Peterson’s Principles of Oral and Maxillofacial Surgery

Preface
Contents
Contributors
I: Medicine, Surgery, and Anesthesia
1: Wound Healing
1.1 Introduction
1.2 The Healing Process
1.3 Wound Healing Response
1.3.1 Inflammatory Phase
1.3.2 Proliferative Phase
1.3.3 Remodeling Phase
1.4 Specialized Healing
1.4.1 Nerve
1.4.2 Bone
1.4.3 Extraction Wounds
1.4.4 Skin Grafts
1.5 Wound Healing Complications
1.5.1 Wound Infection
1.5.2 Wound Dehiscence
1.5.3 Proliferative Scarring
1.6 Optimizing Wound Healing
1.6.1 Tissue Trauma
1.6.2 Hemostasis and Wound Debridement
1.6.3 Tissue Perfusion
1.6.4 Diabetes
1.6.5 Immunocompromise
1.6.6 Radiation Injury
1.6.7 Hyperbaric Oxygen (HBO) Therapy
1.6.8 Age
1.6.9 Nutrition
1.7 Advances in Wound Healing
1.7.1 Growth Factors
1.7.2 Gene Therapy
1.7.3 Dermal and Mucosal Substitutes
Conclusion
References
2: Medical Management and Preoperative Patient Assessment
2.1 Introduction
2.2 Cardiovascular Assessment and Disease
2.2.1 Coronary Artery Disease
2.2.2 Congestive Heart Failure
2.2.3 Valvular Heart Disease
2.2.4 Prosthetic Valve Replacement
2.2.5 Arrhythmias
2.2.6 Hypertension
2.2.7 Automatic Implantable Cardioverter Defibrillators and Pacemakers
2.3 Respiratory Disease
2.3.1 Asthma
2.3.2 Chronic Obstructive Pulmonary Disease
2.3.3 Pneumonia
2.3.4 Pulmonary Embolus
2.3.5 Atelectasis
2.3.6 Pulmonary Edema
2.3.7 Airway
2.4 Renal Disease
2.5 Liver Disease
2.6 Blood Disorders
2.6.1 Anemia
2.6.2 Myeloproliferative Disease
2.6.3 Leukemia
2.6.4 Lymphoma and Multiple Myeloma
2.6.5 Thrombocytopenia
2.6.6 Coagulopathy
2.6.7 Hemophilia A and B
2.6.8 Warfarin Therapy
2.6.9 Hypercoagulable Diseases
2.7 Endocrinology
2.7.1 Diabetes Mellitus
2.7.1.1 Preoperative
2.7.2 Thyroid
2.7.3 Adrenal
2.7.4 Pituitary Disease
2.8 Neurologic Disease
2.8.1 Trauma
2.8.2 Seizures
2.8.3 Cerebrovascular Accident
2.8.4 Myasthenia Gravis
2.9 Other Conditions
2.9.1 Malignant Hyperthermia
2.9.2 Autoimmune Disease
2.9.3 Immunodeficiencies
2.9.4 Substance Abuse
2.9.5 Obesity
2.9.6 Geriatric Patients
2.9.7 Pediatric Patients
2.9.8 Pregnancy
Conclusion
References
3: Pharmacology of Outpatient Anesthesia Medications
3.1 Pharmacodynamics and Pharmacokinetics
3.1.1 Pharmacodynamics
3.1.2 Pharmacokinetics
3.2 Benzodiazepines and Opioids
3.2.1 Benzodiazepines
3.2.1.1 Diazepam
3.2.1.2 Midazolam
3.2.1.3 Lorazepam
3.2.1.4 Triazolam
3.2.1.5 Remimazolam
3.2.1.6 Flumazenil
3.2.2 Opioids
3.2.2.1 Morphine
3.2.2.2 Hydromorphone
3.2.2.3 Meperidine
3.2.2.4 Fentanyl
3.2.2.5 Remifentanil, Sufentanil, and Alfentanil
3.2.2.6 Nalbuphine
3.2.2.7 Naloxone
3.3 Sedative Medications Intended for General Anesthesia
3.3.1 Propofol
3.3.2 Etomidate
3.3.3 Ketamine
3.3.4 Barbiturates
3.3.4.1 Thiopental
3.3.4.2 Methohexital
3.3.4.3 Pentobarbital
3.4 Inhalation Anesthetics
3.4.1 Nitrous Oxide
3.4.2 Potent Inhalation Agents
3.4.2.1 Isoflurane
3.4.2.2 Sevoflurane
3.4.2.3 Desflurane
3.4.2.4 Halothane
3.5 Neuromuscular Blocking Medications
3.5.1 Succinylcholine
3.5.2 Nondepolarizing Agents
3.6 Reversal of Nondepolarizing Agents
3.6.1 Anticholinesterases
3.6.2 Anticholinergics
3.6.3 Sugammadex
3.7 Adjunct Medications
3.7.1 NSAIDs (Nonsteroidal Anti-Inflammatory Drugs)
3.7.2 Acetaminophen
3.7.3 Alpha-2 Agonists
3.7.4 Local Anesthetics
3.8 Antiemetic Medications
Conclusion
References
4: Outpatient Anesthesia
4.1 Introduction
4.2 Level of Sedation
4.3 Goals of Sedation
4.3.1 Patient Safety
4.4 Patient Assessment
4.4.1 Airway Assessment
4.4.2 Airway Preparation
4.4.3 Smoking
4.4.4 Obesity
4.4.5 Nil Per Os (NPO)
4.4.5.1 Emergency Treatment: Full Stomach
4.4.6 Pregnancy Testing
4.4.7 Substances
4.4.7.1 Opioids
4.4.7.2 Anesthesia for Addicted Patients [20]
4.4.7.3 Marijuana
4.4.7.4 Alcohol
4.4.7.5 Amphetamine
4.4.7.6 Cocaine
4.4.7.7 “Ecstasy”
4.4.7.8 Inhalational Substances
4.4.7.9 Lysergic Acid Diethylamide (LSD)
4.4.7.10 PCP
4.5 Patient Assessment: Understanding the Changes with Age
4.5.1 The Pediatric Patient
4.5.2 Anatomic Considerations in the Pediatric Patient
4.5.2.1 Pediatric Respiratory System
Endotracheal Intubation
Upper Respiratory Infection
4.5.2.2 Pediatric Cardiovascular System
Cardiac Output
Neural Innervation
Blood Pressure
4.5.2.3 Psychological Assessment
4.5.3 The Geriatric Patient
4.5.3.1 Cardiovascular
4.5.3.2 Pulmonary
4.5.3.3 Urinary and Hepatic System
4.6 Anesthetic Concepts
4.6.1 Monitoring
4.6.1.1 Respiratory Monitoring
4.6.2 Fluids
4.6.3 Patient Positioning
4.7 Sedative Techniques: Considerations Based on Age
4.7.1 Sedative Techniques in the Pediatric Patient
4.7.1.1 Routes of Administration
4.7.1.2 Pharmacologic Agents for the Pediatric Patient
Ketamine
Midazolam
Induction Agents
Inhalational Agents
Other Medications
4.8 Pharmacology of Intravenous Drugs in the Geriatric Patient
4.9 Perioperative Complications
4.9.1 Airway Distress
4.9.2 Bronchospasm
4.9.3 Pulmonary Aspiration
4.9.4 Laryngospasm
4.9.4.1 Succinylcholine
4.9.5 Nausea and Vomiting
4.9.5.1 Phenothiazines
4.9.5.2 Benzamides
4.9.5.3 Histamine Antagonists
4.9.5.4 Muscarinic Receptor Antagonists
4.9.5.5 Serotonin Receptor Antagonists
4.9.5.6 Glucocorticoids
4.10 Postoperative Recovery and Discharge
4.11 Postoperative Analgesia
4.12 Special Considerations
4.12.1 Attention-Deficit/Hyperactivity Disorder
4.12.2 Autism
4.12.3 Cerebral Palsy
4.12.4 Down Syndrome
4.12.5 Muscular Dystrophy
4.13 Quality Assurance Protocols for Office-Based Anesthesia
Box 4.1 Goals of Simulation
Summary
References
II: Dentoalveolar and Implant Surgery
5: Impacted Teeth
5.1 Incidence and Etiology
5.1.1 Impactions Other than Third Molars
5.1.2 Impacted Third Molars
5.2 Clinical Evaluation
5.3 Treatment of an Impacted Tooth
5.3.1 Indications for Removal of Impacted Third Molars
5.3.1.1 Periodontitis
5.3.1.2 Pericoronitis
5.3.1.3 Orthodontic Considerations
5.3.1.4 Prevention of Odontogenic Cysts and Tumors
5.3.1.5 Root Resorption of Adjacent Teeth
5.3.1.6 Teeth Under Dental Prostheses
5.3.1.7 Prevention of Jaw Fracture
5.3.1.8 Management of Unexplained Pain
5.3.2 Contradictions to Treatment of Impacted Teeth
5.3.2.1 Extremes of Age
5.3.2.2 Compromised Medical Status
5.3.2.3 Surgical Damage to Adjacent Structures
5.4 Surgery and Perioperative Care for Impactions Other than Third Molars
5.4.1 Exposure Versus Exposure and Bonding
5.4.2 Surgical Technique
5.4.2.1 Exposure and Bonding
5.4.2.2 Surgical Uprighting
5.4.2.3 Transplantation
5.4.2.4 Removal
5.5 Surgery and Perioperative Care for Impacted Third Molars
5.5.1 Determining Surgical Difficulty
5.5.2 Technique for Removal
5.5.3 Technique for Coronectomy
5.5.4 Use of Perioperative Systemic Antibiotics
5.5.5 Use of Perioperative Steroids
5.6 Expected Postoperative Course
5.6.1 Bleeding
5.6.2 Swelling
5.6.3 Stiffness
5.6.4 Pain
5.7 Complications Following Third Molar Surgery
5.7.1 Infection
5.7.2 Tooth Fracture
5.7.3 Alveolar Osteitis
5.7.4 Nerve Disturbances
5.7.5 Rare Complications
5.8 Periodontal Healing After Third Molar Surgery
Conclusion
References
6: Pre-Prosthetic Surgery
6.1 Introduction
6.1.1 Workup and Evaluation
6.2 Alveoloplasty (. Figs. 6.4, 6.5, 6.6, 6.7, 6.8, 6.9, 6.10, and 6.11)
6.2.1 Genial Tubercle Reduction
6.2.2 Vestibuloplasty Procedures and Floor of Mouth Lowering
6.2.3 Mylohyoid Ridge Reduction
6.2.4 Mandibular and Maxillary Tori Reduction
6.2.5 Maxillary Labial Frenectomy (. Figs. 6.34, 6.35, 6.36, 6.37, and 6.38)
6.2.6 Epulis Removal
Conclusion
References
7: Pediatric Dentoalveolar Surgery
7.1 Introduction
7.2 Impacted Teeth
7.3 Impacted Maxillary Canines
7.3.1 Maxillary Canine Exposure
7.3.2 Palatally Impacted Canines: Technique (. Fig. 7.5)
7.3.3 Labially Impacted Canines: Technique (. Fig. 7.6)
7.3.4 Maxillary Canine Autotransplantation
7.4 Impacted Mandibular and  Maxillary Premolars
7.4.1 Impacted Premolar Exposure: Technique
7.5 Impacted Maxillary Incisors
7.5.1 Maxillary Incisor Exposure: Technique
7.6 Impacted First and Second Molars
7.6.1 Impacted Molar Exposition: Technique
7.7 Supernumerary Teeth
7.8 Hypodontia
7.9 Transplantation of Teeth
7.9.1 Molar Tooth Transplantation: Technique (. Fig. 7.11)
7.10 Dental Implants in the Growing Child
7.11 Prominent Maxillary Labial Frenum
7.12 Techniques
7.12.1 Standard Frenectomy
7.12.2 Laser Frenectomy
7.13 Mandibular Labial Frenum
