- Email: [email protected]
Bilateral cleft lip repair: an outcome assessment
Abstracts Complications in orthognathic surgery, what do we tell our patients? A.G. Becking Academic Medical and Academic Centre Dentistry (ACTA), Amsterdam, The Netherlands Good clinical practice comprises complication management according to local, national and/or international guidelines. Distinction between calculated risks and complications are merely made to ease the minds of clinicians. For patients, terminology is not relevant; all adverse outcomes are considered complications. Technical issues as bad splits and sensory disturbances are rather easily assessable: incidences are known and can be categorised and shared with future patients as statistic changes. Planning errors do occur at relevant levels in orthognathic surgery and they may lead to unacceptable outcomes and reoperations. Asymmetries may in this respect be more prone to planning errors and changes may be depending on complexity of the caseload and skills and experience of the surgical team. These items are harder to discuss, on an individual basis, but need attention. Psychological issues and dissatisfaction are not uncommon in orthognathic cases and are merely based on cosmetic expectancies and outcomes. Case selection is paramount in this respect and it may be argued that a psychological assessment is mandatory as part of an orthognathic work-up. On an international level, the other race effect or the other race bias may be an important factor to cope with in planning orthognathic surgery. An orthognathic surgeon ideally should be informed and familiar with different ethnic canons, if not third party consultation or referral may be indicated to prevent miscommunication and complications. http://dx.doi.org/10.1016/j.ijom.2017.02.030 Diagnosis and treatment of unilateral condylar hyperplasia A.G. Becking Academic Medical and Academic Centre Dentistry (ACTA), Amsterdam, The Netherlands Unilateral condylar hyperplasia (UHC) is the most common growth disorder of the mandible. However, aetiology, incidence and histopathology remain an enigma. It is considered a unilateral disease of the mandible, producing a growth-resembling enlargement of the hemimandible. However, the resulting asymmetry is pluriform and not well understood. Diagnosis is first aimed at progression of the disease, maybe necessitating a condylectomy and secondly at the asymmetry and its indication for orthodontics, orthognathic surgery and adjunctive symmetry correcting procedures. Current treatment concepts combine therapies, to shorten treatment time, but overtreatment may be a serious problem. A treatment plan for patients with UCH needs to be tailor made, with some use of current algorithms, but still need to be individualised towards patients needs and wishes. Some minimal invasive surgical procedures and threedimensional virtual planning concepts will be included in current treatment protocols for condylar hyperplasia. http://dx.doi.org/10.1016/j.ijom.2017.02.031
9
Transoral robotic surgery for head and neck cancer R.B. Bell Providence Cancer Center, Portland, OR, United States The Food and Drug Administration approved transoral robotic surgery (TORS) in 2009 for surgical treatment of head and neck cancer and since that time there are an increasing number of patients being treated with a transoral surgical approach in an effort to tailor and de-escalate therapy where possible. There is now 2–5 year follow-up data that locoregional control using TORS with risk adapted adjuvant therapy is at least not inferior to definitive radiation/chemoradiation for the treatment of human papillomavirus-associated oropharyngeal squamous cell carcinoma. Though survival outcomes are excellent with either modality, the major benefit of surgery in this setting is that it allows the treatment to be tailored based upon histopathologic interrogation and risk stratification, thereby eliminating the need for radiation therapy or chemotherapy in some patients and potentially resulting in a lower incidence of dysphagia and long-term gastrostomy tube dependence as well as better quality of life indices. This lecture will review the current indications and techniques for TORS, provide an update on currently accruing clinical trials, and explore future directions and technological innovations. http://dx.doi.org/10.1016/j.ijom.2017.02.032 Three-dimensional tools in cleft and craniofacial surgery S. Berge Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands Documentation, diagnosis, analysis, treatment planning and surgery of orthognathic, cleft, craniofacial and patients with complex facial problems improved using information from the cone-beam computed tomography scan, the three-dimensional (3D) stereophotogrammetry and intraoral scanning. The information from all separate techniques finally resulted in an augmented model of the head with accurate textured soft tissue information, accurate skeletal information and accurate dental information. This new method proved to be a non time-consuming, patient and user-friendly method and seemed not to be prone to errors. Nowadays, all orthognathic, cleft, oncology, trauma, implantology in craniofacial patients at the Nijmegen department are planned completely in a 3D environment using this augmented model technique. Based on this information, we will present the added value of 3D-printing, intraoperative navigation, augmented reality, robotica and further automation of surgical procedures. This presentation has a focus on the added value of 3D imaging in cleft and craniofacial surgery. http://dx.doi.org/10.1016/j.ijom.2017.02.033 Bilateral cleft lip repair: an outcome assessment K. Bonanthaya Bhagwan Mahaveer Jain Hospital, Bangalore, India Cleft lip and palate is the most common birth anomaly of the face with prevalence of 1:800 live births. Treatment of bilateral cleft lip and more importantly the assessment of the outcome pose a major
