[Ballistic injuries of the mandible in civilian practice. Practical attitudes].
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Biomedical subjects
Publications and source records attributed to M Vesse.
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The authors review the etiological, and therapeutic data obtained from a statistical study of a homogenous group of 50 patients after submandibular gland resections. The operation was conducted for calculi in the gland in 56% of cases, infections in 24% and for other causes in the few remaining cases, including 4% with glandular tumors. From the technical point of view, the two cutaneous approaches with section of the vessels and simple enucleation were able to be employed in 76% and 24% of the cases respectively; the ease with which cleavage was obtained being the main factor whatever the etiology. Wharton's duct must be systematically and completely removed when calculi are present. The indications for therapy can be summarized as follows: -- systematic operation on any suspicious tumor for which the etiology is not rapidly discovered, -- determining factors for operation are also infections, recurrences, and a posterior localization of the calculi, -- postoperative complications are minor and consist mainly of paresis of the VIIth cranial nerve, which always regressed in this series.
The authors present a new technique for the treatment of a pseudoarthrosis by local graft. The graft, taken from the basilar bone, is moved to the site of lost bone substance whilst retaining its internal muscular attachments. The result is very satisfactory and avoids the use of an iliac graft.
After describing the technique of embolisation and its therapeutic indications,the authors present two cases of different indications:--embolisation as the sole treatment,--pre-operative embolisation of a haemorrhagec tumour. These two cases illustrate two applications of the technique of embolisation:--Medical therapeutic value: making possible the reduction or stabilisation of the size of a vascular tumour difficult to excise surgically, in addition to eliminating the complications (haemorrhage, local trophic disturbance, pain);--Surgical interest: elective lesional embolisation such as is carried out at present greatly facilitates the surgical procedure in operations which may be associated with severe bleeding. Problems of healing are avoided. The procedure is carried out at the same time as selective arteriography. When in the hands of a skilled team, scarcely any risk is involved.
Since the studies of Bell and Cadenat about dento-alveolar revascularization after alveolar osteotomies, orthodontic surgery knows new developments. The surgical correction of isolated incisal malpositions by interalveolar corticotomies with immediate repositionning of dento-osseous segments, represents actually a rapid therapeutic method in comparison with orthodontic treatment or combined surgico-orthodontic procedure. The authors present a study upon 31 corticotomies performed these last two years. They clear the usual indications, note the importance of the pre-operative planning, expose their technique, finally they give an idea about the value of this procedure.
Thus in the area of prognathism, modifications would seem to develop during the first three months after deblocking:-true recurrences are rare and would appear to be avoidable by careful technique;-secondary sliding shoud not be the source of too much anxiety, being the result of spontaneous attempts at equilibrium and are of little aesthetic consequence. Our statistics indicate that sagittal osteotomy of the ascending rami gives 82% good results. This would agree with statistics generally found in the literature.
The authors describe 315 cases of total maxillo-facial fracture and the conclusions to be drawn from them: --Endobuccal and orthopaedic surgical treatment under general anaesthetic, the osteosynthetic material being perfectly well tolerated: less than 3% having to be removed. --Treatment requiring a careful pre-operative radio-clinical assessment which can never be adequately carried out in an emergency, therefore treatment is delayed (5th and 8th days) except in cases of special emergency (wounds). --Delayed sequelae, bearing in mind the often spectacular lesions, are relatively rare.
The authors present a case of longstanding luxation of the left temporo-mandibular joint, leading to prognathism with lateral deviation. The functional and aesthetic problems due to this deformity were advantageously corrected by saggital cleavage of the ascending left ramus, after previous orthodontic treatment and study on Chateau's articulator.
The authors describe five cases of surgical correction of dysmorphisms of the maxillaries requiring orthodontic treatment before surgery. Pre-operative orthodontic treatment of the adult has the advantage of enabling the arches to be aligned, facilitating the operation when the osteotomized fragments are positioned and resulting in immobilisation in a good position.
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The authors propose a technical variant of the method of enclaves for the retention of the full denture, this in the inferior maxilla because it is there that the problem of retention is posed with the greatest acuity and frequency. But whereas in the processes described the enclaves, 2 in number, corresponding with the zone of implantation of the canines, are perpendicular to the mandible in the frontal and sagittal planes, in the technique explained here each of the enclaves makes with the mandible, in the frontal plane, an angle of 10 degrees with respect to the median axis, thus leading to a convergence and hence an increased retention of the prosthesis with which they are connected.
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