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Technical developments in maxillofacial reconstruction
Abstracts
57
Optimal treatment of the clinically node positive neck (cN+) in oral cavity cancer continues to be debated. Comprehensive versus selective neck dissection in a variety of forms have been advocated. This presentation will discuss current available evidence available to guide clinicians in this important decision.
salivary gland carcinoma and a variety of sarcomas. Many clinical disciplines with differing education and training are managing these patients, including surgeons and physicians. It is widely accepted including within Australia, that head and neck cancer patients are best managed in multidisciplinary (MD) clinics by appropriately trained and credentialed practitioners. The MD Team (MDT) includes surgeons, oral and maxillofacial, otolaryngology, head and neck, plastic and reconstructive, and general as regular participants, neuro and thoracic surgeons participate in selected cases. Physicians, radiation and medical oncologists, radiologists, pathologists and nuclear medicine are required. The full range of specialist dentists, allied health practitioners and nurses are essential team members. The MD Meeting, prior to commencing treatment, should review individual patients with appropriate clinical information. A consensus approach to management is generally achieved, acknowledging the responsible clinician for each patient. The MDT is also responsible for clinical teaching and training at both undergraduate and postgraduate levels. Research in all aspects of head and neck cancer, clinical, translational and laboratory is encouraged and supported by the MDT There are many challenges to MD care in head and neck cancer, including inter-professional rivalry, a commitment to quality care, research and training by team members. Institutional commitment, resources and funding must be achieved for success and improved patient outcome.
http://dx.doi.org/10.1016/j.ijom.2017.02.208
http://dx.doi.org/10.1016/j.ijom.2017.02.210
The frontiers in modern oral and maxillofacial surgery: hopes and limitations with regards to tissue engineering
Reconstructive concepts for tumours invading the facial skin
This presentation will review emerging and established evidence for elective and therapeutic neck dissection and discuss clinical decision-making for individual patients based on the data available. The topics of pre-test probability, sensitivity and specificity will be covered in the context of diagnostic and surgical adjuncts for recommending neck dissection considering tumour specific characteristics including tumour location, size, and patterns of invasion as well as patient factors including age and medical comorbidities. The presentation will support the concept that personalised surgical decisions amalgamate all available information for recommendations that are both evidence based and patient specific. http://dx.doi.org/10.1016/j.ijom.2017.02.207 Treatment recommendations for the neck in the clinically node positive neck oral cavity cancer patient B. Ward University of Michigan Hospital, United States
P. Warnke University of Kiel, Kiel, Germany
K.D. Wolff Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
Cancer surgery in the head and neck region often leads to significant and disfiguring defects. Subsequent tissue repair remains a challenge for the surgeon. Cancer survivors may suffer from aesthetic and functional impairment that result in a reduced quality of life. However, latest stem cell and tissue engineering techniques may offer the potential to grow body parts anew. There is hope that this may even allow to grow entire organ replacements with the patient’s own cells in the future, thus making the complicated search for organ donors redundant. This talk will outline pioneering strategies for complex tissue regeneration and repair in oral and maxillofacial surgery. Current techniques and the goals for future use of adult stem cells and computer assisted ‘perfect fit’ organ design will be outlined. Furthermore the hurdles to translate novel techniques from bench to bedside and the limitations for cell applications in clinical practice will be explained.
If tumours of the head and neck involve the facial skin, strategies of reconstruction must follow the aim of achieving the best possible aesthetic result. Other than in the oral cavity where the use of free tissue transfer has become a standard procedure, method of the first choice is the use of local flaps under consideration of the aesthetic units and relaxed skin tension lines of the face. Whereas this principle can be applied in many cases of small or medium sized skin cancers, advanced tumours with deep infiltration of the surrounding tissues must often be treated using free tissue transfer. In challenging cases, combinations with additional local flaps or epitheses are necessary. In the lecture, a schematic procedure of reconstructive steps and a choice of the most useful free flaps are presented. Moreover, basic considerations about the indication for surgery and its limitations are discussed.
