and effective long-term management modality in a pa-tient population with the conditions listed above.

References

Mercuri LG, Wolford LM, Sanders B, et al: Custom CAD/CAM Totaltemporomandibular Joint Reconstruction System: Preliminary multi-center report. J Oral Maxillofac Surg 53:106, 1995

Mercuri LG: The TMJ Concepts Patient Fitted Total Temporoman-dibular Joint Reconstruction Prosthesis. Oral Maxillofac Surg ClinNorth Am 12:73, 2000

Mercuri LG, Wolford LM, Sanders B, et al: Long-term follow-up of theCAD/CAM total temporomandibular joint reconstruction system. J OralMaxillofac Surg 60:1440, 2002

S110Rotation of the MaxillomandibularComplex (alteration of the occlusalplane): Indications, Treatment Planning,and Treatment OutcomesJohan P. Reyneke, MChD, FCMFOS(SA), Rivonia, SouthAfrica

Introduction: The principle of rotation of the maxillo-mandibular complex (MMC) as orthognathic treatmentdesign is not always fully understood. This surgical de-sign is used in cases where the desired aesthetic resultscannot be achieved by conventional treatment designs.

Indications: The indications for this alternative surgicaltreatment design will be discussed by using clinical examples.

Geometry: The geometry of rotations of the MMC inall 3 dimensions (clockwise and counterclockwise in asagittal plane, as well as transverse and coronal rota-tions) and the expected soft tissue results will be dis-cussed. The importance of selecting the correct pointaround which the MMC should be rotated for specificcases with the focus on development of a visual treat-ment objective will be demonstrated.

Clinical cases: Cases demonstrating the importance ofrotation point and direction of rotation will be presented.

References

Reyneke JP, Evans WG: Surgical manipulation of the occlusal plane.Int J Adult Orthod Orthognath Surg 5:99, 1990

Reyneke JP: Surgical manipulation of the occlusal plane: New con-cepts in geometry. Int J Adult Orthod Orthognath Surg 13:307, 1998

Reyneke JP: Surgical cephalometric prediction tracing for the alter-ation of the occlusal plane by means of rotation of the maxilloman-dibular momplex. Int J Adult Orthod Orthognath Surg 14:55, 1999

S111Drug-Drug Interactions andPharmacology Update: Important for theOral and Maxillofacial SurgeonJeffrey Bennett, DMD, Farmington, CT

(no abstract provided)

S112The 3 Bs of Upper Face Rejuvenation:Blepharoplasty, Browlifting, andBotulinumSteven Guttenberg, DDS, MD, Washington, DC

Ptosis of the upper-face soft tissues can lead to theappearance of aging, which is easily noticed by ourpatients and their peers. Rejuvenation of this facial thirdis relatively straightforward and can lead to dramtic im-provement of the maturing visage.

After one has evaluated the patient and arrived at adiagnosis, there are several office-based, outpatient pro-cedures that can be used to correct the defect(s). Injec-tion of Clostridium botulinum toxin type A to weakenperiorbital depressor muscle contractions can diminishwrinkles and frown lines and may even raise the browsuperiorly. Use of this neurotoxin complex is a quickand facile method to renew the upper facial third.

Chronologic aging, ultraviolet radiation, and genetic andenvironmental factors can lead to the descent of periorbitaland intraorbital fat, which contributes to an unaestheticappearance. Upper and lower blepharoplastic proceduresto correct this baggy eyelid deformity can aid greatly incosmetic improvement of this facial zone. Use of the car-bon dioxide laser to perform the procedures results invirtually bloodless operations and minimizes postoperativecomplications. The laser can also be used for resurfacingthe upper eyelids and the lower eyelid skin in conjunctionwith transconjunctival blepharoplasties, eliminating or di-minishing wrinkles while mitigating the risks of postoper-ative scleral show or ectropion.

In patients in whom there is lowering of the eyebrowsbelow the superior orbital rim, brow/forehead lifting is atechnique that has gained popularity. Much of the reluc-tance of patients to undergo this procedure has been di-minished by virtue of an advancement in technology. Spe-cifically, use of the endoscope with small, hidden incisionshas all but replaced the previously used “ear-to-ear” hairlineincisions. Patient acceptance has increased, results haveimproved, and morbidity has diminished.

The use of these aforementioned procedures, alone or incombination, has significantly helped oral and maxillofacialsurgeons to improve the facial cosmesis of their patients.

S201Treatment of Facial Skin LesionsMichael F. Zide, DMD, Fort Worth, TX

Skin cancer can be part of any practice that treatspatients over age 35. Approximately 1 million new casesare diagnosed per year in the United States alone.

This talk will discuss which patients are most suscep-

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tible as well as provide a simple yet formal method toincorporate skin cancer into the daily practice.

