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Development of an animal model to tissue engineer human lips and anal sphincters
Oral Presentation severely resorbed maxillae and with a very low frequency and late onset of sinusitis. http://dx.doi.org/10.1016/j.ijom.2015.08.537 Influence of perioperative allogenic blood transfusions on recurrence and survival in patients undergoing primary surgery for oral squamous cell carcinoma M. Ermer ∗ , G. Bittermann, B. Malakoudi, P. Voss, M. Metzger, R. Schmelzeisen Department of Oral and Maxillofacial Surgery, University Medical Center Freiburg, Freiburg, Germany Background: The influence of perioperative blood transfusion on recurrence and survival in oral squamous cell carcinoma (OSCC) is still not determined. For colorectal cancer, evidence indicates that effects in the host’s immunomodulation due to transfusion can be related to adverse clinical outcomes and poorer survival rates. Objectives: The objective of this study was to assess the influence of perioperative transfusions on the outcome of patients who underwent primary surgery of OSCC. Methods: 476 consecutive patients undergoing primary surgery for OSCC between 2000 and 2014 form a single institution were included. Demographic, clinical and pathologic factors as well as transfusion data were analyzed retrospectively. Survival data were calculated using Kaplan and Meier analysis. Univariate and multivariate analyses were performed to assess predictors for clinical outcome. Findings: 182 (39.1%) patients presented with UICC Stage III + IV disease. Perioperative transfusion was required in 59 (12.4%) patients. Overall survival rate was 73.5% compared to 55.9% in transfused patients. Overall recurrence rate was 31.8% compared to 35.6% in transfused patients, median time to recurrence dropped from 11.2 to 8.1 months. In univariate and multivariate analysis, only tumor stage was significantly associated with recurrence and survival rates (p < 0.01). Lymph node status (p = 0.504) and transfusion (p = 0.227) showed no significant impact. Conclusions: Allogenic blood transfusions seem not to significantly influence overall survival or recurrence rates in patients undergoing primary surgery for OSCC. Still a trend to a shorter disease-free interval and reduced overall survival can be seen. http://dx.doi.org/10.1016/j.ijom.2015.08.538 Is it more important to know the antibiotic sensitivities in penicillin allergic patients with cervicofacial infection? A retrospective analysis L. Feinberg ∗ , F. Ryba, K. Fan Kings College Hospital, London, England, United Kingdom Penicillin allergy is reported by 5–10% of patients, a true IgE mediated response is identified in far fewer. Penicillin based antibiotics such as Co-Amoxiclav are the first line for the management of cervicofacial infection. The literature supports the use of clindamycin, metronidazole and macrolides including erythromycin and clarithromycin in the penicillin allergic. Clinicians often choose to use a combination of agents. All maxillofacial patients undergoing a general anaesthetic for incision and drainage in the year 2014 were identified. Clinical
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notes were reviewed to identify those who self reported as penicillin allergic. Their notes were then analysed. The number of surgical procedures identified was 146, 15 patients (10%) self reported as penicillin allergic. Five patients were managed with clindamycin, 7 with both clarithromycin and metronidazole and 3 with an alternative antibiotic combination. Thirteen patients (87%) had pus sent for culture and sensitivity, 6 (46%) showed no significant growth. One third of these patients were not sensitive to our usual antibiotic choices. Resistance to macrolide type antibiotics was identified in 2 cases, resistance to clindamycin in 2 cases and resistance to Co-Amoxiclav in 1 case. Antibiotics used in the penicillin allergic are not as broad spectrum as Co-Amoxiclav. Antibiotic resistance is increasing, therefore it is extremely important that pus is sent for C&S and that the results are reviewed by the clinician. Consultation with a clinical microbiologist is often advised and in some cases it may be prudent to consider whether or not the patient has a true penicillin allergy. http://dx.doi.org/10.1016/j.ijom.2015.08.539 Severe dental implant abscess: two cases requiring hospitalisation L. Feinberg ∗ , F.M. Ryba, A. Brett, M. Tailor, R. Bentley Oral and Maxillofacial Surgery Department, King’s College Hospital, London, UK Dental implants have now become commonplace with a variety of practitioners placing them from general dental practitioners to specialists periodontists and oral surgeons. In the UK dental implants are usually placed in the private sector, falling outside the scope of the NHS and therefore there are few opportunities for the Oral and Maxillofacial Surgery (OMFS) trainee to gain experience during specialist training. We have recently treated two cases of severe cervico-facial abscess secondary to dental implants that required surgical draining and several days of parenteral antibiotics. The first case presented with an abscess in their cheek and associated cellulitis three days following placement of two dental implants in the maxillary arch and a sinus lift with bone graft. The second case presented with signs of sepsis and an abscess in their submental space ten years after placement of two implants to support a complete lower denture. A review of the current literature did not reveal any