Oral and maxillofacial surgery

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