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Translocation composite facial flap as approach for surgical treatment of tumors of the paranasal sinuses and skull base
e54
Oral Presentation
Surgical treatment of benign orbital tumors 1,∗
2
2
P. de Leyva , J.M. Eslava , M. Sales-Sanz , E. Sánchez-Jáuregui 2 , J. González 2 , J. Acero 2 1
Quirón University Hospital, Madrid, Spain Ramón y Cajal University Hospital, Puerta de Hierro University Hospital, Madrid, Spain
2
Background: The orbit may be affected by a huge variety of space occupying lesions. These lesions can be classified regarding different criteria: histology (benign, malignant, vascular and cystic lesions), surgical anatomy (bony and subperiostical space, intraconic, extraconic and muscular spaces), and they can also be classified regarding the approach and surgical treatment. Methods: A review of the most common benign space occupying lesions of the orbit is made, classifying them by its location. A review of the surgical techniques and approaches used for the treatment of the most relevant orbital pathology is presented. Findings: Twelve patients are reviewed in this paper. The diagnoses were as follows: orbital cherubism (2), osteoma (2), dermoid cyst (3), thyroid orbitopathy (1), cavernous haemangioma (2), solitary fibrous tumor (1) and meningioma (1). The locations of these tumors were: extraconic (3), bony space (4), muscular (1) and intraconic (4) within different depths. The approaches used, alone or in combination, were: perilimbic (1), transconjunctival (3), upper blepharoplasty incision (4), pterional (2), coronal (3) and Weber-Fergusson (1). Furthermore, the following temporal osteotomies were used in some of the cases: frontal (2), supraorbital (1) and lateral marginotomies (2), C osteotomies (1) and pterional craniotomy (2). Conclusions: Benign space occupying lesions of the orbit are uncommon. Small lesions located anteriorly can be approached conservatively. Larger or deeper lesions may require an osteotomy of the orbital rim. In orbital surgery is key that the approach must never cross the optic nerve. http://dx.doi.org/10.1016/j.ijom.2015.08.523 Botulinum toxin, lidocaine, dry-needling and sham dryneedling injections in patients with myofascial pain T. Develi 1,∗ , C. Delilbasi 1 , S. Tolu 2 , E. Dilaver 1 , O. Ozyilmaz 3 , H. Kurt 3 , S. Uckan 1 1
Medipol University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Istanbul, Turkey 2 Medipol University, Department of Physical Medicine and Rehabilitation, Istanbul, Turkey 3 Medipol University, Faculty of Dentistry, Department of Prosthodontics, Istanbul, Turkey
Background: Myofascial pain syndrome (MPS) is described as distinct type of regional musculoskeletal pain complaint that is caused by myofascial trigger points (TrPs) within muscles. Objectives: This prospective, randomized-controlled clinical study was proposed to compare and evaluate TrP injection with Botulinum toxin type A (BTX-A) to dry needling, sham dry needling and lidocaine injection in MPS. Methods: 100 patients with MPS were treated and randomly assigned to four groups; lidocaine injection (n;25), dry needling(n;25), sham dry needling(n;25) and BTX-A injection(n;25). Clinical assessment including TrP pain pressure algometry (PPA) scores, and visual analog scales (VAS) for pain were evaluated at entry, the end of the 4th week and sixth month. Additionally, depression were evaluated with the Back depression
inventory, quality of life was assessed using the Short Form36(SF-36) and sleeping quality was assessed using Pitsburgh Sleep Quality Index (PSQI). One milliliter of 0.5% lidocaine was administered to each TrP in the lidocaine injection group, 10–20 IU of BTX-A to each TrP in the BTX-A group, and dry needling to each TrP in the last group, followed by stretching of the muscle groups involved. And sham dry needling was applied in the placebo group. Findings: In the BTX-A group, PPA values were significantly higher than in the dry needle and the lidocaine group. In all, VAS significantly decreased in the lidocaine injection and BTX-A groups and did not significantly change in the dry needle group. Conclusions: Even cost of the treatment choice is higher the most effective management could be obtained with BTX-A in MPS. http://dx.doi.org/10.1016/j.ijom.2015.08.524 Translocation composite facial flap as approach for surgical treatment of tumors of the paranasal sinuses and skull base A. Dikarev ∗ , V. Porhanov, E. Kochergina, K. Kokaev, Y. Savosin, V. Tkachev Research Institute, Regional Clinical Hospital N 1, Krasnodar, Russia In the structure of the oncopathology 80% is maxilla lesion and 0.2–1.4% is maxillary sinus. The actuality is very high due to hard morbidity, complicated and late primary diagnostic, difficulties in treatment and rehabilitation. In case of the squamous cell carcinoma surgical treatment is the predictive prognostic factor. Considering functional and aesthetic significance of the area incision design and dissection plane are of prevalent importance. There is a necessity of good surgical approach, proximal control of great vessels, ability of simultaneous reconstruction with secure closure of resection defect and good aesthetics. Classical skull base approaches lead to destruction the healthy structures, increase of rehabilitation period and surgical steps that make treatment more expensive and desocialize the patients. Suggested surgical approach implies transposition of the combined facial flap consisted of superficial and deep soft tissues, bony structures of the midface, defining individuality. This method provides vast approach to the area saving functionality and aesthetics. Surgical protocol consists of facial flap raising including parts of the maxilla and zygomatic bone with blood supply and attachment of the mimic muscles to the bone. January 2013 to November 2014 we applied this method 6 times. We achieved primary healing in all cases as well as decreased hospitalization comparing to control group/3 people/, that underwent traditional transfacial approaches. In the study group there was no need for revision surgery. Suggested surgical approach to deep facial bony structures provides optimal surgical, oncological and aesthetic outcomes. http://dx.doi.org/10.1016/j.ijom.2015.08.525