7.14 Techniques
7.14.1 Standard Technique
7.14.2 Z-Plasty Technique
7.14.3 Laser Frenectomy
7.15 Lingual Frenum
Conclusion
References
8: Utilization of Three-Dimensional Imaging Technology to Enhance Maxillofacial Surgical Applications
8.1 Introduction
Case One: CBCT Diagnostics for a Horizontally Impacted Maxillary Canine and More
Case Two: CBCT Diagnostics for a Mandibular Implant Evaluation and More
Case Three: CBCT Diagnostics to Assess Potential Graft Augmentation
Case Four: CBCT Diagnostics in the Mandible—Implants and More
Conclusion
Suggested Readings
9: Dynamic Navigation for Dental Implants
9.1 Introduction
9.2 Principles of Dynamic Navigation
9.2.1 Fundamentals of DN
9.2.2 Image Processing, Analysis
9.2.3 Diagnosis
9.2.4 Planning
9.2.5 Surgical Simulation
9.3 Accuracy and Precision of Dynamic Navigation
9.4 Components of Dynamic Navigation
9.4.1 Important Definitions
9.4.2 Computer
9.4.3 Monitor
9.4.4 Cameras
9.4.5 Digital-Analog Interface
9.4.6 Patient Tracking Arrays
9.4.7 Instrument Tracking Array
9.4.8 Planning Software
9.4.9 Tracking Software
9.4.10 Surgical Handpiece Chuck and Drill Extension
9.5 Basic Workflow of Dynamic Navigation
9.5.1 Workflow Overview
9.6 Dentate Patient Work Flow
9.6.1 Fiducial Clip Considerations
9.6.2 Fiducial Clip Preparations
9.6.3 Fiducial Clip Impressions
9.6.4 Fiducial Clip Placement
9.6.5 Dual Arch Considerations
9.6.6 Multiple Fiducial Clips on the Same Arch
9.7 Edentulous Patient Workflow
9.7.1 Location of Edentulous Fiducials
9.7.2 CT Acquisition
9.7.3 Dual Scan Technique
9.7.4 Dual Scan Procedure Overview
9.7.5 Detailed Steps
9.7.6 CT Scan for All Patients
9.7.7 Planning Workflow
9.7.8 Creating the Panoramic Curve Step by Step:
9.7.9 Marking Nerve
9.7.10 Deleting Nerves
9.7.10.1 Intra-Oral Scan Registration
9.7.10.2 Import Intra-Oral Scan
9.7.11 Marking Points on STL File (Intra-Oral Scan) and DICOM File (Bone Surface)
9.7.11.1 Removing Points
9.7.11.2 Planning Virtually Waxed-Up Crowns
9.7.12 Adjusting Crown to Preferred Position
9.7.13 Crown Rx Panel
9.7.13.1 Planning Implant
9.7.14 Planning Implant in 2D Views
9.7.15 Adjusting Implant to  Preferred Position
9.7.16 Mark Edentulous Fiducials (Edentulous Patients Only)
9.7.17 Surgical Instruments Preparation Overview
9.7.18 Surgical Instruments Selection
9.7.19 Calibrate Contra-Angle Handpiece
9.7.19.1 Contra-Angle Handpiece Body Calibration
9.7.19.2 Contra-Angle Handpiece Chuck Calibration
9.7.19.3 Calibrate Probe (. Fig. 9.28)
9.7.20 Probe Pivot Calibration
9.7.20.1 Surgery Preparation Procedure Overview
9.7.21 Choosing the Appropriate Patient Tracker Arm (. Fig. 9.29)
9.7.21.1 Patient Tracker Calibration
9.7.22 Patient Tracker and Fiducial Clip Calibration
9.7.23 Drill Bit Confirmation
9.7.24 Calibration Check
9.7.25 Calibration Check Failure
9.7.25.1 Implant Surgery with Dynamic Navigation System: Dentate
9.7.25.2 Performing Navigation Surgery in Dentate Patient
9.7.25.3 Understanding the 3D Target View
9.7.25.4 Surgery Preparation Procedure Overview for Edentulous Patients
9.7.25.5 Patient Tracker and Edentulous Plate Assembly
9.7.25.6 Performing Navigation Surgery in Edentulous Patient
9.7.25.7 Postsurgery for All Patients
Conclusion
References
10: Implant Prosthodontics
10.1 Introduction
10.2 Biomechanical Considerations
10.3 Radiographic Evaluation
10.4 Implant Surgical Guides
10.5 Implant Site Selection
10.6 Crown-to-Implant Ratio
10.7 Occlusion
10.8 Full-Arch Restorations
10.9 Implant Selection
10.10 Single-Tooth Replacement
10.11 Restorations for the Partially Edentulous Patient: Fixed Partial Dentures (FPDs)
10.12 Restorations for the Edentulous Patient
10.13 Contemporary Techniques
10.14 Maxillofacial Prostheses
10.15 Complications
10.16 Maintenance
10.17 Success Criteria
Conclusion
References
11: The Science of Osseointegrated Implant Reconstruction
11.1 Introduction
11.2 Diagnosis and Treatment Planning
11.2.1 Radiographic Imaging
11.2.2 Specific Evaluation of the Potential Implant Sites
11.2.2.1 Posterior Mandible
11.2.2.2 Anterior Mandible
11.2.2.3 Posterior Maxilla
11.2.2.4 Anterior Maxilla
11.3 Implants in Regional Sites
11.3.1 The Single Tooth in the Esthetic Zone
11.3.1.1 Establishing the Goals
11.3.1.2 Determination of Bone Height and Width
11.3.1.3 Relating the Cone Beam to  Clinical Situation
11.3.1.4 Thin Gingiva and Its Conversion to Thick Gingiva
11.3.1.5 When to Use Soft Tissue Grafts
11.3.1.6 Labial Bone Loss in the  Esthetic Zone
11.3.1.7 Specific Algorithms for Treatment
11.3.2 Grafting Material Characteristics
11.3.2.1 Xenograft
11.3.2.2 Surface Characteristics
11.4 Restoration of Bone Volume After Tooth Removal
11.4.1 Vertical Height Restoration for Placement of Implants in the Posterior Maxilla by Grafting the Inferior Aspect of the Sinus Floor
11.4.2 Restoration of Bone Width for a Narrow Alveolar Ridge
11.5 Grafting the Extraction Site
11.5.1 Mineralized Bone Allograft
11.6 Concave Bone Deformities: Tunneling Versus Open Approaches
11.6.1 Treatment of Concave Congenitally Missing Lateral Incisors
11.6.2 The Tunnel Approach
11.6.3 Surgical Technique
11.7 The Mandibular First Molar
11.7.1 Grafting the Molar Site
11.7.2 Immediate Implant Placement in the Mandibular Molar Site
11.8 Quadrant Multiunit Restorations on Implants
11.8.1 Surgical Method
11.9 The Edentulous Jaw
11.9.1 Surgery of the Anterior Mandible
11.9.1.1 Placement of Two to Five Implants in the Anterior Mandible (. Figs. 11.13 and 11.14)
11.9.2 Evaluation of Anatomy: Physical Examination of the Patient Without Teeth
11.9.3 Evaluation of Anatomy: Radiologic Examination of the Patient Without Teeth
11.9.4 Surgical Treatment for Placing Implants in the Mandible
11.9.5 Placement of Two Implants
11.9.6 Placement of Four or More Implants
11.9.7 Immediate Loading of the Edentulous Mandible
11.9.8 Use of Computed Tomography Guide Stent for Fabrication of a Fixed Provisional
11.9.9 Preoperative Preparation for Full-Arch Immediate Provisional Cases
11.9.10 Preoperative Laboratory Procedures
11.9.11 Surgical Procedure for Computed Tomography-Guided Implant Placement in an Edentulous Mandible
11.9.12 Placement of the Temporary Cylinders
11.9.13 Connecting the Temporary Cylinders to the Denture
11.10 The Flangeless Maxillary Restoration
11.10.1 Preoperative Evaluation: Esthetic Evaluation
11.10.2 Laboratory Workup
11.10.3 Provisional Prosthesis Fabrication
11.10.4 Surgical Treatment Considerations
11.10.5 Patient Follow-Up
11.11 Single Molars in the Maxilla
11.11.1 Treatment Strategies
11.11.2 Radiographic Evaluation
11.11.3 Presence of Greater Than 9 mm of Bone Within the Furcation
11.11.4 Insufficient Bone Height Within the Furcation for Primary Implant Stability (. Fig. 11.20)
11.11.5 Surgical Procedure
11.12 Crestal Approach for Sinus Augmentation
11.13 Anatomic Considerations for Material and Method for Sinus Augmentation
11.13.1 Bone Thickness
11.13.2 Bone Height 9 mm or Greater
11.13.3 Bone Height 5 mm or Greater
11.13.4 Bone Height 3–5 mm
11.13.5 Bone Height 2 mm or Less
11.14 The Crestal Window Approach
11.14.1 Surgical Technique: Creation of an Island of Bone to Avoid Removal of Bone at the Time of Elevation of the Sinus Floor (. Figs. 11.21 and 11.22)
11.15 The Use of Navigation to Guide Implant Placement
11.15.1 Static Guides
11.15.2 Dynamic Navigation (. Fig. 11.23)
11.15.3 Accuracy Considerations
11.15.4 Indications for Each Method
References
12: Comprehensive Implant Site Preparation: Mandible
12.1 Single Missing Teeth
12.1.1 Mandibular Incisor Sites
12.1.2 Canine-Bicuspid
12.1.3 Single-Molar Sites
12.2 Segmental Mandibular Defects
12.2.1 Anterior Segmental
12.2.2 Mandibular Posterior Segment
12.3 Full Arch
12.3.1 Discussion
Summary
References
13: A Graft-less Approach for Treatment of the Edentulous Maxilla: Contemporary Considerations for Treatment Planning, Biomechanical Principles, and Surgical Protocol
13.1 Introduction
13.2 Patient Selection
13.2.1 Screw Access Canals: The “Black and Red Dotted Lines”
13.3 Radiographic Evaluation
13.3.1 Zones of the Maxilla
13.3.2 Zygoma Anatomy-Guided Approach (ZAGA)
13.4 Preoperative Considerations
13.5 Biomechanical Considerations
13.5.1 Primary Load-Bearing Bone Under Function
13.6 Surgical Protocol
13.6.1 “Rescue Concept”
