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P13 The sternocleidomastoid flap as a salvage procedure
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Posters / British Journal of Oral and Maxillofacial Surgery 48 (2010) S25–S55
P12 Incidence of chyle leaks following neck dissections at Rotherham Foundation NHS Trust over a 7 year period C. Pace, R. Crosher, D. Holt, G. Idaboh. Rotherham NHS Foundation Trust, UK Aim: To find out the incidence of chyle leaks following level I–IV and level I–V neck dissections at Rotherham over a 7 year period and compare with published data. Method: Data collected retrospectively from case notes over a 7 year period between January 2002 and December 2008. All the neck dissections involved levels I–IV as a minimum and were carried out by the same two surgeons. Results: 138 consecutive neck dissections were analysed of which 105 involved levels I–IV and I–V. Of these 79 were selective, 11 radical and 15 modified radical. No chyle leaks were recorded. Conclusion: This highlights the importance of careful dissection at level IV. The reported incidence is low (1–3%) but this study suggests that the incidence can be as low as 0% with careful dissection. P13 The sternocleidomastoid flap as a salvage procedure D. Gahir, C. Avery. Leicester Royal Infirmary, UK Introduction: Salvage surgery is typically necessary after disease recurrence or flap failure but is challenging as the surgical site is often scarred, irradiated and contaminated. The sternocleidomastoid (SCM) flap is overlooked due to a poor arc of rotation, limited volume and proximity to recurrent neck disease; however, it may sometimes be an alternative to the pedicled pectoralis major flap (PPMF). We describe a novel technique for raising a pedicled free style SCM flap and review our experience with a small group of complex reconstructions when other options had been exhausted or the SCM offered a simpler and quicker solution. Method: An island of skin may be raised over the caudal aspect of the muscle if required. The clavicular insertions of the muscle are divided and the superior thyroid vessels are isolated. The mastoid origin of the muscle is divided and the vascularity of the tissues assessed. Excision of potentially non-viable tissue is performed. The flap is mobilised on the vascular pedicle and the arc of rotation is greatly increased as it has no proximal or distal attachments. Clinical relevance: With this technique the SCM flap may retain a niche role in the management of complex cases. If the flap is not viable then it may be sacrificed and a pectoralis major flap raised. As it is often necessary to sacrifice the SCM in order to create sufficient space to inset a PPMF there may be no extra associated morbidity. P14 Survey of routine follow up for oral cancer patients in the UK J. Flanagan, S. Endersby, R. Banks. Sunderland Royal Hospital, UK Introduction: As squamous cell carcinoma of the oral cavity recurs in 25–48% of patients frequent follow up post-treatment is required. At present there are no evidence based guidelines as to the most appropriate follow up routine. Methods: A national survey was undertaken to establish the follow up routine clinicians are using at present for these patients. Questions focused on how frequently these patients are reviewed and for how long, what their indications for reviewing the patients are and whether they felt more regular review would improve the
patient’s prognosis. The questionnaires were sent to the head of oncology of all the oral and maxillofacial units in the UK. Results: The follow up routine used by clinicians varies throughout the country with the majority of clinicians reviewing their patients at 1-month intervals for the first year, 2-month intervals for the second year and 4-month intervals for the third year. Most clinicians felt that increasing the frequency of follow up visits would not improve the patient’s prognosis. We are awaiting further results. Conclusion and Clinical relevance: There is great variation in follow up routines used by oral and maxillofacial units in the U.K. Although the survey suggests that more frequent follow up is not thought to be appropriate by the majority of units it is still important for reassuring the patient, identifying post operative complications and for clinical audit purposes. P15 A pictorial review of the role of CT angiography (CTA) in head and neck cancer imaging T. Boye, A. Yousefpour, A. Smith, N. Hoggard. Sheffield Teaching Hospital, UK Introduction: With the introduction of multislice CT scanners CT angiography (CTA) has become a viable widely used technique for assessment of the supra-aortic and intracranial vessels. We have been using CTA for planning of flap surgery and monitoring of buried flaps. Aims: To show a pictorial review of the role of CTA in head and neck cancer imaging. Methods: We show examples of preoperative CTA planning, post surgical follow up and other uses including investigation of accidental arterial trauma. All imaging was performed on a 64 slice GE Lightspeed CT scanner using a pump injector, 20 ml contrast (300 mgI/ml) for bolus timing and 70 ml for the angiogram injected at 4 ml/s, with a 20 ml saline flush chaser. Results: We are able to produce consistently high quality CTA for planning of flap surgery showing good external carotid artery branch demonstration. We have successfully predicted buried flap failure and survival on the basis of CTA. We show a series of examples from our experience using these techniques and of ongoing developments. Discussion: CTA is a viable alternative in routine clinical practice to digital subtraction angiography (DSA); it is less invasive for patients; gives soft tissue detail and is a cheaper procedure than DSA. P16 Blood transfusion in head and neck oncology J. Morrison, L. Colgan, W.S. Hislop. Crosshouse Hospital, Kilmarnock, UK Introduction: Historically, patients have been routinely cross matched prior to head and neck ablative and reconstructive procedures. Blood products are a scarce resource and their use should be regularly reviewed. Blood transfusion is not without risk including adverse reactions and transmission of infectious diseases. The transfusion of these patients may also have an adverse impact on prognosis. Aims: The aim of the study was to evaluate the requirement for pre-operative cross matching in patients undergoing head and neck ablative and reconstructive procedures. A literature review of blood transfusion in head and neck oncology was also undertaken. Materials and Method: A retrospective case note analysis of 50 consecutive head and neck patients was undertaken. The analysis