cases of severe facial infection related to dental implants that required inpatient surgical management. These two cases, demonstrating one early and one late complication, highlight the need for appropriate OMFS training in dental implants in order to be able to manage these potential complications, especially as these cases tend to present out of hours and require specialist equipment. We expect there to be an increasing number of implant related complications presenting to OMFS in the future. http://dx.doi.org/10.1016/j.ijom.2015.08.540 Development of an animal model to tissue engineer human lips and anal sphincters S. Feinberg ∗ , I. Makovey, W. Zhang, Z. Wang, M. Urbanchek University of Michigan Ann Arbor, Michigan, USA Objectives: Difficult regions to reconstruct after traumatic avulsion is the lips and anal sphincter, due to the complex natural
e60
Oral Presentation
architecture of the lost tissue (skin, mucosa and muscle). Present surgical procedures to address these tissue loses have been unsatisfactory. The ability to develop “designer” vascularized prefabrication flap will increase the options available to a reconstructive surgeon for these sphincters. Methods: We have developed a rat model to assess the functional aspect of sphincter contraction by creating a prelaminated flap utilizing the latissimus dorsi muscle and a mucocutaneous construct for both the lips and anal sphincter Results: The muco-cutaneous construct was placed onto the latissimus dorsi muscle to create a prelaminated flap. At the time of placement either a surgically created stoma or opening was made for lips and a tube was made for the anal sphincter to create a circular ring of muscle fibers simulating the orbicularis oris and anal sphincter, respectively. Muscle function tests were performed to demonstrate sphincter closure on muscle stimulation. Conclusions: We report the development of an animal model to assist in the tissue engineering of a set of autogenous human lips and anal sphincters that could be used for surgical lip and anal reconstruction in individuals suffering from lip and anus loss from cancer, congenital deformations, and traumatic injuries. Funding: AFIRM I: DoD W81XWH-08-2-0034 (SEF); AFIRM II: DoD W81XWH-13-2-0052 (SEF, MU). http://dx.doi.org/10.1016/j.ijom.2015.08.541 Restoration of mental nerve function in major ablation surgeries
Buccal rotational flap against free flaps in reconstruction of hemiresected tongue A.M. Ferdousi ∗ , A. Siddika Delta Medical College, Dhaka, Bangladesh Human tongue has high incidence of cancer which commonly is treated by surgery. In hemi or near hemiglossectomy, when the defect is closed directly – results a twisted tongue, inability of free tongue movement, deficient speech leading to social embarrassment. Present day reconstruction technique is free transfer of vascularized tissue which usually gives a huge bulk at the reconstructed area, consumes many hours of surgical time and moreover results distant indemnity apart from chance of flap failure. Posteriorly based buccal mucosal rotational flap is found very satisfactory in reconstructing a near hemiresected tongue. The surgery involves only a few additional minutes. Technically this procedure is easy to perform and results virtually good healing. Buccal mucosal flap keeps the shape of the tongue to almost normal, allows free full movement showing no deficiency in phonetics from the early postoperative days. Most important is its easy manoeuvre, almost no failure rate and early recovery of tongue with good shape and function. This procedure was performed in five patients. Among them one only had some postoperative oozing at the donor base and others had no complication at all. All showed good tongue function, free full movement, excellent phonetics and had good tongue form.
A.M. Ferdousi ∗ , A. Siddika Delta Medical College, Dhaka, Bangladesh Ordinary sensation of the skin of lower lip, chin and lower labial mucosa and lower anterior gingivae are supplied by mental nerve, a bifurcated terminal branch of the inferior alveolar nerve of trigeminal nerve. Severance (Complete section or tearing) of mental nerve is not uncommon in ablation surgeries in the treatment of oral and facial malignancy. Patient suffers complete sensory loss and numbness at the skin of lower lip and chin area-is often a social embarrassment for the victim when liquid food/drink spills over the lower lip and chin, in public, without appreciation by the victim. A simple surgical technique to preserve the mental nerve has found to have good recovery in sensory loss. Mental nerve and its terminal branches are identified, dissected and separated from the underneath muscle along with a sleeve of thin muscle layer (attached and beneath terminal branches). The whole neuromuscular pedicle is kept wrapped in gauze socked in normotonic Nacl. Following completion of the main procedure the sleeve of muscle containing the mental nerve branches (pedicle) is re-harboured at the donor site with absorbable suture. This technique has been found helpful in regaining the common sensation at the lower lip and chin in 5 patients out of 6 to almost normal within 14–26 weeks. Tectile and cold sensation recovered faster than crude. The remaining one patient had partial recovery in achieving full function of the mental nerve. http://dx.doi.org/10.1016/j.ijom.2015.08.542
