Poster presentations / British Journal of Oral and Maxillofacial Surgery 51 (2013) e107–e129 e113

neck was 7.2 mm (SD 6.54). Other poor prognostic factorssuch as non-cohesive invasion, lymphovascular and perineu-ral invasion were more frequently seen in association withpositive nodes.

In accordance with published literature, we found apositive correlation between increasing depth and nodalmetastases (p = 0.031 for tumours above 3 mm depth). How-ever, a proportion was associated with more superficiallyinvasive tumours and there appear to be multiple variablesassociated with positive nodes. In light of this we wouldsuggest the consideration of a prophylactic functional neckdissection in patients with tumours less than 3 mm in thick-ness.

http://dx.doi.org/10.1016/j.bjoms.2013.05.098

P16

Squamous cell carcinoma arising from a recurrent orallichen planus lesion on the radial forearm flap: first reportin the English-language literature

Kemal Mustafa Tekeli ∗, Muneer Patel, Jeremy McKenzie,Marcus Sinanan, Christopher W. Hendy, Nicholas M.Goodger

East Kent Hospitals University NHS Foundation Trust,United Kingdom

Lichen planus is a chronic muocutaneous disease affectingmouth mucosa, skin and tongue. The possibility of malignanttransformation of lichen planus is well recognized. Malignanttransformation of oral lichen planus (OLP) rate varies in theliterature. However it does not exceed 1%.

The aim of this report is to present the first case of squa-mous cell carcinoma arising from OLP lesion recurring onthe radial forearm flap in the floor of mouth.

A 72 year old patient presented to our department with alongstanding OLP lesion. She stayed under surveillance andunfortunately developed a squamous cell carcinoma (SCC)arising from OLP in the floor of mouth. She underwentresection and subsequent reconstruction with radial forearmfree flap. After 12 months of follow up, she started to developOLP on the radial forearm flap which was proven by anincisional biopsy. 6 months after this, she developed a newprimary SCC within this new area of OLP. She underwentfurther treatment.

To our knowledge, such a presentation has not beenreported to date. We discuss the importance of long termfollow up and possibility of further recurrence.

http://dx.doi.org/10.1016/j.bjoms.2013.05.099

P17

Oral and Maxillofacial Surgery in the MDT skin cancerclinic: the use of Photodynamic Therapy

Karl F.B. Payne ∗, Kathleen Fan

King’s College Hospital, London, United Kingdom

Photodynamic Therapy (PDT) utilises a light activatedphotosensitising agent, to create reactive oxygen speciesthat in turn cause cell death. This treatment is currentlyNICE approved for the treatment of non-melanomatous skinlesions; primarily Actinic Keratosis (AK), Bowen’s Disease(BD) and Basal Cell Carcinoma (BCC).

Over a 12 month period in an Oral and MaxillofacialSurgery and Dermatology MDT clinic, 66 patients weretreated with Metvix topical PDT (methyl aminolevulinicacid); mean age 65.6 years (range 34–88) with near equalsex distribution. Treatment consisted of 1–2 cycles of PDT(diagnosis dependant), with review at 3 months to determineresponse. Fifty percent (n = 33) of patients were treated forBCC, 25.8% (n = 17) for BD and 24.2% (n = 16) for AK.

Over eighty percent of patients had a positive response,with no relationship between skin lesion and response rate.In line with current literature we report a low level of adverseevents. PDT of head and neck lesions were more painful thanother areas. Of those failing initial treatment, the majorityrequired further surgical management, in the form of curet-tage or excision. Of the total cohort, 45.5% (n = 30) exhibiteda lesion in the head and neck; common areas of diseaseincluded the scalp, forehead, cheek and neck.

PDT is a clinically underused treatment, particularly use-ful in elderly frail patients or those with multiple skin lesionsincluding transplant patients. We report a high success ratewith minimal complications and a useful modality for man-agement of skin cancer patients, especially those of the headand neck.

http://dx.doi.org/10.1016/j.bjoms.2013.05.100

P18

Head and neck sarcomas: a 12 year retrospective reviewof 40 cases

Craig Pearce ∗, Zahra Al-Asaadi, Hazel Williams, DavidPeake, Khaleeq-Ur Rehman, Tim Martin, Sat Parmar

University Hospital Birmingham, United Kingdom

Introduction: Sarcomas are rare tumours accounting foraround 1% of all malignancies. Sarcomas in the head andneck region make up approximately 15% of all sarcomas,with the most common being rhabdomyosarcoma in childrenand osteosarcoma and angiosarcoma in adults.

