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The treatment OD oral leukoplakia with the CO2 laser: a retrospective study of 65 patients
e82
Oral Presentation
to 22 months). The average bone absorption was 5.41 mm (21.9% of the initial height). Tip of the grafted bone was reformed round. The average MMO was 31.6 mm, which had a significant difference between the pre-operative values (p < 0.05). Four of 5 patients developed open bite, the other 1 patient had TMJA recurrence. In CCG group, the average follow-up duration was 14.4 months (ranged from 6 to 30 months). The average bone absorption was 2.44 mm (6.2% of the initial height). The average MMO was 33.6 mm, which had a significant difference between the preoperative values (p < 0.05). One of 5 patients developed open bite, the other 4 patients had stable occlusion. No TMJA recurrence was found. Conclusions: In the treatment of TMJA, bony absorption rate in FCPG patients was higher than that in CCG patients, which is easy to cause open bite occlusion.
however, those sustained in fatal assault have yet to be quantified. This study aims to identify the patterns of brain and facial injuries, specific risk factors for fatal outcomes, the mechanism of physical impact and the socio-demographic circumstances of the individuals involved. Between 2006 and 2015, the autopsy and pathology, clinical images, CT radiology and emergency service reports of 126 cases involving fatal blunt trauma assault to the head and facial region have been assessed. Results present in detail, the specific nature and frequency of intracranial bleed and penetrating brain injuries, facial and skull fractures, soft tissue lacerations and contusions and pharmacological agents present during the assault. These outcomes have important implications in identifying fatal injury patterns for medical and emergency personal, the etiology of fatal assault, the behavioral/social interactions that occur prior to fatal assault and to provide adjunct medical information into the circumstances surrounding the death for the medico-legal process.
http://dx.doi.org/10.1016/j.ijom.2015.08.605 http://dx.doi.org/10.1016/j.ijom.2015.08.607 The treatment OD oral leukoplakia with the CO2 laser: a retrospective study of 65 patients J.A. Hueto-Madrid
1,2,∗
, A. Mogedas-Vegara
1,2
1
Autonoma University of Barcelona, Barcelona, Spain 2 ´ Vall dHebron University Hospital, Barcelona, Spain
The use of hydroxyapatite for augmentation of the facial skeleton R.J. Huggins 1,∗ , B.C. Mendelson 2 1 2
The use of CO2 laser has become a common procedure in daily practice for the treatment of oral leukoplakia. In this retrospective study, 65 patients with oral leukoplakia treated with CO2 laser vaporization were evaluated. The main location was the tongue (32.3%, 21/65). The initial biopsy showed mild/moderate dysplasia (n = 29, 44.6%) followed by hyperplasia without dysplasia (n = 21, 32.3%). The recurrence rate of the sample was 33.8% (n = 22) and the malignant transformation rate was 15.4% (n = 10). The average follow-up was 15.0 (10.6) months. The rate of procedure-related complications was 7.7% (5/65). The Kaplan–Meier curves for time to recurrence showed differences only for the location of the lesion in the gingiva compared to the location on the tongue (log rank p = 0.032). Malignant transformation of leukoplakia is independent of the treatment although it seems advisable to treat leukoplakia with or without dysplasia. http://dx.doi.org/10.1016/j.ijom.2015.08.606 The pattern of head and facial trauma associated with fatal blunt force assault R. Huggins 1,∗ , A. Heggie 2 , M. Lynch 3 1
Trainee, Royal Melbourne Hospital, Melbourne Australia Head of Unit, Royal Children’s Hospital, Melbourne Australia 3 Senior Forensic Pathologist, Victorian Institute of Forensic Medicine, Melbourne Australia 2
Violent assault to the head and facial region is a common cause of aesthetic and functional deficits of both temporary and permanent nature. This results in significant and immense pressure being placed on emergency and medical services and is accompanied with traumatic experiences for those involved. The severe cases where injuries are fatal, have widespread repercussions with devastating and prolonged outcomes. Awareness surrounding the increase in prevalence of interpersonal violence has become a major focus around Australia in recent years, especially in relation to alcohol and ‘one-punch’ deaths. Fatal injury patterns in Motor Vehicle Accidents, sporting incidents and facial trauma requiring in-patient admission, have previously been well described,
