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Beware of the awareness
486 Free Papers—Oral Presentations
O9.35 Cryosurgery—its development and future H. Mahendra ∗ , M. Kohli, N. Sharma, L.C. Gupta Department of Oral and Maxillofacial Surgery, Saraswati Dental College and Hospital, Rajendra Nagar, Lucknow, Uttar Pradesh, India
Therapeutic use of cold temperature has existed for a long time in the medical setting, first and foremost for its anaesthetising effects. A review of the history of cryosurgery shows that it has progressed in leaps, and that each leap has usually been triggered by immediately preceding technologic innovations. The fact that the application of temperatures lower than −100 ◦ C could induce cell death was supported by Schreuder’s investigations. Today, the major aim of cryosurgery is destruction of diseased tissue, such as benign and malignant neoplasms, by application of exceedingly low temperature. Over the past 4 decades, it has become an important, widely used, and increasingly indispensable method of treatment, providing excellent results that are equivalent, and often superior, to those with other surgical modalities. Modern cryosurgery achieves efficiency and effectiveness through good, uncomplicated surgical results, a high cure rate, and a high quality of life for patients. The “power of cold” needs to be understood and accepted by many more surgeons and other therapists. This paper includes all the pros and cons of development of cryosurgery and its future. doi:10.1016/j.ijom.2009.03.316
O9.36 Beware of the awareness K. Moturi Department of Oral and Maxillofacial Surgery, Vishnu Dental College, Vishnupur, Bhimavaram, Andhra Pradesh
Awareness during general anaesthesia is a serious complication with potential long-term psychological consequences. Because of the routine use of neuromuscular blocking agents, the patient is often unable to communicate with the surgical team, if it occurs. Its occurrence is reported to be 2 in 1000 anaesthetic cases. This is more common in hemodynamically unstable patients or patients undergoing cardiac, obstetric or major traumatic surgeries. Awareness during elective maxillofacial surgical procedures is a rare entity and not many cases have been reported, but it
occurs. Patients who undergo this horrific situation require a long-term psychological support therapy to overcome posttraumatic stress. This presentation deals with the causes, various protocols and algorithms used to reduce its incidence. We also report a case of awareness under general anaesthesia for an orthognathic surgery with emphasis on our Prevention and Management protocol. doi:10.1016/j.ijom.2009.03.317
O9.37 Rhytidectomy vs retromandibular approaches for open reduction and internal fixation of mandibular condyle—a comparative study S. Shetty Department of Oral and Maxillofacial Surgery, J.S.S. Dental College and Hospital, Mysore, Karnataka, India
Background and Objectives: Various approaches have been described to gain access to the mandibular condyle. The retromandibular incision is one of the most common approaches used. Few authors in recent times advocate the rhytidectomy approach to overcome problems associated with other approaches. The objectives of this study were to evaluate the clinical outcome and morbidity of rhytidectomy and retromandibular approaches and to compare both in terms of their outcome in open reduction and internal fixation (ORIF) of mandibular condyle. Methods: Thirty patients with condylar fractures were randomly divided into two groups of 15 each. Group I underwent ORIF via the rhytidectomy approach and Group II via the retromandibular approach. The patients were assessed for duration of surgery, surgical access, anatomic reduction, facial nerve morbidity, scarring and other complications. Results: There was a statistically significant difference between the two groups in the duration of surgery, surgical access and postoperative scarring. Duration of surgery was found to be significantly lesser for group II, access better in group I and well camouflaged scar in group I. There was no statistical significance in facial nerve morbidity between the two groups. Conclusion: The rhytidectomy incision has all the advantages of the retromandibular approach with an added advantage of a less conspicuous scar and a wider exposure of the fracture site. The only disadvantage is the added time required for the closure which is not a concern as
the aesthetic outcome of this technique is superior to the other approaches. doi:10.1016/j.ijom.2009.03.318
O9.38 Outcome of minimally invasive management of salivary calculi in 4691 patients L. Zhang ∗ , H. Iro, J. Zenk, M.P. Escudier, O. Nahlieli, P. Capaccio, P. Katz, J.E. Brown, M. McGurk Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
Background and Objectives: To evaluate the application of minimally invasive techniques in the management of salivary calculi. Methods: Observational study of 5528 consecutive sialolithiasis patients treated by minimally invasive methods, including lithotripsy, endoscopy, basket retrieval and/or surgery in five specialist centres from 1990 to 2004. A total of 567 cases were excluded leaving 4691 patients (parotid n = 1165: submandibular = 3526) for analysis. Data concerning salivary calculi was collated retrospectively. Results: Salivary calculi were eliminated in 3775/4691 (80.5%) of cases and partly cleared in 782/4691 (16.7%). Salivary glands were removed in 134/4691 (2.8%) of patients with symptoms in whom treatment failed. Conclusion: Minimally invasive techniques move treatment of salivary calculi to an outpatient or a day case setting. They are reliable ways of both retrieving stones and eliminating symptoms, and mean that the gland rarely has to be removed. doi:10.1016/j.ijom.2009.03.319
O9.39 The relationship between the degree of enophthalmos and the change of orbital volume following orbital fracture Z.Y. Zhang ∗ , Y. Zhang, Y. He, J.G. An Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
Background and Objectives: This study is aimed to analyse the relationship between the degree of enophthalmos and the change of orbital volume following orbital fracture. Methods: Computed tomography-data based computer-aided measurement was applied to evaluate the whole orbital
