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Technique for surgical tongue reduction in Beckwith-Weidemann syndrome macroglossia
442 Free Papers—Oral Presentations Department of Oral and Maxillofacial Surgery, Cardiff University Dental Hospital, Heath Park, Cardiff, United Kingdom
A 10-year retrospective review of oral cancer treatment at the maxillofacial unit Cardiff is presented. Utilising the Walton database, the stage of the disease at presentation, the resection and the type of neck dissection performed, the method of reconstruction and the primary site and neck recurrence as well as survival rates are presented. There is a follow up period of between 2 and 12 years. A previous presentation with a subsequent published paper by the senior author emphasised the shortcomings of the supraomohyoid neck dissection and the need for the inclusion of level IV and this presentation will support these views. doi:10.1016/j.ijom.2009.03.163
O2.32 Total palatal reconstruction—fact or fiction C.V. Thomas ∗ , M.J. Fardy, A. Cronin, A. McGroary Department of Oral and Maxillofacial Surgery, Cardiff University Dental Hospital, Heath Park, Cardiff, United Kingdom
The aim of total palatal reconstruction is to provide a structure on which the patient can return to swallowing and have good speech. We would like to describe experience of senior authors with this difficult problem. In particular we will review the surgical technique in applying a radial forearm flap to achieve a two layer closure with skin coverage on the nasal as well as the oral side on 25 patients. We will describe the pre- and postoperative results in relation to speech and swallowing. doi:10.1016/j.ijom.2009.03.164
O2.33 O-(2-[F-18]fluorethyl)-L-tyrosine positron emission tomography in the diagnosis of head and neck cancer: increased amino acid transporter expression in squamous cell carcinomas A. Zimmermann ∗ , D. Salber, G. Stoffels, S. Klein, D. Pauleit, ¨ N.R. Kubler, K. Hamacher, H.H. Coenen, K.J. Langen Department of Maxillofacial and Facial Plastic Surgery, University Hospital, Heinrich-Heine University, Dusseldorf, Germany
Background and Objectives: O-(2-[F18]fluorethyl)-L-tyrosine (FET) is useful in brain tumour diagnostics and also shows high uptake in squamous cell carcinomas (SCC). In contrast to the standard positron emission tomography (PET) tracer [18 F]fluorodeoxyglucose (FDG) in head and neck tumour imaging, with FET a differentiation between tumour and inflammatory tissue seems possible. It is assumed that this special uptake behaviour is caused by selective transport of FET via the LAT2 subtype of the system L amino acid transporter. Methods: Seven patients with head-neck tumours had FDG and FET whole body PET. In the subsequent operation 14 tissue probes were taken from FDG positive tumour or lymph node metastases. Six of the 14 lesions were FET positive. Expression of the system L Amino acid transporter subtypes LAT1 and LAT2 as well as the heterodimer CD98 that is relevant for functional expression of both transporter subtypes was measured using real-time polymerase chain reaction. Results: Increased LAT2/CD98expression was found in 5 of 6 FET positive tumour probes while all FET negative tumours exhibited low LAT2transporter expression. High LAT1 expression was observed in 6 out of 14 tissue probes, 3 of which were FET negative. Furthermore, 3 of the 6 FET positive tumour probes had low LAT1 expression. Conclusions: The results confirm the hypothesis that FET accumulation is related to the expression of the LAT2 subtype of system L amino acid transporter, which is overexpressed in SCC but not in inflammatory tissue. doi:10.1016/j.ijom.2009.03.165
O3: Cleft Lip and Palate/ Craniofacial Surgery O3.1 Anthropometric and gradation of alar base and maxillary bone of uilateral cleft lip secondary nasal deformity Z. Lei Department of Oral and Maxillofacial Surgery, School of Stomatology, China Medical University, Shenyang, China
Background and Objectives: The study was conducted to measure the alar base and maxillary bone of unilateral cleft lip secondary nasal deformity and to investigate the satisfaction of patients, in order to
