- Email: [email protected]
Endoscopic assisted procedures in maxillofacial surgery
Oral Presentations/O11. TMJ II
21
can be endoscopically assisted or done by conventional methods. A 3 cm incison is made in the temporal tuft, perpendicular to the alar-canthal line, down to the level of the superficial layer of the deep temporal fascia. A dissection in this layer progresses to the subperiosteal layer over the midface. Next, a gingival sulcular incision is made and joins the pervious temporal dissection. The malar fat pad is identified and secured with a suture that is then passed up through the temporal dissection and fixated to the temporal fascia. The nasolabial folds are then addressed with Gore-Tex implants, fat injection, CO2 laser resurfacing in a single or combined method. Additionally, some patients and or surgeons prefer midfacial augmentation with alloplastic implants. For the average oral and maxillofacial surgeon placement of midfacial implants can be performed with local anesthesia in 10 minutes per side. This lecture will address implant patient selection, implant types and indications, surgical placement and complications. The author will show evidence of effectiveness and simplicity when using midfacelift and malar and submalar implants. Midfacelift and the placement of malar and submalar implants are simple procedures and provide safe, effective and lasting augmentation when used for cosmetic rejuvenation of aging midface.
FG-•-•
THE
ASSESSMENT
AND
WRINKLES
AND
MANAGEMENT
OF
SKIN
- Later surgery: total remodelling. Reduction surgery: - Contouring is the easiest method but is limited to small; irregularities and also to supra-orbital rim; - Osteotomy of the anterior wall of the frontal sinuses is better in many cases. Augmentation surgery: - Bone graft surgery is indicated in small defects; - Splitting forehead surgery can give good results but is difficult to achieve; - Prosthetic augmentation is the simplest and most reliable method to obtain good results even for major defects. Results of the different techniques are presented. The forehead, often neglected, is very important in the facial harmony. Both minor and major techniques can be used but minor adjustements can already produce interesting results. For augmentation, we prefer use surgical cement which is prepared and modeled during the surgery.
Oll.
FOLDS
TMJ II
M.A.A. Suhr, C. Lenzen, I.N. Springer. HBEC, Germany [-GT~ Treatment decisions relating to the smoothening or obliteration of skin pores, furrows, wrinkles and folds are not objectivized to the extent of being fully reproducible between different operators. Evidence to support treatment indications relies heavily on patient acceptance and satisfaction, rather than on clearly defined biometric parameters. The relationship between those biometric variables that were documented and the treatment decision was investigated. We searched Medline for publications comparing one treatment modality to another and included personal observations. Few, if any, publications state wrinkle or skin fold density, depth, length and relation to muscle function. We therefore additionally reviewed the currently available facial morphometry devices in their potential suitability for the study of facial wrinkle treatment. In our search we came across a clinically useful device using the technique of phaseshift rapid in-vivo measurement of skin (PRIMOS®). A method of measuring skin excess is to mark 2 points on the skin adjacent to a wrinkled region. A measurement is obtained at rest (r), stretch (s), maximum stretch to a point of skin blanching of the wrinkled region, (smax), compression (c) and maximum compression to the point of blanching the skin lateral to the compressed region (cmax). Thickness of skin is defined as t and moisture content m. Blanching is assumed to be relieved by creep, although we know this is not a reliable assumption in the clinical setting. Absolute skin excess is then smax-cmax if one wishes to remove all excess skin and stretch the skin intraoperatively to the point of blanching. Skin thickness and moisture content are equal for compression and stretch and these factors may be left out of the equation for the purposes of defining absolute skin excess. The exact magnitude of stretch and point of blanching should be ascertained with a cutometer and recorded. For the physics and biometrics purist a comprehensive equation is available from the principal author. Cutometry and the PRIMOS ® were essential in objectivising pre- and posttreatment effects, and analyse the role of the mimicking musculature. The absolute amount of skin excess may dictate the necessity for a surgical approach. We suggest that an objective measure of wrinkle, fold and pore depth is possible and should be performed before, during and after treatment may enable the comparison of different methods and, if clinically applicable, may influence the choice of treatment.
