tal attachments (Figure A1.7). In addition, detached right footand left foot proximal implants for initial bone anchorage andsubsequent are mandibular distractor attachment included(Figure A1.8). The distractor is placed on the mandible span-ning the osteotomy site, with an external activator extendingthrough a small submandibular percutaneous incision. Thescrews utilized are 2.0 self-tapping screws in 6-, 8-, 10-mmlengths (12 and 14 are also available) and 2.4-mm emergencyscrews in 6-, 8-, 10-mm lengths (12 and 14 are also available).In evaluating ramus height on radiographs, the Single VectorAngulation Planner should be used to determine distractorlength as well as vector and foot placement. The drilling ofholes and insertion of screws is performed utilizing the plateholding trocar, which stabilizes the implant (Figure A1.9).First, on the superior aspect of the planned osteotomy, the de-tachable proximal foot is placed with slot inferior (FigureA1.10a). Then, the distractor body is inserted into the proxi-mal foot (Figure A1.10b) to complete screw fixation of thedistractor device. Activation and percutaneous exposure areachieved (Figure A1.10c). The implants are activated by anactivation screwdriver with an internal hex (Figure A1.11),which has a directional arrow for counterclockwise activationin which one rotation equals .5 mm. Usually two rotations,which equal 1 mm of distraction, are recommended on a dailybasis, but this is subject to variability at the surgeon’s discre-tion. The total days of distraction multiplied by two equals thenumber of days recommended for the distractor to remain inplace for bone consolidation to occur. Following consolida-tion, a 3-step procedure is followed for distractor body re-moval. First, the activator screwdriver is turned clockwise 10rotations (opposite to the arrow handle marker). Then distalfoot disengagement is achieved by turning the distractor re-moval instrument 4 clockwise rotations (in the direction of thearrow marker) (Figure A1.12). Then the distractor body is re-moved via the percutaneous port (Figure A1.13). The modulecontains the black narrow screwdriver blade (self-retaining),1.5-mm drill bits (Stryker J latch), distractor removal instru-ment, and activation screwdriver.

757

Appendix A1Distraction Osteogenesis of the MandibleAlex M. Greenberg and Joachim Prein

Mandible Single Distractor Module Stainless Steel Set

Color: BlackIndications: Mandibular ramus lengthening

The Mandible Distractor Module Set (Figure A1.1) is com-posed of stainless steel implants, specifically a mandibulardistractor with right foot and mandibular distractor with leftfoot (Figure A1.2). The distractor is placed on the mandiblespanning the osteotomy site with an external activator ex-tending through a small submandibular percutaneous incision(Figure A1.3). The screws utilized are 2.0-mm stainless steelself-tapping screws in 10-, 12-, and 14-mm lengths, and 2.4-mm stainless steel emergency screws in 10-, 12-, and 14-mmlengths. The implants are activated by an activation screw-driver. Figure A1.4 with an internal hex (Figure A1.5). Thisscrewdriver has a directional arrow for counterclockwise ac-tivation, in which one rotation equals .5 mm. Usually, two ro-tations, equal to 1 mm of distraction, are recommended on adaily basis, but this is subject to variability at the surgeon’sdiscretion. The total days of distraction multiplied by twoequals the number of days recommended for the distractor tobe in place for bone consolidation to occur. The placement ofthe distractor requires the use of the trocar system (FigureA1.6). The module also contains the black narrow screwdriverhandle, cruciform screwdriver blade (self-retaining), and 2.0-mm holding forcep (for screws).

The Titanium Single Vector Distractor

Color: BlackIndications: Mandibular ramus lengthening

The Titanium Single Vector Distractor Module is composedof titanium implants, specifically 20-mm and 30-mm lengthmandibular distracts with right foot and left foot types as dis-

758 A.M. Greenberg and J. Prein

FIGURE A1.1 Mandible distractor module set. (Courtesy of SynthesMaxillofacial, Paoli, PA)

FIGURE A1.4 Mandible distractor activation screwdriver. (Courtesyof Synthes Maxillofacial, Paoli, PA)

FIGURE A1.2 Mandible distractor with left foot. (Courtesy of Syn-thes Maxillofacial, Paoli, PA)

FIGURE A1.3 Mandible distractor in place. (Courtesy of SynthesMaxillofacial, Paoli, PA)

FIGURE A1.5 Mandible distractor activation. (Courtesy of SynthesMaxillofacial, Paoli, PA)

FIGURE A1.6 Mandible distractor placement with transcutaneous tro-car system. (Courtesy of Synthes Maxillofacial, Paoli, PA)

Appendix A1. Distraction Osteogenesis of the Mandible 759

FIGURE A1.7 Titanium single vector distractor. (Courtesy of SynthesMaxillofacial, Paoli, PA)

FIGURE A1.8 Right and left titanium single vector distractors withdetachable feet. (Courtesy of Synthes Maxillofacial, Paoli, PA)

FIGURE A1.9 Insertion of screws utilizing the plate holding trocar.(Courtesy of Synthes Maxillofacial, Paoli, PA)

a

b

c

FIGURE A1.10 (a) The detachable proximal foot is initially placedwith slot inferior, (b) the distractor is inserted for attachment, and(c) the percutaneous incision is made exposing the activation screw.(Courtesy of Synthes Maxillofacial, Paoli, PA)

The Titanium Multivector Distractor (TMVD)

Color: BlackIndications: Mandibular bone lengthening for simple to se-vere hypoplasia, including straight to multidirectional re-quirements.This is used as an external fixator device with percutaneousKirschner wire (pin) implants for stabilization. The TitaniumMulti-Vector Distractor (Figure A1.14) module is composedof a titanium multi-vector distractor assembly with titaniummulti-vector arms in 5 lengths (15, 25, 35, 45, and 55 mmwith 65, 75, and 85 mm also available) and activation in-strumentation (Figure A1.15). Implants consist of 2-mmKirschner W with thread and trocar point (pin) for self-drillingand self-tapping. Following the use of a preoperative radi-ograph TMVD angulation planner, an osteotomy site is per-formed via an intraoral or percutaneous approach. Insertionof the first pair of pins is achieved using the wire guide/tissue protector, along with an optional trocar, thumbscrew,and check retractor ring (Figure A1.16). Then, the two infe-

760 A.M. Greenberg and J. Prein

FIGURE A1.11 The distractor is activated via an activation screwdrivercounterclockwise. (Courtesy of Synthes Maxillofacial, Paoli, PA)

FIGURE A1.12 Disengagement of the distractor by rotating the dis-tractor removal instrument clockwise. (Courtesy of Synthes Max-illofacial, Paoli, PA)

FIGURE A1.13 Removal of the distractor percutaneously, leaving thefoot implants in place. (Courtesy of Synthesis Maxillofacial, Paoli,PA)

normal mandibular body horizontal size. This case report il-lustrates this procedure in a male with mandibular retrog-nathia secondary to a shortened ramus for which the patientunderwent bilateral mandibular single vector distraction os-teogenesis using the AO/ASIF Single Vector Distractor withimprovement in occlusion from Class II to Class I and moresatisfactory facial appearance (Figures A21–27). (Case reportof Prof. Dr. med Joachim Prein, Kantonsspital Basel, Basel,Switzerland).

Appendix A1. Distraction Osteogenesis of the Mandible 761

rior pins are inserted and the distractor assembly is placed,followed by completion of the osteotomy. Pins are cut to thedesired length and adjustment of the distractor assembly isperformed. Mandibular lengthening is achieved by turning theactivation instrument two rotations counterclockwise; fol-lowing the arrow marker is recommended (Figure A1.17), butis subject to the surgeon’s discretion. After a bony regener-ate of at least 10 mm has been achieved, angular adjustmentis performed using the angular adjustment instrument (Fig-ures A1.18A and B). After consolidation has occurred, the4.0-mm carbon fiber rod (60 and 80 mm, also available in100-200 mm in 20-mm increments) are applied with theTMVD clamp for carbon fiber rods after the distractor as-sembly has been removed (Figures A1.19 and A1.20).