The Royal Melbourne Hospital, Parkville VIC Australia The Centre for Facial Plastic Surgery, Toorak VIC Australia
The recent finding that shrinkage of key areas of the facial skeleton contributes to the aging appearance of the face has prompted a search for the most appropriate bone-like substitute material. Options currently available are onlay implants including MedPore and silicone. The biological compatibility of granular hydroxyapatite supports it being used to correct age related atrophy as well as inherently deficient areas of the facial skeleton. The histological response, surgical placement and the aesthetic outcome of hydroxyapatite requires a better understood for it to be recommended. This study investigated the histology of subperiosteal hydroxyapatite granules and radiological stability over time. The surgical techniques required for placement and potential complications are also discussed. Samples of hydroxyapatite were obtained from 17 patients during revision procedures, at various time intervals, following original placement for augmentation of the facial skeleton. In all cases the individual granules were embedded within a mass of collagen that contained fibroblasts, lymphocytes, fine elastin, vessels and occasional granulomas. The granules were separated from each other by the collagen that made up nearly half of the total implant volume. By two years, new compact bone containing osteoblasts and osteocytes was present in all specimens, at least in the deep (osseous) aspect. The bone progressively replaced the original collagen between the individual granules. Comprehensive CT scans over a 5-year post operative period demonstrated negligible resorption. Placement is sensitive to surgical skill and experience, however, complications including infection, migration of granules and aesthetic dissatisfaction were experienced by less than 3% of patients in this study. Key advantages include the minimal access required, intra-operative customization of the implant and the negligible complications. These attributes suggest granular hydroxyapatite can be a useful onlay implant material over traditional options and an important adjunct procedure to conventional orthognathic and osteotomy procedures. http://dx.doi.org/10.1016/j.ijom.2015.08.608
Oral Presentation
to 22 months). The average bone absorption was 5.41 mm (21.9% of the initial height). Tip of the grafted bone was reformed round. The average MMO was 31.6 mm, which had a significant difference between the pre-operative values (p < 0.05). Four of 5 patients developed open bite, the other 1 patient had TMJA recurrence. In CCG group, the average follow-up duration was 14.4 months (ranged from 6 to 30 months). The average bone absorption was 2.44 mm (6.2% of the initial height). The average MMO was 33.6 mm, which had a significant difference between the preoperative values (p < 0.05). One of 5 patients developed open bite, the other 4 patients had stable occlusion. No TMJA recurrence was found. Conclusions: In the treatment of TMJA, bony absorption rate in FCPG patients was higher than that in CCG patients, which is easy to cause open bite occlusion.
however, those sustained in fatal assault have yet to be quantified. This study aims to identify the patterns of brain and facial injuries, specific risk factors for fatal outcomes, the mechanism of physical impact and the socio-demographic circumstances of the individuals involved. Between 2006 and 2015, the autopsy and pathology, clinical images, CT radiology and emergency service reports of 126 cases involving fatal blunt trauma assault to the head and facial region have been assessed. Results present in detail, the specific nature and frequency of intracranial bleed and penetrating brain injuries, facial and skull fractures, soft tissue lacerations and contusions and pharmacological agents present during the assault. These outcomes have important implications in identifying fatal injury patterns for medical and emergency personal, the etiology of fatal assault, the behavioral/social interactions that occur prior to fatal assault and to provide adjunct medical information into the circumstances surrounding the death for the medico-legal process.
