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30ongenital anomalies associated with cleft lip and palate

rabhjot Singh Sekhon∗, C. Bhasker Rao, A.F. Markus

SDM College of Dental Sciences and Hospital, Dharwad,ndia

Introduction: The association of cleft lip and palate withther congenital malformations has a documented incidence,arying from 1.5 to 63.4%.

Objective: Patients with oral clefts (OCs) often have otherssociated congenital defects. The reported incidence andypes of associated malformations vary between differenttudies. The purpose of this investigation was to assess therevalence of associated malformations in a geographicallyefined population in India.

Method: The prevalence, at birth, of associated malforma-ions in patients with OCs were collected between 2001 and004 prospectively on all patients who reported to the Cran-ofacial Unit and Research Centre, SDM College & Hospital,harwad, India.Results: Of the 1623 cleft patients seen during the period,

4.8% had associated malformations. Associated malforma-ions were most frequent in patients who had unilateral cleftip and palate (37%). The occurrence in cleft palate was2.5%, in bilateral cleft lip and palate 20%, in cleft lip with orithout alveolus 17% and submucous cleft 3.3%. The anoma-

ies were subdivided according to anatomical sites, the largestroup being the facial region (21.4%) followed by the ocular,entral nervous system, skeletal system, cardiovascular sys-em, neck and chest, auricular, gastrointestinal and urogenitalystem.

Conclusion: It was observed that the incidence of anoma-ies decrease along the cephalocaudal gradient, indicating theomplexity of craniofacial embryogenesis and morphogene-is in which a single, disruptive factor can lead to multiple,ascading, detrimental effects. This emphasizes the need forthorough investigation of infants with clefts. Genetic coun-

elling seems warranted in most of these complicated cases.

oi:10.1016/j.bjoms.2007.07.133

31etting ahead in maxillofacial: A 2-year retrospective

udit of clinical outcomes following cranioplasty

ohn V. Williams∗, D.M. Adlam, M.K. Thompson, M.G.ameron, J.S. Fraser

Addenbrooke’s Hospital, Cambridge, United Kingdom

Introduction: Cranioplasty is the surgical repair of cranialefects, usually as a result of surgical craniectomy. Whilstrauma is the most common event leading to cranioplasty, it

ay also be used in the management of cerebral infection,ongenital defects and neoplastic growth.

The indications for cranioplasty are essentially to improveosmesis and offer cerebral protection to defects of more

ant

illofacial Surgery 45 (2007) e1–e29

han 3cm diameter. More contentious indications are the alle-iation of neurological conditions and patient discomfort,ermed ‘sinking skin flap syndrome’. A 2 year retrospec-ive audit of clinical outcomes following cranioplasty waserformed.

Methods: The Maxillofacial Laboratory was approachedor a chronological list of patients for whom cranioplastyrostheses had been requested. Patient medical records wereraced for 160 patients. Following the application of inclu-ion criteria, the clinical outcomes of 90 procedures werebtained. An infection rate ‘standard’ of 10% was set.

Results: Clinically acceptable outcomes were achieved in3/90 (81%) of procedures. The main cause of failure wasnfection in 10/90 (11%). The time frame included prosthe-es constructed from acrylic and titanium, and infection waselated to the former.

Conclusions: The infection rate of 11% is comparable torevious studies and just breached the 10% standard applied.crylic prostheses have not been constructed since May 2005

nd a second prospective audit cycle is being undertaken toudit the infection rate with titanium prostheses.

oi:10.1016/j.bjoms.2007.07.134

32nferior alveolar nerve injury and surgical difficultyrediction in third molar surgery: The role of dentalanoramic tomography

ohammed El Maaytah∗, W. Jerjes, B. Swinson, T. Upile,. Thompson, S. Gittelmon, D. Baldwin, H. Hadi, M.ourvachis, N. Abizadeh, M. Al Khawalde, C. Hopper

Oral & Maxillofacial Surgery/Head & Neck Unit, Universityollege London Hospitals, United Kingdom

Introduction: The purpose of this study was to evaluatehe relationship between preoperative panoramic radiologicalndings and postoperative inferior alveolar nerve paraesthe-ia following third molar surgery and to assess the surgicalifficulty.

