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Mandibular advancement for patients with obstructive sleep apnoea syndrome: a comparison of bilateral mandibular distraction osteogenesis and bilateral sagittal split osteotomy
249 causes quantifiable improvement in QoL forms the crux of this study. Methods: A total of 50 patients of head and neck cancer (25 cases, 25 controls) were enrolled in the study and their QoL was recorded, at regular intervals during radiotherapy. The study group received oral honey along with radiotherapy while the control group received standard oral hygiene instructions only. Results: The QoL scores were significantly better in the study group compared to controls after completion of radiotherapy.
New nanoantioxidant approach to improve healing of oral surgery wounds: a randomised, pilot placebo-controlled, double-blind clinical trial
http://dx.doi.org/10.1016/j.ijom.2017.02.839
Background: The wound healing (WH) is a part of any surgical procedures. Oxidative stress plays important roles in WH. Antioxidants can be very important weapon in the fight against inflammation. Nanotechnology produced antioxidants can surpass the moist intraoral environment, enter the cells and support healing of oral surgery wounds. Objectives: The aim of this pilot study was to compare the efficacy of newly nanoantioxidant gel (NAG) with a placebo gel (PG) in improving of the WH after surgical incisions in the oral cavity. The hypothesis was that no difference was present in WH between the both groups. The present study is designed according to the CONSORT rules. Methods: Using MinimPy software for allocation through minimisation ninety patients after suturing were instructed to use either NAG or PG applying three times daily. Outcomes measured were: assessment of WH on third and seventh day postoperatively with Modified index score of Landry and the index used by Galli. Reproducibility was assessed by evaluating agreement between two independent operators using the weighted Kappa statistic. Results: There were statistically significant differences for wound healing between the groups assessed clinically by the blinded operators in the Landry index after the third day and in the index Galli after the third and seventh day. There was a substantial agreement between operators in the wound scoring. No complications or side effects encountered. Conclusion: The new formulated gel does appear that can improve oral wound healing particularly in the first three days after suturing.
An overview of microvascular diversion and bypass techniques for salvage of lethal and sublethal intracranial neurovascular lesions — a collaborative maxillofacial/neurosurgical enterprise A.T. Smith ∗ , U.J. Patel Departments of Oral and Maxillofacial Surgery, Neurosurgery, Sheffield Teaching Hospitals and University of Sheffield, South Yorkshire, United Kingdom Background: Over the past 5 decades developing open cranial access, improved imaging and vascular contrast studies recognise conditions with lethal or life limiting effects. Aneurysm, complex vascular malformation, giant aneurysm (>2.5 cm diameter), Moya Moya disease and other conditions can be managed by import of blood supply locally, by vessel diversion, or by distant harvested artery interpositional bypass. Following the groundwork of Tulleken, Spetzler and more recent exponents, we show how a collaborative team approach and utilising craniotomy, orbitozygomatic osteotomy, sophisticated imaging techniques, computed tomography navigational localisation of vessels, artery harvest and the skills in neck access and microvascular anastomosis brought by maxillofacial expertise facilitate our neurosurgical colleagues’ surgical treatment of these conditions. Methods: We overview the indirect and direct blood supply augmentations to the neuroaxis, in management of the progressive ischaemic injury of Moya Moya disease. Valuable lessons have been learned in approach, task allocation and coordination, brain protection with anaesthetic agents and cooling techniques, and subtle improvements in craniotomy design, vessel protection during harvest and prevention of dangerous vasospasm during interpositional bypass. Improved tunnelling of bypass grafts from cranial cavity to neck vessels is shown, with details of the anastomosis sequence and tips on maintaining critical patency — and some ‘spinoff’ developments useful in head and neck reconstructive microsurgery which have resulted are outlined. Results: 32 procedures; 23 low-flow, one PICA to PICA, one unsuccessful. Nine high-flow interpositional bypasses — eight radial artery, one saphenous vein, one occluded and one death perioperative (pre-bypass). http://dx.doi.org/10.1016/j.ijom.2017.02.840
A. Stamatoski ∗ , J. Fidoski, A. Vasilev, L. Todorovska, A. Petlichkovski Faculty of Dental Medicine, Skopje Sts Cyril and Methodius University, Skopje, Macedonia
http://dx.doi.org/10.1016/j.ijom.2017.02.841 Mandibular advancement for patients with obstructive sleep apnoea syndrome: a comparison of bilateral mandibular distraction osteogenesis and bilateral sagittal split osteotomy W.K. Tsui ∗ , C. McGrath, J.K.F. Ng, Y. Yang, Y.Y. Leung Discipline of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong Background: Maxillomandibular advancement (MMA) is a wellestablished surgical treatment for patients with obstructive sleep apnoea (OSA). The advancement of the mandible could be achieved by bilateral sagittal split osteotomies (BSSO) or bilateral mandibular distraction osteogenesis (BMDO). It is important to know their treatment outcomes, effectiveness of both techniques. Objectives: This study aims to evaluate effectiveness of both techniques in terms of airway functions, skeletal stability, changes in airway dimensions, clinical morbidities and complications, neurosensory disturbance and temporomandibular joint functions, facial aesthetics and quality of life (QoL).
