- Email: [email protected]
Dermoid cysts in the craniofacial region: the liverpool experience
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.
S102
Poster presentation / British Journal of Oral and Maxillofacial Surgery 49S (2011) S26–S116
Intracranial extension of a dermoid cyst can have serious consequences. We will present our experience of management as well indicators of intracranial and complications of these lesions.
P214
doi:10.1016/j.bjoms.2011.03.218
L.A. Skoglund ∗ , E.C. Vigen, L. Jorkjend
P213
Section of Dental Pharmacology and Pharmacotherapy, University of Oslo, Oslo, Norway
Karapandzic flap for reconstruction of lateral upper lip defects K.C. Rabindra Telfer
Singh ∗ ,
L. Kanneganti, A. Campbell, M.R.
York Hospital, United Kingdom Introduction: The Karapandzic flap is a well-established method of reconstruction of large lower lip defects. However, its use in the reconstruction of upper lip defects is scarcely documented. We report our experience on the subjective and objective outcome of reconstruction of lateral upper lip defects with this flap. Methods: We reviewed medical records all patients who underwent Karapandzic flap repair for lateral upper lip defects at York Hospital, York. Data were collected on patient demographics, complications, histology, resection dimensions and margins. The functional and cosmetic outcomes were assessed in terms of lip sensation, oral stoma, oral competence, diet/cutlery/denture use, facial expression and speech. We invited patients for follow up and carried out patient and clinician assessment of the outcome using Patient and Observer Scar Assessment Scale (POSAS). Results: 18 patients were identified. There were 12, 5 and 1 cases of Basal Cell Carcinoma, Squamous Cell Carcinoma and Malignant Melanoma, respectively. There were no wound complications and no recurrences. 3 patients had altered sensation, one of them 2 years after surgery. None reported difficulty with oral competence, dietary function and speech. One patient reported stiffness on smiling. The mean Patient and Observer Scar Assessment Scores were 8.5 and 7.6 respectively. Conclusions: The Karapandzic flap is a reliable technique that offers good functional and cosmetic outcome following repair of lateral upper lip defects. We discuss indications and surgical technique. doi:10.1016/j.bjoms.2011.03.219
Identifying predictors of postoperative pain experience using a dental soft tissue model (gingivectomy). Preliminary results
Introduction: Conflicting opinions are expressed regarding key factor(s) that may influence the pain experience after oral surgery. We used retrospective data from a standardized dental soft tissue pain model of limited to moderate pain intensity to identify factors which may determine the patients’ postoperative pain experience. Methods: From 1984 to 2005, 526 Norwegian white patients (204 females/322 males), ASA class I–III, mean age 49.5 years (28–93 years), were subjected to gingivectomy only, using lidocaine 2% + adrenalin 1:80 000 (Astra, Sweden). Patients scored subjective pain on 100 mm visual analogue scales. Sum pain intensity for 11 h starting immediately after surgery was calculated as the dependent variable (postoperative pain experience). Other relevant data was also collected. Stepwise Linear Regression analyses of selected patient and surgical factors were done with PASW Statistics, release 18.0.1. Patient consent and Norwegian Ethical Committee approvals were obtained prior to data collection. Results: Time used for surgery was identified as a key predictor of postoperative pain experience. Patient age, injected volume of local anaesthetic, time used for injection of local anaesthetic, time of the day when surgery was finished, and number of teeth involved in surgery were not identified. Only 30 females and 6 males used various OTC analgesics during the observation period. Gender was not included due to unbalanced patient groups. Somewhat more pain were reported by females than males. Clinical relevance: Time used for surgery may be a key factor determining the patients’ postoperative pain experience, at least after dental soft tissue surgery. doi:10.1016/j.bjoms.2011.03.220 P215 MDT’s in cleft lip and palate: alveolar bone grafting, getting the process right V. Sood ∗ , P. Soneji, M. Devlin, T. Gillgrass, A. Ray, S. Wallace, A. Crawford Cleft Team, Royal Hospital For Sick Children, Glasgow, United Kingdom Introduction: This paper evaluates the outcomes of alveolar bone grafts (ABG) before and after the introduction of a dedicated multidisciplinary team (MDT) clinic within the West of Scotland Cleft services.