http://dx.doi.org/10.1016/j.ijom.2015.08.605 http://dx.doi.org/10.1016/j.ijom.2015.08.607 The treatment OD oral leukoplakia with the CO2 laser: a retrospective study of 65 patients J.A. Hueto-Madrid
1,2,∗
, A. Mogedas-Vegara
1,2
1
Autonoma University of Barcelona, Barcelona, Spain 2 ´ Vall dHebron University Hospital, Barcelona, Spain
The use of hydroxyapatite for augmentation of the facial skeleton R.J. Huggins 1,∗ , B.C. Mendelson 2 1 2
The use of CO2 laser has become a common procedure in daily practice for the treatment of oral leukoplakia. In this retrospective study, 65 patients with oral leukoplakia treated with CO2 laser vaporization were evaluated. The main location was the tongue (32.3%, 21/65). The initial biopsy showed mild/moderate dysplasia (n = 29, 44.6%) followed by hyperplasia without dysplasia (n = 21, 32.3%). The recurrence rate of the sample was 33.8% (n = 22) and the malignant transformation rate was 15.4% (n = 10). The average follow-up was 15.0 (10.6) months. The rate of procedure-related complications was 7.7% (5/65). The Kaplan–Meier curves for time to recurrence showed differences only for the location of the lesion in the gingiva compared to the location on the tongue (log rank p = 0.032). Malignant transformation of leukoplakia is independent of the treatment although it seems advisable to treat leukoplakia with or without dysplasia. http://dx.doi.org/10.1016/j.ijom.2015.08.606 The pattern of head and facial trauma associated with fatal blunt force assault R. Huggins 1,∗ , A. Heggie 2 , M. Lynch 3 1
Trainee, Royal Melbourne Hospital, Melbourne Australia Head of Unit, Royal Children’s Hospital, Melbourne Australia 3 Senior Forensic Pathologist, Victorian Institute of Forensic Medicine, Melbourne Australia 2
Violent assault to the head and facial region is a common cause of aesthetic and functional deficits of both temporary and permanent nature. This results in significant and immense pressure being placed on emergency and medical services and is accompanied with traumatic experiences for those involved. The severe cases where injuries are fatal, have widespread repercussions with devastating and prolonged outcomes. Awareness surrounding the increase in prevalence of interpersonal violence has become a major focus around Australia in recent years, especially in relation to alcohol and ‘one-punch’ deaths. Fatal injury patterns in Motor Vehicle Accidents, sporting incidents and facial trauma requiring in-patient admission, have previously been well described,
The Royal Melbourne Hospital, Parkville VIC Australia The Centre for Facial Plastic Surgery, Toorak VIC Australia
The recent finding that shrinkage of key areas of the facial skeleton contributes to the aging appearance of the face has prompted a search for the most appropriate bone-like substitute material. Options currently available are onlay implants including MedPore and silicone. The biological compatibility of granular hydroxyapatite supports it being used to correct age related atrophy as well as inherently deficient areas of the facial skeleton. The histological response, surgical placement and the aesthetic outcome of hydroxyapatite requires a better understood for it to be recommended. This study investigated the histology of subperiosteal hydroxyapatite granules and radiological stability over time. The surgical techniques required for placement and potential complications are also discussed. Samples of hydroxyapatite were obtained from 17 patients during revision procedures, at various time intervals, following original placement for augmentation of the facial skeleton. In all cases the individual granules were embedded within a mass of collagen that contained fibroblasts, lymphocytes, fine elastin, vessels and occasional granulomas. The granules were separated from each other by the collagen that made up nearly half of the total implant volume. By two years, new compact bone containing osteoblasts and osteocytes was present in all specimens, at least in the deep (osseous) aspect. The bone progressively replaced the original collagen between the individual granules. Comprehensive CT scans over a 5-year post operative period demonstrated negligible resorption. Placement is sensitive to surgical skill and experience, however, complications including infection, migration of granules and aesthetic dissatisfaction were experienced by less than 3% of patients in this study. Key advantages include the minimal access required, intra-operative customization of the implant and the negligible complications. These attributes suggest granular hydroxyapatite can be a useful onlay implant material over traditional options and an important adjunct procedure to conventional orthognathic and osteotomy procedures. http://dx.doi.org/10.1016/j.ijom.2015.08.608