http://dx.doi.org/10.1016/j.ijom.2015.08.543 Reconstruction of the maxillo-facial region in children: our experience S. Ferrari ∗ , D. Lanfranco, B. Bianchi, A. Ferri, E. Sesenna Department of Biomedical, Biotechnological and Translational Sciences, and Center for Molecular and Translational Oncology (COMT), University of Parma, Parma, Italy Background: Reconstructing defects in children after maxillafacial oncological resections presents a challenge for the reconstructive surgeon because of the critical role played by the maxillo facial skeleton in facial function and esthetics. While first-line treatment in adults is resection, the challenges associated with resection and reconstruction of these tumors in children often lead to radiation therapy as primary treatment. This report highlights the feasibility and efficacy of midface reconstruction in the pediatric population after resection. In most cases, the same principles utilized in reconstructing midface defects in adults hold for the pediatric population. Objective: This study presents the experience of our department in the reconstruction of the maxillo-facial region in children comparing the use of free flaps with the use of bone grafts Patients and methods: From 2000 to 2015 ten pediatric patients underwent resection and reconstruction for head and neck cancer. These patients ranged in age from 18 months to 14 years. Six patients were reconstructed with autogenous rib grafts, four were reconstructed with microvascular free flaps. Follow-up ranged from 15 months to 4.5 years. Reconstructive, oncological, and functional outcomes were analyzed. Findings and conclusions: In this paper we present the experience of our department in the reconstruction of the maxillofacial
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notes were reviewed to identify those who self reported as penicillin allergic. Their notes were then analysed. The number of surgical procedures identified was 146, 15 patients (10%) self reported as penicillin allergic. Five patients were managed with clindamycin, 7 with both clarithromycin and metronidazole and 3 with an alternative antibiotic combination. Thirteen patients (87%) had pus sent for culture and sensitivity, 6 (46%) showed no significant growth. One third of these patients were not sensitive to our usual antibiotic choices. Resistance to macrolide type antibiotics was identified in 2 cases, resistance to clindamycin in 2 cases and resistance to Co-Amoxiclav in 1 case. Antibiotics used in the penicillin allergic are not as broad spectrum as Co-Amoxiclav. Antibiotic resistance is increasing, therefore it is extremely important that pus is sent for C&S and that the results are reviewed by the clinician. Consultation with a clinical microbiologist is often advised and in some cases it may be prudent to consider whether or not the patient has a true penicillin allergy. http://dx.doi.org/10.1016/j.ijom.2015.08.539 Severe dental implant abscess: two cases requiring hospitalisation L. Feinberg ∗ , F.M. Ryba, A. Brett, M. Tailor, R. Bentley Oral and Maxillofacial Surgery Department, King’s College Hospital, London, UK Dental implants have now become commonplace with a variety of practitioners placing them from general dental practitioners to specialists periodontists and oral surgeons. In the UK dental implants are usually placed in the private sector, falling outside the scope of the NHS and therefore there are few opportunities for the Oral and Maxillofacial Surgery (OMFS) trainee to gain experience during specialist training. We have recently treated two cases of severe cervico-facial abscess secondary to dental implants that required surgical draining and several days of parenteral antibiotics. The first case presented with an abscess in their cheek and associated cellulitis three days following placement of two dental implants in the maxillary arch and a sinus lift with bone graft. The second case presented with signs of sepsis and an abscess in their submental space ten years after placement of two implants to support a complete lower denture. A review of the current literature did not reveal any cases of severe facial infection related to dental implants that required inpatient surgical management. These two cases, demonstrating one early and one late complication, highlight the need for appropriate OMFS training in dental implants in order to be able to manage these potential complications, especially as these cases tend to present out of hours and require specialist equipment. We expect there to be an increasing number of implant related complications presenting to OMFS in the future. http://dx.doi.org/10.1016/j.ijom.2015.08.540 Development of an animal model to tissue engineer human lips and anal sphincters S. Feinberg ∗ , I. Makovey, W. Zhang, Z. Wang, M. Urbanchek University of Michigan Ann Arbor, Michigan, USA Objectives: Difficult regions to reconstruct after traumatic avulsion is the lips and anal sphincter, due to the complex natural
e60
Oral Presentation
