Surgical Clinics

SURGICAL CLINICS TUESDAY, SEPTEMBER 16

Attendance for each surgical clinic (SC) is limited. AAOMS members will be given first priority and then only to other health care professionals registered as such. Attendance is determined on a first-come, first-served basis. Tickets are obtained by completing and returning the pre-registration form on page 81. Pre-registration for each individual is limited to a total of four (4) SCs and/or Practice Clinics (PCs) combined. Cost per SC varies depending on the length of the program. When pre-registering for clinics, indicate your choices in order of preference in the space provided on the registration form. :\OTE: The computer will not automatically assign the alternate session, for those clinics offered twice, if your first choice is not available. (Please see top of page 83 for course fees). Tickets may be purchased on-site based on space availability. Kindly note that, per AAOMS policy, refunds for ticketed events/courses will not be granted.

Tuesday, September 16 8:00am - 10:00 am (SOl-SO?) SOl

A Long-Term Review of Alveolar Segmental Osteotomies Robert B. \1aclntosh, ODS Detroit, Ml Segmental alveolar arch surgery was one of the most exciting elements of orthognathic surgery introduced into the United States by Obwegeser in 1966. Since that time, it has become significantly less popular. This 30-year review of segmental techniques describes their indications, complications, problems, and advantages over whole-arch surgery, with the goal of stimulating a re-interest in their application.

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The Temporalis Muscle Flap and its Use in Reconstruction of Intraoral Defects

SOl Rhinoplasty Brian C. Harsha, ODS, MS Myrtle Beach, SC A comprehensive presentation of multiple surgical techniques involved in open and closed rhinoplasty will be provided. Proper diagnosis is vital and will determine the surgical sequence of events. Emphasis will be placed on the nasal tip with methods presented that affect tip projection, rotation and volume.

S04

Bone Graft Harvesting for the OMS Peter E. Larsen, DDS Columbus, OH The purpose of this surgical clinic is to review the technique for harvesting bone from the anterior and posterior ilium, rib, tibia, and cranium. Emphasis will be placed on development of predictable techniques with minimal morbidity. Alteration of surgical technique for specific oral and maxillofacial surgery settings such as bone harvesting in an outpatient setting and bone harvesting with intravenous sedation will also be discussed.

sos Current Concepts in the Management of Obstructive Sleep Apnea B.D. Tiner, DDS, MD San Antonio, TX John R. Jones, DMD, MD Austin, TX Obstructive sleep apnea syndrome (OSAS) is a debilitating disorder affecting 4% of the workforce, with the potential to cause severe cardiorespiratory disorders and lost productivity. While the primary form of therapy remains nasal continuous positive airway pressure (CPAP), orthognathic surgery with adjunctive procedures has proven to be efficacious.

506

A. Omar Abubaker, 0\10, PhD Richmond, VA

Temporomandibular Joint Dysfunction and Orofacial Pain: Problem Based Learning

For reconstruction of small intraoral defects, local flaps can be used successfully with minimal morbiditv. However, for moderate to large defects." regional or free flaps are 'often necessary. Because of the potential morbidity associated with free flaps, regional flaps provide more viable alternative for some patients. Among the regional flaps the temporalis muscle flap is the most versatile and the most commonly used. The technique of the temporalis muscle flap and its uses in reconstruction of intraoral defects will be discussed.

Richard P. Harper, DDS Dallas, TX Problem solving for patients presenting with temporomandibular joint dysfunction and orofacial pain requires a basic foundation of knowledge with respect to embryologic development, gross and microscopic anatomy, biomechanics and determinants of dental occlusion. This interactive seminar will explore a "problem-based learning" approach to TMD through the identification of ISSUES and formulation of LEARNING OBJECTIVES.

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SURGICAL CLINICS TUESDAY, SEPTEMBER 16

S07 C0 2 Laser Skin Resurfacing: Basic to Advanced Applications Bruce B. Chisholm, DDS, MD Palm Desert, CA

Laser therapy has become the treatment of choice for facial conditions that were historically difficult or impossible to treat. Common conditions include facial rhytids, actinic changes, hypertrophic and postsurgical scarring, and generalized facial aging and laxity. The continuous wave CO, laser can produce significant thermal injury when used on skin. The pulsed CO, laser was developed to avoid this unwanted side effect. The uitrapulse CO, laser is effective for skin resurfacing and rh ytid reduction. The ultra-pulse CO~ laser has the capability of delivering char-free ablation and permits control, precision and predictability in cutaneous resurfacing. Wrinkles are eliminated, texture is improved and facial skin is tightened. The CO, laser is the treatment of choice in skin resurfacing and rejuvena-tion.

SlO

The TMI System-From Progressive Bone Loss to Controlled Bone Growth Michael P. Powers, DDS, \IS Clcwlawl,OH

Hans Bosker, DDS, PhD THE NETHERLL\'lJS

Bone growth has been demonstrated in multiple long-term follow-up investigations of patients rehabilitakd with the T\11 system. Surgical and prosthetic protocols will be discussed to ensure controlled bone growth, restored masticatory function and improved facial esthetics in patients suffering from severe mandibular atrophy.

Sll Cranial Base Surgery: Extended Role for the OMS james B. Holton, DDS, MSD Tyler, TX

10:30 a1n -12:30 pm (S08-S14) S08 Guided Tissue Regeneration in Jaw Reconstruction: Review and Application

The oral and maxillofacial surgeon is uniquely qualified to participate in cranial base surgery. This lecture reviews: (I) a transoral/transfacial approach to the upper cervical spine and clivus; (2) a transorbital/zygomatica approach to the middle cranial fossa; and (3) transfrontal approach to the anterior cranial fossa.

Pamela L. Alberto, DMD Sparta, N/

S12

Guided bone regeneration has expanded the indications of optimal implant placement. Many different first and second generation membranes are now available. Critical biologic criteria and surgical protocols will be reviewed with the use of these membranes. Utilization of membranes, bone grafts and soft tissue with augmentation techniques will be discussed.

