Publications by authors named "Helios Bertin"

26 Publications

  • Page 1 of 1

A case report of condyle metastasis and a review of the literature.

J Stomatol Oral Maxillofac Surg 2021 May 7. Epub 2021 May 7.

Service de chirurgie maxillo-faciale et stomatologie, CHU de Nantes, 1 place Alexis Ricordeau, 44093 Nantes, France; Laboratoire des sarcomes osseux et remodelage des tissus calcifiés (Phy.Os UMR1238), faculté de médecine, 1 rue Gaston Veil, 44000 Nantes, France. Electronic address:

Metastasis of the oral cavity is a rare condition and should be investigated for a primary tumor in the lungs, breast, kidney and prostate. Involvement of the mandibular condyle frequently mimics TMJ dysfunction with pain, swelling and limitation of mouth opening. We report the case of atypic TMJ dislocation as an inaugural sign of condyle metastasis. We also discuss the diagnostic approach by a brief review of the literature.
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http://dx.doi.org/10.1016/j.jormas.2021.04.013DOI Listing
May 2021

Clinical evaluation of the efficacy of materials used for primary reconstruction of orbital floor defects: Meta-analysis.

Head Neck 2021 Feb 4;43(2):679-690. Epub 2020 Nov 4.

Department of Maxillofacial Surgery, Nantes University Hospital, Nantes Cedex 1, France.

Background: The aim of this network meta-analysis (NMA) was to compare the clinical results obtained after primary reconstruction of orbital floor fractures (OFF) using different materials.

Methods: PubMed, Cochrane, and Google Scholar databases were screened from 1989 to 2019. For a study to be eligible, it had to evaluate two or more materials and report the following clinical parameters: diplopia and/or enophthalmos and/or other complications.

Results: Nine studies involving 946 patients presenting with an OFF were included. After the surgical procedure, 105 patients (11%) had diplopia, while 43 patients (4.5%) suffered from enophthalmos. The NMA revealed that less postoperative diplopia and enophthalmos were obtained either by using polydioxanone (PDS), or a polymer of l-lactic acid and dl-lactic acid (P[L/DL]LA), or porous polyethylene, or titanium mesh compared with the use of autologous bone grafts.

Conclusion: P(L/DL)LA and PDS seem to be the best options for small and intermediate defects, whereas the association of porous polyethylene and titanium should be preferred for larger defects.
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http://dx.doi.org/10.1002/hed.26518DOI Listing
February 2021

Osteosarcoma of the jaws: An overview of the pathophysiological mechanisms.

Crit Rev Oncol Hematol 2020 Dec 10;156:103126. Epub 2020 Oct 10.

Bone Sarcoma and Remodeling of Calcified Tisues (PhyOs, UMR 1238), Nantes Medical School, 1 Rue Gaston Veil, 44035 Nantes Cedex, France. Electronic address:

Osteosarcoma (OS) is the most common cancer of bone. Jaw osteosarcoma (JOS) is rare and it differs from long-bone OS (LBOS) in terms of the time of onset (two decades later), lower metastatic spread, and better survival. OS is characterized by the proliferation of osteoblastic precursor cells and the production of osteoid or immature bone. OS arises from a combination of genetic aberrations and a favourable microenvironment. This local microenvironment includes bone cells, blood vessels, stromal cells, and immune infiltrates, all of which may constitute potential targets for anti-cancer drugs. Differences in the clinical and biological behaviour of JOS versus LBOS are likely to at least in part be due to differences in the microenvironment between the two sites. The present review provides a brief overview of the known pathophysiological parameters involved in JOS.
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http://dx.doi.org/10.1016/j.critrevonc.2020.103126DOI Listing
December 2020

Dental and maxillofacial features of condylo-mandibular dysplasia: A case series of 21 patients.

J Craniomaxillofac Surg 2020 Oct 25;48(10):956-961. Epub 2020 Jul 25.

Service de Chirurgie Maxillo-faciale et Stomatologie, CHU de Nantes, 1 Place Alexis Ricordeau, 44093, Nantes Cedex 1, France. Electronic address:

Introduction: Camel-hump condylo-mandibular dysplasia is a specific form of condyle dysostosis, first described by Delaire. The aim of this study was to describe the clinical and radiographic phenotype of the disease, and to discuss therapeutic options.

Case Series: Twenty-one patients were analyzed retrospectively. They exhibited the same unilateral facial asymmetry, which was of mandibular origin, with an elevated commissural line and occlusal cant, and a deviated chin on the side of the deformity. The soft tissues and the ears were always normal in terms of their physical appearance. Radiographic analysis generally revealed a short, curved, and anteriorly displaced condyle, with a high and sharp coronoid process. CT scans revealed that the glenoid fossa was empty. Twelve patients exhibited dental abnormalities, consisting mainly of dental inclusions affecting the lower first and/or second molars (10 patients). A good response to functional orthodontic treatment was achieved in eight patients, while 13 patients required a surgical mandibular lengthening procedure.