In the UK, sarcomas are reviewed in specialised sarcomamultidisciplinary teams (MDT). NICE recommend that eachMDT should see at least 100 new cases per year (soft tissue)and, if dealing with bone sarcomas an additional 50 bone

e114 Poster presentations / British Journal of Oral and Maxillofacial Surgery 51 (2013) e107–e129

cases per year. There are currently around 14 sarcoma MDTsnationwide, including one based in Birmingham.

Aims: We review the patients presenting with head andneck sarcoma over the period 2000–2011, describing the typeof sarcomas, site of origin, stage at presentation, treatmentmodalities, and prognosis of this relatively rare group of headand neck tumours.

Materials and methods: A retrospective review of thesarcoma database, the general pathology database, the headand neck database and a review of case notes.

Results: We present results relating to demographics, pre-sentations and outcomes, including:

• 40 patients (M:F 2:1).• Swelling most common presenting sign.• Crude 5-year survival 45%, median time to recurrence 36

months.• Surgery predominant treatment modality.

Conclusions: There are few large case series of head andneck sarcomas in the literature. The importance of radicalresections and the use of neoadjuvant chemotherapy are dis-cussed.

http://dx.doi.org/10.1016/j.bjoms.2013.05.101

P19

The role of TBX1 in the developing secondary palate

Stephanie Bryan ∗, M. Zoupa, G.M. Xavier, M. Arno, M.T.Cobourne

King’s College London Dental Institute, United Kingdom

Introduction: The Tbx1 gene is a candidate for causinga number of developmental abnormalities including humansyndromic cleft palate. The aim of this study was to assessthe influence of Tbx1 on the gene expression profile withinthe developing palate.

Design and setting: This was an in vitro study completedby the King’s College London Department of CraniofacialDevelopment and Orthodontics in collaboration with theKing’s College London Genomics Centre.

Materials and methods: A microarray screen was con-ducted using RNA isolated from the secondary palate ofE13.5 embryos wild type, heterozygous and mutant mice forTbx1. Microarray screening revealed significant differencesbetween geneotype, with a total of 67 genes showed at leasta 2-fold change (p < 0.05) in expression. For validation ofthe microarray results, real-time quantitative PCR was car-ried out using the original RNA samples and gene-specificprimers. Of the 67 genes identified in the microarray analysis63 genes were tested.

Results: From the 63 genes tested, the real time quanti-tative PCR showed that 18 genes were significantly changedbetween wildtype and mutant and 24 between heterozygoteand mutant. 15 of these genes were present in both groups,apart from 1 gene, which was downregulated. From these

genes, associations with early muscle development, contrac-tion and calcium channel signaling were found.

Conclusions: Significant differences in the gene expres-sion profile within the secondary palate of wildtype andmutant embryos suggests a direct role for Tbx1 during palato-genesis.

http://dx.doi.org/10.1016/j.bjoms.2013.05.102

P20

An unconventional use of ultrasound guided botulinumtoxin injections in hemifacial microsomia

Sinitta Madhani ∗, C.K. Lau, S. Thomas, J. Makdissi, L.Cheng

Department of Oral & Maxillofacial Surgery, Barts HealthNHS Trust, The Royal London Hospital, London, UnitedKingdom

Introduction: Hemifacial microsomia is a congenital dis-order that affects lower facial development. It is the secondmost common facial birth defect after clefts, with an inci-dence between 1 in 3500 to 4500. The deformity in hemifacialmicrosomia varies greatly in the degree of severity and in thearea of the face involved. Extensive facial reconstruction maybe required in cases of severe disfigurement.

Case history: A forty year old male with mild hemifacialmicrosomia presented to our department with concerns aboutthe asymmetrical appearance of his lower right lip. Althoughthere was minimal asymmetry at rest, this was especiallynoticeable during speech.

Weakness of the mandibular branch of the right facialnerve was initially suggested as a cause, however neuro-physiology investigations using electromyography showedsymmetrical findings on facial nerve stimulation. Throughintuitive planning, the patient’s concerns were addressed by amasking procedure using ultrasound guided botulinum toxininjections to the lower lip on the contralateral side of hishemifacial microsomia. This essentially reduced the lip activ-ity of patient’s unaffected side thus improving his overallsymmetry.

Facial symmetry was achieved and patient was very con-tent with the outcome. At his last review appointment sevenmonths post-procedure, the patient is still enjoying the resultsfrom the botulinum toxin injections.

Conclusion: This case serves to highlight the unconven-tional way of combining the use of imaging modality andbotulinum toxin to improve aesthetics in patients with facialdeformities.

http://dx.doi.org/10.1016/j.bjoms.2013.05.103