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Biomedical subjects

B Raphaël

Publications and source records attributed to B Raphaël.

At least 19 recordsLinked to original sources
PubMed2002

[Alveolar and hard palate repair by tibial periosteal graft in complete unilateral cleft lip and palate. Long-term follow-up of 51 cases].

PURPOSE OF THE STUDY: The purpose of this study was double: appreciate the osteogenic and growth capacities of the free tibial periosteal graft concerning the alveolar and hard palate repair in the complete unilateral cleft lip and palate, and evaluate long-term follow-up concerning maxillo-mandibular morphology and palatal air-tight. MATERIAL AND METHOD: This retrospective study concerns 51 patients, of more than 13 years of age, treated for complete unilateral cleft lip and palate. The treatment included a Skoog type cheiloplasty, a tibial periosteal graft between 4 and 6 months (as described by M. Stricker) and a staphyloraphy between 8 and 18 months. Our documentation was: figures, pictures and precise description of the initial cleft, dental casts, teleradiographies, dental panorams performed at different stages of treatment, orthodontic, orthophonic and otologic follow-up. Growth was evaluated using casts during the first 6 years then by profil teleradiographies after puberty. Ossification was evaluated quantitatively by CT scan in 18 patients. RESULTS: Results confirm an ossification of the periosteal graft in 72% of cases and the advantage of periosteal graft in palatal air-tight. 85% of cases show equilibrated squeletal growth with good occlusion, and 13.7% of cases needed deferral osteotomy. CONCLUSION: We propose a method for long-term cleft results evaluation, with the use of periosteal graft.

Adolescent↗
PubMed2002

[Labial function].

Lips should be considered as a phylogenic summary for nasolabial and facial mask evolution. They're the centre point of facial morphogenesis. The progressive development of oral and facial functions is a specific human necessity: feeding, suction, oral competence, swallowing, language and mimics. Each discontinuity create function and anatomic failures. Each damage create facial unbalance.

Deglutition↗
PubMed2002

[Development of lip reconstructive procedures].

The history of lip repair shows significant parallelism with the evaluation of ideas in plastic and reconstructive surgery. The first attempts were addressed mainly to full-thickness lower lip repair as the resulting labial incompetence was more handicapping. However, techniques and knowledge evolved rapidly to the modern state of the art. Almost all the procedures used today were already described in the early 20th century and their progress based on a profound knowledge of functional anatomy established the principles of labial sphincter dynamic repair by tissue redistribution.

History, 19th Century↗
PubMed2002

[Tools available for the diagnosis of obstructive sleep apnea syndrome. Measurements for the evaluation of therapeutic efficacy].

Obstructive sleep apnea syndrome (OSAS) is characterized by the development of repeated episodes of pharyngeal collapse. Respiratory movements attempt to reopen the closed pharynx leading to resumption of ventilation associated with micro-arousals. Three kinds of measurements are needed to establish the diagnosis of OSAS: airflow (reduction or complete interruption), respiratory effort in response to increased airway resistance, micro-arousals associated with the end of the respiratory event. Classically, polysomnography was used to establish sleep architecture using electroencephalography, electromyography and electro-oculography. Air flow was measured by thermistors, chest and abdominal movements and oximetry were monitored. Other more accessible methods can also be used to establish reliable diagnosis. Measuring pulse transit time using ECG and oximeter sensors provide a semi-quantitative measurement of respiratory effort. Likewise, cardiovascular markers (heart rate, blood pressure, pulse time) can be used instead of electroencephalography to establish the arousal pattern. Cardiovascular markers are as sensitive and probably as specific as EEG for identifying micro-arousals. Measuring nasal pressure provides a much less invasive quantitative assessment of airflow than pneumotachography. The shape of the inspiratory signal is also an indirect marker of respiratory effort. These new tools can be used to characterize the three elementary abnormalities observed in OSAS: variations in airflow, increased respiratory effort, fragmented sleep, using a very simplified setting compared with classical techniques. Therapeutic monitoring of OSAS patients, particularly after surgery, should not be limited to physical examination known to lack sufficient sensitivity. It should also include simplified methods or complete polysomnography to obtain a precise measurement of residual respiratory events and sleep pattern after treatment.

Air Pressure↗
PubMed2002

[Surgery and obstructive sleep apnea syndrome: indications and precautions].