Conclusion: Condylo-mandibular dysplasia is a congenital condyle deformity that needs to be recognized and differentiated from craniofacial microsomia in order to be able to provide patient-specific treatments.
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http://dx.doi.org/10.1016/j.jcms.2020.07.007DOI Listing
October 2020

Tailored Three-Dimensionally Printed Triply Periodic Calcium Phosphate Implants: A Preclinical Study for Craniofacial Bone Repair.

ACS Biomater Sci Eng 2020 01 22;6(1):553-563. Epub 2019 Nov 22.

INSERM, U 1229, Laboratoire Regenerative Medicine and Skeleton (RMeS), 1 place Alexis Ricordeau, Nantes F - 44042, France.

Finding alternative strategies for the regeneration of craniofacial bone defects (CSD), such as combining a synthetic ephemeral calcium phosphate (CaP) implant and/or active substances and cells, would contribute to solving this reconstructive roadblock. However, CaP's architectural features (i.e., architecture and composition) still need to be tailored, and the use of processed stem cells and synthetic active substances (e.g., recombinant human bone morphogenetic protein 2) drastically limits the clinical application of such approaches. Focusing on solutions that are directly transposable to the clinical setting, biphasic calcium phosphate (BCP) and carbonated hydroxyapatite (CHA) 3D-printed disks with a triply periodic minimal structure (TPMS) were implanted in calvarial critical-sized defects (rat model) with or without addition of total bone marrow (TBM). Bone regeneration within the defect was evaluated, and the outcomes were compared to a standard-care procedure based on BCP granules soaked with TBM (positive control). After 7 weeks, de novo bone formation was significantly greater in the CHA disks + TBM group than in the positive controls (3.33 mm and 2.15 mm, respectively, P=0.04). These encouraging results indicate that both CHA and TPMS architectures are potentially advantageous in the repair of CSDs and that this one-step procedure warrants further clinical investigation.
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http://dx.doi.org/10.1021/acsbiomaterials.9b01241DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7064275PMC
January 2020

Evaluation of vertical ramus osteotomy for the surgical correction of unilateral mandibular posterior vertical insufficiency: Long-term follow-up results.

J Craniomaxillofac Surg 2020 Apr 23;48(4):349-356. Epub 2020 Feb 23.

Service de chirurgie Maxillo-faciale et stomatologie, CHU de Nantes, 1 place Alexis Ricordeau, 44093, Nantes Cedex 1, France; Laboratoire des sarcomes osseux et remodelage des tissus calcifiés (PhyOs, UMR 1238), Faculté de médecine, 1 rue Gaston Veil, 44035, Nantes cedex, France. Electronic address:

Purpose: Unilateral posterior vertical insufficiency (PVI) is a growth defect of the mandibular condyle that results in a facial asymmetry. Various surgical procedures can be used to elongate the hypoplastic ramus. The aim of this study was to evaluate long-term aesthetic and architectural outcomes of vertical ramus osteotomy (VRO) in patients with unilateral PVI.

Materials And Methods: Patients operated on with unilateral VRO were included in this retrospective study. Aesthetic and architectural parameters were evaluated on frontal photographs as well as on frontal and lateral cephalograms preoperatively, postoperatively, at 1-year and at the end of the follow-up.

Results: A total of 48 patients were analyzed. The aesthetic assessment revealed significant correction of the chin deviation (CD) and of the lip commissural line tilt after VRO (p1 = 0.0038 and p2 = 0.0067, respectively) with stable results. The architectural analysis revealed significant improvement in the maxillary and mandibular occlusal planes, as well as the chin deviation (p < 0.0001). A tendency to relapse was noted for the mandibular canting and the CD during the follow-up. VRO allowed for a mean mandibular lengthening of 8.39 mm (ranging from 2.5 to 14 mm).

Conclusion: VRO allows for immediate restoration of the symmetry of the lower third of the face in patients with unilateral PVI. A revisional procedure may be needed due to a tendency for the chin deviation to relapse.
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http://dx.doi.org/10.1016/j.jcms.2020.02.013DOI Listing
April 2020

Postimplantation radiation therapy in head and neck cancer patients: Literature review.

Head Neck 2020 04 3;42(4):794-802. Epub 2020 Jan 3.

Laboratoire des sarcomes osseux et remodelage des tissus calcifiés, Unité Mixte de Recherche, Faculté de Médecine, 1 rue Gaston Veil, Nantes Cedex, France.

