Transconjunctival Lower Lid Blepharoplasty With Simultaneous Chemical Peel: Predictable Results With Minimal Complications

Surgical Clinics corporating adjunctive osteotomies to help decrease the overall treatment time. Ongoing studies at the Swedish Medical Center include the use of computerized 3-D imaging techniques in analyzing soft tissue changes following orthognathic surgery, topographic scanner to analyze the transverse corrections and relapse following segmental LeFort I osteotomy, and the outcome study on resorbable screw fixation in mandibular osteotomies which are gaining increasing popularity among patient population. In addition, the course will focus on the challenges and controversies surrounding the surgical management of apertognathia, transverse discrepancy, Class III skeletal deformity and obstructive sleep apnea. Discussions and case presentations will emphasize the following: 1. Limiting surgery to one jaw, maxilla vs. mandible in apertoganthia 2. Proximal segment rotation and implications of increasing posterior facial height 3. Mandibular constriction for transverse discrepancy, in conjunction with multi-segment LeFort I osteotomy 4. Unique clinical features of Class III malocclusion and obstructive sleep apnea and correlation between mandibular setback and OSA Finally, practical issues such as establishment of global orthognathic surgery fee structures in a hospital, time management and cost containment, operating room personnel training and incorporating clinical research into private practice will be discussed. References

tions are illustrated with cases, including necrotizing fasciitis, brain abscess, mediastinitis, and cavernous sinus thrombosis. Orofacial infections usually spread in a predictable fashion from one anatomic space into another, depending on the site of origin and the causative organism. The ability of the oral and maxillofacial surgeon to predict the clinical behavior of deep space infections of the head and neck make this specialist the expert in the management of these conditions. That anatomic and surgical knowledge is summarized in this lecture, including the borders, contents, relations, and likely causes of infections in the deep fascial spaces. The clinical presentation, diagnosis, and surgical therapy of infections of each of these spaces are illustrated with several cases. Anesthetic and airway considerations in the management of orofacial infections are then discussed. The diagnosis of airway compromise is reviewed, and currently available airway management techniques are compared. Recent studies that identify predictors of length of hospital stay and complications in these infections are also evaluated and discussed. References Flynn TR: Anatomy of oral and maxillofacial infections, in Topazian RG, Goldberg MH, Hupp JR (eds): Oral and Maxillofacial Infections (ed 4). Philadelphia, PA, Saunders, 2002 Bennett J, Flynn TR: Anesthetic and airway considerations in oral and maxillofacial infections, in Topazian RG, Goldberg MH, Hupp JR (eds): Oral and Maxillofacial Infections (ed 4). Philadelphia, PA, Saunders, 2002 Huang TT, Liu TC, Chen PR, Tseng FY, et al: Deep neck infection: Analysis of 185 cases. Head Neck 26:854, 2004

Bloomquist D: Mandibular narrowing: advantage in transverse problems. J Oral Maxillofac Surg 62:365, 2004 Joondeph D, Bloomquist D: Open bite closure with mandibular osteotomy. Am J Orthod Dentofacial Orthop 126:296, 2004 Proffit WR, Fields HW Jr, Moray LJ: Prevalence of malocclusion and orthodontic treatment need in the United States: Estimates from the NHANES III survey. Int J Adult Orthod Orthognath Surg 13:97, 1998

S117

S116

Vernon A. Sellers, DMD, Virginia Beach, VA Albert W. Parulis, DMD, Suffolk, VA

Anatomy and Surgery of Oral and Maxillofacial Infections Thomas R. Flynn, DMD, Boston, MA The principles of the management of deep space head and neck infections include early and rapid assessment of the severity of the infection by anatomic location, rate of progression, and the potential for airway compromise. After evaluation of host defenses, early definitive surgical management is a key to arresting further progression of the infection. The use of drains, medical supportive care, and followup management of these infections are presented. Unusual and complicated infec114

Transconjunctival Lower Lid Blepharoplasty With Simultaneous Chemical Peel: Predictable Results With Minimal Complications

The most common complication associated with lower lid blepharoplasty is lid malposition/retraction. Clinical postoperative presentation may range from increased scleral show to lateral canthal rounding or ectropion. Any of these complications can exacerbate other ocular problems, such as dry eye syndrome, requiring more extensive oculoplastic correction. Transconjunctival lower lid blepharoplasty has been proven to produce a lower incidence of postoperative lid malposition versus open excision techniques. Coupled with surgical lid tightening and skin resurfacing, transconjunctival blepharoplasty is a safe and effective AAOMS • 2005

