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S122: Cleft Lip and Palate: Comprehensive Care From Infancy Through Adolescence
Surgical Clinics with atrophied alveolar ridge, because for oral and maxillofacial surgeons to understand the process of the bone formation of the grafted materials is a very important issue. References Ueno T, Mizukawa N, Sugahara T: Experimental study of bone formation from autogenous periosteal graft following insulin-like growth factor I administration. J CranioMaxillofac Surg 27:308-311 1999 Ueno T, Kagawa T, Kanou M, Sugahara T: Cellular Origin of Endochondral Ossification From Grafted Periosteum. Anat Rec 264;348-357, 2001 Ueno T, Kagawa T, Kanou M, Sugahara T: The histological and radiographical evaliation of beta-tricalciumphosphate for dental implants requiring bone augmentation. XVIII Journal of CranioMaxillofac Surg. Proceeding. Congress of the European Association for CranioMaxillofacial Surgery. Barcelona, International Proceedings. 117-120, 2006
S121 Tissue Expansion in Maxillofacial Reconstruction David B. Powers, DMD, MD, Lackland AFB, TX Brent L. Kincaid, DDS, Colorado Springs, CO Implantable tissue expanders have been utilized in plastic and reconstructive surgery for over two decades to repair a wide variety of soft tissue defects. The basic premise that native, living tissue is the best replacement for absent or lost tissue has driven the explosion of research and innovations in this field. Yet despite its widespread use in other fields, there is scant mention of tissue expansion in the oral and maxillofacial literature. This indicates either a dearth of knowledge in this area, lack of interest in this area by the profession at large, or simply the lack of suitable cases to report. Regardless of the reason, we feel this is an exciting and underutilized treatment modality in our specialty. The purpose of this lecture is to provide background on the history of tissue expansion, and review the indications, biologic effects, and basic principles of utilizing tissue expanders in the maxillofacial region, focusing on scalp defects. We have also included two case reports of tissue expanders utilized for repair of traumatic, avulsive scalp defects in children. References Cook HE, Lewis MK, Stoker NG. Tissue expansion reconstruction of soft tissue avulsions of the face: report of two cases. J Oral Max Surg 45:362, 1987 Neumann CG. The expansion of an area of skin by progressive distention of a subcutaneous balloon; use of the method for securing skin for subtotal reconstruction of the ear. Plast Reconstr Surg 19:124, 1957 Argenta LC. Tissue Expansion. In Plastic, Maxillofacial, and Reconstrcutive Surgery, 3rd ed. Georgiade GS, Riefkohl R, Levin LS, editors. 1999:87-98
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S122 Cleft Lip and Palate: Comprehensive Care From Infancy Through Adolescence Bernard J. Costello, DMD, MD, Pittsburgh, PA Ramon L. Ruiz, DMD, MD, Fort Myers, FL Surgeons caring for children with cleft lip and palate deformities must proceed with a firm cognitive understanding of three-dimensional regional anatomy, the extent of the hard and soft tissue defects, and the complex interplay between surgery and subsequent maxillofacial growth. This allows the clinician to appropriately formulate and sequence the staged surgical treatment of patients with cleft lip and palate deformities from the initial consultation in infancy through adulthood. Thoughtful, interdisciplinary planning of the reconstruction saves the patient family unnecessary therapies and operative procedures. As such, appropriate planning avoids needlessly burdening the patient and/or health care system with inefficacious or unproven modalities. This clinic will provide a comprehensive review of the treatment rationale, diagnostic approach, and operative techniques (primary lip repair, primary and secondary palatal reconstruction, orthognathic surgery, and rhinoplasty) involved in the staged management of oro-facial clefts. References Strauss RP: Health policy and craniofacial care: Issues in resource allocation. Cleft Palate Craniofac J 31: 78, 1994 American Cleft Palate-Craniofacial Association: Parameters for the evaluation and treatment of patients with cleft lip/palate or other craniofacial anomalies. Cleft Palate Craniofac J 30 (suppl 1): 4, 1993 Koop CE: Surgeon General’s Report: Children with Special Health Care Needs. Washington, D.C. Government Printing Office, June 1987
