Clinical and biomechanical approaches to mandibular osteosynthesis after bone healing

L’utilisation de miniplaques d’ostéosynthèse en titane est la technique de fixation de référence des fractures de la mandibule ou des ostéotomies mandibulaires.Les conséquences biomécaniques de la conservation de ses miniplaques en cas de traumatisme mandibulaire n’ont pas été étudiées, alors qu’elles pourraient exposer à un risque de fractures plus complexes.L’objectif de notre travail a été d’évaluer les conséquences biomécaniques d’un traumatisme mandibulaire survenant sur une mandibule porteuse de miniplaques d’ostéosynthèse après consolidation osseuse.Une mise au point sur la biomécanique de la mandibule et les propriétés de ses ostéosynthèses, ainsi que sur la consolidation osseuse a permis de comprendre les controverses actuelles autour de l’ablation du matériel d’ostéosynthèse. Une série de cas de fractures sur mandibules porteuses de miniplaques d’ostéosynthèse a identifié les patients à risque et a décrit les fractures observées en pratique clinique. Une étude expérimentale sur sujets anatomiques a montré, qu’en présence de miniplaques, les traits de fracture apparaissaient plus complexes et survenaient en bordure de celles-ci. Enfin une analyse en éléments finis mandibulaire a décrit une répartition différente des contraintes en présence de miniplaques pouvant expliquer la complexité des fractures sur mandibules porteuses de miniplaques. La conservation de miniplaques d’ostéosynthèse entraine un risque de fractures plus complexes en cas d’impact direct sur les miniplaques. Cette information devrait être donnée aux patients après la mise en place de matériel d’ostéosynthèse et leur ablation proposée si le patient en fait la demande.Titanium miniplates are the gold standard for mandibular fractures and osteotomies fixation.The titanium biological properties of osseointegration have questioned the value of removing miniplates after bone healing. However, the biomechanical consequences of keeping the miniplates in case of mandibular trauma have not been studied, while they could expose to a risk of more complex fractures. Our aim was to evaluate the biomechanical impact of titanium mandibular osteosynthesis in case of trauma after bone healing.A focus on the biomechanics of the mandible and the properties of its osteosynthesis, as well as on bone healing, allowed understanding the current controversies regarding the removal of miniplates. A case series of mandibular fractures with miniplates identified patients at risk of fracture on a mandible with miniplates, and described the fracture patterns observed in clinical practice. An experimental study on post mortem human subjects showed that in the presence of miniplates, fracture features appeared more complex and occurred at the edges of the miniplates. Finally, a mandibular finite element analysis described a different distribution of stresses in the presence of miniplates, which could explain the complexity of fractures on miniplates. The treatment of these fractures is more complex.Keeping mandibular miniplates could lead to a risk of more complex fractures in case of direct impact on the miniplates. This information should be given to the patients benefitting from mandibular fixation with titanium miniplates and their removal after bone healing should be proposed to patients with a high risk of mandibular fracture

Epidémiologie d'une consultation spécialisée hospitalo-universitaire de chirurgie orale

International audienceEpidémiologie d'une consultation spécialisée hospitalo-universitaire de chirurgie oral

Epidémiologie d'une consultation spécialisée hospitalo-universitaire de chirurgie orale

International audienceEpidémiologie d'une consultation spécialisée hospitalo-universitaire de chirurgie oral

Update of photobiomodulation in oral mucositis: a systematic review

Introduction: Oral mucositis (OM) is a common side effect of radiotherapy (RT) or radio-chemotherapy (RT/CT) for head and neck cancers. It causes lesions leading to impairment of the quality of life, dysphagia, pain, and in up to 20% of cases, a dosimetry concession, decreasing local tumor control, thereby impacting the survival rate. Positive results of photobiomodulation (PBM) to treat it have been reported in the literature. PBM has multiple parameters (type of laser, emission mode, number of sessions to be performed, wavelength, power, energy, fluence, exposure time, number of points) making it difficult to implement in clinical practice. Materials and methods: A literature search strategy was applied in Medline by selecting articles published between 2010 and 2020 to answer the following research question: “In patients treated with RT or RT/CT, what is the place of PBM in the management of OM?”, in accordance with PICO (patient, intervention, comparison and outcomes) criteria. The inclusion criteria were all original articles (clinical cases and clinical studies) which answered the research question. Meta-analyses, systematic reviews of the literature and journals, animal or in vitro studies, studies published in a language other than French or English, and full-text articles not accessible via inter-university credits were excluded. Results: Seventeen articles were included, representing 1576 patients. The PBM was intraoral in 16 papers and combined intra- and extra-oral emission in 1 paper. InGaAlP diode laser and HeNe laser significantly reduced OM compared with placebo in 62.5% and 75% of the studies, respectively. Pain reduction was poorly or not documented and when it was, it did not correlate with the reduction of analgesics. Temporary or permanent interruption of radiotherapy was also poorly documented. Discussion: The MASCC/ISOO (2019) report is an important step forward to establish a reproducible protocol for PBM, which as our results show, is heterogeneous in use. Our results showed that the studies started PBM on the first day of RT, using a wavelength of 660 nm for diode laser and 632.8 nm for HeNe laser. However, there is no scientific evidence vis-à-vis the values for power, energy, fluence, exposure time, or number of points. Although PBM appears to be effective in reducing OM scores, its effectiveness on improving patient quality of life, pain, painkiller consumption, compliance with treatment and the occurrence of complications remains to be defined. The relationship between PBM and survival rate was not an objective of this work. We found that of the 17 articles, 15 stated that they did not illuminate the tumor site during PBM sessions. Conclusion: The main objective of this work was to determine the place of PBM in the treatment of OM. Overall, the results on OM scores were favorable in almost ¾ of the studies. Despite its efficacy, the questions of the adjustment of the parameters of PBM, the harmonization on OM scale and its safety on carcinologic recurrence remain to be studied. In view of the lack of comparability of studies and the lack of reported data, studies that harmonize endpoints and follow-up criteria are needed to establish a standard protocol

