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The study aimed to evaluate and discuss the use of an innovative PSI made of porous hydroxyapatite, with interconnected porosity promoting osteointegration, called MyBone Custom® implant (MBCI), for maxillofacial bone reconstruction. A multicentric cohort of 13 patients underwent maxillofacial bone reconstruction surgery using MBCIs for various applications, from genioplasty to orbital floor reconstruction, including zygomatic and mandibular bone reconstruction, both for segmental defects and bone augmentation. The mean follow-up period was 9 months (1-22 months). No infections, displacements, or postoperative fractures were reported. Perioperative modifications of the MBCIs were possible when necessary. Additionally, surgeons reported significant time saved during surgery. For patients with postoperative CT scans, osteointegration signs were visible at the 6-month postoperative follow-up control, and continuous osteointegration was observed after 1 year. The advantages and disadvantages compared with current techniques used are discussed. MBCIs offer new bone reconstruction possibilities with long-term perspectives, while precluding the drawbacks of titanium and PEEK. The low level of postoperative complications associated with the high osteointegration potential of MBCIs paves the way to more extensive use of this new hydroxyapatite PSI in maxillofacial bone reconstruction., Competing Interests: Declaration of competing interest EC is a CERHUM employee. J-LN and GN have direct ownership in CERHUM. The other authors have no conflicts of interest., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The occurrence of pneumomediastinum and subcutaneous emphysema following oral treatment is the result of the inappropriate use of dental equipment using pressurised air. However, their use in oral surgery, including dental extractions, continues nowadays. In addition to being a source of subcutaneous and pneumomediastinum emphysema at risk of infection, pneumatic instrumentation can also be a source of potentially serious gas embolisms. A thorough knowledge of this type of complication by the practitioners and the proper use of the instrumentation will enable a significant reduction of the incidence of theses complications.

The history of transgenderism is reaching a new turning point. From the medical beginnings of the 1940's to the real innovations of the last decade, surgery can, more than ever, contribute to the gender reassignment process. This article will firstly describe the evolution of the transgender demand, and will then review the specificities of male and female facial anatomy. We will conclude by defining the maxillofacial surgical field and the new role of the reference center at the University Hospital of Liège in this promise of treatment, that is both intimate and innovative.

The use of new technologies in medicine becomes more and more frequent because they allow us to raise therapeutic quality. This is the case in maxillofacial surgery. 3D planning for oncological resection and reconstruction brings many benefits. In this article, we will present the first case operated with this technology at CHU Liege and discuss the advantages and disadvantages of this technique.

In our society, the number of gender affirming surgeries is increasing. Mastectomy is usually the initial surgical procedure performed for the treatment of gender dysphoria in transgender men. It has been shown to improve quality of life and to promote assimilation into the new genre. Creating an aesthetic male chest requires adjustment of the breast tissue volume, proper placement of nipple areola complex, and removal of the inframammary fold. Although many papers have been published on this topic, there is still no consensus as to which surgical technique should be preferred. This article deals with the procedures performed in our plastic surgery department at CHU in Liège and reviews the literature relating to the various surgical techniques, postoperative complications as well as patient satisfaction.

Multidisciplinary Sleep Clinics for sleep apnea have long existed, bringing together neurologists, sleep specialists, dentists, orthodontists and surgeons. In Belgium, a shift in funding for obstructive sleep apnea treatment was implemented from January 1st, 2017. Funding was allowed for moderate to severe obstructive sleep apnea and the rules shifted for treatments delivery and monitoring by authorised medical opinion. We aimed to assess whether a shift in treatment funding was associated with a change in the multidisciplinary sleep practice. Sample consisted of all patients discussed in the sleep multidisciplinary team meetings of the University Hospital of Liege from January 2016 to December 2018. Interrupted times series, Mann-Whitney U tests and descriptive statistics were produced. There were no differences in patients age, male sex preponderance, body mass index, clinical presentation and level of obstruction. Baseline obstructive sleep apnea severity was significantly lower (mean apnea-hypopnea index and mean oxygen desaturation index lowered with p = 0.0189 and p = 0.0466, respectively) after the funding rules changed. Oral appliance and ENT surgery were more often offered after the shift in funding. The key changes of the new funding rules for obstructive sleep apnea were reflected in the patient selection and management by sleep multidisciplinary team meeting. Funding terms could influence the care we give, not only in treatment options, but also in patients selection.

In recent years, 3D design and printing technology has been successfully used in maxillofacial bone reconstruction procedures. We had the opportunity to observe its benefits in the manufacture of custom facial implants. The production is so precise that perfect anatomical congruence and biocompatibility are possible. Within the plastic and maxillofacial surgery department of the University Hospital of Liège, we had the opportunity to perform two operations requiring facial skeleton redefinition implants. The purpose of this article is to highlight the current possibilities of facial prostheses via new 3D techno¬logies, but also the advantages and possible complications of this type of surgery.

