Patients’ Perceptions of Recovery After Orthognathic Surgery

Scientific Poster Session of the referral process, particularly referral from the primary care clinician to a specialist. References McLeod NM, Saeed NR, Ali EA: Oral cancer: Delays in referral and diagnosis persist. Br Dent J 198(11):681, 2005 Scott SE, Grunfeld EA, Main J, McGurk M: Patient delay in oral cancer: A qualitative study of patients’ experiences. Psychooncology 2005. Funding Source: Department of Oral and Maxillofacial Surgery, UCSF

POSTER 46 Juvenile Recurrent Parotitis– Sialoendoscopic Treatment, Update and Review

Conclusion: Sialography and ultrasound are both useful techniques for diagnosing JRP. Sialography and sialoendoscopy are the only methods for diagnosing other pathologies like kinks and strictures of the ducts. Sialoendoscopy is a unique method for diagnosis and immediate treatment and prevention of JRP with a high success rate. References Nahlieli O, Shacham R, Shlezinger M, Eliav E: Juvenile recurrent parotitis—A new method of diagnosis and treatment. Pediatrics 114, No. 1, Jul 2004, pp 9-12 Moody AB, Avery CM, Walsh S, Sneddon K, Langdon JD: Surgical management of chronic parotid disease. Br J Oral Maxillofac Surg 38, No. 6, Dec 2000, pp 620-622 Shimizu M, Ussmuller J, Donath K, Yoshiura K, Ban S, Kanda S, Ozeki S, Shinohara M: Sonographic analysis of recurrent parotitis in children: A comparative study with sialographic findings. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 86, No. 5, Nov 1998, pp 606-615

Rachel Shacham, DMD, Kibutz Nizanim, 79290, Israel (Nahlieli O) Statement of the Problem: Juvenile Recurrent Parotitis (JRP) is no more a rare phenomenon (following the universal MMR vaccination), but still the etiology is unknown, and treatment and prevention of these infections are under debate. The reported treatment is divided into conservative, mild surgical intervention like duct ligation, and aggressive surgical procedures like superficial parotidectomy. On July 2004 we reported our initial experience with sialoendoscopic treatment. In this update we review our experience on a large group of patients. Materials and Methods: Sixty-one young patients were diagnosed and treated for JRP between the years 1993 and 2005. All patients underwent clinical examination, ultrasonography of the salivary glands and the neck, and blood count. Parotid sialography and sialoendoscopy were performed bilaterally in all children, most of them under general anesthesia. Lavage of the ductal system and dilatation of strictures were conducted under direct vision using endoscope and miniature instrumentation. All the children (and their parents) were guided to increase drinking and to massage the glands after meals following the procedures. Method of Data Analysis: Subjective analysis. Results: Sialography and ultrasound examination demonstrated sialectasis of the affected glands in all of the patients. Sialography is also capable of demonstrating kinks and strictures. Sialoendoscopy showed a white unvascularized appearance of the ductal system. Strictures were seen in 78% of the glands, and kinks were demonstrated in 25% of the glands. In a mean follow up of 18.6 months (3-72 months) we had 83.6% of success. Only 4 patients of the 10 patients that experienced recurrence of the infections chose to undergo the procedure again, the rest were treated conservatively. AAOMS • 2006

POSTER 47 Patients’ Perceptions of Recovery After Orthognathic Surgery David S. Stoker, DDS, 7 Hampshire Court, Durham, NC 27713 (Phillips C; Turvey T; Blakey G; Stoker D) Statement of the Problem: A patient’s assessment of the cost/benefit of orthognathic surgery should include information on the surgical convalescence (Dickerson et al., 1993). However, few studies have documented the patient’s report of day-to-day symptom recovery in the first months following orthognathic surgery. The purpose of this study was to assess the utility of a HRQOL instrument similar to that used with patients following third molar removal (Conrad et al, 1999) as a post-orthognathic surgery health diary. Materials and Methods: The HRQOL instrument was designed to assess patient perception of recovery in 4 main areas on each postoperative day (POD) for at least 30 days: 1) pain (average, worst, medication use); 2) oral function (opening, chewing, talking); 3) general activity (sleeping, daily activities, social interaction, and sports); and 4) other symptoms (nausea, bleeding, swelling). Pain was recorded on a 7-point Likert scale and the other items on a 5 point Likert scale. Method of Data Analysis: Pain was recorded on a 7-point Likert scale and the other items on a 5 point Likert scale. Results: 88 patients (mean age ⫽ 24; std ⫾ 7.9; 70% female; 39% two jaw surgery; 35% maxillary only) agreed to participate and completed at least the first 30 POD diary. At least 50% of the patients reported no or little trouble in less than 8 days for bruising, bleeding, and sleeping; and between 10 and 13 days for swelling, talking, routine and social life activities, and medication use. 50% reported no or little average pain in 9 days; no 91

