Merkel cell carcinoma

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E-Poster Presentation

Anatomic difference of the pterygoid plate and descending palatine artery in relation to the maxillary growth pattern Y.R. Choi ∗ , M.G. Kim, D.S. Kim, J.Y. Kim, J.K. Huh, K.H. Park Department of Oral and Maxillofacial Surgery, Gangnam Severance Hospital, Yonsei Universit, College of Dentistry, Seoul, Republic of Korea Background: One of the major complications of Le Fort I osteotomy is an injury to posterior maxillary structures. We noticed that anatomic differences of the pterygoid plate and descending palatine artery are related to the maxillary growth patterns. An increased understanding of the anatomical structures of the posterior maxilla for each individual skeleton would minimize the intra-operative complications. Objectives: The purpose of this study is to report the anatomical differences of posterior maxillary structures in relation to patients’ own skeletal characteristics. Methods: Total 53 patients met the criteria from 412 patients who underwent orthognathic surgery. We divided these patients into 4 groups according to growth pattern – maxilla retrognathism, normal, prognathism and facial asymmetry. The anatomical differences among these groups were analyzed using 3-dimension computed tomography analysis program from various anatomic points of views. Findings: Distance from pyriform rim to descending palatine artery is increased by maxilla protrusion, without significant difference among groups. The most significant correlation with the maxillary growth pattern was vertical height of pterygoid plate. The more maxillary protrusive tendency or steeper occlusal plane angle, the lower pterygomaxillary junction located. In facial asymmetry patients, there was a positive correlation between alveolar crest canting and pterygoid plate canting. Conclusions: With understanding anatomic characteristics for individual, especially in relation between pterygoid plate and descending palatine artery according to maxillary growth pattern, making osteotomy line will be easier to clinicians during Le Fort I osteotomy. http://dx.doi.org/10.1016/j.ijom.2015.08.055 Temporomandibular joint internal derangement on MRI in patient with facial asymmetry Y.R. Choi ∗ , C.W. Jeong, D.J. Ryu, K.H. Park, J.K. Huh

symmetry group, skeletal class II group showed higher occurrence of severe internal derangement than other groups. And strong association with bilateral disc displacement without reduction group was also showed, while class III group showed relationship with bilateral normal disc position group (p < 0.0001). In asymmetry group, there was no statistically significant difference among three lateral skeletal groups about TMJ internal derangement (p = 0.0546), but all of three groups had higher tendency of side dominance of bilateral TMJs. And joint status of shifted side showed more advanced internal derangement than non-shifted side (p < 0.0001). Conclusions: In this study, not only simple associations between facial asymmetry and internal derangement, but high relationship between lateral skeletal profile and direction of facial asymmetry was also revealed significantly. http://dx.doi.org/10.1016/j.ijom.2015.08.056 Use of the Internet for clinical information and options by Oral and Maxillofacial patients M. Davidson ∗ , A. Jabbar Taunton and Somerset NHS Foundation Trust, Taunton, UK Aim: To obtain a better understanding of the level of Internet usage by new patients revered to our Oral and Maxillofacial unit. Methods: A standardised questionnaire was given to new referral patients at our base Oral and Maxillofacial unit prior to initial consultation. The questionnaire included questions about reason for visit, degree of Internet access, prior Internet research, and views regarding Internet health related research. Results: 193 questionnaires returned. Mean age participants 48 (SD 18.3) the majority of patients had home access to the Internet or work (85%), 76% used it on a regular basis, 81% used a mainstream Internet search engine. Despite this the vast majority (82%) did not use the Internet prior to their initial consultation to research or inform their condition. The majority of patients over 79 years of age were not regular Internet users and had no Internet access (60%) Older patients tended to agree less that Internet research pre initial appointment would give them peace of mind. Conclusions: The results show that while most patients use the Internet regularly, few used it to research health topics relevant to their referral. Prior research was more likely to occur among younger patients. A significant number of patients did not feel health related Internet research would reassure them.

Department of Oral and Maxillofacial Surgery, Gangnam Severance Hospital, Yonsei University College of Dentistry, Seoul, Republic of Korea

http://dx.doi.org/10.1016/j.ijom.2015.08.059

Background: TMJ disorders at puberty influence facial bone growth leading to various dentofacial deformities. On the contrary, if one has facial asymmetry with genetic factor, it can also results in different mechanical movement of bilateral TMJ which can cause internal derangement of disc. Objectives: The aim of this study is to prove the relationship between direction of facial asymmetry and disc derangement. Methods: 79 patients with TMJ disorders accompanied with facial asymmetry were selected. Data including clinical examination, panoramic radiograph, posteroanterior and lateral cephalogram were assessed for skeletal analysis. To find the disc internal derangement, MRIs were used. Findings: The percentage of unilateral internal derangement in asymmetry group was higher than in symmetry group. In

M.J. Davidson ∗ , B. Collard, M. Huston, J. Ingham, G. Merrick

Merkel cell carcinoma

Musgrove Park Hospital NHS Trust, United Kingdom Background: Merkel cell carcinoma (MCC) is a rare neuroendocrine carcinoma of the skin. They most commonly arise in elderly patients in the head and neck, and are particularly prevalent on sun-exposed areas.1 Patients often present with recurrence, regional lymph node metastasis, and distant metastasis. Common metastatic sites are the liver, lungs, bones, and brain.2 They frequently present as an asymptomatic, fleshy coloured solitary nodule that can easily be easily misdiagnosed both clinically and pathologically. To date there is no national database of the incidence of MCC in the UK, however worldwide trends

E-Poster Presentation suggest it is increasing. Because of the rare entity of this condition optimal treatment is not currently well defined in the literature.3 Objectives

Perforator flaps in head and neck reconstruction

1. To present the diagnosis, management and outcomes of 7 patients with MCC treated within our trust. 2. To explore current management guidelines for MCC.

