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Preliminary evaluation of quality of life in patients with oral cancer
450 Free Papers—Oral Presentations it takes a longer course of treatment, more referrals, and higher cost. For patients with secondary deformities who have some difficulties in accepting ‘team approach’ treatment, we use a double dentition denture as a treatment alternative, which can correct the maxillary hypoplasia before taking nasolabial repair surgery. But in severe skeletal angle III malocclusion cases (ANB <–4◦ ), as a result of a larger anti-overjet, it is difficult to obtain normal overjet and overbite while doing single dental treatment. In order to create conditions for prosthodontic treatment, we attempt to push mandible backward by mandibular sagittal split ramus osteotomy (SSRO), and then wear the double dentition denture. Case Reports: We introduce two cases: Case A, 19-year-old male diagnosed with secondary deformity of cleft lip and palate (after alveolar bone graft). PE: ANB = –14◦ , anti-overjet = 13 mm; Case B, 17-year-old female diagnosed with secondary deformity of cleft lip and palate (without alveolar bone graft). PE: ANB = –10◦ , anti-overjet = 14 mm. It was unfeasible for these two cases to undergo the ‘team approach’ treatment, because they both required improvement in nasolabial appearance immediately, and their economic condition was very poor. The referral procedure with orthodontic treatment was also difficult in them. With the consultation and agreement of cleft lip and palate centre, orthognathic surgery centre, and prosthodontics department, we decided to do a comprehensive treatment and make satisfactory preoperative and postoperative evaluation. Process is as follows: carry out bilateral sagittal split ramus osteotomy surgery. Six weeks later, when the occlusal relationship becomes stable, carry out the double dentition denture treatment. After dental treatment perform nasolabial repair surgery. In this article, we record and describe the basic information, detailed treatment procedures, preoperative and postoperative satisfaction of the two cases. It resulted in a successful treatment, in which patients were in good compliance, without significant postoperative complications, and postoperative satisfaction was markedly improved over that of the preoperative period. The method is simple, time-saving, economical, meeting the demands of patients in the shortest interval. Conclusion: We should consider various factors when choosing the treatment method for secondary deformities of cleft lip and palate, we should provide appropriate treatment tailor-made for different patients. Though ‘team approach’
treatment is the preferred choice, for patients who have difficulties in accepting the ‘team approach’ treatment, and have an urgent requirement to improve the nasolabial appearance with poor selfcondition, we have adopted a method of SSRO orthognathic surgery assisting a double dentition denture treatment to meet the patients’ needs.
Conclusion: Cleft lip and palate is the most common disease of the maxillofacial region, and many projects are being undertaken by different charities and foundations all over the world. The kind and quality of surgeries have a correlation to equipment of the hospital and skills of the surgeon. Follow-up of surgery is the more important task which ought to be intensified in future.
doi:10.1016/j.ijom.2009.03.191 doi:10.1016/j.ijom.2009.03.192
O3.27 Comparison of therapy of cleft lip and palate in different areas of China and the Philippines G.M. Wang ∗ , Y. Chen, Y.L. Wu, Y.S. Yang, Y. Zhang, K. Wang Department of Oral and Maxillofacial Surgery, Shanghai Jiaoton Unversity, Medicine, Affiliated Shanghai Ninth People’s Hospital, Shanghai, China
Background and Objectives: To compare of therapy status of cleft lip and palate in areas of China and the Philippines. Methods: All patients underwent surgery between February and July 2007. The first group included 200 patients from 3 hospitals of Davao Medical Center, the Philippines—133 males and 167 females; 150 unilateral cleft lip (UCL), 48 bilateral cleft lip (BCL) and 2 cleft palate (CP); age distribution: 3–12 months 53, 2–4 years 85, 5–12 years 52, 13–18 years 4, 19–25 years 4, >26 years 2. The second group included 160 cases from the First People’s Hospital affiliated to Lanzhou University, China—85 males and 75 females; UCL 54, BCL 7, CP 53, nasolabial deformities 17, alveolar cleft 1, fistula of palate 28; age distribution: 3–12 months 10, 2–4 years 56, 5–12 years 58, 13–18 years 23, 19–25 years 8, >26 years 5. The 3rd group included 300 cases from the Craniofacial Center affiliated to the Shanghai Jiao Tong University, China, with 175 males and 125 females; UCL 36, BCL 16, CP 98, nasolabial deformities 36, alveolar cleft 33, facial cleft 5, fistula of palate 29, pharyngoplasty 32, velo-cardio-facial syndrome 12, Robin sequence 3; age distribution: 0–12 months 72, 2–4 years 90, 5–12 years 52, 13–18 years 43, 19–25 years 42, >26 years 1. Results: The patients in group 1 were older than those in the other two groups. The mean age of patients in group 3 was the youngest. The method of operation in group 1 was mainly Millard and muscle restoration. The kind of diseases in group 3 was most abundant. The width of upper lip in the frontal two groups was not enough.