Surgery has long been a therapeutic option for obstructive sleep apnea syndrome (OSAS). The first procedures targeted the soft palate but results of isolated uvulo-palatopharyngoplasty (UPPP) were inconstant. A better understanding of the mechanisms involved in pharyngeal collapse incited interest in the role of the tongue and the retropharyngeal space. Surgical procedures were then developed for this level of the upper airways. There are a large number of possibilities. Excepting tracheostomy which court-circuits the collapsed zone, all the other procedures are designed to widen more or less one or more of the upper airway levels. The target can be the nose, the soft palate or the tongue, alone or in combinations. In all cases, the surgical alternative should be balanced against a non-invasive option: continuous positive pressure ventilation. The objective is to minimize the operative risks and sequelae while assuring success equivalent to positive pressure ventilation. It is important to note that sufficiently effective and permanent results have not been proven for any surgical technique, excepting tracheostomy and to a lesser degree bimaxillary advancement osteotomy, due to the lack of objective long-term rigorous evaluation. A considerable effort must be made in this domain.

Humans↗
PubMed2001

[Mandibular growth, its environmental interactions].

A thorough knowledge of mandibular growth is necessary for proper comprehension of growth disorders and malformations affecting the lateral cranio-facial region. The growth mechanisms are complex and multifactorial, the mandible itself is subdivided into two heterogeneous and interdependent segments, as far as growth is concerned. These are the ramus and the corpus. The ramus is interacting with the middle cranial base through the TMJ and the temporo-pterygoid muscle belt. The mandibular body is interacting with the maxilla and the anterior cranial base. Its occlusal role is a function of the adaptive capacity of the alveolodental region.

Alveolar Process↗
PubMed2001

[Morphological alterations of oto-mandibular syndromes].

Otomandibular dysplasia is a congenital malformation defined by a certain degree of temporomandibular or pterygomandibular hypoplasia. The syndrome is characterised by the variability of clinical findings, but the three major features are auricular, mandibular and maxillary hypoplasia. All the laterofacial structures may be affected. The deformity is usually unilateral but bilateral cases exist; a lot of associated malformations have been described. Multiple classification systems have been published. Some of them are very complex, but it is possible to define a simple diagnostic diagram based on ethiopathogenic data. Bilateral involvement affects predominantly the zygoma, and concerns hereditary syndromes. When the mandibular hypoplasia is evident Franceschetti or Goldenhar syndrome is suspected; otherwise Treacher-Collins syndrome is probable. Unilateral cases are not, in general, hereditary and the hypoplasia predominates on the mandible. The difference between hemifacial microsomia or mandibular dysplasia is made by the presence of associated laterofacial deformities.

Ear, External↗
PubMed2001

[Bilateral labio-maxillo-palatal clefts. Therapeutic evaluation].

The wide diversity of bilateral facial clefts makes it most difficult to assess surgical success, particularly in terms of long-term outcome. The aim of this work was to examine the rationale for the current protocol used for cleft surgery at the Grenoble University Hospital. In a first group of 28 children, a 3-step surgical protocol was applied. The first two steps were performed between 4 and 8 months with at least 3 months between each procedure. Skoog's unilateral cheilo-rhino-uranoplasty was used, associated with a periosteal tibial graft. The third step, performed between 10 and 12 months, was for staphylorraphy. Outcome was analyzed at 15 years and evidenced the deleterious effect of excessive and asymmetrical premaxillary scars, of the 2-step cheiloplasty and of columella lengthenings from the lip. The frequency of secondary revision of the superior labial vestibule and the medial labial tubercule (43%) was considered to be high; this procedure should be re-examined as should be osteotomy (32% revision). Palatine closure, acquired in 82% of the cases and premaxillary stability, achieved in 86%, would appear to favor use of the periosteal tibial graft. The osteogenic capacity of this graft tissue was less satisfactory after a second harvesting (from the same tibia three months later). These results have led us to modify our protocol, favoring early and total closure of the bony palate and continued use of the periosteal tibial graft. We now use the following operative protocol: premaxillary alignment using an active orthopedic plate at 2 months, lip adhesion associated with staphylorraphy and passive palatine contention plate at 3 months, definitive bilateral cheilo-uranoplasty associated with a single periosteal graft at 7 months. The preliminary results with this protocol in a group of 12 children have shown better quality scars, more harmonious maxillary arches, an excellent occlusion of the deciduous dentition, and preservation of the positive results obtained with the periosteal tibial graft.

Adolescent↗
PubMed2000

A simulator for maxillofacial surgery integrating 3D cephalometry and orthodontia.

