→ Nose plastic surgery (Rhinoplasty):

During the pre-surgery visit, the patient and surgeon jointly establish the future nose project on few photographs using a morphing program so as to clearly determine the result sought.

The surgeon removes the hump, straightens up the nose curve, shapes up the tip of the nose to make it thinner or reduces the nose width while preserving the harmony of the whole face. The operation is often performed through the inside of the nose so it leaves no scar at all; sometimes a small external incision is necessary for the complicated rhinoplasties. A mentoplasty is sometimes associated with the rhinoplasty for a good facial profile harmony.

Practically:

• Usual pre-operative assessment.
• Duration of the operation: 1 to 2 hours.
• General anesthesia.
• Checking out on the same day.
• The packing is removed the next day.
• If sutures, they are removed on the 10th day. 
• The dressing is kept for 10 days.

The final results are obtained 6 months after surgery (depending on your type of skin).

→ Nose reconstructive surgery:

The most common nose reconstructive procedures are tumor removal, scar, nose repair post burns, traumatic injuries, and congenital malformations. Nose reconstructive plastic surgery is usually performed to improve nasal function, and to give approximately a normal appearance.

→ Facial and cervical plastic surgery:

Introduction:

No face is similar to another; the difference is in the expression not in the morphology. The expression of the face gives its beauty and its seduction. So the facial aesthetic surgery is concerned to restore the harmony of the face, in preserving its personality.

1. Otoplasty (Protruding ears):

The procedure is under general anesthesia. The incision is carried out in the fold behind the ears. The cartilage is reshaped and the ear is attached to the mastoid. Results are usually very satisfactory. This procedure may be carried out as early as the age of 8 years (if psychological grounds exist).

2. The Mentoplasty:

The chin surgery (augmentation or reduction) is carried out to improve the patient’s profile. It is often performed in combination with rhinoplasty.

Chin Augmentation:

Chin augmentation can be performed by inserting an implant under the skin of the chin or by performing a sliding genioplasty. Insertion of an implant takes 30–60 minutes, while a sliding genioplasty takes slightly longer, 45–90 minutes. To insert the implant, the surgeon makes the incision inside the mouth (intraoral). The surgeon makes a pocket in the connective tissue inside the chin and washes it out with an antiseptic solution. The sterile implant is then inserted in the pocket and positioned properly. The incision is closed and the the patient's chin is wrapped with a pressure dressing

A sliding genioplasty may be performed if the patient's chin is too small for augmentation with an implant, or if the deformity is more complex. In this procedure, the surgeon cuts through the jawbone with an oscillating saw and removes part of the bone. Then the bone segment is moved forward, holding it in place with metal plates and screws. After the bone segment has been fixed in place, the incision is closed and the patient's chin is wrapped with a pressure dressing. The fat may be also injected into the area below the chin to plump up the skin and minimize the apparent size of the chin. This technique, however, is limited to minor disproportions of chin size.

Chin Reduction:

Reduction of an overly large or protruding chin may be done either by direct reduction or a sliding genioplasty. In a direct reduction, the surgeon makes either an intraoral incision and removes excess bone from the chin with a burr. A sliding genioplasty reduction is similar to a genioplasty to augment the chin, except that the bone segment is moved backward rather than forward. The facial liposuction can be also used together with or instead of mentoplasty to improve the patient's profile. In particular, removal of fatty tissue below the chin can make a receding chin look larger or more prominent.

3. Lifting:

The Principle of this procedure:

 The lifting is a procedure consisting of the treatment of age-related loosening of the skin. Suspending the muscles lying beneath the skin (SMAS) has been the major development in facelift procedures, because it provides adequate muscle tension while not referring that tension onto the skin. Hence, with this technique, the facelift may be carried out the natural way while ensuring long-term effects (7 to 8 years). The cervico-facial facelift covers the cheeks, the jowls and the neck. The scars following a facelift are quite hidden in most of the cases, and they end up disappearing almost completely.

