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Resume Introduction L’evisceration est une intervention chirurgicale dont le but est l’ablation du contenu orbitaire tout en conservant la sclere. Elle permet d’obtenir des resultats esthetiques satisfaisants apres la mise en place d’une prothese oculaire. Note technique L’evisceration sur table comporte 3 temps operatoires : (1) l’ablation du globe oculaire apres section du nerf optique (enucleation) ; (2) l’ablation du contenu du globe sur table operatoire (evisceration) et (3) l’implantation dans la cavite orbitaire d’un implant d’hydroxyapatite enveloppe par la sclere afin de conserver le volume orbitaire. Discussion L’evisceration est indiquee en cas d’œil non voyant, douloureux et inesthetique ne pouvant etre conserve. Contrairement a l’enucleation, l’evisceration a l’avantage de conserver la sclere du patient. L’evisceration sur table est une technique simple permettant d’apporter un volume suffisant et de permettre la realisation d’une prothese oculaire mobile grâce a la mise en place d’une bille d’hydroxyapatite dans la coque sclerale du patient et a la reinsertion des muscles oculomoteurs.

Climate change is considered as one of the main factors controlling sediment fluxes in mountain belts. However, the effect of El Niño, which represents the primary cause of inter-annual climate variability in the South Pacific, on river erosion and sediment transport in the Western Andes remains unclear. Using an unpublished dataset of Suspended Sediment Yield (SSY) in Peru (1968–2012), we show that the annual SSY increases by 3–60 times during Extreme El Niño Events (EENE) compared to normal years. During EENE, 82% to 97% of the annual SSY occurs from January to April. We explain this effect by a sharp increase in river water discharge due to high precipitation rates and transport capacity during EENE. Indeed, sediments accumulate in the mountain and piedmont areas during dry normal years, and are then rapidly mobilized during EENE years. The effect of EENE on SSY depends on the topography, as it is maximum for catchments located in the North of Peru (3–7°S), exhibiting a concave up hypsometric curve, and minimum for catchments in the South (7–18°S), with a concave down hypsometric curve. These findings highlight how the sediment transport of different topographies can respond in very different ways to large climate variability.

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.

Temporomandibular joint (TMJ) dysfunction associates pain, limited mouth opening and joint noise. Failures of conservative treatments may lead to arthroscopy. The aim of our study was to evaluate the current interest of arthroscopy in the treatment of TMJ dysfunction.Using the keywords "TMJ" and "Arthroscopy", 1668 articles were found in the Sciencedirect database. We selected 17 papers published between September 2012 and May 2016. Six questions were asked: (1) what treatment should be given to patients suffering from TMJ dysfunction? (2) What treatment should be performed for TMJ disorders when conservative treatments failed? (3) Does Wilkes staging change the surgical indication? (4) What has to be done in case of arthroscopy failure? (5) Can disc position be improved after surgery? (6) Should the disc position be improved?(1) Conservative treatment should always be considered in first intention (2) In case of conservative treatment failures, surgery can be proposed, beginning with the less invasive one (3) Whatever the Wilkes stage, treatment should begin by the less invasive one (4) In case of arthroscopy failure, TMJ arthrotomy can be indicated (5) Disc position may be improved in the long term but it is complex to obtain (only one paper) (6) there is no evidence that disk has to be repositioned.

