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Biomedical subjects

L C Merville

Publications and source records attributed to L C Merville.

At least 19 recordsLinked to original sources
PubMed1991

[Coronal approach of zygoma and direct osteosynthesis in post-traumatic dysmorphic sequelae].

A direct approach to the zygomatic arch can be a useful alternative for primary or secondary deformities in which simple well known technics are ineffective. This approach is very limited because of the anatomical elements located directly over the zygomatic region. The exposure of the fracture site is performed by an unusual surgical approach which allows visualization of both zygomatic arches simultaneously, to correct all deformities and to perform osteosynthesis. Four cases using this technique are reported and the value of this approach is assessed.

Adult↗
PubMed1989

[Retro-maxillary sequellae of craniofacial stenosis. The value of fronto-facial advancement using the Tessier monobloc technic].

Monobloc fronto-facial advancement (TESSIER's technic) seems to be the best therapeutic to correct retromaxillia, sequellae of cranio-facio-stenosis. From an aesthetical and functional point of view the result is more satisfactory than with a simple LE FORT III osteotomy advancement. Intermaxillary fixation is not necessary. Of course an orthodontic sequence must be associated to correct dental malposition.

Acrocephalosyndactylia↗
PubMed1987

Postero-lateral expansion osteotomy of maxilla. A case report.

The posterior-maxillary osteotomy introduced by Schuchardt was designed to close skeletal anterior open bite. Also, it can be used to reduce a posterior cross bite. But in this latter case, the most important problem is the difficulty in expanding the maxilla because of the relative inelasticity of the palatal mucosa. This paper reports on the result obtained by a surgical expansion technique without orthodontic treatment. The use of a local soft tissue flap is necessary; the anteroposterior part of the palatal incision is placed contralaterally to the bone incision. A palatal appliance is used for the retention of the palatal flap.

Adult↗
PubMed1987

Long face: new proposals for taxonomy, diagnosis, treatment.

The authors suggest a taxonomy and a specific terminology from Greek etymology for vertical maxillo/mandibular excess dysmorphies, "long face" or "high face" (hypsoprosopia) to be more exact, so as to make their diagnosis and their therapeutic approach easier. They distinguish three anomalies which may, separate or in association, cause an increased vertical dimension of the face: hypsomaxillia, hypsogenia and inter incisal anterior vertical gap or hyposostomy, which may itself be differentiated into 3 aetiological sites (vertical posterior maxillary dento-alveolar excess, vertical anterior mandibular dento-alveolar deficiency, excessive gonial angle opening or amblygonia). They submit a clinical and teleradiographic table specific for each anomaly, relying on patients having achieved their full dento-osseous growth. When confronted with associated cases, they can therefore more systematically apply the various osteotomies, partial or total, maxillary or mandibular, or even combined operations.

Cephalometry↗
PubMed1985

[An unusual form of isolated fracture of the orbital floor: "valve fracture". Therapeutic problems].

Among isolated fractures of the orbital floor, the authors are pointing out an unusual clinical type characterized by the irreducibility of the orbital contents ruptured in the maxillary sinus by using classical procedures. This primary failure is due to a bone fragment dropped in the sinus and being attracted by the herniated collar when trying to integrate the hernia in the orbit. To name this type of lesion, the word "valve fracture" is proposed because of the analogy of the one way function of a valve and its different mechanism from the classical trapdoor fracture. The different concepts of the pathogenesis of isolated fractures of the orbital floor and the physiopathology of the frequently associated ocular disturbances are briefly exposed. The authors report the case which confronted them to the valve fracture. Following a direct trauma to the right orbital area a 13-year-old child presented a limitation of the upwards movements of the right eye with diplopia and a positive forced duction test. The surgical exploration shows an orbital hernia in the sinus which is impossible to reposition either with a higher incision (under the orbital rim) or with a lever incision, upper vestibular incision (through maxillary sinus). Only the infraorbital marginotomy described by P. Tessier exposes completely the lesions and allows understanding of the mechanism of this primary irreducibility related to the valve movement of the fractured bone fragment. Above all, marginotomy allows an atraumatic set. If is performed combining gentle handles of pulling and forcing back on the ruptured pieces while keeping opened the valve.

Adolescent↗
PubMed1984

[Vertical maxillo-mandibular dysmorphias due to excessive growth. Terminology, diagnosis and treatment].

The authors propose a system of terminology for vertical maxillo-mandibular dysmorphia, "long face" or rather "high face", and "hypsoprosopia" hypsomaxillia to facilitate the diagnosis and the therapeutic approach. They distinguish 3 abnormalities which are responsible, alone or in combination, for an increased height in the face: hypsomaxilla, hypsogenia and vertical anterior inter-incisive aperture (open bite), which can arise in three situations (supra erupted posterior alveolar maxillary segment, infra erupted anterior alveolar mandibular segment, exaggerated opening of the angle of the mandible or amblygonia). They present the clinical picture and the specific teleradiographic features of each abnormality, supported by cases of patients with definite dento-maxillary growth. On the basis of this classification, the authors propose a more systematized approach to the various segmental or total maxillary or mandibular osteotomies, which may be coupled or even combined with advancements or transverse movements in cases of associated dysmorphosis.

Cephalometry↗
PubMed1983

Fronto-orbito-nasal dislocations. Secondary treatment of sequelae.

