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Extended use of temporomandibular joint (TMJ) replacement. A case of combined bimaxillary osteotomy and TMJ replacement
Abstracts / British Journal of Oral and Maxillofacial Surgery 53 (2015) e37–e110
P 153 Adult exceptional aesthetic referral protocol and its implications on the consent for Orthognathic surgery P. Fee ∗ , A. Siddiqui, R. Morrison, M. Ryan Aberdeen Royal Infirmary, United Kingdom Introduction: In 2011 Scottish government released adult exceptional aesthetic referral protocol (AEARP),1 which regulates cosmetic surgery in Scotland under the NHS. According to the protocol, aesthetic procedures which are not treating an underlying disease process, are not routinely available in the NHS and can only be provided on exceptional basis where there is clear evidence of benefit to the patient. Aim and rationale: Facial deformity treatment for aesthetic reasons runs the risk of falling within AEARP. We audited our practice to record the indications for carrying out Orthognathic operations on the consent forms. Patients and methods: The project was carried out in the regional oral and maxillofacial unit – Aberdeen Royal Infirmary. Permission was obtained from the local clinical governance body and a retrospective review of the case records of 100 consecutive patients admitted for Orthognathic surgical procedures between January 2012 and December 2014 was carried out. The patient records and consent forms were examined to record indications/intended benefits, patient particulars, treatment details and complications. Results: 13% of patients in our cohort had aesthetics as an indication for their Orthognathic procedure. However, there was a decreasing trend in quoting ‘aesthetics’ as an indication for surgery. Conclusions and clinical relevance: We aim to generate a discussion on AEARP and its implications on facial deformity patients.
e93
(OAV) syndrome or hemifacial microsomia, is associated with incomplete development of the facial structures usually on one side of the body. Patients will usually require combined orthodontic and orthognathic surgery to manage the resultant facial asymmetry. The patient underwent Le Fort I osteotomy, right sagittal split osteotomy, left condylectomy and left TMJ replacement as a combined procedure. Simulated virtual surgical planning allowed accurate assessment. The combination of atrophic left mandibular ramus, absence of left TMJ and resultant occlusal cant made conventional orthognathic surgical options impossible. Concurrent use of TMJ replacement and orthognathic surgery has been described for cases of condylar resorption 1 and for revision of previous orthognathic surgery 2 but we believe this to be the first case where this has been used to correct facial deformity as a primary procedure.1,2
References 1. Osher J, Gillman L, Matthews NS. Contemporary management of idiopathic condylar resorption utilising virtual surgical planning and single stage, bilateral, custom TMJ replacement with or without concurrent orthognathic surgery. BJOMS 2013, September. 2. Hills AJ, Nabeela A. Concurrent bilateral total temporomandibular joint replacement surgery and conventional maxillary osteotomy utilizing virtual surgical planning web-based technology. J Craniofac Surg 2014, May.
http://dx.doi.org/10.1016/j.bjoms.2015.08.161 P 155 Completeness of orthognathic records using the BOS/BAOMS minimum dataset Proforma G.A. Ghaly ∗ , E. Gonzalez Malaga, J. O’Neill, C. Harrop
Reference 1. Adult exceptional aesthetic referral protocol. http:// eastscotlandplasticsurgery.org/wpcontent/uploads/2013/01/AEARP.pdf.
