e10 Abstracts / British Journal of Oral and Maxillofacial Surgery 45 (2007) e1e29

P 30
Congenital anomalies associated with cleft lip and palate
Prabhjot Singh Sekhon

, C. Bhasker Rao, A.F. Markus

SDM College of Dental Sciences and Hospital, Dharwad,
India
Introduction: The association of cleft lip and palate with
other congenital malformations has a documented incidence,
varying from 1.5 to 63.4%.
Objective: Patients with oral clefts (OCs) often have other
associated congenital defects. The reported incidence and
types of associated malformations vary between different
studies. The purpose of this investigation was to assess the
prevalence of associated malformations in a geographically
dened population in India.
Method: The prevalence, at birth, of associated malforma-
tions in patients with OCs were collected between 2001 and
2004 prospectively on all patients who reported to the Cran-
iofacial Unit and Research Centre, SDMCollege &Hospital,
Dharwad, India.
Results: Of the 1623 cleft patients seen during the period,
14.8% had associated malformations. Associated malforma-
tions were most frequent in patients who had unilateral cleft
lip and palate (37%). The occurrence in cleft palate was
22.5%, in bilateral cleft lip and palate 20%, in cleft lip with or
without alveolus 17%andsubmucous cleft 3.3%. The anoma-
lies were subdivided according to anatomical sites, the largest
group being the facial region (21.4%) followed by the ocular,
central nervous system, skeletal system, cardiovascular sys-
tem, neck and chest, auricular, gastrointestinal and urogenital
system.
Conclusion: It was observed that the incidence of anoma-
lies decrease along the cephalocaudal gradient, indicating the
complexity of craniofacial embryogenesis and morphogene-
sis in which a single, disruptive factor can lead to multiple,
cascading, detrimental effects. This emphasizes the need for
a thorough investigation of infants with clefts. Genetic coun-
selling seems warranted in most of these complicated cases.
doi:10.1016/j.bjoms.2007.07.133
P 31
Getting ahead in maxillofacial: A 2-year retrospective
audit of clinical outcomes following cranioplasty
John V. Williams

, D.M. Adlam, M.K. Thompson, M.G.

Cameron, J.S. Fraser
Addenbrookes Hospital, Cambridge, United Kingdom
Introduction: Cranioplasty is the surgical repair of cranial
defects, usually as a result of surgical craniectomy. Whilst
trauma is the most common event leading to cranioplasty, it
may also be used in the management of cerebral infection,
congenital defects and neoplastic growth.
The indications for cranioplasty are essentially to improve
cosmesis and offer cerebral protection to defects of more
than 3cmdiameter. More contentious indications are the alle-
viation of neurological conditions and patient discomfort,
termed sinking skin ap syndrome. A 2 year retrospec-
tive audit of clinical outcomes following cranioplasty was
performed.
Methods: The Maxillofacial Laboratory was approached
for a chronological list of patients for whom cranioplasty
prostheses had been requested. Patient medical records were
traced for 160 patients. Following the application of inclu-
sion criteria, the clinical outcomes of 90 procedures were
obtained. An infection rate standard of 10% was set.
Results: Clinically acceptable outcomes were achieved in
73/90 (81%) of procedures. The main cause of failure was
infection in 10/90 (11%). The time frame included prosthe-
ses constructed from acrylic and titanium, and infection was
related to the former.
Conclusions: The infection rate of 11% is comparable to
previous studies and just breached the 10% standard applied.
Acrylic prostheses have not been constructed since May 2005
and a second prospective audit cycle is being undertaken to
audit the infection rate with titanium prostheses.
doi:10.1016/j.bjoms.2007.07.134
P 32
Inferior alveolar nerve injury and surgical difculty
prediction in third molar surgery: The role of dental
panoramic tomography
Mohammed El Maaytah

