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O147 The use of free flaps based on the thoracodorsal artery for free flap reconstruction
Oral and Symposium abstracts, Saturday 19 May
Techniques for maxillary reconstruction are well described, these techniques can be tailored for specific defects based on the classification of the defect [1]. For free flap reconstruction of the maxilla we describe an alternative based on the thoracodorsal vessels. This utilises bone from the scapula tip as well as muscle cuffs of latissimus dorsi and serratus anterior providing the soft tissue bulk for these defects. For intra oral defects the muscle mucosalises however for the true composite defect one can also harvest skin in a more conventional manner. We describe this technique in 10 patients having undergone this form of reconstruction and would recommend it within the armamentarium of the reconstructive surgeon. Keywords: maxilla, cancer, free flap, reconstruction Reference(s) [1] Brown JS, Rogers SN, McNally DN, Boyle M. A modified classification for the maxillectomy defect. Head Neck 2000 Jan;22(1):17 26. O148 3D CT based contouring of free fibula bone for mandibular reconstruction S. Iyer, M.A. Kuriakose *, K.P. Sreekumar, K. Kumar. Amrita Institute of Medical Sciences, India Introduction: Three-dimensional contouring of bone to simulate the parent bone is essential to restore form and function following mandibular reconstruction. The availability of 3D CT imaging technology and computer software to manipulate these images, allow us to create virtual mandible to replace the resected segment of mandible. It is then possible to create a template based on this virtual mandible, which may be used to contour and in-set the neo-mandible. Herein we report effectiveness of this novel technique to assist mandibular reconstruction. Materials and Methods: From a high-definition CT scan acquired at 1 mm thickness 3D reformatted image of the mandible was created. Using image manipulation software, the planned segment of mandible was removed from the image. Utilizing mirroring technique of the software, a virtual mandible was recreated using the contralateral side as guide. The image of the neo-mandible was corrected to 1:1 magnification. Prints of antero-posterior, lateral and axial views were then obtained. A template using malleable aluminum plate was then created by molding on this virtual mandible, which was sterilized and used for intra-operative contouring of the bone and fixation of the neo-mandible. The functional and esthetic result of the reconstruction was evaluated by assessing the post-operative occlusion and contour in comparison to the normal side. Results: The technique was used where the mandible could not be used as guide to contour template for neo-mandible. This includes secondary reconstruction of mandibular defect and those cases where the tumor had distorted the mandible preventing template contouring. Six patients underwent mandibular reconstruction using free fibula flap assisted by 3D CT virtual imaging technique. In all patients there was good occlusion and satisfactory restoration of mandibular contour. Conclusion: 3D CT based virtual planning of mandibular reconstruction is simple and cost-effective adjunct for contouring bone in mandibular reconstruction. Keywords: mandible, fibula, reconstruction, computer imaging
O149 The use of vascularized iliac crest with internal oblique muscle flap for composite upper maxillary reconstruction M. Maranzano *, G. Mazzoleni. Regional Hospital Trust ‘Ca’ Foncello’ Treviso, Italy The middle third defects of the face following total or partial maxillectomy for oncological purposes include very important structures both for aesthetical and for functional reasons. Among the outcomes big oro-nasal or oro-maxillary fistulas due to big bone segments and soft tissues asportation had been for a long time the consequences of such extensive surgical ablations. In the last years, immediate reconstruction of maxillary bones together with soft tissues following large oncological defects or late effects of radiation therapy has been proved as a reliable morpho-functional reconstruction technique. The use of vascularized iliac crest with internal oblique flap, among other free flaps as composite fibula, composite scapula or composite radial, has become our flap choice for morphofunctional maxillary reconstruction when there is no need for overlying facial skin or oral sphincter reconstruction and for bone segments within 6 and 15 cm of length. The advantages of this composite bone flap are the large and resizable bone stock available, the quality of the bone transferred with an optimal height, depth and contour of bone to maintain a good facial profile and the possibility to reconstruct properly the oral lining together with orbital content and maxillary soft tissues with a portion of the internal oblique muscle flap raised with the same pedicle that epithelializes during the healing stages. Keywords: free flap, maxilla, bone reconstruction, immediate reconstruction Epidemiology II O150 Participation in cancer screenings: perceived risks for Blacks and Puerto-Rican Hispanics vs Whites in the US R. Katz1 *, C. Claudio2 , B.L. Green3 , N. Kressin4 , M.Q. Wang5 , S. Russell1 . 