F
GAESTHETIC - •FOREHEAD - •REMODELLING
ENDOSCOPIC ASSISTED PROCEDURES IN MAXlLLOFACIAL SURGERY
S. Sembronio, F. Costa, M. Robiony, C. Toro, F. Polini, M. Politi.
Department of Maxillo-Facial Surgery, Faculty of Medicine, University of Udine, Udine, Italy Minimally invasive endoscopic surgery has been developed for various indications in the cranio-maxillofacial area. The increased availability of endoscopic instrumentation has enabled maxillofacial surgeons to use endoscopic assisted treatment in multiple conditions. The endoscopic assisted procedure has been described for the treatment of maxillary sinus and temporomandibular joint diseases. The Authors present their favourable early experience using endoscopic assisted procedures for surgical treatment of mandibular condilar fractures, orbital fractures, cysts of the jaws, and osteodistractions Endoscopic assisted operations in 27 patients are analyzed. Seven patients had endoscopic assisted treatment of condylar fractures throught an intraoral approach. Twelve patients had reduction of orbital floor fractures by endoscopic assisted transantral technique. Five patients underwent endoscopic assisted surgical treatment of voluminous mandibular cysts involving the ascending ramus. Three patients underwent a mandibular osteodistraction that requires endoscopic assisted procedure. Each patient had a 1-year follow-up period. The procedures can be performed with no increase in operative time and with minimal morbidity. The endoscopic surgical approach described was reliable and minimally invasive. No complications during and after the surgery were observed. The use of endoscopic assisted techniques allows intraoral limited incisions for the reduction of condylar process fractures. Intraoperative control after condylar fracture reduction and fixation of fractures by miniplate osteosynthesis in areas of limited exposure and visibility is possible. With reference to orbital floor fractures, the endoscopic transantral approach allows better visualization of the posterior edge of fractures involving the posterior portion of the orbital floor, and it facilitates confirmation that all orbital soft tissues has been elevated from the fracture site. The use of the endoscopic assisted procedure allows surgeons to check the excision of the cyst while operating and also to check the cavity after the excision of the cyst expecially in voluminous multiloculated cysts. During mandibular osteodistraction, the endoscopy helps to check the osteotomies and the simulation of the distraction. The endoscopic-assisted approach has proved to be a reliable surgical method in that situation of insufficient visibility.
S. Duvigneaud, M. Shahla, B. Ouattara, G. Swennen, A. Lema~tre.
Department of Cranio Maxillo Facial Surgery, Chirec, Brussels, Belgium Even though the forehead plays a major part in facial aesthetics, it is too often ignored. The contours of the forehead are basically very difficult to modify. Nevertheless, minor, medium and major adjustements of the forehead can complement a surgery of the mid and lower parts of the face and improve its global aesthetics. In this presentation, we will first introduce the basic criteria of forehead aesthetics. We will then describe different techniques and their results: craniofacial deformities, reduction surgery and augmentation surgery. Craniofacial deformities: - Early surgery: floating forehead;
[ - G ' ~ - ~ ARTHROSCOPIC LYSIS, LAVAGE AND CAPSULAR STRECH VERSUS ARTHROPLASTY AND DISC REPOSlTIONING FOR THE TREATMENT OF CHRONIC CLOSED LOCK OF THE TEMPOROMANDIBULAR JOINT S. Sembronio, M. Robiony, N. Zerman, C. Toro, E Polini, M. Politi.
Department of Maxillo-Facial Surgery, Faculty of Medicine, University of Udine, Udine, Italy The paper shows the 1-year results obtained comparing the efficacy of the arthroscopic lysis, lavage and capsular strech and open surgery,
21
can be endoscopically assisted or done by conventional methods. A 3 cm incison is made in the temporal tuft, perpendicular to the alar-canthal line, down to the level of the superficial layer of the deep temporal fascia. A dissection in this layer progresses to the subperiosteal layer over the midface. Next, a gingival sulcular incision is made and joins the pervious temporal dissection. The malar fat pad is identified and secured with a suture that is then passed up through the temporal dissection and fixated to the temporal fascia. The nasolabial folds are then addressed with Gore-Tex implants, fat injection, CO2 laser resurfacing in a single or combined method. Additionally, some patients and or surgeons prefer midfacial augmentation with alloplastic implants. For the average oral and maxillofacial surgeon placement of midfacial implants can be performed with local anesthesia in 10 minutes per side. This lecture will address implant patient selection, implant types and indications, surgical placement and complications. The author will show evidence of effectiveness and simplicity when using midfacelift and malar and submalar implants. Midfacelift and the placement of malar and submalar implants are simple procedures and provide safe, effective and lasting augmentation when used for cosmetic rejuvenation of aging midface.
FG-•-•
THE
ASSESSMENT
AND
WRINKLES
AND
MANAGEMENT
OF
SKIN
- Later surgery: total remodelling. Reduction surgery: - Contouring is the easiest method but is limited to small; irregularities and also to supra-orbital rim; - Osteotomy of the anterior wall of the frontal sinuses is better in many cases. Augmentation surgery: - Bone graft surgery is indicated in small defects; - Splitting forehead surgery can give good results but is difficult to achieve; - Prosthetic augmentation is the simplest and most reliable method to obtain good results even for major defects. Results of the different techniques are presented. The forehead, often neglected, is very important in the facial harmony. Both minor and major techniques can be used but minor adjustements can already produce interesting results. For augmentation, we prefer use surgical cement which is prepared and modeled during the surgery.
Oll.