The talk will highlight the 4 critical aspects of care:1. Patient evaluation2. Lesion therapy3. Defect reconstruction4. Appropriate follow-up

Patient evaluation will be discussed in light of medicaland social problems and how they influence care.

A simple biopsy method will be shown. Lesion ther-apy will provide a delayed method that will eliminatefear of the deep margin as well as fear that the defect willprogress beyond surgical capabilities.

Decision making will show how one chooses an ap-propriate reconstructive method—secondary epithelial-ization graft or flap. The methods of harnessing the fullcapabilities of the adjacent akin will be discussed, includ-ing inherent extensibility, mechanical creep, and biolog-ical creep.

References

Zide MF: Treatment decisions for skin cancer of the head and neck.Selected Readings Oral Maxillofac Surg 8, 1999

Zide MF, Dean J: Lip reconstruction, in Booth PW, Schendel S,Hauaanien JB (eds): Maxillofacial Surgery. Edinburgh, Churchill Living-stone, 1999, pp 735-756

Escobar V, Zide MF: Delayed repair of skin cancer defects. J OralMaxillofac Surg 57:271, 1999

S202Intraoral Maxillofacial DistractionOsteogenesisDavid Walker, DDS, MS, Toronto, Ontario, Canada

Distraction osteogenesis is a powerful technique forcreating new bone during significant lengthening of themandible or maxilla, without the need for bone graftingand associated donor site morbidity. Controversy existsregarding the application of distraction osteogenesistechniques versus conventional surgical procedures.Clinical experience and documentation in the literatureconfirm that large maxillary and mandibular advance-ments frequently require simultaneous bone grafting andmay develop significant postsurgical relapse. Intraoraldistraction osteogenesis techniques allow greater length-ening of the mandible and maxilla with improved softtissue response and skeletal stability, compared withconventional surgical procedures.

Craniofacial syndromes and patients who have under-gone previous orthognathic surgery or reconstructive sur-gery present with challenging bony anatomy. Distractionosteogensis techniques can be applied to rudimentary orunusual bony anatomy of the maxilla and mandible withsimple osteotomy design compared with conventional os-teotomies. Distraction histogenesis, the gradual soft tissue

adaptation, and cellular proliferation can be particularlybeneficial if there is a scarred soft tissue bed that is difficultto manage with acute movements.

A thorough understanding of the biologic basis ofdistraction osteogenesis is important to apply the param-eters of distraction to a given clinical situation. Parame-ters such as type of osteotomy, latency period, rate andrhythm of distraction, and consolidation time may bemodified based on many different factors. Animal modelresearch has been integral in determining the appropri-ate parameters for maxillofacial distraction osteogenesis,which varies from limb distraction osteogenesis.

Preoperative planning for distraction osteogenesis is par-ticularly important to determine adequate occlusal out-comes and skeletal harmony. Preoperative 3-dimensionalvectorselection is based on careful clinical, radiographic,and CT scan analysis, with complex model surgery. In-traoral distraction osteogenesis device selection is based onthe device design, existing bony anatomy, and the ability toadjust the vector or distraction after device placement.Multidirectional intraoral distraction osteogenesis deviceshave overcome the complications and obstacles of externaldistraction devices. Simultaneous or secondary orthog-nathic surgical procedures may be required to correct ad-ditional areas of skeletal disharmony.

Concomitant orthodontic therapy can enhance dis-traction osteogenesis occlusal outcomes. In growing pa-tients, postdistraction osteogenesis functional appliancetherapy can allow occlusal manipulation that may avoidand/or decrease further surgical procedures at the com-pletion of growth. Fixed orthodontic appliances areused in patients who have passed the mixed dentitionstage, to aid in occlusal preparation prior to or afterdistraction osteogenesis techniques.

Long-term growth follow-up postdistraction osteogen-esis needs further documentation. Distraction osteogen-esis techniques in growing patients often use overcor-rection as the genetic growth potential of the maxilla ormandible appears unchanged by distraction osteogene-sis techniques.

Intraoral distraction osteogensis devices and tech-niques have continued to undergo refinement allowingpredictable successful outcomes. Distraction osteogene-sis is suited to the most complex and challengingdeformities where traditional surgical techniques haveresulted in less favorable outcomes. Distraction osteo-genesis is an important technique in the armamentariumof oral and maxillofacial surgeons and is here to stay.

References

Walker D: Management of severe mandibular retrognathia in theadult patient using distraction osteogenesis. J Oral Maxillofac Surg60:1341, 2002

Samchukov M, Cope J, Cherkasin A (eds): Craniofacial DistractionOsteogenesis. St Louis, MO, Mosby, 2001

Arnaud E, Diner P (eds): Third International Congress on Cranial andFacial Bone Distraction Osteogenesis, Paris, France/Bologna, Italy,Monduzzi Editore, 2001

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