gradate the depression of alar base and provide reference for the clinical surgery. Methods: Thirty patients had been treated in the past six months at the Department of Oral and Maxillofacial Surgery, School of Stomatology, China Medical University. The posterior-anterior films, lateral projection and three-dimensional computed tomography (CT) taken before surgery, and the data of noses before and after surgery were analysed for the relationship of soft tissues and maxillary bones. Gradation of alar base was also made based on these data. Results: In all cases, the cleft-side piriform margin was downward, abduction and depression. The position of alar base was related to the piriform morphous. However, in contrast with bony position, the cleft-side alar base was located more upward than the non-cleft side alar base in 10 of 30 patients, located more endoduction than the non-cleft side alar base in 12 of 30 patients and located more anteriorly than the non-cleft side alar base in 20 of 30 patients. The satisfaction of nose had more relationships with skewness of dorsum of nose, skewness of nasal columella, symmetry of nostrils and the depression of alar base. When the depression was <4 mm, we obtained a fine appearance of nose only through the repair of soft tissues; When the depression was ≥4 mm, we had to combine with graft or the restitution of cleft of alveolus. There was no difference between the results from X-ray and three-dimensional CT when we measured the piriform of uilateral cleft lip secondary nasal deformity. Conclusions: The growth of maxillary bone for the patients with cleft lip and palate was insufficient. Bony depression did not necessarily lead to postoperative alar depression, and the alar base can be adjusted to a suitable place through the operation. Anthropometry of nose was important before surgery in order to choose the methods and got the satisfaction. doi:10.1016/j.ijom.2009.03.166
O3.2 Technique for surgical tongue reduction in BeckwithWeidemann syndrome macroglossia J.E. Portnof Department of Plastic and Maxillofacial Surgery, Royal Children’s Hospital of Melbourne, Parkville Victoria, Australia
Background and Objectives: Beckwith Weidemann syndrome (BWS) is a rare
Free Papers—Oral Presentations congenital overgrowth disorder encountered by craniomaxillofacial surgeons. It is characterised by macroglossia, anterior abdominal wall defects, and gigantism. Many techniques have been described to surgically treat the macroglossia associated with this syndrome. The many techniques advocated demonstrate that a less than ideal result is achieved. Our stellate/keyhole surgical reduction pattern allows for the appropriate reduction of tongue mass and volume with conservation of motor and sensory function as well as preservation of good anatomical contour. Methods: Records were retrospectively reviewed for cases of macroglossia in which this tongue reduction protocol was utilised for the past decade and 10 were identified. Patients that underwent tongue reduction surgery for macroglossia not associated with BWS, or patients for whom records were incomplete, were excluded from the study. The tongue reduction technique described here has been utilised to treat BWS macroglossia 7 times between the years 1999 and 2009. 2 male patients and 5 female patients were treated with this surgical technique. Patient ages ranged between 6 and 21 months. Clinical followup was performed to assess patient and parent satisfaction with tongue function and cosmesis. Results and Conclusions: Follow-up ranged from 4 months to 9 years postoperatively. All patients were evaluated postsurgically and the stellate/keyhole technique provided a successful method for reducing tongue bulk, width, and length while preserving cosmetic form and anatomical function. doi:10.1016/j.ijom.2009.03.167
O3.3 Mandibular symphysis as a donor site in alveolar bone grafting—a study on donor site morbidity R. Das ∗ , M. Veerabahu, B. Vikraman Department of Oral and Maxillofacial Surgery, Ragas Dental College and Hospital, Uthandi, Chennai, India
Bone grafting of the alveolar process defect is a procedure used in almost all patient with an alveolar cleft. The recommended donor site used to fill the cleft defect can be harvested from various sites, of which mandibular symphysis is one common site. Mandibular symphysis has following advantages over other sites such as osteoplasty and harvesting site remains confined to oral cavity, duration of operation is short
and postoperative complication are minimal. At the same time the disadvantage is that because the nature of bone is cortical, it has to be grounded. Our study was to evaluate the postoperative donor site morbidity when harvested from mandibular symphysis. Our study included a total of 10 patients, in whom 7 were male and 3 were female with an age distribution between 11 to 26 years. Based on the results of this study it is apparent that the mandibular symphysis can be reliably selected as the harvest site in alveolar bone grafting.
