as well as the short- and long-term results will be dis-cussed.

References

Baker SR, Swanson NA: Local Flaps in Facial Reconstruction. StLouis, MO, Mosby, 1995

Jackson IT: Local Flaps in Head and Neck Reconstruction. St Louis,MO, Mosby, 1985

Urken ML, Cheney ML, Sullivan MJ, et al: Atlas of Regional and FreeFlaps for Head and Neck Reconstruction. New York, NY, Raven Press,1995

S309Pediatric SedationJeffrey Bennett, DMD, Farmington, CT

(no abstract provided)

S310Midfacial Traumatic SkeletalReconstructionGregory Lutcavage, DDS, Goldsboro, NCJuan Lopez, DDS, DMD, Goldsboro, NC

Midfacial fracture management has undergone a dra-matic transformation during the past 2 decades with theincorporation of craniofacial surgical access approachesand low-profile rigid fixation.

Historically, midfacial osseous trauma was treatedthrough utilization of a variety of local surgical ap-proaches and stabilization instrumentation, which in-cluded Kirschner wires, Steinmann pins, wire osteosyn-thesis, and external head frames. Each served its purposein its day, but inherent deficiencies were apparent withsome of these techniques, not the least of which wasosseous settling and compromised soft tissue draping.

With a thorough understanding of the surgical anat-omy and available craniofacial pillars to support fixationdevices, a treatment methodology can be employed thatwill preserve the anatomical height, width, and projec-tion of the midfacial structures. This is enhanced by theunparalleled surgical exposure gained through craniofa-cial approaches, particularly the coronal flap. Addition-ally, the surgeon has the ability to use a variety of tissueflaps for barrier isolation through a single approach inselected cases.

In this clinic, a treatment philosophy and managementprotocol will be presented incorporating these princi-ples.

References

Manson PN, Clark N, et al: Comprehensive management of pan-facialfractures. J Craniomaxillofac Trauma 1:43, 1995

Alvi A, Carrau RL: The bicoronal flap approach in craniofacialtrauma. J Craniomaxillofac Trauma 2:40, 1996

Haug RH, Cunningham LL: Management of fractures of the frontalbone and frontal sinus. Selected Readings Oral Maxillofac Surg 10:6,2002

S311Maxillary Reconstruction WithZygomatic ImplantsTimothy Welch, MD, DDS, Eugene, OR

Prosthetic reconstruction of the extremely atrophicmaxilla continues to be a challenge. A myriad of proce-dures as complex as composite bone grafting with LeFort osteotomy to as simple as sinus bone augmentationhave various degrees of success. These procedures re-quire a separate surgery and often months of healingprior to implant placement.

A successful alternative to these staged proceduresinvolves the zygomatic implant developed by Branemarkin 1988. It is a titanium endosteal implant ranging from30 to 52.5 mm in length. The apical two thirds of theimplant is 4 mm in diameter, and the alveolar third is 5mm in diameter. The implant is started in the premolarregion and traverses the maxillary sinus, and the apex ofthe implant embeds firmly into the body of the zygoma.Bilateral placement of this implant coupled with 2 to 4conventional implants in the anterior maxilla enable acomplete fixed prosthesis to be fabricated after onesurgery.

This clinic will concentrate on the practitioner’s ex-perience in the placement of his first 20 zygomaticimplants in an office practice. It is intended for thosewith limited zygomatic experience or just consideringthe procedure. Other topics will include the character-istics of an ideal first case and the details of the surgicalprocedure that will facilitate successful completion.

References

Boyne PJ, James RA: Grafting of the maxillary sinus floor withautogenous marrow and bone. J Oral Surg 38:613, 1980

Bedrossian E, et al: The zygomatic implant. Int J Oral MaxillofacImplants 17:861, 2002

S312Surgical and Restorative Challenges ofthe Severely Atrophic MaxillaJack Zosky, DDS, FRCD(C), FICD, Toronto, Ontario,Canada

Alveolar and basal bone can be lost for a variety ofreasons. These include advanced periodontitis, trauma,infection, and physiologic disuse atrophy. The degree ofresorption varies from patient to patient, and there isusually a different pattern to the resorption in the max-illa compared with the mandible. In the mandible, the

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