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Mandibular symphysis as a donor site in alveolar bone grafting—a study on donor site morbidity
Free Papers—Oral Presentations congenital overgrowth disorder encountered by craniomaxillofacial surgeons. It is characterised by macroglossia, anterior abdominal wall defects, and gigantism. Many techniques have been described to surgically treat the macroglossia associated with this syndrome. The many techniques advocated demonstrate that a less than ideal result is achieved. Our stellate/keyhole surgical reduction pattern allows for the appropriate reduction of tongue mass and volume with conservation of motor and sensory function as well as preservation of good anatomical contour. Methods: Records were retrospectively reviewed for cases of macroglossia in which this tongue reduction protocol was utilised for the past decade and 10 were identified. Patients that underwent tongue reduction surgery for macroglossia not associated with BWS, or patients for whom records were incomplete, were excluded from the study. The tongue reduction technique described here has been utilised to treat BWS macroglossia 7 times between the years 1999 and 2009. 2 male patients and 5 female patients were treated with this surgical technique. Patient ages ranged between 6 and 21 months. Clinical followup was performed to assess patient and parent satisfaction with tongue function and cosmesis. Results and Conclusions: Follow-up ranged from 4 months to 9 years postoperatively. All patients were evaluated postsurgically and the stellate/keyhole technique provided a successful method for reducing tongue bulk, width, and length while preserving cosmetic form and anatomical function. doi:10.1016/j.ijom.2009.03.167
O3.3 Mandibular symphysis as a donor site in alveolar bone grafting—a study on donor site morbidity R. Das ∗ , M. Veerabahu, B. Vikraman Department of Oral and Maxillofacial Surgery, Ragas Dental College and Hospital, Uthandi, Chennai, India
Bone grafting of the alveolar process defect is a procedure used in almost all patient with an alveolar cleft. The recommended donor site used to fill the cleft defect can be harvested from various sites, of which mandibular symphysis is one common site. Mandibular symphysis has following advantages over other sites such as osteoplasty and harvesting site remains confined to oral cavity, duration of operation is short
and postoperative complication are minimal. At the same time the disadvantage is that because the nature of bone is cortical, it has to be grounded. Our study was to evaluate the postoperative donor site morbidity when harvested from mandibular symphysis. Our study included a total of 10 patients, in whom 7 were male and 3 were female with an age distribution between 11 to 26 years. Based on the results of this study it is apparent that the mandibular symphysis can be reliably selected as the harvest site in alveolar bone grafting.
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post-distraction from early conversion to slow progression to oral feeds and three continued to require supplemental nasogastric feeds. Conclusion: Mandibular distraction in neonates and infants with upper airway obstruction secondary to micrognathia has dramatically reduced the need for tracheostomy and length of hospitalisation. Feeding has been facilitated earlier and our algorithm for management together with representative cases will be discussed. doi:10.1016/j.ijom.2009.03.169
doi:10.1016/j.ijom.2009.03.168
O3.4 Outcome of mandibular distraction for the management of micrognathia and obstructive apnoea J.M. Shand ∗ , A.A. Heggie, J. Massie Oral and Maxillofacial Surgery Unit and Melbourne Craniofacial Unit, Royal Children’s Hospital of Melbourne, Parkville, Victoria, Australia
Background and Objectives: Infants and children with craniofacial anomalies, such as Robin sequence, craniofacial microsomia and Treacher Collins syndrome, often present with varying degrees of upper airway obstruction due to micrognathia. The aim of this study is to present the outcome of the management of 32 neonatal, infants and young children with micrognathia who had undergone mandibular distraction for severe upper airway obstruction. Methods: All patients underwent mandibular distraction with internal appliances. The age at the time of surgery ranged from 5 weeks to 36 months. Two patients were tracheostomy dependent, one intubated, two continuous positive airway pressure-dependent, twenty six patients were nasopharyngeal tube (NPT) dependent and one NPT/positionally managed. Polysomnography studies were undertaken preoperatively when possible and postoperatively. All patients had 12-months or more of follow-up since surgery. Results: In the tracheostomy-dependent group post-distraction, one was decannulated after distraction and one was delayed until correction of choanal atresia correction was completed. Twenty six patients had no further obstructive symptoms following mandibular distraction. Five patients had continuing or developed further obstructive symptoms during the follow-up period, and one patient underwent further mandibular distraction at 7-years of age. Feeding responses varied
O3.5 Seasonal variations of conception dates in some Nigerian cleft lip and palate patients F.O. Oginni ∗ , J.K. Olabanji, A.O. Oladele Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, College of Health Science, Obafemi Awolowo University, Nigeria
Background and Objectives: Although the multifactoral concept of the aetiology of cleft lip and palate is widely accepted, its aetiology remains unclear. The roles of diverse exogenous and endogenous factors have been substantiated considerably. This retroprospective observational study was designed to determine the seasonal variation in the conception and birth of individuals with non-syndromic orofacial clefts in a cohort of cleft patients. Methods: Records of non-syndromic orofacial clefts patients at the Obafemi Awolowo University Teaching Hospital were analysed retroprospectively. Data obtained from the records and patients, included patients’ demographics, dates of birth, length of pregnancy and mother’s last menstrual period (where available). The months of conception and birth were derived for each patient and compared with data from a control group randomly selected from normal births in the hospital birth registry. Data was analysed using the SPSS version 11.0 Results: A total of 134 patients met the inclusion criteria. There was a female preponderance (M:F = 76:58). Conception of patients with milder deformities (cleft of the primary palate and isolated cleft of the secondary palate) occurred predominantly during the rainy season while conception of patients with more deformities (complete cleft of the primary and secondary palate) occurred mostly during the dry season. This was significantly different from the conception periods in the control group.