443
post-distraction from early conversion to slow progression to oral feeds and three continued to require supplemental nasogastric feeds. Conclusion: Mandibular distraction in neonates and infants with upper airway obstruction secondary to micrognathia has dramatically reduced the need for tracheostomy and length of hospitalisation. Feeding has been facilitated earlier and our algorithm for management together with representative cases will be discussed. doi:10.1016/j.ijom.2009.03.169
doi:10.1016/j.ijom.2009.03.168
O3.4 Outcome of mandibular distraction for the management of micrognathia and obstructive apnoea J.M. Shand ∗ , A.A. Heggie, J. Massie Oral and Maxillofacial Surgery Unit and Melbourne Craniofacial Unit, Royal Children’s Hospital of Melbourne, Parkville, Victoria, Australia
Background and Objectives: Infants and children with craniofacial anomalies, such as Robin sequence, craniofacial microsomia and Treacher Collins syndrome, often present with varying degrees of upper airway obstruction due to micrognathia. The aim of this study is to present the outcome of the management of 32 neonatal, infants and young children with micrognathia who had undergone mandibular distraction for severe upper airway obstruction. Methods: All patients underwent mandibular distraction with internal appliances. The age at the time of surgery ranged from 5 weeks to 36 months. Two patients were tracheostomy dependent, one intubated, two continuous positive airway pressure-dependent, twenty six patients were nasopharyngeal tube (NPT) dependent and one NPT/positionally managed. Polysomnography studies were undertaken preoperatively when possible and postoperatively. All patients had 12-months or more of follow-up since surgery. Results: In the tracheostomy-dependent group post-distraction, one was decannulated after distraction and one was delayed until correction of choanal atresia correction was completed. Twenty six patients had no further obstructive symptoms following mandibular distraction. Five patients had continuing or developed further obstructive symptoms during the follow-up period, and one patient underwent further mandibular distraction at 7-years of age. Feeding responses varied
O3.5 Seasonal variations of conception dates in some Nigerian cleft lip and palate patients F.O. Oginni ∗ , J.K. Olabanji, A.O. Oladele Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, College of Health Science, Obafemi Awolowo University, Nigeria
Background and Objectives: Although the multifactoral concept of the aetiology of cleft lip and palate is widely accepted, its aetiology remains unclear. The roles of diverse exogenous and endogenous factors have been substantiated considerably. This retroprospective observational study was designed to determine the seasonal variation in the conception and birth of individuals with non-syndromic orofacial clefts in a cohort of cleft patients. Methods: Records of non-syndromic orofacial clefts patients at the Obafemi Awolowo University Teaching Hospital were analysed retroprospectively. Data obtained from the records and patients, included patients’ demographics, dates of birth, length of pregnancy and mother’s last menstrual period (where available). The months of conception and birth were derived for each patient and compared with data from a control group randomly selected from normal births in the hospital birth registry. Data was analysed using the SPSS version 11.0 Results: A total of 134 patients met the inclusion criteria. There was a female preponderance (M:F = 76:58). Conception of patients with milder deformities (cleft of the primary palate and isolated cleft of the secondary palate) occurred predominantly during the rainy season while conception of patients with more deformities (complete cleft of the primary and secondary palate) occurred mostly during the dry season. This was significantly different from the conception periods in the control group.
A 10-year retrospective review of oral cancer treatment at the maxillofacial unit Cardiff is presented. Utilising the Walton database, the stage of the disease at presentation, the resection and the type of neck dissection performed, the method of reconstruction and the primary site and neck recurrence as well as survival rates are presented. There is a follow up period of between 2 and 12 years. A previous presentation with a subsequent published paper by the senior author emphasised the shortcomings of the supraomohyoid neck dissection and the need for the inclusion of level IV and this presentation will support these views. doi:10.1016/j.ijom.2009.03.163
O2.32 Total palatal reconstruction—fact or fiction C.V. Thomas ∗ , M.J. Fardy, A. Cronin, A. McGroary Department of Oral and Maxillofacial Surgery, Cardiff University Dental Hospital, Heath Park, Cardiff, United Kingdom
The aim of total palatal reconstruction is to provide a structure on which the patient can return to swallowing and have good speech. We would like to describe experience of senior authors with this difficult problem. In particular we will review the surgical technique in applying a radial forearm flap to achieve a two layer closure with skin coverage on the nasal as well as the oral side on 25 patients. We will describe the pre- and postoperative results in relation to speech and swallowing. doi:10.1016/j.ijom.2009.03.164
O2.33 O-(2-[F-18]fluorethyl)-L-tyrosine positron emission tomography in the diagnosis of head and neck cancer: increased amino acid transporter expression in squamous cell carcinomas A. Zimmermann ∗ , D. Salber, G. Stoffels, S. Klein, D. Pauleit, ¨ N.R. Kubler, K. Hamacher, H.H. Coenen, K.J. Langen Department of Maxillofacial and Facial Plastic Surgery, University Hospital, Heinrich-Heine University, Dusseldorf, Germany
