international programme symposium optimisation in cmf trauma care · 2017-07-21 · 1 optimisation...
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OptimisatiOn in CMF trauMa
care
PROG
RAM
ME
Spring Meeting of the Dutch Association of Oral and Maxillofacial Surgery/
International Symposium Optimisation in CMF traumacare
i nte rnati onal s ymp os i um
May 19-20, 2016 Groningen, the Netherlands
Nederlandse Vereniging voor Mondziekten, Kaak- en Aangezichtschirurgie
Dutch association of Oral and maxillofacial surgery
Wenckebach Instituut
3267
0692
-NL-1
410
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OptimisatiOn in CMF trauMa
care
i nte rnati onal s ymp os i um
May 19-20, 2016 Groningen, the Netherlands
Wenckebach Instituut
Spring Meeting of the Dutch Association of Oral and Maxillofacial Surgery/
International Symposium Optimisation in CMF traumacare
Nederlandse Vereniging voor Mondziekten, Kaak- en Aangezichtschirurgie
Dutch association of Oral and maxillofacial surgery
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3
index
Dutch association of Oral and maxillofacial surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
preface – Welcome to Groningen! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
about Groningen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
addresses and travel directions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
List of sponsors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
scientific programme . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Keynote speakers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
abstracts free papers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
summaries teD talks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
colophon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
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Dutch Association of Oral and Maxillofacial Surgery
EXECUTIVE BOARD president prof . dr . F .K .L . spijkervetsecretary Dr . r .H . Groottreasurer Dr . J .e . BergsmaVice president prof . dr . J . de Langepast president Dr . th .J .m . Hoppenreijscommunications Dr . J . pijpe
Honorary president prof . dr . m . Hut †
Honorary members prof . dr . W .a .m . van der Kwast † prof . dr . G . Boering † prof . dr . p . egyedi prof . dr . H .p .m . Freihofer prof . c .a . merkx † prof . dr . G . pfeifer † prof . dr . p .J .W . stoelinga prof . dr . i . van der Waal sir terence Ward † prof . dr . L .G .m . de Bont prof . dr . J .L .n . roodenburg
Members of merit Dr . G .J . van Beek Dr . a .V . van Gool Dr . J . Hovinga J .a . tolmeijer † Dr . J .i .J .F . Vermeeren Dr . th .c . Vriezen B . Witsenburg
Organisation Committeeprof . dr . F .K .L . spijkervetDr . B . van minnenmrs . L . Kempersmrs . n .e . Geurts-Jaeger
Scientific Committeeprof . dr . r .r .m . BosDr . B . stegengaDr . B . van minnenDr . a .c . van LeeuwenDr . m .H .J . Doff
Conference Office Wenckebach institute / UmcG, Groningen
mr . H . Gubbels
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Welcome to Groningen!
Dear colleagues,
this year the Dutch association of Oral and maxillofacial surgery (nVmKa) celebrates its 60th
anniversary . in this time frame our specialty has been tremendously changed due to achievements in
knowledge based on scientific evidence and clinical craftsmanship .
One of our fields with major developments is the cranio maxillofacial trauma care; it is only 25 years
back in time that the first possibilities came available to reduce midfacial fractures with mini-plates and
screws, as before the treatment possibilities were mainly related to wire fixation techniques .
nowadays our focus should be on optimisation of care, by combining the possibilities of all different
fields involved together in care paths, which makes complex treatment more efficient and provides
more predictable outcomes .
With the selection of the previous board of the Dutch association to hold their 2016 spring meeting in
Groningen, we feel very honored to be able to focus on this subject of cmF trauma care as a farewell
for prof . ruud Bos . He is the first dedicated professor in cmF trauma in the netherlands, and will retire
this year .
the symposium will focus on the current insights on fracture fixation, the accurate preoperative
imaging and planning, with consideration on esthetic awareness .
the compact university city of Groningen provides us an excellent environment to join each other for
both the academic as well as the social point of the meeting .
On behalf of the Department of OmF surgery Groningen
and the Dutch association of Oral and maxillofacial surgery,
Fred spijkervet
chairman Department of Oral maxillofacial surgery
president Dutch association of Oral and maxillofacial surgery
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About Groningen
Some Facts concerning the City of Groningen
Groningen is the major city of the northern netherlands and, with a population of 200,000, the eighth
largest city in the netherlands .
Groningen has a university, a university of applied sciences, a school for fine art and design, an academy
of music and many more training institutes . Because of all these institutes, half the population is under
35, allowing Groningen to be able to call itself the “youngest” city of the netherlands . Besides being a
university city, Groningen is also at the leading edge in the development of research, innovation and
entrepreneurship . in other words, Groningen is a real city of talent .
city of talent is a strategic partnership in which the municipality of Groningen, the University of
Groningen, the University medical center Groningen (UmcG), the Hanzehogeschool Groningen and
the province of Groningen have joined forces .
they are investing half a billion euros in innovation and knowledge infrastructure in the city over the
coming years . a considerable share of the amount will be spent on innovation in the fields of energy,
ict, life sciences and nanotechnology .
Groningen strongly believes in the riches of the arts and therefore generously invests in creative talent .
Besides the many permanent theatres and other performance venues, Groningen hosts a number of
(annual) shows and festivals, attracting visitors in their hundreds of thousands from far and wide . many
Dutch rock groups have seen their careers launched at the Festival eurosonic / noorderslag which is
held each year in January . the noorderzon theatre Festival, which is held each late summer, provides a
mix of young talent, new productions and established performers .
also its wide range of museums is bound to provide a few surprises . they include the museum of
Groningen, the anatomical museum, the northern maritime museum, the niemeijer tobacco
museum, the Gerardus van der Leeuw anthropological museum, the museum of Graphic arts and the
University museum .
Groningen is a city with varied opportunities for living, working, shopping and relaxing . it is rich in
history and offers plenty for the visitor to see . around the Grote markt is a shopping area with a choice
of stores, shops and boutiques providing everything one can possibly wish for . three days a week there
is a busy produce and goods market in the two central squares Grote markt and Vismarkt . When tired
from sight-seeing and shopping you are welcome to enjoy a cup of coffee and more in one of the many
cafés, pubs and restaurants .
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the city center boasts no fewer than 160 bars, cafés and discotheques, and scores of open-air terraces
on which to enjoy a balmy summer evening . there is something for everyone - from the traditional
Dutch ‘brown café’ to the trendiest hi-tech . and because Groningen is the ‘youngest’ city in the
netherlands (there are many students and over half the population are under thirty-five) these bars are
not only lively at weekends, but on weekdays as well . Groningen was elected ‘Best inner city 2007’ . also
with regard to prices there is much variation . the same counts for hotels . there is variation, but hotel
accommodation is reasonably priced .
Of course, the city center is not all bars and cafés . it is also a district in which people live, work, shop
and soak up a little culture . it is rich in history and offers plenty for the visitor to see . the central square,
Grote markt, is undergoing a remarkable transformation in these years .
many newspaper articles, both national and international, have been devoted to the architectural highlights: the renowned museum of Groningen . Buildings such as the remarkable yet reserved public
Library, the ‘organic’ Gasunie headquarters, the nostalgic Waagstraat project and the painstakingly
restored railway station have also been singled out as architectural treasures in their own right .
in the city centre the Groninger Forum will arise; a huge project that will conclude in 2017 . it will be
a meeting place, a center of knowledge and culture, containing the archives and a debating centre . a
cinema, the public library and parts of the Groninger museum will find a place here .
Groningen’s main higher educational institutes - the Hanzehogeschool and the University of Groningen
- have a total of 48,500 students, who are able to enjoy an unrivalled range of opportunities . there are
over 275 different courses on offer . the Hanzehogeschool aims to develop independent, creative and
critical minds, with the ‘new media’ playing an important part in its curriculum . the Hanzehogeschool
includes a music conservatorium and the minerva academy of art .