13.6.2 Prosthetic Conversion Technique
13.6.3 Postoperative Care
13.6.4 Discussion
References
14: Soft Tissue Management in Implant Therapy
14.1 Soft Tissue Integration
14.2 Flap Management Considerations
14.2.1 Introduction
14.2.2 Design for Submerged Implant Placement
14.2.3 Design for Abutment Connection and Nonsubmerged Implant Placement
14.2.4 Surgical Maneuvers for Management of Peri-implant Soft Tissues
14.2.4.1 Resective Contouring
14.2.4.2 Papilla Regeneration
14.2.4.3 Lateral Flap Advancement
14.3 Rationale for Soft Tissue Grafting with Implants
14.4 Clinical Guidelines for Soft Tissue Augmentation
14.5 Principles of Oral Soft Tissue Grafting
14.6 Epithelialized Palatal Graft Technique for Dental Implants
14.6.1 General Considerations
14.6.2 Contemporary Surgical Technique
14.7 Subepithelial Connective Tissue Grafting for Dental Implants
14.7.1 General Considerations
14.7.2 Surgical Technique: Donor-Site Surgery
14.7.3 Surgical Technique: Recipient-Site Surgery
14.7.3.1 Closed Technique
14.7.3.2 Open Technique
14.8 Vascularized Interpositional Periosteal Connective Tissue Flap
14.8.1 General Considerations
14.8.2 Surgical Technique
14.9 Oral Soft Tissue Grafting with Acellular Dermal Matrix
14.9.1 General Considerations
14.9.2 Surgical Technique
Conclusion
References
15: Craniofacial Implant Surgery
15.1 Introduction
15.2 Prosthetic Reconstruction
15.3 Autogenous Reconstruction
15.4 Technical Considerations
15.4.1 Temporal Implants
15.4.2 Orbital Implants
15.4.3 Nasal Implants
15.5 Surgical Technique
15.5.1 Pretreatment Criteria
15.5.2 Pre-resection Collaboration
15.5.3 Residual Bony Volume
15.5.4 Computer-Guided Treatment Planning
15.5.5 Overlying Soft Tissues
15.5.6 Transition Line
15.5.7 Surgical Considerations
15.5.7.1 Extraoral Implants
15.5.7.2 Intraoral and Intranasal Implants
15.5.8 Preparing the Osteotomy
15.5.9 Orbital Defects
15.5.10 Nasal Defects
15.5.11 Complex Maxillofacial Defects
15.5.12 Unusual Maxillofacial Defects
15.6 Healing Period
15.6.1 Abutment Connection and Impression Taking
15.6.2 Soft Tissue Reactions and Infections
15.7 Longevity of Cranial Implants
15.8 Radiation in Cranial Implantation
15.9 Prosthetic Considerations
15.9.1 Preoperative Planning
15.9.1.1 Options without Cranial Implant Surgery
15.9.1.2 Options with Cranial Implant Surgery
15.9.2 Prosthetic Surgical Considerations
15.9.2.1 Auricular Considerations
15.9.3 Templates
15.9.3.1 Auricular Templates
15.9.4 Construction of the Prosthesis
15.9.4.1 Nasal Prostheses
15.9.4.2 Color and Tinting of the Prosthesis
15.10 Discussion
15.10.1 Retention Components
15.10.2 Management of the Skin Tissues Around the Extraoral Abutments
15.10.3 Long-Term Maintenance
Conclusion
References
Suggested Reading
III: Maxillofacial Trauma
16: Initial Management of the Trauma Patient
16.1 Introduction
16.2 Assessment of the Severity of Injury
16.2.1 Glasgow Coma Scale
16.2.2 Trauma Score and Revised Trauma Score
16.2.3 Injury Severity Score
16.2.4 Other Scoring Systems
16.3 Primary Survey: ABCs
16.3.1 Airway Maintenance with Cervical Spine Control
16.3.2 Breathing
16.3.3 Circulation
16.3.4 Neurologic Examination
16.3.5 Exposure of the Patient
16.4 Secondary Assessment
16.4.1 Head and Skull
16.4.2 Chest
16.4.3 Maxillofacial Area and Neck
16.4.4 Spinal Cord
16.4.5 Abdomen
16.4.6 Focused Assessment with Sonography for Trauma (FAST) Exam
16.4.7 Genitourinary Tract
16.4.8 Extremities
16.4.9 Opioids
Conclusion
References
17: Soft Tissue Injuries
17.1 Introduction
17.2 Principles of Management
17.3 Anatomic Evaluation
17.4 Sequence of Repair and Basic Technique
17.5 Types of Injuries
17.5.1 Abrasions
17.5.2 Contusions
17.5.3 Lacerations
17.5.4 Avulsive Injuries
17.5.5 Animal and Human Bites
17.5.6 Gunshot Wounds to the Face
17.6 Regional Considerations
17.6.1 Scalp and Forehead
17.6.2 Eyelid and Nasolacrimal Apparatus
17.6.3 Nose
17.6.4 Ear
17.6.5 Lip
17.6.6 Neck
17.6.7 Cheek
17.7 Postoperative Wound Care
Conclusion
References
18: Rigid Versus Nonrigid Fixation
18.1 Rigid Internal Fixation
18.2 Nonrigid Internal Fixation
18.3 Selection of Fixation Schemes: How Much Fixation (Rigidity) Is Enough?
18.4 Biomechanic Studies Versus Clinical Outcomes
18.5 Load-Bearing Versus Load-Sharing Fixation
18.6 Regional Dynamic Forces
18.7 One-Point Versus Two-Point Fixation
18.8 Compression Versus Noncompression Plate Osteosynthesis
18.9 Locking Plate-Screw Systems
18.10 Lag Screw Fixation
18.11 Plate Fatigue
18.12 Single Versus Multiple Mandibular Fractures
Summary
References
19: Dentoalveolar and Intraoral Soft Tissue Trauma
19.1 Introduction
19.2 Etiology and Demographics
19.2.1 Epidemiology
19.3 History and Physical Examination
19.4 Imaging
19.5 Classification of Dentoalveolar Fractures
19.5.1 Dental Tissues and Pulp
19.6 Treatment of Injuries to the Hard Tissues and Pulp
19.6.1 Enamel Fractures Crown Infractions
19.6.2 Crown Fracture Without Pulp Involvement
19.6.3 Crown Fracture with Pulp Involvement
19.6.4 Crown-Root Fracture
19.6.5 Root Fracture
19.6.6 Periodontal Tissue Injury and Treatment
19.6.7 Exarticulations (Avulsions)
19.6.8 Treatment
Box 19.1 Treatment Summary for Avulsed Teeth
Box 19.2 Treatment Summary for Teeth Avulsed >2 ha
Box 19.3 Splint Requirements
Box 19.4 Sequence of Acid-Etch Splinting Techniquea
19.6.9 Treatment of Fractures of the Alveolar Process
19.6.10 Treatment of Trauma to the Gingiva and Alveolar Mucosa
19.6.11 Pediatric Dentoalveolar Trauma Treatment
19.6.12 Thermal Injuries
Conclusion
References
20: Contemporary Management of Mandibular Fractures
20.1 Introduction
20.2 World War and Influential Surgeons of Maxillofacial Trauma Surgery
20.3 Classification
20.4 Biomechanics
20.5 Treatment: Historical Perspectives
20.5.1 The Splint Age, 1866–1918
20.5.2 The Wire Age, 1918–1968
20.5.3 The Metal Plate Age and the Evolution of Modern Systems of Internal Fixation, 1968–Present
20.5.3.1 Rigid Internal Fixation and the AO/ASIF: “The German School”
20.5.3.2 Functional Fixation, Michelet and Champy: “The French School”
20.6 Diagnosis
20.7 Perioperative Management
20.8 Operative Management
20.9 Closed Treatment with Maxillo-mandibular Fixation vs. Open Reduction and Internal Fixation
20.10 Interdental Wire Fixation as an  Aid to Open Reduction and  Internal Fixation
20.11 Surgical Approach
20.12 Hardware Selection
20.12.1 Principles of Rigid Internal Fixation
20.13 Teeth in the Line of Fracture
20.13.1 Isolated Mandibular Symphysis, Parasymphysis, and Body Fractures
20.13.2 Use of Bone Reduction Forceps
20.13.3 Mandibular Angle Fractures
20.13.4 Bilateral Mandible Fractures
20.13.5 Comminuted Mandibular Fractures
20.13.6 Edentulous Atrophic Mandibular Fractures
20.13.7 Pediatric Mandibular Fractures
20.14 Intraoperative Imaging and Virtual Surgical Planning
20.15 Intraoperative 3D Imaging
20.16 Intraoperative Navigation/ Surgical Navigation (SN)
20.17 Virtual Surgical Planning
20.18 Complications
20.18.1 Infection
20.18.2 Malunion
20.18.3 Nonunion
Conclusions
References
21: Fractures of the Mandibular Condyle
21.1 Introduction
21.2 Etiology
21.3 Anatomy
21.4 Fracture Patterns
21.4.1 Biomechanics
21.4.2 Classification
21.5 Diagnosis and Assessment
21.5.1 Clinical Findings
21.5.2 Radiographic Evaluation
21.6 Treatment
21.6.1 General Principles
21.6.2 Closed
21.6.3 Open
21.6.4 Submandibular
21.6.5 Retromandibular
21.6.6 Preauricular/Endaural
21.6.7 Retroauricular
21.6.8 Transoral
21.6.9 Reduction and Fixation
21.6.10 Endoscopy-Assisted Reduction
21.6.11 Virtual Surgical Planning
21.7 Postoperative Treatment
21.8 Complications
21.8.1 Malocclusion
21.8.2 Mandibular Hypomobility
21.8.3 Ankylosis
21.8.4 Asymmetry
21.8.5 Dysfunction/Degeneration
21.8.6 Chronic Pain
21.9 Pediatric Condylar Fractures
21.9.1 Craniofacial Growth
21.9.2 Diagnosis
21.9.3 Treatment Options
21.9.4 Posttreatment Management and Complications
Conclusion
References
22: Management of Maxillary Fractures
22.1 Introduction
22.2 History
22.3 Le Fort Classification System
22.3.1 Le Fort I Level
22.3.2 Le Fort II Level
22.3.3 Le Fort III Level
22.4 Anatomy
22.5 Diagnosis
22.5.1 Clinical Examination
22.5.2 Imaging
22.6 Treatment
22.6.1 Surgical Splints
22.6.2 Special Considerations
22.6.3 Complications
Box 22.1 Complications Associated with Maxillary Fractures
Conclusion
References
23: Management of Zygomatic Complex Fractures
23.1 Introduction
23.2 Surgical Anatomy
23.3 Diagnosis
23.3.1 Radiographic Evaluation
23.4 Treatment
23.4.1 Zygomatic Arch Fractures
23.4.2 Zygomatic Complex Fractures
23.4.3 Internal Fixation
23.5 Complications
Conclusion
References
24: Orbital and Ocular Trauma
24.1 Introduction
24.2 Orbital Fractures
24.2.1 Anatomy
Box 24.1 Eyelid layers: cutaneous (anterior) to conjunctival (posterior)
24.3 Fracture Configurations
24.4 Clinical Examination
24.5 Imaging
24.6 Ocular Injuries and Disturbances
24.6.1 Visual Impairment
24.6.2 Diplopia
24.6.3 Posttraumatic Enophthalmos
24.6.4 Oculocardiac Reflex
24.6.5 Eyelid Lacerations
24.6.6 Lacrimal Injuries
24.6.7 Telecanthus
24.7 Nonoperative Management of Orbital Fractures
24.8 Operative Management of Orbital Fractures
24.8.1 Indications
24.8.2 Surgical Approaches
24.8.3 Lateral Tarsal Approaches
24.8.4 Acute Repair
24.8.5 Virtual Surgical Planning and Mirror Imaging Overlay(MIO)
24.8.6 Navigation-Guided Implant Placement
24.8.7 Intraoperative Imaging
Conclusion
References
25: Management of Frontal Sinus and Naso-orbitoethmoid Complex Fractures
25.1 Introduction
25.2 Anatomy and Physiology
25.2.1 Embryology of the Sinus
25.2.2 Physiology of the Sinus
25.2.3 Osteology
25.2.4 Neurovascular Structures
25.2.5 Interorbital Space
25.2.6 Medial Canthal Tendon
25.2.7 Lacrimal Apparatus
25.3 Patient Evaluation
25.3.1 Clinical Findings
25.3.2 Imaging
25.3.3 Patency of the NFOT
25.3.4 Classification of NOE Fractures
25.3.5 Classification of Frontal Sinus Fractures
25.4 Treatment
25.4.1 Treatment Goals
25.4.2 Surgical Access
25.4.3 Osseous Recovery and Access
25.4.4 Intraoperative Evaluation of the NFOT
25.4.5 Anterior Table Fractures
25.4.6 Posterior Table Fractures
25.4.7 Orbital Roof and Supraorbital Bar Reconstruction
25.4.8 Nasofrontal Outflow Tract (NFOT) Obstruction
25.4.9 Sinus Obliteration
25.4.10 Endoscopy in the Management of Frontal Fractures
25.4.11 NOE Reconstruction
25.4.12 Medical Therapy of the Sinus Postoperatively
25.5 Complications
25.5.1 Dacryocystorhinostomy
25.6 Correction of Posttraumatic Deformity
Conclusion
References
26: Nasal Fractures
26.1 Introduction
26.2 Surgical Anatomy
26.3 Clinical and Radiographic Diagnostic Tools
26.4 Surgical Management
26.5 Postoperative Care and Complications
Conclusion
Reference and Further Reading
27: Maxillofacial Firearm Injuries
27.1 Introduction
27.2 Epidemiology
27.2.1 Fatal and Nonfatal Firearm Injuries
27.2.2 Risk Factors for Firearm Injuries
27.2.2.1 Unintended Firearm Injuries
27.2.2.2 Pediatric Firearm Injuries
27.2.2.3 Alcohol and Drug Abuse
27.2.2.4 Other Risk Factors
27.3 Characteristics of Maxillofacial Ballistic and Missile Injuries
27.3.1 Categorizations of Gunshot Injuries
27.3.2 Injury Patterns and Associated Injuries
27.4 Acute Care Considerations
27.4.1 Airway Management
27.4.2 Hemorrhage Management
