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hitney rank test was applied for all comparisons. Theesults of the comparisons are given as the mean oredian. Values of P � 0.05 were considered to indicate

tatistical significance.Results: We observed that the TCR repertoire is quite

ifferent between primary tumor and metastatic lymphode in individuals. Furthermore, we observed no sig-ificant increases in CD8 positive and Th1/Tc1 pheno-ype T cells in the metastatic lymph nodes than that ofon metastatic lymph nodes.Conclusion: It is suggested that metastatic lymph

odes may be formed by changing the nature of primaryumor antigens, and indicated the possibilities that pri-ary tumors of HNSCC can escape from the T cell

mmune responses and transport or proliferate in theervical lymph nodes in order to make the metastaticesions.

References

Burnet FM. The concept of immunological surveillance. Prog Expumor Res. 1970;13:1-27Marincola FM, Jaffee EM, Hicklin DJ, Ferrone S. Escape of human

olid tumors from T-cell recognition: molecular mechanisms and func-ional significance. Adv Immunol. 2000;74:181-273

OSTER 21uality of Life of Vascular Versus Non-ascular Bone Graft Reconstruction ofegmental Mandibular Defectsavid D. Vu, PharmD, San Francisco, CA (Schmidt BL)

Statement of the Problem: Mandibular resection forenign and malignant head and neck pathology often hasegative consequences on patient quality of life. Foregmental resections, the vascular fibular free flap oron-vascular iliac crest are commonly used for recon-truction. The purpose of this study is to compare theuality of life between these two methods of mandibulareconstruction to gain insight that may help guide ther-peutic decisions.Materials and Methods: The charts of 76 patientsho had undergone segmental mandibular resection in

he Department of Oral and Maxillofacial Surgery at theniversity of California, San Francisco were reviewed

etrospectively. Of those, 38 were identified who hadeconstruction with either a vascular fibular free flap oron-vascular iliac crest bone graft (ICBG). Patient qualityf life was assessed with a modified version of the Uni-ersity of Washington Quality of Life Questionnaire, ver-ion 4. Responses to the questionnaire for these tworoups were tallied and compared for significant differ-nces. Radiation therapy has the potential to have signif-cant adverse consequences and was more prevalent inhe fibula group. To try to control for radiation and also

uantify its impact on quality of life, fibula patients with s

AOMS • 2009

o history of radiation therapy were compared to fibulaatients that did have a history of such treatment. Fibulaatients with no history of radiation therapy were alsoompared to ICBG patients.Method of Data Analysis: Twenty-five of the 38

atients agreed to participate. Patients were invited overthree year period, at one year post-operatively, becauseuality of life is relatively stable at this time. Statisticalnalysis was carried out with the Kruskal-Wallis testsing SAS statistical software.Results: Of the 25 respondents, 13 were recon-

tructed with a fibula, and 12 with an ICBG. Comparisonf these two groups indicated that ICBG patients hadignificantly better chewing, swallowing, taste, and sa-iva scores (p�0.005, p�0.003, p�0.01, and p�0.044espectively). Comparison of radiated fibula patients toon-radiated fibula patients showed no differences ex-ept for saliva (there was a trend for improved salivacores with no radiation, p�0.056). Comparison of theon-radiated fibula patients to ICBG patients showedetter taste (p�0.012) and activity scores (p�0.048) inavor of the ICBG. A trend for better chewing (p�0.065),wallowing (p�0.098), and donor site anxiety scoresp�0.065) favored ICBG reconstruction.

Conclusion: These findings suggest that reconstruc-ion with the ICBG offered benefits in orofacial functionnd possibly donor site morbidity. Radiation therapy wasignificant for causing salivary hypofunction while qual-ty of life is influenced more by the type of reconstruc-ion chosen. Continued study will further elucidate theole of these two differing reconstructions as a determi-ant of patient quality of life, and thus satisfaction withreatment.

References

Vu DD, Schmidt BL. Quality of life evaluation for patients receivingascularized versus nonvascularized bone graft reconstruction of seg-ental mandibular defects. J Oral Maxillofac Surg. 2008 Sep; 66(9):

856-63Pogrel MA, Podlesh S, Anthony J, et al. A comparison of vascularized

nd nonvascularized bone grafts for reconstruction of mandibularontinuity defects. J Oral Maxillofac Surg. 1997;55:1200-1206

OSTER 22istopathological Evaluation of Boneealing of Bone Defects, Performed Withr,Cr:YSGG Laser and Steel Burs, Filledith Bone Morphogenetic Protein andraft Material (HA��-TCP)eniz Isik, PhD, Istanbul, Turkey (Oner B; Alatli C;lgac V; Gulgezen G)

Statement of the Problem: Bone cutting or model-ing is required for many indications in maxillofacial

urgery, oral surgery, implant placement and periodon-

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olgy. Traditionally a variety of hard instruments, such asow speed drills, diamond drills, steel burs or saws aresed to remove, shape or cut bone. These techniquesrequently cause mechanical trauma, excessive tissueeating and bleeding. It has long been recognized that anlternative to drills or steel burs may be a laser that isdapted to remove bone precisely without thermal orechanical damage. This study compares the bone re-air process after bone defects performed either with

he Er,Cr:YSGG laser or with the steel burs, filled with boneorphogenetic protein and graft material (HA��-TCP).Materials and Methods: Seventy-two adult Sprague-

awley rats were used for this study. The animals wereandomly divided into 6 experimental groups. The rightibia of the rats was perforated by steel bur, and the leftibia of them perforated by an Er,Cr:YSGG laser. Createdone defects were filled with only graft (HA� �-TCP) orraft�BMP. Each main group was then divided into 3ubgroups as per their sacrifice days (7, 21, 45).

