Cosmetic surgery of the lips and facial rejuvenation
1
S205 Management of Neonatal and Pediatric Airway Obstruction: Treatment with Distraction Osteogenesis Kevin Smith, DDS, Oklahoma City, OK The use of distraction osteogenesis (DO) for the suc- cessful treatment of obstructive sleep apnea in the pedi- atric population has been reported by multiple authors over the last several years. The focus of this clinic will be to review the diagnosis and treatment modalities for neonates and children with airway obstruction. The clinician for this course has treated children and neonates with DO over the last 7 years and will present the techniques, pitfalls, and out- comes of his experience. The use and long-term outcomes of DO and other airway-changing surgery will be discussed. References Smith KS, Harnish M: Pediatric sleep apnea treated with distraction osteogenesis, in Craniofacial Distraction Osteogenesis. St Louis, MO, Mosby, 2001, chap 21 William JK, et al: Early decanulation with bilateral mandibular dis- traction for tracheostomy dependent patients. PRS 103:48, 1999 S206 Cosmetic Surgery of the Lips and Facial Rejuvenation Richard Joseph, DMD, Jacksonville, FL Cosmetic surgery to rejuvenate the aging face, including surgical procedures to augment the lips, will be discussed. Oral and maxillofacial surgeons are in a unique position to evaluate and manage patients seeking facial rejuvenation and cosmetic treatment. Facial cosmetic surgery represents a natural extension and a complement to our orthognathic skills. Most of our treatment decisions regarding orthog- nathic procedures are predicated on existing facial aes- thetic norms and cephalometric analysis. The oral and maxillofacial surgeon is also able to provide aesthetic ser- vices on a routine basis in an outpatient setting using local anesthesia with intravenous sedation. There are a number of methods and techniques used to augment, recontour, or rejuvenate the lips and the face. 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, operative technique, and postoperative management as- sociated with the procedures. This presentation is in- tended to be an introduction and brief overview of procedures used in my practice that can easily be incor- porated into the practice of most oral and maxillofacial surgeons. References Tobin HA, Karas ND: Lip augmentation using alloderm graft. J Oral Maxillofac Surg 56:6, 1998 Faivre J: Surgical treatment of aging of the orolabial region. Am J Cosmetic Surg 8:1, 1991 Binder W: Submalar augmentation: An alternative to face lift surgery. Arch Otolaryngol Head Neck Surg 115, 1989 S207 Oral Appliances and Hypomandibular Surgery in the Treatment of Snoring and Obstructive Sleep Apnea David C. Stanton, DMD, MD, Philadelphia, PA Patients with primary snoring and/or obstructive sleep apnea frequently fail to respond to or are not appropri- ate candidates for behavior measures such as weight loss or change in sleep position. Frequently those individuals also cannot tolerate or refuse treatment with nasal CPAP. Therefore, many types of oral appliances have been used successfully to move the base of the tongue forward in order to enlarge the upper airway. Despite considerable variation of the design of these appliances, the positive clinical effects have been remarkably consistent. The American Sleep Disorders Association review in 1995 concluded that, in patients studied, the mean ap- nea/hypopnea index (AHI) was reduced from 47 to 19, with approximately half of the patients treated achieving an AHI of less than 10. Overall compliance seemed significantly higher than nasal CPAP. As a result, they produced practice parameters for the treatment of snor- ing and obstructive sleep apnea with oral appliances. For those treating obstructive sleep apnea and upper airway resistance syndrome, oral appliances offer a rea- sonable nonsurgical approach and/or presurgical evalu- ation tool for a variety of patients. Oral and maxillofacial surgeons working in conjunction with other sleep spe- cialists are uniquely trained to offer this service. Since all conservative medical measures used to man- age snoring and sleep disordered breathing, including CPAP, BiPAP, demand positive airway pressure, oral ap- pliances, and weight loss, etc., have limitations such as patient tolerance and patient compliance, combined sur- gical procedures offer encouraging results in the treat- ment of patients with moderate to severe obstructive sleep apnea, Although maxillomandibular osteotomy ap- pears to offer impressive success rates, consent for such surgery is mediated by patient acceptance, the severity of symptoms, and the level of upper airway collapse. Since no single surgical procedure, except tracheostomy, consis- Surgical Clinics 112 AAOMS • 2003
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Transcript of Cosmetic surgery of the lips and facial rejuvenation
S205Management of Neonatal and PediatricAirway Obstruction: Treatment withDistraction OsteogenesisKevin Smith, DDS, Oklahoma City, OK
The use of distraction osteogenesis (DO) for the suc-cessful treatment of obstructive sleep apnea in the pedi-atric population has been reported by multiple authorsover the last several years.
