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Characterisation of coronal suture fusion in a Crouzon mouse model
Oral presentations / British Journal of Oral and Maxillofacial Surgery 50S (2012) S1–S41
assessed at one and two hours from the end of surgery by visual analogue scale (VAS). Results: 126 patients completed the study. Both groups were shown to be comparable by the chosen parameters. For primary outcome measure, the numbers of patients in groups OP and IP reporting satisfactory pain relief by VAS score at one hour were 15 and 17 respectively. The 90% confidence intervals for these numbers fall within a clinically accepted difference of 20%. The secondary outcome measure of mean (SD) 1 h VAS score for the whole of each group were 5.1(2.2) for OP and 4.7(2.2) for IP. Again for a clinically tolerable difference of up to 20% on the VAS score being equivalent. Conclusions: On the measures we have chosen, we have demonstrated no superiority of one route over the other. On this basis, when facilities exist to premedicate patients with oral paracetamol prior to surgery, there would seem little benefit in using intravenous paracetamol in preference to oral. http://dx.doi.org/10.1016/j.bjoms.2012.04.230 85 Airway management in the head and neck oncology patient-overnight endotracheal intubation versus tracheostomy: a comparative study M.J. Coyle ∗ , A. Felstead, C. Thomas, D. Godden
Hughes, C.
Perkins, S.
University of Bristol, Gloucestershire Hospitals, NHS Trust, United Kingdom Introduction and aims: Tracheostomy is commonly used to provide a secure airway in the peri and postoperative period for patients undergoing major head and neck surgery. Tracheostomy is associated with significant morbidity. A previous retrospective study by our group showed that overnight endotracheal intubation without tracheostomy is a safe alternative. The purpose of this study was to examine if outcomes were better in patients managed with endotracheal intubation versus tracheostomy. Materials and methods: A multicentre retrospective review of patients undergoing resection of intraoral tumour with neck dissection and reconstruction with free flap. In one unit airway management was with overnight intubation, in the other the airway was managed with tracheostomy. 50 patients from each unit were identified. Age, ASA grade, smoking status, tumour location, TNM stage, type of neck dissection and type of reconstruction were recorded for each patient. Outcomes recorded were: length of ITU and hospital stay, number of days to first oral intake and airway complications. Results: All patients who were intubated overnight without tracheostomy in the ITU were safely extubated and fit for transfer to a ward the following morning. Patients with a tracheostomy had on average a greater length of ITU stay, greater length of hospital stay and greater time to first oral intake. Patients with a tracheostomy also had a higher incidence of LRTI.
S33
Conclusions and clinical relevance: Overnight endotracheal intubation is a safe alternative to tracheostomy. A number of important patient outcomes are improved when tracheostomy is avoided. The continued use of tracheostomy must be questioned. http://dx.doi.org/10.1016/j.bjoms.2012.04.231 86 Characterisation of coronal suture fusion in a Crouzon mouse model S. Kumar ∗ , E. Peskett, E. Pauws, J.A. Britto Institute of Child Health, University College London and the Craniofacial Unit, Great Ormond Street, United Kingdom In the Crouzon Syndrome mouse model (Fgfr2C342Y/+) coronal suture synostosis (CSS) is observed to progress from prenatally to eventual closure by two weeks postnatally. The cellular and histological changes of murine coronal suture fusion in this Crouzon phenocopy are described in agematched specimens and cultured calvarial explants. Progression of the coronal suture from E18.5-P14 in both wild-type (WT) and heterozygous Fgfr2C342Y/+ wholemount calvaria was investigated histochemically in comparable parasagittal sections. Additionally, frontoparietal calvarial explants of WT and Fgfr2C342Y/+ embryos were dissected at E18.5 and cultured. Respective calvaria demonstrating the coronal suture were fixed at 7 and 14 days in 100% ethanol and stained with Alizarin Red. There is a consistent overlap of frontal to parietal bone in both WT and Fgfr2C342Y/+giving the murine coronal suture a characteristic consistent shape. Gradual loss of overlap proceeding to suture fusion occurs in Fgfr2C342Y/+ mice at ages E18.5, P7, P10 and P14. Explant calvaria in culture progress to coronal suture fusion. There is a vertex-to-cranial base direction of closure of the coronal suture in Fgfr2C342Y/+ mice. The frontal bone in heterozygotes is more porous than parietal bone, a feature which is more marked than in WT. Our work aims to clarify the spatiotemporal progression of CSS in the Crouzon murine model pre and postnatally. There are distinct differences in WT and Fgfr2C342Y/+ mice during synostosis between frontal and parietal bone fronts. The explant culture system will form the basis of a detailed analysis of the molecular events during synostosis. http://dx.doi.org/10.1016/j.bjoms.2012.04.232
assessed at one and two hours from the end of surgery by visual analogue scale (VAS). Results: 126 patients completed the study. Both groups were shown to be comparable by the chosen parameters. For primary outcome measure, the numbers of patients in groups OP and IP reporting satisfactory pain relief by VAS score at one hour were 15 and 17 respectively. The 90% confidence intervals for these numbers fall within a clinically accepted difference of 20%. The secondary outcome measure of mean (SD) 1 h VAS score for the whole of each group were 5.1(2.2) for OP and 4.7(2.2) for IP. Again for a clinically tolerable difference of up to 20% on the VAS score being equivalent. Conclusions: On the measures we have chosen, we have demonstrated no superiority of one route over the other. On this basis, when facilities exist to premedicate patients with oral paracetamol prior to surgery, there would seem little benefit in using intravenous paracetamol in preference to oral. http://dx.doi.org/10.1016/j.bjoms.2012.04.230 85 Airway management in the head and neck oncology patient-overnight endotracheal intubation versus tracheostomy: a comparative study M.J. Coyle ∗ , A. Felstead, C. Thomas, D. Godden
Hughes, C.