There is no recommendation regarding the timing for implant surgery in patients with head and neck cancer (HNC) who require postoperative radiation therapy (RT). This systematic review focused on the literature about the outcomes of implants placed during ablative surgery in patients with HNC who underwent postoperative RT. Implants placed after radiation therapy and implants placed in reconstructed jaws were excluded. Four comparative studies involving 755 native mandible primary implants were analyzed. The survival rate with postimplantation RT was 89.6% vs 98.6% in patients with no additional radiation. The overall success of implant-retained overdenture in patients with RT performed postimplantation was 67.4% vs 93.1% in patients with implant surgery that was carried out 1 year after the completion of radiation therapy. Only five cases of osteoradionecrosis (ORN) of the jaw were reported. The outcomes for implant survival rates appear to be positive for irradiated implants.
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http://dx.doi.org/10.1002/hed.26065DOI Listing
April 2020

Management of maxillofacial trauma in the elderly: A European multicenter study.

Dent Traumatol 2020 Jun 9;36(3):241-246. Epub 2020 Jan 9.

Department of Maxillofacial and Oral Surgery, University Medical Centre, Ljubljana, Slovenia.

Background/aims: Management of maxillofacial trauma in the geriatric population poses a great challenge due to anatomical variations and medical comorbidities. The aim of this study was to analyze the management variables, timing, and outcomes of facial fractures in elderly patients (aged 70 years or more) at several European departments of oral and maxillofacial surgery.

Materials And Methods: This study was based on a systematic computer-assisted database that allowed the recording of data from all geriatric patients with facial fractures from the involved maxillofacial surgical units across Europe between 2013 and 2017.

Results: A total of 1334 patients were included in the study: 665 patients underwent closed or open surgical treatment. A significant association (P < .005) was found between the presence of concomitant injuries and a prolonged time between hospital admission and treatment. The absence of indications to treatment was associated with comorbidities and an older age (P < .000005).

Conclusions: Elderly patients require specific attention and multidisciplinary collaboration in the diagnosis and sequencing of trauma treatment. A prudent attitude may be kept in selected cases, especially when severe comorbidities are associated and function is not impaired.
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http://dx.doi.org/10.1111/edt.12536DOI Listing
June 2020

Surgical management of unilateral body fractures of the edentulous atrophic mandible.

Oral Maxillofac Surg 2020 Mar 17;24(1):65-71. Epub 2019 Dec 17.

Department of Oral and Maxillofacial Surgery, Aalborg University Hospital, Aalborg, Denmark.

Introduction: Management of body fractures in patients with edentulous atrophic mandibles represents a challenging task due to patient's age, medical comorbidities, poor bone quality, and vascularity, as well as reduced contact area between the fracture ends. The aim of the study was to assess the demographic and clinical variables, the surgical technique, and outcomes of unilateral body fractures of the edentulous atrophic mandible managed at several European departments of oral and maxillofacial surgery.

Methods: This study is based on a systematic computer-assisted database that allowed the recording of data of all patients with fractures of the atrophic edentulous mandible from the involved maxillofacial surgical units across Europe between 2008 and 2017. The following data were recorded for each patient: gender, age, comorbidities, etiology, synchronous body injuries, degree of atrophy of the mandible according to Luhr classification, type of surgical approach and fixation, length of hospitalization, and presence and type of complications.

Results: A total of 43 patients were included in the study: 17 patients' mandibles were classified as class I according to Luhr, 15 as class II, and 11 as class III. All patients underwent open reduction and internal fixation by extraoral approach in 25 patients, intraoral in 15 patients, and mixed in 3 patients. A single 2.0 miniplate was used in 16 patients, followed by a single 2.4 reconstruction plate in 13 patients, by two 2.0 miniplates, and three 2.0 miniplates. Outcome was considered to be satisfying in 30 patients, with no complications. Complications were observed in 13 cases.

Conclusions: Treatment of unilateral body fractures of the edentulous mandible must still be based on the type of fracture, degree of atrophy, experience of the surgeon, and patients' preference. An adequate stability can be obtained by different plating techniques that have to be appropriately tailored to every single specific patient.
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http://dx.doi.org/10.1007/s10006-019-00824-8DOI Listing
March 2020

The epidemiology of edentulous atrophic mandibular fractures in Europe.

J Craniomaxillofac Surg 2019 Dec 29;47(12):1929-1934. Epub 2019 Nov 29.

Department of Oral and Maxillofacial Surgery, Aalborg University Hospital, Aalborg, Denmark.

Introduction: The objective of the present study was to assess the demographic variables, causes, and patterns of edentulous atrophic fractures of the mandible managed at several European departments of oral and maxillofacial surgery. The results of this multicenter collaboration over a 10-year period are presented.

Methods: The data of all patients with fractures of the atrophic edentulous mandible from the involved maxillofacial surgical units across Europe between January 1, 2008, and December 31, 2017 were recorded: gender; age; voluptuary habits; comorbidities; etiology; fracture sites; synchronous body injuries; atrophy of the mandible according to Luhr classification; eventual type of treatment; timing of the eventual surgery; length of hospital stay.

