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Reconstruction of the mandible using 2.0 mm Unilock locking plates
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Abstracts / British Journal of Oral and Maxillofacial Surgery 46 (2008) e32–e67
also useful in following up head and neck patients in the clinic. doi:10.1016/j.bjoms.2008.07.040 40 An audit comparing supra-fascial with sub-fascial dissection for radial forearm free flaps Peter Alex Stockton ∗ , M. Garg John Radcliffe Hospital, Oxford Introduction: Radial forearm free flaps are frequently employed for reconstruction of intraoral defects. Microvascular anastomosis of radial vessels in the neck has a high success rate. Radial forearm free flaps are largely fasciocutaneous as many surgeons perform a sub-fascial dissection. Our unit recently changed to a technique of supra-fascial dissection when raising radial free flaps. We carried out an audit to look at flap success, post-operative radial nerve function, hand function and uptake of split skin grafts on the fascial bed. Methods: We reviewed 50 consecutive radial forearm free flaps raised in our unit out of which 26 were sub- and 24 supra-fascial. All patients were examined post-operatively for sensory function of the radial nerve using light touch and two-point discrimination tests. Percentage uptake of split skin at the donor site and flap survival were also recorded. Results: It was found that supra-fascial dissection for harvesting radial forearm free flaps had no adverse effect on flap success and several advantages over sub-fascial dissection. Leaving the fascia on the forearm allowed more reliable preservation of the radial nerve and better post-operative neural recovery in the supra-fascial group. The fascial covering of the tendons provides a suitable surface for split or full thickness skin and it was seen that the supra-fascial group of patients had good graft uptake without the need for muscle coverage with adverse effects on motor function. Conclusion: Supra-fascial dissection for harvesting radial forearm free flaps reduces donor site morbidity without compromising flap survival. doi:10.1016/j.bjoms.2008.07.041 41 The prospective experience of a maxillofacial surgeon with the percutaneous endoscopic gastrostomy technique Christopher Avery ∗ , S. Shenoy, S. Shetty, C. Siegmund, I. Mazhar, N. Taub University Hospitals of Leicester Introduction: A percutaneous endoscopic gastrostomy (PEG) is the method of choice for enteral feeding of patients with head and neck malignancy. It is commonly inserted whenever nutritional support is required for more than 2 to 4 weeks.
Methods: The largest published prospective experience of a head and neck surgeon.1 Insertion of a PEG was attempted on 225 occasions, mainly for oral malignancy. The “pull” technique and a Freka gastrostomy system were used. Results: Seventy-five percent (169/225) were inserted at the time of definitive surgery. The rate of successful insertion was 97.3% (219/225). The incidence of minor complications was 11.5% and major 3.1%. There was no procedure related mortality. The median PEG duration was 337 (SE 31) days. Duration was significantly longer for stage T3-4 tumours (P = 0.028), N1 or greater neck disease (P = 0.034), following surgery with radiotherapy when compared to surgery alone (P < 0.001), particularly glossectomy (P = 0.038) and maxillectomy procedures (P = 0.003), after two separate surgical procedures and radiotherapy (P = 0.046) and following a composite bone resection (P = 0.031), or radiotherapy alone when compared to surgery alone (P = 0.003). There was no relationship to the type of flap used for reconstruction. Conclusions: The early insertion of a PEG is recommended with all major flap reconstructions. The procedure may be safely performed by a maxillofacial surgeon.
Reference 1. Avery C, Shenoy S, Shetty S, Siegmund C, Iqbal M, Taub N. The prospective experience of a maxillofacial surgeon with the percutaneous endoscopic gastrostomy technique. Int J Oral Maxillofac Surg 2008 (in press). http://dx.doi.org/10.1016/j.ijoms.2007.08.465.
doi:10.1016/j.bjoms.2008.07.042 42 Reconstruction of the mandible using 2.0 mm Unilock locking plates Khaleeq-Ur Rehman ∗ , S. Parmar, T. Martin, A. Brown University Hospital Birmingham Introduction: Mandibular reconstruction is an interesting and a challenging procedure to undertake following the resection of the mandible. The reconstruction of the mandibular defect is very important to maintain function, cosmesis and stability. Many techniques have been used to bridge the gap following mandibular resection such as soft tissue coverage for smaller defect of the body of the mandible, the use of reconstruction plates as a primary procedure or with a composite free flap. The reconstruction plates currently used are very bulky and rigid and this leads to many post operative complications such as infection and wound dehiscence leading to plate exposure. However more recently, plates of smaller dimension have been available to overcome such complications. Aim and Objective: The aim and objective of this study was to analyse any post operative complications with the use of Unilock 2.0 mm plates and composite free flaps for mandibular reconstruction.