O3.28 Preliminary evaluation of quality of life in patients with oral cancer Y.B. Yan ∗ , C. Mao, X. Peng, G.Y. Yu, C.B. Guo, L. Zhang Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
Background and Objectives: To investigate the change of quality-of-life (QOL) of patients with oral cancer and analyse the impacting factors for the QOL of diseasefree survivors. Methods: The QOL of 70 consecutive patients with oral cancer were assessed preoperatively and at 3 months and 12 months postoperatively by means of two questionnaires: SF-36 (Chinese version) and UW-QOL version 4. Among all the patients, 15 patients died postoperatively, local recurrences were found in 7 patients and 48 patients were disease-free survivors. Results: The trend of QOL of diseasefree survivors: there was a profound fall from preoperative level at 3 months postoperative and then an improvement at 1 year postoperative. The scores of pain and emotional well-being improved obviously at 1 year and even surpassed preoperative values, however, the scores of some disease-specific problems, e.g. appearance, speech, chewing and shoulder, could not approach the pretreatment level by 12 months. Recurrence was an important factor impacting postoperative QOL. At 3 months postoperatively, the factors impacting composite score of UW-QOL were gender, tumour site, radiotherapy and type of mandibular defect; at 12 months postoperatively, the factors impacting composite score of UW-QOL were gender, radiotherapy and extent of surgical resection. Conclusion: Measurement of QOL of patients with oral cancer can reveal the factors impacting postoperative QOL and reflect their health status and needs for rehabilitation. Diminishing recurrence
Free Papers—Oral Presentations
451
rate, strengthening social supports and providing necessary instructions of rehabilitation and treatment can improve postoperative QOL of patients with oral cancer.
O4: Dentoalveolar Surgery
Craniomaxillofacial Hospital, Kassel, Germany
O4.1 Modified connective tissue flap approach in oroantral fistula closure: clinical study
doi:10.1016/j.ijom.2009.03.193
G. Dergin ∗ , G. Gurler, B. Gürsoy Department of Oral and Maxillofacial Surgery, Marmara University, Istanbul, Turkey
Background and Objectives: Jaw defects are often caused by cysts, odontogenic tumours or atrophy after tooth extractions. For defect filling either bone substitution materials e. g. beta-tricalcium phosphate (-TCP) or autologous bone are used. Unfortunately bone removal causes a new defect. The aim was, to examine retrospectively which advantages and disadvantages of -TCP could be found. Methods: In the time period between 2006 and 2008 in 305 patients -TCP (Cerasorb® , particle size 1000 m) was used in cases of removal of odontogenic cysts or augmentation of the jaw with implant at insertion. In cases of cysts defect filling -TCP without autologous bone was used. All patients received an antibiosis prophylaxis postoperatively. Results: All together in 265 patients (mean age, 49 years) a defect filling after cyst or tumour removal and in 40 patients (mean age, 51.5 years) a jaw augmentation were carried out. 88% of the patients with cysts and 100% of the patients with augmentation could be examined 6 months postoperatively. In both groups after 6 months a good bone healing could be found. In 14% of the patients with additional resection of the root of the teeth and cystectomy a new apical granuloma could be proofed. In both groups, in 4% of the cases a postoperative wound defect with partial loss of augmented material occurred. Especially, in augmented patients despite the mixture with autologous bone and membrane technique a different partial resorption could be seen. Conclusions: The defect filling with TCP is suitable for cysts and for jaw augmentation. The defect filling of cysts can be carried out successfully without autologous bone. A postoperative antibiosis seems to be useful for avoiding infections. The exact soft tissue management is an essential factor for a primary healing and bone regeneration. To be mentioned critically is the possible resorption and volume loss in jaw augmentation.
