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Poster 09: Delayed Reaction to Fibrin Sealant After Facelift Surgery
Poster Session 7.8%) and 3D facial analysis method (0.4%; ⫺10.4% to 11.1%). These data suggest that 3D facial analysis and manual analysis of extraoral casts may be used interchangeably as methods for obtaining pre-PNAM nasal measurements. Because extraoral impressions present an asphyxiation risk, 3D surface imaging and analysis should be considered the method of choice in this context. References: Grayson BH, Cutting CB. Presurgical nasoalveolar orthopedic molding in primary correction of the nose, lip, and alveolus of infants born with unilateral and bilateral clefts. Cleft Palate Craniofac J. 2001;38: 193–198. Kecik D, Enacar A. Effects of nasoalveolar molding therapy on nasal and alveolar morphology in unilateral cleft lip and palate. J Craniofac Surg. 2009;20:2075–2080.
external scar, a correct muscle repositioning is required. Also, a linear closure of the skin defect makes unnecessary a Z or W-plasty correction to avoid lateral deviation of the commissure and scar contraction. References: Rogers GF, Mulliken JB. Repair of transverse facial cleft in hemifacial microsomia: long-term anthropometric evaluation of commissural symmetry. Plast Reconstr Surg. 2007 Sep;120(3):728-37. Eppley BL, et al. The spectrum of orofacial clefting. Plast Reconstr Surg. 2005 Jun;115(7):101e-114e.
COSMETIC MAXILLOFACIAL SURGERY POSTER 09
POSTER 08 Transverse Facial Cleft (Macrostomia): Linear Closure Repare L. Lennon, S. F. Calleja: Exequiel Gonza´lez Cortes Hospital, L. Canto, L. Castellon Background and Purpose: Transverse facial cleft also known as Macrostomia or Tessier type 7 cleft is a rare condition. Its incidence has been estimated at 1 in 80000 live births. And it is considered to be produced by an incomplete mesenchymal merging of the maxillary and mandibular prominences of the first pharyngeal arch. Many technical variations at the surgical repair of the muscular and skin defect exist. The purpose of this study is to evaluate postoperatively long time lip symmetry and lateral deviations of the oral commissure when transverse linear closure technique in facial cleft is used. Materials and Methods: This descriptive cross sectional study was designed to evaluate the results from surgically corrected macrostomia cases, between the years 2007 to 2011 using linear closure technique. All patients receive surgical correction by the same surgeon and physiotherapy. Photographic records and anthropometry was used to evaluate operative outcomes objectively measured with a Vernier Caliper. Aspects considered for the evaluation were: age of surgical repair, macrostomia affected side, presence or absence of Hemifacial Microsomia, and assessment of cleft and non cleft sides. Results and Discussion: Four female patients with transverse facial cleft were studied, with a 2 years average follow-up. Repairing average period was 12 months. Macrostomia locations were 3 left, 1 right. No significant deviation by scar contraction of the labial commissure was observed at any patient. Conclusion: In order to obtain oral symmetry with a functional orbicularis oris muscle, with natural appearance of the commissure and the lesser dimension of e-44
Delayed Reaction to Fibrin Sealant After Facelift Surgery: A Case Report and Literature Review R. Pugao: Louisiana State University, J. Perenack Fibrin sealants are commonly used in facelift surgery to diminish postoperative ecchymosis and edema, and to support soft tissues during healing.1 Fibrin sealants are two-component systems consisting of fibrinogen and thrombin with aprotinin as a fibrin-clot stabilizer, which potentially could lead to adverse reactions due to its bovine origin.2 This case report is about a patient undergoing facelift surgery in which fibrin sealant was used followed by a type-IV allergic reaction to the sealant. A literature review was also performed using the electronic database, Pubmed, and entering keywords such as fibrin tissue sealant, fibrin glue, allergy, adverse reaction, face-lift, and rhytidectomy. A 55-year-old Caucasian female presented to an affiliatecosmetic surgical center for evaluation and improvement of moderate facial and neck skin laxity. Patient described a history of asthma, rosacea, angioedema, vertigo, migraine headaches, and arthritis. Medications taken by the patient were amitriptyline, Aleve, Epipen, meclizine, promethazine, minocycline, hydroquinone, and cyclobenzaprine. She noted an allergy reaction to penicillin and Neosporin, as well as to certain fabrics. Patient revealed a surgical history of anterior cervical fusion in 1988 and tonsillectomy in 1960. Patient denied any general anesthetic complications during and after both surgeries. The patient underwent a facelift procedure with upper and lower blepharoplasty. The facelift procedure involved extensive pre- and posterior-auricular undermining with submental platysmalplasty. Fibrin sealant was applied at the end of the facelift procedure prior to closure. No complications were encountered before, during, and after surgery. The patient had uneventful follow-ups at post-op day one and five. AAOMS • 2012
