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Local anaesthetic versus general anaesthetic for manipulation of nasal fractures
E-Poster Presentation Usefulness of piezoelectric surgery to reduce neurosensory disturbances of inferior alveolar nerve after SSRO M. Takano 1,∗ , T. Shibahara 1 , C. Saito 1 , A. Watanabe 1 , K. Muramatsu 1 , M. Murayama 1 , Y. Hamada 1 , A. Katakura 2 , K. Kasahara 2 , K. Sugahara 2
This case describes a 76 year old female who presented with a bleeding AVM involving the left buccal mucosa who underwent surgical excision. Clinical and histological presentation, diagnosis and management, including options such as sclerotherapy, embolization are also discussed.
1 Tokyo Dental College, Department of Oral and Maxillofacial Surgery, Tokyo, Japan 2 Tokyo Dental College, Department of Oral Pathophysiology Science and Surgery, Tokyo, Japan
http://dx.doi.org/10.1016/j.ijom.2015.08.344
Background: Sagittal splitting ramus osteotomy (SSRO) of the mandible is an established procedure in oral and maxillofacial surgery. However, postoperative neurosensory disturbances (NSD) can develop in the inferior alveolar nerve with this procedure. The incidence of NSD has been attributed to various factors. Its occurrence following SSRO is believed to be associated with the close postoperative proximity of cancellous bone from the split portion to the mandibular canal. Several studies have investigated the development of NSD based on measurement of the distance between the mandibular canal and external cortical bone or the course of the mandibular canal through the mandible. It is expected to reduce postoperative NSD after SSOR with piezoelectric surgical devises. Objectives: The aim of this study was to compare the development of NSD after SSRO with or without piezoelectric surgery in the high-risk group patients whose mandibular canal contacted to external cortex of ramus. Methods: A total of 10 patients who had been diagnosed as skeletal mandibular deformity with their mandibular canals had contacted to external cortical bone based on preoperative CT images were included. For surgical treatment, Bilateral SSRO were performed with piezoelectric surgery (n = 5) and without piezoelectric surgery (n = 5). Comparative evaluation of the correlation between NSD incidences in the mental nerve region with a mono-filament sensory tester was performed immediately after and 6 months after surgery. Findings and conclusions: There was some difference in the presence or absence of NSD after surgery with and without piezoelectric surgical devises. We conclude that piezoelectric surgery is useful to reduce NSD after SSRO.
S. Tan 1,∗ , P. Marsh 2
http://dx.doi.org/10.1016/j.ijom.2015.08.343 Arteriovenous malformation of the oral cavity: a case report S. Tan 1,∗ , P. Marsh 2 1 2
Royal Brisbane Hospital, Brisbane, Australia Townsville Hospital, Townsville, Australia
Arteriovenous malformations (AVMs) are part of a group of vascular anomalies which can be further sub classified into neoplasms and malformations, characterised by specific morphology, pathophysiology, clinical behaviour and management. AVMs in the oral and maxillofacial region are rare but potentially lifethreatening vascular lesions. Bleeding, facial asymmetry, loose teeth and headache are commonly seen at presentation. Management of maxillofacial AVMs remains challenging, as total excision is required to ensure complete cure and to prevent recurrence, as the remnant AVM has the potential to grow quickly and exceed pre treatment size. Surgical excision however, carries the risk of massive life threatening intraoperative bleeding due to replacement of normal tissue with disease vessels.
e295
Local anaesthetic versus general anaesthetic for manipulation of nasal fractures
1 2
Royal Brisbane Hospital, Brisbane, Australia Townsville Hospital, Townsville, Australia
Background: Nasal fractures are the most common form of facial fractures, and are managed by surgical specialties including otolaryngology, plastic surgery and oral and maxillofacial surgeons. Manipulation of uncomplicated nasal fractures can be performed under local or general anaesthesia. Choice of technique is largely dependent on surgeon preference, patient comorbidities, specialty departments and hospital protocol. Objectives: A literature review was performed to determine whether outcomes from nasal fracture reduction differ with the use of local anaesthetic or general anaesthetic. Methods: A literature review was performed searching the Cochrane Database, PubMed, EMBASE, ClinicalTrials.gov and Google Scholar for relevant studies comparing outcomes of local versus general anaesthetic for the manipulation of nasal bone fractures. All types of studies including randomised controlled trials (RCT) and retrospective review were included. Findings and conclusions: After exclusions, 11 studies (including 2 RCTs) were found comparing the outcomes of nasal fracture manipulation under local vs general anaesthetic. All studies except one found that both general and local anaesthetic provided acceptable and satisfactory methods of anaesthesia for reduction of simple displaced nasal fractures. Need for reoperation was higher with local anaesthetic in one study due to poorer cosmesis and function. Overall, local anaesthetic was an acceptable alternative to general anaesthetic for providing acceptable patient outcomes, such as pain scores and aesthetics. However decisions must also consider factors such as the severity of nasal fracture, timing of surgery, patient preference, co morbidities, associated risks and morbidity, financial costs, hospital resource allocation, and surgical experience in both techniques. http://dx.doi.org/10.1016/j.ijom.2015.08.345 Complications of orbital floor fracture repair: how do we compare? S. Tan 1,∗ , P. Marsh 2 1 2
Royal Brisbane Hospital, Brisbane, Australia Townsville Hospital, Townsville, Australia
Background: Complication rates following repair of orbital fractures vary broadly in the literature. However complications of orbital surgery can include problems that surgery was aimed to avoid, such as vision loss, diplopia, globe malposition, lid malposition and hypoesthesia.
