2^nd International Conference on Craniofacial Surgery October 8-9, 2018 London, UK

Naser Azmi Khayat has been working as a lecturer in the Arab American university, Palestine. He did his B.Sc. in Dentistry from Baghdad University in Iraq in 1998 and M.Sc. in Orthodontics from AL-Mosul University in Iraq in 2000. He is also the Chairman of “Palestinian Academy for TMD & Dental Sleep Medicine” from 2018 and since 2014 until now he has been doing PhD researches in the relation between orthodontic problems and temporomandibular disorders at Tel Aviv University.

Temporomandibular disorder (TMDs) is a term for pain and dysfunction involving the masticatory muscles and the temporomandibular joints (TMJs) and is the most common orofacial pain condition. Prominent features are regional pain in the face and preauricular area, limitations in jaw movements and noise from the TMJs during jaw movements. TMD affects up to 15% of adults, with a peak incidence at 20 to 40 years of age. Chronic pain is the overwhelming reason for patients with TMD treatment. TMD can be associated with impaired general health, depression and other psychological disabilities and affect quality of life and well-being of the patient. The recently published diagnostic criteria for TMD (DC/TMD) have been found to be reliable and valid. These criteria include the most common types of TMDs including pain-related disorders, such as myofacial pain, headache attributed to TMD, arthralgia, as well as disorders associated with the TMJ, primarily disc displacements and degenerative disease. Co-morbid pain conditions such as headache, back and neck pain are common among TMD patients. Of

this headache is most commonly reported and a significant overlap between headache and TMD-pain has been reported. Both conditions involve trigeminal neural processes, are characterized by pain in the head and/or face and pericranial tenderness. The primary utility of the DC/TMD diagnosis headache attributed to TMD is that it points to TMD treatment as a therapeutic approach for headache. Most patients with TMD improve with a combination of noninvasive therapies, including behavior therapy, pharmacotherapy, physical therapy and occlusal appliances. Obstructive sleep apnea (OSA) is a disorder in which recurrent closure of the upper airways occur during sleep. It is characterized by repetitive episodes of complete (apnea) or partial (hypopnea) upper airway obstruction occurring during sleep. Whereas apnea is complete cessation of airflow, hypopnea is characterized by a 70% reduction of airflow for ≥10 seconds or any reduction in airflow that is associated with either an

arousal from sleep or a ≥3% arterial oxygen desaturation. These frequent arousals are the primary cause of excessive daytime somnolence, are associated with impaired daytime cognitive function and are recognized as a cofactor in the etiology of road traffic accidents. Sleep apnea may also be associated with increased cardiovascular and increased cerebrovascular morbidity and mortality. An estimated 82% of men and 92% of women with moderate to severe sleep apnea remain undiagnosed. OSA treatment is chosen is based on patients clinical features. Its resolution may occur by losing weight, if the patient is obese, avoiding sleep in the supine position, if the OSA is position dependent, avoiding alcohol consumption during the evening and treating hypothyroidism if present. When these approaches are proved to be unsuccessful, other treatment should be chosen: nasal continuous positive pressure (CPAP), surgical treatment or the application of oral appliances. Actually the role of a dentist is multi-level both in clinical evaluation and in treatment of OSA.

Robert J. Wood, has been appointed as the Associate Medical Director Craniofacial and Plastic Surgery, Gillette Children's Specialty Healthcare in 2014. He is also the Medical Director, Minnesota Centre for Craniofacial Services since 1999. His interests in the field are mostly with Craniofacial and Plastic Surgery.

Primary open repair of craniosynostosis has reported transfusion rates approaching 100%. We have developed a multimodal approach to blood conservation in an attempt to decrease rates of transfusion. Children aged one year or under undergoing primary repair of craniosynostosis from 10/1/13 to 1/15/16 received a multimodal approach to blood conservation including: pre operative erythropoietin and oral ferrous sulfate, tumescent infiltration of the scalp incision, plasma blade incision and dissection, modest hemodilution and I V tranexamic acid. All children with an HgB less than 7g/dL or symptomatic of anemia were transfused. Surgical technique remained unchanged withclassic fronto-orbital advancement and anterior cranial vault remodeling for anterior craniosynostosis, posterior calvarial remodeling for lambdoid and sagittal craniosynostosis including barrel stave type osteotomies, out fracture of the cranial base and interposition bone grafts. 96 children underwent repair with a mean age of 0.51 years. 74 (77%) did not require transfusion. Posterior repairs (n=55) averaged 6.5 mL/kg blood loss and 18% transfusion rate. Anterior repairs (n=41) averaged 9.1 mL/kg blood loss and 29% transfusion rate. Operative time averaged 55 minutes for posterior repairs and 82 minutes for anterior repairs. This is a significant advance in blood conservation. Transfusion rates have dropped 82% for our posterior repairs. As experience is gained we expect further decreases in rates of transfusion.

