Biomedical subjects
M Freidel
Publications and source records attributed to M Freidel.
[Perioperative medical complications in orthognathic surgery].
PURPOSE: To describe per and postoperative medical complications. STUDY DESIGN: Prospective, observational study. PATIENTS: Between July and December 1999, 59 patients scheduled for programmed orthognathic surgery were included. METHODS: Anaesthetic and surgical procedures were standardised including patient information and training of surgical ward' nurses. During perioperative periods (in operative and recovery theater and in surgical ward), all the events were qualified on an anaesthetic spreadsheet for a qualitative analysis (description of events and treatment procedures). RESULTS: Two main complications were described 1) one atelectasia due to blood inhalation during the recovery period and 2) local sepsis in surgical ward. These two events were medically treated and recovered. No need of blood transfusion or stay in ICU were noted. CONCLUSION: Anaesthetic and surgical cooperation is associated with poor morbidity of this functional surgery performed in young subjects.
[Lactic acid polymer implants in the repair of traumatic defects of the orbital floor].
BACKGROUND: The criteria determining the choice of the technique used to repair traumatic orbital floor defects include the quality of the expected result, morbidity, ease of use and plasticity of the method, and its cost and availability. Among the different methods proposed, lactic acid polymer implants are particularly interesting. MATERIAL AND METHODS: Eighteen patients with an isolated blow-out fracture of the orbital floor were treated with a lactic acid polymer implant between 1995 and 1996. Ten of these patients were reviewed at 24 to 43 months follow-up. RESULTS: The mean age of the patients was 35 years (20-52 years). No residual diplopia was observed. None of the patients had an anomalous orbital volume or ocular dystopia. None of the implants migrated. One patient experienced episodes of palpebral inflammation that resolved spontaneously. The ten patients reviewed were satisfied with the outcome. DISCUSSION: The properties of lactic acid polymer implants facilitate their use, avoid morbidity and provide a quality result. This is the procedure of choice for repairing tissue loss of the orbital floor. It has several advantages over alternative methods (the implants are rigid, thin, resorbable and well tolerated) without having their defects (thickness, fragility, roughness, predetermined form, rapid alteration, specific instrumentation, iatrogenic disorders). In addition, lactic acid polymer plates can be remodeled when heated, allowing a precise adaptation of the implant to the orbital structures. Finally, the cost, compared with the advantages, is not a barrier for routine use.
[Primary osseous leiomyosarcoma of the jaw. Apropos of a case].
Primary leiomyosarcoma of bone is a malignant smooth muscle tumour uncommonly found in the jaws. We report a case of primary leiomyosarcoma of the mandible in a 31-year-old man treated with wide resection and radiotherapy then secondary reconstruction with a fibula free flap. No recurrence or distant metastasis has developed four years after the initial surgery. We review the literature on primary leiomyosarcoma of the jaws.
Congenital infiltrating lipomatosis of the face: case report.
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[Treatment of low-pressure vascular malformations by injection of Ethibloc. Study of 19 cases and analysis of complications].
We retrospectively studied the cases of 19 patients suffering from low flow vascular malformations who were treated with Ethibloc sclerotherapy. Out of 10 venous angiomas, 5 entirely disappeared, 3 considerably decreased and 2 remained unaltered. Out of 7 cystic lymphangiomas, 7 were completely cured and in the 2 other cases, outcome was quite good. Post-treatment complications consisted in a local inflammatory reaction. This reaction occurred immediately and disappeared within a few days without after-effects. It materialized as an Ethibloc exteriorization among 5 patients suffering from venous angiomas and 3 patients suffering from lymphangiomas and as an inflammatory lump for 2 venous angiomas carriers and for 4 lymphangiomas carriers. This lump was located at the puncture point of the product and it was due to some Ethibloc residue. Fourteen of these local reactions spontaneously decreased; 5 of them required a surgical operation but in all cases, after-effects were minor. These satisfactory results (volume decreasing in 90% of the malformations) as well as the mildness of the side effects encourage to use Ethibloc in the treatment of low flow vascular malformations. In our experience, Ethibloc is particularly appropriate for the treatment of large lymphangiomas.
[Regarding orthognathic surgery].
The author scrutinises the evolution of orthognathic surgery for the last twenty years through the different parameters that participate to its origin; esthetic motivation, orthodontico-surgical collaboration, the limitation of widely used technics, a simple surgical solution, the spreading of rigid fixation, the interest of primary or secondary genioplasty, the consideration of ethnic differences,the usefulness of a maxillo-facial chain, the possible retreatment of failures and consideration for the stability of results.
[An experimental study of a new bidirectional distraction appliance].
The goals of mandibular distraction are to restore a normal length but also a normal shape to the hypoplastic mandible. These two goals are related to the elongation vector which is itself related to the location of the cortictomy and of the device. Other factors influence this elongation vector. So it is impossible to precisely predict the elongation vector. With the monodirectional distraction device no modification can be made during the distraction time. With a bidirectional distraction device offering the possibility to modulate the angulation between the two elongation rods it is possible to adjust the elongation vector during distraction. Precise distraction gap modeling is possible. This is particularly important to correct anterior open-bite. This device was tested on animals (pigs).
[Congenital infiltrating lipomatosis of the face. Presentation of a new clinical case].
