by the effective doses. Surgery still has a role of choice in the therapeutic schedule, even if it cannot be contemplated as the sole treatment. Considering the usually young age of the patients, we currently think that reconstruction must be immediate and must resort to all the techniques likely to produce the best possible functional and morphological result.

Adolescent↗

PubMed1991

[Value of MRI in the visualization of the meniscus in temporomandibular joints].

Modern imaging techniques, among which nuclear magnetic resonance currently ranks first, have made it much easier to understand the internal disorders of the temporomandibular joint. While computed tomography still is the ideal technique for all bony affections in the articular region, especially for injuries. MRI now is an essential first-intention complementary examination. It allows assessing the location of the meniscus and very well defines the pathology being explored: reducible or irreducible dislocation of the meniscus, either purely anterior or anterolateral, the latter being better visible on coronal views (which are not systematically taken). The examination includes T1-weighted parasagittal views perpendicular to the axis of the condyle, taken with a surface coil (knee coil). Two sequences are performed, one with the mouth open and one with the mouth shut. The meniscus appears as a biconcave hypointense signal, which normally lies on the head of the condyle both when the mouth is open and when it is shut. T2-weighted sequences have the advantage of revealing possible effusion or intra-articular adhesion between the capsule and the synovial membrane. They may also better demonstrate a possible myxoid degeneration of the meniscus. The considerable increase in scanning time required for these sequences accounts for their unfrequent use. The condition of the bone can also be assessed, but we find MRI less accurate than direct sagittal CT scans. The future prospects include shorter imaging times owing to fast-imaging sequences (short T1 with partial flip angle).

Cartilage, Articular↗

PubMed1991

[Surgical problems arising from ethmoid adenocarcinomas].

Adenocarcinomas are the most frequent ethmoid tumors. The only curative treatment at present is surgery. Potential extensions of these tumors require a wide exeresis. This is best ensured with an approach that is cranial and of the Cairns type at first, then in some cases facial and patterned on the Moure-Sebileau course of approach. This procedure demands the immediate reconstruction of the 3 levels involved: the dura mater, the bone and the mucosa of the nasal fossae. We reconstruct the dura mater with a pericranial flap, the bone with bone grafts, and the mucosa with a flap from the galea.

Adenocarcinoma↗

PubMed1991

[The vallecula: an anatomic reality?].

The vallecula epiglottica is a borderline area between the pharynx and the larynx, though covered by the epiglottis, and a functionally strategic site and breeding ground for epidermoid carcinoma, but it has remained unappreciated by anatomists. The borders of the vallecula within the oropharynx are represented by the anchoring systems of the epiglottic cartilage; the basilingual margin is sometimes inaccurate. We would like to emphasize the topographical relationships in the vallecular region, in particular: --the proximity to the base of the tongue, which is the preferred are of extension of epitheliomas, --and the features of the hyoepiglottic membrane, which is a veritable barrier for neoplastic infiltration. The valleculae epiglotticae are a definite oropharyngeal anatomical entity, and deserve the attention of maxillofacial surgeons, who should be able to suggest a surgical treatment of cancers that would be practicable both from a functional and from an oncological point of view.

Epiglottis↗

PubMed1991

[A case of cellular blue nevus with bone and meningeal invasion].

The blue naevus is an essentially benign tumour. However, the cellular variety may rarely undergo malignant transformation. The authors report an unusual case of blue naevus in terms of size and evolution. This tumour which involved the occipitovertebral and parotid regions infiltrated underlying tissues and organs, in particular, the occipital bone, the dura mater and the parotid gland. The clinical, histological and histogenic problems associated with the blue naevus are discussed. There are only scattered reports of tumours of a similar nature in the literature and for this reason we felt that this case merited being reported.

Adolescent↗

PubMed1990

[Role of micro-anastomosed muscular transplantation in corrective surgery of permanent facial paralysis].