Oral Presentation
Surgical treatment of benign orbital tumors 1,∗
2
2
P. de Leyva , J.M. Eslava , M. Sales-Sanz , E. Sánchez-Jáuregui 2 , J. González 2 , J. Acero 2 1
Quirón University Hospital, Madrid, Spain Ramón y Cajal University Hospital, Puerta de Hierro University Hospital, Madrid, Spain
2
Background: The orbit may be affected by a huge variety of space occupying lesions. These lesions can be classified regarding different criteria: histology (benign, malignant, vascular and cystic lesions), surgical anatomy (bony and subperiostical space, intraconic, extraconic and muscular spaces), and they can also be classified regarding the approach and surgical treatment. Methods: A review of the most common benign space occupying lesions of the orbit is made, classifying them by its location. A review of the surgical techniques and approaches used for the treatment of the most relevant orbital pathology is presented. Findings: Twelve patients are reviewed in this paper. The diagnoses were as follows: orbital cherubism (2), osteoma (2), dermoid cyst (3), thyroid orbitopathy (1), cavernous haemangioma (2), solitary fibrous tumor (1) and meningioma (1). The locations of these tumors were: extraconic (3), bony space (4), muscular (1) and intraconic (4) within different depths. The approaches used, alone or in combination, were: perilimbic (1), transconjunctival (3), upper blepharoplasty incision (4), pterional (2), coronal (3) and Weber-Fergusson (1). Furthermore, the following temporal osteotomies were used in some of the cases: frontal (2), supraorbital (1) and lateral marginotomies (2), C osteotomies (1) and pterional craniotomy (2). Conclusions: Benign space occupying lesions of the orbit are uncommon. Small lesions located anteriorly can be approached conservatively. Larger or deeper lesions may require an osteotomy of the orbital rim. In orbital surgery is key that the approach must never cross the optic nerve. http://dx.doi.org/10.1016/j.ijom.2015.08.523 Botulinum toxin, lidocaine, dry-needling and sham dryneedling injections in patients with myofascial pain T. Develi 1,∗ , C. Delilbasi 1 , S. Tolu 2 , E. Dilaver 1 , O. Ozyilmaz 3 , H. Kurt 3 , S. Uckan 1 1
Medipol University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Istanbul, Turkey 2 Medipol University, Department of Physical Medicine and Rehabilitation, Istanbul, Turkey 3 Medipol University, Faculty of Dentistry, Department of Prosthodontics, Istanbul, Turkey
Background: Myofascial pain syndrome (MPS) is described as distinct type of regional musculoskeletal pain complaint that is caused by myofascial trigger points (TrPs) within muscles. Objectives: This prospective, randomized-controlled clinical study was proposed to compare and evaluate TrP injection with Botulinum toxin type A (BTX-A) to dry needling, sham dry needling and lidocaine injection in MPS. Methods: 100 patients with MPS were treated and randomly assigned to four groups; lidocaine injection (n;25), dry needling(n;25), sham dry needling(n;25) and BTX-A injection(n;25). Clinical assessment including TrP pain pressure algometry (PPA) scores, and visual analog scales (VAS) for pain were evaluated at entry, the end of the 4th week and sixth month. Additionally, depression were evaluated with the Back depression
inventory, quality of life was assessed using the Short Form36(SF-36) and sleeping quality was assessed using Pitsburgh Sleep Quality Index (PSQI). One milliliter of 0.5% lidocaine was administered to each TrP in the lidocaine injection group, 10–20 IU of BTX-A to each TrP in the BTX-A group, and dry needling to each TrP in the last group, followed by stretching of the muscle groups involved. And sham dry needling was applied in the placebo group. Findings: In the BTX-A group, PPA values were significantly higher than in the dry needle and the lidocaine group. In all, VAS significantly decreased in the lidocaine injection and BTX-A groups and did not significantly change in the dry needle group. Conclusions: Even cost of the treatment choice is higher the most effective management could be obtained with BTX-A in MPS. http://dx.doi.org/10.1016/j.ijom.2015.08.524 Translocation composite facial flap as approach for surgical treatment of tumors of the paranasal sinuses and skull base A. Dikarev ∗ , V. Porhanov, E. Kochergina, K. Kokaev, Y. Savosin, V. Tkachev Research Institute, Regional Clinical Hospital N 1, Krasnodar, Russia In the structure of the oncopathology 80% is maxilla lesion and 0.2–1.4% is maxillary sinus. The actuality is very high due to hard morbidity, complicated and late primary diagnostic, difficulties in treatment and rehabilitation. In case of the squamous cell carcinoma surgical treatment is the predictive prognostic factor. Considering functional and aesthetic significance of the area incision design and dissection plane are of prevalent importance. There is a necessity of good surgical approach, proximal control of great vessels, ability of simultaneous reconstruction with secure closure of resection defect and good aesthetics. Classical skull base approaches lead to destruction the healthy structures, increase of rehabilitation period and surgical steps that make treatment more expensive and desocialize the patients. Suggested surgical approach implies transposition of the combined facial flap consisted of superficial and deep soft tissues, bony structures of the midface, defining individuality. This method provides vast approach to the area saving functionality and aesthetics. Surgical protocol consists of facial flap raising including parts of the maxilla and zygomatic bone with blood supply and attachment of the mimic muscles to the bone. January 2013 to November 2014 we applied this method 6 times. We achieved primary healing in all cases as well as decreased hospitalization comparing to control group/3 people/, that underwent traditional transfacial approaches. In the study group there was no need for revision surgery. Suggested surgical approach to deep facial bony structures provides optimal surgical, oncological and aesthetic outcomes. http://dx.doi.org/10.1016/j.ijom.2015.08.525