- Email: [email protected]
Classification and management of head and neck vascular malformations
Abstracts
e11
Quoting Lanny Johnson; the pioneer famous orthopaedic arthroscopic surgeon saying ‘Show me the hole and I’d put the ball in’, we clearly demonstrate the ability to negotiate the joint arthroscopically with all types of advanced modalities, yet the future dictates the use of growing revolutionary tissue engineering technology in order to obviate the need to end up with open surgery and/or total joint replacement. We are now prepared to deliver regenerative products in TMJ at any site arthroscopically. All such advanced modalities are meant to end up with one purpose, which is reaching a brighter future meeting the ultimate goal of treating all TMD patients through the treatment cascade primarily arthroscopically.
in post-implantation pain? Do patients with TMJ TJR devices have enhanced sensitivity to the component materials or any other implanted device materials as a result of the tribocorrosion process? What is the relationship does bearing surface geometry have to the enhancement of the tribocorrosion process? What are the functional loads delivered to these surfaces? Micromotion leads to component loosening and device failure. Does micromotion promote the tribocorrosion process and does the tribocorrosion process promote micromotion? There are a number of labs interested in developing a bioengineered TMJ TJR device. Developing the appropriate scaffold upon which to seed the cartilage and bone cells remains under constant investigation. What might be some tribocorrosion and nanotechnology considerations?
http://dx.doi.org/10.1016/j.ijom.2015.08.951
http://dx.doi.org/10.1016/j.ijom.2015.08.953
TMJ arthroscopy: reconstruction and rejuvenation
New technologies and modern planning strategies in CMF trauma cases
J.P. McCain
1,2
1
Baptist Health Systems, Miami, FL, USA Florida International University, Faculty of Medicine, Miami, FL, USA
2
M. Metzger University Hospital Freiburg, Baden-Württemberg, Germany
The management of temporomandibular joint (TMJ) disorders from a surgeon’s perspective has improved significantly since the advent of arthroscopy. Arthroscopic observations have provided an in vivo examination of the joint. Disc position and quality, texture of articular cartilage, and vascularity and redundancy of synovium can be observed clearly and precisely. Prior to arthroscopy, joint pathology and surgical correction efforts were targeted towards disc displacement, condyle dislocation, and osteoarthrosis with osteophyte formation. Currently, the emphasis has shifted to the surgical management of the chemistry of joint space inflammation. This refocus of priorities has been successful in reducing joint pain and increasing joint mobility. Structural joint reconstruction is completed secondarily following reduction of pain, when indicated. This lecture offers an arthroscopic cascade in the overall management of the orthopedic TMJ patient with evidence based data and statistical results.
As a principle, ideas and visions constantly become real after a period of time. Affected by an incredible fast moving evolution within the digital world quantum jumps can be recorded in all kind of technologies. Internet communication offers a fast immeasurable platform bundling and designing knowledge in a self-learning process moving in an exponential spiral. One consequence at the moment is that software itself more and more is moved in server based internet application presenting better computer performance than the own PC. Even all web-based plugins for browsers will soon appear as Stone Age. A wonderful level of diagnostic and planning tools in the medical world already exist. An increasing number of production technologies such as titanium laser melting procedures are going to determine new treatment standards. However, the interexchange and the communication are still located in the analog era. In this presentation we intend to demonstrate ideas and visions to solve this problem.
