- Email: [email protected]
Fracture patterns of the anterior cranial fossa
Oral Presentation from a diagnostic procedure is considered as unacceptable.2 Parotid gland biopsies will overcome the disadvantages of labial biopsies, and are superior in early detection and disease control of MALT-lymphoma associated SS2. How: Parotid gland biopsies could be taken under local anesthesia during a 10-min procedure. An 1–1.5 cm incision below and mainly behind the earlobe is preferred for cosmetic reasons, without concessions to the diagnostic capacity. In this presentation an exclusively for this meeting produced film on the state of art parotid biopsy technique will be shown. The parotid gland biopsy technique should be part of the toolbox of every SS-research team.
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responders with non-responders, number of CD20+ B-cells/mm2 parenchyma at baseline was significantly higher in responders (2763 cells/mm2 versus 925 cells/mm2 , p < 0.05). Conclusion: RTX treatment leads to major reduction of lymphocytic infiltration, number of B-cells, germinal centres and lymphoepithelial lesions in parotid salivary gland parenchyma. The pre-treatment number of CD20+ B-cells/mm2 parotid gland parenchyma predicts responsiveness of pSS patients to RTX treatment. Herewith baseline parotid salivary gland histopathological characteristics may contribute to a more personalized treatment approach of pSS. http://dx.doi.org/10.1016/j.ijom.2015.08.814
References Meiners, P., Vissink, A., Kroese, F., Spijkervet, F., et al. (2014). Abatacept treatment reduces disease activity in early pSjögrens Syndrome. Ann Rheum Dis, 73, 1393–1396. Delli, K., Vissink, A., & Spijkervet, F. (2014). Salivary gland biopsy for Sjögren’s Syndrome. Oral Maxillofac Surg Clin N Am, 26, 23–33.
http://dx.doi.org/10.1016/j.ijom.2015.08.813 Towards personalized treatment in primary Sjögren’s syndrome: baseline parotid histopathology predicts responsiveness to rituximab treatment F. Spijkervet 1,∗ , K. Delli 1 , E. Haacke 2,3 , F. Kroese 2 , R. Pollard 1 , S. Ihrler 4 , A. Vissink 1 , H. Bootsma 2 1
University Medical Center Groningen, Department of Oral & Maxillofacial Surgery, Groningen, The Netherlands 2 University Medical Center GroningenDepartment of Rheumatology & Clinical Immunology, Groningen, The Netherlands 3 University Medical Center Groningen, Department of Pathology and Medical Biology, Groningen, The Netherlands 4 Klinikum Augsburg, Institute of Pathology, Augsburg, Germany Objectives: To assess the prognostic value of parotid gland histopathology with regard to responsiveness of patients with primary Sjögren’s syndrome (pSS) to rituximab (anti-CD20; RTX) treatment. Methods: In a double-blinded, placebo-controlled trial sequential parotid gland biopsies were taken from 20 RTX and 10 placebo treated pSS patients, i.e., before and 12 weeks after RTX or placebo treatment. The relative amount of lymphocytic infiltrate (stained for CD45), absolute number of T-cells and B-cells per mm2 parenchyma (stained for CD3 and CD20, respectively), the focus score, and number of germinal centers and lymphoepithelial lesions per mm2 in parotid gland parenchyma were assessed. Histopathology data were separately analysed for responders (change in European League Against Rheumatism (EULAR) Sjögren’s Syndrome Disease Activity Index (ESSDAI) 12 weeks after treatment ≥ 3) and non-responders (change in ESSDAI < 3) to RTX treatment. Results: In RTX treated patients, a significant reduction in the number of CD20+ B-cells/mm2 parenchyma was observed, while no such reduction was observed in placebo-treated patients. The levels of CD3+ T-cells/mm2 in parenchyma did not change in both groups. Furthermore, the number of lymphoepithelial lesions/mm2 and germinal centres/mm2 was significantly reduced in RTX-treated patients and did not change in placebo-treated patients. When comparing the pre-treatment characteristics of