Primary intraosseous carcinoma (PIOC) of the jaws is a rare epidermoid carcinoma from epithelial origin and initially strictly localized within the bone. Histologically, type 3 PIOC (PIOC3) is a de novo primary intraosseous carcinoma. Because of the rarity of this illness, we propose an analysis of a personal case and a revue of the literature.Two search engines (PubmedThirty articles concerning 54 patients (sex ratio: 2.4; mean age: 56.8; extreme: 24-78) met the inclusion criterions. The most common symptoms were swelling (53%), pain (44.9%) and infra-alveolar nerve paresthesia (30.6%). The time to diagnosis was 13 weeks. Classification of Zwetyenga et al. showed more than 80% of T2 and T3 stages. The lesions were predominantly mandibular (85.2%) and posterior. Less than a third of patients had lymph node and 10% had distant metastasis. Treatment consisted mostly in a combination of surgery and radiotherapy. With a mean follow-up of 74.8 months, 70.8% were in remission with no evidence of recurrence. We report the case of a 58-year-old patient, with no medical history, complaining since several months about periodontitis with teeth mobility in the right mandibular area. The panoramic X-ray showed a bone lysis at the place of tooth No. 46. In the absence of alveolar healing after extraction and antibiotherapy, a biopsy was made that diagnosed a differentiated keratinizing squamous cell carcinoma. CT scan and MRI showed a mandibular cortical bone loss with involvement of adjacent structures and lymphadenopathy in the ipsilateral IB area. The patient was treated with a combination of chemotherapy and surgery. Postoperative chemo- and radiotherapy is still going on.The PIOC3 is a rare tumor, mainly arising in males around 50. Diagnosis should be evoked in the presence of painful swelling and nervous symptoms. The time to diagnosis is long. Tumors are usually seen at late stages. Treatment classically combines surgery and radiotherapy.

Basal cell carcinoma (BCC) is the most common skin cancer in France. It is commonly diagnosed in front of a papule or nodule of the face. The surgeon should be able to question the diagnosis of BCC when nodular lesions are untypical, keeping in mind that some differential diagnoses require only medical treatment.The authors successively describe three non infectious entities mimicking BCC of the face, requiring purely medical treatment: facial granuloma described by Lever, cutaneous pseudolymphoma, sarcoidosis.In front of a non-typical skin nodule CBC, a dermatological expert advice may be quite helpful. The value of this collaboration is to guide or otherwise to suspend surgical excision.

Humanitarian surgical missions provide cares in developing countries and in difficult conditions. Preparation of these missions is a mandatory step for both technical and human points of view. Before the departure, care must be taken to accomplish all the administrative (visa application, valid passport…) and the medical formalities (mandatory and recommended vaccinations). The aim of this article is to present a helpful vade mecum allowing any surgeon, especially the juniors, to prepare a humanitarian mission abroad.

Skin carcinomas require excision with clear margins. In the head and neck region, these excisions most often result in round or oval defects. Due to the big size of the defect and limited tissue elasticity, it is not always possible to close these defects in the same operation. We describe a technique to minimize the size of the defect.It is an improved purse string suture technique. The purse string suture is realized with a circular continuous intradermal suture and is improved by three or four V-Y sutures, in order to reduce the skin defect.It is an easy, fast and effective technique for decreasing the size of the skin defect and for speeding up the healing.

Evisceration consists in removal of the orbital content whilst preserving the sclera. It allows for good esthetic results after fitting of an eye prosthesis.The "on the table" evisceration technique consists in 3 operative steps: (1) removal of the eyeball after optic nerve section (enucleation); (2) removal of the content of the globe on the operating table (evisceration) and (3) implantation in the orbital cavity of a hydroxyapatite orbital implant wrapped into the sclera in order to keep the orbital volume.Evisceration is indicated in blind, painful and unaesthetic eyes that cannot be preserved. The "on the table" evisceration technique is an easy procedure allowing for a good volume restauration and for supporting a mobile eye prosthesis thanks to the placement of a hydroxyapatite orbital implant wrapped into the patient's own sclera and to muscular re-insertion.

