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Orbital exenterations: reconstructive techniques
Oral Presentation Maxillofacial osteosarcoma: outcomes and update of current treatment protocols A.F. DeAngelis 1,∗ , T. Iseli 1 , J. Desai 2 , A.L. Nastri 1 , D. Wiesenfeld 1 1
Head and Neck Oncology Tumour Stream, Department of Surgery, University of Melbourne, Royal Melbourne Hospital, Parkville, Victoria, Australia 2 Sarcoma Service, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia Background: Osteosarcoma is a rare and aggressive malignancy of mesenchymal cell origin that occurs in the maxillofacial region in 5–13% of all osteosarcoma cases. Although osteosarcoma of the maxillofacial region and long bones share similar histological features, the biological behaviour and survival outcome is different. Current treatment protocols have been extrapolated from long bone protocols and, given the differences in tumour biology, are comparatively less well understood. We have previously reported on a series of 15 cases treated over a 24 year period1 which discussed treatment protocols and survival rates. Objectives: The aim of this presentation is to review our previously published conclusions in light of the current literature and provide updated treatment recommendations. Methods: We undertook a literature review of all articles published on the topic of maxillofacial osteosarcoma from the period of 2011 to present. Findings and conclusions: The majority of the scientific literature on maxillofacial osteosarcoma is limited to small retrospective case series. In our series 2, 5 and 15 year survival rates were 92%, 77% and 74% respectively and only increasing T stage (P = .01) and positive margins (P = .003) was found to affect survival. Since then there have been a further 7 articles and case series published in the literature on the surgical management and role of chemotherapy and radiotherapy in maxillofacial osteosarcoma. We present and discuss the findings of these articles which are concordant with our previously published findings.
Reference DeAngelis, et al. (2012). J Oral Maxillofac Surg, 70(3), 734–739.
http://dx.doi.org/10.1016/j.ijom.2015.08.520 Pattern of maxillofacial fractures among population in Assam, India S. Debnath ∗ , A. Adhyapok, A. Vatsyayan Regional Dental College, Guwahati, Assam, India Background: Surveys of facial injuries have shown that etiology varies from country to country and even within the same country depending on the prevailing socioeconomic, cultural and environmental factors.1 Objectives: To highlight the factors that could be considered in planning preventive strategies, identifying new frequencies and patterns of maxillofacial injuries in the region. Methods: The study was performed on patients presenting to Regional Dental College, Guwahati, Assam, India during the period from the month of January 2010 to December 2012, accounts to total of 338 patients.
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Results: Out of 177 RTA cases maximum subjects were males in the age group of <25 years with a male: female ratio of 4.7:1. Among 171 mandibular fractures, most common location was the parasymphysis (36.25%), followed by the symphysis (27.48%), angle (19.29%), condyle (16.95%), and least common sites were ramus and coronoid (0.39%) each. Among 72 cases of midface fractures, incidence of Lefort I (40.20%) was highest. Among 95 cases of upper face fractures, nasal fractures (29.47%), ZMC fracture (23.15%), orbital fractures (23.15%) and least were frontal sinus fractures (11.57%). Conclusion: Economically productive age-group (21–30) years were mostly involved; indicating role of social factors such as improper attitudes and practices as the underlying causative agents predisposing to fractures and the potential numbers of victims that may be involved in RTA in the geographical area demands an urgent public policy response.
Reference Olasoji, H. O., Tahir, A., & Arotiba, G. T. (2002). Changing picture of facial fractures in northern Nigeria. Br J Oral Maxillofac Surg, 40, 140–143.
http://dx.doi.org/10.1016/j.ijom.2015.08.521 Orbital exenterations: reconstructive techniques P. de Leyva 1,∗ , M. Picón 2 , M. Sales-Sanz 2 , E. Sánchez-Jáuregui 2 , F. Almeida 2 , J. Nú˜nez 2 , J. Acero 2 1
Quirón University Hospital, Madrid, Spain Ramón y Cajal University Hospital, Puerta de Hierro University Hospital, Madrid, Spain
2
Background: Orbital exenteration is a radical procedure that involves the removal of the contents of the orbit. This results not only in visual dysfunction but also in psychosocial disability for the patients. The reconstructive procedure should be adapted to the extent of the defect and the individual needs of the patient. Methods: A retrospective review of 50 consecutive patients who underwent orbital exenteration between 1990 and 2012 is presented. The indications for exenteration and the reconstructive techniques used are reviewed. Findings: Fifty patients (29 men and 21 women) with a mean age of 71 years underwent orbital exenteration. Squamous cell carcinoma was the most frequent tumor removed (30%). The eyelids were the most common site for the primary neoplasm (32.7%). The temporalis muscle flap was the main technique used for reconstruction (62.2%). Other options were the radial forearm free flap, the ALT flap, the conjunctiva-eyelid sparing technique and the reconstruction with and orbital prosthesis, which can be retained by osseointegrated implants. Conclusions: Orbital exenteration is a disfiguring procedure that results in a functional, aesthetic and psychological impact for the patients. Its main goal is to increase survival. For these reasons, both the extension of surgery and the reconstructive technique should be carefully planned in advance. Reduced morbidity in old patients, tolerance to radiotherapy and the possibility to accommodate a prosthesis are issues that need to be taken into account. http://dx.doi.org/10.1016/j.ijom.2015.08.522
Head and Neck Oncology Tumour Stream, Department of Surgery, University of Melbourne, Royal Melbourne Hospital, Parkville, Victoria, Australia 2 Sarcoma Service, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia Background: Osteosarcoma is a rare and aggressive malignancy of mesenchymal cell origin that occurs in the maxillofacial region in 5–13% of all osteosarcoma cases. Although osteosarcoma of the maxillofacial region and long bones share similar histological features, the biological behaviour and survival outcome is different. Current treatment protocols have been extrapolated from long bone protocols and, given the differences in tumour biology, are comparatively less well understood. We have previously reported on a series of 15 cases treated over a 24 year period1 which discussed treatment protocols and survival rates. Objectives: The aim of this presentation is to review our previously published conclusions in light of the current literature and provide updated treatment recommendations. Methods: We undertook a literature review of all articles published on the topic of maxillofacial osteosarcoma from the period of 2011 to present. Findings and conclusions: The majority of the scientific literature on maxillofacial osteosarcoma is limited to small retrospective case series. In our series 2, 5 and 15 year survival rates were 92%, 77% and 74% respectively and only increasing T stage (P = .01) and positive margins (P = .003) was found to affect survival. Since then there have been a further 7 articles and case series published in the literature on the surgical management and role of chemotherapy and radiotherapy in maxillofacial osteosarcoma. We present and discuss the findings of these articles which are concordant with our previously published findings.