Method of Data Analysis: The fixed bone specimensere decalcified in 5% nitric acid solution and processed

n paraffin wax. Histological sections were prepared andtained with Hematoxylin and Eosin. Histomorphometri-al assessment of newly formed bone areas was mea-ured with “Olympus Soft imaging system analySISIVE.”Results: In histopathological evaluation after 7 days of

ealing; angiogenesis, osteoclastic activity and fibrosis aretatistically significant greater in the steel bur group thanaser group (p�0.05). After 21 days of healing; osteoblasticctivity is statistically very significantly greater in theaser�graft�BMP group than in the steel bur�graft�BMProup (p�0.005), osteoclastic activity is statistically veryignificantly greater in the steel bur�graft�BMP grouphan in the laser�graft�BMP group (p�0.005). After 45ays of healing; angiogenesis and fibrosis are statisticallyignificant greater in steel bur group than laser groupp�0.05). After 21 days of healing; histomorphometricalssessment of newly formed bone areas was measured withOlympus Soft imaging system analySIS FIVE” in all groups,he greatest new bone formation areas measured inaser�graft�BMP group (62.5%).

Conclusion: Based on the results of this study, Er,Cr:SGG laser may be used clinically for bone surgery with

aster healing than steel burs. And also, Biphasic ceramichosphate graft material (HA� �-TCP) can be combinedith BMP (bone morphogenetic proteins) for better os-

eogenesis in bone defects.

References

Strauss RA, DDS, Fallon SD, DMD. Lasers in contemporary oral andaxillofacial surgery. Dent Clin North Am. 2004 Oct;48(4):861-88Bloemers FW, Pakta P, Bakker HJ, Wippermann BW, Harmann HJ.

he use of calcium phosphates as a bone substitute material in trauma

urgery. Osteosynthesis and Trauma Care. 2002;10:33-7 F

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OSTER 23omparison of the Rotationaldvancement Flap and an Anatomicalubunit Approximation Technique forlosure of Unilateral Cleft Liponita Dyalram-Silverberg, DDS, MD, Brooklyn, NY

Dyalram-Silverberg D; Jamali M; Hoffman D; LazowK; Berger JR)

Statement of the Problem: The goal of cleft lipepair is to restore normal function and form whilechieving the best cosmetic appearance. Over the yearshere have been several techniques of cleft lip closurehich uniquely vary in the position of the cutaneous

car. In the technique described by Dr. Fisher, utilizinghe anatomical subunits of the lip and nose, the scar haseen placed in the “ideal line of repair.” In this study, weompare the esthetics of unilateral cleft lip repair usingwo methods, the rotational advancement flap (Millard)nd the Fisher flap.Materials and Methods: Sixteen non-syndromic pa-

ients with unilateral cleft lip were operated on by theame surgeon (DH) using these two different operatingechniques. One group prior to 2006, consisting of tenatients, had cheiloplasty using a rotational advance-ent flap while the second group of six patients, after

006 had their cleft lip repaired via the Fisher technique.or both groups, nasal formers were utilized in caseshere the nasal dome was not in ideal position. The

verage age of repair was three months. Patients fromoth groups were followed for approximately 1.5 years.he criteria for evaluation of the esthetics were symme-

ry of Cupid’s bow, nasal symmetry, symmetry of theree vermillion border, wet and dry vermillion relation-hip, hypertrophy/discoloration of scar and spreading ofuture mark. This method of evaluation was originallyescribed by Operation Smile as a quality control for itsurgeons; it was not intended to discriminate betweenhe methods of closure. A score of 1, 2, or 3, (with 1eing a poor repair, 2 being an adequate repair and 3eing an excellent repair) was given to each category.he overall “look” of the repair was also rated by totalingll the scores in each category. Two surgeons werehosen to evaluate the different groups.Method of Data Analysis: The data was evaluated

sing Chi square analysis.Results: On the criteria of symmetry of Cupid’s bow,

he Fisher technique was found to be slightly superior,ut did not reach statistical significance (p�0.47). Inegard to the nasal symmetry, the Fisher technique wasound to be better, p�0.024. Symmetry of the free ver-ilion border was similar with both repair techniques,owever there was less notching of the lip with the

isher technique. The wet and dry vermillion relations

AAOMS • 2009