- Email: [email protected]
Treatment of Unusual Tessier Cleft 7
Poster Session ANESTHESIA POSTER 01 Outcomes with Ambulatory Anesthesia Delivered in an Oral and Maxillofacial Surgery Training Program
intra-operative or acute post-operative complications associated with delivery of intravenous anesthesia in conjunction with performing surgical procedure simultaneously by the same provider. This may be associated to the patient risk assessment and selection process for safe delivery of intravenous anesthesia prior to the procedure performed by the surgeon in training.
L. Christensen, J. H. D. Lyu, B. Voegele: University of Minnesota, B. Springer, J. D. Barclay Background: Oral and maxillofacial surgeons in the United States have the ability to provide anesthesia, including conscious to deep sedation, while simultaneously performing the surgical procedure in a clinic setting. These skill sets are taught during residency, where residents learn a variety of sedation techniques by performing sedation. Objectives: The objective of this study is to examine the anesthesia techniques utilized in a single oral and maxillofacial surgery program and to assess both intra and post-operative adverse events and/or complications. Methods: Trainees in the Oral and Maxillofacial Surgery program at the University of Minnesota choose his/her preferred anesthesia technique and fill out demographic form for each patient including type of anesthetics delivered and any complications intraoperatively and post-operatively. The patient is asked to fill out an online survey sent via email 7 days following the procedure. The survey includes questions about his/her post-operative condition and complications experienced. This study is ongoing with a target patient population of 2000. Results: Of the patients sedated between June 2016-February 2017 (N=398), mean age of patient is 23.9 years old who were classified as having none to mild systemic medical conditions. 98.5% of patients received a benzodiazepine, midazolam, during the sedation with an average dose of 3.87mg. 79.6% of patients received an opioid, fentanyl, with an average dose of 51.6mcg. Many patients also received propofol (43% with mean dose of 113mg) and/or ketamine (70.9% with a mean dose of 37.9mg). On average, the length of the anesthesia time was 30.6 minutes and post-anesthesia recovery time was 27.4 minutes. The only reported adverse events intra and post-operatively by the surgeon was nausea (3 patients), post-operative hypertension (2 patients, diastolic in 120s both which resolved with no additional meds given). To date, 4 patients reported post-operative nausea. 3 patients reported vomiting. Conclusion: There is a variety of intravenous anesthesia techniques being delivered by oral and maxillofacial surgery residents. There appears to be very little
e-370
References: 1. Senel AC, Altintas NY, Senel FC, et al. Evaluation of sedation in oral and maxillofacial surgery in ambulatory patients: failure and complications. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012;114(5):592-6 2. Perrott DH, Yuen JP, Andresen RV, Dodson TB. Office-based ambulatory anesthesia: outcomes of clinical practice of oral and maxillofacial surgeons. J Oral Maxillofac Surg. 2003;61(9):983-95
CLEFT & CRANIOFACIAL SURGERY POSTER 02 Treatment of Unusual Tessier Cleft 7 J. W. Whiting: Kings County Hospital, S. Ngan, R. Temkin, D. C. Hoffman, S. K. Lazow Introduction: Lateral facial cleft lip (Tessier type 7) is estimated to be as rare as 1:175,000 live births. Lateral cleft is secondary to failure of fusion of maxillary and mandibular processes causing a cleft at the commissures resulting in macrostomia. The etiology of why the maxillary and mandibular processes fail to fuse is not fully understood. Some theories include mandibular dysplasia, transverse soft tissue deficiency, hematoma in area of the stapedial artery and amniotic bands. It is associated with 1st and 2nd brachial arch syndromes, skin tags, defective development of ear, TMJ, zygomatic arch,mandible, eyelids and polydactyly. Severity of lesion may be a slight cleft at commissure to full-thickness defect extending from the mouth to the tragus with any number of combinational facial anomalies of soft and hard tissue. It is more commonly unilateral but 10-20% are bilateral. Bilateral lateral cleft lip is challenging to treat due to lack of a normal side that can serve as a reference to the surgeon on where to place the commissure. Due to the rarity of lateral clefts there is mostly anecdotal studies on surgical management. Various methods of treatment have been described in the literature including Z pasty, W plasty, simple linear flap and triangular flap. Case Report: This is a case report of a baby girl born at full term via Cesarean section in September 2016 at one of our affiliate hospitals with bilateral, lateral facial clefts.
