Tracheotomy A-Z

Surgical Clinics tutes now include: polymers, biologic glasses, collagen and demineralized bone preparations, collagen and bone morphogenetic protein (BMP), collagen and hydroxyapatite (HA), calcium sulfate, tricalcium phosphate, hydroxyapatites, laboratory-modified HA, laboratory-modified bovine bone HA, and laboratory-produced synthetic HA. In reconstructive implant surgery, bone substitutes have utility in: 1) socket grafting, 2) ridge preservation surgery, 3) grafting defects around implants, 4) augmenting deficient alveolar bone to prepare for future implants, 5) in sinus augmentation, 6) in periapical surgery to graft periapical defects, and 7) to form composite grafts with autogenous bone. Autogenous block and particulate grafts have been the traditional method for alveolar bone regeneration. Currently, bone substitutes are challenging the use of traditional bone grafts for successful outcomes. Their use is predicated on knowledge of the graft healing process, and the scientific information specific for each bone substitute product. Many of these materials have been shown to be extremely predictable, and more importantly, don’t require a second surgery site with its attendant morbidity. Future emerging technologies in the form of growth factors, signaling molecules, stem cell therapy, as well as gene therapy will continue to revolutionize this aspect of reconstructive osseous surgery. References Valentini P, Abensur D: Maxillary sinus grafting with anorganic bovine bone: A clinical report of long-term results. Int J Oral Maxillofac Impl 18: 556, 2003 Schmitt JM, Buck DC, Seong-Pil J, et al.: Comparison of porous bone mineral and biologically active glass in critical-sized defects. J Periodontol 68: 1043, 1997 van Meekren JJ.: 1682 Observationes Medicochirurgical Henrici and Bloom, Amsterdam, p. 8

S127 Lower Lid Blephroplasty and Midface Lifting via Subtarsal Incision Gene A. Vandervort, DDS, MD, Portsmouth, VA Over the past decade the transconjunctival blepharoplasty technique has been written about extensively as a means to rejuvenate the lower eyelids with no visible scar and minimal risk of ectropion. Most older adults, however, also suffer some degree of midface ptosis, malar festooning, lower eyelid dermatochalasis, and/or orbicularis oculi hypertrophy, none of which can be addressed through the transconjunctival approach. The Oral and Maxillofacial Surgeon will learn that a direct transcutaneous subtarsal approach allows for correction of all of these sequella of facial aging leaving a virtually non noticeable scar hidden in the subtarsal fold and little chance of post-op ectropion. 118

References Patipa M: Plast Reconstr Surg 113, No. 5, Apr 15, 2004, pp 14591477 Hester T: Plast Reconstr Surg lOS, No. 1, Jan 2000, pp 393-406 Putterman A: Cosmetic Oculoplastic Surgery (3rd ed). 1999, chapter 24, pp 235-247

S211 The Applied Anatomy of the Skull Base and Related Areas and Its Application in Transfacial Surgical Access Procedures Barrie Evans, FRCS(Eng), FRCS(Edin), FDSRCS(Eng), FFDRCS(Ire), Southampton, Hampshire, UK Surgery of the base of the skull forms part of the remit of Oral and Maxillofacial Surgeons. The anatomy of the skull base and the related subcranial regions can appear complex; surgeons in particular can experience difficulty in relating subcranial anatomy to intracranial structures and locating surgical landmarks to safely negotiate regions such as the infratemporal fossa. It is emphasized that surgery of the skull base does not always require a craniotomy with a combined intracranial / extracranial approach. With the more frequent use of facial disassembly techniques in particular, surgeons are regularly operating in this region in the management of both benign and malignant tumors. This anatomy is of course also of relevance in the treatment of craniomaxillofacial trauma and orthognathic surgery. This surgical clinic will discuss the anatomy of the central and lateral skull base and the associated areas and relate these to the surgical approaches to these areas. References Evans BT, Wiesenfeld D, Clauser L, et al: Surgical approaches to the infratemporal fossa, in Langdon J, Berkovitz BKB, Moxham B (eds): Surgical Anatomy of the Infratemporal Fossa. Martin Dunitz Publishers, 2003, pp 141-180 Friedman WH, Katsantonis GP, Cooper MH, et al.: Stylohamular dissection: A new method for en-bloc resection of malignancies of the infratemporal fossa. Laryngoscope 91:1869, 1981 Cushing HA: A method of total extirpation of the Gasserian ganglion for trigeminal neuralgia by a route through the temporal fossa and beneath the middle meningeal artery. JAMA 34:1035

S212 Tracheotomy A-Z Thomas J. Teenier, DDS, MD, Corpus Christi, TX Eric Dierks, DMD, MD, Portland, OR James Eyre, DMD, MD, Salem, OR Airway emergencies are a common concern to Oral and Maxillofacial Surgeons. Failed attempt to secure a non-surgical airway is an emergent situation that requires a clear head, knowledge of proper surgical airway AAOMS • 2005