Treatment particularities in extended parotidectomy E. Popescu, O. Stamatin ∗ , O. Boisteanu, C. Ciocan, V.V. Costan, D. Agop Forna Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania Background: The treatment of the extended parotid surgery involves a multifaceted approach through the complex adjacent anatomical structures, functional concentration of elements, aesthetics and general status of patients. Objectives: Case assessments and establishing a treatment protocol for extensive parotid tumours targeting reestablishing of the normal functionality and esthetics. Methods: Thirty-six patients diagnosed with extensive parotid tumours (male:female, 22:14; mean age 57 years) treated from January 2005 to November 2014 were identified. These were primary (19) or secondary (14) from skin tumour infiltration (11) or metastatic parotid lymphnodes (6). The reconstruction approach included 8 radialis and 6 latissimus dorsi free flap, 7 platysma flap, 3 major pectoralis musculocutaneous flap, one major pectoralis muscle flap, 5 sternocleidomastoid flap, 5 skin rotation flap and 1 no reconstruction. Facial asymmetry was addressed in 8 cases using Coleman technique, while paralytic lagophthalmos was treated in 7 cases with a golden weight implant in upper eyelid. Findings: Surgical complications included Pectoralis Major musculocutaneous flaps suffered an important atrophy resulting facial asymmetry, while the appropriate esthetic and functional results were obtained with free flaps. Golden weight implant wars effective in treatment of lagophtalmos, one case with latissimus dorsi encountered dehiscence of the wound in the parotid region and ectropion. Conclusions: The extended parotidectomy requires an integrated surgical approach with both accurate and complete first stage treatment and corrective interventions proves effective through careful coordination can improve the quality of life of patients and proper social integration. http://dx.doi.org/10.1016/j.ijom.2015.08.815 Fracture patterns of the anterior cranial fossa J.R. Stephens 1,∗ , S. Holmes 2 , B.T. Evans 1 1
University Hospital Southampton, Southampton, United Kingdom 2 The Royal London Hospital, London, United Kingdom Background: The anterior cranial fossa (ACF) may be considered an ‘orphan’ site as far as analysis of fracture patterns is
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Oral Presentation
concerned, as individual fractures are only reduced and fixed if they have relevance to the facial skeleton &/or the frontal sinus. Objectives: (1) To assesses the possibility of differing fracture patterns being sustained to the ACF depending on the predominant direction of force to the frontal bone (2) To consider the possible clinical relevance of any such differences. Methodology: Eighty-one patients who sustained frontobasal fractures* and treated at either University Hospital Southampton or The Royal London Hospital, were identified. The patients were divided into two groups:
The fracture patterns of the two groups were recorded by analysing the Computed Tomography images. The first recorded Glasgow Come Score and the requirement for intubation/decompressive craniectomy were considered as markers of severity of head injury. Findings: There were significant differences in both the severity of the head injuries and the patterns of fractures sustained by the patients in these two groups. Conclusion: A new system of ‘functional buttresses’ of the skull base is proposed, in light of this study. *Frontobasal fractures can be defined as – ‘Fractures of the floor of the anterior cranial fossa resulting from blunt force to the frontal bone’. http://dx.doi.org/10.1016/j.ijom.2015.08.817
- those who received a predominantly anterior impact and - those who received a predominantly lateral impact
Effects of capsaicin and carbachol on secretion from transplanted submandibular glands and prevention of duct obstruction
to the frontal bone. The fracture patterns of the two groups were recorded and compared. Findings: Significantly different and reproducible patterns of fracture were sustained by each group, with possible protective features being identified in the anatomy of the ACF in those patients who received a predominantly anterior impact. Conclusions: Different and reproducible patterns of fractures are sustained by the ACF depending on the predominant direction of the impact force to the frontal bone. There appear to be protective features in the anatomy of the ACF when the frontal bone receives a predominantly anterior impact. * Frontobasal fractures can be defined as – ‘Fractures of the floor of the anterior cranial fossa resulting from blunt force to the frontal bone’.
