Treatment of obstructive sleep apnea syndrome by mandibular elongation using osseous distraction followed by a Le Fort I advancement osteotomy: case report.
Explore the source record for details and available documents.
Adult↗
Biomedical subjects
J R Paoli
Publications and source records attributed to J R Paoli.
Craniofacial differences according to the body mass index of patients with obstructive sleep apnoea syndrome: cephalometric study in 85 patients.
We examined the craniofacial characteristics of patients with obstructive sleep apnoea syndrome (OSAS) and correlated them with the body mass index (BMI (weight (kg) x height (m2)). Eighty-five men with OSAS diagnosed by conventional polysomonography were divided into two groups according to their BMI (< 30 and > or = 30). Cephalometry was analysed by using 31 measurements of the size of the bone structures, their relationships and the size of the airways. The groups were comparable for age and the apnoea-hypopnoea index (mean 49, standard deviation (SD) 23). Patient with a BMI < 30 had a shorter anterior floor of cranial base, a smaller mandible and retroposition of the mandible compared with severly obese patients. These skeletal differences were associated with narrower velopharyngeal and linguopharyngeal spaces. This study sh ows that there is a craniofacial difference between two populations, divided according to their BMI.
Body Mass Index↗
Traumatic intracranial impaction of the zygoma: case report.
Explore the source record for details and available documents.
Accidents, Traffic↗
[Results of 248 patients with sleep apnea syndrome treated by continuous positive pressure ventilation between 1990 and 1995. A study of compliance and outcome of the apnea-hypopnea index].
Between 1990 and 1995, 369 patients were investigated for obstructive sleep apnea syndrome (OSAS) by polysomnography. Among them, 248 patients with a mean Apnea-Hyponea index (AHI) of 37.7 per hour were treated by nasal continuous positive airway pressure (n-CPAP). Mean follow up was 39.5 +/- 20.4 months. In this group, 23 patients (9.2%) refused nCPAP immediately or after the first night and 39 (15.7%) gave up later. 15 patients (6%) died during the period of the study. The cumulative compliance reached 70% at 72 months. Non compliant patients usually gave up n-CPAP before the end of the first year. We compared the group of 150 patients always treated at the date of 31/12/95 with the group of 62 patients who refused nCPAP initially or gave up later. There was no difference in clinical parameters or polysomnographic data between the two groups. In 94 patients treated by nCPAP for more than a year we evaluated the outcome of AHI by a polysomnography performed after 72 hours of nCPAP cessation. Mean AHI of the group at this time was 38.2 +/- 20.3/h and was well correlated with the initial index (r = 0.41, p < 0.0001). However for 28 patients (29.7%) we observed, at the time of this second AHI determination, a variation (plus or minus) of at least 50% of the index. 6 patients, without any significative weigth loss, had an AHI below 5/h at this second determination. In this small group nCPAP was interrupted for 6 to 12 months, then another polysomnography was performed. At this time mean AHI was 42.4/h and clinical symptoms had reappeared in all patients. This study demonstrated that compliance to nCPAP in OSAS patients is good. No clinical or polysomnographic factors allow to predict non compliance. AHI is not modified by long term treatment with nCPAP.
Female↗
[Upper airway changes after mandibular setback osteotomy. Concerns for obstructive sleep apnea].
INTRODUCTION: Cases of obstructive sleep apnea syndrome have been described after setback osteotomy. Although such cases are rare, they emphasize the importance of taking into account the structure of the upper airways when performing this type of procedure. We studied the modifications provoked in the upper airways by mandibular setback osteotomy performed for dysmorphism. MATERIAL AND METHOD: We conducted a retrospective cephalometric study in a series of 25 patients. Preoperative and late postoperative films were digitalized to obtain a precise measurement of the bone displacements and changes in the caliber of the retrovelar and retrolingual spaces. The statistical analysis examined the parameters modified by surgery, particularly airway parameters, and those factors which influenced these modifications. RESULTS: We observed a reduction in the retrolingual space [mean 1.7 mm (p < 0.05)] and displacement of the hyoid bone [mean 2 mm lowering compared with the bi-spinal plane (p < 0.05) and 4.1 mm setback in the Francfort projection (p < 0.01)]. These modifications were not correlated with the mandibular setback (measured as the gonial mental angle) but were strongly dependent on variations in the gonial angle. In 20% of the cases, mandibular setback produced a paradoxical effect: enlargement of the airways. DISCUSSION: Little work has been done on the modifications in the upper airways provoked by osteotomies. Mandibular setback osteotomy can, though only a few cases have been reported, create an anatomic situation favoring obstructive sleep apnea. This series demonstrated the very wide variability of the effects on the upper airways. CONCLUSION: The risk of apnea should be included as an important parameter in assessing indications for setback osteotomy.