Some facts concerning the University Medical Center Groningen
the UmcG is the only university medical center in the northern part of the netherlands, and therefore
the final point of referral for many patients .
patients go to the UmcG for basic care as well as highly specialist top clinical and top reference care,
such as organ transplants, complex neuro-surgery, neonatology, clinical genetics, in Vitro Fertilization
(iVF), pediatric oncology, renal dialysis and traumatology . all medical and dental specialties are
represented, as well as education programs for all medical disciplines .
the UmcG focuses on healthy ageing in all priority areas: research, clinical care and education . the
healthy ageing-related research is bundled in the institute of Healthy ageing . this institute forms
the shell in which the healthy ageing activities are embedded, such as the cohort study LifeLines, the
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UmcG center for Geriatric medicine (UcO) and the european research institute on the Biology of
ageing (eriBa) .
the more than 10,000 employees and 1,300 beds make the UmcG one of the largest hospitals in the
netherlands . it is sometimes called ‘a city inside a city’, because of the architecture, with covered
streets that lead to the nursing units and outpatients clinics . moreover, thousands of employees
provide numerous services to even a greater number of patients and visitors . each year, many symposia
are organized in the hospital, with participants from abroad . there are shops, a branch of one of the
national banks, gardens, as well as lunchrooms, in order to make patients less aware that they are in a
hospital . this philosophy has led to a hospital that is unique in europe .
research at the UmcG is characterized by a combination of fundamental and patient oriented clinical
research . the interaction between these two stimulates the development of new clinical and research
opportunities . problems that occur in the clinical practice act as a catalyst which sets new fundamental
research in motion, whereas fundamental research can come up with new clinical possibilities .
the UmcG is demonstrably among the best scientific educational institutes in the netherlands in
the area of medicine, dentistry and human movement sciences . Groningen is not only renowned for
its successful modernization of scientific education, but also has a reputation for its innovation of
nursing education and competency-based continuing education, training and courses to (para)medics
and nurses . the fact that the UmcG is a forerunner in the development of education and training is
underlined by the hyper-modern UmcG Wenckebach skills center . in this mini hospital, with operating
and patient rooms and an intensive care Unit, healthcare providers from different disciplines and
educational levels undergo virtual and ‘almost real’ training to practice skills, new surgery techniques
and treatment methods . training for other aspects, such as teamwork, is also available in the skills
center . at the bottom of this page, you will find a link to more information .
the UmcG is one of the very few hospitals worldwide that perform all organ transplants . this does
not only concern kidney, heart, lung, liver, and small bowel transplants, but also combined organ
transplants, such as heart-lung, lung-liver, and liver-kidney transplants . the UmcG annually performs
over 150 organ transplants . apart from organ transplants, also skin, thin bowel, heart valve, cornea,
bone and bone marrow transplants are carried out .
the UmcG is one of ten recognized trauma centers in the netherlands . it has all the necessary
specialties and facilities at its disposal to immediately treat patients from serious traffic accidents, work-
related accidents or violent crimes . in addition, the UmcG has its own trauma helicopter . the UmcG’s
catchment area covers one-third of the netherlands . moreover, many locations are remote and difficult
to reach . therefore, a helicopter is indispensable in getting the specialized medical team, the mobile
medical team (mmt), quickly to the scene of an accident . the mmt consists of consultants who can
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anaesthetize patients on the spot, and are capable of performing small surgical procedures . the trauma
helicopter is especially equipped for accident victims . For them, quick, high-quality treatment is crucial .
the UmcG architectures sets it apart from other hospitals . the influence of the patient has played a
decisive part in this . the UmcG is designed to embody the reliability of a bank and the kindness of a
community center . construction began in 1983 and is still ongoing . architects and builders succeeded
one another, and each of the outpatients’ clinics was designed by a different interior decorator . each
outpatient’s clinic has its own image and unique identity . the building itself does not dominate or
overwhelm, but instead empowers the patients who visit it and the people who work there . this makes
the UmcG one of the finest state-of-the-art hospitals of europe .
Facts (2013)
• number of employees: 12,425
• number of medical students: 3,850
• number of hospital beds: 1,339
• number of consultations: 521,309
• number of admissions: 37,249
• 181 phD defenses per year
• 2,050 scientific publications per year
Some Facts concerning the University of Groningen
the University of Groningen has a rich academic tradition dating back to 1614 . Out of this tradition rose
a nobel prize-winner, the first woman student and the first woman lecturer in the netherlands, the first
Dutch astronaut and the first president of the european central Bank . Geographically, the university is
rooted in the north of the netherlands, a region very close to its heart .
the university provides high quality research and education in a broad and varied range of fields of
study . it is distinguished by the close bond the University of Groningen creates between research and
education, a bond that does justice to their mutual dependence .
as an institution of scientific research and education the university works at the forefront in its
respective fields . the university undertakes its co-operative relations on the basis of openness
and equality . in these relationships, the university is socially involved, purposeful and creative .
the university stimulates current debate on scientific, social and cultural issues . the University of
Groningen comes across as clear and convincing in such debates .
research and education at the University of Groningen is internationally oriented . students from every
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continent prepare themselves in Groningen for their international career paths . researchers operating
within an extensive network of cooperation contacts work at the threshold of knowledge, thus
affirming the university’s worldwide renown and reputation .
Facts • 26,700 students
• 6,000 first year students
• 4,691 fte staff
• 364 fte professors
• 1,500 phD students
• 60 Bachelor’s programmes, 115 master’s programmes
• 75 english-taught master’s programmes, of which 10 Double Degree programmes
• 8 english-taught Bachelor’s prowgrammes
• 16 research masters
• 9 faculties, 9 Graduate schools
• turnover: 550 million
http://www .rug .nl
SAVET H EDATE
MegaGenEuropeanScientificMeetingLondon, United Kingdom15 OCTOBER 2016
“I nnovat ion: tools , techniques or both?”
Dr. Kwang Bum Park
Dr. Jong Cheol Kim
Dr. Howard Gluckman
Dr. SamuelLee
Prof. Giuseppe Luongo
Dr. Zaki Kanaan
Dr. Davide Farronato
Dr. Achraf Souayah
Dr. Souheil Bechara
Dr. Iulian Filipov
Dr. Mikkel Ro Larsen
www.megagen.nl
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Venuethe symposium will be held at the University medical center Groningen (UmcG) . the registration
desk will be situated at the ‘Fonteinpatio’, easily recognisable by the large fountain nearby . plenary
sessions will be held in the ‘Blauwe Zaal’ .
Address and contact informationUniversity medical center Groningen
Hanzeplein 1
nL-9713 GZ Groningen
General phone number: +31-(0)50 361 61 61
Wi-Fi at the UMCGFree Wi-Fi available, code: UmcG-Guest
SAVET H EDATE
MegaGenEuropeanScientificMeetingLondon, United Kingdom15 OCTOBER 2016
“I nnovat ion: tools , techniques or both?”
Dr. Kwang Bum Park
Dr. Jong Cheol Kim
Dr. Howard Gluckman
Dr. SamuelLee
Prof. Giuseppe Luongo
Dr. Zaki Kanaan
Dr. Davide Farronato
Dr. Achraf Souayah
Dr. Souheil Bechara
Dr. Iulian Filipov
Dr. Mikkel Ro Larsen
www.megagen.nl
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Find your way in Groningen to the venue (UMCG)
By Bus
arriving at the central railway station in Groningen, several busses (for instance line 5) will take you to
the UmcG . the Buss company is called: Qbuzz .
For more information: http://9292 .nl/en .
By taxi
taxi’s can be found in front of the main railway station .
t +31 (0)50 5497676 (taxi centrale Groningen) .
By car
parking facilities (paid parking) are available in the ‘parking Garage noord’ .
entrance: Vrydemalaan . Follow the traffic/road sign posts to ‘UmcG noord’ .
By foot
the central railway station (Groningen) is situated at about 20 minutes walking distance from the
UmcG .
Traveling to and from the airportSchiphol Airportthe international airport in the netherlands is called schiphol airport and is located near amsterdam .
the easiest way to travel to and from schiphol is by public transportation .
if you enter ‘schiphol’ and ‘UmcG’ in the route planner, you will find the easiest route from schiphol
to the UmcG . You can purchase your train ticket at one of the self-service ticket machines or at
the service desk at the train station, or purchase bus tickets in the bus . Visit www .ns .nl for more
information about purchasing train tickets .
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Accommodation
We have selected a number of hotels in Groningen . the hotels are situated in the city center .
