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13 Nasogastric tube insertion: A novel approach for head and neck patients
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Oral presentations / British Journal of Oral and Maxillofacial Surgery 48 (2010) S1–S24
post operative photographs were analysed for symmetry, alar base width, nasal tip position and septal deviation in a frontal view and worms eye view. We also carried out VAS scoring amongst 5 clinicians to see if the residual asymmetry, if present was nil (0), mild (1) – severe (5). Results and Conclusions: We present the results for our study and discuss the pitfalls in treating this complex group of patients. 13 Nasogastric tube insertion: A novel approach for head and neck patients J. Blythe1 , N.J. Baker1 , C. Feres2 , A.A. Webb1 . 1 Department of Oral and Maxillofacial Surgery, Southampton General Hospital, 2 Dept of ENT, Southampton General Hospital, UK Introduction and Aims: Nasogastric tube insertion for feeding is common in secondary care management for head and neck oncology patients. Whilst this is often a simple task, it can be exceedingly difficult in patients with unfavourable pharyngeal and regional anatomy or dysphagia. Maxillofacial surgeons and Otolaryngologists may be called upon to provide expert assistance in NGT insertion. This often requires the nasendoscope to provide fibre-optic guidance, commonly passing the endoscope through one nostril, and the nasogastric tube through the other. Method: This article recommends a technique not previously reported in maxillofacial surgery literature to maximise efficiency and minimise patient distress. The ‘piggy back’ technique allows the nasogastric tube to be transported in unison with the endoscope into the upper oesophagus, through one nostril. Our experience of this technique at Southampton General Hospital is reviewed. Conclusion: This technique has a number of advantages. Firstly, the NGT and endoscope act as one unit improving operator technique. The approach reduces the need for assistance. Patient anxiety is less when only the single nostril is accessed. And finally there is a reduction in expense and radiation exposure associated with radiologically-guided techniques. 14 Determining molecular pathways using comparative genomic hybridisation in metastatic oral squamous cell carcinoma J. Dhanda, R. Shaw, B. Lloyd, D.R. Sibson, J.A. Woolgar, J.M. Risk. University of Liverpool, UK Background: Extracapsular spread (ECS) in metastatic oral squamous cell carcinoma (OSCC) represents the most significant adverse prognostic indicator. The aim of this study was to use comparative genome hybridisation (CGH) analysis in an initial exploratory study hypothesising that molecular pathways would be significantly enriched according to the presence of ECS. Methods: Macromolecules were purified from fresh frozen samples representing T2 and T4 stage disease with or without nodal disease or ECS (n = 43). CGH analysis was performed using 720,000 human genomic probes per array (Nimblegen). Genomic segmentation was used to identify regional copy number changes. Genes identified in the segments were mapped to canonical pathways to assess significance according to metadata defining the samples. Results: Significant copy number changes were found in node positive status affecting multiple pathways including cytoskeletal remodelling, apoptosis, transcription and immune response. Significantly affected networks included angiogenesis, protein
folding and proteasome proteolysis between disease free versus recurrence. Significant associations for ECS were not found. Discussion: This is the highest density CGH array study specifically on OSCC of which we are aware. The high resolution uniquely allowed significantly associated pathways to be determined. Samples associated with ECS could not be distinguished. This may be a result of their smaller numbers (n = 11) or due to underlying reduced host immune responses. Future work expanding the number of samples with regard to ECS cases and also including expression array studies is underway. These are planned to further test the significance and examine the possibility of expression changes associated with ECS. 15 Impact of nerve involvement in oral squamous cell carcinomas S. Bhatia, M.J. Fardy. University Dental Hospital and University Hospital of Wales, UK Perineural Invasion has been thought to be an important variable affecting the outcome of Oral squamous cell carcinomas. In an attempt to identify the impact of the nerve involvement on the recurrence and prognosis in such patients, we retrospectively looked at 100 consecutive cases of Oral squamous cell carcinomas treated surgically from 2000 to 2004 in our unit. An incidence of 22% of perineural invasion was found on histopathology. 50% of these patients were still alive at 5 years. 85% of perineural invasion cases had Well or moderately differentiated SCC as histology and only 15% as Poorly differentiated SCC. Nearly 50% of these patients had either T1–T2 lesions contrary to the belief that the lesions are usually larger. The depth the tumours ranged from 3.5 mm to 51 mm with a mean depth of the tumour of 21 mm. We discuss the relevance of Perineural index and review the results with literature. 16 Changes in resonance and articulation following midface advancement P. Bordbar, W. Blumenow, D. Richardson, C. Duncan. Alder Hey Children’s Hospital, UK Aims: To analyse changes in resonance and articulation following midface advancement in syndromic craniofacial patients, and to assess the influence of craniofacial diagnosis, and the presence or absence of cleft palate. Method: An audit of pre- and post-operative resonance and articulation assessment records in a cohort of fifteen craniofacial patients who underwent midface advancement between 2002 and 2009. Five patients had a concomitant diagnosis of cleft palate. All patients underwent perceptual assessment of articulation and resonance using GOS.SP.ASS. 98 revised. Nasoendoscopy and videofluroscopy were carried out only when clinically indicated. Results: Velopharyngeal function deteriorated in six out of fifteen patients (40%) post-operatively. Five of these patients had Apert Syndrome. The patients with Crouzon Syndrome did not display deterioration in their velopharyngeal function post-operatively. Four out of the six patients with deterioration in velopharyngeal function had a cleft palate. All had Apert Syndrome except one patient. The two patients without a cleft palate that deteriorated also had Apert Syndrome. Significant change in articulatory pattern occurred in only one patient. Conclusion: Our findings suggest 1. There is a high risk of deterioration in velopharyngeal function following midface advancement in patients with Apert
