Biomedical subjects
Publications and source records attributed to P Daelemans.
This series encompasses thirteen fractures of the mandible treated by external fixation. The indications were five fractures of edentulous mandible, four fractures through missile wounding, and four fractures without soft tissue lesion treated in Africa. Twelve patients were found to show good or excellent results. In our indications, this method is a successful approach to the treatment of the fractured jaw.
The concept of osseointegration which means direct contact between bone and implant has provided new possibilities for implantology and a much more serious approach of the method. Implants are placed following a two phases schedule: first a surgical procedure with a sophisticated insertion of the implants and 3 to 6 months later a prosthetic procedure. Implants can be used in many applications: single tooth replacement, partial and total edentulism. Osseous grafts can be added if needed. Connected and non-connected bridges are built on implants with a tendency to use more non-connected bridges. If all the conditions of placement of the implants and of realisation of the prosthetic supra-structures are respected, there are very few complications. Implants are actually the unique possibility to give the patient fixed oral rehabilitation while preserving the remaining bone and teeth.
The development of microvascular surgery has allowed the transfer of revascularized bone grafts. The surgical techniques of the most useful transfers are explained. The advantages, disadvantages and indications of these procedures, as compared with the other techniques of bone reconstruction, are discussed.
Development of microsurgery has involved the use of revascularized bone grafts in maxillo-facial surgery. They are essentially indicated in rebuilding of complex tissues lost including bone. Their utility is well know in maxillofacial surgery, cervico-facial cancerology, ballistics trauma and in the cure of some mandibular osteoradionecrosis. Only scapular and iliac autogenous bone transplants were used by the authors. Following their short experience, they preferred the pediculated iliac transplants on the deep circumflex vessels more easy to handle and more secure. They brought some modifications in the graft technics in order to decrease the functional and the esthetic damages at the donor site: the incisions were parallel to the iliac crest an to the crural arch. The transplant respected the integrity of the antero-superior-iliac-spine and the crural arch. At the receiving site the muscle was left denuded in the oral cavity. The reepithelialization was observed in a short time.
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The authors present a serie of 20 cases of craniofacial injuries with or without CSF leakage. They propose a simple classification in 2 groups following the impact: braniofacial injury or orbitofacial injury. For their, craniofacial or orbitofacial injuries are to be operated in one stage by an neurosurgical and maxillofacial team. The best time for operation is approximately around the 10th day following trauma.
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