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Purpose: To determine the prevalence of renal vein variants. To investigate the distribution of renal veins., Methods: We retrospectively reviewed spiral computed tomography (CT) scans of the abdomen performed during a two-month period. The same protocol was used for all CT scans: same multidetector-row CT scanner (Siemens(®)), 1 to 2-mm section thickness, injection of intravenous iomeprol. The study group included 121 patients, aged 21.7 to 93.4 years (mean age 60.9 ± 15.4 years). The sex ratio was 2/1, with 80 men and 41 women., Results: Seventy-three percent of the study group (88 patients) had no variants of the renal veins. Indeed almost 40% (48 patients) had one artery and one vein on each side, with typical course, and 33% (40 patients) had course and/or number variants of the renal arteries. Variants of the right renal vein consisted in multiple veins in 20.6% (25 cases). We detected no case of multiple left renal veins, but we described variations of its course in 9.1% (11 cases): 5 cases of retroaortic left renal vein (4.1%) and 6 cases of circumaortic left renal vein (5%). Three of these 11 patients had an associated double right renal vein. The probability to have a right renal vein variant was significantly higher than a left one (OR = 2.6, P = 0.01). And we found a significantly higher risk of having a venous variant in women (OR = 2.4, P = 0.04). We detected no case of inferior vena cava variant., Conclusion: In our study, prevalence of a circum- or retroaortic left renal vein appeared higher than previously reported in the literature (9.1%). Knowledge of anatomical variants of renal vasculature is crucial and this study puts the emphasis on variations of course and number of renal vessels. Those variations are not so uncommon and should be known by radiologists and also by surgeons. Their knowledge has major clinical implications in practice and it contributes to the safety of renal and retroperitoneal surgery., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

The development of computer-aided design (CAD) technologies applied to biomaterials has allowed designing patient-specific implants perfectly adapted to the area to rebuild, and ensuring an easier, less invasive, and optimal reconstruction of the craniofacial skeleton. Custom-made implants, originally developed for the reconstruction of large cranial vault defects, were used to optimize cosmetic results, avoiding the morbidity related to donor site bone harvesting, or preventing frequent asymmetrical result due to peroperative biomaterial design. These implants thus proved very useful for facial skeleton reconstruction including for the orbital region. The preoperative computerized simulation made in collaboration with manufacturers allows optimizing reconstructions specifically for each patient., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Introduction: Septic pseudarthrosis of the mandible is an uncommon complication with several etiologies. The presence of a tooth next to a fracture site is one of the etiological factors. Conservative management of a tooth in or near the mandibular fracture site is often the issue when treating fracture of a toothed part., Observation: A 49 year-old male patient was hospitalized in our department for a bifocal fracture of the mandible (right parasymphysis and left sub-condylar). An open reduction internal fixation with plates and screws was performed. The immediate postoperative period was uneventful except for persistent tooth pain in the parasymphyseal fracture site. At 1 postoperative month, the fracture site was stable and signs of consolidation were documented by the panoramic view. A dentist performed root canal treatment on tooth 42, 8 weeks after surgery, because of recurrent complaint by the patient. At 6 months, clinical and radiological examinations revealed mandibular pseudarthrosis., Discussion: This type of pseudarthrosis case is relatively infrequent. It occurs after endodontic treatment of a healthy tooth close to the fracture site (performed after the physiological delay before bone healing). The bacterial colonization of the fracture site could be related to this endodontic treatment. This case raises questions on the need for endodontic treatment of a tooth near a mandibular fracture site., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Introduction: The use of miniplates in orthognatic surgery, and especially for Le Fort I osteotomies, has brought great improvement in technical aspects, postoperative evolution, and long-term stability. Nevertheless, accurate modelling of theses plates remains problematic because the right balance between malleability and rigidity is hard to determine. This is why we designed an original new miniplate model. The aim of this study was to assess our new model in clinical settings., Material and Method: This novel plate was made of two lateral sockets with two holes on each side, linked by a central bar, 1mm thick like the plate. Three lengths were available. A mechanical study proved that this plate was stronger than a 0.6 millimeter thick plate and that its adaptability was much superior to that of a common 1-mm thick plate. We retrospectively studied 180 patients having undergone a Le Fort I osteotomy with or without mandibular osteotomy. Follow-up ranged from 6 to 12 months. Congenital abnormalities were excluded., Results: Bone healing was achieved without any complication in due time for all but two patients. In one case, a plate fracture was observed. In the other case, a slight mobility of the upper jaw appeared after removal of the device. No intolerance was observed., Discussion: This novel miniplate seems to be improved when compared to other available devices. Rigid osteosynthesis of a Le Fort I osteotomy can be problematic because of the repositioning gap and the variable anatomy of the maxilla. The device must be rigid enough, inconspicuous, and well tolerated. Only three plate lengths are necessary to treat all cases, which reduces cost and storage. The only requirement is to mandatorily insert four plates every time. Removal of the plates does not seem necessary.

