Otolaryngology Head and Neck Surgery P90
Scientific Sessions- - Monday
Guided Tissue Regeneration of Cranlofaclal Defects Using Membrane Techniques KHALID CHOWDHURY, MD, FRCSC, FACS (presenter), JONATHAN HODES, MD, and A. LARRY ITEN, DVM, Lexington, Ky.
Large craniofacial bone defects resulting from trauma, surgery, or tumor resection are replaced by fibrous tissue. Reconstruction with use of alloplastic materials has numerous disadvantages, including rejection, infection, loosening, and tissue toxity. The drawbacks of using autogenous bone grafts include lack of availability of sufficient material, donor site morbidity, and graft resorption. Critical size craniofacial bone deficits heal by fibrous tissue ingrowth with little spontaneous regeneration of bone. Prior research in guided tissue regeneration has demonstrated that the use of membranes over a bony defect provides a barrier to the ingrowth of fibrous tissue and may permit successful healing with regeneration of bone if the membranes do not collapse. This investigation used 20 adult cats in which 40 large calvarial defects (two 1.5 x 1.5 cm defects per animal) above critical size were created and covered with polytetrafluoroethylene membranes as a barrier for the ingrowth of connective tissue. The previously encountered problems of membrane collapse over large defects were avoided by using an outer semirigid titanium mesh framework to prevent membrane collapse into the defect. The animals were divided into three groups: a control group with unrepaired defects, a second group in which membranes were used without a supporting framework, and a third group in which the membranes were used with the supporting mesh framework. Following sacrifice between 12 and 26 weeks after the operation, the skull vaults of the animals were dissected with a rim of surrounding normal bone. Radiographs of the specimens were obtained to allow bone densitometry measurements, followed by preparation of the specimens for bone histomorphometry to document the extent of new bone formation. This experiment demonstrates, with use of an animal model, that guided tissue regeneration using membrane techniques may have clinical applications in the reconstruction of craniofacial skeletal defects and that the problem of membrane collapse can be surmounted by using a semirigid mesh supporting framework.
Wound Healing Using Scalpel, Electrocautery, CO 2 Laser and KTP Laser in Rat Tongue: A Comparative Study of Oral Intake, Histology and Tensile Strength JOHN F, CAREW, MD (presenter), ROBERTF, WARD, MD, ANTHONY LABRUNA, PETERTORZILLI,PhD, and W. SHAIN SCHLEY, MD, New York, N,Y.
The use of the laser as a surgical tool and its application in treatment of disorders of the upper aerodigestive tract has increased substantially during the past three decades.
However, few studies have objectively examined the effects of the various lasers on pain and wound healing in the upper aerodigestive tract. In this study, postoperative oral intake, histologic depth of wound healing, and tensile mechanical strength were measured in rat tongues after creating incisions using a scalpel, electrocautery, carbon dioxide (CO2) laser, and potassium titanyl phosphate (KTP) laser. An unpaired, two-tailed Student t test was used to compare results between the experimental groups. Oral intake, indirectly assessed by postoperative weight loss, by the third postoperative day was significantly decreased in the electrocautery (p = 0.004), CO 2 laser (p = 0.001), and KTP laser (p = 0.0001) groups compared with the scalpel group. The depth of the wound healing, as assessed by histologic examination on the tenth postoperative day, was successively greater for the scalpel (75 • 13 /am), electrocautery (110 • 10 lam), CO 2 laser (145 _+ 10 lain), and KTP laser (195 • 23/am) groups. However, this difference was only statistically significant for the CO 2 laser (t9 = 0.006) and KTP laser (p = 0.01) groups compared with the scalpel group. On gross examination of the wounds, none of the scalpel group had visible dehiscences, while 30% of the electrocautery group, 20% of the CO L laser group, and all of the KTP laser group had visible dehiscences. Wounds created by the KTP laser had the lowest strength (76.5 • 6.9 kPa) compared with the CO 2 laser group (156 • 28.4 kPa), electrocautery group (153 • 15.7 kPa), and scalpel group (249 • 61.8 kPa). This difference was only statistically significant for the KTP laser group (p = 0.02) when compared with the scalpel group. Our results indicate that wounds created in the upper aerodigestive tract of rats by scalpels cause the least pain, tissue destruction, and impairment of wound healing, while wounds created by the KTP laser demonstrated a significantly greater impairment of oral intake, depth of wounding, and decrease in tensile strength. Poster 41
The Use of Dlclofenac and Pethldlne for Preemptive Paln Control in Tonsillectomy: A Controlled Study STEPHEN W, HONE (presenter), PETERO'SULLIVAN, DECLAN McGEE, and DONALD P. McSHANE, Chicago, Ill., and Dublin, Ireland
Objective: We designed a randomized controlled study to compare the effects of rectal diclofenac and intramuscular Pethidine given at induction with Pethidine alone in children undergoing tonsillectomy. Methods: Fifty-nine patients (26 male and 33 female) were entered into the study. The mean age was 6 years (range, 3 to 13 years). Patients were randomized according to chart number. Thirty-five patients received rectal diclofenac after induction, and 24 patients acted as controls. Results: There were no significant differences in operating time or operative blood loss between the two groups. In the recovery room the diclofenac group was significantly less restless than the control group (p < 0.05, Chi square)