S09 Soft Tissue Flaps in Facial Reconstruction

Establishing an Office Setting for Outpatient Orthognathic Surgery Patrick J. Dolan, DDS, \IS Fairfilx, \'A

This course presents office design and engineering for a major maxillofacial surgical facility. Patient preparation and management are discussed. Documentation of perioperatiw records is reviewed. Postoperative care and patient transfer are discussed.

joseph I. Helman, DMD Ann Arbor, Ml

S13

Stephen E. Feinberg, DDS, MS, PhD

The Mandibular Fracture: ATreatment Protocol

Ann Arbor, .\11

This clinic is designed to assist the oral and maxillofacial surgeon with the principles of soft tissue reconstruction of patients after ablative surgery or traumatic defects of soft tissue in the facial area. The rationale of flap use will be approached by reviewing the anatomy, physiology, and design of local facial intra/extraoral flaps. Selected flaps will be illustrated and discussed.

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Steward K. l.azow, DDS, \11) Brookl,rn, N\'

A review of -BS mandibular fractures in 26!! patients treated by the OMS service of Kings County Hospitai-SU\Y Brooklyn from 1992-1995 is presented. Our complication rate requiring reoperation or readmission was 3.-!'X, with 99% bony healing. Historical perspectives, demographics, treatment modalities, controversies, complications, and a treatment protocol for mandibular fractures are presented.

SURGICAL CLINICS TUESDAY, SEPTEMBER 16

514 Overview of TMJ Surgery: Arthroscopy, Arthroplasty, Total Joint Replacement

517 The Perioperative Management of the Pediatric Maxillofacial Surgery Patient

David C. Hoffman, DDS Stall'n Island, X\'

Barry Steinberg, DDS, MD, PhD Am1 Arbor, Ml

:\ comprehensive review of three types of T~l joint surgery will be : presented. Equal time will be spent describing arthroscopy, , arthroplasty or open joint surgery, and total joint replacement. ' Each will be looked at with regard to indications, surgical techniques, a review of current literature, expected or predictable results, and postoperative management. The program will begin with current concepts in "outcome oriented" treatment and algorithms for T\1 joint surgery. The material will be comprised from the experiences and outcomes of approximately 400 surgical procedures.

2:00 pm - -!:00 pm (S 1S-S21) 51S Practical Guidelines for the Reconstruction of the Maxillofacial Skeleton, Part 1Mandible and Maxilla \lark E. Wong, DDS Houston, TX Brian R. Smith, DDS, \IS Silrewport, f...l With the wide range of treatment options now available, surgeons are challenged to select the optimal method, material and timing for a particular reconstruction. This surgical clinic will focus on immediate reconstruction of the mandible with reconstruction plates and delayed bony reconstruction with autogenous bone. Reconstruction of the maxillectomy defect with split thickness skin graft and obturator or with temporalis flaps will also be discussed.

516 Hair Transplantation and Micrografting Barry H. Hendler, DDS, MD Pililadelpilia, PA Cosmetic surgery is rapidly evolving as an integral part of 0\1S practice. This presentation is designed to give a working knowledge of hair transplantation and micrografting technique; the most common procedure for facial enhancement. Specific details will be rendered in regard to how surgery is performed via videotape analysis.

' Bruce B. Horswell, DDS, \1D, \IS Ellicott Ci~·. MD Perioperative management of pediatric maxillofacial surgery patients differs from that of adults. This presentation will discuss the pediatric history and physical, airway management, fluids, and electrolytes, laboratory values, diet, and complications. Emphasis will be placed on specific differences between the adult and pediatric patient.

518 Post-Traumatic Rhinoplasty John R. Werther, D\1D, \1D Xasilrille, TN This presentation will review the etiology, classification, and analysis of post traumatic nasal deformity. A step-wise approach for the management of septal deformity, saddle nose deformity, the twisted nose, tip cartilage deformity, and nasal airway obstruction will be reviewed in detail. Selection, harvest, and placement of cartilage (rib, septal, earl and bone grafts will be discussed.

519 Reconstruction of the Soft Tissue Upper Airway for the Treatment of Obstructive Sleep Apnea ;-..;, Ray Lee, DDS Newport Xews, \'A A review of the pathophysiology, diagnosis, nonsurgical and surgical treatment for OSAS will be presented. The indicated workup, including preoperative and postoperative polysomnography, anatomic sites of obstruction, and indications for surgery will be discussed. Various surgical options and their relevance including nasoseptal surgery, uvulopalatopharyngoplasty (Ul'PP), anterior mandibular osteotomy with genioglossus muscle advancement (A\10), maxillary and/or mandibular osteotomies, and hyoid myotomy with advancement will be reviewed. Postoperative functional changes of the upper airway will be discussed, as will possible complications. Analysis of results from a study of SO surgical patients will form the basis for a rational, stagedapproach for the surgical treatment of OSAS.

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SURGICAL CLINICS TUESDAY, SEPTEMBER 16

520 Skin Graft Vestibuloplasty: ASimplified Stentless Technique

523 Implant Surface Treatments and Their Effects on Tissue Integration

Hillel D. Ephros, DMD, MD

John C. Keller, MS, PhD

Paterson, N/

Iowa City, /A

Alan Samit, DDS

Daniel S. Sarasin, DDS

East Orange, NJ

Iowa City, /A

Skin graft vestibuloplasty provides a safe, reliable means of increasing denture support and stability for patients with or without dental implants. Experience with more than 800 cases over 15 years has evolved a stentless technique that requires only 1.5 hours of operating time and is associated with high patient acceptance.

Oral and maxillofacial implants and devices undergo a series of surface preparation treatments prior to distribution to the clinician. The role of surface roughening procedures and altered chemistry due to the addition of coatings and other procedures including sterilization will be reviewed in the context of their effects on integration in host bone and soft tissue.

521 Advanced Techniques in TMJ Arthroscopy Including Use of the Holmium: YAG Laser

524 Maxillofacial Surgery Syringe Liposuction John P. Schmitz, DDS, MS, PhD

Allen W. Tarro, DMD

San Antonio, TX

Lowell, MA

The most advanced techniques in TMJ arthroscopy will be presented, including triangulation techniques, superior lateral pterygoid myotomy, laser synovectomy, subintimal injection techniques ( steroids and sclerosing agents), removal of adhesions and fibrillated cartilage, disc repositioning, and disc suturing techniques. Emphasis will be placed on the use of the holmium: YAG laser in performing arthroscopic surgical procedures. The result of over 1100 TMJ arthroscopic surgeries will be discussed, including the rationale for TMJ arthroscopy and definitive treatment for specific types of TMJ intracapsular disorders. This presentation is intended for surgeons with previous education and experience in TMJ arthroscopy.