You can make a hotel reservation at the Groningen convention Bureau (GcB) by using the hotel
reservation form on the website: www .cmftraumacare2016 .com
Information and reservations for the hotelsGroningen congres Bureau (GcB)
mrs . Jellemieke ekens
Ubbo emmiussingel 37B
nL-9711 Bc Groningen
the netherlands
(t): +31 (0)50 316 88 77
(f): +31 (0)50 312 60 47
(e): jellemieke@gcb .nl
Website: http://www .gcb .nl
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Hotels
NH Groningen Hotel (opposite UmcG)
Hanzeplein 132, 9713 GW Groningen
+31 (0)50 584 81 81
www .nh-hotels .nl/hotel/nh-groningen
Martini HotelGedempt Zuiderdiep 8, 9711 HG Groningen
+31 (0)50 312 99 19
www .martinihotel .nl
Hampshire City HotelGedempt Kattendiep 25, 9711 pm Groningen
+31 (0)50 316 29 55
www .hampshire-groningen .nl
Conference dinner and party
Conference dinner and party in Grand TheatreGroningenGrote markt 35
9711 LV Groningen
+31 (0)50 368 03 68
www .grandtheatregroningen .nl
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List of sponsors
the spring meeting of the Dutch association of Oral and maxillofacial surgery is made possible thanks
to the following sponsors:
MAIN SPONSOR Dutch Association of Oral and Maxillofacial SurgeryKLs martin Group
LONGTERM SPONSORS Dutch Association of Oral and Maxillofacial Surgery
Dam medical
Dentalair
Dent-med materials
Dentsply implants
Henry schein
nobel Biocare
straumann
Zimmer Biomet
CONFERENCE SPONSORS
arseus Dental
Brainlab
B Braun
Dental Union
De puy synthes
Lactona
megagen
mis implants
robouw medical
septodont
surgi-tec
special thanks to our colleagues Dr . e .m . Baas and Dr . J .e . Bergsma for their activities for the committee
sponsor relationships of the Dutch association of Oral and maxillofacial surgery .
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Scientific programme
Day 1: Thursday May 19, 2016
Time Subject Chairmen Speaker
09:15 Registration and coffee at the ‘Fonteinpatio’
10:00 Welcome at the ‘Blau-we Zaal’
Fred spijkervet, head of department OmFs, Groningen/president Dutch association of Oral and maxillofacial surgery
10:15 atLs and the cmF surgeon
patrick nieboer, trauma surgeon, Groningen
11:00 imaging in cmF trauma
Gerlig Widmann, radiologist, innsbruck
11:45 Break
12:15 Free papers Fred rozema
michiel Doff
1 . potential of low dose cBct and msct for zygomaticomaxillary fracture diagnosis (romke rozema, UmcG Groningen)
2 . a contemporary virtual 3D method: mirroring and surface based matching techniques for measuring zygomaticomaxillary complex symmetry (Jean-pierre Ho, amc amsterdam)
3 . mandibular trauma: a two centre study (petra Vaandrager, VUmc amsterdam)
4 . eUrmat in children: a multicenter and prospective study (sofie Kommers, VUmc amsterdam)
5 . Facial gunshot injury (Jolanda Boverhoff, erasmus mc rotterdam)
13:05 Lunch
14:15 the D-problem in relation to cmF trauma
Kevin tsang, neurosurgeon, London
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15:00 Free papers condylar fractures session i
peter Kessler
anne van Leeuwen
1 . closed treatment of a mandibular condyle fracture comparing imF with screws or arch bars (Bart van den Bergh, spaarne Gasthuis Haarlem/Hoofddorp)
2 . imF screws in closed treatment of mandibular condyle fractures: quality of life and technical aspects & pitfalls (Bart van den Bergh)
3 . closed treatment of mandibular condyle fractures: a systematic review (antoinette rozeboom, amc amsterdam )
15:30 Break
16:00 Free papers condylar fractures session ii
peter Kessler
anne van Leeuwen
1 . endoscopically assisted open reduction and internal rigid fixation of condyle fractures using 3D plates (Günter Lauer, University Hospital Dresden)
2 . mandibular condyle fractures: clinical and radiological results after surgical treatment using triangular positioned double miniplate osteosynthesis (Wolfgang puelacher, medical University innsbruck)
3 . complaints related to mandibular function impairment after closed treatment of fractures of the mandibular condyle (pieter Dijkstra, UmcG Groningen)
16:30 panel discussion/controversies condylar fractures
ruud Bos panel: ian Holland, Jan de Lange, Günter Lauer, richard Loukota, Baucke van minnen, Wolfgang puelacher
17:00 closing remarks Fred spijkervet, head of department OmFs, Groningen/president Dutch association of Oral and maxillofacial surgery
18:30- finish
Welcome Reception and Conference Dinner at the Grand theatre This welcome reception is offered to you by the University of Groningen, the Municipality of Groningen and the Province of Groningen
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Day 2: Friday May 20, 2016
Time Subject Chairmen Speaker
08:30 Coffee at the ‘Fonteinpatio‘
09:00 the Haaksbergen monstertruck disaster: an over wiew of the whole traumachain, experiences and lessons learned
roy Horsthuis, medisch spectrum twente enschede
09:30 choices in surgical approaches
richard Loukota, OmF surgeon, Leeds
10:15 Break
10:45 Free papers/teD stefaan Bergé
sebastiaan de Visscher
1 . non-imF mandibular fracture reduction techniques: a review of the literature (enkh-Orchlon Batbayar, UmcG Groningen)
2 . Orbital fractures reconstructed with autogenous bone: analysis of 20 years of orbital surgery in rotterdam (elske strabbing, erasmus mc rotterdam)
3 . teD taLK Design of fracture reduction forceps for panfacial application: the Groningen repo project (Baucke van minnen, UmcG Groningen)
4 . teD taLK two approaches of secondary correction of combined orbital- zygomatic complex fractures with patient specific implants: the orbit first! (Leander Dubois, amc amsterdam)
5 . teD taLK Digital workflow in facial traumatology and reconstruction: the combination of additive manufacturing and navigation (marie-chris Donders, amc amsterdam)
11:30 the evidence in fix-ation of cmF fractures
ian Holland, OmF surgeon, Glasgow
12:15 Lunch
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13:15 Free papers Gert-Jan van Beek
Ferdinand Broekema
1 . a comparison of torque forces used to apply intermaxillary fixation bone screws (arjan Bins, VUmc amsterdam)
2 . Fracture of the severe atrophic edentulous mandible: load bearing or load sharing? (celine Bender, erasmus mc rotterdam)
3 . experiences following cranioplasty using either titanium of polyetherketone (mona Haj, erasmus mc rotterdam)
4 . Fractures of the mandibular coronoid process: a two centres study (meshkan moghimi, VUmc amsterdam)
13:55 panel discussion/controversies
ruud Bos panel: Leander Dubois, ian Holland, Günter Lauer, richard Loukota, Baucke van minnen, Wolfgang puelacher, Gerlich Widmann
14:35 Break
15:05 cmF surgery in art Frank iJpma, trauma surgeon, Groningen
15:50 closing remarks Fred spijkervet, head of department OmFs, Groningen/president Dutch association of Oral and maxillofacial surgery
16:00 spring membership meeting Dutch association of Oral and maxillofacial surgery at the ‘rode Zaal’
17:15 – Drinks and snacks at the ‘Fonteinpatio’
Saturday May 21, 2016
09:00 – 18:00
sOrG Hands on workshop access surgery in cmF trauma on fresh frozen cadavers
Limited attendance: 40 participants together with sOrG
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Keynote Speakers
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SUBJECT: ATLS AND THE CMF SURGEON
Patrick Nieboer, trauma surgeon UMC Groningen, the Netherlands
patrick nieboer studied at the university of Groningen . His first job as a
doctor was in a burn clinic and subsequently he was trained as a general
surgeon . in his last year he focused on trauma surgery and also became
involved in the new started Hems (helicopter emergency medical service
/ mmt) at the UmcG . the following years he completed his specialization
in trauma surgery and became a member of the trauma staff at the UmcG .
in his daily work he takes care of all sorts of injured patients and has special
interest in wrist / hand and pelvic / acetabular problems .
From an educational perspective he is involved as a teacher, program
developer, director and examiner in professional refresher courses for
surgeons, in programs for surgical residents and students . He takes special
interest in the dynamics of teaching and learning in the Or and this is the
topic of his research .
patrick nieboer is married to an abdominal-transplant surgeon and
together they have three sons . in his spare time he loves to sail and give the
necessary care for maintaining their old ship .