Cephalometry↗
[Two or three things about the PMSI in stomatology and maxillofacial surgery].
The Information Systems Medicalization Program (PMSI in French) was created in 1985 for Public Health Service Hospitalisation Structures. It appeared to be directly derived from the North-American Diagnosis Related Groups (DRGs) system. Since them, the PMSI has been progressively developed in private structures as well. The authors have had the opportunity to use the latest version of the computer program which was elaborated in order to share the patients into more than 500 different groups of pathology. These groups were called "Homogeneous Patients Groups" (GHM in French). To each group corresponds a "Synthetic Activity Index" number (ISA in French). It is supposed to be representative of the average cost of the management of each kind of patients, based on the diagnosis and the surgery possibly done. Several astonishing findings have been made. Some of them can be summarized as mentioned below: In maxillofacial Surgery, each group (GHM) seems in fact to be extremely inhomogeneous: for example, total parotidectomy with preservation of the facial nerve belongs to the same group as accessory salivary gland exeresis. Total skin graft is in the same group as free composite osseous flap with vascular anastomosis. Coding a surgical procedure leads often to reduce the ISA number in comparison with the same patient without surgery: "impacted third molar" gives 754 points without surgery but only 658 if surgery is performed. Carcinologic surgery is wholly grouped in the same category, even for rather short procedures as isolated partial glossectomy. This group corresponds to a great number of ISA points (6486) while bimaxillary surgery or free flap transfer gives less than 2500 points. In conclusion, the use of the PMSI to allocate financial means can be extremely dangerous for maxillofacial surgery units and consequently for the quality of the medical care in our Specialty. Further studies are obviously necessary to complete a critical analysis of the current system and to improve it.
Abstracting and Indexing↗
[Mandibular fractures in sports. Retrospective study of 48 cases].
We present a retrospective study of 48 isolated mandibular fractures related to athletic activities. We studied patient age, sex, sport involved, mandibular location of the fracture and the therapeutic implication. The sex ratio was 4/1 and mean age 24 years. Rugby and cross-country biking were the more frequently involved sports (79%). We recall preventive measures. Miniplate osteosynthesis was used as often as possible in order to avoid intermaxillary fixation (IMF) (40%) or to limit the duration of IMF. This allowed early return to sport activities.
Adolescent↗
[Multiple lipoma of the tongue. Apropos of a case and review of the literature].
Lipomas are uncommonly located in the tongue and multiple forms are rare. We describe a case of multiple lipoma of the tongue in a female patient aged 60 years who also presented subcutaneous cervical lipoma. The literature on multiple lipomas is discussed.
Female↗
[Ballistic data for plastic surgeons].
After a brief review of portable firearms or small caliber guns, the authors discuss various concepts concerning wound ballistics. Kinetic energy plays an important part in the damaging action of bullets, while the concepts of "shock wave" and "stopping power" have been supereded by the definition of wound profiles. These profiles are characteristic of each bullet. Clinically, they take the form of a temporary cavitation zone and a permanent cavity. The reaction of tissues crossed by the bullet largely depend on the elasticity of these tissues and the presence of bone. The concept of high velocity bullets should be abandoned. The phenomenon of cavitation alone and its dramatic clinical consequences should be taken into account and must guide the therapeutic approach.
Humans↗
[Gunshot injuries of the face. Clinical observations in 21 cases].
The authors report their experience of facial ballistic trauma based on a series of twenty one homogeneous cases. After a review of the aetiopathogenesis, the characteristics of facial shocks by missiles of fire arms are described, with particular emphasis on specific wounds encountered in the head and neck. Two classifications are suggested: on based on the main clinical features and the other based on the various types of bullets organized according to wound profiles and modern ballistics. This new ballistic classification is related to the clinical features. Although a better approach to ballistics and wound profiles helps to guide the clinical assessment, the medical and surgical treatments are based on same principles and approaches in war surgery and in civilian practice.
Facial Injuries↗
[Tools of the Internet in maxillofacial surgery and oral medicine. Practical applications].
Internet has a wide range of functions applicable in the medical domain. Its use has had a clear impact on routine medical practice. The user can consult colleagues, send and receive multimedia files, order books from the library, access specialized reviews or worldwide scientific data on-line as well as publish results, and participate in forums, telephone or organize teleconferences in real time. Faced with the abundance of the available information flow and the methodological difficulty in extracting precisely useful data, the ordinary user can wander a long time in cyber-space before learning the skills required for efficient navigation. We recall here the fundamental principles of the Internet and describe the types of information the maxillofacial surgeon can use in his everyday practice. Certain unanswered questions are debated as well as certain difficulties related to the use of the Internet in its present state of development.