Malignant cutaneous adnexal neoplasms are rare and have been characterized only recently. They can occur at any age but preferentially in elderly. There are 3 of them: trichoblastic carcinoma, trichilemmal carcinoma and malignant pilomatricoma. The aim of our study was to make a diagnostic and therapeutic update about these tumors when located at the face or at the scalp.A bibliographic research was made on PubMed using following keywords: appendage skin carcinoma AND pathology AND/OR therapeutic. Articles published before 2000 were considered outdated and were excluded.Twenty-five articles met the inclusion criteria. Clinical presentation was non-specific. Histological examination only allowed for diagnosis. Lesions were locally or loco-regionally aggressive. Lymphatic or hematogenous metastasis were reported. No consensus about treatment was found. When surgery was used, it consisted in resection with safety margins ranging from 0.5 to 3cm depending on the teams. In case of metastasis, treatment consisted in chemo- and/or radiotherapy. A quarterly medical monitoring was recommended.Malignant cutaneous adnexal tumors are rare. There is nowadays no treatment consensus. An initial staging by mean of a head and neck, chest, abdominal and pelvic CT-scan is mandatory. Treatment has to be decided in a multidisciplinary cancer committee. In the absence of metastasis, the reference treatment is surgical resection, possibly by Mohs micrographic technique, with large safety margins. In case of metastasis or if the loco-regional extension does not allow for a complete excision, chemotherapy and/or radiotherapy may be proposed. A close monitoring is essential.

Ranula is a pseudocyst of the sublingual gland, often of unknown etiology. In few cases, it can extend to the neck when passing through the mylohyoid muscle. Diagnosis is not always easy as other cervical cystic lesions may have the same clinical aspect. Some ranulas recur after removal. The aim of our study was to conduct a review about plunging ranulas, with a focus on the most useful paraclinical exams and the most effective treatment.A review of the literature has been conducted in the PubMed database between 2015 and 2010 using following keywords: plunging ranula, recurrent plunging ranula.Thirteen articles reporting 37 cases of plunging ranulas have been selected. Among these cases, 3 recurred. Paraclinical exams consisted in US, CT scan and MRI. Main reported treatment was sublingual gland removal, sometime associated with marsupialization.The most useful paraclinical exam is CT scan. Total sublingual gland removal is the most efficient treatment.

Parotid lithiasis is the main cause of calcifications in the parotid space. However, there are many other less known causes. The aim of our study was to point out the non-lithiasic causes of calcifications in the parotid space.We conducted an exhaustive review of the literature by mean of PubMed, using the keywords "parotid" and "calcification" and limiting our analysis to the original articles in humans published in English and in French. Articles reporting about microscopic calcifications and who were not dealing with parotid calcifications were excluded.Twenty articles met the inclusion criterions. Tumoral and non-tumoral local causes and systemic causes of parotid calcification were found. The way they revealed was variable. The main tumoral local causes were pleomorphic adenomas, salivary duct carcinomas and adenocarcinomas. The main non-tumoral local causes included vascular malformations and calcified parotid lymph nodes. The main systemic causes were chronic kidney diseases, HIV infection, chronic alcoholism, elevated levels of alkaline phosphatase and auto-immune diseases.Eighteen different etiologies of parotid space calcifications could be identified. First line exploration of these lesions relies mainly on conventional radiography and ultrasound examination that are easily available. CT scan remains the reference examination.

Resume La plupart des « faces etroites » sont dysmorphofonctionnelles et liees a un defaut d'expansion maxillomalaire lui-meme consecutif a une obstruction nasale chronique. La valgisation fonctionnelle des malaires par osteotomie transmalaire permet de corriger cette dysmorphose avec une faible morbidite a condition d'utiliser une greffe osseuse d'interposition associee a une osteosynthese par miniplaque. Cette technique evite les sinusites observees lors de l'utilisation de biomateriaux. La correction de la « face etroite » est naturelle car celle-ci est assuree par le corps du malaire et non pas par un greffon d'apposition, et le resultat a long terme est stable. Une rhinoplastie a visee fonctionnelle est souvent associee. Cette intervention ainsi presentee peut etre une alternative elegante a certains liftings mediofaciaux. Notre experience porte sur 15 cas cliniques.

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° 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.

