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A treatment algorithm for mandibular ameloblastoma
222
British
Journal
of Oral and Maxillofacial
Surgery Single-stage titanium cranioplasty for the infected bone flap: ‘putting the lid on infection’. R. K. Lee’, J. P. Grievez. P. T. Blenkinsopp’, B. Conroy’, H. T. Marsh*. ‘Norman Rowe Maxillofacial Unit, Queen Mary’s Hospital, Roehampton, London; ZDepartment of Neurosurgery, Atkinson Morley Hospital, London, UK.
References 1. Hassan S J, Weymuller E A. Assessment of quality of life in head and neck cancer oatients. Head Neck 1993: 15: 485496. 2. Bjordal K, Kassa S. Ps>chometric validation of the EORTC core Quality of Life Questionnaire, 30-item version and a diagnostic-specific module for head and neck cancer patients Acta Oncol 1992; 31: 311-321. 3. Bjordal K, Ahlner-Elmqvist M, Tollesson E et al. Development of a European Organisation for Research and Treatment of Cancer (EORTC) questionnaire module to be used in quality of life assessments in head and neck cancer patients. Acta Oncol 1994; 3303): 879-885.
A treatment algorithm for mandibular ameloblastoma. D. Sampson, M. A. Pogrel. Department of Oral and Maxillofacial Surgery, University of California, San Francisco, CA, USA.
E.
Objective: To develop a treatment algorithm for the management of intraosseous ameloblastoma. Muterials und methods: A retrospective study of 21 consecutive patients referred for management of intraosseous mandibular ameloblastoma. Twelve patients (44%) had already had treatment carried out elsewhere and were referred because of recurrence. Fifteen patients (56%) had soft-tissue involvement on referral. Treatment consisted of curettage alone (n = 2) curettage combined with cryotherapy (n = 7), segmental mandibular resection (n = 16) and soft tissue resection only (n = l), patient refusing treatment (n = 1). The patient having soft-tissue surgery only required a neck dissection and two patients required skull-base surgery for recurrence. Results: The 2 patients treated by curettage alone suffered from tumor recurrence. Of the 7 patients treated by curettage with liquid nitrogen cryotherapy, all had intraosseous lesions only and there were no recurrences. Of the 16 patients having segmental resections because of extraosseous spread, there was one recurrence and this was actually diagnosed histologically as an ameloblastic carcinoma. The one patient having soft-tissue resection only required further surgery for another soft-tissue recurrence at the base of the skull. patients were reconstructed as appropriate with either primary or secondary grafting. Only 3 patients went on to have full reconstruction including osseointegrated implants. Conclusions: Local curettage of ameloblastoma results in unacceptable recurrence rates. Treatment of lesions still contained within the mandible by localized surgery and cryotherapy produces good results. Incontinuity segmental resection of the mandible and associated soft tissues for lesions extending beyond the mandible provides good results. Tumors undergoing inadequate primary treatment can lead to the need for extensive resection for soft-tissue extension and complex management for skull-base lesions. Few patients go on to full reconstruction, including osseointegrdted implants.
Implants in the maxillary sinus - how far can you go? L. Duncan’, I. HollandL, K. Postlethwaite’, J Huwkesfbrdl, D.G. Smith’. ‘Newcastle General Hospital, Newcastle; Sunderland Royal Hospital, Sunderland, 3Newcastle Dental Hospital, Newcastle, UK Satisfactory restoration of the upper dental arch is sometimes only possible with the aid of implant retained prostheses. Grafting of the maxillary sinus is commonly required to provide sufftcient bone into which to place the implants. The factors influencing the successful outcome of ultimate restoration following implant placement are many. Significant amongst them is the length of implant it is possible to place within the grafted sinus. This depends entirely on the amount of graft placed in the sinus and degree of resorption that occurs prior to implant placement. This latter element is unpredictable. Postgrafting CT scanning is utilized to attempt to predict the height of bone present and consequently implant length usable in the grafted site. We report the results of implants placed in a retrospective study of 25 patients who have undergone a sinus lift and bone grafting procedure between 1992 and 1997.
The incidence of bone flap infections following craniotomies is around 2%. The traditional treatment for this is divided into two stages; initially to remove the infected bone flap, then the delayed insertion of a cranioplasty. This involves a minimum of two general anaesthetics and a variable period in between when the patient is at risk from a defect in the skull and has to endure the associated deformity. This prospective study evaluates a single-stage procedure of removing infected bone flaps and the insertion of a titanium cranioplasty. Seven patients, aged between 32 and 75 years, underwent this procedure during the period of July 1994 until November 1997. All the patients subsequently achieved full wound healing and none show signs of active infection to date. With the favourable results that have been obtained so far, bearing in mind the relatively small number of patients, it would seem that this technique demonstrates a significant advance in the management of patients with infected cranial bone flaps. This success is likely to be in part attributable to the properties of titanium as a material which is inert, highly biocompatible, does not induce hypersensitive reactions and its favourable surface properties.
