O.230 Laterocervical schwannoma – case report

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Journal of Cranio-Maxillofacial Surgery 36(2008) Suppl. 1

the era of Galen, writing on almost every aspect of medicine described in a very detailed and diligent manner some interesting aspects of cranio-maxillofacial surgery in general, and particularly salivary glands pathology. O.228 Craniofacial surgery in the Arab world 1970–2008 M. Elmassry. Ministry of Health, Kuwait, Kuwait Craniofacial surgery started at Alexandria, Egypt, 1976, as a new speciality based on dual qualifications. Over the years the progress of this speciality was not easy, and it needed dedicated personnel. This article is to show what is being done at the different aspects of craniofacial surgery at the arab countries and to show different state if the art surgeries that have been carried out in craniofacial anomalies and difficult reconstructions as well as rare categories of craniofacial pathology. O.229 European law for the European maxillofacial surgeon A. Ezsias. Cardiff, UK Since the Treaty of Rome over fifty years ago in 1957 the European countries have come a long way to put into practice the ideas, thoughts, concepts and visions of the ‘founding fathers’ who started an uncharted journey to rebuild Europe from the ravages of wars. From the humble origin of European Coal and Steel Community (ECSC; 1951) to the Lisbon Treaty (2007) the road has been complex and the consequences are far reaching to many generations of Europeans, the vast majority of them have had no direct experiences of a major war in Europe. The free movement of persons, freedom of establishment and freedom to provide and receive services are fundamental concepts of the now European Union (EU) effecting the every day lives and works of each maxillofacial surgeon in Europe. The author, a consultant maxillofacial surgeon who was called to the English Bar in 2008 becoming a barrister, will give a brief summary of the laws which directly and indirectly shaping the lives of each and every European maxillofacial surgeon from cradle to retirement and beyond. Relevant legislations and recent developments will be touched upon.

Abstracts, EACMFS XIX Congress Recommended treatment is surgical. Adequate imaging should be carried out preoperatively to gain as much information as possible about the individual tumour and allow informed patient counseling regarding to potential risks and morbidity of surgical intervention. O.231 Referrals to a surgical tracheostomy service B. Bisase, S. Matthews, B. Afzhal. King’s College Hospital, London, UK Introduction: The benefits of early tracheostomy, who should have one, by which method and the criteria used to make appropriate referrals for tracheostomy, are ongoing debates in literature. Accepting the referral to perform a surgical tracheostomy (ST) should include scrutiny of patient characteristics, indications and alternative methods to secure the airway. Although elective tracheostomy may reduce the length of stay in intensive care units (ICU), there is little evidence on tracheostomy reducing mortality or morbidity and little data on the risk benefit of the procedure where inappropriate selection is made. Objectives: To review the characteristics of referrals made for ST in order to better understand their appropriateness and whether there is a need to re-visit the criteria used. Methods: A prospective study over a 6 months period analysed all referrals made to the ST service from 3 ICU’s. Data collected related to patient demographics, reasons and timing of referral and intubation, patient ICU parameters at the time of referral and outcomes. Results: 46 referrals were received with a male: female ratio 1:1 and a mean age of 55 (28−75). The most common reason for referral was a concern about body habitus or anatomy and the mean duration of intubation at the time of referral was 4 days (1−17). 70% proceeded to ST with the remainder undergoing a percutaneous approach or no tracheostomy at all, as referrals were made too early or with poor prognostic ITU features. Conclusions: Our findings suggest there is a tendency to premature referral for ST and that there is a need for clearer referral guidelines between ICU and the tracheostomy service in order to optimise the yield of appropriate referrals.

O.232 The current use of oropharyngeal ‘throat’ packs in the UK B. Bisase, S. Matthews. King’s College Hospital, London, UK

O.230 Laterocervical schwannoma – case report Gr.D. Mihalache, M. Ciofu, O. Boisteanu, C. Vicol. University of Medicine and Pharmacy Iasi, Iasi, Romania Schwannomas of the head and neck are very uncommon tumours that arise from the sheath of any peripheral, cranial or autonomic nerve in this region. They are rare and usually solitary, with clearly delimited capsules. They occur in the head and neck region in only 25% of the cases. Objectives: To present our experience and the outcome in managing a patient with laterocervical schwannoma. Methods: A 46 year old woman presented in our clinic with five months history of left laterocervical, hard and painless lump and an ulceration 1.5/1 cm on the left margin of the tongue, just in line with two remaining dental roots 35, 36. After the teeth extraction, the tongue ulceration had slowly remitted without any modification on the laterocervical site. Computer tomography showed a homogeneous left laterocervical tumor, about 7/4 cm. The treatment was surgical by tumour extirpation. The tumour extension reached the temporal styloid process. Results: The tumour was diagnosticated as schwannoma of deep cervical plexus. Conclusions: Schwannomas are very rare tumours, solitaire, mostly benign and with very little relapse.

Introduction: The use of oropharyngeal throat packs (OPTP) has been practiced for decades. Indications relate to the prevention of migration of secretions, blood or debris into the hypopharynx or larynx. Disadvantages include post-operative sore throat, mucosal damage, and its retention. The position of the mandible may be significantly altered by an OPTP during mandibular surgery (orthognathic or trauma). This may necessitate a prolonged or second anaesthetic to rectify any occlusion anomalies. Such advantages and disadvantages may explain why the use of OPTP remains controversial to date, as demonstrated by trusts still reporting critical incidents related to their use or retention. Objective: To establish the current use of OPTP in the UK. Methods: 360 anonymous questionnaires exploring the current practice, attitudes, opinions and experiences of consultant oral and maxillofacial surgeons (OMFS) (180) and anaesthetists (180) were disseminated nationwide. Results: The response rate was 85% and 75% respectively. Just over 1/3 of OMFS rarely or never use an OPTP and over 90% of anaesthetists routinely use one. Over 12 of all responders reported an involvement in 1−4 non-fatal adverse incidents of OPTP retention and 5% in 1−2 cases of fatality. A third of OMFS reported problems with occlusion. There was a marked difference in opinions within and between the two groups as regards OPTP removal and whose ultimate responsibility it is to remove.