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Predicting factors of neurosensory disturbance after sagittal split ramus osteotomy
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Oral Presentation
Evaluating the success of osseointegrated implants placed in composite free flaps using resonance frequency analysis – a prospective study A. Chellappah ∗ , A. Crombie, M. Batstone Royal Brisbane and Women’s Hospital, Brisbane, Australia Background and objectives: Resonance frequency analysis (RFA) is a non-invasive, reproducible method to assess implant stability. Implant stability refers to the absence of clinical mobility and is crucial to immediate and long-term implant success. This prospective study is the first study to examine the stability of implants placed in fibula and deep circumflex iliac artery (DCIA) free-flaps using RFA. Methods: RFA was performed intraoperatively during first stage and second stage implant surgeries amongst patients who had previously received free-flap reconstructions of maxillary and mandibular defects. Implant Stability Quotient (ISQ) values were recorded based upon the orientation of the transducer (buccolingual/mesio-distal; BL/MD) using an Ostell MentorTM device. The impact of factors including gender and prior radiotherapy on derived ISQ values was also assessed. Findings: Amongst twelve patients who received fibula and eight who received DCIA free-flap reconstructions 58 implants were placed. The mean ISQ values ± standard deviation of implants placed in fibula free-flap reconstructions at the time of the stage one surgery indicated adequate primary stability (BL/MD 65.90 ± 13.55/74.13 ± 12.41). With osseointegration, the average ISQ values were seen to increase by the time of the second stage surgery (BL/MD 73.44 ± 12.29/77.72 ± 8.58). Similar results were observed for implants placed in DCIA free-flaps at Stage I (BL/MD 73.11 ± 8.09/76.19 ± 6.71) and Stage 2 (BL/MD 74.08 ± 5.74/74.25 ± 5.49). Five implants (8.6%) did not integrate and were removed. These patients all received adjuvant radiotherapy to the free-flap. ISQ values in these cases were predictive of implant failure. Conclusions: RFA is an objective test that confirms fibula and DCIA free-flaps enable predictable rehabilitation with osseointegrated implants. http://dx.doi.org/10.1016/j.ijom.2015.08.496 Predicting factors of neurosensory disturbance after sagittal split ramus osteotomy M.Y. C Chen ∗ , K.J. Chen, Y.F. Wu Department of OMS, Taichung China Medical University Hospital, Taiwan Background and objectives: Sagittal split ramus osteotomy(SSRO) is a worldwide accepted modality for correction of mandibular hypo- and hyperplasia, however, neurosensory disturbance(NSD) of the inferior alveolar nerve still remains a major concern of this procedure. IAN damage may be caused by a variety of reasons, including excessive nerve manipulation (stretching) during soft tissue reflection and large amount of mandibular advancement as well as inadvertent bone cutting, splitting and fixation procedures. The aim of this study is to find out whether there’s any relevant predicting factors of IAN injury after SSRO. Methods: From January of 2012 to September of 2013, a consecutive 89 SSRO (L’t side:46; R’t side:43) in 47 patients, either a isolated procedure or in combination with Le Fort I osteotomy and/or genioplasty, using two different splitting techniques were
analysed. 49 rami were split by ‘Obwegesor Osteotome’ (group1) while the other 40 rami splitted by ‘Smith Ramus Separator’ (group-2). All the following data were gathered for assessment, including age, sex, type of mandibular canal position according the images of occlusomandibular CT(A,B,C),IAN exposure during the operation, incidence of postoperative lower lip numbness and the period of neurosensory disturbance. Findings: No IAN laceration occurred in our patients. Immediate postoperative lower lip numbness occurred in 33 surgical sites (70.2%) in 26 patients of group-1 and 22 surgical sites (55%) in 14 patients of group-2. There is a significantly less risk of IAN exposure (17.4%) and postoperative NSD (52.2%) in patients with ‘type-A’ mandibular canal as compared to those of ‘type-B + C’, 56.5% and 91.3% respectively. But most (65.5%) of neurosensory recovery occurred within one month and all the other NSD recovered within postoperative 4 months. Conclusion: Splitting mandibular ramus using ‘Smith ramus separator’ and patients with type-A mandibular