Yasser Mohamed Elsheikh is awarded Doctor Degree in Plastic, Oral & Maxillofacial Surgery from Alexandria University, Egypt in 2006. He holds a Master Degree (MSc) in General Surgery from Alexandria University, Egypt in 1997, followed by a Bachelor’s Degree (BSc) in E.N.T. from Alexandria University, Egypt in 1992. Currently, he is working as an Associate Professor for MENOUFIA UNIVERSITY. His international experience includes various programs, contributions and participation in different countries for diverse fields of study. His research interests as an Associate Professor reflect in his wide range of publications in various national and international journals. He is the Board Member of Member of Egyptian Society of Plastic and Reconstructive Surgery and serves as a member of Pan Arab Association and Egyptian Society of Oncology.

Surgery for saliva control has been available. A variety of operations have been tried, some being more successful than others. The surgery that is currently aims to redirect the saliva sitting at the front of the mouth to going back down the throat. There are 3 major pairs of glands in the mouth, the submandibular, sublingual and parotids. The submandibular and sublingual glands produce saliva through ducts in the front of the mouth just under the tongue. The submandibular produce most of the saliva in the mouth (about 65%) and it is watery. The sublingual produce a little saliva but it is thick and mucousy. The parotid glands produce saliva through ducts which open into the mouth near the second upper molar tooth. The saliva from the parotid is very helpful in making the food go down when we eat. The current study entails five patients complaining of sialorrhea and saliva drooling and one patient complain of postoperative atresia of both orifices of submandibular ducts and one patient has a suspicious swelling over the orifice of the left submandibular duct. Rerouting of submandibular duct was a very successful operation to solve their salivary problems.

Muayed M. Radi Alkhafaji received his Medical Degree from University of Al- Mustansiriyah Medical School, (1986) and Board Certificate in ORL-HNS from Baghdad University, Iraq (1996) respectively. He is an ENT-Otolaryngologist in Doha, Qatar and is affiliated with multiple hospitals in the area, including Hamad General Hospital, Ambulatory Care Center, Alkhor Hospital and Weill Cornell Medical School-Qatar.

HFNC is a recently described technique proven to provide an adequate oxygenation & ventilation in patient undergoing various upper air way surgeries without the need of the endotracheal intubation or jet ventilation. The objective of this research is to evaluate the adequacy of HFNC technique as a sole method of providing adequate Oxygenation & ventilation for patients undergoing upper air way endoscopy (Micro laryngoscope, esophagoscope, Panendoscope) which are minor procedures need short duration of GA. Because the anesthetist & the surgeon sharing the same space there is high risk of interruption of ventilation, oxygenation, loss of airway in addition to inherent complication of the surgery. HFNC has the advantage of less interference during the procedure and gives large space for surgical manipulation and lastly decreases the intubation complication. This clinical trial will give additional impact of this treatment on ventilation (CO2  limination) and oxygenation of the patient during prolongs apnea. The methodology involved a prospective, randomized interventional study using of computer program for randomization. The sample size for this study is 60 (30 in each group). Study is going on right now at (ACC) Ambulatory Care Center   at Doha, Qatar and it will be completed within a year. The following criteria  were taken into consideration: Inclusion criteria: adult population - both male and female - ASA 1 and 2 (American Society of Anesthesiologist) – for upper airway procedures. Exclusion criteria: age <18 years - BMI >35; for pregnant patient - procedure anticipation >45 min - total airway obstruction; for patient with sever nasal obstruction- parameters: age, gender, height, weight, BMI, HR, Bp, SPO2, TcPO2, ETCO2, TcPCO2 and BIS. Trans nasal Tracheoscope (TNT): a new Technique in Laryngeal Anesthesia in office base procedures. Laryngeal Office based procedures are well known to most of the  laryngologist for the past 10 years. Many of these procedures used to be performed only in the operating room and required general anesthesia.  However, general anesthesia carries a higher risk of complications and requires more recovery time than office-based procedures. Doing the procedure at office is cost effective in compare to the procedures under general anesthesia with use of hospital resources in a wise way. Complications such as bleeding are very rare and patients can return to work after the procedure eats or drink one hour after the procedure. My Innovation is to use channeled endo-sheath which is designed for the FEESST (Flexible Endoscopic Evaluation of Swallowing with Sensory Testing) test to be used for anesthesia for the larynx. By this way we replace old method of Abraham cannula through the oral cavity or trans-tracheal injection, with more precise & under direct vision technique, where the lidocaine fall directly on the laryngeal inlet, which will give better  anesthesia the fundamental part in all the Laryngeal Office based procedures.

