Jean-Charles Doucet - Academia.edu (original) (raw)

Papers by Jean-Charles Doucet

Research paper thumbnail of Bilateral idiopathic calf muscle hypertrophy: An exceptional cause of unsightly leg curvature

Annales de Chirurgie Plastique Esthétique, 2015

HAL is a multidisciplinary open access archive for the deposit and dissemination of scientific re... more HAL is a multidisciplinary open access archive for the deposit and dissemination of scientific research documents, whether they are published or not. The documents may come from teaching and research institutions in France or abroad, or from public or private research centers.

Research paper thumbnail of Mandibular effects of maxillary distraction osteogenesis in cleft lip and palate

International journal of oral and maxillofacial surgery, 2014

Maxillary distraction osteogenesis (DO) is a reliable treatment for severe maxillary deficiency i... more Maxillary distraction osteogenesis (DO) is a reliable treatment for severe maxillary deficiency in cleft lip and palate (CLP). The objective was to analyze its long-term effects on the mandible. A retrospective study of 24 CLP treated with maxillary DO using the Polley and Figueroa technique was done; patients were followed for more than 4 years. Preoperative (T0), 6-12 months postoperative (T1), and ≥ 4 years postoperative (T2) cephalometric radiographs were evaluated. A classical cephalometric analysis was used to assess treatment stability, and a Procrustes superimposition method was used to assess local changes in the shape of the mandible. The mean age of patients at T0 was 15.4 ± 4.1 years. SNA increased at T1 and T2 (P < 0.001), with no significant relapse between T1 and T2, indicating stability at 1 year after treatment (T0 = 72.4 ± 5.3°; T1 = 81.3 ± 6.2°; T2 = 79.9 ± 6.1°). SNB, facial angle, gonial angle, and symphyseal angle remained stable. Long-term analysis of the m...

Research paper thumbnail of Rapid deterioration of pain sensory-discriminative information in short-term memory

Pain, 2004

The assessment of pain and analgesic efficacy sometimes relies on the retrospective evaluation of... more The assessment of pain and analgesic efficacy sometimes relies on the retrospective evaluation of pain felt in the immediate, recent or distant past, yet we have a very limited understanding of the processes involved in the encoding, maintenance and intentional retrieval of pain. We examine the properties of the short-term memory of thermal and pain sensation intensity with a delayed-discrimination task using pairs of heat pain, warm and cool stimulation in healthy volunteers. Performance decreased as a function of the inter-stimulus interval (ISI), indicating a robust deterioration of sensory information over the test period of 4-14 s. As expected, performance also decreased with smaller temperature differences (Delta-T) and shorter stimulus durations (6-2 s). The relation between performance and Delta-T was adequately described by a power function, the exponent of which increased linearly with longer ISI. Importantly, performance declined steadily with increasing ISI (from 6 to 14 s)--but only for pairs of heat pain stimuli that were relatively difficult to discriminate (Delta-T &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; or = 1.0 degree C; perceptual difference &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; or = 32/100 pain rating units) while no deterioration in performance was observed for the largest temperature difference tested (Delta T = 1.5 degrees C; perceptual difference of 50 units). These results are consistent with the possibility that short-term memory for pain and temperature sensation intensity relies on a transient analog representation that is quickly degraded and transformed into a more resistant but less precise categorical format. This implies that retrospective pain ratings obtained even after very short delays may be rather inaccurate but relatively reliable.

Research paper thumbnail of Effects of growth on maxillary distraction osteogenesis in cleft lip and palate

Journal of Cranio-Maxillofacial Surgery, 2013

The objective was to analyze the effects of growth on the long-term result of maxillary distracti... more The objective was to analyze the effects of growth on the long-term result of maxillary distraction osteogenesis (DO) in cleft lip and palate (CLP). Retrospective study of 24 CLP cases with long-term follow-up operated for maxillary DO using the Polley and Figueroa technique: 10 patients were distracted during growth, while 14 patients were operated after their growth spurt. Preoperative (T0), 6-12 months postoperative (T1), and ≥4 years postoperative (T2) cephalometric radiographs were evaluated. A classical cephalometric analysis was used to assess the treatment stability, and a Procrustes superimposition method was performed to assess local changes in the maxilla and the mandible. At T0, the mean age was of 11.9 ± 1.4 years for growing patient, and 17.9 ± 3.5 years for patient treated after their growth spurt (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Between T0 and T1, a greater increase of the SNA was shown in growing patients (P = 0.036), but the relapse was more important between T1 and T2, with a significant decrease of the SNA (P = 0.002) and ANB (P = 0.032) compared to the patients treated after their growth spurt. Although not significant, growing patients showed greater rotations of their palatal plane and mandibular plane. Maxillary DO in CLP does not correct the growth deficit inherent to the pathology. Overcorrection of at least 20% is advised during growth.

