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The commisures are the two extremities of the mouth. They make a big complex in their architecture and their function. Their repairing should have an important attention to their final shape and function. The frequency of the retraction of the scarring tissue imposes additional muscular exercise which has to be premature, intense, and prolonged. [Copyright &y& Elsevier]

The attractive color of the red lip must be the object of very meticulous reconstruction in their form and pigmentation. This can be done only by using the buccal mucosa. The graf is less indicated. There are multiple local flaps that have been proposed using the same lip, the jugal mucosa and the tongue. The authors will show the principal procedures found in the literature. [Copyright &y& Elsevier]

Labial ageing process combining relaxation, distension and ptosis is aggravated by underlying structure modification: dental and bony. If the inferior lip moves back and collapses, the superior lip will go down and widen. The authors analyse the different ageing process components (intrinsic and extrinsic) as well as therapeutic principles. [Copyright &y& Elsevier]

The labial balance appreciated by statics and movement is the guarantee of morphology, bilabial competence and symmetry in function (ou bien in movement?). The restoration of the lips aims for this balance, the basic axiom is “to repair the lip by the lip”. Three main technical forms meet these requirements: forward movement, rotation and transposition. [Copyright &y& Elsevier]

The full-thickness tissue loss of the lip leads to the loss of lip continuity. The classic principle is to repair a lip with a lip, giving the best results. Although the size of tissue lost can force to use local flaps, these could be naso-labio-jugal, labio-mental or submental. Even though the microsurgical labial replantation is the technique of choice, unfortunately, most of the time it cannot be done as a result of the situation and the conservation of the avulsed fragment. [Copyright &y& Elsevier]

The aetiologies of the labial desequilibrium are multiple. They respond to the anomalies of the position and the dimension. The authors will enumerate the different variety and their etiology. [Copyright &y& Elsevier]

Introduction: The skin property to adapt to external constraints is widely used in plastic surgery. Tissue expansion is the most known and codified application. Tissue extension appears to be an attractive alternative. The authors propose the usage of a simplified procedure to deal with skin loss in the superior or inferior members., Material and Method: Thirty-one patients underwent uni-axial traction between February 2000 and October 2003., Results: Closure of skin loss on the upper member has been obtained in 6 days and in 8 days on the inferior member., Discussion: Efficiency, reliability and no subsequent aftermaths are strong arguments in favor of the development of a simplified extension procedure., Conclusion: The tissue extension procedure, although scarcely used is an attractive procedure for the coverage of skin losses.

Introduction: The purpose of this study was to determine the types of facial injuries treated in a one-year in a maxillo-facial unit operating in a mountainous region., Methods: All patients admitted to the Grenoble University Hospital maxillo-facial unit for a one year period were studied. We noted cause of trauma, age, sex, type and location of fracture, type of soft tissue injury, time between trauma and surgery., Results: A total of 994 patients presenting maxillo-facial trauma underwent surgery over one year; 30% of the unit's maxillo-facial surgical activity. On average, 80 patients were treated for maxillo-facial trauma per month, with a peak of 97 facial injuries in July; 65.6% were hospitalized in the maxillo-facial unit; 25,4% of the injured were aged between 21 and 30 years. Sex-ratio was 2.7M/1F. The most frequent cause was sports injuries (25.8%) followed, in decreasing order, by traffic injuries (23.1%), home injuries (17.6%), fight injuries (3.4%), work injuries (3.4%) and dog bites (3.2%). 10.5% of the injuries occurred in a mountainous setting and 40.7% were sports injuries, 95% of which during practice of winter's sports. Injuries included facial fractures (65.5%) with or without soft tissue damage, and soft tissue injuries only (34.5%); 33.6% of the patients had other lesions of the body. 67.2% underwent surgery within the first 24 hours and 86.9% before the fifth day., Discussion: Sports accidents are the leading cause of facial trauma in the mountainous regions. Most facial injuries result from ski, surf and other winter sports accidents. Most of the victims were given surgical care within the first 24 hours following the accident.

Recent advancement of head and neck surgery has been marked by the development of endoscopic and video-assisted minimally invasive surgery. This study reports the feasibility of endoscopic submandibular gland resection in human cadavers. Twelve submandibular gland resections were performed in six human cadavers. A 30 degrees angle endoscope and conventional surgical instruments were inserted through two 15 mm submandibular incisions. Dissection was carried out bluntly with scissors in an avascular plane superficial to the gland. No insufflation was needed since transcutaneous sutures lead to effective retraction. Facial vessels, the lingual nerve and Wharton's duct were identified and protected. Vascular ligatures were performed using surgical miniclips. After the procedure, an open submandibular dissection was performed to control the integrity of the anatomical structures. In all cases, the resection of the submandibular gland was successful without the need for an additional incision. Injuries of the facial artery and lingual nerve occurred when the procedure was carried out initially. The operative time decreased with training, from 120 min for the first cases to 35 min for the later ones. In conclusion, endoscopic submandibular gland resection is possible without major difficulty. Training and experience reduce the operative time and the complication rate.

