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Open reduction of fractured mandibular condyles: an audit comparing an intraoral and extraoral approach
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Abstracts / British Journal of Oral and Maxillofacial Surgery 47 (2009) e35–e69
location and differentiation was recorded, as was the development of local recurrence or regional metastases. Treatment modalities included curette and cautery, surgical excision and radiotherapy, with no significant difference found between treatment modality used and rates of recurrence or risk of metastases. The completeness of original excision also did not significantly affect risk of metastases. Discussion: We will discuss current guidelines for the management of cutaneous SCC with specific emphasis on SCC of the face and scalp. Local results for the treatment of cutaneous SCC of the face and scalp are in keeping with
damage may be increased by using an extraoral approach. Further, larger studies would be able to detect such small differences. An equal level of patient satisfaction, a possible reduced risk of facial nerve damage and salivary fistula formation, along with avoidance of a visible extraoral surgical scar indicate that intraoral ORIF may be the superior treatment option compared to extraoral ORIF. Table showing the difference in mean scores for the five variables between patients who underwent intraoral open reduction and those who underwent extraoral open reduction (CI: confidence interval).
Variables
Total score
TMJ dysfunction
Facial nerve damage
Effect on activities
Difference (95% CI)
1.25 (−10.64, 13.12)
0.83 (−11.47, 13.13)
0.75 (−2.72, 4.22)
0.03 (−1.30, 1.35)
national and international data for rates of completeness of excision, recurrence and metastases.
social
Duration of recovery
0.47 (−0.19, 1.14)
doi:10.1016/j.bjoms.2009.06.082 56
doi:10.1016/j.bjoms.2009.06.081 55 Open reduction of fractured mandibular condyles: an audit comparing an intraoral and extraoral approach Joanna Pararajasingham ∗ , Christoph Huppa, Kathleen Fan King’s College London, United Kingdom Introduction: Mandibular condylar fractures can be treated by closed reduction with intermaxillary fixation or open reduction with plate and screw fixation (ORIF). Plate and screw fixation can be performed either through an intraoral or extraoral approach. Aim: To test the hypothesis that there is no difference in patient satisfaction between patients who undergo ORIF via intraoral approach (Group I) and those who undergo ORIF via extraoral approach (Group II). Method: A retrospective study was carried out using a structured questionnaire to conduct telephone interviews of patients who had undergone ORIF of a condylar fractured at King’s College Hospital at least 6 months previously. Twentyone patients were included: 9 in Group I and 12 in Group II. Results: The means of five variables (TMJ Dysfunction Score, Facial Nerve Injury Score, Adverse Effects on Social Activities Score, Duration of Recovery Score, Total Score) were not found to be different between the two treatment groups (see table). Mean acceptability of the external surgical scar in Group II was 0.4 out of 5 (0 = best outcome). Conclusions: While the samples in this study were not large enough to detect small differences between the treatment groups, others have suggested that risk of facial nerve
Do guidelines for skin cancer excision margins correlate with clinical practice? Are we removing too much or too little? Roger Currie ∗ , V. McTaggart, E.R. Nairn, W.S. Hislop Oral and Maxillofacial Surgery and Pathology, Crosshouse Hospital, Kilmarnock, United Kingdom Abstract: In Non Melanotic Skin Cancer (NMSC) the assessment of surgical clearance is relevant to the risk of recurrence. The aim of this prospective study of 61 patients was to investigate the assessment, and accuracy of macroscopic surgical margins in NMSC’s at time of excision and compare this with the histological margins following laboratory processing using digital photography to record and measure these margins. Results: Each surgical margin was found to have a unique response to excision and laboratory processing, reacting independently to the tumour attached. There was no direct correlation between the fresh specimen and the microscopic measurements with less shrinkage at the 3’o clock margin, and more shrinkage with thinner tumours; whilst the microscopic margin remains the gold standard for assessing the status of excision margins the full results and clinical relevance in terms of tissue preservation will be presented and discussed. doi:10.1016/j.bjoms.2009.06.083
Abstracts / British Journal of Oral and Maxillofacial Surgery 47 (2009) e35–e69
location and differentiation was recorded, as was the development of local recurrence or regional metastases. Treatment modalities included curette and cautery, surgical excision and radiotherapy, with no significant difference found between treatment modality used and rates of recurrence or risk of metastases. The completeness of original excision also did not significantly affect risk of metastases. Discussion: We will discuss current guidelines for the management of cutaneous SCC with specific emphasis on SCC of the face and scalp. Local results for the treatment of cutaneous SCC of the face and scalp are in keeping with
damage may be increased by using an extraoral approach. Further, larger studies would be able to detect such small differences. An equal level of patient satisfaction, a possible reduced risk of facial nerve damage and salivary fistula formation, along with avoidance of a visible extraoral surgical scar indicate that intraoral ORIF may be the superior treatment option compared to extraoral ORIF. Table showing the difference in mean scores for the five variables between patients who underwent intraoral open reduction and those who underwent extraoral open reduction (CI: confidence interval).
