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Seeing may be believing but measuring takes faith out of the equation
Abstracts / British Journal of Oral and Maxillofacial Surgery 45 (2007) e30–e63
80% of cases, a standard flap designed (70 mm × 50 mm) around the “B” point contained a useful perforator, although in several cases the doppler mapping helped to reposition the flap. In 40% of cases, the operating surgeon felt that doppler mapping had been helpful. A viable flap was raised in all cases. Conclusions: Although doppler mapping of the ALT is liable to inaccuracies, in minority of cases there was significant benefit to flap design. In order to minimise donor site morbidity the authors recommend using this technique. doi:10.1016/j.bjoms.2007.07.053 52 Seeing may be believing but measuring takes faith out of the equation Andrew Douglas ∗ , S. Abbas, S. Holmes, D. Chin-Shong Barts and The London NHS Trust, United Kingdom Introduction: Communication over the phone regarding patients with facial lacerations is often based on estimations. Accurate recording of lengths is important both for clinical assessment and medicolegal issues. The purpose of this study was to evaluate the accuracy of a range of clinicians with different experience. Methods: A proforma with nine different line lengths was constructed. This was completed by the subjects (n = 80) who were immediately given the same proforma again but with a ruler printed on the same page as a frame of reference. The ruler was orientated to prevent direct measurement. Demographic information including the subject’s years of experience, specialty and gender were also noted. The results were entered into a database and analysed using multivariate linear regression with Levene’s Test for equality of variance. Results: The mean error was 9.09 mm which represented a 20% overall error. Statistical analysis showed the only significant (P < 0.001) variable to affect estimation was the presence of a printed ruler. This had an odd’s ration of 3.85 (95% CI 1.82–5.68). This decreased the mean error to 5.08 mm. Conclusion: Having sterile measuring devices to hand is not always practical but frequently necessary. This study shows that a frame of reference markedly improves the accuracy of measurement and reinforces the need for direct measurement as the gold standard. We suggest that a ruler should be printed on the hospital continuation sheets and Accident and Emergency Cards as an ever present frame of reference. doi:10.1016/j.bjoms.2007.07.054
e47
53 Recurrent Langerhan’s cell histiocytosis: What should follow when chemotherapy is unsuccessful? Adekunmi Fasanmade ∗ , Pamela Kearns, Kashif Anjum, Steve Thomas Bristol Royal Infirmary and Bristol Children’s Hospital, United Kingdom Langerhan’s cell histiocytosis (LCH) is an uncommon disease of unknown aetiology characterised by clonal proliferation of bone marrow derived dendritic cells with features of langerhan’s cells. LCH may present either as an isolated localised lesion or as multifocal lesions with widespread systemic involvement. Focal LCH accounts for approximately 60% of all cases and is considered benign. Multifocal LCH accounting for 30% of cases runs a more aggressive course. LCH in children below 2 years of age (Letterer-Siwe disease) is an acute fulminant disease often with 50% fatality in treated cases. Treatment options include curettage, steroid therapy, chemotherapy and radiotherapy. The treatment of recurrent and relapsing LCH continues to pose a challenge. We present a case of a 10-year-old girl who presented to our unit. A histological diagnosis of LCH involving the right mandible was made. Lesional cells were positive for S100 protein and CD1a antigen. Initial treatment in the form of intralesional steroids was unsuccessful. Further management proceeded in line with the LCH III study group protocol—oral Prednesolone and a 6 weekly course of intravenous vinblastine. This treatment was discontinued because of toxicity. Subsequently, 2-chlorodeoxyadenosine (2CdA) also known as, cladribine was introduced to treat further recurrence with a favourable response. Although the mandibular lesion is quiescent at present, a new lesion has been identified in the spine on recent radiographs. We discuss the controversies of management and complications of such therapy in children. The role of bisphosphonates and focal radiotherapy in the management of recurrent LCH is discussed. doi:10.1016/j.bjoms.2007.07.055 54 Internal fixation of the sagittally fractured maxilla across the anterior nasal spine: The stealth plate Jeremy Sherman ∗ , Gerrard Gillan Beds, Herts and Bucks Maxillofacial Network, United Kingdom Background: The fractured hemimaxilla is a relatively rare occurrence (8% rising to 20–25% when associated with motor vehicle accidents.1 Following severe frontal trauma to the midface, this must be differentiated from the more common dentoalveolar fracture without involvement of the palatal vault. It may also arise as a planned midline split in maxillary orthognathic surgery.