O3.29 Is a transverse facial cleft a Tessier 7 cleft? Appearances and its surgical reconstruction K.W. Bütow Facial Cleft Deformity Clinic, Department of Maxillo-Facial and Oral Surgery, University of Pretoria, South Africa
Background and Objectives: To analyse the appearances of the rare transverse (lip) or lateral facial cleft, and of the Tessier 7 cleft, and to report on a specialised surgical procedure. Methods: Since the establishment (1983) of the Cleft Clinic, cases of 3226 patients have been recorded, including their clinical appearances and reconstructive surgical procedure. Results: 21 (0.65%) cases presented with a transverse facial cleft. Associated syndromes occurred in 13 (61.9%) cases as Goldenhar (9), oto-mandibular dysostosis (2), Treacher Collins (1) and amniotic band syndrome (1). In the general cleft lip only population, the left-sided cleft is more prevalent (bilateral: 15.4%; right-side: 31.3%; left-side: 53.3%), and this is basically reflected in the transverse cleft (bilateral: 26.1%; right-side: 26.1%; left-side: 47.8%). The appearance of the transverse cleft was compared to the Tessier 7 cleft: 57.1% complied with a Tessier 7 cleft. Furthermore, the transverse cleft also occurs horizontally or inferiorly. Eight patients were surgically reconstructed by means of a cutaneous single (short cleft, <1 cm) or double z-approach (long cleft, >1 cm). The intra-oral mucosal lining was partially reconstructed with lip mucosa, and the muscular modulus re-aligned for normal function. Conclusions: The Tessier 7 cleft rotates superiorly (1st) at the angle of the mouth. There is also a central (2nd) and inferiorly rotation (3rd) transverse or lateral facial cleft, thus three different transverse clefts. A single z- or double z-approach (cutaneous layer) with mucosal and muscle approaches to the deeper layers are used for reconstruction. doi:10.1016/j.ijom.2009.03.194
Background and Objectives: Various techniques have been examined for the closure of oroantral communications. However, the most common question is how to provide better healing of the defect area and the donor site. Palatal rotational flaps with blood supply from greater palatal artery cause superior healing when compared with other methods. However difficulties at the manipulation of the palatal full thickness flap at maxillary tuber region and long term healing period of palatal donor site are the question marks. Methods: 16 patients with oroantral fistulae were treated by modified arterial palatal connective tissue flap between the years 2005 and 2008 in the Clinics of Oral and Maxillofacial Surgery of Marmara University. Results: All of the patients were treated by modified connective tissue flap. Severe bleeding was not seen in intraoperative and postoperative period. None of the patients show palatal bone exposition and secondary infection at surrounding soft tissues. Although patients did not use palatal plate, only one of our patients had slight burning at the surgical site. Good repair was noted in all cases in 2–3 weeks of period. Only 2 (12%) of our patients showed slight ecchymosis under the palatal flap. There was no diminution in vestibular sulcus height or need for secondary pre-prosthetic surgery. Conclusion: Modified palatal connective tissue pedicle flap shows a promising healing. Increased patient comfort, good healing capability, no dog ear formation and great flexibility of connective tissue are the main advantages of this technique. doi:10.1016/j.ijom.2009.03.195
doi:10.1016/j.ijom.2009.03.196
O4.2 Results of more than 300 cases using beta-tricalcium phosphate for defect reconstruction in oral and maxillofacial surgery A. Ludwig ∗ , G. Keller, M. Klin Department of Cranio-Maxillofacial Surgery, MGK Medical and
O4.3 Management of anterior maxillary deficiency for implant placement A. Rachmiel ∗ , O. Emodi, D. Aisenbud, M. Peled
treatment is the preferred choice, for patients who have difficulties in accepting the ‘team approach’ treatment, and have an urgent requirement to improve the nasolabial appearance with poor selfcondition, we have adopted a method of SSRO orthognathic surgery assisting a double dentition denture treatment to meet the patients’ needs.
Conclusion: Cleft lip and palate is the most common disease of the maxillofacial region, and many projects are being undertaken by different charities and foundations all over the world. The kind and quality of surgeries have a correlation to equipment of the hospital and skills of the surgeon. Follow-up of surgery is the more important task which ought to be intensified in future.