10
Abstracts
challenge to the surgeon, as there is no standard or universally accepted scale to measure the results. Studies in the past have described methods to assess the outcome of unilateral cleft lip cases. In this study, we have assessed the outcomes of the repair of bilateral cleft lip cases using a newly developed scale taking into account the lip, nasal components of the repair and the scar assessment using two-dimensional photographs in frontal and worms eye views 6 months postoperatively. The scale aims at overcoming the shortcomings of other outcome measures and need of software analysis that is expensive and time consuming. The introduction of this scale will help identification of the areas that require secondary correction and also is easy and simple to use. Our studies indicate that this scoring system when used consistently can help in evaluating the outcomes of various techniques, and might provide an insight to the most pertinent technique in future and also help to improve outcomes by focusing on the areas that need further correction. http://dx.doi.org/10.1016/j.ijom.2017.02.034 Bilateral cleft lip revision: techniques and results K. Bonanthaya Bhagwan Mahaveer Jain Hospital, Bangalore, India Bilateral cleft lip deformities can be difficult to correct and it is universally agreed that a large number of cases will require further revisions after the primary repair. The need for secondary repair and the type of secondary deformities is determined by the following: 1. Type and severity of the initial cleft. 2. The principles applied in the primary repair of these deformities. This presentation will look at the effect of different principles applied during the primary repair and how to manage the secondary deformities resulting from use of different principles of repair. The principles of repair will be considered under the following heads: 1. Presurgical orthopaedics 2. Lip adhesion procedures 3. Staging of bilateral lip repair 4. The utilisation of the prolabial tissues 5. Muscle approximation 6. Reconstruction of the central vermilion 7. Sulcal release incision 8. Management of the nasal deformities. http://dx.doi.org/10.1016/j.ijom.2017.02.035 Orthognathic surgery in cleft and craniofacial patients P. Bordbar The Royal Children’s Hospital, The Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia Orthognathic surgery is used to surgically correct dentofacial deformities. This is usually in conjunction with orthodontic treatment. These dentofacial deformities may be acquired or congenital in nature. In the latter group, the management of the cleft and craniofacial patient can present some additional challenges, and considerations, for the clinicians involved in caring for these patients.
This presentation will provide an overview of current treatment pathways and objectives for these patients as part of multidisciplinary team within a tertiary setting. Case presentations will be used to demonstrate treatment challenges, including consideration of complex medical co-morbidities, psychosocial interactions, anatomical variations, missing soft and hard tissues, including missing and malformed teeth. http://dx.doi.org/10.1016/j.ijom.2017.02.036 Is there a difference in frequency and type of maxillary sinus septa between dentate and edentulous posterior maxillae? M.M. Bornstein ∗ , M. Schriber, P. Sendi, T. von Arx, V.G.A. Suter Applied Oral Sciences, Faculty of Dentistry, The University of Hong Kong, Prince Philip Dental Hospital, Hong Kong Background and Objectives: To evaluate and compare the frequency, type and origin of maxillary sinus septa in patients with a dentate and an edentulous posterior maxilla using cone-beam computed tomography (CBCT) imaging. Methods: The study included 100 maxillary sinuses – 50 from patients with a dentate and 50 from patients with an edentulous posterior maxilla – to evaluate the frequency, morphology and location of maxillary sinus septa in axial, sagittal and coronal CBCT images. Differences regarding age, gender, side, septa location and type of dentition (dentate/edentulous posterior maxilla) were analysed. Findings: The mean age of the patients was 58.3 years. A total of 60 sinus septa were found in exactly half of the evaluated sinuses. Most of the septa were located on the floor of the maxillary sinus (n = 34; 56.7%). Of these, the majority was found in the region of the second maxillary molars (n = 27; 79.4%). Regarding the distribution of sinus septa, septa were present in 26 (52%) dentate and in 24 (48%) edentulous regions. Thus, for a potential influence of the status of the dentition in the posterior maxilla on the frequency of sinus septa, no significant impact was found (P = 0.69). Conclusions: Sinus septa are equally often found in patients with a dentate and an edentulous posterior maxilla. As sinus septa are reported to be an important reason for surgical complications during sinus floor elevation procedures, a three-dimensional radiographic examination using CBCT prior to surgery might be helpful for diagnosis and treatment planning. http://dx.doi.org/10.1016/j.ijom.2017.02.037 Through and through cheek defects: a systematic review and proposition of a classification J. Bouguila La Rabta University Hospital, Tunisia Background: Reconstruction of through-and-through cheek defects has always been difficult and remains a challenging aspect of facial plastic and reconstructive surgery. Several options have been reported with variable results. No classification has been proposed in the literature for a better comparison of results and better indication of flaps. Methods: A systematic review of the literature using PubMed and Medline searches on reconstructing these defects were performed of the English literature. The PRISMA criteria were conducted. Search terms included: “reconstructive surgical procedures”, “free tissue flaps” and “cheek”.
