years. There has been a movement in the specialty to-wards bigger ablation and reconstructive cases, which isevident by the increasing number of fellowships in thespecialty. This trend, however, is not evident in verylarge urban cities, specifically the Northeast. In addition,as OMFS increases in this arena, we have been met withincreasing resistance by other surgical colleagues. Oftenthe argument is that at larger institutions we are com-peting for a similar patient pool and not adding value tothe hospital. However, dentists have been reported tofind lower stage cancers and this is a referral source thatis underutilized at major centers. This study will com-pare variables between different services performingoral oncology at a major urban hospital.

Materials and Methods: A retrospective chart reviewof all patients with oral cancer undergoing surgery atBellevue Hospital from July 1, 2006 to October 31, 2007was done. Charts were found through the Cancer Reg-istry and Medical Records.

Methods of Data Analysis: The patients were dividedinto two groups based on specialty: OMFS group andNon OMFS group. Variables reviewed were age, sex,primary service, referral source, staging, location of tu-mor, and treatment. Descriptive statistics were recordedand the data were further analyzed using the Mann-Whitney-Wilcoxon test to assess whether there weredifferences in staging among the groups. The Fisherexact test was used to evaluate whether the dental pro-fession referred patients with lower stage oral cancersthan other referrals.

Results: Two primary surgical services, Oral and Max-illofacial Surgery and Otolaryngology, were found. Gen-eral Surgery and Plastic Surgery were involved in thereconstruction and ancillary services, i.e. pegs, however,not a primary operating service. Overall there were 28patients who underwent surgical treatment for their oralcancer at Bellevue Hospital during the specified timeperiod. The number of patients seen by OMFS and non-OMFS were 22 and 6, respectively. There were 64%males (n�18) and 36% females (n�10). Referrals fromdentists to a surgical specialty for management of theoral malignancies totaled 18, 64% of the total oral cancercases. OMFS referrals from a dental specialty accountedfor 77.3% while non-OMFS 16.7%. Otolaryngology had83.3% referral from non-dental specialties includingemergency room, primary care, other ENTs and walk-ins.OMFS had 22.7% of non-dental referrals which includedemergency room, plastic surgery, dermatology, walk-ins.The average age of patients being treated for oral cancerwas 55.9 years. The Fisher’s Exact Test indicated thatlower cancer stage was related to whether the patienthad been referred by a dental specialty versus anothergroup (p � 0.004). The average cancer stage for patientsreferred from a general dentist versus patients not re-ferred from a general dentist was 1.3 and 3.4, respec-tively. the Mann-Whitney-Wilcoxon test indicated that

there were no differences in overall cancer stage be-tween the 2 groups (p � 0.001); however 77% of OMFSreferrals were from the dental specialty vs. 16.7% nonOMFS from dental specialties.

The treatment rendered from both groups rangedfrom excision with primary closure to free tissue trans-fer. Complication rates in OMFS patients were 4 of 22(18.2%) including pneumonia, exploration for bleedingtrach site, wound dehiscensce, and decubitus. NonOMFS complication rate was 1 of 6 (16.7%).

Conclusions: As seen in this urban center, OMFStreated almost 80% of the oral cancer patients in theinstitution. As survival and prognosis for head and neckcancer has not changed in 50 years, it is paramount tofind this disease at an early stage. As previously thoughtthis study confirms that dentists find oral cancer at ear-lier stages. We also confirm that dental specialists tend torefer to other members of dental specialties (OMFS) fordefinitive treatment. This combination gives oral andMaxillofacial surgeons the unique ability to impact sur-vival associated with oral cancer and increase the num-ber of patients treated.

References

Holmes J, Dierks E, Homer L, Potter B, Is detection of oral andoropharyngeal squamous cancer by a dental health care provider as-sociated with a lower stage at diagnosis? Journal of Oral and Maxillo-facial Surgery, Volume 61, Issue 3, March 2003, Pages 285-291

McGurk, M.G., Fan, K.F.M., MacBean, A.D., Putcha, V. Complica-tions encountered in a prospective series of 182 patients treatedsurgically for mouth cancer. Oral Oncology, Volume 43, Issue 5, May2007, Pages 471-476

POSTER 008A Retrospective Survey of ComplicationsWith Surgically Assisted Rapid PalatalExpansion (SARPE)Alessandro Silva, DDS, MS, PhD, Kaiser PermanenteHospital, 280 W. MacArthur Blvd, Oakland, CA 94611(Silva A; O’Ryan F; Martin D; Wagner R; Poor D;Laureano Filho J)

Statement of Problem: Surgically-assisted rapid palatalexpansion (SARPE) is indicated for the treatment ofsignificant transverse maxillary deficiency in non-grow-ing individuals. Although frequently performed, there isa paucity of outcomes literature evaluating complica-tions with this procedure. This project aims to retrospec-tively investigate the prevalence, pattern, and clinicalcharacteristics of complications in a cohort of patientsundergoing SARPE over a 3 year period at one institu-tion.

