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Biomedical subjects

P A Diner

Publications and source records attributed to P A Diner.

At least 19 recordsLinked to original sources
PubMed2001

[Mandibular advancement: osteotomy or distraction osteogenesis? A case report].

From an experience in osteogenic distraction techniques acquired since 1993 and facing a case of retromandible, the authors have tried to define the criteria leading them to suggest a distraction rather a classical surgical procedure. The selection of the patient is based upon the age, the significance of the advancement, the asymmetry of the advancement and the former existence of a temporomandibular joint degenerative disease. Monitoring the distraction, in particular with per- and post-distraction orthodontics, remains complicated. The overcorrection and the reduction of recurrences after advancement using distraction remain openly discussed.

Adolescent↗
PubMed2001

[Oto-mandibular dysplasias: genetics and nomenclature of syndromes].

Otomandibular dysplasia are characterised by a combination of anomalies of the ear and the mandible. From the surgical point of vue, facial dysostosis is prominent and focus the attention. For the geneticist it is a group of different entities, familial or sporadic. Familial history, detailed clinical examination looking for extra-facial associated malformations, characteristics of the facial dysostosis, unilaterality or bilaterality and biological or radiological findings allow sometimes to identify a known syndrome. A bilateral and symetric dysostosis with predominant zygomatic and malar hypoplasia suggest the diagnosis of Treacher-Collins or Franceschetti syndrome or mandibulofacial dysostosis, particularly in the presence of positive familial history. Acral anomalies associated with facial dysostosis allow the distinction between Treacher-Collins syndrome and acrofacial dysostosis (Nager and Miller syndromes). Unilateral and bilateral asymmetrical anomalies, namely facioauriculovertebral syndrome, hemifacial microsomia, otomandibular dysostosis, no. 7 cleft, first branchial arch syndrome, Goldenhar syndrome were lumping together by Gorlin in 1990, who proposed to use the term "oculoauriculovertebral spectrum". This classification is the first step before genetic studies, who need homogeneous group of patients. Lastly recurrence risk can be evaluated and genetic counselling can be done only if a precise genetic diagnosis is known.

Child↗
PubMed2001

[Hemifacial microsomia treated with mandibular lengthening using intraoral distractors. On precise indications].

Mandibular hypoplasia in the hemifacial microsomia have largely benefited from distraction techniques especially intraoral. In fact, these techniques are possible in the child, replacing him in a better morphological, psychological and functional configuration. They can redynamise growth and, in any case, diminish secondary distant effects. The authors, from precise criteria, propose a surgical classification to facilitate the therapeutic decision. Intraoral and sometimes bidirectional distraction, whose results are equivalent to external distraction, present numerous advantages that, in the majority of cases, make it preferred now to external distraction. Its three-dimensional (3D) effect on bone and soft tissues and the long term follow-up must be evaluated more objectively, as pre and post-distraction stereolithographic or 3D photogrammetric may get. It must be considered in the child as the first step of skeletic surgery preparing to a facilitated second step orthopedic, orthodontic or orthognathic after puberty. In the young adult, it is in competition with conventional surgery but the slow progressive process, kind with the temporo-mandibular joints, allows in mandibular asymmetries an adaptation having avoided the need for controlateral osteotomy or a bone graft.

Adolescent↗
PubMed2001

"Distraction" of grafted alveolar bone in cleft case using endosseous implant.

