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The use of nasolabial flaps for head and neck cancer reconstruction: An analysis of 101 cases
Free poster abstracts numbered P1 - P255 / British Journal of Oral and Maxillofacial Surgery 54 (2016) e66–e153
RP125 The East Grinstead Consent Collaborative: National Audit of Consent for Head and Neck Surgery , www.eg-cc.com East Grinstead Consent Collaborative Queen Victoria Hospital, East Grinstead Background: Litigation surrounding matters of consent is increasingly seen, the NHS Litigation Authority paid out £7million for compensation regarding inadequate consent in 2010. The East Grinstead head and neck consent forms were introduced three years ago and were well received by both patients and surgeons. We wanted to offer the same protection to our colleagues, but firstly, we needed to determine nationwide practices of consent. The East Grinstead Consent Collaborative, the first trainee collaborative project, was formed to determine this. Method: 55 trainee collaborators nationwide will be supplying data from 27 units for 2000 patients. Data will include general and specific risks documented, provision of additional material, the timing of consent and grade of surgeons. This will be compared to 100 patients selected from East Grinstead since the introduction of the head and neck specific consent forms. MedCalc v16.1 was used for statistical analysis Results: We have received data for 1200 patients from 15 units and data collection will be complete by January. Preliminary analysis has shown significant variability in content (p < 0.001, 1-way ANOVA). 27% of patients were warned of the risk of death; 95% of patients were consented by senior trainees or consultants and 50% of patients were consented on the day off, or day before surgery. Conclusion: Consent is an increasing factor in negligence cases, especially sinceMontgomery v Lanarkshire Health Board (2015).We hope to improve the documentation of consent by providing online consent forms, available via association websites, that generate patient and procedure specific consent forms. http://dx.doi.org/10.1016/j.bjoms.2016.11.123 P126 Oral cancer reconstruction: A five year review Ben Collard ∗ , Shameen Belone, Andrew McLennan, John Bowden, Mike Esson, Graham Merrick Royal Devon and Exeter Hospital Aims: We provide an oral cancer ablative and reconstructive service in the South-West of England. We aim to look back at the last 5 years of treatment and analyse the flap reconstruction for oral cancer defects we have provided. Method: A retrospective analysis has been undertaken from our database between 2011 to 2015, in relation to patient age, gender, performance status, defect location and type
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of flap reconstruction. No patients were excluded from our study. Results: Over the 5 year period of our study we have reconstructed 224 patients with oral cancer. The vast majority have been squamous cell carcinoma and these have been found most commonly on the lateral tongue and floor of mouth. Radial forearm free flap is the most commonly utilised microvascular form of reconstruction, the most common pedicled flap we have used has been a nasolabial flap. We have also reconstructed routinely with temporalis, anterolateral thigh, DCIA, pectoralis major and fibula flaps. Conclusion: We have treated and reconstructed 224 cases of oral cancer with flap reconstruction between 2011 and 2015. We have used both free flaps and pedicled flaps. We have chosen our flap reconstruction based on the location of the disease and the patients performance status and comorbities. We plan to continue to analyse and learn from our data collection as we treat patients and plan oral cancer reconstruction for the foreseeable future. http://dx.doi.org/10.1016/j.bjoms.2016.11.124 P127 The use of nasolabial flaps for head and neck cancer reconstruction: An analysis of 101 cases Ben Collard ∗ , Shameen Belone, Rupert Scott, Andrew Mclennan, John Bowden, Mike Esson, David Cunliffe Royal Devon and Exeter Hospital Introduction: The nasolabial flap is a highly versatile flap used for both intraoral and extra oral defects. It allows for the restoration of small to medium defects with positive outcomes, both aesthetically and functionally, with low failure rates. The aim of this study is to look at the use of nasolabial flaps, over a ten year period in reconstructive surgery of patients with head and neck cancer. Methods: We retrospectively analysed 101 patients who have undergone oral cancer resection using nasolabial flaps for reconstruction. As well as the general outcome and complications faced, we looked at the tumour location and the size of the defect reconstructed. All cases were compiled on an excel spreadsheet. Results: Over a ten year period we analysed 101 cases of nasolabial flaps. We reconstructed defects in the maxilla, buccal mucosa, mandible, tongue and floor of mouth. The most common site reconstructed was the lateral tongue, followed by the floor of mouth. The patient age ranged from 46-90 years. In most cases, a neck dissection was also performed. A two stage surgical technique was used for all patients. Discussion: The nasolabial flap is an excellent local flap of choice in patients requiring oral reconstruction. It provides reliable coverage of intraoral defects with few complications. It offers good long term aesthetic and functional benefits with