Distraction Osteogenesis of the Mandible Case Report

Single vector distraction osteogenesis of the mandible is in-dicated for deformities of mandibular ramus hypoplasia with

FIGURE A1.14 Titanium multivector distractor. (Courtesy of SynthesMaxillofacial, Paoli, PA)

FIGURE A1.16 Insertion of screws via trocar. (Courtesy of SynthesMaxillofacial, Paoli, PA)

FIGURE A1.15 Titanium multivector distractor activation instrumen-tation. (Courtesy of Synthes Maxillofacial, Paoli, PA)

FIGURE A1.17 Activation of titanium multivector distractor withcounterclockwise turns. (Courtesy of Synthes Maxillofacial, Paoli,PA)

762 A.M. Greenberg and J. Prein

FIGURE A1.18 (a) Angular adjustment using the angular adjustmentinstrument. (b) Transverse adjustment using the angular adjustmentinstrument. (Courtesy of Synthes Maxillofacial, Paoli, PA)

FIGURE A1.19 (a) First, the carbon rod is placed. (b) The multivec-tor distractor body is removed. (c) The multivector distractor armsare then removed. (d) The carbon rod remains in place for consoli-dation. (Courtesy of Synthes Maxillofacial, Paoli, PA)

a

a

b

c

d

b

Appendix A1. Distraction Osteogenesis of the Mandible 763

FIGURE A1.20 Carbon rod in place maintaining the segment posi-tions while the bony regenerate undergoes consolidation. (Courtesyof Synthes Maxillofacial, Paoli, PA)

FIGURE A1.22 Patient with mandibular retrognathia lateral profileview.

FIGURE A1.21 Patient with mandibular retrognathia facial view. FIGURE A1.23 Preoperative lateral cephalometric radiograph demon-strating Class II malocclusion with mandibular ramus hypoplasia.

764 A.M. Greenberg and J. Prein

FIGURE A1.24 Postoperative lateral cephalometric radiographdemonstrating mandibular ramus lengthening with single vector dis-traction device with occlusion corrected to Class I.

FIGURE A1.26 Postoperative facial view with improved mandibularlengthening.

FIGURE A1.25 Postoperative lateral profile view with distractors stillin place with percutaneous exposure.

FIGURE A1.27 Postoperative lateral profile view with improvedmandibular lengthening and chin position.

Appendix A2ITI Strauman Dental Implant SystemAlex M. Greenberg

Recent developments in the ITI Strauman dental implant sys-tem (Figure A2.1) (Institut Strauman AG, Waldenburg,Switzerland) have improved the surface layer (SLE) as wellas the basic prosthetic procedures (Figures A2.2 and A2.3).Illustrated here are several examples of these techniques. A

simplified technique using solid abutments (Figures A2.4 andA2.5), transfer systems for impressions (Figures A2.6–A2.8),laboratory steps (Figures A2.9–A2.12) is shown. A specialorthodontic appliance is also available (Figure A2.13).

765

FIGURE A2.1 ITI implant in situ with ideal bone contact and gingi-val contour. (Courtesy of Institut Strauman AG, Waldenburg,Switzerland)

FIGURE A2.2 Corresponding abutment to the synOcta implant. (Cour-tesy of Institut Strauman AG, Waldenburg, Switzerland)

FIGURE A2.3 Finite element model of entire synOcta implant testsetup. (Courtesy of Institut Strauman AG, Waldenburg, Switzerland)

FIGURE A2.4 Overview of solid abutments. (Courtesy of InstitutStrauman AG, Waldenburg, Switzerland)

766 A.M. Greenberg

FIGURE A2.5 Wide neck ITI implant with corresponding abut-ment for cemented restoration. (Courtesy of Institut Strauman AG,Waldenburg, Switzerland)

FIGURE A2.6 Corresponding solid abutments with transfer system.(Courtesy of Institut Strauman AG, Waldenburg, Switzerland)

FIGURE A2.7 Transfer system for solid abutment. (Courtesy of In-stitut Strauman AG, Waldenburg, Switzerland)

FIGURE A2.9 Implant laboratory analogs. (Courtesy of Institut Strau-man AG, Waldenburg, Switzerland)

FIGURE A2.8 Transfer system in place for clinical application. (Cour-tesy of Institut Strauman AG, Waldenburg, Switzerland)

FIGURE A2.10 Positioning cylinder and transfer coping embedded inimpression material. (Courtesy of Institut Strauman AG, Walden-burg, Switzerland)

Appendix A2. ITI Strauman Dental Implant System 767

FIGURE A2.13 Indication for use with an orthodontic appliance in combination with ITI implants. (Courtesy of Institut Strauman AG,Waldenburg, Switzerland)

FIGURE A2.11 Full metal implant laboratory analog in situ. (Cour-tesy of Institut Strauman AG, Waldenburg, Switzerland)

FIGURE A2.12 Master cast with implant laboratory analog. (Courtesyof Institut Strauman AG, Waldenburg, Switzerland)

AAbrasion injuries, craniomaxillofacial, 48Abutments

intrusion of, 248–250for ITI dental implants, 143–152selection of, by the restorative dentist,

234–235surgery at, and progressive bone

loading, 189Achondroplasia, saddle nose deformity in,

52Acrocephalosyndactyly. See Apert

syndromeAcrocephaly, defined, 10Acrylic implants

fractures of, 256self-cure versus light cured or

autopolymerized, 238–239wafer

construction of, cleft lip and palate,561

placement in a Le Fort I osteotomy,cleft lip and palate, 566

Actinomycotic osteomyelitis, 80Adaptation

membrane, in localized ridgeaugmentation, 156

in response to osteotomy, 639Adenoid cystic carcinoma, involving the

mandibular angle, 392–393Adenoid faces, 40Advantages

of genioplasty, 652of intraoral vertical ramus osteotomy,

646of mandibular midline split, 648of midface osteotomy, 657of rigid fixation

with mandibular sagittal split ramusosteotomies, 642–643

with maxillary surgery, 654of subapical osteotomy, 651

Aestheticsin craniomaxillofacial bone surgery,

280–286in Crouzon syndrome, assessment of,

713–714of dental implant restoration, 255–256

769

Index

in dental implant restoration, mandibleversus maxilla, 236–237

in Treacher Collins syndrome, 283Alar base, support of, in cleft lip and

palate, 540, 542Alar crease (A), for evaluation of

craniomaxillofacial deformity, 7Allogeneic grafts

healing of, 126–127for the maxillary sinus, 181–182for sinus lift procedures, outcomes, 132

Alloplastic graftsdefect-bridging, 419healing of, 126–127maxillary sinus, 182–184

Alternatives, consideration of risks andbenefits of bimaxillary surgery, 523

Alveolar augmentation, 160Alveolar defect, secondary, 549–550Alveolar nerve, inferior, computerized

tomography imaging of, 198, 201Amblyopia, preventing with surgery, in

Apert syndrome, 750Ameloblastomas, 59–61

bone resection and reconstruction in,166, 324

condylar prosthesis after surgery, 375panoramic images, 223–224reconstruction after surgery for, 406–408

American Association of Cleft PalateRehabilitation (AACPR), 23

Anastomoses, end-to-end, revascularizationof grafts as a result of, 125

Anatomyfacial, analysis of, 623–624in Le Fort II osteotomy, 660of the maxillary sinus, 179of midface hypoplasia, 664soft tissue landmarks, 7–8See also Facial anatomy

Andy Gump Deformity, 414–415Anesthesia

local, for hemostasis, 591during maxillary surgery, 528

Aneurysmsbasilar tip, transfacial access osteotomies

for repair of, 494

basilar tip and midbasilar artery,transfacial access osteotomies forrepair of, 489

midbasilar artery, transfacial accessosteotomies for repair of, 492

Angiofibromas, juvenile nasopharyngeal,resection with transfacial accessosteotomy, 489, 493

Angle classification, in skeletalmalocclusions, 38

Ankylosisbilateral condylar replacement with steel

prosthesis in, 376condylar prostheses in patients with,

377–381fibrous, of the temporomandibular joint,

following rigid fixation, 619Anterior areas, in maxillary implant

positioning, 244, 246–247Anterior examination, before orthognathic

surgery, 506–509Anterior mandibular defects, microvascular

tissue transfer for, 414–418Antibiotics

for posttraumatic osteomyelitistreatment, 433

in transfacial access osteotomies, 496Apertognathia

anteriormaxillary osteotomies for correction

of, 603secondary to posterior maxillary

vertical hyperplasia, 586tongue habits as a cause of, 647

Apert syndrome (acrocephalosyndactyly),35–36, 664, 679–680, 682

bilateral coronal synostosis in, 675craniosynostosis in, 673hypertelorism and telecanthus in, 509surgical correction of craniofacial

deformities in, 749–755temporal abnormality in, 11

Apicocoronal positioning, in single toothrestorations, 250

Application, of classification of cranialbone deformities, 96–97

Arteriogram, of a midbasilar arteryaneurysm, 492

Arthroplastyautogenous, 343costochondral, relative advantages and

disadvantages of, 343interpositional, for treating restricted

mobility of the temporomandibularjoint, 353–354

partial, replacement of the condyle in,372

Arthrosis, before costochondralreconstruction, 463

Ascending ramus, microvascularreconstruction of, 462–477

Assessment. See EvaluationAsymmetry assessment, 8Auricle

deformity of, 16in hemifacial microsomia, 730

reconstruction of, in hemifacialmicrosomia, 733

Autogenous bone graftscontraindications to, 377maxillary sinus, 180–181for maxillofacial reconstruction,