250 Methods: Eighteen subjects with moderate to severe OSA were recruited in a randomised controlled trial and allocated in the BMDO and BSSO groups for mandibular advancement in MMA. Findings: Airway functions were significantly improved in terms of reduction in apnoea/hypopnoea index and increase lowest oxygen saturation. The overall success rate was 88.9%. Patients with BMDO had less skeletal relapse in large advancements of 10–15 mm (6.7% versus 13.6%) but they experienced more complications and morbidities. The degrees of neurosensory disturbance and associated functional impairment were similar and were reduced to near-normal levels. All patients reported improved facial aesthetics after MMA and the general-health related and OSA-specific quality of life were significantly improved. Conclusion: Maxillomandibular advancement with BMDO or BSSO is highly effective treatment for OSA patients. Surgeons have to be aware of the pros and cons of both techniques to make the correct clinical judgment in choosing the correct technique and to allow patients to be well informed. http://dx.doi.org/10.1016/j.ijom.2017.02.842 The effect of two packing types for throat pain and postoperative nausea and vomiting during maxillofacial surgery C. Vural ∗ , E. Yurttutan, K. Sancak, A. Mine, T. Oncul Ankara University, Ankara, Turkey Operations of oral maxillofacial surgery cause the blood escape into stomach and trachea. Therefore, throat packing is applied. Endotracheal tube cuff is not protective from aspiration. While packing is preventing blood leakage, it may cause postoperative pain due to the pressure. Postoperative nausea and vomiting (PONV) occurs in 30% of patients receiving general anaesthesia. Ingested blood is also emetic factor. Packing placed between oropharynx and hypopharynx before surgery to prevent leakage to stomach and trachea. The aim of this pilot study is to compare the efficacy of two packing types in throat pain. The secondary aim is to compare in preventing PONV in two groups. 13 patients were evaluated. Seven patients’ packs soaked with isotonic sodium chloride (Group1) and 6 patients’ packs soaked with chlorhexidine gluckonate/benzydamine hydrochloride (Group2). All patients throat pain evaluated with visual analogue scale and Likert Pain Score at 2, 4, 6, 12 and 24 h. Also PONV was evaluated. Mann–Whitney U test and Spearmans rho test were used for statically analyses. The mean operation time was 261.92 min. No significant difference was found in the incidence of PONV. Significant difference was found in the incidence of throat pain at 12 and 24 h (P 0.02, P 0.05). Packing with chlorhexidine/benzydamine was found more effective at long-term for throat pain. Our research continues for better results, we planned as 100 patients to finish this study. http://dx.doi.org/10.1016/j.ijom.2017.02.843
Retrospective study of oral and maxillofacial cases treated in university of dental medicine, Mandalay, Myanmar K.K.S. Win University of Dental Medicine, Mandalay, Myanmar Background: University of Dental Medicine, Mandalay is one of the two dental universities in Myanmar, which was established in 2000. The other one is in Yangon and it was established in 1964. Patients treated in the Department of Oral and Maxillofacial Surgery, University of Dental Medicine, Mandalay between 2015 and 2016 were analysed in this study. The patients were recorded into mainly two groups: out patients and in patients. Records of outpatients treated in the university and those of patients hospitalised and operated in the nearby 300-bedded teaching hospital were checked. Objectives: To access the patient types treated in the Department of Oral and Maxillofacial Surgery, University of Dental Medicine, Mandalay. To check the treatment outcome. Methods: Retrospective study