architecture of the lost tissue (skin, mucosa and muscle). Present surgical procedures to address these tissue loses have been unsatisfactory. The ability to develop “designer” vascularized prefabrication flap will increase the options available to a reconstructive surgeon for these sphincters. Methods: We have developed a rat model to assess the functional aspect of sphincter contraction by creating a prelaminated flap utilizing the latissimus dorsi muscle and a mucocutaneous construct for both the lips and anal sphincter Results: The muco-cutaneous construct was placed onto the latissimus dorsi muscle to create a prelaminated flap. At the time of placement either a surgically created stoma or opening was made for lips and a tube was made for the anal sphincter to create a circular ring of muscle fibers simulating the orbicularis oris and anal sphincter, respectively. Muscle function tests were performed to demonstrate sphincter closure on muscle stimulation. Conclusions: We report the development of an animal model to assist in the tissue engineering of a set of autogenous human lips and anal sphincters that could be used for surgical lip and anal reconstruction in individuals suffering from lip and anus loss from cancer, congenital deformations, and traumatic injuries. Funding: AFIRM I: DoD W81XWH-08-2-0034 (SEF); AFIRM II: DoD W81XWH-13-2-0052 (SEF, MU). http://dx.doi.org/10.1016/j.ijom.2015.08.541 Restoration of mental nerve function in major ablation surgeries
Buccal rotational flap against free flaps in reconstruction of hemiresected tongue A.M. Ferdousi ∗ , A. Siddika Delta Medical College, Dhaka, Bangladesh Human tongue has high incidence of cancer which commonly is treated by surgery. In hemi or near hemiglossectomy, when the defect is closed directly – results a twisted tongue, inability of free tongue movement, deficient speech leading to social embarrassment. Present day reconstruction technique is free transfer of vascularized tissue which usually gives a huge bulk at the reconstructed area, consumes many hours of surgical time and moreover results distant indemnity apart from chance of flap failure. Posteriorly based buccal mucosal rotational flap is found very satisfactory in reconstructing a near hemiresected tongue. The surgery involves only a few additional minutes. Technically this procedure is easy to perform and results virtually good healing. Buccal mucosal flap keeps the shape of the tongue to almost normal, allows free full movement showing no deficiency in phonetics from the early postoperative days. Most important is its easy manoeuvre, almost no failure rate and early recovery of tongue with good shape and function. This procedure was performed in five patients. Among them one only had some postoperative oozing at the donor base and others had no complication at all. All showed good tongue function, free full movement, excellent phonetics and had good tongue form.
A.M. Ferdousi ∗ , A. Siddika Delta Medical College, Dhaka, Bangladesh Ordinary sensation of the skin of lower lip, chin and lower labial mucosa and lower anterior gingivae are supplied by mental nerve, a bifurcated terminal branch of the inferior alveolar nerve of trigeminal nerve. Severance (Complete section or tearing) of mental nerve is not uncommon in ablation surgeries in the treatment of oral and facial malignancy. Patient suffers complete sensory loss and numbness at the skin of lower lip and chin area-is often a social embarrassment for the victim when liquid food/drink spills over the lower lip and chin, in public, without appreciation by the victim. A simple surgical technique to preserve the mental nerve has found to have good recovery in sensory loss. Mental nerve and its terminal branches are identified, dissected and separated from the underneath muscle along with a sleeve of thin muscle layer (attached and beneath terminal branches). The whole neuromuscular pedicle is kept wrapped in gauze socked in normotonic Nacl. Following completion of the main procedure the sleeve of muscle containing the mental nerve branches (pedicle) is re-harboured at the donor site with absorbable suture. This technique has been found helpful in regaining the common sensation at the lower lip and chin in 5 patients out of 6 to almost normal within 14–26 weeks. Tectile and cold sensation recovered faster than crude. The remaining one patient had partial recovery in achieving full function of the mental nerve. http://dx.doi.org/10.1016/j.ijom.2015.08.542
http://dx.doi.org/10.1016/j.ijom.2015.08.543 Reconstruction of the maxillo-facial region in children: our experience S. Ferrari ∗ , D. Lanfranco, B. Bianchi, A. Ferri, E. Sesenna Department of Biomedical, Biotechnological and Translational Sciences, and Center for Molecular and Translational Oncology (COMT), University of Parma, Parma, Italy Background: Reconstructing defects in children after maxillafacial oncological resections presents a challenge for the reconstructive surgeon because of the critical role played by the maxillo facial skeleton in facial function and esthetics. While first-line treatment in adults is resection, the challenges associated with resection and reconstruction of these tumors in children often lead to radiation therapy as primary treatment. This report highlights the feasibility and efficacy of midface reconstruction in the pediatric population after resection. In most cases, the same principles utilized in reconstructing midface defects in adults hold for the pediatric population. Objective: This study presents the experience of our department in the reconstruction of the maxillo-facial region in children comparing the use of free flaps with the use of bone grafts Patients and methods: From 2000 to 2015 ten pediatric patients underwent resection and reconstruction for head and neck cancer. These patients ranged in age from 18 months to 14 years. Six patients were reconstructed with autogenous rib grafts, four were reconstructed with microvascular free flaps. Follow-up ranged from 15 months to 4.5 years. Reconstructive, oncological, and functional outcomes were analyzed. Findings and conclusions: In this paper we present the experience of our department in the reconstruction of the maxillofacial