S103Cosmetic Surgery of the Lips and FacialRejuvenationRichard W. Joseph, DMD, Jacksonville, FL

Cosmetic surgery to rejuvenate the aging face includ-ing surgical procedures to augment and rejuvenate thelips, will be discussed. Oral and maxillofacial surgeonsare in a unique position to evaluate and manage patientsseeking facial rejuvenation and cosmetic treatment. Fa-cial cosmetic surgery represents a natural extension anda complement to our orthognathic skills. Most of ourtreatment decisions regarding orthognathic proceduresare predicated on existing facial esthetic norms andcephalometric analysis. The oral and maxillofacial sur-geon is also able to provide esthetic services on a routinebasis in an outpatient setting using local anesthesia withintravenous sedation.

There are a number of methods and techniques usedto augment, recontour, or rejuvenate the lips and theface. These include implantation of alloplastic materials,grafting of autologous tissues, and recontouring of adja-cent hard and soft tissues. We will discuss patient selec-tion, augmentation materials, anesthetic technique, op-erative technique, and postoperative management asso-ciated with the procedures. This presentation isintended to be an introduction and brief overview ofprocedures utilized in my practice that can easily beincorporated into the practice of most oral and maxillo-facial surgeons.

References

Tobin HA, Karas ND: Lip augmentation using Alloderm graft. J OralMaxillofac Surg 56:6, 1998

Faivre J: Surgical treatment of aging of the orolabial region. Am JCosmet Surg 8:141, 1991

Coleman S: Facial recontouring with lipostructure. Clin Plast SurgFac Cosmet Surg 24:347, 1997

Greenwald A: The lip lift: Cheilopexy for cheiloptosis. Am J CosmetSurg 2:16, 1985

Austin H: The lip lift. Plast Reconstr Surg 77:990, 1986Jeter TS, Nishioka GJ: The lip lift: An alternative corrective proce-

dure. J Oral Maxillofac Surg 46:323, 1988

S104Microsurgical Repair of TrigeminalNerve InjuriesVincent B. Ziccardi, DDS, MD, Newark, NJ

Sensory disturbances to the peripheral branches of thetrigeminal nerve can create a devastating disruption topatients. This can lead to problems with speech, masti-cation, food and liquid incompetence, and difficultywith public interaction. These injuries can arise from a

number of causes in oral and maxillofacial surgery. Themost common cause of trigeminal nerve injury in oraland maxillofacial surgery results from the removal ofimpacted teeth. There are a multitude of other causesincluding osteotomies, endodontic surgery, implantplacement, fractures, pre prosthetic surgery, and treat-ment of maxillofacial pathology.

Some of the etiological factors for trigeminal nerveinjury such as trauma are unpreventable; however, moreprecise surgical techniques and better imaging modali-ties may help reduce the incidence of these injuries.Injuries to the trigeminal nerve branches are a knownand accepted risk in oral and maxillofacial surgery. It isimportant for practitioners to explain these risks to pa-tients as part of the informed consent process and torecognize and document the presence of nerve injuries.Patients must be treated in a timely fashion or referred topractitioners skilled in microsurgical techniques for op-timal sensory improvement. This surgical clinic shallreview the etiologies of trigeminal nerve injury, neuro-sensory testing and documentation, classificationschemes, indications for treatment and referral, micro-surgical techniques, and outcome assessments.

References

Meyer RA: Applications of microneurosurgery to the repair of tri-geminal nerve injuries. Oral Maxillofac Surg Clin North Am 4:405, 1992

Sandstedt P, Sorensen S: Neurosensory disturbances of the trigemi-nal nerve: A long-term follow-up of traumatic injuries. J Oral MaxillofacSurg 53:498, 1995

Zuniga JR, LaBanc JP: Advances in microsurgical nerve repair. J OralMaxillofac Surg 51:62, 1993

S105Management of Mandibular CondyleFracturesDennis-Duke Yamashita, DDS, Los Angeles, CABach Le, DDS, MD, Whittier, CA

Mandibular condyle fractures account for 25% to 35%of all mandibular fractures. The treatment of this fracturehas generated more discussion than any other topic infacial trauma. Most are treated with relatively simplemethods. This has led to the misconception that condy-lar fractures are less complex. Because of the potentialfor long-term morbidity and because the principles fortreating fractures in this area vary widely from thoseused to treat other areas of the mandible, special con-siderations must be given to condylar fractures. In addi-tion, controversy continues to surround the manage-ment of these injuries. This course will attempt to out-line a reasonable course of management for patientswith injuries to the condylar apparatus, with special

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emphasis on the surgical approaches that offer safe andreliable outcome to management of condylar fractures.