AAOMS 2017
Poster Session She was also found to have skin tags in the left preauricular and zygoma regions. She was thoroughly evaluated at time of birth and found to have no other systemic health problems or craniofacial abnormalities. Patient was referred to the Maimonides Medical Center Cleft Lip and Palate team that includes a multidisclipinary team of oral maxillofacial surgeons, ENT, geneticists, speech pathologists and pediatricians. The baby was found to have no other congenital abnormalities and was deemed a good candidate for surgical repair. Surgery was scheduled at six months to limit psychological impact on child and family, as well as to avoid future speech and masticatory difficulties. It was determined to use serial z-plasties to avoid scar contracture and provide a satisfactory cosmetic result comparable to other methods. Results: Restoration of facial form and symmetry. Conclusion: Serial Z plasties remain a viable surgical option for optimal cosmetic and functional results. References: 1. Schwarz R, Sharma D. ‘ Straight line closure of congenital macrostomia.’’ Indian J Plast Surg. 2004;37:121-3 2. Mohan, Ravi Prakash Sasankoti et al. ‘ Bilateral Macrostomia.’’ BMJ Case Reports 2013 (2013): bcr2013010429. PMC. Web. 25 Jan. 2017 3. Gorlin, RobertJ, Michael M. Cohen, and Raoul C.M. Hennekam. Syndromes of the Head and Neck. 4th ed. New York: Oxford, 200, p. 868-871 4. Wyszynske, DiegoF. Cleft Lip and Palate From Origin to Treatment. New York: Oxford, 2002, p. 62-64
DENTAL IMPLANTS POSTER 03 Displacement of Dental Implants into the Mandibular Bone Marrow Space - Cause and Treatment J. W. Kim: Kyungpook National University School of Dentistry, J. Y. Paeng, S. Y. Choi, T. G. Kwon Implant placement in the mandibular posterior area is relatively predictable and a simple procedure if enough bone exists. However, even though it rarely happens, cases of accidental implant displacement into the marrow space of mandibular body have been continuously reported. Severe implant displacement can first violate the inferior alveolar nerve (IAN) and the subsequent surgical procedure for the implant retrieval also can secondarily injure the IAN. The purpose of this Clinical Case Letter is to investigate the pattern of dental implant displacements into the mandibular marrow space and to suggest a suitable method for the removal of the displaced implants. Five patients were consulted at the authors’ institute. All patients had experienced sudden displacement of an AAOMS 2017
implant into the mandibular medullary cavity. Except for one female patient, no patient had a history of osteoporosis. After CBCT to confirm the relative location between displaced implant and IAN, the displaced implants were retrieved by crestal hole widening or lateral decortication. Only 7 articles and 10 patients were identified in previously published literature. Therefore, including our five cases, 15 cases were investigated. Based on our cases and those of others, 15 cases of implant displacement into the mandibular medullary cavity have been reported. Most cases involved women and there was no specific age predisposition. Only three patients had been diagnosed with osteoporosis. The direction of the surgical approach could be classified largely into two categories, crestal or lateral approach. The majority of the cases (n = 10) used the lateral approach. Because of the insufficient information in previous publications, we could find only two articles mentioning hypoesthesia after implant removal. Including our cases, hypoesthesia was observed in 47% of total cases (n = 7/15) In more than 50 % of cases (n = 8/15), the implants were confirmed to be displaced to the lingual side of the inferior alveolar nerve. The crestal approach has some limitation in terms of the operation field and risk of further displacement. Accidental implant displacement into the mandibular bone marrow space mostly occurred in women above 50 years of age. However, there was no clear evidence of association with osteoporosis. It is reasonable to suggest that fewer and lower trabeculae in the posterior mandible would be associated with implant displacement during fixture placement. It is recommended to remove the displaced implants through the lateral approach rather than a crestal approach, especially when the implant is deeply displaced relative to the IAN.
POSTER 04 Grafting of Alveolar Cleft Defects in Preparation for Endosseous Dental Implant Placement and Orthodontic Tooth Movement V. Watts: Nova Southeastern University Oral and Maxillofacial surgery, J. Portnof Objective: Prosthodontic rehabilitation of patients with edentulous sites secondary to cleft palate has shown a paradigm shift towards implant placement in skeletally mature patients. Patients with residual alveolar cleft defects after secondary grafting at the optimal age of 8-11 years old have presented with persistent defects precluding implant placement. The purpose of this article is to revisit an approach to augmentation bone grafting of the residual maxillary alveolar cleft defect in preparation for endosseous dental implant placement. e-371
intra-operative or acute post-operative complications associated with delivery of intravenous anesthesia in conjunction with performing surgical procedure simultaneously by the same provider. This may be associated to the patient risk assessment and selection process for safe delivery of intravenous anesthesia prior to the procedure performed by the surgeon in training.