Abstracts / British Journal of Oral and Maxillofacial Surgery 46 (2008) e32–e67
Method: A 3 year retrospective analysis of all the patients who underwent mandibular reconstruction with a composite free flap using Unilock 2.0 mm plates at the University Hospital Birmingham, UK. Results: The results of the study will be presented. Conclusions: The Unilock 2.0 mm plates are user friendly and give a much better facial profile and their use is associated with lower complications. doi:10.1016/j.bjoms.2008.07.043 43 Laser management for oral soft tissue haemangiomas and vascular malformations Ali Saafan Cairo University, Egypt Congenital vascular anomalies have been and remain poorly understood. Since 1982 haemangiomas and vascular malformations have been recognised as distinct entities that exhibit unique characteristics and demand appropriately tailored treatment plans. Aim of the study: The aim of this study was to help in stabilization different techniques and strategies of laser application in the treatment of soft tissue hemangiomas and vascular mal formations in maxillofacial region. Patients And Methods: A series of 50 patients (31 female &19 male) were treated in this study. The age of the patients ranged from 3 months to 28 years,the treated lesions were 27 hemangioma,15 vascular malformation and 8 lymphangioma. Patients were followed up for three years for detection of any sings of recurrence. Different types of lasers were used in different protocols and modes of applications these lasers were,Diode laser 980 nm, ND:YAG laser 1064 nm and Dye laser 595 nm. Results: No recurrence was detected in treated hemangiomas, while Five cases recurrence were detected in vascular malformation and Two in lymphangioma. In Conclusion: Laser can be considered as an excellent tool for the treatment of hemangiomas and vascular malformations in the maxillofacial region, in case of use the suitable wave lengths, parameters and delivery techniques as well as suitable case selection. doi:10.1016/j.bjoms.2008.07.044
e47
44 Internal mammary vessels for reconstruction in vessel depleted necks Satyajeet Bhatia ∗ , S. Mustafa, R. Parkin, A.J. Cronin, P. O’Keefe, M.J. Fardy University Hospital of Wales Cardiff Wales, UK Introduction: Reconstructive options in Head and Neck cancer can be limited by number of factors. Lack of suitable vessels after radiotherapy and bilateral neck dissection can be the most significant factor dictating the choice of vessels for micro vascular anastomoses. Anastomotic challenge can be further complicated by the length of vascular pedicle. We report first use of internal mammary vessels (IMV) harvested with an open sternotomy approach as means of circumventing these problems. Methods: 2 patients previously treated for oral cancer managed with bilateral neck dissections and radiotherapy were reconstructed with micro vascular transfer. In both cases Internal mammary artery (IMA) was used after an unsuccessful attempt to provide adequate donor artery from the established alternatives like transverse cervical artery. In addition one of these patients also received Internal mammary vein as a recipient vessel. IMV were harvested with an open sternotomy approach. Results: The use of IMV provided optimal length with good calibre vessels free of radiotherapy changes in irradiated neck. The anastomosis was technically simple and worked without problems. The presentation presents the advantages, disadvantages, limitations, complications and review of literature for the IMV in such cases. Conclusion: IMV harvested with open sternotomy approach could be considered as an alternative, when micro vascular anastomosis is planned in vessel depleted necks. The length restrictions for pedicles posed by standard harvesting techniques published before are circumvented by this open sternotomy approach. doi:10.1016/j.bjoms.2008.07.045 45 p16 promoter methylation predicts malignant transformation in oral epithelial dysplasia Richard John Shaw ∗ , G.L. Hall, D.N. Sutton, J.M. Risk University of Liverpool Management of the patient with oral epithelial dysplasia (OED) depends on the ability to predict malignant transformation. Histological grading of OED fails in this regard and is also subject to inter and intra-pathologist variability. This study uses longitudinal clinical samples to explore the prognostic value of a previously validated panel of methylation biomarkers in a cohort of patients with histologically proven oral dysplasia. The methylation enrichment pyrosequencing (MEP) assays used offer the sensitivity offered by
Abstracts / British Journal of Oral and Maxillofacial Surgery 46 (2008) e32–e67
