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A forgotten technique: Autotransplantation in the management of hypodontia
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P21 / British Journal of Oral and Maxillofacial Surgery 52 (2014) e75–e127
Clinical Relevance: We chose this approach to reduce surgical morbidity anticipated with alternative approaches. The risks of iatrogenic injury to the facial and lingual nerves are reduced. This technique allowed good lateral and medial access to the expansive odontogenic cyst. An intraoral approach would require coronoidectomy and further lateral and medial ramus cortical bone removal with an increased risk of condylar fracture. The TMAP approach would permit direct condylar osteosynthesis in the event of intraoperative fracture. Direct visualisation whilst sectioning the third molar permitted safe removal and reduced the risk of haemorrhage in the medial ramus region. http://dx.doi.org/10.1016/j.bjoms.2014.07.172 P71 A forgotten technique: Autotransplantation in the management of hypodontia Alice Dyke ∗ , Andrew J. Dickenson Royal Derby Hospital Hypodontia management aims to restore a functioning occlusion with elimination of arch spacing. In most cases this is not possible with orthodontics alone and may require either removable or fixed prostheses. Patients are more discerning and increasingly requesting a fixed prosthesis, which may be either destructive to the natural teeth or inappropriate due to age. While it is a neglected technique, in carefully selected cases, autotransplantation can be an appropriate treatment option. Autotransplantation is the surgical relocation of a tooth from one site in the mouth, normally from an area of crowding, to another in the same individual. Previously neglected due to a reported high failure rate, recent developments in the understanding of the biological processes following autotransplantation produces success rates of up to 95%. Success is influenced by a number of factors, such as (a) patient age, (b) age at treatment (c) root apex development (d) surgical technique (e) condition of the recipient site and (f) orthodontic technique. Autotransplant survival can be increased by applying the accepted principles used in implant surgery. It is essential that there is an adequate bone volume at the recipient site, which may require pre-transplantation bone augmentation. Careful surgical and post-transplant orthodontic management contributes to bone development and maintenance. The following cases illustrate a variety of applications of the autotransplantation technique in young patients. The surgical techniques will also be described, emphasising the correct insertion angle of the autotransplant, stabilisation methods and the immediate orthodontic technique. http://dx.doi.org/10.1016/j.bjoms.2014.07.173
P72 Suggested proforma for national standard of parental satisfaction with tongue frenolutomy procedures Ghaly A. Ghaly ∗ , Stephen C. Toynton, Angeles Espeso Severn Deanery Introduction/Aims: Tongue-tie division (tongue frenulotomy) is a procedure performed by OMFS and ENT surgeons. Currently there is no national standard for assessment of efficacy and parental satisfaction of babies’ tongue frenulotomy. We are presenting a suggested proforma for assessment of the efficacy and parental satisfaction for this procedure in out-patient setting. Materials/Methods: Ethical approval was obtained from the Audit and Research Department at Plymouth Hospitals NHS Trust promoting postal contact with the parents of the infants who underwent division of tongue-tie between December 2006 and September 2009. An explanatory letter about the purpose of the study, an anonymous questionnaire and a self addressed/stamped envelope were sent by post to 185 parents. Results were analysed using SPSS 12.5. Results/Statistics: One hundred and one (54.6%) responses obtained. Eighty-nine had complete resolution of their symptoms including: feeding difficulties, wind problems and drooling while feeding within 4 weeks (75% improved within one week). 20% reported minor immediate post-intervention bleeding which resolved within 5 minutes. No significant complications were described in 98.2% of cases. 100 responses indicated a high lead of satisfaction (9.4 ± 0.6 on VAS). Conclusions/Clinical Relevance: Our suggested proforma can be used as a tool for assessment of parental satisfaction after tongue frenulotomy performed as an outpatient procedure. Sending the proforma by post has its limitations and further studies might be needed to assess its efficacy as aid to a telephone conversation or outpatient consultation. http://dx.doi.org/10.1016/j.bjoms.2014.07.174 P73 An interesting presentation of craniofacial Langerhans cell histiocytosis Elizabeth Gruber ∗ , Sarah Waring, Laith Al Qamachi, Timothy Malins University Hospital of North Staffordshire Background: Langerhans cell histiocytosis (LCH) is a rare disease involving clonal proliferation of Langerhans cells. Clinically the manifestations range from isolated bone lesions to multisystem disease.
