- Email: [email protected]
60 Speech and swallowing outcomes in head and neck cancer patients with jejunal free flap reconstruction of the hypopharynx
S16
Oral presentations / British Journal of Oral and Maxillofacial Surgery 48 (2010) S1–S24
59 Day case surgery for oral and maxillofacial trauma: a cost-effective and efficient way of managing patients S. Mehmet, E. Mearing-Smith, J. Vizkelety, R.P. Bentley. King’s College Hospital NHS Trust, UK Introduction: Day case surgery is a cost-effective and efficient method in the management of a wide variety of surgical patients. In our Oral and Maxillofacial Surgery unit, there is a high volume of trauma patients treated on an inpatient basis on both Emergency and Elective operating lists that we believe could be treated on Day Surgery or Rapid Access Lists. Method: Data was collected retrospectively over a 6-month period on patients operated on with facial trauma including fractured nasal bones, mandibles, zygomas, orbital floors and soft tissue injuries. Polytrauma patients with any other significant injuries were excluded from the study. Our main interest in data collection was average length of hospital stay for the various procedures, reason for delays in treatment, and whether any nursing or medical interventions were required post-operatively overnight which would have precluded discharge on the day of surgery. We also looked at the volume of facial trauma being operated on ‘out of hours’ and the grade of surgeon. Conclusions: As has been previously described, it is possible to treat certain Maxillofacial injuries on a Day Case basis. Our data supports the feasibility of introducing such a system for our patient cohort. This system would reduce average length of stay and decongest the emergency theatre in a Major Trauma Centre. It would also optimise training opportunities that have been limited by the introduction of the European Working Time Directive in August 2009 by providing dedicated, supervised operating lists for trainees. 60 Speech and swallowing outcomes in head and neck cancer patients with jejunal free flap reconstruction of the hypopharynx R. Walker, P. Praveen, S. Parmar, T. Martin, R. Anand, M. Simms. University Hospitals Birmingham, UK Introduction and Aims: This audit investigates return of speech and swallowing and restoration of function in Head and Neck Cancer patients following reconstruction with jejunal free tissue transfer to the hypopharynx. Materials and Methods: A retrospective study was completed of patients who underwent free jejunal tissue transfer at University Hospitals Birmingham as part of their reconstruction for oropharyngeal cancer between 1980 and 2009. Post operative return of speech was recorded together with the type of speaking valve used. A grading system was used to quantify quality of speech assessed by the Speech and Language Therapy Team. Return of swallowing was also recorded along with the choice of feeding adjunct used peri-operatively. Results and Statistics: A total of 164 patients underwent free jejunal tissue transfer as part of their head and neck cancer management over a period of 29 years (the largest series to date) Over 90% of patients returned home on a normal oral intake with only 8.6% requiring a long term feeding adjunct. Less than half of the patients required follow up by Speech and Language Therapy. Over 80% of these patients were noted to have a functional voice or better at 1 year of follow up. Conclusions: The Jejunal Free Flap allows coverage of large defects with tissue that secretes mucous, tolerates radiotherapy and contracts minimally. The operation is associated with low
morbidity and early return of speech and swallowing is common. This paper describes the Birmingham experience. 61 Orbital wall reconstruction with Medartis Modus OPS 1.5 system – University Hospital Birmingham experience over 12 months V. Bhatt, A. Jilka, I. Sharp. University Hospital Birmingham, UK Introduction: Preformed titanium orbital floor plates have been used for over a decade. Several companies have introduced preformed orbital plates. Medartis recently (2008) introduced the Modus OPS 1.5 orbital plate system. Objectives: We present our experience at the University Hospital Birmingham in the use of the Modus OPS 1.5 system in terms of both operator experience and patient outcomes over a 12 month period. Materials and Methods: This is a retrospective comparative study. All patients who had orbital wall fracture reconstruction with preformed titanium plates either in isolation or as part of repair of a zygomatic complex fracture from 1st November 2008 to 31st October 2009 were included. The data was collected from theatre and case records. The choice of plate used for repair was operator dependant. All surgeons involved in these operations were given questionnaires to express their experience. Patient outcomes in terms of any residual clinically significant diplopia, enophthalmos, and dystopia were recorded. Implant related complications were also recorded. Results: 40 patients were included. 17 had Modus OPS 1.5 plates inserted. No significant adverse outcomes were encountered with the systems. A survey of the surgeons revealed comparable ease of use and adaptability. The only drawback quoted most commonly was that the Modus plates may deform during insertion. This may be related to technique. Surgeons who used it felt reluctant to use them to bridge very large defects. 62 The Birmingham experience with composite free vascularised osseous flaps in the reconstruction of post osteoradionecrosis mandibular resection defects L.M. Hanu-Cernat, T. Martin, S. Parmar, A.M.S. Brown, K. Webster. University Hospital Birmingham, UK Osteoradionecrosis (ORN) of the mandible is a serious complication of radiation therapy to the head and neck. Pathological fractures may occur in advanced cases sometimes leading to resection of large segments of the mandible. Composite flaps are often required to reconstruct these patients. Assessment of the bony reconstruction in a large series of patients with severe ORN was carried out through a retrospective review of theatre log books, oncology database and case notes of patients who underwent resection surgery and reconstruction with composite free flaps between 2005 and 2009 at the University Hospital Birmingham. As part of their management a total of 22 of patients with advanced ORN had mandibular segmental resection and immediate reconstruction with a free bony flap. There were 18 composite fibula flaps and 4 scapula flaps. There were no flap failures in our series. Problems and solutions related to vascular access and flap harvesting are discussed. No patients required interpositional vein grafts. Minor donor site complications were encountered in 3 cases. Long term prognosis of these complex patients is good with a marked improvement in their quality of life.