Research paper thumbnail of Computer-assisted midface reconstruction in Treacher Collins syndrome part 2: Soft tissue reconstruction

Journal of Cranio-Maxillofacial Surgery, 2013

Introduction: Treacher Collins syndrome (TCS) is a severe and complex craniofacial malformation a... more Introduction: Treacher Collins syndrome (TCS) is a severe and complex craniofacial malformation affecting the facial skeleton and soft tissues. The palate as well as the external and middle ear are also affected, but his prognosis is mainly related to neonatal airway management. Methods of zygomaticoorbital reconstruction are numerous and currently use primarily autologous bone, lyophilized cartilage, alloplastic implants, or even free flaps. This work developed a reliable "customized" method of zygomatico-orbital bony reconstruction using a generic reference model tailored to each patient. Methods: From a standard computed tomography (CT) acquisition, we studied qualitatively and quantitatively the skeleton of four individuals with TCS whose age was between 6 and 20 years. In parallel, we studied 40 controls at the same age to obtain a morphometric database of reference. Surgical simulation was carried out using validated software used in craniofacial surgery. Results: The zygomatic hypoplasia was very important quantitatively and morphologically in all TCS individuals. Orbital involvement was mainly morphological, with volumes comparable to the controls of the same age. The control database was used to create three-dimensional computer models to be used in the manufacture of cutting guides for autologous cranial bone grafts or alloplastic implants perfectly adapted to each patient's morphology. Presurgical simulation was also used to fabricate custom positioning guides permitting a simple and reliable surgical procedure. Conclusions: The use of a virtual database allowed us to design a reliable and reproducible skeletal reconstruction method for this rare and complex syndrome. The use of presurgical simulation tools seem essential in this type of craniofacial malformation to increase the reliability of these uncommon and complex surgical procedures, and to ensure stable results over time.

Research paper thumbnail of New Neonatal Classification of Unilateral Cleft Lip and Palate—Part 1: To Predict Primary Lateral Incisor Agenesis and Inherent Tissue Hypoplasia

The Cleft Palate-Craniofacial Journal, 2014

Objectives To bring a neonatal classification system of unilateral cleft lip and palate (UCLP) an... more Objectives To bring a neonatal classification system of unilateral cleft lip and palate (UCLP) and to correlate this classification with the distribution of the primary lateral incisor. Design Retrospective with longitudinal follow-up. Setting Tertiary. Patients One hundred twenty-one patients with treated UCLP. Thirteen plaster casts were used as controls. Main Outcome Measures The UCLP patients were classified anatomically into four categories: class 1 corresponds to a maxillary arch with a narrow alveolar cleft, class 2 corresponds to a balanced form, class 3 corresponds to a wide cleft and short maxilla, and class 4 corresponds to a wide cleft and long maxilla. Clinical validity was evaluated with a concordance analysis (intra- and interexaminer). This anatomical classification was also corroborated with an automatic classification determined by morphometric parameters measured on neonatal maxillary plaster casts. The class was finally correlated with the distribution of the pri...

Research paper thumbnail of Speech outcomes of early palatal repair with or without intravelar veloplasty in children with complete unilateral cleft lip and palate

British Journal of Oral and Maxillofacial Surgery, 2013

We compared the early speech outcomes of 40 consecutive children with complete unilateral cleft l... more We compared the early speech outcomes of 40 consecutive children with complete unilateral cleft lip and palate (UCLP) who had been treated according to different 2-stage protocols: the Malek protocol (soft palate closure without intravelar veloplasty at 3 months; lip and hard palate repair at 6 months) (n = 20), and the Talmant protocol (cheilorhinoplasty and soft palate repair with intravelar veloplasty at 6 months; hard palate closure at 18 months) (n = 20). We compared the speech assessments obtained at a mean (SD) age of 3.3 (0.35) years after treatment by the same surgeon. The main outcome measures evaluated were acquisition and intelligibility of speech, velopharyngeal insufficiency, and incidence of complications. A delay in speech articulation of one year or more was seen more often in patients treated by the Malek protocol (11/20) than in those treated according to the Talmant protocol (3/20, p = 0.019). Good intelligibility was noted in 15/20 in the Talmant group compared with 6/20 in the Malek group (p = 0.010). Assessment with an aerophonoscope showed that nasal air emission was most pronounced in patients in the Malek group (p = 0.007). Velopharyngeal insufficiency was present in 11/20 in the Malek group, and in 3/20 in the Talmant group (p = 0.019). No patients in the Talmant group had an oronasal fistula (p < 0.001). All other outcomes were similar. Despite later closure of the soft and hard palate, early speech outcomes were better in the Talmant group because intravelar veloplasty was successful and there were no fistulas after closure of the hard palate in 2 layers.

