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Opinions of maxillofacial surgeons on curettage and excision margins of head and neck basal cell cancer
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Abstracts / British Journal of Oral and Maxillofacial Surgery 46 (2008) e5–e31
larger than 20 mm in diameter. They are slow growing but locally destructive. Their management remains controversial. Aim: To investigate the management strategies, of post operative residual basal cell carcinoma, by maxillofacial consultants in the U.K. Materials and methods: A self-completion questionnaire relating to the management of residual BCC was sent to 350 maxillofacial consultants in the U.K. Results: There was a response rate of 66%. Fifty one per cent of respondents re-excise a positive lateral margin when the initial defect is closed primarily. Fifty per cent of respondents re-excise a positive lateral margin when initial defect was closed with a local flap or skin graft. Sixty six per cent of respondents re-excise a positive deep margin when the initial defect was closed primarily. Sixty four per cent of respondents re-excise a positive deep margin when the initial defect was closed primarily. Conclusion: This study confirms the considerable variation in management of residual basal cell carcinomas amongst maxillofacial surgeons. doi:10.1016/j.bjoms.2008.07.117 P 16 Opinions of maxillofacial surgeons on curettage and excision margins of head and neck basal cell cancer A national survey Anil Kamisetty ∗ , O.P. Ceallaigh, C.J. Lloyd Glan Clwyd Hospital Inroduction: Basal cell carcinomas are the commonest form of skin malignancy. Exposed areas such as the head and neck are the most commonly involved sites. They are slow growing and locally destructive.BCC’s are neither life threatening or trivial. The importance of adequate treatment cannot be overstated. Unfortunately, there is no agreement as to the optimal width of surgical margins. Recommended excision margins vary from 2 to 15 mm. A large surgical margin is often not feasible on the face because of cosmetic and functional concerns. Therefore, treatment is a compromise between safe excision margins and obtaining a satisfactory cosmetic result. Curettage before excision may decreases the frequency of positive margins by up to 26% in Basal cell carcinoma BCC. Material and methods: A self-completion questionnaire was sent to 350 maxillofacial consultants in the U.K. There was a response rate of 66%. Opinions on curettage prior to excision and excision margins were obtained. Results: Surgeons who treated less than ten BCC’s per annum took a larger excision margin than those who treated more than ten. Only 2.7 percent of surgeons curetted the BCC prior to excision.
Conclusion: Curettage of BCC’s in high risk areas should be utilized by more maxillofacial surgeons. doi:10.1016/j.bjoms.2008.07.118 P 17 Antibiotic prophylaxis in cleft surgery James Ian Morrison ∗ , M.F. Devlin, S. Wallace, A. Crawford, K. Harvey-Wood Royal Hospital for Sick Children, Glasgow Introduction: An audit was undertaken of nasal and throat swabs taken 1 day preoperatively prior to cleft surgery. The type of surgery undertaken included primary and secondary cleft repair, alveolar bone graft and speech surgery. 192 patients were recruited. 514 specimens were received from 247 admissions. The commonest pathogens isolated, in descending order, were Staph aureus, Strep pneumoniae, Group A Strep and Group B Strep. Due to surgeon preference, one group of patients received prophylactic antibiotics and the other group received no antibiotics. No significant difference in outcome was observed between the two groups. Material and Method: Using the data previously retrieved, a proforma was constructed with the above pathogens and the current antibiotic prophylaxis regimens used by the cleft surgeons in Scotland. This was sent to five consultant microbiologists and they were asked to choose which of the prophylactic regimens was most appropriate. They were also given the option to suggest their own regimen or no antibiotics at all. Results/Discussion: The results are discussed with suggestion for a method of targeted antibiotic prophylaxis for cleft surgery. doi:10.1016/j.bjoms.2008.07.119 P 18 Transverse maxillary distraction in unilateral alveolar cleft: technical note Naseem Ghazali ∗ , P. Haers, N. Taylor, E. Sepassi Royal County Surrey Hospital, Guildford Autologous secondary bone grafting is the contemporary method of alveolar cleft repair. This method is technically challenging when gross tissue deficiency is present, particularly after arch expansion and alignment, where the resultant cleft defect is made wider or in cases where multiple congenitally missing teeth lead to disuse atrophy of the graft. In these cases, alveolar distraction is a viable method of repairing wide clefts defects as generation of new bone and attached gingiva eliminates the need for autologous bone grafting. Moreover, in cases of nasal spine deviation, distraction of the premaxillary block can correct the deviation toward the cleft side.