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Free poster abstracts numbered P1 - P255 / British Journal of Oral and Maxillofacial Surgery 54 (2016) e66–e153
low donor morbidity making it a perfect procedure for elderly patients or those with numerous comorbidities http://dx.doi.org/10.1016/j.bjoms.2016.11.125 P128 Case presentation on ReCell (TM) resurfacing of near total scalp defect post melanoma excision Negine Vatani Poole General Hospital Introduction: We present a case of extensive scalp defect reconstructed with Re-cell (TM) technique. An 87 year old gentleman presented with a large lentigo malignant melanoma, which when excised caused a defect comprising 75% of his scalp. The patient’s multiple co-morbidities prevented split skin grafting. We present a series of photographs detailing the complete healing process over a four month period. Material and Methods: A full thickness skin graft (1.5 cm in diameter) was taken from the patient’s right ear. This was then used within the ReCellTM technique and was placed over a base of pericranium. A dressing was placed for three weeks and subsequent dressings were required until epithelialisation was fully complete. Conclusion: We feel that in a medically compromised patient that with an extensive skin loss that ReCellTM provides an excellent aesthetics for scalp reconstruction. http://dx.doi.org/10.1016/j.bjoms.2016.11.126 P130 Implant Rehabilitation of Hypodontia Patients: Surgical Considerations Petros Mylonas ∗ , Despoina Chatzistavrianou, Paul Wilson, Rhodri Williams Queen Elizabeth Hospital Birmingham Aims: To evaluate the surgical and clinical outcomes of hypodontia patients undergoing surgical management and implant rehabilitation between the Queen Elizabeth Hospital Birmingham (QEHB) and the Birmingham Dental Hospital (BDH) Methods: A retrospective analysis of clinical records from the Hypodontia Clinic database of patients treated within the Oral and Maxillofacial Surgery Department at the QEHB and the Restorative Dentistry Department at the BDH was conducted. Surgical data was collected and compared with reporting of adverse events with a follow up period of up to 6.7 years. Results: 67 patients aged 17 to 75 years old (average age 34.1); received 304 implants. Follow up period was 0.1 to 6.7 years (average 2.7 years).
53.8% patients required surgical bone augmentation prior to implant placement using: mandibular ramus (80.3%), iliac crest (11.9%), and bovine origin xenografts (7.8%). 63.5% implants were place in grafted sites. 19.4% patients encountered complications after grafting and implant placement, these included dehiscence/fenestration (n = 4) and sensory disturbances (n = 7) after implant placement, and graft failure (n = 2). Grafting success rate was 94.4% irrespective of donor site. Implant success rate was 99.6%, up to 6.7 years with 1 implant failing in a grafted site. Conclusions: Implant and bone graft survival rates for hypodontia patients are seldom reported in literature. Our data suggests bone grafting hypodontia cases prior to implant placement carries high success rates irrespective of donor site. Our complication rates after bone augmentation and surgical implant placement are similar to other studies in the literature. http://dx.doi.org/10.1016/j.bjoms.2016.11.127 P131 The Reverse Zygomatic Implant: A New Implant For Maxillofacial Reconstruction Jonathan Collier ∗ , Andrew Dawood Chelsea & Westminster Hospital Oncological treatment for large maxillary carcinomas can often lead to significant challenges for dental rehabilitation. Limited jaw opening, radiotherapy, difficult access through the flap to the bony site, and the very small amount of bone available in which to anchor implants can render patients impossible to rehabilitate using conventional, zygomatic or pterygoid implants. To address these challenges the new “reverse zygomatic” implant was developed in which treatment, site preparation and implant insertion were accomplished using an extraoral approach. We report a small series of successful cases including the rehabilitation of a patient who had been treated with a hemimaxillectomy, reconstruction with a latissimus dorsi vascularized free flap, and radiotherapy for carcinoma of the sinus some years previously. The reverse zygoma implant was used along with two other conventional zygomatic implants to provide support for a milled titanium bar and overdenture to rehabilitate the maxilla. Two years later, the patient continues to enjoy a healthy reconstruction. In our opinion, the reverse zygomatic implant appears to show promise as a useful addition to the implant armamentarium for the treatment of the patient undergoing maxillectomy. http://dx.doi.org/10.1016/j.bjoms.2016.11.128