Research paper thumbnail of Early Secondary Alveolar Bone Grafting and Facial Growth of Patients with Complete Unilateral Cleft Lip and Palate

The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association, 2022

OBJECTIVE To investigate the craniofacial growth outcomes of early secondary alveolar bone grafti... more OBJECTIVE To investigate the craniofacial growth outcomes of early secondary alveolar bone grafting(ABG) around 6 years of age. DESIGN Retrospective cohort study. SETTING 1 North-American and 5 Northern-European cleft centers. SUBJECTS 33 subjects with CUCLP consecutively treated with secondary ABG around 6 years of age were compared to 105 subjects from 4 centers treated with late secondary ABG and 19 subjects from 1 center with primary ABG. METHODS Preorthodontic standardized lateral cephalometric radiographs taken after 12 years of age were traced and analyzed according to the Eurocleft Study protocol. Fourteen angular and two proportional measurements were performed. Measurement means from the Study Center(SC) were compared to 5 Northern-European centers using analysis of variance and Welch's modified t-tests, and P < .05 was considered statistically significant. RESULTS For the SC, the mean age ± SD at the time of bone graft was 5.85 ± 0.71 years and the mean age at the ...

Research paper thumbnail of Reconstruction of Orbital Wall Defect

Research paper thumbnail of The Effect of Earlier Bone Grafting, Prior to Orthodontic Treatment, on SWAG Ratings of Graft Outcomes

The Cleft Palate-Craniofacial Journal

Objective: To compare the outcomes between 2 groups of patients with complete clefts treated with... more Objective: To compare the outcomes between 2 groups of patients with complete clefts treated with early secondary alveolar bone grafting (ABG) at 2 centers (5-7 years, before orthodontic intervention) and to a third group of patients treated at one of those centers (center 1) who had received later secondary ABG (8-10 years, after orthodontic intervention). Design: Blind retrospective analysis of cleft site radiographs using Americleft Standardized Way to Assess Grafts (SWAG) scale. Patients: A total of 99 patients with complete clefts from 2 North American cleft/craniofacial centers. Interventions: Secondary ABG representing 2 protocols: early grafting at a mean age of 6.6 years prior to any orthodontic intervention, and later grafting at a mean age of 10.2 years following pregrafting orthodontic intervention. Main Outcome Measures: Using occlusal radiographs, the SWAG scale from 0 (failed graft) to 6 (ideal) was used. Six trained, calibrated raters scored each radiograph twice, wi...

Research paper thumbnail of Active Presurgical Infant Orthopedics for Unilateral Cleft Lip and Palate: Intercenter Outcome Comparison of Latham, Modified McNeil, and Nasoalveolar Molding

The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association, 2018

To compare dental arch relationship, craniofacial form, and nasolabial aesthetic outcomes among c... more To compare dental arch relationship, craniofacial form, and nasolabial aesthetic outcomes among cleft centers using distinct methods of presurgical infant orthopedics (PSIO). Retrospective cohort study. Four cleft centers in North America. One hundred ninety-one children with repaired complete unilateral cleft lip and palate (CUCLP). Dental arch relationship was assessed using the GOSLON Yardstick. Craniofacial form was assessed by 12 cephalometric measurements. Nasolabial aesthetics were assessed using the Asher-McDade system. Assessments were performed between 6 and 12 years of age. The center that used no PSIO achieved the most favorable dental arch relationship and maxillomandibular relationship, with a median GOSLON score of 2.3 ( P < .01) and an ANB angle of 5.1° ( P < .05). The proportion of children assigned a GOSLON score of 4 or 5, predictive of the need for orthognathic surgery in adolescence, was 16% at the center that used no PSIO and no secondary surgery, compare...

Research paper thumbnail of Facial Growth of Patients With Complete Unilateral Cleft Lip and Palate Treated With Alveolar Bone Grafting at 6 Years

The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association, Jan 13, 2018

To investigate the effect that alveolar bone grafting (ABG) around 6 years of age has on facial g... more To investigate the effect that alveolar bone grafting (ABG) around 6 years of age has on facial growth by assessing craniofacial growth outcomes. Retrospective cohort study. North American cleft centers. A total of 33 children with complete unilateral cleft lip and palate who were consecutively treated with secondary ABG around 6 years of age were compared to 148 participants from 4 centers with late secondary ABG. Preorthodontic standardized lateral cephalometric radiographs were analyzed and traced according to the Americleft Study protocol. Sixteen angular and 2 proportional measurements were performed. The outcomes of all ABG were assessed using the Standardized Way to Assess Graft scale. Measurement means from the study center (SC) were compared to 4 North American centers using analysis of variance and Welch modified t tests, and P < .05 was considered statistically significant. For the SC, the mean age (SD) at the time of bone graft was 5.85 (0.71) years and the mean age a...

