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A review of palatoplasty in a Nigerian Teaching Hospital
ICOMS 2011—Abstracts: Oral Papers
68 A review of palatoplasty in a Nigerian Teaching Hospital F.O. Oginni 1,∗ , A.O. Oladele 2 , O.A. Fatusi 1 1 Oral and Maxillofacial Surgery, Faculty of Dentistry, College of Health Sciences, Ile-Ife, Nigeria 2 Plastic Surgery Unit, Faculty of Clinical Sciences, College of Health Sciences, Ile-Ife, Nigeria
Introduction: Assessing treatment outcome is an integral part of audit process in surgical practise. This goes along way in identifying the strengths and weaknesses of adopted protocols and help to improve on them. Objective: To appraise the outcome of cleft palate repairs carried out in the Obafemi Awolowo University Teaching Hospital (OAUTH) Ile-Ife over a five year period. Methods: Cases of cleft palate managed at the OAUTHC over a five year period (July 2005–June 2010) were reviewed prospectively. Information on patients’ demographics, type and severity of defects, surgical techniques employed, post operative care protocol and complication(s) of surgery were obtained and analysed. Results: Forty two patients (19 males and 23 females) aged 1–38 years were reviewed. Their mean age (SD) was 6.45 (7.95) years. Sixty percent had clefts of hard and soft palate while others were isolated cleft of the soft palate. Defects measured 4–22 mm widest dimension mean (SD) was 14.08 (4.2) mm. Majority (88%) had primary palatoplasties while the rest were secondary. The vonLangenbeck technique was carried out in all cases except two. We observed two distinct patterns of post operative care. Three cases of dehiscence and five fistulae at the junction of hard and soft palate were found (19.1% complication rate). Only one patient complied with post operative speech assessment for 3 months. Conclusion: Although speech outcome could not be determined in this series basically due to loss to follow up, our surgical complication rate is comparable with reported figures. Size of defects and poor compliance with post surgical care are implicated. Conflict of interest: None declared. doi:10.1016/j.ijom.2011.07.069
69 Evaluation of oro-mandibular-facial reconstruction using vascularized free fibular osteomyocutaneous flap S. Xing ∗ , Y. Wu, L. Wan, Z. Tao, H. Jiang, Y. Yuan Oral and Maxillofacial surgery, Affiliated Hospital of Stomatology/Nanjing Medical University, Nanjing, China
Ninety-eight patients with segmental mandible defect were reconstructed with vascularized free fibular flap, in which 63 were males and 35 females, the age ranging from 16 to 76 years, and the mean age 39.0. Ninety-three cases were immediately reconstructed, and five cases were secondarily reconstructed. Sixtyseven free fibular flaps and 31 fibular osteomyocutaneous flaps were used. The length of harvested fibula was ranging from 6 cm to 21 cm with the average of 13.91 cm. The fibula was transplanted in one piece or cut into two or more pieces according to the shape of the mandible, with the maximum of up to 6 pieces. Bony segments were fixed by miniplates and/or reconstruction plates. Five cases of double barrel fibular flaps were used with immediate dental implant. Six double skin paddle flaps were used for reconstructing the oromandibular through-and-through defects. All donor sites were closed by normal approximation except in one case, which was closed by split skin graft. The postoperative course was smoothly in 93 cases. Vascular crisis was appeared in 5 cases, 3 being rescued and 2 failed. The success rate was 97.96%. The patients regained good or fair or acceptable shape and function. It is concluded that free vascularized fibular flap reflects good functional and esthetic results with high degree of consistency and acceptable level of complications, and is the first choice for mandibular defect reconstruction. Conflict of interest: None declared. doi:10.1016/j.ijom.2011.07.070