Computer Communication Networks↗
[Cephalometric study of changes in the upper airways after orthognathic surgery. Significance in the management of obstructive sleep apnea syndromes. Apropos of 43 cases].
The aim of this work was to study long-term airways space changes after maxillomandibular osteotomy in order to assess benefit of this surgery in case of obstructive sleep apnea syndrome. Preoperative and postoperative cephalometric airway spaces evaluation of 43 patients (who did not have obstructive sleep apnea) was done. Analysis revealed no charge in velopharyngeal space, lingual-pharyngeal augmentation in case of mandibular advancement. Hyoid bone position was not modified by osteotomy. Signification and interest of this finding for patients with obstructive sleep apnea are discussed through literature data.
Adolescent↗
[Treatment of fractures of the mandibular angle using miniplates attached through the transjugal approach].
We present 114 cases of mandibular angle fractures treated by screwed miniplates placed through a transbuccal incision with transbuccal trochar instrumentation. Usually patients were young men who suffered traffic accidents. The mean hospitalization time was 7 days. 94.5% of the patients healed without incident, no malocclusion complication was observed. Two postoperative hematomas required surgical drainage without healing complication. One non union required removal of the miniplate and maxillo-mandibular immobilization. 2 temporary postoperative hypoaesthesiae were observed. One patient presented a pericoronary infection of a third impacted molar, four months after surgery, but the fracture was healed. The comparison of the results with the others in the literature confirms the reliability of this technique.
Accidents, Traffic↗
[A rapid intermaxillary fixation technic].
The authors describe a new intermaxillary fixation (IMF) technique. This technique is particularly easy and quick. It needs usual 4/10 or 5/10 steel wire with a small pearl fixed at one extremity. Four wires are used, passed from lingual side to vestibular side, between premolars. Wires are then linked and intermaxillary fixation is performed. Osteosynthesis is realised by intraoral approach. This technique does not allow to maintain IMF during a long postoperative period. Therefore, it should be reserved for cases where miniplate osteosynthesis will be sufficient. It seems interesting to use this technique for monofocal mandibular fractures, in association with rigid miniplate osteosynthesis.
Bicuspid↗
[Treatment of a case of multiple tooth agenesis: an orthodontic and implant solution].
Now, the excellent long term results observed in oral implantology allow use of implants in young people. They change habitual prosthetic indications which need healthy teeth mutilations. The authors present a case of multiple dental agenesis in a young girl. She was treated by orthodontic preparation and implants with a good final result (2 years end treatment follow up).
Anodontia↗
[The Internet in oral medicine and maxillofacial surgery].
The authors give an Internet short historical record, then describe the different services offered and the possible applications for oral and maxillo-facial surgery. Electronic-mail (E-mail) provides the ability to compose, send and receive messages through the computer and allows exchanging informations with colleagues around the world. Programs, files and graphics can be transferred from one computer to another. The "news groups" are interesting in various subjects and allow a team work. We find several hundred sites about maxillo-facial surgery. These sites present a medical department, diagnosis problems or therapeutic solutions, medical press. Any information submitted is insecure and could be observed by a third party while in transit. Internet potential (educational benefits, digital access to medical literature, online consultation service) is mentioned in the end of the article.
Communication↗
[A superiorly pedicled nasobuccal flap. Its value in the reconstruction of posterior-superior loss of substance of the oral mucosa].
Superiorly based nasolabial flap is an interesting solution for reconstruction of moderate size maxillary defects. The operative technique and its results are described. Advantages (reliability in flap vascularity, versatility, easiness of elevation) and limits of this procedure for closure maxillary defects are mentioned. Then they are compared to the other reconstructive maxillary techniques.
Aged↗
[The value of lidocaine-prilocaine cream in the surgery of detached ears].
The possibility to obtain a skin anaesthesia using only an ointment may be very usefull for outpatient surgery. Recently available in France, the lidocaine-prilocaine cream give an interesting local anaesthesia. We have used this new presentation as skin preparation before otoplasty for 10 patients. As the local anaesthesia injections are then performed without pain, the comfort of the patient is greatly improved. Furthermore, it is easy to sue and without side-effect. The main disadvantage consists in the action delay of one hour, with the necessity to ask the patient to come earlier.
Adolescent↗