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Prophylactic bone-plating of the radial osteocutaneous donor site
204
British
Journal
of Oral
and Maxillofacial
Surgery
Subjects: All patients undergoing microvascular tissue transfer utilizing a scapula flap over a four-year period were entered into the study. Results: Overall, the flap survival rate was 84%. Anatomical features of the osseocutaneous components are discussed. Conclusion: The osseomyocutaneous scapula flap is a versatile flap for oral reconstruction, especially for three-dimensionally complex defects. Congenital torticollis: an audit of a simple surgical technique. C. J. Kerawala. Department of Oral and Facial Surgery, Sunderland District General Hospital, Sunderland, UK. Torticollis (sternocleidomastoid tumour) is not an uncommon problem in infancy and can lead to a significant craniofacial asymmetry as well as poor head shape and posture in adolescence and adulthood. Patients receive a number of different treatments from radical excision of the tumour in infancy, multiple Z-plasties in childhood and correction of orbital dystopia, bimaxillary osteotomy and masking procedures such as genioplasty in adulthood. A simple technique is introduced adopting the principles of preprosthetic surgery to detach and reattach muscles at a lower level in the mastoid area, combined with a tenotomy through a small incision at the sternoclavicular junction. The surgery is supported by active physiotherapy. Fourteen patients, of age 4 months to 29 years, have been treated under both general anaesthetic and intravenous sedation. The procedure in previously unoperated cases is relatively simple and safe. The technique, results and complications will be demonstrated and discussed. Prophylactic bone-plating of the radial osteocutaneous donor site. C. M. E. Avery, J. Pike, V. Nunez. Department of Maxillofacial Surgery, The Royal Surrey County Hospital, Guilford, Surrey, UK. The donor site morbidity following the harvesting of free radial osteocutaneous grafts can be considerable. We audited our experience at the Royal Surrey County Hospital between April 1992 and November 1995. Twelve patients had undergone reconstruction with free radial osteocutaneous grafts following oral tumour ablation. Five (42%) suffered a fracture of the donor site. Volumetric assessment of the amount of bone resected was unreliable and bone mineral densitometry was unhelpful at assessing those at risk of fracture. There was a marked reduction in donor (non-dominant) forearm grip strength in the fracture group. The dominant arm was used as an internal control. As a result of this audit, we now electively plate our forearm donor sites. There has been no other alteration in graft harvesting technique or perioperative management. In the subsequent twelve months, we have had no fracture in six consecutive patients. We recommend routine prophylactic plating of radial donor site. Treatment of isolated mandibular angle fractures using an upper border non-compression miniplate: a prospective study. J. P. Worthington, J. C. Beirne, A. Zeidan, F. A. Brady. St James’s Hospital, Dublin, Eire. The mandibular angle fracture is associated with the greatest postoperative complication rate.’ However, all studies to date of the mandibular angle fracture have incorporated patients having fractures in other regions of the mandibular arch.’ The aim of this prospective study was to evaluate postoperative outcome in patients treated for isolated fractures of the mandibular angle with a single upper border non-compression miniplate. Thirty-five patients over a period of six months presented with an isolated fracture of the mandibular angle. They were treated by open reduction and internal fixation using one upper border noncompression miniplate. All patients were treated by one of two surgeons (JPW/JCB). No intermaxillary fixation was applied postoperatively and data were collected on an individualized proforma. Assaults were the main cause of fracture (25). Seventeen had a premorbid malocclusion. Twenty had an open bite on the fracture side postoperatively, all of which resolved on one-week review.