L. Christensen, J. H. D. Lyu, B. Voegele: University of Minnesota, B. Springer, J. D. Barclay Background: Oral and maxillofacial surgeons in the United States have the ability to provide anesthesia, including conscious to deep sedation, while simultaneously performing the surgical procedure in a clinic setting. These skill sets are taught during residency, where residents learn a variety of sedation techniques by performing sedation. Objectives: The objective of this study is to examine the anesthesia techniques utilized in a single oral and maxillofacial surgery program and to assess both intra and post-operative adverse events and/or complications. Methods: Trainees in the Oral and Maxillofacial Surgery program at the University of Minnesota choose his/her preferred anesthesia technique and fill out demographic form for each patient including type of anesthetics delivered and any complications intraoperatively and post-operatively. The patient is asked to fill out an online survey sent via email 7 days following the procedure. The survey includes questions about his/her post-operative condition and complications experienced. This study is ongoing with a target patient population of 2000. Results: Of the patients sedated between June 2016-February 2017 (N=398), mean age of patient is 23.9 years old who were classified as having none to mild systemic medical conditions. 98.5% of patients received a benzodiazepine, midazolam, during the sedation with an average dose of 3.87mg. 79.6% of patients received an opioid, fentanyl, with an average dose of 51.6mcg. Many patients also received propofol (43% with mean dose of 113mg) and/or ketamine (70.9% with a mean dose of 37.9mg). On average, the length of the anesthesia time was 30.6 minutes and post-anesthesia recovery time was 27.4 minutes. The only reported adverse events intra and post-operatively by the surgeon was nausea (3 patients), post-operative hypertension (2 patients, diastolic in 120s both which resolved with no additional meds given). To date, 4 patients reported post-operative nausea. 3 patients reported vomiting. Conclusion: There is a variety of intravenous anesthesia techniques being delivered by oral and maxillofacial surgery residents. There appears to be very little
e-370
References: 1. Senel AC, Altintas NY, Senel FC, et al. Evaluation of sedation in oral and maxillofacial surgery in ambulatory patients: failure and complications. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012;114(5):592-6 2. Perrott DH, Yuen JP, Andresen RV, Dodson TB. Office-based ambulatory anesthesia: outcomes of clinical practice of oral and maxillofacial surgeons. J Oral Maxillofac Surg. 2003;61(9):983-95
CLEFT & CRANIOFACIAL SURGERY POSTER 02 Treatment of Unusual Tessier Cleft 7 J. W. Whiting: Kings County Hospital, S. Ngan, R. Temkin, D. C. Hoffman, S. K. Lazow Introduction: Lateral facial cleft lip (Tessier type 7) is estimated to be as rare as 1:175,000 live births. Lateral cleft is secondary to failure of fusion of maxillary and mandibular processes causing a cleft at the commissures resulting in macrostomia. The etiology of why the maxillary and mandibular processes fail to fuse is not fully understood. Some theories include mandibular dysplasia, transverse soft tissue deficiency, hematoma in area of the stapedial artery and amniotic bands. It is associated with 1st and 2nd brachial arch syndromes, skin tags, defective development of ear, TMJ, zygomatic arch,mandible, eyelids and polydactyly. Severity of lesion may be a slight cleft at commissure to full-thickness defect extending from the mouth to the tragus with any number of combinational facial anomalies of soft and hard tissue. It is more commonly unilateral but 10-20% are bilateral. Bilateral lateral cleft lip is challenging to treat due to lack of a normal side that can serve as a reference to the surgeon on where to place the commissure. Due to the rarity of lateral clefts there is mostly anecdotal studies on surgical management. Various methods of treatment have been described in the literature including Z pasty, W plasty, simple linear flap and triangular flap. Case Report: This is a case report of a baby girl born at full term via Cesarean section in September 2016 at one of our affiliate hospitals with bilateral, lateral facial clefts.