9
Transoral robotic surgery for head and neck cancer R.B. Bell Providence Cancer Center, Portland, OR, United States The Food and Drug Administration approved transoral robotic surgery (TORS) in 2009 for surgical treatment of head and neck cancer and since that time there are an increasing number of patients being treated with a transoral surgical approach in an effort to tailor and de-escalate therapy where possible. There is now 2–5 year follow-up data that locoregional control using TORS with risk adapted adjuvant therapy is at least not inferior to definitive radiation/chemoradiation for the treatment of human papillomavirus-associated oropharyngeal squamous cell carcinoma. Though survival outcomes are excellent with either modality, the major benefit of surgery in this setting is that it allows the treatment to be tailored based upon histopathologic interrogation and risk stratification, thereby eliminating the need for radiation therapy or chemotherapy in some patients and potentially resulting in a lower incidence of dysphagia and long-term gastrostomy tube dependence as well as better quality of life indices. This lecture will review the current indications and techniques for TORS, provide an update on currently accruing clinical trials, and explore future directions and technological innovations. http://dx.doi.org/10.1016/j.ijom.2017.02.032 Three-dimensional tools in cleft and craniofacial surgery S. Berge Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands Documentation, diagnosis, analysis, treatment planning and surgery of orthognathic, cleft, craniofacial and patients with complex facial problems improved using information from the cone-beam computed tomography scan, the three-dimensional (3D) stereophotogrammetry and intraoral scanning. The information from all separate techniques finally resulted in an augmented model of the head with accurate textured soft tissue information, accurate skeletal information and accurate dental information. This new method proved to be a non time-consuming, patient and user-friendly method and seemed not to be prone to errors. Nowadays, all orthognathic, cleft, oncology, trauma, implantology in craniofacial patients at the Nijmegen department are planned completely in a 3D environment using this augmented model technique. Based on this information, we will present the added value of 3D-printing, intraoperative navigation, augmented reality, robotica and further automation of surgical procedures. This presentation has a focus on the added value of 3D imaging in cleft and craniofacial surgery. http://dx.doi.org/10.1016/j.ijom.2017.02.033 Bilateral cleft lip repair: an outcome assessment K. Bonanthaya Bhagwan Mahaveer Jain Hospital, Bangalore, India Cleft lip and palate is the most common birth anomaly of the face with prevalence of 1:800 live births. Treatment of bilateral cleft lip and more importantly the assessment of the outcome pose a major
10
Abstracts
challenge to the surgeon, as there is no standard or universally accepted scale to measure the results. Studies in the past have described methods to assess the outcome of unilateral cleft lip cases. In this study, we have assessed the outcomes of the repair of bilateral cleft lip cases using a newly developed scale taking into account the lip, nasal components of the repair and the scar assessment using two-dimensional photographs in frontal and worms eye views 6 months postoperatively. The scale aims at overcoming the shortcomings of other outcome measures and need of software analysis that is expensive and time consuming. The introduction of this scale will help identification of the areas that require secondary correction and also is easy and simple to use. Our studies indicate that this scoring system when used consistently can help in evaluating the outcomes of various techniques, and might provide an insight to the most pertinent technique in future and also help to improve outcomes by focusing on the areas that need further correction. http://dx.doi.org/10.1016/j.ijom.2017.02.034 Bilateral cleft lip revision: techniques and results K. Bonanthaya Bhagwan Mahaveer Jain Hospital, Bangalore, India Bilateral cleft lip deformities can be difficult to correct and it is universally agreed that a large number of cases will require further revisions after the primary repair. The need for secondary repair and the type of secondary deformities is determined by the following: 1. Type and severity of the initial cleft. 