http://dx.doi.org/10.1016/j.ijom.2015.08.952
http://dx.doi.org/10.1016/j.ijom.2015.08.954
Total temporomandibular joint replacement translational research and future technology
Classification and management of head and neck vascular malformations
L.G. Mercuri
S. Nair
Rush University Medical Center, Department of Orthopedic Surgery, Chicago, USA
Department of Maxillofacial Surgery, B.M. Jain Hospital, Bangalore, India
Translational research between orthopedic total joint and total temporomandibular joint replacement (TMJ TJR) offers potential answers to the biology of common complications that occur after TMJ TJR as well as the use of developing technology to improve these devices and clinical outcomes. The major complications of TMJ TJR are infection (1.57%), heterotopic bone formation (0.47%), post-implantation pain (0.16%), and material sensitivity (0.14%). Does tribocorrosion contribute to the development or enhancement of any of TMJ TJR complications? What role might nanotechnology play in either monitoring these changes in vivo or managing them so that the devices could remain in the patient? Does the tribocorrosion process set up an environment in surrounding tissues that enhances or promotes the development of infections, heterotopic bone or lead to enhancement of neurological injury or integrin formation which can all result
Vascular Anomalies of the head and neck region are by far the commonest congenital anomaly observed in infants and children. Their occurrence in the head and neck is a source of functional and aesthetic compromise. The differentiation of these anomalies into hemangiomas and vascular malformations is important in both classifying and surgically managing the lesions. Diagnosis was based on the history, behaviour and minimal imaging modality. The ability to identify early lesions allow better control with use of systemic medications. A surgical classification based on their anatomic location in the head and neck region helps formulate a treatment protocol with good functional and cosmetic outcome. Selective use of blood flow into the lesion is preoperatively determined. External carotid control was a very effective method of reducing blood supply to the lesion allowing definitive ablation.
e12
Abstracts
Evidence to prove reduction in blood supply to the lesion was demonstrated radiographically. Use of surgical access is important and planned in aesthetic units of the face and neck. The presentation aims at key diagnostic features, suggested imaging modality and careful preoperative classification and management. Total ablation is the key to successful treatment. Complications were limited to minimal morbidity and nil mortality in over 300 cases treated by the surgeon. Commonest complications are discussed. http://dx.doi.org/10.1016/j.ijom.2015.08.955 Posterior airway manipulation – an orthognathic cure for obstructive sleep apnoea (OSA) I. Ormiston University Hospitals of Leicester, Leicester, UK Background: The Cochran database on surgery for OSA in adults (2008) suggests that they cannot support the widespread use of surgery in patients with mild to moderate OSA. Objectives: We believe this to be incorrect. Maxillofacial orthognathic surgical practice encompasses the manipulation of the facial skeleton, to correct dentofacial deformity. This surgery also manipulates the posterior airway nasally retro palatally and lingually. Orthognathic procedures can therefore have an important role to play in management of OSA. Method: Maxillo mandibular advancement (MMA) ± genioplasty modifies the posterior airway at multiple levels and hence has an important role to play in OSA. Results: Our series of 52 patients1 that underwent (MMA) for moderate to severe OSA, the mean preoperative AHI was 42 (SD 17) this reduced to AHI 8 (SD 7) P < 0.001 Epworth Sleepiness Score (ESS) reduced from mean 14 preoperatively to mean 5 postoperatively P < 0.001. Success rates are in the order of 85–100%. Conclusion: These patients immediately feel better subjectively with no daytime somnolence, no nocturia, improved cognition, returning their CPAP machines almost immediately. Maxillo mandibular advancement has been shown to improve many of the metabolic conditions associated with severe OSA in addition to reducing the risks of road traffic accidents. Surgical cure is a 24 h 7 day a week correction of airway, unlike CPAP with very variable compliance.
Reference Islam, S., Uwadiae, N., & Ormiston, I. (2014). Orthognathic surgery in the management of OSA, experience from a maxillofacial unit in the UK. Br J Oral Maxillofac Surg, 52, 496–500.