of the patient records. Findings: In out patient section, 15–26% came for tooth extraction, 1.5–2% were for biopsy and oral submucous fibrosis patients were 4–5% came for steroid injection. Other patients are due to fracture, infection, impaction and some are for postoperative check up and dressings. Among the in patients, majority of the patients are squamous cell carcinoma patients who need to be treated by primary tumour removal and level I, II, and III neck dissections. Radical neck dissection and reconstructions are rarely done. Some of the cases have recurrence. Conclusion: Proper recording system and continuing training program are necessary. http://dx.doi.org/10.1016/j.ijom.2017.02.844 Sialendoscopy-assisted treatment for chronic obstructive parotitis related to Sjögren’s syndrome C.B. Wu ∗ , Q. Zhou China Medical University, China Objectives: Chronic obstructive parotitis related to Sjögren’s syndrome is not uncommon, but it is rarely reported in the literature. The aim of this study was to describe our experience of treating chronic obstructive parotitis related to Sjögren’s syndrome. Methods: Seventeen patients with chronic obstructive parotitis related to Sjögren’s syndrome who were treated with sialendoscopy from June 2014 to June 2015 at the Department of Oral and Maxillofacial Surgery, School of Stomatology, China Medical University were retrospectively reviewed. The cohort underwent ultrasonography, salivary gland scintigraphy (SGS) examinations and sialography before sialendoscopy. All patients were asked to undergo a visual analogue scale (VAS) evaluation before and six months after surgery. A paired t test was conducted, and P < 0.05 was considered statistically significant. Results: The 17 patients (27 parotid glands) successfully underwent interventional sialendoscopy under local anaesthesia. Compared with the mean preoperative VAS score of 6, the mean VAS score six months after sialendoscopy was 4.5, which was significantly lower than the preoperative VAS score (P < 0.05).
New nanoantioxidant approach to improve healing of oral surgery wounds: a randomised, pilot placebo-controlled, double-blind clinical trial
http://dx.doi.org/10.1016/j.ijom.2017.02.839
Background: The wound healing (WH) is a part of any surgical procedures. Oxidative stress plays important roles in WH. Antioxidants can be very important weapon in the fight against inflammation. Nanotechnology produced antioxidants can surpass the moist intraoral environment, enter the cells and support healing of oral surgery wounds. Objectives: The aim of this pilot study was to compare the efficacy of newly nanoantioxidant gel (NAG) with a placebo gel (PG) in improving of the WH after surgical incisions in the oral cavity. The hypothesis was that no difference was present in WH between the both groups. The present study is designed according to the CONSORT rules. Methods: Using MinimPy software for allocation through minimisation ninety patients after suturing were instructed to use either NAG or PG applying three times daily. Outcomes measured were: assessment of WH on third and seventh day postoperatively with Modified index score of Landry and the index used by Galli. Reproducibility was assessed by evaluating agreement between two independent operators using the weighted Kappa statistic. Results: There were statistically significant differences for wound healing between the groups assessed clinically by the blinded operators in the Landry index after the third day and in the index Galli after the third and seventh day. There was a substantial agreement between operators in the wound scoring. No complications or side effects encountered. Conclusion: The new formulated gel does appear that can improve oral wound healing particularly in the first three days after suturing.