27
SUBJECT: IMAGING IN CMF TRAUMA
Gerlig Widmann, radiologist Medical University Innsbruck, Austria
Gerlig Widmann is Doctor of Human medicine (mD, medical University of
innsbruck) and privatdozent, (Habilitation „venia docendi“, phD equivalent)
in radiology (pD, medical University of innsbruck) . He is consultant
radiologist and chief of Head & neck radiology at the Department of
radiology, medical University of innsbruck, austria . He has received
several national awards including the eduard-Wallnoefer-award (2004),
the scientific award of the austrian society of implantology (2009), and
Dr .-Franz-Holeczke preis (2013) . He is involved in many multidisciplinary
and interuniversity research collaborations, with a special focus on
3Dnavigation / stereotaxy, interventional radiology, and dose management .
His scientific records include more than 65 scientific publications in
peer reviewed international journals, numerous book contributions and
congress publications besides many invited national and international
lectures . He is past-secretary of the austrian roentgen society, Deputy
Head of the austrian Working Group Head & neck radiology, and Vice
president of computer aided implantology academy .
28
SUBJECT: THE D-PROBLEM IN RELATION TO CMF TRAUMA
Kevin Tsang, neurosurgeon, Imperial College Healthcare NHS Trust,
London
Kevin tsang, was born in Hong Kong and studied medicine at Guy’s
and st thomas’ schools of medicine in London, achieving a distinction
on graduation . He also undertook a Bsc in neurosciences leading to a
publication in the journal Glia on neurotransmission and a First Honour
degree . He subsequently trained as a junior resident at various hospitals
across London, cambridge and Oxford in cardiology, respiratory medicine,
urology, general surgery, emergency medicine and neurosurgery . He
then continued his neurosurgical training in plymouth and Bristol, having
specifically spent a year with the craniofacial team and undertaking
trauma, reconstruction and oncological surgery in joint neurosurgery and
maxillofacial cases . He obtained his neurosurgical qualifications (Frcs
(sn)) in July 2014 and became a consultant, specialising in cranial and spinal
trauma, at the major trauma centre of st mary’s Hospital in October 2014 .
During this period, he has undertaken a number of audits and research
projects . He published various papers and gave international presentations
on neurosurgical topics . more specifically for trauma, he has published
a review article on Head injury Update in the British Journal of Oral and
maxillofacial surgery and contributed to two books on head trauma and
one on spinal trauma . He is currently involved in setting up three trials in
head and spine injuries and started data collection on an audit of frontal
sinus fractures .
From an education point of view, he is an instructor for the european
trauma course, the surgical trauma in austere environment course and
the neuroanaesthesia simulation course and he regularly talks at various
teaching events for trainees in neurosurgery, orthopaedics, paediatrics and
emergency medicine in the UK .
29
SUBJECT: CHOICES IN SURGICAL APPROACHES
Richard Loukota, OMF Surgeon Leeds, United Kingdom
prof . richard Loukota trained in medicine and Dentistry at Guy’s Hospital
in London . He underwent basic surgical training in London and sheffield,
then higher training in Leeds and at the royal London Hospital . in 1994 he
was appointed as consultant in OmFs in Leeds and held posts in OmFs/
plastic surgery in Wakefield .
prof . Loukota’s areas of surgical interests were initially traumatology and
Orthognathic surgery and then also Distraction Osteogenesis .
mr Loukota became the titular professor in Leeds in 2008 . Other positions
held include assessor of intercollegiate examiners, intercollegiate
examiner . Fellow of BaOms, FDsrcs & Frcs (england and edinburgh),
editorial Board member of BJOms . OmFs assessor for national clinical
advisory service (nHs) . member and past Vice-chairman of sOrG .
prof . Loukota has published numerous papers and written chapters on
condylar fracture management in several books . He is currently working
with prof . U . eckelt on the 2nd edition of their book on management of
Fractures of the manibular condyle .
30
SUBJECT: THE EVIDENCE IN FIXATION OF CMF FRACTURES
Ian Holland, OMF Surgeon Glasgow, United Kingdom
ian Holland trained in Dentistry and then medicine in the north east of
england at newcastle University . He stayed in the north east for basic
surgical and higher training, training in newcastle, sunderland and
middlesbrough . in 2001 he was appointed as a consultant in Oral and
maxillofacial surgery in the West of scotland initially working between
canniesburn Hospital and Forth Valley Hospitals and from 2006 onward at
the regional maxillofacial unit in Glasgow .
ian’s areas of surgical interests were initially traumatology and Orthognathic
surgery and latterly have become the management of the trauma and other
urgent/emergency workload at the regional unit .
ian has recently demitted office after 8 year as programme training Direct
for Oral and maxillofacial surgery in scotland and has served on the
specialty advisory committee for OmFs UK . He is now recruitment lead for
OmFs UK and will assume the role of treasurer of BaOms in Jan 16 . He is a
fellow of the royal college of surgeons and physicians of Glasgow and has
served on the Dental Faculty council for the last 10 years .
31
SUBJECT: CMF SURGERY IN ART
Frank IJpma, trauma surgeon UMC Groningen, the Netherlands
Frank iJpma was trained in trauma and abdominal surgery in the isala
Zwolle and the Umc Groningen in the netherlands . He went abroad to
south africa, russia and Ghana to practice and perform research . He had
an early interest in the history of surgery, which led him to write a book
on the world famous collection of Dutch painted anatomy lessons . He
focused on the connection between surgery and painted art . His book,
entitled ‘amsterdamse anatomische lessen ontleed’ was presented in 2013
on occasion of the ‘anatomy lesson’ in the concert hall of amsterdam .
the next year, he defended his thesis, entitled ‘the anatomy lessons of the
amsterdam Guild of surgeons’ on the same subject . Frank iJpma is now
working as a trauma surgeon at the University medical center Groningen .
32 www.surgi-tec.com
Same placing system
One partner
DISTRACTION
ANCHORAGE
OSTEOSYNTHESIS...
33
abstracts
34
1. POTENTIAL OF LOW DOSE CBCT AND MSCT FOR ZYGOMATICOMAXILLARY FRACTURE DIAGNOSIS
R. ROZEMA 1, R.N. HARTMAN 2, M.H. DOFF 1, P.M.A. VAN OOIJEN3,
H.E. WESTERLAAN 2, M.F. BOOMSMA 2, B. VAN MINNEN 1
1 Department of Oral and maxillofacial surgery, University medical center Groningen,
Groningen, the netherlands2 Department of radiology, University medical center Groningen, Groningen, the netherlands3 Department of anatomy, University medical center Groningen, Groningen, the netherlands
INTRODUCTION AND AIMto assess the diagnostic acceptability of
low dose cBct and msct protocols for
zygomaticomaxillary fracture diagnosis
METHODSUnilateral zygomaticomaxillary fractures were
inflicted on four out of six fresh frozen human
cadaver head specimen . all specimen were
scanned using two cBct and four msct
protocols where the radiation exposure was
systematically reduced . a blinded diagnostic
routine was recreated where 16 radiologists and
8 oral and maxillofacial surgeons performed 144
randomized image assessments . the presence
of fractures was verified by a dissection of the
zygomatic region and as a gold standard to verify
the outcome of the image assessments .
RESULTSZygomaticomaxillary fractures were correctly
diagnosed in 90 .3 percent (n=130) of the image
assessments . the zygomatic arch was the
most often correctly diagnosed (91 .0%) . the
zygomatic alveolar crest showed the highest
degree of misdiagnosis (65 .3%) . no significant
decrease of correctly diagnosed fracture sites
was found between the regular and low dose
cBct and msct protocols . Dose reduction
did not significant decrease the ability to assess
dislocation, comminution, orbital volume,
volume rendering and soft tissues . OmF surgeons
considered the low dose protocols sufficient for
treatment planning . the effective dose of msct
(129 .9 to 51 .0 µsv) remained well in range of cBct
(122 to 28 µsv) .
CONCLUSIONLow dose cBct and msct protocols do not
decrease the diagnostic acceptability for the
diagnosis of zygomaticomaxillary fractures .