Vascularized and reinnervated transfer of a muscle from the body to the face is never a simple procedure. It is important to evaluate the pre-operative state of facial muscles. It is difficult to define the correct indications for the various surgical techniques proposed: muscle selection, selection of recipient vessels, selection of a reinnervation method, the positioning of the transferred muscle. The authors present a series of 12 cases of long standing facial paralysis for more than 3 years. Results are presented. The authors think that the ideal muscular transfer is still unknown. In principle, nothing can replace facial muscles except facial muscles. Currently, the authors prefer the latissimus dorsi flap with partial transfer. For reinnervation, the facial nerve must take the priority, while all other reinnervation technics should take second place. In all cases, great attention must be paid to the positioning of the muscle, the usefulness of conventional palliative procedures and the continuous moral support to all of these patients.

Facial Paralysis↗

PubMed1990

[Evaluation of the use of free flaps of the anterior iliac crest. Review of 49 cases].

Because of the septic environment, the reconstruction of extensive losses of substance of the mandible has always raised numerous problems, especially as in a certain number of cases, concomitant radiotherapy represents an additional difficulty. Free flaps offer an important contribution. Up until now, we have essentially used the anterior iliac crest flap vascularised by the deep iliac circumflex pedicle. After 55 flaps of this type, the authors present an analysis of their results and try to analyse the causes for the failures. On the basis of their experience, they consider: that it is preferable to perform the bone and soft tissue repair by means of two different procedures (or at least by means of two different pedicles); that it is preferable, as far as possible, to perform immediate reconstructions rather than deferred reconstructions, especially in the case of malignant tumours.

Evaluation Studies as Topic↗

PubMed1990

[Osteosynthesis using a screwed plate in fractures of the mandibular condyle].

The surgical treatment of sub-condylar fractures allows rapid reestablishment of the bite, temporo-mandibular joint function and facial appearance. A pre-auricular approach is used involving dissection of the facial nerve and its upper branch. Surgical reduction is performed under direct vision. Fixation is via a plate with 4 screws. The condylar fragment needs to be large enough to accept at least two screws and hence this needs to be confirmed preoperatively by CT scan examination. In the adult we feel that fixation is indicated for low displaced sub-condylar fractures. We do not feel that surgery is indicated for recent trauma in children.

Adult↗

PubMed1990

[A complete intermediate temporomandibular joint prosthesis. Evaluation after 6 years].

Since 1983 we have inserted more than 100 temporomandibular joint prostheses. A review after 6 years allows the respective indications to be listed and the complications to be studied in 72 insertions involving 62 cases suitable for analysis. The prosthesis is a total intermediary prosthesis forming an unsealed cupula composed of 2 halves--a mandibular portion and a temporal portion. Insertion of the prosthesis requires preliminary facial nerve dissection then osteotomy of the mandibular condyle and its subsequent drilling to allow the screwing in of the prosthesis. The prosthesis was used in traumatology, in condylar and high sub-condylar fractures, in the event of failure of functional treatment, in malformation syndromes, in tumors and, finally, in degenerative pathology. 13 prostheses were removed. A study of the probable causes of complications shows a predominance of technical problems related to inaccurate positioning of the prosthesis, in that it was not placed in the axis of the condyle, or that inadequate bicortical support was present. In our opinion, these complications do not question the conception of the prosthesis but rather indicate that it is necessary to perfect the insertion technique while taking advantage of improvements in the prosthesis which are currently under study.

Ankylosis↗

PubMed1990

[Reconstruction of the temporomandibular joint and its alternatives].

Reconstruction of the temporomandibular joint is always quite problematic. --Use of a prosthesis. Many prostheses have been propounded to deal with the operational problems. As, in our opinion, these seem not to meet the usual orthopaedic surgery requirements, we developed a totally intermediate prosthesis with non-sealed cupula. The use of this prosthesis, whenever feasible, provides the solution for the problems with which we have to contend during reconstruction surgery in traumatology and degenerative or tumoral disease. Nonetheless, its use remains limited to adults. --Utilization of biological material: following numerous attempts made with the conventional osteocartilagenous grafts (metatarsal, rib), we believe that the proper orientation, walking in Chang's footsteps, is toward the use of the head of the second metatarsal bone as a microanastomotic transfer. It seems to us that this technique must be used in children, particularly those with malformation syndromes or ankylosis.

Bone Transplantation↗