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Hanazama Y, Itoh K, Mabashi T, Sato K. Closure of oroantral com- munications using a pedicled buccal fat pad graft. 1995 Jul;53(7):771-5; discussion 775-6 POSTER 010 In Vitro Photodynamic Treatment of S. Mutans With m-THPC Kyle J. Thorsrud, BSEME, 380 Campus Drive, Apt 2, Snyder, NY 14226 (Mang TS; Hall RE) Introduction: Photodynamic therapy (PDT), an oft used minimally invasive/surgical modality, has proven to be an effective treatment for many types of cancers. PDT is proving to be an interesting therapeutic approach to controlling cariogenic oral bacteria, specifically Strepto- coccus mutans. Objectives: The objective of this study was to deter- mine the killing efficacy of m-THPC and 652 nm laser light on streptococcus mutans. This photodynamic com- bination will be compared to previously studied photo- dynamic combinations of porfimer sodium and 630 nm laser light. Methods: Two planktonic photodynamic assays were conducted to quantify the killing efficacy of the photo- sensitizer and light combinations. The assays expose a planktonic suspension of S. mutans to the photosensi- tizer for fifteen minutes in darkness, and then treat with a prescribed light dose of specific wavelength. The sus- pension is diluted, plated on tryptic soy agar, and incu- bated in triplicate for seventy-two hours at 37°C. The colony forming units are quantified and compared across the control and treatment groups. The first assay tested the combinations of porfimer sodium, or Photofrin, and 630 nm laser light from a KTP/YAG-Dye laser combina- tion (Laserscope, San Jose CA). Photofrin (Axcan Pharma, Mt St. Hilaire QC) was investigated at a concen- tration of 24ug/mL with light doses of 15, 30, and 45 Joules. The second assay tested the combinations of meso-tetra-hydroxyphenol chlorin, or m-THPC (bioLitec, Farmingdale MA), and 652 nm laser light. m-THPC was investigated at concentrations of 10ug/mL and 1ug/mL with light doses of 1, 3, and 5 Joules. Results: The Photofrin assay showed light dose depen- dent killing of S. mutans. The following average kill percentages were found at their respective light dose: 40.91% at 15 J, 67.13% at 30 J, and 93.22% at 45 J. The m-THPC assay showed complete killing of S. mutans at all three light doses of 1, 3, and 5 Joules in concentra- tions of, 10ug/mL and 1ug/mL. Conclusion: m-THPC and 652 nm laser light are an effective photodynamic combination for killing S. mu- tans in vitro. It is a much more potent combination than Photofrin and 630 nm laser light. 652nm light may con- fer the advantage of deeper penetration into tissues than 630 nm laser light. Further studies should be conducted to identify concentration and light dose combinations to demonstrate light dose dependent killing, prior to con- duct of human clinical trials. References Chen J, Keltner L, Christophersen J, Zheng F, Krouse M, Singhal A, et al (2002). New technology for deep light distribution in tissue for phototherapy. Cancer J 8(2):154-163 Durantini E (2006). Photodynamic Inactivation of Bacteria. Current Bioactive Compounds 2(2):127-142 Funding Source: This investigation was supported (in part) by a Student Research Training Award from the Oral and Maxillofacial Surgery Foundation POSTER 011 Rigid Internal Fixation of Infected Mandible Fractures Emily J. Van Heukelom, DDS, Boston University Medical Center, YACC-5 Dept of Oral & Maxillofacial Surgery, 850 Harrison Ave, Boston, MA 02118 (Mehra P) Statement of Problem: Maxillomandibular fixation and external fixation devices have traditionally been used in the management of infected fractures. However, rigid internal fixation techniques offer benefits to the patient and are becoming more popular among surgeons. This study evaluated treatment outcomes of rigid internal fixation for management of infected mandible fractures. Patients and Methods: A retrospective chart review of infected mandible fracture cases managed by a single oral and maxillofacial surgeon with multiple residents at a level I trauma center over a seven year period was accomplished by independent examiners. All patients were treated with a standard protocol including one surgical operation for: incision and drainage with irriga- tion drain placement, culture and sensitivity testing, ex- traction of non-salvageable teeth, placement of MMF for one week postoperatively (when possible), fracture de- bridement and decortication, rigid internal fixation of the mandible by an extraoral approach, and intravenous antibiotic therapy. Medical and social history was con- tributory in the majority of patients. Analysis was com- pleted based on evaluation of patients with soft tissue infected fractures versus those with hard tissue infected fractures (biopsy-proven osteomyelitis). Method of Data Analysis: 44 patients with average follow up time of 18.2 months and minimum of 3 months were included. At follow-up appointments, clin- ical and radiographic exam were accomplished to assess presence of infection as well as evidence of fracture healing and hardware stability. Scientific Poster Session 74 AAOMS 2008

Poster 011: Rigid Internal Fixation of Infected Mandible Fractures

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Page 1: Poster 011: Rigid Internal Fixation of Infected Mandible Fractures

Hanazama Y, Itoh K, Mabashi T, Sato K. Closure of oroantral com-munications using a pedicled buccal fat pad graft. 1995 Jul;53(7):771-5;discussion 775-6

POSTER 010In Vitro Photodynamic Treatment of S.Mutans With m-THPCKyle J. Thorsrud, BSEME, 380 Campus Drive, Apt 2,Snyder, NY 14226 (Mang TS; Hall RE)

Introduction: Photodynamic therapy (PDT), an oftused minimally invasive/surgical modality, has proven tobe an effective treatment for many types of cancers. PDTis proving to be an interesting therapeutic approach tocontrolling cariogenic oral bacteria, specifically Strepto-coccus mutans.

