Stability of maxillary expansion osteotomy using patient-specific fixation implants without necessitating removable appliances: a retrospective analysis

OBJECTIVE

This study aimed to evaluate the long-term stability of surgical maxillary expansion using patient-specific fixation implants (PSFIs) without intraoral retention.

MATERIALS AND METHODS

Fifteen patients who had undergone segmented Le Fort I osteotomy and PSFIs with available preoperative (t0) early (t1) and 1-year follow-up computed tomography (CT) scans (t2) were evaluated. The early and 1-year 3D models were superimposed to transfer the bony landmarks; the distances between each pair of landmarks at the different time points were then measured. The distances between the canines and second molars were also measured directly on the CT scans.

RESULTS

The achieved maxillary expansions ranged from a median of 4.39 (2.00-6.27) mm at the greater palatine foramina to a median of 2.14 (1.56-2 > 83) mm at the canine level of the palatal bone. One year postoperatively, the changes in skeletal diameters ranged from a median of - 0.53 (- 1.65 to 0.41) mm at the greater palatine foramina (p = 0.12) to 0.17 (- 0.09 to 0.32) mm at the canine level of the palatal bone (p = 0.56). Changes in dental arch diameters ranged from a median of - 0.6 (- 2 to 0.00) mm between the second molars to - 1.3 (- 1.8 to - 0.25) mm between the canines (P < 0.05).

CONCLUSION

This study showed the stability of maxillary expansion osteotomy using PSFIs, even without postoperative intraoral retention.

CLINICAL RELEVANCE

PSFIs are a reliable method for the surgical treatment of transverse maxillary discrepancy. PFSIs are easy-to-use and improve surgical accuracy.

Do mandibular titanium miniplates affect the biomechanical behaviour of the mandible? A preliminary experimental study

INTRODUCTION

Whether to conserve or remove titanium miniplates after rigid internal fixation of mandibular fractures still remains controversial. Miniplates could affect the biomechanical behaviour of the mandible in case of trauma, and therefore cause more complex fractures.

MATERIALS AND METHODS

An experimental study, consisting in simulating a mandibular trauma, was designed in order to compare the fractures caused by an impact on the mandible in the presence or absence of an internal fixation. We simulated an impact on the right parasymphysis region in 10 post-mortem human subjects, according to the Charpy impact test method at an impact speed of 7.4 m/s, using a 5 kg test impactor.

RESULTS

In the control group, the fracture lines were vertical and straight, without comminution. In the miniplate group, the fractures occurred close to the miniplates (4 cases) and under the miniplates (one case). The fracture lines were more complex, even comminuted in 2 cases. Thus, miniplates impacted the biomechanical behavior of the mandible, resulting in more complex fractures.

CONCLUSION

Our experimental study highlighted the impact of the presence of miniplates on the mandible in case of trauma, and the risk of causing more complex fractures. We therefore recommend further investigations to determine if titanium miniplates should be systematically removed after bone healing, in patients with a higher risk of trauma in relation with previous assault injuries, alcohol or substance abuse, the practice of fighting or contact sport/activities, and soldiers.

The association of Le Fort midfacial fractures with frontobasal injuries: a 17-year review of 125 cases, reflections on biomechanics, classifications and treatment

The frequency of midface and frontobasal fractures has increased over the past 40 years despite the improvement and stringent regulation implemented on modern safety equipment (belts, helmets…). This observation might be correlated with the progress of radiodiagnosis tools. Literature was reviewed according to Prisma guidelines. We searched for reviewed articles, published between January 2000 and December 2017, through Medline (Pubmed) online databases and ScienceDirect, using the following MeSH Keywords: "Le Fort classification", "Le Fort fracture", "Frontobasal fracture", "skull base fracture", "Midface Fractures". Among 652 patients with frontobasal fractures, 125 (19.1%) were associated with a Le Fort fracture. 59 (9%) were associated with Le Fort III fracture, 51 (7.8%) with Le Fort II fracture and 15 (2.3%) with Le Fort I fracture. When frontobasal fractures were associated with midfacial fractures, we found 18 cerebrospinal fluid leaks (11.8 %) and 19 cases of meningitis (12.5 %). When only the frontobasal area was involved, there were 6 cerebrospinal fluid leaks (4.3 %) and 6 meningitis (4.3 %). Our results highlight a regular association between Le Fort fractures and frontobasal fractures for stages II and stage III of Le Fort fractures and also found a higher rate of neuro-septic complication. Further research shall investigate treatment and monitoring recommendations fitting modern epidemiology of craniofacial traumatology.