1 NYU College of Dentistry, United States, 2 University of Puerto Rico, United States, 3 Moffitt Cancer Center and Research Institute, United States, 4 Boston University and Boston VA, United States, 5 University of Maryland, United States Introduction: The purpose of this Cancer Screening Participation Study analysis was to determine whether minorities differed in their perception of risks associated with participating in cancer screenings, including oral cancer. Material and Methods: The Cancer Screening Questionnaire, developed within the NYU Oral Cancer RAAHP* Center (* = Research on Adolescent and Adult Health Promotion), an NIDCR/NIH Oral Health Disparities Center, was administered via random-digit dial telephone interviews to adults in three cities: New York City, NY; Baltimore, MD; San Juan, PR. Results: A total of 1,148 interviews were completed (30.9% Blacks, 27.1% Puerto-Rican Hispanics, and 42.0% Whites) with a response rate of 50%, and a completion rate of 84%. When asked if Blacks and PR Hispanics were less likely to get a thorough and careful cancer screening exam than Whites, both Blacks and PR Hispanics were three times as likely, compared to Whites, to answer ‘Always/Most of the time’ (23% vs 7%) and only half as likely to answer ‘Rarely/Never’ (24% vs 48%). The responses to this question were positively correlated with ‘fear of being a guinea pig’ and ‘lack of trust in medical people’ for Blacks (0.12 and 0.18, respectively, both at p 0.05), but were not correlated with self-reported ‘likelihood of participating in cancer screenings’ for Blacks, PR Hispanics or Whites. Selfreported willingness to participate in cancer screening was uniformly high for Blacks, PR Hispanics and Whites at 80%, 82%, and 71%, respectively.
Oral abstracts
O147 The use of free flaps based on the thoracodorsal artery for free flap reconstruction R. Anand *, M. Ethunandan, P. Ramchandani, V. Ilankovan. Poole Hospital NHS Trust, United Kingdom
109
Techniques for maxillary reconstruction are well described, these techniques can be tailored for specific defects based on the classification of the defect [1]. For free flap reconstruction of the maxilla we describe an alternative based on the thoracodorsal vessels. This utilises bone from the scapula tip as well as muscle cuffs of latissimus dorsi and serratus anterior providing the soft tissue bulk for these defects. For intra oral defects the muscle mucosalises however for the true composite defect one can also harvest skin in a more conventional manner. We describe this technique in 10 patients having undergone this form of reconstruction and would recommend it within the armamentarium of the reconstructive surgeon. Keywords: maxilla, cancer, free flap, reconstruction Reference(s) [1] Brown JS, Rogers SN, McNally DN, Boyle M. A modified classification for the maxillectomy defect. Head Neck 2000 Jan;22(1):17 26. O148 3D CT based contouring of free fibula bone for mandibular reconstruction S. Iyer, M.A. Kuriakose *, K.P. Sreekumar, K. Kumar. Amrita Institute of Medical Sciences, India Introduction: Three-dimensional contouring of bone to simulate the parent bone is essential to restore form and function following mandibular reconstruction. The availability of 3D CT imaging technology and computer software to manipulate these images, allow us to create virtual mandible to replace the resected segment of mandible. It is then possible to create a template based on this virtual mandible, which may be used to contour and in-set the neo-mandible. Herein we report effectiveness of this novel technique to assist mandibular reconstruction. Materials and Methods: From a high-definition CT scan acquired at 1 mm thickness 3D reformatted image of the mandible was created. Using image manipulation software, the planned segment of mandible was removed from the image. Utilizing mirroring technique of the software, a virtual mandible was recreated using the contralateral side as guide. The image of the neo-mandible was corrected to 1:1 magnification. Prints of antero-posterior, lateral and axial views were then obtained. A template using malleable aluminum plate was then created by molding on this virtual mandible, which was sterilized and used for intra-operative contouring