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Evaluation of clinical notes in maxillofacial trauma: introduction of a proforma
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Oral Presentation
encompasses the periumbilical area of the lower and upper abdomen to include the dominant perforators, thus increasing the overall vascularization of the flap. Methods: Retrospective study of consecutive cancer patients who underwent microsurgical reconstruction of composite defects of the Head & Neck with infraumbilical free flaps. The main aim of the study was to assess abdominal wall integrity and the esthetic result at 1 year. Results: Between January 2006 and December 2014, 19 patients underwent primary reconstruction with free flaps harvested from the lower abdomen, for a total of 28 free flaps (17 VRAM; 11 DIEAP). Nine patients underwent bilateral harvest of flaps and abdominoplasty was performed to achieve direct closure. Total flap necrosis occurred in 2 cases (1 VRAM, 1 DIEAP) that required additional microsurgical reconstructive procedures; partial flap necrosis (10–40% volume) occurred in 4 cases. Marginal abdominal skin necrosis occurred in 3 patients postoperatively. Bulging of the abdomen occurred in one case; abdominal wall weakness was not encountered at a median follow-up of one year. Esthetic results were always satisfactory. Eight patients died of cancer-related disease during the follow-up. Conclusions: We confirm that the infraumbilical region is a safe donor area of free flaps for head & neck reconstruction that does not impact abdominal wall strength. http://dx.doi.org/10.1016/j.ijom.2015.08.470 Radiographic study of TMJ ankylosis cases and proposal of a CT reporting format K. Bhatt ∗ , A. Roychoudhury, G. Jain, M. Mohod, O. Bhutia All India Institute of Medical Sciences, New Delhi, India Background: There are many radiographic aspects of temporomandibular (TMJ) ankylosis that are not covered in conventional classifications.1,2 Objective: To study the surgically important parameters, with a goal to develop difficulty index in future. Methodology: CT-scans and records of 94 TMJ ankylosis patients (60 unilateral, 34 bilateral) were evaluated. Demographics, etiology, duration, radiolucent zone, increase in width of ramus, medially displaced condylar fragment (MDCF), widening of arch and type of ankylosis (intra-articular, juxta-articular or combination) were noted. Dimensions of ankylosis, distances from the arthrotomy to the pterygoid plate and inferior alveolar canal were measured. Pearson Chi2 , t-test were used. Findings: Mean age was 13.44 ± 8.84 years, and mean duration 5.4 ± 4.35 years. 46/94 were males and 48/94 females. 76/94 were post-traumatic, 9 post-infection and 9 arthritic/idiopathic. Widening of mandibular arch was seen in just one case. Radiolucent zone didn’t correlate significantly with etiology or duration (p-value 0.98, 0.09 respectively). The only factor affecting type of ankylosis and width of ramus was etiology (p-value < 0.001). Conclusion: Post-traumatic ankylosis show juxta-articular predilection whereas post-infection/arthritic cases are mainly intra-articular. Post-infection cases show thickening and sclerosis of the ramus. Factors bearing surgical implications should be separately reported, rather than a particular classification.
References Aggarwal, S., et al. (1990). Bony ankylosis of the temporomandibular joint: a computed tomography study. Oral Surg Oral Med Oral Pathol, 69, 128–132. He, D., et al. (2011). Traumatic temporomandibular joint ankylosis: our classification and treatment experience. J Oral Maxillofac Surg, 69, 1600–1607.
http://dx.doi.org/10.1016/j.ijom.2015.08.471 Evaluation of clinical notes in maxillofacial trauma: introduction of a proforma V. Bhatt ∗ , M. Fuentes-Martinez Southend University Hospital NHS Foundation Trust, Southend-on-Sea, United Kingdom Background: The initial assessment of patients who have suffered maxillofacial trauma is generally performed by junior staff. This is an essential duty which comprises the collection of all the relevant data related to the patient and their injury, which is then passed on to seniors in order to decide an appropriate management plan. Objectives: The aim was to evaluate the quality of the clinical notes recorded during the primary survey performed by juniors, as well as to identify any missing information that is considered necessary for seniors to give an appropriate diagnosis and treatment plan. A proforma has been designed and implemented in order to improve the accuracy of data collection. Methods: A standard was set to define the data considered necessary for a comprehensive initial clinical record in maxillofacial trauma. A total of 50 clinical notes were chosen to be assessed retrospectively against the standard, obtaining a percentage score of the information defined as essential which was actually collected. The proforma was then introduced and 50 further clinical records assessed prospectively against the same standard. Findings: To date 15 records have been analysed retrospectively, obtaining an average score of 46% (min 23%, max 60%). 17 records have been analysed following the implementation of the proforma, with an average score of 94% (min 71%, max 100%). Conclusions: The standard of the initial clinical records assessed retrospectively was considered low. The use of a proforma can improve the accuracy of the data collected by junior staff in maxillofacial trauma. http://dx.doi.org/10.1016/j.ijom.2015.08.472 Correction of secondary facial deformity using patient specific implants designed by CAD/CAM technology D. Palumbo, V. Bhatt ∗ Southend University Hospital, UK Background: Traditionally malunited fractures of the zygomatic complex were treated by osteotomy and repositioning by visual assessment. With the advent of modern software accurate preoperative virtual repositioning is possible which can be translated to the surgical procedure. Objectives: Using CAD/CAM technology generated patient specific implants to aid osteotomy and repositioning of the malar bone accurately in 3 dimensions. Methods: We present a 24-year-old patient with a malunited left zygomatic complex fracture treated by preoperative virtual
