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R Combelles

Publications and source records attributed to R Combelles.

At least 19 recordsLinked to original sources

Tumours and pseudotumorous lesions of the temporomandibular joint: a diagnostic challenge.

Tumours and pseudotumorous lesions originating from the synovial membrane of the temporomandibular joint are rare. We report a series of six cases of such disorders. There were two cases of synovial chondromatosis, two of calcium pyrophosphate dihydrate crystal deposition disease, one nodular synovitis and one synovial sarcoma. Three patients were female and three were male. Their ages ranged from 36 to 70 years. All had atypical clinical and radiographical presentation. The prevalence, clinical and radiographical findings and pathological features of each disease entity are discussed and a review of the literature is made concerning all tumours and pseudotumours arising from the temporomandibular joint.

Adult↗

[Use of reverse blood flow vascular island nasolabial pedicle flap in the repair of the columella].

The authors report the use of a vascular island nasolabial flap with facial arterial pedicle and reverse blood flow inspired by the flap described by C. Le Quang in an unpublished indication. This case concerns a 64-year-old patient with a large botryomycoma of the columella. The size of the defect following excision and the length of the columella authorized reconstruction using a split thickness nasolabial reverse flap. At one year post-operatively the result was aesthetic and defatting was unnecessary. This flap is used to repair defects of the nasal lateral wall and ala. In some conditions, it can be used to repair the collumela, providing a safe vascular support in one stage.

Face↗

A tridimensional study using cuts at a low temperature of the infratemporal region.

Although the infratemporal region is well defined anatomically, its complex topography has been the subject of numerous, and sometimes, opposite works. That is the reason why it appeared necessary for the authors to re-evaluate this topic using the original method of Combelles and Boyer, allowing to define three referential planes, and thereby, a tridimensional shape and the volume of this region. This study allows to conclude that the infratemporal region is a triangular prism with an horizontal main axis 47 mm long. Its anterior base has a mean area of 733 mm2. The posterior top consists of the Juvara slot and has a mean area of 490 mm2. This infratemporal prism contains another one, the pterygomandibular space, prismatic too. It widens out from coronoïd plane (93 mm2) to mandibular foramen plane (169 mm2) before ending as a narrow groove between the neck of the mandibular condyle and the interpterygoïd fascia. The volume of the pterygomandibular space is quite superior to the value usually reported in the dental literature. It is of 4.8 ml to 5.8 ml according to denture. These results point out the opportunity to accomodate more important volumes of anesthesic solutions, than the 1.8 ml usually performed, without any leak out of the infratemporal region.

Aged↗

[Osteosynthesis using micro-plates in fractures of the orbital floor].

The exploration of orbital floor in case of blow-out fractures shows frequently only one or two important fragments. This fact leads us to realize osteosyntheses with titanium micro-plates in this kind of fractures. This was done for ten patients by transconjunctival approach. This technic has provided good results, clinically and radiologically. The tolerance of titanium implant was excellent. Therefore, it is unnecessary to preleve bone for grafting or to use biomaterials. Micro-plates ablation is not necessary.

Bone Plates↗

[Calcinosis of the temporomandibular joint: apropos of a case and critical review of the literature].

We report a case of calcinosis of the temporo-mandibular joint. This microcrystalline arthropathy by deposits of calcium pyrophosphate crystals is exceptional at this level; it is necessary to look for other localizations joints to diagnose articular chondrocalcinosis. The local prognosis is the same with surgical treatment in case of articular destruction or significant deposits.

Calcium Pyrophosphate↗

[A study of the cranio-pharyngo-mandibular space by sections at low temperature].

After acrylic injections into the vessels and mandibular block anaesthesia the pterygo-mandibular space is studied in 38 anatomical pieces. 538 colour slides have been obtained from anatomical cuts at low temperature with the scannigraph system. The results point out that a cranio-pharyngo-mandibular space is clearly distinguished laterally, from a medial maxillo-pharyngeal space. There is no transversal communication between them. On the contrary, the cranio-pharyngo-mandibular space communicates, forward and upward, with the temporal space; forward and downward, with the sub-mandibular space. The cranio-pharyngo-mandibular space contains an interpterygoid space communicating with the oval foramen by a "chimney" largely filled by the emissary pterygoid veins. A pericondilar plexus of veins is also observed. The cranio-pharyngo-mandibular space is characterised by the cellulo-adipose tissue by which it is filled and which guides the diffusion of injected solutions to the oval foramen.