canal position both seemed to have led to a lower incidence of IAN nerve exposure during theoperation and postoperative neurosensory disturbance. Occlusomandibular CT image study is highly recommended before all kinds of ramus osteotomy especially for SSRO and VSRO. http://dx.doi.org/10.1016/j.ijom.2015.08.497 Reconstruction of palatomaxillary defects following cancer ablation with temporalis muscle flap in medically compromised patients: a 15-year single institutional experience J. Cheng ∗ , J. Ye, H. Wu, L. Wan, Z. Tao, H. Jiang, Y. Wu Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, PR China Background: Successful reconstruction of palatomaxillary defects following cancer ablation represents a formidable challenge for surgeons to achieve consistently favorable outcomes. Objectives: The purpose of this article is to present our experience in oncologic palatomaxillary repair with temporalis muscle flap (TMF) for medically compromised patients who are not ideal candidates for microvascular reconstruction at a Chinese tertiary referral hospital over a 15-year period (1998–2012). Method: A retrospective chart review was performed to identify patients with compromised medical conditions who underwent oncologic palatomaxillary reconstruction using TMF. Patients’ demographics, clinicopathological variables and surgical techniques were presented. Postoperative functional and aesthetic outcomes were assessed by measurements and patients self-evaluations. Findings: Sixty-nine TMFs were successfully harvested and used for immediate oncologic palatomaxillary reconstruction in sixty-seven patients (31 males and 36 females, mean age 60.4-year) with diverse primary malignancies. These patients’ co-morbidities included systemic diseases, preoperative chemotherapy/radiotherapy and elder over 65-year which precluded the ideal utility of free flaps. Fifty-one patients remained alive without disease, while nine had recurrences/metastases and seven died during the follow-up (0.5–10.4 years, mean 3.7 years). All flaps survived with only partial necroses in 4 cases. Complications and donor-site morbidities were minimal with 5 transient facial paralysis and 4 mild diplopia and enophthalmos. Unrestricted diet and mouth opening, intelligible speech and satisfactory temporal aesthetics were obtained in most patients.
Oral Presentation
Evaluating the success of osseointegrated implants placed in composite free flaps using resonance frequency analysis – a prospective study A. Chellappah ∗ , A. Crombie, M. Batstone Royal Brisbane and Women’s Hospital, Brisbane, Australia Background and objectives: Resonance frequency analysis (RFA) is a non-invasive, reproducible method to assess implant stability. Implant stability refers to the absence of clinical mobility and is crucial to immediate and long-term implant success. This prospective study is the first study to examine the stability of implants placed in fibula and deep circumflex iliac artery (DCIA) free-flaps using RFA. Methods: RFA was performed intraoperatively during first stage and second stage implant surgeries amongst patients who had previously received free-flap reconstructions of maxillary and mandibular defects. Implant Stability Quotient (ISQ) values were recorded based upon the orientation of the transducer (buccolingual/mesio-distal; BL/MD) using an Ostell MentorTM device. The impact of factors including gender and prior radiotherapy on derived ISQ values was also assessed. Findings: Amongst twelve patients who received fibula and eight who received DCIA free-flap reconstructions 58 implants were placed. The mean ISQ values ± standard deviation of implants placed in fibula free-flap reconstructions at the time of the stage one surgery indicated adequate primary stability (BL/MD 65.90 ± 13.55/74.13 ± 12.41). With osseointegration, the average ISQ values were seen to increase by the time of the second stage surgery (BL/MD 73.44 ± 12.29/77.72 ± 8.58). Similar results were observed for implants placed in DCIA free-flaps at Stage I (BL/MD 73.11 ± 8.09/76.19 ± 6.71) and Stage 2 (BL/MD 74.08 ± 5.74/74.25 ± 5.49). Five implants (8.6%) did not integrate and were removed. These patients all received adjuvant radiotherapy to the free-flap. ISQ values in these cases were predictive of implant failure. Conclusions: RFA is an objective test that confirms fibula and DCIA free-flaps enable predictable rehabilitation with osseointegrated implants. http://dx.doi.org/10.1016/j.ijom.2015.08.496 