Introduction: Bilateral sagittal split osteotomy (BSSO) of the mandibular ramus is the most frequent orthognatic surgery. The risk of neurosensory disorders remains high even their incidence varies according to numerous publications. The anatomical location of the alveolar pedicle seems to be one of the most important factors in these disorders. The aim of this study was to determine its exact role., Material and Method: We performed a retrospective study on 76 patients and 152 osteotomy sides, all of them operated according to the Epker technique by the same surgeon between 2000 and 2004. For each operative side we noted the position of the inferior alveolar nerve during the split: Type I entirely in the internal cortical bone, Type II partially in the external cortical bone, Type III mostly or completely in the external cortical bone. The neurosensory disorders were recorded during clinical examination and simply classified into two categories: "absent" or "present". The outcome was noted during the postoperative follow-up at D1; D15; M1,5, M6, and M12. After that, it was documented through a written questionnaire or telephone conversation., Results: Since there was no difference between the right and the left sides, the study enclosed all of the operative sides together (152). The anatomical distribution was: 97 Type I (63.8%), 28 Type II (18.4%), and 27 Type III (17.8%). Immediate postoperative neurosensory disorders (D1) occurred on 74.3% of sides, with important significant differences between Type I (64.9%) on one hand, Type II (89.2%) and Type III (92.6%) on the other hand. At one year of follow-up, the rate of neurosensory disorders was 20.4% with also a difference between Type I (13.4%) and Types II and III (35.7% and 29.6%)., Discussion: The anatomical location of the alveolar pedicle seems to be important. This study confirms previously published studies and raises the question of CT scan assessment before performing BSSO.

Introduction: Cases of obstructive sleep apnea syndrome have been described after setback osteotomy. Although such cases are rare, they emphasize the importance of taking into account the structure of the upper airways when performing this type of procedure. We studied the modifications provoked in the upper airways by mandibular setback osteotomy performed for dysmorphism., Material and Method: We conducted a retrospective cephalometric study in a series of 25 patients. Preoperative and late postoperative films were digitalized to obtain a precise measurement of the bone displacements and changes in the caliber of the retrovelar and retrolingual spaces. The statistical analysis examined the parameters modified by surgery, particularly airway parameters, and those factors which influenced these modifications., Results: We observed a reduction in the retrolingual space [mean 1.7 mm (p < 0.05)] and displacement of the hyoid bone [mean 2 mm lowering compared with the bi-spinal plane (p < 0.05) and 4.1 mm setback in the Francfort projection (p < 0.01)]. These modifications were not correlated with the mandibular setback (measured as the gonial mental angle) but were strongly dependent on variations in the gonial angle. In 20% of the cases, mandibular setback produced a paradoxical effect: enlargement of the airways., Discussion: Little work has been done on the modifications in the upper airways provoked by osteotomies. Mandibular setback osteotomy can, though only a few cases have been reported, create an anatomic situation favoring obstructive sleep apnea. This series demonstrated the very wide variability of the effects on the upper airways., Conclusion: The risk of apnea should be included as an important parameter in assessing indications for setback osteotomy.

The Information Systems Medicalization Program (PMSI in French) was created in 1985 for Public Health Service Hospitalisation Structures. It appeared to be directly derived from the North-American Diagnosis Related Groups (DRGs) system. Since them, the PMSI has been progressively developed in private structures as well. The authors have had the opportunity to use the latest version of the computer program which was elaborated in order to share the patients into more than 500 different groups of pathology. These groups were called "Homogeneous Patients Groups" (GHM in French). To each group corresponds a "Synthetic Activity Index" number (ISA in French). It is supposed to be representative of the average cost of the management of each kind of patients, based on the diagnosis and the surgery possibly done. Several astonishing findings have been made. Some of them can be summarized as mentioned below: In maxillofacial Surgery, each group (GHM) seems in fact to be extremely inhomogeneous: for example, total parotidectomy with preservation of the facial nerve belongs to the same group as accessory salivary gland exeresis. Total skin graft is in the same group as free composite osseous flap with vascular anastomosis. Coding a surgical procedure leads often to reduce the ISA number in comparison with the same patient without surgery: "impacted third molar" gives 754 points without surgery but only 658 if surgery is performed. Carcinologic surgery is wholly grouped in the same category, even for rather short procedures as isolated partial glossectomy. This group corresponds to a great number of ISA points (6486) while bimaxillary surgery or free flap transfer gives less than 2500 points. In conclusion, the use of the PMSI to allocate financial means can be extremely dangerous for maxillofacial surgery units and consequently for the quality of the medical care in our Specialty. Further studies are obviously necessary to complete a critical analysis of the current system and to improve it.