Materials and Methods: A retrospective cross-sectionalanalytic survey to assess the prevalence and possible riskfactors for postoperative complications among patients

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who underwent SARPE at the Division of MaxillofacialSurgery at Kaiser Permanente Oakland Medical Center(Oakland, CA) between January 2003 and March 2006was done. A retrospective analysis of all individuals over13 years of age who underwent SARPE was performed.

Method of Data Analysis: Data collected from the med-ical charts and health plan data bases included patientand surgical characteristics during the hospital admis-sion and for up to 6 months following surgery. Compli-cations were defined as any unexpected event related tosurgical treatment (SARPE) and were analyzed as to thetype of complication and time of occurrence. Patientcharacteristics (including comorbid conditions), sur-geon’s level of experience (years following completionof an accredited residency), and involvement of residentsurgeons were evaluated. Compilation of data and per-centage analyses were performed. Statistical analysesincluded Chi-Square test, Mantel-Haenszel Chi-Square,Fisher’s Exact test and Student t test. Results were con-sidered to be significant at 5% critical level (p�0.05).

Results: Among 114 patients evaluated, 59 (51.75%)were female. The minimum age was 13 years-old with amaximum of 61 years-old. The mean age was 30.93 and themedian was 30 with a standard variation of 11.2. Almost30% of patients developed postoperative SARPE complica-tions. Infections were the most frequent complication(20.59%). Six patients had epistaxis; 5 of which were con-trolled with nasal packing and one required reoperation.Six patients had uneven expansion (17.65%), of which 2required reoperation. Paresthesia (V2) was reported in 6patients (17.65%). Among 34 patients with complications,five presented more than one complication. There weremore complications when SARPE was performed with res-idents (15.79%). Among the cohort 60, (52.63%) individu-als were non-smokers, 15 (13.16%) were smokers, and 39(34.21%) charts were missing these data. Of 34 patientswith complications, 7 were smokers. Surgeon’s expertisewas inversely proportional to the rate of complications.Surgeons with more experience (more than 10 years ) hadsignificantly fewer complications (p�0.048). Gender, age,smoking status, BMI, resident involvement, estimatedblood loss and postoperative nausea and vomiting were notstatistically significant.

Conclusion: A high prevalence of complications, almost30%, was found in this cohort study. The most importantfactor related to complications was the surgeon’s expertise.This research provided useful data regarding risk factors forpostoperative complications following SARPE and high-lights the need for future prospective studies.

Acknowledgement: Funding Source: Stryker CMF(Kalamazoo, MI) for the financial support of this re-search.

References

Lanigan DT, Mintz SM. Complications of surgically assisted rapidpalatal expansion: Review of the literature and report of a case. J OralMaxillofacial Surg, 60:104-10, 2002

Koudstaal MJ, Poort LJ, van der Wal KG, Wolvius EB, Prahl-Andersen B, Schulten AJ: Surgically assisted rapid maxillary expan-sion (SARME): a review of the literature. Int J Oral Maxillofac Surg34:709-14, 2005

POSTER 009Treatment of Oroantral CommunicationsUsing a Pedicled Buccal Fat Pad Flap:Study in Manaus–BrazilPetrus P. Gomes DDS, Msc, PhD, Av. Djalma Batista1661 Sl. 702, Medical Tower, Millennium Center,69050-010, Manaus, AM, Brazil (Kirsh D; Jesus GP)

Statement of the Problem: Oroantral fistula is a com-mon issue at the amazon region considering the scarcedental care and local difficulties related with transporta-tion from small communities to larger cities to get accessto an oral and maxillofacial surgeon. Chronicle sinusitisand purulent drainage are frequent findings on thesepatients. Most lesions are the result of dental extractions.The pedicled buccal fat pad flap has been frequentlyused associated with sinusectomy for closusing the oro-antral communications and has proved to be consistentlysuccessful on that.

Materials and Methods: In three years thirty patientsfrom remote areas of the Amazon region had their oro-antral fistula treated at Oral and Maxillofacial Servicefrom Amazon Federal University in Manaus–Brazil. Pa-tients had surgical treatment in different periods fromthe extractions ranging from a week to eight years. Allsubjects had chronic oroantral communication and si-nusitis and have been treated similarly by sinusectomyand communication closure with pedicled buccal fat padflap.

Results: The 12-month follow-up revealed uneventfulhealing in all of the patients. The cases hasn’t exhibednecrosis of the flap. The procedure was successful in 13of 14 patients. Postoperatively, the orally exposed fatgradually was transformed into a granulation-like tissueand epithelization developed within 3 weeks. All oro-antral communition were closed successfully.

Conclusions: The use of pedicled buccal fat pad (BFP)is an acceptable alternative, reliable and convenientmethod for closure of oroantral communications. It canalso be considered as a reliable back-up procedure in theevent of failure of other techniques. It was concludedthat the procedure has wide application and a highdegree of success. Good vascularization, ease of access,and minimal donor site morbidity make it a reliable softtissue graft.

References

Dolanmaz D, Tuz H, Bayraktar S, Metin M, Erdem E, Baykul T. Use ofpedicled buccal fat pad in the closure of oroantral communication:analysis of 75 cases. 2004 Mar;35(3):241-6

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