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70 A comparative study of craneoplastic techniques in neurosurgical patients I. Trujillo Ramos 1,∗ , E. Torche Velez 1 , ˜ Carrasco 1 , R. Munoz L. Elso Sanhueza 1 , S. Vigueras Alvarez 1 , F. Perez Cuadros 1 , A. Farias Calderon 1 , F. Luna Andrade 1 , L. Cantillano 1 , M. Torche Velez 1 , M. Torche Astete 1 , W. Rivas Weber 1 , J. Pinto 1 , R. Vigueras 1 , M. Rodriguez 1 , G. Jeldes 2 , F. Constanzo 1 , Pedro Pinacho D. 3 1 Servicio Neurocirugia, Hospital Guillermo Grant Benavente, Concepcion, Chile 2 Servicio Maxilofacial, Hospital Sotero del Rio, Santiago, Chile 3 Departamento de Ingeniería Informática, Universidad de Santiago de Chile, Santiago de Chile, Chile
Background: Many materials and techniques have been described for the treatment of craneal bone defects derived from decompressive craneotomy procedure, useful for endocranean hypertension treatment. The exclusive use of titanium mesh in large craneal defects may cause the exposure of the implant. Other material, acrylic cement, lacks of ductibility and resistance, causing poor aesthetical results. Purpose: This work presents the joined use of titanium mesh and acrylic cement in reconstruction procedure of craneal bone defects. The aim of the study is establish the advantage of this technique over the use of exclusive titanium mesh. Materials and methods: The research is based on 67 surgically treated patients from Hospital Guillermo Grant Benavente, Chile between 2008 and 2010. The craneoplastic surgery was applied to male (41) and female (26) of ages between 3 and 69, all with large defects (≥10 cm), most of these over right frontal parietal (29). This work reviews the relation of localization, aesthetical results and presence of complications. Results: Over 37 patients surgically treated with titanium mesh, 5 complications (13.5%) were found, most of these (60%) correspond to a exposure of the implant and related infection, causing the lost of the titanium mesh, while only 3 complications were found in 26 patients treated with mesh and acrylic (11.5%) being most of these (66%) dehiscence, without presence of exposition or infection. Conclusions: Aesthetically the result of the mesh-acrylic technique was better
68 A review of palatoplasty in a Nigerian Teaching Hospital F.O. Oginni 1,∗ , A.O. Oladele 2 , O.A. Fatusi 1 1 Oral and Maxillofacial Surgery, Faculty of Dentistry, College of Health Sciences, Ile-Ife, Nigeria 2 Plastic Surgery Unit, Faculty of Clinical Sciences, College of Health Sciences, Ile-Ife, Nigeria
Introduction: Assessing treatment outcome is an integral part of audit process in surgical practise. This goes along way in identifying the strengths and weaknesses of adopted protocols and help to improve on them. Objective: To appraise the outcome of cleft palate repairs carried out in the Obafemi Awolowo University Teaching Hospital (OAUTH) Ile-Ife over a five year period. Methods: Cases of cleft palate managed at the OAUTHC over a five year period (July 2005–June 2010) were reviewed prospectively. Information on patients’ demographics, type and severity of defects, surgical techniques employed, post operative care protocol and complication(s) of surgery were obtained and analysed. Results: Forty two patients (19 males and 23 females) aged 1–38 years were reviewed. Their mean age (SD) was 6.45 (7.95) years. Sixty percent had clefts of hard and soft palate while others were isolated cleft of the soft palate. Defects measured 4–22 mm widest dimension mean (SD) was 14.08 (4.2) mm. Majority (88%) had primary palatoplasties while the rest were secondary. The vonLangenbeck technique was carried out in all cases except two. We observed two distinct patterns of post operative care. Three cases of dehiscence and five fistulae at the junction of hard and soft palate were found (19.1% complication rate). Only one patient complied with post operative speech assessment for 3 months. Conclusion: Although speech outcome could not be determined in this series basically due to loss to follow up, our surgical complication rate is comparable with reported figures. Size of defects and poor compliance with post surgical care are implicated. Conflict of interest: None declared. doi:10.1016/j.ijom.2011.07.069
