Enhancing facial harmony

Oral Presentations / O38, Orthognathic Surgery IV between long term chronic inflammatory change and carcino-genesis is suggested. We present a case of pemphigus vulgaris with multiple primary oral cancers on Long Period. Patient was 63 years old, Japanese women. She visited us with chief complaint of contact soreness at oral mucosa in December 3rd, 1986. Anti-hypertensives had been medicated. Intra-oral findings, erosive lesions could be recognized at maxillary alveolus, palatal and tongue mucosa. No skin legion had been recognized. Laboratory data showed no particular abnormality except 40 mm/h of ESR. Biopsy specimens taken from tongue edge lesion showed acantholitic bulla in prickle cell layer of suprabasal position as typical pemphigus vulgaris histopathologically and indirect immunofluorescens testing. For this lesion, local and systemic treatment by predonisolon (PSL) was employed. The effects were not enough and erosive lesions remained. Three years later, papillomatous change could be recognized at maxillary gingiva and mucobuccal fold. Seven years later, biopsied specimens were taken again from three oral mucosal lesions and showed multi centric oral cancers. Further more, 17 years later from the first visit, the 4th oral cancer was recognized on the lower lip. Surgical excision was selected for the treatment of these lesions. The lip cancer was controlled well, but 1 year and 5 months after this treatment, the 5th oral cancer was recognized on the right buccal mucosa. The first cancer was verrucous carcinoma on the right upper gingival, the 2nd was squamous cell carcinoma on the left mucobuccal fold, 3rd was carcinoma in situ on the right cheek mucosa, 4th was early invasive squamous cell carcinoma on the lower lip and 5th was squamous cell calcinoma. At present, there are wide spread severe erosions on the oral mucosa by pemphigus vulgaris, and the patient did not agree for surgical cancer treatment. Only chemotherapy for cancer and predonine per os treatment are continued. 1. A rare case with pemphigus vulgaris complicated with 5 primary oral cancers under the long term observation is presented. 2. All the oral cancers occurred on the erosive lesion of pemphigus vulgaris. 3. It is suggested that there may be a relation between a long term chronic inflammatory change of poorly controlled pemphigus vulgaris and carcinogenesis. [-~-~

RECURRENT AMELOBLASTIC CARCINOMA EX AMELOBLASTOMA OF MAXILLA - A CASE REPORT

L.H. Chi, "~H. Li, B.'~ Pemg. Department of Oral & Maxillofacial Surgery,

Taipei Medical University Hospital 252, Wu-Xing Street, Taipei, Taiwan (ROC) We report the 19th case of a maxillary ameloblastic carcinoma in the English literature. It is a rare odontogenic malignancy. A 23-yearold male presented to us for a recurrent right maxillary tumor. Surgical history of this site was performed 2 years ago, histology diagnosis as ameloblatoma. After a thorough head and neck examination, CT/MRI evaluation, tumor excision surgery was performed via CaldwellLuc approach. Surgical pathology revealed ameloblastic carcinoma ex ameloblastoma, because of focal squamous metaplasia, frequent mitotic figures, apoptosis, tumor necrosis and mild pleomorphism present. Post-operative adjuvant radiotherapy with IMRT mode was performed. Ameloblastoma is 1% of all odontogenic tumor, and 20% in maxilla. The malignant transformation from ameloblatoma is very rare, compared with arising de novo. In the English literature, no report is mentioned about IMRT for this cancer. References

[1] Dhir K, Sciubba JJ, Tufano R. Ameloblastic carcinoma. Oral Oncology 2003; 39:736-741. [ - ~ - - ~ - - 1 S Y N O V I A L SARCOMA OF THE PALATE - CASE REPORT AND REVIEW OF LITERATURE S. Ramachandra, R. Lee, M. Bailey. Ashford and St. Peters Hospitals

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SURGICAL MANAGEMENT OF LARGE CYSTIC ODONTOGENIC TUMORS; A CONSERVATIVE APPROACH