P21 / British Journal of Oral and Maxillofacial Surgery 52 (2014) e75–e127
Clinical Relevance: We chose this approach to reduce surgical morbidity anticipated with alternative approaches. The risks of iatrogenic injury to the facial and lingual nerves are reduced. This technique allowed good lateral and medial access to the expansive odontogenic cyst. An intraoral approach would require coronoidectomy and further lateral and medial ramus cortical bone removal with an increased risk of condylar fracture. The TMAP approach would permit direct condylar osteosynthesis in the event of intraoperative fracture. Direct visualisation whilst sectioning the third molar permitted safe removal and reduced the risk of haemorrhage in the medial ramus region. http://dx.doi.org/10.1016/j.bjoms.2014.07.172 P71 A forgotten technique: Autotransplantation in the management of hypodontia Alice Dyke ∗ , Andrew J. Dickenson Royal Derby Hospital Hypodontia management aims to restore a functioning occlusion with elimination of arch spacing. In most cases this is not possible with orthodontics alone and may require either removable or fixed prostheses. Patients are more discerning and increasingly requesting a fixed prosthesis, which may be either destructive to the natural teeth or inappropriate due to age. While it is a neglected technique, in carefully selected cases, autotransplantation can be an appropriate treatment option. Autotransplantation is the surgical relocation of a tooth from one site in the mouth, normally from an area of crowding, to another in the same individual. Previously neglected due to a reported high failure rate, recent developments in the understanding of the biological processes following autotransplantation produces success rates of up to 95%. Success is influenced by a number of factors, such as (a) patient age, (b) age at treatment (c) root apex development (d) surgical technique (e) condition of the recipient site and (f) orthodontic technique. Autotransplant survival can be increased by applying the accepted principles used in implant surgery. It is essential that there is an adequate bone volume at the recipient site, which may require pre-transplantation bone augmentation. Careful surgical and post-transplant orthodontic management contributes to bone development and maintenance. The following cases illustrate a variety of applications of the autotransplantation technique in young patients. The surgical techniques will also be described, emphasising the correct insertion angle of the autotransplant, stabilisation methods and the immediate orthodontic technique. http://dx.doi.org/10.1016/j.bjoms.2014.07.173
P72 Suggested proforma for national standard of parental satisfaction with tongue frenolutomy procedures Ghaly A. Ghaly ∗ , Stephen C. Toynton, Angeles Espeso Severn Deanery Introduction/Aims: Tongue-tie division (tongue frenulotomy) is a procedure performed by OMFS and ENT surgeons. Currently there is no national standard for assessment of efficacy and parental satisfaction of babies’ tongue frenulotomy. We are presenting a suggested proforma for assessment of the efficacy and parental satisfaction for this procedure in out-patient setting. Materials/Methods: Ethical approval was obtained from the Audit and Research Department at Plymouth Hospitals NHS Trust promoting postal contact with the parents of the infants who underwent division of tongue-tie between December 2006 and September 2009. An explanatory letter about the purpose of the study, an anonymous questionnaire and a self addressed/stamped envelope were sent by post to 185 parents. Results were analysed using SPSS 12.5. Results/Statistics: One hundred and one (54.6%) responses obtained. Eighty-nine had complete resolution of their symptoms including: feeding difficulties, wind problems and drooling while feeding within 4 weeks (75% improved within one week). 20% reported minor immediate post-intervention bleeding which resolved within 5 minutes. No significant complications were described in 98.2% of cases. 100 responses indicated a high lead of satisfaction (9.4 ± 0.6 on VAS). Conclusions/Clinical Relevance: Our suggested proforma can be used as a tool for assessment of parental satisfaction after tongue frenulotomy performed as an outpatient procedure. Sending the proforma by post has its limitations and further studies might be needed to assess its efficacy as aid to a telephone conversation or outpatient consultation. http://dx.doi.org/10.1016/j.bjoms.2014.07.174 P73 An interesting presentation of craniofacial Langerhans cell histiocytosis Elizabeth Gruber ∗ , Sarah Waring, Laith Al Qamachi, Timothy Malins University Hospital of North Staffordshire Background: Langerhans cell histiocytosis (LCH) is a rare disease involving clonal proliferation of Langerhans cells. Clinically the manifestations range from isolated bone lesions to multisystem disease.