Research paper thumbnail of Morbidity of Patients with Cleft Lip and Palate Treated with Alveolar Bone Grafting at About 6 Years of Age

Journal of Oral and Maxillofacial Surgery

The data was analyzed with a t-test, Fisher’s Exact test, and logistic regression. Of the 70 pati... more The data was analyzed with a t-test, Fisher’s Exact test, and logistic regression. Of the 70 patients, 45 received ICBG and 25 received ICBG with BMP-2. The mean age of the ICBG group was 8.87 years vs 9.16 years for BMP-2. 15/45 (33 percent) of patients treated with an ICBG required an additional operation compared to only 4/25 (16 percent) for those treated with BMP-2 (p=0.12). 27% of patients required a second operation deemed necessary for orthodontic treatment (at a mean age 11.38 years) due to inadequate bone support in the cleft site. The results indicate that the children with ICBG were 2.06 times more likely to need a second surgery than those treated with both ICBG and BMP-2. Overall, patients with a right unilateral cleft who were treated with BMP-2 had the lowest probability of having a second surgery. This study supports the potential for BMP-2 reducing the need for additional bone grafting surgery for cleft repair in preparation for orthodontic therapy or implant placement in the cleft site. This quality analysis indicates that 84% of patient’s who were treated with BMP-2 are successfully treated with one surgery compared to 67% for patient’s treated with iliac crest bone grafting alone. As a result, the percentage could continue to improve with the use of BMP-2 for alveolar cleft augmentation surgeries.

Research paper thumbnail of Prospective Evaluation of the Effect of the Presence of Third Molars During Sagittal Split Osteotomies

Journal of Oral and Maxillofacial Surgery, 2010

Research paper thumbnail of Rapid deterioration of pain sensory-discriminative information in short-term memory

Research paper thumbnail of Surgical Treatment of VPI – Sphincter Pharyngoplasty

Research paper thumbnail of Modélisation biomécanique du muscle masséter : étude préliminaire

Research paper thumbnail of Bilateral idiopathic calf muscle hypertrophy: An exceptional cause of unsightly leg curvature

Annales de Chirurgie Plastique Esthétique, 2015

ABSTRACT Nous présentons ici la prise en charge d’une jeune patiente présentant une hypertrophie ... more ABSTRACT Nous présentons ici la prise en charge d’une jeune patiente présentant une hypertrophie musculaire des mollets sans cause retrouvée. Considérant les souhaits de la patiente, ses antécédents et le siège de l’hypertrophie, nous avons choisi de réaliser une résection sub-totale bilatérale du muscle gastrocnémien médial. Cette procédure a été réalisée à l’aide d’un bistouri harmonique, permettant un excellent résultat cosmétique tout en diminuant les risques de complications ou de déficience fonctionnelle. Après avoir revu les techniques couramment utilisées dans ce cadre pathologique, les auteurs discutent de l’approche chirurgicale choisie en tenant compte de sa particularité clinique.

Research paper thumbnail of Mandibular effects of maxillary distraction osteogenesis in cleft lip and palate

International journal of oral and maxillofacial surgery, 2014

Maxillary distraction osteogenesis (DO) is a reliable treatment for severe maxillary deficiency i... more Maxillary distraction osteogenesis (DO) is a reliable treatment for severe maxillary deficiency in cleft lip and palate (CLP). The objective was to analyze its long-term effects on the mandible. A retrospective study of 24 CLP treated with maxillary DO using the Polley and Figueroa technique was done; patients were followed for more than 4 years. Preoperative (T0), 6-12 months postoperative (T1), and ≥ 4 years postoperative (T2) cephalometric radiographs were evaluated. A classical cephalometric analysis was used to assess treatment stability, and a Procrustes superimposition method was used to assess local changes in the shape of the mandible. The mean age of patients at T0 was 15.4 ± 4.1 years. SNA increased at T1 and T2 (P < 0.001), with no significant relapse between T1 and T2, indicating stability at 1 year after treatment (T0 = 72.4 ± 5.3°; T1 = 81.3 ± 6.2°; T2 = 79.9 ± 6.1°). SNB, facial angle, gonial angle, and symphyseal angle remained stable. Long-term analysis of the m...

Research paper thumbnail of Delays in treatment of oral cancer: a review of the current literature

Oral surgery, oral medicine, oral pathology and oral radiology, 2014

This review aims to update the reader as to the current issues surrounding the delay in treatment... more This review aims to update the reader as to the current issues surrounding the delay in treatment of oral cancer. We searched Medline/PubMed and the Cochrane database. English-language publications were included. Paired reviewers selected articles for inclusion and extracted data. The strength of the evidence was graded as high, moderate, or low. Eighteen studies met our inclusion criteria. The majority of the studies were retrospective case-control studies (55%). Patient delay continues to be the greatest contributor to overall delay in treatment of head and neck cancers, with an average delay of 3.5 to 5.4 months. In addition, the average professional delay is approximately 14 to 21 weeks. Cumulatively, the amount of delay may be causative for the late stage at which head and neck cancers are diagnosed and subsequently treated.

