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Treatment of obstructive sleep apnea with anterior repositioning appliance and its correlation to pretreatment cephalometric measurements
Vol. 119 No. 5 May 2015
Scientific Abstracts from the ACOMS Third Annual Residents Meeting November 8-9, 2014, Jefferson Medical College, Philadelphia
Thirty-one oral and maxillofacial surgery residents from 17 programs presented abstracts and case reports at the Third Annual ACOMS Residents Meeting, November 8-9, 2014, at Jefferson Medical College in Philadelphia, Pennsylvania, USA. Presentations were scored by a panel of faculty members in attendance and were evaluated based on significance of the problem and results, clarity of the conclusions, support for conclusions, and next steps and outcomes. We are pleased to announce the winners for Outstanding Oral Scientific Abstract or Case Report. Each winner will receive complimentary registration and reimbursement for travel expenses of up to $500 for the ACOMS 36th Annual Scientific Conference and Exhibition, April 18e20, 2015, at the RitzCarlton, Fort Lauderdale, Florida, USA.
Please congratulate our winners: Mysterious infection of the head and neck Author: Meena Bhatti, DMD Residency Program: University of Maryland Medical Center Presented by: Dr. Meena Bhatti The ugly side of facial fillers: Three patients with major complications Authors: Adam Fisher, DMD; Bradley Andrew Shessel, DMD; Jordan Kaltman, DMD; Shawn McClure, DMD Residency Program: Nova Southeastern University Presented by: Dr. Adam Fisher Glenoid fossa fracture with mandibular condylar impaction: A case report and review of the literature Authors: James Gates, DMD; Allen Champion, DDS Residency Program: Thomas Jefferson University Hospital Presented by: Dr. James Gates CT data is useful in differentiation of mandibular lesions Authors: Jia J. Ooi, DMD; Philipp Kupfer, DMD, MD; Mark Engelstad, DDS, MD Residency Program: University of Louisville Presented by: Dr. Jia Ooi Closure of temporomandibular jointeexternal auditory canal fistula using interpositional temporoparietal fascial flap: Two case reports Authors: David W. Lui, DMD, MD; Samir Singh, DMD Residency Program: Virginia Commonwealth University Department of Oral and Maxillofacial Surgery Presented by: Dr. Samir Singh Isolated osteomyelitis of the condylar head resulting from infectious parotitis Authors: Geoffrey Zinberg, DMD; John Vorrasi, DDS; Matthew Krieger, DMD Residency Program: Christiana Care Health System OMS Presented by: Dr. Geoff Zinberg
All accepted scientific abstracts presented at the Third Annual ACOMS Residents Meeting are available in Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology.
CT DATA IS USEFUL IN DIFFERENTIATION OF MANDIBULAR LESIONS Authors: Jia J. Ooi, DMD; Philipp Kupfer, DMD, MD; Mark Engelstad, DDS, MD Residency Program: University of Louisville Presented by: Dr. Jia Ooi Objective: The purpose of this study was to determine if Hounsfield unit (HU) data can be used to differentiate between two lesions commonly found in the posterior mandible. Study Design: Seven patients with ameloblastoma and 10 with keratocystic odontogenic tumor (KOT) were included in this study. Three HU samples of the same size were obtained for each lesion on the axial cuts of 3-mm bone computed tomography images: one sample in the center of the lesion, one sample in the slice 3 mm superior, and one sample in the slice 3 mm inferior. Each sample taken had an area of 44.0 mm2 and a perimeter of 23.5 mm. Samples were taken from the middle of the lesion, avoiding the borders. Values for the three samples were then averaged and recorded as the HU for that lesion. The HUs for all ameloblastomas and KOTs were averaged. The average HUs for ameloblastoma and KOT were then compared using the t test. Results: Ameloblastoma had an average of 30.88 HU with a standard deviation of 10.48 HU. KOT had an average of 9.67 HU with a standard deviation of 11.50 HU. The average value for ameloblastomas was not equal to the average value for KOTs at a 95% confidence interval (P < 0.05). Conclusions: Although not able to provide diagnostic HUs, this study highly suggests that there are differences between an ameloblastoma and a KOT in terms of HUs on a computed tomography scan. Further studies with larger populations may lead to creation of a diagnostic HU database.