http://dx.doi.org/10.1016/j.ijom.2017.02.209
Technical developments in maxillofacial reconstruction
Meeting the challenges of multidisciplinary head and neck cancer care D. Wiesenfeld Victorian Comprehensive Cancer Centre, Melbourne, Australia Head and neck cancer presents a challenge for management throughout the world, with more than 550,000 cases and 300,000 deaths per annum, not including thyroid cancer. There are a broad range of pathological types including squamous cell carcinoma,
http://dx.doi.org/10.1016/j.ijom.2017.02.211
K.D. Wolff Klinikum rechts der Isar der Technischen Universität München, Munich, Germany Since more than three decades, microvascular tissue transfer is a proven procedure, but challenges still remain. An increasing number of patients present with comorbidities, in old age or with an irradiated and vessel depleted neck. Advances of intra- and perioperative patient care as well as methods like vascular loops, reverse
58
Abstracts
L.M. Wolford
of a syndrome, the perinatal period, and the management of airway and nutritional problems. Eighteen children (31%) needed respiratory support because of severe respiratory distress, and a sleep study found obstructive apnoea’s in another eight children who had been managed by prone positioning and/or monitoring. In the isolated group significantly fewer children needed respiratory support compared to the non-isolated group. After the age of one year, 10% of the Robin sequence cohort was still in need of treatment for obstructive symptoms. Almost half (47%) needed temporary nutritional support. The prevalence of respiratory distress in children with Robin sequence is high. In most children, treatment with prone positioning was sufficient to relieve the airway obstruction. Successful treatment with prone positioning was significantly more often seen in children with an isolated Robin sequence. About one-third of all Robin sequence children needed respiratory support in the neonatal and/or infant period. However, in childhood, only 10% of the total Robin sequence cohort was still dependent on respiratory support. In this presentation the controversies with regard to airway management will be discussed.
Texas A&M University, Baylor College of Dentistry, Dallas, TA, United States
http://dx.doi.org/10.1016/j.ijom.2017.02.214
flow anastomoses, and carrier flaps were developed to expand the scope of reconstructive possibilities. During the past years, technical innovations like individual cutting devices for bony reconstructions have been developed, and methods of teaching flap raising using pulsatile perfused cadavers have been established to perfectly mimic the clinical situation. Monitoring systems can help to detect perfusion problems of the flap before clinical signs of congestion appear. Moreover, the new field of perforator flaps further improves the quality of reconstruction and minimises donor site morbidities. Finally, an extracorporeal perfusion device has been introduced, possibly making free flap transplantation feasible without microvascular anastomoses in patients with missing, severely destroyed or heavily arteriosclerotic neck vessels. http://dx.doi.org/10.1016/j.ijom.2017.02.212 Orthognathic surgery relapse: can you blame it on the temporomandibular joints?
Orthognathic surgery outcomes are not always stable and can result in relapse. Can surgical relapse be blamed on the temporomandibular joints (TMJs)? Postsurgical relapse resulting in jaw and occlusal malalignment are commonly associated with TMJ pathology accompanied by other associated conditions such as pain, headaches, earaches, tinnitus, vertigo, sleep apnoea, etc. Most TMJ conditions and pathologies can be placed into specific diagnostic categories that can aid in determining the nature and progression of the TMJ pathology and identify the necessary treatment to achieve highly predictable results. Diagnostic records, including MRI, provide information for diagnosis and treatment planning. Based on the diagnosis, specific treatment protocols may include TMJ surgery, orthognathic surgery and other adjunctive procedures to obtain the best results. The most common TMJ conditions causing occlusal instability, dysfunction, and pain include: displaced discs, osteoarthritis, adolescent internal condylar resorption, reactive arthritis, congenital deformities, condylar hyperplasia, iatrogenic injuries, trauma, ankylosis, connective tissue/autoimmune diseases, and end-stage pathology. This presentation will discuss these common TMJ conditions that cause skeletal and occlusal instability and pain; the specific surgical treatment protocols to address the TMJ pathology and correct other associated jaw problems (i.e. malocclusion, jaw malalignment, jaw dysfunction, sleep apnoea, pain, etc.); and clinical studies to validate these protocols. http://dx.doi.org/10.1016/j.ijom.2017.02.213 Long-term outcome of robin sequence E.B. Wolvius Dutch Craniofacial Centre, Rotterdam, The Netherlands The airway management of children with Robin sequence is controversial. We conducted a retrospective cohort study of 59 children (<1 year old) with Robin sequence managed between 2000 and 2010. Robin sequence was defined as the presence of mandibular hypoplasia and clinical signs of airway obstruction. Data were collected on demographic characteristics, the presence
Use of three-dimensional planning and patient specific guides and implants: the Singapore experience R. Wong National University of Singapore, Singapore Use of three-dimensional planning and additive manufacturing to manufacture patient specific guides is not new to oral and maxillofacial surgery. Most of the reports in the literature pertains to its use in orthognathic surgery and reconstructive surgery where accuracy is much more important. Other advantages include timesaving in the operating room, creation of guides to avoid vital anatomic structures and fashioning of patient specific implants/osteosynthesis plates. Implementation of changes in technology is daunting to the clinician in terms of knowledge and cost. Some of these challenges are not only institution specific but also country specific. This talk will cover the usage and implementation of these newer technologies in the context of a small country and the challenges faced. http://dx.doi.org/10.1016/j.ijom.2017.02.215 Effectively planning an orthognathic surgery using computer-aided surgical simulation J.J. Xia ∗ , J. Gateno, J.F. Teichgraeber, P. Yuan Houston Methodist Research Institute, Houston, TX, United States The success of orthognathic surgery depends not only on the surgical techniques, but also on an accurate surgical plan. The adoption of computer-aided surgical simulation (CASS) has created a paradigm shift in surgical planning. However, planning an orthognathic operation using CASS differs fundamentally from planning using traditional methods. With this in mind, the Surgical Planning Laboratory of Houston Methodist Research Institute has developed a CASS protocol designed specifically for orthognathic surgery. The purpose of this presentation is to present an algorithm using virtual tools for effectively planning a double-jaw orthognathic
57
Optimal treatment of the clinically node positive neck (cN+) in oral cavity cancer continues to be debated. Comprehensive versus selective neck dissection in a variety of forms have been advocated. This presentation will discuss current available evidence available to guide clinicians in this important decision.
salivary gland carcinoma and a variety of sarcomas. Many clinical disciplines with differing education and training are managing these patients, including surgeons and physicians. It is widely accepted including within Australia, that head and neck cancer patients are best managed in multidisciplinary (MD) clinics by appropriately trained and credentialed practitioners. The MD Team (MDT) includes surgeons, oral and maxillofacial, otolaryngology, head and neck, plastic and reconstructive, and general as regular participants, neuro and thoracic surgeons participate in selected cases. Physicians, radiation and medical oncologists, radiologists, pathologists and nuclear medicine are required. The full range of specialist dentists, allied health practitioners and nurses are essential team members. The MD Meeting, prior to commencing treatment, should review individual patients with appropriate clinical information. A consensus approach to management is generally achieved, acknowledging the responsible clinician for each patient. The MDT is also responsible for clinical teaching and training at both undergraduate and postgraduate levels. Research in all aspects of head and neck cancer, clinical, translational and laboratory is encouraged and supported by the MDT There are many challenges to MD care in head and neck cancer, including inter-professional rivalry, a commitment to quality care, research and training by team members. Institutional commitment, resources and funding must be achieved for success and improved patient outcome.
