[Uranostaphylopharyngoplasty with lower pedicle (theoretical principles, technic, indications)].
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Biomedical subjects
Publications and source records attributed to J Delaire.
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In a difficult case of bilateral loss of substance of the body of the mandible, with aplasia of the residual tissue, in an elderly psychotic patient, reconstruction was obtained simply by the insertion of two rib grafts each fixed by a single Kirschner's wire (removed four months later).
The sliding of the inner and outer cortex of the mandible based on the sagittal splitting (Obsegeser 1955) is usually confined to the ramus and angle area. It can, however, also be performed in the body of the mandible even in cases with normal dentition. In these cases, the sagittal split is carried out below the dentoalveolar region (Mehnert 1959). The technical possibilities and the experiences made are shown. It can be concluded that this technique is particularly indicated in cases of open bite and severe deep over bite whether they are associated or not with a prognathism or retromandibulism of moderate degree.
Usually when reference is made to the Orbicularis oris muscle of the upper lip only the horizontal bands of muscle are mentioned. This muscle also comprises oblique fibres (Orbicularis externus) that are of very great importance in lip movements. The balance of the lip derives from the activity of the two types of muscle fibers. The lip can thus perform, at the same time, a movement of compression of the underlying structures and projection movements whereby these structures are freed. These different modes of action are well demonstrated by selective electromyography. There is also, in the middle of the upper lip, a medial cellulo-fibrous septum forming a prolongation of the septum and penetrating into the median interincisive suture and ending at the frenulum of the upper lip. This medial septum seems to play a very important physiological role in the growth of the premaxilla.
Cranio-facial morphogenesis and (in particular) maxillo-mandibular relations are linked with cervico-cephalic stasic. In cases of mandibular prognathia in the presence of cervical lordosis, treatment should thus take this special feature into account and seek for preference anterior maxillo-mandibular adaptation (associated when necessary with partial glossectomy), rather than the correction of skeletal abnormalities linked to a problem of position which cannot be influenced. At a time when the most highly qualified American orthodontists accept the possibility of altering basic bone features and recommend the replacement of the term orthodontics by more suitable expression dento-facial orthopaedics (10), attention must also be paid to the possibilities of true cervico-cephalic orthopaedics (in the context of general orthopaedics (17, 18, 19, 20)).
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The purpose of this article is to draw the reader's attention to a fairly frequent complication in root treatments with suspicious clinical symptoms and in which painful complications are particularly to be feared. This complication appears therefore to be a stomatological emergency, treatment for which is aimed at bringing about regeneration of the traumatised nerve, prognosis being dependent on prompt surgical measures, the site of the complication and the anatomical damage done to the lower dental nerve.
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The soft palate has a major influence on mandibulo-lingual statics. Thus in the case of congenital cleft palate, there is in general glossoptosis with mandibular retrognathia. Conversely, palatal shortening may be associated with functional mandibular prognathia which it is possible to correct by urano-staphylo-pharyn-goplasty, if carried out sufficiently early. In many cases of mandibular prognathia the soft palate has a special shape and orientation. The problem is to know whether this appearance is secondary to the dysmorphosis or partially responsible for it.
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The functional treatment of condylar and sub-condylar fractures requires very early mobilisation of the mandible, in protraction. This form of treatment, suggested in France since 1928 by L. Lebourg, is usually carried out with the aid of traction using a plaster helmet. The authors use more simple inter-maxillary traction (as parallel as possible from the standpoint of occlusion) followed by propulsion plates.
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