Research paper thumbnail of Bilateral idiopathic calf muscle hypertrophy: An exceptional cause of unsightly leg curvature

Annales de Chirurgie Plastique Esthétique, 2015

HAL is a multidisciplinary open access archive for the deposit and dissemination of scientific re... more HAL is a multidisciplinary open access archive for the deposit and dissemination of scientific research documents, whether they are published or not. The documents may come from teaching and research institutions in France or abroad, or from public or private research centers.

Research paper thumbnail of Mandibular effects of maxillary distraction osteogenesis in cleft lip and palate

International journal of oral and maxillofacial surgery, 2014

Maxillary distraction osteogenesis (DO) is a reliable treatment for severe maxillary deficiency i... more Maxillary distraction osteogenesis (DO) is a reliable treatment for severe maxillary deficiency in cleft lip and palate (CLP). The objective was to analyze its long-term effects on the mandible. A retrospective study of 24 CLP treated with maxillary DO using the Polley and Figueroa technique was done; patients were followed for more than 4 years. Preoperative (T0), 6-12 months postoperative (T1), and ≥ 4 years postoperative (T2) cephalometric radiographs were evaluated. A classical cephalometric analysis was used to assess treatment stability, and a Procrustes superimposition method was used to assess local changes in the shape of the mandible. The mean age of patients at T0 was 15.4 ± 4.1 years. SNA increased at T1 and T2 (P < 0.001), with no significant relapse between T1 and T2, indicating stability at 1 year after treatment (T0 = 72.4 ± 5.3°; T1 = 81.3 ± 6.2°; T2 = 79.9 ± 6.1°). SNB, facial angle, gonial angle, and symphyseal angle remained stable. Long-term analysis of the m...

Research paper thumbnail of Rapid deterioration of pain sensory-discriminative information in short-term memory

Pain, 2004

The assessment of pain and analgesic efficacy sometimes relies on the retrospective evaluation of... more The assessment of pain and analgesic efficacy sometimes relies on the retrospective evaluation of pain felt in the immediate, recent or distant past, yet we have a very limited understanding of the processes involved in the encoding, maintenance and intentional retrieval of pain. We examine the properties of the short-term memory of thermal and pain sensation intensity with a delayed-discrimination task using pairs of heat pain, warm and cool stimulation in healthy volunteers. Performance decreased as a function of the inter-stimulus interval (ISI), indicating a robust deterioration of sensory information over the test period of 4-14 s. As expected, performance also decreased with smaller temperature differences (Delta-T) and shorter stimulus durations (6-2 s). The relation between performance and Delta-T was adequately described by a power function, the exponent of which increased linearly with longer ISI. Importantly, performance declined steadily with increasing ISI (from 6 to 14 s)--but only for pairs of heat pain stimuli that were relatively difficult to discriminate (Delta-T &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; or = 1.0 degree C; perceptual difference &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; or = 32/100 pain rating units) while no deterioration in performance was observed for the largest temperature difference tested (Delta T = 1.5 degrees C; perceptual difference of 50 units). These results are consistent with the possibility that short-term memory for pain and temperature sensation intensity relies on a transient analog representation that is quickly degraded and transformed into a more resistant but less precise categorical format. This implies that retrospective pain ratings obtained even after very short delays may be rather inaccurate but relatively reliable.

Research paper thumbnail of Effects of growth on maxillary distraction osteogenesis in cleft lip and palate

Journal of Cranio-Maxillofacial Surgery, 2013

The objective was to analyze the effects of growth on the long-term result of maxillary distracti... more The objective was to analyze the effects of growth on the long-term result of maxillary distraction osteogenesis (DO) in cleft lip and palate (CLP). Retrospective study of 24 CLP cases with long-term follow-up operated for maxillary DO using the Polley and Figueroa technique: 10 patients were distracted during growth, while 14 patients were operated after their growth spurt. Preoperative (T0), 6-12 months postoperative (T1), and ≥4 years postoperative (T2) cephalometric radiographs were evaluated. A classical cephalometric analysis was used to assess the treatment stability, and a Procrustes superimposition method was performed to assess local changes in the maxilla and the mandible. At T0, the mean age was of 11.9 ± 1.4 years for growing patient, and 17.9 ± 3.5 years for patient treated after their growth spurt (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Between T0 and T1, a greater increase of the SNA was shown in growing patients (P = 0.036), but the relapse was more important between T1 and T2, with a significant decrease of the SNA (P = 0.002) and ANB (P = 0.032) compared to the patients treated after their growth spurt. Although not significant, growing patients showed greater rotations of their palatal plane and mandibular plane. Maxillary DO in CLP does not correct the growth deficit inherent to the pathology. Overcorrection of at least 20% is advised during growth.

