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bipartition surgery
S10
Oral presentations / British Journal of Oral and Maxillofacial Surgery 48 (2010) S1–S24
Overall complication rate is 20%. 3.5% (n = 3) of our patients had devitalisation of teeth. 2.4% (n = 2) of patients developed minor localised periodontal defects which were clinically significant, 1.2% (n = 1) had tooth loss secondary to mobility. Maxillary osteosynthesis removal was carried out in 8.2% (7) of patients. 4.7% (n = 4) patients developed post-operative palatal fistula: 3 were managed conservatively, one healed spontaneously and two persisted; one persisted despite surgical repair. There was no segmental loss of bone or teeth. Conclusion: Our results show complication rates in this cohort is relatively low. It shows that segmental maxillary surgery is safe as an adjunct in carefully selected cases. 36 Craniofacial resection for skull base malignancies: a single centre’s experience. O. Hussain, P. Sayal, A. Yousefpour, T.A. Carroll. Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, UK Aim: Skull Base malignancies which were previously considered unresectable have been made amenable to resection in an en bloc fashion with advanced operative techniques. Our aim was to analyse the results of craniofacial resections and reconstructions for skull base malignancies conducted at our institution. Materials and Methods: We conducted a retrospective clinical notes review of patients who underwent craniofacial resection and reconstruction for skull base malignancies in our unit during the 6 year period from January 2004 till December 2009. Results: At the Royal Hallamshire Hospital, 41 patients with a mean age of 54 (range 20–74) underwent Craniofacial resections for tumours involving the nasopharynx/infratemporal fossa during the 6 year period. These included 13 petrousectomies along with parotidectomy, neck dissection and tracheostomy. The remaining 28 patients underwent craniofacial resection with Orbital exenteration (n = 8)/Orbito-maxillectomy (n = 11)/Maxillectomy (n = 3)/Ethmoidectomy (n = 3)/Mandibulectomy (n = 3). There were 25 free flaps and 16 pedicled flaps for reconstruction. There was one intra-operative complication and 3 failures of free flaps and 1 pedicled flap failure. Median duration of hospital stay was 28 days (range 10–155). There were 9 readmissions due to delayed post-operative complications. 31 patients had adjuvant radiotherapy, 2 had adjuvant stereotactic radiosurgery, 5 had neoadjuvant radiotherapy and 3 did not undergo any other treatment. There was one peri-operative mortality. Conclusion: Despite the extensive nature of surgery required for skull base malignancies, these tumours can be resected with acceptable morbidity. 37 Patient-centred evaluation of satisfaction levels following orthognathic surgery A. Ketabchi, B. Soneji, A. Ahmed, M. Heliotis. Regional Maxillofacial Unit, Northwick Park Hospital, London, UK In addition to objective clinical outcome measures, there is an increasing trend in the NHS to concentrate on the more subjective patient-centred outcomes of orthognathic treatment to distinguish between patient and clinician viewpoints. Patient experience and its integration into clinical decision making is one of the fundamental aspects of Clinical Governance. The purpose of this study was to establish the level of satisfaction of patients undergoing complex orthognathic surgery carried out primarily for the correction of developmental deformities.
