1196 Sonographic Assessment Versus Direct Clinical Measurement of Sialolith Size and Its Influence on Modality of Endoscopic Removal

Aim

The aim of this retrospective case series was to investigate the influence of sialolith size on the potential for endoscopic stone removal.

Method

The records of 52 patients who underwent salivary endoscopy between September 2018 and February 2020 were reviewed. Included cases presented with at least one symptomatic major salivary gland, and sonographic or radiographic evidence of stone disease.

Results

A total of 25 patients (48%) and 27 stones were identified. These patients had a mean age of 45.2 years (range 16–72); 52% were female. Most cases (19/25) involved the submandibular gland, with a virtually even division between left and right sides. The overall success rate of sialendoscopic retrieval was 23/27 (85%), with 17/27 stones removed intact and 6/27 undergoing fragmentation with an intraoral salivary pneumatic lithotripter (Cook Medical). Median (sonographic) stone size in the largest dimension for those stones removed intact was 4mm (range 3-12mm), while for those undergoing fragmentation it was 7mm (range 3-11mm). Ultrasound provided an accurate assessment of stone size in most cases, but underestimated diameter by an average of 1mm in 6/27 cases, and overestimated size by 1mm in a single case.

Conclusions

Sialendoscopic stone retrieval is a minimally invasive and effective treatment for sialolithiasis. It is possible to remove most stones using a basket, with intraoral lithotripsy employed for larger stones. Ultrasound is a reliable diagnostic tool for predicting stone size but may underestimate size in a small proportion of cases.

1203 Sialendoscopy In Non-Stone Sialadenitis Is an Effective Therapeutic Approach

Introduction

The aim of this retrospective case series was to investigate the therapeutic effectiveness of salivary endoscopy for non-stone related sialadenitis and obstructive symptoms.

Method

The records of 46 patients who underwent salivary endoscopy between September 2018 and December 2019 were reviewed. Included cases presented with at least one symptomatic major salivary gland, with no history or evidence of stone disease on clinical or radiologic examinations.

Results

A total of 22 patients (48%) and 26 glands were identified. These patients had a mean age of 50.8 years (range 27–74) and 73% were female. Most cases (19/26) involved the parotid gland. The primary imaging modality used was ultrasound, with sialography reserved for suspected strictures. The most common sonographic finding was ductal dilation (50%). Dexamethasone was instilled at completion of sialendoscopy in 23/26 cases. Outcomes included symptomatic improvement in 15/18 patients (4 patients have follow-up pending) with 5/15 experiencing complete symptom resolution. 2/18 patients did not have any symptomatic improvement, and 1/18 experienced acute infection that was treated with antibiotics. No patients required gland excision.

Conclusions

Salivary endoscopy is a minimally invasive and effective treatment for patients with non-stone sialadenitis that is refractory to conservative measures. Our review demonstrated 83% therapeutic benefit with gland preservation in all patients.

1395 The Influence of Shortened Antimicrobial Courses in Surgical Management of Mid 1/3rd Facial Fractures

Aim

Antimicrobial resistance (AMR) is an increasing issue posing a grave threat to global public health. A prospective pilot study within our OMFS unit investigated the effects a shortened course of perioperative antimicrobial cover had on infective post-operative complications in patients who had surgical management of mid 1/3rd facial fractures.

Method

As per the World Health Organisation (WHO) global action plan on antimicrobial resistance, with our microbiology team we developed and implemented a shortened antimicrobial protocol for use in the surgical management of mid 1/3rd facial fractures. Following protocol implementation, the records of 55 patients who underwent surgery for their mid 1/3 facial fractures between May 2019 and May 2020 were reviewed.

Results

Of 55 patients who underwent surgical management of mid 1/3rd facial fractures 28/55 (50.9%) were prescribed a shortened course of perioperative antimicrobials depending on whether an intra or extra oral surgical approach was used, whilst 27/55 (49.1%) were prescribed a longer course of antimicrobials. Of those given a shortened course of antimicrobials 1/28 (3.6%) experienced infective post-operative complications. Conversely 4/27 (14.8%) of those given a longer course of antibiotics experienced infective post-operative complications.

Conclusions

This data supports growing evidence that shorter courses of antimicrobials are appropriate in the surgical management of facial fractures. As OMFS surgeons we can utilise evidence-based medicine to provide optimal surgical care whilst simultaneously contributing to healthcare professionals’ obligations to tackle the increasing challenge of antimicrobial resistance.

1633 Developing Confidence in Dental Core Trainees; A National Review of The Trainee Experience

Aim

In the U.K, Dental Core Training (DCT) is an elective postgraduate training programme. There are over 700 DCT jobs with the majority in Oral and Maxillofacial Surgery (OMFS). Our focus was to measure the confidence and skills of 103 DCTs, as they mature during a year in OMFS.