Abstracts / British Journal of Oral and Maxillofacial Surgery 46 (2008) e5–e31
larger than 20 mm in diameter. They are slow growing but locally destructive. Their management remains controversial. Aim: To investigate the management strategies, of post operative residual basal cell carcinoma, by maxillofacial consultants in the U.K. Materials and methods: A self-completion questionnaire relating to the management of residual BCC was sent to 350 maxillofacial consultants in the U.K. Results: There was a response rate of 66%. Fifty one per cent of respondents re-excise a positive lateral margin when the initial defect is closed primarily. Fifty per cent of respondents re-excise a positive lateral margin when initial defect was closed with a local flap or skin graft. Sixty six per cent of respondents re-excise a positive deep margin when the initial defect was closed primarily. Sixty four per cent of respondents re-excise a positive deep margin when the initial defect was closed primarily. Conclusion: This study confirms the considerable variation in management of residual basal cell carcinomas amongst maxillofacial surgeons. doi:10.1016/j.bjoms.2008.07.117 P 16 Opinions of maxillofacial surgeons on curettage and excision margins of head and neck basal cell cancer A national survey Anil Kamisetty ∗ , O.P. Ceallaigh, C.J. Lloyd Glan Clwyd Hospital Inroduction: Basal cell carcinomas are the commonest form of skin malignancy. Exposed areas such as the head and neck are the most commonly involved sites. They are slow growing and locally destructive.BCC’s are neither life threatening or trivial. The importance of adequate treatment cannot be overstated. Unfortunately, there is no agreement as to the optimal width of surgical margins. Recommended excision margins vary from 2 to 15 mm. A large surgical margin is often not feasible on the face because of cosmetic and functional concerns. Therefore, treatment is a compromise between safe excision margins and obtaining a satisfactory cosmetic result. Curettage before excision may decreases the frequency of positive margins by up to 26% in Basal cell carcinoma BCC. Material and methods: A self-completion questionnaire was sent to 350 maxillofacial consultants in the U.K. There was a response rate of 66%. Opinions on curettage prior to excision and excision margins were obtained. Results: Surgeons who treated less than ten BCC’s per annum took a larger excision margin than those who treated more than ten. Only 2.7 percent of surgeons curetted the BCC prior to excision.
Conclusion: Curettage of BCC’s in high risk areas should be utilized by more maxillofacial surgeons. doi:10.1016/j.bjoms.2008.07.118 P 17 Antibiotic prophylaxis in cleft surgery James Ian Morrison ∗ , M.F. Devlin, S. Wallace, A. Crawford, K. Harvey-Wood Royal Hospital for Sick Children, Glasgow Introduction: An audit was undertaken of nasal and throat swabs taken 1 day preoperatively prior to cleft surgery. The type of surgery undertaken included primary and secondary cleft repair, alveolar bone graft and speech surgery. 192 patients were recruited. 514 specimens were received from 247 admissions. The commonest pathogens isolated, in descending order, were Staph aureus, Strep pneumoniae, Group A Strep and Group B Strep. Due to surgeon preference, one group of patients received prophylactic antibiotics and the other group received no antibiotics. No significant difference in outcome was observed between the two groups. Material and Method: Using the data previously retrieved, a proforma was constructed with the above pathogens and the current antibiotic prophylaxis regimens used by the cleft surgeons in Scotland. This was sent to five consultant microbiologists and they were asked to choose which of the prophylactic regimens was most appropriate. They were also given the option to suggest their own regimen or no antibiotics at all. Results/Discussion: The results are discussed with suggestion for a method of targeted antibiotic prophylaxis for cleft surgery. doi:10.1016/j.bjoms.2008.07.119 P 18 Transverse maxillary distraction in unilateral alveolar cleft: technical note Naseem Ghazali ∗ , P. Haers, N. Taylor, E. Sepassi Royal County Surrey Hospital, Guildford Autologous secondary bone grafting is the contemporary method of alveolar cleft repair. This method is technically challenging when gross tissue deficiency is present, particularly after arch expansion and alignment, where the resultant cleft defect is made wider or in cases where multiple congenitally missing teeth lead to disuse atrophy of the graft. In these cases, alveolar distraction is a viable method of repairing wide clefts defects as generation of new bone and attached gingiva eliminates the need for autologous bone grafting. Moreover, in cases of nasal spine deviation, distraction of the premaxillary block can correct the deviation toward the cleft side.