doi:10.1016/j.ijom.2009.03.191 doi:10.1016/j.ijom.2009.03.192
O3.27 Comparison of therapy of cleft lip and palate in different areas of China and the Philippines G.M. Wang ∗ , Y. Chen, Y.L. Wu, Y.S. Yang, Y. Zhang, K. Wang Department of Oral and Maxillofacial Surgery, Shanghai Jiaoton Unversity, Medicine, Affiliated Shanghai Ninth People’s Hospital, Shanghai, China
Background and Objectives: To compare of therapy status of cleft lip and palate in areas of China and the Philippines. Methods: All patients underwent surgery between February and July 2007. The first group included 200 patients from 3 hospitals of Davao Medical Center, the Philippines—133 males and 167 females; 150 unilateral cleft lip (UCL), 48 bilateral cleft lip (BCL) and 2 cleft palate (CP); age distribution: 3–12 months 53, 2–4 years 85, 5–12 years 52, 13–18 years 4, 19–25 years 4, >26 years 2. The second group included 160 cases from the First People’s Hospital affiliated to Lanzhou University, China—85 males and 75 females; UCL 54, BCL 7, CP 53, nasolabial deformities 17, alveolar cleft 1, fistula of palate 28; age distribution: 3–12 months 10, 2–4 years 56, 5–12 years 58, 13–18 years 23, 19–25 years 8, >26 years 5. The 3rd group included 300 cases from the Craniofacial Center affiliated to the Shanghai Jiao Tong University, China, with 175 males and 125 females; UCL 36, BCL 16, CP 98, nasolabial deformities 36, alveolar cleft 33, facial cleft 5, fistula of palate 29, pharyngoplasty 32, velo-cardio-facial syndrome 12, Robin sequence 3; age distribution: 0–12 months 72, 2–4 years 90, 5–12 years 52, 13–18 years 43, 19–25 years 42, >26 years 1. Results: The patients in group 1 were older than those in the other two groups. The mean age of patients in group 3 was the youngest. The method of operation in group 1 was mainly Millard and muscle restoration. The kind of diseases in group 3 was most abundant. The width of upper lip in the frontal two groups was not enough.
O3.28 Preliminary evaluation of quality of life in patients with oral cancer Y.B. Yan ∗ , C. Mao, X. Peng, G.Y. Yu, C.B. Guo, L. Zhang Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
Background and Objectives: To investigate the change of quality-of-life (QOL) of patients with oral cancer and analyse the impacting factors for the QOL of diseasefree survivors. Methods: The QOL of 70 consecutive patients with oral cancer were assessed preoperatively and at 3 months and 12 months postoperatively by means of two questionnaires: SF-36 (Chinese version) and UW-QOL version 4. Among all the patients, 15 patients died postoperatively, local recurrences were found in 7 patients and 48 patients were disease-free survivors. Results: The trend of QOL of diseasefree survivors: there was a profound fall from preoperative level at 3 months postoperative and then an improvement at 1 year postoperative. The scores of pain and emotional well-being improved obviously at 1 year and even surpassed preoperative values, however, the scores of some disease-specific problems, e.g. appearance, speech, chewing and shoulder, could not approach the pretreatment level by 12 months. Recurrence was an important factor impacting postoperative QOL. At 3 months postoperatively, the factors impacting composite score of UW-QOL were gender, tumour site, radiotherapy and type of mandibular defect; at 12 months postoperatively, the factors impacting composite score of UW-QOL were gender, radiotherapy and extent of surgical resection. Conclusion: Measurement of QOL of patients with oral cancer can reveal the factors impacting postoperative QOL and reflect their health status and needs for rehabilitation. Diminishing recurrence
Free Papers—Oral Presentations
451
rate, strengthening social supports and providing necessary instructions of rehabilitation and treatment can improve postoperative QOL of patients with oral cancer.
O4: Dentoalveolar Surgery
Craniomaxillofacial Hospital, Kassel, Germany
O4.1 Modified connective tissue flap approach in oroantral fistula closure: clinical study
doi:10.1016/j.ijom.2009.03.193
G. Dergin ∗ , G. Gurler, B. Gürsoy Department of Oral and Maxillofacial Surgery, Marmara University, Istanbul, Turkey
Background and Objectives: Jaw defects are often caused by cysts, odontogenic tumours or atrophy after tooth extractions. For defect filling either bone substitution materials e. g. beta-tricalcium phosphate (-TCP) or autologous bone are used. Unfortunately bone removal causes a new defect. The aim was, to examine retrospectively which advantages and disadvantages of -TCP could be found. Methods: In the time period between 2006 and 2008 in 305 patients -TCP (Cerasorb® , particle size 1000 m) was used in cases of removal of odontogenic cysts or augmentation of the jaw with implant at insertion. In cases of cysts defect filling -TCP without autologous bone was used. All patients received an antibiosis prophylaxis postoperatively. Results: All together in 265 patients (mean age, 49 years) a defect filling after cyst or tumour removal and in 40 patients (mean age, 51.5 years) a jaw augmentation were carried out. 88% of the patients with cysts and 100% of the patients with augmentation could be examined 6 months postoperatively. In both groups after 6 months a good bone healing could be found. In 14% of the patients with additional resection of the root of the teeth and cystectomy a new apical granuloma could be proofed. In both groups, in 4% of the cases a postoperative wound defect with partial loss of augmented material occurred. Especially, in augmented patients despite the mixture with autologous bone and membrane technique a different partial resorption could be seen. Conclusions: The defect filling with TCP is suitable for cysts and for jaw augmentation. The defect filling of cysts can be carried out successfully without autologous bone. A postoperative antibiosis seems to be useful for avoiding infections. The exact soft tissue management is an essential factor for a primary healing and bone regeneration. To be mentioned critically is the possible resorption and volume loss in jaw augmentation.