Poster Session At 4 weeks, patient presented with mild swelling below the chin not extending past the hyoid bone. She denied fevers or chills and was maintaining her own airway without any distress. Upon physical examination, there was firm but fluctuant edema with urticaria and erythema along the submental region without tenderness to palpation. Lymphadenopathy was also present. No other signs of urticaria, edema, and erythema noted elsewhere on the face or torso. Submental aspirate collections revealed 1.5mL of pink, clear fluid, which flattened the submental region. Aspirate was sent for cultures, and the patient was prescribed antibiotics and a steroid dose-pack. At 6 weeks, surgical exploration was performed via submental incision and midline platysma-plication sutures were removed. Initial thought was that the patient experienced an allergic reaction to the silk suture. Surgical exploration was uneventful which noted no obvious granulation formations, except for thin, serous fluid. A biopsy was performed and submitted for pathology. Cultures and gram stain were negative, and the patient appeared to respond well to the steroid dose-pack. Pathology reported chronic inflammatory infiltrates. Over the next 6 months, erythema and swelling were evident but gradually subsided while surgical incisions healed well. Patient’s symptoms eventually resolved completely without any further events. Type-I reactions to aprotinin are well documented in the literature. It is important to note that reactions related to aprotinin use involved mostly intravascular administration and a previous history of exposure.3 Other case reports describe anaphylactic reactions to fibrin sealants after topical application.4 On this patient, fibrin sealant was applied topically, but the symptoms clinically resembled a delayed hypersensitivity reaction. This is the first recorded incident of a type-IV hypersensitivity to fibrin sealant use in facelift surgery. References: Fezza J, et al. The Use of Fibrin Sealant in Facelift Surgery. Am J Cosmetic Surg 2002 Nov 4;19:219-221. Fattahi T, et al. Clinical Applications of Fibrin Sealants. J Oral Maxillofac Surg 2004;62:218-224. Beierlein W, et al. Forty Years of Clinical Aprotinin Use: A Review of 124 Hypersensitivity Reactions. Ann Thorac Surg 2005;79:741-748. Shirai T, et al. Anaphylaxis to Aprotinin in Fibrin Sealant. Internal Medicine 2005 Nov 10;44:1099-1089.
DENTAL IMPLANTS POSTER 10 Highly Nonlinear Solitary Waves for the Assessment of Dental Implant Stability R. P. Shupak: University of Pittsburgh Medical Center The use of endosseus dental implants has dramatically increased over the last decade. Methods to assess stabilAAOMS • 2012
ity and bone-implant interface during healing have yet to be standardized. Currently there are few commercially developed systems that adequately determine implant stability. Although radiographs are useful for monitoring dental implant healing and maintenance, they cannot be used alone. Ideally a non-destructive and minimally invasive technique to determine implant stability would benefit both practitioner and patient. The purpose of this study is to quantify implant stability utilizing highly nonlinear solitary waves (HNSWs).1 In this study we hypothesized that the reflection of HNSWs interacting with an implant is affected by the progression of the osseointegration process2. We propose that the stability of a dental implant inserted into a living bone can be assessed by observing the propagation of the solitary waves within a chain of spherical particles in contact with the prosthetic apparatus. Our final goal is to develop a noninvasive approach that can accurately and consistently assess the osseointegration progress enabling surgeons to determine when adequate healing or osseointegration occurs. An in vitro experiment was developed utilizing HNSWs to monitor the reverse osseointegration process. Implants (4.3 ⫻ 13mm) were placed into bovine bone model at ⱖ 40 Ncm. A unique HNSW transducer was attached to a prosthetic abutment. The HNSW transducer-abutment produced and monitored wave reflection properties. The implant and bone complex was immersed in a 67% nitric acid bath and transducer recordings were made at the time of initial placement and at 15-minute intervals for 13 hours. Additionally, aliquots from the acid bath were sampled every two hours and calcium quantified using an atomic absorption spectrometer to assess bone degradation. The data were analyzed by plotting the amplitude ratio of the primary solitary wave as a function of the monitoring time which was normalized with respect to the averaged data taken at the baseline. A linear decrease of the normalized ratio was clearly visible by the end of the monitoring period, the ratio decreased by approximately 90%. A strong correlation was found between stability and certain characteristics of HNSWs. These wave form pattern shifts also corresponded to the leaching out of calcium. The use of HNSWs provides unique advantages over other established systems. Multiple characteristics of reflected HNSWs can be quantified and analyzed to determine implant stability through a non-destructive modality. The research presented will be instrumental in developing clinical trials of a novel, non-invasive protocol to determine implant stability and detection of failing or compromised implants so that therapeutic interventions can be undertaken in a timely manner. The vision is to eventually develop a “smart” abutment to monitor implant stability. References: Yang, J., Silvestro, C., Khatri, D., De Nardo, L., Daraio, C., 2011, “Interaction of Highly Nonlinear Solitary Waves with Linear Elastic Media,” Phys. Rev. E, 83, 046606.
