The current role of the pedicled pectoralis major flap in reconstructive head and neck surgery

The current role of the pedicled pectoralis major flap in reconstructive head and neck surgery

Abstracts / British Journal of Oral and Maxillofacial Surgery 47 (2009) e35–e69 occur. Consequently, in many cases surgery can be avoided. In additio...

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Abstracts / British Journal of Oral and Maxillofacial Surgery 47 (2009) e35–e69

occur. Consequently, in many cases surgery can be avoided. In addition, the physical properties of Onyx allow it to be used in lesions which would previously been dangerous to do so; for example, in those which have transorbital or transcranial vascular feeders. Onyx has been used in 12 cases at the time of writing this abstract and the results suggest that this is a significant advance in the management of high flow malformations. doi:10.1016/j.bjoms.2009.06.049 23 The scapula myo-osseous flap Andrew M.S. Brown University Hospital Birmingham, United Kingdom Introduction: We began to use the free scapula flap in 1993, reconstructing oral soft tissue defects using its skin paddle. By 1997, however, we realised that this skin was neither necessary nor desirable in most cases. Experience suggested that bone and vascularised muscle alone should perform well, and this has proved to be the case. We presented our early results (AAOMS/BAOMS Conference, Boston) in 1999, and now present our further experience of over a decade. Methods: As a part of a larger retrospective analysis of all our scapula flaps since 2003, we have examined the 28 cases where the mandibular or maxillary reconstruction was myo-osseous. Results: Our review of these cases demonstrates that the myo-osseous flap is versatile and reliable (failure rate 2% for the whole series). Granulation, epithelialisation and atrophy of the denervated muscle have been predictable and morbidity has been exceptionally low. Prosthodontic rehabilitation, using implants or removable tissue borne techniques, has been straight forward. No serious complications were encountered in our series. We shall describe the surgical technique and perioperative management in detail. Discussion: The scapula myo-osseous flap is in many ways the ideal option for the reconstruction of large oro-facial bone defects. It has proved to be very reliable, surgically undemanding, and presents very low donor site morbidity. It provides an excellent foundation for implant borne and removable dental prostheses. doi:10.1016/j.bjoms.2009.06.050

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24 Trends in craniofacial surgery at Birmingham—the story of a decade Ojas Prince Krishnan ∗ , P. Praveen, Martin Evans, Stephen Dover Birmingham Children’s Hospital, United Kingdom Introduction: This study looked at the trends in craniofacial surgery at the Childrens Hospital, Birmingham over a 10-year period from 1997 to 2006. Methods: This is a retrospective study of all consecutive craniofacial surgeries at the Craniofacial Supra-regional Unit, Childrens Hospital, Birmingham. Only those children were included whose demographic and surgical details were available in the hospital database, theatre notes and case notes. We have compared the years 1997–2001 and 2002–2006. Results: 681 Surgeries were performed between 1997 and 2006. The bulk of the cases treated over the decade were for craniosynostosis (292), with fronto-orbital advancement and sagittal craniectomy being the majority. There were 11 F-O advancements and 32 sagittal craniectomies between 1997 and 2001 and 49 F-O advancements and 70 sagittal craniectomies between 2002 and 2006. There were 119 cases of craniofacial pathologies and 52 facial osteotomies. All the procedures performed have been thus analysed and compared. The results illustrate the changing patterns of cases and surgeries performed. Conclusion: This study has shown a steady increase in the number as well as the variety of cases presenting to the SupraRegional Craniofacial unit at Birmingham. It continues to be a major centre for craniofacial procedures. doi:10.1016/j.bjoms.2009.06.051 25 The current role of the pedicled pectoralis major flap in reconstructive head and neck surgery Stephen Crank ∗ , J.P. Hayter, C.M.E. Avery Department of Oral and Maxillofacial Surgery, University Hospitals of Leicester, United Kingdom Introduction: The pedicled pectoralis major myocutaneous flap has long been superseded as the reconstruction of first choice for major head and neck ablative surgery by the development of free tissue transfer techniques. The aim of this study is to evaluate the current use and indications of the pedicled pectoralis major flap in modern oncological surgical practice. Methods: A 10 year retrospective review between 1997 and 2007. Data recorded included basic demographics, indications for the pectoralis major flap, staging of disease, type of resection, ASA grade, previous surgical treatment and post operative complications.

