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The anterior approach for prophylactic internal fixation of the radial osteocutaneous donor site
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Abstracts / British Journal of Oral and Maxillofacial Surgery 45 (2007) e1–e29
P 36 Microscope enhanced impacted mandibular 3rd molar surgery夽
P 37 The anterior approach for prophylactic internal fixation of the radial osteocutaneous donor site
G. Kumar Vijayalakshmi
Christopher Avery∗ , M. Danford, P. Johnson
Aishwarya Dental Centre, India
University Hospitals of Leicester and Royal Surrey County Hospital, Guildford, United Kingdom
Introduction: The use of the dental operating microscope in Oral Surgery for impacted wisdom teeth removal has not been described. A new technique to use the microscope in this condition has been developed and applied in clinical practice, with significant advantages to both the patient and the surgeon. Material/methods: The operating microscope was used in18 patients(age range 20–37 yrs, mean 28 yrs), for surgical removal of difficult impacted mandibular wisdom teeth. IV sedation was used in 3 cases, and the rest were done under local anesthesia, in the dental clinic. The surgery was performed standing, using a longer focal length objective lens, a major change from the usual protocol of sitting down microscope dentistry. Results: The microscope significantly helps in removal of difficult, impacted, mandibular 3rd molars. There were no complications due to the use of the microscope. All the patients were very comfortable intra-operatively, and postoperatively. Clinical relevance: The significant advantages of using the microscope for removal of wisdom teeth are: • Greatly magnified view of the operating field (3.5X–21X). • Brilliant illumination. • Improved ergonomic posture of surgeon’s head, neck and back. • Video and still camera attachment allows much better view for the assistant, very good documentation for teaching, and surgical skill training of residents. • Easier removal of broken roots and checking of hemisection. • Finer sutures, and smaller burs used, causing much less surgical trauma. The microscope can be considered a very useful tool in difficult complicated mandibular 3rd molar removal. 夽 Previously
submitted at: 5th Annual Meeting of Academy of Microscope Enhanced Dentistry (AMED) USA Tuscon Az USA November 2006.
doi:10.1016/j.bjoms.2007.07.139
Introduction: The popularity of the radial osteocutaneous flap declined as alternative flaps were described because of the small volume of bone available and the morbidity of the donor site. Fracture is not unusual, 15% (Thoma 1999), mean of 25% (Bowers 2000) and 18% (Clark 2004). Fractures are often displaced and require secondary surgery, 46% (Clark 2004) and 67% (Thoma 1999). Limiting the bone resection and bevelling the osteotomy has minimal benefit because 70% of the radial strength is lost after osteotomy (Swanson 1990; Meland 1992). Prophylactic internal fixation of the radius (PIF) to prevent fracture was first described by Nunez in 1999. Method: The anterior surgical approach is described. A 3.5 mm dynamic compression plate is placed over the section defect with a minimum of 4 bicortical screws. Results: The incidence of fracture was 3.8% (1 out of 26 donor sites). The fracture was caused by a technical error and was undisplaced. There was no significant morbidity and none of the plates have required removal. Discussion: Others have reported low fracture rates with the anterior approach, zero (Villaret 2003) and 1.9% (Kim 2005) or a posterior approach with the plate on the intact opposite cortex, 9.6% (Werle 2000) and zero (Militsakh 2005). The popularity of the radial osteocutaneous flap with PIF has increased, although in our practice it still has only a niche role. A reasonable volume of bone may be safely harvested. We recommend the routine use of PIF. doi:10.1016/j.bjoms.2007.07.140 P 38 Minimising risk to the vascularity of the osteotomised fibula: A technical note Luke Cascarini∗ , D.M. Coombes, A.E. Brown Queen Victoria Hospital, East Grinstead, United Kingdom The fibula free flap may be osseous or osteocutaneous and is supplied by the peroneal artery and vein. The lateral approach which is universally adopted for raising the flap was first described by Gilbert in 1979.Hidalgo first described the utilization of the free fibula for mandibular reconstruction in 1989. We describe a minor modification to this technique which we believe reduces the risk to the vascularity of the osteotomised fibula, particularly the distal segment. doi:10.1016/j.bjoms.2007.07.141
