Newest techniques of oral cancer treatment at department of oral and maxillofacial surgery in Cracow

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Oral Presentation

Orthognathic approach to correct skeletal facial asymmetry of hemifacial microsomia in adults E. Luo ∗ , J. Li, J. Li, S. Zhu, J. Hu West China Hospital of Stomatology, Sichuan University, Chengdu, China Background: Hemifacial microsomia (HFM) is derived from aberrations of development of derivatives of the first and second branchial arches. HFM on its own commonly presents with an extremely variably asymmetric unilateral or bilateral hypoplasia of the orbits, maxilla, mandible, ear, cranial nerves, and related soft tissues.1 Management of HFM is multitude and controversial. Objective: This article describes a successful bimaxillary orthognathic treatment in adult patients diagnosed as HFM. Methods: Adult patients with HFM who were seen from 2008 to 2014 were treated by an orthognathic approach including Lefort I osteotomy, inverted-L osteotomy, iliac bone grafting, sagittal split ramus osteotomy, genioplasty, and distraction osteogenesis. Clinical examination, radiographs, photographs, and details of operation outcomes were used postoperatively to evaluate the clinical effects of the treatment. Results: All patients demonstrated a marked aesthetic improvement, including levelling of the occlusal plane, lowering of the labial commissure on the affected side and improved ratios between affected and non affected ramal heights without obvious relapse. There were no obvious complications postoperatively. Findings and conclusions: The result of these cases suggests that bimaxillary orthognathic and distraction osteogenesis might be a suitable and efficient to treat adult HFM patients.

Reference Poswillo, D. (1974). Otomandibular deformity: pathogenesis as a guide to reconstruction. J Maxillofac Surg, 2, 64–72.

http://dx.doi.org/10.1016/j.ijom.2015.08.682 Progressive bimaxillary osteolysis (Gorhams disease): clinicopathological presentation and treatment Alaa Abdelrahim ∗ , A. Elimairi, I. Elimairi, A. Sami National Ribat University, Khartoum, Sudan Background: Gorham’s disease is of unknown aetiology resulting in progressive destruction of bony structures. The disease was characterised by Gorham in 1954. The pelvis, humeral head, shaft, axial skeleton and mandible are the most commonly affected areas in the body. Case summary: An 18 year old female was referred from the periodontal department with generalised grade 3 tooth mobility and without any periodontal pathology. A panoramic radiograph marked bimaxillary full height alveolar bone loss and resorption. CT revealed a generalised atrophy of the mandible and maxilla, as well as changes to the skull base. A 3-phase bone scan with Tc-99mMDP revealed a significantly abnormal high uptake of radiotracer in the mandible, maxilla, cervical spine C7, bilateral girdle joints and lumbar spine (L3 and L4 and sacral S1). These findings are suggestive of disseminated degenerative Gorham’s disease. Biopsy of the extracted socket and associated parts of alveolar mucosal tissue were of normal histology. Treatment involved full clearance of teeth followed by initiation of oral bisphosphonate therapy. A single implant on the lower arch

was placed to monitor progress. This was followed by full mouth non-guided placement of basal (Bicortical) implants (utilising pterygoid plates for posterior implants) and full mouth non-guided fixed immediate reconstruction. Conclusions: Reconstruction of these bimaxillary defects remains a challenge in Gorham patients for both oral medicine practitioners and maxillofacial surgeons because of the unknown aetiopathogenesis of this disease as well as difficult therapeutic treatment and surgical intervention (relationship of anatomical structures to vital areas). http://dx.doi.org/10.1016/j.ijom.2015.08.683 Autologous blood injection for the treatment of chronic recurrent TMJ dislocation: the prospective 6 months follow up study V. Machon ∗ , J. Levorova, R. Foltan Charles University and Faculty Hospital Prague, Prague, Czech Republic Background: Autologous blood application for treatment of chronic, recurrent TMJ dislocation was first described in 1964 by Brachmann, and again in 1973 by Schulz. The overall success rate of autologous blood treatment has been reported to be approximately 80%. Most studies have involved the intra- and peri-articular application of autologous blood. Objectives: The objective of the study was to compare results of hypermobility treatment for chronic, recurrent temporomandibular joint (TMJ) dislocation by autologous blood application using two different methods of administration (combination intra- and peri-articular; and peri-articular alone). Methods: Forty patients diagnosed with chronic, recurrent TMJ dislocation were randomly divided into two groups (A and B). Twenty patients in group A were treated by intra- and peri-articular blood application, and 20 patients in group B were treated by periarticular application alone. The follow-up was 1, 3 and 6 months. The study assessed pain (VAS, 1-10), interincisal mouth opening, and the presence of sound phenomena. The treatment was considered successful in patients without hypermobility symptoms, without sound phenomena, and with a VAS of 0-1. Findings: Eighty percent of patients in group A (8 patients), and 50% of patients in group B (5 patients) had successful outcomes at the 6-month follow-up evaluation. Conclusion: Intra- and peri-articular autologous blood application is more effective than peri-articular blood application alone in the treatment of chronic, recurrent TMJ dislocation. http://dx.doi.org/10.1016/j.ijom.2015.08.684 Newest techniques of oral cancer treatment at department of oral and maxillofacial surgery in Cracow M. Maciejowska ∗ , J. Zapa Department of Oral and Maxillofacial Surgery, Krakow, Poland Most oral cancer patients are diagnosed at a late stage, when treatment is less successful and treatment-associated morbidity is more severe. The factors that affect choice of treatment are related to the tumor and the patient. Surgery is the most well established mode of initial definitive treatment for a majority of oral cancers. Primary site, size, location, proximity to bone, and depth of infiltration are factors which influence a particular surgical approach. The aim of this study is to present the

