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Treatment of late complications in head and neck cancer survivors — trismus and chewing problems
20
Abstracts
bone fractures, patients (49.9%) suffered from dentoalveolar, and patients (62.5%) from soft tissue injuries. This study differentiates between injury mechanisms in craniomaxillofacial trauma and will provide insight into changes on injury patterns, cause of injury, age and gender, type of injury, injury mechanisms, location and frequency of soft tissue injuries, dentoalveolar trauma, facial bone fractures and concomitant injuries over a period of 25 years. The specially trained surgeons treating craniomaxillofacial trauma are the primary source of information for the public and legislators on implementing preventive measures for high-risk activities. In facial trauma, older persons are prone to bone fractures and soft tissue injuries while younger persons are more susceptible to dentoalveolar trauma. http://dx.doi.org/10.1016/j.ijom.2017.02.070 Treatment of late complications in head and neck cancer survivors — trismus and chewing problems R. Gassner Medical University Innsbruck – Tirol Kliniken, Innsbruck, Austria This presentation consists of four parts: a first part on the basic foundation of the talk, a second part on the consequences, sequelae and complications of irradiation, a third part on surgical patient treatment and care, and a fourth part on preventive strategies based on the scientific foundation. First muscles such as masseter, temporal, medial und lateral pterygoid muscle support motion of the temporomandibular joint which is neglected in situations of radiation therapy which is usually an important antiinflammatory stimulus. Second radiogenic mucositis, xerostomia, trismus, dysphagia, caries, and effects on jaw and tooth development contribute to malfunction or even loss of function of the stomatognathic system. Third surgical treatment may necessitate microvascular reconstructive procedures to overcome bad healing conditions in irradiated tissue. Fourth new research data reveal that in irradiated bone mesenchymal stem cells survive in their immunologic niche and growth factors may improve and even prevent tissue breakdown. In summary, this presentation will provide insight into the treatment of late complications in head and neck cancer survivors especially with trismus and chewing problems. http://dx.doi.org/10.1016/j.ijom.2017.02.071 Advanced computer-assisted procedures in craniomaxillofacial surgery: where we came from and where are we going to? N.C. Gellrich Hannover Medical School, Hannover, Germany The aim of the presentation is to show the evolutionary process in using computer-assistance for reconstructive surgery in the field of craniomaxillofacial surgery. In the past the focus was on developing powerful computer systems to deal with image data, whereas nowadays we focus on integrated solutions to ease the use of computer assistance and make it applicable for the surgeon. Formerly, the first steps of computer assistance were taken towards reconstruction of the cranial vault. Nowadays, basically all areas (e.g. from orbital surgery to extension lines in implant dentistry)
can be addressed and computer assistance allows for individual patient-specific solutions thus solving difficult cases precisely. However, there is a clear distinction between “outside the OR” virtual modelling for preoperative planning and digital engineering and intraoperative use of computer-assistance by visualizing three-dimensional (3D)-data of the patient versus the digital blue print during surgery: The aim is to enhance operative knowledge or even to update it by using intraoperative navigation or intraoperative imaging. The third pillar of computer assistance is the postoperative quality control, where image fusion of pre-, intraor postoperative 3D-data is performed to check the adequacy of the plan, surgery and clinical outcome. This is a completely new workflow thinking and use of 3D-data, apart from the limitation to diagnostics only. In the end, it comes to the idea of fulfilling a common trunk for DICOM (digital imaging and communications in medicine) driven data workflow no matter of the anatomical region, language and pathology to further – and above diagnostics use of a Voxelbased dataset in clinical environment. Part of the common trunk is the implementation of either specifically formed biomaterials or quality controlling versus documentary purposes of navigation or image fusion of intraoperative required cone-beam up to – if needed – robotics. Twenty years of personal involvement in establishing these workflows and accomplishing of the digital common trunk – ideas are presented and demonstrated by cases of complex craniomaxillofacial surgery where also the chances, challenges and limitations of using these technologies are explained. Computer-assistance does not allow skipping surgical skills or biological principles. However, it is a superb tool to use 3D Voxelbased datasets above diagnostics to the benefit of the patients and our specialty. http://dx.doi.org/10.1016/j.ijom.2017.02.072 Trigeminal microsurgery: from lingual sensitive recovery to corneal neurotisation P. Gennaro ∗ , I.V. Aboh, F. Cascino, G. Gabriele, G. Iannetti University of Siena, Siena, Italy Trigeminal nerve injuries can have different aetiologies and affect each portion. Iatrogenic lesions are common, the majority of which interest the third branch. Microsurgical strategies can be effective in treating trigeminal lesions at every level. Mandibular and lingual nerve lesions can occur as a consequence of odontoiatric, orthognathic or oncologic surgeries.1 Lingual nerve lesions often produce considerable impairment and discomfort for the patient. Trigeminal microsurgery may be used to treat mandibular nerve injuries as well as to restore lingual sensibility after lingual nerve damage. Several different techniques have been described.2 Furthermore, the first trigeminal branch also can be interested by iatrogenic or non-iatrogenic lesions resulting in the loss of corneal sensibility and consequently in corneal damage. The affected cornea can be treated by microsurgical neurotisation using the first contralateral branches or the second homolateral one in order to re-establish corneal sensibility. In conclusion trigeminal microsurgery offers a variety of surgical strategies that can be effective in different clinical situations interesting each branch of the trigeminal nerve.
References 1. Gennaro, P., Gabriele, G., Mihara, M., Kikuchi, K., & De Caris, F. (2014). Side-to-end trigeminal to trigeminal fascicular neurorrhaphy to restore lingual sensibility: a new technique. J Reconstr Microsurg, 30, 211–214.