Research paper thumbnail of Computer-assisted midface reconstruction in Treacher Collins syndrome part 2: Soft tissue reconstruction

Journal of Cranio-Maxillofacial Surgery, 2013

Introduction: Treacher Collins syndrome (TCS) is a severe and complex craniofacial malformation a... more Introduction: Treacher Collins syndrome (TCS) is a severe and complex craniofacial malformation affecting the facial skeleton and soft tissues. The palate as well as the external and middle ear are also affected, but his prognosis is mainly related to neonatal airway management. Methods of zygomaticoorbital reconstruction are numerous and currently use primarily autologous bone, lyophilized cartilage, alloplastic implants, or even free flaps. This work developed a reliable "customized" method of zygomatico-orbital bony reconstruction using a generic reference model tailored to each patient. Methods: From a standard computed tomography (CT) acquisition, we studied qualitatively and quantitatively the skeleton of four individuals with TCS whose age was between 6 and 20 years. In parallel, we studied 40 controls at the same age to obtain a morphometric database of reference. Surgical simulation was carried out using validated software used in craniofacial surgery. Results: The zygomatic hypoplasia was very important quantitatively and morphologically in all TCS individuals. Orbital involvement was mainly morphological, with volumes comparable to the controls of the same age. The control database was used to create three-dimensional computer models to be used in the manufacture of cutting guides for autologous cranial bone grafts or alloplastic implants perfectly adapted to each patient's morphology. Presurgical simulation was also used to fabricate custom positioning guides permitting a simple and reliable surgical procedure. Conclusions: The use of a virtual database allowed us to design a reliable and reproducible skeletal reconstruction method for this rare and complex syndrome. The use of presurgical simulation tools seem essential in this type of craniofacial malformation to increase the reliability of these uncommon and complex surgical procedures, and to ensure stable results over time.

Research paper thumbnail of New Neonatal Classification of Unilateral Cleft Lip and Palate—Part 1: To Predict Primary Lateral Incisor Agenesis and Inherent Tissue Hypoplasia

The Cleft Palate-Craniofacial Journal, 2014

Objectives To bring a neonatal classification system of unilateral cleft lip and palate (UCLP) an... more Objectives To bring a neonatal classification system of unilateral cleft lip and palate (UCLP) and to correlate this classification with the distribution of the primary lateral incisor. Design Retrospective with longitudinal follow-up. Setting Tertiary. Patients One hundred twenty-one patients with treated UCLP. Thirteen plaster casts were used as controls. Main Outcome Measures The UCLP patients were classified anatomically into four categories: class 1 corresponds to a maxillary arch with a narrow alveolar cleft, class 2 corresponds to a balanced form, class 3 corresponds to a wide cleft and short maxilla, and class 4 corresponds to a wide cleft and long maxilla. Clinical validity was evaluated with a concordance analysis (intra- and interexaminer). This anatomical classification was also corroborated with an automatic classification determined by morphometric parameters measured on neonatal maxillary plaster casts. The class was finally correlated with the distribution of the pri...

Research paper thumbnail of Speech outcomes of early palatal repair with or without intravelar veloplasty in children with complete unilateral cleft lip and palate

British Journal of Oral and Maxillofacial Surgery, 2013

We compared the early speech outcomes of 40 consecutive children with complete unilateral cleft l... more We compared the early speech outcomes of 40 consecutive children with complete unilateral cleft lip and palate (UCLP) who had been treated according to different 2-stage protocols: the Malek protocol (soft palate closure without intravelar veloplasty at 3 months; lip and hard palate repair at 6 months) (n = 20), and the Talmant protocol (cheilorhinoplasty and soft palate repair with intravelar veloplasty at 6 months; hard palate closure at 18 months) (n = 20). We compared the speech assessments obtained at a mean (SD) age of 3.3 (0.35) years after treatment by the same surgeon. The main outcome measures evaluated were acquisition and intelligibility of speech, velopharyngeal insufficiency, and incidence of complications. A delay in speech articulation of one year or more was seen more often in patients treated by the Malek protocol (11/20) than in those treated according to the Talmant protocol (3/20, p = 0.019). Good intelligibility was noted in 15/20 in the Talmant group compared with 6/20 in the Malek group (p = 0.010). Assessment with an aerophonoscope showed that nasal air emission was most pronounced in patients in the Malek group (p = 0.007). Velopharyngeal insufficiency was present in 11/20 in the Malek group, and in 3/20 in the Talmant group (p = 0.019). No patients in the Talmant group had an oronasal fistula (p < 0.001). All other outcomes were similar. Despite later closure of the soft and hard palate, early speech outcomes were better in the Talmant group because intravelar veloplasty was successful and there were no fistulas after closure of the hard palate in 2 layers.

