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Reconstruction of the orbit by 3D-planning
Oral Presentation identified. Analyses of gender, age and tumour stage and subsites were explored. Where available, data on second primaries, survival, and the human papilloma virus were aggregated and compared. Data from The Cancer Genome Atlas was also included in this study. Principal findings: Ten datasets from tertiary centres in 8 different countries were sourced, totaling 887 patients without known risk factors for oral cavity SCC. The NSND subgroup tends to be older, female and present with oral cavity lesions, particularly on the tongue. Second primary data from 3 papers demonstrates an overall second primary tumour rate of 20%. There are differences in reported mortality rates of the NSND patients when compared to smokers and drinkers. The overall frequency of NSND patients with OSCC is 10.1%. Conclusion: Multiple studies indicate that OCSCC in NSND patients is a distinct subgroup with unique characteristics and has different clinical behaviour to cancers in smokers and drinkers. Novel aetiological agents have been postulated but not identified. An understanding of genetic characteristics may improve treatment protocols. http://dx.doi.org/10.1016/j.ijom.2015.08.460 Reconstruction of the orbit by 3D-planning A. Baumann 1,∗ , G. Dorner 2 1 Medical University of Vienna, Department of Oral Maxillofacial Surgery, Vienna, Austria 2 Medical University of Vienna, Department of Ophthalmology, Vienna, Austria
Background: Injuries to the orbit may cause enophthalmos and diplopia. During orbital reconstruction the volume of the orbit has to be restored to allow structural and functional recovery. Reconstruction procedures in the orbit are more often done by computer planning especially in complex cases. Objectives: Improves computer planning the outcome for the reconstruction procedure? Methods: 22 patients were reconstructed after complex orbital fractures. There were 17 male and 5 female patients. Prebended implants were inserted in 14 patients without 3-D planning. In 8 patients ‘Patient Specific Implants’ (PSI) were manufactured according 3-D planning. Preoperative CT scans of all fractured orbit were analyzed retrospective. The orbit was reconstructed by mirroring the non-fractured into the fractured side with Brainlab software. Implant position was checked with this planning. Ophthalmic parameters were evaluated pre and postoperative. Findings: Ophthalmic parameters as diplopia and motility improved in all patients after, which is the important factor in this procedure. Discrepancy in the overlapping of the simulated reconstruction to the perbended implant position were found. The implant was inserted in few patient not in the ideal ‘planned’ position. The enophthalmos measurement in this group showed in few patients a discrepancy of 1–2 mm, without the need of secondary correction. The handling and insertion of PSI was easier in comparison to the stock implants and showed a good correlation between planning and postoperative outcome. Conclusion: Reconstruction procedures of the bony orbit region can be easier and quicker performed by PSI implants and 3-D planning on the computer. http://dx.doi.org/10.1016/j.ijom.2015.08.461
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Management of head and neck necrotising fasciitis: a review and case series K. Bayetto ∗ , A. Cheng, P. Sambrook, A. Goss Royal Adelaide Hospital, Adelaide, Australia Objective: 1. To establish the incidence of head and neck necrotising fasciitis (NF) in South Australia. 2. To review the current literature regarding management of head and neck NF. Method: A retrospective audit of all patients admitted to the Royal Adelaide Hospital Oral and Maxillofacial Surgery Unit 2006–2015 with severe odontogenic infections was carried out. Patient demographics were recorded and treatment details were collected and analysed. Results: A total of 695 patients were admitted for management of severe odontogenic infections. Of these, three were identified as NF. One case was treated using hyperbaric oxygen as an adjunct to conventional surgical and medical management. Two cases were managed using aggressive surgical management alone. Two patients survived. The incidence of head and neck NF in South Australia is 48 per 100,000 infections per year. A review of the literature was carried out to assess the efficacy of hyperbaric oxygen in the treatment of NF. The current available evidence on management of NF will be presented. The management of three clinical cases will be presented and compared. Conclusion: The first line treatment of severe odontogenic infections remains conventional surgical and medical management, however hyperbaric oxygen therapy may have an additional role in the management of NF and other rare severe infections in medically complex patients. http://dx.doi.org/10.1016/j.ijom.2015.08.462 Comparison of locking and non-locking reconstruction platescrew system in lateral mandibular defects by FEA B. Bayram 1,∗ , G. Muftuoglu 2 1
Baskent University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Ankara, Turkey 2 Private Clinic, Ankara, Turkey
Background: Reconstruction plate systems have been used to restore function following mandibular resection. Objective: The purpose of this study is to analyze and compare stress distribution on bone screws and plate systems in locking and non-locking screw-plates design with lateral mandibular defects. Methods: Solid mathematical model of the mandible was created by three-dimensional finite elements analysis and 25 mm in length of lateral resection was performed on model. Models were reconstructed with two different reconstruction plate system including three 2.4 mm titanium screws. Realistic mastication force was applied by simulating natural muscles vectors. The stress formation on bone and hardware system were evaluated and compared. Findings: The stress values of the cortical bone, plate and screw system of the conventional plate model was higher than the locking system model. The highest stress values were measured in the proximal segment especially in conjunction with conventional screw system. Furthermore, the distribution of the stress on bone surface more homogeneously in the locking system.