27.5 Management of Gunshot Wounds to the Face
27.5.1 Soft and Hard Tissue Involvement
27.5.2 Bone and Soft Tissue Reconstruction
27.6 Postoperative Complications
Conclusion
References
28: Pediatric Facial Trauma
28.1 Introduction
28.2 History
28.2.1 Child Maltreatment
28.3 Physical Evaluation
28.3.1 Airway
28.3.2 Breathing
28.3.3 Circulation
28.3.4 Cervical Spine
28.3.5 Disability
28.3.6 Exposure
28.4 Head Injuries
28.5 Concussions
28.6 Neck and Airway
28.7 Cervical Spine
28.7.1 Pediatric Perioperative Management
28.8 Soft Tissue Injuries
28.9 Regional Soft Tissue Wounds
28.9.1 The Ear
28.10 The Eyelid and Lacrimal System
28.11 Lacrimal Apparatus
28.12 The Nose
28.13 Epistaxis
28.14 The Scalp
28.15 The Cheek
28.16 The Lip and Oral Cavity
28.16.1 Wound Care Adjuncts
28.16.1.1 Wound Support
28.16.1.2 Antibiotic Ointments
28.16.1.3 Silicone Agents
28.16.1.4 Dog Bites
28.17 Hard Tissue Injuries—Facial Bone Fractures
28.18 Diagnosis of Facial Fractures
28.19 Fixation—Absorbable Versus Titanium
28.20 Anterior Cranial Fractures
28.20.1 Frontal Sinus
28.20.2 Orbital Roof
28.20.3 Upper Facial Fractures
28.20.3.1 Naso-Orbital–Ethmoid (NOE) Complex
28.20.3.2 Nasal Complex
28.20.4 Orbital Floor
28.21 Zygomaticomaxillary Complex (ZMC)
28.22 Lower Facial Fractures
28.22.1 Maxillary Fractures
28.22.2 Mandible Fractures
28.23 Condyle
28.24 Body and Symphysis
28.25 Dentoalveolar Injuries
28.26 Growth Disturbance
References
29: Management of Panfacial Fractures
29.1 Introduction
29.2 Historic Perspective
29.2.1 Etiology
29.3 Anatomic Considerations
29.3.1 Facial Buttresses
29.3.2 Key Landmarks
29.3.3 Dental Arches
29.3.4 The Mandible
29.3.5 Sphenozygomatic Suture
29.3.6 Intercanthal Region
29.4 Imaging
29.5 Surgical Approaches
29.6 Bone Grafting and Soft Tissue Resuspension
29.6.1 Bone Grafting
29.6.2 Soft Tissue Resuspension
29.7 Sequence of Treatment
29.7.1 Airway Management
29.7.2 Fracture Management
Box 29.1 Bottom-Up and Inside-Out
Box 29.2 Top-Down and Outside-In
29.8 Complications
29.9 Computer-Assisted Surgery
29.9.1 Virtual Surgical Planning
29.9.2 Intraoperative Navigation
29.9.3 Intraoperative Imaging
29.9.4 Onsite 3D Printing
29.9.5 Future Considerations
Conclusion
References
IV: Maxillofacial Pathology/Infections
30: Differential Diagnosis of Oral Disease
30.1 Introduction
30.2 The Diagnostic Process
Case Study: From Differential Diagnosis to Final Diagnosis
30.2.1 History
30.2.2 Clinical Examination
30.3 Developing the Differential Diagnosis (DDx)
Case Study: Neophyte Versus Expert Clinician
30.4 Determining the Final Diagnosis: Adjunctive Diagnostic Methods
30.4.1 Diagnostic Imaging
30.4.2 Analysis of Lesional Tissue: Histologic, Immunohistochemical, and Molecular Evaluation
30.5 Patient Follow-Up
Box 30.1 Follow-up of oral pathology
Conclusion
References
31: Odontogenic Cysts and Tumors
31.1 Introduction
31.2 Odontogenic Cysts
Box 31.1 World Health Organization (WHO) 2017 Classification of Odontogenic Cysts [4]
31.2.1 Dentigerous Cyst
31.2.2 Odontogenic Keratocyst
Box 31.2 Clinical Features of the Nevoid Basal Cell Carcinoma Syndrome
31.2.2.1 Nevoid Basal Cell Carcinoma Syndrome
31.2.3 Glandular Odontogenic Cyst
31.2.4 Calcifying Odontogenic Cyst
31.3 Odontogenic Tumors
Box 31.3 World Health Organization (WHO) 2017 Classification of Benign Odontogenic Tumors [4]
31.3.1 Ameloblastoma
31.3.1.1 Ameloblastoma
31.3.1.2 Unicystic Ameloblastoma
31.3.1.3 Extraosseous/Peripheral Ameloblastoma
31.3.1.4 Metastasizing Ameloblastoma
31.3.2 Malignant Odontogenic Tumors
Box 31.4 World Health Organization (WHO) 2017 Classification of Malignant Odontogenic Tumors [4]
31.3.2.1 Ameloblastic Carcinoma
31.3.2.2 Primary Intraosseous Carcinoma
31.3.2.3 Clear Cell Odontogenic Carcinoma
31.3.3 Ameloblastic Fibroma
31.3.4 Ameloblastic Fibro-Odontoma
31.3.5 Odontoma
31.3.6 Odontogenic Myxoma
31.3.7 Calcifying Epithelial Odontogenic Tumor
31.3.8 Adenomatoid Odontogenic Tumor
31.4 Conclusion
References
32: Benign Nonodontogenic Lesions of the Jaws
32.1 Benign Fibro-Osseous Disease
32.1.1 Fibrous Dysplasia
32.1.2 Cemento-Osseous Dysplasia
32.1.2.1 Periapical Cemento-Osseous Dysplasia
32.1.2.2 Focal Cemento-Osseous Dysplasia
32.1.2.3 Florid Cemento-Osseous Dysplasia
32.1.3 Familial Gigantiform Cementoma
32.1.4 Fibro-Osseous Neoplasms
32.1.4.1 Ossifying Fibroma
32.1.4.2 Juvenile Aggressive Ossifying Fibroma
32.2 Osteoblastoma and Osteoid Osteoma
32.3 Chondroma
32.4 Osteoma
32.5 Synovial Chondromatosis and Osteochondroma
32.6 Aggressive Mesenchymal: Tumors of Childhood
32.7 Lesions Containing Giant Cells
32.7.1 Central Giant Cell Granuloma
32.7.2 Giant Cell Tumor
32.7.3 Hyperparathyroidism
32.7.4 Cherubism
32.7.5 Aneurysmal Bone Cyst
32.8 Vascular Malformations
32.8.1 Langerhans’ Cell Histiocytosis
32.9 Nonodontogenic Cysts of the Jaws
32.9.1 Globulomaxillary Lesion
32.9.2 Nasolabial Cysts
32.9.3 Median Mandibular Cyst
32.9.4 Nasopalatine Duct Cyst
32.9.5 Traumatic Bone Cyst
32.9.6 Stafne’s Bone Defect
32.10 Neurogenic Tumors
32.10.1 Schwannoma
32.10.2 Neurofibroma
32.10.3 Traumatic Neuroma
32.11 Paget’s Disease
32.12 Gorham’s Disease (Gorham-Stout Syndrome)
32.13 Tori
32.13.1 Torus Palatinus
32.13.2 Torus Mandibularis
References
33: Oral Cancer: Classification, Diagnosis, and Staging
33.1 Introduction
33.2 Epidemiology
33.2.1 Projections
33.2.2 Survival
33.3 Risk Factors
33.3.1 Tobacco
33.3.2 Alcohol
33.3.3 Oncogenic Viruses
33.3.3.1 Human Papillomavirus (HPV)
33.3.3.2 Genetic Factors
33.4 Race
33.4.1 Other Risk Factors
33.5 Oral Potentially Malignant Disorders
33.5.1 Red, White, and Mixed Lesions
33.5.2 Oral Lichen Planus
33.5.3 Oral Submucous Fibrosis
33.6 Subsites of the Oral Cavity
33.6.1 Mucosal Lip
33.6.2 Buccal Mucosa
33.6.3 Floor of Mouth
33.6.4 Oral Tongue
33.6.5 Mandibular Gingiva and Alveolar Ridge
33.6.6 Maxillary Gingiva, Alveolar Ridge, and Hard Palate
33.6.7 Retromolar Trigone
33.7 Regional Lymphatics
33.8 Diagnosis and Workup: NCCN Guidelines
33.8.1 Assessment for Bone Invasion
33.8.2 Biopsy
33.8.3 Histological Features and Grading
33.8.4 Adverse Histologic Features
33.8.4.1 Perineural Invasion
33.8.5 Lymphovascular Invasion
33.8.5.1 Brandwein–Gensler Risk Model
33.8.5.2 Assessment of Regional Lymphatics
33.8.5.3 CT
33.8.5.4 MRI
33.8.5.5 Ultrasound
33.8.5.6 PET/CT to Diagnose “Regional” Lymphatics
33.8.5.7 Sentinel Node Biopsy
33.8.6 Distant Metastasis Workup
33.9 Staging: AJCC
Conclusion
References
34: Oral Cancer Management
34.1 Introduction
34.2 Histology
34.3 Management of Premalignant Lesions
34.4 Role of Panendoscopy in Treatment Planning
34.5 Choosing a Treatment
34.6 Surgery
34.6.1 Perioperative Issues in Oral Cavity Cancer Treatment
34.6.2 Airway
34.6.3 Perioperative Antibiotics
34.6.4 Alcohol Withdrawal
34.6.5 Deep Venous Thrombosis
34.6.6 Fluid Management
34.6.7 Transfusion
34.6.8 Nutrition
34.6.9 Complications of Surgery
34.7 Radiation
34.8 Chemotherapy
34.9 Immunotherapy
34.10 Chemoprevention
34.11 Special Treatment Considerations by Site
34.11.1 Lip
34.11.2 Buccal Mucosa
34.11.3 Retromolar Trigone
34.11.4 Tongue
34.11.5 Floor of Mouth
34.11.6 Alveolus and Gingiva
34.11.7 Palate
34.12 Management of the Mandible in Oral Cavity Cancer
34.13 Management of the Cervical Lymph Nodes in Oral Cavity Squamous Cancer
34.14 Neck Dissection in Oral Cavity Squamous Cell Cancer
34.15 Sentinel Node Biopsy
34.16 Therapeutic Neck Dissection
34.17 Recurrence and Follow-Up Surveillance
34.18 Future Treatments
Conclusion
References
35: Lip Cancer
35.1 Introduction
35.2 Epidemiology and Etiology
35.3 Anatomic Considerations
35.4 Management
35.4.1 Evaluation
35.4.2 Surgical Treatment
35.4.3 Lip Reconstruction
35.4.4 Cervical Lymphadenectomy
35.5 Treatment Results
Conclusions
References
36: Head and Neck Skin Cancer
36.1 Introduction
36.2 Background
36.3 Epidemiology
36.3.1 Basal Cell Carcinoma
36.3.2 Squamous Cell Carcinoma
36.3.3 Melanoma
36.4 Etiology
36.4.1 Host Factors
36.4.2 Syndromes
36.4.3 Predisposing Lesions
36.4.4 Immunologic Factors
36.4.5 Environmental Factors
36.5 Prevention
36.6 Diagnosis
36.6.1 Biopsy
36.6.2 Basal Cell Carcinoma
36.6.3 Squamous Cell Carcinoma
36.6.4 Melanoma
36.7 Treatment
36.7.1 Standard Excision
36.7.2 Mohs’ Micrographic Surgery (MMS)
36.7.3 Radiation Therapy
36.7.4 Cryosurgery
36.7.5 Curettage and Electrodesiccation (C&E)
36.7.6 Topical Chemotherapy
36.7.7 Lasers
36.7.8 Photodynamic Therapy
36.7.9 Interferons
36.7.10 Retinoids
36.7.11 Targeted Therapy
36.7.12 Follow-Up
36.8 Reconstructive Surgery
36.8.1 Flaps, Grafts, and Healing by Secondary Intention
36.8.2 Skin Biomechanics
36.8.3 Flap Undermining
36.9 Flap Designs
36.9.1 Advancement Flaps
36.9.2 Rotational Flaps
36.9.3 Transposition Flaps
36.9.4 Axial Pattern Flaps
36.9.5 Skin Grafts
36.9.6 Full-Thickness Skin Grafts
36.9.7 Split-Thickness Skin Grafts
36.9.8 Composite Grafts
36.9.9 Free Tissue Transfer
36.10 Complications
36.10.1 Smoking
36.10.2 Infection
36.10.3 Bleeding
36.10.4 Poor Cosmetic Results
Conclusion
References
37: Salivary Gland Disease
37.1 Introduction
37.2 Diagnostic Modalities
37.3 Nonneoplastic Salivary Gland Disorders
37.3.1 Obstructive Disease: Sialolithiasis
37.3.2 Cystic Conditions: Mucous Extravasation and Retention Phenomena, Ranulas, Sialoceles, Parotid Gland Cysts
37.3.3 Inflammatory
37.3.4 Noninflammatory/Autoimmune Conditions
37.4 Neoplastic Salivary Gland Disorders
37.4.1 General Considerations
37.4.2 Benign Salivary Gland Tumors
37.4.3 Malignant Salivary Gland Tumors
Box 37.1 Biologic Classification of Salivary Gland Malignant Tumors
37.5 Selective Complications of Salivary Gland Surgery
Conclusions
References
38: Mucosal and Related Dermatologic Diseases
38.1 Introduction
38.2 Infectious Stomatitis
38.2.1 Bacterial Infections
38.2.1.1 Tuberculosis
38.2.1.2 Syphilis
38.2.1.3 Gonorrhea
38.2.2 Viral Infections
38.2.3 Fungal Infections
38.2.3.1 Candidosis
38.2.3.2 Deep Fungal Infections
38.3 Noninfectious Stomatitis
38.3.1 Recurrent Aphthous Stomatitis (Recurrent Aphthous Ulcerations; Canker Sores)
38.3.2 Erythema Migrans (Geographic Tongue; Benign Migratory Glossitis: Wandering Rash of the Tongue: Erythema Areata Migrans: Stomatitis Areata Migrans)
38.3.3 Oral Lichen Planus
38.3.4 Oral Lichenoid Drug Reaction and Oral Lichenoid Contact Hypersensitivity Reaction
38.3.5 Lupus Erythematosus
38.3.6 Graft Versus Host Disease
38.3.7 Chronic Ulcerative Stomatitis
38.3.7.1 Pemphigus Vulgaris
38.3.7.2 Paraneoplastic Pemphigus
38.3.7.3 Mucous Membrane Pemphigoid (Cicatricial Pemphigoid)
38.3.7.4 Bullous Pemphigoid
38.3.7.5 Lichen Planus Pemphigoides
38.3.8 Erythema Multiforme and Related Disorders
38.4 Pigmented Lesions of Oral Mucosa and Skin
38.4.1 Localized Pigmented Lesions
38.4.1.1 Ephelis (Freckle)
38.4.1.2 Lentigo
38.4.1.3 Melanotic Macule
38.4.1.4 Post-inflammatory Melanosis
38.4.1.5 Oral Melanoacanthoma
38.4.1.6 Melanocytic Nevi
38.4.1.7 Seborrheic Keratosis
38.4.1.8 Melanoma
38.4.2 Vascular Lesions
38.4.2.1 Telangiectasia and Varix
38.4.2.2 Hemangioma
38.4.2.3 Angiosarcoma and Kaposi Sarcoma
38.4.3 Lesions Produced by Extravasated Blood
38.4.3.1 Hematoma
38.4.3.2 Tattoos
38.4.4 Generalized Pigmented Lesions
Conclusion
References
39: Pediatric Maxillofacial Pathology
39.1 Introduction