Research paper thumbnail of Early Secondary Alveolar Bone Grafting and Facial Growth of Patients with Complete Unilateral Cleft Lip and Palate

The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association, 2022

OBJECTIVE To investigate the craniofacial growth outcomes of early secondary alveolar bone grafti... more OBJECTIVE To investigate the craniofacial growth outcomes of early secondary alveolar bone grafting(ABG) around 6 years of age. DESIGN Retrospective cohort study. SETTING 1 North-American and 5 Northern-European cleft centers. SUBJECTS 33 subjects with CUCLP consecutively treated with secondary ABG around 6 years of age were compared to 105 subjects from 4 centers treated with late secondary ABG and 19 subjects from 1 center with primary ABG. METHODS Preorthodontic standardized lateral cephalometric radiographs taken after 12 years of age were traced and analyzed according to the Eurocleft Study protocol. Fourteen angular and two proportional measurements were performed. Measurement means from the Study Center(SC) were compared to 5 Northern-European centers using analysis of variance and Welch's modified t-tests, and P < .05 was considered statistically significant. RESULTS For the SC, the mean age ± SD at the time of bone graft was 5.85 ± 0.71 years and the mean age at the ...

Research paper thumbnail of Reconstruction of Orbital Wall Defect

Research paper thumbnail of The Effect of Earlier Bone Grafting, Prior to Orthodontic Treatment, on SWAG Ratings of Graft Outcomes

The Cleft Palate-Craniofacial Journal

Objective: To compare the outcomes between 2 groups of patients with complete clefts treated with... more Objective: To compare the outcomes between 2 groups of patients with complete clefts treated with early secondary alveolar bone grafting (ABG) at 2 centers (5-7 years, before orthodontic intervention) and to a third group of patients treated at one of those centers (center 1) who had received later secondary ABG (8-10 years, after orthodontic intervention). Design: Blind retrospective analysis of cleft site radiographs using Americleft Standardized Way to Assess Grafts (SWAG) scale. Patients: A total of 99 patients with complete clefts from 2 North American cleft/craniofacial centers. Interventions: Secondary ABG representing 2 protocols: early grafting at a mean age of 6.6 years prior to any orthodontic intervention, and later grafting at a mean age of 10.2 years following pregrafting orthodontic intervention. Main Outcome Measures: Using occlusal radiographs, the SWAG scale from 0 (failed graft) to 6 (ideal) was used. Six trained, calibrated raters scored each radiograph twice, wi...

Research paper thumbnail of Active Presurgical Infant Orthopedics for Unilateral Cleft Lip and Palate: Intercenter Outcome Comparison of Latham, Modified McNeil, and Nasoalveolar Molding

The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association, 2018

To compare dental arch relationship, craniofacial form, and nasolabial aesthetic outcomes among c... more To compare dental arch relationship, craniofacial form, and nasolabial aesthetic outcomes among cleft centers using distinct methods of presurgical infant orthopedics (PSIO). Retrospective cohort study. Four cleft centers in North America. One hundred ninety-one children with repaired complete unilateral cleft lip and palate (CUCLP). Dental arch relationship was assessed using the GOSLON Yardstick. Craniofacial form was assessed by 12 cephalometric measurements. Nasolabial aesthetics were assessed using the Asher-McDade system. Assessments were performed between 6 and 12 years of age. The center that used no PSIO achieved the most favorable dental arch relationship and maxillomandibular relationship, with a median GOSLON score of 2.3 ( P < .01) and an ANB angle of 5.1° ( P < .05). The proportion of children assigned a GOSLON score of 4 or 5, predictive of the need for orthognathic surgery in adolescence, was 16% at the center that used no PSIO and no secondary surgery, compare...

Research paper thumbnail of Facial Growth of Patients With Complete Unilateral Cleft Lip and Palate Treated With Alveolar Bone Grafting at 6 Years

The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association, Jan 13, 2018

To investigate the effect that alveolar bone grafting (ABG) around 6 years of age has on facial g... more To investigate the effect that alveolar bone grafting (ABG) around 6 years of age has on facial growth by assessing craniofacial growth outcomes. Retrospective cohort study. North American cleft centers. A total of 33 children with complete unilateral cleft lip and palate who were consecutively treated with secondary ABG around 6 years of age were compared to 148 participants from 4 centers with late secondary ABG. Preorthodontic standardized lateral cephalometric radiographs were analyzed and traced according to the Americleft Study protocol. Sixteen angular and 2 proportional measurements were performed. The outcomes of all ABG were assessed using the Standardized Way to Assess Graft scale. Measurement means from the study center (SC) were compared to 4 North American centers using analysis of variance and Welch modified t tests, and P < .05 was considered statistically significant. For the SC, the mean age (SD) at the time of bone graft was 5.85 (0.71) years and the mean age a...