OBJECTIVES: This paper presents a new simulator for maxillofacial surgery that gathers the dental and maxillofacial analyses together into a single computer-assisted procedure. The idea is to first propose a repositioning of the maxilla via the introduction of 3D cephalometry applied to a 3D virtual model of the patient's skull. Orthodontic data are then integrated into this model, using optical measurements of plaster casts of the teeth. MATERIALS AND METHODS: The feasibility of the maxillofacial demonstrator was first evaluated on a dry skull. To simulate malformations (and thus simulate a "real" patient), the skull was modified and manually cut by the surgeon to generate a given maxillofacial malformation (with asymmetries in the sagittal, frontal, and axial planes). RESULTS: The validation of our simulator consisted of evaluating its ability to propose a bone repositioning diagnosis that would restore the skull to its original configuration. An initial qualitative validation is provided in this paper, with a 1.5-mm error in the repositioning diagnosis. CONCLUSIONS: These results mainly validate the concept of a maxillofacial numerical simulator that integrates 3D cephalometry and guarantees a correct dental occlusion.

Cephalometry↗
PubMed2000

Obstructive sleep apnea syndrome. fifty-one consecutive patients treated by maxillofacial surgery.

The place of surgical treatment in obstructive sleep apnea syndrome (OSAS) remains unclear. Uvulopalatopharyngoplasty (UPPP) has a response rate of 41% overall and only 5% when retrolingual narrowing is present. Thus, in cases with suspected hypopharyngeal collapse maxillofacial surgery has been proposed with improved results. The Stanford group has designed a step-by-step surgical procedure tailored to the specific anatomical abnormalities encountered in each patient. The goal is to avoid a full maxillomandibular advancement osteotomy (MMO), at least in a subgroup of patients, beginning with a limited mandibular osteotomy (with or without hyoid myotomy and hyothyroidopexy and with or without UPPP) (phase 1 surgery). In this procedure MMO is performed as the second or third step (phase 2 surgery). The present study reports on our prospective experience with 51 consecutive patients (64 surgical procedures) treated by the step-by-step maxillofacial surgery previously described by the Stanford team. Only 2 of the 53 patients initially treated were lost for follow-up. Surgery was considered a success if the postoperative apnea and hypopnea index (AHI) was less than 15/h with at least a 50% reduction. Forty-four patients had phase 1 surgery. The success rate was 22.7% (10 of 44). The mean AHI was unchanged with a trend for reduction in the apnea index. Twenty patients had maxillomandibular advancement surgery (phase 2) (13 failures of phase 1, 7 patients primarily because of facioskeletal deformities). The AHI decreased from 59 +/- 29/h to 11 +/- 9/h after phase 2. Of the patients 75% (15 of 20) were considered to have had a successful outcome. In conclusion, phase 1 does not seem effective in most patients with OSAS. The results of phase 2 surgery are successful in young patients with severe OSAS even if the surgical technique is more aggressive.

Female↗
PubMed2000

[Functional evaluation of intraoral reconstructive surgery. A valuable tool: articulatory evaluation of the acoustic signal].

Functional tests are needed to assess the quality of reconstructive surgery after treatment of intraoral cancers. Quality of Life tests are subjective and Cinefluoroscopy is a demanding and non-comparative procedure. We develop here a method to test the capacity of patients to maximize use of their articulatory space. We recorded a corpus of sounds. These sounds were analyzed with classical signal processing procedures. By comparison with a non-distorded sound database, it was possible to evaluate speech disorders, localize the defect, and provide a guide for rehabilitation. This method is an objective, reproductible, and comparative measurement tool.

Cohort Studies↗
PubMed2000

[Prominent ears: a simple ambulatory technique under local anesthetic].

We present a simple otoplasty technique for the correction of prominent ears. Children can be operated starting from 8 years old, after meticulous analysis of the deformity which usually associates chonchal malposition and failure of scapha folding. Chonchal malposition can be corrected by a posterior access and chonchal-mastoid sutures. Failure of scapha folding can be corrected by an anterior access, cartilage scoring and mattress sutures. Our retrospective study of 368 patients shows 83% very good and good results. The morbidity rate is low and comparable to that of other studies. This technique is simple, didactic, easily performed under local anesthesia on an outpatient basis. Moreover, it is not aggressive and is easily adaptable to various deformities.

Ambulatory Surgical Procedures↗
PubMed1998

[The role fo function in the growth of form].

The cranio-facial shape is the outcome of growth, unequally influenced by heredity and environment. Even if limited, the influence of function is certain, and results essentially from neuromuscular behavior. This relationship imposes the taking into account and correction of any functional abnormality by training, during the correction of malocclusions.

Craniofacial Abnormalities↗