AAOMS 2017
Poster Session She was also found to have skin tags in the left preauricular and zygoma regions. She was thoroughly evaluated at time of birth and found to have no other systemic health problems or craniofacial abnormalities. Patient was referred to the Maimonides Medical Center Cleft Lip and Palate team that includes a multidisclipinary team of oral maxillofacial surgeons, ENT, geneticists, speech pathologists and pediatricians. The baby was found to have no other congenital abnormalities and was deemed a good candidate for surgical repair. Surgery was scheduled at six months to limit psychological impact on child and family, as well as to avoid future speech and masticatory difficulties. It was determined to use serial z-plasties to avoid scar contracture and provide a satisfactory cosmetic result comparable to other methods. Results: Restoration of facial form and symmetry. Conclusion: Serial Z plasties remain a viable surgical option for optimal cosmetic and functional results. References: 1. Schwarz R, Sharma D. ‘ Straight line closure of congenital macrostomia.’’ Indian J Plast Surg. 2004;37:121-3 2. Mohan, Ravi Prakash Sasankoti et al. ‘ Bilateral Macrostomia.’’ BMJ Case Reports 2013 (2013): bcr2013010429. PMC. Web. 25 Jan. 2017 3. Gorlin, RobertJ, Michael M. Cohen, and Raoul C.M. Hennekam. Syndromes of the Head and Neck. 4th ed. New York: Oxford, 200, p. 868-871 4. Wyszynske, DiegoF. Cleft Lip and Palate From Origin to Treatment. New York: Oxford, 2002, p. 62-64
DENTAL IMPLANTS POSTER 03 Displacement of Dental Implants into the Mandibular Bone Marrow Space - Cause and Treatment J. W. Kim: Kyungpook National University School of Dentistry, J. Y. Paeng, S. Y. Choi, T. G. Kwon Implant placement in the mandibular posterior area is relatively predictable and a simple procedure if enough bone exists. However, even though it rarely happens, cases of accidental implant displacement into the marrow space of mandibular body have been continuously reported. Severe implant displacement can first violate the inferior alveolar nerve (IAN) and the subsequent surgical procedure for the implant retrieval also can secondarily injure the IAN. The purpose of this Clinical Case Letter is to investigate the pattern of dental implant displacements into the mandibular marrow space and to suggest a suitable method for the removal of the displaced implants. Five patients were consulted at the authors’ institute. All patients had experienced sudden displacement of an AAOMS 2017
implant into the mandibular medullary cavity. Except for one female patient, no patient had a history of osteoporosis. After CBCT to confirm the relative location between displaced implant and IAN, the displaced implants were retrieved by crestal hole widening or lateral decortication. Only 7 articles and 10 patients were identified in previously published literature. Therefore, including our five cases, 15 cases were investigated. Based on our cases and those of others, 15 cases of implant displacement into the mandibular medullary cavity have been reported. Most cases involved women and there was no specific age predisposition. Only three patients had been diagnosed with osteoporosis. The direction of the surgical approach could be classified largely into two categories, crestal or lateral approach. The majority of the cases (n = 10) used the lateral approach. Because of the insufficient information in previous publications, we could find only two articles mentioning hypoesthesia after implant removal. Including our cases, hypoesthesia was observed in 47% of total cases (n = 7/15) In more than 50 % of cases (n = 8/15), the implants were confirmed to be displaced to the lingual side of the inferior alveolar nerve. The crestal approach has some limitation in terms of the operation field and risk of further displacement. Accidental implant displacement into the mandibular bone marrow space mostly occurred in women above 50 years of age. However, there was no clear evidence of association with osteoporosis. It is reasonable to suggest that fewer and lower trabeculae in the posterior mandible would be associated with implant displacement during fixture placement. It is recommended to remove the displaced implants through the lateral approach rather than a crestal approach, especially when the implant is deeply displaced relative to the IAN.
POSTER 04 Grafting of Alveolar Cleft Defects in Preparation for Endosseous Dental Implant Placement and Orthodontic Tooth Movement V. Watts: Nova Southeastern University Oral and Maxillofacial surgery, J. Portnof Objective: Prosthodontic rehabilitation of patients with edentulous sites secondary to cleft palate has shown a paradigm shift towards implant placement in skeletally mature patients. Patients with residual alveolar cleft defects after secondary grafting at the optimal age of 8-11 years old have presented with persistent defects precluding implant placement. The purpose of this article is to revisit an approach to augmentation bone grafting of the residual maxillary alveolar cleft defect in preparation for endosseous dental implant placement. e-371