Fronto-orbito-nasal dislocation untreated or maltreated can have many important sequelae for both function and aesthetics. Two types of cases may be observed, those with: -extensive bone loss -malunited fracture. The treatment of sequelae caused by bone loss in order to be rational, logical and complete necessitates: 1. protection of the underlying elements = eye and meningo-cerebral tissues, 2. reconstitution of an harmonious cranio-facial profile, 3. definitive isolation of cranial contents from the facial cavities. 4. repair of nasal and orbital walls and the necessary ligamentous re-insertions on them. The best material for such a repair remains the autogenous bone graft. The treatment of sequelae caused by malunited fractures necessitates repositioning osteotomies. In addition to rotation, elevation and translation osteotomies the following may be required: -either a monoblock advancement osteotomy, -or an "expansion" osteotomy. They require solid fixation. This may be obtained by: -either superior fixation to a previously conserved intermediate frontal strut -or a rebuilding of the shape of the vault, laterally fixed to sound bone parts, and an interposed bone graft to act as a "keystone" of the vault. Such repairs seem to be better than simple onlay bone grafts which are useful from an aesthetic point of view, but which neglect the underlying injuries with their concomitant functional sequelae, and which expose the patient to secondary sinus or cerebro-meningeal complications. They permit a single, total, simultaneous, and definitive repair of all the sequelae both functional and aesthetic; an approach which is more rational than successive surgical sessions. But they require: 1. Dura mater repair by suture and pericranial grafting. 2. Total isolation of cranial contents from the face. 3. Obliteration of the frontal sinus. It is therefore necessary to work with a combined neuro- and maxillo-facial team. Four cases are described to illustrate these proposed procedures, one case with very extensive bone loss, three with malunited fractures: the first orbito-frontal, the second with a fronto-zygomatic lateral component, the third with a fronto-nasal medical component.

Bone Transplantation↗
PubMed1982

[Fractures of the frontal sinus. Therapeutic indications].

Attitudes towards therapy of frontal sinus fractures, in the Plastic and Maxillofacial Surgical Department of the Foch Medical-Surgical Unit, are discussed. Only those fractures with displacement, a possible cause of complications, are envisaged, the conduct adopted being described in detail as a function of the wall affected. Treatment should be directed along the following lines: --A harmonious frontal outline can be obtained by osteosynthesis of the bone fragments if certain conditions are fulfilled, or by a bone graft. --The sinus cavity should be excluded and filled by spongy grafts when an anterior wall graft is inserted. --Neurosurgical explorations are necessary if a posterior wall defect provides a threat to the meninges, followed by cranialization and obturation of the nasofrontal canal. --Physiological drainage must be ensured for the sinus cavity, particularly in inferior wall fractures.

Fracture Fixation, Internal↗
PubMed1981

Fronto-orbito nasal dislocations. Initial total reconstruction.

The craniofacial trauma can produce compound fractures with bone displacement in the central part of the upper face, i.e. the bones constituting the forehead, orbit, and nose. such dislocations are called fronto-orbito-nasal dislocations. A total and definite surgical reconstruction in one stage offers advantages such as good aesthetic and functional results. An injured person can enter professional and social life without further delay. A major advantage is also the minimizing of the risk of meningeal fistula with infectious mortal risk. A prerequisite for this surgery is accurate clinical and radiological examination to permit a preoperative three-dimensional visualization of the lesions as a basis for careful planning of the operation. The surgical team should include neurosurgeons and plastic surgeons with experience in the maxillofacial area. The operative procedure should start with repair of the orbital frame, beginning at the upper and lateral side, followed by exploration of the four walls of the orbital chamber and of the lacrimal system. The reconstruction then proceeds with the eyelid ligaments and the nervous and vascular pedicles, especially the infra-orbital one, followed by reconstruction of the sinus maxillaris. Afterwards transnasal internal canthopexy wires are placed, the nose reconstructed and bone grafts are used to restore the orbital chamber behind the frame. The lacrimal system is repaired before the tightening of the canthopexies. In cases where neurosurgical intervention is necessary, such as suturing of dura sores or reconstruction of the anterior cranial fossa by bone grafting, this will precede the facial reconstruction. Without a strong frontal cornice it is impossible to restore the nose and orbit. Ocular injuries are treated by ophthalmic surgeons when the orbit is repaired. The last phase of the reconstruction is suturing of the muscular, mucosal and cutaneous lacerations.

Frontal Bone↗
PubMed1981

Fronto-orbito-nasal dislocations., Secondary treatment of sequelae.

Untreated or maltreated fronto-orbito-nasal dislocations can give rise to serious sequelae of a functional or aesthetic nature. Two major problems may be discerned, namely extensive bone loss and malunited fractures. The loss of bone can result in an unfavourable aesthetic appearance and functional disturbances, e.g. loss of eye motility, cerebral herniations and meningitis. The treatment should therefore include protection of the underlying elements, such as eye and meningocerebral tissues with a definite isolation of the cranial content from facial cavities. An important measure to be taken is also the repair of nasal and orbital walls, including re-insertion of the canthal ligaments. Autogenous bone grafting is superior in the repair of bone defects. Malunited fractures are treated by repositioning osteotomies, sometimes including rotation, elevation, or translation. The reposition can be achieved either by advancement of a monobloc or by an expansion. Solid fixation is essential and can be obtained either by an upper fixation to an intermediary frontal bridge or by lateral fixation to safe bone parts with an intermediary bone graft in cases of trauma in the midline. Our approach allows a definite and total repair in one operation and requires repair of the dura mater by suturing and, if necessary, pericranial grafting. In cases of interference of the frontal sinus, 'cranialization' must be performed. In our opinion it is necessary to work in a team including maxillofacial and neurosurgeons.

Frontal Bone↗