The use of the short preauricular incision in access to the TMJ

The use of the short preauricular incision in access to the TMJ

Abstracts / British Journal of Oral and Maxillofacial Surgery 47 (2009) e35–e69 was performed on each CT scan with the standard deviation, maximum, m...

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Abstracts / British Journal of Oral and Maxillofacial Surgery 47 (2009) e35–e69

was performed on each CT scan with the standard deviation, maximum, minimum and mean pixel values (Hounsefield Unit equivalent) recorded. A histogram was produced to delineate fat, muscle and haematoma in comparison to known values. The volume of each defect was also calculated. Preoperative CT reports and region of interest (ROI) analyses were compared to the operative findings in order to determine the sensitivity and specificity of each method. Clinical relevance: This new method of measurement may provide the clinician with a means to quantitively decide for or against orbital exploration. doi:10.1016/j.bjoms.2009.06.113 87 The use of the short preauricular incision in access to the TMJ Simon Holmes ∗ , Chris Bridle, Sonia Alam Barts and The London NHS Trust, United Kingdom The access to the TMJ and zygomatic arch as described by Al-Kayat and Bramley represents a seminal and oft quoted work. The original paper deals with the skin incision, together with management of the fascial tissues avoiding the upper branches of the facial nerve. Whilst the management of the temporalis fascia is as relevant and logical today as it was then, the skin incision is rarely practised in its full extent. Access to the TMJ is required in both traumatic and degenerative joint disease. Some conditions such as extended ankyloses and chondromas require larger incisions, but intracapsular surgery and modern lag screw fixation of intracapsular fractures do not. We present a series of 150 preauricular incisions with progressively shorter temporal incisions which have led to the development of an incision extending not beyond the superior attachment of the auricle. The technique is discussed with operative video demonstrating the access that can be achieve to the intracapsular space, and the head of the condyle. Whilst it is important to extend the incision to improve surgical access if required, these instances are entirely predictable preoperatively. We no longer routinely shave hair for this procedure. Cosmesis is excellent, operative time reduced, and we observed no facial verve involvement. doi:10.1016/j.bjoms.2009.06.114


88 Intraoperative 3-dimensional imaging in maxillofacial surgery; early experiences Sherif Bayoumi ∗ , S.F. Mustafa, S. Bhatia, A.W. Sugar, P.W. Baxter, S.J. Key Morriston Hospital, Swansea, United Kingdom Introduction: 2D intraoperative imaging is of limited value in Maxillofacial surgery due to the complex nature of head and neck anatomy. Recent advances offering three dimensional imaging using Cone Beam CT type acquisition has added a wealth of information enabling the surgeon to view complex anatomical structures, position of implants and fixation devices intraoperatively. Patients and methods: One of the small number of Carm imaging systems designed to be used in the operating theatre (Phillips BV Pulsera) was trialled on a series of 12 patients at Morriston Hospital, Swansea. It provides good quality three dimensional, axial, sagittal and coronal views and standard two dimensional C-arm images. A questionnaire was completed by the operating surgeon at the end of every procedure. Issues addressed were the ease of setting up the Carm, time taken to position the patient, acquiring the images and the usefulness of these images. Results: A case mix of emergency and elective procedures were performed including pan-facial trauma, orbital floor reconstruction, orthognathic surgery and distraction osteogenesis. A demonstration of the set up and use of this system will be presented together with a detailed analysis of the surgeons’ views and comments. Conclusion: Despite minor technical challenges, the intraoperative imaging system proved to be useful and effective in complex maxillofacial cases. It immediately highlights any inaccuracies allowing the operator to rectify them. It provides an on the spot confirmation of the good reduction of fractures and appropriate positioning of fixation devices or alloplastic implants reducing the need for postoperative imaging. doi:10.1016/j.bjoms.2009.06.115 89 Correction of lower lip ptosis using Mitek anchorage screws—a report of three cases Syedda Abbas ∗ , Manolis Heliotis, Harpoonam Kalsi, Caroline Mills Northwick Park Hospital, North West London Hospitals NHS Trust, United Kingdom Introduction: The lips are anatomically, physiologically and aesthetically important to the facial profile. Lower lip ptosis can cause cosmetic disfigurement and also a functional deficit in terms of speech and eating. It has a number of aetiologies but one of the commoner causes is multiple surgeries to the chin and incorrect or