35
2. A CONTEMPORARY VIRTUAL 3D-METHOD: MIRRORING AND SURFACE BASED MATCHING TECHNIQUES FOR MEASURING ZYGOMATICMAXILLARY COMPLEX SYMMETRY
J.P.T.F. HO, R. SCHREURS, L. DUBOIS, T.J.J. MAAL, J. DE LANGE, A.G. BECKING
Department of Oral and maxillofacial surgery, academic medical center, amsterdam, the netherlands
INTRODUCTION AND AIMthe aim of this study is to validate a new semi
automatic mirroring method (samm) to quantify
hard tissue symmetry of the zygomaticomaxillary
complex (Zmc) and to objectively analyze Zmc
fractures .
METHODSFour examiners reconstructed virtual three-
dimensional hard-tissue models from computed
tomography (ct) datasets of 26 healthy individuals
with a samm . the models were mirrored and
superimposed through surface base matching
techniques . the absolute average distance (aD)
and 90th percentile distance (npD) were used
to measure overall and maximal symmetry
respectively . the intraclass correlation coefficient
(icc) was calculated to measure interobserver
consistency . in order to determine if this technique
is able to diagnose Zmc fractures, two examiners
examined 10 ct datasets of individuals with a
unilateral Zmc fracture .
RESULTSFor the unaffected group the mean aD was
0 .84±0 .29mm (95% ci 0 .72-0 .96) and the mean
npD was 1 .58±0 .43mm (95% ci 1 .41-1 .76) . the icc
was 0 .97 (0 .94-0 .98 as 95% ci), indicating almost
perfect agreement between observers . in the
affected group the mean aD was 2 .97±1 .76mm
(95% ci 1 .71-4 .23) and the mean npD was
6 .12±3 .42mm (95% ci 3 .67-8 .57) . the affected
group showed a near perfect interobserver
agreement with an icc of 0 .996 (0 .983-0 .999 as
95% ci) .
CONCLUSIONthe new samm proved to be accurate and
reproducible . the use of landmarks, symmetry
planes, perfect head positioning and patient
oriented axis systems was circumvented with
the use of mirroring and surface base matching
techniques . the method is believed to be clinically
usable for the objective analysis of the Zmc and
Zmc fractures .
36
3 . MANDIBULAR TRAUMA: A TWO-CENTER STUDY
P. VAANDRAGER, P. BOFFANO, K.H. KARAGOZOGLU, C. GALLESIO, T. FOROUZANFAR
Department of Oral and maxillofacial surgery, VU medical center, amsterdam, the netherlands
INTRODUCTION AND AIMthe aims of this study were to assess and compare
epidemiological data on mandibular fractures from
two european centers and to perform a review of
the literature
METHODSthis study was based on information from
two computer-assisted databases that have
continuously recoded data on patients hospitalizes
with maxillofacial fractures treated surgically at
the Division of maxillofacial surgery, san Giovanni
Battista Hospital in turin, italy and the department
of Oral and maxillofacial surgery, Vrije Universiteit
medical center, amsterdam, the netherlands .
Data from between January 2001 and December
2010 were analysed .
RESULTSBetween 2001 and 2010, a total of 752 patients with
a total of 1167 mandibular fractures were admitted
to a hospital in turin, and 245 patients with a total
of 434 mandibular fractures were admitted to a
hospital in amsterdam . the mean age in turin was
34 .8 years and in amsterdam was 32 years . the age
group 20-29 years showed the highest incidence of
mandibular fractures in both centers . the fractures
were mainly the result of assaults, in agreement
with several articles in the recent literature,
followed by falls .
CONCLUSIONthe continuous long-term and multicenter
collection of data on the epidemiology of
maxillofacial trauma is important because it
provides the information necessary for the
development of preventative measures aimed at
reducing the incidence of facial injuries .
37
4. EUROPEAN MAXILLOFACIAL TRAUMA (EURMAT) IN CHILDREN: A MULTICENTER AND PROSPECTIVE STUDY
S. KOMMERS, P. BOFFANO, K.H. KARAGOZOGLU, B. MEIJER, T. FOROUZANFAR
Department of Oral and maxillofacial surgery, VU medical center, amsterdam, the netherlands
INTRODUCTION AND AIMthe aim of this study is to present and discuss
the results of a european multicenter prospective
study about pediatric maxillofacial trauma
epidemiology during a year .
METHODSthe following data were recorded: gender, age,
etiology, site of fracture, date of injury . Of the
3396 patients with maxillofacial fractures admitted
within the study period, 114 (3 .3%) were children
aged 15 years and younger, with a male/female
ratio of 2 .6:1 . mean age was 10 .9 years . most
patients (63%) were aged 11-15 years .
RESULTSthe most frequent cause of injury was fall (36
patients) . sport injuries and assaults were almost
limited to the oldest group, whereas falls were
more uniformly distributed in the 3 groups . the
most frequently observed fracture involved
the mandible with 47 fractures . in particular, 18
condylar fractures were recorded, followed by 12
body fractures .
CONCLUSIONFalls can be acknowledged as the most important
cause of facial trauma during the first years of
life . the high incidence of sport accidents after
10 years may be a reason to increase the use of
mouthguards and other protective equipment .
Finally, the mandible (and in particular the
condyle) was confirmed as the most frequent
fracture site .
38
5. FACIAL GUNSHOT INJURY
J.C. BOVERHOFF, E.B. WOLVIUS, M.J. KOUDSTAAL
Department of Oral and maxillofacial surgery, erasmus University medical center, rotterdam,
the netherlands
INTRODUCTION AND AIMas all trauma, facial gunshot wounds can
cause functional impairment and altered facial
appearance . aim of the presentation is to present
and discuss diverse patients with facial gunshot
injuries and the challenges they present in the
management of this specific trauma .
METHODSpatients with facial gunshot injuries treated at
our department were analyzed for etiology,
mechanism, extent of tissue damage, the
management chosen and follow-up .
RESULTSWe present 5 patients with facial gunshot injury .
in four cases the trauma was related to shots
to the face in interpersonal settings and one
was a suicide attempt . the patient with suicide
attempt used a shotgun at close range resulting
in mandibular damage and the anterior part of
the maxilla and nose to be blown away . another
patient was shot in the cheek, through the face
resulting in extensive blood loss . management of
gunshot injuries often require immediate control
of bleeding and action to rescue as much tissue as
possible in the acute stage . in most cases multiple
procedures are indicated in a staged fashion .
CONCLUSIONFacial gunshot injuries cause extensive soft
and hard tissue destruction . treatment often
involves extensive wound management, staged
reconstruction and rehabilitation . the main
challenge is to preserve and if possible reconstruct
as much as possible in the first stage to minimize
staged corrections and esthetically unsatisfying
outcome .
39
6. CLOSED TREATMENT OF A MANDIBULAR CONDYLE FRACTURE: COMPARING IMF WITH SCREWS OR ARCH BARS
B. VAN DEN BERGH
Department of Oral and maxillofacial surgery, spaarne Gasthuis Haarlem/Hoofddorp, the netherlands
INTRODUCTION AND AIMa mandibular condyle fracture can be treated with
intermaxillary fixation (imF) or by open reposition
and internal fixation (OriF) . many imF-modalities
can be chosen, including imF-screws (imFs) .
METHODSthis prospective multicenter randomised clinical
trial compared the use of imFs with the use of
arch bars in the treatment of mandibular condyle
fractures .
RESULTSthe study population consisted of 50 patients
(mean age: 31 .8 years) . twenty-four (48%) patients
were allocated in the imFs-group . twenty-six
(52%) patients were assigned to the arch bars
group . in total 188 imF-screws were used (5-12
screws per patient, mean 7 .83 screws per patient) .
all pain scores were lower in the imFs-group .
three patients developed a malocclusion (iFms-
group: one patient, arch bars-group: two patients) .
mean surgical time was significantly shorter in the
imFs-group (59 vs . 126 min; p < 0 .001) . there were
no needlestick injuries (0%) in the imFs-group
and eight (30 .7%) in the arch bars group (p=0 .003) .
One imF-screw fractured on insertion (0 .53%), one
(0 .53%) screw was inserted into a root . six (3 .2%)
screws loosened spontaneously in four patients .
mucosal disturbances were seen in 22 patients,
equally divided over both groups .
CONCLUSIONconsidering the advantages and the disadvantages
of imFs, and observing the results of this study,
the authors conclude that imFs provide a superior
method for imF .
imFs are safer for the patients and surgeons .