295–309for ridge augmentation, 157

Autoimmune disorders, deformitiesinfluenced by, 5

Autologous bone graftshealing of, 125–126resorption of, 129vascularized, healing of, 126

Avulsion injuries, craniomaxillofacial, 43

BBar-retained overdentures, 241–242Barrier membrane, for localized ridge

augmentation, 155–156Basalioma, forehead, 368Basel approach, to cleft lip and palate,

544–546Bicoronal suture release, in initial

treatment for Crouzon syndrome,717

Bicortical grafts, for mandibularreconstruction, 300

Bilateral complete cleft lip and palate(UCLP), deformities in, 557

Bilateral sagittal split ramus osteotomy(BSSRO), 527, 639–645

Bimaxillary retrusion, aesthetic repair in,284

Binder syndrome (maxillonasal dysplasia),51–52, 520, 660

Biocompatibilityof grafts, and success of incorporation,

127of polymers for bone fixation, 114–115

Biodegradable materials, for bone fixation,113

Biomechanical considerationsfor mandibular fixed reconstructions,

239–240in single tooth replacement, 253

Bioresorbable materials, for bone fixation,113–123

Birth process, nasal injuries during, 54Bite, recording, in planning for

orthognathic surgery, 514–518Block grafts, experimental comparison

with particulate grafts, 128Blood transfusion, autologous, in elective

surgery, 591Bolton standard heads and faces, 514–518Bone

benign tumors of the maxillofacialregion, 59–64

fixation of, bioresorbable materials for,113–123

fragments of, rotation and interpositionof, 631

principles of healing, 101quality and strength of, in fixation, 104quality and volume of, for dental

implant restoration, 233resection of tumors and reconstruction,

condyle and ascending ramus, 470substitutes for, in mandibular

reconstruction, 336trimming of, and maxillary positioning,

597–600See also specific entries, e.g. Frontal bone

Bone-anchored hearing aid (BAHA), 132Bone grafts

for alveolar cleft defect, 542–554calvarial, harvesting techniques,

700–712fixation of, for mandibular continuity

defects, 317–326free autogenous, in maxillofacial

reconstruction, 295–300iliac, factors affecting success of

mandibular continuity defectreconstruction, 339–341

to improve stability of maxillaryosteotomies, clinical studies, 587

for nasal reconstruction, 483–488pedicled, in maxillofacial reconstruction,

300–308secondary, 554–555See also Autogenous bone grafts;

Autologous bone grafts; Cancellousbone grafts; Corticocancellous bonegrafts; Endochondral bone grafts;Iliac entries

Bone morphogenic protein (BMP), 180Boo-Chai classification, of facial clefts, 23Brachycephaly

in Apert syndrome, 675–677in Crouzon syndrome, 675–677, 713

simple, versus Crouzon syndrome,715–717

Braincoverage of, with musculocutaneous

flaps, 364limitation on growth, in

craniosynostosis, 673Breathing, difficulty in, Crouzon

syndrome, 713Bridging osteosynthesis, 321

for mandibular continuity defects, 327Buccolingual atrophy, 204

computerized tomography imaging of,206–207

CCaldwell “C” osteotomy, 610Callostasis, 648–650Calvaria

bone flaps from, for reconstruction inmaxillary midface defects, 356–359

defects in, from traumatic injury, 708,710

graft harvestingmorbidity in, 668techniques, 700–712

Cancellous bone grafts, 125–126, 130harvesting blocks from the iliac crest,

299–300healing of, maxillary sinus grafting, 180

Cancer. See MalignanciesCarpenter syndrome, 29–30

facial features in, 36Case example

abutments and overdentures, 146–153cleft lip and alveolus, unilateral

complete, 548–550cleft lip and palate

bilateral complete, 548, 551, 554,557–559

unilateral, 547unilateral complete, 551–553

cleft palate, in one of identical twins,557, 560

cranial-based defect reconstruction, withcalvarial bone grafts, 711–712

distraction osteogenesis, 649–650early relapse, after mandibular sagittal

split ramus osteotomy, 643–644genial deficiency, 652–653genioplasty, 653infection followed by anterior frontal

bone collapse, 711infraorbital rim defect, 705–706intraoral vertical ramus osteotomy,

646–647the Le Fort I maxillary osteotomy

for apertognathia and mandibularexcess, 655–657

midface, 657–658

770 Index

long-term relapse, mandibular sagittalsplit ramus osteotomy, 644–645

mandibular midline split, study of rigidfixation versus wire osteosynthesis,648

maxillary advancement and downwardmovement, in cleft lip and palate,unilateral, 567, 572–573

maxillary and chin advancement, in cleftlip and palate, unilateral, 567,570–571

maxillary buttress defect, 705, 707–708maxillary hypoplasia, in cleft lip and

palate, bilateral complete, 562, 565

naso-maxillary hypoplasia, in cleft lipand palate, unilateral complete,574–576

orbital floor defects, 704–705orbital reconstruction, 480–482osteotomy, in cleft lip and palate,

bilateral complete, 567–569overdentures, 262–265premaxilla repositioning, cleft lip and

palate, bilateral complete, 562–564radiologic follow-up of bone grafts,

220–231ridge augmentation, 159–162of subapical osteotomy, 651THORP-plate reconstruction of bilateral

maxillary defects, 439–444zygomatic arch defect, 708–709

Casts, mastertransfer copings for fabrication of dental,

238–239verification of fit, 239

Cephalometrics, 285, 514Cervical spine

deformities of, in Apert syndrome,750–751

osteomyelitis of, 85–86Cheeks, assessing deformity of, 14–15Chemical reactions, of metals in solution,

109–110Chemicals, association with craniofacial

malformation, 671Children

craniomaxillofacial implants in, 134–135effects on growth capacity of harvesting

vascularized bone grafts, 361Children’s Medical Center, Dallas, orbital

rim advancement at, 673Chin, as a donor site for bone grafts,

295–296. See also GenioplastyChin-neck contour, assessment of, in

craniomaxillofacial deformity,18–19

Chromosome disorders, nasalmanifestations of, 50. See alsoHereditary conditions

Classificationof bone quality and quantity, Lekholm

and Zarb, 234of cleft lip and palate deformities,

539–540of craniofacial deformities, 22of craniomaxillofacial deformities,

90–97nasal, 49–58traumatic, 43–46

of craniosynostosis, 673–678syndromes, 35–36

of facial clefts, 23of genioplasties, 627of hemifacial microsomia, 683–684,

730–733of nasal encephaloceles, 53

Cleft lip and palate, 22–29cancellous bone grafting for, 356nasal deformity in, 50–51reconstruction of osseous defects in,

539–580segmental osteotomy in, 587

Cleft palate (CP)association with Apert syndrome, 679case example, 557narrowing the mandible for, 648treatment planning for, 526

Clefts, all-in-one surgery to close, 545–546Clinical characteristics

of hemifacial microsomia, 682–683,728–730

of Treacher Collins syndrome, 685Clinical examination

findingsin acute osteomyelitis, 80–81in osteomyelitis of the frontal bone,

85history of craniomaxillofacial deformity,

6–7before orthognathic surgery, 497–512

Clinical implications, of metal implants,111

Clinical studiesof biodegradable materials in fracture

surgery, 116–117of osteotomy segments, with and

without bone grafts, 587of radiation, effects of reconstruction

plates, 422–429See also Research

Clivus chordomas, resection of, withtransfacial access osteotomies,489–496

Cocaine, nasal deformities from abuse of,57

Cohen classification, of craniosynostosissyndromes, 35–36

Collateral circulation, labiobuccal andpalatal vascular, 581, 585

Complicationsof bone graft harvesting, 703of dental implant restoration, 253–257of free-tissue transfer, 393of genioplasty, 631–638of iliac corticocancellous grafts, 339of irradiation, effects on soft tissue, 427of Le Fort I osteotomy, necrosis of the

maxilla, 83of Le Fort III osteotomy

in Crouzon syndrome, 723–724midface reconstruction, 667–668

of mandibular condylar prostheses,379–387

with mandibular condylar prosthesis,377–388

of maxillary osteotomies, 587, 590–591of maxillary sinus grafting, 189–195of orthognathic surgery, 519–520of reconstruction

with cancellous bone and marrow intitanium trays, 299–300

in irradiated fields, 290of mandibular continuity defects,

317–319of rigid internal fixation, 618–619of temporomandibular joint surgery, 346