Liposuction continues to remain the most frequently requested cosmetic procedure in the world today. Most oral and maxillofacial surgery practices contain an unlimited source of patients who would benefit from treatment of their facial lipomatosis. Liposuction techniques also have utility in rhytidectomy procedures, neck lifts, and are amenable to a variety of adjunctive soft tissue procedures. Specific indications for the use of syringe liposuction of the face, as an in-office procedure using tumescent anesthesia, as well as adjunctive procedures will be discussed.

525 Diagnosis and Management of White Lesions Mark E. Wohlford, DDS, PhD

4:30 pm - 6:30 pm (S22-S28) 522 Improved Exposure of the Maxilla by the Midface Degloving Approach

Indianapolis, IN

The management of white lesions provides a challenge for oral and maxillofacial surgeons. Aclinical finding of leukoplakia can encompass a wide variety of diagnoses which require radically different treatments. This course will review the current state-ofthe-art in diagnosing and treating these lesions.

Jon P. Bradrick, DDS Cleveland, OH

Midface degloving provides improved exposure of the nasalmaxillary complex by connection of intraoral and intranasal incisions. This course will review history and pertinent anatomy of the procedure. Diagrammatic illustrations, followed by surgical examples will outline the approach. Guidelines for treatment planning, intraoperative techniques, and complication management will be presented.

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526 Practice and Principles of Bone and Soft Tissue Reconstructive Surgery Robert E. Marx, DDS Coral Gables, FL

The principle of today's bony reconstruction is the transfer of viable marrow-derived osteocompetent cells. It requires the knowledge of harvesting techniques, cell viability, growth factors, and reconstruction cribs to successfully reconstruct the facial skeleton. Similarly, soft tissue reconstruction requires the transfer of viable soft tissue elements from the choice of several donor sites and the knowledge of which to choose, how to perform the surgery, and what to expect from each tissue composite.

SURGICAL CLINICS TUESDAY, SEPTEMBER 16 WEDNESDAY, SEPTEMBER 17 S27 Current Concepts in the Surgical Management of Facial Skin Cancer: Esthetic Considerations

S30 The Art and Science of Skin Resurfacing Advanced Surgical Technique and Reiuvenation

Victor Escobar, DDS, PhD Fort Worth, TX

john P. LaBanc, DMD, MS Flagstaff, AZ john E. Griffin, Jr., DMD Columbus, MS Donald P. Max, DDS Columbus, MS

Anumber of malignant conditions of the skin present the oral and maxillofacial surgeon with the dilemma of treatment, referral and subsequent facial reconstructions. In most cases the surgeon refers the patients for treatment, thereby missing a unique opportunity to provide a service to the patient and to introduce the concepts of facial cosmetic reconstruction. This presentation will introduce the oral and maxillofacial surgeon to the principles of skin cancer management and the preparation of the surrounding tissues for subsequent reconstruction with local skin flaps, grafts or primary closure.

Acne, solar keratosis and wrinkling are common skin problems. These can be treated with chemical, mechanical, and laser resurfacing. The art and science of skin resurfacing, clinical decision-making and techniques will be discussed.

S28 TMD: Neurologic Basis for Differential Diagnosis and Treatment Considerations

S31 The Total, Comprehensive Perio/Prosthetic Implant Rehabilitation Process: The Team Approach

Richard G. Burton, DDS, MS North Bethesda, MD

Charles A. Babbush, DDS, MSD Beachwood, OH

Peter M. Bertrand, DDS North Bethesda, MD Successful management of TMD demands a differential diagnosis that includes understanding of cranial nerve activity, brain controlled muscle function, pain mechanisms, and how pain disrupts physiology. Interrelated concepts include: sustained norepinephrine release (stress). neurogenic inflammation, referred pain, trigger points, headache, abuse, sleep deficit, postural fatigue, muscle co-contraction and bruxism. The goal is to make these concepts relevant and provide therapeutic options so that nm can be diagnosed and managed more effectively.

Wednesday, September 17 7:00am-9:00am (S29-S35) S29 Osseointegrated Dental Implants in Children and Adolescents Affected by Ectodermal Dysplasia JaimeS. Brahim, DDS, MS Bethesda, MD Aprevalent finding in ectodermal dysplasia is total or partial anodontia. This study evaluates the use of osseointegrated implants in growing jaws. Twelve children (ages 7- 11) and 23 adolescents (ages 12- 17) affected by ectodermal dysplasia received 175 implants in the mandible. Study objectives include the effects of implant placement on growth and development. Success rates (91% adolescents, 86% children) suggest that functional implants can provide a successful alternative to conventional prosthodontics for these individuals. Serial cephalometric analysis also provides evidence that the relative position of the implant within the symphysis remains stable, even when significant growth occurs.

Material will be presented relating to accomplishing patient evaluation and the initial treatment planning process in a systematic manner. The concept of the joint treatment planning conference, surgeon/restorative dentist, along with final treatment considerations will be discussed. Final presentation of the case to the patient will be outlined and include aspects of implant reconstruction.

S32 Nerve lniuries: Prevention, Evaluation and Management Roger A. Meyer, DDS, MD, MS Marietta, GA Peripheral trigeminal nerve injuries may cause significant sensory dysfunction. Evaluation based upon neuropathophysiology and a classification system guides the clinician in management decisions. A rational approach includes methods of prevention, nonsurgical treatment and microsurgical repair. Areview of 400 nerve operations demonstrates the efficacy of microneurosurgery in selected patients.

S33 Facelift: A Practical Outpatient Approach Ghali E. Ghali, DDS, MD Shreveport, LA Brian R. Smith, DDS, MS Shreveport, LA In recent years a multitude of techniques have been introduced to improve the long-term results in rhytidectomy surgery. Often, these techniques are more time consuming, more technically difficult to perform, and are potentially associated with increased morbidity. With this in mind, this presentation will focus on techniques which are readily adaptable to many outpatient oral and maxillofacial surgery practices. This clinic will discuss patient selection, anesthetic technique, operative technique, postoperative management, and complications associated with face-lifting procedures.