An overview of microvascular diversion and bypass techniques for salvage of lethal and sublethal intracranial neurovascular lesions — a collaborative maxillofacial/neurosurgical enterprise A.T. Smith ∗ , U.J. Patel Departments of Oral and Maxillofacial Surgery, Neurosurgery, Sheffield Teaching Hospitals and University of Sheffield, South Yorkshire, United Kingdom Background: Over the past 5 decades developing open cranial access, improved imaging and vascular contrast studies recognise conditions with lethal or life limiting effects. Aneurysm, complex vascular malformation, giant aneurysm (>2.5 cm diameter), Moya Moya disease and other conditions can be managed by import of blood supply locally, by vessel diversion, or by distant harvested artery interpositional bypass. Following the groundwork of Tulleken, Spetzler and more recent exponents, we show how a collaborative team approach and utilising craniotomy, orbitozygomatic osteotomy, sophisticated imaging techniques, computed tomography navigational localisation of vessels, artery harvest and the skills in neck access and microvascular anastomosis brought by maxillofacial expertise facilitate our neurosurgical colleagues’ surgical treatment of these conditions. Methods: We overview the indirect and direct blood supply augmentations to the neuroaxis, in management of the progressive ischaemic injury of Moya Moya disease. Valuable lessons have been learned in approach, task allocation and coordination, brain protection with anaesthetic agents and cooling techniques, and subtle improvements in craniotomy design, vessel protection during harvest and prevention of dangerous vasospasm during interpositional bypass. Improved tunnelling of bypass grafts from cranial cavity to neck vessels is shown, with details of the anastomosis sequence and tips on maintaining critical patency — and some ‘spinoff’ developments useful in head and neck reconstructive microsurgery which have resulted are outlined. Results: 32 procedures; 23 low-flow, one PICA to PICA, one unsuccessful. Nine high-flow interpositional bypasses — eight radial artery, one saphenous vein, one occluded and one death perioperative (pre-bypass). http://dx.doi.org/10.1016/j.ijom.2017.02.840
A. Stamatoski ∗ , J. Fidoski, A. Vasilev, L. Todorovska, A. Petlichkovski Faculty of Dental Medicine, Skopje Sts Cyril and Methodius University, Skopje, Macedonia
http://dx.doi.org/10.1016/j.ijom.2017.02.841 Mandibular advancement for patients with obstructive sleep apnoea syndrome: a comparison of bilateral mandibular distraction osteogenesis and bilateral sagittal split osteotomy W.K. Tsui ∗ , C. McGrath, J.K.F. Ng, Y. Yang, Y.Y. Leung Discipline of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong Background: Maxillomandibular advancement (MMA) is a wellestablished surgical treatment for patients with obstructive sleep apnoea (OSA). The advancement of the mandible could be achieved by bilateral sagittal split osteotomies (BSSO) or bilateral mandibular distraction osteogenesis (BMDO). It is important to know their treatment outcomes, effectiveness of both techniques. Objectives: This study aims to evaluate effectiveness of both techniques in terms of airway functions, skeletal stability, changes in airway dimensions, clinical morbidities and complications, neurosensory disturbance and temporomandibular joint functions, facial aesthetics and quality of life (QoL).