O9.35 Cryosurgery—its development and future H. Mahendra ∗ , M. Kohli, N. Sharma, L.C. Gupta Department of Oral and Maxillofacial Surgery, Saraswati Dental College and Hospital, Rajendra Nagar, Lucknow, Uttar Pradesh, India
Therapeutic use of cold temperature has existed for a long time in the medical setting, first and foremost for its anaesthetising effects. A review of the history of cryosurgery shows that it has progressed in leaps, and that each leap has usually been triggered by immediately preceding technologic innovations. The fact that the application of temperatures lower than −100 ◦ C could induce cell death was supported by Schreuder’s investigations. Today, the major aim of cryosurgery is destruction of diseased tissue, such as benign and malignant neoplasms, by application of exceedingly low temperature. Over the past 4 decades, it has become an important, widely used, and increasingly indispensable method of treatment, providing excellent results that are equivalent, and often superior, to those with other surgical modalities. Modern cryosurgery achieves efficiency and effectiveness through good, uncomplicated surgical results, a high cure rate, and a high quality of life for patients. The “power of cold” needs to be understood and accepted by many more surgeons and other therapists. This paper includes all the pros and cons of development of cryosurgery and its future. doi:10.1016/j.ijom.2009.03.316
O9.36 Beware of the awareness K. Moturi Department of Oral and Maxillofacial Surgery, Vishnu Dental College, Vishnupur, Bhimavaram, Andhra Pradesh
Awareness during general anaesthesia is a serious complication with potential long-term psychological consequences. Because of the routine use of neuromuscular blocking agents, the patient is often unable to communicate with the surgical team, if it occurs. Its occurrence is reported to be 2 in 1000 anaesthetic cases. This is more common in hemodynamically unstable patients or patients undergoing cardiac, obstetric or major traumatic surgeries. Awareness during elective maxillofacial surgical procedures is a rare entity and not many cases have been reported, but it
occurs. Patients who undergo this horrific situation require a long-term psychological support therapy to overcome posttraumatic stress. This presentation deals with the causes, various protocols and algorithms used to reduce its incidence. We also report a case of awareness under general anaesthesia for an orthognathic surgery with emphasis on our Prevention and Management protocol. doi:10.1016/j.ijom.2009.03.317
O9.37 Rhytidectomy vs retromandibular approaches for open reduction and internal fixation of mandibular condyle—a comparative study S. Shetty Department of Oral and Maxillofacial Surgery, J.S.S. Dental College and Hospital, Mysore, Karnataka, India
Background and Objectives: Various approaches have been described to gain access to the mandibular condyle. The retromandibular incision is one of the most common approaches used. Few authors in recent times advocate the rhytidectomy approach to overcome problems associated with other approaches. The objectives of this study were to evaluate the clinical outcome and morbidity of rhytidectomy and retromandibular approaches and to compare both in terms of their outcome in open reduction and internal fixation (ORIF) of mandibular condyle. Methods: Thirty patients with condylar fractures were randomly divided into two groups of 15 each. Group I underwent ORIF via the rhytidectomy approach and Group II via the retromandibular approach. The patients were assessed for duration of surgery, surgical access, anatomic reduction, facial nerve morbidity, scarring and other complications. Results: There was a statistically significant difference between the two groups in the duration of surgery, surgical access and postoperative scarring. Duration of surgery was found to be significantly lesser for group II, access better in group I and well camouflaged scar in group I. There was no statistical significance in facial nerve morbidity between the two groups. Conclusion: The rhytidectomy incision has all the advantages of the retromandibular approach with an added advantage of a less conspicuous scar and a wider exposure of the fracture site. The only disadvantage is the added time required for the closure which is not a concern as
the aesthetic outcome of this technique is superior to the other approaches. doi:10.1016/j.ijom.2009.03.318
O9.38 Outcome of minimally invasive management of salivary calculi in 4691 patients L. Zhang ∗ , H. Iro, J. Zenk, M.P. Escudier, O. Nahlieli, P. Capaccio, P. Katz, J.E. Brown, M. McGurk Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
Background and Objectives: To evaluate the application of minimally invasive techniques in the management of salivary calculi. Methods: Observational study of 5528 consecutive sialolithiasis patients treated by minimally invasive methods, including lithotripsy, endoscopy, basket retrieval and/or surgery in five specialist centres from 1990 to 2004. A total of 567 cases were excluded leaving 4691 patients (parotid n = 1165: submandibular = 3526) for analysis. Data concerning salivary calculi was collated retrospectively. Results: Salivary calculi were eliminated in 3775/4691 (80.5%) of cases and partly cleared in 782/4691 (16.7%). Salivary glands were removed in 134/4691 (2.8%) of patients with symptoms in whom treatment failed. Conclusion: Minimally invasive techniques move treatment of salivary calculi to an outpatient or a day case setting. They are reliable ways of both retrieving stones and eliminating symptoms, and mean that the gland rarely has to be removed. doi:10.1016/j.ijom.2009.03.319
O9.39 The relationship between the degree of enophthalmos and the change of orbital volume following orbital fracture Z.Y. Zhang ∗ , Y. Zhang, Y. He, J.G. An Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
Background and Objectives: This study is aimed to analyse the relationship between the degree of enophthalmos and the change of orbital volume following orbital fracture. Methods: Computed tomography-data based computer-aided measurement was applied to evaluate the whole orbital