Compression, toleration by dental implants,233–234

Computed tomography (CT)in craniomaxillofacial bone infections,

78for craniomaxillofacial dental

implantology, 198–209for evaluating craniofacial deformities,

672in infantile osteomyelitis, 83of the maxillary sinus, 176in oral malignancies, 69

three-dimensional reconstruction,oromandibular complex, 291

for quantitative assessment of the cranio-orbito-zygomatic skeleton, 714

reformatting into cross-sectional views,for dental implant restoration, 232

three-dimensional reconstructions from,for planning surgical procedures, 462

for visualization of the bony orbit, 478Computer packages, for planning

orthognathic surgery, 561Condylar heads, remodeling and resorption

of, 618Condyle

abnormality of, in hemifacialmicrosomia, 729

benign tumor of, image aftertemporomaxillary jointalloarthroplasty, 380

microvascular reconstruction of,462–477

Index 771

Condyle (Continued)resorption of, and late relapse after

osteotomy, 639, 643setting the position of, in bimaxillary

surgery, 527Congenital deformity

craniomaxillofacial, 5dysplasia as an indication for

costochondral grafting, 354facial clefting, 22–29nasal, 49–54See also Hereditary conditions

Connective tissue, around dental implants,plasma-sprayed titanium, 142–143

Contraindicationsto autogenous transplants, 377to fibula donation, smoking as, 414

Coronal synostosis, unilateral, 675Corrosion, of metal in internal fixation,

107Cortical bone

for grafts and implants, clinicaloutcomes, 130

healing of grafts of, 126maxillary sinus grafting, 180

skull donor sites for grafting of, 300Corticocancellous bone grafts, 130–131

autologous intramembranous, to maxilla,131–132

free, for the maxilla, 356–371hip inner surface as a donor site for, 300for mandibular continuity defects, 321for the maxillary sinus, 180–181

Cosmetic failure, in genioplasty, 634–638Costochondral arthroplasty, polymer

screws for fixation of, 121Costochondral grafts

advantage of, response to growth, 353for condylar reconstruction,

disadvantages of, 462free, mandibular condyle reconstruction

with, 343–355in hemifacial microsomia, 733–735

Cranial basecalvarial bone grafts for reconstruction

of, 711–712microsurgical reconstruction of large

defects of, 356–371Cranial bones

deformities of, classification, 95as donor sites

in cranio-orbito-zygomatic procedures,715

in midface reconstruction, 662Cranial circumference, for evaluating

craniomaxillofacial deformity, 9–10Cranial deformities

clefts, 25in hemifacial microsomia, 728

Cranial modular fixation system, 456–458

Cranial suturesexamination of, 10premature closure of, classification of

anomalies from, 29Cranial vault, in Crouzon syndrome

osteotomy, 722–723reshaping of, 718–719

Craniocervical junction, exposure of, 494Craniofacial deformities, 22–37

clefts, 25dysostosis, 678–681

in Crouzon syndrome, 713principles of management of, 671–692surgical correction of, in Apert

syndrome, 749–755Craniofacial fixation system

effects on the growing craniofacialskeleton, 693–699

hardware review, 445–461Craniofacial Modular Fixation System,

445–450Craniofacial osteotomy instrumentation

sets, 629Craniofacial reconstruction, vascularized

bone grafts for, 313Craniofacial Repair System (CRS),

459–461Craniofacial synostoses, inherited, 52Craniomaxillofacial bone

healing ofbiomechanics and rigid internal

fixation, 101–106after surgery, 124–137

infections of, 76–89radiographic diagnosis, 78

metal for internal fixation, 107–112radiographic evaluation of, 210–219

Craniomaxillofacial deformityclassification system for, 90–97evaluation of, 5–21nasal, 49–58traumatic, 43–48

Craniomaxillofacial dental implantology,198–209

Craniomaxillofacial surgery, 1reconstructive

versus corrective, 41–42current practice and trends in, 310–316

Cranio-orbital decompression, in Crouzonsyndrome, 715–717

Cranio-orbito-zygomatic procedures,cranial bones as donor sites in, 715

Craniostenosis, surgical correction of thebony forehead in, 8

Craniosynostosis, 673–678classification of, 29–37in Crouzon syndrome, 713

Craniotomy bone flap, 703Cranium, donor site, for nasal

reconstruction, 483, 486–488

Creeping substitutiondefined, 125fixation required for, 327in maxillary sinus grafting, 180in ridge augmentation, 157

Cross sectional images, computer-generated, 200–201

Crouzon syndrome, 29, 32, 35, 664, 673,678–679

basic dysmorphology and staging ofreconstruction, 713–726

bilateral coronal synostosis in, 675Cupar technique, 601

for anterior maxillary osteotomydownfracture, 591

Cuspid area, in maxillary implantpositioning, 243

DDegenhardt classification, of craniofacial

deformity, 23Delaire analysis, in planning orthognathic

surgery, 514Demineralized freeze-dried bone (DFDB),

bone morphogenic protein in,181–182

Dental compensations, in hemifacialmicrosomia, 729

Dental examination, before orthognathicsurgery, 512

Dental implantsgrafts from the fibula for insertion of,

327ITI system, 138–154

Dentascan program, examples of imagesgenerated by, 198, 201–208

Dermoids, nasal, 54Developmental deformity,

craniomaxillofacial, 5. See alsoEmbryology

Dexamethasone, postoperativeadministration of, in transfacialaccess osteotomy, 496

Diagnosisdifferential, of hemifacial microsomia,

727of oral squamous cell carcinoma, 67–68of orbital hypertelorism, 738of osteomyelitis of the cervical spine, 86

Disadvantagesof genioplasty, 652of intraoral vertical ramus osteotomy,

646of mandibular midline split, 648of midface osteotomy, 657of rigid fixation

in mandibular sagittal split ramusosteotomy, 643

in maxillary surgery, 654of subapical osteotomy, 651

772 Index

Diseasematernal, and nasal deformities, 50systemic, and nasal deformities, 57See also Infection

Displacement, osseous, in osteotomy, 639

Distraction osteogenesis, 648–650Donor sites

for alveolar grafts, 544calvarial, reconstruction with alloplastic

materials, 702for mandibular reconstruction, 310–313for midface reconstruction, 662

morbidity at, 668for nasal reconstruction, 483

parietal bone, 742Dosimetry, on an irradiation phantom,

420–421Double barrel graft, fibular, for arched

mandibular defects, 329–333Downfracture, risks of, 567Drugs, association with craniofacial

malformation, 671Dura, coverage of, with musculocutaneous

flaps, 364Dysmorphology

in cleft lip and palate, 540–542defined, 672

Dysostosis, craniofacial, in Crouzonsyndrome, 713. See alsoMandibulofacial dysostosis

EEconomic considerations

in internal fixation, 2in primary reconstruction, in gunshot

wounds, 416in rigid internal fixation, for bimaxillary

surgery, 522Ectodermal cysts, nasal dermoid, 54Edentulous restorations, dental implant,

236–237partial, 245–250

Embryologyof the calvarium, 700–701of the craniofacial region, 671of nasal deformities, 49–50of the palate, lip and alveolus, 539–542

Emergence Profile System, for single toothabutments, 252

Encephaloceles, nasal, 53Endochondral bone grafts

for maxillary sinus grafting, 180–181preformed, clinical use of, 130–131

Endocrine disorders, deformities causedby, 5

Endosseous implantsand bone grafting, 124–132selection of, 184–185

Eosinophilic granuloma, treatment for, 63

Epidemiologyof craniomaxillofacial fractures and

defects, 5of hemifacial microsomia, 727of oral squamous cell carcinoma, 65

Epiphyseal dysplasia, in Apert syndrome,750

Epithelium, around dental implants,plasma-sprayed titanium, 142–143

Ethanol, nasal deformities due to in uteroexposure to, 50

Etiologyof cleft lip and palate, 539of craniofacial deformities, congenital,

671–672of craniomaxillofacial deformities

in Apert syndrome, 749–750nasal, 49–58

of hemifacial microsomia, 727–728of oral malignancies, 65of osteomyelitis, 76–77

of the frontal bone, 84of skeletal malocclusion, 38–42of suppurative osteomyelitis of the

mandible, 80See also Pathogenesis

Etiopathology, of orbital hypertelorism,739–740

Evaluationof Apert syndrome patients, 750–751of craniomaxillofacial deformity

patients, 5–21before reconstructive surgery, 390of tumor extension, in oral malignancies,

