Observations on the role of surgical splints in orthognathic surgery

Surgical splints can be used in orthognathic surgery, following orthodontic-surgical symbiosis. These splints are used to monitor the maxillomandibular region and three-dimensional intraoperative movements. The use of these splints is currently based on findings from a clinico-radiological analysis and preparation by the dental technician using tools like maxillomandibular occlusion waxes and articulator. The results seen so far are all satisfactory. We will discuss the emergence of digital surgical splints and changing results

La gouttière chirurgicale, place dans la chirurgie orthognathique et perspectives

La chirurgie orthognathique, issue de la symbiose orthodontico-chirurgicale, peut s’appuyer pour sa réalisation sur l’utilisation de la gouttière chirurgicale. Ce sont des guides chirurgicaux qui permettent de transmettre les informations relatives aux mouvements tridimensionnels maxillo-mandibulaires souhaités en peropératoire. Leur confection repose actuellement sur un travail d’analyse clinico-radiologique et une préparation par le prothésiste au terme d’une série de procédures qui seront détaillées. Les gouttières chirurgicales permettent de traduire le plan de traitement en une réalisation technique chirurgicale. Avec la numérisation chirurgicale en pleine expansion, les moyens de réalisation des gouttières seront amenés à changer, nous détaillons ces perspectives

Trans-oral versus cervico-facial lift approach for mandibular angle resection in facial feminization: A retrospective study

International audienceINTRODUCTION: Mandibular angle resection is an important procedure in facial feminization surgery. Two different approaches are described: trans-oral and cervico-facial lift (CFL) approaches. The aim of the study was to compare surgical outcomes and patient's satisfaction between the two approaches. MATERIAL AND METHODS: We retrospectively analyzed medical charts of patients who underwent mandibular angle resection in the same center by the same surgeon between 2017 and 2019. Aesthetic and functional results were objectively assessed using serial photographs and subjectively with patient self-assessments. All patients benefited from a medical consultation at least 6 months after the surgery. RESULTS: Seven patients benefited from trans-oral approach and 14 from CFL approach. The mean age was 42. No major complications occurred. No long-term nerve damage was found. Aesthetic evaluation showed mostly an improved result. All patients answered positively to the quality of life survey. DISCUSSION: These preliminary results of the study suggest that mandibular angle resection is a much-needed and safe surgical procedure regardless of the surgical approach. Patients who underwent facial feminization surgery frequently present a mixed indication of CFL and mandibular angle resection. The study is limited by the low number of patients included. Moreover, interpretation of results is biased because the patients benefited from other minor facial cosmetic procedures in the same surgery. We reported the first analysis of transgender patient's satisfaction concerning mandibular angle resection. This procedure improves quality of life as well as facial aesthetics for transgender patients

Reverse tensor fascia latae perforator flap for reconstruction of knee defect: Anatomic study by computed tomographic angiography and a case report

International audienceBACKGROUND: Reverse anterolateral thigh perforator (ALTp) pedicle flap can be used to reconstruct perigenicular defect thanks to the anastomoses between the descending branch of the lateral circumflex femoral artery (LCFA) and the perigenicular network. In a few cases, however, patients do not present any ALTp. We hypothesized that, in such cases, an adjacent perforator, the tensor fascia latae perforator (TFLp), emerging from the LCFA ascending branch, could be used instead. To assess the feasibility of this technique, a radiological study was conducted. A first patient was treated using this option. METHODS: Sixty lower limb computed tomography were analyzed. The first treated patient was a 50-years-old man suffering from a 5-mm chronic bone exposure and osteomyelitis. Other reconstructive options were not indicated since he presented a multiscarry leg, severe arteriopathy, and no ALTp. A TFLp flap was raised, and the LCFA ascending and descending branches were dissected in continuity. After ligation of the LCFA, the blood flow reversed in the descending branch to irrigate the flap through the ascending branch. RESULTS: A TFL perforator was observed in all the cases of the radiological study. The LCFA branching pattern was compatible with achieving a reverse TFL perforator flap in 43 cases (72%). The average pedicle length was 32 cm (22-38 cm). In the first clinical case, the flap covered the defect easily. After three months, the patient showed no evidence of infection recurrence and recovered a painless walk. CONCLUSION: The reverse TFLp flap can be a suitable option for perigenicular reconstruction

A mantle plume origin for the Palaeoproterozoic Circum-Superior Large Igneous Province

The Circum-Superior Large Igneous Province (LIP) consists predominantly of ultramafic-mafic lavas and sills with minor felsic components, distributed as various segments along the margins of the Superior Province craton. Ultramafic-mafic dykes and carbonatite complexes of the LIP also intrude the more central parts of the craton. Most of this magmatism occurred ∼1880 Ma. Previously a wide range of models have been proposed for the different segments of the CSLIP with the upper mantle as the source of magmatism. New major and trace element and Nd-Hf isotopic data reveal that the segments of the CSLIP can be treated as a single entity formed in a single tectonomagmatic environment. In contrast to most previous studies that have proposed a variety of geodynamic settings, the CSLIP is interpreted to have formed from a single mantle plume. Such an origin is consistent with the high MgO and Ni contents of the magmatic rocks, trace element signatures that similar to oceanic-plateaus and ocean island basalts and εNd-εHf isotopic signatures which are each more negative than those of the estimated depleted upper mantle at ∼1880 Ma. Further support for a mantle plume origin comes from calculated high degrees of partial melting, mantle potential temperatures significantly greater than estimated ambient Proterozoic mantle and the presence of a radiating dyke swarm. The location of most of the magmatic rocks along the Superior Province margins probably represents the deflection of plume material by the thick cratonic keel towards regions of thinner lithosphere at the craton margins. The primary magmas, generated by melting of the heterogeneous plume head, fractionated in magma chambers within the crust, and assimilated varying amounts of crustal material in the process