Oral presentations / British Journal of Oral and Maxillofacial Surgery 48 (2010) S1–S24
post operative photographs were analysed for symmetry, alar base width, nasal tip position and septal deviation in a frontal view and worms eye view. We also carried out VAS scoring amongst 5 clinicians to see if the residual asymmetry, if present was nil (0), mild (1) – severe (5). Results and Conclusions: We present the results for our study and discuss the pitfalls in treating this complex group of patients. 13 Nasogastric tube insertion: A novel approach for head and neck patients J. Blythe1 , N.J. Baker1 , C. Feres2 , A.A. Webb1 . 1 Department of Oral and Maxillofacial Surgery, Southampton General Hospital, 2 Dept of ENT, Southampton General Hospital, UK Introduction and Aims: Nasogastric tube insertion for feeding is common in secondary care management for head and neck oncology patients. Whilst this is often a simple task, it can be exceedingly difficult in patients with unfavourable pharyngeal and regional anatomy or dysphagia. Maxillofacial surgeons and Otolaryngologists may be called upon to provide expert assistance in NGT insertion. This often requires the nasendoscope to provide fibre-optic guidance, commonly passing the endoscope through one nostril, and the nasogastric tube through the other. Method: This article recommends a technique not previously reported in maxillofacial surgery literature to maximise efficiency and minimise patient distress. The ‘piggy back’ technique allows the nasogastric tube to be transported in unison with the endoscope into the upper oesophagus, through one nostril. Our experience of this technique at Southampton General Hospital is reviewed. Conclusion: This technique has a number of advantages. Firstly, the NGT and endoscope act as one unit improving operator technique. The approach reduces the need for assistance. Patient anxiety is less when only the single nostril is accessed. And finally there is a reduction in expense and radiation exposure associated with radiologically-guided techniques. 14 Determining molecular pathways using comparative genomic hybridisation in metastatic oral squamous cell carcinoma J. Dhanda, R. Shaw, B. Lloyd, D.R. Sibson, J.A. Woolgar, J.M. Risk. University of Liverpool, UK Background: Extracapsular spread (ECS) in metastatic oral squamous cell carcinoma (OSCC) represents the most significant adverse prognostic indicator. The aim of this study was to use comparative genome hybridisation (CGH) analysis in an initial exploratory study hypothesising that molecular pathways would be significantly enriched according to the presence of ECS. Methods: Macromolecules were purified from fresh frozen samples representing T2 and T4 stage disease with or without nodal disease or ECS (n = 43). CGH analysis was performed using 720,000 human genomic probes per array (Nimblegen). Genomic segmentation was used to identify regional copy number changes. Genes identified in the segments were mapped to canonical pathways to assess significance according to metadata defining the samples. Results: Significant copy number changes were found in node positive status affecting multiple pathways including cytoskeletal remodelling, apoptosis, transcription and immune response. Significantly affected networks included angiogenesis, protein
folding and proteasome proteolysis between disease free versus recurrence. Significant associations for ECS were not found. Discussion: This is the highest density CGH array study specifically on OSCC of which we are aware. The high resolution uniquely allowed significantly associated pathways to be determined. Samples associated with ECS could not be distinguished. This may be a result of their smaller numbers (n = 11) or due to underlying reduced host immune responses. Future work expanding the number of samples with regard to ECS cases and also including expression array studies is underway. These are planned to further test the significance and examine the possibility of expression changes associated with ECS. 15 Impact of nerve involvement in oral squamous cell carcinomas S. Bhatia, M.J. Fardy. University Dental Hospital and University Hospital of Wales, UK Perineural Invasion has been thought to be an important variable affecting the outcome of Oral squamous cell carcinomas. In an attempt to identify the impact of the nerve involvement on the recurrence and prognosis in such patients, we retrospectively looked at 100 consecutive cases of Oral squamous cell carcinomas treated surgically from 2000 to 2004 in our unit. An incidence of 22% of perineural invasion was found on histopathology. 50% of these patients were still alive at 5 years. 85% of perineural invasion cases had Well or moderately differentiated SCC as histology and only 15% as Poorly differentiated SCC. Nearly 50% of these patients had either T1–T2 lesions contrary to the belief that the lesions are usually larger. The depth the tumours ranged from 3.5 mm to 51 mm with a mean depth of the tumour of 21 mm. We discuss the relevance of Perineural index and review the results with literature. 16 Changes in resonance and articulation following midface advancement P. Bordbar, W. Blumenow, D. Richardson, C. Duncan. Alder Hey Children’s Hospital, UK Aims: To analyse changes in resonance and articulation following midface advancement in syndromic craniofacial patients, and to assess the influence of craniofacial diagnosis, and the presence or absence of cleft palate. Method: An audit of pre- and post-operative resonance and articulation assessment records in a cohort of fifteen craniofacial patients who underwent midface advancement between 2002 and 2009. Five patients had a concomitant diagnosis of cleft palate. All patients underwent perceptual assessment of articulation and resonance using GOS.SP.ASS. 98 revised. Nasoendoscopy and videofluroscopy were carried out only when clinically indicated. Results: Velopharyngeal function deteriorated in six out of fifteen patients (40%) post-operatively. Five of these patients had Apert Syndrome. The patients with Crouzon Syndrome did not display deterioration in their velopharyngeal function post-operatively. Four out of the six patients with deterioration in velopharyngeal function had a cleft palate. All had Apert Syndrome except one patient. The two patients without a cleft palate that deteriorated also had Apert Syndrome. Significant change in articulatory pattern occurred in only one patient. Conclusion: Our findings suggest 1. There is a high risk of deterioration in velopharyngeal function following midface advancement in patients with Apert