Background and Objectives: O-(2-[F18]fluorethyl)-L-tyrosine (FET) is useful in brain tumour diagnostics and also shows high uptake in squamous cell carcinomas (SCC). In contrast to the standard positron emission tomography (PET) tracer [18 F]fluorodeoxyglucose (FDG) in head and neck tumour imaging, with FET a differentiation between tumour and inflammatory tissue seems possible. It is assumed that this special uptake behaviour is caused by selective transport of FET via the LAT2 subtype of the system L amino acid transporter. Methods: Seven patients with head-neck tumours had FDG and FET whole body PET. In the subsequent operation 14 tissue probes were taken from FDG positive tumour or lymph node metastases. Six of the 14 lesions were FET positive. Expression of the system L Amino acid transporter subtypes LAT1 and LAT2 as well as the heterodimer CD98 that is relevant for functional expression of both transporter subtypes was measured using real-time polymerase chain reaction. Results: Increased LAT2/CD98expression was found in 5 of 6 FET positive tumour probes while all FET negative tumours exhibited low LAT2transporter expression. High LAT1 expression was observed in 6 out of 14 tissue probes, 3 of which were FET negative. Furthermore, 3 of the 6 FET positive tumour probes had low LAT1 expression. Conclusions: The results confirm the hypothesis that FET accumulation is related to the expression of the LAT2 subtype of system L amino acid transporter, which is overexpressed in SCC but not in inflammatory tissue. doi:10.1016/j.ijom.2009.03.165
O3: Cleft Lip and Palate/ Craniofacial Surgery O3.1 Anthropometric and gradation of alar base and maxillary bone of uilateral cleft lip secondary nasal deformity Z. Lei Department of Oral and Maxillofacial Surgery, School of Stomatology, China Medical University, Shenyang, China
Background and Objectives: The study was conducted to measure the alar base and maxillary bone of unilateral cleft lip secondary nasal deformity and to investigate the satisfaction of patients, in order to
gradate the depression of alar base and provide reference for the clinical surgery. Methods: Thirty patients had been treated in the past six months at the Department of Oral and Maxillofacial Surgery, School of Stomatology, China Medical University. The posterior-anterior films, lateral projection and three-dimensional computed tomography (CT) taken before surgery, and the data of noses before and after surgery were analysed for the relationship of soft tissues and maxillary bones. Gradation of alar base was also made based on these data. Results: In all cases, the cleft-side piriform margin was downward, abduction and depression. The position of alar base was related to the piriform morphous. However, in contrast with bony position, the cleft-side alar base was located more upward than the non-cleft side alar base in 10 of 30 patients, located more endoduction than the non-cleft side alar base in 12 of 30 patients and located more anteriorly than the non-cleft side alar base in 20 of 30 patients. The satisfaction of nose had more relationships with skewness of dorsum of nose, skewness of nasal columella, symmetry of nostrils and the depression of alar base. When the depression was <4 mm, we obtained a fine appearance of nose only through the repair of soft tissues; When the depression was ≥4 mm, we had to combine with graft or the restitution of cleft of alveolus. There was no difference between the results from X-ray and three-dimensional CT when we measured the piriform of uilateral cleft lip secondary nasal deformity. Conclusions: The growth of maxillary bone for the patients with cleft lip and palate was insufficient. Bony depression did not necessarily lead to postoperative alar depression, and the alar base can be adjusted to a suitable place through the operation. Anthropometry of nose was important before surgery in order to choose the methods and got the satisfaction. doi:10.1016/j.ijom.2009.03.166
O3.2 Technique for surgical tongue reduction in BeckwithWeidemann syndrome macroglossia J.E. Portnof Department of Plastic and Maxillofacial Surgery, Royal Children’s Hospital of Melbourne, Parkville Victoria, Australia
Background and Objectives: Beckwith Weidemann syndrome (BWS) is a rare
Free Papers—Oral Presentations congenital overgrowth disorder encountered by craniomaxillofacial surgeons. It is characterised by macroglossia, anterior abdominal wall defects, and gigantism. Many techniques have been described to surgically treat the macroglossia associated with this syndrome. The many techniques advocated demonstrate that a less than ideal result is achieved. Our stellate/keyhole surgical reduction pattern allows for the appropriate reduction of tongue mass and volume with conservation of motor and sensory function as well as preservation of good anatomical contour. Methods: Records were retrospectively reviewed for cases of macroglossia in which this tongue reduction protocol was utilised for the past decade and 10 were identified. Patients that underwent tongue reduction surgery for macroglossia not associated with BWS, or patients for whom records were incomplete, were excluded from the study. The tongue reduction technique described here has been utilised to treat BWS macroglossia 7 times between the years 1999 and 2009. 2 male patients and 5 female patients were treated with this surgical technique. Patient ages ranged between 6 and 21 months. Clinical followup was performed to assess patient and parent satisfaction with tongue function and cosmesis. Results and Conclusions: Follow-up ranged from 4 months to 9 years postoperatively. All patients were evaluated postsurgically and the stellate/keyhole technique provided a successful method for reducing tongue bulk, width, and length while preserving cosmetic form and anatomical function. doi:10.1016/j.ijom.2009.03.167
O3.3 Mandibular symphysis as a donor site in alveolar bone grafting—a study on donor site morbidity R. Das ∗ , M. Veerabahu, B. Vikraman Department of Oral and Maxillofacial Surgery, Ragas Dental College and Hospital, Uthandi, Chennai, India
Bone grafting of the alveolar process defect is a procedure used in almost all patient with an alveolar cleft. The recommended donor site used to fill the cleft defect can be harvested from various sites, of which mandibular symphysis is one common site. Mandibular symphysis has following advantages over other sites such as osteoplasty and harvesting site remains confined to oral cavity, duration of operation is short
and postoperative complication are minimal. At the same time the disadvantage is that because the nature of bone is cortical, it has to be grounded. Our study was to evaluate the postoperative donor site morbidity when harvested from mandibular symphysis. Our study included a total of 10 patients, in whom 7 were male and 3 were female with an age distribution between 11 to 26 years. Based on the results of this study it is apparent that the mandibular symphysis can be reliably selected as the harvest site in alveolar bone grafting.
