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Allogenic bone grafting after cyst enucleation
1056
Reconstructive Surgery
Sciences and Hospital, Dharwad, Karnataka 580009, India Management of sino-nasal pathology is always a challenge and achieving satisfactory results has lead to evolution of various techniques. Frequently oral cancer necessitates the complete or partial resection of the maxilla apart from the very loss of osseous structure due to trauma or infections, leaving the patient with a defect that compromises with the integrity and function of the oral and nasal cavities. In this paper we have tried to evaluate the various kinds of maxillectomies and the surgical and prosthetic rehabilitation performed thereafter, in the Craniofacial Unit, Dept. of Oral and Maxillofacial Surgery, S.D.M. College of Dental Sciences, Dharwad. Reconstruction of midfacial defects and rehabilitation of facial contours and oronasal functions can be achieved by immediate and delayed procedures involving surgical as well as prosthetic modalities. By careful consideration of the factors like the aggressiveness and extent of the pathology, age of the patient and the functional and aesthetic needs of the patient we can formulate a treatment plan to achieve the best possible outcome. doi:10.1016/j.ijom.2007.08.348
O14.22 Needs and trends for corals in oral and maxillofacial defects M. Misra*, B. Vikraman, M. Veerabahu Department of Oral & Maxillofacial Surgery, Ragas Dental College & Hospital, 2/102, East Coast Road, Uthandi, Chennai 600119, India Reconstruction with bone grafts has long been a challenge to surgeons. Research on the feasibility of using natural coral as a resorbable bone graft substitute has been underway from past three decades. Natural coral porous calcium carbonate appears to be a clinically useful bone replacement graft material that gains essentially or slightly better responses in osseous defects than other replacement graft materials. The objective of this paper is to evaluate the ease of preparing a potential alloplastic bone substitute and its use for different bone grafting procedures for application as grafting material filling various oral and maxillofacial defects. Method: A total number of eight patients with different oromaxillofacial defects received natural coral derived from Madrepora. They were
reviewed for 4–8 weeks and were evaluated both clinically and radiographically until the coral was replaced by bone completely. Results: Only in one case the graft was exposed and had to be removed. Rest of the cases had no complication. Conclusion: An ideal bone grafting material should be one that is biologically inert, readily available, easily adaptable to the site in terms of shape and size and replaceable by host bone. The coral fulfils all the requirements and can be increasingly used as a bone substitute. doi:10.1016/j.ijom.2007.08.349
O14.23 Allogenic bone grafting after cyst enucleation B. K. Das*, M. M. Iqbal, E. Islam, Q. B. Rahman, M. Ahammed, M. R. Molla Bangabandu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh Cyst of the mandible and maxilla require surgical intervention followed by with or without bone graft. After conventional treatment like enucleation of large cyst, severe facial deformity may occur, and also may produce some other complications. This deformity may be restored and complication may be prevented by use of different types of bone graft. Lyophilized freeze dried bank bone can be used to eliminate the need of a second site operation and reduces the rate of donor site morbidity, minimizes surgical shock, reduces surgical time, shortening healing time and decreases the chances of postoperative infection or complication. Total 52 patients were treated in OMS Department of BSMMU. Among them, after enucleation, 27 cases were treated with allograft and 25 cases were treated without graft. It was observed that only one patient had infection in case of allograft but four other patients had infection treated without allograft. Other observations show use of allograft is better in all respect than without graft. doi:10.1016/j.ijom.2007.08.350
O14.24 Orofacial reconstruction and postoperative assessment of quality of life T. Zachariah*, I. A. Motiwala, M. Baliga Department of Oral & Maxillofacial Surgery, Manipal College of Dental
Sciences, Kasturba Medical College & Hospital, Lighthouse Hill Road, Mangalore 575001, Karnataka, India Objectives: Orofacial defects after tumour extirpation present surgeons with some of the greatest challenges in reconstructive surgery. The intricate interaction between form, function and appearance is greater in this anatomical subsite than any other. In this study, we attempted to evaluate the flap choices available for orofacial reconstruction after tumour resection and the quality of life thereafter. Methods: We studied the buccal fat pad, tongue, nasolabial, sternocleidomastoid, temporalis and pectoralis major flaps for orofacial reconstruction with/without mandibular reconstruction from the last 5 years in our unit. Assessment of quality of life was based on the EORTC (European Organization for Research and Treatment of Cancer) and UW-QOL (University of Washington – Quality of Life) protocols. Results: Effect on oral incompetence was most significant. doi:10.1016/j.ijom.2007.08.351
O14.25 Does the application of vein grafting in head and neck free flaps work? C.-H. Lo*, T.-S. Lin, W.-S. Hsu, F.-H. Lee Maxillofacial Department, St. Martin De Porres Hospital, Chia Yi City, Taiwan With microvascular techniques and instruments improving, we now do more and more flaps in head and neck reconstructions. The basic requirement for a good success rate of free flap anastomosis is to have well prepared recipient vessels. But patients with a history of previous treatments on neck or recurrent disease make it more difficult to prepare these. So an interposition vein graft is necessary at this crucial point. From February 2001 to February 2007, we did 132 free flaps on 123 patients. There were eight flaps which required interposition vein grafts, one for LD flap, one for ALT flap, three for fibula flaps and three for radial forearm flaps. The total free flap success rate was 95%. The vein graft success rate was 88%, one vein graft failed. In this study only the vein required an interposition vein graft. There were three sources of vein graft: four utilized the great saphenous vein, two utilized the cephalic vein and two utilized the exterior jugular vein. The average length of the vein graft was 4.5 cm. Due to the high success rate of this study, the inter-position vein graft is