40
7. IMF-SCREWS IN CLOSED TREATMENT OF MANDIBULAR CONDYLE FRACTURES: QUALITY OF LIFE AND TECHNICAL ASPECTS & PITFALLS
B. VAN DEN BERGH
Department of Oral and maxillofacial surgery, spaarne Gasthuis, Haarlem/
Hoofddorp, the netherlands
INTRODUCTION AND AIMarch bars as treatment for a fractured mandibular
condyle are inconvenient to patients and are said
to lower quality of life (QOL) . to overcome these
inconveniences, imF-screws (imFs) are developed .
the purpose of the present study is to investigate
and compare QOL for patients treated for a
fractured mandibular condyle with either imFs or
arch bars .
another aim is to present some technical aspects
and pitfalls when applying imFs .
METHODSthis prospective multicenter randomised clinical
trial compared the QOL when using imFs or
arch bars in the closed treatment of mandibular
condyle fractures .
RESULTSthe study population consisted of 50 patients
(mean age: 31 .8 years) . twenty-four (48%) patients
were allocated in the imFs-group . twenty-six
(52%) patients were assigned to the arch bars
group . significant results were observed in the
subscales social isolation, possibility to eat and
vary diet, influence on sleep and satisfaction with
the given treatment, all in favour of imFs .
CONCLUSIONUsing imFs as a method for closed treatment
of condylar fractures leads to a higher QOL
during the six-week period of fracture healing .
in comparison to arch bars, patients treated with
imFs experienced less social isolation, experience
less problems with eating and express the feeling
they are able to continue their normal diet .
Furthermore it seems that the use of imFs has
a lower negative impact on social and financial
aspects of the patient .
41
8. CLOSED TREATMENT OF MANDIBULAR CONDYLE FRACTURES: A SYSTEMATIC REVIEW
A. ROZEBOOM1, L. DUBOIS1, R.R.M. BOS 2, R. SPIJKER 1, J. DE LANGE 1
1 Department of Oral and maxillofacial surgery, academic medical center,
amsterdam, the netherlands2 Department of Oral and maxillofacial surgery, University medical center Groningen,
Groningen, the netherlands
INTRODUCTION AND AIM Of all mandibular fractures, 25 - 35% are fractures
of the condyle . most studies focus on the question
whether to treat a mandibular condyle fracture
open or closed . an important but unresolved issue
is the method of closed treatment . a uniform
protocol/guideline for closed treatment is required
to be able to come to good clinical practice . the
aim of this systematic review is to give an overview
of the literature published exclusively on closed
treatment and to summarize the existing closed
treatment modalities and their clinical outcomes .
METHODS a systematic literature search (updated may 19th,
2015) in pubmed (all indexed years) and embase
(all indexed years) with multiple search terms was
performed .
RESULTS after primary and secondary exclusion, 16 studies
with in total 1535 patients were selected for further
analysis . if maxillomandibulary fixation (mmF)
was used, elastic bands or wires were applied,
often fixated with archbars or mmF-screws .
the mean duration of mmF was 3 weeks (range
7 days- 49 days) . regarding complications after
closed treatment, the presence of malocclusion
ranged from 0 to 24%, in 17% the mouth opening
was limited after the fracture, the range of motion
was affected in 16% of the cases and in 7% of the
patients, pain persist after treatment .
CONCLUSION Unfortunately there is no uniform standard in
closed treatment of condylar fractures . Based on
current literature, a suggestion is made for a clear
definition of expectative and closed treatment of
condylar fractures .
42
9. ENDOSCOPICALLY ASSISTED OPEN REDUCTION AND INTERNAL RIGID FIXATION OF CONDYLE FRACTURES USING 3D-PLATES
G. LAUER, A. NOWACK, H. LEONHARDT
Department of Oral and maxillofacial surgery, University Hospital Dresden, Dresden, Germany
INTRODUCTION AND AIMprospective, multicenter studies have proven
that open reduction and internal rigid fixation
(OriF) of subcondylar and condylar neck fractures
has considerable advantages compared to
conservative treatment options . However, OriF
requires surgical approaches which are related
with certain difficulties like working in a narrow
defined space under difficult visibility and risks
like facial nerve palsy example for the extraoral
approach .
METHODSto minimize both, the intraoral endoscope assisted
approach using special plates is a modern and
reliable treatment option . in our department we
have been using the intraoral endoscopic assisted
approach and small 3D-plates (Delta-plate,
rhombic-plate) for nearly 10 years .
RESULTSthe highlights of the technique and special
tricks will be presented . the results of more
than 70 cases gives evidence of return to normal
mouth opening and jaw movement after 3 to 6
months and that there are only very few minor
complications with loosening of screws . major
failures of OriF like plate fractures were not
observed . the limitations of the approach are
discussed particular in condylar neck fractures .
CONCLUSIONthe small 3D-plates seem to be a reliable fixation
device in condylar fractures . they can be applied
via a transoral endoscope assisted approach .
43
10. MANDIBULAR CONDYLE FRACTURES : CLINICAL AND RADIOLOGICAL RESULTS AFTER SURGICAL TREATMENT USING TRIANGULAR POSITIONED DOUBLE MINIPLATE OSTEOSYNTHESIS
W. PUELACHER, D. DALLA TORRE, G. WIDMANN, M. RASSE
University clinic for craniomaxillofacial surgery, medical University innsbruck, innsbruck, austria
INTRODUCTION AND AIMthe analysis describes the combination of a
retromandibular, transparotideal approach,
respectively enoral approach combined with
a triangular-positioned double-miniplate
osteosynthesis, with a special regard for the
patients’ long term outcomes .
METHODSclinical data of 102 patients with 124 condyle
fractures treated with the mentioned surgical
procedure were evaluated . Functional parameters
such as the maximal interincisal distance,
deviations/deflections, facial nerve function,
occlusion as well as complications regarding
the parotid gland, osteosynthesis, and esthetics
were evaluated 1 week, 2 weeks, 3 months, and 6
months postoperatively .
RESULTSthe mean maximal interincisal distance ranged
from 38 mm after 1 week to 45 mm after 6 months .
Deviations/deflections were seen in 22 .5% of the
cases 1 week postoperatively and decreased to
2% at 6 months postoperatively . a temporary
facial palsy was diagnosed in 3 .9% during the first
follow-up, whereas no impairment was recorded
after 3 or 6 months . at the same time, no patient
had occlusional disturbances or complications
regarding the parotid gland or the osteosynthesis
6 months postoperatively .
CONCLUSIONstable three-dimensional fracture stabilization
seems to be the main advantage of the
presented combination of surgical approach and
osteosynthesis technique .
44
11. TRAUMA CARE TWENTE EUREGIO, AN OVERVIEW OF THE WHOLE TRAUMA CHAIN, EXPERIENCES AND LESSONS LEARNED
R. HORSTHUIS1, B. KOLENAAR1, F. HINDERKS1, H. RAKHORST2, W. MASTBOOM3, R. de WIT4
Department of Oral and maxillofacial surgery1, plastic and reconstructive surgery2, General surgery3
and traumatology4 medisch spectrum twente, enschede and Ziekenhuisgroep twente, almelo,
the netherlands
INTRODUCTIONin september 2014 a local event with a monster-
truck turned into a disaster as the truck drove
into the spectators resulting in 3 fatalities and
27 injuries . most patients were presented at our
Level 1 trauma center mst (16/27), followed by
our second hospital location the ZGt (9/27) . We
present an overview of the whole trauma chain .
at the trauma site, the netherlands triage system
(nts) as single triage system was used . Focusing
on cmF trauma, we treated 4/27 (15%) trauma
cases . the injuries seen, covered the whole cmF
trauma spectre known . One trauma case showed
us similarities with the defects seen in oncologic
head and neck surgery . the reconstruction of this
patient demonstrated the value of the existing
interdisciplinary approach known in the head and
neck oncology team using advanced free vascular
flap and nerve graft-techniques .
CONCLUSIONLarge trauma series as seen in disasters provide an
excellent overview of the requirements needed in
comprehensive trauma care . careful evaluation of
these events is an excellent tool in providing best
care through lessons learned . standardization of
the chain of trauma care by means of protocols
seems necessary for minimizing failures in
communication and contributes to optimal
patient outcome . concerning cmF trauma care
we advocate that patients with large soft tissue
defects should be treated by an interdisciplinary
approach in a Level 1 trauma center with a Level 3
icU and a Head and neck reconstruction team .