We present the results of a comprehensive survey of sixty consecutive patients who underwent orthognathic surgery in a regional unit by a single surgeon to assess their levels of satisfaction with all aspects of their patient journey. Patient satisfaction was assessed using a retrospective questionnaire, assessing parameters such as motivation and expectations related to the proposed joint treatment. Levels of satisfaction with every step of pre-operative, operative and post-operative pathway, the role and involvement of parents, and the importance of emotional and psychological factors were also examined. The questionnaires were independently completed and analysed to avoid bias. We explore the connection between pre-operative expectations and post-operative reality. We discuss the sources of and the reasons for dissatisfaction, and suggest changes that can be implemented to improve patient experience. We highlight objective and subjective complications of orhognathic surgery in our cohort, and contrast them with national figures. We found that the majority of patients are very satisfied with orthognathic treatment and that they felt their pre-treatment expectations were met. 38 Frontal lobe imaging changes following monobloc/bipartition surgery A. Cobb, P. Boavida, D. Saunders, R. Hayward. Great Ormond Street Hospital, UK The fronto-facial monobloc advancement often incorporating distraction techniques has become well-accepted as surgical treatment for children with complex forms of craniosynostosis. The procedure has many advantages over smaller sequential operations in which the cranial and facial segments are advanced separately. However, the subfrontal osteotomy cuts needed to free the facial skeleton from the skull base involve the extradural retraction of the frontal lobes. The purpose of this study was to determine from postoperative imaging the frequency and degree of any radiologically identifiable frontal lobe changes in order to determine whether if and when such changes occurred they affected the patients’ postoperative outcome. Methods: A retrospective review of the clinical records and the pre- and post-operative imaging of all patients undergoing monobloc fronto-facial advancement were reviewed by two clinical neuroradiologists and by members of the neurosurgical and craniofacial teams. Preoperative details of the patient, their diagnosis, indications for – and type of – surgery were recorded. Early post-op complications such as CSF leak or infection and later complications and any clinical indications of frontal lobe damage (ie epilepsy, deterioration in cognitive function) were then related to the any frontal lobe changes following the surgery, which were graded. Results: We will discuss the incidence of frontal lobe changes following fronto-facial monobloc. The location, degree and clinical relevance of these changes is relation to the patient age, type of operation, underlying syndrome and period of time in which the patients were operated on is discussed. 39 Psychological aspects of orthognathic surgery and its effects on quality of life J. Blythe1 , N.J. Baker1 , A.A. Webb1 , N. Smith2 , R. Evans2 . 1 Southampton General Hospital, 2 Dept of Orthodontics, Southampton General Hospital, UK Introduction and Aims: The prevalence of dentofacial anomalies in the United Kingdom is approximately 20%. Ten percent of
Oral presentations / British Journal of Oral and Maxillofacial Surgery 48 (2010) S1–S24
Overall complication rate is 20%. 3.5% (n = 3) of our patients had devitalisation of teeth. 2.4% (n = 2) of patients developed minor localised periodontal defects which were clinically significant, 1.2% (n = 1) had tooth loss secondary to mobility. Maxillary osteosynthesis removal was carried out in 8.2% (7) of patients. 4.7% (n = 4) patients developed post-operative palatal fistula: 3 were managed conservatively, one healed spontaneously and two persisted; one persisted despite surgical repair. There was no segmental loss of bone or teeth. Conclusion: Our results show complication rates in this cohort is relatively low. It shows that segmental maxillary surgery is safe as an adjunct in carefully selected cases. 36 Craniofacial resection for skull base malignancies: a single centre’s experience. O. Hussain, P. Sayal, A. Yousefpour, T.A. Carroll. Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, UK Aim: Skull Base malignancies which were previously considered unresectable have been made amenable to resection in an en bloc fashion with advanced operative techniques. Our aim was to analyse the results of craniofacial resections and reconstructions for skull base malignancies conducted at our institution. Materials and Methods: We conducted a retrospective clinical notes review of patients who underwent craniofacial resection and reconstruction for skull base malignancies in our unit during the 6 year period from January 2004 till December 2009. Results: At the Royal Hallamshire Hospital, 41 patients with a mean age of 54 (range 20–74) underwent Craniofacial resections for tumours involving the nasopharynx/infratemporal fossa during the 6 year period. These included 13 petrousectomies along with parotidectomy, neck dissection and tracheostomy. The remaining 28 patients underwent craniofacial resection with Orbital exenteration (n = 8)/Orbito-maxillectomy (n = 11)/Maxillectomy (n = 3)/Ethmoidectomy (n = 3)/Mandibulectomy (n = 3). There were 25 free flaps and 16 pedicled flaps for reconstruction. There was one intra-operative complication and 3 failures of free flaps and 1 pedicled flap failure. Median duration of hospital stay was 28 days (range 10–155). There were 9 readmissions due to delayed post-operative complications. 