RP125 The East Grinstead Consent Collaborative: National Audit of Consent for Head and Neck Surgery , www.eg-cc.com East Grinstead Consent Collaborative Queen Victoria Hospital, East Grinstead Background: Litigation surrounding matters of consent is increasingly seen, the NHS Litigation Authority paid out £7million for compensation regarding inadequate consent in 2010. The East Grinstead head and neck consent forms were introduced three years ago and were well received by both patients and surgeons. We wanted to offer the same protection to our colleagues, but firstly, we needed to determine nationwide practices of consent. The East Grinstead Consent Collaborative, the first trainee collaborative project, was formed to determine this. Method: 55 trainee collaborators nationwide will be supplying data from 27 units for 2000 patients. Data will include general and specific risks documented, provision of additional material, the timing of consent and grade of surgeons. This will be compared to 100 patients selected from East Grinstead since the introduction of the head and neck specific consent forms. MedCalc v16.1 was used for statistical analysis Results: We have received data for 1200 patients from 15 units and data collection will be complete by January. Preliminary analysis has shown significant variability in content (p < 0.001, 1-way ANOVA). 27% of patients were warned of the risk of death; 95% of patients were consented by senior trainees or consultants and 50% of patients were consented on the day off, or day before surgery. Conclusion: Consent is an increasing factor in negligence cases, especially sinceMontgomery v Lanarkshire Health Board (2015).We hope to improve the documentation of consent by providing online consent forms, available via association websites, that generate patient and procedure specific consent forms. http://dx.doi.org/10.1016/j.bjoms.2016.11.123 P126 Oral cancer reconstruction: A five year review Ben Collard ∗ , Shameen Belone, Andrew McLennan, John Bowden, Mike Esson, Graham Merrick Royal Devon and Exeter Hospital Aims: We provide an oral cancer ablative and reconstructive service in the South-West of England. We aim to look back at the last 5 years of treatment and analyse the flap reconstruction for oral cancer defects we have provided. Method: A retrospective analysis has been undertaken from our database between 2011 to 2015, in relation to patient age, gender, performance status, defect location and type
e109
of flap reconstruction. No patients were excluded from our study. Results: Over the 5 year period of our study we have reconstructed 224 patients with oral cancer. The vast majority have been squamous cell carcinoma and these have been found most commonly on the lateral tongue and floor of mouth. Radial forearm free flap is the most commonly utilised microvascular form of reconstruction, the most common pedicled flap we have used has been a nasolabial flap. We have also reconstructed routinely with temporalis, anterolateral thigh, DCIA, pectoralis major and fibula flaps. Conclusion: We have treated and reconstructed 224 cases of oral cancer with flap reconstruction between 2011 and 2015. We have used both free flaps and pedicled flaps. We have chosen our flap reconstruction based on the location of the disease and the patients performance status and comorbities. We plan to continue to analyse and learn from our data collection as we treat patients and plan oral cancer reconstruction for the foreseeable future. http://dx.doi.org/10.1016/j.bjoms.2016.11.124 P127 The use of nasolabial flaps for head and neck cancer reconstruction: An analysis of 101 cases Ben Collard ∗ , Shameen Belone, Rupert Scott, Andrew Mclennan, John Bowden, Mike Esson, David Cunliffe Royal Devon and Exeter Hospital Introduction: The nasolabial flap is a highly versatile flap used for both intraoral and extra oral defects. It allows for the restoration of small to medium defects with positive outcomes, both aesthetically and functionally, with low failure rates. The aim of this study is to look at the use of nasolabial flaps, over a ten year period in reconstructive surgery of patients with head and neck cancer. Methods: We retrospectively analysed 101 patients who have undergone oral cancer resection using nasolabial flaps for reconstruction. As well as the general outcome and complications faced, we looked at the tumour location and the size of the defect reconstructed. All cases were compiled on an excel spreadsheet. Results: Over a ten year period we analysed 101 cases of nasolabial flaps. We reconstructed defects in the maxilla, buccal mucosa, mandible, tongue and floor of mouth. The most common site reconstructed was the lateral tongue, followed by the floor of mouth. The patient age ranged from 46-90 years. In most cases, a neck dissection was also performed. A two stage surgical technique was used for all patients. Discussion: The nasolabial flap is an excellent local flap of choice in patients requiring oral reconstruction. It provides reliable coverage of intraoral defects with few complications. It offers good long term aesthetic and functional benefits with