Practically: 

• Usual pre-operative assessment.
• General anesthesia.
• One night at the clinic. 
• Checking out the next morning after drain removal.
• The stitches are removed 8 days after the surgery.

4. Facial dimples (cheeks and chin):

The operation is under local anaesthesia, and the results are lasting.

5. Infraorbital dark circles:

The surgeon chooses the treatment according to each patient. Treatment options:

1. Surgery (fat transplantation or extrusion).
2. Laser CO2.
3. Superficiel chemical peeling with trichloroacetic acid.

6. Wrinkle therapy:

The wrinkle therapy is depending on the area of face treated.

Practically:

• Forehead wrinkles, lion’s wrinkles and crow’s foot wrinkles: they are treated with botox.
• Upper and lower lips wrinkle: For the deep wrinkles: we use fillers (acid hyaluronic). For the superficial wrinkles: we use the dermabrasion technique.
• The nasolabial folds are treated with fillers (acide hyaluronic, radiesse and fat).

7. Scar and acne therapies:

Ance and pimples:

Acne is an inflammatory disease of the skin of varying severity and scope, affecting the pilosebaceous follicles (the glands that secrete sebum) at the root of hairs, and resulting in pimples. Regions most affected by acne are the face, neck, décolleté, shoulders and back. Typical forms of acne are seborrhea (oily skin), comedones (microcysts) and blackheads, papules (inflammatory bulges developping on a comedo) which are small and disappear on their own or evolve into pustules (pus lesions), and lastly nodules, the deep inflammatory lesions which eventually burst and leave a scar on the skin.

Dermabrasion:

• Dermabrasion can sometimes improve the appearance of certain superficial scars caused by Acnes.
• Dermabrasion is an ablative treatment using a device with a high-speed rotating wheel that the surgeon moves over raised scarring to smooth it out down to the level of surrounding skin.
• Generally performed under local anesthesia.
• After dermabrasion, a dressing is placed for forty-eight hours and personalized care is prescribed.
• The epidermis regenerates itself in eight days, and the skin.

Hypertrophic scar (keloid):

abnormal scarring due to overgrowth of scar tissue (excessive production of collagen forming a ridge on the surface of the skin).

The treatment of abnormal and unsightly scars uses different methods:

• Surgical revision: Most often performed under local anesthesia, scar surgical revision involves the removal of the scar and its replacement with another scar whose evolution will be regularly monitored.
• Pressure garments: On certain hypertrophic scars, when surgical revision does not seem interesting, continuous pressure exercized by a suitable dressing or by a tailored garment made of elastic fabric that fits like a second skin, may be successful and lead to a flatter, softer, and paler scar.
• Corticosteroid injection: Injection of corticosteroids is made directly into the scar through a needle.
• Scar massaging: Repeated massages and kneading exert pressures that enhance the involution of keloids or hypertrophic scars and accelerate the natural process of maturation.

8. Brow lift:

Sometimes the brows sag so much that they need to be lifted. The procedure is under local anesthesia, an incision along the hair line is performed .

9. Peelings:

There are many different types of peelings: superficial providing a soft, and refreshed look, or a deeper with more important postoperative care.

The type of peeling selected must be adapted depending on the patient's skin.

10. Wrinkle filing:

The non resorbed products are not recommended because they cause lots of complications. The products used are resorbed and degradable products.

They are resorbed from 4 months to 2 years:

• Depending on the product density.
• Depending on the treated area.
• Depending on the severity of the wrinkles.
• Depending on the patient’s skin.

11.  Augmentation of the temporal area :

          1-Acid hyaluronic:
The technique consists to inject under local anaesthesia the hyaluronic acid (SubQ), a natural gel of biotechnologic origin, dense, resorbed in 18 to 20 months.
Oedema and hematoma can be seen one week after injection. It is necessary to wait 10 days for an optimal result.
A meeting of correction can be necessary one month later, in order to rectify a light asymmetry or to increase volume.