Results: A total of 197 patients (86 male and 111 female patients) with 285 mandibular fractures were included in the study. Mean age of the study population was 75 years. Statistically significant associations were found between Luhr classes I - II and condylar fractures on one hand (p < .0005), and between Luhr class III and body and parasymphyseal fractures on the other hand (p < .05). Finally, 135 patients underwent open reduction and internal fixation, 56 patients did not undergo any intervention, and 6 patients underwent closed reduction. No statistically significant association was observed between treatment, timing of treatment, comorbidities, and concomitant injuries.

Conclusions: The management of edentulous atrophic mandibular fractures remains challenging. Treatment decisions should continue to be based on the clinician's previous experience and on the degree of bone resorption in edentulous mandible in relation to fracture subsites.
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http://dx.doi.org/10.1016/j.jcms.2019.11.021DOI Listing
December 2019

Radiographic evaluation of percutaneous transfacial wiring versus open internal fixation for surgical treatment of unstable zygomatic bone fractures.

PLoS One 2019 15;14(8):e0220913. Epub 2019 Aug 15.

Service de Chirurgie Maxillo-faciale et Stomatologie, Centre Hospitalier Universitaire de Nantes, Nantes, France.

Introduction: The fixation of unstable zygomaticomaxillary complex (ZMC) fractures can be achieved by open reduction with rigid internal fixation (ORIF) and/or by closed reduction with percutaneous transfacial Kirschner wire fixation (CRWF). The aim of this study was to tomographically assess the symmetry and the protrusion of the cheekbone with unstable ZMC fractures that had been treated by ORIF vs. CRWF.

Materials And Methods: Sixty patients exhibiting a surgically unstable tetrapodal ZMC fracture were included in this multicenter retrospective study. The coordinates of 5 landmarks representing the zygomatic protrusion were comparatively studied on the healthy and on the broken side using preoperative and postoperative tridimensional computed tomography (CT) scans or cone beam CT.

Results: No significant difference was found in the zygomatic protrusion irrespective of the surgical technique that was used. The zygomatico-maxillary ansa was found to be the most complicated area to reduce, particularly in the frontal plane with both the CRWF and the ORIF technique (p1 = 0.001 and p2 = 0.0009, respectively). There was no difference in terms of the level of complications, while the mean duration of the surgery was significantly less for the CRWF group.

Conclusion: With good postoperative radiographic outcomes, the CRWF can be proposed as an alternative or in association with the ORIF technique for fixation of tetrapodal fractures of the ZMC.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0220913PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6695106PMC
March 2020

Mandibular bone effects of botulinum toxin injections in masticatory muscles in adult.

Oral Surg Oral Med Oral Pathol Oral Radiol 2020 Feb 20;129(2):100-108. Epub 2019 Mar 20.

Groupe Etudes Remodelage Osseux et bioMatériaux, GEROM, UNIV Angers, SFR 42-08, IRIS-IBS Institut de Biologie en Santé, Chu d'Angers, Angers, Cedex, France. Electronic address:

Objective: Botulinum toxin (BTX) is injected into masticatory muscles to treat various conditions. Animal studies have demonstrated bone loss at the condylar and alveolar regions of the mandible after BTX injection into masticatory muscles. The aim of the present study was to investigate mandibular bone changes in patients who received BTX injections in masticatory muscles.

Study Design: Twelve adult patients who received BTX injections into masticatory muscles were included in this study. Cone beam computed tomography (CBCT) was performed before and 12 months after the injection. The condylar and alveolar regions of the mandible were analyzed by using texture analysis of the CBCT images with the run length method. Condylar cortical thickness was measured, and 3-dimensional analysis of the mandible was also performed. Six patients who did not receive BTX injections were used as controls.

Results: A run length parameter (gray level nonuniformity) was found to be increased in condylar and alveolar bones. A significant cortical thinning was found at the anterior portion of the right condyle. Three-dimensional analysis showed significant changes in the condylar bone and at the digastric fossa. No changes in mandibular angles were found.

Conclusions: This study identified mandibular bone changes in adult patients who received BTX injection into masticatory muscles.
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http://dx.doi.org/10.1016/j.oooo.2019.03.007DOI Listing
February 2020

Motor vehicle accidents-related maxillofacial injuries: a multicentre and prospective study.

Oral Surg Oral Med Oral Pathol Oral Radiol 2019 Sep 13;128(3):199-204. Epub 2018 Dec 13.

Department of Oral and Maxillofacial Surgery/Pathology, VU University Medical Center and Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands.

Objectives: The purpose of this European multicenter prospective study was to obtain more precise information about the demographic characteristics and etiologic/epidemiologic patterns of motor vehicle accidents (MVA)-related maxillofacial fractures.