Surgical Clinics method for improving lower lid contour and reducing rhytids while producing minimal complications. Keys to predictable clinical success are understanding lower lid anatomy and its relation to structure/support of the lid complex, recognizing changes associated with the aging eyelid complex, assessment and planning for surgery to restore structure, and avoiding operative techniques with a high probability of complications in patients with pre-existing eyelid or ocular problems. References Popp, JC: Complications of blepharoplasty and their management. Dermatol Surg Oncol 992:1122, 1992 Shorr N, Enzer YR: Considerations in aesthetic eyelid surgery. Dermatol Surg Oncol 992:1081, 1992 Zarem HA, Resnick JI: Operative techniques for transconjunctival lower lid blepharoplasty. Clin Plast Surg 19:351, 1992

S121 Update on the Management of Oral Cancer: Diagnostic and Therapeutic Modalities Eric J. Dierks, DMD, MD, FACS, Portland, OR Jon D. Holmes, DMD, MD, FACS, Birmingham, AL Approximately 30,000 patients will be diagnosed with oral cancer in the United States this year. The vast majority (90%) of these will be squamous cell cancers. Oral and maxillofacial surgeons are involved in the management of patients with oral cancer. Frequently, it is an oral and maxillofacial surgeon who first sees a patient with a suspicious lesion, and is confronted with breaking the news regarding a biopsy that reveals malignancy. For these reasons, it is incumbent for them to be conversant in current diagnostic and treatment modalities. The goal of this surgical clinic is to update the clinician in current diagnostic and treatment modalities for oral cancer. Included in the presentation will be new modalities such as positron emission tomography (PET) scanning, intensity modulated radiation treatment (IMRT), and the role of combined chemoradiotherapy, as well as advances in ablative and reconstructive surgical treatments. References Holmes J, Dierks E: Oral cancer treatment, in Miloro (ed): Peterson’s Principles of Oral and Maxillofacial Surgery (ed 2). Lewiston, NY, BC Decker, 2004 Jemal A, Murray T, Samuels A, et al: Cancer statistics, 2004. CA Cancer J Clin 54:8, 2004 Pillsbury HC, Clark M: A rationale for therapy of the NO neck. Laryngoscope 107:1294, 1997

AAOMS • 2005

S122 Minimally Invasive TMJ Surgery: From Arthrocentesis to Advanced Laser Arthroscopy Allen W. Tarro, DMD, Lowell, MA Minimally invasive TMJ surgery is indicated for the initial surgical treatment of most symptomatic TMJ intracapsular disorders that have not been resolved by properly performed non-surgical modalities. These procedures (from arthrocentesis to advanced laser arthroscopy) have certain indications and, properly performed, should hopefully minimize the number of unsuccessful, multiple operated TMJ patients in the future. Diagnosis, recommended treatment according to the specific type of TMJ intracapsular disorder, and minimally invasive surgical treatments will be presented. Office procedures including arthrocentesis and blunt sweeping of the superior joint space will be discussed as well as basic TMJ arthroscopic procedures. The major portion of this presentation, however, will be advanced laser arthroscopy. Arthroscopy is not only minimally invasive but also has revolutionized surgery of the temporomandibular joint. Lysis and lavage arthroscopy is commonly performed in the temporomandibular joint today. However, further advances in techniques and instrumentation have been made in TMJ arthroscopy. One of these advances is the use of an appropriate laser instrument in the TMJ, and the advanced surgical techniques facilitated by the use of this instrumentation. Selection of a laser instrument for TMJ arthroscopy involves a knowledge of the available laser systems and consideration of both the surgical site and the types of surgical procedures to be performed. A number of currently available lasers have particular characteristics that are less than ideal for use in the temporomandibular joint. At the present time, there is one laser system that is appropriate and approved for arthroscopic surgery. This is the holmium:YAG laser system with a wavelength of 2100 nanometers. It is a pulsed, free-beam laser that can transmit laser energy through available quartz fiberoptics and can function properly in a fluid environment. Standard arthroscopic irrigation solutions can be used with this instrument. The holmium:YAG laser has low tissue penetration with precise control and low heat generation. It can ablate, sculpt, incise, and coagulate tissue with minimal thermal damage to surrounding tissue. The small size of the laser tip allows excellent access to cramped areas in this small joint with minimal iatrogenic damage. TMJ arthroscopic surgical procedures that may be performed with the holmium:YAG laser include anterior muscle release procedures (superior lateral pterygoid myotomy), lysing and removing fibrous adhesions and pseudowalls, treatment of chondromalacia (includ115