Reconstructive Surgery
Sciences and Hospital, Dharwad, Karnataka 580009, India Management of sino-nasal pathology is always a challenge and achieving satisfactory results has lead to evolution of various techniques. Frequently oral cancer necessitates the complete or partial resection of the maxilla apart from the very loss of osseous structure due to trauma or infections, leaving the patient with a defect that compromises with the integrity and function of the oral and nasal cavities. In this paper we have tried to evaluate the various kinds of maxillectomies and the surgical and prosthetic rehabilitation performed thereafter, in the Craniofacial Unit, Dept. of Oral and Maxillofacial Surgery, S.D.M. College of Dental Sciences, Dharwad. Reconstruction of midfacial defects and rehabilitation of facial contours and oronasal functions can be achieved by immediate and delayed procedures involving surgical as well as prosthetic modalities. By careful consideration of the factors like the aggressiveness and extent of the pathology, age of the patient and the functional and aesthetic needs of the patient we can formulate a treatment plan to achieve the best possible outcome. doi:10.1016/j.ijom.2007.08.348
O14.22 Needs and trends for corals in oral and maxillofacial defects M. Misra*, B. Vikraman, M. Veerabahu Department of Oral & Maxillofacial Surgery, Ragas Dental College & Hospital, 2/102, East Coast Road, Uthandi, Chennai 600119, India Reconstruction with bone grafts has long been a challenge to surgeons. Research on the feasibility of using natural coral as a resorbable bone graft substitute has been underway from past three decades. Natural coral porous calcium carbonate appears to be a clinically useful bone replacement graft material that gains essentially or slightly better responses in osseous defects than other replacement graft materials. The objective of this paper is to evaluate the ease of preparing a potential alloplastic bone substitute and its use for different bone grafting procedures for application as grafting material filling various oral and maxillofacial defects. Method: A total number of eight patients with different oromaxillofacial defects received natural coral derived from Madrepora. They were
reviewed for 4–8 weeks and were evaluated both clinically and radiographically until the coral was replaced by bone completely. Results: Only in one case the graft was exposed and had to be removed. Rest of the cases had no complication. Conclusion: An ideal bone grafting material should be one that is biologically inert, readily available, easily adaptable to the site in terms of shape and size and replaceable by host bone. The coral fulfils all the requirements and can be increasingly used as a bone substitute. doi:10.1016/j.ijom.2007.08.349
O14.23 Allogenic bone grafting after cyst enucleation B. K. Das*, M. M. Iqbal, E. Islam, Q. B. Rahman, M. Ahammed, M. R. Molla Bangabandu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh Cyst of the mandible and maxilla require surgical intervention followed by with or without bone graft. After conventional treatment like enucleation of large cyst, severe facial deformity may occur, and also may produce some other complications. This deformity may be restored and complication may be prevented by use of different types of bone graft. Lyophilized freeze dried bank bone can be used to eliminate the need of a second site operation and reduces the rate of donor site morbidity, minimizes surgical shock, reduces surgical time, shortening healing time and decreases the chances of postoperative infection or complication. Total 52 patients were treated in OMS Department of BSMMU. Among them, after enucleation, 27 cases were treated with allograft and 25 cases were treated without graft. It was observed that only one patient had infection in case of allograft but four other patients had infection treated without allograft. Other observations show use of allograft is better in all respect than without graft. doi:10.1016/j.ijom.2007.08.350
O14.24 Orofacial reconstruction and postoperative assessment of quality of life T. Zachariah*, I. A. Motiwala, M. Baliga Department of Oral & Maxillofacial Surgery, Manipal College of Dental
Sciences, Kasturba Medical College & Hospital, Lighthouse Hill Road, Mangalore 575001, Karnataka, India Objectives: Orofacial defects after tumour extirpation present surgeons with some of the greatest challenges in reconstructive surgery. The intricate interaction between form, function and appearance is greater in this anatomical subsite than any other. In this study, we attempted to evaluate the flap choices available for orofacial reconstruction after tumour resection and the quality of life thereafter. Methods: We studied the buccal fat pad, tongue, nasolabial, sternocleidomastoid, temporalis and pectoralis major flaps for orofacial reconstruction with/without mandibular reconstruction from the last 5 years in our unit. Assessment of quality of life was based on the EORTC (European Organization for Research and Treatment of Cancer) and UW-QOL (University of Washington – Quality of Life) protocols. Results: Effect on oral incompetence was most significant. doi:10.1016/j.ijom.2007.08.351
O14.25 Does the application of vein grafting in head and neck free flaps work? C.-H. Lo*, T.-S. Lin, W.-S. Hsu, F.-H. Lee Maxillofacial Department, St. Martin De Porres Hospital, Chia Yi City, Taiwan With microvascular techniques and instruments improving, we now do more and more flaps in head and neck reconstructions. The basic requirement for a good success rate of free flap anastomosis is to have well prepared recipient vessels. But patients with a history of previous treatments on neck or recurrent disease make it more difficult to prepare these. So an interposition vein graft is necessary at this crucial point. From February 2001 to February 2007, we did 132 free flaps on 123 patients. There were eight flaps which required interposition vein grafts, one for LD flap, one for ALT flap, three for fibula flaps and three for radial forearm flaps. The total free flap success rate was 95%. The vein graft success rate was 88%, one vein graft failed. In this study only the vein required an interposition vein graft. There were three sources of vein graft: four utilized the great saphenous vein, two utilized the cephalic vein and two utilized the exterior jugular vein. The average length of the vein graft was 4.5 cm. Due to the high success rate of this study, the inter-position vein graft is