[Salivary glands disease].

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Quality of life in patients with head and neck cancer : impact of prosthetic rehabilitation

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Sialendoscopy-Assisted Duct Transposition in Ectopic Accessory Parotid Gland: Case Report and Surgical Management

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Cystinuria: One Possible Reason for Kidney and Salivary Gland Lithiasis Relationship

International audienceSalivary gland lithiasis affects 1 to 2% of adults. The submandibular glands are concerned in 87% of cases. An association between kidney and salivary lithiases, although often mentioned, has rarely been observed. We relate an exceptional case of parotid and submandibular cystine sialolithiasis with kidney cystine lithiasis in a patient with cystinuria. Cystine lithiasis occurs in 1% of kidney lithiasis cases. The purpose of this article is to discuss the arguments, diagnosis, and therapeutic attitude in front of salivary cystine lithiasis. The patient was a 56-year-old woman treated for cystinuria undergoing a consultation for parotid lithiases. We obtained a panoramic view and performed a cervicofacial computed tomography scan, sialo-magnetic resonance imaging, and sialendoscopy. We found multiple lithiases in the distal portions of the Stensen duct, and 2 days after sialendoscopy, the patient expelled small sialoliths. Salivary lithiasis in patients with cystinuria has the same biochemical composition as kidney lithiasis. A computed tomography scan is efficient in most cases, but sialo-magnetic resonance imaging may be the only noninvasive method to diagnose small cystine salivary lithiases, such as those that can be seen in patients with cystinuria. Sialendoscopy is still an efficient diagnostic and therapeutic method for every type of salivary lithiasis.Copyright © 2017 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved

Salivary Calculi Removal by Minimally Invasive Techniques: A Decision Tree Based on the Diameter of the Calculi and Their Position in the Excretory Duct

International audiencePURPOSE: To suggest a decision tree for the choice of the best minimally invasive technique to treat submandibular and parotid calculi, according to the diameter of the calculi and their position in the excretory duct.MATERIALS AND METHODS: Submandibular and parotid ducts can both be divided into thirds, delineated by easily recognizable landmarks. The diameter of calculi is schematically classified into 1 of these 3 categories: floating, slightly impacted, or largely impacted.RESULTS: Using 3 criteria, the type of gland involved (G), the topography (T) of the calculus and its diameter (D), a 3-stage GTD classification of calculi was established. Next, the best indication for each available minimally invasive technique (sialendoscopy, transmucosal approach, a combined approach, intra- or extracorporeal stone fragmentation) was determined for each calculus stage.CONCLUSIONS: The minimally invasive treatment options are numerous and have replaced invasive resection surgical approaches (submandibulectomy and parotidectomy) in the management of salivary calculi, significantly improving the prognosis of these diseases. We emphasize the need for flexibility in the surgical indications and challenge the dogma of "all endoscopic" management of salivary calculi.Copyright © 2017 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved

Do mandibular miniplates increase the risk of complex fracture in facial trauma recurrence? Case series

Whether to conserve or remove miniplates, widely used in oral and maxillofacial surgery, has not been agreed on in the literature. Complications such as pain, infection, and screw exposure or loosening have already been largely described. We present the consequences of a trauma recurrence on a mandible with miniplates. The data of 13 patients who had a mandibular fracture previously surgically treated with miniplates (ten mandibular fractures and three mandibular osteotomies) were analysed. All the patients were male; the average age was 32 years (range, 20-64 years). The mechanism of the second trauma was assault in most of the cases. The average time between the first osteosynthesis and the new fracture was 35 months (range, 6-128 months). The fractures occurred at a distance from the miniplates in all the cases except two. No plate fracture was reported. We hypothesised that miniplates reinforced the underlying bone, protecting it from fractures, and transmitted the forces to areas anterior or posterior to the miniplates or to the condyle. Thus, the risk of mandible trauma recurrence should be taken into account in the indication of plate removal, and the biomechanical consequences of the conservation of the miniplates should be studied