http://dx.doi.org/10.1016/j.ijom.2017.02.208
http://dx.doi.org/10.1016/j.ijom.2017.02.210
The frontiers in modern oral and maxillofacial surgery: hopes and limitations with regards to tissue engineering
Reconstructive concepts for tumours invading the facial skin
This presentation will review emerging and established evidence for elective and therapeutic neck dissection and discuss clinical decision-making for individual patients based on the data available. The topics of pre-test probability, sensitivity and specificity will be covered in the context of diagnostic and surgical adjuncts for recommending neck dissection considering tumour specific characteristics including tumour location, size, and patterns of invasion as well as patient factors including age and medical comorbidities. The presentation will support the concept that personalised surgical decisions amalgamate all available information for recommendations that are both evidence based and patient specific. http://dx.doi.org/10.1016/j.ijom.2017.02.207 Treatment recommendations for the neck in the clinically node positive neck oral cavity cancer patient B. Ward University of Michigan Hospital, United States
P. Warnke University of Kiel, Kiel, Germany
K.D. Wolff Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
Cancer surgery in the head and neck region often leads to significant and disfiguring defects. Subsequent tissue repair remains a challenge for the surgeon. Cancer survivors may suffer from aesthetic and functional impairment that result in a reduced quality of life. However, latest stem cell and tissue engineering techniques may offer the potential to grow body parts anew. There is hope that this may even allow to grow entire organ replacements with the patient’s own cells in the future, thus making the complicated search for organ donors redundant. This talk will outline pioneering strategies for complex tissue regeneration and repair in oral and maxillofacial surgery. Current techniques and the goals for future use of adult stem cells and computer assisted ‘perfect fit’ organ design will be outlined. Furthermore the hurdles to translate novel techniques from bench to bedside and the limitations for cell applications in clinical practice will be explained.
If tumours of the head and neck involve the facial skin, strategies of reconstruction must follow the aim of achieving the best possible aesthetic result. Other than in the oral cavity where the use of free tissue transfer has become a standard procedure, method of the first choice is the use of local flaps under consideration of the aesthetic units and relaxed skin tension lines of the face. Whereas this principle can be applied in many cases of small or medium sized skin cancers, advanced tumours with deep infiltration of the surrounding tissues must often be treated using free tissue transfer. In challenging cases, combinations with additional local flaps or epitheses are necessary. In the lecture, a schematic procedure of reconstructive steps and a choice of the most useful free flaps are presented. Moreover, basic considerations about the indication for surgery and its limitations are discussed.
http://dx.doi.org/10.1016/j.ijom.2017.02.209
Technical developments in maxillofacial reconstruction
Meeting the challenges of multidisciplinary head and neck cancer care D. Wiesenfeld Victorian Comprehensive Cancer Centre, Melbourne, Australia Head and neck cancer presents a challenge for management throughout the world, with more than 550,000 cases and 300,000 deaths per annum, not including thyroid cancer. There are a broad range of pathological types including squamous cell carcinoma,
http://dx.doi.org/10.1016/j.ijom.2017.02.211
K.D. Wolff Klinikum rechts der Isar der Technischen Universität München, Munich, Germany Since more than three decades, microvascular tissue transfer is a proven procedure, but challenges still remain. An increasing number of patients present with comorbidities, in old age or with an irradiated and vessel depleted neck. Advances of intra- and perioperative patient care as well as methods like vascular loops, reverse
58
Abstracts
L.M. Wolford
of a syndrome, the perinatal period, and the management of airway and nutritional problems. Eighteen children (31%) needed respiratory support because of severe respiratory distress, and a sleep study found obstructive apnoea’s in another eight children who had been managed by prone positioning and/or monitoring. In the isolated group significantly fewer children needed respiratory support compared to the non-isolated group. After the age of one year, 10% of the Robin sequence cohort was still in need of treatment for obstructive symptoms. Almost half (47%) needed temporary nutritional support. The prevalence of respiratory distress in children with Robin sequence is high. In most children, treatment with prone positioning was sufficient to relieve the airway obstruction. Successful treatment with prone positioning was significantly more often seen in children with an isolated Robin sequence. About one-third of all Robin sequence children needed respiratory support in the neonatal and/or infant period. However, in childhood, only 10% of the total Robin sequence cohort was still dependent on respiratory support. In this presentation the controversies with regard to airway management will be discussed.