Study Design: Of the 3260 patients with maxillofacial fractures admitted within the study period, 326 traumas were caused by MVAs with a male/female ratio of 2.2:1.

Results: The maximum incidence was found in Zagreb (Croatia) (18%) and the minimum in Bergen (Norway) (0%). The most frequent mechanisms were car accidents, with 177 cases, followed by motorcycle accidents. The most frequently observed fracture involved the mandible, with 199 fractures, followed by maxillo-zygomatic-orbital (MZO) fractures.

Conclusions: In all the 3 groups (car, motorcycle, and pedestrian), mandibular and MZO fractures were the 2 most frequently observed fractures, with some variations. The importance of analyzing MVA-related facial injuries and their features and characteristics should be stressed.
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http://dx.doi.org/10.1016/j.oooo.2018.12.009DOI Listing
September 2019

Intraoperative imaging and navigation with mobile cone-beam CT in maxillofacial surgery.

Oral Maxillofac Surg 2019 Dec 16;23(4):487-491. Epub 2019 May 16.

Department of Oral and Maxillofacial Surgery, Nantes University Hospital, 1 place Alexis-Ricordeau, 44093, NANTES Cedex 1, France.

Introduction: Intraoperative mobile Cone-Beam Computed Tomography (CBCT) trends to develop for the management of complex facial fractures. It allows a real-time imaging and surgical navigation.

Aim: Through the presentation of two clinical cases, we aimed at presenting the procedure of intra-operative CBCT and new applications in maxillofacial surgery.

Results: A young patient with extended orbito-frontal fibrous dysplasia, and a child with the recurrence of a temporomandibular joint ankylosis secondary to mastoïditis, were operated using a intra-operative imaging control. In both cases, the intraoperative CBCT increased precision and safety of the bone resection. No surgical complication was noted and a good healing was obtained.

Conclusion: Intraoperative CBCT raises the problems of radiation exposure and increased operating time. However, it represents a useful imaging tool and a navigation system in complex situations as osseous dysplasia and surgery of the temporo-mandibular joint.
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http://dx.doi.org/10.1007/s10006-019-00765-2DOI Listing
December 2019

The "European Mandibular Angle" research project: the analysis of complications after unilateral angle fractures.

Oral Surg Oral Med Oral Pathol Oral Radiol 2019 Jul 28;128(1):14-17. Epub 2019 Feb 28.

Department of Oral and Maxillofacial Surgery/Pathology, VU University Medical Center and Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands.

Objective: The aim of this study was to analyze the complications and outcomes of surgical treatment of angle fractures managed at departments of maxillofacial surgery in several European countries.

Study Design: Patients hospitalized with unilateral isolated angle fractures between 2013 and 2017 were included. The following data were recorded: gender and age of patients, fracture etiology, presence of the third molar, maxillomandibular fixation, osteosynthesis technique, and complications.

Results: In total, 489 patients were included in the study. The Champy technique was found to be the most frequently chosen osteosynthesis technique. Sixty complications were observed, at a rate of 12.3%. Complications were associated with the absence of third molars (P < .05). Instead, the Champy technique was associated with fewer complications (P < .05), in comparison with the other adopted techniques.

Conclusions: The management of angle fractures still represents a challenging task with a significant complication rate. The Champy technique still seems to be a valid option for the treatment of such injuries.
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http://dx.doi.org/10.1016/j.oooo.2019.02.027DOI Listing
July 2019

Jaw osteosarcoma models in mice: first description.

J Transl Med 2019 02 27;17(1):56. Epub 2019 Feb 27.

Laboratoire des sarcomes osseux et remodelage des tissus calcifiés (Phy.OS), UMR 1238, Faculté de médecine, 1 rue Gaston Veil, 44035, Nantes Cedex, France.

Background: Osteosarcoma (OS) is the most common cancer of bone. Jaw osteosarcoma (JOS) is rare and it differs from other OS in terms of the time of occurrence (two decades later) and better survival. The aim of our work was to develop and characterize specific mouse models of JOS.

Methods: Syngenic and xenogenic models of JOS were developed in mice using mouse (MOS-J) and human (HOS1544) osteosarcoma cell lines, respectively. An orthotopic patient-derived xenograft model (PDX) was also developed from a mandibular biopsy. These models were characterized at the histological and micro-CT imaging levels, as well as in terms of tumor growth and metastatic spread.

Results: Homogeneous tumor growth was observed in both the HOS1544 and the MOS-J JOS models by injection of 0.25 × 10 and 0.50 × 10 tumor cells, respectively, at perimandibular sites. Histological characterization of the tumors revealed features consistent with high grade conventional osteosarcoma, and the micro-CT analysis revealed both osteogenic and osteolytic lesions. Early metastasis was encountered at day 14 in the xenogenic model, while there were no metastatic lesions in the syngenic model and in the PDX models.