J.Z. Su 1,∗ , G.Y. Yu 1 , X.J. Liu 1 , Y. Wang 1 , Z.G. Cai 1 , L. Zhang 1 , L. Lv 2 , Z. Wang 1 , X. Hong 1
http://dx.doi.org/10.1016/j.ijom.2015.08.816 Functional buttresses of the skull base J.R. Stephens 1,∗ , S. Holmes 2 , B.T. Evans 1 1 University Hospital Southampton, Southampton, United Kingdom 2 The Royal London Hospital, London, United Kingdom
Background: Skull base buttresses (‘pillars of strength’) have been proposed based primarily on osseous anatomy but do not appear to consider the severity of head injury in these patients. Objectives: To consider: (1) The possible association between the severity of the head injuries and the associated fracture patterns in two groups of patients who sustained frontobasal fractures*. The two groups: (a) Those struck with a predominantly anterior impact. (b) Those struck with a predominantly lateral impact. (2) The possible clinical relevance of the findings in determining the skeletal buttresses of the base of the skull. Methodology: Eighty-one patients, who sustained frontobasal fractures and were treated at either University Hospital Southampton or The Royal London Hospital, were identified and divided into two groups depending on the predominant direction of force to the frontal bone.
1
Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China 2 Department of Ophthalmology, Affiliated Beijing Tong Ren Hospital, Capital University of Medical Science, Beijing, China
Background: Submandibular gland (SMG) transplantation is an useful treatment for severe cases of dry eye syndrome. Duct obstruction in transplanted SMGs seriously hampers treatment effects. Objectives: To investigate the effect of capsaicin and carbachol for promoting secretion from and preventing duct obstruction in transplanted SMGs. Methods: A retrospective cohort study was performed on consecutive patients with severe keratoconjunctivitis sicca who had undergone successful SMG transplantation between 1999 and 2012 in Peking University School of Stomatology. Patients were divided into two groups, one exposed group which received both capsaicin and carbachol after surgery, and one unexposed group which received neither. Secretory flow rate changes in response to capsaicin and carbachol administration were recorded in patients from the exposed group. The main outcome measures were secretory flow rate and rate of duct obstruction in the transplanted SMGs. Findings: Forty-four patients (44 eyes) in the unexposed group and 115 patients (128 eyes) in the exposed group were followed up for more than 3 months postoperatively. The baseline characteristics were similar between the groups. Changes in the secretory flow rate of the transplanted SMGs after capsaicin or carbachol administration were recorded for 43 eyes, and significant increases were found (P < 0.001 for both). In the exposed group, 6.25% eyes had duct obstruction, while 18.18% eyes in the unexposed group had duct obstruction (odds ratio = 0.300, 95% CI = 0.105–0.856, P = 0.031). Conclusions: Capsaicin and carbachol are effective in promoting secretion from and preventing duct obstruction in transplanted SMGs. http://dx.doi.org/10.1016/j.ijom.2015.08.818
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responders with non-responders, number of CD20+ B-cells/mm2 parenchyma at baseline was significantly higher in responders (2763 cells/mm2 versus 925 cells/mm2 , p < 0.05). Conclusion: RTX treatment leads to major reduction of lymphocytic infiltration, number of B-cells, germinal centres and lymphoepithelial lesions in parotid salivary gland parenchyma. The pre-treatment number of CD20+ B-cells/mm2 parotid gland parenchyma predicts responsiveness of pSS patients to RTX treatment. Herewith baseline parotid salivary gland histopathological characteristics may contribute to a more personalized treatment approach of pSS. http://dx.doi.org/10.1016/j.ijom.2015.08.814
References Meiners, P., Vissink, A., Kroese, F., Spijkervet, F., et al. (2014). Abatacept treatment reduces disease activity in early pSjögrens Syndrome. Ann Rheum Dis, 73, 1393–1396. Delli, K., Vissink, A., & Spijkervet, F. (2014). Salivary gland biopsy for Sjögren’s Syndrome. Oral Maxillofac Surg Clin N Am, 26, 23–33.