Can orbital shape and volume be reliably restored with alloplastic sheet implants following trauma? A prospective study. .I McMahon, A. IV Baker, A. Sugar, K. E Moos. Canniesburn Hospital, Glasgow; Morriston Hospital, Swansea, UK. Background: The use of alloplastic implants in the repair of moderate-sized defects of the orbital walls has been widely advocated. At Canniesburn and Morriston Hospitals, a trial of two such implants has been conducted. One of the inclusion criteria was that the maximal size of the orbital wall defects should not exceed 2 cm. This report examines the validity of this inclusion criterion with regard to subsequently deserved enophthalmos. Method: Patients were randomly assigned at operation to undergo reconstruction of the orbital wall defect with either PDS or titanium mesh provided the inclusion criteria were met. The nature of the injury sustained, including size of the orbital wall defect, was recorded. Details of the surgical procedure were also recorded. Patient review was at 3 and 12 months, Result: 54 patients were recruited with follow-up in 40. Enophthalmos was observed in 8 out of 24 patients whose orbital wall defect exceeded 1.5 cm in maximal dimension. For those 16 patients in which the maximal dimension was 1.5 cm or less, subsequent enophthalmos was observed in only 1 patient (P = 0.044, x2 test). Conclusion: The use of alloplastic sheet implants in early reconstruction of the orbit should be confined to those cases in which the maximal dimension of the defect does not exceed 1.5 cm. The possible reasons for failure to reliably reconstruct the orbit with larger defects are discussed.
Primary temporary reconstruction of mandibular defects using A0 reconstruction plates: a retrospective analysis of 51 cases. H. Schdning, R. Emshoff Department of Oral and Maxillofacial Surgery, University of Innsbruck, Innsbruck, Austria. This study assessed the incidence of complications and revisions following primary temporary A0 plate reconstructions (PT-AOPR) of the mandible performed between 1971 and 1996. In a retrospective record review, the data of 51 patients undergoing PT-AOPR after composite mandibular resection were analysed according to age, sex, date of reconstruction, anatomic location of reconstruction, use of additional irradiation therapy and/or flap surgery, and incidence of associated complications and revisions. Of the entire sample, the most common complication encountered was infection (33.5) followed by plate exposure (27.9) and plate fracture (10.7). With revisions showing an incidence rate of
British
Journal
of Oral and Maxillofacial
Surgery Single-stage titanium cranioplasty for the infected bone flap: ‘putting the lid on infection’. R. K. Lee’, J. P. Grievez. P. T. Blenkinsopp’, B. Conroy’, H. T. Marsh*. ‘Norman Rowe Maxillofacial Unit, Queen Mary’s Hospital, Roehampton, London; ZDepartment of Neurosurgery, Atkinson Morley Hospital, London, UK.
References 1. Hassan S J, Weymuller E A. Assessment of quality of life in head and neck cancer oatients. Head Neck 1993: 15: 485496. 2. Bjordal K, Kassa S. Ps>chometric validation of the EORTC core Quality of Life Questionnaire, 30-item version and a diagnostic-specific module for head and neck cancer patients Acta Oncol 1992; 31: 311-321. 3. Bjordal K, Ahlner-Elmqvist M, Tollesson E et al. Development of a European Organisation for Research and Treatment of Cancer (EORTC) questionnaire module to be used in quality of life assessments in head and neck cancer patients. Acta Oncol 1994; 3303): 879-885.
A treatment algorithm for mandibular ameloblastoma. D. Sampson, M. A. Pogrel. Department of Oral and Maxillofacial Surgery, University of California, San Francisco, CA, USA.
E.
Objective: To develop a treatment algorithm for the management of intraosseous ameloblastoma. Muterials und methods: A retrospective study of 21 consecutive patients referred for management of intraosseous mandibular ameloblastoma. Twelve patients (44%) had already had treatment carried out elsewhere and were referred because of recurrence. Fifteen patients (56%) had soft-tissue involvement on referral. Treatment consisted of curettage alone (n = 2) curettage combined with cryotherapy (n = 7), segmental mandibular resection (n = 16) and soft tissue resection only (n = l), patient refusing treatment (n = 1). The patient having soft-tissue surgery only required a neck dissection and two patients required skull-base surgery for recurrence. Results: The 2 patients treated by curettage alone suffered from tumor recurrence. Of the 7 patients treated by curettage with liquid nitrogen cryotherapy, all had intraosseous lesions only and there were no recurrences. Of the 16 patients having segmental resections because of extraosseous spread, there was one recurrence and this was actually diagnosed histologically as an ameloblastic carcinoma. The one patient having soft-tissue resection only required further surgery for another soft-tissue recurrence at the base of the skull. patients were reconstructed as appropriate with either primary or secondary grafting. Only 3 patients went on to have full reconstruction including osseointegrated implants. Conclusions: Local curettage of ameloblastoma results in unacceptable recurrence rates. Treatment of lesions still contained within the mandible by localized surgery and cryotherapy produces good results. Incontinuity segmental resection of the mandible and associated soft tissues for lesions extending beyond the mandible provides good results. Tumors undergoing inadequate primary treatment can lead to the need for extensive resection for soft-tissue extension and complex management for skull-base lesions. Few patients go on to full reconstruction, including osseointegrdted implants.