We present a retrospective study of 48 isolated mandibular fractures related to athletic activities. We studied patient age, sex, sport involved, mandibular location of the fracture and the therapeutic implication. The sex ratio was 4/1 and mean age 24 years. Rugby and cross-country biking were the more frequently involved sports (79%). We recall preventive measures. Miniplate osteosynthesis was used as often as possible in order to avoid intermaxillary fixation (IMF) (40%) or to limit the duration of IMF. This allowed early return to sport activities.

Internet has a wide range of functions applicable in the medical domain. Its use has had a clear impact on routine medical practice. The user can consult colleagues, send and receive multimedia files, order books from the library, access specialized reviews or worldwide scientific data on-line as well as publish results, and participate in forums, telephone or organize teleconferences in real time. Faced with the abundance of the available information flow and the methodological difficulty in extracting precisely useful data, the ordinary user can wander a long time in cyber-space before learning the skills required for efficient navigation. We recall here the fundamental principles of the Internet and describe the types of information the maxillofacial surgeon can use in his everyday practice. Certain unanswered questions are debated as well as certain difficulties related to the use of the Internet in its present state of development.

Lipomas are uncommonly located in the tongue and multiple forms are rare. We describe a case of multiple lipoma of the tongue in a female patient aged 60 years who also presented subcutaneous cervical lipoma. The literature on multiple lipomas is discussed.

The authors describe a new intermaxillary fixation (IMF) technique. This technique is particularly easy and quick. It needs usual 4/10 or 5/10 steel wire with a small pearl fixed at one extremity. Four wires are used, passed from lingual side to vestibular side, between premolars. Wires are then linked and intermaxillary fixation is performed. Osteosynthesis is realised by intraoral approach. This technique does not allow to maintain IMF during a long postoperative period. Therefore, it should be reserved for cases where miniplate osteosynthesis will be sufficient. It seems interesting to use this technique for monofocal mandibular fractures, in association with rigid miniplate osteosynthesis.

The aim of this work was to study long-term airways space changes after maxillomandibular osteotomy in order to assess benefit of this surgery in case of obstructive sleep apnea syndrome. Preoperative and postoperative cephalometric airway spaces evaluation of 43 patients (who did not have obstructive sleep apnea) was done. Analysis revealed no charge in velopharyngeal space, lingual-pharyngeal augmentation in case of mandibular advancement. Hyoid bone position was not modified by osteotomy. Signification and interest of this finding for patients with obstructive sleep apnea are discussed through literature data.

The authors give an Internet short historical record, then describe the different services offered and the possible applications for oral and maxillo-facial surgery. Electronic-mail (E-mail) provides the ability to compose, send and receive messages through the computer and allows exchanging informations with colleagues around the world. Programs, files and graphics can be transferred from one computer to another. The "news groups" are interesting in various subjects and allow a team work. We find several hundred sites about maxillo-facial surgery. These sites present a medical department, diagnosis problems or therapeutic solutions, medical press. Any information submitted is insecure and could be observed by a third party while in transit. Internet potential (educational benefits, digital access to medical literature, online consultation service) is mentioned in the end of the article.

Now, the excellent long term results observed in oral implantology allow use of implants in young people. They change habitual prosthetic indications which need healthy teeth mutilations. The authors present a case of multiple dental agenesis in a young girl. She was treated by orthodontic preparation and implants with a good final result (2 years end treatment follow up).

The possibility to obtain a skin anaesthesia using only an ointment may be very usefull for outpatient surgery. Recently available in France, the lidocaine-prilocaine cream give an interesting local anaesthesia. We have used this new presentation as skin preparation before otoplasty for 10 patients. As the local anaesthesia injections are then performed without pain, the comfort of the patient is greatly improved. Furthermore, it is easy to sue and without side-effect. The main disadvantage consists in the action delay of one hour, with the necessity to ask the patient to come earlier.

A 71 patients series is presented, concerning primary orbital floor reconstruction by a polydioxanone cup (PDS degree) which has been used for five years. The technical data and surgical procedure are exposed. No infection either intolerance manifestation has been observed until the materiel was resorbed. Two early displacements of the implant are reported, due to a technical fault during the insertion of the cup. Only one late enophtalmy was observed for a patient with a large orbital floor defect. The loss a the rigidity of the polydioxanone seems to be relatively fast (probably 2-3 months) and leads to contraindicate its use in cases of large osseous traumatic defects. In all other cases, this surgical technique seems to be very useful.