Research paper thumbnail of Morbidity of Patients with Cleft Lip and Palate Treated with Alveolar Bone Grafting at About 6 Years of Age

Journal of Oral and Maxillofacial Surgery

The data was analyzed with a t-test, Fisher’s Exact test, and logistic regression. Of the 70 pati... more The data was analyzed with a t-test, Fisher’s Exact test, and logistic regression. Of the 70 patients, 45 received ICBG and 25 received ICBG with BMP-2. The mean age of the ICBG group was 8.87 years vs 9.16 years for BMP-2. 15/45 (33 percent) of patients treated with an ICBG required an additional operation compared to only 4/25 (16 percent) for those treated with BMP-2 (p=0.12). 27% of patients required a second operation deemed necessary for orthodontic treatment (at a mean age 11.38 years) due to inadequate bone support in the cleft site. The results indicate that the children with ICBG were 2.06 times more likely to need a second surgery than those treated with both ICBG and BMP-2. Overall, patients with a right unilateral cleft who were treated with BMP-2 had the lowest probability of having a second surgery. This study supports the potential for BMP-2 reducing the need for additional bone grafting surgery for cleft repair in preparation for orthodontic therapy or implant placement in the cleft site. This quality analysis indicates that 84% of patient’s who were treated with BMP-2 are successfully treated with one surgery compared to 67% for patient’s treated with iliac crest bone grafting alone. As a result, the percentage could continue to improve with the use of BMP-2 for alveolar cleft augmentation surgeries.

Research paper thumbnail of Prospective Evaluation of the Effect of the Presence of Third Molars During Sagittal Split Osteotomies

Journal of Oral and Maxillofacial Surgery, 2010

Research paper thumbnail of Rapid deterioration of pain sensory-discriminative information in short-term memory

Research paper thumbnail of Surgical Treatment of VPI – Sphincter Pharyngoplasty

Research paper thumbnail of Modélisation biomécanique du muscle masséter : étude préliminaire

Research paper thumbnail of Bilateral idiopathic calf muscle hypertrophy: An exceptional cause of unsightly leg curvature

Annales de Chirurgie Plastique Esthétique, 2015

ABSTRACT Nous présentons ici la prise en charge d’une jeune patiente présentant une hypertrophie ... more ABSTRACT Nous présentons ici la prise en charge d’une jeune patiente présentant une hypertrophie musculaire des mollets sans cause retrouvée. Considérant les souhaits de la patiente, ses antécédents et le siège de l’hypertrophie, nous avons choisi de réaliser une résection sub-totale bilatérale du muscle gastrocnémien médial. Cette procédure a été réalisée à l’aide d’un bistouri harmonique, permettant un excellent résultat cosmétique tout en diminuant les risques de complications ou de déficience fonctionnelle. Après avoir revu les techniques couramment utilisées dans ce cadre pathologique, les auteurs discutent de l’approche chirurgicale choisie en tenant compte de sa particularité clinique.

Research paper thumbnail of Mandibular effects of maxillary distraction osteogenesis in cleft lip and palate

International journal of oral and maxillofacial surgery, 2014

Maxillary distraction osteogenesis (DO) is a reliable treatment for severe maxillary deficiency i... more Maxillary distraction osteogenesis (DO) is a reliable treatment for severe maxillary deficiency in cleft lip and palate (CLP). The objective was to analyze its long-term effects on the mandible. A retrospective study of 24 CLP treated with maxillary DO using the Polley and Figueroa technique was done; patients were followed for more than 4 years. Preoperative (T0), 6-12 months postoperative (T1), and ≥ 4 years postoperative (T2) cephalometric radiographs were evaluated. A classical cephalometric analysis was used to assess treatment stability, and a Procrustes superimposition method was used to assess local changes in the shape of the mandible. The mean age of patients at T0 was 15.4 ± 4.1 years. SNA increased at T1 and T2 (P < 0.001), with no significant relapse between T1 and T2, indicating stability at 1 year after treatment (T0 = 72.4 ± 5.3°; T1 = 81.3 ± 6.2°; T2 = 79.9 ± 6.1°). SNB, facial angle, gonial angle, and symphyseal angle remained stable. Long-term analysis of the m...

Research paper thumbnail of Delays in treatment of oral cancer: a review of the current literature

Oral surgery, oral medicine, oral pathology and oral radiology, 2014

This review aims to update the reader as to the current issues surrounding the delay in treatment... more This review aims to update the reader as to the current issues surrounding the delay in treatment of oral cancer. We searched Medline/PubMed and the Cochrane database. English-language publications were included. Paired reviewers selected articles for inclusion and extracted data. The strength of the evidence was graded as high, moderate, or low. Eighteen studies met our inclusion criteria. The majority of the studies were retrospective case-control studies (55%). Patient delay continues to be the greatest contributor to overall delay in treatment of head and neck cancers, with an average delay of 3.5 to 5.4 months. In addition, the average professional delay is approximately 14 to 21 weeks. Cumulatively, the amount of delay may be causative for the late stage at which head and neck cancers are diagnosed and subsequently treated.