Implants in the maxillary sinus - how far can you go? L. Duncan’, I. HollandL, K. Postlethwaite’, J Huwkesfbrdl, D.G. Smith’. ‘Newcastle General Hospital, Newcastle; Sunderland Royal Hospital, Sunderland, 3Newcastle Dental Hospital, Newcastle, UK Satisfactory restoration of the upper dental arch is sometimes only possible with the aid of implant retained prostheses. Grafting of the maxillary sinus is commonly required to provide sufftcient bone into which to place the implants. The factors influencing the successful outcome of ultimate restoration following implant placement are many. Significant amongst them is the length of implant it is possible to place within the grafted sinus. This depends entirely on the amount of graft placed in the sinus and degree of resorption that occurs prior to implant placement. This latter element is unpredictable. Postgrafting CT scanning is utilized to attempt to predict the height of bone present and consequently implant length usable in the grafted site. We report the results of implants placed in a retrospective study of 25 patients who have undergone a sinus lift and bone grafting procedure between 1992 and 1997.
The incidence of bone flap infections following craniotomies is around 2%. The traditional treatment for this is divided into two stages; initially to remove the infected bone flap, then the delayed insertion of a cranioplasty. This involves a minimum of two general anaesthetics and a variable period in between when the patient is at risk from a defect in the skull and has to endure the associated deformity. This prospective study evaluates a single-stage procedure of removing infected bone flaps and the insertion of a titanium cranioplasty. Seven patients, aged between 32 and 75 years, underwent this procedure during the period of July 1994 until November 1997. All the patients subsequently achieved full wound healing and none show signs of active infection to date. With the favourable results that have been obtained so far, bearing in mind the relatively small number of patients, it would seem that this technique demonstrates a significant advance in the management of patients with infected cranial bone flaps. This success is likely to be in part attributable to the properties of titanium as a material which is inert, highly biocompatible, does not induce hypersensitive reactions and its favourable surface properties.
Can orbital shape and volume be reliably restored with alloplastic sheet implants following trauma? A prospective study. .I McMahon, A. IV Baker, A. Sugar, K. E Moos. Canniesburn Hospital, Glasgow; Morriston Hospital, Swansea, UK. Background: The use of alloplastic implants in the repair of moderate-sized defects of the orbital walls has been widely advocated. At Canniesburn and Morriston Hospitals, a trial of two such implants has been conducted. One of the inclusion criteria was that the maximal size of the orbital wall defects should not exceed 2 cm. This report examines the validity of this inclusion criterion with regard to subsequently deserved enophthalmos. Method: Patients were randomly assigned at operation to undergo reconstruction of the orbital wall defect with either PDS or titanium mesh provided the inclusion criteria were met. The nature of the injury sustained, including size of the orbital wall defect, was recorded. Details of the surgical procedure were also recorded. Patient review was at 3 and 12 months, Result: 54 patients were recruited with follow-up in 40. Enophthalmos was observed in 8 out of 24 patients whose orbital wall defect exceeded 1.5 cm in maximal dimension. For those 16 patients in which the maximal dimension was 1.5 cm or less, subsequent enophthalmos was observed in only 1 patient (P = 0.044, x2 test). Conclusion: The use of alloplastic sheet implants in early reconstruction of the orbit should be confined to those cases in which the maximal dimension of the defect does not exceed 1.5 cm. The possible reasons for failure to reliably reconstruct the orbit with larger defects are discussed.
Primary temporary reconstruction of mandibular defects using A0 reconstruction plates: a retrospective analysis of 51 cases. H. Schdning, R. Emshoff Department of Oral and Maxillofacial Surgery, University of Innsbruck, Innsbruck, Austria. This study assessed the incidence of complications and revisions following primary temporary A0 plate reconstructions (PT-AOPR) of the mandible performed between 1971 and 1996. In a retrospective record review, the data of 51 patients undergoing PT-AOPR after composite mandibular resection were analysed according to age, sex, date of reconstruction, anatomic location of reconstruction, use of additional irradiation therapy and/or flap surgery, and incidence of associated complications and revisions. Of the entire sample, the most common complication encountered was infection (33.5) followed by plate exposure (27.9) and plate fracture (10.7). With revisions showing an incidence rate of