Background. The target blood concentrations of propofol and remifentanil, when used in combination, required to blunt the cough response to tracheal intubation, cuff inflation, and tracheal suctioning without neuromuscular blocking agents are not known. Methods. In a randomized prospective study, 81 patients were enrolled to determine which of three target remifentanil blood concentrations was required to blunt coughing during intubation, cuff inflation, and tracheal suctioning. Anaesthesia was achieved with propofol at a steady effect-site concentration of 3.5 μg ml −1 . The target blood remifentanil concentrations were 5, 10, or 15 ng ml −1 . These concentrations were maintained for 12 min before intubation. Results. There was no cough response to intubation in more than 74% of patients and no significant difference in the incidence of coughing with intubation between the three groups. Significant difference in coughing, diminishing with increasing remifentanil target concentration, was observed with cuff inflation ( P =0.04) and tracheal suctioning ( P =0.007). Bradycardia and hypotension was more frequent with the remifentanil target concentration of 15 ng ml −1 . Tracheal suctioning resulted in more coughing than intubation ( P =0.01) or cuff inflation ( P =0.004). Conclusion. Target remifentanil blood concentrations of 5, 10, and 15 ng ml −1 associated with a 3.5 μg ml −1 propofol target blood concentration provided good intubating conditions and absence of cough about 75% of the time. Higher target remifentanil concentrations were associated with less coughing during tracheal tube cuff inflation and tracheal suctioning.

Ophthalmic manifestations of nasal obstruction can involve palpebral, orbital and ophthalmic disturbances. They can be the consequence of: directly with the nasal obstruction because the orbital cavity drains partly in the nasal fossae: rings, lipoptosis, blepharochalasis, fat protrusions, aggravation of exophthalmy in Grave's disease, enophthalmia. 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 lack of naso-sinusal expansion, often associated to malocclusion, there is a biomechanical correlation between the dental occlusion and the orbital area because of the presence of the maxillary sinus. Every occlusal disorder have an influence on projections of the supra and infraorbital rims.

Because of its anatomical position, the lingual nerve may be severed during oral surgical procedures, such as third molar removal. Early suturing of the nerve promotes better recovery. We describe the end-to-end suture of this nerve.The suture is carried-out under general anesthesia. The approach is made in the mouth floor, in the same way as for submandibular gland lithiasis transoral removal. This approach allows good exposure and some laxity to displace the nerve stumps. The latter can then be sutured under microscope assistance before closing the mucosa.Lingual nerve suture is a simple, quick and inexpensive procedure. Unlike other procedures, it cannot be used in case of large loss of substance because of the small amount of laxity of the nerve. Nerve function recovery is better if performed before the 6th post-traumatic month, and in young patients.

The authors describe a rejuvenation surgical technic of cervical area ptosis. It is called LOV for "Lifting of the Oval of Visage". LOV is realised under local anaesthesia, lasts about 40 minutes. In this study, post-operative results are evaluated after one year.retrospective study with anonymous questionnaire measuring patient's satisfaction, operated between january 2011 and december 2011, by the same surgeon in the department.43/45 questionnaires were analyzed, 40 females (93%) and 3 males (7%). Average age was 56 years, with a range of 51 years to 66 years. Our satisfaction ratings values after surgery were: very good: 32 (74.4%), good: 8 (18.6%), intermediate: 2 (4.6%), unsatisfied: 1 (2.3%), will not undergo LOV again: 1 (2.3%), would not recommend LOV to a friend: 2 (4.6%), recommend LOV to a friend: 37 (86%). The only complication (2.3%) was an unilateral hypoesthesia earlobe.LOV is simple and effective. It is a surgical alternative in the treatment of cervical area ptosis. Performed under local anesthesia, this short procedure responds to complaints of patients: safe rejuvenation and natural looking. Since 2008, LOV is performed in our department. Recruitment is most often "word of mouth", as confirmed by 86% of patients who would "recommend it to a friend". In cosmetic procedure, we should always keep in mind "a good result is measured to good patient satisfaction".

