40 The Coleman fat transfer technique as a temporal fossa ‘filler’ a technical note

Oral presentations / British Journal of Oral and Maxillofacial Surgery 48 (2010) S1–S24

this population will have a skeletal discrepancy not amenable to corrective orthodontics alone. In addition to anatomical indications for orthognathic surgery, psychosocial and biophysiological factors have a significant influence. The aim of this contemporary study is to review preoperative motives and postoperative satisfaction in patients following single jaw or bimaxillary osteotomy surgery at Southampton General Hospital between 2005 and 2010, and compare the findings with concurrent literature. Material and Methods: A standardised postal retrospective questionnaire was completed by patients receiving orthognathic surgery over a five-year period to identify motives for seeking surgery, the degree of satisfaction with the outcome and its effect on quality of life. Results and Statistics: The main preoperative motive for orthognathic surgery was for aesthetic reasons. The importance of correcting malocclusion and oral function appeared to score less as a motive. In addition, postoperatively there was a positive patient response about the outcome of surgery as well as its effect on their quality of life. Conclusion and Clinical relevance: This article demonstrates the importance patients place on aesthetics over biophysiological factors. These results seem to reflect patient opinion in similar studies in North America but contrast findings across Scandinavia. 40 The Coleman fat transfer technique as a temporal fossa ‘filler’, a technical note A. Halka, R. Mohammed-Ali, T. Nanidis, A. Yousefpour, A. Fitzgerald. Sheffield Teaching Hospitals, UK Introduction: Hollowing of the temporal fossa is aesthetically displeasing and psychologically distressing to patients. Unilateral temporal muscle atrophy causes noticeable head and facial asymmetry which is not easily disguised. Percutaneous and invasive approaches have emerged to improve temporal fossa deficit. Dermal fillers, like silicone and bovine collagen, although effective, have temporary efficacy. Dermal fillers may induce early-onset swelling and redness and a late-onset foreign body immune response, causing granulomata. Cranial synostosis-induced temporal fossa hollowing requires drastic temporal bone reshaping. Fat transfer employing the Coleman technique rejuvenates various anatomical areas including the hands and eyelids. Cheek hollowing and acne scarring-induced buccal adhesions have also benefitted from Coleman fat transfer. The Coleman technique to correct hollowing of the temporal fossa has not been described. Methods: Eight patients with temporal fossa hollowing underwent fat transfer using the Coleman technique by the same plastic surgeon. Under general anaesthesia as a day case, fat harvested from the abdominal wall using the standard protocol was grafted to the temporal fossa. Pre-operative and post-operative images were obtained with appropriate consent. Results: All patients showed immediate improvement in their general appearance due to the temporal fossa being slightly overfilled. Patients required another fat transfer after approximately six months with no further procedures being required. Discussion: Coleman fat transfer noticeably improved the appearance and quality of life of patients with temporal fossa hollowing. The technique is easy to perform as a day case, has minimal risks at the host site due to fat being autologous and has reproducible results.

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41 Preventing unfavourable splits in BSSO: a study of 254 splits and the anatomically based technical modifications used A. Wilson, N. O’Connor, J. Majdneya, M. Al-Gholmy. St Richard’s Hospital, Chichester, UK Introduction: Bilateral saggital split osteotomy (BSSO) techniques aim to increase predictability of splitting, and minimise soft tissue stripping. Reported rates of unfavourable splits vary from 0.9% to 23%. Materials and Methods: We present a retrospective study which involves analysis of 127 consecutive patients who underwent BSSO, with or without concomitant maxillary surgery. This included 254 mandibular splits carried out in one hospital, by one operator or under the direct supervision of this operator. Sixty-six per cent of the patients were female, 34% were male. The age range was from 16 to 52 years with a mean age of 22. 53% of patients had a Class II malocclusion and 47% were Class III. At the time of surgery, wisdom teeth were present in 66% of sites. In 20% of sites the wisdom teeth remained postoperatively and in 45% of sites they were removed simultaneously. The incidence of bad splits was 0%. Conclusion: Our study demonstrates that successful BSSO is not necessarily related to presence or absence of wisdom teeth or the age of the patient. Adaptation of the surgical technique based on anatomical observations has produced reliable and reproducible results. We review the literature, present a cadaveric study and our technical refinements. 42 Early experience with the Hilotherapy in oral and maxillofacial surgery P. Ramsay-Baggs, J. Hanratty, E. Qudairat. The Ulster Hospital, Dundonald, UK Hilotherapy is a term used to describe the application of cold fluid at a controlled temperature to areas of the body that have been subjected to trauma or surgery. The temperature is controlled by a Hilotherm® machine and the fluid is delivered to the relevant area by a specially designed cuff or a mask. It has been used in Sports medicine, Plastic Surgery, Orthopaedics and more recently in Oral & Maxillofacial Surgery. Cold therapy to reduce pain and swelling has been in use for centuries, usually by applying ice or other materials at around 0°C. Although this is believed to be advantageous, the use of such a low temperature also carries some disadvantages, ranging from a reactive hyperaemia to skin damage. These adverse effects are seen with temperatures below 14°C. In Hilotherapy the fluid circulating in the cuff or mask can be regulated to the ideal temperature for the area being treated and kept constant. In the case of the head & neck this is between 16°C and 20°C depending on the site. The result is the advantages of reducing pain and swelling and producing a quicker recovery without the adverse effects seen with lower temperatures. We report our very positive experience with the Hilotherapy device which has been used in orthognathic, post traumatic and dentoalveolar surgical cases. We have also found it useful in patients with spreading infection. Our experience suggests that this technique has a role in Oral & Maxillofacial Surgery.