http://dx.doi.org/10.1016/j.ijom.2015.08.813 Towards personalized treatment in primary Sjögren’s syndrome: baseline parotid histopathology predicts responsiveness to rituximab treatment F. Spijkervet 1,∗ , K. Delli 1 , E. Haacke 2,3 , F. Kroese 2 , R. Pollard 1 , S. Ihrler 4 , A. Vissink 1 , H. Bootsma 2 1
University Medical Center Groningen, Department of Oral & Maxillofacial Surgery, Groningen, The Netherlands 2 University Medical Center GroningenDepartment of Rheumatology & Clinical Immunology, Groningen, The Netherlands 3 University Medical Center Groningen, Department of Pathology and Medical Biology, Groningen, The Netherlands 4 Klinikum Augsburg, Institute of Pathology, Augsburg, Germany Objectives: To assess the prognostic value of parotid gland histopathology with regard to responsiveness of patients with primary Sjögren’s syndrome (pSS) to rituximab (anti-CD20; RTX) treatment. Methods: In a double-blinded, placebo-controlled trial sequential parotid gland biopsies were taken from 20 RTX and 10 placebo treated pSS patients, i.e., before and 12 weeks after RTX or placebo treatment. The relative amount of lymphocytic infiltrate (stained for CD45), absolute number of T-cells and B-cells per mm2 parenchyma (stained for CD3 and CD20, respectively), the focus score, and number of germinal centers and lymphoepithelial lesions per mm2 in parotid gland parenchyma were assessed. Histopathology data were separately analysed for responders (change in European League Against Rheumatism (EULAR) Sjögren’s Syndrome Disease Activity Index (ESSDAI) 12 weeks after treatment ≥ 3) and non-responders (change in ESSDAI < 3) to RTX treatment. Results: In RTX treated patients, a significant reduction in the number of CD20+ B-cells/mm2 parenchyma was observed, while no such reduction was observed in placebo-treated patients. The levels of CD3+ T-cells/mm2 in parenchyma did not change in both groups. Furthermore, the number of lymphoepithelial lesions/mm2 and germinal centres/mm2 was significantly reduced in RTX-treated patients and did not change in placebo-treated patients. When comparing the pre-treatment characteristics of
Treatment particularities in extended parotidectomy E. Popescu, O. Stamatin ∗ , O. Boisteanu, C. Ciocan, V.V. Costan, D. Agop Forna Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania Background: The treatment of the extended parotid surgery involves a multifaceted approach through the complex adjacent anatomical structures, functional concentration of elements, aesthetics and general status of patients. Objectives: Case assessments and establishing a treatment protocol for extensive parotid tumours targeting reestablishing of the normal functionality and esthetics. Methods: Thirty-six patients diagnosed with extensive parotid tumours (male:female, 22:14; mean age 57 years) treated from January 2005 to November 2014 were identified. These were primary (19) or secondary (14) from skin tumour infiltration (11) or metastatic parotid lymphnodes (6). The reconstruction approach included 8 radialis and 6 latissimus dorsi free flap, 7 platysma flap, 3 major pectoralis musculocutaneous flap, one major pectoralis muscle flap, 5 sternocleidomastoid flap, 5 skin rotation flap and 1 no reconstruction. Facial asymmetry was addressed in 8 cases using Coleman technique, while paralytic lagophthalmos was treated in 7 cases with a golden weight implant in upper eyelid. Findings: Surgical complications included Pectoralis Major musculocutaneous flaps suffered an important atrophy resulting facial asymmetry, while the appropriate esthetic and functional results were obtained with free flaps. Golden weight implant wars effective in treatment of lagophtalmos, one case with latissimus dorsi encountered dehiscence of the wound in the parotid region and ectropion. Conclusions: The extended parotidectomy requires an integrated surgical approach with both accurate and complete first stage treatment and corrective interventions proves effective through careful coordination can improve the quality of life of patients and proper social integration. http://dx.doi.org/10.1016/j.ijom.2015.08.815 Fracture patterns of the anterior cranial fossa J.R. Stephens 1,∗ , S. Holmes 2 , B.T. Evans 1 1
University Hospital Southampton, Southampton, United Kingdom 2 The Royal London Hospital, London, United Kingdom Background: The anterior cranial fossa (ACF) may be considered an ‘orphan’ site as far as analysis of fracture patterns is
e148
Oral Presentation
concerned, as individual fractures are only reduced and fixed if they have relevance to the facial skeleton &/or the frontal sinus. Objectives: (1) To assesses the possibility of differing fracture patterns being sustained to the ACF depending on the predominant direction of force to the frontal bone (2) To consider the possible clinical relevance of any such differences. Methodology: Eighty-one patients who sustained frontobasal fractures* and treated at either University Hospital Southampton or The Royal London Hospital, were identified. The patients were divided into two groups:
