SP112 – Subscapular system free flaps in the pediatric population

SP109 – Silhouette lift for facial reanimation Joanna C Stephens, MBChB, MRCS, (Glasg) DOHNS (presenter); Jon Hughes, MD; George Mochloulis, MD, CCST (ORL-HNS); Nil De Zoysa; Joseph Wasson, MD OBJECTIVES: Facial nerve palsy is a feared complication of head and neck surgery, and facial paralysis is an extremely distressing condition for patients. In the case of established paralysis, the focus of surgical intervention becomes the face itself. In patient cases where radical methods are inappropriate, Botulinum toxin has been employed to reasonable effect. We present an alternative solution to this difficult scenario. METHODS: A small case series, conducted between 20082008 in a regional head and neck cancer centre. All patients had Grade 6 facial nerve palsy and were not suitable for more complex procedures. Main outcome measure was cosmetic result. RESULTS: All patients treated with this simple form of facial reanimation were happy with the results, with no significant morbidity or complications. CONCLUSIONS: Silhouette lift for facial reanimation is a longer lasting alternative to the use of Botulinum toxin for established facial nerve palsy. SP112 – Subscapular system free flaps in the pediatric population Anthony Fama, MD (presenter); Eric Moore, MD OBJECTIVES: 1) Describe the versatility of free flaps based on the subscapular system. 2) Discuss the use of free tissue transfer for reconstruction in pediatric patients. METHODS: Retrospective review of four pediatric patients, ages 2-15, with large head and neck defects who underwent free flap reconstructions based on the subscapular system. Electronic medical records, photographs, outpatient clinic notes, and operative reports were reviewed. RESULTS: Four pediatric patients were identified who had undergone resections of the maxilla, mandible, and parapharynx. The initial pathologies included two rhabdomyosarcomas, a desmoid tumor, and a necrotizing infection. These patients underwent reconstruction with a combination of scapular, parascapular, and latissimus dorsi free flaps. One patient had partial flap necrosis, and three patients had complete flap survival. The donor sites caused minimal morbidity with no evidence of functional deficits or physical abnormalities. CONCLUSIONS: There is growing literature regarding the use of free flaps in the pediatric population, but few papers discuss the use of combined subscapular system flaps for defects requiring restoration of multiple tissue types. The subscapular system is unique in that it provides a large amount of skin, muscle, and bone that can be harvested for reconstruction on one patient. The flaps available include the scapular flap, parascapular flap, serratus anterior flap, and latissimus dorsi

P131 flap, which can be used individually or in a combined manner to reconstruct extensive defects. The morbidity from harvesting this flap in pediatric patients is minimal. SP124 – The association between severity of facial paralysis and psychosocial consequences Carole Fakhry, MD (presenter); Derek Boahene, MD; Patrick Byrne, MD; Michael Alperovich, MD; Tarik Farrag, MD; Lisa Ishii, MD; Alfonse Marchie OBJECTIVES: Facial paralysis (FP) can have profound psychosocial consequences. Prior studies have evaluated the effect of FP on quality of life (QOL) using generalized, non-specific QOL measures. Most relevant QOL measure in this study population is the ability to interface with other individuals and the psychosocial consequences of these interactions. We identify the relationship between severity of FP and QOL using objective and validated measures for both variables. We hypothesized that with increasing severity of FP, patients would have worsening psychosocial function. METHODS: Patients who were evaluated for facial paralysis retrospectively completed a questionnaire which consisted of multiple validated instruments: Facial Clinimetric Evaluation (FaCE), Social Avoidance and Distress (SAD), Fear of Negative Evaluation (FNE) and Synkinesis Assessment Questionnaire. SAD and FNE evaluate anxiety in social interactions and evaluative conditions, with higher scores suggestive of higher social dysfunction. Descriptive statistics and univariate linear regression models were used. RESULTS: The study population was 85 patients, the majority of whom were females (65%) and had FP due to vestibular schwannoma (46%). Mean FaCE score (measure of facial disability), SAD and FNE scores were 40.7, 14.1 and 11.9, respectively. As severity of facial impairment increased (decreasing FaCE score), the level of social anxiety (increasing SAD scores) and evaluative fear (increasing FNE scores) also tended to rise. There was a moderate correlation between these two variables (r^2⫽ 0.5 and 0.39, respectively). Gender, age and synkinesis had no effect. CONCLUSIONS: A high level of social avoidance and fear of negative evaluation occurs among patients with worse facial paralysis. SAD and FNE are important considerations in this patient population, should be used in future prospective studies and as a measure of quality of life. SP128 – The caudal septum angle of deflection: An objective analysis Stephen Maturo, MD (presenter); Manuel Lopez, MD OBJECTIVES: 1) To describe an objective technique for the evaluation of caudal septum deviation (CSD). 2) To evaluate the effectiveness of an open septorhinoplasty technique for treatment of CSD.

POSTERS

Program Poster Presentations