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SURGICAL CLINICS WEDNESDAY, SEPTEMBER 17

534 Treatment of Facial Skin Cancer: Diagnosis, Moh' s Surgery and Reconstruction

537 TMJ Laser Arthroscopic Surgery

David C. Hoffman, DDS

Birmingham, AL

Statm Island,,\'}'

Leon Kircil;, \ID Staten /.\land, ,\'}'

Skin cancer of the face is one of the most commonlv encountered cancers in this countrv. Essential to successful treatment of this disease are early diagnosis and prevention. Basal cell and squamous cell carcinoma present with a variety of appearances. Treatment includes radiation therapy, curettage and electrocautery desiccation, local excisions and \loh's surgery. \loh's is considered the most effective treatment because of microscopic control and maximal tissue sparing. Reconstruction following \loh's surgery is a challenge to the surgeon and a true benefit to the patient. This surgical clinic will review the different treatment options and reconstruction techniques using local flaps of the face.

535 Total Temporomandibular Joint Reconstruction with Alloplasts Peter D. Quinn, D\ID, \ID Philadelphia, PA

With the proper understanding of biomaterial and biomechanical considerations, total alloplastic reconstruction of the temporomandibular joint should be a viable option for oral and maxillofacial surgeons. The multi-operated patients with severe degenerative disease, recurrent ankylosis, grossly distorted anatomy from trauma, tumor surgery or previous failed autogenous grafts, are clearly in need of a safe and effective temporomandibular joint prosthesis. The history of joint reconstruction with the following systems will be reviewed: KentVitek, Svnthes, Ti-Mesh/Delrin, Tech-\ledica, and Christensen. We wil!' also present initial clinical data on a newly designed prosthesis from Biomet, Inc. In addition to the historical overview, the absolute relative indications for alloplastic joint replacements, as well as contraindications and detailed surgical techniques, will be presented.

3:30 pn1 - 5:30pm (536-543) 536 Endoscopic Forehead Rejuvenation for the OMS john H. Watts, DDS Portsmouth, VA

Vernon A. Sellers, D\ID l'urtsnwuth, FA

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Endoscopic forehead rejuvenation is an exciting area of cosmetic 0\IS practice. Surgeons with experience in T\lj endoscopy and coronal flap surgery can perform this procedure with safe, predictable results. Diagnostic and patient selection criteria, anesthesia, and instrumentation requirements and detailed operative techniques will be presented. Postoperative results and management of complications will be reviewed.

\lichael G. Koslin, D\ID vVith the advent of increasing arthroscopic knowledge of temporomandibular joint pathology, surgical modalities are being tailored to allow for their proper management. Arthroscopic laser temporomandibular joint surgery with and without articular disc suture stabilization, allows the clinician to manage pathologies, synovitis, inflammatory joint disease, articular disc dysfunction, locking, and painful pops. In addition, salvage procedures for perforated articluar discs have also proven to be extremely successful.

538 Immediate Reconstruction and Implant Placement at the Time of Ablative Cancer Surgery Allen Sclaroff, DDS St. Louis, ,\10

Technique for reconstruction of the mandible after ablative cancer surgery utilizing microvascular surgical free flaps to replace hard and soft tissue defects is followed by placement of osseointegrated implants. rour to six weeks after reconstruction, full course radiotherapy is followed by six months of healing then second stage implant surgery.

539 New Codcepts in Orthognathic Surgery Larry \1. Wolford, DDS IJal/as, TX

Surgical modifications of mandibular subapical, genioplasty, body, ramus, and maxillary osteotomies; with rigid fixation, hydroxylapatite grafting, double jaw surgery techniques, and surgical alteration of the occlusal plane will be presented. Simultaneous rhinoplasty and facial augmentation, as well as new model surgery modifications and surgical sequencing will also be discussed.

540 Submental Liposuction: A Great Place to Start john E. Fidler, Jr., DDS Bethesda, MIJ

This course offers the surgeon interested in submental liposuction basic information into the procedure. The participants will learn how to evaluate the patient, the instrumentation needed to perform the procedure and the basics of the procedure. They will also learn the indications, contraindications and risks involved. The preoperative and postoperative course of the surgery along with expectations and results will be addressed.

SURGICAL CLINICS WEDNESDAY, SEPTEMBER 17 THURSDAY, SEPTEMBER 18 S41 Diagnosis and Treatment of Hypomobility of the Mandible james Q. Swift, DDS .\finnmpoli.1. .\IX

\fandibular hvpomobility, or limited range of motion of the mandible, is a clinical problem experienced by many patients. There can be many causes ranging from postsurgical fibrosis after temporomandibular joint surgery to displaced condylar fracture of the mandible. Identifying the direct cause of the restriction can be problematic. :\ systematic and empiric approach to diagnosis and management i\ essential for positive outcome.

S42 Surgical Rejuvenation of the Chin and Submental Region \'incent B. Ziccardi. D\ID, \ID Elmh11rst, Xl'

Ronald E. Schneider. DDS Jamaica, .\'1'

This surgical clinic shall provide the practitioner with some adjunctive esthetic surgical techniques which can be readily utilized and applied to a clinical practice with regards to surgery of the chin and the submental region. These surgical procedures can be readily performed in any modern oral and maxillofacial surgical office with existing armamentarium and surgical techniques will be reviewed. Liposuction, alloplastic and osteoplastic genioplasty as well as submentallipectomv and excision will be discussed and illustrated with case examples. Surgical complications, pitfalls, expectations and proper informed consent will also be addressed.

S43 Outpatient Bone Graft Procurement Using Minimally Invasive Surgery George K.B. Sandor, DDS, \ID 011tario, CA.\'AVA

\finimally invasive surgical techniques sacrifice open access for lower postoperative morbidity by disturbing less surrounding tissue. This course reviews the principles of minimally invasive surgery and applies these principles to bone graft procurement. One such application includes a power driven trephine to harvest bone grafts in a minimally destructive technique. The course provides a comprehensive review of potential bone graft donor sites. Both theoretical and hands-on training using a power driven trephine are also provided in this course. Both surgical and prosthodontic reconstructive applications are discussed with the focus being on outpatient procedures.

Thursday, September 18 7:00 an1 - 9:00 an1 (544-SSl) S44 Evaluation and Management of Zygomaticomaxillary fractures Anthony J. Casino, DDS Grmt Seck, NY

\fanagement of zygomaticomaxillary fractures is a simple yet complicated procedure performed by most oral and maxillofacial surgeons. The clinic will provide a review of the clinical evaluation and radiographic/imaging techniques currently utilized. The main focus of the clinic will concern the classification of the types of fractures that are encountered and appropriate method of treatment. Issues that will be discussed include the amount and points of fixation/exposure and types of incisions used for each. Indications for orbital floor exploration and methods of orbital floor reconstruction will be discussed. Postoperative complications will also be included.

