- Email: [email protected]
Clinical and patient subjective evaluation of different reconstruction methods in mandibular defects
584 Free Papers—Poster Presentations production will be presented. The implants were produced for a particular patient individually with high accuracy in order to achieve not only fully functional, but also aesthetic defect replacements. Conclusion: Individual implants compensate the loosed function and repair patient’s aesthetic visage, reduce time necessary for surgery and are comfortable for surgeons during the surgery. doi:10.1016/j.ijom.2009.03.652
P180 Suction drainage of odontogenic keratocysts of the mandible B. Liu ∗ , Y.F. Zhao, W.F. Zhang Department of Oral and Maxillofacial Surgery, School of Stomatology, Wuhan University, Wuhan, Hubei Province, China
Background and Objectives: The aim of this study was to evaluate the effects of suction drainage on odontogenic keratocysts (OKCs) of the mandible and its role in conjunction with curettage. To analyse the effect of suction drainage on Ki-67 and IPO-38 labelling indices of odontogenic keratocysts before and after suction drainage. Methods: Biopsy and suction drainage were performed simultaneously in 39 cases of OKC of the mandible. Clinical and radiological examinations of these patients were carried out regularly. The curettage via intraoral incision was completed until the extent of disease significantly shrunk. The volume of the cavity and area of the cyst on a panoramic radiograph were measured preoperatively and postoperatively. The labelling index (LI), employing two cell proliferation markers IPO-38 and Ki-67, was studied by the immunohistochemical technique. From preoperative and postoperative specimens of each case were stained with monoclonal antibodies for IPO-38 and Ki-67 respectively. The labelling indices for Ki-67 and IPO38 were recorded and compared between fields. Comparison was made between preoperative and postoperative labelling indices. Results: After a mean duration of suction drainage of 5.5 months, the size of OKCs had shrunk by a mean of 62.4% based on the panoramic radiographs findings. A parakeratinised epithelium was transformed into a hyperplastic, stratified, nonkeratinising squamous epithelium after suction drainage in 37 cases (94.9%), and higher inflammatory density was found postoperatively than preoperatively. Postoperatively, there was higher inflammatory
density in metaplastic epithelium than in classic OKC epithelium. The radiolucent area of cyst on a panoramic radiograph was linearly related to the volume in the cavity. The average LIs for Ki-67 and IPO-38 were lower postoperatively than preoperatively, and with LI for Ki-67 significantly lower (P = 0.021). When postoperative LI for Ki-67 in metaplastic epithelium was compared with that in classic parakeratinised epithelium, there was a decreased LI in the former (P = 0.033). No complication occurred after curettage and no recurrence appeared with an average follow-up of 4 years. Conclusions: It appears that suction drainage resulted in the classic parakeratinised epithelium of OKC transformed histologically to metaplastic squamous epithelium and induced new bone formation surrounding the cyst. It preserved anatomical structures and reduced recurrence after secondary curettage. doi:10.1016/j.ijom.2009.03.653
P181 Clinical and patient subjective evaluation of different reconstruction methods in mandibular defects Q. Wan Department of Oral and Maxillofacial Surgery, School of Stomatology, Wuhan University, Wuhan, Hubei Province, China
Background and Objectives: To evaluate retrospectively the clinical and patient subjective outcomes of different reconstruction methods in mandibular defects. Methods: A retrospective analysis of 254 patients undergoing reconstruction of mandibular defects over the past 15 years was performed. The patients were divided into four groups according to the reconstruction methods: free bone grafts (FBG group; n = 122); particulate bone cancellous marrow grafts (PBCM group; n = 91); reconstruction plates (RP group; n = 22); microvascular free flaps (MFF group; n = 19). The clinical history review, clinical and radiological examination, and questionnaires were performed to compare the survival rates, complication rates, functional and aesthetic results among four groups. Sample characteristics were described with descriptive statistics and comparisons of results among the groups were made with Fisher exact tests (alpha = 0.05). Results: The mean follow-up was 58.7 months (range, 3–176 months), lost 31 patients. 9 patients died, survival rate was
lowest in RP group (P = 0.02). 14 patients had complications, complication rates were no significant different among four groups (P = 0.45). The functional and aesthetic comparison showed that mastication, diet, satisfaction of facial appearance, oral continence, social activities, and speech were no significant different among four groups (P > 0.05 respectively). The bite force was lowest in RP group (P = 0.012). Conclusions: This study demonstrates that clinically and patient subjectively evaluated results of the four reconstruction methods were no significant different. According patient’s etiopathogenesis, diseased region, treatment planning, age, sexuality, and occupation, etc., to choose the optimal method for each patient is the key factor to get the best prognosis. doi:10.1016/j.ijom.2009.03.654
P182 Are routine prophylactic dalteparin doses appropriate in patients undergoing head and neck cancer resection and reconstruction? S.E. Bond Department of Maxillofacial Surgery, The John Radcliffe Hospital, Headington, Oxford, United Kingdom
The use of free flap surgery for reconstruction following head and neck cancer has become routine practise. Intra- or postoperative anastomotic thrombosis is the leading cause of flap failure occurring most frequently during the first two postoperative days. In an attempt to address this, approximately 96% of microsurgeons report to routinely use anticoagulants. Additionally, this group of patients are at increased risk of postoperative venous thromboembolism (VTE), and the need for adequate prophylaxis critical. Low molecular weight heparins (LMWH) have broadly replaced unfractionated heparin due to more preferable pharmacokinetics and a better safety profile. With only a moderate prolonging effect on the activated partial thromboplastic time, anti-Xa levels are preferentially used to monitor LMWH therapy. For dalteparin the manufacturer recommends the peak anti-Xa level to be 0.5–1.0 U/mL and the trough > 0.1 U/mL. The adverse outcomes in patients with acute coronary syndrome with subtherapeutic anti-Xa levels have been reported. The aim of this study was to review the anti-Xa response to standard dalteparin prophylaxis in patients following free flap surgery for head and neck