This case describes a 76 year old female who presented with a bleeding AVM involving the left buccal mucosa who underwent surgical excision. Clinical and histological presentation, diagnosis and management, including options such as sclerotherapy, embolization are also discussed.
1 Tokyo Dental College, Department of Oral and Maxillofacial Surgery, Tokyo, Japan 2 Tokyo Dental College, Department of Oral Pathophysiology Science and Surgery, Tokyo, Japan
http://dx.doi.org/10.1016/j.ijom.2015.08.344
Background: Sagittal splitting ramus osteotomy (SSRO) of the mandible is an established procedure in oral and maxillofacial surgery. However, postoperative neurosensory disturbances (NSD) can develop in the inferior alveolar nerve with this procedure. The incidence of NSD has been attributed to various factors. Its occurrence following SSRO is believed to be associated with the close postoperative proximity of cancellous bone from the split portion to the mandibular canal. Several studies have investigated the development of NSD based on measurement of the distance between the mandibular canal and external cortical bone or the course of the mandibular canal through the mandible. It is expected to reduce postoperative NSD after SSOR with piezoelectric surgical devises. Objectives: The aim of this study was to compare the development of NSD after SSRO with or without piezoelectric surgery in the high-risk group patients whose mandibular canal contacted to external cortex of ramus. Methods: A total of 10 patients who had been diagnosed as skeletal mandibular deformity with their mandibular canals had contacted to external cortical bone based on preoperative CT images were included. For surgical treatment, Bilateral SSRO were performed with piezoelectric surgery (n = 5) and without piezoelectric surgery (n = 5). Comparative evaluation of the correlation between NSD incidences in the mental nerve region with a mono-filament sensory tester was performed immediately after and 6 months after surgery. Findings and conclusions: There was some difference in the presence or absence of NSD after surgery with and without piezoelectric surgical devises. We conclude that piezoelectric surgery is useful to reduce NSD after SSRO.
S. Tan 1,∗ , P. Marsh 2
http://dx.doi.org/10.1016/j.ijom.2015.08.343 Arteriovenous malformation of the oral cavity: a case report S. Tan 1,∗ , P. Marsh 2 1 2
Royal Brisbane Hospital, Brisbane, Australia Townsville Hospital, Townsville, Australia
Arteriovenous malformations (AVMs) are part of a group of vascular anomalies which can be further sub classified into neoplasms and malformations, characterised by specific morphology, pathophysiology, clinical behaviour and management. AVMs in the oral and maxillofacial region are rare but potentially lifethreatening vascular lesions. Bleeding, facial asymmetry, loose teeth and headache are commonly seen at presentation. Management of maxillofacial AVMs remains challenging, as total excision is required to ensure complete cure and to prevent recurrence, as the remnant AVM has the potential to grow quickly and exceed pre treatment size. Surgical excision however, carries the risk of massive life threatening intraoperative bleeding due to replacement of normal tissue with disease vessels.
e295
Local anaesthetic versus general anaesthetic for manipulation of nasal fractures
1 2
Royal Brisbane Hospital, Brisbane, Australia Townsville Hospital, Townsville, Australia
Background: Nasal fractures are the most common form of facial fractures, and are managed by surgical specialties including otolaryngology, plastic surgery and oral and maxillofacial surgeons. Manipulation of uncomplicated nasal fractures can be performed under local or general anaesthesia. Choice of technique is largely dependent on surgeon preference, patient comorbidities, specialty departments and hospital protocol. Objectives: A literature review was performed to determine whether outcomes from nasal fracture reduction differ with the use of local anaesthetic or general anaesthetic. Methods: A literature review was performed searching the Cochrane Database, PubMed, EMBASE, ClinicalTrials.gov and Google Scholar for relevant studies comparing outcomes of local versus general anaesthetic for the manipulation of nasal bone fractures. All types of studies including randomised controlled trials (RCT) and retrospective review were included. Findings and conclusions: After exclusions, 11 studies (including 2 RCTs) were found comparing the outcomes of nasal fracture manipulation under local vs general anaesthetic. All studies except one found that both general and local anaesthetic provided acceptable and satisfactory methods of anaesthesia for reduction of simple displaced nasal fractures. Need for reoperation was higher with local anaesthetic in one study due to poorer cosmesis and function. Overall, local anaesthetic was an acceptable alternative to general anaesthetic for providing acceptable patient outcomes, such as pain scores and aesthetics. However decisions must also consider factors such as the severity of nasal fracture, timing of surgery, patient preference, co morbidities, associated risks and morbidity, financial costs, hospital resource allocation, and surgical experience in both techniques. http://dx.doi.org/10.1016/j.ijom.2015.08.345 Complications of orbital floor fracture repair: how do we compare? S. Tan 1,∗ , P. Marsh 2 1 2
Royal Brisbane Hospital, Brisbane, Australia Townsville Hospital, Townsville, Australia
Background: Complication rates following repair of orbital fractures vary broadly in the literature. However complications of orbital surgery can include problems that surgery was aimed to avoid, such as vision loss, diplopia, globe malposition, lid malposition and hypoesthesia.