S123 ABCs of Maxillofacial Reconstruction Deepak Kademani, DMD, MD, Rochester, MN Steven L. Moran, MD, Rochester, MN Ablation of benign and malignant oropharnygeal tumors can lead to significant functional and cosmetic morbidity. Often the patient’s ability to speak and take adequate oral alimentation is severely compromised. Although cancer survival rates from head and neck malignancies have remained essentially unchanged over the last two decades, advances in reconstructive surgical techniques have lead to decrease in functional and cosmetic sequlae from ablative surgery. The optimal goal after ablation of any oropharyngeal tumor or trauma is to perform not only a corrective operation but to provide a functional and cosmetic reconstruction with minimal morbidity. It is critically important for the reconstructive surgeon to have a diverse armamentarium of reconstrucAAOMS • 2007
S121 Tissue Expansion in Maxillofacial Reconstruction David B. Powers, DMD, MD, Lackland AFB, TX Brent L. Kincaid, DDS, Colorado Springs, CO Implantable tissue expanders have been utilized in plastic and reconstructive surgery for over two decades to repair a wide variety of soft tissue defects. The basic premise that native, living tissue is the best replacement for absent or lost tissue has driven the explosion of research and innovations in this field. Yet despite its widespread use in other fields, there is scant mention of tissue expansion in the oral and maxillofacial literature. This indicates either a dearth of knowledge in this area, lack of interest in this area by the profession at large, or simply the lack of suitable cases to report. Regardless of the reason, we feel this is an exciting and underutilized treatment modality in our specialty. The purpose of this lecture is to provide background on the history of tissue expansion, and review the indications, biologic effects, and basic principles of utilizing tissue expanders in the maxillofacial region, focusing on scalp defects. We have also included two case reports of tissue expanders utilized for repair of traumatic, avulsive scalp defects in children. References Cook HE, Lewis MK, Stoker NG. Tissue expansion reconstruction of soft tissue avulsions of the face: report of two cases. J Oral Max Surg 45:362, 1987 Neumann CG. The expansion of an area of skin by progressive distention of a subcutaneous balloon; use of the method for securing skin for subtotal reconstruction of the ear. Plast Reconstr Surg 19:124, 1957 Argenta LC. Tissue Expansion. In Plastic, Maxillofacial, and Reconstrcutive Surgery, 3rd ed. Georgiade GS, Riefkohl R, Levin LS, editors. 1999:87-98
82
S122 Cleft Lip and Palate: Comprehensive Care From Infancy Through Adolescence Bernard J. Costello, DMD, MD, Pittsburgh, PA Ramon L. Ruiz, DMD, MD, Fort Myers, FL Surgeons caring for children with cleft lip and palate deformities must proceed with a firm cognitive understanding of three-dimensional regional anatomy, the extent of the hard and soft tissue defects, and the complex interplay between surgery and subsequent maxillofacial growth. This allows the clinician to appropriately formulate and sequence the staged surgical treatment of patients with cleft lip and palate deformities from the initial consultation in infancy through adulthood. Thoughtful, interdisciplinary planning of the reconstruction saves the patient family unnecessary therapies and operative procedures. As such, appropriate planning avoids needlessly burdening the patient and/or health care system with inefficacious or unproven modalities. This clinic will provide a comprehensive review of the treatment rationale, diagnostic approach, and operative techniques (primary lip repair, primary and secondary palatal reconstruction, orthognathic surgery, and rhinoplasty) involved in the staged management of oro-facial clefts. References Strauss RP: Health policy and craniofacial care: Issues in resource allocation. Cleft Palate Craniofac J 31: 78, 1994 American Cleft Palate-Craniofacial Association: Parameters for the evaluation and treatment of patients with cleft lip/palate or other craniofacial anomalies. Cleft Palate Craniofac J 30 (suppl 1): 4, 1993 Koop CE: Surgeon General’s Report: Children with Special Health Care Needs. Washington, D.C. Government Printing Office, June 1987
S123 ABCs of Maxillofacial Reconstruction Deepak Kademani, DMD, MD, Rochester, MN Steven L. Moran, MD, Rochester, MN Ablation of benign and malignant oropharnygeal tumors can lead to significant functional and cosmetic morbidity. Often the patient’s ability to speak and take adequate oral alimentation is severely compromised. Although cancer survival rates from head and neck malignancies have remained essentially unchanged over the last two decades, advances in reconstructive surgical techniques have lead to decrease in functional and cosmetic sequlae from ablative surgery. The optimal goal after ablation of any oropharyngeal tumor or trauma is to perform not only a corrective operation but to provide a functional and cosmetic reconstruction with minimal morbidity. It is critically important for the reconstructive surgeon to have a diverse armamentarium of reconstrucAAOMS • 2007