Abstracts / British Journal of Oral and Maxillofacial Surgery 45 (2007) e1–e29
P 36 Microscope enhanced impacted mandibular 3rd molar surgery夽
P 37 The anterior approach for prophylactic internal fixation of the radial osteocutaneous donor site
G. Kumar Vijayalakshmi
Christopher Avery∗ , M. Danford, P. Johnson
Aishwarya Dental Centre, India
University Hospitals of Leicester and Royal Surrey County Hospital, Guildford, United Kingdom
Introduction: The use of the dental operating microscope in Oral Surgery for impacted wisdom teeth removal has not been described. A new technique to use the microscope in this condition has been developed and applied in clinical practice, with significant advantages to both the patient and the surgeon. Material/methods: The operating microscope was used in18 patients(age range 20–37 yrs, mean 28 yrs), for surgical removal of difficult impacted mandibular wisdom teeth. IV sedation was used in 3 cases, and the rest were done under local anesthesia, in the dental clinic. The surgery was performed standing, using a longer focal length objective lens, a major change from the usual protocol of sitting down microscope dentistry. Results: The microscope significantly helps in removal of difficult, impacted, mandibular 3rd molars. There were no complications due to the use of the microscope. All the patients were very comfortable intra-operatively, and postoperatively. Clinical relevance: The significant advantages of using the microscope for removal of wisdom teeth are: • Greatly magnified view of the operating field (3.5X–21X). • Brilliant illumination. • Improved ergonomic posture of surgeon’s head, neck and back. • Video and still camera attachment allows much better view for the assistant, very good documentation for teaching, and surgical skill training of residents. • Easier removal of broken roots and checking of hemisection. • Finer sutures, and smaller burs used, causing much less surgical trauma. The microscope can be considered a very useful tool in difficult complicated mandibular 3rd molar removal. 夽 Previously
submitted at: 5th Annual Meeting of Academy of Microscope Enhanced Dentistry (AMED) USA Tuscon Az USA November 2006.
doi:10.1016/j.bjoms.2007.07.139
Introduction: The popularity of the radial osteocutaneous flap declined as alternative flaps were described because of the small volume of bone available and the morbidity of the donor site. Fracture is not unusual, 15% (Thoma 1999), mean of 25% (Bowers 2000) and 18% (Clark 2004). Fractures are often displaced and require secondary surgery, 46% (Clark 2004) and 67% (Thoma 1999). Limiting the bone resection and bevelling the osteotomy has minimal benefit because 70% of the radial strength is lost after osteotomy (Swanson 1990; Meland 1992). Prophylactic internal fixation of the radius (PIF) to prevent fracture was first described by Nunez in 1999. Method: The anterior surgical approach is described. A 3.5 mm dynamic compression plate is placed over the section defect with a minimum of 4 bicortical screws. Results: The incidence of fracture was 3.8% (1 out of 26 donor sites). The fracture was caused by a technical error and was undisplaced. There was no significant morbidity and none of the plates have required removal. Discussion: Others have reported low fracture rates with the anterior approach, zero (Villaret 2003) and 1.9% (Kim 2005) or a posterior approach with the plate on the intact opposite cortex, 9.6% (Werle 2000) and zero (Militsakh 2005). The popularity of the radial osteocutaneous flap with PIF has increased, although in our practice it still has only a niche role. A reasonable volume of bone may be safely harvested. We recommend the routine use of PIF. doi:10.1016/j.bjoms.2007.07.140 P 38 Minimising risk to the vascularity of the osteotomised fibula: A technical note Luke Cascarini∗ , D.M. Coombes, A.E. Brown Queen Victoria Hospital, East Grinstead, United Kingdom The fibula free flap may be osseous or osteocutaneous and is supplied by the peroneal artery and vein. The lateral approach which is universally adopted for raising the flap was first described by Gilbert in 1979.Hidalgo first described the utilization of the free fibula for mandibular reconstruction in 1989. We describe a minor modification to this technique which we believe reduces the risk to the vascularity of the osteotomised fibula, particularly the distal segment. doi:10.1016/j.bjoms.2007.07.141