TREATMENT OF OBSTRUCTIVE SLEEP APNEA WITH ANTERIOR REPOSITIONING APPLIANCE AND ITS CORRELATION TO PRETREATMENT CEPHALOMETRIC MEASUREMENTS Authors: Garth Porter, DDS; J Marshall Green, III, DDS; Damon Jensen, DDS; David Bitonti, DMD Residency Program: National Capital Consortium Oral and Maxillofacial Surgery Presented by: Dr. Garth Porter Objective: The use of a mandibular anterior repositioning splint (ARS) for the patient with nonsurgical obstructive sleep apnea (OSA) has become an important treatment modality in combatting this significantly debilitating condition. Although continuous positive airway pressure (CPAP) remains the gold standard for nonsurgical treatment, this modality is often poorly tolerated and can have social and interpersonal repercussions. In the military population, the use of CPAP can disqualify a soldier
e253
ACOMS ABSTRACTS e254 Abstracts from deployment and selected duty assignments. The purpose of this study was to identify the efficacy of an ARS in relation to the patient’s pretreatment anatomic measurements, in the hope that this information would assist the surgeon in identifying which patients are good candidates for an ARS. Study Design: A retrospective review was completed including 209 patients who had failed CPAP therapy and were treated with a mandibular ARS in the OMS Clinic at the former National Naval Medical Center and Walter Reed National Military Medical Center. The ARS was set at 70% of the patient’s maximum mandibular protrusion and approximately 5 mm of vertical opening. Initial data analyzed included the respiratory disturbance index (RDI), Frankfort horizontalemandibular plane angle (FH-MPA), posterior pharyngeal airway space (PAS), and mandibular planeehyoid distance (MP-H). Results: Thirty-six patients met the review criteria: preand postappliance polysomnograms, RDI >5, lateral cephalometric radiograph, and follow-up evaluation. The average improvement in RDI was 18.5 after 6 weeks to 3 months of ARS therapy. With the ARS in place, the average MPA increased by 2.9 mm, the average PAS increased by 2.75 mm, and the average MPH distance decreased by 7.8 mm. Of the patients with moderate to severe OSA (RDI >15), 96% had an MP-H distance >14 mm, 68% had a PAS <12 mm, and 60% had a FH-MPA >22 . Conclusions: All patients had 50% improvement in their OSA after a 6-week to 3-months ARS trial, with the highest post-ARS RDI recorded at 18.5. The severity of OSA was most closely correlated with pretreatment MP-H distance. Although we hypothesized that a greater reduction in MP-H distance would correlate with greater improvement in RDI, we did not always find this to be the case. Nor did we find that improvement in PAS and FH-MPA was strongly correlated RDI. We conclude that the causes of OSA are multifactorial and, although strongly associated with MP-H distance, PAS, and FH-MPA, are likely influenced by other factors as well. We also conclude an ARS can be a successful adjunct to treatment of OSA.
UTILIZATION OF THE ALL-SUTURE BIOMET JUGGERKNOT SOFT ANCHOR FOR DISC REPOSITIONING IN THE SURGICAL MANAGEMENT OF INTERNAL DERANGEMENTS OF THE TEMPOROMANDIBULAR JOINT Authors: Charles Hanley, DDS; S. Ross Martin, DMD; Steven Sullivan, DDS Residency Program: University of Oklahoma Health Sciences Center Presented by: Dr. Ross Martin Objective: The purpose of this study was to describe techniques for and assess outcomes with the use of the all-suture JuggerKnot Soft Anchor system (Biomet, Warsaw, IN, USA) for disc repositioning in the surgical management of internal derangements that lead to a dysfunctional temporomandibular joint (TMJ). Study Design: All patients who underwent disc repositioning using the JuggerKnot Soft Anchor for management of TMJ internal derangements from June 2012 to September 2014 were identified by retrospective chart review. A total of 150 Biomet JuggerKnot Soft Anchors were placed on 89 patients. All patients included in the study were diagnosed with anterior disc displacement with or without reduction. For each patient, preoperative and postoperative questionnaires were provided to collect subjective and objective data for comparison. The
OOOO May 2015 variables taken into account in this study were pain, range of motion, joint noise, diet, and quality of life. Results: Preliminary analysis of the short-term data revealed improvements in painful symptoms, joint noise, range of motion, diet, and quality of life. These findings are consistent with previously published results on the comparable Mitek Mini Anchor (Mitek Surgical Products, Westwood, MA, USA) for disc repositioning. Conclusions: The surgical placement of the Biomet JuggerKnot Soft Anchor is a viable tool for managing internal derangements of the TMJ, yielding evident clinical improvements in pain, range of motion, diet, and dysfunction. Short-term outcomes appear favorable, and continued follow-up is vital to measure long-term success rates.