Oral Presentation newest techniques of treatment of oral cancer that were used at Department of Oral and Maxillofacial Surgery in Cracow, Poland in years of 2013–2014. Research material for this study consisted of 92 patients diagnosed with oral cancer with of T1, T2, T3, T4 stages (floor of mouth, oral tongue, alveolar ridge, retromolar trigone, hard palate, buccal mucosa). http://dx.doi.org/10.1016/j.ijom.2015.08.685 Quality of life assessment after resection of mandible and reconstruction with a free fibula flap G. Madiwale ∗ , M. Padhye, G. Venkateshwar, P. Mehta, S. Dahiya, K. Vij, P. Pardeshi D.Y. Patil University School of Dentistry, Navi Mumbai, India Tumors sometimes lead to large segmental resections of the mandible. Fibula free-flaps are used to reconstruct these defects. The aim of this study was to determine the quality of life of the patient post the reconstruction. We hoped to gain better insight into patients’ evaluation of a successful procedure to help guide the decision toward the type of intervention best suited. Background: Free vascularized tissue transfer has become a well-established procedure and is now widely used in managing defects in the head and neck. The free vascularized fibula flap (FFF) has selectively been used for extensive mandibular reconstructions. Objectives: The objective of the present study was to assess patients’ quality of life (QOL) after mandibular resection and reconstruction with the free fibula flap (FFF). Methods: The study group consisted of consecutive patients treated for reconstruction of discontinuity defects of the mandible, using the FFF. The patients were contacted and asked to complete a QOL assessment questionnaire. The patients’ photographs were taken pre and post-operative (1 week, 3 months, 6 months) and evaluated for the esthetic outcomes after surgery. A visual analog scale was used and compared with the patients’ self-evaluations. A descriptive analysis was used for data analysis. Findings and conclusions: 78% patients who underwent this surgery reported satisfaction with their overall QOL. The remaining patients had reported difficulty with speech and aesthetics. http://dx.doi.org/10.1016/j.ijom.2015.08.686 Functional outcomes and long term complications following Le Fort I distraction osteogenesis of the maxilla – a systematic review M. Mah 1,∗ , N. Samman 2 1 Faculty of Dentistry, University of Technology MARA, Shah Alam, Selangor, Malaysia 2 Faculty of Dentistry, University of Hong Kong, Hong Kong

Background: Maxillary distraction osteogenesis (DO) has been described to treat severe maxillary deficiency. However, there is a lack of long term data on the outcomes and complications of this treatment. Objectives: This is a systematic review on the functional outcomes and long term complications following Le Fort I distraction osteogenesis (DO). Methods: A structured systematic literature search with predefined inclusion and exclusion criteria from various electronic databases and relevant journals were performed. The journals were

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evaluated and critically appraised in three rounds according to the level of evidence and the quality of methodology in the specific field of functional outcomes and long term complications following Le Fort I DO. Findings: Eighteen articles were included in the final review. Maxillary advancement was beneficial in patients with cleft maxillary hypoplasia in achieving aesthetic outcomes but the risk for velopharyngeal insufficiency remains uncertain. The achieved maxillary advancement was stable if performed on adult patients while a recurrence of midface retrusion was noted if performed on growing patients. Overcorrection was recommended in these cases to an estimated value of 20–50%. DO produced more stable results for advancing the maxilla compared to conventional orthognathic surgery but caused restricted growth potential of the distracted bone. Conclusions: Benefits of performing DO during active growth should be weighed against the need for a second surgery due to a growth deficit of distracted bone and future surrounding bone growth. However, DO in adults remain an alternative to conventional orthognathic surgery and choice of treatment should be patient centred. http://dx.doi.org/10.1016/j.ijom.2015.08.687 New trends in mandibular reconstruction A. Mahmoud Al-Azhar University, Cairo, Egypt Reconstruction of maxillo-facial defects creates a challenge for oral and maxillo-facial surgeons. It requires basic knowledge of anatomy and thorough skills for harvesting osseous and soft tissue to reconstruct the defective area. Aim: To select and compare between different approaches for mandibular reconstruction. Patients and methods: A total number of thirty patients of different age groups complaining of different mandibular lesions were selected for resection and reconstruction of their defects either simultaneously or delayed after thorough investigations. The reconstruction will depend on many factors which include size, site of the defect, age and medical status of the patient, nature of the donor and recipient site. Results: Immediate reconstruction is preferred than delayed one if it is feasible. In children preservation of the periosteum is mandatory for self bone regeneration without harvesting bone graft. Micro-vascular bone grafting is the golden standard for reconstructing large bone defects while non vascularized iliac crest bone grafting is suitable for mild to moderate bone defects. Recommendations: Rehabilitation of the reconstructed patient is mandatory as soon as possible for preserving bone, contour and facial symmetry by inserting dental implants with bridges or over dentures. http://dx.doi.org/10.1016/j.ijom.2015.08.688 Rational approach to the surgical management of ameloblastoma J.U. Mahmood 1,∗ , I. Ara Hydar 1 , N. Amin 2 1 2

Dhaka Dental College, Dhaka, Bangladesh Sapporo Dental College, Dhaka, Bangladesh

Background: Ameloblastoma is slow growing, benign but locally invasive odontogenic tumors of epithelial origin within