45
12. COMPLAINTS RELATED TO MANDIBULAR FUNCTION IMPAIRMENT AFTER CLOSED TREATMENT OF FRACTURES OF THE MANDIBULAR CONDYLE
P.U. DIJKSTRA, E.T. NIEZEN, R.R.M. BOS, L.G.M. DE BONT, B. STEGENGA
Department of Oral and maxillofacial surgery, University medical center Groningen, Groningen,
the netherlands
INTRODUCTION AND AIMthis study analyzed the relationship between
complaints and mandibular function after closed
treatment of fractures of the mandibular condyle
in a prospective study .
METHODSin a 1-year follow-up, complaints were assessed
during physical examination and function
was assessed using the mandibular function
impairment questionnaire (mFiQ), scoring range
0–68 . Data from 114 patients (41 women, 73 men),
mean age 28 .1 years (sD 13 .3), were available .
RESULTSOn average the mFiQ scores were low 3 .4 (sD
7 .3) . ten patients (9%) experienced pain and
45 (39%) patients had a mFiQ score > 0 . mean
mouth opening was 51 .9 mm (sD 8 .4) . Occlusion
was perceived as moderate or poor by 24% of
the patients . in the logistic regression analysis
mandibular function impairment (mFiQ score > 0)
was entered as a dependent variable . risk factors
for mandibular function impairment were: pain,
perceived occlusion (moderate or poor), absolute
difference between left and right horizontal
movements and age . a protective factor was
mouth opening .
CONCLUSIONthe results of this study show that complaints
(i .e . pain, perceived occlusion, reduced mouth
opening, difference between left and right lateral
movements and increased age) are predictors
of mandibular function impairment after closed
treatment of fractures of the mandibular condyle .
46
13. NON-IMF MANDIBULAR FRACTURE REDUCTION TECHNIQUES: A REVIEW OF THE LITERATURE
E. BATBAYAR, B. VAN MINNEN, R.R.M.BOS
Department of Oral and maxillofacial surgery, University medical center Groningen, Groningen,
the netherlands
INTRODUCTION AND AIMthe aim of this study is to review all studies related
to reduction forceps and other non-intermaxillary
fixation (imF) reduction techniques in order to
assess which currently available forceps can be
used and which developments are needed .
METHODS a systematic search was performed in the
databases of medline and embase, with no initial
date and language preference, updated until
February, 2016 . citations of the retrieved articles
were screened to identify further relevant articles .
RESULTS 12 articles were chosen for this review . selected
articles were categorized as either clinical or
experimental studies . ten of the 12 articles were
clinical studies and, tension band wiring technique,
elastic rubber band technique and, repositioning
forceps were used in order to reduce fracture
gaps . accuracy of fracture reduction is described
in terms of postoperative complications in the
clinical studies .
Design of the repositioning forceps has two
main categories: modified towel clamps and new
specific designs for maxillofacial applications .
Generally, both the modified towel clamps and
new designs were able to stable pre-compression
for the internal fixation with plates and screws .
However, the number of studies is very limited .
CONCLUSION Based on this review it could be concluded that
only few designs of repositioning forceps have
been proposed in the literature . Quick and
adequate reduction of fractures seems possible
with this technique . Further development
and clinical testing of the reduction forceps
is necessary to establish their future role in
maxillofacial fracture treatment .
47
14. ORBITAL FRACTURES RECONSTRUCTED WITH AUTOGENOUS BONE: ANALYSIS OF 20 YEARS OF ORBITAL SURGERY IN ROTTERDAM
E.M. STRABBING, K.G.H. VAN DER WAL, E.B. WOLVIUS, D.A. PARIDAENS, M.J. KOUDSTAAL
Department of Oral and maxillofacial surgery, erasmus medical center, rotterdam, the netherlands
INTRODUCTION AND AIMtreatment of orbital fractures remains a challenge,
partly because studies regarding outcome are
difficult to compare . the erasmus medical center
has a large historic well-documented database
with orbital trauma patients mainly reconstructed
with autogenous bone with adequate follow-up .
What can we learn from this group regarding
indication, treatment outcome and complications?
METHODSall patients who underwent surgical repair of an
orbital fracture were retrospectively analyzed .
the patients were divided into two groups:
group 1 contains patients where one procedure
sufficed . a subgroup of patients with pure orbital
fractures was analyzed . Group 2 contains patients
who required a second revision reconstruction
following primary surgery in another center .
indications, timing, pre-and postoperative
ophthalmological sequelae, the influence of
involvement of the medial wall, the difference
in outcome of secondary reconstructions and
complications are reviewed .
RESULTSa total of 211 patients were included . the need for
surgery is based upon the presence of persisting
diplopia and enophthalmos . Group 1 contained
173 patients, with a subgroup of 60 patients with
pure orbital fracture with a follow-up of at least 1
year . Group 2 contains 38 patients . the donor side
morbidity of iliac crest bone harvesting is low and
temporary in all cases . the subgroup of 60 patients
with pure orbital fractures showed no clinically
significant diplopia and 11% of enophthalmos at
one-year follow-up .
CONCLUSIONGood functional and esthetic results can be
obtained with orbital reconstruction using
autogenous bone .
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15. A COMPARISON OF TORQUE FORCES USED TO APPLY INTERMAXILLARY FIXATION BONE SCREWS
A. BINS, J.A. BAART, T. FOROUZANFAR, J.W.A. VAN LOON
Department of Oral and maxillofacial surgery, VU medical center, amsterdam, the netherlands
INTRODUCTION AND AIMWhen establishing intermaxillary fixation using
bone screws, fracture of a screw is a complication
possible to occur . this study was conducted
to investigate the forces which arise on bone
screw insertion and to determine safety margins
between torque for hand-tight insertion and
torque until break for different screwing systems,
which could ultimately favor the use of one screw
based on a decreased risk of complications .
METHODSFor hand-tight insertion, three oral and
maxillofacial surgeons applied eight screws
each of every screwing system (KLs martin,
synthes, Jeilmed) into porcine mandibles . the
porcine mandibles were evaluated for cortical
thickness and suitable insertion sites by cBct .
For torque until break measurements, eight
screws (four used and four ‘virgin’) per system
were applied into pre-drilled aluminum plates .
a digital torque screwdriver in continuous data,
measuring 180 data points per second, recorded
the measurements .
RESULTSmeasurements indicate a clear significant
difference in torsion forces between hand-tight
insertions and torque until break tests for all
three screwing systems . no significant difference
in safety margins was found between screwing
systems . no significant difference in torque for
break was found between used and ‘virgin’ screws .
CONCLUSIONsince no significant differences were found
between screwing systems regarding safety
margins, this study indicates that bone screw
selection should be based on other clinical factors,
such as ease of usage, or economical reasons .
although the selection was small, bone screws
seem safe to be re-applied after initial incorrect
placement .
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16. FRACTURE OF THE SEVERE ATROPHIC EDENTULOUS MANDIBLE: LOAD BEARING OR LOAD SHARING?
C.A. BENDER, M.J. KOUDSTAAL, E.B. WOLVIUS
Department of Oral and maxillofacial surgery, erasmus medical center, rotterdam, the netherlands
INTRODUCTION AND AIMseveral techniques have been employed to treat
fractures of the atrophic edentulous mandible,
including gunning splint, trans-oral open reduction
and internal fixation (OriF) with miniplates and
OriF with reconstruction plate from an extra-oral
approach . the aim of this study is to analyze the
outcome of the repair of these fractures .
METHODSFrom December 2010 until February 2016 all
patients with fractures of the severe atrophic
edentulous mandible were included . all files
were retrospectively studied . patients with
osteoradionecrosis of the mandible following
radiotherapy were excluded .
RESULTSeight patients (mean age 75 years old, male n=3,
female n=5) with solitary or multiple fracture(s) of
atrophic edentulous mandible were identified . the
mean follow-up was 13 months .
in 2 cases the fracture occurred after dental
implant explantation and placing an implant bar . in
6 cases the mandible fractured following trauma .