PARENTAL PERSPECTIVE OF CLEFT LIP/PALATE: EXPERIENCE IN PRENATAL COUNSELING FOR PARENTS OF CLEFT PATIENTS Authors: Kevin Smith, DDS; Bryan Christensen, DMD; David Sylvester, II, DDS Residency Program: University of Oklahoma Health Sciences Center Presented by: Dr. David Sylvester Objective: The purpose of this study was to evaluate the importance of prenatal assessment and the ability to psychologically help parents during the postnatal period who have an infant diagnosed with a cleft lip/palate. Study Design: The study comprised two Likert scale survey designs that asked parents of children with cleft lip/palate questions regarding their feelings/emotions, areas of concern, coping/education, prenatal knowledge, and termination of the pregnancy. Seventy-four surveys targeted parents who possessed prenatal knowledge of their child’s diagnosis of cleft lip/palate. Twenty-six surveys targeted parents who had no prenatal knowledge of their child’s diagnosis of cleft lip/palate. The results were statistically analyzed for significance using Fisher’s c2 test with a 5% level of significance. Results: Parents who possessed prenatal knowledge of their child’s diagnosis of cleft lip/palate displayed an overall decrease in negative emotions and a reduction in concerns. Positive emotions increased overall among parents with prenatal awareness. The majority of parents with either pre- or postnatal knowledge felt that an early diagnosis was or would have been preferred. Even with a diagnosis of cleft lip/palate, termination of pregnancy was not a highly considered option. Even with ultrasound advancements and opportunities for early diagnosis, several parents did not undergo prenatal assessment. Conclusions: Prenatal diagnosis of cleft lip/palate allows parents to be better prepared psychologically to cope with their infant’s defect at the time of birth. This reinforces the importance of recommending prenatal ultrasound assessment and counseling to expectant parents.
POSTDISCHARGE NAUSEA AND VOMITING FOLLOWING THIRD MOLAR EXTRACTIONS UNDER AMBULATORY ANESTHESIA Authors: Ray English, III, DMD; Alireza Ashrafi, DMD; Sepideh Sabooree, BS, DMD candidate; Mina Boulos, DMD candidate; Archana Viswanath, BDS, MS Residency Program: Tufts Unversity School of Dental Medicine Presented by: Dr. Ray English
Scientific Abstracts from the ACOMS Third Annual Residents Meeting November 8-9, 2014, Jefferson Medical College, Philadelphia
Thirty-one oral and maxillofacial surgery residents from 17 programs presented abstracts and case reports at the Third Annual ACOMS Residents Meeting, November 8-9, 2014, at Jefferson Medical College in Philadelphia, Pennsylvania, USA. Presentations were scored by a panel of faculty members in attendance and were evaluated based on significance of the problem and results, clarity of the conclusions, support for conclusions, and next steps and outcomes. We are pleased to announce the winners for Outstanding Oral Scientific Abstract or Case Report. Each winner will receive complimentary registration and reimbursement for travel expenses of up to $500 for the ACOMS 36th Annual Scientific Conference and Exhibition, April 18e20, 2015, at the RitzCarlton, Fort Lauderdale, Florida, USA.
Please congratulate our winners: Mysterious infection of the head and neck Author: Meena Bhatti, DMD Residency Program: University of Maryland Medical Center Presented by: Dr. Meena Bhatti The ugly side of facial fillers: Three patients with major complications Authors: Adam Fisher, DMD; Bradley Andrew Shessel, DMD; Jordan Kaltman, DMD; Shawn McClure, DMD Residency Program: Nova Southeastern University Presented by: Dr. Adam Fisher Glenoid fossa fracture with mandibular condylar impaction: A case report and review of the literature Authors: James Gates, DMD; Allen Champion, DDS Residency Program: Thomas Jefferson University Hospital Presented by: Dr. James Gates CT data is useful in differentiation of mandibular lesions Authors: Jia J. Ooi, DMD; Philipp Kupfer, DMD, MD; Mark Engelstad, DDS, MD Residency Program: University of Louisville Presented by: Dr. Jia Ooi Closure of temporomandibular jointeexternal auditory canal fistula using interpositional temporoparietal fascial flap: Two case reports Authors: David W. Lui, DMD, MD; Samir Singh, DMD Residency Program: Virginia Commonwealth University Department of Oral and Maxillofacial Surgery Presented by: Dr. Samir Singh Isolated osteomyelitis of the condylar head resulting from infectious parotitis Authors: Geoffrey Zinberg, DMD; John Vorrasi, DDS; Matthew Krieger, DMD Residency Program: Christiana Care Health System OMS Presented by: Dr. Geoff Zinberg
All accepted scientific abstracts presented at the Third Annual ACOMS Residents Meeting are available in Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology.
