Oral and maxillofacial surgery

A technical note describing the use of a carotid artery bypass graft in the management of head and neck cancer with carotid artery involvement and review of literature (2019)

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Type of publication:
Conference abstract

Author(s):
*Hamps C.; *Pilkington R.; *Merriman C.; *Thomas S.; *Bhatia S.

Citation:
British Journal of Oral and Maxillofacial Surgery; Dec 2019; vol. 57 (no. 10)

Abstract:
Introduction Carotid blowout syndrome (CBS) refers to rupture of the carotid artery and is an uncommon but often catastrophic complication of head and neck cancer when arterial wall integrity is compromised,
particularly where surgical procedures and radiotherapy are involved. Rupture occurs most commonly in the common carotid artery in proximity to the furcation, often within 10-40 days post surgery. Methods We present the use of a great saphenous vein carotid artery bypass graft in the management of a 47-year-old woman with recurrent squamous cell carcinoma (T2 N1 M0 RO V1) utilizing the Pruitt F3 carotid shunt system to minimize cerebral perfusion compromise. We explore pre and post-operative surgical considerations including suggested graft-monitoring protocols. Results The body of evidence supporting the use of carotid bypass grafts is limited. Despite data paucity, case series are available demonstrating variable mortality. A systematic review of PubMed was conducted revealing three English language case series. One series reported a 2-year survival of 82% with carotid sacrifice and autogenous venous graft where distant metastatic disease is absent. 96% of patients experienced no neurologic sequela whilst 3.9% suffered CVA post-operatively. Our own patient remains free of neurologic symptoms and graft patency has been confirmed at 3 months. Clinical Relevance Tumour resection involving in the carotid artery presents an array of surgical management possibilities including tumour shaving, artery ligation or resection. The long-term survival of carotid bypass graft is unknown and reported complications vary, it remains a promising technique in the prevention of carotid blowout syndrome.

The change in presentation and treatment of dental abscess in ten years at Telford Hospital (2019)

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Type of publication:
Conference abstract

Author(s):
*Wu E.

Citation:
British Journal of Oral and Maxillofacial Surgery; Dec 2019; vol. 57 (no. 10)

Abstract:
Background A dental infection often requires simple treatment but an abscess can turn into a life threatening condition. In the UK in April 2006 a new dental contract was introduced, it changed the renumeration tariffs from pay per item to a 3 tier banding payment system in the hope of shifting the balance to prevention rather than treatment. Aims The aim of this project is to study the change in incidence and severity of dental infections presenting to Telford Hospital Emergency Department (ED), the treatment required plus the potential implications on Maxillofacial Services. Methods Data was collected from 2006 and 2016. Using the ED database codes for 'soft tissue infection/abscess or Facio-maxillary conditions' patients were identified. Only those notes stating a clear dental cause were included. Results The median age range in 2006 and 2016 was 30years old. In 2016, 20% of patients had been commenced on Antibiotics (most commonly amoxicillin) compared to only 3% in 2006. The number of patients presenting to ED doubled in 2016 and the procedures (LA/ GA) more than quadrupled resulting in a rise in inpatient stay from 1 to 11 days in total. The increase in GA could indicate increased severity of the abscess. Conclusions It would appear that the work load managed by Maxillofacial Surgeons has increased. There has also been an increase in incidence and severity of dental infections.  Whether this is secondary to deterioration in dental health or unwillingness by the public to pay to for dental health care is unclear.

Temporal artery biopsy harvesting length audit, patient satisfaction with post op management. A guide for clinical commissioning group planning (2019)

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Type of publication:
Conference abstract

Author(s):
*Pilkington R.; *Chundoo S.; *Rollings L.; *Messahel A.; *Thomas S.; *Bhatia S.

Citation:
British Journal of Oral and Maxillofacial Surgery; Dec 2019; vol. 57 (no. 10)

Abstract:
Introduction: Giant cell or temporal arteritis (GCA) is a vasculitis mainly affecting patients over 50yrs. Diagnosis is facilitated by a temporal artery biopsy (TAB). Due to the increased risk loss of visual loss, patients are started on high dose steroids to reduce this risk. However, a timely diagnosis with the aid from a TAB can help steer the patient into a more medically directed pathway of an appropriate reduction or prolonged use of steroids. We used British Society of Rheumatology (BSR) guidelines to audit our harvest length (recommend > 20 mm) and a telephone questionnaire to follow up patients. Method Retrospective audit over 2.5 years, 146 patients underwent a TAB performed at the Princess Royal and Royal Shrewsbury Hospital.
Results: Male:female (30:70), average age 69yrs.We had a 99.3% TAB harvest of the artery and harvest length > 10 mm was 100% and > 20 mm was 87%. Mean length 24 mm. A positive diagnosis of GCA was made from 24.6% of the TAB. A telephone questionnaire was conducted with a 44% response. 11% reported some postoperative bleeding and 4% some discomfort from the sutures. 0% reported any ongoing problems from the surgical site or concerns from the scar. Clinical relevance In our unit we provide a comprehensive service to a large geographical region. In line with Clinical Commissioning Groups (CCG) this audit shows that we are providing a quality service to the practitioners who refer their patients for this treatment provision. Hopefully this audit can be used to further improve our service.

Reconstruction of the radial forearm free flap donor site with an acellular dermal regenerative matrix "Integra" on Fitzpatrick Type 1 skin (2019)

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Type of publication:
Conference abstract

Author(s):
*Pilkington R.; *Saggu M.; *Thomas S.; *Bhatia S.

Citation:
British Journal of Oral and Maxillofacial Surgery; Dec 2019; vol. 57 (no. 10)

Abstract:
Introduction: The radial forearm free flap (RFFF) is still one of the most commonly used free flaps in oral and maxillofacial surgery. The flap provides a thin flap making intra-oral repair less bulky however, one of the drawbacks to this flap is the donor site morbidity. We report the use of an acellular dermal regenerative matrix material (Integra, Integra Life Sciences, Plainsboro, NJ) to provide a substrate for wound coverage. Method: Our novel approach is used to minimise the donor site scarring and is used to treat a fit and healthy right handed 37-year-old man who presented with a mucoepidermoid carcinoma arising from minor salivary glands in the hard palate. He required resection with reconstruction with a left RFFF. He has Type 1 Fitzpatrick skin and is prone to severe keloid scarring and is not keen to have a skin graft taken to cause further scarring.
Results: We review the types of techniques to close the RFFF donor site. This is the first case using integra to close this site and show the healing stages involved. Clinical relevance This case reveals that the use of the Integra has resulted in a neodermis which then allowed ingress of the surrounding epidermis to fully cover the donor site. It has alleviated the need to take a split skin or full thickness graft which would have added more keloid scarring for the patient.

Three-layered technique to repair an oroantral fistula using a posterior-pedicled inferior turbinate, buccal fat pad, and buccal mucosal advancement flap (2018)

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Type of publication:
Journal article

Author(s):
*Darr, A; *Jolly, K; Martin, T; Monaghan, A; Grime, P; Isles, M; Beech, T; Ahmed, S

Citation:
British Journal of Oral and Maxillofacial Surgery; Volume 56, Issue 7, September 2018, Pages 638-639