Scientific Poster Session or little worst pain in 13 days. Resolution took greater than 30 days for eating, opening, chewing, and sports participation. Percentage of Patients Reporting No (0) or Little(1) Trouble or Interference In Daily Activities Related to Each Item Bleeding

Sleeping

Swelling

Day 1

19

38

8

Day 7

80

51

33

Day14

97

80

72

Day21

98

84

Day28

99

93

Talking

Worst Pain

Eating

Opening

Chewing

7

1

2

0

0

25

28

7

8

3

57

56

17

19

7

76

68

67

23

28

13

90

74

75

32

43

17

Conclusion: In general, patients reported that symptoms resolved first, followed by general activity involvement and pain, and finally oral function. Such information will allow a day-by-day characterization of recovery after orthognathic surgery and provide a data collection method to compare clinical practices adopted to improve recovery. Supported in part by NIH DE013967 and DE005215. References Dickerson HS, White RP Jr, Turvey TA, Phillips C, Mohorn DJ: Recovery following orthognathic surgery: Mandibular bilateral sagittal split osteotomy and Le Fort I osteotomy. Int J Adult Orthod Othognath Surg 8:237, 1993 Conrad SM, Blakey GH, Shugars DA, Marciani RD, Phillips C, White RP Jr: Patients’ perceptions of recovery after third molar surgery. J Oral Maxillofac Surg 57:1288, 1999

between the predictor variables and time to FSR; associations with p ⬍ 0.15 were included in a multivariate Cox proportional hazards model. The multivariate model was used to evaluate the simultaneous effects of multiple covariates. A p-value ⬍0.05 was considered statistically significant in the multivariate model. Results: Over the study period, 89 subjects had lingual nerve repair. Of these subjects, 64 (71.9%) met the inclusion criteria for the study. The mean time between injury and repair was 153.2 ⫹/⫺ 192.4 days; 21.2% of subjects had early repair. The mean age of the subjects was 28.4 ⫹/⫺ 8.0 years and 62.5% were female. Fortynine nerves (76.6%) were repaired by direct suture, 15 nerves (23.4%) were repaired with exploration and decompression. At the time of operation, forty-three (67.2%) subjects had evidence of neuroma formation. In univariate analyses, early repair and exploration/decompression were statistically or near statistically associated with decreased time to FSR (p ⬍ 0.12) when compared to late repair and direct suture, respectively. In the adjusted multiple Cox proportional hazards model, early repair was associated with decreased time to FSR (p ⬍ 0.01). Subjects with early repairs were 2.3 times more likely to achieve FSR within one-year post-operatively (95% CI: 1.2, 4.7). Conclusion: Early repair of lingual nerve injuries is associated with an increased likelihood of obtaining FSR by one year when compared to subjects who have late repair. References

Funding Source: NIH DE013967 and DE005215

POSTER 48 A Comparison of Functional Outcomes After Early and Late Lingual Nerve Repair Srinivas M. Susarla, BA, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, 55 Fruit Street, Warren 1201, Boston, MA 02114 (Kaban LB; Donoff RB; Dodson TB) Statement of the Problem: The purpose of this study was to evaluate the relationship between timing of lingual nerve repair and functional sensory recovery (FSR). Materials and Methods: This was a retrospective cohort study enrolling a sample of subjects who had lingual nerve repair between January 1998 and January 2005 and had at least one post-operative visit. The predictor variable was elapsed time between injury and repair, categorized as early (90 days after injury). The outcome variable was the duration from operation to functional sensory recovery (FSR), measured in days. Other variables were categorized as demographic, anatomic, and operative. Method of Data Analysis: Univariate Cox proportional hazards models were used to evaluate the associations 92

Robinson PP, Loescher AR, Smith KG: A prospective, quantitative study on the clinical outcome of lingual nerve repair. Br J Oral Maxillofac Surg 38, No. 4, Aug 2000, pp 255-263 Robinson PP, Smith KG: A study on the efficacy of late lingual nerve repair. Br J Oral Maxillofac Surg 34, No. 1, Feb 1996, pp 96-103 Funding Source: Massachusetts General Hospital Department of Oral and Maxillofacial Surgery Education and Research Fund, Oral and Maxillofacial Surgery Foundation Fellowship in Clinical Investigation

POSTER 49 Percutaneous Dilational Tracheotomy in the Critically Ill Trauma Patient: A Retrospective Cost Comparison Study Alex K. Walker, DMD, 1000 South Ocean Blvd Apt# 9P, Pompano Beach, FL 33062 (Parra M; Puente I; Koyama T) Statement of the Problem: Analyze the complication incidence, resource utilization and cost-effectiveness with two methods of tracheostomy: traditional open surgical versus percutaneous dilational tracheotomy (PDT). Hypothesis: Bedside modified percutaneous dilational tracheotomy provides similar incidence of complications, is more cost effective, utilizes less hospital reAAOMS • 2006