A new case of this rarely described pathology is reported. It concerns a benign infiltrating lipomatosis, strictly located to the face. However, dento-musculo-squelettal structures are constantly involved, usually located to a hemiface. A young female patient has been followed up from her birth. Surgical procedures are reported. Diagnostic and therapeutic difficulties of this rare clinicopathologic entity are discussed.
[Maxillofacial fractures. Surgical and prosthetic procedures].
A patient presented complex fractures of the face and skull with leg trauma after a traffic accident. Maxillofacial repair used sophisticated procedures: bone grafts, muscle flaps and multiple osteotomies. After reconstructing the mid face and the mandibular repair, bone implants were used to stabilize the maxillary prosthesis. The psychological and functions problems raised in this case are discussed considering the occupational and social outcome.
[Secondary rhinoplasty for unilateral cleft lip and palate. Review of the literature and 50 clinical cases].
The nasal sequelae of unilateral cleft lip and palate are almost always present: more or less severe deformities, essentially consisting of nostril deformity and deviated septum. After an anatomical study of nasal deformities and the consequences of the primary procedures of cheiloplasty or cheilorhinoplasty, the authors review all of the most satisfactory technical aspects of secondary proposed in the literature. Five clinical cases illustrate the therapeutic strategy and the results.
[Esthetic reconstruction of the superior hemilip using the Abbé technique modified by Burget. Apropos of 5 cases].
When a patient must undergo resection of part of the upper lip for the treatment of a cancer or following a traumatic defect of the upper hemilip, the surgeon is faced with the problem of reconstruction of a lip whose appearance and function must be as close as possible to the normal lip. The limits of the normal lip must be restored: the symmetry, equilibrium of the lips and position of the commissures must be maintained. The upper lip esthetic unit can be divided into subunits, as described by Burget and Menick. If a large part of a subunit is removed, replacement of the entire subunit rather than simple reconstruction of the defect often gives a better esthetic result (Burget). The best tissue for esthetic reconstruction of a full thickness defect of the upper lip is the lower lip. We apply Burget's principles to raise an Abbé flap, which is transferred in two stages. This approach is illustrated by 5 patients operated by this technique. Finally, this technique is compared to other techniques allowing reconstruction of the upper hemilip.
[Patient-controlled exercise therapy in temporomandibular joint pain-dysfunction syndrome].
Self-controlled gymnastics in SADAM relaxes the masticator muscles, allows precise assessment of occlusion and helps the patient acquire occlusion-conscience. The technique is entirely patient controlled.
[Late results of the surgical treatment of temporomandibular joint ankylosis in children].
Long-term outcome after surgical treatment of temporomandibular joint ankylosis is not always satisfactory in children. Interposition of a temporalis muscle flap is insufficient to ensure good functional results if the surgical procedure is not followed by careful active and passive physiotherapy. The results can be evaluated only after the child has grown.
[A case of aggressive juvenile fibromatosis of the mandible].
We report a new case of aggressive juvenile fibromatosis (FJA) in a 20 months old girl. It was initially treated by hemimandibulectomy. A secondary reconstruction was performed with a fibular flap at the age of 9 years. FJA is a locally aggressive lesion which does not metastasize. It occurs chiefly in girls during childhood. Radiographs are non-specific (extensive osteolytic lesion). The clinicopathologic diagnosis is discussed with the other mandibular fibrous tumors in children.
[Osteosynthesis using intrafocal nailing of low subcondylar fractures in adults. Surgical technics and initial results].
We describe a method for fixation of condylar fractures using a Kirschner pin. A retromandibular approach is used. This protocol was evaluated in 12 consecutive patients.
[Do corticotherapy and hemodilution decrease postoperative inflammation after maxillofacial surgery?].
OBJECTIVE: To assess the efficiency of corticosteroids and preoperative acute normovolaemic haemodilution (PANHD) in reducing postoperative inflammation after maxillofacial surgery. STUDY DESIGN: Randomized clinical trial. PATIENTS: Thirty-two patients scheduled to undergo maxillary osteotomy for facial dysmorphia were randomized into four groups of eight (PANHD or not; corticosteroids or not). METHODS: PANHD decreased haematocrit to 30%. In the corticosteroid groups, methylprednisolone 1.5 mg.kg-1 was given intravenously at the beginning of surgery (after PANHD in haemodiluted group), and after surgery, 1.5 mg.kg-1 iv daily for three days. Postoperative inflammation was assessed with an X-Ray technique (radiotelemetry) providing data on tissue thickness (extent of facial oedema), and by measurement of plasma concentrations of four acute phase proteins during the first postoperative week. RESULTS: No change in facial oedema and in acute phase proteins occurred with PANHD. Corticosteroids decreased postoperative oedema and acute phase proteins. CONCLUSION: Corticosteroids decrease postoperative inflammation after maxillofacial surgery but not PANHD.
[The Abbe-Estlander flap: anatomic basis, surgical technic and indications for lip repair].
The Abbe-Estlander flap is a full-thickness lip-switch flap rotated from mid lower lip to fill defects of the upper lip. In 1872, Estlander emphasized the importance of this flap. Abbe, in 1898, was the first to switch a lower lip flap into the upper lip for a cleft deformity. The lip-switch flap is an arterialized flap, based on the constant inferior labial artery. This flap is widely used to repair the defects from cancer and traumatism or in repair of the cleft lip deformities.