Essentials of Facelift Surgery

Surgical Clinics

S225 Practical Management of Sleep-Related Breathing Disorders N. Ray Lee, DDS, Newport News, VA The interest in surgical treatment for sleep-related breathing disorders has increased over the past decade. Indicated surgical treatments are selected based on the diagnosis: simple snoring, upper airway resistance syndrome, or obstructive sleep apnea. A comprehensive diagnostic work-up including a detailed history and physical examination of the upper airway is essential in making an accurate diagnosis. A multidisciplinary team approach, involving sleep medicine, pulmonology, oral and maxillofacial surgery, otolaryngology, general dentistry and psychology will enhance the treatment outcome. Multiple surgical procedures have been reported in the literature for the treatment of snoring and obstructive sleep apnea. Treatment selection is dependent on many variables, and while there are no universally-accepted treatment protocols, a site-specific surgical reconstruction of the upper airway is generally accepted. The surgeon treating sleep related breathing disorders must be knowledgeable about the available procedures and their efficacy. The literature supports a multitude of surgical procedures in the reconstruction of the upper airway for the treatment of sleep-related breathing disorders. Therefore, scientific analysis of surgical outcome data is vital as new techniques evolve in order to continue to advance in this rapidly growing field. References Woodson TB, et al: Oper Techn Otolaryngol Head Neck Surg II, No. 1, 2000 Powell NB, Riley RW, Troell RJ, et al: Radiofrequency volumetric reduction of the palate in subjects with sleep-disordered breathing. Chest 113:1163, 1998 Riley RW, Powell NB, Guilleminault C: Obstructive sleep apnea syndrome: A review of 306 consecutively treated surgical patients. Otolaryngol Head Neck Surg 108:117, 1998

S226 Precision Open Septo-Rhinoplasty Michel Matouk, MD, DDS, Aventura, FL Rhinoplasty surgery is improving and more predictable techniques are being introduced regularly. The open approach to rhinoplasty has recently regained popularity as the technique of choice allowing a precise, graduated method to the plastic reconstruction of a beautiful and functional nose. The modem rhinoplasty patient undergoes a standardized aesthetic evaluation and measurements. Endoscopic and cephalometric analyses are often needed to ade122

quately diagnose the underlying problems. Nasal obstruction should be meticulously pursued as it may affect the surgical methodology. Once the surgical plan is finalized taking into account those variables and the patient’s own wishes, a guide of the desired surgical outcome can be fashioned. This guide, as well as other techniques, allow the precise intra-operative re-evaluation of the results. Simplified surgical steps are described. Once satisfied with the procedure, the postoperative process is then planned to maintain the results throughout the healing period. This course describes the step-wise approach to the evaluation, surgical technique and post-operative care with the ultimate aim to produce more predicable septorhinoplasty results. References Gruber RP: In search of the ideal nose. Plast Reconstr Surg 105:2570, 2000 Guyuron B: Nasal osteotomy and airway changes. Plast Reconstr Surg 102:856, 1998 Daniel RK: Rhinoplasty: A simplified three-stitch, open tip suture technique: I. primary rhinoplasty. Plast Reconstr Surg 103:1491, 1999

S227 Essentials of Facelift Surgery Joseph Niamtu III, DMD, Richmond, VA Facelift surgery is the ultimate rejuvenative procedure for the cosmetic surgery patient. Oral and Maxillofacial Surgeons have the expertise and surgical skills to perform this procedure. The basic procedure is very similar to TMJ surgical approaches. This course will provide introduction to the novice facelift surgeon or a refresher to those with beginning experience. The course will cover the following: 1. Patient Selection 2. Facelift anatomy 3. Types of facelifts 4. Step by step procedure with actual surgical video 5. Intraoperative and anesthetic considerations 6. Combination procedures 7. Postoperative care 8. Complications 9. Follow up At the end of this lecture the attendees should have a basic understanding of the relevant surgical anatomy and surgical approaches, patient selection, potential complications, and a general overall appreciation for facelift surgery. Facelift surgery has been around in some way, shape, or form since early recorded history. All of humanity has had the desire to stave off the effects of aging and no other single procedure has such an impact on rejuvenaAAOMS • 2005

