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PD16. Role of OI implants in dental rehabilitation in oral cancer
S10
Abstracts / Oral Oncology 47 (2011) S5–S14
therapy can be tailored in these tumours. Further knowledge about the tumour biology and identification of additional clinical useful markers combining with HPV status for appropriate risk stratification are needed in future studies to optimise the treatment.
[Abstract not available at time of print.] doi:10.1016/j.oraloncology.2011.06.048
doi:10.1016/j.oraloncology.2011.06.045 PD19. Advances and principles in oral tongue reconstruction Subramania Iyer Panel Discussion #5: PD16. Role of OI implants in dental rehabilitation in oral cancer Brent B. Ward Oral and Maxillofacial Surgery, Maxillofacial Head and Neck Oncology, University of Michigan Hospitals, Ann Arbor, MI, USA Reconstruction The utilization of osseointegrated implants has greatly enhanced functional rehabilitation for cancer patients undergoing bony resections with reconstruction. Surgeons can now be guided by computer simulation to assist in all phases of the planning, reliably leading to implant supported prostheses as the outcome. This presentation will review the present options and key principles in decision making which lead to successful dental rehabilitation with implants in the oral cancer patient. doi:10.1016/j.oraloncology.2011.06.046
PD17. Advances in mandibular reconstruction John Yoo Department of Otolaryngology – Head and Neck Surgery, Schulich School of Medicine & Dentistry, University of Western Ontario, Canada Contemporary reconstructions for oromandibular defects following cancer surgery require composite free tissue transfers. Restoration of aesthetics and function, while minimizing donor site morbidity are the key elements of the ideal reconstruction. Free flaps that incorporate bone include the fibula, iliac crest, radial forearm, scapula, and the scapular tip. The broad spectrum of reliable flaps available to the surgeon enables the best match for a specific soft-tissue and bone requirement for each patient. The purpose of this presentation is to provide a broad overview of mandibular reconstruction using free tissue transfers. A clinical algorithm will incorporate advantages and disadvantages of various flaps, with a focus on patient-specific decision-making. Particular attention will be given to the subscapular system of flaps. Although incomparably versatile, these flaps have enjoyed less popularity than many other bone flaps. A personal experience with the subscapular bone flap will be presented as well as some novel approaches using the scapular tip bone flap based on the angular branch of the thoracodorsal artery. All examples will be highlighted with clinical cases. doi:10.1016/j.oraloncology.2011.06.047
PD18. Advances in maxilla reconstruction Ralph W. Gilbert Otolaryngology – Head and Neck Surgery, Surgical Oncology & Reconstructive Microsurgery, University Health Network/Toronto General Hospital, Toronto, Ontario, Canada
Division of Plastic and Reconstructive Surgery and Head and Neck Surgery/Oncology, Amrita Institute of Medical Sciences, Kochi, Kerala, India Reconstruction of the oral tongue after cancer resection has been a topic that has aroused interest as well as controversies. When the tongue defect is combined with that of the segment of mandible and beyond, the objective of reconstruction is to provide the epithelial lining and bulk. The choice of reconstruction is between a pectoral is major flap or a bulky free flap like rectus/ALT flap. But when the defect is limited to that of a partial or total glossectomy retaining the mandibular continuity, retaining or reconstructing a mobile and just adequately thick tongue becomes important to maintain good speech and swallowing functions. The necessity and benefits of reconstructing hemiglossectomy or smaller defects is not backed by strong evidence and is not universally practised. Free flaps play a major role in reconstruction of these defects, the choice of flaps being radial forearm, lateral arm and ALT flaps. Submental flap is to be one alternative to these in patients whose donor area is suitable. Use of sensate flaps have been reported, but studies do not support their improvement in functional rehabilitation of patients with regarding to swallowing. Reconstruction of total tongue defects have been mainly achieved through using flaps like pectoralis major/ALT or rectus abdominis, the emphasis being only in providing the bulk of aid swallowing. But few reports of providing mobility to the reconstructed tongues using dynamic muscles like gracilis is have been also reported. doi:10.1016/j.oraloncology.2011.06.049
PD20. Template-based reconstruction of the oral cavity Douglas B. Chepeha Director of Microvascular Surgery, University of Michigan Health System, USA Reconstruction of the tongue is necessary when oral cavity obliteration, premaxillary contact, and mobility will be impaired to an extent that normal swallowing and speech will be adversely affected. Template based reconstruction involves the reconstruction of specific anatomic subsites in the oral cavity. This approach is designed to maximize function of the remaining tissue and optimize overall oral cavity function. This presentation will focus on reconstruction of the tongue and highlight the rectangle tongue template reconstruction of the hemiglossectomy defect. The steps for designing and insetting the template will be briefly discussed. In addition, data relating metrics of obliteration, elevation and protrusion will be correlated to speaking and eating outcomes. Prior work has shown that the mean tongue tip protrusion with this approach was.7 cm (0–1.7 cm) and the mean elevation was 1.7 cm (1–3 cm). The patients with protrusion >.8 cm had significantly better swallowing scores with ‘‘range of solids’’ and a trend toward better ‘‘eating in public’’ scores. Attention to the shape of
Abstracts / Oral Oncology 47 (2011) S5–S14
therapy can be tailored in these tumours. Further knowledge about the tumour biology and identification of additional clinical useful markers combining with HPV status for appropriate risk stratification are needed in future studies to optimise the treatment.