http://dx.doi.org/10.1016/j.bjoms.2015.08.160 P 154 Extended use of temporomandibular joint (TMJ) replacement. A case of combined bimaxillary osteotomy and TMJ replacement L. Feeney ∗ , Ansell, Laverick, Mcloughlin Member with Student Status/Working at Ninewells Hospital, United Kingdom The patient is an 18 yr old male with Goldenhar syndrome. Goldenhar syndrome is a developmental disorder that is believed to have genetic and environmental factors. Goldenhar syndrome, often referred to as Oculo-Auriculo-vertebral
Oxford Deanery, United Kingdom Introduction: In 2004 the British Orthodontic Society and the British Association of Oral and Maxillofacial Surgeons issued an advisory dataset that should be viewed as the minimum records required during the course of treatment for orthognathic patients. We aimed to assess the current data collection regime at two hospitals and compare record taking with the recommended Minimum Dataset. Method: 100% compliance was set as Gold Standard. All patients assessed had Orthodontic treatment at one hospital, and Orthognathic Surgery at both hospitals between January 2005 and December 2010. Full records were examined thoroughly and a Proforma was completed retrospectively for each patient. Results: 130 patients identified as having undergone orthognathic surgery. 60 were excluded for data deficiency. 70 were included. There was a lack of compliance in recording the presence of altered sensation, however, good record keep-
P 153 Adult exceptional aesthetic referral protocol and its implications on the consent for Orthognathic surgery P. Fee ∗ , A. Siddiqui, R. Morrison, M. Ryan Aberdeen Royal Infirmary, United Kingdom Introduction: In 2011 Scottish government released adult exceptional aesthetic referral protocol (AEARP),1 which regulates cosmetic surgery in Scotland under the NHS. According to the protocol, aesthetic procedures which are not treating an underlying disease process, are not routinely available in the NHS and can only be provided on exceptional basis where there is clear evidence of benefit to the patient. Aim and rationale: Facial deformity treatment for aesthetic reasons runs the risk of falling within AEARP. We audited our practice to record the indications for carrying out Orthognathic operations on the consent forms. Patients and methods: The project was carried out in the regional oral and maxillofacial unit – Aberdeen Royal Infirmary. Permission was obtained from the local clinical governance body and a retrospective review of the case records of 100 consecutive patients admitted for Orthognathic surgical procedures between January 2012 and December 2014 was carried out. The patient records and consent forms were examined to record indications/intended benefits, patient particulars, treatment details and complications. Results: 13% of patients in our cohort had aesthetics as an indication for their Orthognathic procedure. However, there was a decreasing trend in quoting ‘aesthetics’ as an indication for surgery. Conclusions and clinical relevance: We aim to generate a discussion on AEARP and its implications on facial deformity patients.
e93
(OAV) syndrome or hemifacial microsomia, is associated with incomplete development of the facial structures usually on one side of the body. Patients will usually require combined orthodontic and orthognathic surgery to manage the resultant facial asymmetry. The patient underwent Le Fort I osteotomy, right sagittal split osteotomy, left condylectomy and left TMJ replacement as a combined procedure. Simulated virtual surgical planning allowed accurate assessment. The combination of atrophic left mandibular ramus, absence of left TMJ and resultant occlusal cant made conventional orthognathic surgical options impossible. Concurrent use of TMJ replacement and orthognathic surgery has been described for cases of condylar resorption 1 and for revision of previous orthognathic surgery 2 but we believe this to be the first case where this has been used to correct facial deformity as a primary procedure.1,2
References 1. Osher J, Gillman L, Matthews NS. Contemporary management of idiopathic condylar resorption utilising virtual surgical planning and single stage, bilateral, custom TMJ replacement with or without concurrent orthognathic surgery. BJOMS 2013, September. 2. Hills AJ, Nabeela A. Concurrent bilateral total temporomandibular joint replacement surgery and conventional maxillary osteotomy utilizing virtual surgical planning web-based technology. J Craniofac Surg 2014, May.
http://dx.doi.org/10.1016/j.bjoms.2015.08.161 P 155 Completeness of orthognathic records using the BOS/BAOMS minimum dataset Proforma G.A. Ghaly ∗ , E. Gonzalez Malaga, J. O’Neill, C. Harrop
Reference 1. Adult exceptional aesthetic referral protocol. http:// eastscotlandplasticsurgery.org/wpcontent/uploads/2013/01/AEARP.pdf.
http://dx.doi.org/10.1016/j.bjoms.2015.08.160 P 154 Extended use of temporomandibular joint (TMJ) replacement. A case of combined bimaxillary osteotomy and TMJ replacement L. Feeney ∗ , Ansell, Laverick, Mcloughlin Member with Student Status/Working at Ninewells Hospital, United Kingdom The patient is an 18 yr old male with Goldenhar syndrome. Goldenhar syndrome is a developmental disorder that is believed to have genetic and environmental factors. Goldenhar syndrome, often referred to as Oculo-Auriculo-vertebral
Oxford Deanery, United Kingdom Introduction: In 2004 the British Orthodontic Society and the British Association of Oral and Maxillofacial Surgeons issued an advisory dataset that should be viewed as the minimum records required during the course of treatment for orthognathic patients. We aimed to assess the current data collection regime at two hospitals and compare record taking with the recommended Minimum Dataset. Method: 100% compliance was set as Gold Standard. All patients assessed had Orthodontic treatment at one hospital, and Orthognathic Surgery at both hospitals between January 2005 and December 2010. Full records were examined thoroughly and a Proforma was completed retrospectively for each patient. Results: 130 patients identified as having undergone orthognathic surgery. 60 were excluded for data deficiency. 70 were included. There was a lack of compliance in recording the presence of altered sensation, however, good record keep-