FOLDS
TMJ II
M.A.A. Suhr, C. Lenzen, I.N. Springer. HBEC, Germany [-GT~ Treatment decisions relating to the smoothening or obliteration of skin pores, furrows, wrinkles and folds are not objectivized to the extent of being fully reproducible between different operators. Evidence to support treatment indications relies heavily on patient acceptance and satisfaction, rather than on clearly defined biometric parameters. The relationship between those biometric variables that were documented and the treatment decision was investigated. We searched Medline for publications comparing one treatment modality to another and included personal observations. Few, if any, publications state wrinkle or skin fold density, depth, length and relation to muscle function. We therefore additionally reviewed the currently available facial morphometry devices in their potential suitability for the study of facial wrinkle treatment. In our search we came across a clinically useful device using the technique of phaseshift rapid in-vivo measurement of skin (PRIMOS®). A method of measuring skin excess is to mark 2 points on the skin adjacent to a wrinkled region. A measurement is obtained at rest (r), stretch (s), maximum stretch to a point of skin blanching of the wrinkled region, (smax), compression (c) and maximum compression to the point of blanching the skin lateral to the compressed region (cmax). Thickness of skin is defined as t and moisture content m. Blanching is assumed to be relieved by creep, although we know this is not a reliable assumption in the clinical setting. Absolute skin excess is then smax-cmax if one wishes to remove all excess skin and stretch the skin intraoperatively to the point of blanching. Skin thickness and moisture content are equal for compression and stretch and these factors may be left out of the equation for the purposes of defining absolute skin excess. The exact magnitude of stretch and point of blanching should be ascertained with a cutometer and recorded. For the physics and biometrics purist a comprehensive equation is available from the principal author. Cutometry and the PRIMOS ® were essential in objectivising pre- and posttreatment effects, and analyse the role of the mimicking musculature. The absolute amount of skin excess may dictate the necessity for a surgical approach. We suggest that an objective measure of wrinkle, fold and pore depth is possible and should be performed before, during and after treatment may enable the comparison of different methods and, if clinically applicable, may influence the choice of treatment.
F
GAESTHETIC - •FOREHEAD - •REMODELLING
ENDOSCOPIC ASSISTED PROCEDURES IN MAXlLLOFACIAL SURGERY
S. Sembronio, F. Costa, M. Robiony, C. Toro, F. Polini, M. Politi.
Department of Maxillo-Facial Surgery, Faculty of Medicine, University of Udine, Udine, Italy Minimally invasive endoscopic surgery has been developed for various indications in the cranio-maxillofacial area. The increased availability of endoscopic instrumentation has enabled maxillofacial surgeons to use endoscopic assisted treatment in multiple conditions. The endoscopic assisted procedure has been described for the treatment of maxillary sinus and temporomandibular joint diseases. The Authors present their favourable early experience using endoscopic assisted procedures for surgical treatment of mandibular condilar fractures, orbital fractures, cysts of the jaws, and osteodistractions Endoscopic assisted operations in 27 patients are analyzed. Seven patients had endoscopic assisted treatment of condylar fractures throught an intraoral approach. Twelve patients had reduction of orbital floor fractures by endoscopic assisted transantral technique. Five patients underwent endoscopic assisted surgical treatment of voluminous mandibular cysts involving the ascending ramus. Three patients underwent a mandibular osteodistraction that requires endoscopic assisted procedure. Each patient had a 1-year follow-up period. The procedures can be performed with no increase in operative time and with minimal morbidity. The endoscopic surgical approach described was reliable and minimally invasive. No complications during and after the surgery were observed. The use of endoscopic assisted techniques allows intraoral limited incisions for the reduction of condylar process fractures. Intraoperative control after condylar fracture reduction and fixation of fractures by miniplate osteosynthesis in areas of limited exposure and visibility is possible. With reference to orbital floor fractures, the endoscopic transantral approach allows better visualization of the posterior edge of fractures involving the posterior portion of the orbital floor, and it facilitates confirmation that all orbital soft tissues has been elevated from the fracture site. The use of the endoscopic assisted procedure allows surgeons to check the excision of the cyst while operating and also to check the cavity after the excision of the cyst expecially in voluminous multiloculated cysts. During mandibular osteodistraction, the endoscopy helps to check the osteotomies and the simulation of the distraction. The endoscopic-assisted approach has proved to be a reliable surgical method in that situation of insufficient visibility.
S. Duvigneaud, M. Shahla, B. Ouattara, G. Swennen, A. Lema~tre.
Department of Cranio Maxillo Facial Surgery, Chirec, Brussels, Belgium Even though the forehead plays a major part in facial aesthetics, it is too often ignored. The contours of the forehead are basically very difficult to modify. Nevertheless, minor, medium and major adjustements of the forehead can complement a surgery of the mid and lower parts of the face and improve its global aesthetics. In this presentation, we will first introduce the basic criteria of forehead aesthetics. We will then describe different techniques and their results: craniofacial deformities, reduction surgery and augmentation surgery. Craniofacial deformities: - Early surgery: floating forehead;
[ - G ' ~ - ~ ARTHROSCOPIC LYSIS, LAVAGE AND CAPSULAR STRECH VERSUS ARTHROPLASTY AND DISC REPOSlTIONING FOR THE TREATMENT OF CHRONIC CLOSED LOCK OF THE TEMPOROMANDIBULAR JOINT S. Sembronio, M. Robiony, N. Zerman, C. Toro, E Polini, M. Politi.
Department of Maxillo-Facial Surgery, Faculty of Medicine, University of Udine, Udine, Italy The paper shows the 1-year results obtained comparing the efficacy of the arthroscopic lysis, lavage and capsular strech and open surgery,