39.2 Odontogenic Pathology
39.2.1 Odontogenic Cysts
39.2.2 Epithelial Odontogenic Tumors
39.2.3 Mesenchymal Odontogenic Tumors
39.2.4 Mixed Odontogenic Tumors
39.3 Non-odontogenic Pathology
39.3.1 Benign Mesenchymal Tumors
39.3.1.1 Giant Cell Lesions
39.3.1.2 Fibro-osseous Lesions
39.3.2 Hematopoietic Reticuloendothelial Tumors
39.3.3 Neurogenic Tumors
39.3.4 Vascular Pathology
39.3.5 Congenital Head and Neck Masses and Cysts
39.3.6 Epithelial Neoplasms
39.3.7 Mesenchymal Neoplasms
39.4 Salivary Gland Pathology
39.4.1 Inflammatory Salivary Gland Disease
39.4.2 Cystic Conditions of the Salivary Glands
39.5 Salivary Gland Neoplasms
39.5.1 Benign Salivary Gland Tumors
39.5.2 Malignant Salivary Gland Tumors
Conclusions
References
40: Odontogenic Infections
40.1 Introduction
40.2 Principles of Surgical Management of Odontogenic Infections
40.3 Principles of Modern Antibiotic Therapy
40.4 Step 1: Determine the Severity of Infection
40.4.1 Anatomic Location
40.4.2 Rate of Progression
40.4.3 Airway Compromise
40.5 Step 2: Evaluate Host Defenses
40.5.1 Immune System Compromise
Box 40.1 Factors Associated with Immune System Compromise
40.5.2 Systemic Reserve
40.6 Step 3: Decide on the Setting of Care
Box 40.2 Indications for Hospital Admission
40.7 Step 4: Treat Surgically
40.7.1 Airway Security
Box 40.3 When to Go to the Operating Room
40.7.2 Surgical Drainage
40.7.3 Timing of Incision and Drainage
40.7.4 Culture and Sensitivity Testing
40.8 Step 5: Support Medically
40.9 Step 6: Choose and Prescribe Antibiotic Therapy
40.9.1 Surgery to Remove the Cause and Establish Drainage is Primary; Antibiotics are Adjunctive Treatment
40.9.2 Use Therapeutic Antibiotics Only When Clinically Indicated
Box 40.4 Indications for Antibiotics in Odontogenic Infections
40.9.3 Use Specific Antibiotic Therapy as Soon as Possible, Based on Culture and Sensitivity Testing
40.9.4 Use the Narrowest Spectrum Empiric Antibiotic Effective Against the Most Likely Pathogens
40.9.5 Avoid the Use of Combination Antibiotics, Except in Specific Situations Where They are Shown to be Necessary
40.9.6 Use the Least Toxic Indicated Antibiotic, Considering Interaction with Concurrent Medications
40.9.7 Minimize the Duration of Antibiotic Therapy, as Appropriate to the Presenting Type of Infection
40.9.8 Use the Most Cost-effective Appropriate Antibiotic
40.10 Step 7: Administer the Antibiotic Properly
40.11 Step 8: Evaluate the Patient Frequently
Box 40.5 Causes of Treatment Failure
Box 40.6 Criteria for Changing Antibiotics
Summary
References
41: Osteomyelitis, Osteoradionecrosis (ORN), and Medication-Related Osteonecrosis of the Jaws (MRONJ)
41.1 Osteomyelitis
41.1.1 Pathogenesis
41.1.2 Microbiology
41.1.3 Classification
41.1.4 Clinical Presentation
41.1.5 Treatment
41.1.6 Surgical Options
41.2 Osteoradionecrosis
41.3 Medication-Related Osteonecrosis of the Jaws
41.3.1 List of Bisphosphonates
41.3.2 Medications Linked to Osteonecrosis of the Jaws and their Clinical Indication
41.3.3 Patients About to Initiate Bisphosphonate Therapy
41.3.4 Patients Receiving Intravenous Bisphosphonates
41.3.5 Patients Receiving Oral Bisphosphonates
41.3.6 Staging of MRONJ
Conclusion
References
V: Maxillofacial Reconstruction
42: Local and Regional Flaps
42.1 Introduction
42.2 Flap Principles
42.3 Flap Nomenclature
42.3.1 Blood Supply
42.3.2 Location
42.3.3 Configuration
42.3.4 Tissue Content
42.3.5 Method of Transfer
42.4 Designing the Flap
42.5 Types of Flaps
42.5.1 Local Flaps
42.5.1.1 Advancement Flaps
42.5.1.2 Rotation Flaps
42.5.1.3 Transposition Flaps
42.5.1.4 Interpolation Flaps
42.5.2 Regional Flaps
42.5.2.1 Pectoralis Major Myocutaneous Flap
42.5.2.2 Deltopectoral Flap
42.5.2.3 Temporalis Flap
42.5.2.4 Sternocleidomastoid Flap
42.5.2.5 Trapezius Myocutaneous Flap
42.5.2.6 Latissimus Dorsi Myocutaneous Flap
42.6 Complications
Conclusion
References
43: Nonvascularized Reconstruction
43.1 Introduction
43.2 Anatomic Considerations
43.3 Defects of the Mandible
43.4 Defects of the Maxilla
43.5 Limitation of Bony Reconstruction
43.6 Bone Biology
43.7 Bone Grafting Biology
43.8 Bone Morphogenic Protein
43.9 Platelet-Rich Plasma (PRP)
43.10 Bone Marrow Aspirate
43.11 Autogenous Sites
43.12 Intraoral
43.13 Cranial
43.14 Costochondral Graft
43.15 Iliac Crest
43.15.1 Anterior Iliac Crest
43.15.2 Posterior Iliac Crest
43.16 Tibial Plateau
43.17 Hyperbaric Oxygen
Conclusion
• Reconstruction of Mandible
• Reconstruction of Maxilla
References
44: Vascularized Reconstruction
44.1 Introduction
44.1.1 Microvascular Techniques and Setup
44.2 Microvascular Soft Tissue Flaps
44.2.1 Radial Artery Fasciocutaneous Flap
44.2.1.1 Flap Harvesting
44.2.1.2 Applications
44.2.2 Anterolateral Thigh Flap
44.2.2.1 Flap Harvesting
44.2.2.2 Applications
44.2.3 Rectus Abdominus Myocutaneous Flap
44.2.3.1 Flap Harvesting
44.2.3.2 Applications
44.2.4 Latissimus Myocutaneous Free Flap
44.2.4.1 Flap Harvesting
44.2.4.2 Applications
44.2.5 Lateral Arm Free Flap
44.2.5.1 Flap Harvesting
44.2.5.2 Applications
44.3 Microvascular Composite Bone Flaps
44.3.1 Osteocutaneous Radial Forearm Flap
44.3.1.1 Flap Harvesting
44.3.1.2 Applications
44.3.2 Osteocutaneous Fibula Flap
44.3.2.1 Flap Harvesting
44.3.2.2 Applications
44.3.3 Scapula Free Flap
44.3.3.1 Flap Harvesting
44.3.3.2 Applications
44.3.4 Iliac Crest Free Flap
44.3.4.1 Flap Harvest
44.3.4.2 Applications
Conclusion
References
45: Microneurosurgery
45.1 Introduction
45.2 Demographics
Box 45.1 Risk Factors for Nerve Injury During Third Molar Removal
Box 45.2 Rood’s Radiographic Predictors of Potential Tooth Proximity to the Inferior Alveolar Canal
45.3 Trigeminal Nerve Anatomy and Physiology
45.4 Nerve Injury Classification
45.4.1 Clinical Neurosensory Testing
Box 45.3 Clinical Neurosensory Testing
Box 45.4 Systemic Pharmacologic Agents
45.5 Nonsurgical Treatment
45.6 Trigeminal Neuralgia
45.7 Treatment Algorithms
45.8 Surgical Treatment
45.8.1 Exposure
45.8.2 External Neurolysis
45.8.3 Internal Neurolysis
45.8.4 Nerve Stump Preparation
45.8.5 Approximation
45.8.6 Coaptation
45.8.7 Neurorrhaphy
45.8.8 Nerve Grafts
45.8.9 Entubulation Techniques
45.8.10 Immediate IAN Reconstruction with Mandibular Resection
45.9 Postsurgical Management
45.10 Medicolegal Issues
Conclusions
References/Additional Resources
Further Readings
46: Comprehensive Management of Facial Clefts
46.1 Introduction
46.2 History of Cleft Lip and Palate Repair
46.3 Embryology
46.4 Genetics and Etiology
46.5 Classification
46.6 Prenatal Counseling
46.7 Feeding the Child with a Cleft Palate
46.8 Surgical Treatment Planning and Timing
46.9 Technical Considerations for Cleft Lip and Palate Repair
46.10 Presurgical Taping and Presurgical Orthopedics
46.11 Lip Adhesion
46.12 Primary Unilateral Cleft Lip Repair
46.13 Primary Bilateral Lip Repair
46.14 Cleft Palate Repair
46.15 Complex Facial Clefting
46.16 Outcome Assessment
Conclusion
References
47: Alveolar Cleft Reconstruction
47.1 Introduction
47.2 Rationale for Grafting
47.3 Measuring Outcomes
47.4 Timing of the Graft
Box 47.1 Timing of Alveolar Bone Grafting
Box 47.2 Factors Contributing to Timing of  Grafting during the Mixed Dentition
47.5 Source of Bone Graft
47.6 Pre- Versus Postsurgical Orthodontics
47.7 Surgical Technique for Grafting the Cleft Alveolus
47.8 Stepwise Approach to the Comprehensive Management of the Alveolar Cleft Patient
Conclusion
References
48: Nonsyndromic Craniosynostosis
48.1 Introduction
48.2 Functional Considerations
48.2.1 Intracranial Hypertension
48.2.2 Visual Impairment
48.2.2.1 Visual Acuity
48.2.2.2 Ocular Motor Disturbances
48.2.3 Limitation of Brain Growth
48.2.4 Neuropsychiatric Disorders
48.3 Diagnosis/Preoperative Data Collection
48.3.1 Physical Examination
48.3.2 Laboratory and Radiological Studies
48.4 Classification
48.4.1 Sagittal Synostosis/Scaphocephaly
48.4.2 Unilateral Coronal Synostosis/Anterior Plagiocephaly
48.4.3 Metopic Synostosis/Trigonocephaly
48.4.4 Bilateral Coronal Synostosis/Brachycephaly
48.4.5 Unilateral Lambdoid Synostosis/Posterior Plagiocephaly
48.5 Principles of Management
48.5.1 Multidisciplinary Team Approach
48.5.2 Virtual Surgical Planning
48.5.3 Airway Management
48.5.4 Intravenous Access
48.5.5 Monitoring
48.5.6 Patient Positioning and Eye Protection
48.5.7 Transfusion Protocol
48.5.8 Current Surgical Approach
48.6 Surgical Considerations
48.6.1 Sagittal Synostosis
48.6.2 Unilateral Coronal Synostosis
48.6.3 Metopic Synostosis
48.6.4 Bilateral Coronal Synostosis
48.6.5 Unilateral Lambdoid Synostosis
48.6.6 Complications
48.7 Summary
References
49: Craniofacial Dysostosis Syndromes: Evaluation and Treatment of the Skeletal Deformities
49.1 Introduction
49.2 Genetic Aspects
49.3 Functional Considerations
49.3.1 Brain Growth and Intracranial Pressure
49.3.2 Vision
49.3.3 Hydrocephalus
49.3.4 Effects of Midface Deficiency on Airway
49.3.5 Dentition and Occlusion
49.3.6 Hearing
49.3.7 Extremity Anomalies
49.4 Morphologic Considerations
49.4.1 Frontoforehead Aesthetic Unit
49.4.2 Posterior Cranial Vault Aesthetic Unit
49.4.3 Orbitonasozygomatic Aesthetic Unit
49.4.4 Maxillary–Nasal Base Aesthetic Unit
49.4.5 Quantitative Assessment
49.4.6 CT Scan Analysis
49.4.7 Anthropometric Surface Measurements
49.4.8 Cephalometric Analysis
49.5 Surgical Management
49.5.1 Historical Perspectives
49.5.2 Philosophy Regarding Timing of Intervention
49.5.3 Incision Placement
49.5.4 Management of Cranial Vault Dead Space
49.5.5 Soft Tissue Management
49.6 Crouzon Syndrome
49.6.1 Primary Cranio-orbital Decompression: Reshaping in Infancy
49.6.2 Repeat Craniotomy for Additional Cranial Vault Expansion and Reshaping in Young Children
49.6.3 Management of “Total Midface” Deformity in Childhood
49.6.4 Orthognathic Procedures for Definitive Occlusal and Lower Facial Aesthetic Reconstruction
49.6.5 Assessment of Results in the Crouzon Patient
49.6.6 Quantitative Assessment of Presenting Crouzon’s Deformity and Surgical Results Based on CT Scan Analysis After First-Stage Cranio-orbital Reconstruction
49.6.7 Quantitative Intracranial Volume Measurements Before and After Cranio-orbital Reshaping in Children with Crouzon Syndrome
49.6.8 Quantitative Assessment of Presenting Deformity in Children with Crouzon Syndrome and Surgical Results After Monobloc Osteotomy Based on CT Scan Analysis
49.7 Apert Syndrome
49.7.1 Primary Cranio-orbital Decompression: Reshaping in Infancy
49.7.2 Further Craniotomy for Additional Cranial Vault Expansion and Reshaping in Young Children
49.7.3 Management of the “Total Midface” Deformity in Childhood
49.7.4 Orthognathic Procedures for Definitive Occlusal and Lower Facial Aesthetic Reconstruction
49.7.5 Assessment of Results in the Apert Patient
49.7.5.1 Quantitative Assessment of Presenting Apert’s Deformity and Surgical Results Based on CT Scan Analysis After First-Stage Cranio-orbital Reconstruction
49.7.5.2 Quantitative Intracranial Volume Measurements Before and After Cranio-orbital Reshaping in Children with Apert Syndrome
49.7.5.3 Quantitative Assessment of Presenting Deformity in Children with Apert Syndrome and Surgical Results After Facial Bipartition Osteotomy Based on CT Scan Analysis
49.8 Pfeiffer Syndrome
49.9 Carpenter Syndrome