have been developed to restore alveolar bone volume deficiency including; allogeneic and autogeneous onlay bone grafting with particulate bone graft, block bone graft, guided bone regeneration techniques with permanent or resorbable membranes, distraction osteogenesis, vascularized ridge splitting techniques and sinus floor augmentation. The techniques are successfully used mainly for lateral ridge augmentation in a relative small bony defect. However, the success of large vertical and horizontal bone deficiency has been associate with significant complication mainly relate to the level of soft tissue dissection to achieve tension free closure and the selection and design of the graft containment. This presentation will discuss the principles of practical bone reconstruction to optimize three dimensional alveolar bone regeneration for predictable surgical implant placement and restoration. The principles of graft containment in addition to indications, preparation, dose and proper use of graft materials and rhBMP2 will also be discussed in detail. http://dx.doi.org/10.1016/j.ijom.2015.08.957 Nerve damage from root canal filling materials T. Pogrel University of California, San Francisco, USA All root canal sealants have the potential to be neurotoxic. Depending on their chemical constituents, they can take anything from 15 min, for paraformaldehyde, to several days, for calcium hydroxide, to cause injury to a nerve (usually the inferior alveolar nerve). If nerve damage does occur, the incidence of dysesthesia is high. For the past 10 years we have tried to institute a policy of operating very early on these patients to remove any filling material in contact with the nerve. We have tried to operate within 72 h of the injury and have performed the surgery through a lateral decortication of the mandible, identification and mobilization of the inferior alveolar nerve, followed by copious irrigation and replacement of the lateral cortex. When this has been carried out within 72 h, we have had almost 100% return of sensation and elimination of dysesthesia. When carried out after 10 days, there has been very little improvement, and when no surgery is performed, only about 10% of patients with radiographic evidence of root canal material in contact with the nerve show any signs of improvement. In conclusion, very early removal of root canal filling material in contact with the inferior alveolar nerve appears to offer the best hope of resolution of symptoms. http://dx.doi.org/10.1016/j.ijom.2015.08.958
http://dx.doi.org/10.1016/j.ijom.2015.08.956
The management of the KCOT
Three dimensional alveolar bone reconstruction
T. Pogrel
M. Peleg
University of California, San Francisco, USA
University of Miami, Miller School of Medicine, Department of Surgery, Division of Oral and Maxillofacial Surgery, Miami, FL, USA
The most appropriate management for the lesion now known as the keratocystic odontogenic tumor (previously known as the odontogenic keratocyst) remains controversial. This presentation will review the different management protocols adopted by one surgical unit over the last 30 years and the results obtained from different treatment modalities. It is known that simple curettage is followed by recurrence in around fifty per cent of cases, and that segmental resection is not associated with recurrence. However, since this is a benign lesion,
Three Dimensional Alveolar Bone reconstruction remains a challenge in the reconstruction of the atrophic maxilla and mandible. The main problem arises from the need to expand the soft-tissue envelope to achieve tension free closure and proper three dimensional bony architecture. Numerous techniques
e11
Quoting Lanny Johnson; the pioneer famous orthopaedic arthroscopic surgeon saying ‘Show me the hole and I’d put the ball in’, we clearly demonstrate the ability to negotiate the joint arthroscopically with all types of advanced modalities, yet the future dictates the use of growing revolutionary tissue engineering technology in order to obviate the need to end up with open surgery and/or total joint replacement. We are now prepared to deliver regenerative products in TMJ at any site arthroscopically. All such advanced modalities are meant to end up with one purpose, which is reaching a brighter future meeting the ultimate goal of treating all TMD patients through the treatment cascade primarily arthroscopically.
in post-implantation pain? Do patients with TMJ TJR devices have enhanced sensitivity to the component materials or any other implanted device materials as a result of the tribocorrosion process? What is the relationship does bearing surface geometry have to the enhancement of the tribocorrosion process? What are the functional loads delivered to these surfaces? Micromotion leads to component loosening and device failure. Does micromotion promote the tribocorrosion process and does the tribocorrosion process promote micromotion? There are a number of labs interested in developing a bioengineered TMJ TJR device. Developing the appropriate scaffold upon which to seed the cartilage and bone cells remains under constant investigation. What might be some tribocorrosion and nanotechnology considerations?
http://dx.doi.org/10.1016/j.ijom.2015.08.951
http://dx.doi.org/10.1016/j.ijom.2015.08.953
TMJ arthroscopy: reconstruction and rejuvenation
New technologies and modern planning strategies in CMF trauma cases
J.P. McCain
1,2
1
Baptist Health Systems, Miami, FL, USA Florida International University, Faculty of Medicine, Miami, FL, USA
2
M. Metzger University Hospital Freiburg, Baden-Württemberg, Germany
The management of temporomandibular joint (TMJ) disorders from a surgeon’s perspective has improved significantly since the advent of arthroscopy. Arthroscopic observations have provided an in vivo examination of the joint. Disc position and quality, texture of articular cartilage, and vascularity and redundancy of synovium can be observed clearly and precisely. Prior to arthroscopy, joint pathology and surgical correction efforts were targeted towards disc displacement, condyle dislocation, and osteoarthrosis with osteophyte formation. Currently, the emphasis has shifted to the surgical management of the chemistry of joint space inflammation. This refocus of priorities has been successful in reducing joint pain and increasing joint mobility. Structural joint reconstruction is completed secondarily following reduction of pain, when indicated. This lecture offers an arthroscopic cascade in the overall management of the orthopedic TMJ patient with evidence based data and statistical results.