S4S The Inherent Risks of the Pterygomaxillary Dysfunction and Maxillary Downfracture Dennis T. Lanigan, D\ID, MD Saskatclu'll'illl, CrlNAIJA

A number of rare important complications have been reported following LeFort I osteotomies including hemorrhage, stroke, carotid-cavernous sinus fistulae, CNS leaks and ophthalmic complications. These complications may arise from untoward fractures associated with the pterygomaxillary dysjunction and maxillary downfracture. The possible etiology and prevention of these complications will be discussed.

S46 Practical Guidelines and Reconstruction of the Maxillofacial Skeleton: Part 11-0rbit and Zygoma Mark E. Wong, DDS Ho11stoll, TX

Brian R. Smith, DDS, \IS Shrel'eport, Lrl

This clinic will focus on reconstruction of the orbit and zygoma. Reconstruction of the orbit after fresh trauma and tumor ablation will be discussed. Reconstruction of the more difficult secondarv orbital defects, as well as the orbito-zygomatic malunion will also be addressed. Tips to aid in predictable success will be given.

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SURGICAL CLINICS THURSDAY, SEPTEMBER 18

547 Sinus Elevation with Grafting: An Aid to Implant Placement

551 Surgical Aspects of Apicoectomies with "Hands-On" Demonstration of Microapical Preparation

Barry E. Zweig, DDS West Orange, NJ

Stuart E. l.ieblich, Avon, CT

This is an in-depth, step-by-step course in the restoration with implants of the anatomically compromised posterior maxilla. Special emphasis is placed on the various grafts and their harvesting. Numerous cases will be utilized to demonstrate the management of diverse clinical situations.

The oral and maxillofacial surgeon is often involved with periapical surgery. This clinic will review the literature to discuss the indications for surgery as well as factors that influence success and failure. A clinical portion will have participants prepare an extracted tooth with the ultrasonic device.

548 Inferior Border Grafting for the Severely Atrophic Mandible

3:30 pm - 5:30 pn1 (SS2-SS9)

Peter D. Quinn, DMD, MD Philadelphia, PA

The reconstruction of the severely atrophic mandible can be a vexing problem for oral and maxillofacial surgeons. In particular, the mandible with advanced resorption (less than 6mm of bone) also poses a risk of pathologic fracture. Based on ~arx's work with composite grafts in continuity defects, we have adapted the use of the cadaver freeze-dried mandibular "tray" in conjunction with autogenous iliac crest marrow grafts. A rationale for this tec?nique, along with the basic biology of bone grafting, will be revie~ed. The advantages of this pre-implant bone grafting techmque, over superior border grafting, will be reviewed and the results of a 5-year follow-up to assess the degree of postaugmentation resorption will be presented.

549 Surgical Indications & Techniques of Bone Grafting Steven J. Richter DDS Winchester, MA

This course will encompass the clinical use of bone graft material i~ the eve~d_ay practice of oral and maxillofacial surgery. There Will be specific cases presented with emphasis on immediate grafting of second molars after the removal of wisdom teeth the use with both internal and regular sinus lifts, and the use wlth placement of dental implants immediately after extraction. The use with pathology and ridge augmentation will be discussed.

550 Facial Reiuvenation: Use of the C0 2 laser Rosemarie Valentine DMD, MS Fort Lauderdale, FL

The use of the C0 2 laser for skin resurfacing and rejuvenation is an adjunct within the scope of oral and maxillofacial surgery. Techniques _for sk_i~ resurfacing, transconjunctival blepharoplasty and upper hd exclSional blepharoplasty will be demonstrated using the C0 2 laser. Skin preparation, dressing selection and management of postoperative sequelae including prevention of common complications will be discussed.

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D~D

552 Microbiology and Antibiotic Therapy of Oral and Maxillofacial Infections Thomas R. flynn,

D~D

Bronx, NY

The changing microbiology of odontogenic and other head and neck infections, including the role of anaerobic bacteria, the effects of immune system compromise and the changing nomenclature of oral pathogens is presented. The rational and cost-effective use of old and new antibiotics is discussed according to their antimicrobial spectrum, cost, and sid~-effects. Additional topics include drug interactions and complications of antibiotics, along with the indications and contraindications for their use.

553 Advanced Bone Grafting-Surgical & Prosthetic Strategies for Long· Term Implant Success ~ichael

A. Pikos, DDS

Palm Harbor, FL

This talk will deal with office-based advanced bone grafting techniques as used for compromised anatomical implant sites. Monocortical symphyseal onlay grafts, sinus grafting, and particulate grafting are covered in detail. Emphasis will be on diagnosis/treatment planning, surgical techniques, and prosthetic implications. Biologic, biomechanical and prosthetic principles will be stressed.

554 Nasal-Ethmoidal-Orbital Dislocation Fractures Mark R. Stevens, DMD Miami,FL

!he cli~ic will address the management of craniofacial injuries as It pertams to the frontal basilar skull, frontal sinus and nasaethmoidal areas. Special consideration on nasal injuries and their immediate and late reconstruction will also be discussed.

SURGICAL CLINICS THURSDAY, SEPTEMBER 18 FRIDAY, SEPTEMBER 19

sss

ssa

Diagnosis and Treatment of Transverse Maxillomandibular Discrepancy

Diagnosis and Management of Trigeminal Nerve Injuries

:\orman J. Betts, DDS, \IS

Michael Miloro, DMD, MD

,\'c\\'ark, X/

Columbus, OH

H. Dexter Barber, DDS l'lriladdpl1ia, l'A

Control of the transverse dimension during correction of dentofacial deformities is vital for a stable, functional occlusion. Transverse maxillomandibular deficiency is often unrecognized or inadequately treated. Diagnostic and surgical techniques for recognition and treatment of this deformity will be presented with special attention given to surgically assisted rapid maxillary expansion.

