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Cranial index as an objective outcome measure in patients with sagittal synostosis—an analysis of a single surgical technique
Poster presentation / British Journal of Oral and Maxillofacial Surgery 49S (2011) S26–S116
P210 First report of use of Indomethacin in improving mouth opening and prevent re-ankylosis in TMJ ankylosis M. Shorafa ∗ , O. Shaikh, P. Ayliffe University College London Hospital, United Kingdom Introduction: Indomethacin is a non-selective inhibitor of cyclooxygenase (COX) 1 and 2, enzymes that participate in prostaglandin synthesis from arachidonic acid. Indomethacin is used most commonly for the treatment of inflammation and pain resulting from rheumatic disease. Orthopaedic surgeons have been using Indomethacin to prevent the formation of heterotopic bone after hip replacement surgery. Studies have demonstrated that Indomethacin is a potent inhibitor of local remodelling and repair of bone after trauma. To our knowledge there are no reports in the literature of its use post operatively to prevent TMJ ankylosis or its use to improve TMJ mobility. Method: Indomethacin was given to patients in the divided doses based on their weight following TMJ ankylosis surgery. Indomethacin was used over the past 4 years at our department in twenty-two patients, smaller group of eight patients were selected as control. Results: This preliminary presentation shows our finding that using Indomethacin in TMJ ankylosis either improved mouth opening or it remained the same, compared to the control group who were not administered the drug due to intolerance or parents’ refusal. Conclusions: TMJ ankylosis in children is a challenge to treat. Surgical correction may show satisfactory result but incidence of recurrence is high. Initial results for the longterm use of Indomethacin have been favourable, providing a solution for many of our patients however further research is warranted in the form of a randomized, double blind clinical trial. doi:10.1016/j.bjoms.2011.03.216 P211 Cranial index as an objective outcome measure in patients with sagittal synostosis—an analysis of a single surgical technique C. Siegmund ∗ , J. Ward, D. Rodriguez, N. White, H. Nishikawa, S. Dover, G. Solanki Department of Craniofacial Surgery, Birmingham Children’s Hospital, United Kingdom Objective: An objective outcome measure tool in craniofacial surgery is the established cranial index (CI) which is the ratio of bi-parietal to antero-posterior diameter of the skull. The aim of the study was to review the change in CI in two defined age groups presenting with scaphocephalus undergoing a single surgical technique procedure.
S101
Design: Retrospective longitudinal study comparing the pre- and post-operative CI changes of sagittal synostosis patients operated with a single surgical technique in a SupraRegional Craniofacial Unit. Subjects: 67 patients with scaphocephalus aged between 165 and 398 days (24 girls and 43 boys) who underwent surgery using a single technique. Methods: Cranial Indices were measured pre-operatively and at various follow-up appointments. Two age groups were analysed: an early age group (6 months of age at time of surgery) and a late age group (11 months). Results: Younger children (6 month age group) increase their average CI more than older infants (11 month age group) at various follow-up appointments. More importantly, there seems to be NO REGRESSION in the younger age group compared to a rate of 20% who present with REGRESSION in the older age group based on the initial pre-surgical CI values. Conclusions: The age at the time of surgery for scaphocephalic patients is important for the outcome of surgery measured by the CI improvement. doi:10.1016/j.bjoms.2011.03.217 P212 Dermoid cysts in the craniofacial region: the liverpool experience P. Sillifant ∗ , C. Duncan Alderhey Childrens Hospital, United Kingdom Dermoid cysts in craniofacial region: experience of 100 cases. Aim: Present our units experience of dermoid cysts in the craniofacial region. Background: Dermoid cysts in the craniofacial region are relatively uncommon occurrence. Dermoids occur due to problems during embryogenesis caused by defects in fusion in the craniofacial processes. Dermoids usually present in young children as a small lump under the skin with or without a punctum. However they can present without any mass as a sinus. There is a spectrum of disease from indolent asymptomatic lump through to potentially life threatening if they become infected with intracranial extension. This paper will present data on presentation, sites, management and complications. Results: This large series of dermoids has been collected in the craniofacial and plastic surgery departments from 2005 to present. Sites affected: Fronto-zygomatic 65%, Naso-frontal 20%, Vertex 5%, Pterional 5%, and other 5%. We will present our approach to management including investigations and surgical procedures to treat dermoids in these locations.