CT DATA IS USEFUL IN DIFFERENTIATION OF MANDIBULAR LESIONS Authors: Jia J. Ooi, DMD; Philipp Kupfer, DMD, MD; Mark Engelstad, DDS, MD Residency Program: University of Louisville Presented by: Dr. Jia Ooi Objective: The purpose of this study was to determine if Hounsfield unit (HU) data can be used to differentiate between two lesions commonly found in the posterior mandible. Study Design: Seven patients with ameloblastoma and 10 with keratocystic odontogenic tumor (KOT) were included in this study. Three HU samples of the same size were obtained for each lesion on the axial cuts of 3-mm bone computed tomography images: one sample in the center of the lesion, one sample in the slice 3 mm superior, and one sample in the slice 3 mm inferior. Each sample taken had an area of 44.0 mm2 and a perimeter of 23.5 mm. Samples were taken from the middle of the lesion, avoiding the borders. Values for the three samples were then averaged and recorded as the HU for that lesion. The HUs for all ameloblastomas and KOTs were averaged. The average HUs for ameloblastoma and KOT were then compared using the t test. Results: Ameloblastoma had an average of 30.88 HU with a standard deviation of 10.48 HU. KOT had an average of 9.67 HU with a standard deviation of 11.50 HU. The average value for ameloblastomas was not equal to the average value for KOTs at a 95% confidence interval (P < 0.05). Conclusions: Although not able to provide diagnostic HUs, this study highly suggests that there are differences between an ameloblastoma and a KOT in terms of HUs on a computed tomography scan. Further studies with larger populations may lead to creation of a diagnostic HU database.
TREATMENT OF OBSTRUCTIVE SLEEP APNEA WITH ANTERIOR REPOSITIONING APPLIANCE AND ITS CORRELATION TO PRETREATMENT CEPHALOMETRIC MEASUREMENTS Authors: Garth Porter, DDS; J Marshall Green, III, DDS; Damon Jensen, DDS; David Bitonti, DMD Residency Program: National Capital Consortium Oral and Maxillofacial Surgery Presented by: Dr. Garth Porter Objective: The use of a mandibular anterior repositioning splint (ARS) for the patient with nonsurgical obstructive sleep apnea (OSA) has become an important treatment modality in combatting this significantly debilitating condition. Although continuous positive airway pressure (CPAP) remains the gold standard for nonsurgical treatment, this modality is often poorly tolerated and can have social and interpersonal repercussions. In the military population, the use of CPAP can disqualify a soldier
e253
ACOMS ABSTRACTS e254 Abstracts from deployment and selected duty assignments. The purpose of this study was to identify the efficacy of an ARS in relation to the patient’s pretreatment anatomic measurements, in the hope that this information would assist the surgeon in identifying which patients are good candidates for an ARS. Study Design: A retrospective review was completed including 209 patients who had failed CPAP therapy and were treated with a mandibular ARS in the OMS Clinic at the former National Naval Medical Center and Walter Reed National Military Medical Center. The ARS was set at 70% of the patient’s maximum mandibular protrusion and approximately 5 mm of vertical opening. Initial data analyzed included the respiratory disturbance index (RDI), Frankfort horizontalemandibular plane angle (FH-MPA), posterior pharyngeal airway space (PAS), and mandibular planeehyoid distance (MP-H). Results: Thirty-six patients met the review criteria: preand postappliance polysomnograms, RDI >5, lateral cephalometric radiograph, and follow-up evaluation. The average improvement in RDI was 18.5 after 6 weeks to 3 months of ARS therapy. With the ARS in place, the average MPA increased by 2.9 mm, the average PAS increased by 2.75 mm, and the average MPH distance decreased by 7.8 mm. Of the patients with moderate to severe OSA (RDI >15), 96% had an MP-H distance >14 mm, 68% had a PAS <12 mm, and 60% had a FH-MPA >22 . Conclusions: All patients had 50% improvement in their OSA after a 6-week to 3-months ARS trial, with the highest post-ARS RDI recorded at 18.5. The severity of OSA was most closely correlated with pretreatment MP-H distance. Although we hypothesized that a greater reduction in MP-H distance would correlate with greater improvement in RDI, we did not always find this to be the case. Nor did we find that improvement in PAS and FH-MPA was strongly correlated RDI. We conclude that the causes of OSA are multifactorial and, although strongly associated with MP-H distance, PAS, and FH-MPA, are likely influenced by other factors as well. We also conclude an ARS can be a successful adjunct to treatment of OSA.