One major complication occurred involving a delayed union secondarv to infection. Two natients suffered minor complications of disco&fort and granulation tissue around the incision line, which resolved on a course of oral antibiotics. Neither patient required plate removal. We conclude that the isolated mandibular angle fracture may not have as high a complication rate as those associated with other fractures of the mandibular arch. A high proportion of these patients appear to have a pre-existing malocclusion, perhaps predisposing them to fracture. References 1. Passeri LA, Ellis E, Sinn DP. Complications of non-rigid fixation of mandibular angle fractures. J Oral Maxillofac Surg 1993; 51: 382-387. 2. Ellis E, Lee RW. Treatment of mandibular angle fractures using one noncompression miniplate. J Oral Maxillofac Surg 1996; 54: 864-871. Quality of life and oral satisfaction in the maxillectomy patient: free flap reconstruction versus obturation. S. N. Rogers, A. Zuydam, M. Chan, J. S. Brown, I?. D. Vaughan. Regional Maxillofacial Unit, Walton Hospital, Aintree Trust, Liverpool, UK. The functional rehabilitation of the maxillectomy defect is difficult. Despite a well-fitting obturator, common problems include hypernasality of speech, nasal regurgitation, denture discomfort with difficulties of insertion and instability. Although the defect can be successfully restored using free tissue transfer, it can prove challenging to restore masticatory function and appearance. The aim of this pilot study is to compare the quality of life, oral satisfaction and clinical function in patients rehabilitated using either an obturator or a free flap. Measures used to assessquality of life include the EORTC C30 (v2), EORTC H&N, UOW, and the body-satisfaction scale.’ Oral and denture satisfaction were investigated using a symptom check list’ and denture satisfaction questionnaire.3 Obturator satisfaction was evaluated by the Obturator Functioning Scale.4 Objective clinical examination included speech-assessment, prosthodontic evaluation, masticatory efficiency and photography. In the four years 1992-1996, 39 patients underwent partial or total maxillectomy. Those having only tuberosity resection as part of the ablation were not included. Twenty-three patients are alive and disease free, ten with obturators and thirteen following free flap reconstruction. The merits of the two different techniques in the functional rehabilitation of the maxillectomy defect will be discussed. References 1. Slade PD, Dewey ME, Newton T, Brodie DA, Kiemle G. Development and preliminary validation of the body satisfaction scale (BSS). Psycho1 Health 1990; 4: 213-220. 2. Kent G, Johns R. A controlled longitudinal study on the psychological effects of osseointegrated dental implants. Int J Oral Maxillofac Implants 1991; 6: 470-474. 3. Vervorn JM, Duinkerke ASH, Luteijn F, van de Peo ACM. Relative importance of psychologic factors in denture satisfaction. Community Dent Oral Epidemiol 1991; 19: 45-47. 4. Kornblith AB, Zlotolow IM, Gooen J et al. Quality of life of maxillectomy patients using an obturator prosthesis. Head Neck 1996; 18: 323-334. Long-term outcome following surgical repair of orbital blow-out fractures. D. C. Jones, S. Natha, I. B. Marsh. Regional Maxillofacial Unit, Walton Hospital, Aintree Trust, Liverpool, UK. Surgical repair of orbital blow-out fractures carries a risk of both ophthalmological and maxillofacial complications. This study aims to evaluate the long-term morbidity of such surgery. All patients who had sustained a pure orbital blow-out fracture
British
Journal
of Oral
and Maxillofacial
Surgery
Subjects: All patients undergoing microvascular tissue transfer utilizing a scapula flap over a four-year period were entered into the study. Results: Overall, the flap survival rate was 84%. Anatomical features of the osseocutaneous components are discussed. Conclusion: The osseomyocutaneous scapula flap is a versatile flap for oral reconstruction, especially for three-dimensionally complex defects. Congenital torticollis: an audit of a simple surgical technique. C. J. Kerawala. Department of Oral and Facial Surgery, Sunderland District General Hospital, Sunderland, UK. Torticollis (sternocleidomastoid tumour) is not an uncommon problem in infancy and can lead to a significant craniofacial asymmetry as well as poor head shape and posture in adolescence and adulthood. Patients receive a number of different treatments from radical excision of the tumour in infancy, multiple Z-plasties in childhood and correction of orbital dystopia, bimaxillary osteotomy and masking procedures such as genioplasty in adulthood. A simple technique is introduced adopting the principles of preprosthetic surgery to detach and reattach muscles at a lower level in the mastoid area, combined with a tenotomy through a small incision at the sternoclavicular junction. The surgery is supported by active physiotherapy. Fourteen patients, of age 4 months to 29 years, have been treated under both general anaesthetic and intravenous sedation. The procedure in previously unoperated cases is relatively simple and safe. The technique, results and complications will be demonstrated and discussed. Prophylactic bone-plating of the radial osteocutaneous donor site. C. M. E. Avery, J. Pike, V. Nunez. Department of Maxillofacial Surgery, The Royal Surrey County Hospital, Guilford, Surrey, UK. The donor site morbidity following the harvesting of free radial osteocutaneous grafts can be considerable. We audited our experience at the Royal Surrey County Hospital between April 1992 and November 1995. Twelve patients had undergone reconstruction with free radial osteocutaneous grafts following oral tumour ablation. Five (42%) suffered a fracture of the donor site. Volumetric assessment of the amount of bone resected was unreliable and bone mineral densitometry was unhelpful at assessing those at risk of fracture. There was a marked reduction in donor (non-dominant) forearm grip strength in the fracture group. The dominant arm was used as an internal control. As a result of this audit, we now electively plate our forearm donor sites. There has been no other alteration in graft harvesting technique or perioperative management. In the subsequent twelve months, we have had no fracture in six consecutive patients. We recommend routine prophylactic plating of radial donor site. Treatment of isolated mandibular angle fractures using an upper border non-compression miniplate: a prospective study. J. P. Worthington, J. C. Beirne, A. Zeidan, F. A. Brady. St James’s Hospital, Dublin, Eire. The mandibular angle fracture is associated with the greatest postoperative complication rate.’ However, all studies to date of the mandibular angle fracture have incorporated patients having fractures in other regions of the mandibular arch.’ The aim of this prospective study was to evaluate postoperative outcome in patients treated for isolated fractures of the mandibular angle with a single upper border non-compression miniplate. Thirty-five patients over a period of six months presented with an isolated fracture of the mandibular angle. They were treated by open reduction and internal fixation using one upper border noncompression miniplate. All patients were treated by one of two surgeons (JPW/JCB). No intermaxillary fixation was applied postoperatively and data were collected on an individualized proforma. Assaults were the main cause of fracture (25). Seventeen had a premorbid malocclusion. Twenty had an open bite on the fracture side postoperatively, all of which resolved on one-week review.