O3.3 Mandibular symphysis as a donor site in alveolar bone grafting—a study on donor site morbidity R. Das ∗ , M. Veerabahu, B. Vikraman Department of Oral and Maxillofacial Surgery, Ragas Dental College and Hospital, Uthandi, Chennai, India
Bone grafting of the alveolar process defect is a procedure used in almost all patient with an alveolar cleft. The recommended donor site used to fill the cleft defect can be harvested from various sites, of which mandibular symphysis is one common site. Mandibular symphysis has following advantages over other sites such as osteoplasty and harvesting site remains confined to oral cavity, duration of operation is short
and postoperative complication are minimal. At the same time the disadvantage is that because the nature of bone is cortical, it has to be grounded. Our study was to evaluate the postoperative donor site morbidity when harvested from mandibular symphysis. Our study included a total of 10 patients, in whom 7 were male and 3 were female with an age distribution between 11 to 26 years. Based on the results of this study it is apparent that the mandibular symphysis can be reliably selected as the harvest site in alveolar bone grafting.
443
post-distraction from early conversion to slow progression to oral feeds and three continued to require supplemental nasogastric feeds. Conclusion: Mandibular distraction in neonates and infants with upper airway obstruction secondary to micrognathia has dramatically reduced the need for tracheostomy and length of hospitalisation. Feeding has been facilitated earlier and our algorithm for management together with representative cases will be discussed. doi:10.1016/j.ijom.2009.03.169
doi:10.1016/j.ijom.2009.03.168
O3.4 Outcome of mandibular distraction for the management of micrognathia and obstructive apnoea J.M. Shand ∗ , A.A. Heggie, J. Massie Oral and Maxillofacial Surgery Unit and Melbourne Craniofacial Unit, Royal Children’s Hospital of Melbourne, Parkville, Victoria, Australia
Background and Objectives: Infants and children with craniofacial anomalies, such as Robin sequence, craniofacial microsomia and Treacher Collins syndrome, often present with varying degrees of upper airway obstruction due to micrognathia. The aim of this study is to present the outcome of the management of 32 neonatal, infants and young children with micrognathia who had undergone mandibular distraction for severe upper airway obstruction. Methods: All patients underwent mandibular distraction with internal appliances. The age at the time of surgery ranged from 5 weeks to 36 months. Two patients were tracheostomy dependent, one intubated, two continuous positive airway pressure-dependent, twenty six patients were nasopharyngeal tube (NPT) dependent and one NPT/positionally managed. Polysomnography studies were undertaken preoperatively when possible and postoperatively. All patients had 12-months or more of follow-up since surgery. Results: In the tracheostomy-dependent group post-distraction, one was decannulated after distraction and one was delayed until correction of choanal atresia correction was completed. Twenty six patients had no further obstructive symptoms following mandibular distraction. Five patients had continuing or developed further obstructive symptoms during the follow-up period, and one patient underwent further mandibular distraction at 7-years of age. Feeding responses varied
O3.5 Seasonal variations of conception dates in some Nigerian cleft lip and palate patients F.O. Oginni ∗ , J.K. Olabanji, A.O. Oladele Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, College of Health Science, Obafemi Awolowo University, Nigeria
Background and Objectives: Although the multifactoral concept of the aetiology of cleft lip and palate is widely accepted, its aetiology remains unclear. The roles of diverse exogenous and endogenous factors have been substantiated considerably. This retroprospective observational study was designed to determine the seasonal variation in the conception and birth of individuals with non-syndromic orofacial clefts in a cohort of cleft patients. Methods: Records of non-syndromic orofacial clefts patients at the Obafemi Awolowo University Teaching Hospital were analysed retroprospectively. Data obtained from the records and patients, included patients’ demographics, dates of birth, length of pregnancy and mother’s last menstrual period (where available). The months of conception and birth were derived for each patient and compared with data from a control group randomly selected from normal births in the hospital birth registry. Data was analysed using the SPSS version 11.0 Results: A total of 134 patients met the inclusion criteria. There was a female preponderance (M:F = 76:58). Conception of patients with milder deformities (cleft of the primary palate and isolated cleft of the secondary palate) occurred predominantly during the rainy season while conception of patients with more deformities (complete cleft of the primary and secondary palate) occurred mostly during the dry season. This was significantly different from the conception periods in the control group.