One patient used bisphosphonates .
the mean height of the mandible was 10 .1 mm,
as measured in the symphyseal area . in one case
initially a closed treatment was chosen, and
in one case primary treatment was employed
using trans-oral OriF with miniplates . additional
OriF was needed . in 6 cases consolidation was
successful with OriF using reconstruction plate . in
3 cases short dental implants were placed several
months following fracture repair . complications
were damage of the inferior alveolar nerve, peri-
implantitis and loss of dental implants .
CONCLUSIONin case of an atrophic edentulous mandibular
fracture, we advise OriF with load bearing
reconstruction plate . in selected cases secondary
oral rehabilitation with short dental implants and
implant supported prosthesis is feasible .
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17. EXPERIENCES FOLLOWING CRANIOPLASTY USING EITHER TITANIUM OR POLYETHERKETONE (PEEK) IMPLANT
M. HAJ, J. SNAATHORST, T. DUMANS, M.J. KOUDSTAAL
Department of Oral and maxillofacial surgery, erasmus medical center, rotterdam, the netherlands
INTRODUCTION AND AIMthe goal of cranioplasty following craniectomy
is soft tissue protection, preventing neurological
deficits and restoring the calvarial contour for
optimization of the esthetic result . advances in
imaging technology have improved precision and
efficacy of these procedures . Despite attempts to
improve outcome there is a risk of postoperative
complications ranging from 15 to 43 percent in
the literature . Our aim is to share our experience
following cranioplasty for a variety of indications
in patients treated with either a titanium plate
or custom made polyetheretherketone (peeK)
implants .
METHODS pre-operative, intra-operative, and post-operative
data of all patients who underwent cranioplasty
between 2003 and 2016 was collected .
RESULTS 64 patients underwent cranioplasty . titanium
was used in 44 cases and peeK implant in 20 . the
indications for cranioplasty were deformities
following tumor resection, decompression
craniectomy and posttraumatic deformities . the
most common site of reconstruction was the
frontal region followed by parietal and temporal
area . the overall outcome was satisfactory .
reported complications were infection, empyema,
exposure of the implant, cerebrospinal fluid
leakage and epilepsy . these occurred in cases
after earlier radiotherapy, drug abuse and previous
site infection/empyema . Frontal defects were the
predominant site of complication .
CONCLUSIONthe overall outcome following cranioplasty with
both titanium and peeK implants is satisfactory in
reducing neurological symptoms and improving
cosmesis . preventing postoperative complications,
especially following local radiotherapy or prior
infection with compromised soft tissue quality
remains a challenging task . critical assessment of
the patient history, timing of the procedure and
materials used for reconstruction is needed to
achieve most favorable outcome .
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18. FRACTURES OF THE MANDIBULAR CORONOID PROCESS: A TWO CENTERS STUDY
M. MOGHIMI, P. BOFFANO, S. KOMMERS, F. ROCCIA, C. GALLESIO, T. FOROUZANFAR
Department of Oral and maxillofacial surgery, VU medical center, amsterdam, the netherlands
INTRODUCTION AND AIMthe aim of this study was to assess the
characteristics of patients with coronoid fractures
treated in two european centers over 10 years and
to briefly review the literature .
METHODSthis study is based on 2 systematic computer-
assisted databases that have continuously
recorded patients hospitalized with maxillofacial
fractures and surgically treated in two european
centers between 2001 and 2010 .
RESULTSDuring the 10 years, 1818 patients and 523 patients
with maxillofacial fractures were admitted to the
two centers respectively: 21 patients (16 males,
5 females) were admitted with 21 coronoid
fractures and 28 associated maxillofacial fractures .
a mean age of 42 .1 years was observed . the
fractures were mainly the result of motor vehicle
accidents, followed by assaults and falls . the most
frequently observed associated maxillofacial
fracture was a zygomatic fracture (13 fractures) . in
both centers, mandibular coronoid fractures are
treated conservatively unless a severe dislocation
of the fractured coronoid is observed or a
functional mandibular impairment is encountered .
conservative treatment can be used, together
with the open reduction and internal fixation of
associated fractures . the crucial point is to prevent
ankylosis, which may be prevented by correct and
early postoperative physiotherapy and mandibular
function .
CONCLUSIONa coronoid process fracture can be treated
conservatively when there is no severe dislocation
or functional impairment of the mandible . the
main goal is to prevent ankyloses .
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53
ted talks
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1. DESIGN OF FRACTURE REDUCTION FORCEPS FOR PANFACIAL APPLICATION: THE GRONINGEN REPO PROJECT
B. VAN MINNEN, J. DE BEIJ, R.R.M. BOS
Department of Oral and maxillofacial surgery, University medical center Groningen, Groningen,
the netherlands
repositioning forceps, or fracture reduction
forceps, have been used for fracture repositioning
purposes for decades in orthopaedic and trauma
surgery . part of the commercially available forceps
can also be applied in the maxillofacial area .
However, these instruments are not specifically
designed to fit the volumes and curvatures of the
facial bones .
a methodical design method according
to Kesselring was used to determine the
specifications of a set of repositioning forceps,
dedicated to the bony structures of the skull .
the computer aided Designed (caD) set
of repositioning forceps will be presented .
Furthermore, the findings of a human cadaver
experiment with the first prototypes will be
shown . application in the clinical setting will be
achievable after some design modifications and
accurate production of the revised prototypes .
55
2. TWO APROACHES OF SECONDARY CORRECTION OF COMBINED ORBITAL-ZYGOMATIC COMPLEX FRACTURES WITH PATIENT SPECIFIC IMPLANTS: THE ORBIT FIRST!
L. DUBOIS, R. SCHREURS, J. DE LANGE, A.G. BECKING
Department of Oral and maxillofacial surgery, academic medical center, amsterdam, the netherlands
adequate repositioning of the Zmc is promoted
as an essential step in restoring the orbital contour .
if there is a combination of Zmc fracture with a
nOe fracture or the Zmc is comminuted, small
irregularities in the positioning of the Zmc can
easily appear, which may even lead to an increase
of orbital volume . in the treatment of functional
enophthalmos suboptimal alignment can be
corrected by camouflage or re-ostetomizing the
Zmc . most authors prefer a two stage procedure:
Zygomatic osteotomy, followed by an orbital
reconstruction . nowadays, computer assisted
planning facilitates the full digital workflow
which potentially enables the surgeon to control
both steps . Backward planning combined with
additive manufacturing of sawing guides and
implants creates the possibility to plan the orbital
reconstruction before actual positioning the Zmc .
the proof of principle is showed by two different
approaches of secondary reconstruction of orbital-
zygomatic fractures with patient specific implants .
56
3. DIGITAL WORKFLOW IN FACIAL TRAUMATOLOGY AND RECONSTRUCTION: THE COMBINATION OF ADDITIVE MANUFACTURING AND NAVIGATION
H.C.M. DONDERS, R. SCHREURS, T.JJ. MAAL, L. DUBOIS, A.G. BECKING
Department of Oral and maxillofacial surgery, academic medical center, amsterdam, the netherlands
preoperative virtual surgery planning is the most
important step in computer assisted surgery
(cas) . it is possible to transfer the preoperative
planning to surgery with the use of helpful
guides in order to exactly achieve the planned
result . static guidance is delivered with the use
of additive manufactured templates, which are
inserted during surgery and define the planned
position and orientation . in dynamic guidance
image-guided navigation is used .
the combination of these two concepts delivers
additional and extraordinary benefits for surgery .
templates may be rigidly positioned with
navigation and will deliver control at local level, eg
acting as a sawing or drilling mall . navigation can
subsequently be used to assess the overall result
in surgery .
in this teD talk we share our experiences and
promising results of simultaneous static and
dynamic guidance in patients with complex post-
traumatic reconstructions .
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Notes
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Colophon
Department of Oral and maxillofacial surgery, University medical center Groningen
Design: Letter & Lijn, Groningen, letterenlijn .nl
programme and summaries of the spring meeting of the Dutch association of Oral and maxillofacial surgery/international symposium Optimisation in cmF trauma care, may 19-20, 2016, Groningen, the netherlands
all rights reserved . no part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, electronic, photocopying, recording or otherwise, without the prior written consent of the board of the Dutch association of Oral and maxillofacial surgery .
60 jaar3-4 november 2016Utrecht
Nederlandse Vereniging voor Mondziekten,Kaak- en Aangezichtschirurgie
Osteosynthesis
Voor informatie en/of het aanvragen van een demo, kunt u contact opnemen via; [email protected]
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