Surgical Clinics technique, and proper armamentarium. Variations in situation as well as anatomy may call for modification in technique while securing a surgical airway. This seminar will focus on location of proper anatomic landmarks, specific surgical technique and the hardware necessary to perform a surgical airway. Surgical airway history, prudent anatomy, surgical technique, and surgical instruments and tubes will be discussed. A hands-on demonstration will be provided, discussing germane pearls and pitfalls of each procedure. Anatomic, situational, and age related variations in technique will also be discussed. Updated techniques including percutaneous tracheotomy and cricothyroidotomy will be described in detail. A reading list, outline, and instrument hardware list will be provided. References Zacharides N, Rapidis, et al: The significance of tracheostomy in the management of fractures of the facial skeleton. J Maxillofac Surg 11:180, 1983 Cole RR, Aguilar EA: Crichothyroidotomy: A decade of experience in Denver. Ann Otol Rhinol Laryngol 96:519, 1987 Demas PN, Sotereanous GC: The use of tracheotomy in oral and maxillofacial surgery. J Oral Maxillofac Surg 46:483, 1988

S214 Microsurgical Repair of Trigeminal Nerve Injuries Vincent B. Ziccardi, DDS, MD, Newark, NJ Sensory disturbances to the peripheral branches of the trigeminal nerve can create a devastating disruption to patients. This can lead to problems with speech, mastication, food and liquid incompetence, and difficulty with public interaction. These injuries can arise from a number of causes in oral and maxillofacial surgery. The most common cause of trigeminal nerve injury in oral and maxillofacial surgery results from the removal of impacted teeth. There are a multitude of other causes including osteotomies, endodontic surgery, implant placement, fractures, pre prosthetic surgery, and treatment of maxillofacial pathology. Some of the etiological factors for trigeminal nerve injury such as trauma are unpreventable; however, more precise surgical techniques and better imaging modalities may help reduce the incidence of these injuries. Injuries to the trigeminal nerve branches are a known and accepted risk in oral and maxillofacial surgery. It is important for practitioners to explain these risks to patients as part of the informed consent process and to recognize and document the presence of nerve injuries. Patients must be treated in a timely fashion or referred to practitioners skilled in microsurgical techniques for optimal sensory improvement. This surgical clinic shall review the etiologies of trigeminal nerve injury, neurosensory testing and documentation, classification schemes, indications for treatment and referral, microsurgical techniques, and outcome assessments. AAOMS • 2005

References Meyer RA: Applications of microneurosurgery to the repair of trigeminal nerve injuries. Oral Maxillofac Surg Clin North Am 4:405, 1992 Sandstedt P, Sorensen S: Neurosensory disturbances of the trigeminal nerve: A long-term follow-up of traumatic injuries. J Oral Maxillofac Surg 53:498, 1995 Zuniga JR, LaBanc JP: Advances in microsurgical nerve repair. J Oral Maxillofac Surg 51:62, 1993

S215 Functional Palotomaxillary Reconstruction Daniel Buchbinder, DMD, MD, New York, NY Mark Urken, MD, New York, NY Currently, the rehabilitation of palatomaxillary defects is achieved with a prosthetic obturator. While this is a simple and often effective method for immediate oral dental rehabilitation, patients often complain of the difficulty maintaining hygiene. Additionally, patients complain of prosthetic instability following rehabilitation of extensive defects. The shortcomings associated with prosthetic rehabilitation are more pronounced in those patients that require resection of the orbital rim, zygoma, and vertical defects of the maxilla. Reconstruction of the palate and maxilla can be accomplished using local pedicled flaps, soft tissue free flaps, and bonecontaining free flaps. Our group has an extensive experience with the application of flap reconstruction and the impact on quality of life and function. When properly applied, reconstruction of the palatomaxillary defect can provide patients with a functional and aesthetic reconstruction that functions comparable to the native palate. In this seminar, we will review the indications, approaches, and functional and aesthetic results of palatomaxillary reconstruction. We will also discuss the role of dental implants following bony reconstruction of the hard palate and alveolus. References Genden et al: A comparison of the functional and quality of life outcomes in patients with and without palatomaxillary reconstruction. Okay et al: Prosthodontic guidelines for surgical reconstruction of the maxilla.

S216 Temporalis Muscle Flap for Reconstruction of Intraoral Defects A. Omar Abubaker, DMD, PhD, Richmond, VA For reconstruction of small intraoral defects, local flaps can be used successfully with minimal morbidity. However, for moderate to large size defects, regional or free flaps are often necessary. Because of the potential 119