68–69Examination cycle, before orthognathic

surgery, 500Exophthalmus, association with

hyperthyroidism, 5Exorbitism

in Apert syndrome, 35, 750in bilateral coronal synostosis, 675in malar deficiency, 15

Expectations, patient’s, in dental implantrestoration, 256–257

Explosions, craniomaxillofacial injuriesfrom, 47

Extender System, ITI, 164Extracranial procedures, in orbital

hypertelorism management, 744Eye, evaluating, 11–12. See also VisionEyebrows, position of, evaluating, 12–13Eyelids

deformities of, in Apert syndrome, 752

evaluating, 13

FFacial anatomy

analysis of, for genioplasty, 623–624

clinical evaluation of, in cleft lip andpalate, 551

growth of, in hemifacial microsomia,729–730

planning height, in bimaxillary surgery,526–527

proportions, for clinical examination,506–507

width, describing in a clinicalexamination, 508–509

Facial angles, for evaluation ofcraniomaxillofacial deformity, 7–8

Facial appearanceclinical evaluation of, in cleft lip and

palate, 556concepts of harmony in, 280–284

Facial bipartition, in orbital hypertelorismmanagement, 742–745

Facial clefting, 22–29embryological origin of, 671rare, 52–53

Facial contour angle (FCA), for evaluation ofcraniomaxillofacial relationships, 8

Facio-auriculo-vertebral (FAV)malformation complex, 727

Faciolingual orientation, in single toothrestorations, 250

Farm injuries, craniomaxillofacial, 47–48Fetal compression, nasal injuries from, 54Fibroma, ossifying, reconstruction after

removal, in a child, 368–369Fibrous dysplasia, treatment for, 63Fibula

and combined flaps, for maxillofacialreconstruction, 306–308

dissection of, 391as a donor site

advantages of, 414for ascending ramus and condyle

grafts, 466for mandibular continuity defects, 321for mandibular reconstruction, 310,

312–313, 471–474, 475–476indications and technical

considerations for use of, 327–334Fibular flap, for mandibular reconstruction,

389–390Finnish Cancer Registry, standardized

incidence ratio for oral cancer, 65–66Fixation methods

in bimaxillary surgery, 532–533biodegradable polymer screws for, in

sagittal osteotomy, 119, 121during bone healing, 101–106, 336–337in the craniofacial system, hardware

review, 445–461in genioplasty, 628–633in nasal reconstruction, 483–484in orbital hypertelorism reconstruction, 744See also Plates; Screws

Index 773

Fixture insertioncomputerized tomography images for

reviewing placement, 205surgical technique, maxillary sinus

grafting, 187Flap contouring, for maxillofacial

reconstruction, 303–304Follow-up

after oral cancer treatment, 72–73after temporomandibular joint surgery,

350–351See also Outcomes

Fontanellesin craniomaxillofacial deformity, Apert

syndrome, 749description of, 671evaluating, in craniomaxillofacial

deformity, 10Forehead

advancement of, in Apert syndrome, 751

landmarks of, 10–11Foreign body reactions, to self-reinforcing

polylactide copolymer, 115Fractures

fixation of, self-reinforced polymers for,120–121

posttraumatic osteomyelitis at the site of,433

spontaneous, of an irradiated edentulousmandible, 229–230

Franceschetti-Zwahlen-Klein syndrome,Tessier classification of, 28

Frankfort horizontal plane (FH), forevaluation of craniomaxillofacialdeformity, 7

Free-tissue transfer, in mandibularreconstruction, 338

Frontal boneanterior, calvarial bone graft

reconstruction, 711deformities of, classification, 95osteomyelitis of, 84–85

Frontal view, for evaluatingcraniomaxillofacial deformity, 9

Frontonasal dysplasia, 52Full-thickness outer cortex calvarial bone

graft, 702Functional considerations

in Crouzon syndrome, 713problems associated with

craniosynostosis, 673

GGallium-67 scans

in craniomaxillofacial bone infection, 79in osteomyelitis of the frontal bone, 85

Garre sclerosing osteomyelitis, 82Genetic counseling

in craniofacial deformity, 672

for orthognathic surgery candidates,497–500

Genetic diagnosis, in craniofacialdeformities, 672

Genetic predisposition, in primarycraniosynostosis, 29

Genial deficiency, aesthetic repair of, 282Genioplasty, 574, 651–653

combination with ramus osteotomy, 648considerations for rigid internal fixation,

623–638mandibular horizontal osteotomy for,

611passive, 624–626sliding, 612

rigid fixation in, 617Giant cell granulomas, 62Gingival tissues, evidence of implant

failure in, 253–254Glenoid reconstruction, in hemifacial

microsomia, 734Gliomas, nasal, 53Globe, position of, and craniomaxillofacial

deformity, 13Gnathion (Gn), for evaluation of

craniomaxillofacial deformity, 7Gold

for dental restoration substructures, 239for octa-abutment screw-retained dental

restorations, 145–147Goldenhar syndrome, 463, 727

macrostomia in, 730vertebral defects in, 728

Gonzalez-Ulloa line, for evaluatingcraniomaxillofacial deformity, 9

Graftscantilevered bone, for orbital

reconstruction, 480corticocancellous block, harvesting for

ridge augmentation, 157factors affecting success of, 127fixation of, in mandibular continuity

defect reconstruction, 319–320materials for maxillary sinus grafting,

179metatarsal, for mandibular

reconstruction, 474for nasal reconstruction, 483–488reconstructive, 124–132resorption as a measure of failure in,

216tertiary, in cleft lip and palate, 556See also Bone grafts

Grisel syndrome, 86Growth

disturbances ofassociation with cleft lip and palate,

541–542association with midface

reconstruction, 668

effects of plate and screw fixation on thecraniofacial skeleton, 693–699

excessive, after reconstruction of themandible, 464

facialeffect of cleft lip and palate surgery,

500in hemifacial microsomia, 729–730

of nonvascularized grafts, 462restricted, after osteotomy and fixation,

696–699Guided bone regeneration (GBR), 155–163

biodegradable membranes used in,118–120

case report, 161chin, after harvesting bone, 296

Guided tissue regeneration (GTR), 127Gunshot wounds, 43–46

HHandgun injuries, 47Haptens, metals as, 110Hardware

for internal fixation, 599–601in intraoral vertical ramus osteotomy,

646in mandibular sagittal split ramus

osteotomy, 640–642in ramus osteotomy, 648in subapical osteotomy, 651

for Le Fort I maxillary osteotomy, 654midface, 657

for stabilizing genioplasty, 652Harkens classification, of cleft lip and

palate, 23Harvesting, of calvarial bone grafts,

701–703Healing

duration of, in ridge augmentation,157–158

in maxillary sinus grafting, 179–181of posttraumatic osteomyelitis, by

secondary intention, 433process of, 125of reconstruction, after radiation therapy,

335soft-tissue, in the presence of a

membrane, 156after surgery, craniomaxillofacial,

124–137Hearing disorders

in cleft infants, 541in Crouzon syndrome, 713external hearing aids for, skin-

penetrating implants, 132–133Helsinki University Central Hospital,

Department of Oral andMaxillofacial Surgery, 377

Hematomas, nasal, deformity fromuntreated, 55

774 Index

Hemifacial microsomia (HFM), 681–685,727–737

presurgery and postsurgery views,686–687

Hemimandibulectomyfor osteogenic sarcoma, 469reconstruction following, 471reconstruction with alloplast, 385