Surgical Clinics tion. Many myths exist as to what exactly a facelift is and what a facelift does. In the late 19th century surgeons began removing excess facial tissue and placing selected tension on other tissues of the face. Various procedures fell in and out of popularity with varied results. In the 1950s Skoog described a procedure with hidden hairline incisions that involved a lipocutaneous flap between the skin and subcutaneous tissues that was pulled in a positive vector to improve facial jowling and neck laxity. In the 1960s Mitz and Peyrone described the superficial musculoaponeurotic system (SMAS) and manipulation of this anatomic structure greatly improved the results and longevity of facelift procedures. Since then, hundreds of modifications have been brought forth that involve SMAS suspension, placation, imbrication, and excision. In addition, some surgeons advocate subperiosteal or deep plane techniques to improve results and longevity. Contemporary facelift techniques are tailored to the patient and many variations are available. There exist mini, moderate, and maxi options that are designed to suit a patient’s health status, recovery period, amount of aging, and finances. Technological advances such as tumescent liposuction, new anesthetic techniques, laser and endoscopic techniques have also advanced the science of facelifting. Today’s patients are having facelift surgery at a much younger age. The mean age today is 48, compared to 62 years old in 1978. People no longer wish to wait to look old before they have surgery. This course will discuss facelifting for the novice or intermediate surgeon. Diagnosis, equipment, preoperative planning, anesthetic and medical implications, intraoperative technique, postoperative care, follow-up, and complications will be discussed. References Niamtu J (ed): Minimally invasive cosmetic surgery. Oral Maxillofac Surg Clin North Am 17:1, 2005 Niamtu J: The adjustable vector deep plane midface lift. Atlas Oral Maxillofac Surg Clin North Am 12:199, 2004 Niamtu J: Cosmetic facial surgery. Oral Maxillofac Surg Clin North Am 12, 2000

S231 Surgical Management of Odontogenic Tumors Eric R. Carlson, DMD, MD, Knoxville, TN J. Michael McCoy, DDS, Knoxville, TN Odontogenic tumors represent a fascinating spectrum of benign and malignant tumors whose management occupies a time-honored place in our specialty’s surgical repertoire. The number of recommended surgical techniques is at least as significant as the number of tumors, AAOMS • 2005

leading to much confusion as to the best way to treat these tumors. While it is clear that a majority of these tumors are benign, different types of treatment should be offered to patients with curative intent. Benign odontogenic tumors are highly curable entities such that appropriate, first-line surgical therapy must be planned logically and appropriately. This notwithstanding, there is substantial disagreement in the international literature regarding the biologic behavior of these tumors and how best to treat them. An evidence-based approach to the management of these tumors is therefore required to optimize the chance for cure of our patients, while at the same time minimizing the deformity that might occur. In particular, the solid or multicystic ameloblastoma is a locally aggressive slow-growing benign neoplasm that is prone to persistence when treated in a conservative fashion. As such, it is generally recommended that a resection with 1.0-1.5 cm linear bony margins be performed at the onset of disease so as to cure such patients. Such treatment is curative, while also allowing for effective reconstruction to be performed on an immediate or delayed basis. It is our belief that similar surgical treatment should also be performed for the odontogenic myxoma and Pindborg tumor. The unicystic ameloblastoma exhibiting exclusively intraluminal tumor, however, may be treated more conservatively with the same likelihood of cure. An enucleation and curettage surgery is generally regarded as conservative, yet appropriate and curative surgery for this subtype of ameloblastoma. A similar approach may be followed for management of the ameloblastic fibroma and ameloblastic fibro-odontoma. The malignant odontogenic tumors, represented by the ameloblastic carcinoma and the clear cell odontogenic carcinomas, require more aggressive cancer surgeries, and are associated with a less favorable prognosis. Long-term postoperative follow-up is generally recommended for all patients with odontogenic tumors so as to ensure effective tumor control. References Carlson ER: Odontogenic cysts and tumors, in Miloro (ed): Peterson’s Principles of Oral and Maxillofacial Surgery (ed 2). 2004, chap 30, pp 575-596 Carlson ER, August M, Ruggiero S: Locally aggressive benign processes of the oral and maxillofacial region. Select Readings Oral Maxillofac Surg 12, 2004 Carlson ER: Pathologic facial asymmetries, in Lew D (ed): Management of Facial Asymmetries, Atlas of the Oral and Maxillofacial Surgery Clinics of North America. Philadelphia, PA, Saunders, 1996, pp 19-35

S232 TMJ Arthroscopic Surgery—Current Concepts, Rationale, and Technique Jeffrey J. Moses, DDS, Encinitas, CA The clinical basis for the diagnostic and therapeutic usefulness of TMJ Arthroscopy has been well established 123