References

Ellis EE, Dean J: Rigid fixation of mandibular condyle fractures. OralSurg Oral Med Oral Pathol 76:6, 1993

Le BT: A minimally invasive approach for open treatment of man-dibular condyle fractures. J Oral Maxillofac Surg 59:94, 2001 (suppl)

Sorel B: Open versus closed reduction of mandible fractures. OralMaxillofac Surg Clin North Am 10:541, 1998

S106Management of Salivary Gland DisordersBrian L. Schmidt, DDS, MD, PhD, San Francisco, CAR. Bryan Bell, DDS, MD, Portland, OR

The practicing oral and maxillofacial surgeon rou-tinely sees and is referred patients with salivary glanddisorders ranging from infections to neoplasms. Manage-ment of salivary gland disorders tests all of the oral andmaxillofacial surgeon’s clinical, diagnostic, and surgicalskills. The goal of this course is to review contemporarytechniques for diagnosing and managing salivary glanddisorders.

Salivary gland neoplasms vary widely in their presen-tation and clinical behavior. A clear understanding oftumor behavior, imaging, and presurgical planning arefundamental for successful management of salivary glandneoplasms. The histologic types, incidence, and manage-ment of minor and major salivary gland neoplasms, bothbenign and malignant, will be reviewed in this course.Contemporary imaging techniques for salivary glandneoplasms will also be reviewed. Surgical managementand reconstructive options, ranging from an obturator tolocal flaps, will be presented in the context of clinicalcases. Management of salivary gland infections and sialo-lithiasis can be frustrating for both patients and practi-tioners. Surgical and non-surgical management of sali-vary gland infections and stones will be reviewed.

In this course the practitioner will learn the fundamen-tals of the diagnosis and management of salivary glanddisorders. The available diagnostic and surgical tech-niques will be discussed from a clinical standpoint withthe use of illustrative clinical cases.

References

Ord RA: Surgical management of parotid tumors. Oral MaxillofacSurg Clin 7:529, 1995

Pogrel MA: The diagnosis and management of tumors of the sub-mandibular and sublingual salivary glands. Oral Maxillofac Surg Clin7:565, 1995

Carlson ER, Schimmele SR: The management of minor salivary glandtumors of the oral cavity. Atlas Oral Maxillofac Surg Clin 6:75, 1998

S107Management of Facial Skin CancersJonathan S. Bailey, DMD, MD, Urbana, IL

Skin cancer is the most common malignancy in hu-mans, accounting for over 1,000,000 cases/year. Leftuntreated, these lesions may become locally destructiveand have the potential for metastatic spread. As oral andmaxillofacial surgeons, we have the opportunity to eval-uate, diagnose, and treat patients presenting with facialskin cancers.

Basal cell carcinoma and squamous cell carcinoma arethe most common non-melanotic cutaneous neoplasms.Malignant melanoma is an aggressive cutaneous neo-plasm whose incidence continues to increase dramati-cally. Other premalignant lesions such as actinic kerato-sis and dysplastic nevi may also be treated by the oraland maxillofacial surgeon.

Diagnosis of facial skin cancer is accomplished withmultiple techniques including shave biopsy, incisionalbiopsy, or excisional biopsy. Each technique has itsindications, advantages, and potential disadvantages.

The primary treatment of facial skin cancer is surgicalexcision. The histologic subtype dictates surgical mar-gins. Other treatment modalities such as cryotherapy,topical chemotherapy, and rarely radiation therapy mayalso be indicated. Management of cutaneous neoplasmslocated within each facial subunit has its own surgicalimplications. A thorough understanding of regional anat-omy is paramount. Maxillofacial dermatologic surgerymust be based upon sound oncologic principles, yetpreserve the available reconstructive options.

Oral and maxillofacial surgeons are intimately familiarwith the regional anatomy and available reconstructivetechniques. Therefore, we are uniquely qualified to treatpatients with facial skin cancers. This offers our patientsan invaluable service and enriches the diversity of ourspecialty.

References

Cancer Facts and Figures 2003. American Cancer SocietyPadgett J, Hendrix J: Otolaryngol Clin North Am 34:523, 2001Habif TP: Skin Disease: Diagnosis and Treatment. St Louis, MO,

Mosby, 2001

S108Anatomy and Surgical Therapy of Oraland Maxillofacial InfectionsThomas R. Flynn, DMD, Boston, MA

The principles of the management of deep space headand neck infections include early and rapid assessmentof the severity of the infection by anatomic location, rateof progression, and the potential for airway compro-

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