OBJECTIVE: Presentation of a specific surgical technique of vertical alveolar ridge distraction performed on an alveolar bone graft 1 year after the primary grafting procedure designed to correct a labioalveolar cleft. The graft had not obtained the results desired and presented heavily scarred mucosal tissue. TECHNIQUE: A dental implant placed within the graft once it has been entirely freed by osteotomies functions as an endless screw. To avoid vascular risk, the alveolar bone graft is detached as a whole along its total height. Consequently, no bone remains above it to provide support for a conventional alveolar distractor. An osteosynthetic miniplate, fastened in a horizontal position beneath the nasal mucosae above the graft, is used to replace the missing bony support and to stabilize the implant, which activates the distraction process. PATIENT: This study is based on our first clinical case with a follow-up of 18 months at present. RESULT: A vertical displacement of the entire graft was achieved, including its attached mucosal layer, which repositioned both bone and mucosa on a far better level in the cleft area. Thus, a normal length of abutment was obtained permitting prosthetic rehabilitation based on the same endosseous implant, which was left in place within the graft. CONCLUSION: This technique may prove particularly helpful in certain cases in which a primary alveolar bone grafting procedure has produced borderline results. In such cases, on the one hand, neither the reasonably satisfactory volume of the bone graft itself nor the poor quality of its scarred mucosal tissue argue in favor of a secondary grafting procedure. On the other hand, it is impossible to resort to currently available alveolar distracters since our choice of techniques leaves no bone support above the graft.

Adolescent↗
PubMed1999

[Circumscribed mandibular osteitis in children due to hematogenous dissemination. Apropos of 5 clinical cases].

In children, mandibular swelling associated with an X-ray bone osteolysis may correspond to tumoral or infection diseases. Circumscribed osteitis of a child's mandibula, with no dental etiology occurs around 7-years of age, adjacent to a healthy first molar. Five cases reports were analyzed. Clinically, it is a bone swelling of the mandibula's lateral cortical associated with a soft tissue swelling. X-ray signs were not specific but all cases showed a bone lacuna with sharp outlines. Such clinical and X-ray signs strongly suggest diagnosis of osteitis which has a higher incidence than malignant tumors. The lack of dental pathology suggests bloodstream dissemination from another localized sepsis. Surgical removal of pathologic bone in addition to antibiotics (6 or 8 weeks) appears to be an effective treatment.

Amoxicillin↗
PubMed1999

Intraoral mandibular distraction: indications, technique and long-term results.

This report describes the experience of the Trousseau Hospital, Paris, France, with distraction osteogenesis of the mandible using an intraoral distraction device. From 1993 to 1998, 26 paediatric patients with mandibular hypoplasia underwent distraction of the mandible using the Leibinger Intraoral Distractor. The majority of the patients had hemifacial microsomia. Distraction was performed at a rate of 1 mm a day following complete osteotomy of the mandible. A mean of 15 mm of distraction was obtained. In conjunction with combined orthodontic management, satisfactory morphologic results were achieved in the majority of patients with good facial symmetry, adequate occlusal relationships and balanced maxillary mandibular relationships. Radiographic evaluation revealed that substantial new bone formation and remodelling was induced by the intraoral distraction along the entire hemimandible on the distracted side and that this contributed significantly to the aesthetically pleasing clinical results.

Adolescent↗
PubMed1997

Submerged intraoral device for mandibular lengthening.

The authors report a new technique for mandibular distraction. Lengthening of the mandible by gradual intraoral distraction was obtained in nine young patients. An intraoral device was used in order to avoid external scars. Seven patients had hemifacial microsomia, one patient had a ramus hypoplasia after TMJ ankylosis and one patient had the Treacher-Collins syndrome. The amount of mandibular lengthening ranged from 12 to 28 mm depending on the duration of expansion. Retention after expansion, to allow ossification to take place, lasted for 3 weeks on average. The follow-up period ranged from a minimum of 5 months to a maximum of 44 months.

Ankylosis↗
PubMed1997

[Mandibular distraction].

The authors review the bone lengthening techniques used in orthopaedics, analyse the application of osteogenesis by surgical distraction of the mandible and describe the progress in techniques and equipment. The presentation of clinical cases of mandibular hypoplasia treated by intraoral distraction emphasizes the value of this new technique, particularly in terms of the morphological results, which are superior to those obtained by conventional techniques.

Child↗
PubMed1994

[Bone distraction using an external fixator: a new mandibular lengthening technic. A preliminary study apropos of 2 cases of children with mandibular hypoplasia].

