Maxillomandibular-chin surgical advancement for patients with obstructive sleep apnoea — review of 13 patients

368 inevitable exposure to the infection perhaps unwittingly so given that approximately 18,100 (17%) people living with HIV in the United Kingdom (UK) are unaware of their HIV positive status. There is therefore a need for guidance specific to oral and maxillofacial surgery (OMFS) procedures to establish an acceptable threshold of known and unknown risk to both the patient and OMFS personnel with regard to HIV infection, both diagnosed and undiagnosed. Objectives: We explore the surgical opinion of OMFS surgeons within the UK on managing the HIV positive OMFS patient. Methods: An online questionnaire was performed to assess the current awareness of HIV and its management, establish opinions, concerns and the incumbent challenges involved in managing such patients in the context of OMFS. Findings: The majority of clinicians felt they had limited knowledge on the complexities involved in managing such patients and sort clearer additional guidance on how to best optimise this patient group. Conclusion: Clearer guidance is required in the management of the HIV positive OMFS patient and this study will help to inform this. http://dx.doi.org/10.1016/j.ijom.2017.02.1237 Sialoendoscopy for treatment of obstructive sialadenitis D. Hirjak ∗ , I. Kupcova, M. Beno, B. Galis Department of Oral and Maxillofacial Surgery, Comenius University, University Hospital Ruzinov, Bratislava, Slovakia Background: Salivary duct obstruction is a common disease of the major salivary glands. Sialolithiasis and other aetiologies including inflammation, strictures, mucous plugs, foreign bodies, kinks are possible causes of obstructive salivary gland diseases. Traditional diagnostic imaging, plain radiography, ultrasonography, computed tomography (CT) and others cannot identify the aetiology and location of obstruction. Sialoendoscopy is a relatively new minimally invasive method that enables direct visualisation of the ducts of the major salivary glands. Besides the diagnostic options, interventional sialoendoscopy allows therapeutical intervention. Present analysis was performed to assess the effectiveness of interventional sialoendoscopic treatment of obstructive sialadenitis of major salivary glands. Methods: This is a retrospective study of 41 patients with obstructive sialadenitis of submandibular and parotid glands who underwent sialoendoscopy between 2010 and 2015. The symptoms and clinical findings were confirmed by plain radiographs, CT scans and ultrasonography. Various interventional sialoendoscopic techniques were used, dilation of strictures and irrigation, stone retrieval by basket and stone removal by endoscopic-assisted transmucosal incision. Results: Symptomatic relief was achieved in 39 patients. Dilatation and lavage of the duct system without stone was accomplished in 17 patients. Sialoliths were removed in 24 patients. Conclusion: Sialoendoscopy is a useful minimally invasive interventional technique for direct visual detection of cause of obstruction and enables us for therapeutic options. http://dx.doi.org/10.1016/j.ijom.2017.02.1238

Maxillomandibular-chin surgical advancement for patients with obstructive sleep apnoea — review of 13 patients L.I. Ho ∗ , S.C. Fung Dentistry and Maxillofacial Surgery, United Christian Hospital, Hong Kong Background and Objectives: This is to share our experience in the management of patients with obstructive sleep apnoea via the maxillomandibular-chin surgical advancement and to review the treatment outcomes. Methods: Patients with obstructive sleep apnoea underwent maxillomandibular advancement between 2011 and 2016 were included. No pre- and postoperative orthodontics treatment was performed in all patients. Maxillomandibular advancement of 1 cm with or without advancement genioplasty in trapezoid mortised design and concomitant intrapharyngeal soft tissue surgery were performed dictated by the preoperative polysomnography and drug-induced sleep endoscopy. Surgical cure was defined as postoperative apnoea-hypopnoea index (AHI) of fewer than 5 events/h. Surgical success was defined as postoperative AHI with more than 50% reduction to fewer than 20 events/h. Findings: A total of 13 male patients with age ranging from 32–67 years (mean, 51 years) were included. 12 patients had maxillomandibular-chin advancement. The remaining patient had maxillomandibular advancement as he had genioplasty done earlier. Six patients had concomitant intrapharyngeal soft tissue surgery. Mean reduction of AHI was 85.5%. The mean lowest oxygen saturation was improved from 71.4% to 86.5% postoperatively. Eight patients achieved surgical cure and four patients achieved surgical success. The remaining patient, though not achieving surgical success, had significant reduction of AI to AHI ratio. All patients had subjective improvement in daytime performance. Complications encountered were regarded as minor, including transient nerve injury, minor occlusal change and infection of plates. Conclusion: Maxillomandibular-chin surgical advancement showed a promising treatment outcomes in the management of patients with obstructive sleep apnoea. http://dx.doi.org/10.1016/j.ijom.2017.02.1239 Nitrous oxide laughing matter M. Huston ∗ , J. Ingham, A. Baker School of Medicine, Trinity College Dublin, Ireland Background: We present the case of a young male who presented to the emergency department of our hospital complaining of gross swelling of his right face. He reported no causative history for this presentation. A computed tomography head and neck was completed which revealed significant air emphysema in the soft tissues in the absence of bony trauma. On follow-up examination some days later, the patient disclosed the cause of the incident to be associated with the recreational use of nitrous oxide (N2 O) gas. Discussion: N2 O is increasingly being used as the drug of choice amongst rave and festival goers. It is reported to create a transient sensation of relaxation, euphoria and hallucination amongst users. It is widely available and laws on restriction are difficult to enforce owing to its myriad of commercial and medical uses. In recent