Surgical clinics

Surgical Clinics S101 Facelift and Endoscopic Forehead Lift: A Step by Step Approach John Griffin, DMD, Columbus, MS P.J. Schaner, DMD, Marietta, GA Interest in facial rejuvenation has greatly increased in recent years. Some of this interest stems from advances in technology and improved surgical technique. These advances are making it possible for the facial cosmetic surgeon to reliably produce excellent results with fewer risks of complications. This translates into satisfied patients and greater patient acceptance of proposed treatment plans. The natural aging process, heredity, exposure to the sun, and other factors cause the skin to wrinkle and sag. Folds of the skin become more prominent around the mouth, chin, jaw line, and neck. The laser-assisted endoscopic forehead lift provides an alternative to traditional brow lifting techniques. Without question, the periorbital area is one of the most expressive areas of the face, and there are many techniques available which affect the position of the eyebrows. The brow lift technique using the endoscope and the CO2 laser is proving to be readily accepted by patients and provides consistently excellent results with fewer complications than other methods. Before this technique is added to the armamentarium of the cosmetic surgeon, it is important to understand the indications for the procedure to insure a good outcome. In the last decade there have been many advancements in the technique of the facelift operation. These have resulted from a better understanding of the anatomy of the face and the neck and how the process of aging affects these tissues and alters their position. Currently, the long flap rhytidectomy is the most popular procedure. This includes wide detachment of skin over the face, neck, mastoid, and frontotemporal regions. The superficial musculoaponeurotic system (SMAS) is then suspended in a superior and posterior direction. The contour of the neck is very important in facial rejuvenation. A well-contoured mandibular border is one of the key signs of a youthful appearance. Liposuction of the submental and submandibular areas to remove fat is performed along with resection or plication of the platysmal muscle. A sling suture from the midline platysma muscle to the contralateral mastoid fascia is used to achieve the youthful appearing neck. Oral and maxillofacial surgeons should become familiar with the various rhytidectomy techniques along with a good understanding of the anatomy. Preoperative and postoperative care is also crucial to obtaining excellent results. AAOMS • 2003

References Griffin J, Frey B, Max D, et al: Laser-assisted endoscopic forehead lift. J Oral Maxillofac Surg 56:1040, 1998 Epker B: Esthetic Maxillofacial Surgery. Philadelphia, PA, Lea and Febiger, 1994 Rees DT, LaTrenta SG: Aesthetic Plastic Surgery. Philadelphia, PA, Saunders, 1994 Tardy ME, Regan T Jr, Brown JR: Facial Aesthetic Surgery. St Louis, MO, Mosby, 1995 Giamppapa CV, Di Bernardo EB: Neck recontouring with suture suspension and liposuction: An alternative for the early rhytidectomy candidate. Aesth Plast Surg 19:217, 1999

S102 Practical Approach to the Diagnosis and Treatment of Temporomandibular Disorders M. Franklin Dolwick, DMD, PhD, Gainesville, FL The diagnosis and management of common temporomandibular disorders continue to present a challenge to clinicians. The differential diagnosis of common muscle and temporomandibular joint disorders is a mandatory requirement for successful treatment. During this presentation, diagnostic criteria for the common muscle and temporomandibular joint disorders will be reviewed and discussed. A simple nonsurgical treatment approach for myofascial pain and temporomandibular joint internal derangement, which results in a high rate of success, will be presented. The relationship of bruxism to internal derangement will be discussed emphasizing the role of increased joint loading as an etiological factor for osteoarthritis and disc displacement. Arthrocentesis for the treatment of temporomandibular joint internal derangement will be discussed in detail. For those small numbers of patients who do not respond to conservative treatment, surgical alternatives will be reviewed. The benefits and limitations of each of the surgical procedures are readily determined on an individual-case basis. The goal is to determine the most appropriate technique that will yield the highest probability of success with the lowest morbidity. Arthroscopic lavage and lysis, arthroplasty (disc preservation, eminectomy and discectomy), and condylotomy will be discussed. The discussion will include indications, techniques, outcomes, and complications associated with each procedure. References Dolwick MF, Dimitroulis G: Is there a role for temporomandibular joint surgery? Br J Oral Maxillofac Surg 32:307, 1994 Dimitroulis G, Dolwick MF, Martinez A: Temporomandibular joint arthrocentesis and lavage for the treatment of closed lock: A follow-up study. Br J Oral Maxillofac Surg 33:23, 1995 Nitzan DW: The process of luberication impairment and its involvement in temporomandibular joint disk displacement. A theoretical concept. J Oral Maxillofac Surg 59:26, 2001

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