O3.29 Is a transverse facial cleft a Tessier 7 cleft? Appearances and its surgical reconstruction K.W. Bütow Facial Cleft Deformity Clinic, Department of Maxillo-Facial and Oral Surgery, University of Pretoria, South Africa
Background and Objectives: To analyse the appearances of the rare transverse (lip) or lateral facial cleft, and of the Tessier 7 cleft, and to report on a specialised surgical procedure. Methods: Since the establishment (1983) of the Cleft Clinic, cases of 3226 patients have been recorded, including their clinical appearances and reconstructive surgical procedure. Results: 21 (0.65%) cases presented with a transverse facial cleft. Associated syndromes occurred in 13 (61.9%) cases as Goldenhar (9), oto-mandibular dysostosis (2), Treacher Collins (1) and amniotic band syndrome (1). In the general cleft lip only population, the left-sided cleft is more prevalent (bilateral: 15.4%; right-side: 31.3%; left-side: 53.3%), and this is basically reflected in the transverse cleft (bilateral: 26.1%; right-side: 26.1%; left-side: 47.8%). The appearance of the transverse cleft was compared to the Tessier 7 cleft: 57.1% complied with a Tessier 7 cleft. Furthermore, the transverse cleft also occurs horizontally or inferiorly. Eight patients were surgically reconstructed by means of a cutaneous single (short cleft, <1 cm) or double z-approach (long cleft, >1 cm). The intra-oral mucosal lining was partially reconstructed with lip mucosa, and the muscular modulus re-aligned for normal function. Conclusions: The Tessier 7 cleft rotates superiorly (1st) at the angle of the mouth. There is also a central (2nd) and inferiorly rotation (3rd) transverse or lateral facial cleft, thus three different transverse clefts. A single z- or double z-approach (cutaneous layer) with mucosal and muscle approaches to the deeper layers are used for reconstruction. doi:10.1016/j.ijom.2009.03.194
Background and Objectives: Various techniques have been examined for the closure of oroantral communications. However, the most common question is how to provide better healing of the defect area and the donor site. Palatal rotational flaps with blood supply from greater palatal artery cause superior healing when compared with other methods. However difficulties at the manipulation of the palatal full thickness flap at maxillary tuber region and long term healing period of palatal donor site are the question marks. Methods: 16 patients with oroantral fistulae were treated by modified arterial palatal connective tissue flap between the years 2005 and 2008 in the Clinics of Oral and Maxillofacial Surgery of Marmara University. Results: All of the patients were treated by modified connective tissue flap. Severe bleeding was not seen in intraoperative and postoperative period. None of the patients show palatal bone exposition and secondary infection at surrounding soft tissues. Although patients did not use palatal plate, only one of our patients had slight burning at the surgical site. Good repair was noted in all cases in 2–3 weeks of period. Only 2 (12%) of our patients showed slight ecchymosis under the palatal flap. There was no diminution in vestibular sulcus height or need for secondary pre-prosthetic surgery. Conclusion: Modified palatal connective tissue pedicle flap shows a promising healing. Increased patient comfort, good healing capability, no dog ear formation and great flexibility of connective tissue are the main advantages of this technique. doi:10.1016/j.ijom.2009.03.195
doi:10.1016/j.ijom.2009.03.196
O4.2 Results of more than 300 cases using beta-tricalcium phosphate for defect reconstruction in oral and maxillofacial surgery A. Ludwig ∗ , G. Keller, M. Klin Department of Cranio-Maxillofacial Surgery, MGK Medical and
O4.3 Management of anterior maxillary deficiency for implant placement A. Rachmiel ∗ , O. Emodi, D. Aisenbud, M. Peled