Predicting factors of neurosensory disturbance after sagittal split ramus osteotomy M.Y. C Chen ∗ , K.J. Chen, Y.F. Wu Department of OMS, Taichung China Medical University Hospital, Taiwan Background and objectives: Sagittal split ramus osteotomy(SSRO) is a worldwide accepted modality for correction of mandibular hypo- and hyperplasia, however, neurosensory disturbance(NSD) of the inferior alveolar nerve still remains a major concern of this procedure. IAN damage may be caused by a variety of reasons, including excessive nerve manipulation (stretching) during soft tissue reflection and large amount of mandibular advancement as well as inadvertent bone cutting, splitting and fixation procedures. The aim of this study is to find out whether there’s any relevant predicting factors of IAN injury after SSRO. Methods: From January of 2012 to September of 2013, a consecutive 89 SSRO (L’t side:46; R’t side:43) in 47 patients, either a isolated procedure or in combination with Le Fort I osteotomy and/or genioplasty, using two different splitting techniques were
analysed. 49 rami were split by ‘Obwegesor Osteotome’ (group1) while the other 40 rami splitted by ‘Smith Ramus Separator’ (group-2). All the following data were gathered for assessment, including age, sex, type of mandibular canal position according the images of occlusomandibular CT(A,B,C),IAN exposure during the operation, incidence of postoperative lower lip numbness and the period of neurosensory disturbance. Findings: No IAN laceration occurred in our patients. Immediate postoperative lower lip numbness occurred in 33 surgical sites (70.2%) in 26 patients of group-1 and 22 surgical sites (55%) in 14 patients of group-2. There is a significantly less risk of IAN exposure (17.4%) and postoperative NSD (52.2%) in patients with ‘type-A’ mandibular canal as compared to those of ‘type-B + C’, 56.5% and 91.3% respectively. But most (65.5%) of neurosensory recovery occurred within one month and all the other NSD recovered within postoperative 4 months. Conclusion: Splitting mandibular ramus using ‘Smith ramus separator’ and patients with type-A mandibular canal position both seemed to have led to a lower incidence of IAN nerve exposure during theoperation and postoperative neurosensory disturbance. Occlusomandibular CT image study is highly recommended before all kinds of ramus osteotomy especially for SSRO and VSRO. http://dx.doi.org/10.1016/j.ijom.2015.08.497 Reconstruction of palatomaxillary defects following cancer ablation with temporalis muscle flap in medically compromised patients: a 15-year single institutional experience J. Cheng ∗ , J. Ye, H. Wu, L. Wan, Z. Tao, H. Jiang, Y. Wu Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, PR China Background: Successful reconstruction of palatomaxillary defects following cancer ablation represents a formidable challenge for surgeons to achieve consistently favorable outcomes. Objectives: The purpose of this article is to present our experience in oncologic palatomaxillary repair with temporalis muscle flap (TMF) for medically compromised patients who are not ideal candidates for microvascular reconstruction at a Chinese tertiary referral hospital over a 15-year period (1998–2012). Method: A retrospective chart review was performed to identify patients with compromised medical conditions who underwent oncologic palatomaxillary reconstruction using TMF. Patients’ demographics, clinicopathological variables and surgical techniques were presented. Postoperative functional and aesthetic outcomes were assessed by measurements and patients self-evaluations. Findings: Sixty-nine TMFs were successfully harvested and used for immediate oncologic palatomaxillary reconstruction in sixty-seven patients (31 males and 36 females, mean age 60.4-year) with diverse primary malignancies. These patients’ co-morbidities included systemic diseases, preoperative chemotherapy/radiotherapy and elder over 65-year which precluded the ideal utility of free flaps. Fifty-one patients remained alive without disease, while nine had recurrences/metastases and seven died during the follow-up (0.5–10.4 years, mean 3.7 years). All flaps survived with only partial necroses in 4 cases. Complications and donor-site morbidities were minimal with 5 transient facial paralysis and 4 mild diplopia and enophthalmos. Unrestricted diet and mouth opening, intelligible speech and satisfactory temporal aesthetics were obtained in most patients.