e110
Free poster abstracts numbered P1 - P255 / British Journal of Oral and Maxillofacial Surgery 54 (2016) e66–e153
low donor morbidity making it a perfect procedure for elderly patients or those with numerous comorbidities http://dx.doi.org/10.1016/j.bjoms.2016.11.125 P128 Case presentation on ReCell (TM) resurfacing of near total scalp defect post melanoma excision Negine Vatani Poole General Hospital Introduction: We present a case of extensive scalp defect reconstructed with Re-cell (TM) technique. An 87 year old gentleman presented with a large lentigo malignant melanoma, which when excised caused a defect comprising 75% of his scalp. The patient’s multiple co-morbidities prevented split skin grafting. We present a series of photographs detailing the complete healing process over a four month period. Material and Methods: A full thickness skin graft (1.5 cm in diameter) was taken from the patient’s right ear. This was then used within the ReCellTM technique and was placed over a base of pericranium. A dressing was placed for three weeks and subsequent dressings were required until epithelialisation was fully complete. Conclusion: We feel that in a medically compromised patient that with an extensive skin loss that ReCellTM provides an excellent aesthetics for scalp reconstruction. http://dx.doi.org/10.1016/j.bjoms.2016.11.126 P130 Implant Rehabilitation of Hypodontia Patients: Surgical Considerations Petros Mylonas ∗ , Despoina Chatzistavrianou, Paul Wilson, Rhodri Williams Queen Elizabeth Hospital Birmingham Aims: To evaluate the surgical and clinical outcomes of hypodontia patients undergoing surgical management and implant rehabilitation between the Queen Elizabeth Hospital Birmingham (QEHB) and the Birmingham Dental Hospital (BDH) Methods: A retrospective analysis of clinical records from the Hypodontia Clinic database of patients treated within the Oral and Maxillofacial Surgery Department at the QEHB and the Restorative Dentistry Department at the BDH was conducted. Surgical data was collected and compared with reporting of adverse events with a follow up period of up to 6.7 years. Results: 67 patients aged 17 to 75 years old (average age 34.1); received 304 implants. Follow up period was 0.1 to 6.7 years (average 2.7 years).
53.8% patients required surgical bone augmentation prior to implant placement using: mandibular ramus (80.3%), iliac crest (11.9%), and bovine origin xenografts (7.8%). 63.5% implants were place in grafted sites. 19.4% patients encountered complications after grafting and implant placement, these included dehiscence/fenestration (n = 4) and sensory disturbances (n = 7) after implant placement, and graft failure (n = 2). Grafting success rate was 94.4% irrespective of donor site. Implant success rate was 99.6%, up to 6.7 years with 1 implant failing in a grafted site. Conclusions: Implant and bone graft survival rates for hypodontia patients are seldom reported in literature. Our data suggests bone grafting hypodontia cases prior to implant placement carries high success rates irrespective of donor site. Our complication rates after bone augmentation and surgical implant placement are similar to other studies in the literature. http://dx.doi.org/10.1016/j.bjoms.2016.11.127 P131 The Reverse Zygomatic Implant: A New Implant For Maxillofacial Reconstruction Jonathan Collier ∗ , Andrew Dawood Chelsea & Westminster Hospital Oncological treatment for large maxillary carcinomas can often lead to significant challenges for dental rehabilitation. Limited jaw opening, radiotherapy, difficult access through the flap to the bony site, and the very small amount of bone available in which to anchor implants can render patients impossible to rehabilitate using conventional, zygomatic or pterygoid implants. To address these challenges the new “reverse zygomatic” implant was developed in which treatment, site preparation and implant insertion were accomplished using an extraoral approach. We report a small series of successful cases including the rehabilitation of a patient who had been treated with a hemimaxillectomy, reconstruction with a latissimus dorsi vascularized free flap, and radiotherapy for carcinoma of the sinus some years previously. The reverse zygoma implant was used along with two other conventional zygomatic implants to provide support for a milled titanium bar and overdenture to rehabilitate the maxilla. Two years later, the patient continues to enjoy a healthy reconstruction. In our opinion, the reverse zygomatic implant appears to show promise as a useful addition to the implant armamentarium for the treatment of the patient undergoing maxillectomy. http://dx.doi.org/10.1016/j.bjoms.2016.11.128