Oral Presentation
encompasses the periumbilical area of the lower and upper abdomen to include the dominant perforators, thus increasing the overall vascularization of the flap. Methods: Retrospective study of consecutive cancer patients who underwent microsurgical reconstruction of composite defects of the Head & Neck with infraumbilical free flaps. The main aim of the study was to assess abdominal wall integrity and the esthetic result at 1 year. Results: Between January 2006 and December 2014, 19 patients underwent primary reconstruction with free flaps harvested from the lower abdomen, for a total of 28 free flaps (17 VRAM; 11 DIEAP). Nine patients underwent bilateral harvest of flaps and abdominoplasty was performed to achieve direct closure. Total flap necrosis occurred in 2 cases (1 VRAM, 1 DIEAP) that required additional microsurgical reconstructive procedures; partial flap necrosis (10–40% volume) occurred in 4 cases. Marginal abdominal skin necrosis occurred in 3 patients postoperatively. Bulging of the abdomen occurred in one case; abdominal wall weakness was not encountered at a median follow-up of one year. Esthetic results were always satisfactory. Eight patients died of cancer-related disease during the follow-up. Conclusions: We confirm that the infraumbilical region is a safe donor area of free flaps for head & neck reconstruction that does not impact abdominal wall strength. http://dx.doi.org/10.1016/j.ijom.2015.08.470 Radiographic study of TMJ ankylosis cases and proposal of a CT reporting format K. Bhatt ∗ , A. Roychoudhury, G. Jain, M. Mohod, O. Bhutia All India Institute of Medical Sciences, New Delhi, India Background: There are many radiographic aspects of temporomandibular (TMJ) ankylosis that are not covered in conventional classifications.1,2 Objective: To study the surgically important parameters, with a goal to develop difficulty index in future. Methodology: CT-scans and records of 94 TMJ ankylosis patients (60 unilateral, 34 bilateral) were evaluated. Demographics, etiology, duration, radiolucent zone, increase in width of ramus, medially displaced condylar fragment (MDCF), widening of arch and type of ankylosis (intra-articular, juxta-articular or combination) were noted. Dimensions of ankylosis, distances from the arthrotomy to the pterygoid plate and inferior alveolar canal were measured. Pearson Chi2 , t-test were used. Findings: Mean age was 13.44 ± 8.84 years, and mean duration 5.4 ± 4.35 years. 46/94 were males and 48/94 females. 76/94 were post-traumatic, 9 post-infection and 9 arthritic/idiopathic. Widening of mandibular arch was seen in just one case. Radiolucent zone didn’t correlate significantly with etiology or duration (p-value 0.98, 0.09 respectively). The only factor affecting type of ankylosis and width of ramus was etiology (p-value < 0.001). Conclusion: Post-traumatic ankylosis show juxta-articular predilection whereas post-infection/arthritic cases are mainly intra-articular. Post-infection cases show thickening and sclerosis of the ramus. Factors bearing surgical implications should be separately reported, rather than a particular classification.
References Aggarwal, S., et al. (1990). Bony ankylosis of the temporomandibular joint: a computed tomography study. Oral Surg Oral Med Oral Pathol, 69, 128–132. He, D., et al. (2011). Traumatic temporomandibular joint ankylosis: our classification and treatment experience. J Oral Maxillofac Surg, 69, 1600–1607.
http://dx.doi.org/10.1016/j.ijom.2015.08.471 Evaluation of clinical notes in maxillofacial trauma: introduction of a proforma V. Bhatt ∗ , M. Fuentes-Martinez Southend University Hospital NHS Foundation Trust, Southend-on-Sea, United Kingdom Background: The initial assessment of patients who have suffered maxillofacial trauma is generally performed by junior staff. This is an essential duty which comprises the collection of all the relevant data related to the patient and their injury, which is then passed on to seniors in order to decide an appropriate management plan. Objectives: The aim was to evaluate the quality of the clinical notes recorded during the primary survey performed by juniors, as well as to identify any missing information that is considered necessary for seniors to give an appropriate diagnosis and treatment plan. A proforma has been designed and implemented in order to improve the accuracy of data collection. Methods: A standard was set to define the data considered necessary for a comprehensive initial clinical record in maxillofacial trauma. A total of 50 clinical notes were chosen to be assessed retrospectively against the standard, obtaining a percentage score of the information defined as essential which was actually collected. The proforma was then introduced and 50 further clinical records assessed prospectively against the same standard. Findings: To date 15 records have been analysed retrospectively, obtaining an average score of 46% (min 23%, max 60%). 17 records have been analysed following the implementation of the proforma, with an average score of 94% (min 71%, max 100%). Conclusions: The standard of the initial clinical records assessed retrospectively was considered low. The use of a proforma can improve the accuracy of the data collected by junior staff in maxillofacial trauma. http://dx.doi.org/10.1016/j.ijom.2015.08.472 Correction of secondary facial deformity using patient specific implants designed by CAD/CAM technology D. Palumbo, V. Bhatt ∗ Southend University Hospital, UK Background: Traditionally malunited fractures of the zygomatic complex were treated by osteotomy and repositioning by visual assessment. With the advent of modern software accurate preoperative virtual repositioning is possible which can be translated to the surgical procedure. Objectives: Using CAD/CAM technology generated patient specific implants to aid osteotomy and repositioning of the malar bone accurately in 3 dimensions. Methods: We present a 24-year-old patient with a malunited left zygomatic complex fracture treated by preoperative virtual