2. The principles applied in the primary repair of these deformities. This presentation will look at the effect of different principles applied during the primary repair and how to manage the secondary deformities resulting from use of different principles of repair. The principles of repair will be considered under the following heads: 1. Presurgical orthopaedics 2. Lip adhesion procedures 3. Staging of bilateral lip repair 4. The utilisation of the prolabial tissues 5. Muscle approximation 6. Reconstruction of the central vermilion 7. Sulcal release incision 8. Management of the nasal deformities. http://dx.doi.org/10.1016/j.ijom.2017.02.035 Orthognathic surgery in cleft and craniofacial patients P. Bordbar The Royal Children’s Hospital, The Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia Orthognathic surgery is used to surgically correct dentofacial deformities. This is usually in conjunction with orthodontic treatment. These dentofacial deformities may be acquired or congenital in nature. In the latter group, the management of the cleft and craniofacial patient can present some additional challenges, and considerations, for the clinicians involved in caring for these patients.
This presentation will provide an overview of current treatment pathways and objectives for these patients as part of multidisciplinary team within a tertiary setting. Case presentations will be used to demonstrate treatment challenges, including consideration of complex medical co-morbidities, psychosocial interactions, anatomical variations, missing soft and hard tissues, including missing and malformed teeth. http://dx.doi.org/10.1016/j.ijom.2017.02.036 Is there a difference in frequency and type of maxillary sinus septa between dentate and edentulous posterior maxillae? M.M. Bornstein ∗ , M. Schriber, P. Sendi, T. von Arx, V.G.A. Suter Applied Oral Sciences, Faculty of Dentistry, The University of Hong Kong, Prince Philip Dental Hospital, Hong Kong Background and Objectives: To evaluate and compare the frequency, type and origin of maxillary sinus septa in patients with a dentate and an edentulous posterior maxilla using cone-beam computed tomography (CBCT) imaging. Methods: The study included 100 maxillary sinuses – 50 from patients with a dentate and 50 from patients with an edentulous posterior maxilla – to evaluate the frequency, morphology and location of maxillary sinus septa in axial, sagittal and coronal CBCT images. Differences regarding age, gender, side, septa location and type of dentition (dentate/edentulous posterior maxilla) were analysed. Findings: The mean age of the patients was 58.3 years. A total of 60 sinus septa were found in exactly half of the evaluated sinuses. Most of the septa were located on the floor of the maxillary sinus (n = 34; 56.7%). Of these, the majority was found in the region of the second maxillary molars (n = 27; 79.4%). Regarding the distribution of sinus septa, septa were present in 26 (52%) dentate and in 24 (48%) edentulous regions. Thus, for a potential influence of the status of the dentition in the posterior maxilla on the frequency of sinus septa, no significant impact was found (P = 0.69). Conclusions: Sinus septa are equally often found in patients with a dentate and an edentulous posterior maxilla. As sinus septa are reported to be an important reason for surgical complications during sinus floor elevation procedures, a three-dimensional radiographic examination using CBCT prior to surgery might be helpful for diagnosis and treatment planning. http://dx.doi.org/10.1016/j.ijom.2017.02.037 Through and through cheek defects: a systematic review and proposition of a classification J. Bouguila La Rabta University Hospital, Tunisia Background: Reconstruction of through-and-through cheek defects has always been difficult and remains a challenging aspect of facial plastic and reconstructive surgery. Several options have been reported with variable results. No classification has been proposed in the literature for a better comparison of results and better indication of flaps. Methods: A systematic review of the literature using PubMed and Medline searches on reconstructing these defects were performed of the English literature. The PRISMA criteria were conducted. Search terms included: “reconstructive surgical procedures”, “free tissue flaps” and “cheek”.