Basic rhinoplasty techniques for the OMS

SurgicalRoundtable Clinics the surgicalplan andprovidethe surgeonwith quantitative information for usein the operatingroom. Conceptually, treatment planningand thereforemodel surgery procedurescan be broken down into three general treatment categoriesor schemes.These categoriesare mandibular surgery,maxillary surgeryand two-jaw surSRC 123 gery.This SRC will introducea systematictechniquefor Basic Rhinoplasty Tecldques for the OiUS accuratelyorienting and measuringmaxillary and manR. GregorySmith, DDS, MD, PonteVedra Beach,FL dibular surgicalmodels. Surgicalcorrectionof dentofacialdeformitiesinvolves Esthetic rhinoplastyis gaining importanceas an ad- a complexseriesof surgicalandnonsurgicalprocedures. junct to the practice of oral & maxillofacial surgeryin Dentofacial deformities,whether developmentalor acthree areas.First, as an adjunct to the treatment of quired,requirea carefuland thoroughevaluationof the patientswith jaw deformities,rhinoplastyhelpsto assure stnmturalandfunctionalproblemsassociatedwith them. goodpostoperativefacial balancein thosepatientswho Restorationof normal jaw function, the proper threehaveconcomittantnasaldeformities. dimensionalplacementof the jaws within the face and Secondly,it is very usefulin correctionof the sequelae longterm stabilityof the surgicalresultare all important of facial fractures which involve the nasal,complex, featuresof successfultreatment. whethertheybe functional or esthetic. The most under utilized component of a patient’s Lastly, due to the increasingpublic awarenessof the surgicalwork-up is the model analysis.When properly benefitsof estheticfacial surgery,the oral,andmaxiIlofa- mountedon a full-size anatomicarticulator,pre-surgical cial surgeonis receivingmore requeststo render this models offer a wealth of information. Articulator cosmeticsurgicalservice. mountedmodelswill stimulatethe patientboth functionThis surgical roundtable clinic will present indica- ally and spatially. It has, however,been difEcult to tions, anatomy,and some basic techniquesof esthetic quantify this information. The Model Platform is an rhinopIasty(open and closed)through the clinical pre- instrumentwhich is designedto accuratelymeasure,in a sentationof patientsfrom the abovementionedcatego- reproducible manner, articulator mounted models in ries. three planesof space.This allows the treatment planA brief discussionof complications and long-term ning surgeonto definethe three-dimensionalposition of resultswill also be included.In addition the credential- both the maxilla and mandible. Using a common refering processwill be reviewed. ence plane, the models are accuratelycorrelatedwith both cephalometricradiographsand the clinical exam. sional rhinoplasty are selectedto emphasizethe basic steps of rhinoplasty and highlight common problem areas.

References Smith, R.G., Cesteleyn, L., Akuamoa-Boateng, E.: The importance of rhinoplasty in maxillo-facial surgery. Book of Abstracts of the European Association of Cranio Maxillo-Facial Surgery 10th annual meeting. Brussels, Be&m, September, 1990 Waite, P.D., et al.: Siultaneous rhinoplasty procedures in orthognathic surgery. Int J MaxiIlofac Surg 17:298-302,198g Hupp, J.R.: Early delayed rhinoplasty after orthognathic surgery using the external approach. Oral Maxillofac Surg Clin North Am 2:327-338,19%

SRC 124

References Erickson, K.: Analytic modelsurgery, in W.H. Bell (ed): Surgical Correction of Dentofacial Deformities, vol IV. Philadelphia, Saunders, 1990 (to be published) Wolford, L., Hilliard, F., Dugan, D.: Surgical Treatment Objective: A Systematic Approach to the Prediction Tracing. St. Louis, Moshy, 1985 Andrews, L.: The six keys to normal occlusion. Am J Orthod 62:2%-309,1972

SRC 125/225

Analytic Model Surgery Kim L. Erickson.DDS. Grand Rapids,MI

MipsgementoftheM~comgrOmised

Surgical movements of the jaws are complicated three-dimensionalproblems of geometrically complex structures.The diagnosticinformation gainedfrom preoperative clinical and radiographicexaminationsmust be carefullyintegratedwith the patient’ssurgicalmodels in order to establisha surgicaltreatmentplan. The final treatment “prescription” is expressedin the model surgery.Model surgerywill both allow conthmation of

The need to thoroughly assessa patient’s systemic healthprior to surgeryhasincreased.This is becauseof the increasingage of the population, the advancesin medical knowledgewhich keepspatients healthier despitethe presenceof sign&ant disease,andthe increasing numberof procedureswhich are beingdoneas same

MOMS

.

1991

Patiws,PaItIandPartII StevenM. Roser,DMD, MD, New York, NY

19