SS6 Management of Acute Chronic Pain in the Oral and Maxillofacial Surgery Patient Warren 1'. \"allerand, DDS

Newark, .\'f

\luch misinformation and myth exist regarding pain control and analgesic use. As a result, pain is frequently under treated. Acute pain is common following most oral and maxillofacial surgery procedures. Also, numerous conditions such as temporomandibular joint dysfunction and neuropathies produce a significant chronic pain management problem for the oral and maxillofacial surgeon. This presentation will cover the newest agents and concepts for effective pain control. Protocols for control of specific painful conditions will be covered.

A variety of procedures performed routinely by the oral and maxillofacial surgeon may place the peripheral branches of the trigeminal nerve at risk for iatrogenic injury. Evolving diagnostic methodology as well as current microneurosurgical reconstructive options permit patient treatment which can prevent potentially disabling morbidity. This surgical clinic will examine the diagnostic evaluation, and the medical and surgical treatment options for patients with trigeminal nerve injuries.

SS9 Cleft Lip /Palate David S. Precious, DDS, MSc HalifilX, NS CANADA

This course provides a step-by-step strategy for management of unilateral and bilateral primary and secondary cleft lip, cleft palate and cleft alveolus. Timing and surgical techniques will be presented in detail.

Friday, September 19 7:00am-9:00am (S60-S67)

SS7 Laser-Assisted Endoscopic Forehead Lifts and Laser Skin Resurfacing

S60 Anatomy and Surgical Therapy of Oral and Maxillofacial Infections

John E. Griffin, Jr., D\1D

Thomas R. Flynn, DMD

Columlm.1, .\LS

Bronx, NY

Donald \lax, DDS

A review and update on the clinically relevant anatomy of deep facial space infections, their surgical therapy, and complications of these infections, such as mediastinitis, cavernous sinus thrombosis, brain abscess, and necrotizing fascitis. Surgical principles, anesthesia and airway considerations, and aspiration are also discussed.

Colwnb11.1, .\:IS

Bradley frey, DDS Columbus, .\IS

This course will introduce attendees to some of the new techniques and advances to cosmetic oral and maxillofacial surgery. Laser-assisted endoscopic forehead lifts and laser skin resurfacing will be discussed in detail including patient selection, technique and pre- and post-op care.

S61 Laser-Assisted Uvulopalatoplasty and the Management of Snoring/OSAS Robert A. Strauss, DDS Richmond, VA

Laser -assisted uvulopalatoplasty has become an accepted tool in the management of snoring and, sometimes, mild OSAS. This clinic will discuss the indications, contraindications, alternatives and interesting complications of this exciting procedure. Technical aspects and variations of the surgery will be covered in detail. Finally, a review of the current literature including the results of over 300 procedures performed at the Medical College of Virginia will be presented.

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SURGICAL CLINICS FRIDAY, SEPTEMBER 19

562 Surgical Management of the Lip /Palate Deformity Part 1: Primary Procedures

565 Periodontics into the 21 '' Century

Daniel Buchbinder, DMD New York, NY Rafael R. Rodriguez, DDS

Chicago, IL

Mexico City, MEXICO

juan L. Noriega, DDS Mexico City, MEXICO

The goal of this clinic is to demystify the surgical procedures most frequently used in the treatment of the cleft lip and palate deformities. Simple, step-by-step instructions for the primary repair of the cleft palate using the Von Langenbeck, VKW V-Y pushback, Furlow double Z-plasty and Vomer flap will be presented. Similarly, a step-by-step demonstration of the quadrangular (le Mesurier), triangular (Tennison) and the rotation-advancement (Millard) techniques for the repair of the unilateral and bilateral cleft lip deformities will be presented. The indications for each technique and timing of the surgical procedures will also be discussed.

563 Closed Syringe Lipocontouring of the Face & Neck Robert W. Alexander, DMD, MD Edmonds, WA

Presentation of current techniques in lipocontouring procedures using timescent local infiltration and closed syringe system for cervicofacial liposuction. Selputial technique and current instrumentation will be discussed. A review of potential risks, complications and management of the postoperative patients will be provided.

564 laser-Assisted Removal of Facial Rhytids and lesions Steven A. Guttenberg, DDS Washington, DC

This course will present in-depth information on using the highenergy, short-pulsed carbon dioxide laser to ablate cervicofacial pathologic lesions and markedly diminish or obliterate wrinkles. The techniques utilized will be illustrated with numerous clinical slides and a short videotaped presentation of actual surgical procedures.

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Robert M. Pick, DDS, MS The field of periodontics is changing rapidly as we approach the 21st Century. Over the last several years, we have seen new advances and procedures in periodontics that have changed our approach to treating various conditions and problems. Guided tissue regeneration has shifted the focus of periodontics from "removal and resection" to "replacement and regeneration." Periodontal plastic surgery now allows us to even more predictably cover exposed root surfaces (even those areas previously restored), cover crown margins, augment collapsed ridges, and correct areas of excessive gingival display. Today's esthetically conscious patients are demanding better performance and superior cosmetic results. New diagnostic procedures and non-surgical therapies allow us to predictably diagnose conditions and assist in the therapeutic resolution of disease processes. The laser has also expanded our options in the treatment of soft tissue problems.

566 New Concepts in TMJ Surgery Larry M. Wolford, DDS Dallas, TX

This presentation will discuss the diagnosis and treatment of a wide variety of TMJ pathologies. Accurate diagnosis and appropriate techniques will provide the best functional and esthetic results and help improve pain levels. Disc repositioning, autogenous disc and/or condyle replacements and total joint prostheses will be discussed.

567 Contemporary Functional and Esthetic Implant Restoration of the Partially Edentulous Patient Louis F. Clarizio, DDS Portsmouth, NH

In this presentation you will learn ideal positioning to achieve esthetic and functional results. The focus will be on the maxillary central ~ncisor and mandibular and maxillary first molar implant restoratiOns. The nonsubmerged or one-staged approach will be discussed as a way to increase case acceptance, decrease chair time and discomfort for the patient and gain excellent soft tissue healing prior to restoration. An extraction site protocol for replacing or maintaining alveolar bone will be discussed. Cases involving the restoration of missing alveolar bone will be presented utilizing bone grafts taken from the tuberosity, chin and/or iliac crest. Finally, a basic presentation on the subantral augmentation procedure will be given.