As a principle, ideas and visions constantly become real after a period of time. Affected by an incredible fast moving evolution within the digital world quantum jumps can be recorded in all kind of technologies. Internet communication offers a fast immeasurable platform bundling and designing knowledge in a self-learning process moving in an exponential spiral. One consequence at the moment is that software itself more and more is moved in server based internet application presenting better computer performance than the own PC. Even all web-based plugins for browsers will soon appear as Stone Age. A wonderful level of diagnostic and planning tools in the medical world already exist. An increasing number of production technologies such as titanium laser melting procedures are going to determine new treatment standards. However, the interexchange and the communication are still located in the analog era. In this presentation we intend to demonstrate ideas and visions to solve this problem.
http://dx.doi.org/10.1016/j.ijom.2015.08.952
http://dx.doi.org/10.1016/j.ijom.2015.08.954
Total temporomandibular joint replacement translational research and future technology
Classification and management of head and neck vascular malformations
L.G. Mercuri
S. Nair
Rush University Medical Center, Department of Orthopedic Surgery, Chicago, USA
Department of Maxillofacial Surgery, B.M. Jain Hospital, Bangalore, India
Translational research between orthopedic total joint and total temporomandibular joint replacement (TMJ TJR) offers potential answers to the biology of common complications that occur after TMJ TJR as well as the use of developing technology to improve these devices and clinical outcomes. The major complications of TMJ TJR are infection (1.57%), heterotopic bone formation (0.47%), post-implantation pain (0.16%), and material sensitivity (0.14%). Does tribocorrosion contribute to the development or enhancement of any of TMJ TJR complications? What role might nanotechnology play in either monitoring these changes in vivo or managing them so that the devices could remain in the patient? Does the tribocorrosion process set up an environment in surrounding tissues that enhances or promotes the development of infections, heterotopic bone or lead to enhancement of neurological injury or integrin formation which can all result
Vascular Anomalies of the head and neck region are by far the commonest congenital anomaly observed in infants and children. Their occurrence in the head and neck is a source of functional and aesthetic compromise. The differentiation of these anomalies into hemangiomas and vascular malformations is important in both classifying and surgically managing the lesions. Diagnosis was based on the history, behaviour and minimal imaging modality. The ability to identify early lesions allow better control with use of systemic medications. A surgical classification based on their anatomic location in the head and neck region helps formulate a treatment protocol with good functional and cosmetic outcome. Selective use of blood flow into the lesion is preoperatively determined. External carotid control was a very effective method of reducing blood supply to the lesion allowing definitive ablation.
e12
Abstracts
Evidence to prove reduction in blood supply to the lesion was demonstrated radiographically. Use of surgical access is important and planned in aesthetic units of the face and neck. The presentation aims at key diagnostic features, suggested imaging modality and careful preoperative classification and management. Total ablation is the key to successful treatment. Complications were limited to minimal morbidity and nil mortality in over 300 cases treated by the surgeon. Commonest complications are discussed. http://dx.doi.org/10.1016/j.ijom.2015.08.955 Posterior airway manipulation – an orthognathic cure for obstructive sleep apnoea (OSA) I. Ormiston University Hospitals of Leicester, Leicester, UK Background: The Cochran database on surgery for OSA in adults (2008) suggests that they cannot support the widespread use of surgery in patients with mild to moderate OSA. Objectives: We believe this to be incorrect. Maxillofacial orthognathic surgical practice encompasses the manipulation of the facial skeleton, to correct dentofacial deformity. This surgery also manipulates the posterior airway nasally retro palatally and lingually. Orthognathic procedures can therefore have an important role to play in management of OSA. Method: Maxillo mandibular advancement (MMA) ± genioplasty modifies the posterior airway at multiple levels and hence has an important role to play in OSA. Results: Our series of 52 patients1 that underwent (MMA) for moderate to severe OSA, the mean preoperative AHI was 42 (SD 17) this reduced to AHI 8 (SD 7) P < 0.001 Epworth Sleepiness Score (ESS) reduced from mean 14 preoperatively to mean 5 postoperatively P < 0.001. Success rates are in the order of 85–100%. Conclusion: These patients immediately feel better subjectively with no daytime somnolence, no nocturia, improved cognition, returning their CPAP machines almost immediately. Maxillo mandibular advancement has been shown to improve many of the metabolic conditions associated with severe OSA in addition to reducing the risks of road traffic accidents. Surgical cure is a 24 h 7 day a week correction of airway, unlike CPAP with very variable compliance.