Among the skeletal causes of limited mouth opening, uni- or bilateral coronoid process hypertrophy, or Langenbeck disease, is the most frequent. It can be associated with an osteochondroma or a coronoid-malar bone conflict and is then called Jacob disease, an unilateral pathology. Treatment rests on coronoidectomy in both cases. This technique is illustrated via two cases, one Langenbeck and one Jacob disease.A transoral approach was performed. After subperiosteal dissection, the coronoid process was cleared. The process was than severed at its base by means of a burr, freed from its temporal muscular fibers and removed. Mouth opening improved peroperatively. The surgical procedure was completed by active long-term physiotherapy beginning immediately after surgery.Transoral coronoidectomy is a simple, quick and safe procedure. Extra-oral approaches present a high risk of facial nerve injury. In our first case, mouth opening improved from 24 to 36 mm after bilateral coronoidectomy and to 40 mm after physiotherapy. In our second case, mouth opening improved from 22 to 38 mm after unilateral coronoidectomy and to 43 mm after one year physiotherapy. Long-term post-operative physiotherapy is mandatory to get and maintain good results.

We recorded similarities between patients managed in the psychiatry department and in the maxillo-facial surgical unit. Our hypothesis was that some psychiatric conditions act as risk factors for facial trauma. We had for aim to test our hypothesis and to validate a simple and efficient questionnaire to identify these psychiatric disorders.Fifty-eight consenting patients with facial trauma, recruited prospectively in the 3 maxillo-facial surgery departments of the Marseille area during 3 months (December 2012-March 2013) completed a self-questionnaire based on the French version of 3 validated screening tests (Self Reported Psychopathy test, Rapid Alcohol Problem Screening test quantity-frequency, and Personal Health Questionnaire).This preliminary study confirmed that psychiatric conditions detected by our questionnaire, namely alcohol abuse and dependence, substance abuse, and depression, were risk factors for facial trauma.Maxillo-facial surgeons are often unaware of psychiatric disorders that may be the cause of facial trauma. The self-screening test we propose allows documenting the psychiatric history of patients and implementing earlier psychiatric care.

Hydro-sedimentology development is a great challenge in Peru due to limited data as well as sparse and confidential information. Consequently, little is known at present about the relationship between the El Niño Southern Oscillation (ENSO), precipitation, runoff, land use and the sediment transport dynamics. The aim of this paper is to bridge this gap in order to quantify and understand the signal of magnitude and frequency of the sediment fluxes from the central western Andes; also, to identify the main erosion control factor and its relevance. The Tablachaca River (3132 km2) and the Santa River (6815 km2), two mountainous Andean catchments that are geographically close to each other, both showed similar statistical daily rainfall and discharge variability but high contrast in sediment yield (SY). In order to investigate which factors are of importance, the continuous water discharge and hourly suspended sediment concentrations (SSC) of the Santa River were studied. Firstly, the specific sediment yield (SSY) at the continental Andes range scale for the Pacific side is one of the highest amounts (2204 t km2 yr−1). Secondly, no relationship between the water discharge (Q) and El Niño/La Niñ a events is found over a 54 yr time period. However, the Santa Basin is highly sensitive during mega Niños (1982–1983 and 1997–1998). Lastly, dispersed micro-mining and mining activity in specific lithologies are identified as the major factors that control the high SSY. These remarks make the Peruvian coast key areas for future research on Andean sediment rates.

We have studied the influence of plasma treatment in various gases (Ar, NH3, N2) on the surface modification of polycarbonate (PC) and on the adhesion of plasma-deposited silica layers to PC. Surface modification was investigated using in situ IR ellipsometry, X-ray photoelectron spectroscopy, and contact angle measurements interpreted in terms of electron-acceptor/ donor groups. In addition, in situ UV-visible ellipsometry enabled crosslinking analysis. Due to UV photon emission, Ar plasma treatment induced crosslinking as well as photo-Fries rearrangements and related reactions, thus creating phenolic groups. These groups are acidic sites and are likely to react with the electronegative oxygen atoms of silica. Adhesion of silica to PC, as measured by the micro-scratch test, was enhanced by Ar plasma treatment. The improvement is attributed to the crosslinking of PC, on the one hand, and to acid-base interactions and/or covalent bonding between PC and silica, on the other hand. A further improvement in a...