        2- Lipofilling :
This technique consists in obtaining fat from the patient's own body utilizing special cannulas that avoid fat cell destruction. Usually, infraumbilical region is taken as a donor site. The fat is then centrifuged in order to separate the pure fat cells from blood components and triglycerides.
The Fat injection in temporal area is good technique, the operation is under general anaesthesia, and the results are more lasting.

        3-Augmentation of  temporal area by insertion of silicone prothesis:
The operation is under general anaesthesia, and the results are lasting.

12. Laser resurfacing:

The laser treats the wrinkles by abrasion of the surface layers of the skin. The wrinkles of the mouth and the chin are most often treated, as well as the contour of the eyes, the face can be treated in entirety.
The laser light causes in contact with the skin an evaporation of the surface layers with a more or less significant effect of heating of the deep layers carrying out a tensor effect.
Laser CO2:
The laser CO2 causes a more or less major abrasion according to the number of passage on the skin. It requires a local anaesthesia according to the treated zones (eyelids, contour of the mouth, upper lip, etc…) even a general anaesthesia if the whole face is treated.
A preparation of the skin is necessary (creams) 8 to 10 days before the meeting and a social eviction from 1 to 3 weeks after the treatment according to its depth. After treatment, swelling (oedema), seepage during 2 or 3 days, and rednesses can be seen. The bandage is required from 4 to 6 days, then daily care. The redness disappears in several weeks, and requires a make-up and a solar protection.
This laser is indicated in important ageing of solar origin, and in clear skins. One session is necessary.
Duration of the treatment: from 20 minutes to1 hour depending on treated area.

13. Facial lipofilling :

This technique consists in obtaining fat from the patient’s own body utilizing special cannulas that avoid fat cell destruction. Usually, infraumbilical region is taken as a donor site. The fat is then centrifuged in order to separate the pure fat cells from blood components and triglycerides in suspension based on their density. Fat injection in some facial areas, like the cheeks (malar region) and the nasolabial folds, allows oval facial restoration and precise outlining of facelift goals, which is complete facial rejuvenation.

14. Cervical lipo-aspiration:

The cervical lipo-aspiration improves of the under-chin and cervical area. The required result is the reduction of under-chin and submaxillary fat excess. It is reliable and not very invasive technique.

15. Dermabrasion:

This is an excellent treatment for upper and lower lips wrinkles and for the whole mouth contour. Somewhere between the peeling, not quite effective enough, and the laser treatment involving heavy post-operative consequences, the dermabrasion gives good results on the upper and lower lips wrinkles.
The skin is red from 4 to 7 days post-operatively.
Sunbathing is possible towards the 21st day using total sunscreens every 2 hours.
Dermabrasion is often carried out in combination with a facelift.

16. Orthognathic surgery :

The orthognathic surgery is the surgery of congenital or acquired malformations of the jaw-bones (Maxilla and Mandible). The purpose of this surgery is obtaining an ideal dental occlusion, a good articulated dental functional, and an aesthetic improvement (harmonious face). A surgery of the chin is frequently associated in order to optimize the result. This surgery requires a close cooperation between the surgeon and the orthodontist, charged to align the teeth.

17. Botox:

The Botox is an excellent product, very widely used in the treatment of the forehead horizontal wrinkles, vertical lines (lion’s wrinkles) and eyes wrinkles (crow’s feet).

Practically:

• The injection is painless .
• Duration of the procedure: 10 min.
• Visible results after 4 days.
• Effect lasting: 6 months.

18.Eyelides:

          Upper eyelids surgeries:
With age, the upper eyelids usually sag. The procedure consists in removing the excessive skin and, the underlying accumulation of fatty tissue usually found in the inner corner of the eye.
The important point in this operation is to obtain precise measurements of the quantity of skin to be removed prior to the procedure, in the operating room.

