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Oral Session 1: Evidence Based Practice Thromboprophylaxis in Oral and Maxillofacial Surgery

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Oral Session 1: Evidence Based Practice Thromboprophylaxis in Oral and Maxillofacial Surgery ORAL SESSION 1: EVIDENCE BASED PRACTICE THROMBOPROPHYLAXIS IN ORAL AND MAXILLOFACIAL SURGERY. HOW LOW CAN YOU GO? M. Gregory1, J. Hanratty2, B. Thomas3 1Altnagelvin Area Hospital, Oral & Maxillofacial Surgery, Newry, United Kingdom 2Ulster Hospital, Oral & Maxillofacial Surgery, Belfast, United Kingdom 3Altnagelvin Area Hospital, Oral & Maxillofacial Surgery, Londonderry, United Kingdom Introduction NICE guidelines advise that pharmacological venous thromboembolism (VTE) prophylaxis in the form of low molecular weight (LMW) heparin should be considered for all patients undergoing procedures with a total anaesthetic time above 1.5 hours.1 Many hospital policies advise a dose of 40mg, although no specific dose is guided. Mechanical VTE prophylaxis is also advised in all such patients unless contraindicated.1 We have experienced that the 40mg dose can increase the complication of intra and post-operative bleeding and post- operative haematomas, both important complications in head and neck surgery and that the lower dose of 20mg has no adverse effects. Aims The primary goal of this study is to demonstrate that the lower (20mg) dose of LMW heparin is sufficient in head and neck surgery for thromboprophylaxis and that no adverse effects (PE, DVT) are demonstrated. Methods A retrospective study of all case notes, theatre log-books and all GP attendance was undertaken on all patients undergoing maxillofacial procedures with a total anaesthetic time of 2 hours or greater starting April 2011 in Altnagelvin Hospital. Results 102 patients were included in the study, including Oncological (18), Trauma (9) and Facial Deformity (47). Surgical times ranged from 2–14 hours. All patients who received pharmacological VTE prophylaxis received 20mg (LMW heparin). There were no DVT or PE cases in those studied. Conclusion This study demonstrates that using the lower (20mg) dose of LMW heparin is sufficient for VTE prophylaxis with no VTE events recorded 1. NICE Clinical Guideline 92. 2010, revised 2015. NICE ORAL SESSION 1: EVIDENCE BASED PRACTICE SOME ASPECTS OF APPLYING PERONEAL AUTOTRANSPLANTS FOR RECONSTRUCTING MID-FACE AREA E. Verbo1, A. Kulakov1, S. Butsan1, O. Moskaleva1, K. Gileva1, M. Bolshakov1, T. Brayalovskaya1, M. Chernenkiy1 1Central Research Institute of Dental and Maxillofacial Surgery, Reconstructive Maxillofacial surgery, Moscow, Russia Aim To improve functional and aesthetic results of treating patients having combined defects in midface area. Materials and methods: The authors analysed practice of treating 23 patients having combined defects in midface area. Special features of fibula flap application were: computer three-dimensional analysis of defects, studying structure of sensing osseous tissues and formation of counterforts for sound fixation. Method used Inverse planning of reconstructive operation. This comprises virtual modeling of final orthopedic result. Positioning of the bone part of the auto-transplant corresponds to the axis of the implants' position. The transplants' osteotomy was performed at an individually calculated angle taking into account the opposite side's symmetrisation. Cutting and assembling guides were made for that purpose. Results In 1 case the necrosis of the auto-transplant was observed while in 22 other cases there was complete autotransplant acceptance. Computer simulation of peroneal auto-transplants has made it possible to successfully eliminate various mid-face area defects: upper jaw, cheek bone, the lateral border of eyehole and the infra-orbital edge. Simulating the terminal parts of a peroneal bone based on the shape of the sensing fragment enabled the reliable fixing of auto-transplants. In 70 % of cases, more reliable fixation of extended flaps required the autotransplantation of some fragments of individually simulated parietal bone into the lost counterforts area. Conclusions Applying a peroneal bone and a subsequent auto-transplantation of parietal bone into the counterforts area make it possible to obtain guaranteed full-scale dento-alveolar rehabilitation. Applying contour correction and lipofilling provides good aesthetic results. ORAL SESSION 1: EVIDENCE BASED PRACTICE PREDICTIVE VALUE OF PANORAMIC RADIOGRAPHY FOR INJURY OF INFERIOR ALVEOLAR NERVE AFTER MANDIBULAR THIRD MOLAR SURGERY N. Su1, A. van wijk1, E. Berkhout2, G. Sanderink2, J. De Lange3, H. Wang4, G.J.M.G. van der Heijden1 1Academic Centre for Dentistry Amsterdam, Department of Social Dentistry, Amsterdam, Netherlands 2Academic Centre for Dentistry Amsterdam, Department of Oral Radiology, Amsterdam, Netherlands 3Academic Medical Centre/Academic Centre for Dentistry Amsterdam, Department