also useful in following up head and neck patients in the clinic. doi:10.1016/j.bjoms.2008.07.040 40 An audit comparing supra-fascial with sub-fascial dissection for radial forearm free flaps Peter Alex Stockton ∗ , M. Garg John Radcliffe Hospital, Oxford Introduction: Radial forearm free flaps are frequently employed for reconstruction of intraoral defects. Microvascular anastomosis of radial vessels in the neck has a high success rate. Radial forearm free flaps are largely fasciocutaneous as many surgeons perform a sub-fascial dissection. Our unit recently changed to a technique of supra-fascial dissection when raising radial free flaps. We carried out an audit to look at flap success, post-operative radial nerve function, hand function and uptake of split skin grafts on the fascial bed. Methods: We reviewed 50 consecutive radial forearm free flaps raised in our unit out of which 26 were sub- and 24 supra-fascial. All patients were examined post-operatively for sensory function of the radial nerve using light touch and two-point discrimination tests. Percentage uptake of split skin at the donor site and flap survival were also recorded. Results: It was found that supra-fascial dissection for harvesting radial forearm free flaps had no adverse effect on flap success and several advantages over sub-fascial dissection. Leaving the fascia on the forearm allowed more reliable preservation of the radial nerve and better post-operative neural recovery in the supra-fascial group. The fascial covering of the tendons provides a suitable surface for split or full thickness skin and it was seen that the supra-fascial group of patients had good graft uptake without the need for muscle coverage with adverse effects on motor function. Conclusion: Supra-fascial dissection for harvesting radial forearm free flaps reduces donor site morbidity without compromising flap survival. doi:10.1016/j.bjoms.2008.07.041 41 The prospective experience of a maxillofacial surgeon with the percutaneous endoscopic gastrostomy technique Christopher Avery ∗ , S. Shenoy, S. Shetty, C. Siegmund, I. Mazhar, N. Taub University Hospitals of Leicester Introduction: A percutaneous endoscopic gastrostomy (PEG) is the method of choice for enteral feeding of patients with head and neck malignancy. It is commonly inserted whenever nutritional support is required for more than 2 to 4 weeks.
Methods: The largest published prospective experience of a head and neck surgeon.1 Insertion of a PEG was attempted on 225 occasions, mainly for oral malignancy. The “pull” technique and a Freka gastrostomy system were used. Results: Seventy-five percent (169/225) were inserted at the time of definitive surgery. The rate of successful insertion was 97.3% (219/225). The incidence of minor complications was 11.5% and major 3.1%. There was no procedure related mortality. The median PEG duration was 337 (SE 31) days. Duration was significantly longer for stage T3-4 tumours (P = 0.028), N1 or greater neck disease (P = 0.034), following surgery with radiotherapy when compared to surgery alone (P < 0.001), particularly glossectomy (P = 0.038) and maxillectomy procedures (P = 0.003), after two separate surgical procedures and radiotherapy (P = 0.046) and following a composite bone resection (P = 0.031), or radiotherapy alone when compared to surgery alone (P = 0.003). There was no relationship to the type of flap used for reconstruction. Conclusions: The early insertion of a PEG is recommended with all major flap reconstructions. The procedure may be safely performed by a maxillofacial surgeon.
Reference 1. Avery C, Shenoy S, Shetty S, Siegmund C, Iqbal M, Taub N. The prospective experience of a maxillofacial surgeon with the percutaneous endoscopic gastrostomy technique. Int J Oral Maxillofac Surg 2008 (in press). http://dx.doi.org/10.1016/j.ijoms.2007.08.465.
doi:10.1016/j.bjoms.2008.07.042 42 Reconstruction of the mandible using 2.0 mm Unilock locking plates Khaleeq-Ur Rehman ∗ , S. Parmar, T. Martin, A. Brown University Hospital Birmingham Introduction: Mandibular reconstruction is an interesting and a challenging procedure to undertake following the resection of the mandible. The reconstruction of the mandibular defect is very important to maintain function, cosmesis and stability. Many techniques have been used to bridge the gap following mandibular resection such as soft tissue coverage for smaller defect of the body of the mandible, the use of reconstruction plates as a primary procedure or with a composite free flap. The reconstruction plates currently used are very bulky and rigid and this leads to many post operative complications such as infection and wound dehiscence leading to plate exposure. However more recently, plates of smaller dimension have been available to overcome such complications. Aim and Objective: The aim and objective of this study was to analyse any post operative complications with the use of Unilock 2.0 mm plates and composite free flaps for mandibular reconstruction.