• Usual pre-operative assessment.
• Duration of the operation: 1/2 hour.
• Local anesthesia or general anesthesia.
• Checking out on the same day.
• Sutures are removed on the 5th day. They can be removed abroad.

           Lower eyelids surgeries:
Concerning fatty pouches:

• The procedure consists in removing these fatty pouches.
• The incision is carried out flush to the eyelash line, so it is absolutely invisible on the following day, or it can be internal (trans-conjunctival ).
• The procedure takes half an hour.
• The ecchymoses (bruises) are frequent (60%). They are absorbed from 5 to 7 days.If sutures, they are removed on the 5th day.

   If excess skin
The incision is carried out flush to the eyelash line, so it is absolutely invisible on the following day, the sutures are removed on the 5th day.
   If wrinkles:
Usually, these are expression wrinkles; they must be leaved in some people to keep a natural look.
There are many treatments available to minimize the wrinkles of the lower eyelids (filling...) without changing the look.
Finally, the surgeon can combine the eyelids surgeries with the facelift.

19.  The augmentation of the malar region (cheeks):

     ♦ Acid hyaluronic:
The technique consists to inject under local anaesthesia the hyaluronic acid (SubQ), a natural gel of biotechnologic origin, dense, resorbed in 18 to 20 months.
Oedema and hematoma can be seen one week after injection. It is necessary to wait 10 days for an optimal result.
A meeting of correction can be necessary one month later, in order to rectify a light asymmetry or to increase volume.

      ♦ Hydroxyapatite (CaHA) (Radiesse):
The radiesse is Composed of calcium hydroxyapatite (CaHA) synthetic. It is biocompatible and biodegradable (resorbed in 18 to 24 months).
It does not contain any derivative human or animal, there is thus no risk of toxicity or allergy. the Radiesse stimulates the organization to produce collagen.  The injection is carried out under local anaesthesia.

      ♦ Lipofilling :
This technique consists in obtaining fat from the patient's own body utilizing special cannulas that avoid fat cell destruction. Usually, infraumbilical region is taken as a donor site. The fat is then centrifuged in order to separate the pure fat cells from blood components and triglycerides.
The Fat injection in cheekbones (malar region) is good technique, the operation is under general anaesthesia, and the results are more lasting.

20. Increase techniques of the lips: 

  Fillers:
To give more contours to the lips, the surgeon can inject a synthetic product.  The hyaluronic acid is a natural product already present in the body. It is easily injectable with an immediate result.
The duration of effectiveness differs according to the product injected. 
The lips consist of muscles, reason for which the duration of absorbed products action is not very long (approximately 6 months).

The intervention lasts only few minutes, using a very fine needle and without anaesthesia. The pain is light and completely bearable. The intervention can be carried out on the two lips (lower and higher) or on only one according to the morphology and the patient’ desire.
  Lipofilling:
In addition, the injection of a small quantity of grease of the patient is also possible "lipofilling". Grease necessary is taken on the buttocks, the belly or the thigh. The intervention is under general anaesthesia. The duration of effectiveness of the lipofilling is from 12 to 24 months.

→ Facial and cervical reconstructive surgery:

Reconstructive plastic surgery is performed to correct functional impairments caused by burns; traumatic injuries, such as facial bone fractures and breaks; congenital abnormalities, such as cleft palates or cleft lips; developmental abnormalities; infection and disease; and cancer or tumors. Reconstructive plastic surgery is usually performed to improve function, but it may be done to approximate a normal appearance. The most common reconstructive procedures are tumor removal, laceration repair, scar repair, cleft lip and palate surgery Plastic surgeons use microsurgery to transfer tissue for coverage of a defect when no local tissue is available. Free flaps of skin, muscle, bone, fat, or a combination may be removed from the body, moved to another site on the body, and reconnected to a blood supply by suturing arteries and veins.