443
post-distraction from early conversion to slow progression to oral feeds and three continued to require supplemental nasogastric feeds. Conclusion: Mandibular distraction in neonates and infants with upper airway obstruction secondary to micrognathia has dramatically reduced the need for tracheostomy and length of hospitalisation. Feeding has been facilitated earlier and our algorithm for management together with representative cases will be discussed. doi:10.1016/j.ijom.2009.03.169
doi:10.1016/j.ijom.2009.03.168
O3.4 Outcome of mandibular distraction for the management of micrognathia and obstructive apnoea J.M. Shand ∗ , A.A. Heggie, J. Massie Oral and Maxillofacial Surgery Unit and Melbourne Craniofacial Unit, Royal Children’s Hospital of Melbourne, Parkville, Victoria, Australia
Background and Objectives: Infants and children with craniofacial anomalies, such as Robin sequence, craniofacial microsomia and Treacher Collins syndrome, often present with varying degrees of upper airway obstruction due to micrognathia. The aim of this study is to present the outcome of the management of 32 neonatal, infants and young children with micrognathia who had undergone mandibular distraction for severe upper airway obstruction. Methods: All patients underwent mandibular distraction with internal appliances. The age at the time of surgery ranged from 5 weeks to 36 months. Two patients were tracheostomy dependent, one intubated, two continuous positive airway pressure-dependent, twenty six patients were nasopharyngeal tube (NPT) dependent and one NPT/positionally managed. Polysomnography studies were undertaken preoperatively when possible and postoperatively. All patients had 12-months or more of follow-up since surgery. Results: In the tracheostomy-dependent group post-distraction, one was decannulated after distraction and one was delayed until correction of choanal atresia correction was completed. Twenty six patients had no further obstructive symptoms following mandibular distraction. Five patients had continuing or developed further obstructive symptoms during the follow-up period, and one patient underwent further mandibular distraction at 7-years of age. Feeding responses varied
O3.5 Seasonal variations of conception dates in some Nigerian cleft lip and palate patients F.O. Oginni ∗ , J.K. Olabanji, A.O. Oladele Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, College of Health Science, Obafemi Awolowo University, Nigeria
Background and Objectives: Although the multifactoral concept of the aetiology of cleft lip and palate is widely accepted, its aetiology remains unclear. The roles of diverse exogenous and endogenous factors have been substantiated considerably. This retroprospective observational study was designed to determine the seasonal variation in the conception and birth of individuals with non-syndromic orofacial clefts in a cohort of cleft patients. Methods: Records of non-syndromic orofacial clefts patients at the Obafemi Awolowo University Teaching Hospital were analysed retroprospectively. Data obtained from the records and patients, included patients’ demographics, dates of birth, length of pregnancy and mother’s last menstrual period (where available). The months of conception and birth were derived for each patient and compared with data from a control group randomly selected from normal births in the hospital birth registry. Data was analysed using the SPSS version 11.0 Results: A total of 134 patients met the inclusion criteria. There was a female preponderance (M:F = 76:58). Conception of patients with milder deformities (cleft of the primary palate and isolated cleft of the secondary palate) occurred predominantly during the rainy season while conception of patients with more deformities (complete cleft of the primary and secondary palate) occurred mostly during the dry season. This was significantly different from the conception periods in the control group.