One major complication occurred involving a delayed union secondarv to infection. Two natients suffered minor complications of disco&fort and granulation tissue around the incision line, which resolved on a course of oral antibiotics. Neither patient required plate removal. We conclude that the isolated mandibular angle fracture may not have as high a complication rate as those associated with other fractures of the mandibular arch. A high proportion of these patients appear to have a pre-existing malocclusion, perhaps predisposing them to fracture. References 1. Passeri LA, Ellis E, Sinn DP. Complications of non-rigid fixation of mandibular angle fractures. J Oral Maxillofac Surg 1993; 51: 382-387. 2. Ellis E, Lee RW. Treatment of mandibular angle fractures using one noncompression miniplate. J Oral Maxillofac Surg 1996; 54: 864-871. Quality of life and oral satisfaction in the maxillectomy patient: free flap reconstruction versus obturation. S. N. Rogers, A. Zuydam, M. Chan, J. S. Brown, I?. D. Vaughan. Regional Maxillofacial Unit, Walton Hospital, Aintree Trust, Liverpool, UK. The functional rehabilitation of the maxillectomy defect is difficult. Despite a well-fitting obturator, common problems include hypernasality of speech, nasal regurgitation, denture discomfort with difficulties of insertion and instability. Although the defect can be successfully restored using free tissue transfer, it can prove challenging to restore masticatory function and appearance. The aim of this pilot study is to compare the quality of life, oral satisfaction and clinical function in patients rehabilitated using either an obturator or a free flap. Measures used to assessquality of life include the EORTC C30 (v2), EORTC H&N, UOW, and the body-satisfaction scale.’ Oral and denture satisfaction were investigated using a symptom check list’ and denture satisfaction questionnaire.3 Obturator satisfaction was evaluated by the Obturator Functioning Scale.4 Objective clinical examination included speech-assessment, prosthodontic evaluation, masticatory efficiency and photography. In the four years 1992-1996, 39 patients underwent partial or total maxillectomy. Those having only tuberosity resection as part of the ablation were not included. Twenty-three patients are alive and disease free, ten with obturators and thirteen following free flap reconstruction. The merits of the two different techniques in the functional rehabilitation of the maxillectomy defect will be discussed. References 1. Slade PD, Dewey ME, Newton T, Brodie DA, Kiemle G. Development and preliminary validation of the body satisfaction scale (BSS). Psycho1 Health 1990; 4: 213-220. 2. Kent G, Johns R. A controlled longitudinal study on the psychological effects of osseointegrated dental implants. Int J Oral Maxillofac Implants 1991; 6: 470-474. 3. Vervorn JM, Duinkerke ASH, Luteijn F, van de Peo ACM. Relative importance of psychologic factors in denture satisfaction. Community Dent Oral Epidemiol 1991; 19: 45-47. 4. Kornblith AB, Zlotolow IM, Gooen J et al. Quality of life of maxillectomy patients using an obturator prosthesis. Head Neck 1996; 18: 323-334. Long-term outcome following surgical repair of orbital blow-out fractures. D. C. Jones, S. Natha, I. B. Marsh. Regional Maxillofacial Unit, Walton Hospital, Aintree Trust, Liverpool, UK. Surgical repair of orbital blow-out fractures carries a risk of both ophthalmological and maxillofacial complications. This study aims to evaluate the long-term morbidity of such surgery. All patients who had sustained a pure orbital blow-out fracture