Materials and methods: This retrospective study involveswo groups of patients that were randomly selected. The firstroup presented with inferior alveolar nerve (IAN) paraes-hesia following surgery and the second group presented witho complications including IAN paraesthesia. Radiologicalndings were collected from the panoramic radiographs of

hose patients and compared to postoperative paraesthesia.Results: The application of Chi-square testing and logis-

ic regression showed that parameters like type of impactionfully impacted), depth of impaction (depth C), ramus/spaceclass 3), spatial relationship (distoangular and horizontal),umber of roots (multiple and incomplete), shape of rootthick and incomplete), shape of the tip of the root (curved

nd incomplete), relation to IAN (touching, superimpose oron-specific) are highly significant (p < 0.000) in predictinghe incidence of temporary and permanent paraesthesia.

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A classification tree has been developed and found to beery accurate in predicting permanent numbness (95%) ando numbness (100%) in third molar surgery depending on theadiological findings.

Conclusions: Surgical difficulty of impacted third molarsay be assessed radiographically through seven factors. By

eveloping a classification tree, it is easier to predict theossibility of temporary or permanent paraesthesia.

oi:10.1016/j.bjoms.2007.07.135

33hipps Cross Hospital referral letters audit

obina Jan∗, Nayeem Ali

Whipps Cross University Hospital NHS Trust, London,nited Kingdom

Introduction: Some PCTs assume ‘routine’ Oral surgeryases originally referred to secondary care can be treatedithin primary care, with triage based purely on the refer-

al letter. This Audit examines this assumption as well as theppropriateness of the referrals and the proportion of casesuitable for training Oral and Maxillofacial Surgery (OMFS)HOs.

Method: 122 referral letters were assessed, an attemptade to predict the treatment they would seem to require

nd suitability for primary or secondary care, thereby simu-ating a PCT triage process. The validity of these assumptionsas then tested by seeing the patients and noting the actual

reatment they needed.Results: A total of 122 routine referrals were seen by the

onsultant in OMFS.Only 26% could be accurately triaged from the referral

etter alone. Of these 28% proved suitable for primary care.owever, a third of these were suitable for SHO teaching.This audit demonstrated that only 9/122 (7%) could be

ccurately triaged as suitable for primary care from the refer-al letter alone. If cases suitable for teaching were retained inecondary care then this drops further to 6/122 (or 5% of theotal).

Conclusions:

With the information currently given in routine OMFSreferrals, it is not possible to determine the treatment needsfor the patient from the referral letter alone.A reasonable proportion of cases suitable for primary careare also suitable for teaching within the secondary caresetting.

A full analysis/discussion of the data and its implicationsor patient care will be given.

oi:10.1016/j.bjoms.2007.07.136

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illofacial Surgery 45 (2007) e1–e29 e11

34re-surgical evaluation of mandibular third molars usingomputed tomography imaging and cone beam volumet-ic tomography imaging

ichael W. Mahoney∗, Paul Monsour

Queensland Diagnostic Imaging, Australia

The poster will demonstrate a range of anatomic variantshat can affect treatment planning. Meaningful correlationetween the CT/CBCT images and Dental Panoramic (OPG)mages will also be demonstrated.

oi:10.1016/j.bjoms.2007.07.137

35n investigation of emergency dental splinting materials

ouise Mangnall∗, Ann Garrahy

Newcastle General Hospital, United Kingdom

Introduction: Emergency dental splinting in the generalospital setting is usually performed by the senior housefficer/foundation year doctor on the maxillofacial surgeryeam. Of necessity, this task is often performed without accesso dental chair-side facilities and without assistance whilender pressure to discharge the patient from the Accident &mergency department.

Aims: To establish the range of dental splinting materialsvailable for use in an Accident & Emergency departmentetting without the support of a dental assistant.

To compare and contrast the products within that range.To establish the cost per case of the selected materials.Material and methods: The maxillary dental cast of a

ubject in the late mixed dentition phase was measured tondicate the span of dental splinting required for fixation of ae-implanted avulsed central incisor and an adjacent reducedubluxed central incisor.

Dental suppliers catalogues, printed and online, werexamined. Based on published manufacturer’s claims, a listf dental splinting materials considered suitable for use inhe circumstances described above was prepared. One exam-le of each category of dental splinting material was selectedandomly.

Method of use, working and setting times and the needor chemical or mechanical adjuncts for each of the selectedroducts were compared and contrasted. The cost of materialor a single case was calculated for each product listed.

Statistical analysis was not performed. Product rankingas not performed.

Results: Qualitative results with unit costs will be pre-

ented in tabulated format.

oi:10.1016/j.bjoms.2007.07.138