As the leading cause of blindness in the world, corneal diseases are second only to cataracts. However, the epidemiology of corneal disease is complex and includes a wide variety of infectious and inflammatory eye diseases (trachoma), immune sequelae (cicatricial pemphigoid on Lyell's disease) of after trauma (chemical burn). The general treatment for severe corneal disease is the corneal transplantation with penetrating keratoplasty. However, the failure of this treatment is virtually certain when the ocular surface is severely compromised. Keratoprosthesis is therefore the only viable option to restore vision in these patients. Only practiced by less than a dozen teams in the world, the osteo-odonto-keratoprosthesis (OOKP) is regularly practiced at the University Hospital of Liège, thanks to a close collaboration between the ophthalmology and maxillofacial surgery teams. Thanks to removal of a tooth and his bone support, patients suffering from bilateral dry eye following pathologies such as burns or cicatricial pemphigoid can benefit from this technique in order to recover an optimal visual acuity in a sustainable way.

Although well studied since the 50's, bruxism remains a largely unknown pathology. Its origin is complex, mixing psychological as well as neurological, odontological and hypnic aspects. However, the few analyzes performed on this topic have allowed to set convincing etiopathological hypotheses, including central dysregulation of the dopaminergic system as well as of the neuro-masticatory system. To avoid harmful consequences as headaches, temporomandibular disorders and premature dental scuffs / fractures, it is mandatory to diagnose bruxism as early as possible. For this purpose, and in addition to anamnestic and clinical data, the practitioner can confirm diagnosis with polysomnography, including electromyographic study of masticatory muscles and audiovisual recording. Some orthodontic, pharmacological and psychological solutions have already proved efficient. Nevertheless, a better knowledge of causative neurobiological mechanisms would allow to foresee etiology-based treatments.

Dento-maxillofacial dysmorphoses represent a considerable area of maxillofacial surgery. Their incidence has constantly been on the rise since the beginning of the century. This can be explained by variations in the food and society habits.We will first discuss the various causes (congenital and environnemental) and the pathophysiology of these disorders. Then, we will separate them according to the skeletal and Angle's classifications. We will examine the predictive criteria of these dysmorphoses from the youngest age and consider their clinical and cephalometrical diagnosis. We will envisage their functional and aesthetic consequences and expose the preventive options. Finally, we will describe the orthodontic and surgical treatment available today and conclude that surgery remains the gold standard by restoring the conventional axis.

In recent years, medication-related osteonecrosis of the jaw (MRONJ) became an arising disease due to the important antiresorptive drug prescriptions to treat oncologic and osteoporotic patients, as well as the use of new antiangiogenic drugs such as VEGF antagonist. So far, MRONJ physiopathogenesis still remains unclear. Aiming to better understand MRONJ physiopathology, the first objective of this review would be to highlight major molecular mechanisms that are known to be involved in bone formation and remodeling. Recent development in MRONJ pharmacological treatments showed good results; however, those treatments are not curative and could have major side effects. In parallel to pharmacological treatments, MSC grafts appeared to be beneficial in the treatment of MRONJ, in multiple aspects: (1) recruitment and stimulation of local or regional endogenous cells to differentiate into osteoblasts and thus bone formation, (2) beneficial impact on bone remodeling, and (3) immune-modulatory properties that decrease inflammation. In this context, the second objective of this manuscript would be to summarize the molecular regulatory events controlling osteogenic differentiation, bone remodeling, and osteoimmunology and potential beneficial effects of MSC related to those aspects, in order to apprehend MRONJ and to develop new therapeutic approaches., Competing Interests: The authors declare that they have no competing interests.

Anterior dislocation of the temporomandibular joint is not uncommon and requires prompt management. A defect of dislocation reduction can lead to severe functional impairment of a complex, and often active joint. The diagnosis is clinical and relatively obvious. It is made by the frontline medical team, general practitioner or emergency doctor. Recurrent cases are a matter for maxillofacial surgeons. This article describes a conventional technique for anterior dislocation reduction, to achieve urgently. The second part of the article deals with the specialized surgical treatment of relapsing forms.

Various systemic diseases can affect salivary glands. After a short anatomical and semiological recall, we describe the pathologies according to their possible salivary demonstrations, and we propose in a table a useful memorandum in daily practice.

Objective: We examine geniopexy efficacy in OSAS treatment., Study Design: Seven patients, aged 36 to 61 years, were studied. The mean body mass index was normal., Results: Surgical late complications (modified symphysis proprioception) occurred in 4 patients. No patient was improved in sleep problems. Retromaxilly and retromandibuly were found in all patients by cephalometric study., Discussion: Our results are quite different from these described successfully by other centers. Geniopexy do not move maxillar and mandibular skeletal bones, which are retruded in our serie. This explains maybe our bad results. Actually, we propose for this patients maxillo-mandibular advancement.

Despite recent advances in automobile safety, facial trauma remains a common event. Cranio-facial trauma, which usually occurs within a context of multiple trauma, can, in some patients, lead to serious life-threatening vascular complications. Such injury usually involves the carotid system (hemorrhage, aneurysm, dissection). Management of these vascular injuries must be given the same priority as other multiple trauma injuries. We present few typical cases illustrating carotid-cavernous or vertebro-vertebral fistulae, false aneurysms, arterial dissections or oro-facial bleeding. Bleeding is generally controlled by ligation or compression, other lesions being diagnosed secondarily by arteriography depending on the particular clinical situation. Treatment may involve endovascular procedures to achieve intravascular embolism or vascular occlusion.