   1. Facial Burn:

A burn is a type of injury to the skin caused by heat, electricity, chemicals, light, and radiation. Most burns only affect the skin and rarely deeper tissues, such as muscle, bone, and blood vessels can also be injured. Managing burns is important because they are common, painful and can result in disfiguring and disabling scarring. Burns can be complicated by shock, infection, multiple organ dyspunction syndrome, and respiratory distress. Large burns can be fatal, but modern treatments have significantly improved the prognosis of such burns, especially in children and young adults.
  Wound management:
The essential aspects of wound management are an initial assessment, to determine burn area and depth, and then debridement (removing devitalised tissue and contamination), cleaning and then dressings. Burn wounds are painful so analgesia (pain relief) should be given. The wound should then be regularly re-evaluated until it is healed. Wounds requiring surgical closure with skin grafts or flaps should be dealt with as early as possible. One of the major advances in burn care has been the early excision and skin grafting of full thickness and deep-dermal burn wounds.

   2. Facial skin tumors:

• Tumeurs bénignes like naevus: the treatment is often surgical (excision).
• Malignant cutaneous tumors: consisting primarily of basal cell carcinoma, squamous cell carcinoma, and melanoma, are exceedingly common. Diagnosis is made by visual examination of the skin surface and biopsy of any suspicious lesions. Treatment for malignant tumors is surgical (excision).
• Tumors intermediary like dermatofibrosarcoma: the treatment is surgical (excision).
• Angioma: the treatment is always by surgery and/or laser.

The Closing after excision can be simple or requires a flap or a graft of skin according to the loss of substance. The excised lesion is systematically sent to a pathology laboratory for analysis. Sutures are removed on average between the sixth and the twelfth day and the scar will be regularly monitored.

   3. Facial trauma:

Facial trauma, also called maxillofacial trauma, is any physical trauma physical to the face. Facial trauma can involve soft tissue injuries such as burns, bruises, or fractures of the facial bones such as nasal fractures and fractures of the jaw, as well as trauma such as eye injuries. Symptoms are specific to the type of injury; for example, fractures may involve pain, swelling, loss of function, or changes in the shape of facial structures. The therapy of the facial trauma is often surgical.

   4. Cleft lip:

Cleft lip and cleft palate which can also occur together as cleft lip and palate, are variations of a type of clefting congenital deformity caused by abnormal facial development during gestation. A cleft is a fissure or opening. It is the non-fusion of the body's natural structures that form before birth. Approximately 1 in 700 children born have a cleft lip and/or a cleft palate. It has sometimes colloquially been equated with the phrase harelip, but this is used incorrectly, as that term refers to the pulling of the lip towards the nose.
  Cleft lip treatment:
Within the first 2–3 months after birth, surgery is performed to close the cleft lip.

→ Ear:

Functional examinations of the ear:

Audiometry: 

 Impedancemetry:
 

Oto-emissions: 

Pathologies of the ear:

• External ear: malformations, foreign bodies of the external auditory canal, otitis, benign and malignant tumours.
• Eustachian tube pathologies: obstruction, dysfunction.
• Middle ear: acute and chronic otitis, mastoiditis, cholesteatoma, benign and malignant tumours, tympanostomy tube, tympanic perforation, ossiculoplasty, otosclerosis).

  
        Tympanic perforation

    
                                                  Middle ear ossicles fractures

    
                                                         Ossiculoplasty

     
                                   Otosclerosis

   
               Cholesteatoma

• Inner ear: labyrintic fistula, labyrinthitis, acoustic neurinoma.

 
        Acoustic neurinoma

• Vertigo:

• Tinnitus:

• Auditory prosthesis :

• Bone anchored hearing aid (BAHA):

• Implants of middle ear:

• Cochlear implant:

→ Nose-sinus-cavum:

The surgery practised for all patients is the endoscopic endonasal surgery.

Pathologies:

• Olfation disorders.
• Nasal pains.
• Epistaxis.
• Deviations of the septum.