Posters / British Journal of Oral and Maxillofacial Surgery 48 (2010) S25–S55
P12 Incidence of chyle leaks following neck dissections at Rotherham Foundation NHS Trust over a 7 year period C. Pace, R. Crosher, D. Holt, G. Idaboh. Rotherham NHS Foundation Trust, UK Aim: To find out the incidence of chyle leaks following level I–IV and level I–V neck dissections at Rotherham over a 7 year period and compare with published data. Method: Data collected retrospectively from case notes over a 7 year period between January 2002 and December 2008. All the neck dissections involved levels I–IV as a minimum and were carried out by the same two surgeons. Results: 138 consecutive neck dissections were analysed of which 105 involved levels I–IV and I–V. Of these 79 were selective, 11 radical and 15 modified radical. No chyle leaks were recorded. Conclusion: This highlights the importance of careful dissection at level IV. The reported incidence is low (1–3%) but this study suggests that the incidence can be as low as 0% with careful dissection. P13 The sternocleidomastoid flap as a salvage procedure D. Gahir, C. Avery. Leicester Royal Infirmary, UK Introduction: Salvage surgery is typically necessary after disease recurrence or flap failure but is challenging as the surgical site is often scarred, irradiated and contaminated. The sternocleidomastoid (SCM) flap is overlooked due to a poor arc of rotation, limited volume and proximity to recurrent neck disease; however, it may sometimes be an alternative to the pedicled pectoralis major flap (PPMF). We describe a novel technique for raising a pedicled free style SCM flap and review our experience with a small group of complex reconstructions when other options had been exhausted or the SCM offered a simpler and quicker solution. Method: An island of skin may be raised over the caudal aspect of the muscle if required. The clavicular insertions of the muscle are divided and the superior thyroid vessels are isolated. The mastoid origin of the muscle is divided and the vascularity of the tissues assessed. Excision of potentially non-viable tissue is performed. The flap is mobilised on the vascular pedicle and the arc of rotation is greatly increased as it has no proximal or distal attachments. Clinical relevance: With this technique the SCM flap may retain a niche role in the management of complex cases. If the flap is not viable then it may be sacrificed and a pectoralis major flap raised. As it is often necessary to sacrifice the SCM in order to create sufficient space to inset a PPMF there may be no extra associated morbidity. P14 Survey of routine follow up for oral cancer patients in the UK J. Flanagan, S. Endersby, R. Banks. Sunderland Royal Hospital, UK Introduction: As squamous cell carcinoma of the oral cavity recurs in 25–48% of patients frequent follow up post-treatment is required. At present there are no evidence based guidelines as to the most appropriate follow up routine. Methods: A national survey was undertaken to establish the follow up routine clinicians are using at present for these patients. Questions focused on how frequently these patients are reviewed and for how long, what their indications for reviewing the patients are and whether they felt more regular review would improve the
patient’s prognosis. The questionnaires were sent to the head of oncology of all the oral and maxillofacial units in the UK. Results: The follow up routine used by clinicians varies throughout the country with the majority of clinicians reviewing their patients at 1-month intervals for the first year, 2-month intervals for the second year and 4-month intervals for the third year. Most clinicians felt that increasing the frequency of follow up visits would not improve the patient’s prognosis. We are awaiting further results. Conclusion and Clinical relevance: There is great variation in follow up routines used by oral and maxillofacial units in the U.K. Although the survey suggests that more frequent follow up is not thought to be appropriate by the majority of units it is still important for reassuring the patient, identifying post operative complications and for clinical audit purposes. P15 A pictorial review of the role of CT angiography (CTA) in head and neck cancer imaging T. Boye, A. Yousefpour, A. Smith, N. Hoggard. Sheffield Teaching Hospital, UK Introduction: With the introduction of multislice CT scanners CT angiography (CTA) has become a viable widely used technique for assessment of the supra-aortic and intracranial vessels. We have been using CTA for planning of flap surgery and monitoring of buried flaps. Aims: To show a pictorial review of the role of CTA in head and neck cancer imaging. Methods: We show examples of preoperative CTA planning, post surgical follow up and other uses including investigation of accidental arterial trauma. All imaging was performed on a 64 slice GE Lightspeed CT scanner using a pump injector, 20 ml contrast (300 mgI/ml) for bolus timing and 70 ml for the angiogram injected at 4 ml/s, with a 20 ml saline flush chaser. Results: We are able to produce consistently high quality CTA for planning of flap surgery showing good external carotid artery branch demonstration. We have successfully predicted buried flap failure and survival on the basis of CTA. We show a series of examples from our experience using these techniques and of ongoing developments. Discussion: CTA is a viable alternative in routine clinical practice to digital subtraction angiography (DSA); it is less invasive for patients; gives soft tissue detail and is a cheaper procedure than DSA. P16 Blood transfusion in head and neck oncology J. Morrison, L. Colgan, W.S. Hislop. Crosshouse Hospital, Kilmarnock, UK Introduction: Historically, patients have been routinely cross matched prior to head and neck ablative and reconstructive procedures. Blood products are a scarce resource and their use should be regularly reviewed. Blood transfusion is not without risk including adverse reactions and transmission of infectious diseases. The transfusion of these patients may also have an adverse impact on prognosis. Aims: The aim of the study was to evaluate the requirement for pre-operative cross matching in patients undergoing head and neck ablative and reconstructive procedures. A literature review of blood transfusion in head and neck oncology was also undertaken. Materials and Method: A retrospective case note analysis of 50 consecutive head and neck patients was undertaken. The analysis