Salivary side effects after radioiodine treatment for differentiated papillary thyroid carcinoma: Long-term study

BACKGROUND

Although many studies focus on short-term side effects of radioiodine therapy, almost none studied long-term side effects. We assessed radioiodine long-term salivary side effects after radioiodine treatment for differentiated papillary thyroid carcinoma and compared it to short-term morbidity within the same population.

METHODS

A standardized self-administrated questionnaire was submitted in 2019 by patients treated with radioiodine between January 2011 and December 2012. These patients had already answered the same questionnaire 6 years before.

RESULTS

Our study showed a significant reduction for salivary side effects: discomfort in submandibular or parotid area, swelling, pain, a bad or salty taste in the mouth, allowing to get back to a "normal" diet.

CONCLUSIONS

Our study suggests that a significant rate of patients will recover from I¹³¹ therapy salivary side effects. As almost 30% of these remissions happened during our late stage follow-up, we highlight the necessity of a long-term follow-up in these patients.

Severe idiopathic pneumoparotitis: Case report and study review

Parotitis is a frequent disease in general pediatrics. Pneumoparotitis is a rare affection that belongs to differential diagnoses of parotitis, along with infections, lymphadenitis, autoimmune disorders, inflammatory conditions, vascular malformations or neoplasms. It is usually described in musicians using wind instruments or in other situations involving a Vasalva maneuver. We report the case of a 12 years old boy with severe idiopathic pneumoparotitis without any of these well-known causes and whose autoimmune familial background of Sjögren syndrome might be relevant.

Retrieving a displaced third molar from the infratemporal fossa: case report of a minimally invasive procedure

Background

The appropriate management of postoperative complication of wisdom teeth removal is of utmost importance as it can result in legal procedures.

The accidental displacement of a maxillary third molar in the infratemporal fossa (ITF), is a rare complication that can occur even with experienced surgeons.

The numerous retrieval techniques reported are invasive and provide an unpredictable access.

Our aim was to achieve the safe and swift retrieval of the tooth displaced to an area of such complex anatomy.

Case presentation

We describe the case of a 17-year-old female patient whose right upper third molar was accidentally pushed upward to the ITF and became unreachable.

Retrieval based on interventional radiology using the CT-guided placement of a bone trocar above the displaced tooth was successfully performed. The postoperative course was uneventful.

Conclusions

CT scan assisted interventional radiology provides both, real-time assessment of the tooth position through image refreshment, and steady stabilization of the displaced tooth. Therefore, it allows a safe and non-traumatic retrieval with a time-efficient procedure achieved through a minimally-invasive approach with inconspicuous scaring. We believe that such a procedure is an interesting treatment option for optimal outpatient care.

To our knowledge, no such case has been previously described.

Electronic supplementary material

The online version of this article (10.1186/s12903-019-0852-z) contains supplementary material, which is available to authorized users.

Stensen duct dilation: Case series of minimally invasive treatment

Stensen's duct dilation is a rare condition characterized by a global or partial idiopathic dilation of the Stensen duct. Affected individuals usually show either aesthetically compromised features, such as a tubular-shaped swelling in the cheek, or with mildly painful inflammatory episodes. Three women between ages 61 and 67 years were diagnosed with Stensen duct dilation after sialo-magnetic resonance imaging (MRI). They were treated with botulinum toxin A (BTX-A). Our preliminary results suggest that BTX-A was efficient as a suspensive treatment. BTX-A should remain a first-line treatment of the early silent symptoms of Stensen duct dilation, such as swelling and aesthetic issues. The use of BTX-A avoids more serious procedures and further complications.