["Search or research". On the qualification for director of research].
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Biomedical subjects
Publications and source records attributed to C Chossegros.
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Preprosthetic rehabilitation of the maxillary bone is sometimes difficult due to severe bone resorption in the posterolateral regions. The sinus lift with autogenous bony graft has given us satisfactory results since 1990 but requires a rigorous protocol before and during surgery to assure a lasting anchorage to the prosthesis. We describe morbidity and technical choices of this intervention in a series of 55 patients.
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Conventional x-ray films (orthopantomogram, teleradiogram) visualize many signs of dysfunction of the manducatory apparatus (DAM). Progress in our knowledge of the pathophysiology of DAM has brought new light to these radiographic signs. The orthopantomogram allows an assessment of modifications in muscle insertion zones secondary to their dysfunction and, more difficulty, the articular remodeling of the TMJ, mainly of the mandibular condyle and the articular space. The lateral teleradiogram studied by architectural and structural analysis provides information on the biomechanical balance of the cranio-facial structures and, especially, on the position of the mandibular rami. These standard radiograms are indispensable in the differential diagnosis, useful in the etiological diagnosis and are preliminary examinations prior to using other imaging techniques (MRI, CT). Standard films are easily reproducible for post-therapy follow-up.
Surgery is sometimes indicated in cases of recurrent temporomandibular joint dislocation (luxation). Among the panel of available techniques, therapeutic arthroscopy with retrodiscal tissue and oblique protuberance coagulation has been used to prevent new episodes. Therapeutic arthroscopy was used for 6 patients. Outcome was considered to be satisfactory in 66% with a mean 3.1-year follow-up. This technique can be recommended as first line therapy when surgery is indicated. In case of failure, eminectomy is scheduled.
A variety of interposition materials have been used to prevent recurrence after arthroplasty in treatment of temporomandibular joint ankylosis. The purpose of this retrospective study of our experience was to compare the different materials (skin, temporal muscle, homologous cartilage) used for interposition arthroplasty over a period of 22 years. A total of 25 patients (32 joints) with at least 3 years of follow-up were included. Good results were achieved in 92% of cases using total full thickness skin graft and 83% of cases using temporal muscle flap. Homologous cartilage gave poor results.
A 15 patients series is presented concerning complications following the use of silicone orbital floor implants. The more frequent complications are inferior eyelid swelling, pain and ocular dystopia. Complications may occur very belatedly, 10 years for a patient, 9 years for an other. The mean delay from insertion to removal for complication of the implant is 4.3 years. Sinus troubles are found in 70% patients that may indicate a relationship between sinusal pathology and complications observed. The CT study is described. Precautions in insertion of the implant are given. Suggestions are done to prevent such complications.
Phylogenesis, embryology and anatomy are emphasizing that two ligaments are found between the temporo-mandibular joint and the middle ear. These two oto-mandibular ligaments are named the disco-mallear ligament and the malleo-mandibular ligament. Originating from the first arch, these ligaments are not involved in the otologic manifestations of the temporo-mandibular joint syndrome. The disco-mallear ligament is a brake applied to the anterior excursion of the disc. When this disco-mallear ligament is stretched the disc can be displaced anteriorly breeding disc displacement, hypermobility and temporo-mandibular dislocation. The malleo-mandibular ligament is a remainder of the Meckel's cartilage: its role is not clear. When excessive forces are applying on the mandible, ossicles dislocation can be seen the forces being transmitted through it.
Various approaches have been proposed for surgical treatment of displaced condylar fractures included submandibular approach, preauricular approach, rhytidectomy approach or intraoral approach. Since 1992, we used a short retromandibular approach to treat displaced subcondylar fractures with a miniplate. When open reduction and osteosynthesis are required, the retro-mandibular approach is an easy and safe technique for displaced condylar fractures. The aim of this article was to describe the short retro-mandibular approach. Indications for surgical treatment, surgical approach and techniques of osteosynthesis for condylar fractures are discussed.