Maxillo-mandibular myxomas are rare lesions and their pathogeny remains unclear. The poor clinical picture and the absence of pain makes the diagnosis difficult. Because of the long lasting course, the tumor is usually large at the time of diagnosis. Although this tumor is benign, the local aggression and the high rate of recurrence dictate a radical treatment.

Several cephalometric studies have been published to study sleep apnea and hypopnea. The purpose of this review is to provide a clear analysis of the different and apparently contradictory cephalometric results and to describe certain pitfalls of the method. In general, an excessive development of the tongue and soft palate are observed in these subjects, limiting the pharyngeal airway. Bony anomalies include mandibular retrognathism and an excessive anterior ventral development of the skull associated with insufficient anterior growth of the base of the skull. The head is held in extension. These different factors contribute to blocking the upper airway and favor pharyngeal collapse. Cephalometry can be used to identify patients at risk and to propose an apnea/hypopnea index for precise etiological diagnosis and therapeutic decision making.

Microorganisms harbored in the oral cavity have long been recognized to cause systemic disease with a well known mechanism of spread via the blood stream. Different factors, including the presence of periodontal disease, the number of dental extractions or the duration of dental surgery have an influence on the risk of bacteremia. Infectious endocarditis is classically cited, but there are other potential problems including brain abscess, meningitis, lung or lie abscess, and even for some authors, a risk of thrombotic heart disease. It is important to keep in mind that some of these focal infections may be possible complications of dental (or buccal) infection. Prevention is crucial.

One of the most common symptoms of obstructive sleep apnea syndrome (OSAS) is daytime drowsiness. It is associated with a high cardiovascular morbidity and mortality, and an elevated incidence of car crashes. In general, young patients don't want conservative treatment because symptomatic and to prevent secondary effects. In this article, we briefly define sleep disorders and the interest of cephalometric examination. We describe the different treatment possibilities and stress the important role of orthognathic surgery in this syndrome.

Maxillomandibular advancement is an integral part of the surgical treatment of patients suffering from obstructive sleep apnea. A number of publications report its efficacy and have attempted to define predictive success criteria. However, few authors have shown an interest in the surgical specificity of this intervention and in the difficulties that can be encountered, which differ from those seen in conventional orthognathic surgery. In this article, a series of patients treated with maxillomandibular osteotomy to correct obstructive sleep apnea syndrome (n = 17) are compared with patients who underwent surgery for the correction of dentofacial disharmonies (n = 33). Observations emphasized the importance of respecting a strict surgical and postsurgical protocol to avoid any technical traps linked to maxillomandibular advancement, both in preoperative simulations and during and after surgery. Results concerning sleep parameters will be the subject of a future publication.

Vascular anomalies can be classified as hemangiomas or vascular malformations. Hemangiomas are benign neoplasms, frequently diagnosed in infancy. The vast majority of these anomalies are totally harmless and spontaneously regress, although they often worry the parents because of esthetic reasons. Only a few (1/4), however, are endangering and will require therapy. Vascular malformations are rather vessel abnormalities which, unlike hemangiomas, persist. They require a thorough evaluation and most will benefit from an intervention. The recent development of informative imaging techniques (ultrasonography, Dopplerflow imaging and magnetic resonance) has permitted significant advances in the etiology and therapy of these vascular anomalies. All too often, these patients shuffle from physician-to-physician seeking help. Thus the authors recommend a multidisciplinary approach. This team should include a plastic surgeon, a radiologist and a paediatrician.

Surgically assisted rapid maxillary expansion is an accepted method for correction of transverse skeletal and dental discrepancies. The surgical technique includes a Lefort I osteotomy with medial palatine osteotomy. The maxillary must be totally released to achieve the desired expansion. There are several advantages: bone apposition in osteotomy sites, reduced risk of dental version or extrusion compared with orthopedic care, secondary surgical cure of complex dysmorphism requiring fewer segmentary osteotomies. Finally, we examined skeletal side effects induced by surgically assisted rapid maxillary expansion in the vertical and sagittal dimension of the face.

The authors report the advantages and disadvantages of the calvarial bone used as bone graft in the maxillofacial area. They review most of the parietal bone's indications and report their experience with clinical cases.

The dental carie is one of the most frequent chronic disease in humans. The causes are well known actually, so preventive actions against dental caries have been carried out. Administration of fluoride is one of these preventive actions. It is difficult to estimate the interest of fluoride supplementation during pregnancy for the newborns: was the transplacental passage of fluoride demonstrated, and if it was, which advantage for a fetus without complete mineralisation of the teeth? Dental embryology, physiopathology of dental caries, action, metabolism and toxicity of fluoride are successively studied, so it will be easier to estimate the utility and the benefits of fluoride supplementation in pregnant women.