Hemorrhagein craniofacial surgery, 667–668in maxillary sinus grafting, 194

Hemostasis, in maxillary surgery, 528Hereditary conditions

autosomal dominantApert syndrome, 679Crouzon syndrome, 678–679hemifacial microsomia, 727–728

nasal deformity in, 50–52See also Congenital deformity

Heterotopic bone, formation of, intemporomandibular jointarthroplasty, 381

Histology, clinical, of implants in bonegrafts, 128–130

Historyof the Le Fort I osteotomy, 581of mandibular osteotomies, 606–609Mesopotamian, of craniofacial cleft, 27observation of osteomyelitis, 76Roman, of osteomyelitis of the frontal

bone, 84of segmental maxillary osteotomy, 587of a surgical approach to

craniosynostosis, 715History, patient’s, assessment of

craniomaxillofacial deformity, 6Holoprosencephaly, facial anomalies in, 52Human experimentation, on the stability of

maxillofacial implants, 135Hunsuck effect, avoiding, 615–616Hydantoin, nasal deformities due to in

utero exposure to, 50Hydrocephalus

association with Crouzon syndrome, 713

in Kleeblatschumldel deformity, 36Hydroxyapatite (HA), synthetic, 182–184Hyperbaric oxygen treatment (HBO), effect

of, on implant success, 133–134Hypertelorbitism, in cleft lip and palate,

bilateral complete, 567–569Hypertelorism, in clefts, 28–29

IIatrogenic injuries, nasal deformities from,

57Iliac bone grafts

morbidity in harvesting, 668onlay grafts, outcomes, 131radiologic follow-up, 222

with soft tissue flaps, for maxillofacialreconstruction, 301–303

Iliac corticocancellous graftscomplications of, 339immediate versus delayed placement,

study, 131Iliac crest, donor site

for ascending ramus and condyle grafts,465–467

for free bone grafts, 298–300for mandibular continuity defect repair,

321for mandibular reconstruction, 310–311,

389–390, 414for nasal reconstruction, 483

Ilizarov method, for distractionosteogenesis, 648–650

Imagingmethods for evaluation of the

craniomaxillofacial region, 210–212in osteomyelitis of the frontal bone,

85in suppurative osteomyelitis, 81

Immunocompetence, and osteomyelitisincidence, 76–77

Implantsconnecting to natural teeth, 247–248defined, 124–125dental

failure of, 253–254full-body-screw (S), 138, 164hollow-cylinder, 139–140hollow-screw, 138–139

fracture of, 254metal, mechanical properties of,

110–111module selections, 451–456osseointegrated, in cleft lip and palate,

548, 551Incidence

of clefting, by geographic location andracial group, 539

of cleft lip and palate, 22of nasal fractures, 55of oral squamous cell carcinoma, 65

Incisor display, noting in a clinicalexamination, 509–510

Indicationsfor bilateral sagittal split ramus

osteotomy, 639–640for bimaxillary surgery, 522–523for calvarial bone grafts, 704–711for condyle replacement, 372for fibula grafts, 327–334for free bone grafts, 295for genioplasty, 624–627, 651for hemifacial microsomia treatment,

733–734for intraoral vertical ramus osteotomy,

645–647

for Le Fort I maxillary osteotomy, 656for Le Fort II osteotomy, 660for Le Fort III osteotomy, midface

reconstruction, 664for microvascular bone flaps, 301for onlay grafting, 177–178for orthognathic surgery, 557, 561for subapical osteotomy, 650for temporomandibular joint restoration,

343Indium scan, white blood cell, in

craniomaxillofacial bone infection,79

Infantile osteomyelitis, 83Infection

in craniofacial surgery, 667–668of craniomaxillofacial bone, location of,

79frontal bone collapse after, calvarial

bone graft reconstruction, 711in genioplasty, 634maternal, craniofacial deformities

associated with, 671in maxillary sinus grafting, 194opportunistic, nasoseptal manifestations

of, 57postoperative, demonstration on

computerized tomography image,204

Inferior vermilion border (Vi), forevaluation of craniomaxillofacialdeformity, 7

Infraorbital rim defect, calvarial bone graftfor reconstruction of, 705–706

Inner cortex calvarial bone graft, 703Instrumentation sets, craniofacial

osteotomy, 629Instruments, craniofacial modular fixation

system, 450–451Intermaxillary fixation, placement with

powerchain, 566Internal fixation

considerations in radiation therapy,419–432

functionally stable, 1Le Fort II osteotomy, 662–663Le Fort III osteotomy, midface

reconstruction, 666–667technique for, 599–601, 603See also Rigid internal fixation

Interocclusal splintpreparing from models, 523–525transitional, 525–526

Intracranial pressurein Apert syndrome, before or after

forehead advancement, 750and hypertension, association with

craniosynostosis, 673, 713monitoring of, in young children with

Crouzon syndrome, 718

Index 775

Intracranial procedures, for orbitalhypertelorism management,740–744

Intracranial volume, in Apert syndrome, 749Intramembranous grafts and implants,

131–132Intraoperative radiation therapy (IORT),

advantages of, 427–429Intraoral technique, for stabilization in

mandibular sagittal split ramusosteotomy, 642

Intraoral tissue, restoration of, after cancersurgery of the head and neck, 290

Intraoral vertical ramus osteotomy (IVRO),606–607, 614–615

indications for, 645–647In utero exposure, nasal deformities due to,

50Irradiated bone, osteogenetic potential of,

444ITI Strauman Dental Implant System,

765–767

JJaw

deformity in Crouzon syndrome,management of, 724

dysfunction of, psychological aspects in,634

lower, reconstructive surgery of,radiographic assessment, 213–218

upper, imaging sequence andinterpretation, 212

KKeratocysts, recurrence of, 59–61, 350–351Key area, in repair of the orbit, 478–479Kirschner wires, for craniomaxillofacial

bone healing, 102Kleeblatschumldel deformity, 29, 35–37Kufner osteotomies, posterior maxillary, 588

segmental, 602–603

LLacrimal apparatus, damage to, in Le Forte

III osteotomy, 668Lag screw technique

advantages of, in craniofacial surgery, 715in mandibular osteotomy, 615–616

sagittal split ramus, 609, 641in nasal reconstruction, 484–488

Lambdoid synostosis, unilateral, 676–678Lateral arm free flap, for mandibular

reconstruction, 338–339Latissimus-dorsi musculocutaneous flaps,

361, 370–371Le Fort I maxillary osteotomy

advantages of, 523in cleft lip and palate, 562

bilateral complete, 565–566

examples of fracture patterns, 582history of, 581maxillary, 653–656

necrosis as a complication of, 83multiple segment, planning for, 526surgical technique, 591–601types of, 583–584

Le Fort II osteotomyin midface reconstruction, and

considerations for internal fixation,660–668

in nasomaxillary hypoplasia, 574Le Fort III osteotomy

in Crouzon syndrome, history of, 715malar maxillary, 574for midface reconstruction

considerations for internal fixation,660–668

in Crouzon syndrome, 678–679,719–721, 723–724

Limberg oblique osteotomy, 610Lips, clinical assessment of, in

craniomaxillofacial deformity, 17–18Loading, of grafts

maxillary sinus, 175progressive, 189and success of incorporation, 127

Lower facial plane (LFP), for evaluation ofcraniomaxillofacial relationships, 8

Lund classification, of craniofacialdeformity, 23

Lymphomas, of extranodal origin, 70

MMagnetic resonance imaging

in craniomaxillofacial bone infections,78

in oral malignancies, 69Malar bone

absence of, in Franceschetti-Zwalen-Klein syndrome, 28

aesthetic repair of deficiency of, 282–283evaluating, in craniomaxillofacial

deformity, 15Malar prominence, defining, in a clinical

examination, 509Malignancies

carcinoma of the tongue, 400condylar reconstruction in, 381head and neck cancer, reconstruction in,

289–294oral, 65–75

mandible resection in, 317recurrence rates, after marginal

mandibulectomy, 411See also Tumors

Malocclusionin Crouzon syndrome, management of,

724after Le Forte III osteotomy, 668

Mandibleanteroposterior deficiency of, in cleft lip

and palate, 557–559atypical ossifying fibroma in, panoramic

image, 225–226biomechanical considerations in

reconstruction of, 239–240classification of deformities of, 91–92comminuted fracture of, 165continuity defects of

decisions about reconstruction of, 335fixation of bone grafts in

reconstruction, 317–326distraction osteogenesis of, 757–764edentulous, 237–243

with overdenture bar, 263fixation of

with experimental polymers, 116with polyglycolide materials, 117

hardware review, 269–279implants in, study, 131internal fixation of, 1, 533with maxillary fixed bridge, 263–264midline split of, 647–650multiple fractures of, aesthetic repair, 281ossifying fibroma in, computerized

tomography image, 227–228osteomyelitis of, 80–82posttraumatic osteomyelitis of, 433–438reconstruction of, with vascularized bone

grafts, 310–313resection due to carcinoma, and

restoration, 166–167resorption of, in edentulous patients, 236

Mandible Distractor Module Set, 269,278–279

Mandible reconstruction module, 273Mandible trauma module, 271–273Mandibular alveolar osteotomy, total, 606,

650–651Mandibular alveolar ridge, atrophy of,

168–169Mandibular angle

deficiency in, aesthetic repair of, 282reconstruction of defects of, 389–394

Mandibular body reconstruction, 395–410Mandibular condylar reconstruction

with free costochondral grafting,343–355

problems with prostheses, 377–388Mandibular continuity, reconstruction of,

with an angular THORP plate,404–405

Mandibular osteotomy, 104–105, 529anterior midline, 611–613

rigid fixation in, 617with rigid internal fixation, 606–622,

639–659Mandibular prognathism, 5

in cleft patients, 574

776 Index

intraoral vertical ramus osteotomy fortreatment of, 606

Mandibular reconstruction plate, exposureof, and infection, 444

Mandibular resection, in oral cancer, 70–72Mandibular sagittal split ramus osteotomy,