80% of cases, a standard flap designed (70 mm × 50 mm) around the “B” point contained a useful perforator, although in several cases the doppler mapping helped to reposition the flap. In 40% of cases, the operating surgeon felt that doppler mapping had been helpful. A viable flap was raised in all cases. Conclusions: Although doppler mapping of the ALT is liable to inaccuracies, in minority of cases there was significant benefit to flap design. In order to minimise donor site morbidity the authors recommend using this technique. doi:10.1016/j.bjoms.2007.07.053 52 Seeing may be believing but measuring takes faith out of the equation Andrew Douglas ∗ , S. Abbas, S. Holmes, D. Chin-Shong Barts and The London NHS Trust, United Kingdom Introduction: Communication over the phone regarding patients with facial lacerations is often based on estimations. Accurate recording of lengths is important both for clinical assessment and medicolegal issues. The purpose of this study was to evaluate the accuracy of a range of clinicians with different experience. Methods: A proforma with nine different line lengths was constructed. This was completed by the subjects (n = 80) who were immediately given the same proforma again but with a ruler printed on the same page as a frame of reference. The ruler was orientated to prevent direct measurement. Demographic information including the subject’s years of experience, specialty and gender were also noted. The results were entered into a database and analysed using multivariate linear regression with Levene’s Test for equality of variance. Results: The mean error was 9.09 mm which represented a 20% overall error. Statistical analysis showed the only significant (P < 0.001) variable to affect estimation was the presence of a printed ruler. This had an odd’s ration of 3.85 (95% CI 1.82–5.68). This decreased the mean error to 5.08 mm. Conclusion: Having sterile measuring devices to hand is not always practical but frequently necessary. This study shows that a frame of reference markedly improves the accuracy of measurement and reinforces the need for direct measurement as the gold standard. We suggest that a ruler should be printed on the hospital continuation sheets and Accident and Emergency Cards as an ever present frame of reference. doi:10.1016/j.bjoms.2007.07.054
e47
53 Recurrent Langerhan’s cell histiocytosis: What should follow when chemotherapy is unsuccessful? Adekunmi Fasanmade ∗ , Pamela Kearns, Kashif Anjum, Steve Thomas Bristol Royal Infirmary and Bristol Children’s Hospital, United Kingdom Langerhan’s cell histiocytosis (LCH) is an uncommon disease of unknown aetiology characterised by clonal proliferation of bone marrow derived dendritic cells with features of langerhan’s cells. LCH may present either as an isolated localised lesion or as multifocal lesions with widespread systemic involvement. Focal LCH accounts for approximately 60% of all cases and is considered benign. Multifocal LCH accounting for 30% of cases runs a more aggressive course. LCH in children below 2 years of age (Letterer-Siwe disease) is an acute fulminant disease often with 50% fatality in treated cases. Treatment options include curettage, steroid therapy, chemotherapy and radiotherapy. The treatment of recurrent and relapsing LCH continues to pose a challenge. We present a case of a 10-year-old girl who presented to our unit. A histological diagnosis of LCH involving the right mandible was made. Lesional cells were positive for S100 protein and CD1a antigen. Initial treatment in the form of intralesional steroids was unsuccessful. Further management proceeded in line with the LCH III study group protocol—oral Prednesolone and a 6 weekly course of intravenous vinblastine. This treatment was discontinued because of toxicity. Subsequently, 2-chlorodeoxyadenosine (2CdA) also known as, cladribine was introduced to treat further recurrence with a favourable response. Although the mandibular lesion is quiescent at present, a new lesion has been identified in the spine on recent radiographs. We discuss the controversies of management and complications of such therapy in children. The role of bisphosphonates and focal radiotherapy in the management of recurrent LCH is discussed. doi:10.1016/j.bjoms.2007.07.055 54 Internal fixation of the sagittally fractured maxilla across the anterior nasal spine: The stealth plate Jeremy Sherman ∗ , Gerrard Gillan Beds, Herts and Bucks Maxillofacial Network, United Kingdom Background: The fractured hemimaxilla is a relatively rare occurrence (8% rising to 20–25% when associated with motor vehicle accidents.1 Following severe frontal trauma to the midface, this must be differentiated from the more common dentoalveolar fracture without involvement of the palatal vault. It may also arise as a planned midline split in maxillary orthognathic surgery.