of Oral and Maxillofacial Surgery, Amsterdam, Netherlands 4West China Hospital of Stomatology, State Key Laboratory of Oral Disease, Chengdu, China Aims: To assess the added value of panoramic radiography in predicting (ruling in or out) postsurgical injury of inferior alveolar nerve (IAN) in the decision making prior to mandibular third molar surgery (MM3S). Methods: MEDLINE and EMBASE were searched electronically to identify studies that had assessed the predictive value of 7 panoramic radiographic signs including root-related signs (darkening of root, deflected of root, dark and bifid apex of root) and canal-related signs (interruption of white line of canal, diversion of canal and narrowing of canal) for IAN injury after MM3S. Results: A total of 8 studies were included for meta-analyses. The pooled sensitivity and specificity of the 7 signs ranged from 0.06 to 0.49 and 0.81 to 0.97, respectively. The area under the summary receiver-operator curve (sAUC) ranged from 0.42 to 0.89. The pooled positive predictive value (PPV) and negative predictive value (NPV) ranged from 7.5% to 26.6% and 2.3% to 4.0%, respectively. The added value (PPV minus prior probability) in ruling in IAN ranged from 3.4% to 22.2%. The added value in ruling out IAN (NPV minus prior probability) ranged from 0.1% to 2.2%. Conclusions: For all 7 signs the NPV and added values are too low to consider them valid for ruling out postsurgical IAN in the decision making prior to MM3S. The PPV and added values for presence of the canal-related signs and darkening of root may be considered sufficient for ruling in the risk of postsurgical IAN injury in the decision making prior to MM3 surgery. ORAL SESSION 1: EVIDENCE BASED PRACTICE ORAL CAVITY CANCER FOLLOW-UP: PATTERN OF RECURRENCE M. Brands1, L. Smeekens2, A. Verbeek3, T. Merkx1, S. Geurts3 1Radboudumc, Department of Oral and Maxillofacial surgery, Nijmegen, Netherlands 2Radboud University Nijmegen, Medical Student, Nijmegen, Netherlands 3Radboudumc, Department for Health Evidence, Nijmegen, Netherlands Aims Routine follow-up after curative treatment of oral cancer (OC) for 5 years is common practice because second primaries and recurrences (i.e. second events) occur frequently. Current follow- up is not evidence based and the benefits are unclear. This is even more so for follow-up after a second event. To facilitate the development of a personalized follow-up program for OC, we investigated the timing of the second and subsequent events and aimed to define several risk groups related to the risk, timing and treatment intent of these events. Methods We retrospectively studied 594 patients treated for OC with curative intent in our unit in 2000- 2012. Overall survival was calculated with the Kaplan Meier method. Risk of recurrence was calculated taking death as competing risk into account. Results The risk of recurrence was highest in the first year after treatment (i.e. 17%). All locoregional recurrences occurred within 1.5 years after primary treatment (fig. 1). The incidence of second primary tumors was constant over the years (fig.1). It was not possible to define clinically relevant high and low risk groups for a second event. These patterns were similar for the third event. Conclusions Our findings support a shorter follow-up time of 1.5 years after curative treatment for OC. Based on patterns of recurrence, a separate follow-up protocol after treatment of second events is not necessary. Figure 1: cumulative incidence of locoregional recurrences, distant metastases and second primary tumors ORAL SESSION 1: EVIDENCE BASED PRACTICE TO COMPARE THE RECORDING OF TOBACCO HISTORY AND SMOKING CESSATION REFERRALS IN A PRIMARY CARE DENTAL PRACTICE (GDP) TO A SECONDARY CARE (MAXILLO-FACIAL UNIT) L. Maybin1, D. Keshani2 1Bradford Teaching Hospital Trust- Maxillo-facial, Maxillo-facial, Bradford, United Kingdom 2Bradford Teaching Hospital Trust, Maxillo-facial, Bradford, United Kingdom Introduction: Studies confirm a referral to a smoking cessation clinic has a good outcome for quitting smoking. The evidence behind the success of brief intervention has shown that just three minutes of brief intervention has helped 2% of smokers stop smoking and is cost effective in the long term. Aim: Identify tobacco/alcohol history record keeping. Identify the number of patients offered a SCR in primary vs secondary care. Gold standard: 100% of clinician should offer a SCR. Methodology: The audit compared GDPs and clinicians in secondary care. Retrospective data collection from March–April 2015, re-audited January-February 2016 and July-August 2016. The data recorded from 600 patients medical records included: the number of cigarettes smoked, years smoked, SCR offered and if the patient accepted or declined the referral. Additionally Alcohol units were recorded. Results: There has been a significant improvement of 3%-53% in the SCR
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