612–614Mandibular segmental subapical osteotomy

anterior, 606, 608–611rigid internal fixation and acrylic splint

in, 617Mandibular-temporomandibular joint

complex, in hemifacial microsomia,729

Mandibulectomy, marginal, 411–413Mandibulofacial dysostosis

familial, ear deformities in, 16Tessier classification of, 28in Treacher Collins syndrome, 685

Mandibulotomy, stable fixation of, 494Maternal idiosyncrasies, as potential causes

of malformation, 671Maxilla

atrophied, augmentation of, 131bilateral defects of, 439–444deformities of, 92–93edentulous, 243–245implants in, study, 131internal fixation of, 532–533microsurgical reconstruction of large

defects of, 356–371osteomyelitis of, 82–83sarcoma of, 366–367

Maxillary alveolar hyperplasia, history oftreatment for, 581

Maxillary and chin advancement, afterrepair of a cleft lip and palate,unilateral complete, 567, 570–571

Maxillary buttress defect, calvarial bonegraft reconstruction in, 705,707–708

Maxillary hyperplasia, posterior,management of, 598–599

Maxillary hypoplasia, in a cleft patient,556–557

outcome of surgery for, 498Maxillary/midface defects, reconstruction

of, 356–359Maxillary osteotomies, 581–605

in cleft lip and palate, 551–577stability of, with rigid internal fixation,

639–659Maxillary segmental osteotomies

anterior, 601posterior, 602–603

Maxillary sinuscomputerized tomography imaging of

pathology of, 206, 208grafting and osseointegration surgery,

174–197

Maxillofacial bonesITI dental implant system for, 164–173tumors of, and bone invasion, 59–64

Maxillofacial surgery, 1advantages of rigid internal fixation in,

581Maxillomandibular fixation (MMF)

for autogenous transplants, 377history of, 606in orthognathic surgery, radiologic

record keeping for, 513for vertical ramus osteotomy, 615

Maximal Interincisal Opening (MIO),reduction in, and fixation method,618

Mechanical considerations, in fixation, 104Medication, maternal exposure to, and

nasal deformities, 50Melanoma, of the oral cavity, 70Membrane reflections, surgical technique,

maxillary sinus grafting, 186–187Meningiomas, sphenoid wing, transfacial

access osteotomies for resection of,489–496

Mental protuberance, defined, 623Mentocervical angle (MCA), in evaluation

of craniomaxillofacial relationships,8

Mentolabial sulcus (MLS), in evaluation ofcraniomaxillofacial deformity, 7

Menton (M), soft tissue, for evaluation ofcraniomaxillofacial deformity, 7

Mesh module, cranioplast, 456–458Mesh plate, for orbital reconstruction, 480Mesiodistal orientation, in single tooth

restorations, 250Metal, for craniomaxillofacial internal

fixation, 107–112Metastatic tumors, of the oral cavity, 70Metopic synostosis, 675–678Microbiology

of osteomyelitis of the frontal bone, 85of suppurative osteomyelitis of the

mandible, 80Microplate fixation, resorbable, in surgery

for metopic suture release, 675Microsomia, hemifacial, 22, 40

reconstruction in, 362–363Microsurgery, for reconstruction of large

defects, 356–371Microtia

craniomaxillofacial microsomiaassociated with, 16

prosthesis for, 133Microvascular bone surgery

composite flaps, for maxillofacialreconstruction, 301

current practice and trends in correctivesurgery, 310–316

for reconstruction of defects of the

mandibular angle, 389for reconstruction of the condyle and

ascending ramus, 462–477Microvascular free flaps, for head and

neck reconstruction, 289–290Microvascular module, 273Microvascular tissue transfer, in

reconstruction of anterior defects ofthe mandible, 414

Midfacedefects of, in hemifacial microsomia,

729Le Fort I osteotomy for deformity of,

656–657history, 581

management of deformity of, inchildhood, 719

microsurgical reconstruction of largedefects of, 356–371

multiple fractures of, aesthetic repair, 281reconstruction of

after cancer surgery, 291–292Le Fort II and III osteotomies,

660–668Miniplate fixation systems, 445

anterior mandibular segmental andgenioplasty osteotomies, 611–613

craniofacial system, 599–600in mandibular osteotomies, 617

sagittal split ramus, 642–643modules, United States and worldwide,

445titanium, in orbital hypertelorism

reconstruction, 744Models

dental, for planning bimaxillary surgery,523

for planning orthognathic surgery, 561three-dimensional, fabrication from

computerized tomography data, 463Modules

cranial bone flap fixation, 1.0–1.5 mm,457–458

craniofacial modular fixation system,1.0–20 mm, 445–448

Monobloc osteotomiesin Apert syndrome, 751–752

avoiding, 752–753in Crouzon syndrome, 722–723

Morbidityversus benefit from bimaxillary surgery,

523disability from radical excision of oral

cancer, 70–73long-term, in mandibular continuity

defect repair, 327in repeat craniotomy for Crouzon

syndrome, 718–719Morian classification, of craniofacial

deformity, 22–23

Index 777

Mucosal coverage, utilization forreconstruction incraniomaxillofacial deformity,classification, 90

Multidisciplinary team conceptfor managing craniofacial deformities,

672, 733for managing hemifacial microsomia,

727Myocutaneous flap, pectoralis major, 289,

412–413for bilateral maxillary defect repair,

442–444

NNasal aperture, donor site for free bone

grafts, 296Nasal dermoids, 54Nasal dorsum hematomas, 55Nasal encephalocele, description of, 53Nasal gliomas, 54Nasal structure

cavity, nonseparation from the oralcavity, 540

classification of deformities, 94description of bone, 483restoring with bone grafts and rigid

internal fixation, 483–488septum, managing in transfacial access

osteotomy, 495Nasoendotracheal tube, placing and

securing in maxillary surgery, 528Nasofacial angle, measuring, 14Nasofrontal angle (NFA), for evaluation of

craniomaxillofacial relationships, 7Nasomaxillary region, reconstruction of,

after cancer surgery, 292Naso-orbital-ethmoid deformities, 94Necrosis, aseptic, following maxillary

osteotomy, 590Nerve damage

in genioplasty, 634in Le Forte III osteotomy, 668in rigid internal fixation using bicortical

screws, 615Nerve tissue availability, in

craniomaxillofacial deformity,classification, 90

Neural crest cells, role in craniofacialdevelopment, 38. See alsoEmbryology

Neuralgia-inducing cavitationalosteonecrosis (NICO), 82

Neurologic manifestations, in hemifacialmicrosomia, 728

Neuropsychiatric disorders, associationwith craniosynostosis, 673

Neurosensory disturbances, as acomplication of rigid internalfixation, 619

Nickel, in tissue, toxicity of, 109–110Nomenclature

of alveolar bone grafting, 543of hemifacial microsomia, 727See also Classification

Noseassessing the structure of, 13–14functions of, 49

Nutritionin cleft infants, 540–541disorders of, affecting development, 5

OOcclusion, assessment of

in cleft lip and palate, 556in craniomaxillofacial deformity, 19–20in dental implant restoration, 241in mandibular overdentures, 243

Occupational injuries, craniomaxillofacial,47–48

Ocular mobility, in craniomaxillofacialdeformity, 13–14. See also Vision

Odontogenic tumors, 59–62Onlay bone grafts

in Apert syndrome, 754maxillary, versus sinus inlay graft, 177

Open bite deformitiesanterior, bilateral posterior segmental

osteotomies for treating, 587correction of, preoperative and

postoperative x-rays, 535–536Operative procedure. See Surgical

approach/proceduresOphthalmopathy, association with

hyperthyroidism, 5Oral cavity

assessment of, in craniomaxillofacialdeformity, 19

nonseparation from the nasal cavity, 540

Orbitclinical evaluation of, 12deformities of, in hemifacial

microsomia, 728–729reconstruction of, 478–482

Orbital blowout, polylactide plates forrepairing, 115–116

Orbital cleftcentral superior, 28superolateral, 28superomedial, 28

Orbital expansion, in hemifacialmicrosomia, timing of, 733

Orbital floor repairof defects, 362–365

calvarial bone graft reconstruction,704–705

polymers for fracture fixation, 117Orbital hypertelorism, 738–748

analysis of malformation in, 738–739

in bilateral coronal synostosis, 675in metopic synostosis, 675

Orbital implants, 133Orbital rim advancement (ORA),

preoperative and postoperativeviews, 675–676

Orbitomaxillary cleft, medial, 26–27Orbitozygomatic reconstruction, 105Orientation