Method

OMFS DCTs answered questionnaires in month 1, 3 and 6 of their training post, regarding confidence and proficiency in assessment of dental infections, facial fractures, swellings, pathology, airway risk, imaging and performing suturing.

Results

In month 1, 55% of DCTs were ‘somewhat confident’ in performing intra-oral suturing and assessing dento-facial infection out of the skills assessed. Only 22% of DCTs were ‘extremely confident’ in any competencies. Specifically, DCTs felt ‘not at all confident’ with interpretation of scans (78%) and assessment of facial fractures (35%). Between month 1 and month 6 there has been an increase in confidence across all competencies. Notably, a 42% confidence increase in extra-oral suturing and 61% increase in assessing mandibular fractures.

Conclusions

We demonstrate that an OMFS training year improves confidence in clinical skills and that an adequate time in a post is required to attain that. Our results highlight areas where DCTs lack confidence early in their posts. These could be targeted at dental school, during the hospital induction process or through guided support and training in the initial phase of their jobs. This study adds clarity to both dentists and doctors contemplating a training year in OMFS and gives insight into how to support and train them.

1341 Outcomes of Sialendoscopic Stone Retrieval Under Local Anaesthesia in The Outpatient Setting- A Single Surgeon’s Experience

Aim

The aim of this retrospective case series was to investigate the success rate of sialendoscopic stone retrieval under local anaesthetic.

Method

The records of 52 patients who underwent salivary endoscopy between September 2018 and February 2020 were reviewed. Included cases presented with at least one symptomatic major salivary gland, and sonographic or radiographic evidence of stone disease.

Results

A total of 25 patients (48%) and 27 stones were identified. Most cases (19/25) involved the submandibular gland, with a virtually even division between left and right sides. 19/25 patients underwent stone retrieval under local anaesthetic (LA) in the first instance (two of these patients had two stones). 6/25 patients underwent stone retrieval under general anaesthetic (GA) in the first instance, and this was successful in 5/6 cases. The overall success rate of LA sialendoscopic stone retrieval was 18/21 (86%), with 14/21 stones (66%) being successfully removed at the first treatment session and a further four at the subsequent treatment session. Under LA, 13/18 stones were removed intact, while the remaining 5 underwent fragmentation with an intraoral salivary pneumatic lithotripter (Cook Medical).

Conclusions

Sialendoscopic stone retrieval is a minimally invasive and effective treatment for both submandibular and parotid duct stones. It is possible to remove most stones under local anaesthetic at the first treatment session, using intraoral lithotripsy as an adjunct when indicated. This treatment modality provides therapeutic benefit with 86% success of stone retrieval under local anaesthetic with gland preservation in the vast majority of patients.

Factors influencing local control in patients undergoing breast conservation surgery for ductal carcinoma in situ

BACKGROUND

The aim of our study was to assess various predictors for local recurrence (LR) in patients undergoing breast conservation surgery (BCS) for ductal carcinoma in situ (DCIS).

MATERIALS AND METHODS

An audit was performed of 582 consecutive patients with DCIS between Jan 1975 to June 2008. In patients undergoing BCS, local guidelines reported a margin of ≥10 mm during the above period. Guideline with regard to margin of excision changes soon after this period. We retrospectively analysed clinical and pathological risk factors for local recurrence in patients undergoing BCS. Statistical analysis was carried out using SPSS version 19, and a cox regression model for multivariate analysis of local recurrence was used.

RESULTS

Overall 239 women had BCS for DCIS during the above period. The actuarial 5-year recurrence rate was 9.6%. The overall LR rate was 17% (40/239. LR was more common in patients ≤50 years: (10/31 patients, 32%) compared to patients > 50 years (30/208, 14%, P = 0.02). Forty three per cent of patients (6/14) with <5 mm margin developed LR which was significantly higher compared to patients with 5-9 mm margin (12%, 3/25) and with ≥10 mm margin (14%, 27/188, P = 0.01). On multivariate analysis age ≤50 years, <5 mm pathological margin were independent prognostic factors for local recurrence.

CONCLUSION

Our study shows that younger age (≤50 years) and a margin < 5 mm are poor prognostic factors for LR in patients undergoing breast conservation surgery for DCIS.

Flexor tendon excursion and load during passive and active simulated motion: a cadaver study

The aim of this study was to quantify the amount of tendon excursion and load experienced during simulated active and passive rehabilitation exercises. Six cadaver specimens were utilized to examine tendon excursion and load. Lateral fluoroscopic images were used to measure the excursions of metal markers placed in the flexor digitorum superficialis and profundus tendons of the index, middle, and ring fingers. Measurements were performed during ten different passive and active simulated motions. Mean tendon forces were higher in all active versus passive movements. Blocking movements placed the highest loads on the flexor tendons. Active motion resulted in higher tendon excursion than did passive motion. Simulated hook position resulted in the highest total tendon excursion and the highest inter-tendinous excursion. This knowledge may help optimize the management of the post-operative exercise therapy regimen.