plates

ICOMS 2011—Abstracts: Invited Papers medicine, oral pathology, restorative dentistry, growth and development (2 years). 5. General clinical surgical education managing the surgical patient in a variety of clinical settings with colleagues engaged in other surgical specialties (1 year). 6. Comprehensive achievement of knowledge and skill in all aspects of oral and maxillofacial surgery (3 years). In our century, this 14 years educational experience will result in the educational achievement consistent with the complexity of the contemporary oral and maxillofacial surgery environment. Most graduates will be 32 years of age or older and will seek additional education through fellowship, continuing education, individualized lifelong learning and volunteerism. This session will detail the rationale and necessary components of that education and will point out the important shortcomings of education that lacks any of these essential components. doi:10.1016/j.ijom.2011.07.866

27 Education and training of oral and maxillofacial surgery in Asia L.K. Cheung Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong

Asia covers a wide geographical area and populated by over half of the world’s population in over 20 countries. There is a great shortage of well trained oral and maxillofacial surgeons, particularly in the developing countries. The guideline of education and training of oral and maxillofacial surgery has been defined and endorsed by the Asian Association of Oral and Maxillofacial Surgeons in 2004. The education is primarily dentally based except China, which is based on Stomatology as a recognized division of Medicine. The guideline recommends a dedicated training of at least four years, of which most of the countries with established training pathways have complied. Some of developing countries still have no organized training pathway that the Asian Association is trying hard to help. There are abundant quantities of deformities, such as cleft lip and palate, and oral cancers due to the huge population and predisposing factors, such as betel nut chewing and tobacco usage. Most trainees have ample exposure to a wide range of pathologies and surgical scope under dedicated surgical training centres. They then go through an exit examination to be recognized as special-

ist oral and maxillofacial surgeons. Many of them will continue to serve the public hospitals and universities. The Asian Association has endorsed the vision and will soon establish an Asian Board for providing a qualification for nationally qualified specialists to compete in attempt to set a standard of education and training in Asia. doi:10.1016/j.ijom.2011.07.867

28 Management of the risk for the inferior dento alveolar nerve during wisdom tooth removal T.F. Renton ∗ , Z. Yilmaz Oral Surgery, Kings College London, London, UK

Trigeminal nerve injury is the most problematic consequence of dental surgical procedures with major medico-legal implications. The incidence of lingual nerve injury has remained static in the UK over the last 30 years, however the incidence of inferior alveolar nerve injury has increased; the latter being due to implant surgery and endodontic therapy. Iatrogenic injuries to the third division of the trigeminal nerve remain a common and complex clinical problem. Altered sensation and pain in the orofacial region may interfere with speaking, eating, kissing, shaving, applying make up, tooth brushing and drinking, in fact just about every social interaction we take for granted. Thus these injuries have a significant negative effect on the patient’s quality of life and the iatrogenesis of these injuries lead to significant psychological effects. With regard lingual nerve injuries related to third molar surgery most patients recover normal sensation without treatment but those with inferior alveolar nerve injury often have permanent deficits with severe disability, as indicated by the high proportion of lawsuits in such cases. Worldwide, surgical removal of mandibular third molars is the commonest oral surgical procedure. We present case series of 120 patients with third molar related trigeminal nerve injuries and review or the literature will shed some light on the systematic approach may be considered to prevent or minimize the damage to the inferior dental nerve during such surgeries. doi:10.1016/j.ijom.2011.07.868

1013

29 Dentoalveolar surgery corticotomies in rapid orthodontics D. Sinn Division of Oral Surgery, UT Southwestern, Dallas, TX, USA

Dentoalveolar surgery includes osteotomies and corticotomies of individual teeth to accelerate orthodontic tooth movement. This presentation includes the history of this technique and the more current applications. It has long been known that bone manipulation that includes osteotomy increases the bone metabolism/turnover rate. During a 2–6-week time frame the rapid movement of teeth that are orthodontically activated occur in response to this increase in bone turnover and increased metabolism. The hard and soft tissue response at this time is increased enough to allow changes not seen without this approach. In adult orthodontics this can be extremely helpful in movements that would normally not occur without this assistance or would be extremely slow. Comparison of the technique of each procedure will be reported. The biologic concepts and flap design for each technique are essential to successful use of these procedures. Care must be exercised to preserve blood supply to both the hard and soft tissues to avoid loss of teeth and the surrounding soft tissue component. Applications in the maxilla and mandible can yield unusual tooth movements in adults or the adolescent patients that require individual changes to finalize occlusal position in case completion. Patient presentation and outcomes will be presented to complete the review of these procedures and their applications in contemporary dentoalveolar surgery. doi:10.1016/j.ijom.2011.07.869

30 Aspects of anchorage in orthodontics with miniscrews/plates S. van Teeseling Dept of Oral and Maxillofacial Surgery, VU University Medical Centre, Amsterdam, The Netherlands

The use of temporary anchorage devices (TADs) in orthodontics has broadened the orthodontic horizon. TADs like miniscrews, can be used to facilitate orthodontic tooth movement, where traditional orthodontic anchorage is difficult to achieve or is not possible at all. In modern orthodontics miniplates are more and

1014 ICOMS 2011—Abstracts: Invited Papers more applied in the orthopaedic treatment of maxillary hypoplasia. doi:10.1016/j.ijom.2011.07.870

