endosteal implant ranging from 30 mm to 52.5 mm inlength. The implant is introduced in the second premo-lar area, traversing the maxillary sinus, and is fixated intothe body of the zygomatic bone. Placement of a mini-mum of 2 premaxillary implants in the canine position orideally 4 premaxillary implants in the canine and thecentral incisor positions, allows for the fabrication offixed hybrid prostheses.

References

Bedrossian E: J Prosthet Dent 86, 2001Bedrossian E: Int J Oral Maxillofac Implants, December 2002

S320Tracheotomy A-ZThomas Teenier, DDS, MD, Campus Christi, TXEric Dierks, DMD, MD, Portland, ORJames Eyre, DMD, MD, Salem, OR

(no abstract provided)

S321Craniosynostosis and CraniofacialDysostosis: Diagnosis and SurgicalManagementRamon Ruiz, DMD, MD, Chapel Hill, NCBernard Costello, DMD, MD, Pittsburgh, PA

Craniosynostosis is defined as the premature fusion orabsence of 1 or more of the cranial vault sutures and isassociated with clinically significant neurologic and mor-phologic consequences. Growth is arrested perpendicu-lar to the fused suture and a compensatory overgrowthoccurs across the sutures that remain open. The result isa characteristic craniofacial dysmorphology and lack ofcranial vault growth that restricts the growing brain.Management of craniosynostosis requires release of theinvolved suture(s) combined with the dismantling andreconstruction of the dysmorphic skeletal components.Plagiocephaly resulting from postnatal external deforma-tional forces (benign positional skull molding) is gener-ally not associated with any functional neurologic prob-lems and is not a surgical problem.

The craniofacial dysostosis syndromes (Crouzon, Ap-ert, Carpenter, Saethre-Chotzen, Pfieffer) are familialforms of craniosynostosis in which there is involvementof the midfacial sutures. Successful correction of thefacial anomalies seen in these syndromic conditions re-quires multiple, carefully sequenced stages of surgicalreconstruction. Initially, release of the synostosis withreshaping of the cranial vault is undertaken. A secondstage of reconstruction centers around the managementof the total orbital/midfacial deficiency during child-hood. The decision regarding what type of osteotomy

(subcranial Le Fort III versus monobloc advancement) iscarried out must be based on the specific skeletal dys-morphology and the anteroposterior position and con-tour of the fronto-orbital region. As the child approachesskeletal maturity, definitive orthognathic surgical proce-dures are often required in order to finalize occlusalrelationships.

This surgical clinic will provide course participantswith exposure to the evaluation and management (sur-gical and nonsurgical) of infants with plagiocephaly.Specific clinical findings, radiographic studies, and cur-rent operative techniques will be covered with detailedcase-based examples. In addition, the rationale and spe-cific surgical procedures involved in a staged reconstruc-tive approach to the craniofacial dysostosis syndromeswill be discussed.

References

Posnick JC: Craniofacial and Maxillofacial Surgery in Children andYoung Adults. Philadelphia, PA, Saunders, 2000

Turvey TA, Ruiz RL: Craniosynostosis and craniofacial dysostosis, inFonseca RJ (ed): Oral and Maxillofacial Surgery. Philadelphia, PA,Saunders, 2001

Posnick JC, Ruiz RL: The craniofacial dysostosis syndromes: Currentsurgical thinking and future directions. Cleft Palate Craniofac J 37:434,2000

S401Diagnosis and Management ofTrigeminal Nerve DisordersMichael Miloro, DMD, MD, Omaha, NE

Injuries to the terminal branches of the trigeminalnerve may occur commonly after a variety of routineprocedures performed by the oral and maxillofacial sur-geon. Nerve damage constitutes a large proportion ofthe medicolegal matters facing surgeons today. Mostcommonly, third molar surgery is responsible for a ma-jority of injuries to both the inferior alveolar and lingualnerves. The reported incidence of nerve injury variesdepending on the literature cited, but generally, bothtemporary and permanent paresthesia must be consid-ered. Nerve injury may occur after orthognathic surgery,and maxillofacial trauma, and with the current increas-ing trends in implant placement in the mandible, theinferior alveolar nerve is further subject to potentialtrauma. The anatomy of the trigeminal nerve system isunique, since it carries, in some branches, both generalsensory information as well as special sensation (ie,taste). Injury to the nerve may result in neuroma forma-tion, which can present in a variety of forms. Nerveinjuries are classified by 2 popular classificationschemes, which are based on the likelihood of an injurednerve to recover spontaneously. A basic understandingof normal nerve wound healing is essential in order tomost appropriately manage clinical situations.

Surgical Clinics

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