Abstracts 69
and in vitro experiments. By using the rodent and rabbit inferior ulous surgical planning and advanced bone preservation tech-
alveolar nerve (IAN) transection model, increasing studies have niques alongside informed consent, outcomes can be improved.
indicated that IAN injury can lead to a delayed process of bone
healing in the mandible. However, the actual effects of IAN nerve https://doi.org/10.1016/j.ijom.2019.03.211
injury on human mandible have not been elucidated
Objectives: To assess actual effects of IAN nerve injury Wisdom teeth - a case for early removal
on human mandible by comparing the pre- and post-surgical
panoramic radiographs and CT images of 6 patients with uni- B. Tomasetti ∗ , M. Glasgow, B. Chai, PhD, J.B. Phillips
lateral IAN broken during bilateral sagittal split ramus osteotomy Denver Health and Hospitals OMS Residency Program Denver,
(BSSRO). Colorado USA
Methods: A total of 6 cases (3 males and 3 females) who had
undergone unilateral IAN injury during BSSRO were included. Background: Wisdom teeth have been a much-debated issue
Neurosensory examinations, panoramic radiograph assessment for both the General Dentist and the Oral and Maxillofacial Sur-
and CT images measurement were performed up to 6 months after geon. For the most part patients know about them and do not want
the surgery. them removed unless they hurt. Unfortunately, by the time they
Findings: Articles in the literature focused mainly on hard are hurting, significant problems may have occurred. Tomasetti
tissue injuries to teeth or on the carcinogenic effects on the s et al Localized Alveolar Osteitis: a retrospective study Journal of
By analysing the panoramic radiograph KI and inter-trabecular General Dentistry 41: Nov 1993.
space indexes, no significant sign of abnormal bone resorption Objectives: AAOMS Position Paper on Third Molars 2016.
on both sides of the mandible was observed. CT images analysis “Third molars that are associated with disease or at high risk of
further showed that normal bone healing was found at both sides developing disease should be surgically managed. Removal should
of mandible of all patients. No significant differences of bilateral be favored when the third molar is or likely to be nonfunctional,
mandibular cortical bone thickness and trabecular bone density there is an overlying removable prosthesis, orthodontic removal
was found before and after the surgery. is justified and planned orthognathic surgery.”
oft tissue. There was limited literature relating to patterns of Methods: Complications, both prior to and after removal have
soft tissue injury. Self-cannibalism, mucosal changes, inflamma- been well documented. There is, however, little discussion about
tion and fistula formation have all been reported. the consequences of not removing wisdom teeth.
Conclusion: In conclusion, our primary result indicated that Findings: Both the General Dentist and OMS share joint
IAN injury during BSSRO may not significantly impair the bone responsibility in making the decision as to whether to remove
healing process of the human mandible. wisdom teeth or to monitor the patient.
Conclusion: Early removal of wisdom teeth can play a large
https://doi.org/10.1016/j.ijom.2019.03.210 part in preventing future morbidity and expense. NIH Consensus
Conference 0n Third Molars - The least morbidity occurs when the
Use of cbct in surgical planning and damage limitation in third molars are removed between the ages of 15 and 25. Morbidity
deeply impacted teeth is lowest when third molar roots are not fully formed.
A. Thomson ∗ , S. Reddy, K. Ganesan https://doi.org/10.1016/j.ijom.2019.03.212
Southend University Hospital, Essex, United Kingdom
Management of pediatric odontogenic infections: pediatric
Background: A tooth is defined as deeply impacted when the dentists and oral and maxillofacial surgeons
crown is below the middle third of the root of a fully erupted
tooth and/or lack of basal bone. Assessing the likelihood of com- M. Turner ∗ , T. Kim, D. Han
plications depends to a great extent on preoperative radiographic Icahn Mount Sinai School of Medicine
examination and quantifying this is not fully possible in 2D plain
radiography. Background: This research study is aimed to obtain informa-
Objectives: To demonstrate that advanced imaging improves tion regarding management of odontogenic infections by pediatric
predictability, bone preservation and helps to prevent adverse out- dentists and oral and maxillofacial surgeons (OMFS).
comes (nerve damage, fracture of the mandible, oro-nasal and Objectives: The study goals were achieved by a com-
oro-antral fistulas, damage to adjacent teeth) in the management parison of management modalities of six case scenarios
of deeply impacted teeth. describing pediatric odontogenic infections of various clinical
Methods: Data was analysed from patients seen for surgical presentations.
removal of deeply impacted permanent teeth from 2011-2015. Methods: Two case scenario questionnaires were created for
This included 120 children. All post-operative complications were pediatric dentists and OMFS. Questionnaires were emailed to
recorded. 20% of randomly selected representative sample of pediatric den-
Findings: The minimum follows up period was six months. tists and 20% of randomly selected representative sample of
There were no complications reported in the pediatric population. OMFS.