1

Methods: The Histopathology Database was searched for all confirmed cases managed over the previous 10 years. We review the case notes, histopathology reports and imaging of 7 patients diagnosed with MCC within our trust. We review outcomes and complications post operatively. We will then proceed to review the published literature on current management guidance for MCC Findings and conclusions: The aetiology is not fully understood, however immunosuppression, increased age, sun exposure and the presence of Polyomaviruse have been inextricably linked to causation. It is now accepted that MCC has metastatic potential irrespective of the size of the presenting tumour. Various papers quote 5-year disease associated mortality rates in the region of 46–50%. Current accepted practice for the management of MCC is the combination of both surgery and radiotherapy. Various protocols regarding management have been put forward over the last number of years however no national census has been agreed upon. There is some suggestion that chemotherapy should be considered for those patients with advanced disease that is not treatable with surgery. This has yet to be universally accepted.4 Despite its rare occurrence, MCC is a particularly aggressive disease which warrants further discussion in both national and international forums. The authors believe a clear management strategy is necessary in order to provide standardised best practice amongst surgeons.

References He, W., Zhang, D., Jiang, J., Chen, Y., & Wu, C. (2015). Merkel cell carcinoma in the left groin: a case report and review of the literature. Oncol Lett, 9(March (3)), 1197–1200. http://dx.doi.org/10.3892/ol.2015.2861. PMCID: PMC4315128 Ac¸ıkalın, A., Paydas¸, S., Küc¸ükgöz Gülec¸, Ü., U˘guz, A., & Gümürdülü, D. (2014). Unique case of Merkel cell carcinoma with ovarian metastasis. Balkan Med J, 31(December (4)), 356–359. http://dx.doi.org/10.5152/balkanmedj.2014.14117. PMCID: PMC4318410A Akhtar, S., Oza, K. K., & Wright, J. (2000). Merkel cell carcinoma: report of 10 cases and review of the literature. Am Acad Dermatol, 43(November (5 Pt 1)), 755–767. Hughes, M. P., Hardee, M. E., Cornelius, L. A., Hutchins, L. F., Becker, J. C., & Gao, L. (2014). Merkel cell carcinoma: epidemiology, target, and therapy. Curr Dermatol Rep, 3(1), 46–53. http://dx.doi.org/10.1007/s13671-014-0068-z. PMCID: PMC3931972

http://dx.doi.org/10.1016/j.ijom.2015.08.060

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P. de Leyva 1,∗ , M. Picón 2 , F. Almeida 2 , J. Nú˜nez 2 , T. Martínez-Iturriaga 3 , J. Acero 2 Quirón University Hospital, Madrid, Spain Ramón y Cajal University Hospital, Puerta de Hierro University Hospital, Madrid, Spain 3 San Rafael Hospital, Madrid, Spain 2

Background: Perforator flaps, since their first description in 1989, have in many ways revolutionized reconstructive surgery. A perforator flap is a flap consisting of skin and/or subcutaneous fat whose supplying vessels are isolated perforators. The basic concept is that any larger named vessel in the body will give off smaller branches toward the skin on which flaps can be designed and raised as pedicled or free flaps. Methods: A review of the most relevant perforator flaps used in head and neck reconstruction in our department is made. We provide a succinct overview of their vascular anatomy, main characteristics, major advantages, flap design, utilization and pitfalls. Findings: Different reliable perforator flaps of various sizes and compositions are reviewed here. Some of them can be transferred as free flaps. However, some others offer the possibility of using tissue adjacent to the defect that can be transferred as a local perforator flap. This provides a simpler repair leading in a superior aesthetic result because of better tissue match. Conclusions: Seeking the best way to achieve the optimal functional and aesthetic result, with the least donor site morbidity is key in surgical reconstruction. Perforator flaps have contributed to improve functional and aesthetic outcomes for head and neck reconstruction while preserving donor site function.1,2

References Cormack, G. C., & Lamberty, B. G. (1984). Fasciocutaneous flap nomenclature. Plast Reconstr Surg. Taylor, G. I. (2003). The angiosomes of the body and their supply to perforator flaps. Clin Plast Surg.

http://dx.doi.org/10.1016/j.ijom.2015.08.061 Case presentation of severe panfacial trauma with early reconstruction, using contra angle drills and screwdrivers to anatomicly reduce normal mandibular projection to serve as a platform to corectly disinpact the midface A. de Waal University of the Western Cape, Stellenbosch Mediclinic, Stellenbosch, South Africa Purpose: To indicate the value of early anatomical reconstruction of the mandible using contra angled hand pieces in combination with standard facial reconstruction techniques, to create a platform to anatomically reposition the midface after disimpaction. Patients and methods: A 17-year-old MVA male patient with severe Le Fort III fractures, dentoalveolar fractures as well as open midline split of the maxilla. He also had a frontal sinus outer table fracture as well as bilateral displaced condyle neck and symphsial mandibular fractures. There were no other underlying comorbid factors and the patient was taken to theatre before severe facial swelling. A tracheostomy was done to secure the airway, using the standard direct approach. The mandible was reconstructed with an intra oral as well as a minimalistic preauricular approach,