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Minimally invasive techniques (MIT), including sialendoscopy, extracorporeal lithotripsy and intraoral approach, have to be preferred in parotid stones removal. In case of MIT failure, a combined intra- and extra-oral approach can be achieved. The aim of our study was to evaluate the efficacy and the complications of these combined approaches.A retrospective study has been conducted on patients treated between 2006 and 2015. All adult patients presenting with one or more parotid stones and in whom TMI failed have been included. Age and sex of the patients, number, size and location of the stones, result of the procedure, occurrence of pain, swelling, or infection have been recorded.Nine patients were included (mean age: 56). Mean follow-up was 48 months. Eighty-eight percent of patients had an unique stone. Nine stones were extracted by combined approach. Mean diameter of the stones was 8.5mm and 33% of them were located at the junction between middle and posterior third of parotid duct. All the patients suffered preoperatively from daily retention symptoms, such as pain (55%) and swelling (100%). Two patients had an infectious complication (duct and/or gland infection). Seventy-five percent (9/12) of stones were removed. Complications consisted of 1 fistula, 1 facial paresis, 3 recurrences. Seven of 9 patients (77%) had a total relieve after surgery.Surgical combined approaches for parotid stones removals are indicated after failure of MIT when symptoms affect quality of life.

The aim of our study was to report the incidence of complications requiring early or late reoperation after bone and fat orbital decompression for Graves's ophthalmopathy.We conducted a retrospective bicentric study in the Maxillofacial Surgery Departments of Marseille and Lyon. Ninety patients were selected from 2006 to 2010, accounting for 168 orbital decompressions. The surgical indication was morphological and functional for all patients. Several surgical techniques were used: bone and fat orbital decompression by trans-palpebral resection, two or three wall orbital decompression, malar valgization.Ten patients were reoperated for 12 revisions, two patients needed two revisions. There were four early revisions for two retro-orbital hematoma, one inadequate orbital decompression with persistent posterior compressive optic neuropathy, and one recurrent maxillary sinusitis with proptosis. The other eight revisions were carried out later for three cases of insufficient correction, four cases of proptosis relapse, and one for excessive correction with enophthalmos. All patients had satisfactory morphological and functional results despite revision surgery.Most reoperations are difficult to anticipate and their prevention is based on more or less specific recommendations. Patients should be informed of the risks and benefits and accept the possibility of reoperation. A systematic multidisciplinary consultation would standardize and improve the management of these patients, by detecting patients at risk of complications and thus reoperation.

Proximal submandibular calculi are usually removed by transcervical submandibular sialadenectomy. The aim of this study was to show that intraoral removal of hilar submandibular calculi gives the same results with fewer complications than submandibulectomy.The surgical indication is assessed by palpability of the stone and confirmed by simple CT scan. The surgical procedure is performed under local or general anaesthesia. At the end of the procedure, the duct is controlled with a sialendoscope to remove remaining concretions. We prospectively followed 36 patients with a mean follow-up of six months (one to 36 months).The transoral removal of calculi was performed in 34 patients without any definitive neurological complication. The procedure failed in two patients with nonpalpable calculi. Two patients had a recurrence of symptoms due to small intraglandular calculi, which were evacuated later.The transoral removal of submandibular hilar calculi is a safe and reproducible procedure with less morbidity than submandibulectomy. It should be recommended for posterior palpable submandibular calculi.

Ophthalmic manifestations of nasal obstruction can involve palpebral, orbital and ophthalmic disturbances. They can be the consequence of -Direct contact with the nasal obstruction because the orbital cavity drains partly in to the nasal fossae: rings, lipoptosis, blephaochalasis, fat protrusions, aggravation of exophthalmy in Grave's disease. -Oral breathing: there are modifications in the shape of the palpebral fissure (round eye) by stretching of the facial mask and modifications of the orbital rims (sad eye) due to a lack of naso sinusal expansion, often associated with malocclusion. -A biomechanical correlation between the dental occlusion and the orbital area because of the presence of the maxillary sinus. Every occlusal disorder has an influence on projections of the supra-and infraorbital rims.

Lingual nerve damage is one of the main complications of mandibular third molar removal. In literature, the series published are heterogeneous so we have decided to study the importance of the lingual protection only during germectomies (wisdom teeth without root formation).We conducted a randomized prospective study in 300 germectomies, operated by the same skilled surgeon. These 300 third molar removals have been divided in two groups, one with lingual nerve protection and one without.Lingual nerve injuries following germectomies, with or without lingual protection was 0%.In germectomies, one can avoid lingual protection.

Genioplasty is one of the safest interventions in orthognathic surgery. We reviewed a series of 200 cases of genioplasty with or without other osteotomies and found 6 complications. We compared our findings with the rare data reported in the literature. We were able to distinguish: peroperative complications: atypical osteotomy, hemorrhage, soft tissue damage, injury to the mental nerve; postoperative complications: neurosensory deficits, hematoma, infection, secondary displacement, bone necrosis, mental ptosis, defective ossification, dental lesions, paradontal lesions, irregular mandibular contours. We present a discussion on means of prevention and treatment of these complications following genioplasty.

The effects of acute anxiety on food intake and preferences were investigated in 12 men awaiting surgery for hernia. Their lunch intake was measured on the day prior to surgery and again after recovery, one month later. Their anxiety was rated on both test days as well as the palatability of the foods they selected and ingested ad libitum. Anxiety was significantly higher on the day before surgery than on control day. However, no hyperphagia appeared and food selection was not systematically disturbed. Protein, lipid, and carbohydrate ratios in the test meals were not affected by the level of stress. The present results are at variance with some, but not all, studies of food intake under stress in animals and humans. Among other factors (nature of stressor, intensity of anxiety, sex of the subjects), culturally determined eating habits could contribute to the discrepancies observed.

Without antibiotherapy, biliary surgery is often followed by infectious complications, possibly serious, indeed life-threatening. Biliary bacteria do are responsible of these complications; mainly E. Coli, Streptococcus faecalis (whose pathogenicity is disputed) and Klebsiella. Bacteroides fragilis and Pseudomonas aeruginosa are restricted to special circumstances. It is often difficult to presee whether bile is infected: some risk factors were emerged by Keighley but their specificity is not excellent; peroperative Gram staining got various results according to the studies. Some prefer to give a systematic antibiotherapy. Preoperative antibiotic treatment should be as short as possible because it does not sterilize bile, but selects resistant bacteria, which induce postoperative complications. It must mainly be aimed at preventing infectious scattering. Surgery is the main part of the treatment. Antibiotic choice has to take into account clinical picture, bacteria (those probably responsible for and their sensibility) and goal of the treatment (prophylactic or curative). Analysis of failures should allow to improve this choice. But only multicenter studies concerning full selected populations of patients are able to prove superiority of one antibiotic to another.

Sixty patients having to undergo a biliary operation with high risk of infection (Keighley's criterions) received at random either cefazolin (CFZ) or cefoperazone (CFP) as a prophylactic antibiotherapy. Postoperative courses were fairly normal: a peak of temperature on day 5 for one case and a digestive bleeding due to hypoprothrombinemia for another case. No further complication occurred. Patient discharge was two days shorter with cefoperazone and biliary positive cultures were in favour of cefoperazone (21% with CFZ, 11% with CFP) but without statistically significant level. Consequently, this trial should be carried out on a larger scale.