Oral presentations / British Journal of Oral and Maxillofacial Surgery 48 (2010) S1–S24
59 Day case surgery for oral and maxillofacial trauma: a cost-effective and efficient way of managing patients S. Mehmet, E. Mearing-Smith, J. Vizkelety, R.P. Bentley. King’s College Hospital NHS Trust, UK Introduction: Day case surgery is a cost-effective and efficient method in the management of a wide variety of surgical patients. In our Oral and Maxillofacial Surgery unit, there is a high volume of trauma patients treated on an inpatient basis on both Emergency and Elective operating lists that we believe could be treated on Day Surgery or Rapid Access Lists. Method: Data was collected retrospectively over a 6-month period on patients operated on with facial trauma including fractured nasal bones, mandibles, zygomas, orbital floors and soft tissue injuries. Polytrauma patients with any other significant injuries were excluded from the study. Our main interest in data collection was average length of hospital stay for the various procedures, reason for delays in treatment, and whether any nursing or medical interventions were required post-operatively overnight which would have precluded discharge on the day of surgery. We also looked at the volume of facial trauma being operated on ‘out of hours’ and the grade of surgeon. Conclusions: As has been previously described, it is possible to treat certain Maxillofacial injuries on a Day Case basis. Our data supports the feasibility of introducing such a system for our patient cohort. This system would reduce average length of stay and decongest the emergency theatre in a Major Trauma Centre. It would also optimise training opportunities that have been limited by the introduction of the European Working Time Directive in August 2009 by providing dedicated, supervised operating lists for trainees. 60 Speech and swallowing outcomes in head and neck cancer patients with jejunal free flap reconstruction of the hypopharynx R. Walker, P. Praveen, S. Parmar, T. Martin, R. Anand, M. Simms. University Hospitals Birmingham, UK Introduction and Aims: This audit investigates return of speech and swallowing and restoration of function in Head and Neck Cancer patients following reconstruction with jejunal free tissue transfer to the hypopharynx. Materials and Methods: A retrospective study was completed of patients who underwent free jejunal tissue transfer at University Hospitals Birmingham as part of their reconstruction for oropharyngeal cancer between 1980 and 2009. Post operative return of speech was recorded together with the type of speaking valve used. A grading system was used to quantify quality of speech assessed by the Speech and Language Therapy Team. Return of swallowing was also recorded along with the choice of feeding adjunct used peri-operatively. Results and Statistics: A total of 164 patients underwent free jejunal tissue transfer as part of their head and neck cancer management over a period of 29 years (the largest series to date) Over 90% of patients returned home on a normal oral intake with only 8.6% requiring a long term feeding adjunct. Less than half of the patients required follow up by Speech and Language Therapy. Over 80% of these patients were noted to have a functional voice or better at 1 year of follow up. Conclusions: The Jejunal Free Flap allows coverage of large defects with tissue that secretes mucous, tolerates radiotherapy and contracts minimally. The operation is associated with low
morbidity and early return of speech and swallowing is common. This paper describes the Birmingham experience. 61 Orbital wall reconstruction with Medartis Modus OPS 1.5 system – University Hospital Birmingham experience over 12 months V. Bhatt, A. Jilka, I. Sharp. University Hospital Birmingham, UK Introduction: Preformed titanium orbital floor plates have been used for over a decade. Several companies have introduced preformed orbital plates. Medartis recently (2008) introduced the Modus OPS 1.5 orbital plate system. Objectives: We present our experience at the University Hospital Birmingham in the use of the Modus OPS 1.5 system in terms of both operator experience and patient outcomes over a 12 month period. Materials and Methods: This is a retrospective comparative study. All patients who had orbital wall fracture reconstruction with preformed titanium plates either in isolation or as part of repair of a zygomatic complex fracture from 1st November 2008 to 31st October 2009 were included. The data was collected from theatre and case records. The choice of plate used for repair was operator dependant. All surgeons involved in these operations were given questionnaires to express their experience. Patient outcomes in terms of any residual clinically significant diplopia, enophthalmos, and dystopia were recorded. Implant related complications were also recorded. Results: 40 patients were included. 17 had Modus OPS 1.5 plates inserted. No significant adverse outcomes were encountered with the systems. A survey of the surgeons revealed comparable ease of use and adaptability. The only drawback quoted most commonly was that the Modus plates may deform during insertion. This may be related to technique. Surgeons who used it felt reluctant to use them to bridge very large defects. 62 The Birmingham experience with composite free vascularised osseous flaps in the reconstruction of post osteoradionecrosis mandibular resection defects L.M. Hanu-Cernat, T. Martin, S. Parmar, A.M.S. Brown, K. Webster. University Hospital Birmingham, UK Osteoradionecrosis (ORN) of the mandible is a serious complication of radiation therapy to the head and neck. Pathological fractures may occur in advanced cases sometimes leading to resection of large segments of the mandible. Composite flaps are often required to reconstruct these patients. Assessment of the bony reconstruction in a large series of patients with severe ORN was carried out through a retrospective review of theatre log books, oncology database and case notes of patients who underwent resection surgery and reconstruction with composite free flaps between 2005 and 2009 at the University Hospital Birmingham. As part of their management a total of 22 of patients with advanced ORN had mandibular segmental resection and immediate reconstruction with a free bony flap. There were 18 composite fibula flaps and 4 scapula flaps. There were no flap failures in our series. Problems and solutions related to vascular access and flap harvesting are discussed. No patients required interpositional vein grafts. Minor donor site complications were encountered in 3 cases. Long term prognosis of these complex patients is good with a marked improvement in their quality of life.