Objectives: The objective of this study was to deter-mine the killing efficacy of m-THPC and 652 nm laserlight on streptococcus mutans. This photodynamic com-bination will be compared to previously studied photo-dynamic combinations of porfimer sodium and 630 nmlaser light.

Methods: Two planktonic photodynamic assays wereconducted to quantify the killing efficacy of the photo-sensitizer and light combinations. The assays expose aplanktonic suspension of S. mutans to the photosensi-tizer for fifteen minutes in darkness, and then treat witha prescribed light dose of specific wavelength. The sus-pension is diluted, plated on tryptic soy agar, and incu-bated in triplicate for seventy-two hours at 37°C. Thecolony forming units are quantified and compared acrossthe control and treatment groups. The first assay testedthe combinations of porfimer sodium, or Photofrin, and630 nm laser light from a KTP/YAG-Dye laser combina-tion (Laserscope, San Jose CA). Photofrin (AxcanPharma, Mt St. Hilaire QC) was investigated at a concen-tration of 24ug/mL with light doses of 15, 30, and 45Joules. The second assay tested the combinations ofmeso-tetra-hydroxyphenol chlorin, or m-THPC (bioLitec,Farmingdale MA), and 652 nm laser light. m-THPC wasinvestigated at concentrations of 10ug/mL and 1ug/mLwith light doses of 1, 3, and 5 Joules.

Results: The Photofrin assay showed light dose depen-dent killing of S. mutans. The following average killpercentages were found at their respective light dose:40.91% at 15 J, 67.13% at 30 J, and 93.22% at 45 J. Them-THPC assay showed complete killing of S. mutans atall three light doses of 1, 3, and 5 Joules in concentra-tions of, 10ug/mL and 1ug/mL.

Conclusion: m-THPC and 652 nm laser light are aneffective photodynamic combination for killing S. mu-tans in vitro. It is a much more potent combination thanPhotofrin and 630 nm laser light. 652nm light may con-fer the advantage of deeper penetration into tissues than630 nm laser light. Further studies should be conducted

to identify concentration and light dose combinations todemonstrate light dose dependent killing, prior to con-duct of human clinical trials.

References

Chen J, Keltner L, Christophersen J, Zheng F, Krouse M, Singhal A,et al (2002). New technology for deep light distribution in tissue forphototherapy. Cancer J 8(2):154-163

Durantini E (2006). Photodynamic Inactivation of Bacteria. CurrentBioactive Compounds 2(2):127-142

Funding Source: This investigation was supported (in part) by aStudent Research Training Award from the Oral and MaxillofacialSurgery Foundation

POSTER 011Rigid Internal Fixation of InfectedMandible FracturesEmily J. Van Heukelom, DDS, Boston UniversityMedical Center, YACC-5 Dept of Oral & MaxillofacialSurgery, 850 Harrison Ave, Boston, MA 02118(Mehra P)

Statement of Problem: Maxillomandibular fixation andexternal fixation devices have traditionally been used inthe management of infected fractures. However, rigidinternal fixation techniques offer benefits to the patientand are becoming more popular among surgeons. Thisstudy evaluated treatment outcomes of rigid internalfixation for management of infected mandible fractures.

Patients and Methods: A retrospective chart review ofinfected mandible fracture cases managed by a singleoral and maxillofacial surgeon with multiple residents ata level I trauma center over a seven year period wasaccomplished by independent examiners. All patientswere treated with a standard protocol including onesurgical operation for: incision and drainage with irriga-tion drain placement, culture and sensitivity testing, ex-traction of non-salvageable teeth, placement of MMF forone week postoperatively (when possible), fracture de-bridement and decortication, rigid internal fixation ofthe mandible by an extraoral approach, and intravenousantibiotic therapy. Medical and social history was con-tributory in the majority of patients. Analysis was com-pleted based on evaluation of patients with soft tissueinfected fractures versus those with hard tissue infectedfractures (biopsy-proven osteomyelitis).

Method of Data Analysis: 44 patients with averagefollow up time of 18.2 months and minimum of 3months were included. At follow-up appointments, clin-ical and radiographic exam were accomplished to assesspresence of infection as well as evidence of fracturehealing and hardware stability.

Scientific Poster Session

74 AAOMS • 2008

Page 2: Poster 011: Rigid Internal Fixation of Infected Mandible Fractures

Results: The treatment protocol was found to be suc-cessful in 100% of 18 patients with soft tissue infectedmandibular fractures and 92% or 24 of 26 patients withhard tissue infected fractures.