31 CONTROLLING AESTHETICS OF THE NASAL DORSUM: ROLE OF OSSEOUS AND CARTILAGE GRAFTS A. Heggie 1,2 Plastic and Maxillofacial Surgery, Royal Children’s Hospital of Melbourne, Australia 2 Melbourne Oral and Facial Surgery, Melbourne, VIC, Australia 1

Aesthetic rhinoplasty is a popular procedure in the cosmetic surgery spectrum, often positively transforming facial balance and, with concomitant septal surgery, providing an opportunity to improve nasal airways. Dorsal hump reduction, correction of asymmetries and tip contouring are commonly undertaken. Rhinoplasty is usually performed as an isolated procedure, but can be combined with orthognathic surgery to enhance the overall result. However, more complicated deformities present the clinician with a greater challenge. Hypoplasia and/or deviation of the nasal dorsum may be due to congenital deformities. However, trauma and iatrogenic surgery are by far the most common causes of distorted nasal contour and projection deformities due to direct disruption of support mechanisms involving the septum and associated osseo-cartilagenous framework. Prior to reconstruction of the collapsed and distorted nasal dorsum, it is important to ensure that the deformity is stable. Clinical assessment of the airways and valvular function must be undertaken together with palpation of support structures to define their integrity. Plain imaging is usually unhelpful, but CT scanning will help to disclose septal asymmetries and distortion of the bony pyramid. Surgical strategies are aimed at rebuilding compromised nasal supports. Cartilage columella struts between the lower lateral cartilages help nasal tip projection but a more general collapse of the mid-dorsum and upper bony dorsum requires additional strength. A depressed naso-ethmoidal fracture may be a strong indication for primary onlay grafting to restore contour. Cases illustrating various techniques of projecting the nasal dorsum will be described together with the rationale for their choice. doi:10.1016/j.ijom.2011.07.871

32 Maxillofacial cosmetic surgery P.S. Tiwana 1,∗ , D.P. Sinn 1 , G.E. Ghali 2 Division of Oral & Maxillofacial Surgery, UT Southwestern Medical Center, Dallas, TX, USA 2 Department of Oral & Maxillofacial Surgery, LSU Shreveport Health Sciences Center, Shreveport, LA, USA 1

The human face is our window to the world. It is both the way we as individuals put forth ourselves for communication and the lens through which others examine us. Years ago, cosmetic surgery was once perceived as only for wealthy, vain, famous, or narcissistic individuals. However, in today’s world, these stereotypes have faded into the past. Everyday people, across the globe, are aiming to improve their appearances. This demand coupled with a focus on personal beauty has stimulated incredible growth and interest in facial cosmetic surgery. Facial cosmetic surgery encompasses a variety of skin treatments, minimally invasive surgeries, as well as larger procedures. At first glance, so many possibilities may seem overwhelming. However, with evaluation and guidance by the trained eye of a surgeon, as well as a detailed medical history and physical exam, the selection process becomes quite personalized. The Oral & Maxillofacial Surgeon is uniquely qualified for assessing and managing patients who desire facial cosmetic surgery. The routine systematic evaluation of the facial skeleton to the overlying soft tissue allows for a more balanced discussion of surgical options beyond the “skin only”. In addition the habituation of facial skeletal osteotomies, while initially more invasive, can allow for a more permanent natural look. This stands in stark contrast to the approach taken by many that demands an artificial or “implant” only driven solution irrespective of the underlying skeletal deformity. doi:10.1016/j.ijom.2011.07.872

33 Facial liftings J.R.P. Jurado Otolaringology, University of Sao Paulo, Sao Paulo, Brazil

The presentation will start with the revision of facial anatomy, definition of the surgical procedure, the indications, surgical steps including local anaesthesia, liposuction, incision, surgical planes, SMAS and platisma treatment, middle third of the face treatment, sutures and packing.

The use of fillers, chemical peelings and botulinum toxin to improve the results will be discussed during the lecture. Post operative care, medications, complications and results will be presented. doi:10.1016/j.ijom.2011.07.873

34 Nasal surgery in orthognathic surgery P. Kessler Cranio-Maxillofacial Surgery, MUMC, Maastricht, The Netherlands

Aesthetic nasal surgery refines the shape of the nose, bringing it into balance with the other features of the face. Precise analysis of the face, careful planning of orthognathic surgery and essential corrections during primary surgery of the jaws are absolute prerequisites for a successful outcome. Different techniques of orthognathic corrective surgery are described in their relation to the nose. Aesthetical changes are displayed and secondary corrections explained. doi:10.1016/j.ijom.2011.07.874

35 Biopsychosocial approaches to the assessment and treatment of TMJ R. Gatchel Psychology, The University of Texas at Arlington, Arlington, TX, USA

Because of the high costs and traditionally poor outcomes among chronic TMJMD patients, the major goals of 3 National Institutes of Health (NIH)-funded projects were to identify predictors of when acute TMJMD incidents were likely to develop into chronic problems. Through these projects, we have: (a) isolated some significant biopsychosocial risk factors that successfully predicted the development of chronicity; (b) developed a statistical algorithm that can be used to identify “high risk” TMJMD patients who are prime candidates for early intervention in order to prevent chronicity (Epker, Gatchel, et al., 1999); (c) found evidence of biopsychosocial differences between the high-risk and low-risk groups (Wright, Gatchel, et al., 2004); and (d) documented support of the hypothesis that early intervention at the acute