Reference Islam, S., Uwadiae, N., & Ormiston, I. (2014). Orthognathic surgery in the management of OSA, experience from a maxillofacial unit in the UK. Br J Oral Maxillofac Surg, 52, 496–500.
have been developed to restore alveolar bone volume deficiency including; allogeneic and autogeneous onlay bone grafting with particulate bone graft, block bone graft, guided bone regeneration techniques with permanent or resorbable membranes, distraction osteogenesis, vascularized ridge splitting techniques and sinus floor augmentation. The techniques are successfully used mainly for lateral ridge augmentation in a relative small bony defect. However, the success of large vertical and horizontal bone deficiency has been associate with significant complication mainly relate to the level of soft tissue dissection to achieve tension free closure and the selection and design of the graft containment. This presentation will discuss the principles of practical bone reconstruction to optimize three dimensional alveolar bone regeneration for predictable surgical implant placement and restoration. The principles of graft containment in addition to indications, preparation, dose and proper use of graft materials and rhBMP2 will also be discussed in detail. http://dx.doi.org/10.1016/j.ijom.2015.08.957 Nerve damage from root canal filling materials T. Pogrel University of California, San Francisco, USA All root canal sealants have the potential to be neurotoxic. Depending on their chemical constituents, they can take anything from 15 min, for paraformaldehyde, to several days, for calcium hydroxide, to cause injury to a nerve (usually the inferior alveolar nerve). If nerve damage does occur, the incidence of dysesthesia is high. For the past 10 years we have tried to institute a policy of operating very early on these patients to remove any filling material in contact with the nerve. We have tried to operate within 72 h of the injury and have performed the surgery through a lateral decortication of the mandible, identification and mobilization of the inferior alveolar nerve, followed by copious irrigation and replacement of the lateral cortex. When this has been carried out within 72 h, we have had almost 100% return of sensation and elimination of dysesthesia. When carried out after 10 days, there has been very little improvement, and when no surgery is performed, only about 10% of patients with radiographic evidence of root canal material in contact with the nerve show any signs of improvement. In conclusion, very early removal of root canal filling material in contact with the inferior alveolar nerve appears to offer the best hope of resolution of symptoms. http://dx.doi.org/10.1016/j.ijom.2015.08.958
http://dx.doi.org/10.1016/j.ijom.2015.08.956
The management of the KCOT
Three dimensional alveolar bone reconstruction
T. Pogrel
M. Peleg
University of California, San Francisco, USA
University of Miami, Miller School of Medicine, Department of Surgery, Division of Oral and Maxillofacial Surgery, Miami, FL, USA
The most appropriate management for the lesion now known as the keratocystic odontogenic tumor (previously known as the odontogenic keratocyst) remains controversial. This presentation will review the different management protocols adopted by one surgical unit over the last 30 years and the results obtained from different treatment modalities. It is known that simple curettage is followed by recurrence in around fifty per cent of cases, and that segmental resection is not associated with recurrence. However, since this is a benign lesion,
Three Dimensional Alveolar Bone reconstruction remains a challenge in the reconstruction of the atrophic maxilla and mandible. The main problem arises from the need to expand the soft-tissue envelope to achieve tension free closure and proper three dimensional bony architecture. Numerous techniques