Conclusion: We describe the first animal model of JOS and its potential use for therapeutic applications. This model needs to be compared with the usual long-bone osteosarcoma models to investigate potential differences in the bone microenvironment.
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http://dx.doi.org/10.1186/s12967-019-1807-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6391788PMC
February 2019

The "European zygomatic fracture" research project: The epidemiological results from a multicenter European collaboration.

J Craniomaxillofac Surg 2019 Apr 30;47(4):616-621. Epub 2019 Jan 30.

Department of Oral and Maxillofacial Surgery/Pathology, VU University Medical Center and Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, the Netherlands.

Purpose: Fractures of the zygomaticomaxillary complex (ZMC) are common injuries that may lead to loss of an aesthetically pleasing appearance and functional impairment. The aim of this study was to analyze the demographics, causes, characteristics, and outcomes of zygomatic fractures managed at several European departments of oral and maxillofacial surgery.

Materials And Methods: This study is based on a multicenter systematic database that allowed the recording of all patients with ZMC fractures between 1 January 2013 and 31 December 2017. The following data were recorded: gender, age, personal medical history, etiology, side of zygomatic fracture, classification of ZMC fracture, associated maxillofacial fractures, symptoms at diagnosis, type of performed treatment, and sequelae/complications.

Results: A total of 1406 patients (1172 males, 234 females) were included in the study. Statistically significant correlations were found between assault-related ZMC fractures and the A3 class (p < .0000005) and between Infraorbital Nerve (ION) anesthesia and B class (p < .00000005).

Conclusion: The most frequent cause of ZMC fractures was assault, followed by falls. The most frequently involved decade of age was between 20 and 29 years. The decision and type of surgical treatment of ZMC fractures depends on several issues that need to be considered on a case by case basis.
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http://dx.doi.org/10.1016/j.jcms.2019.01.026DOI Listing
April 2019

The "European Mandibular Angle" Research Project: The Epidemiologic Results From a Multicenter European Collaboration.

J Oral Maxillofac Surg 2019 Apr 27;77(4):791.e1-791.e7. Epub 2018 Dec 27.

Full Professor, Department of Oral and Maxillofacial Surgery/Pathology, VU University Medical Center and Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands.

Purpose: The aim of this study was to analyze the demographic variables and causes and characteristics of mandibular angle fractures managed at several European departments of maxillofacial surgery.

Materials And Methods: This study was based on a multicenter systematic database that allowed the recording of data from all patients with mandibular angle fractures between January 1, 2013, and December 31, 2017. The following data were recorded: gender, age, etiology, side of angle fracture, associated mandibular fractures, presence of third molar, intermaxillary fixation, and osteosynthesis.

Results: The study included 1,162 patients (1,045 male and 117 female patients). A significant association was found between the presence of a third molar and the diagnosis of an isolated angle fracture (P < .0000005). Furthermore, assaults were associated with the presence of voluptuary habits (P < .00005), a younger mean age (P < .00000005), male gender (P < .00000005), and left-sided angle fractures (P < .00000005).

Conclusions: Assaults and falls actually represent the most frequent causes of angle fractures. The presence of a third molar may let the force completely disperse during the determination of the angle fracture, finding a point of weakness.
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http://dx.doi.org/10.1016/j.joms.2018.12.013DOI Listing
April 2019

Postoperative morbidity of free flaps in head and neck cancer reconstruction: a report regarding 215 cases.

Clin Oral Investig 2019 May 1;23(5):2165-2171. Epub 2018 Oct 1.

Service de Chirurgie Maxillo-faciale et Stomatologie, CHU de Nantes, 1 place Alexis Ricordeau, 44093, Nantes Cedex 1, France.

Objectives: The aim of this study was to identify the factors responsible for free flap failure, the surgical complications, and the non-oral feeding period in patients treated for an oral squamous cell carcinoma.

Materials And Methods: This multicentric study included 215 patients treated by tumour resection with immediate free flap reconstruction for an OSCC between 2010 and 2016. All of the patient medical files were reviewed and the data regarding the patient medical history, the tumour-related features, the surgical procedure, and the postoperative recovery were compiled. A statistical analysis with univariate and multivariate logistic regression was carried out.

Results: The free flap success rate was 94.4% in our series. A postoperative complication occurred in 101 patients (41%). Minor surgical complications were shown to increase the free flap failure rate (OR 3.32; p = 0.04). A major surgical complication was encountered in 48 patients (22.3%), and these were linked to minor surgical complications (OR 2.89; p = 0.004) and the use of a tracheostomy (OR 5.76, p = 0.002). Conversely, a medical history of high blood pressure had a protective effect (p = 0.04). The non-oral feeding rate at the end of the hospital stay was 28.4%, and it correlated with the tracheostomy (p = 0.002), as well as the major and the minor surgical complications (p = 0.04).