Reference DeAngelis, et al. (2012). J Oral Maxillofac Surg, 70(3), 734–739.
http://dx.doi.org/10.1016/j.ijom.2015.08.520 Pattern of maxillofacial fractures among population in Assam, India S. Debnath ∗ , A. Adhyapok, A. Vatsyayan Regional Dental College, Guwahati, Assam, India Background: Surveys of facial injuries have shown that etiology varies from country to country and even within the same country depending on the prevailing socioeconomic, cultural and environmental factors.1 Objectives: To highlight the factors that could be considered in planning preventive strategies, identifying new frequencies and patterns of maxillofacial injuries in the region. Methods: The study was performed on patients presenting to Regional Dental College, Guwahati, Assam, India during the period from the month of January 2010 to December 2012, accounts to total of 338 patients.
e53
Results: Out of 177 RTA cases maximum subjects were males in the age group of <25 years with a male: female ratio of 4.7:1. Among 171 mandibular fractures, most common location was the parasymphysis (36.25%), followed by the symphysis (27.48%), angle (19.29%), condyle (16.95%), and least common sites were ramus and coronoid (0.39%) each. Among 72 cases of midface fractures, incidence of Lefort I (40.20%) was highest. Among 95 cases of upper face fractures, nasal fractures (29.47%), ZMC fracture (23.15%), orbital fractures (23.15%) and least were frontal sinus fractures (11.57%). Conclusion: Economically productive age-group (21–30) years were mostly involved; indicating role of social factors such as improper attitudes and practices as the underlying causative agents predisposing to fractures and the potential numbers of victims that may be involved in RTA in the geographical area demands an urgent public policy response.
Reference Olasoji, H. O., Tahir, A., & Arotiba, G. T. (2002). Changing picture of facial fractures in northern Nigeria. Br J Oral Maxillofac Surg, 40, 140–143.
http://dx.doi.org/10.1016/j.ijom.2015.08.521 Orbital exenterations: reconstructive techniques P. de Leyva 1,∗ , M. Picón 2 , M. Sales-Sanz 2 , E. Sánchez-Jáuregui 2 , F. Almeida 2 , J. Nú˜nez 2 , J. Acero 2 1
Quirón University Hospital, Madrid, Spain Ramón y Cajal University Hospital, Puerta de Hierro University Hospital, Madrid, Spain
2
Background: Orbital exenteration is a radical procedure that involves the removal of the contents of the orbit. This results not only in visual dysfunction but also in psychosocial disability for the patients. The reconstructive procedure should be adapted to the extent of the defect and the individual needs of the patient. Methods: A retrospective review of 50 consecutive patients who underwent orbital exenteration between 1990 and 2012 is presented. The indications for exenteration and the reconstructive techniques used are reviewed. Findings: Fifty patients (29 men and 21 women) with a mean age of 71 years underwent orbital exenteration. Squamous cell carcinoma was the most frequent tumor removed (30%). The eyelids were the most common site for the primary neoplasm (32.7%). The temporalis muscle flap was the main technique used for reconstruction (62.2%). Other options were the radial forearm free flap, the ALT flap, the conjunctiva-eyelid sparing technique and the reconstruction with and orbital prosthesis, which can be retained by osseointegrated implants. Conclusions: Orbital exenteration is a disfiguring procedure that results in a functional, aesthetic and psychological impact for the patients. Its main goal is to increase survival. For these reasons, both the extension of surgery and the reconstructive technique should be carefully planned in advance. Reduced morbidity in old patients, tolerance to radiotherapy and the possibility to accommodate a prosthesis are issues that need to be taken into account. http://dx.doi.org/10.1016/j.ijom.2015.08.522