[Abstract not available at time of print.] doi:10.1016/j.oraloncology.2011.06.048
doi:10.1016/j.oraloncology.2011.06.045 PD19. Advances and principles in oral tongue reconstruction Subramania Iyer Panel Discussion #5: PD16. Role of OI implants in dental rehabilitation in oral cancer Brent B. Ward Oral and Maxillofacial Surgery, Maxillofacial Head and Neck Oncology, University of Michigan Hospitals, Ann Arbor, MI, USA Reconstruction The utilization of osseointegrated implants has greatly enhanced functional rehabilitation for cancer patients undergoing bony resections with reconstruction. Surgeons can now be guided by computer simulation to assist in all phases of the planning, reliably leading to implant supported prostheses as the outcome. This presentation will review the present options and key principles in decision making which lead to successful dental rehabilitation with implants in the oral cancer patient. doi:10.1016/j.oraloncology.2011.06.046
PD17. Advances in mandibular reconstruction John Yoo Department of Otolaryngology – Head and Neck Surgery, Schulich School of Medicine & Dentistry, University of Western Ontario, Canada Contemporary reconstructions for oromandibular defects following cancer surgery require composite free tissue transfers. Restoration of aesthetics and function, while minimizing donor site morbidity are the key elements of the ideal reconstruction. Free flaps that incorporate bone include the fibula, iliac crest, radial forearm, scapula, and the scapular tip. The broad spectrum of reliable flaps available to the surgeon enables the best match for a specific soft-tissue and bone requirement for each patient. The purpose of this presentation is to provide a broad overview of mandibular reconstruction using free tissue transfers. A clinical algorithm will incorporate advantages and disadvantages of various flaps, with a focus on patient-specific decision-making. Particular attention will be given to the subscapular system of flaps. Although incomparably versatile, these flaps have enjoyed less popularity than many other bone flaps. A personal experience with the subscapular bone flap will be presented as well as some novel approaches using the scapular tip bone flap based on the angular branch of the thoracodorsal artery. All examples will be highlighted with clinical cases. doi:10.1016/j.oraloncology.2011.06.047
PD18. Advances in maxilla reconstruction Ralph W. Gilbert Otolaryngology – Head and Neck Surgery, Surgical Oncology & Reconstructive Microsurgery, University Health Network/Toronto General Hospital, Toronto, Ontario, Canada
Division of Plastic and Reconstructive Surgery and Head and Neck Surgery/Oncology, Amrita Institute of Medical Sciences, Kochi, Kerala, India Reconstruction of the oral tongue after cancer resection has been a topic that has aroused interest as well as controversies. When the tongue defect is combined with that of the segment of mandible and beyond, the objective of reconstruction is to provide the epithelial lining and bulk. The choice of reconstruction is between a pectoral is major flap or a bulky free flap like rectus/ALT flap. But when the defect is limited to that of a partial or total glossectomy retaining the mandibular continuity, retaining or reconstructing a mobile and just adequately thick tongue becomes important to maintain good speech and swallowing functions. The necessity and benefits of reconstructing hemiglossectomy or smaller defects is not backed by strong evidence and is not universally practised. Free flaps play a major role in reconstruction of these defects, the choice of flaps being radial forearm, lateral arm and ALT flaps. Submental flap is to be one alternative to these in patients whose donor area is suitable. Use of sensate flaps have been reported, but studies do not support their improvement in functional rehabilitation of patients with regarding to swallowing. Reconstruction of total tongue defects have been mainly achieved through using flaps like pectoralis major/ALT or rectus abdominis, the emphasis being only in providing the bulk of aid swallowing. But few reports of providing mobility to the reconstructed tongues using dynamic muscles like gracilis is have been also reported. doi:10.1016/j.oraloncology.2011.06.049
PD20. Template-based reconstruction of the oral cavity Douglas B. Chepeha Director of Microvascular Surgery, University of Michigan Health System, USA Reconstruction of the tongue is necessary when oral cavity obliteration, premaxillary contact, and mobility will be impaired to an extent that normal swallowing and speech will be adversely affected. Template based reconstruction involves the reconstruction of specific anatomic subsites in the oral cavity. This approach is designed to maximize function of the remaining tissue and optimize overall oral cavity function. This presentation will focus on reconstruction of the tongue and highlight the rectangle tongue template reconstruction of the hemiglossectomy defect. The steps for designing and insetting the template will be briefly discussed. In addition, data relating metrics of obliteration, elevation and protrusion will be correlated to speaking and eating outcomes. Prior work has shown that the mean tongue tip protrusion with this approach was.7 cm (0–1.7 cm) and the mean elevation was 1.7 cm (1–3 cm). The patients with protrusion >.8 cm had significantly better swallowing scores with ‘‘range of solids’’ and a trend toward better ‘‘eating in public’’ scores. Attention to the shape of