Abstracts
bone fractures, patients (49.9%) suffered from dentoalveolar, and patients (62.5%) from soft tissue injuries. This study differentiates between injury mechanisms in craniomaxillofacial trauma and will provide insight into changes on injury patterns, cause of injury, age and gender, type of injury, injury mechanisms, location and frequency of soft tissue injuries, dentoalveolar trauma, facial bone fractures and concomitant injuries over a period of 25 years. The specially trained surgeons treating craniomaxillofacial trauma are the primary source of information for the public and legislators on implementing preventive measures for high-risk activities. In facial trauma, older persons are prone to bone fractures and soft tissue injuries while younger persons are more susceptible to dentoalveolar trauma. http://dx.doi.org/10.1016/j.ijom.2017.02.070 Treatment of late complications in head and neck cancer survivors — trismus and chewing problems R. Gassner Medical University Innsbruck – Tirol Kliniken, Innsbruck, Austria This presentation consists of four parts: a first part on the basic foundation of the talk, a second part on the consequences, sequelae and complications of irradiation, a third part on surgical patient treatment and care, and a fourth part on preventive strategies based on the scientific foundation. First muscles such as masseter, temporal, medial und lateral pterygoid muscle support motion of the temporomandibular joint which is neglected in situations of radiation therapy which is usually an important antiinflammatory stimulus. Second radiogenic mucositis, xerostomia, trismus, dysphagia, caries, and effects on jaw and tooth development contribute to malfunction or even loss of function of the stomatognathic system. Third surgical treatment may necessitate microvascular reconstructive procedures to overcome bad healing conditions in irradiated tissue. Fourth new research data reveal that in irradiated bone mesenchymal stem cells survive in their immunologic niche and growth factors may improve and even prevent tissue breakdown. In summary, this presentation will provide insight into the treatment of late complications in head and neck cancer survivors especially with trismus and chewing problems. http://dx.doi.org/10.1016/j.ijom.2017.02.071 Advanced computer-assisted procedures in craniomaxillofacial surgery: where we came from and where are we going to? N.C. Gellrich Hannover Medical School, Hannover, Germany The aim of the presentation is to show the evolutionary process in using computer-assistance for reconstructive surgery in the field of craniomaxillofacial surgery. In the past the focus was on developing powerful computer systems to deal with image data, whereas nowadays we focus on integrated solutions to ease the use of computer assistance and make it applicable for the surgeon. Formerly, the first steps of computer assistance were taken towards reconstruction of the cranial vault. Nowadays, basically all areas (e.g. from orbital surgery to extension lines in implant dentistry)
can be addressed and computer assistance allows for individual patient-specific solutions thus solving difficult cases precisely. However, there is a clear distinction between “outside the OR” virtual modelling for preoperative planning and digital engineering and intraoperative use of computer-assistance by visualizing three-dimensional (3D)-data of the patient versus the digital blue print during surgery: The aim is to enhance operative knowledge or even to update it by using intraoperative navigation or intraoperative imaging. The third pillar of computer assistance is the postoperative quality control, where image fusion of pre-, intraor postoperative 3D-data is performed to check the adequacy of the plan, surgery and clinical outcome. This is a completely new workflow thinking and use of 3D-data, apart from the limitation to diagnostics only. In the end, it comes to the idea of fulfilling a common trunk for DICOM (digital imaging and communications in medicine) driven data workflow no matter of the anatomical region, language and pathology to further – and above diagnostics use of a Voxelbased dataset in clinical environment. Part of the common trunk is the implementation of either specifically formed biomaterials or quality controlling versus documentary purposes of navigation or image fusion of intraoperative required cone-beam up to – if needed – robotics. Twenty years of personal involvement in establishing these workflows and accomplishing of the digital common trunk – ideas are presented and demonstrated by cases of complex craniomaxillofacial surgery where also the chances, challenges and limitations of using these technologies are explained. Computer-assistance does not allow skipping surgical skills or biological principles. However, it is a superb tool to use 3D Voxelbased datasets above diagnostics to the benefit of the patients and our specialty. http://dx.doi.org/10.1016/j.ijom.2017.02.072 Trigeminal microsurgery: from lingual sensitive recovery to corneal neurotisation P. Gennaro ∗ , I.V. Aboh, F. Cascino, G. Gabriele, G. Iannetti University of Siena, Siena, Italy Trigeminal nerve injuries can have different aetiologies and affect each portion. Iatrogenic lesions are common, the majority of which interest the third branch. Microsurgical strategies can be effective in treating trigeminal lesions at every level. Mandibular and lingual nerve lesions can occur as a consequence of odontoiatric, orthognathic or oncologic surgeries.1 Lingual nerve lesions often produce considerable impairment and discomfort for the patient. Trigeminal microsurgery may be used to treat mandibular nerve injuries as well as to restore lingual sensibility after lingual nerve damage. Several different techniques have been described.2 Furthermore, the first trigeminal branch also can be interested by iatrogenic or non-iatrogenic lesions resulting in the loss of corneal sensibility and consequently in corneal damage. The affected cornea can be treated by microsurgical neurotisation using the first contralateral branches or the second homolateral one in order to re-establish corneal sensibility. In conclusion trigeminal microsurgery offers a variety of surgical strategies that can be effective in different clinical situations interesting each branch of the trigeminal nerve.
References 1. Gennaro, P., Gabriele, G., Mihara, M., Kikuchi, K., & De Caris, F. (2014). Side-to-end trigeminal to trigeminal fascicular neurorrhaphy to restore lingual sensibility: a new technique. J Reconstr Microsurg, 30, 211–214.