• Dermatosis of the nose (folliculitis, furuncle or boil, eczema, rhinophyma).
• Choanal imperforation.
• Fractures of the nasal bones.
• Pathologies of the nasal septum (hematoma, abscess, cyst, perforation).
• Nasal foreign bodies.
• The allergy of the nose and sinus.
• The polyps of the nose and sinus.
• Rhinitis and sinusitis (acute and chronic).
• Benign tumours (mucoceles, papillomas, osteomas) and malignant tumours of the nose and sinus.
• The nasal obstruction can be because of:
  1. Nasal septum deviation that is corrected by an operation called septoplasty.
  2. Inferior turbinate hypertrophy that is corrected by surgery or by radio frequency.
  3. Problems of the external or/and internal valves that are corrected by thendoscopicendonasal surgery.
• Endoscopic endonasal surgery of the hypophysis gland.
• Pathologies of the cavum (benign and malignant tumours).
• Adenoidectomy for children (the surgical removal of the adenoids).

 
        Inferior turbin ate surgery

  
  
Inferior turbinate hypertrophy corrected by radio frequency

    
                                         Polypectomies

       
Rhinitis and sinusitis (acute and chronic)

Benign tumours and malignant tumours of the nose and sinus

Endoscopic endonasal surgery of the hypophysis gland

→ Larynx and trachea:

• Patholgies of the larynx and the trachea (dyspnea, dysphony, acute and chronic laryngitis, tracheitis, stenosis of the larynx and trachea, congenital malformations of the larynx and trachea).
• Foreign bodies of the trachea and bronchuses.
• Traumatisms of the larynx (commotions and contusions, luxation, fractures, and wounds), and of the trachea (wounds, hematomas).
• Malignant and benign tumours of the larynx and the vocal cords (nodules, polyps, papillomas, laryngocels).
• Malignant and benign tumours of the trachea (surgery, laser, prosthesis).
• Exploration of the larynx (Oedema, cords paralysis).
• Endoscopic surgery of larynx (micosurgery, laser).
• Tracheotomy.

  
                                           Endoscopic surgery of larynx

 
                tumors of the larynx  Malignant and benign

 
                 Before                               After 
              The treatment of the larynx oedema

Foreign bodies of the larynx

                   Laryngectomy

→ Mouth, pharynx,Œsophagus:

Pathologies  and surgery of the bucco-pharynx:

• Amygalitis, anginas, chronic and acute pharyngitis, gingivo-stomatitis.
• Abscesses and phlegmons .
• Amygdalectomies.
• Benign and malignant tumours of the bucco-pharynx.
• Stenosis of the pharynx.
• Foreign bodies of the pharynx.
• Nervous disorders of the pharynx.

Oesophagus (exploration, pathology, surgery):

• Oesophagoscopic exploration (stenosis, compression, mega-osophagus, trachoo- oesophageal fistula).
• Foreign bodies.
• Pathologies of the oesophagus (oesophagitis, burn, dysphagy, pain, acid reflux, Spasm, ulcers, varicose).
• Benign and malignant tumours.
• Diverticulum of the oesophagus.

→ Thyroid and parathyroid glands:

The surgery of thyroid and parathyroid glands is performed by a small cervical incision of 3 cm, the closing is aesthetic:

• Cysts.
• Abscess.
• Benign and malignant tumours.

→ Salivary glands :

The pathologies of salivary glands contain:

• Salivery gland acute and chronic infection (parotid and sub maxillary glands).
• Sialolithiasis.
• The benign and malignant tumours.
• The ranula.

→ Cervical tumours: 

• Cervical congenital cysts and fistulas.
• Primitive and secondary ganglionic tumours.
• Nervous tumours (schannomas, paragangliomas), and vascular (arterial aneurisms, lymphangiomas).
• Muscular tumours, fibromas, lipomas.
• Thyroglossal tract cyst.
• Cervical abscesses.