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Abstracts / British Journal of Oral and Maxillofacial Surgery 47 (2009) e35–e69

Results: Fifty two patients were identified and notes obtained for 50 cases. Seventeen pectoralis major flaps were used to salvage a free flap. The remaining flaps (33) were used as the preferred reconstruction for a variety of indications which included; large volume neck disease with resection of skin (6), salvage surgery (5), in conjunction with a free flap (3) and significant medical co-morbidity (8). Twenty nine patients were treated for a primary SCC of the head and neck of which all patients had Stage IV disease and 15 had recurrent disease. Discussion: The indications for the use of the pectoralis major flap have evolved but this flap still has an important role in the management of patients with extensive and recurrent disease, and in those compromised by previous radical surgery or significant medical co morbidity.

into easier and faster work, less fatigue and better tactile feedback. This work was funded and performed by Medartis AG (Switzerland). doi:10.1016/j.bjoms.2009.06.053 27 An algorithm for midfacial prosthetic rehabillitation Ian Downie ∗ , Tim Flood Salisbury NHS Foundation Trust, United Kingdom

Adrian Spiegel ∗ , Dirk Thiel

There are numerous descriptions of elegant free tissue transfer to reconstruct midfacial defects. In selected cases prosthetic rehabilitation presents distinct advantage. We present an algorithm for prosthetic rehabilitation for simple maxillary defects, and extended defects to include the orbit and nose. A variety of techniques are used to aid retention including osseointegrated implants No one reconstruction method suits all defects in the same anatomical region. Flexibility and choice must be available to both surgeon and patient in order to obtain the optimum outcome.

Medartis AG, Switzerland

doi:10.1016/j.bjoms.2009.06.054

Intermaxillary fixation (IMF) is often used for treatment of fractures and for occlusion adjustment in the jaw. Many companies offer IMF screws for these applications. Good in vivo performance depends on ease of handling and soft tissue preservation where handling is determined by the following factors:

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- Force necessary for the screw’s initial grip (gripping force). - Torque needed to drive the screw in: lower torque means easier insertion. - Work required for driving the screw to a defined depth: reduced work results in less fatigue.

King’s College Hospital NHS Trust, London, United Kingdom

doi:10.1016/j.bjoms.2009.06.052 26 Influence of thread geometry on in vitro behaviour of IMF-screws

All of these should be minimized. While gripping force depends on the tip design, torque (and work) can be influenced by reducing the screw diameter or its cutting edge. Since reduced diameter leads to a reduction in strength it is not an option. In vitro behaviour of three screws was compared in sandwiched Sawbones material (to simulate both cortical and cancellous bone). The following screws were compared: • Ti-alloy IMF-screw (company A). • Ti-alloy IMF-screw with special tip and thread (SpeedTip® ) (company A). • Stainless steel IMF-screw (company B). We found the SpeedTip® design to reduce torque (by 29%) and work (by 34%) needed to drive the screw. Compared to company B’s screw gripping force is reduced by 70%, torque by 49%, work by 20%. By optimizing tip-geometry handling of self-drilling screws can be improved while maintaining mechanical strength. For the clinician this translates

Computer aided immediate orbital reconstruction in sphenoidal wing meningiomas: a new technique with volume analysis and clinical outcomes Robert Paul Bentley ∗ , Jeremy Collyer

Introduction: The immediate reconstruction of large defects in the orbit following resection of meningiomas involving the sphenoid and anterior skull base pose a significant challenge. Failure to accurately and fully restore the three dimensional shape and volume of the resultant orbit may lead to complications, which include transmission of the cerebral pulse to the globe, bulbar dystopia, diplopia, residual exopthalmos or enopthalmos and fibrosis of the oculomotor muscles. Materials and methods: In our unit the material of choice for immediate reconstruction has been titanium mesh adapted to the resultant defect which can prove difficult to insert and contour especially when extensive defects are present. A refinement of the technique is presented utilising a standard titanium orbital fan plate (Synthes USA) preformed to a CT mirror image generated stereolithograhic model and then sterilised prior to placement. The technique allows accurate placement of the preformed plate, the size of which is usually sufficient to cover the entire defect and allows for a variable resection depending on the operative findings. Results: The pre and post operative volumetric and 3dimensional CT studies of 5 patients are presented confirming