Conclusion-clinical Relevance: Free flap reconstruction is a safe and reliable technique with head and neck cancer reconstruction. Postoperative care favouring early and safe oral-feeding, and avoiding a tracheostomy can reduce the incidence of surgical complications after OSCC reconstruction.
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http://dx.doi.org/10.1007/s00784-018-2653-1DOI Listing
May 2019

Structural comparison of hemifacial microsomia mandible in different age groups by three-dimensional skeletal unit analysis.

J Craniomaxillofac Surg 2018 Nov 23;46(11):1875-1882. Epub 2018 Aug 23.

Department of Oral and Maxillofacial Surgery (Head: Pf. HJ Kim), Oral Science Research Center, College of Dentistry, Yonsei University, Seoul, Republic of Korea. Electronic address:

Purpose: The goal of this study was to understand the three-dimensional (3D) structural characteristics of hemifacial microsomia (HFM) mandible in terms of skeletal units, especially to locate the underdeveloped skeletal regions for treatment. Another goal was to compare the HFM structure of different age groups to understand growth potential relevant to treatment scheduling.

Materials And Methods: We reconstructed 3D mandibles from computed tomographic images of French and Korean patients with HFM (N = 28; group II) and normal subjects (N = 27; group I). Each mandible was classified by Pruzansky's HFM types I, II and III, and by age group (child, adolescent, and adult). The mandible was divided into skeletal units, and geometrical representation by skeletal unit line was performed, including the condylar, body, coronoid, and angular units. Their length and angulations were measured and statistically analyzed.

Results: The results showed that the affected condylar unit in type II HFM and the condylar/coronoid unit in type III were smaller in young age groups than were other units. The angulation between the skeletal units in type II, though not type III, tended toward normalcy with age, but not to the normal degree of angulations in group I.

Conclusion: Our study shows the major involvement of condylar unit and minor involvement of body unit for HFM, improving with age in type II. The mandibular skeletal unit analysis seems to be a useful tool for individualized diagnosis, allowing identification of the major etiopathogenic area and treatment planning, including a simulation to set up a regimen for successful reconstruction of HFM.
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http://dx.doi.org/10.1016/j.jcms.2018.08.009DOI Listing
November 2018

Quality of life and nasal splints after primary cleft lip and nose repair: Prospective assessment of information and tolerance.

J Craniomaxillofac Surg 2018 Oct 9;46(10):1783-1789. Epub 2018 Aug 9.

Assistance Publique - Hôpitaux de Paris, Service de chirurgie maxillofaciale et plastique, Hôpital Necker - Enfants Malades, Université Paris Descartes, Université Sorbonne Paris Cité, (Head: Pr. Arnaud Picard, MD PhD), Paris, France. Electronic address:

Splints are commonly used after primary cleft surgery in order to secure the position of the nasal cartilages. Although the importance of splints is more and more stressed in the literature, many questions remain unanswered relative to the psychological impact of this device on children and families. Two questionnaires, Information and Tolerance, were used in order to measure the quality of life (QoL) associated with the use of nasal splints after primary cleft surgery. Information assessed the understanding of the parents the day before the procedure. Tolerance assessed their experience 3 months after splint placement. We prospectively included 41 consecutive patients from a Paris cleft center, 21 consecutive patients from a Russian center (Moscow) and 10 consecutive patients form a another French center (Nantes). In Paris and Nantes, an initial fixed splint was placed during the procedure until day 10, and then replaced by a removable splint for a period of 4 months. In the Moscow group, removable splints were used primarily for a total period of 4 months. Three types of removable splints were considered: commercial anatomical self-retentive splints (Nose-Fit™, Moscow, Russian Federation), in-house anatomical self-retentive splints and commercial Talmant-type splints requiring taping (Sebbin, Boissy-l'Aillerie, France). The data was analyzed as Likert scales and internal consistency was assessed using the Cronbach coefficient. Age at surgery, uni- or bilateral cleft, type of splint, number of splint changes and complications were tested against the scores of the questionnaires using multivariate models. We did not find correlations between the factors assessed by the multivariate analysis and the splint type. Information and Tolerance scores were high and showed satisfactory QoL associated with the use of splints. The internal consistency of the combination of the two forms was good. While the effects of splints on nasal morphology still need to be confirmed based on a controlled prospective study, we show here that this device is well tolerated by families and is not associated with specific complications.
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http://dx.doi.org/10.1016/j.jcms.2018.07.022DOI Listing
October 2018

Skeletal unit construction of rat mandible based on the masticatory muscle anatomy and double microcomputed tomography.

Anat Histol Embryol 2018 Oct 25;47(5):417-427. Epub 2018 Jun 25.

Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University, Seoul, Korea.