→ Snoring : 

The surgery and the radio frequency correct the anatomical problems of the palate which is the main cause of snoring.

→ Facial pathologies:

1.       Infectious pathologies of the face:
Infectious pathologies of the face are dangerous; the risk of the facial deep vein thrombosis is raised:

• Staphilococcus or Streptococcus of the face.
• cellulitis (dental origin) of the face and neck.
• Abscesses of the face.

2.     Headache and facial pain:

The principal causes are:

• The migraine.
• Trigeminal Neuralgia.
• Cluster headache.
• Sinusites.
• Temporo-mandibular joint disorder.
• Dental origin.
• Ophthalmologic origin.

3.     Facial nerve paralysis (pathology and surgery):

Facial nerve paralysis is a common problem that involves the paralysis of any structures innervated by the facial nerve facial. The pathway of the facial nerve is long and relatively convoluted, and so there are a number of causes that may result in facial nerve paralysis. The most common is Bell's palsy (an idiopathic disease).

During the physical examination, a distinction must first be made between paralysis and paresis (incomplete paralysis). Not surprisingly, paralysis is far more serious and requires immediate treatment. It must also be determined whether the forehead is involved in the motor defect or not. This is usually accomplished by assessing how well a patient can raise his or her eyebrows. The question is an important one because it helps determine if the lesion is in the upper motor neuron component of the facial nerve, or in its lower motor neuron component.
Bell's palsy
The Bell'pasy is the most common cause of acute facial nerve paralysis (>80%). Previously considered idiopathic, it has been recently linked to herpes simplex infection or linked to herpes zoster infection. Other, less common, the Lyme disease.

Bell's palsy is an exclusion diagnosis. Some factors that tend to rule out Bell's palsy include:

• 1. Recurrent paralysis
• 2. Slowly progressive paralysis (The onset of Bell's palsy is very sudden, usually within 24 hours all the symptoms have been manifested)
• 3. Twitching
• 4. Associated symptoms (either cochlear or neurologic)

Palliative surgery of the facial paralysis:

→ Maxillo-Facial (pathologies and surgery): 

      1.  Orthognathic surgery:
The orthognathic surgery is the surgery of congenital or acquired malformations of the jaw-bones (Maxilla and Mandible).
The purpose of this surgery is obtaining an ideal dental occlusion, a good articulated dental functional, and an aesthetic improvement (harmonious face). A surgery of the chin is frequently associated in order to optimize the result.
This surgery requires a close cooperation between the surgeon and the orthodontist, charged to align the teeth.

      2.   Revascularized free scapular flap in mandibular reconstruction in oncological cervicofacial salvage surgery:
Vascularized free scapular flap bone graft is of immense interest for the reconstruction of important mandibular discontinuity, composite (soft tissue and cutaneous resection) or exclusively osseous defects, secondary to carcinological or osteoradionecrotic resections.

      3.  Mandibular reconstruction by the autologous cancellous bone and marrow grafts:
We use the autologous cancellous bone and marrow grafts for filling defects following cyst removal in the mandible.

  
                          Before                                                        After

      4.  Extraction of Wisdom teeth :
Wisdom teeth are extracted for two general reasons: either the wisdom teeth have already become impacted, or the wisdom teeth could potentially become problematic if not extracted. Potential problems caused by the presence of properly grown-in wisdom teeth include infections caused by food particles easily trapped in the jaw area behind the wisdom teeth where regular brushing and flossing is difficult and ineffective. Such infections may be frequent, and cause considerable pain and medical danger. Other reasons wisdom teeth are removed include misalignment which rubs up against the tongue or cheek causing pain, potential crowding or malocclusion of the remaining teeth.

      5.  Diseases of temporo-mandibular articulation:
The diseases of temporo-mandibular articulation:

• Luxation.
• Arthritis.
• Ankylosis.
• Functional disorders.