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external scar, a correct muscle repositioning is required. Also, a linear closure of the skin defect makes unnecessary a Z or W-plasty correction to avoid lateral deviation of the commissure and scar contraction. References: Rogers GF, Mulliken JB. Repair of transverse facial cleft in hemifacial microsomia: long-term anthropometric evaluation of commissural symmetry. Plast Reconstr Surg. 2007 Sep;120(3):728-37. Eppley BL, et al. The spectrum of orofacial clefting. Plast Reconstr Surg. 2005 Jun;115(7):101e-114e.
COSMETIC MAXILLOFACIAL SURGERY POSTER 09
POSTER 08 Transverse Facial Cleft (Macrostomia): Linear Closure Repare L. Lennon, S. F. Calleja: Exequiel Gonza´lez Cortes Hospital, L. Canto, L. Castellon Background and Purpose: Transverse facial cleft also known as Macrostomia or Tessier type 7 cleft is a rare condition. Its incidence has been estimated at 1 in 80000 live births. And it is considered to be produced by an incomplete mesenchymal merging of the maxillary and mandibular prominences of the first pharyngeal arch. Many technical variations at the surgical repair of the muscular and skin defect exist. The purpose of this study is to evaluate postoperatively long time lip symmetry and lateral deviations of the oral commissure when transverse linear closure technique in facial cleft is used. Materials and Methods: This descriptive cross sectional study was designed to evaluate the results from surgically corrected macrostomia cases, between the years 2007 to 2011 using linear closure technique. All patients receive surgical correction by the same surgeon and physiotherapy. Photographic records and anthropometry was used to evaluate operative outcomes objectively measured with a Vernier Caliper. Aspects considered for the evaluation were: age of surgical repair, macrostomia affected side, presence or absence of Hemifacial Microsomia, and assessment of cleft and non cleft sides. Results and Discussion: Four female patients with transverse facial cleft were studied, with a 2 years average follow-up. Repairing average period was 12 months. Macrostomia locations were 3 left, 1 right. No significant deviation by scar contraction of the labial commissure was observed at any patient. Conclusion: In order to obtain oral symmetry with a functional orbicularis oris muscle, with natural appearance of the commissure and the lesser dimension of e-44
Delayed Reaction to Fibrin Sealant After Facelift Surgery: A Case Report and Literature Review R. Pugao: Louisiana State University, J. Perenack Fibrin sealants are commonly used in facelift surgery to diminish postoperative ecchymosis and edema, and to support soft tissues during healing.1 Fibrin sealants are two-component systems consisting of fibrinogen and thrombin with aprotinin as a fibrin-clot stabilizer, which potentially could lead to adverse reactions due to its bovine origin.2 This case report is about a patient undergoing facelift surgery in which fibrin sealant was used followed by a type-IV allergic reaction to the sealant. A literature review was also performed using the electronic database, Pubmed, and entering keywords such as fibrin tissue sealant, fibrin glue, allergy, adverse reaction, face-lift, and rhytidectomy. A 55-year-old Caucasian female presented to an affiliatecosmetic surgical center for evaluation and improvement of moderate facial and neck skin laxity. Patient described a history of asthma, rosacea, angioedema, vertigo, migraine headaches, and arthritis. Medications taken by the patient were amitriptyline, Aleve, Epipen, meclizine, promethazine, minocycline, hydroquinone, and cyclobenzaprine. She noted an allergy reaction to penicillin and Neosporin, as well as to certain fabrics. Patient revealed a surgical history of anterior cervical fusion in 1988 and tonsillectomy in 1960. Patient denied any general anesthetic complications during and after both surgeries. The patient underwent a facelift procedure with upper and lower blepharoplasty. The facelift procedure involved extensive pre- and posterior-auricular undermining with submental platysmalplasty. Fibrin sealant was applied at the end of the facelift procedure prior to closure. No complications were encountered before, during, and after surgery. The patient had uneventful follow-ups at post-op day one and five. AAOMS • 2012