Yu-Tsai Lin department of Otolaryngology graduated from Taipei Medical University, Taiwan. He finished his ENT Residency training at Kaohsiung's Chang Gung Memorial Hospital and then became a Member of the Faculty. Currently, he is an Assistant Professor and performs many head and neck operations in his department. He was a Visiting Scholar and joined a Skull Base Surgery Team at the University of Pittsburgh Medical Center from 2012 to 2013 for the purpose of studying transnasal endoscopic skull base surgery. After returning to Taiwan, he has successfully completed over 100 endoscopic skull base surgeries in the last four years.

Nasopharyngeal carcinoma (NPC) is a unique disease that only happens in some areas of the world such as southeast China, North Africa, and Southeast Asia. For example in Southeast Asia, the incidence rate are as high as 20 to 30 per 100,000 in male populations and 8 to 15 cases per 100,000 in female populations, respectively. The diseases is especially common among Chinese people, with the age of onset trending towards being earlier than for other tumors; accordingly, most patients fall within the range of 30-50 years. Genetic predisposition, Epstein-Barr virus infection, dietary, and environmental factors are all believed to play an important role in the development of NPC.  adiotherapy is the mainstay of treatment; combined with chemotherapy, the 5 year survival rate is approximately 50~60%. Concurrently, as effective therapeutic methods, radiochemotherapy is used for advance stage treatment whereas only radiotherapy is used for early stage treatment, but the recurrence rate is still nearly 10%. For recurrent nasopharyngeal carcinoma, revised radiotherapy is controversial due to severe complications and poor outcomes. Salvage nasopharyngectomy plays an important role in operable NPC patients, but it is still a challenge operationally because of the complexity of anatomy in the area, as the carotid artery and many cranial nerves are nearby. Salvage nasopharyngectomy included external approaches such as superior trans-skull base approach, lateral infratemporal fossa approach, and current approaches such as trans-maxillary swing, endoscopic nasopharyngectomy, and the robotic assisted trans-palatal approach.

Biplob Bhattacharya is a Postgraduate ENT surgeon at the Institute of Medical Sciences and SUM hospital, Siksha 'O' Anusandhan University, India. He has extensive clinical experience as a GP and taught courses in college medical programs. His research mainly focusses on Otolaryngology and head-neck surgery

Fish bone in throat is a common occurrence in otorhinolaryngological practice. This study focuses on the prevalence of accidental ingestion of fish bones and its management in a tertiary care hospital in eastern India. 330 patients with complains of fish bone in throat who presented to the out patients Department of Otorhinolaryngology and the Emergency Department of a Medical College between January 2010 to December 2017 were shortlisted for the study. Followed by conventional examination, most were subjected to endoscopic examination and removal. The parameters analyzed were age and sex distribution, clinical presentation, duration of symptoms, location of impaction, conventional and endoscopic removal techniques. Results from the study indicate that among 330 patients, no foreign body was found in 80 patients. Patients in age group of 21-30 years and with almost equal sex distribution were mostly affected. Most patients presented with foreign body sensation in throat of short duration with precise finger point localization. Both conventional and endoscopic methods were employed with successful results  but with definite advantage of endoscopic method. Fish bone impaction is a common foreign body in the pharynx. Endoscopic removal is distinctly more helpful than the conventional ones.

Elizabeth Mathew Iype has completed her MBBS, DLO from Medical College Trivandrum, University of Kerala, Dip NB (Otolaryngology) Medical College Trivandrum, Department of Health and Family Welfare, New Delhi and PhD (Head and Neck Oncology) from Regional Cancer Center Trivandrum, University of Kerala. She is an Additional Professor of Surgical Oncology at Regional Cancer Center, Trivandrum, India. She is doing many clinical and basic science researches in Head and Oncology Surgery, both as a Principal Investigator and Co-investigator. She is the Reviewer of journals for Oral Oncology, Indian Journal of Cancer, Laryngoscope and Indian Journal of Surgical Oncology. She has published several scientific articles in both national and international indexed journals.