W. Qadri, S.M. Haider, H.M. Zaidi. Joint departments of oral and

maxillofacial surgery, Karachi Medical and Dental College & Abbasi Shaheed Hospital Karachi, Pakistan This study was done to evaluate the effectiveness of marsupalization in conservative management of large cystic odontogenic tumors. Clinical and histologic examination of 12 cystic large odontogenic tumors were performed before and after surgical management. All the tumors were marsupialized with a standard technique. Clinically and radiographically, the effect of marsupialization was evaluated. Marsupialization was most effective in teenaged patients. In three cases, the tumor disappeared macroscopically, and further surgery was not performed. Histologically, the growth characteristics of the tumor were classified into expansile and invasive types. Premarsupialization, the expansile pattern with the cuboidal cell type was dominant, whereas for postmarsupialization many cases that had been expansile changed to an invasive type showing columnar or basal cell types. Marsupialization was found to be useful as a preliminary treatment of the cystic odontogenic tumors. However, it must be borne in mind that following marsupialization the tumor still has a potential to infiltrate into the surrounding tissues.

038. Orthognathic Surgery IV

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ENHANCING FACIAL HARMONY

S. Benarroch Mahfoda. Aesthetic & Maxillofacial Clinic, Madrid, Spain Determine the type of cosmetic surgery procedures most frequently used to enhance the result of orthognathic surgery Two hundred and fifty two orthognathic surgery patients (180 females and 72 males) that also had plastic procedures over a 7 year period were reviewed retrospectively. The mean age was 26.5 (19-34). All the patients underwent a complete facial analysis. Three groups were evaluated depending on the dentofacial deformity diagnosed. Group I: Maxillar, Group I1: Mandibular, Group II1: Maxillo-mandibular. No distinction was made among patients based on whether the cosmetic surgery was done before, during or after the orthognathic surgery. The facial plastics procedures most frequently associated were: Genioplasty, Rhinoplasty, Malar augmentation, Buccal fat pad removal, Lip-plasties, Submental liposuction, Blepharoplasty. Group I: 110 patients, Genioplasty 63, Rhinoplasty 29, Blepharoplasty (upper lateral canthus, VME) 23, Lip-plasty (lower, reduction) 18, Buccal fat pad removal 15, Malar augmentation 9, Submental liposuction 5. Group I1:88 patients, Genioplasty 43, Rhinoplasty 48, Lip-plasty (lower, reduction) 15, Malar augmentation 14, Queiloplasty (upper, augmentation) 6, Submental liposuction 2. Group II1:54 patients: Genioplasty: 29, Lip-plasty (lower, reduction) 9, Lip-plasty (upper, augmentation) 4. No statistically significant differences in complication rates were found among the groups. The prevalence of morbidity in all groups was practically identical to previous studies. Of the total facial plastic procedures included in this study, 77% were perform at the time of the dentofacial correction. 85% of the patients were satisfied with the final results. Facial harmony is a very complex issue; many studies have been published defining, by mathematical analysis, what constitutes an attractive face. Although there is great variability (sex, race) and subjectivity (eye of the beholder) in appreciation of facial beauty. The results of this retrospective review do not indicate that the combination of cosmetic surgical procedures increases morbidity. The advantages of combined procedures include a single recovery period, reduced surgery costs, and faster patient gratification.

NHS Trust, United Kingdom The aim of this presentation is to discuss a case of a rare tumour (Synovial Sarcoma) of the palate. Review of literature is also discussed. This report is about a 38 year old male with a left palatal lump which proved to be synovial sarcoma. Treatment included left maxillectomy followed by post operative radiotherapy. The tumour was successfully managed with surgery and radiotherapy. The patient has been followed up for the last four years with no local recurrence or metastasis. Synovial sarcoma is an aggressive mesenchymal tumour which is rare in the head and neck region, especially palate. Though this patient has been disease free for the last four years, the overall prognosis of the tumour is poor.

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AESTHETIC CHANGES IN MANDIBULAR MIDLINE OSTEOTOMY FOR CONSTRICTION

R. Lebeda 1,2, M. Baltensperger 1 , R. Alcalde 2, D. Bloomquist 2. 1Center

for Jaw Surgery, Winterthur/Zurich, Switzerland; 2Dept. of OMFS, University of Washington, Seattle, USA Transverse discrepancies in dentofacial deformities can be addressed successfully by constriction with a mandibular midline osteotomy combined with bilateral sagittal split osteotomies (MC-BSSO) and lead to stable and predictive dento-skelettal results. However, soft tissue changes