250 Methods: Eighteen subjects with moderate to severe OSA were recruited in a randomised controlled trial and allocated in the BMDO and BSSO groups for mandibular advancement in MMA. Findings: Airway functions were significantly improved in terms of reduction in apnoea/hypopnoea index and increase lowest oxygen saturation. The overall success rate was 88.9%. Patients with BMDO had less skeletal relapse in large advancements of 10–15 mm (6.7% versus 13.6%) but they experienced more complications and morbidities. The degrees of neurosensory disturbance and associated functional impairment were similar and were reduced to near-normal levels. All patients reported improved facial aesthetics after MMA and the general-health related and OSA-specific quality of life were significantly improved. Conclusion: Maxillomandibular advancement with BMDO or BSSO is highly effective treatment for OSA patients. Surgeons have to be aware of the pros and cons of both techniques to make the correct clinical judgment in choosing the correct technique and to allow patients to be well informed. http://dx.doi.org/10.1016/j.ijom.2017.02.842 The effect of two packing types for throat pain and postoperative nausea and vomiting during maxillofacial surgery C. Vural ∗ , E. Yurttutan, K. Sancak, A. Mine, T. Oncul Ankara University, Ankara, Turkey Operations of oral maxillofacial surgery cause the blood escape into stomach and trachea. Therefore, throat packing is applied. Endotracheal tube cuff is not protective from aspiration. While packing is preventing blood leakage, it may cause postoperative pain due to the pressure. Postoperative nausea and vomiting (PONV) occurs in 30% of patients receiving general anaesthesia. Ingested blood is also emetic factor. Packing placed between oropharynx and hypopharynx before surgery to prevent leakage to stomach and trachea. The aim of this pilot study is to compare the efficacy of two packing types in throat pain. The secondary aim is to compare in preventing PONV in two groups. 13 patients were evaluated. Seven patients’ packs soaked with isotonic sodium chloride (Group1) and 6 patients’ packs soaked with chlorhexidine gluckonate/benzydamine hydrochloride (Group2). All patients throat pain evaluated with visual analogue scale and Likert Pain Score at 2, 4, 6, 12 and 24 h. Also PONV was evaluated. Mann–Whitney U test and Spearmans rho test were used for statically analyses. The mean operation time was 261.92 min. No significant difference was found in the incidence of PONV. Significant difference was found in the incidence of throat pain at 12 and 24 h (P 0.02, P 0.05). Packing with chlorhexidine/benzydamine was found more effective at long-term for throat pain. Our research continues for better results, we planned as 100 patients to finish this study. http://dx.doi.org/10.1016/j.ijom.2017.02.843
Retrospective study of oral and maxillofacial cases treated in university of dental medicine, Mandalay, Myanmar K.K.S. Win University of Dental Medicine, Mandalay, Myanmar Background: University of Dental Medicine, Mandalay is one of the two dental universities in Myanmar, which was established in 2000. The other one is in Yangon and it was established in 1964. Patients treated in the Department of Oral and Maxillofacial Surgery, University of Dental Medicine, Mandalay between 2015 and 2016 were analysed in this study. The patients were recorded into mainly two groups: out patients and in patients. Records of outpatients treated in the university and those of patients hospitalised and operated in the nearby 300-bedded teaching hospital were checked. Objectives: To access the patient types treated in the Department of Oral and Maxillofacial Surgery, University of Dental Medicine, Mandalay. To check the treatment outcome. Methods: Retrospective study of the patient records. Findings: In out patient section, 15–26% came for tooth extraction, 1.5–2% were for biopsy and oral submucous fibrosis patients were 4–5% came for steroid injection. Other patients are due to fracture, infection, impaction and some are for postoperative check up and dressings. Among the in patients, majority of the patients are squamous cell carcinoma patients who need to be treated by primary tumour removal and level I, II, and III neck dissections. Radical neck dissection and reconstructions are rarely done. Some of the cases have recurrence. Conclusion: Proper recording system and continuing training program are necessary. http://dx.doi.org/10.1016/j.ijom.2017.02.844 Sialendoscopy-assisted treatment for chronic obstructive parotitis related to Sjögren’s syndrome C.B. Wu ∗ , Q. Zhou China Medical University, China Objectives: Chronic obstructive parotitis related to Sjögren’s syndrome is not uncommon, but it is rarely reported in the literature. The aim of this study was to describe our experience of treating chronic obstructive parotitis related to Sjögren’s syndrome. Methods: Seventeen patients with chronic obstructive parotitis related to Sjögren’s syndrome who were treated with sialendoscopy from June 2014 to June 2015 at the Department of Oral and Maxillofacial Surgery, School of Stomatology, China Medical University were retrospectively reviewed. The cohort underwent ultrasonography, salivary gland scintigraphy (SGS) examinations and sialography before sialendoscopy. All patients were asked to undergo a visual analogue scale (VAS) evaluation before and six months after surgery. A paired t test was conducted, and P < 0.05 was considered statistically significant. Results: The 17 patients (27 parotid glands) successfully underwent interventional sialendoscopy under local anaesthesia. Compared with the mean preoperative VAS score of 6, the mean VAS score six months after sialendoscopy was 4.5, which was significantly lower than the preoperative VAS score (P < 0.05).