Conclusion: Use of conventional radiographs and standard Findings: Eleven percent of the 884 pediatric dentists (n = 99)
surgical principles have been shown to result in an incidence of and thirteen percent of the 1,191 OMFS (n = 153) responded.
complications ranging from 0.35%-25%. The number and apical Comparisons between the groups regarding case scenarios that
divergence of the roots can be reviewed more reliably on CBCT involved either facial swelling or intraoral abscess from a perma-
than conventional radiographs. The advent and application of nent tooth had statistically significant differences (p < .05) for the
advanced 3D imaging in oral surgery allows us to manage deeply following: incision and drainage (I&D), culture and sensitivity,
impacted teeth more effectively. With the use of a robust and metic- and removing the offending tooth. Pediatric dentists saw more
cases of odontogenic infections than OMFS. The majority of
70 Abstracts
OMFS believed that I&D must be performed whenever a fluctuant Effect of submucosal dexamethasone injections in the preven-
swelling is present intraorally, the majority of pediatric dentists tion of early and late post-operative pain, trismus and oedema
believed it is only rarely indicated. When asked whether antibiotic associated with mandibular third molar extractions: a system-
therapy is necessary once the offending primary or permanent atic review and meta-analysis
tooth is removed, pediatric dentists were less likely to prescribe
B. Wilson ∗ , P. O’Hare, M. Loga, A. Ariyawardana
antibiotics than OMFS.
Conclusion: In this study, significant differences were James Cook University, Cairns, Australia
observed in management modalities of odontogenic infections
between pediatric dentists and OMFS. Considering the unpre- Background: Third molar extraction is one of the most com-
dictable nature of odontogenic infections and the high prevalence monly performed procedures by oral surgeons. The significant
of occurrence, standardized approach in managing these patients is inflammatory reaction after an extraction is the source of many
warranted in order to perform the best care for each patient. Unkel of the negative post-operative sequelae. Localised swelling in
JH, McKibeen DH, Fenton SJ, Nazif MM, Moursi A, Schuit K. the region of masticatory muscles can result in trismus, limit-
Comparison of odontogenic and nonodontogenic facial cellulitis ing the return to normal diet for patients. Post-operative pain is
in a pediatric hospital population. Pediatr Den also attributable to the local damage to bony and soft tissues,
with resultant inflammatory mediator release. The inflamma-
tory source of extraction pain has previously been considered
https://doi.org/10.1016/j.ijom.2019.03.213
in studies investigating the role of oral corticosteroids to reduce
these post-operative inflammatory sequelae. The widespread sys-
Urgent oral and maxillofacial surgery in the pregnant patient: temic side effects that can be associated with oral corticosteroids
a review of the literature have prompted investigation into localised corticosteroid admin-
E. Wates ∗ , B. Ria, E. Samara, J. Higginson istration instead. Consequently, submucosal administration of
corticosteroids in the perioperative period has become a target
Worcestershire Acute Hospitals NHS Trust, Worcester, UK of investigation.
Background: Pregnant patients are presenting more frequently Objectives: The aim of this systematic review and meta-
to OMFS for urgent treatment as a consequence of denied or delay analyses was to determine whether there is a clinically effective
in care in the primary setting; as a result, they often present with reduction in post-operative pain, oedema and trismus after submu-
a more severe infection requiring drainage under general anesthe- cosal dexamethasone administration during impacted mandibular
sia or present after analgesic overdose. Similarly, the incidence of third molar extractions.
head and neck cancers in the younger female population is increas- Methods: Using The Cochrane Register of Controlled Trials
ing and women are often conceiving at later ages. This presents (CENTRAL), MEDLINE (PubMed), EMBASE, Web of Science
an ethical dilemma of managing pregnant patients with head and and Google Scholar databases an electronic search was conducted
neck cancer, balancing optimal treatment for the mother against up to and including June 2018. Randomised and quasi-randomised
protecting the fetus from harm. trials were included. Mean difference or standardised mean dif-
Objectives: The aims of this literature review were to explore ference were extracted and pooled using the fixed effects model
the evidence base behind the safety of carrying out urgent dental or if significant heterogeneity was observed, the random-effects
treatment in pregnant patients. We also explored the evidence for model.
treatment options available to patients diagnosed with oral cancer Findings: Seventeen trials were included for meta-analyses
in pregnancy. and independently assessed for risk of bias. There was low quality
Methods: The authors carried out a literature search in October evidence that submucosal dexamethasone reduced early post-
2018 using Medline. operative pain, early and late post-operative trismus and late
Findings: Barriers to primary care dentists providing urgent post-operative oedema after mandibular third molar extraction.
dental care to pregnant patients include: inability to manage this Moderate quality evidence was found for the reduction of late
anxious patient group; lack of historical evidence on the safety post-operative pain and early post-operative oedema. Submucosal
to the fetus; lack of continuing professional development in this dexamethasone was however more.
area; potential litigation risks; a fear of inducing labor.
Conclusion: The treatment options available for the patient https://doi.org/10.1016/j.ijom.2019.03.215
diagnosed with oral cancer in pregnancy include: termination of
pregnancy; early delivery via cesarean section due to advances in Head & Neck Oncology
neonatology; postpone treatment until after delivery; or to provide
suboptimal treatment during pregnancy. We review the evidence Adenoid cystic carcinoma of the head and neck: demograph-
we have available for these treatment options to help support ics, prognostic features, and outcomes
patient autonomy.
P. Afzali ∗ , N. Syyed, J. McMahon
https://doi.org/10.1016/j.ijom.2019.03.214 Queen Elizabeth University Hospital, Oral and Maxillofacial
Surgery/Head and Neck Surgery, Glasgow, United Kingdom
Background: The behavior of adenoid cystic carcinoma
(ACC) of the head and neck has been shown to be unpredictable,
with frequent local recurrence and distant spread leading to mor-
tality.
Objectives: In the absence of unified treatment protocol, we
evaluated the management and outcomes of patients with ACC of
the head and neck. The aim of this study is to identify prognos-