The fracture patterns of the two groups were recorded by analysing the Computed Tomography images. The first recorded Glasgow Come Score and the requirement for intubation/decompressive craniectomy were considered as markers of severity of head injury. Findings: There were significant differences in both the severity of the head injuries and the patterns of fractures sustained by the patients in these two groups. Conclusion: A new system of ‘functional buttresses’ of the skull base is proposed, in light of this study. *Frontobasal fractures can be defined as – ‘Fractures of the floor of the anterior cranial fossa resulting from blunt force to the frontal bone’. http://dx.doi.org/10.1016/j.ijom.2015.08.817
- those who received a predominantly anterior impact and - those who received a predominantly lateral impact
Effects of capsaicin and carbachol on secretion from transplanted submandibular glands and prevention of duct obstruction
to the frontal bone. The fracture patterns of the two groups were recorded and compared. Findings: Significantly different and reproducible patterns of fracture were sustained by each group, with possible protective features being identified in the anatomy of the ACF in those patients who received a predominantly anterior impact. Conclusions: Different and reproducible patterns of fractures are sustained by the ACF depending on the predominant direction of the impact force to the frontal bone. There appear to be protective features in the anatomy of the ACF when the frontal bone receives a predominantly anterior impact. * Frontobasal fractures can be defined as – ‘Fractures of the floor of the anterior cranial fossa resulting from blunt force to the frontal bone’.
J.Z. Su 1,∗ , G.Y. Yu 1 , X.J. Liu 1 , Y. Wang 1 , Z.G. Cai 1 , L. Zhang 1 , L. Lv 2 , Z. Wang 1 , X. Hong 1
http://dx.doi.org/10.1016/j.ijom.2015.08.816 Functional buttresses of the skull base J.R. Stephens 1,∗ , S. Holmes 2 , B.T. Evans 1 1 University Hospital Southampton, Southampton, United Kingdom 2 The Royal London Hospital, London, United Kingdom
Background: Skull base buttresses (‘pillars of strength’) have been proposed based primarily on osseous anatomy but do not appear to consider the severity of head injury in these patients. Objectives: To consider: (1) The possible association between the severity of the head injuries and the associated fracture patterns in two groups of patients who sustained frontobasal fractures*. The two groups: (a) Those struck with a predominantly anterior impact. (b) Those struck with a predominantly lateral impact. (2) The possible clinical relevance of the findings in determining the skeletal buttresses of the base of the skull. Methodology: Eighty-one patients, who sustained frontobasal fractures and were treated at either University Hospital Southampton or The Royal London Hospital, were identified and divided into two groups depending on the predominant direction of force to the frontal bone.
1
Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China 2 Department of Ophthalmology, Affiliated Beijing Tong Ren Hospital, Capital University of Medical Science, Beijing, China
Background: Submandibular gland (SMG) transplantation is an useful treatment for severe cases of dry eye syndrome. Duct obstruction in transplanted SMGs seriously hampers treatment effects. Objectives: To investigate the effect of capsaicin and carbachol for promoting secretion from and preventing duct obstruction in transplanted SMGs. Methods: A retrospective cohort study was performed on consecutive patients with severe keratoconjunctivitis sicca who had undergone successful SMG transplantation between 1999 and 2012 in Peking University School of Stomatology. Patients were divided into two groups, one exposed group which received both capsaicin and carbachol after surgery, and one unexposed group which received neither. Secretory flow rate changes in response to capsaicin and carbachol administration were recorded in patients from the exposed group. The main outcome measures were secretory flow rate and rate of duct obstruction in the transplanted SMGs. Findings: Forty-four patients (44 eyes) in the unexposed group and 115 patients (128 eyes) in the exposed group were followed up for more than 3 months postoperatively. The baseline characteristics were similar between the groups. Changes in the secretory flow rate of the transplanted SMGs after capsaicin or carbachol administration were recorded for 43 eyes, and significant increases were found (P < 0.001 for both). In the exposed group, 6.25% eyes had duct obstruction, while 18.18% eyes in the unexposed group had duct obstruction (odds ratio = 0.300, 95% CI = 0.105–0.856, P = 0.031). Conclusions: Capsaicin and carbachol are effective in promoting secretion from and preventing duct obstruction in transplanted SMGs. http://dx.doi.org/10.1016/j.ijom.2015.08.818