49.10 Saethre-Chotzen Syndrome
49.11 Cloverleaf Skull Anomaly
Summary
References
50: Technology in Oral and Maxillofacial Reconstruction
50.1 Introduction
50.1.1 Data Acquisition
50.1.2 Preoperative Planning
50.1.3 Manufacturing
50.1.3.1 Patient-Specific Implants
50.1.4 Surgery
50.1.4.1 Intraoperative Navigation
50.1.5 Intra- and Postoperative Assessment
50.2 Craniomaxillofacial Trauma and Reconstruction
50.2.1 Zygoma Reconstruction
50.2.2 Orbital Reconstruction
50.2.3 Mandibular Reconstruction in the Setting of Trauma
50.3 Craniomaxillofacial Surgery
50.3.1 Orthognathic Surgery
50.3.2 Craniofacial Surgery
50.3.3 Custom Cranial Implants
50.4 Head and Neck Surgery and Craniomaxillofacial Reconstruction
50.5 Robotic Surgery
Conclusion
References
VI: Temporomandibular Joint Disease
51: Anatomy and Pathophysiology of the Temporomandibular Joint
51.1 Introduction
51.2 Overall Anatomy
51.3 Osseous Structures
51.4 Cartilage and Synovium
51.5 Articular Disk and Retrodiskal Tissue
51.6 Ligaments
51.7 Vascular Supply and Innervation
51.8 Musculature
51.8.1 Supramandibular Muscle Group
51.8.2 Inframandibular Muscle Group
51.9 Biomechanics of TMJ Movement
51.10 Pathology of the TMJ and Associated Structures
51.10.1 Epidemiology
51.10.2 Types of TMJ Pathology
Box 51.1 Taxonomy of temporomandibular disorders (adapted from Peck et al., 2014 [18])
51.10.3 Joint Pain
51.10.4 Joint Disorders
51.10.4.1 Disk Displacement (Internal Derangement)
51.10.4.2 Hypomobility Disorders (Other Than Disk Disorders)
51.10.4.3 Hypermobility Disorders
51.10.5 Joint Diseases
51.10.5.1 Degenerative Joint Disease
51.10.6 Neoplasms
51.10.7 Infection
Conclusion
References
52: Nonsurgical Management of Temporomandibular Disorders
52.1 Introduction
52.2 Treatment Considerations
Box 52.1 Goals of Nonsurgical Therapy for  Temporomandibular Disorders
52.3 Nonsurgical Therapy Diet
Box 52.2 Soft Diet
52.3.1 Pharmacotherapy
52.4 Analgesics
52.5 Anti-Inflammatory Medications
52.5.1 NSAIDs
Box 52.3 Nonsteroidal Anti-inflammatory Drugs: Ideal Properties
52.5.2 Corticosteroids
52.6 Anxiolytics
Box 52.4 Antianxiety Medications: Benzodiazepines
52.7 Antidepressants
Box 52.5 Antidepressant Medications
52.8 Muscle Relaxants
Box 52.6 Central Muscle Relaxants and Their Effects
Box 52.7 Peripheral Muscle Relaxants
52.9 Botulinum Toxin
52.10 Local Anesthetics
Box 52.8 Local Anesthetics
52.10.1 Physical Therapy
Box 52.9 Physical Therapy
52.11 Exercise Therapy
Box 52.10 Manual Therapy
52.12 Thermal Agents
52.13 Ultrasonography and Phonophoresis
52.14 Electrical Stimulation Transcutaneous Electrical Nerve Stimulation
52.14.1 High-Voltage Stimulation
52.14.2 Iontophoresis
Box 52.11 Electrical Stimulation
52.15 Trigger Points and Muscle Injections
52.15.1 Stress-Reduction Techniques
52.15.1.1 Relaxation and Biofeedback
Box 52.12 Behavioral Therapy
52.16 Acupressure and Acupuncture
52.17 Psychotherapy
52.17.1 Occlusal Appliance Therapy
52.18 Stabilization (Flat Plane) Appliance
Box 52.13 Stabilization Appliance
52.19 Anterior Repositioning Appliance
Box 52.14 Repositioning Appliance
52.20 Occlusal Adjustment
52.21 Causes of Failure
Summary
References
53: Arthroscopy and Arthrocentesis of the Temporomandibular Joint
53.1 History
53.2 Goals
53.3 Indications
Box 53.1 General Indications for Arthroscopy
Box 53.2 Wilkes Classification
53.4 Contraindications
53.5 Advantages
53.6 Patient Evaluation
53.6.1 McCain TMJ Assessment Standardized Forms
53.6.2 Anamnesis
53.6.2.1 Chief Complaint
53.6.2.2 Parafunction and Associated Causes
53.6.3 Analog Scales
53.6.4 History
53.6.5 Diet
53.6.6 Treatment
53.7 Physical Examination
53.7.1 Mouth Opening and Range of Motion
53.7.2 Joint Noise
53.7.3 Pain Assessment of the Joint and Adjacent Musculature
53.7.4 Joint Locking or Dislocation
53.7.4.1 Mahan’s Sign
53.7.5 Head, Eyes, Ears, Nose, and Throat
53.7.6 Panoramic Radiograph
53.7.7 Magnetic Resonance Imaging
53.7.8 Etiology
53.7.9 Diagnosis
53.7.10 Discussion
53.7.11 Rapid TMJ Assessment
53.8 Arthrocentesis
53.8.1 The Arthroscope
53.8.2 Technology of Video Arthroscopy
53.8.3 Armamentarium
53.8.3.1 Hand Instrumentation
Cannulas
Probes
Biopsy Forceps/Tissue Graspers
Meniscus Mender
53.8.3.2 Other Hand Instruments
53.8.3.3 Motorized Instruments
Shavers
Whisker Shaver
Full-Radius Shaver
Abraders
53.8.4 Coblation
53.8.5 Laser
53.8.5.1 Holmium:Yttrium-Aluminum- Garnet Laser
53.8.6 Portals of Entry and Danger Zones
53.8.6.1 Fossa Portal
53.8.6.2 Anterior Eminence Portal
53.8.6.3 Danger Zones
53.8.7 Internal Arthroscopic Anatomy
53.8.7.1 Posterior Pouch
53.8.7.2 Intermediate Zone
53.8.7.3 Anterior Recess
53.8.7.4 Inferior Joint Space Anatomy
53.8.7.5 Posterior Recess
53.8.7.6 Intermediate Zone
53.8.7.7 Anterior Recess
53.8.8 TMJ Arthroscopic Technique
53.8.8.1 Immediate Preoperative Steps
Examination Under Anesthesia
Ear Examination
Palpation of TMJ Anatomy
Marking the Fossa Portal Puncture Site
Insufflation
53.8.8.2 Operative Steps
Fossa Puncture
Technique Pearls and Pitfalls
Outflow Needle Puncture
53.8.8.3 Diagnostic Sweep (Seven Points of Interest of TMJ Arthroscopic Examination)
53.8.8.4 Intra-Articular Pathology
Synovitis
Fibrosis
Villonodular Synovitis
Synovial Chondromatosis
Rheumatoid Arthritis
Pseudogout/Chondrocalcinosis
Joint Stenosis
Articular Dysfunction
Osteoarthritis
53.8.9 Chondromalacia Grading
53.8.9.1 Grade I: Softening of Cartilage
53.8.9.2 Grade II: Furrowing
53.8.9.3 Grade III: Fibrillation and Ulceration
53.8.9.4 Grade IV: Crater Formation and Subchondral Bone Exposure
53.8.9.5 Arthrofibrosis
53.9 Arthroscopic Operative Procedures
53.9.1 Second Puncture
53.9.2 Lysis and Lavage
53.9.2.1 Anterior and Posterior Recess Adhesions
53.9.2.2 Lateral Recess Adhesions
53.9.3 Intra-Articular Medications
53.9.3.1 Steroids
53.9.3.2 Botulinum Toxin A
53.9.3.3 Hyaluronic Acid
53.9.4 Débridement
53.9.5 Synovectomy
53.9.6 Anterior Release
53.9.7 Disc Reduction
53.9.8 Posterior Scarification/Cauterization
53.9.9 Disc Function
53.9.9.1 Arthroscopic Discopexy
53.9.9.2 Discopexy Technique
Placement of the Suture Passing Needle
Placement of the Suture Catching Needle
Retrograde Passing of the Anterior Suture End
Arthroscopic Rigid Disc Fixation
53.10 Postoperative Patient Management
53.10.1 General Anesthesia Considerations
53.10.2 Analgesia/Pain Management
53.10.3 Anti-Inflammatory Management
53.10.4 Antibiotics
53.10.5 Diet
53.11 Postoperative Rehabilitation
53.11.1 Stage I Physiotherapy
53.11.2 Stage II Physiotherapy
53.11.3 Stage III Physiotherapy
53.11.4 Stage IV Physiotherapy
53.12 Complications of TMJ Arthroscopic Surgery
53.12.1 Damage to Cranial Nerve VII and Facial Palsy/Atony
53.12.2 Damage to the Collaterals of Cranial Nerve V (Auriculotemporal [ATN], Lingual, or Inferior Alveolar Paresthesia)
53.12.3 Damage to Cranial Nerve VIII and Vestibulocochlear Dysfunction
53.12.4 Scuffing of Fibrocartilage
53.12.5 Damage to the Maxillary Artery/Collaterals with or without Formation of Arteriovenous Fistula
53.12.6 Damage to the Superficial Temporal Vessels with or Without Formation of AVF
53.12.7 Perforation of the Glenoid Fossa
53.12.8 Damage to the Disc
53.12.9 Hemarthrosis
53.12.10 Infection
53.12.11 Non-infectious Postoperative Effusions
53.12.12 Instrument Failure/Loose Bodies
Conclusion
References
Suggested Reading
54: Internal Derangement of the Temporomandibular Joint
54.1 Introduction
54.2 Pathophysiology
54.2.1 Clinical Course
54.2.2 Etiologic Factors
54.2.2.1 Trauma
54.2.2.2 Joint Laxity
54.2.2.3 Bruxism
54.2.2.4 Changes in the Joint Lubrication System
54.3 Diagnosis
54.3.1 Clinical Diagnosis
54.3.1.1 Joint Incoordination
54.3.1.2 Disc Displacement with Reduction
54.3.1.3 Disc Displacement Without Reduction
54.3.1.4 Anchored Disc Phenomenon
54.3.1.5 Other Conditions
54.3.2 Imaging Diagnosis
54.4 Indications, Goals, and Outcomes Assessment
54.4.1 Indications
54.4.2 Goals
54.4.3 Outcomes Assessment
54.5 Nonsurgical and Minimally Invasive Surgery
54.6 Open Joint Surgery
54.6.1 Surgical Anatomy
54.6.1.1 Fascial Layers
54.6.1.2 Facial Nerve (Main Trunk and Frontal Branch)
54.6.1.3 Auriculotemporal Nerve
54.6.1.4 Superficial Temporal Vessels
54.6.1.5 Internal Maxillary Artery
54.6.2 Surgical Approaches
54.6.2.1 Preauricular Approach
54.6.2.2 Endaural Approach
54.6.2.3 Postauricular Approach
54.6.2.4 Capsular Incisions
54.6.2.5 Horizontal Incision Over the Lateral Rim of the Glenoid Fossa
Horizontal Incision Below the Lateral Rim of the Glenoid Fossa
Horizontal Incisions Above and Below the Disc
T-Shaped Incision
54.6.3 Wound Closure
54.7 Surgical Procedures
54.7.1 Disc Repositioning
54.7.2 Disc Repositioning and Discoplasty
54.7.3 Disc Repositioning and Arthroplasty
54.7.4 Disc Repair
54.7.5 Discectomy
54.7.5.1 Disc Replacements
Temporalis Muscle/Fascia Flap
Ear Cartilage
Dermal Fat Graft
Abdominal Dermis Fat Graft
Tissue-Engineered TMJ Disc
54.7.6 Modified Mandibular Condylotomy
54.8 Postoperative Management
54.9 Complications
54.9.1 Perioperative Complications
54.9.1.1 Vascular Injury and Hemorrhage
54.9.1.2 Neurologic Injury
54.9.1.3 Infection
54.9.1.4 Otologic Complications
54.9.2 Long-Term Complications
54.9.2.1 Malocclusion
54.9.2.2 Ankylosis
54.9.2.3 Reoperations
Conclusions
References
55: Hypomobility and Hypermobility Disorders of the Temporomandibular Joint
55.1 Introduction
55.2 Hypomobility
55.2.1 Classification
55.2.2 Etiology
55.2.3 Clinical Presentation
55.2.4 Imaging Assessment
55.2.5 Post-Traumatic Hypomobility
55.2.6 Postinfectious Hypomobility
55.2.7 Hypomobility After Radiation Therapy
55.2.8 Post-Craniotomy Hypomobility
55.2.9 Inflammatory and Rheumatologic Causes
55.2.10 Hypomobility After Orthognathic Surgery
55.2.11 General Treatment Considerations
55.2.12 Complications Associated with Treatment
55.2.13 Postoperative Physical Therapy
55.3 Hypermobility
55.3.1 Classification
55.3.2 Etiology
Box 55.1 Causes of Hypermobility
55.3.3 Treatment
55.3.3.1 Acute Dislocation
55.3.3.2 Chronic Dislocation
55.3.3.3 Sclerotherapy/Prolotherapy
55.3.3.4 Autologous Blood Injection
55.3.3.5 Botulinum Toxin Injection
55.3.4 Surgical Techniques
55.3.4.1 Temporomandibular Joint Arthroscopy
55.3.4.2 Eminectomy
55.3.4.3 LeClerc/Dautrey Procedure
Conclusion
References
56: Pediatric Temporomandibular Disorders: Juvenile Idiopathic Arthritis
56.1 Introduction
56.2 Diagnosis
56.3 Management of Arthritis
56.4 Management of TMJ Symptoms
56.5 Development of Dentofacial Deformity
56.6 Management of Dentofacial Deformity
56.6.1 Interceptive Treatment in Growing Patients
56.6.2 Correction of the End-Stage Deformity
Conclusion
References
57: End-Stage Temporomandibular Joint Disease
57.1 Introduction
57.2 Autogenous Bone Grafting
57.3 Transport Distraction Osteogenesis
57.4 Bioengineered Tissue for Total Joint Reconstruction
57.5 Alloplastic Total Joint Reconstruction
57.6 History of Alloplastic TMJ Reconstruction
Box 57.1 Indications for Total Joint Replacement
Box 57.2 Goals of TMJ Reconstruction
Box 57.3 Autogenous Bone Grafting TMJR Options
Box 57.4 History of Autogenous TMJR
Box 57.5 Comparison of Advantages of Autogenous and Alloplastic TMJR
Box 57.6 Comparison of Disadvantages of Autogenous and Alloplastic TMJR
Box 57.7 History of Alloplastic TMJR.