Perkins, S.
University of Bristol, Gloucestershire Hospitals, NHS Trust, United Kingdom Introduction and aims: Tracheostomy is commonly used to provide a secure airway in the peri and postoperative period for patients undergoing major head and neck surgery. Tracheostomy is associated with significant morbidity. A previous retrospective study by our group showed that overnight endotracheal intubation without tracheostomy is a safe alternative. The purpose of this study was to examine if outcomes were better in patients managed with endotracheal intubation versus tracheostomy. Materials and methods: A multicentre retrospective review of patients undergoing resection of intraoral tumour with neck dissection and reconstruction with free flap. In one unit airway management was with overnight intubation, in the other the airway was managed with tracheostomy. 50 patients from each unit were identified. Age, ASA grade, smoking status, tumour location, TNM stage, type of neck dissection and type of reconstruction were recorded for each patient. Outcomes recorded were: length of ITU and hospital stay, number of days to first oral intake and airway complications. Results: All patients who were intubated overnight without tracheostomy in the ITU were safely extubated and fit for transfer to a ward the following morning. Patients with a tracheostomy had on average a greater length of ITU stay, greater length of hospital stay and greater time to first oral intake. Patients with a tracheostomy also had a higher incidence of LRTI.
S33
Conclusions and clinical relevance: Overnight endotracheal intubation is a safe alternative to tracheostomy. A number of important patient outcomes are improved when tracheostomy is avoided. The continued use of tracheostomy must be questioned. http://dx.doi.org/10.1016/j.bjoms.2012.04.231 86 Characterisation of coronal suture fusion in a Crouzon mouse model S. Kumar ∗ , E. Peskett, E. Pauws, J.A. Britto Institute of Child Health, University College London and the Craniofacial Unit, Great Ormond Street, United Kingdom In the Crouzon Syndrome mouse model (Fgfr2C342Y/+) coronal suture synostosis (CSS) is observed to progress from prenatally to eventual closure by two weeks postnatally. The cellular and histological changes of murine coronal suture fusion in this Crouzon phenocopy are described in agematched specimens and cultured calvarial explants. Progression of the coronal suture from E18.5-P14 in both wild-type (WT) and heterozygous Fgfr2C342Y/+ wholemount calvaria was investigated histochemically in comparable parasagittal sections. Additionally, frontoparietal calvarial explants of WT and Fgfr2C342Y/+ embryos were dissected at E18.5 and cultured. Respective calvaria demonstrating the coronal suture were fixed at 7 and 14 days in 100% ethanol and stained with Alizarin Red. There is a consistent overlap of frontal to parietal bone in both WT and Fgfr2C342Y/+giving the murine coronal suture a characteristic consistent shape. Gradual loss of overlap proceeding to suture fusion occurs in Fgfr2C342Y/+ mice at ages E18.5, P7, P10 and P14. Explant calvaria in culture progress to coronal suture fusion. There is a vertex-to-cranial base direction of closure of the coronal suture in Fgfr2C342Y/+ mice. The frontal bone in heterozygotes is more porous than parietal bone, a feature which is more marked than in WT. Our work aims to clarify the spatiotemporal progression of CSS in the Crouzon murine model pre and postnatally. There are distinct differences in WT and Fgfr2C342Y/+ mice during synostosis between frontal and parietal bone fronts. The explant culture system will form the basis of a detailed analysis of the molecular events during synostosis. http://dx.doi.org/10.1016/j.bjoms.2012.04.232