P180 Suction drainage of odontogenic keratocysts of the mandible B. Liu ∗ , Y.F. Zhao, W.F. Zhang Department of Oral and Maxillofacial Surgery, School of Stomatology, Wuhan University, Wuhan, Hubei Province, China
Background and Objectives: The aim of this study was to evaluate the effects of suction drainage on odontogenic keratocysts (OKCs) of the mandible and its role in conjunction with curettage. To analyse the effect of suction drainage on Ki-67 and IPO-38 labelling indices of odontogenic keratocysts before and after suction drainage. Methods: Biopsy and suction drainage were performed simultaneously in 39 cases of OKC of the mandible. Clinical and radiological examinations of these patients were carried out regularly. The curettage via intraoral incision was completed until the extent of disease significantly shrunk. The volume of the cavity and area of the cyst on a panoramic radiograph were measured preoperatively and postoperatively. The labelling index (LI), employing two cell proliferation markers IPO-38 and Ki-67, was studied by the immunohistochemical technique. From preoperative and postoperative specimens of each case were stained with monoclonal antibodies for IPO-38 and Ki-67 respectively. The labelling indices for Ki-67 and IPO38 were recorded and compared between fields. Comparison was made between preoperative and postoperative labelling indices. Results: After a mean duration of suction drainage of 5.5 months, the size of OKCs had shrunk by a mean of 62.4% based on the panoramic radiographs findings. A parakeratinised epithelium was transformed into a hyperplastic, stratified, nonkeratinising squamous epithelium after suction drainage in 37 cases (94.9%), and higher inflammatory density was found postoperatively than preoperatively. Postoperatively, there was higher inflammatory
density in metaplastic epithelium than in classic OKC epithelium. The radiolucent area of cyst on a panoramic radiograph was linearly related to the volume in the cavity. The average LIs for Ki-67 and IPO-38 were lower postoperatively than preoperatively, and with LI for Ki-67 significantly lower (P = 0.021). When postoperative LI for Ki-67 in metaplastic epithelium was compared with that in classic parakeratinised epithelium, there was a decreased LI in the former (P = 0.033). No complication occurred after curettage and no recurrence appeared with an average follow-up of 4 years. Conclusions: It appears that suction drainage resulted in the classic parakeratinised epithelium of OKC transformed histologically to metaplastic squamous epithelium and induced new bone formation surrounding the cyst. It preserved anatomical structures and reduced recurrence after secondary curettage. doi:10.1016/j.ijom.2009.03.653
P181 Clinical and patient subjective evaluation of different reconstruction methods in mandibular defects Q. Wan Department of Oral and Maxillofacial Surgery, School of Stomatology, Wuhan University, Wuhan, Hubei Province, China
Background and Objectives: To evaluate retrospectively the clinical and patient subjective outcomes of different reconstruction methods in mandibular defects. Methods: A retrospective analysis of 254 patients undergoing reconstruction of mandibular defects over the past 15 years was performed. The patients were divided into four groups according to the reconstruction methods: free bone grafts (FBG group; n = 122); particulate bone cancellous marrow grafts (PBCM group; n = 91); reconstruction plates (RP group; n = 22); microvascular free flaps (MFF group; n = 19). The clinical history review, clinical and radiological examination, and questionnaires were performed to compare the survival rates, complication rates, functional and aesthetic results among four groups. Sample characteristics were described with descriptive statistics and comparisons of results among the groups were made with Fisher exact tests (alpha = 0.05). Results: The mean follow-up was 58.7 months (range, 3–176 months), lost 31 patients. 9 patients died, survival rate was
lowest in RP group (P = 0.02). 14 patients had complications, complication rates were no significant different among four groups (P = 0.45). The functional and aesthetic comparison showed that mastication, diet, satisfaction of facial appearance, oral continence, social activities, and speech were no significant different among four groups (P > 0.05 respectively). The bite force was lowest in RP group (P = 0.012). Conclusions: This study demonstrates that clinically and patient subjectively evaluated results of the four reconstruction methods were no significant different. According patient’s etiopathogenesis, diseased region, treatment planning, age, sexuality, and occupation, etc., to choose the optimal method for each patient is the key factor to get the best prognosis. doi:10.1016/j.ijom.2009.03.654
P182 Are routine prophylactic dalteparin doses appropriate in patients undergoing head and neck cancer resection and reconstruction? S.E. Bond Department of Maxillofacial Surgery, The John Radcliffe Hospital, Headington, Oxford, United Kingdom
The use of free flap surgery for reconstruction following head and neck cancer has become routine practise. Intra- or postoperative anastomotic thrombosis is the leading cause of flap failure occurring most frequently during the first two postoperative days. In an attempt to address this, approximately 96% of microsurgeons report to routinely use anticoagulants. Additionally, this group of patients are at increased risk of postoperative venous thromboembolism (VTE), and the need for adequate prophylaxis critical. Low molecular weight heparins (LMWH) have broadly replaced unfractionated heparin due to more preferable pharmacokinetics and a better safety profile. With only a moderate prolonging effect on the activated partial thromboplastic time, anti-Xa levels are preferentially used to monitor LMWH therapy. For dalteparin the manufacturer recommends the peak anti-Xa level to be 0.5–1.0 U/mL and the trough > 0.1 U/mL. The adverse outcomes in patients with acute coronary syndrome with subtherapeutic anti-Xa levels have been reported. The aim of this study was to review the anti-Xa response to standard dalteparin prophylaxis in patients following free flap surgery for head and neck