of the bone and fixation of the neo-mandible. The functional and esthetic result of the reconstruction was evaluated by assessing the post-operative occlusion and contour in comparison to the normal side. Results: The technique was used where the mandible could not be used as guide to contour template for neo-mandible. This includes secondary reconstruction of mandibular defect and those cases where the tumor had distorted the mandible preventing template contouring. Six patients underwent mandibular reconstruction using free fibula flap assisted by 3D CT virtual imaging technique. In all patients there was good occlusion and satisfactory restoration of mandibular contour. Conclusion: 3D CT based virtual planning of mandibular reconstruction is simple and cost-effective adjunct for contouring bone in mandibular reconstruction. Keywords: mandible, fibula, reconstruction, computer imaging
O149 The use of vascularized iliac crest with internal oblique muscle flap for composite upper maxillary reconstruction M. Maranzano *, G. Mazzoleni. Regional Hospital Trust ‘Ca’ Foncello’ Treviso, Italy The middle third defects of the face following total or partial maxillectomy for oncological purposes include very important structures both for aesthetical and for functional reasons. Among the outcomes big oro-nasal or oro-maxillary fistulas due to big bone segments and soft tissues asportation had been for a long time the consequences of such extensive surgical ablations. In the last years, immediate reconstruction of maxillary bones together with soft tissues following large oncological defects or late effects of radiation therapy has been proved as a reliable morpho-functional reconstruction technique. The use of vascularized iliac crest with internal oblique flap, among other free flaps as composite fibula, composite scapula or composite radial, has become our flap choice for morphofunctional maxillary reconstruction when there is no need for overlying facial skin or oral sphincter reconstruction and for bone segments within 6 and 15 cm of length. The advantages of this composite bone flap are the large and resizable bone stock available, the quality of the bone transferred with an optimal height, depth and contour of bone to maintain a good facial profile and the possibility to reconstruct properly the oral lining together with orbital content and maxillary soft tissues with a portion of the internal oblique muscle flap raised with the same pedicle that epithelializes during the healing stages. Keywords: free flap, maxilla, bone reconstruction, immediate reconstruction Epidemiology II O150 Participation in cancer screenings: perceived risks for Blacks and Puerto-Rican Hispanics vs Whites in the US R. Katz1 *, C. Claudio2 , B.L. Green3 , N. Kressin4 , M.Q. Wang5 , S. Russell1 . 1 NYU College of Dentistry, United States, 2 University of Puerto Rico, United States, 3 Moffitt Cancer Center and Research Institute, United States, 4 Boston University and Boston VA, United States, 5 University of Maryland, United States Introduction: The purpose of this Cancer Screening Participation Study analysis was to determine whether minorities differed in their perception of risks associated with participating in cancer screenings, including oral cancer. Material and Methods: The Cancer Screening Questionnaire, developed within the NYU Oral Cancer RAAHP* Center (* = Research on Adolescent and Adult Health Promotion), an NIDCR/NIH Oral Health Disparities Center, was administered via random-digit dial telephone interviews to adults in three cities: New York City, NY; Baltimore, MD; San Juan, PR. Results: A total of 1,148 interviews were completed (30.9% Blacks, 27.1% Puerto-Rican Hispanics, and 42.0% Whites) with a response rate of 50%, and a completion rate of 84%. When asked if Blacks and PR Hispanics were less likely to get a thorough and careful cancer screening exam than Whites, both Blacks and PR Hispanics were three times as likely, compared to Whites, to answer ‘Always/Most of the time’ (23% vs 7%) and only half as likely to answer ‘Rarely/Never’ (24% vs 48%). The responses to this question were positively correlated with ‘fear of being a guinea pig’ and ‘lack of trust in medical people’ for Blacks (0.12 and 0.18, respectively, both at p 0.05), but were not correlated with self-reported ‘likelihood of participating in cancer screenings’ for Blacks, PR Hispanics or Whites. Selfreported willingness to participate in cancer screening was uniformly high for Blacks, PR Hispanics and Whites at 80%, 82%, and 71%, respectively.
Oral abstracts
O147 The use of free flaps based on the thoracodorsal artery for free flap reconstruction R. Anand *, M. Ethunandan, P. Ramchandani, V. Ilankovan. Poole Hospital NHS Trust, United Kingdom
109