Box 57.8 Relative Contraindications to Alloplastic TMJR
References
VII: Orthognathic Surgery
58: Craniofacial Growth and Development
58.1 Introduction
58.2 Prenatal Craniofacial Development
58.2.1 Facial Prominences and Formation of Face
58.2.2 Formation of the Craniofacial Bones
58.2.3 The Growth of the Craniofacial Complex During Fetal Period
58.3 Postnatal Craniofacial Development
58.3.1 Cranial Vault
58.3.2 Cranial Base
58.3.3 Nasomaxilla
58.3.4 Mandible
58.3.5 Dental Development
58.3.6 Facial Development
58.3.7 Growth and Facial Changes During Adulthood
58.4 Orthodontic, Orthopedic, and Orthognathic Clinical Considerations
58.4.1 Craniofacial Growth Assessment
58.4.2 Orthopedic Treatment for Growth Modification
58.4.3 Transverse Orthopedic Treatment
58.4.4 Anteroposterior Orthopedic Treatment: Class II
58.4.5 Anteroposterior Orthopedic Treatment: Class III
58.4.6 Vertical Orthopedic Treatment
58.4.7 Orthodontic Camouflage: Orthopedic Consequence Versus Surgical Preparation
Conclusion
References
59: Digital Data Acquisition and Treatment Planning in Orthognathic Surgery
59.1 Introduction
59.2 Initial Consultation
59.2.1 Patient History
59.2.1.1 Chief Complaint, Expectations
59.2.1.2 Orthodontic History
59.2.1.3 Age, Growth, Recognition of Anomalies
59.2.2 Clinical Exam
59.2.2.1 Maxillofacial
59.2.2.2 Airway
59.2.2.3 Dental
59.2.2.4 Esthetic
59.2.3 Digital Data Acquisition
59.2.3.1 Photography
59.2.3.2 Intraoral Scanners
59.2.3.3 Radiography and Other Imaging
59.2.3.4 Polysomnography, Drug-Induced Sleep Endoscopy
59.2.3.5 Cervical Vertebral/Hand Wrist Maturation and Other Imaging
59.2.4 Determining a Diagnosis and Generate a Problem List
59.2.5 Visual Treatment Predictions/ Surgical-Orthodontic Treatment Options and Communication with the Orthodontist
59.3 Peri-Orthodontic Mid-Treatment Review
59.3.1 Evaluation of Growth and Orthodontic Progress for Surgery
59.3.2 Review of History, Chief Complaint, and Clinical Examination
59.3.3 Establishment of an Orthognathic Surgery Digital Planning Timeline
59.4 Digital Surgical Workup: Preoperative Preparation
59.4.1 Database Gathering
59.4.1.1 Minimum Digital Hardware and Software Requirements
59.4.2 Software Requirements for Cephalometric Analysis and Predictive Software
59.4.3 Quality Guidelines: Imaging/Digital Scans, CBCT/CT Acquisition, and Communication Tools
59.4.3.1 Secure Data Sharing
59.4.3.2 Video Conferencing
59.4.3.3 Digital Conferencing Steps
59.4.4 Final Digital Treatment Plan
59.4.5 Recognition of Potential Errors in Digital Planning
59.4.6 Surgery-First Approach
59.4.7 Role of Clear Aligners in Digital Planning
Case I
Case II
Conclusions
References
60: Orthodontics for Orthognathic Surgery
60.1 Introduction
60.1.1 Sequencing
60.2 Orthodontic Goals
60.2.1 Incisor Position
60.2.2 Occlusal Plane Angle (OPA) Surgical Alteration
60.2.3 Dental and Periodontal Treatment
60.3 Treatment Options for Specific Orthodontic Problems
60.3.1 Adjustment for Tooth-Size Discrepancy (TSD)
60.3.2 Correct Over-Angulated (Proclined) and/or Crowded Maxillary or Mandibular Anterior Teeth
60.3.3 Correct Under-Angulated (Retro-Inclined) Maxillary or Mandibular Incisors
60.3.4 Correct Excess Curve of Spee: Maxillary Arch
60.3.5 Correct Accentuated Curve of Spee: Mandibular Arch
60.3.6 Correct Reverse Curve of Spee: Maxillary Arch
60.3.7 Correct Reverse Curve of Spee: Mandibular Arch
60.3.8 Anteroposterior Arch Asymmetry (Maxilla or Mandible)
60.3.9 Divergence of Roots Adjacent to Interdental Surgical Sites
60.3.10 Coordination of Maxillary and Mandibular Arch Widths
60.3.11 Additional Orthodontic Issues
60.3.12 Corticotomies to Accelerate Orthodontic Movement
60.3.13 Final Presurgical Preparation
60.4 Postsurgical Orthodontics
60.4.1 Surgical Stabilizing Devices (Splints)
60.4.2 Postsurgical Orthodontic Management
60.4.3 Orthodontic Instability
Conclusion
References
61: Model Surgery and Computer-Aided Surgical Simulation for Orthognathic Surgery
61.1 Introduction
61.2 Traditional Immediate Preoperative Analytical Model Surgery
61.2.1 Presurgical Clinical Database
61.2.2 Presurgical Records
61.2.2.1 Dental Impressions
61.2.2.2 Facebow Transfer
61.2.2.3 CR Bite Registration
61.3 Mounting Dental Models for Simulated Surgery
61.4 Marking and Measuring the Final Models and Simulating Surgery
61.4.1 Mandibular Surgery
61.4.1.1 Isolated Mandibular Surgery (Sagittal Split Osteotomy or Vertical Ramus Osteotomy Only)
61.4.2 Maxillary Surgery
61.4.2.1 Isolated Maxillary Surgery
61.4.2.2 Vertical Measurements in Maxillary Surgery
61.4.2.3 Segmental Maxillary Surgery
61.4.2.4 Combined Maxillary and Mandibular Surgery
Sequence of Bimaxillary Orthognathic Surgery
Splint Fabrication
61.5 Three-Dimensional Virtual Model Surgical Simulation
61.5.1 Introduction
61.5.2 History
61.5.3 Sequence of Data Acquisition Prior to Computer-Assisted 3D Surgical Simulation (CASS)
61.5.4 Computer-Assisted 3D Surgical Simulation Session
61.6 Other Virtual Surgery Customizations
61.6.1 Custom Plates and Cutting Guides
61.6.2 Limitations of CASS
Conclusion
References
Suggested Reading
Traditional Analytical Model Surgery
Virtual Simulated Orthognathic Surgery
62: Mandibular Orthognathic Surgery
62.1 History
62.2 Anatomic and Physiologic Considerations of Mandibular Surgeries
62.2.1 Vascular Supply
62.2.2 Nerves
62.2.3 Muscles
62.3 Mandibular Osteotomy Techniques
62.3.1 Mandibular Ramus Osteotomies
62.3.2 Vertical Ramus Osteotomy (VRO)
62.3.2.1 Indications
62.3.2.2 Technique
62.3.2.3 Alternative Techniques
62.3.2.4 Complications
Stability
Nerve Damage
TMJ Dysfunction
Other Complications
62.3.3 Inverted-L and C Ramus Osteotomies
62.3.3.1 Indications
62.3.3.2 Techniques
62.3.3.3 Alternative Techniques
62.3.3.4 Complications
62.3.4 Bilateral Sagittal Split Osteotomy
62.3.4.1 Indications
62.3.4.2 Technique
62.3.4.3 Alternative Techniques
62.3.4.4 Complications
Stability
Nerve Damage
TMJ Dysfunction
62.3.4.5 Condylar Malposition
Miscellaneous Complications
62.3.5 Horizontal Ramus Osteotomies
62.3.5.1 Indications
62.3.5.2 Technique
62.3.5.3 Alternative Techniques
62.3.5.4 Complications
Relapse
Neural Complications
62.3.6 Subapical Osteotomies
62.3.6.1 Anterior Subapical Osteotomy
Indications
Procedure
62.3.6.2 Posterior Subapical Osteotomy
Indications
Technique
Alternative Techniques
62.3.7 Total Mandibular Subapical Alveolar Osteotomy
62.3.7.1 Indications
62.3.7.2 Technique
62.3.7.3 Technique Variations
62.3.7.4 Complications
62.3.8 Horizontal Osteotomy of the Symphysis (Genioplasty)
62.3.8.1 Indications
62.3.8.2 Technique
62.3.8.3 Alternative Techniques
62.3.8.4 Complications
References
63: Maxillary Orthognathic Surgery
63.1 Introduction
63.1.1 Basic Principles of Maxillary Surgery
63.1.2 Computer-Assisted 3D Surgical Simulation and Traditional Model Surgery
63.2 Surgical Anatomy
63.2.1 Osseous Structures
63.2.2 Vascular Structures
63.3 The Soft Tissue Envelope of the Maxilla
63.4 Surgical Techniques
63.4.1 Incisions, Dissection, and Exposure of the Maxilla
63.4.2 Osseous Surgery
63.4.3 Segmental Maxillary Procedures
63.4.3.1 Superior Maxillary Repositioning
63.4.3.2 Anterior Maxillary Repositioning
63.4.3.3 Inferior Maxillary Repositioning
63.4.3.4 Posterior Maxillary Repositioning
63.5 Rigid Internal Fixation for Maxillary Osteotomy
63.6 Specific Procedures
63.6.1 Anterior Maxillary Osteotomy
63.6.1.1 Posterior Maxillary Osteotomy
63.6.1.2 Total Maxillary Alveolar Osteotomy
63.7 Surgically Assisted Rapid Palatal Expansion (SARPE)
63.7.1 History
63.7.2 SARPE Versus Multiple-Piece Maxillary Osteotomy
63.7.3 SARPE Surgical Technique
63.7.4 Zygomatic Osteotomy and Modified Le Fort Osteotomies
Conclusion
References
64: Sequencing in Orthognathic Surgery
64.1 Introduction
64.2 Presurgical Planning of Bimaxillary Surgery
64.2.1 Conventional Model Surgery
64.2.2 Maxilla-First Model Surgery
64.2.3 Mandible-First Model Surgery
64.3 Maxilla-First Sequencing
64.3.1 Maxilla-First Surgical Sequence
64.3.2 Scenarios in Which Maxilla-First Sequencing Is Advantageous
64.3.2.1 Clockwise Rotation of the Maxillomandibular Complex
64.3.2.2 Mandibular Osteotomy Is Not Stable
64.4 Mandible-First Sequencing
64.4.1 Mandible-First Surgical Sequence
64.4.2 Scenarios in Which Mandible-First Sequencing Is Advantageous
64.4.2.1 Inaccurate Bite Registration or Discrepancy in Centric Relation and Centric Occlusion
64.4.2.2 Segmented Maxillae
64.4.2.3 Counterclockwise Rotation and Downgrafting of the Posterior Maxilla
64.4.2.4 Large Maxillomandibular Advancements
64.4.2.5 Anterior Open Bite Correction
64.4.2.6 Rigid Fixation of the Maxilla Versus Mandible
64.5 Concomitant TMJ Surgery Staging
64.6 Virtual Surgical Planning
64.6.1 Patient-Specific Implants
Conclusion
References
65: Concomitant Orthognathic and Temporomandibular Joint Surgery
65.1 Introduction
65.2 Indications
65.2.1 Idiopathic Condylar Resorption
65.2.2 Condylar Hyperplasia
65.2.3 Osteochondroma of the Mandibular Condyle
65.2.4 Autoimmune/Connective Tissue (CT) TMJ Diseases
65.2.5 Craniofacial Syndromes
65.2.6 TMJ Ankylosis
65.3 Clinical Scenarios Benefiting from Concomitant Surgery Procedures
65.3.1 TMJ Disk Repositioning Causing Malocclusion
65.3.2 Patient with TMJ Internal Derangement and a Coexisting Dentofacial Deformity
65.3.3 TMJ Arthroplasty (Osseous Condylar Procedures) and Concomitant Orthognathic Surgery
65.4 Expected Outcomes of Concomitant TMJ Disk Surgery and Orthognathic Surgery
65.5 Autogenous Versus Alloplastic TMJ Reconstruction in Concomitant Surgery