Introduction: Primary small cell neuro endocrine carcinoma (SNEC) of nose and paranasal sinuses is an extremely rare malignant tumour known for its aggressive clinical course, high rate of recurrence and poor prognosis.

Objective: Aim of this study is to analyse the clinicopathological features of SNEC of the nasal cavity and paranasal sinuses and to assess the treatment results of surgery with chemoradiation/non-surgical management and also to look at the rate of recurrence among these patients.

Method: The medical records of 14 patients presenting with nasal and paranasal SNEC at our institution from 2001 to 2017, were analysed to determine the clinical features, treatment results and the recurrence rate of the  disease.

Results: Patient data were obtained from the clinical records of the patients with SNEC who attended our clinic from 2001 to 2017. Twelve of the patients were male and two were female, with a mean age at presentation of 55 years (range: 22 to 75 years). Patients' staging for nasal cavity malignancy was: T2, three; T3, two and T4, nine; N0, twelve; N2, two; M0, thirteen; and M1, one. Immunohistochemistry proved useful for diagnosis in 14 cases. Twelve cases were positive for cytokeratin, 14 for chromogranin and 11 for neuron-specific synaptophysin. Five patients underwent surgery, one had endoscopic craniofacial resection and four patients had endoscopic clearance from the nasoethmoid region. Chemoradiation was given to eleven patients and radiotherapy was given to three patients. Recurrence occurred in 8 cases. One patient had visceral metastases and one had recurrent cervical lymph node. Seven of the patients died within five years of onset of the disease. The recurrence rate was more among the patients who underwent nonsurgical management compared to those patients who underwent surgery followed by chemoradiation.

Conclusion: Small cell neuroendocrine carcinoma of the sinonasal tract is an uncommon neoplasm with aggressive clinical behaviour. They can be distinguished based on immunohistochemical characteristics. Recurrence is frequent and the prognosis is poor. However, the surgical treatment followed by chemoradiation gives the best result for such aggressive malignancy.

James Burns is a Laryngeal Surgeon at Massachuestts General Hospital’s Voice Center. He specializes in treatment of laryngeal diseases in patients with voice and swallowing disorders. He completed residency in Otolaryngology-Head and Neck Surgery in 1996 at the University of Virginia Health Sciences Center in Charlottesville, Virginia. He teaches at Harvard Medical School and Co-directs the laryngeal surgery fellowship program at MGH. His research interests include laser laryngeal surgery, vocal fold paralysis, and high-speed vocal fold imaging, and has over 60 publications in national peer-reviewed journals

The purpose of this presentation is to report voice and oncologic results from a cohort of patients with early glottic cancer who were treated with ultra-narrow margins using angiolytic KTP laser surgery. Wound healing after transoral angiolytic laser surgery for early glottic carcinoma was analyzed to identify factors influencing healing and clinical significance of persistent granulation  tissue. A cohort of 117 patients (T1a-71, T1b-11, T2a-10, T2b-25) underwent KTP laser treatment of early glottic cancer with a minimum 4-year follow up. Pre-treatment and post-treatment voice outcome data were obtained in 72/117 patients. Evaluations included objective measures (acoustic and aerodynamic) and Voice-Related Quality of Life survey (VRQOL). Disease control for T1 and T2 lesions was 96% (79/82) and 80% (28/35) respectively. All 10 recurrences were treated with radiotherapy. Larynx preservation and survival were achieved in 99% (81/82) with T1 disease and 89% (31/35) with T2 disease. There were statistically significant post-operative improvements for acoustic measures of voice quality (perturbation and signal-to-noise) and self assessments of vocal function for both groups. Angiolytic KTP laser treatment of early glottic cancer is an effective treatment for early glottic cancer. Oncologic results compare favorably with other reported series and voice results show excellent preservation of glottic function. Most vocal fold wounds heal completely within 3 months after angiolytic laser surgery for early glottic carcinoma. Larger and deeper wounds are more likely to heal with granulation tissue. Granulation can resolve without surgical intervention; however, granulation present >3 months warrants biopsy due to increased risk of malignancy.

Sajidxa Marino completed her studies at the age of 27 at the Central University of Venezuela, specializing in Otorhinolaryngology at the Domingo Luciani Hospital, with studies in France, Spain, Italy and the USA. She was President of the Venezuelan Otorhinolaryngology Society from 2015-2018. Pioneer in the diode laser technique in the office to solve nasal obstructive problems.

