Surgical Clinics

Surgical Clinics S111 Contemporary Management of Cleft Lip/ Palate Deformities Rafael Ruiz-Rodriguez, DDS, Mexico DF, Mexico Daniel Buchbinder, DMD, MD, New York, NY The goal of this surgical clinic is to “demystify” the surgical procedures most commonly utilized for the repair of cleft lip and palate (CUP) deformities. The epidemiology, genetic basis and embryology of CL/P will be reviewed the work-up and multidisciplinary approach to the care of the CUP patient will be discussed. Simple, step by step surgical techniques used for the primary repair of unilateral and bilateral cleft lip will be demonstrated. The different revision techniques for the repair of residual deformities such as whistle tip. Columella (in the bilateral deft) and lower cartilaginous nasal skeleton will also be demonstrated. Similarly, the different palatoplasty techniques both for the primary repair as well as revisions for residual oro-nasal fistulae will be discussed. The timing and techniques for the repair of the alveolar cleft will be reviewed finally the evaluation of velopharyngeal function will be discussed as well as the use of the superiority based pharyngeal flap will also be demonstrated. References Millard DR: Cleft Craft Volumes I & II. Boston, MA, Little, Brown and Co Publishers, 1977 Bulow KW: Treatment of Facial Cleft Deformities: An Illustrated Guide. St Louis, MO, Ishiyaku EuroAmerica Publishers, 1995 Kapetansky DI: Techniques in Cleft Up Nose and Palate Reconstruction. New York, NY, Gower Medical Publishing Ltd, 1987

S112 Gunshot Injuries to the Face Micha Peled, DMD, MD, Haifa, Israel There are various approaches for treatment of gunshot injuries to the face, especially concerning the timing of bone grafts and the use of various flaps in the immediate phase of treatment. There is no dispute about the emergency treatment of gunshot injuries to the face which includes airway management and control of bleeding. A very important issue is the evacuation of the injured person to a tertiary trauma center specialized in multidisciplinary approach to trauma victims. Our protocol based on our Trauma Center experience includes: Primary surgical treatment which includes copious irrigation and debridement. Rigid stabilization of jawbones preserving bone as much as possible. Preserving and suturing the intraoral tissues to cover the comminuted bones. 112

Primary closure of soft tissue wounds of the face with proper drainage. The second phase of surgical treatment consists of reconstruction of the face using bone grafting techniques and soft tissue revision procedures, conducted during the first weeks following trauma. The final reconstruction starts months later and includes bone grafts for augmentation of facial bones and preprosthetic oral soft tissue procedures before placement of dental implants, to enable proper oral function and facial esthetics. References Kihtir T, Lvatury RR, Simon RJ, et al: Early management of civilian gunshot wounds to the face. J Trauma 35:569, 1993 Hollier L, Grantcharova EP, Kattash M: Facial gunshot wounds: A 4-year experience. J Oral Maxillofac Surg 59:277, 2001 Gruss JS, Antonyshyn O, Phillips JH: Early definitive bone and softtissue reconstruction of major gunshot wounds of the face. Plast Reconstr Surg 87:436, 1991

S113 Guided Tissue Regeneration in Jaw Reconstruction: Review and Application Pamela L. Alberto, DMD, Sparta, NJ In 1982, a group of researchers reported that tissues lost to periodontal disease could be regenerated by the use of a surgical technique known as guided tissue regeneration. Since then, tremendous progress has been made in adapting these techniques to jaw reconstruction. Along with the development of guided tissue regeneration procedures were the development of many first-generation and second-generation membrane barriers. The current first-generation barriers available are Gore-Tex and TefGen. Both are made from 100% medical-grade polytetrafluoroethylene, but differ in that TefGen is full density and is impervious to bacteria. GoreTex is expanded polytetrafluoroethylene (e-PTFE) which is porous. The biodegradable second-generation membrane barriers available are Vicryl, BioMend, BioGide, Ossix, Resolut, OsseoQuest, and Capset. Vicryl Mesh is composed of woven polyglactin 910. The pore size allows passage of fluids. It is resorbed in 2 to 6 months. Biomend, BioGide, and Ossix are collagen membranes. BioMend completely resorbed in 4 to 8 weeks. The material must be hydrated in sterile water to saline for approximately 15 minutes before final placements. BioGide is composed of type I & II collagen in a bilayer membrane. It resorbes in 4 months. Ossix is a 6 month resorbable collagen membrane. OsseoQuest and Resolut are barriers made of polyglycolic acid and polylactic acid with trimethylene carbonate. It resorbes in 6 months. Resolut resorbs in 4 months. Capset is calcium sulfate AAOMS • 2005