The authors expose a technical innovation concerning mandibular lengthening without any bone graft, by applying to the mandibular Ilizarov's principles about limb lengthening by osseous distraction. This surgical technique concerns children with mandibular hypoplasia, like the Hanhart's syndrome (aglossia-adactylia, first observation), or Hemifacial Microsomia (second observation). The purpose of this new technique is mandibular lengthening with functional and aesthetic correction of the mandibular growth deficiency, and minimal morbidity. A specialist staff is essential to realize a distraction device with his minimal and appropriate shape for children, as well as a protection device conception. This external distraction device is placed with transmandibular pins. After mandibular corticotomy by endobuccal incision, the distraction is accomplished, at home by the parents, at the rythm of 1 mm p. two days. The distraction goes on about 2 months, depending on the lack of mandibular growth, and a retention device, much more light, is necessary during 8 weeks more to stabilize the osteogenesis. At the term of an eight weeks gradual distraction, the mandibular lengthening is 17.5 mm for the horizontal ramus (first observation), and 13 mm for the vertical ramus (second observation). The functional and aesthetic results, the swift and secure surgical procedure, lead to put forward this mandibular distraction technique in any mandibular or facial defects.

Abnormalities, Multiple↗
PubMed1989

[Retro-maxillary sequellae of craniofacial stenosis. The value of fronto-facial advancement using the Tessier monobloc technic].

Monobloc fronto-facial advancement (TESSIER's technic) seems to be the best therapeutic to correct retromaxillia, sequellae of cranio-facio-stenosis. From an aesthetical and functional point of view the result is more satisfactory than with a simple LE FORT III osteotomy advancement. Intermaxillary fixation is not necessary. Of course an orthodontic sequence must be associated to correct dental malposition.

Acrocephalosyndactylia↗
PubMed1987

Long face: new proposals for taxonomy, diagnosis, treatment.

The authors suggest a taxonomy and a specific terminology from Greek etymology for vertical maxillo/mandibular excess dysmorphies, "long face" or "high face" (hypsoprosopia) to be more exact, so as to make their diagnosis and their therapeutic approach easier. They distinguish three anomalies which may, separate or in association, cause an increased vertical dimension of the face: hypsomaxillia, hypsogenia and inter incisal anterior vertical gap or hyposostomy, which may itself be differentiated into 3 aetiological sites (vertical posterior maxillary dento-alveolar excess, vertical anterior mandibular dento-alveolar deficiency, excessive gonial angle opening or amblygonia). They submit a clinical and teleradiographic table specific for each anomaly, relying on patients having achieved their full dento-osseous growth. When confronted with associated cases, they can therefore more systematically apply the various osteotomies, partial or total, maxillary or mandibular, or even combined operations.

Cephalometry↗
PubMed1986

Unilateral congenital choanal atresia and maxillary sinus development.

Most authors feel that the maxillary sinus and dento-alveolar arch do not develop normally in case of choanal atresia. This as explained by respiratory deficiency on the atretic side. A series of 11 cases of unilateral choanal atresia, either untreated or treated after the period of maximum growth, have been studied by clinical examination, serial X-rays and cephalometric tracings in order to compare atretic and normal sides. No significant difference has been found, neither for size nor shape of the maxillary sinus. These observations are therefore in contradiction to earlier reported findings and require further study.

Adolescent↗
PubMed1984

[Vertical maxillo-mandibular dysmorphias due to excessive growth. Terminology, diagnosis and treatment].

The authors propose a system of terminology for vertical maxillo-mandibular dysmorphia, "long face" or rather "high face", and "hypsoprosopia" hypsomaxillia to facilitate the diagnosis and the therapeutic approach. They distinguish 3 abnormalities which are responsible, alone or in combination, for an increased height in the face: hypsomaxilla, hypsogenia and vertical anterior inter-incisive aperture (open bite), which can arise in three situations (supra erupted posterior alveolar maxillary segment, infra erupted anterior alveolar mandibular segment, exaggerated opening of the angle of the mandible or amblygonia). They present the clinical picture and the specific teleradiographic features of each abnormality, supported by cases of patients with definite dento-maxillary growth. On the basis of this classification, the authors propose a more systematized approach to the various segmental or total maxillary or mandibular osteotomies, which may be coupled or even combined with advancements or transverse movements in cases of associated dysmorphosis.

Cephalometry↗