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Extracapsular dissection versus superficial parotidectomy in treatment of benign parotid tumors: evidence from 3194 patients
Oral Presentation radiotherapy can improve the prognosis and reduce recurrence of SCC post-premolar area. http://dx.doi.org/10.1016/j.ijom.2015.08.871 Implant in vascularized fibula graft reconstructed for segment mandibular defect Y. Wu 1,∗ , J. Yao 1 , W. Shi 2 , X. Yang 1 , X. Ding 1 , X. Song 1 1
Department of Oral and Maxillofacial Surgery, Stomatological Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China 2 Department of Stomatology, Gaoyou People’s Hospital, Jiangsu Province, China
Background: Single-barrel vascularized fibula free flaps can achieve segmental mandibular reconstruction, but height of singlebarrel fibula is not suitable for rehabilitation of ideal occlusion and masticatory function. Vascularized double-barrel fibula grafting and vertical distraction osteogenesis (OD) of single-barrel fibula have become accepted options to rehabilitate the height of segmental mandibular defect. Objectives: To observe the outcome of dental implant in vascularized fibula flap, either in vertical distraction osteogenesis of single-barrel fibula or double-barrel fibula. Methods: 13 patients reconstructed with vascularized singlebarrel or double-barrel fibula flap were involved in this study (2001–2013). Among them, 4 cases were treated with OD of single-barrel fibula before inserting the implant placement, and 9 cases got the implant surgery 6 months later after double-barrel fibula grafting surgery. A total of 43 implants were used, 13 in OD of single-barrel fibula and 30 in double-barrel fibula, respectively. Palatal mucosal grafts were performed in 7 cases and 5 of them were operated after the definitive prostheses loaded. Bone losses around implants and complications such as peri-implant mucositis and peri-implantitis were evaluated during follow-up. Findings: 3 implant failures were observed after a mean follow-up period of 31.2 months, 2 in distracted single-barrel and 1 in double-barrel fibula. Peri-implant mucositis were found temporarily in 11 cases, and 5 cases were relieved after palatal mucosal grafts, peri-implant bone losses were significantly observed in distracted single-barrel fibula. Conclusions: Compared implanting in distracted single-barrel fibula graft with in double-barrel fibula, implant in double-barrel fibula has advantage in some extent; peri-implant bone losses were less than distracted single-barrel fibula. Peri-implant mucositis can be relieved by palatal mucosal grafts. http://dx.doi.org/10.1016/j.ijom.2015.08.872 Extracapsular dissection versus superficial parotidectomy in treatment of benign parotid tumors: evidence from 3194 patients S. Xie 1,∗ , K. Wang 1 , H. Xu 1 , R. Hua 2 , T. Li 1 , X. Shan 1 , Z. Cai 1 1
Peking University School and Hospital of Stomatology, Beijing, China 2 The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China Background: Benign parotid tumor is one of the most common neoplasms in head and neck region. Its therapeutic methods have been debatable topics over the past 100 years.
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Objectives: To compare extracapsular dissection (ECD) with superficial parotidectomy (SP) in the treatment of benign parotid tumors by a meta-analysis. Methods: Literature retrieval covering Cochrane library, Pubmed, Embase, Ovid and Web of Science databases was performed on February 14th 2015. Outcome data were evaluated by pooled risk ratio (RR) and corresponding 95% confidence interval (CI). Findings: After serious scrutiny, a total of 14 cohort studies with 3194 patients were included in this meta-analysis. The pooled RR revealed that there were no significant difference in tumor recurrence rate between ECD and SP (RR = 0.71, 95% CI = 0.40–1.27, p = 0.249). However, there were significantly lower incidences of transient facial nerve dysfunction, permanent facial nerve dysfunction and Frey’s syndrome in patients of ECD group compared with SP group. The pooled RRs and corresponding 95% CIs were 0.40 (0.31–0.50), 0.35 (0.17–0.69) and 0.15 (0.07–0.30), respectively. Conclusions: (1) ECD might be a good choice in treatment of the benign parotid tumor that was mobile, small, located in superficial lobe and without adhesion to facial nerve; (2) the ECD should be performed by the experienced surgeons with the ability of dissection facial nerve, and SP should be performed if surgeons found that tumor adhere to facial nerve during an operation; and (3) a multicenter randomized control trial study is necessary to decide the optimal treatment of benign parotid tumor. http://dx.doi.org/10.1016/j.ijom.2015.08.873 Microsurgical free flaps at a tertiary care hospital in Chitwan, Nepal S.K. Yadav ∗ , S. Shrestha, R.J. Neupanae Chitwan Medical College (CMC), Chitwan, Nepal Background: Microsurgical free flaps have become the first choice for reconstruction of oral and maxillofacial (OMF) defects after tumor resection. Microsurgery is an emerging subspecialty in Nepal. Microsurgery was started at a tertiary care hospital in Chitwan. This study will be useful for establishing a baseline for future comparisons of outcome variables and for defining the challenges of performing microsurgical free flaps in Nepal. Methods: A retrospective cross sectional study was conducted using the clinical records of the most common microvascular free flaps namely, radial forearm free flap (RFFF), anterolateral thigh flap (ALT) and free fibula flap (FFF) that are commonly used in OMF reconstruction that performed at a tertiary care hospital in Chitwan from August 2014 to February 2015. Results: Ten free flaps were performed for neoplasm. RFFF was the commonest flap followed by FFF, ALT. Hospital stay ranged from 10 to 15 days with an average of 12.5 days. None of the patients developed complication. The duration of operation ranged from 6 to 10.5 h with an average of 9 h. The longest follow up was for 6 months. Conclusions: Microsurgery can be started even in very resource-poor center if there is support from advanced centers and if there is commitment of the institution and surgical team. http://dx.doi.org/10.1016/j.ijom.2015.08.874