Texas A&M University, Baylor College of Dentistry, Dallas, TA, United States
http://dx.doi.org/10.1016/j.ijom.2017.02.214
flow anastomoses, and carrier flaps were developed to expand the scope of reconstructive possibilities. During the past years, technical innovations like individual cutting devices for bony reconstructions have been developed, and methods of teaching flap raising using pulsatile perfused cadavers have been established to perfectly mimic the clinical situation. Monitoring systems can help to detect perfusion problems of the flap before clinical signs of congestion appear. Moreover, the new field of perforator flaps further improves the quality of reconstruction and minimises donor site morbidities. Finally, an extracorporeal perfusion device has been introduced, possibly making free flap transplantation feasible without microvascular anastomoses in patients with missing, severely destroyed or heavily arteriosclerotic neck vessels. http://dx.doi.org/10.1016/j.ijom.2017.02.212 Orthognathic surgery relapse: can you blame it on the temporomandibular joints?
Orthognathic surgery outcomes are not always stable and can result in relapse. Can surgical relapse be blamed on the temporomandibular joints (TMJs)? Postsurgical relapse resulting in jaw and occlusal malalignment are commonly associated with TMJ pathology accompanied by other associated conditions such as pain, headaches, earaches, tinnitus, vertigo, sleep apnoea, etc. Most TMJ conditions and pathologies can be placed into specific diagnostic categories that can aid in determining the nature and progression of the TMJ pathology and identify the necessary treatment to achieve highly predictable results. Diagnostic records, including MRI, provide information for diagnosis and treatment planning. Based on the diagnosis, specific treatment protocols may include TMJ surgery, orthognathic surgery and other adjunctive procedures to obtain the best results. The most common TMJ conditions causing occlusal instability, dysfunction, and pain include: displaced discs, osteoarthritis, adolescent internal condylar resorption, reactive arthritis, congenital deformities, condylar hyperplasia, iatrogenic injuries, trauma, ankylosis, connective tissue/autoimmune diseases, and end-stage pathology. This presentation will discuss these common TMJ conditions that cause skeletal and occlusal instability and pain; the specific surgical treatment protocols to address the TMJ pathology and correct other associated jaw problems (i.e. malocclusion, jaw malalignment, jaw dysfunction, sleep apnoea, pain, etc.); and clinical studies to validate these protocols. http://dx.doi.org/10.1016/j.ijom.2017.02.213 Long-term outcome of robin sequence E.B. Wolvius Dutch Craniofacial Centre, Rotterdam, The Netherlands The airway management of children with Robin sequence is controversial. We conducted a retrospective cohort study of 59 children (<1 year old) with Robin sequence managed between 2000 and 2010. Robin sequence was defined as the presence of mandibular hypoplasia and clinical signs of airway obstruction. Data were collected on demographic characteristics, the presence
Use of three-dimensional planning and patient specific guides and implants: the Singapore experience R. Wong National University of Singapore, Singapore Use of three-dimensional planning and additive manufacturing to manufacture patient specific guides is not new to oral and maxillofacial surgery. Most of the reports in the literature pertains to its use in orthognathic surgery and reconstructive surgery where accuracy is much more important. Other advantages include timesaving in the operating room, creation of guides to avoid vital anatomic structures and fashioning of patient specific implants/osteosynthesis plates. Implementation of changes in technology is daunting to the clinician in terms of knowledge and cost. Some of these challenges are not only institution specific but also country specific. This talk will cover the usage and implementation of these newer technologies in the context of a small country and the challenges faced. http://dx.doi.org/10.1016/j.ijom.2017.02.215 Effectively planning an orthognathic surgery using computer-aided surgical simulation J.J. Xia ∗ , J. Gateno, J.F. Teichgraeber, P. Yuan Houston Methodist Research Institute, Houston, TX, United States The success of orthognathic surgery depends not only on the surgical techniques, but also on an accurate surgical plan. The adoption of computer-aided surgical simulation (CASS) has created a paradigm shift in surgical planning. However, planning an orthognathic operation using CASS differs fundamentally from planning using traditional methods. With this in mind, the Surgical Planning Laboratory of Houston Methodist Research Institute has developed a CASS protocol designed specifically for orthognathic surgery. The purpose of this presentation is to present an algorithm using virtual tools for effectively planning a double-jaw orthognathic