Variables
Total score
TMJ dysfunction
Facial nerve damage
Effect on activities
Difference (95% CI)
1.25 (−10.64, 13.12)
0.83 (−11.47, 13.13)
0.75 (−2.72, 4.22)
0.03 (−1.30, 1.35)
national and international data for rates of completeness of excision, recurrence and metastases.
social
Duration of recovery
0.47 (−0.19, 1.14)
doi:10.1016/j.bjoms.2009.06.082 56
doi:10.1016/j.bjoms.2009.06.081 55 Open reduction of fractured mandibular condyles: an audit comparing an intraoral and extraoral approach Joanna Pararajasingham ∗ , Christoph Huppa, Kathleen Fan King’s College London, United Kingdom Introduction: Mandibular condylar fractures can be treated by closed reduction with intermaxillary fixation or open reduction with plate and screw fixation (ORIF). Plate and screw fixation can be performed either through an intraoral or extraoral approach. Aim: To test the hypothesis that there is no difference in patient satisfaction between patients who undergo ORIF via intraoral approach (Group I) and those who undergo ORIF via extraoral approach (Group II). Method: A retrospective study was carried out using a structured questionnaire to conduct telephone interviews of patients who had undergone ORIF of a condylar fractured at King’s College Hospital at least 6 months previously. Twentyone patients were included: 9 in Group I and 12 in Group II. Results: The means of five variables (TMJ Dysfunction Score, Facial Nerve Injury Score, Adverse Effects on Social Activities Score, Duration of Recovery Score, Total Score) were not found to be different between the two treatment groups (see table). Mean acceptability of the external surgical scar in Group II was 0.4 out of 5 (0 = best outcome). Conclusions: While the samples in this study were not large enough to detect small differences between the treatment groups, others have suggested that risk of facial nerve
Do guidelines for skin cancer excision margins correlate with clinical practice? Are we removing too much or too little? Roger Currie ∗ , V. McTaggart, E.R. Nairn, W.S. Hislop Oral and Maxillofacial Surgery and Pathology, Crosshouse Hospital, Kilmarnock, United Kingdom Abstract: In Non Melanotic Skin Cancer (NMSC) the assessment of surgical clearance is relevant to the risk of recurrence. The aim of this prospective study of 61 patients was to investigate the assessment, and accuracy of macroscopic surgical margins in NMSC’s at time of excision and compare this with the histological margins following laboratory processing using digital photography to record and measure these margins. Results: Each surgical margin was found to have a unique response to excision and laboratory processing, reacting independently to the tumour attached. There was no direct correlation between the fresh specimen and the microscopic measurements with less shrinkage at the 3’o clock margin, and more shrinkage with thinner tumours; whilst the microscopic margin remains the gold standard for assessing the status of excision margins the full results and clinical relevance in terms of tissue preservation will be presented and discussed. doi:10.1016/j.bjoms.2009.06.083