Aged↗

[Arthroscopy of temporomandibular joint dysfunctions].

The arthroscopy of the T.M.J. is a mean of diagnosis and treatment of some lesions but it cannot claim to bring about the diagnosis or the treatment of all lesions. After the experience resulting from 29 cases, the value of this technic among the element of diagnosis and treatment is discussed.

Adolescent↗

[Trans-zygomatic approach to the temporomandibular joint].

The articular eminence of the temporal bone may be removed and resect without modifying substantially joint function. Such temporal resection allows for complete exploration and renders surgical treatments easier. The technique which is described here has been carried out on over one hundred patients with a follow-up period spanning 5 years or less. Indications are specified and the approach of interest seems to be complementary to the conventional lateral approach of the temporomandibular joint.

Cartilage↗

[The value of mandibular kinesiography and of T-scanning in the diagnosis and treatment of algo-dysfunctional syndrome of the temporomandibular joint].

The application of T-Scan and kinesiographic techniques in combination with electromyography is of great value to the clinician for substantiating certain clinically hard-to-evidence factors, such as chronology and strength of contact points, muscular activity, or certain mandibular movements. The utilisation of these methods is of benefit for diagnosis, treatment and objective patient follow-up.

Adult↗

[Modifications in the vertical position of the stomion in facial osteotomies and osseous genioplasties].

A retrospective statistical analysis is made on 45 patients who have undergone a facial osteotomy. The authors study the vertical changes of the stomion on pre- and post-operative lateral cephalograms. Considering the bad initial results, it has been necessary to create subdivisions on the surgical procedure and to work on homogeneous groups. The results of this study led to the following conclusions: the stomion follows the vertical displacement of the maxilla on an approximative ratio of 1/3, with rather great variations between the subjects; the functional osseous genioplasties, specially with vertical displacement, are not accompanied by significant vertical changes in the position of the stomion. Furthermore, it is obvious that it is necessary to use a "multivariable" method for a better prevision of the cutaneous changes after facial osteotomies, specially for the lips. Indeed, vertical soft tissue changes are the result of the interactions of many vertical and horizontal surgical squelettal displacements.

Adult↗

[Modifications to the skin profile following facial osteotomy].

Soft tissue changes resulting of maxillary and/or mandibular osteotomies need to be evaluated with a great accuracy for a better prediction of the post-operative profile. As the aesthetic result seems to be most important for our patients, it is necessary to study the relations between the displacements of characteristic cutaneous points and hard structures below, osseous or dental. Then, a retrospective statistical computerized study was performed on 45 patients who underwent facial osteotomies at least three months before. The vertical and horizontal positions of 14 osseous or dental landmarks and 16 cutaneous points were recorded. Corresponding displacements were calculated for each of these, but only six cutaneous and 9 osseous displacements were selectionned for this study. A first correlation research was made, with determination of the lineary regression equations, when it was possible. Then a multivariate study was performed for each cutaneous point, with determination of multiple regression equations. Comparison between the two methods of prediction shows a S.D. over 2 mm for the simple regression versus a S.D. of about 1 mm for the multiple regression. On the other hand, it seems that it is possible to predict the horizontal displacements with the first method without important error. But the vertical displacements cannot be evaluated with good prediction, and particulary the stomion movements. It will be necessary to consider other parameters to obtain better correlation coefficient. But it is obvious that one can join together different groups of patients for a soft tissue changes study with the same results than after separation of those. In fact, the soft tissue reactions are the same although the surgical procedures are different.

Adolescent↗

[Treatment of buccal mucosa lesions with the carbon dioxide laser].

The authors report their experience of the use of the CO2 laser in oral pathology, based on 109 patients treated in 136 sessions. The indications of this type of therapy are reviewed and details of the technic and results are given. The CO2 laser is specially useful in cases of dysplasia and cavernous hemangiomas; it guarantees the quality of the intervention, and avoids post-operative discomfort for the patients. Future prospects of this method are promising.

Cheek↗