Abstracts / British Journal of Oral and Maxillofacial Surgery 46 (2008) e32–e67
Method: A 3 year retrospective analysis of all the patients who underwent mandibular reconstruction with a composite free flap using Unilock 2.0 mm plates at the University Hospital Birmingham, UK. Results: The results of the study will be presented. Conclusions: The Unilock 2.0 mm plates are user friendly and give a much better facial profile and their use is associated with lower complications. doi:10.1016/j.bjoms.2008.07.043 43 Laser management for oral soft tissue haemangiomas and vascular malformations Ali Saafan Cairo University, Egypt Congenital vascular anomalies have been and remain poorly understood. Since 1982 haemangiomas and vascular malformations have been recognised as distinct entities that exhibit unique characteristics and demand appropriately tailored treatment plans. Aim of the study: The aim of this study was to help in stabilization different techniques and strategies of laser application in the treatment of soft tissue hemangiomas and vascular mal formations in maxillofacial region. Patients And Methods: A series of 50 patients (31 female &19 male) were treated in this study. The age of the patients ranged from 3 months to 28 years,the treated lesions were 27 hemangioma,15 vascular malformation and 8 lymphangioma. Patients were followed up for three years for detection of any sings of recurrence. Different types of lasers were used in different protocols and modes of applications these lasers were,Diode laser 980 nm, ND:YAG laser 1064 nm and Dye laser 595 nm. Results: No recurrence was detected in treated hemangiomas, while Five cases recurrence were detected in vascular malformation and Two in lymphangioma. In Conclusion: Laser can be considered as an excellent tool for the treatment of hemangiomas and vascular malformations in the maxillofacial region, in case of use the suitable wave lengths, parameters and delivery techniques as well as suitable case selection. doi:10.1016/j.bjoms.2008.07.044
e47
44 Internal mammary vessels for reconstruction in vessel depleted necks Satyajeet Bhatia ∗ , S. Mustafa, R. Parkin, A.J. Cronin, P. O’Keefe, M.J. Fardy University Hospital of Wales Cardiff Wales, UK Introduction: Reconstructive options in Head and Neck cancer can be limited by number of factors. Lack of suitable vessels after radiotherapy and bilateral neck dissection can be the most significant factor dictating the choice of vessels for micro vascular anastomoses. Anastomotic challenge can be further complicated by the length of vascular pedicle. We report first use of internal mammary vessels (IMV) harvested with an open sternotomy approach as means of circumventing these problems. Methods: 2 patients previously treated for oral cancer managed with bilateral neck dissections and radiotherapy were reconstructed with micro vascular transfer. In both cases Internal mammary artery (IMA) was used after an unsuccessful attempt to provide adequate donor artery from the established alternatives like transverse cervical artery. In addition one of these patients also received Internal mammary vein as a recipient vessel. IMV were harvested with an open sternotomy approach. Results: The use of IMV provided optimal length with good calibre vessels free of radiotherapy changes in irradiated neck. The anastomosis was technically simple and worked without problems. The presentation presents the advantages, disadvantages, limitations, complications and review of literature for the IMV in such cases. Conclusion: IMV harvested with open sternotomy approach could be considered as an alternative, when micro vascular anastomosis is planned in vessel depleted necks. The length restrictions for pedicles posed by standard harvesting techniques published before are circumvented by this open sternotomy approach. doi:10.1016/j.bjoms.2008.07.045 45 p16 promoter methylation predicts malignant transformation in oral epithelial dysplasia Richard John Shaw ∗ , G.L. Hall, D.N. Sutton, J.M. Risk University of Liverpool Management of the patient with oral epithelial dysplasia (OED) depends on the ability to predict malignant transformation. Histological grading of OED fails in this regard and is also subject to inter and intra-pathologist variability. This study uses longitudinal clinical samples to explore the prognostic value of a previously validated panel of methylation biomarkers in a cohort of patients with histologically proven oral dysplasia. The methylation enrichment pyrosequencing (MEP) assays used offer the sensitivity offered by