Background: Injuries to the orbit may cause enophthalmos and diplopia. During orbital reconstruction the volume of the orbit has to be restored to allow structural and functional recovery. Reconstruction procedures in the orbit are more often done by computer planning especially in complex cases. Objectives: Improves computer planning the outcome for the reconstruction procedure? Methods: 22 patients were reconstructed after complex orbital fractures. There were 17 male and 5 female patients. Prebended implants were inserted in 14 patients without 3-D planning. In 8 patients ‘Patient Specific Implants’ (PSI) were manufactured according 3-D planning. Preoperative CT scans of all fractured orbit were analyzed retrospective. The orbit was reconstructed by mirroring the non-fractured into the fractured side with Brainlab software. Implant position was checked with this planning. Ophthalmic parameters were evaluated pre and postoperative. Findings: Ophthalmic parameters as diplopia and motility improved in all patients after, which is the important factor in this procedure. Discrepancy in the overlapping of the simulated reconstruction to the perbended implant position were found. The implant was inserted in few patient not in the ideal ‘planned’ position. The enophthalmos measurement in this group showed in few patients a discrepancy of 1–2 mm, without the need of secondary correction. The handling and insertion of PSI was easier in comparison to the stock implants and showed a good correlation between planning and postoperative outcome. Conclusion: Reconstruction procedures of the bony orbit region can be easier and quicker performed by PSI implants and 3-D planning on the computer. http://dx.doi.org/10.1016/j.ijom.2015.08.461
e35
Management of head and neck necrotising fasciitis: a review and case series K. Bayetto ∗ , A. Cheng, P. Sambrook, A. Goss Royal Adelaide Hospital, Adelaide, Australia Objective: 1. To establish the incidence of head and neck necrotising fasciitis (NF) in South Australia. 2. To review the current literature regarding management of head and neck NF. Method: A retrospective audit of all patients admitted to the Royal Adelaide Hospital Oral and Maxillofacial Surgery Unit 2006–2015 with severe odontogenic infections was carried out. Patient demographics were recorded and treatment details were collected and analysed. Results: A total of 695 patients were admitted for management of severe odontogenic infections. Of these, three were identified as NF. One case was treated using hyperbaric oxygen as an adjunct to conventional surgical and medical management. Two cases were managed using aggressive surgical management alone. Two patients survived. The incidence of head and neck NF in South Australia is 48 per 100,000 infections per year. A review of the literature was carried out to assess the efficacy of hyperbaric oxygen in the treatment of NF. The current available evidence on management of NF will be presented. The management of three clinical cases will be presented and compared. Conclusion: The first line treatment of severe odontogenic infections remains conventional surgical and medical management, however hyperbaric oxygen therapy may have an additional role in the management of NF and other rare severe infections in medically complex patients. http://dx.doi.org/10.1016/j.ijom.2015.08.462 Comparison of locking and non-locking reconstruction platescrew system in lateral mandibular defects by FEA B. Bayram 1,∗ , G. Muftuoglu 2 1
Baskent University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Ankara, Turkey 2 Private Clinic, Ankara, Turkey
Background: Reconstruction plate systems have been used to restore function following mandibular resection. Objective: The purpose of this study is to analyze and compare stress distribution on bone screws and plate systems in locking and non-locking screw-plates design with lateral mandibular defects. Methods: Solid mathematical model of the mandible was created by three-dimensional finite elements analysis and 25 mm in length of lateral resection was performed on model. Models were reconstructed with two different reconstruction plate system including three 2.4 mm titanium screws. Realistic mastication force was applied by simulating natural muscles vectors. The stress formation on bone and hardware system were evaluated and compared. Findings: The stress values of the cortical bone, plate and screw system of the conventional plate model was higher than the locking system model. The highest stress values were measured in the proximal segment especially in conjunction with conventional screw system. Furthermore, the distribution of the stress on bone surface more homogeneously in the locking system.