Diode's laser for in office endoscopic surgery center a new type of ENT Center exclusive for topical cottons anesthesia use in patients with obstructive nasal diagnosis. Description of a new technique of Laser Diode's for Endoscopic Turbinal Surgery IN OFFICE with topical anethesia for inmediatly reincorperation to rutine for patients between 2 years and ancients. Only a one hour preparation with drops and cotton's anesthesia, and five minutes procedure. Indicated for patients with Turbinate Hipertrophy (inferior turbinate or inferior and medial turbinate) with oral respiration, snoring, posterior rhinorrea, or with facial algias, in patients complicated for general anesthesia, athletes who needs training the day after, executives or students who needs work or study the same day of the surgery, or any patiens who needs to correctly brieth without been in a operating room and have the postoperative desincorporation of their routine. Also in patients who has previously turbinate surgery in OR or septoplasty without success. With preoperative and postoperative CT scan and endoscopic evaluation were shows turbinate disminution, and clinical changes like considerate workout in nasal brieth, less snoring, notably disminution of posterior rhinorrea and no more presences of facial Algias for contact of middle turbine with Trigeminal gangly. The 10 years implementation of this new technology at the office with 1000 patients experience has been proved as the only model of resolution of patients at the first Laser In Office Center for Otolaryngology at Caracas, Venezuela, with excellent quality of life results.

G Dave Singh holds three doctorates, including Doctor of Dental Medicine; a PhD in Craniofacial Development, and a DDSc in Orthodontics. At the Center for Craniofacial Disorders, USA, he led a NIH-funded program of craniofacial research. Currently, he is a Member of the World Sleep Society and the American Sleep and Breathing Academy. He is also a Fellow of both the World Federation of Orthodontists, and the International Association for Orthodontics. He has published numerous articles in the medical, dental and orthodontic literature, and has lectured in North America, Asia, Europe, Africa and Australia respectively.

In this study, we investigated changes in upper airway volume, to test the hypothesis that the upper airway can be nonsurgically remodeled in adult patients with sleep disordered breathing. After obtaining informed consent, we undertook a 3D cone-beam CBCT scans of 56-year-old male patient, who was diagnosed with mild obstructive sleep apnea by a sleep specialist. Volumetric 3D reconstruction of the upper airway on the CBCT scan was undertaken, and the upper airway volume was found to be 4.7cm3 with a minimum cross sectional area of 73mm2. The patient was treated using an FDA approved, biomimetic oral device (DNA appliance®, Vivos BioTechnologies, Inc., USA). The active treatment time was approximately 18 months. The patient was followed for a further 5.5 yrs when a follow up 3D cone-beam CBCT scan was undertaken. The results showed that the upper airway volume increased to 31.8 cm3 and the minimum cross-sectional area had increased to 526 mm2 with no device in the patient’s mouth when the CBCT scan was taken. We conclude that biomimetic oral appliance therapy may be able to non-surgically remodel the upper airway in adult patients diagnosed with sleep disordered breathing.

Sei-Young Chun is presently working as the Director of Dohwa Good Morning Dentistry in Korea. His major area of work is Dental Orthodontics, and in fact all round players. It is a lot of minor Surgery such as Implant and Extraction. He studied with interest in Digital Dentistry for 7 years, introduced Digital machine and Software into Dentistry 4 years ago, and has been using modeless practice. He is trying to simulate orthodontics, prosthesis and implant surgery in virtual simulations beforehand, and are trying to realize predictable high-quality treatment.

Most of the current implants have been subjected to surgery by relying on the manual operation of the surgeon by establishing a diagnosis and treatment plan using two-dimensional X-ray, and then taking impression for prostheses are being applied to the implants thus placed (called analogue implant). Author would like to introduce a more accurate system that allows doctors to easily perform surgery and prosthodontics by combining the CBCT, intra-oral scanner, CAD-CAM machines and 3D printer. First, we can obtain all the information and the 3D anatomy by merging the CT and intra-oral scanned three-dimensional virtual images. Before operation, CAD (Computer Aided Design) software is used to complete the entire operation simulation and prostheses design and then fully surgical guide and provisional crown and bridge are manufactured by CAM (Computer Aided Milling) and 3D printer. In order to precisely reproduce the implant position 3-dimensionally at the time of surgery, we use a simulated digital data to fabricate a fully surgical guide, and fabricate abutments, crowns and bridges. After this preparation, the operation is carried out and the provisional crown and bridges are also immediately loaded(called 3D digital implant). All procedures of fully guided implant surgery and prosthodontics are completed easily, accurately and comfortably to the patients and doctors. He wants to introduce a fully guided implant system with highly precision. In addition, he introduces the CAD-CAM-PRINT system which produces the whole process in-house.