Conclusion: A protocol consisting of concomitant in-cision and drainage, mandibular debridement, fracturereduction and stabilization with rigid internal fixationhas predictable successful outcomes for management ofinfected mandible fractures.

References

Koury M, Perrott D, Kaban L. Use of rigid internal fixation inmandibular fractures complicated by osteomyelitis. J Oral MaxillofacSurg 52:1114, 1994

Benson PD, Marshall MK, Engelstad ME, et al. Use of immediate bonegrafting in reconstruction of clinically infected mandibular fractures:Bone grafts in the presence of pus. J Oral Maxillofac Surg 64:122, 2006

POSTER 012Determining the Optimal Length forResection Margins in Treating Oral SCCAllen C. Cheng, DDS, 1800 Turk Street #404, SanFrancisco, CA 94115 (Schmidt BL)

Objective: Oral squamous cell carcinoma (SCC) is adisease that is treated by surgical resection with a 1-1.5cm margin to achieve at least a 5 mm cuff of histopatho-logically normal tissue around the tumor1. Unfortu-nately, this threshold of 5 mm that distinguishes “close”margins from “clear” margins, which is used to predictprognosis and the need for additional therapy, is desig-nated arbitrarily2. The objective of this study is to deter-mine whether the margin length correlates to diseasefree survival and to determine what the appropriatepathological margin length is. A secondary objective is todetermine whether margin length correlates with otherclinical factors namely tumor sub-site, stage, and grade.

Methods: 43 patients were included in this study thatwere treated for primary oral SCC in the Department ofOral and Maxillofacial Surgery at the University of Cali-fornia, San Francisco (UCSF). All patients had tumorsresected with a 1 cm margin by one surgeon. The closesthistologic margin was reported by UCSF pathology. 8 ofthese patients received post-operative radiation therapy(RT). Patients were followed on a monthly basis for aminimum of two years and outcome data were collected.Mean margin length (MML) was compared between pa-tients who developed recurrence or died (R/D) andpatients who had disease free survival at two years(DFS). MML were also analyzed by tumor sub-site, stage,and grade. Sensitivity and specificity for predicting re-currence were calculated using 2, 3, 4, 5, 6, and 7 mm asthresholds for “close” and “clear” margins.

Results: MML by outcome were 4.7 mm for the DFSgroup and 3 mm for the R/D group (p � .097), 1.8 mm

and 2 mm (p � .83) when stratified for RT, 5.3 mm and3.1 mm (p � .05) when stratified by no RT. T1/T2tumors and T3/T4 tumors had MML of 4.8 mm and 2.6mm (p � .03) respectively. Tumors of the buccal muco-sa/retromolar trigone, mandible, maxilla, and tongue hadMML of 2.5, 2.9, 4.7, and 5.6 mm (p � .04) respectively.Grades 1, 2, and 3 tumors had MML of 3.3, 4.7, and 2.3(p � .26) respectively. When analyzed overall, using 3mm as the threshold gave the greatest sensitivity andspecificity for predicting residual or aggressive disease,with a sensitivity and specificity of 71% and 59% (p �.10). When analyzed among patients who did not receiveRT, the sensitivity and specificity using 3 mm was 73%and 67% (p � .07).

Conclusions: Margin length is not the definitive mea-sure of adequacy of resection and disease free survival.More likely, it is a measure of the aggressiveness of apatient’s tumor. 5 mm is probably not the ideal thresholdof margin length for all populations, and the use ofmargin length to predict outcome is less important whenusing post-operative RT.

References

Loree TR, Strong EW. Significance of positive margins in oral cavitysquamous carcinoma. Am J Surg Oct 1990;160(4):410–414

Sutton DN, Brown JS, Rogers SN, Vaughan ED, Woolgar JA. Theprognostic implications of the surgical margin in oral squamous cellcarcinoma. Int J Oral Maxillofac Surg Feb 2003;32(1):30–34

POSTER 013Interferon Alpha Therapy forManagement of Central Giant CellLesions of the JawsCang T. Huynh, DMD, MD, Emory University, Oral andMaxillofacial Surgery, 1365-B Clifton Road NE, Suite2300, Atlanta, GA 30322 (Roser SM; Bouloux GF)

The use of interferon alpha in combination with cu-rettage has been previously described as a promisingstrategy for treatment of aggressive giant cell lesions ofthe jaws. We performed a retrospective analysis of ourcases treated between 2004 and the present time. Ourcase series was unique in that a limited surgical curettageof the lesion was performed on all cases in order topreserve adjacent teeth and the inferior alveolar neuro-vascular bundle.

All subjects underwent a limited surgical curettageunder a general anesthesia. All diagnoses were con-firmed with routine histopathology. In all subjects therewas clear macroscopic evidence of residual disease atthe completion of the surgical procedure. This was doneto avoid potential damage to adjacent structures such asteeth and the inferior alveolar neurovascular bundle. Allsubjects began daily systemic treatment with interferonalpha via subcutaneous injection at 3 million units/m2

Scientific Poster Session

AAOMS • 2008 75