The focus of this clinic will be to review the diagnosisand treatment modalities for neonates and children withairway obstruction. The clinician for this course hastreated children and neonates with DO over the last 7years and will present the techniques, pitfalls, and out-comes of his experience.
The use and long-term outcomes of DO and otherairway-changing surgery will be discussed.
References
Smith KS, Harnish M: Pediatric sleep apnea treated with distractionosteogenesis, in Craniofacial Distraction Osteogenesis. St Louis, MO,Mosby, 2001, chap 21
William JK, et al: Early decanulation with bilateral mandibular dis-traction for tracheostomy dependent patients. PRS 103:48, 1999
S206Cosmetic Surgery of the Lips and FacialRejuvenationRichard Joseph, DMD, Jacksonville, FL
Cosmetic surgery to rejuvenate the aging face, includingsurgical procedures to augment the lips, will be discussed.Oral and maxillofacial surgeons are in a unique position toevaluate and manage patients seeking facial rejuvenationand cosmetic treatment. Facial cosmetic surgery representsa natural extension and a complement to our orthognathicskills. Most of our treatment decisions regarding orthog-nathic procedures are predicated on existing facial aes-thetic norms and cephalometric analysis. The oral andmaxillofacial surgeon is also able to provide aesthetic ser-vices on a routine basis in an outpatient setting using localanesthesia with intravenous 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,operative technique, and postoperative management as-sociated with the procedures. This presentation is in-tended to be an introduction and brief overview ofprocedures used in my practice that can easily be incor-
porated into the practice of most oral and maxillofacialsurgeons.
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 JCosmetic Surg 8:1, 1991
Binder W: Submalar augmentation: An alternative to face lift surgery.Arch Otolaryngol Head Neck Surg 115, 1989
S207Oral Appliances and HypomandibularSurgery in the Treatment of Snoring andObstructive Sleep ApneaDavid C. Stanton, DMD, MD, Philadelphia, PA
Patients with primary snoring and/or obstructive sleepapnea frequently fail to respond to or are not appropri-ate candidates for behavior measures such as weight lossor change in sleep position. Frequently those individualsalso cannot tolerate or refuse treatment with nasal CPAP.Therefore, many types of oral appliances have been usedsuccessfully to move the base of the tongue forward inorder to enlarge the upper airway. Despite considerablevariation of the design of these appliances, the positiveclinical effects have been remarkably consistent.
The American Sleep Disorders Association review in1995 concluded that, in patients studied, the mean ap-nea/hypopnea index (AHI) was reduced from 47 to 19,with approximately half of the patients treated achievingan AHI of less than 10. Overall compliance seemedsignificantly higher than nasal CPAP. As a result, theyproduced practice parameters for the treatment of snor-ing and obstructive sleep apnea with oral appliances.
For those treating obstructive sleep apnea and upperairway resistance syndrome, oral appliances offer a rea-sonable nonsurgical approach and/or presurgical evalu-ation tool for a variety of patients. Oral and maxillofacialsurgeons working in conjunction with other sleep spe-cialists are uniquely trained to offer this service.
Since all conservative medical measures used to man-age snoring and sleep disordered breathing, includingCPAP, BiPAP, demand positive airway pressure, oral ap-pliances, and weight loss, etc., have limitations such aspatient tolerance and patient compliance, combined sur-gical procedures offer encouraging results in the treat-ment of patients with moderate to severe obstructivesleep apnea, Although maxillomandibular osteotomy ap-pears to offer impressive success rates, consent for suchsurgery is mediated by patient acceptance, the severityof symptoms, and the level of upper airway collapse. Sinceno single surgical procedure, except tracheostomy, consis-
Surgical Clinics
112 AAOMS • 2003