31 patients had adjuvant radiotherapy, 2 had adjuvant stereotactic radiosurgery, 5 had neoadjuvant radiotherapy and 3 did not undergo any other treatment. There was one peri-operative mortality. Conclusion: Despite the extensive nature of surgery required for skull base malignancies, these tumours can be resected with acceptable morbidity. 37 Patient-centred evaluation of satisfaction levels following orthognathic surgery A. Ketabchi, B. Soneji, A. Ahmed, M. Heliotis. Regional Maxillofacial Unit, Northwick Park Hospital, London, UK In addition to objective clinical outcome measures, there is an increasing trend in the NHS to concentrate on the more subjective patient-centred outcomes of orthognathic treatment to distinguish between patient and clinician viewpoints. Patient experience and its integration into clinical decision making is one of the fundamental aspects of Clinical Governance. The purpose of this study was to establish the level of satisfaction of patients undergoing complex orthognathic surgery carried out primarily for the correction of developmental deformities.
We present the results of a comprehensive survey of sixty consecutive patients who underwent orthognathic surgery in a regional unit by a single surgeon to assess their levels of satisfaction with all aspects of their patient journey. Patient satisfaction was assessed using a retrospective questionnaire, assessing parameters such as motivation and expectations related to the proposed joint treatment. Levels of satisfaction with every step of pre-operative, operative and post-operative pathway, the role and involvement of parents, and the importance of emotional and psychological factors were also examined. The questionnaires were independently completed and analysed to avoid bias. We explore the connection between pre-operative expectations and post-operative reality. We discuss the sources of and the reasons for dissatisfaction, and suggest changes that can be implemented to improve patient experience. We highlight objective and subjective complications of orhognathic surgery in our cohort, and contrast them with national figures. We found that the majority of patients are very satisfied with orthognathic treatment and that they felt their pre-treatment expectations were met. 38 Frontal lobe imaging changes following monobloc/bipartition surgery A. Cobb, P. Boavida, D. Saunders, R. Hayward. Great Ormond Street Hospital, UK The fronto-facial monobloc advancement often incorporating distraction techniques has become well-accepted as surgical treatment for children with complex forms of craniosynostosis. The procedure has many advantages over smaller sequential operations in which the cranial and facial segments are advanced separately. However, the subfrontal osteotomy cuts needed to free the facial skeleton from the skull base involve the extradural retraction of the frontal lobes. The purpose of this study was to determine from postoperative imaging the frequency and degree of any radiologically identifiable frontal lobe changes in order to determine whether if and when such changes occurred they affected the patients’ postoperative outcome. Methods: A retrospective review of the clinical records and the pre- and post-operative imaging of all patients undergoing monobloc fronto-facial advancement were reviewed by two clinical neuroradiologists and by members of the neurosurgical and craniofacial teams. Preoperative details of the patient, their diagnosis, indications for – and type of – surgery were recorded. Early post-op complications such as CSF leak or infection and later complications and any clinical indications of frontal lobe damage (ie epilepsy, deterioration in cognitive function) were then related to the any frontal lobe changes following the surgery, which were graded. Results: We will discuss the incidence of frontal lobe changes following fronto-facial monobloc. The location, degree and clinical relevance of these changes is relation to the patient age, type of operation, underlying syndrome and period of time in which the patients were operated on is discussed. 39 Psychological aspects of orthognathic surgery and its effects on quality of life J. Blythe1 , N.J. Baker1 , A.A. Webb1 , N. Smith2 , R. Evans2 . 1 Southampton General Hospital, 2 Dept of Orthodontics, Southampton General Hospital, UK Introduction and Aims: The prevalence of dentofacial anomalies in the United Kingdom is approximately 20%. Ten percent of