Poster Session At 4 weeks, patient presented with mild swelling below the chin not extending past the hyoid bone. She denied fevers or chills and was maintaining her own airway without any distress. Upon physical examination, there was firm but fluctuant edema with urticaria and erythema along the submental region without tenderness to palpation. Lymphadenopathy was also present. No other signs of urticaria, edema, and erythema noted elsewhere on the face or torso. Submental aspirate collections revealed 1.5mL of pink, clear fluid, which flattened the submental region. Aspirate was sent for cultures, and the patient was prescribed antibiotics and a steroid dose-pack. At 6 weeks, surgical exploration was performed via submental incision and midline platysma-plication sutures were removed. Initial thought was that the patient experienced an allergic reaction to the silk suture. Surgical exploration was uneventful which noted no obvious granulation formations, except for thin, serous fluid. A biopsy was performed and submitted for pathology. Cultures and gram stain were negative, and the patient appeared to respond well to the steroid dose-pack. Pathology reported chronic inflammatory infiltrates. Over the next 6 months, erythema and swelling were evident but gradually subsided while surgical incisions healed well. Patient’s symptoms eventually resolved completely without any further events. Type-I reactions to aprotinin are well documented in the literature. It is important to note that reactions related to aprotinin use involved mostly intravascular administration and a previous history of exposure.3 Other case reports describe anaphylactic reactions to fibrin sealants after topical application.4 On this patient, fibrin sealant was applied topically, but the symptoms clinically resembled a delayed hypersensitivity reaction. This is the first recorded incident of a type-IV hypersensitivity to fibrin sealant use in facelift surgery. References: Fezza J, et al. The Use of Fibrin Sealant in Facelift Surgery. Am J Cosmetic Surg 2002 Nov 4;19:219-221. Fattahi T, et al. Clinical Applications of Fibrin Sealants. J Oral Maxillofac Surg 2004;62:218-224. Beierlein W, et al. Forty Years of Clinical Aprotinin Use: A Review of 124 Hypersensitivity Reactions. Ann Thorac Surg 2005;79:741-748. Shirai T, et al. Anaphylaxis to Aprotinin in Fibrin Sealant. Internal Medicine 2005 Nov 10;44:1099-1089.
DENTAL IMPLANTS POSTER 10 Highly Nonlinear Solitary Waves for the Assessment of Dental Implant Stability R. P. Shupak: University of Pittsburgh Medical Center The use of endosseus dental implants has dramatically increased over the last decade. Methods to assess stabilAAOMS • 2012
ity and bone-implant interface during healing have yet to be standardized. Currently there are few commercially developed systems that adequately determine implant stability. Although radiographs are useful for monitoring dental implant healing and maintenance, they cannot be used alone. Ideally a non-destructive and minimally invasive technique to determine implant stability would benefit both practitioner and patient. The purpose of this study is to quantify implant stability utilizing highly nonlinear solitary waves (HNSWs).1 In this study we hypothesized that the reflection of HNSWs interacting with an implant is affected by the progression of the osseointegration process2. We propose that the stability of a dental implant inserted into a living bone can be assessed by observing the propagation of the solitary waves within a chain of spherical particles in contact with the prosthetic apparatus. Our final goal is to develop a noninvasive approach that can accurately and consistently assess the osseointegration progress enabling surgeons to determine when adequate healing or osseointegration occurs. An in vitro experiment was developed utilizing HNSWs to monitor the reverse osseointegration process. Implants (4.3 ⫻ 13mm) were placed into bovine bone model at ⱖ 40 Ncm. A unique HNSW transducer was attached to a prosthetic abutment. The HNSW transducer-abutment produced and monitored wave reflection properties. The implant and bone complex was immersed in a 67% nitric acid bath and transducer recordings were made at the time of initial placement and at 15-minute intervals for 13 hours. Additionally, aliquots from the acid bath were sampled every two hours and calcium quantified using an atomic absorption spectrometer to assess bone degradation. The data were analyzed by plotting the amplitude ratio of the primary solitary wave as a function of the monitoring time which was normalized with respect to the averaged data taken at the baseline. A linear decrease of the normalized ratio was clearly visible by the end of the monitoring period, the ratio decreased by approximately 90%. A strong correlation was found between stability and certain characteristics of HNSWs. These wave form pattern shifts also corresponded to the leaching out of calcium. The use of HNSWs provides unique advantages over other established systems. Multiple characteristics of reflected HNSWs can be quantified and analyzed to determine implant stability through a non-destructive modality. The research presented will be instrumental in developing clinical trials of a novel, non-invasive protocol to determine implant stability and detection of failing or compromised implants so that therapeutic interventions can be undertaken in a timely manner. The vision is to eventually develop a “smart” abutment to monitor implant stability. References: Yang, J., Silvestro, C., Khatri, D., De Nardo, L., Daraio, C., 2011, “Interaction of Highly Nonlinear Solitary Waves with Linear Elastic Media,” Phys. Rev. E, 83, 046606.
e-45