65.6 Diagnosis and Treatment Planning
65.6.1 General Patient Evaluation
65.6.2 Problem-Focused Specific Evaluation
65.6.3 Age for Surgical Intervention
65.7 Preoperative Considerations
65.8 Surgical Sequencing
65.9 Intraoperative Considerations
65.10 Postsurgical Management
65.11 Complications
65.12 Case Presentations
65.12.1 Active Condylar Resorption and Dentofacial Deformity (. Figs. 65.9 and 65.10)
65.12.2 TMJ Connective Tissue Disease and Dentofacial Deformity (. Fig. 65.11)
Conclusion
Bibliography
66: Facial Asymmetry
66.1 Etiology of Facial Asymmetry
66.2 Congenital Anomalies
66.2.1 Hemifacial Microsomia
66.3 Cleft Lip and Cleft Palate
66.3.1 Craniosynostosis: Plagiocephaly
66.3.2 Congenital Hemifacial Hyperplasia
66.4 Developmental Facial Asymmetries
66.4.1 Primary Growth Deformities
66.4.1.1 Facial Hemiatrophy
66.4.1.2 Hemimandibular Hyperplasia
66.4.2 Secondary Growth Deformities
66.5 Acquired Facial Asymmetries
66.5.1 Condylar Trauma
66.5.2 Juvenile Idiopathic Arthritis
66.5.3 Degenerative Joint Disease
66.6 Clinical Patient Assessment
66.6.1 Radiographic Assessment
66.6.1.1 Panoramic Radiograph
66.6.1.2 Posteroanterior Cephalometric Radiograph
66.6.1.3 Lateral Cephalometric Radiograph
66.6.2 Computed Tomography
66.6.3 Stereolithographic Modeling
66.6.4 Bone Scans
66.7 Surgical Treatment
66.7.1 Delayed Treatment
66.7.2 Orthodontic Considerations
66.7.3 Surgical Options
66.7.3.1 Facial Asymmetry Case Examples
Case 1
Case 2
Case 3
Case 4
Conclusion
References
67: Soft Tissue Changes and Prediction with Orthognathic Surgery
67.1 Introduction
67.2 General Soft Tissue Effects
67.3 Lateral Cephalometric Prediction (Manual and Computer Assisted)
67.3.1 Mandibular Surgery
67.3.1.1 Mandibular Advancement
67.3.1.2 Mandibular Setback
67.3.1.3 Genioplasty
67.3.2 Maxillary Surgery
67.3.2.1 Maxillary Advancement
67.3.2.2 Maxillary Impaction
67.3.2.3 Maxillary Setback
67.3.2.4 Bimaxillar Surgery
67.4 Photographic Prediction
67.4.1 Computerized Digital Video Imaging
67.4.1.1 Mandibular Advancement
67.4.1.2 Mandibular Setback
67.4.1.3 Bimaxillary Surgery
67.4.1.4 Maxillary Impaction
67.4.2 Three-Dimensional Computer-Assisted Prediction
67.4.2.1 Workup
67.4.2.2 Results
Conclusion
References
68: Complications in Orthognathic Surgery
68.1 Introduction
68.2 Hemorrhage: Acute and Delayed
68.2.1 Acute Maxillary Hemorrhage
68.2.2 Delayed Maxillary Hemorrhage
68.2.3 Mandibular Hemorrhage
68.2.4 Hemorrhage with Sagittal Split Osteotomy
68.2.5 Hemorrhage with Vertical Ramus Osteotomy
68.3 Vascular Compromises: Maxilla and Mandible
68.3.1 Vascular Compromise (Avascular Necrosis)
68.3.2 Nonunion of the Maxilla
68.3.3 Nonunion of the Mandible
68.4 Dental and Periodontal Injuries: Maxilla and Mandible
68.5 Fistula Formation
68.6 Infection
68.7 Nerve Injury: Sensory and Motor
68.7.1 Maxillary Sensory Injuries
68.7.2 Mandibular Sensory Injuries
68.7.2.1 Sagittal Split Osteotomy
68.7.2.2 VRO and Other Ramus Procedures
68.7.2.3 Motor Nerve Injury
68.8 Nasal and Paranasal Sinus Considerations
68.8.1 Alterations in Nasal Form: Septal Deviation
68.8.2 Alterations in Nasal Form: Internal Nasal Valve
68.8.3 Alterations in Nasal Form: Alar Base
68.8.4 Postoperative Sinus Disease
68.9 Unanticipated Mandibular Osteotomy Fractures
68.9.1 Management of bad Splits
68.9.2 Proximal Segment Buccal Plate Fracture, Partial
68.9.3 Proximal Segment Buccal Plate Fracture, Complete
68.9.4 Distal Segment Lingual Plate Fracture
68.10 Displacement of the Proximal VRO Segment
68.11 Proximal Segment Rotation
68.12 Unanticipated Maxillary Fractures
68.13 Postoperative Occlusal Discrepancies
68.13.1 Anterior Open Bite Malocclusions
68.14 Miscellaneous Complications
68.14.1 Epiphora
68.14.2 Auriculotemporal Syndrome
68.14.3 Facial Scars
68.14.4 Dysphagia
68.14.5 Salivary Gland Injuries
Conclusion
Reference and Further Reading
69: Cleft Orthognathic Surgery
69.1 Cleft Distraction Osteogenesis
69.2 Postsurgical Considerations
69.2.1 Velopharyngeal Considerations
References
70: Distraction Osteogenesis of the Craniomaxillofacial Skeleton
70.1 Introduction
70.2 History of DO
70.3 Biological Basis of DO
70.4 Overview of Risk of DO
70.5 Principles of DO
70.6 Patient Evaluation and Vector Planning
70.7 Orthodontics for Craniomaxillofacial DO
70.8 Mandibular Distraction
70.9 Maxillary Distraction (Le Fort I Level)
70.10 Midface Distraction (Le Fort II, III, Monobloc and Facial Bipartition)
70.11 DO for Craniosynostosis
70.12 Alveolar Ridge Distraction
70.13 The Future of  Craniomaxillofacial DO
Conclusion
References
Suggested Readings
71: Surgical and Nonsurgical Manssagement of Obstructive Sleep Apnea
71.1 History
71.2 Normal Sleep Stages
71.3 Sleep Apnea Syndrome
71.3.1 Classification
71.3.2 Differential Diagnosis
71.3.3 History of OSA Syndrome
71.3.4 Clinical Manifestations
71.3.5 Physical Findings
71.4 Diagnosis
71.4.1 Physical Examination
71.4.2 Cephalometric Examination
71.4.3 Computed Tomography
71.4.4 Polysomnography
71.4.5 Site of Obstruction
71.5 Medical Treatment
71.5.1 Oral Appliances
71.5.2 Continuous Positive Airway Pressure
71.6 Surgical Treatment
71.6.1 Tracheostomy
71.6.2 Nasal Surgery
71.6.3 Uvulopalatopharyngoplasty
71.6.4 Laser-Assisted Uvulopalatoplasty
71.6.5 Uvulopalatal Flap
71.6.6 Tongue Surgery
71.6.7 Orthognathic Surgery Procedures
71.6.8 Mandibular Advancement
71.6.9 Genial Tubercle Advancement
71.6.10 Genial Advancement with Hyoid Myotomy and Suspension
71.6.11 Maxillomandibular Advancement
71.6.12 Mandibular Setbacks
71.7 Complications
71.8 Summary
References
VIII: Facial Esthetic Surgery
72: Blepharoplasty
72.1 Introduction
72.2 Nomenclature
72.3 Anatomy
72.3.1 Anterior Lamella
72.3.2 Middle Lamella
72.3.3 Posterior Lamella
72.4 Innervation and Blood Supply
72.5 Lacrimal System
72.6 Patient Evaluation
72.7 Surgical Procedures
72.8 Postoperative Care
72.9 Complications and Management
Conclusion
References
73: Basic Principles of Rhinoplasty
73.1 Introduction
73.1.1 Nasal Anatomy
73.1.2 Surface Anatomy
73.1.3 Skin and Soft Tissue
Box 73.1 Surface anatomy of the nose
73.1.4 Superficial Musculoaponeurotic System and Nasal Musculature
73.1.5 Blood Supply
73.1.6 Bone and Cartilage
73.1.7 Nerves
73.1.8 Nasal Valve
Box 73.2 Tip support mechanisms
73.2 Cosmetic Evaluation
73.2.1 Psychiatric Stability
73.2.2 General Facial Analysis
73.2.3 Nasal Analysis
73.3 General Assessment
73.3.1 Skin
73.3.2 Symmetry
73.3.2.1 Lateral View
Nasofrontal Angle
Nasal Dorsum
Nasal Tip Definition
Nasal Tip Projection
Nasal Tip Rotation
Tip Support
73.3.2.2 Frontal View
Width of Nasal Dorsum
Alar Width
73.3.2.3 Basal View
73.3.2.4 Oblique View
73.3.3 Functional Considerations
73.3.4 Photographs
73.4 Anesthesia
73.5 Incisions/Sequencing
73.5.1 Complete Transfixion
73.5.2 Partial Transfixion
73.5.3 Hemitransfixion
73.5.4 Killian Incision
73.5.5 Intercartilaginous Incision
73.5.6 Intracartilaginous Incision
73.5.7 Rim/Marginal Incision
73.5.8 Transcolumellar Incision
73.6 Septoplasty
Box 73.3 Surgical sequence for endonasal rhinoplasty
Box 73.4 Surgical sequence for external rhinoplasty
73.7 Turbinectomy
73.8 Nasal Dorsum
73.8.1 Reduction
73.8.2 Augmentation
73.8.2.1 Autogenous Augmentation
73.8.2.2 Alloplastic Augmentation
73.8.3 Osteotomies
73.9 Nasal Tip
73.9.1 Tip Projection
73.9.1.1 Increasing Tip Projection
73.9.1.2 Decreasing Tip Projection
73.9.2 Tip Rotation
73.9.2.1 Increasing Tip Rotation
73.9.2.2 Decreasing Tip Rotation
73.9.3 Tip Shape
73.10 Nasal Base Alar Reduction
73.11 Postoperative Management
Conclusion
References
74: Rhytidectomy
74.1 Introduction
74.2 History
Box 74.1 Generations of rhytidectomy
74.3 Patient Evaluation
74.4 Surgical Technique
74.4.1 Flap Development
74.4.2 Skin Closure
74.5 Complications
Conclusion
Appendix Postoperative Rhytidectomy Instructions
Immediately upon Arriving Home
One Day or More After Surgery
Please Report Any of the Following to Our Office
References
75: Forehead and Brow Procedures
75.1 Anatomic and Aesthetic Considerations
75.2 Bony Landmarks
75.3 Muscle and Fascial Anatomy
75.4 Vessel and Nerve Anatomy
75.4.1 Forehead Dissection
75.5 Preoperative Evaluation and  Surgical Preparation
75.6 Coronal Forehead and Brow Lift
75.7 Trichophytic or Pretrichial Forehead and Brow Lift
75.8 Endoscopic Forehead and Brow Lift
75.9 Temporal Lift
75.10 Direct Brow Lift
75.11 Midforehead and Brow Lift
75.12 Transpalpebral and Other Local Brow Procedures
75.13 Botulinum Toxin–Assisted Brow Lift
75.14 Adjunctive Procedures: Skin Care and Micropigmentation
75.15 Postoperative Care
75.16 Complications
Summary and Conclusions
References
76: Otoplastic Surgery for the Protruding Ear
76.1 Embryology of the Auricle
76.2 Surgical Anatomy
76.3 Blood Supply
76.4 Nerve Supply
76.5 Deformities
76.6 Protruding Ear
76.7 Surgical Correction
76.8 Surgical Techniques
76.9 Davis Method
76.10 Mustarde Method
76.11 Correction of the Protruding Earlobe
76.12 Complications
76.13 Hematoma
76.14 Perichondritis
76.15 Keloid and Hypertrophic Scar Formation
76.16 Aesthetic Complications
76.17 Telephone Ear Deformity
76.18 Scapha Buckling
76.19 Narrowed Meatus
76.20 Summary
References
77: Adjunctive Facial Cosmetic Procedures
77.1 Introduction
77.2 Facial Evaluation
77.3 Neuromodulators
77.3.1 Injectable Facial Fillers
77.4 Fat Transfer
77.5 Patient Selection
77.6 Harvesting
77.7 Fat Transfer Procedure
Case Presentation
77.8 Facial Implants
77.9 Surgical Lip Lift
77.10 Skin Resurfacing
Conclusion
References and Further Reading
Index