, W. Jerjes, B. Swinson, T. Upile,

G. Thompson, S. Gittelmon, D. Baldwin, H. Hadi, M.
Vourvachis, N. Abizadeh, M. Al Khawalde, C. Hopper
Oral &Maxillofacial Surgery/Head &Neck Unit, University
College London Hospitals, United Kingdom
Introduction: The purpose of this study was to evaluate
the relationship between preoperative panoramic radiological
ndings and postoperative inferior alveolar nerve paraesthe-
sia following third molar surgery and to assess the surgical
difculty.
Materials and methods: This retrospective study involves
two groups of patients that were randomly selected. The rst
group presented with inferior alveolar nerve (IAN) paraes-
thesia following surgery and the second group presented with
no complications including IAN paraesthesia. Radiological
ndings were collected from the panoramic radiographs of
those patients and compared to postoperative paraesthesia.
Results: The application of Chi-square testing and logis-
tic regression showed that parameters like type of impaction
(fully impacted), depth of impaction (depth C), ramus/space
(class 3), spatial relationship (distoangular and horizontal),
number of roots (multiple and incomplete), shape of root
(thick and incomplete), shape of the tip of the root (curved
and incomplete), relation to IAN (touching, superimpose or
non-specic) are highly signicant (p <0.000) in predicting
the incidence of temporary and permanent paraesthesia.
Abstracts / British Journal of Oral and Maxillofacial Surgery 45 (2007) e1e29 e11
A classication tree has been developed and found to be
very accurate in predicting permanent numbness (95%) and
no numbness (100%) in third molar surgery depending on the
radiological ndings.
Conclusions: Surgical difculty of impacted third molars
may be assessed radiographically through seven factors. By
developing a classication tree, it is easier to predict the
possibility of temporary or permanent paraesthesia.
doi:10.1016/j.bjoms.2007.07.135
P 33
Whipps Cross Hospital referral letters audit
Robina Jan

, Nayeem Ali
Whipps Cross University Hospital NHS Trust, London,
United Kingdom
Introduction: Some PCTs assume routine Oral surgery
cases originally referred to secondary care can be treated
within primary care, with triage based purely on the refer-
ral letter. This Audit examines this assumption as well as the
appropriateness of the referrals and the proportion of cases
suitable for training Oral and Maxillofacial Surgery (OMFS)
SHOs.
Method: 122 referral letters were assessed, an attempt
made to predict the treatment they would seem to require
and suitability for primary or secondary care, thereby simu-
lating a PCTtriage process. The validity of these assumptions
was then tested by seeing the patients and noting the actual
treatment they needed.
Results: A total of 122 routine referrals were seen by the
Consultant in OMFS.
Only 26% could be accurately triaged from the referral
letter alone. Of these 28% proved suitable for primary care.
However, a third of these were suitable for SHO teaching.
This audit demonstrated that only 9/122 (7%) could be
accurately triaged as suitable for primary care from the refer-
ral letter alone. If cases suitable for teaching were retained in
secondary care then this drops further to 6/122 (or 5% of the
total).
Conclusions:
With the information currently given in routine OMFS
referrals, it is not possible to determine the treatment needs
for the patient from the referral letter alone.
A reasonable proportion of cases suitable for primary care
are also suitable for teaching within the secondary care
setting.
A full analysis/discussion of the data and its implications
for patient care will be given.
doi:10.1016/j.bjoms.2007.07.136
P 34
Pre-surgical evaluation of mandibular third molars using
computed tomography imaging and cone beam volumet-
ric tomography imaging
Michael W. Mahoney

, Paul Monsour
Queensland Diagnostic Imaging, Australia
The poster will demonstrate a range of anatomic variants
that can affect treatment planning. Meaningful correlation
between the CT/CBCT images and Dental Panoramic (OPG)
images will also be demonstrated.
doi:10.1016/j.bjoms.2007.07.137
P 35
An investigation of emergency dental splinting materials
Louise Mangnall

, Ann Garrahy
Newcastle General Hospital, United Kingdom
Introduction: Emergency dental splinting in the general
hospital setting is usually performed by the senior house
ofcer/foundation year doctor on the maxillofacial surgery
team. Of necessity, this taskis oftenperformedwithout access
to dental chair-side facilities and without assistance while
under pressure to discharge the patient from the Accident &
Emergency department.
Aims: To establish the range of dental splinting materials
available for use in an Accident & Emergency department
setting 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
subject in the late mixed dentition phase was measured to
indicate the span of dental splinting required for xation of a
re-implanted avulsed central incisor and an adjacent reduced
subluxed central incisor.
Dental suppliers catalogues, printed and online, were
examined. Based on published manufacturers claims, a list
of dental splinting materials considered suitable for use in
the circumstances described above was prepared. One exam-
ple of each category of dental splinting material was selected
randomly.
Method of use, working and setting times and the need
for chemical or mechanical adjuncts for each of the selected
products were compared and contrasted. The cost of material
for a single case was calculated for each product listed.
Statistical analysis was not performed. Product ranking
was not performed.
Results: Qualitative results with unit costs will be pre-
sented in tabulated format.
doi:10.1016/j.bjoms.2007.07.138