UTILIZATION OF THE ALL-SUTURE BIOMET JUGGERKNOT SOFT ANCHOR FOR DISC REPOSITIONING IN THE SURGICAL MANAGEMENT OF INTERNAL DERANGEMENTS OF THE TEMPOROMANDIBULAR JOINT Authors: Charles Hanley, DDS; S. Ross Martin, DMD; Steven Sullivan, DDS Residency Program: University of Oklahoma Health Sciences Center Presented by: Dr. Ross Martin Objective: The purpose of this study was to describe techniques for and assess outcomes with the use of the all-suture JuggerKnot Soft Anchor system (Biomet, Warsaw, IN, USA) for disc repositioning in the surgical management of internal derangements that lead to a dysfunctional temporomandibular joint (TMJ). Study Design: All patients who underwent disc repositioning using the JuggerKnot Soft Anchor for management of TMJ internal derangements from June 2012 to September 2014 were identified by retrospective chart review. A total of 150 Biomet JuggerKnot Soft Anchors were placed on 89 patients. All patients included in the study were diagnosed with anterior disc displacement with or without reduction. For each patient, preoperative and postoperative questionnaires were provided to collect subjective and objective data for comparison. The
OOOO May 2015 variables taken into account in this study were pain, range of motion, joint noise, diet, and quality of life. Results: Preliminary analysis of the short-term data revealed improvements in painful symptoms, joint noise, range of motion, diet, and quality of life. These findings are consistent with previously published results on the comparable Mitek Mini Anchor (Mitek Surgical Products, Westwood, MA, USA) for disc repositioning. Conclusions: The surgical placement of the Biomet JuggerKnot Soft Anchor is a viable tool for managing internal derangements of the TMJ, yielding evident clinical improvements in pain, range of motion, diet, and dysfunction. Short-term outcomes appear favorable, and continued follow-up is vital to measure long-term success rates.
PARENTAL PERSPECTIVE OF CLEFT LIP/PALATE: EXPERIENCE IN PRENATAL COUNSELING FOR PARENTS OF CLEFT PATIENTS Authors: Kevin Smith, DDS; Bryan Christensen, DMD; David Sylvester, II, DDS Residency Program: University of Oklahoma Health Sciences Center Presented by: Dr. David Sylvester Objective: The purpose of this study was to evaluate the importance of prenatal assessment and the ability to psychologically help parents during the postnatal period who have an infant diagnosed with a cleft lip/palate. Study Design: The study comprised two Likert scale survey designs that asked parents of children with cleft lip/palate questions regarding their feelings/emotions, areas of concern, coping/education, prenatal knowledge, and termination of the pregnancy. Seventy-four surveys targeted parents who possessed prenatal knowledge of their child’s diagnosis of cleft lip/palate. Twenty-six surveys targeted parents who had no prenatal knowledge of their child’s diagnosis of cleft lip/palate. The results were statistically analyzed for significance using Fisher’s c2 test with a 5% level of significance. Results: Parents who possessed prenatal knowledge of their child’s diagnosis of cleft lip/palate displayed an overall decrease in negative emotions and a reduction in concerns. Positive emotions increased overall among parents with prenatal awareness. The majority of parents with either pre- or postnatal knowledge felt that an early diagnosis was or would have been preferred. Even with a diagnosis of cleft lip/palate, termination of pregnancy was not a highly considered option. Even with ultrasound advancements and opportunities for early diagnosis, several parents did not undergo prenatal assessment. Conclusions: Prenatal diagnosis of cleft lip/palate allows parents to be better prepared psychologically to cope with their infant’s defect at the time of birth. This reinforces the importance of recommending prenatal ultrasound assessment and counseling to expectant parents.
POSTDISCHARGE NAUSEA AND VOMITING FOLLOWING THIRD MOLAR EXTRACTIONS UNDER AMBULATORY ANESTHESIA Authors: Ray English, III, DMD; Alireza Ashrafi, DMD; Sepideh Sabooree, BS, DMD candidate; Mina Boulos, DMD candidate; Archana Viswanath, BDS, MS Residency Program: Tufts Unversity School of Dental Medicine Presented by: Dr. Ray English