This study aimed to divide the mandible into skeletal units based on three-dimensional (3D) muscular anatomy with microcomputed tomography (micro-CT) of Sprague-Dawley rat. Five normal rats were micro-CT scanned at 12 weeks of age before and after contrast enhancements for the masticatory muscles. Three-dimensional reconstruction of the mandible was performed from the initial micro-CT images, followed by segmentation of the masticatory muscles using the second enhanced micro-CT data. Bone and muscle models were superimposed based on the teeth and bony structures to evaluate muscular orientation and attachment. The mandible was divided into skeletal units using the bony structures and muscle attachments. The mandibular foramen and mental foramen were adopted as the reference points based on their anatomical and developmental significance. The skeletal units consisted of the condylar, coronoid, angular, body and symphyseal units. Further evaluation of these units in relation to development, growth, and other biology and medicine will be helpful in elucidating their biological identities.
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http://dx.doi.org/10.1111/ahe.12374DOI Listing
October 2018

Familial autosomal dominant severe ankyloglossia with tooth abnormalities.

Am J Med Genet A 2018 07 28;176(7):1614-1617. Epub 2018 Apr 28.

Service de Génétique Médicale, CHU de Nantes, Nantes, France.

Ankyloglossia is a congenital oral anomaly characterized by the presence of a hypertrophic and short lingual frenulum. Mutations in the gene encoding the transcription factor TBX22 have been involved in isolated ankyloglossia and X-linked cleft palate. The knockout of Lgr5 in mice results in ankyloglossia. Here, we report a five-generation family including patients with severe ankyloglossia and missing lower central incisors. Two members of this family also exhibited congenital anorectal malformations. In this report, male-to-male transmission was in favor of an autosomal dominant inheritance, which allowed us to exclude the X-linked TBX22 gene. Linkage analysis using short tandem repeat markers located in the vicinity of LGR5 excluded this gene as a potential candidate. These results indicate genetic heterogeneity for ankyloglossia. Further investigations with additional families are required in order to identify novel candidate genes.
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http://dx.doi.org/10.1002/ajmg.a.38690DOI Listing
July 2018

Three-dimensional cone-beam CT sialography in non tumour salivary pathologies: procedure and results.

Dentomaxillofac Radiol 2017 Jan 23;46(1):20150431. Epub 2016 Sep 23.

1 Clinique de Chirurgie Maxillo-Faciale et Stomatologie, CHU de Nantes, Nantes, France.

Objectives: Non-tumour salivary diseases are common. Imaging studies are essential for their diagnosis and before undergoing an endoscopic or surgical treatment. In this study, we aimed at presenting our procedure and results obtained with three-dimensional CBCT (3D-CBCT) sialography for non-tumour salivary gland diseases.

Methods: Patients with parotid or submandibular salivary symptoms were examined by 3D-CBCT sialography. They received an intraductal injection of 0.5 mL of water-soluble contrast medium maintained in the gland, followed by examination in a NewTom wide-field CBCT device. Images were processed with multiplanar and 3D reconstructions.

Results: A ductal exploration could be performed until the fourth divisions. The main lesions found were stones, stenosis, dilatations and "dead tree" appearance of the ductal system. No side effects of the catheterization or the iodine contrast were reported, nor tissue damages related to the contrast keeping technique.

Conclusions: 3D-CBCT sialography seems to represent a reliable non-invasive diagnostic tool for ductal salivary diseases. More studies are needed to assess the value of 3D-CBCT sialography compared with conventional imaging.
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http://dx.doi.org/10.1259/dmfr.20150431DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5595048PMC
January 2017

Assault-related maxillofacial injuries: the results from the European Maxillofacial Trauma (EURMAT) multicenter and prospective collaboration.

Oral Surg Oral Med Oral Pathol Oral Radiol 2015 Apr 11;119(4):385-91. Epub 2014 Dec 11.

Department of Maxillofacial surgery, Stomatology Clinic, Tartu University, Tartu, Estonia.

Objective: The aim of this study is to present and discuss the demographic characteristics and patterns of assault-related maxillofacial fractures as reported by a European multicenter prospective study.

Study Design: Demographic and injury data were recorded for each patient who was a victim of an assault.

Results: Assaults represented the most frequent etiology of maxillofacial trauma with an overall rate of 39% and the values ranging between 60.8% (Kiev, Ukraine) and 15.4% (Bergen, Norway). The most frequent mechanisms of assault-related maxillofacial fractures were fists in 730 cases, followed by kicks and fists. The most frequently observed fracture involved the mandible (814 fractures), followed by orbito-zygomatic-maxillary complex fractures and orbital fractures.

Conclusions: Our data confirmed the strong possibility that patients with maxillofacial fractures may be victims of physical aggression. The crucial role of alcohol in assault-related fractures was also confirmed by our study.
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http://dx.doi.org/10.1016/j.oooo.2014.12.004DOI Listing
April 2015