69 Evaluation of oro-mandibular-facial reconstruction using vascularized free fibular osteomyocutaneous flap S. Xing ∗ , Y. Wu, L. Wan, Z. Tao, H. Jiang, Y. Yuan Oral and Maxillofacial surgery, Affiliated Hospital of Stomatology/Nanjing Medical University, Nanjing, China
Ninety-eight patients with segmental mandible defect were reconstructed with vascularized free fibular flap, in which 63 were males and 35 females, the age ranging from 16 to 76 years, and the mean age 39.0. Ninety-three cases were immediately reconstructed, and five cases were secondarily reconstructed. Sixtyseven free fibular flaps and 31 fibular osteomyocutaneous flaps were used. The length of harvested fibula was ranging from 6 cm to 21 cm with the average of 13.91 cm. The fibula was transplanted in one piece or cut into two or more pieces according to the shape of the mandible, with the maximum of up to 6 pieces. Bony segments were fixed by miniplates and/or reconstruction plates. Five cases of double barrel fibular flaps were used with immediate dental implant. Six double skin paddle flaps were used for reconstructing the oromandibular through-and-through defects. All donor sites were closed by normal approximation except in one case, which was closed by split skin graft. The postoperative course was smoothly in 93 cases. Vascular crisis was appeared in 5 cases, 3 being rescued and 2 failed. The success rate was 97.96%. The patients regained good or fair or acceptable shape and function. It is concluded that free vascularized fibular flap reflects good functional and esthetic results with high degree of consistency and acceptable level of complications, and is the first choice for mandibular defect reconstruction. Conflict of interest: None declared. doi:10.1016/j.ijom.2011.07.070
1045
70 A comparative study of craneoplastic techniques in neurosurgical patients I. Trujillo Ramos 1,∗ , E. Torche Velez 1 , ˜ Carrasco 1 , R. Munoz L. Elso Sanhueza 1 , S. Vigueras Alvarez 1 , F. Perez Cuadros 1 , A. Farias Calderon 1 , F. Luna Andrade 1 , L. Cantillano 1 , M. Torche Velez 1 , M. Torche Astete 1 , W. Rivas Weber 1 , J. Pinto 1 , R. Vigueras 1 , M. Rodriguez 1 , G. Jeldes 2 , F. Constanzo 1 , Pedro Pinacho D. 3 1 Servicio Neurocirugia, Hospital Guillermo Grant Benavente, Concepcion, Chile 2 Servicio Maxilofacial, Hospital Sotero del Rio, Santiago, Chile 3 Departamento de Ingeniería Informática, Universidad de Santiago de Chile, Santiago de Chile, Chile
Background: Many materials and techniques have been described for the treatment of craneal bone defects derived from decompressive craneotomy procedure, useful for endocranean hypertension treatment. The exclusive use of titanium mesh in large craneal defects may cause the exposure of the implant. Other material, acrylic cement, lacks of ductibility and resistance, causing poor aesthetical results. Purpose: This work presents the joined use of titanium mesh and acrylic cement in reconstruction procedure of craneal bone defects. The aim of the study is establish the advantage of this technique over the use of exclusive titanium mesh. Materials and methods: The research is based on 67 surgically treated patients from Hospital Guillermo Grant Benavente, Chile between 2008 and 2010. The craneoplastic surgery was applied to male (41) and female (26) of ages between 3 and 69, all with large defects (≥10 cm), most of these over right frontal parietal (29). This work reviews the relation of localization, aesthetical results and presence of complications. Results: Over 37 patients surgically treated with titanium mesh, 5 complications (13.5%) were found, most of these (60%) correspond to a exposure of the implant and related infection, causing the lost of the titanium mesh, while only 3 complications were found in 26 patients treated with mesh and acrylic (11.5%) being most of these (66%) dehiscence, without presence of exposition or infection. Conclusions: Aesthetically the result of the mesh-acrylic technique was better