Total nasal reconstructions using bone graft, as structural support is the gold standard. We retrospectively studied an alternative technique relying on a titanium miniplate as a structural support.Five patients underwent total nasal reconstruction, using a 1mm titanium miniplate fixed to the frontal bone and to the anterior maxilla. The miniplate was covered by a fascia lata graft in three cases. The functional and aesthetic results were evaluated on a scale from 0 (disappointing results) to 3 (excellent results) by the patient and by the surgeon, at 1 month and at 3 years after the total nasal reconstruction.The functional results were assessed on average at 2.2/3 at 1 month, and 2.4/3 at 3 years postoperatively. The aesthetic results are estimated at 2 (patient) and 1.8 (medical team) at 1 month and at 2.6 (patient) and 2.2 (medical team) at 3 years. There were no major complications. The minor complications were exposure of the two miniplates, which had not been covered with fascia lata. These complications were resolved by local surgery.The functional and aesthetic results of total nasal reconstruction relying on a titanium miniplate were similar to those obtained with a bone graft. This technique is simple, there is no need for an osseous donor site, it is stable at long-term, and its cost is moderate.

Riga-Fede disease is rare. It is an oral mucosal ulceration due to repetitive dental trauma. We report the case of an infant for whom a quick diagnosis prevented many complications.A 45-day-old infant was brought to our consultation for pain during baby-bottle intake, preventing feeding. Oral examination revealed ulceration on the ventral surface of the tongue, associated next to a mandibular incisor present at birth. Pain stopped immediately after dental extraction of the supernumerary tooth. The infant could be fed again without any problem. The ulceration healed in less than three months.The diagnosis of Riga-Fede disease is strictly clinical. The early diagnosis in our case allowed for a quick management and normal feeding before there was any somatic consequence. Dental trauma is the most frequent cause of Riga-Fede disease. Treatment is conservative (polishing, resin) except in case of supernumerary teeth or excessive mobility. In these cases, extraction is indicated. The pathological diagnosis is required only when there is no healing after appropriate management fails, to look looking for another diagnosis.

Two different types of suture are used in our unit after wisdom tooth extraction, Polyglactin 910 [PGS] (Vicryl®, Ethicon) and rapid absorption irradiated Polyglactin 910 [PGI]. No objective comparative study was available so we decided to conduct a preliminary prospective study to check if there was any difference between these two types of suture.Forty patients were included in our study, consecutively operated for impacted wisdom teeth by the same surgeons, between April and June 2010. The symmetry of impaction was systematically controlled on panoramic views before including a patient in the study. PGS and PGI were both used for every patient, PGS on one side and PGI on the other. The "right or left" PGS-PGI distribution was randomized and double-blinded. The patient was his own control. Thirty-two patients were examined at the postoperative consultation, during which an evaluation questionnaire was completed with the surgeon. Pain, difficulty to chew, duration of swelling, dysgeusia, and major complications (inflammation, disunion, infection) were analyzed.The statistical analysis revealed that postoperative pain was greater on the PGS side (VAS=3.7) than on the PGI side (VAS=2.8) without any significant difference. The duration of swelling was significantly higher on the PGS side (5.5days) than on the PGI side (3.1days). Coming back to normal food intake did not seem different; it was not interrupted. PGI also significantly reduced the difficulty to chew and dysgeusia. There was no difference in complications between PGS and PGI.This study proved the superiority of PGI over PGS during the three postoperative weeks after extraction of wisdom teeth, in terms of comfort and edema.