The dacryo-cysto-rhinostomy via the external approach is indicated for obstruction of the lacrymal duct. It consists in the creation of short-circuit between the lacrymal sac and the external nasal wall. The operation stages starts by paracanthal incision, the subperiosteal dissection stops anteriorly to the posterior insertion of the medial canthal ligament (to preserve lacrymal function). An ostectomy is performed between the maxillary bone and the unguis. A stomy is created by individualizing two mucosal flaps. The bicanaliculonasal intubation is systematic and maintained for 10 to 12 weeks.

Reconstruction of radionecrosis of the lower lumbar area is a challenging problem because of the difficulty of mobilization of the irradiated local tissues, absence of a reliable locoregional procedures and prolongation of the receiving vessels of the free flaps. The ideal treatment is a wide excision of the irradiated tissues and an immediate reconstruction in one step, which is better to be done by using a musculocutaneous flap. The latissimus dorsi musculocutaneous flap is ideal for this indication. The authors prefer to do the revascularization of the latissimus dorsi flap by its'thoracodorsal pedicle because of the possibility to have a high pressure blood flow which allow to use long venous bypass, the exposure of the recipient vessels at the same time of dissecting the flap and to have the anastamosis site away from the irradiated tissue. The authors are presenting their experience in treating a case of radionecrosis in the lower lumbar region with exposed vertebrae by a latissimus dorsi musculocutaneous free flap with exposed vertebrae by a latissimus dorsi musculocutaneous free flap with the lengthening of its'pedicle by two 30 cm interposition saphenous vein grafts.

Complete uni-lateral cleft palates resulting from failed union between internal and external nasal buds cause an imbalance of both superficial and deep nasal structures. After summarizing the principles that should guide the care of these anomalies, the authors present their therapeutic procedure, in which orthopaedic and surgical treatments are intimately associated. They conclude their presentation by emphasizing the difficulty of predicting the definitive result because of the extreme diversity of the sequellae that always accompany the treatment of cleft palates.

Surgeons have long been preoccupied with continuity of the bone in the repair of cleft lips and palates. It is no longer necessary to demonstrate the deleterious effect of employing osteoplasty in a first stage procedure; very few practitioners still rely upon it. On the other hand, a great number of authors now advocate a bone graft as a secondary operation, although they have not been able as yet to reach a consensus on its timing, nor upon exactly what its objectives should be. An early bone graft, carried out at the time of the primary dentition, would have as its goal stabilization of the maxillary segments and prevention of relapse of the maxillary retrusion as the dentition becomes mixed. Any hopes that such an intervention would have a beneficial effect with regard to the area of the lateral incisors, which are usually malformed or absent, seem to us illusory. A secondary bone graft, undertaken during the mixed dentition before the eruption of the canines, when a maxillary bony deficit is present with accompanying alveolar insufficiency. We consider that a distinction between the areas of bone, the maxillary and the alveolar, is essential because a continuity of maxillary bone, a guarantee of skeletal stability, can be obtained in more than 70% of cases by perio-osteoplasty (a graft of tibial periosteum or gingivo-perio-osteoplasty). When this cannot be done, a massive bone graft will be needed at the close of orthopedic treatment. Continuity of alveolar bone, the guarantee of occlusal stability, can be obtained at the close of orthodontic treatment with the use of a provisional prosthesis followed by a permanent replacement after completion of gingival correction. We believe a graft to prepare for an implant in an area where scar tissue can be a problem would be risky especially since implants, in our opinion, do not provide the same stability to a dental arch that a fixed bridge affords.

The full-thickness tissue loss of the lip leads to the loss of lip continuity. The classic principle is to repair a lip with a lip, giving the best results. Although the size of tissue lost can force to use local flaps, these could be naso-labio-jugal, labio-mental or submental. Even though the microsurgical labial replantation is the technique of choice, unfortunately, most of the time it cannot be done as a result of the situation and the conservation of the avulsed fragment.

The aetiologies of the labial desequilibrium are multiple. They respond to the anomalies of the position and the dimension. The authors will enumerate the different variety and their etiology.

We present a technique for ambulatory treatment of prominent ears derived from the Kaye method but which uses some procedures aimed at improving reliability and safety.