Thirty-four therapeutic temporomandibular arthroscopies were done during a 24-month period for patients with debilitating joint disorders (mainly disc displacements with or without reduction) who had not responded to non-invasive treatment. Lysis and lavage with prediscal section and retrodiscal coagulation were the techniques used. Analysis of the results indicated subjective improvement of pain in 71% of cases, noise in 78%, jaw opening in 88% and diet in 97% and objective evidence of disappearance of noise in 29% and improvement of jaw opening in 94% (mean 9.24 mm). In jaw opening, improvement was highly significant, compared with the preoperative results, P < 0.01. We conclude that temporomandibular arthroscopy is safe and indicated in disc displacements and joint luxation if medical treatment has failed.
OBJECTIVE: The classic technique for open reduction of subcondylar fracture is the submandibular approach. The aim of this study was to evaluate long-term clinical and radiologic results of the short retromandibular approach to displaced subcondylar fractures. MATERIAL AND METHODS: During a period of 66 months we performed a prospective study with a modified version of the retromandibular approach in 38 patients with displaced subcondylar fractures. In this article we describe clinical and radiologic results in 19 patients with follow-ups longer than 6 months (range, 6 to 66 months). Preoperatively all patients had malocclusion and radiology demonstrated displacement. RESULTS: The retromandibular surgical approach was successful in all cases. Roughly 25 months after surgery, mouth opening was 43 mm with symmetric laterotrusive movements. Permanent marginal nerve palsy was never observed. CONCLUSIONS: Our findings indicate that the short retromandibular approach is an easy and safe technique for displaced subcondylar fractures.
We report a prospective study of thirty four therapeutic temporomandibular arthroscopies that were done during a 24 months period for patients with debilitating joint disorders (mainly disc displacements with or without reduction) who had not responded to no-invasive treatment. The technics used were lysis and lavage with prediscal section and retrodiscal coagulation. Analysis of the results indicated subjective lessening of pain in 71% of cases, noise in 78% (with objective evidence of disappearance of noise in 29%), jaw opening in 94% (mean 9.4 mm) and diet in 97% (mean 9.4 mm). In jaw opening, improvement was highly significant, compared with the preoperative results, p < 0.01. We conclude that temporomandibular arthroscopy is safe and indicated in disc displacements and joint luxation if medical treatment has failed.
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BACKGROUND: Melanotic neuroectodermal tumor is a mostly benign tumor, rare in childhood, essentially located in the head and neck region. CASE REPORT: A two-month-old girl was seen for a rapidly increasing odontogenic tumor which appeared cystic at the CT scan. After enucleation, this premaxillar tumor recurred one month later with an osteogenic aspect at the CT scan. Urine catecholamine excretion was normal; Methyl Iodo Benzyl Guanidin scintigraphy failed to show any fixation and electron microscopy examination of the biopsy showed several varieties of melanocytes. A partial maxillectomy was performed by oral approach. The patient is well 4 1/2 years later. CONCLUSION: This observation confirms the recurrence potential of this tumor and the cosmetic interest of the oral surgical approach.
In literature, the authors demonstrate that progressive distraction osteogenesis, according to the Ilizarov method, is applicable to the mandible. Mandibular distraction is achievable through external approach or through oral approach. Further experimental and clinical studies will be necessary to define the most stable apparatus and the best indications that are currently hemifacial microsomia and facial asymmetry associated with T.M.J. ankylosis.
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Inferior alveolar nerve lateralisation is a new technique. Mostly indicated in implantology, the techniques described are partial and located at the anterior part of the nerve, near the foramen mentalis. The authors describe a technique of total inferior alveolar nerve lateralisation, from the lingulae mandibulae to the foramen mentalis. Total lateralisation technique can be used in dental prosthesis (in mandibular posterior edentulism when the alveolar bone is reduced and when the prosthesis compresses the nerve in the foramen region), in implantology (when terminal implant restitution is needed), or in benign tumors (when the horizontal branch of the mandible is resected).