International audience; We summarise the contemporary carbon budget of South America and relate it to its dominant controls: population and economic growth, changes in land use practices and a changing atmospheric environment and climate. Component flux estimate methods we consider sufficiently reliable for this purpose encompass fossil fuel emission inventories , biometric analysis of old-growth rainforests, estimation of carbon release associated with deforestation based on remote sensing and inventories, and agricultural export data. Alternative methods for the estimation of the continental-scale net land to atmosphere CO 2 flux, such as atmospheric transport inverse modelling and terrestrial biosphere model Published by Copernicus Publications on behalf of the European Geosciences Union. 5408 M. Gloor et al.: The carbon balance of South America predictions, are, we find, hampered by the data paucity, and improved parameterisation and validation exercises are required before reliable estimates can be obtained. From our analysis of available data, we suggest that South America was a net source to the atmosphere during the 1980s (∼ 0.3-0.4 Pg C a −1) and close to neutral (∼ 0.1 Pg C a −1) in the 1990s. During the latter period, carbon uptake in old-growth forests nearly compensated for the carbon release associated with fossil fuel burning and deforestation. Annual mean precipitation over tropical South America as inferred from Amazon River discharge shows a long-term upward trend. Although, over the last decade dry seasons have tended to be drier, with the years 2005 and 2010 in particular experiencing strong droughts. On the other hand, precipitation during the wet seasons also shows an increasing trend. Air temperatures have also increased slightly. Also with increases in atmospheric CO 2 concentrations, it is currently unclear what effect these climate changes are having on the forest carbon balance of the region. Current indications are that the forests of the Amazon Basin have acted as a substantial long-term carbon sink, but with the most recent measurements suggesting that this sink may be weakening. Economic development of the tropical regions of the continent is advancing steadily, with exports of agricultural products being an important driver and witnessing a strong upturn over the last decade.

Osteopetrosis is a metabolic bone disease that leads to bone malformation and bone healing disorders. We report the case of a patient who underwent orthognathic surgery to treat a class III skeletal malocclusion.A 21-year-old patient had presented with osteopetrosis in his childhood, which had been treated by bone marrow transplantation. He presented with esthetic and functional sequels, a class III skeletal malocclusion, lateral mandibular deviation, and dental agenesis. This dysmorphism was corrected by bimaxillar osteotomy. The postoperative outcome was uneventful, with satisfactory and stable healing.The patient's lesions where after-effects of his disease, but the bone structure is normal, because osteopetrosis regressed after bone marrow transplantation. There is no risk for the consolidation. Osteopetrosis, even when treated by bone marrow transplantation, is not a contraindication for maxillomandibular osteotomy.

Most of dentofacial abnomalies are due to mandibular retrognathisms. These abnomalies are surgically treated mostly by mandibular lenghtening with the help of the sagittal split osteotomy although other procedures could be used. Mandibular distraction and advancement of the receding lower jaw by retrocondylar cartilagenous graft are the two main alternatives. The retrocondylar cartilagenous graft has been introduced by Leon Dufourmentel in 1929. This procedure has strong anatomical and physiological basis and has to be better known because it is effective and respects the temporo-mandibular joint. The permanent advancement of the mandible is assured by a retrocondylar graft placed in the pretympanal and extra-articular space located between tympanal bone and retrocondylar venous plexus. All the mandibule retrognathisms should be treated through this approach, especially with associated obstruction sleep apnea syndrome.

Tooth abscess can be diagnosed based solely on clinical findings. No additional studies are required. Abscess can be treated using a few basic instruments.

Humanitarian surgical missions provide cares in developing countries and in difficult conditions. Preparation of these missions is a mandatory step for both technical and human points of view. Before the departure, care must be taken to accomplish all the administrative (visa application, valid passport…) and the medical formalities (mandatory and recommended vaccinations). The aim of this article is to present a helpful vade mecum allowing any surgeon, especially the juniors, to prepare a humanitarian mission abroad.