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La ventilation par embout buccal dans les maladies neuromusculaires.Le document qui suit est la traduction intégrale du compte rendu établi à l’occasion du 252

During the last two decades, computer-assisted surgery (CAS) has drastically changed the strategy for craniofacial reconstructive surgery, especially with respect to the prediction of preoperative virtual and ideal bone repositioning for correction of developmental or post-traumatic malformations. Intraoperative navigation and computer-aided design and modeling techniques (CAD/CAM) allow for the transfer of the virtual planned reconstruction to the operating room by guaranteeing a real time assistance during the realization of the surgical task and respectively by using patient-specific implants, surgical cutting and drilling guides. This approach has thus significantly contributed to improve the clinical accuracy, predictability and patient outcome, compared to traditional techniques.Au cours des deux dernières décennies, la chirurgie assistée par ordinateur (CAO) a drastiquement changé la stratégie de prise en charge des patients en chirurgie reconstructrice crâniofaciale complexe, notamment pour la correction des malformations congénitales ou post-traumatiques. La navigation peropératoire et la conception et fabrication assistées par ordinateur (CFAO) permettent un transfert de la reconstruction planifiée virtuellement, directement au bloc opératoire via une assistance en temps réel pendant l’intervention chirurgicale et en utilisant des implants, des guides de coupe et de forage spécifiques au patient. Par rapport aux techniques conventionnelles, cette méthode a contribué de façon non négligeable à améliorer la précision, la prédictibilité clinique des résultats et la satisfaction des patients.

Dental injuries are among the most common complications of general anesthesia. Yet few studies have assessed the costs and factors that involve the responsibility of the anesthetist.A retrospective study was conducted at the university hospital of Reims on 46 cases of dental injuries directly related to anaesthesia.Ten patients made a claim for compensation. Two of them have received compensation following a medical expertise, which revealed for the first patient a possible alternative to general anaesthesia, and the second, hardware failure of intubation. The Administrative Court was entered once in 9 years. The global insurance-cost amounts to 4476 euros for all patients. The review of all cases of anaesthesia shows clearly that the dental claims are associated with a significant under clinical evaluation of dental status and criteria for difficult intubation during the anaesthesia. The information to the patient on this risk is not obvious from reading the anaesthesia records. No mouth guard was used.This work proves that the statements of caution are the most common and a minority of dental trauma lead to a claim. Claims are due to the high cost of dental care repair. The proportion of patients receiving benefits is extremely low. Medical expertise is an essential part of the evaluation of medical responsibilities. No compensation was paid without expertise. The lack of physical examination and information are contrary to our professional obligations and may involve our responsibility. The lack of patient information is not generated for compensation to the extent that the consequences of failure are easily dental weighed against the benefits of the entire medical-surgical procedure that the patient has agreed.

Wrestling is a sport that is deeply-rooted in Senegalese cultural values. It is a popular sport that comes from local traditions but that has been influenced by boxing. This influence has made wrestling evolve to include the practice of boxing without gloves. Howeve, this practice causes many traumas in the mouth and teeth. The general objective of this study is to determine the frequency of the traumas among wrestlers who practice this form of wrestling associated with boxing. The specific objectives are to appreciate the bucco-dental conditions of the wrestlers, to evaluate the frequency and nature of the traumas in the intention to make recommendations and offer perspectives. 63.2% of wrestlers have at least presented a buckle or dental trauma. 28.8% of bucco-dental traumas occur among young wrestlers between 25 and 30 years and, 22.4% relate to the group between 19 and 24 years. 24.8% of bucco-dental traumas occur among wrestlers of the first category, followed by these of the second category with 21.6%, the fourth category with the lowest rate, 4% being last. It has been noted that 60% of buck-dental traumas occur in championship matches. 77.2% of dental and bucco traumas affect the upper jaw while. 22.8% affect the lower jaw. Affect teeth are often the group incisivo-canin. The National committee for the Management of wrestling in Senegal should make mandation the wearing of adapted gloves to attenuate the impact of blows. The Committee could also ban the inclusion of boxing practices in traditional wrestling and make compulsory the wearing of teeth protect in devices to minimize cases of bucco-dental traumas.

Taking into account the number of teeth which are yearly irreversible traumatised during sport activities, the general use of mouthguards would contribute positively to the prevention of dental injuries. Custom-made mouthguards are more comfortable to wear and offer better retention and protection than stock and mouth-formed mouthguards. Different kinds of materials are available on the market for the construction of mouthguards. A polyethylene-polyvinylacetate copolymer (EVA) is the most suitable material. EVA allows the inclusion of hard or soft layers within the mouthguard. The thickness of a mouthguard is important for the reduction of applied forces to teeth: energy absorption capacity increases with material thickness. Increased thickness however, is associated with a reduction of comfort. Therefore, it is important that dentists take the patients' wishes and demands on both comfort and protection into consideration. A description of the clinical and technical method for the construction of a custom made mouthguard is given.

Taking into account the number of teeth which are yearly irreversible traumatised during sport activities, the general use of mouthguards would contribute positively to the prevention of dental injuries. Custom-made mouthguards are more comfortable to wear and offer better retention and protection than stock and mouth-formed mouthguards. Different kinds of materials are available on the market for the construction of mouthguards. A polyethylene-polyvinylacetate copolymer (EVA) is the most suitable material. EVA allows the inclusion of hard or soft layers within the mouthguard. The thickness of a mouthguard is important for the reduction of applied forces to teeth: energy absorption capacity increases with material thickness. Increased thickness however, is associated with a reduction of comfort. Therefore, it is important that dentists take the patients' wishes and demands on both comfort and protection into consideration. A description of the clinical and technical method for the construction of a custom made mouthguard is given.

Prevention of traumatic tooth injuries during sports practice in children who are particularly at risk due to their dental and maxillary morphology is important when establishing a certificate of aptitude to sport. In some children this may provide an occasion to propose an orthodontal correction for dental protrusion. In any case, fitted protective mouth-pieces made by a competent dental surgeon should be recommended. They are preferable to the commonly available gum shields, which are not secure enough.

Twenty patients with severe and chronic respiratory insufficiency (SaO2 less than or equal to 80% - PaCO2 greater than or equal to 50 mmHg) were treated with intermittent ventilatory assistance. They used volumetric apparatus 2 to 8 hours a day, during at least 6 months (22 months +/- 13). Respiratory status never improved strikingly, on the contrary most of the time it worsened and patients needed other ventilatory technics and/or died (11 of 20). This technic of ventilatory assistance does not seem to really change the prognosis of these patients in a severe and chronic state.

The authors describe an optical technique enabling patients with chronic respiratory insufficiency, at first to get used to assisted ventilation, then to control it, to obtain an active ventilation operated by machine corresponding to a particular shape of the pressure curve and the lesser haemodynamic repercussion.