SURGICAL CLINICS FRIDAY, SEPTEMBER 19

3:30pm - 5:30pm (568-576) 568

Scientific Basis and Clinical Application of Myocutaneous Island Flaps in Head and Neck Reconstruction Uwe Frohberg, DMD, MD Due.mldorf, GERMANY

This course reviews the anatomical basis and clinical application of various myocutaneous island flaps used in head and neck reconstruction. Technical aspects including donor site location, flap design, elevation, and flap inset are discussed. Case reports cover reconstruction after glossectomy, closure of perforations, and skull base defects. Selected cases are presented for discussion.

569

Evaluation & Treatment of the Aging Face John E. Griffin, Jr., DMD Columbus, .\15

Donald P.

~1ax,

DDS

Columbu.\, MS

This course is designed to present options in evaluation and esthetic cosmetic treatment of the aging face. Forehead, eyelids, nose, neck are all covered in the evaluation and treatment process.

570 Surgical Management of Salivary Gland Pathology Eric R. Carlson, DMD Coral Gables, FL

The head and neck region is the source of six major and hundreds of minor salivary glands which may give rise to a variety of neoplastic and non-neoplastic pathologic processes. This lecture reviews the differential diagnosis, the means to establish a diagnosis, treatment and histopathology associated with salivary gland pathology that the oral and maxillofacial surgeon is likely to encounter.

571 Treatment of Mandibular Fractures by Transoral Approach, Advanced Lag Screw Techniques and Cost Analysis William D. Weber, DMD New York, NY Gregory Chotkowski, DMD New York, NY The transoral approach for the treatment of mandibular fractures using primarily lag screw and miniplate techniques with dedicated, newly designed instrumentation reduces operating time, minimizes hardware placed, reduces overall cost of treatment and maximizes the benefits of rigid internal fixation to the patient. Discussed will be case selection, surgical approaches, methods of reduction and fixation and cost analysis compared to traditional transcutaneous techniques.

572 Diagnosis and Treatment of Neoplasms of the Temporomandibular Joint James Q. Swift, DDS Minneapolis, MN Benign or malignant neoplasms of the temporomandibular joint can present a challenge to the oral and maxillofacial surgeon with both the differential diagnosis and surgical treatment planning. The patient presentation may include symptoms that are consistent with the diagnosis and surgical treatment of temporomandibular disorder which may influence the clinician to overlook the possibility of neoplasm as the etiology. Surgical treatment often requires a more comprehensive approach than the usual "TMJ" surgery. Successful outcomes are achieved by obtaining a complete surgical evaluation including diagnostic tests and imaging and thorough surgical access.

573 The Diagnosis and Management of Benign Neoplasms and Calculi of the Major Salivary Glands, Including Ultrasound and Lithotripsy Mark McGurk, DDS, HD, FRCS, FDS London, ENGLAND

Salivary lithotripsy has the potential to supersede surgery as the principal mode of therapy for calculi. Aspects of its application for maxillofacial surgeons will be clarified. Similarly the principles underlying the diagnosis and treatment of pleomorphic adenoma have altered and are discussed with reference to the analysis of 1400 salivary neoplasms.

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SURGICAL CLINICS FRIDAY, SEPTEMBER 19 SATURDAY, SEPTEMBER 20 S74 Intraoral Distraction Osteogenesis: A New Frontier William H. Bell, DDS Plano, TX

Cesar Guerrero, DDS Caracas, VENEZUELA

Maxillary and mandibular lengthening or widening was achieved successfully in 120 patients by intraoral bone-supported or toothsupported osteodistraction appliances. All patients obtained significant mandibular growth and proper dental alignment without the need for extraction, with good bone formation, healthy gingival response, and no sensory nerve disruption or injury to dental follicles.

S75 Rhinoplasty Brent D. Kennedy, DDS, MD Murray, UT

An overview of rhinoplasty is presented. Diagnostic, esthetic, and functional treatment considerations are covered in detail. External and closed rhinoplasty approaches are compared. Surgical techniques and illustrative cases are presented. Emphasis is placed on nasal tip management.

S76 Advanced Surgical Techniques for Implant Reconstruction, Sinus, Nerve, Extraction, Immediate Placement Charles A. Babbush, DDS Beachwood, OH

This presentation will review the diagnosis and treatment planning concepts related to limited bone space for implant reconstruction. A step-by-step technique will be outlined for maxillary antroplasty (sinus-lift) nerve transposition and extraction, and immediate implant placement.

Saturday, September 20 7:00am-9:00am (S77-S84) S77 Endoscopic Sinus Surgery for the Orthognathic Patient jeffrey j. Moses, DDS Encinitas, CA

In combination with coronal CT scanning, nasal endoscopy has become an irreplaceable and routine procedure in the diagnosis and treatment of the patient with sinusitis. This clinic will review pertinent anatomy and pathophysiology critical to understanding the Messerklinger concept of functional endoscopic sinus surgery. Diagnosis, imaging, instrumentation and surgical techniques will be presented in a comprehensive fashion. The predisposing relationship of skeletal-facial deformities to the initiation or aggravation of sinonasal pathology will be explored and demonstrated. Example cases will be presented.

S78 Salivary Gland Disorders Michael Miloro, DMD, MD Columbus, OH

The surgeon is frequently confronted with the need to assess and manage salivary gland pathology. Athorough knowledge of embryology, anatomy, and pathophysiology is necessary in order to treat patients appropriately. This clinic will examine etiology, diagnostic methodology (biopsy techniques, fine needle aspiration biopsy), radiographic evaluation, and management of a variety of salivary gland disorders including sialolithiasis and obstructive phenomena (mucocele and ranula), acute and chronic salivary gland infections, traumatic gland disorders, Sjogren's syndrome and other disorders of salivary flow (chronic drooling), necrotizing sialometaplasia, and benign and malignant salivary gland tumors.

S79 Predictable Correction of Maxillary Bone Deficiency to Allow Successful Prosthetic Rehabilitation Bill C. Terry, DDS Chapel Hill, NC

Bone loss in the anterior maxilla and associated soft tissue and vestibular deformities as well as the less common completely resorbed alveolus, "flat maxilla," can be predictably corrected. An implant-restored mandible functioning against the edentulous, compromised maxilla raises additional concerns. Selection of specific procedures, surgical details and long-term results, including complications, will be discussed and illustrated.