P210 First report of use of Indomethacin in improving mouth opening and prevent re-ankylosis in TMJ ankylosis M. Shorafa ∗ , O. Shaikh, P. Ayliffe University College London Hospital, United Kingdom Introduction: Indomethacin is a non-selective inhibitor of cyclooxygenase (COX) 1 and 2, enzymes that participate in prostaglandin synthesis from arachidonic acid. Indomethacin is used most commonly for the treatment of inflammation and pain resulting from rheumatic disease. Orthopaedic surgeons have been using Indomethacin to prevent the formation of heterotopic bone after hip replacement surgery. Studies have demonstrated that Indomethacin is a potent inhibitor of local remodelling and repair of bone after trauma. To our knowledge there are no reports in the literature of its use post operatively to prevent TMJ ankylosis or its use to improve TMJ mobility. Method: Indomethacin was given to patients in the divided doses based on their weight following TMJ ankylosis surgery. Indomethacin was used over the past 4 years at our department in twenty-two patients, smaller group of eight patients were selected as control. Results: This preliminary presentation shows our finding that using Indomethacin in TMJ ankylosis either improved mouth opening or it remained the same, compared to the control group who were not administered the drug due to intolerance or parents’ refusal. Conclusions: TMJ ankylosis in children is a challenge to treat. Surgical correction may show satisfactory result but incidence of recurrence is high. Initial results for the longterm use of Indomethacin have been favourable, providing a solution for many of our patients however further research is warranted in the form of a randomized, double blind clinical trial. doi:10.1016/j.bjoms.2011.03.216 P211 Cranial index as an objective outcome measure in patients with sagittal synostosis—an analysis of a single surgical technique C. Siegmund ∗ , J. Ward, D. Rodriguez, N. White, H. Nishikawa, S. Dover, G. Solanki Department of Craniofacial Surgery, Birmingham Children’s Hospital, United Kingdom Objective: An objective outcome measure tool in craniofacial surgery is the established cranial index (CI) which is the ratio of bi-parietal to antero-posterior diameter of the skull. The aim of the study was to review the change in CI in two defined age groups presenting with scaphocephalus undergoing a single surgical technique procedure.
S101
Design: Retrospective longitudinal study comparing the pre- and post-operative CI changes of sagittal synostosis patients operated with a single surgical technique in a SupraRegional Craniofacial Unit. Subjects: 67 patients with scaphocephalus aged between 165 and 398 days (24 girls and 43 boys) who underwent surgery using a single technique. Methods: Cranial Indices were measured pre-operatively and at various follow-up appointments. Two age groups were analysed: an early age group (6 months of age at time of surgery) and a late age group (11 months). Results: Younger children (6 month age group) increase their average CI more than older infants (11 month age group) at various follow-up appointments. More importantly, there seems to be NO REGRESSION in the younger age group compared to a rate of 20% who present with REGRESSION in the older age group based on the initial pre-surgical CI values. Conclusions: The age at the time of surgery for scaphocephalic patients is important for the outcome of surgery measured by the CI improvement. doi:10.1016/j.bjoms.2011.03.217 P212 Dermoid cysts in the craniofacial region: the liverpool experience P. Sillifant ∗ , C. Duncan Alderhey Childrens Hospital, United Kingdom Dermoid cysts in craniofacial region: experience of 100 cases. Aim: Present our units experience of dermoid cysts in the craniofacial region. Background: Dermoid cysts in the craniofacial region are relatively uncommon occurrence. Dermoids occur due to problems during embryogenesis caused by defects in fusion in the craniofacial processes. Dermoids usually present in young children as a small lump under the skin with or without a punctum. However they can present without any mass as a sinus. There is a spectrum of disease from indolent asymptomatic lump through to potentially life threatening if they become infected with intracranial extension. This paper will present data on presentation, sites, management and complications. Results: This large series of dermoids has been collected in the craniofacial and plastic surgery departments from 2005 to present. Sites affected: Fronto-zygomatic 65%, Naso-frontal 20%, Vertex 5%, Pterional 5%, and other 5%. We will present our approach to management including investigations and surgical procedures to treat dermoids in these locations.