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.
S102
Poster presentation / British Journal of Oral and Maxillofacial Surgery 49S (2011) S26–S116
Intracranial extension of a dermoid cyst can have serious consequences. We will present our experience of management as well indicators of intracranial and complications of these lesions.
P214
doi:10.1016/j.bjoms.2011.03.218
L.A. Skoglund ∗ , E.C. Vigen, L. Jorkjend
P213
Section of Dental Pharmacology and Pharmacotherapy, University of Oslo, Oslo, Norway
Karapandzic flap for reconstruction of lateral upper lip defects K.C. Rabindra Telfer
Singh ∗ ,
L. Kanneganti, A. Campbell, M.R.
York Hospital, United Kingdom Introduction: The Karapandzic flap is a well-established method of reconstruction of large lower lip defects. However, its use in the reconstruction of upper lip defects is scarcely documented. We report our experience on the subjective and objective outcome of reconstruction of lateral upper lip defects with this flap. Methods: We reviewed medical records all patients who underwent Karapandzic flap repair for lateral upper lip defects at York Hospital, York. Data were collected on patient demographics, complications, histology, resection dimensions and margins. The functional and cosmetic outcomes were assessed in terms of lip sensation, oral stoma, oral competence, diet/cutlery/denture use, facial expression and speech. We invited patients for follow up and carried out patient and clinician assessment of the outcome using Patient and Observer Scar Assessment Scale (POSAS). Results: 18 patients were identified. There were 12, 5 and 1 cases of Basal Cell Carcinoma, Squamous Cell Carcinoma and Malignant Melanoma, respectively. There were no wound complications and no recurrences. 3 patients had altered sensation, one of them 2 years after surgery. None reported difficulty with oral competence, dietary function and speech. One patient reported stiffness on smiling. The mean Patient and Observer Scar Assessment Scores were 8.5 and 7.6 respectively. Conclusions: The Karapandzic flap is a reliable technique that offers good functional and cosmetic outcome following repair of lateral upper lip defects. We discuss indications and surgical technique. doi:10.1016/j.bjoms.2011.03.219
Identifying predictors of postoperative pain experience using a dental soft tissue model (gingivectomy). Preliminary results
Introduction: Conflicting opinions are expressed regarding key factor(s) that may influence the pain experience after oral surgery. We used retrospective data from a standardized dental soft tissue pain model of limited to moderate pain intensity to identify factors which may determine the patients’ postoperative pain experience. Methods: From 1984 to 2005, 526 Norwegian white patients (204 females/322 males), ASA class I–III, mean age 49.5 years (28–93 years), were subjected to gingivectomy only, using lidocaine 2% + adrenalin 1:80 000 (Astra, Sweden). Patients scored subjective pain on 100 mm visual analogue scales. Sum pain intensity for 11 h starting immediately after surgery was calculated as the dependent variable (postoperative pain experience). Other relevant data was also collected. Stepwise Linear Regression analyses of selected patient and surgical factors were done with PASW Statistics, release 18.0.1. Patient consent and Norwegian Ethical Committee approvals were obtained prior to data collection. Results: Time used for surgery was identified as a key predictor of postoperative pain experience. Patient age, injected volume of local anaesthetic, time used for injection of local anaesthetic, time of the day when surgery was finished, and number of teeth involved in surgery were not identified. Only 30 females and 6 males used various OTC analgesics during the observation period. Gender was not included due to unbalanced patient groups. Somewhat more pain were reported by females than males. Clinical relevance: Time used for surgery may be a key factor determining the patients’ postoperative pain experience, at least after dental soft tissue surgery. doi:10.1016/j.bjoms.2011.03.220 P215 MDT’s in cleft lip and palate: alveolar bone grafting, getting the process right V. Sood ∗ , P. Soneji, M. Devlin, T. Gillgrass, A. Ray, S. Wallace, A. Crawford Cleft Team, Royal Hospital For Sick Children, Glasgow, United Kingdom Introduction: This paper evaluates the outcomes of alveolar bone grafts (ABG) before and after the introduction of a dedicated multidisciplinary team (MDT) clinic within the West of Scotland Cleft services.