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SURGICAL CLINICS SATURDAY, SEPTEMBER 20

sao Facial Rejuvenation: Chemical Peel, Dermabrasion, Laser Skin Resurfacing

S84 Secondary Management of the Cleft Lip and Palate Deformity

Peter :-.J. Demas, DMD, \1D Pittsburgh, PA

Mexico City, MEXICO

Chemical peel, dermabrasion and laser skin resurfacing are reconstructive procedures which significantly augment the facial cosmetic surgeon's capabilities. Relevant skin histology, wound healing, peel chemistry, dermabrasion, instrumentation, laser technology, and anesthetic concerns are discussed. Emphasized are indications, contraindications, perioperative therapy and management of potential complications. The presentation enhances the clinician's abilities in patient evaluation, technique selection and surgical management to achieve consistent results.

S81* The Frialit-2-Step Implant System Charles A. Babbush, DDS

Rafael R. Rodriguez, DDS juan L. Noriega, DDS Mexico City, MEXICO

Daniel Buchbinder, DMD New York, NY

The goal of this clinic is to present the most common surgical procedures used in revision cleft lip and palate surgery. This will include revision palatoplasty procedures for residual fistula (e), alveolar bone grafting and pharyngeal flaps for the treatment of velopharyngeal incompetence (V.P.I.). Similarly, revision procedures for the treatment of the residual lip/nose deformities in the unilateral/bilateral cleft lip will also be presented. The indications for each technique and timing of the surgical procedures will be discussed.

Beacilwood, OH

This presentation will deal with the Frialit-2-step screw implant system which was developed primarily for those implant situations where greater demands are placed on the initial stability due to poor quality or insufficient congruity between the implant and implant site, i.e., extraction with immediate implant placement.

S82 Contemporary Office Anesthesia jeffrey B. Dembo, DDS Lexington, KY

jeffrey D. Bennett, D\1D Fannington, CT

Anesthesia care continues to be important to the practice of ambulatory oral and maxillofacial surgery. This care can be potentially enhanced by gaining familiarity with newer anesthetic agents like sevoflurane, desflurane, and propofol, discussing advantages and disadvantages of use of the laryngeal mask airway, and reviewing analgesic therapy.

S83 Guided Bone Regeneration Utilizing Advanced Surgical Techniques with ePTFE Membranes jay P. Malmquist, DMD

3:30 pn1 - 5:30 pm (S85-S92) sss Modified Condylotomy H. David Hall, DMD, MD Nasilville, TN

The rationale for modified condylotomy is that it increases joint space and thereby reduces load on the retrodiskal tissues and joint surfaces. Furthermore, this is achieved without surgical damage or scarring of the joint. A 1-3 year prospective outcomes study and a retrospective study of reoperation of failures and their outcomes document the effectiveness of this operation.

S86 Cosmetic Surgery of the External Ear Todd G. Owsley, DDS, MD Greensboro, NC

Treatment of structural deformities involving the ear, both congenital and acquired, are within the scope of oral and maxillofacial surgeons. Commonly used otoplasty techniques will be reviewed and cases discussed. Treatment of auricular trauma and techniques in harvesting auricular cartilage for facial reconstruction and cosmetic surgery will be presented.

Portland, OR

Guided bone regeneration (GBR) is now an accepted technique to augment implant placement and enhance the long-term prognosis. Techniques are now available to utilize GBR in advanced surgical procedures. This clinic will review the new uses of GBR with membranes. Specifically bone grafts, sinus grafts and esthetic considerations will be reviewd. The use of reinforced membranes, supporting research and resorbable membranes will be addressed. In summary, the clinic will update the surgeon on the most recent uses of GBR with membranes.

• S81 moved to Thursday, September 18 7:00am-9:00am

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SURGICAL CLINICS SATURDAY, SEPTEMBER 20

587 Orthodontics for the Surgery Patient: What, When, How Much and Why?

590 Automatic External Defibrillators

Paul M. Thomas, DMD, MS

Decatur, IL

Durham, NC

Since the goals of presurgical orthodontics are almost always distinctly different from orthodontic camouflage, the commitment to a course of action should be made from the beginning. Attempted camouflage with surgical salvage generally results in compromised results. Treatment planning considerations and a typical orthodontic sequence will be illustrated with case presentation of patients having multidimensional skeletal problems.

588 Wide Diameter Implants: Indications, Considerations and Preliminary Results Over a 4-Year Period Stuart L. Graves, DDS, MS Fairfax, VA

Wide diameter implants may be a useful alternative to conventional implant rehabilitation. Benefits and indications include: increased implant surface area; immediate implant placement; increased predictability in rarified bone; increased prosthetic stability; more normal emergence profiles; and beneficial biomechanical factors. Over a 4-year period, eight hundred S and 6mm diameter implants were placed in 589 patients, with an overall success rate of 93%.

589 Periodontal Plastic Surgery: Advanced Soft Tissue Procedures to Enhance Esthetics in the Partially Edentulous Implant Patient Anthony G. Sclar, DMD Miami, FL

Participants will learn to perform an esthetic periodontal evaluation and to select and sequence indicated periodontal plastic surgery procedures, in order to enhance esthetics. The use of pedicle flaps, free soft tissue onlay grafts, interpositional connective tissue grafts, as well as the principles of ridge preservation and guided soft tissue healing, will be demonstrated.

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Paul E. Jurgens, DMD, MSD Allen Jurgens, DDS Decatur, IL

Basic research, clinical research, technology, need, cost effectiveness, safety, efficacy, legal advocacy, and success rate of the External Automatic Defibrillator will be presented. Demonstration of hands-on practice will be available and encouraged.

591 Application of the Laryngeal Mask Airway for OMS Steven L. Thomas, DDS, MS Overland Park, KS Airway management is an integral part of the training and practice of oral and maxillofacial surgery. There has long been a need for an airwav maintenance device that would fill the void between the nasopharyngeal airway and the endotracheal tube. Our experience with over 1000 cases will be presented, along with a demonstration workshop and hands-on training in the use of the laryngeal mask airway.

592 Microsurgical Reconstruction of the Temporomandibular Joint Utilizing Disc Repair Kenneth S. Rotskoff, DDS, St. Louis, MO

~10

This course will highlight the indications for microsurgical reconstruction of the temporomandibular joint using disc repair and discoplasty. The procedure will be discussed with microsurgical videos to highlight the important aspects of the surgery. Indications, contraindications, and technical highlights will be presented. Postoperative management of the disc repair patient will also be discussed.