Department of Oral and Maxillofacial Surgery, Stomatological Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China 2 Department of Stomatology, Gaoyou People’s Hospital, Jiangsu Province, China
Background: Single-barrel vascularized fibula free flaps can achieve segmental mandibular reconstruction, but height of singlebarrel fibula is not suitable for rehabilitation of ideal occlusion and masticatory function. Vascularized double-barrel fibula grafting and vertical distraction osteogenesis (OD) of single-barrel fibula have become accepted options to rehabilitate the height of segmental mandibular defect. Objectives: To observe the outcome of dental implant in vascularized fibula flap, either in vertical distraction osteogenesis of single-barrel fibula or double-barrel fibula. Methods: 13 patients reconstructed with vascularized singlebarrel or double-barrel fibula flap were involved in this study (2001–2013). Among them, 4 cases were treated with OD of single-barrel fibula before inserting the implant placement, and 9 cases got the implant surgery 6 months later after double-barrel fibula grafting surgery. A total of 43 implants were used, 13 in OD of single-barrel fibula and 30 in double-barrel fibula, respectively. Palatal mucosal grafts were performed in 7 cases and 5 of them were operated after the definitive prostheses loaded. Bone losses around implants and complications such as peri-implant mucositis and peri-implantitis were evaluated during follow-up. Findings: 3 implant failures were observed after a mean follow-up period of 31.2 months, 2 in distracted single-barrel and 1 in double-barrel fibula. Peri-implant mucositis were found temporarily in 11 cases, and 5 cases were relieved after palatal mucosal grafts, peri-implant bone losses were significantly observed in distracted single-barrel fibula. Conclusions: Compared implanting in distracted single-barrel fibula graft with in double-barrel fibula, implant in double-barrel fibula has advantage in some extent; peri-implant bone losses were less than distracted single-barrel fibula. Peri-implant mucositis can be relieved by palatal mucosal grafts. http://dx.doi.org/10.1016/j.ijom.2015.08.872 Extracapsular dissection versus superficial parotidectomy in treatment of benign parotid tumors: evidence from 3194 patients S. Xie 1,∗ , K. Wang 1 , H. Xu 1 , R. Hua 2 , T. Li 1 , X. Shan 1 , Z. Cai 1 1
Peking University School and Hospital of Stomatology, Beijing, China 2 The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China Background: Benign parotid tumor is one of the most common neoplasms in head and neck region. Its therapeutic methods have been debatable topics over the past 100 years.
e167
Objectives: To compare extracapsular dissection (ECD) with superficial parotidectomy (SP) in the treatment of benign parotid tumors by a meta-analysis. Methods: Literature retrieval covering Cochrane library, Pubmed, Embase, Ovid and Web of Science databases was performed on February 14th 2015. Outcome data were evaluated by pooled risk ratio (RR) and corresponding 95% confidence interval (CI). Findings: After serious scrutiny, a total of 14 cohort studies with 3194 patients were included in this meta-analysis. The pooled RR revealed that there were no significant difference in tumor recurrence rate between ECD and SP (RR = 0.71, 95% CI = 0.40–1.27, p = 0.249). However, there were significantly lower incidences of transient facial nerve dysfunction, permanent facial nerve dysfunction and Frey’s syndrome in patients of ECD group compared with SP group. The pooled RRs and corresponding 95% CIs were 0.40 (0.31–0.50), 0.35 (0.17–0.69) and 0.15 (0.07–0.30), respectively. Conclusions: (1) ECD might be a good choice in treatment of the benign parotid tumor that was mobile, small, located in superficial lobe and without adhesion to facial nerve; (2) the ECD should be performed by the experienced surgeons with the ability of dissection facial nerve, and SP should be performed if surgeons found that tumor adhere to facial nerve during an operation; and (3) a multicenter randomized control trial study is necessary to decide the optimal treatment of benign parotid tumor. http://dx.doi.org/10.1016/j.ijom.2015.08.873 Microsurgical free flaps at a tertiary care hospital in Chitwan, Nepal S.K. Yadav ∗ , S. Shrestha, R.J. Neupanae Chitwan Medical College (CMC), Chitwan, Nepal Background: Microsurgical free flaps have become the first choice for reconstruction of oral and maxillofacial (OMF) defects after tumor resection. Microsurgery is an emerging subspecialty in Nepal. Microsurgery was started at a tertiary care hospital in Chitwan. This study will be useful for establishing a baseline for future comparisons of outcome variables and for defining the challenges of performing microsurgical free flaps in Nepal. Methods: A retrospective cross sectional study was conducted using the clinical records of the most common microvascular free flaps namely, radial forearm free flap (RFFF), anterolateral thigh flap (ALT) and free fibula flap (FFF) that are commonly used in OMF reconstruction that performed at a tertiary care hospital in Chitwan from August 2014 to February 2015. Results: Ten free flaps were performed for neoplasm. RFFF was the commonest flap followed by FFF, ALT. Hospital stay ranged from 10 to 15 days with an average of 12.5 days. None of the patients developed complication. The duration of operation ranged from 6 to 10.5 h with an average of 9 h. The longest follow up was for 6 months. Conclusions: Microsurgery can be started even in very resource-poor center if there is support from advanced centers and if there is commitment of the institution and surgical team. http://dx.doi.org/10.1016/j.ijom.2015.08.874