compromised, restoring dental fixtureswith, 255

of single-tooth restoration, 250Oromandibular complex, reconstruction of,

290–291three-dimensional, software for, 291

Oronasal fistulae, closing, 542Orthodontia

for children with cleft lip and palate,541–542, 561

in hemifacial microsomia, 735Orthodontist, role in bimaxillary surgery,

523Orthognathic examination, 497–521Orthognathic modules, craniofacial

modular fixation system, 454–455Orthognathic surgery

after bone graft closure of a palatalfistula, 572–573

in cleft lip and palate, 567defined, 639examination before undertaking,

506–520indications for, in cleft lip and palate,

557, 561models used for planning, 514–518

Orthopedics, preoperativefor cleft infants, 542–543effect on later bone grafting for alveolar

clefts, 555–556Ortho Treatment Planner (software), 514Osseointegration

of dental implants, 155in bone grafts, 327–328

in dentistry, 232evaluation of, with computerized

tomography imaging, 203of implants in cleft lip and palate

reconstruction, 548, 551maintaining, in dental implant

restoration, 253in maxillary sinus grafting, 174–197of metal implants, 124of screws in microvascular grafts, 322of titanium, 110

effects of irradiation on, 419experimental study in dogs, 128plasma-sprayed, 140–142

Osteitisdefined, 76osteoblastic, 83

778 Index

Osteoarthritis, as an indication forcostochondral grafting, 353–354

Osteocutaneous flap, from the fibula,327–328

Osteogenesiseffects of irradiation on, before and after

implantation, 425–426head and neck, 41

Osteogenic sarcoma, hemimandibulectomy,chemotherapy and radiotherapy for,469

Osteoinduction, defined, 180Osteomyelitis

chronic, ankylosis of thetemporomandibular joint caused by,354

historic observation of, 76infantile, 83of the mandible

nonsuppurative, 81–82posttraumatic, 433–438

Osteoplastic segment, maintaining bone as,in skull base surgery, 491

Osteoradionecrosis (ORN), 86–87, 433mandibular, reconstruction in, 475–476

Osteosarcomabone resection and reconstruction in,

324replacement of chin and mandible due

to, 374–375Osteosynthesis, hardware-supported, 1Osteotome

for separation of the pterygoid plates,history of, 581

sinus floor elevation using, 195Osteotomies

mandibular, 104–105maxillary, 581–605surgical technique, maxillary sinus

grafting, 186transfacial access, 491–496

Outcomesof mandibular condyle reconstruction,

347–351of mandibular condyle replacement with

a prosthesis, 374–375unsatisfactory, in orthognathic surgery,

500See also Follow-up

Overdenturesimplant failure rate associated with,

244–245for support in dental restorations,

146–147, 237, 241–243Overdrilling, of holes in genioplasty, 631

PPalate, embryological development of, 539Papilloedema

association with craniosynostosis, 713

association with intracranialhypertension, 673

Parathesia, after maxillary sinus grafting,194

Partial-thickness calvarial bone grafts,outer cortex, “potato chip” graft,701–702

Pathogenesisof craniosynostosis, 673of hemifacial microsomia, 681–682,

728of osteomyelitis, 77

of the frontal bone, 84of the mandible, 80

See also EtiologyPathology, bony, radiology for identifying

before orthognathic surgery, 513Pedicled flaps, for soft tissue involved in

mandibular reconstruction, 338Periodontal problems, in mandibular

midline split, 648Periorbital/cranial base defects,

reconstruction of, 361–367Periorbital region

evaluating, 11reconstruction of defects in, 361–367

Perko-Bell technique, for posteriormaxillary osteotomies, 588, 603

Perthes osteotomy, 610Pfeiffer syndrome, 680–683

facial features of, 36, 664Phagocytosis, in resorption of polylactide,

115Physiological insult, from corrosion of

metals in internal fixation, 107–110Pigs, experimental grafting of mandibular

defects, 127–128Pindborg tumor, panoramic image, graft

with healing, 221Pins, for craniomaxillofacial bone healing,

102Plagiocephaly, 33

anterior, 674defined, 10, 30timing of surgery for, 733

Plain film, for evaluation of thecraniomaxillofacial region, 210

Planningfor bimaxillary surgery, 522–538for maxillary sinus grafting, 174–179for maxillary surgery, 528–547for orthognathic surgery, 561

data base record for training in,501–505

radiologic examination for, 513–518for treatment for oral malignancies,

69–70Planning cycle, completing, for

orthognathic surgery, 519–520Plate and screw fixation, effects on the

growing craniofacial skeleton,693–699

Platesfor craniomaxillofacial bone healing,

104, 451–456polylactide, for mandible fixation, 116See also Reconstruction plates

Pogonion (Pg), soft tissue, for evaluationof craniomaxillofacial deformity, 7

Polychondritis, relapsing, nasoseptalmanifestations of, 57

Polydioxanone (PDS)for fixation of fractures, 113tissue compatibility of, 115

Polyglycolide (PGA)for fixation of fractures, 113tissue compatibility of, 115

Polylactide (PLA)for fixation of fractures, 113lag screws, in temporomandibular joint

repair, 346membranes, for defect repair, 117–118self-reinforcing (SR) technique for

fixation of fractures, 114Polymorphic reticulosis (T-cell

lymphoma), nasoseptalmanifestations of, 57

Polymorphonuclear neutrophil (PMN)function, and sinus lift surgery,178–179

Porcelain, for dental implant restoration,241

Positioningof maxillary sinus implants,

complications of, 194–195to stabilize a mandibular sagittal split

ramus osteotomy, 641in temporomandibular joint prostheses,

381Posterior areas, in maxillary implant

positioning, 243–246Posterior maxillary segmental osteotomies,

602–603Postoperative management

computed tomography imaging to assessosseointegration, 203

mandibular angle grafts, 391–393maxillary sinus grafts, 187–189

Posttraumatic osteomyelitis of themandible (PTOM), 80, 433–438

Pott puffy tumor, 84–85Prediction, measurements for, in

genioplasty, 627Preformed grafts, endochondral, 130–131Premaxilla

in bilateral alveolar cleft, 540union with the maxillary alveolar

process, during development, 539Premaxillary osteotomy, in cleft lip and

palate, 561–562

Index 779

Press-fit implants, for patients with limitedintermaxillary opening, 246

Primary bone repairwith osseointegrated dental implants,

429in posttraumatic osteomyelitis, 434versus secondary bone repair, 323–324

Primates, craniomaxillofacial surgeryresearch using, 693–699

Profile examinationfor evaluating craniomaxillofacial

deformity, 9before orthognathic surgery, 509–512

Prognathismmandibular, correction of, preoperative

and postoperative x-rays, 537in skeletal malocclusion, 39

Prognosis, in oral cancer, 69Progressive condylar resorption (PCR),

with rigid internal fixation,mandibular osteotomy, 617

Projection, nasal, 14Proportional centrofacial T, 746–747Prostheses

condylar, for replacement of themandibular condyle, 372–376

craniomaxillofacial, 132–135in craniomaxillofacial deformity,

classification system, 90facial, skin-penetrating implants for

anchorage of, 133–134mandibular

fixed, 237–241removable, 241–243

maxillaryfixed, 244removable, 244–245

metal, for primary functionalreconstruction, 399

removable, 439–444retention of, screw versus cement for

dental implant restoration, 235–236Prosthodontic concept

dental implant restoration, 232–261ITI dental implant system, 143–146solutions for compromised implant

placement, 254–255Psychological effects

of cleft lip and palate, 542in patients seeking orthognathic surgery,

497–500Psychosocial considerations

adjustment in hemifacial microsomia,735–736

in treatment of oral cancer, 73

QQuantification, of facial harmony, 284–285Quantitative assessment, in Crouzon

syndrome, 714

RRabbits, experimental grafting of tibia

defects, 127–128Race, and incidence of cleft lip and palate,

22Radial forearm flap

advantages and disadvantages of using,389–390

for mandibular reconstruction, 338–339Radial forearm osteomuscular-

fasciocutaneous flap, formaxillofacial reconstruction, 308

Radiated mineralized cancellous allografts(RMCA), experimental evaluationof, 130

Radiationassociation with microcephaly, 671effect on implant failure, 133–134

Radiation therapyeffect on choice of graft procedure, 327,

341, 369and internal fixation devices, 419–432osteoradionecrosis as a result of, 86–87

Radical excision, of oral cancers, 70Radiographic assessment

of craniofacial deformities, 672of craniomaxillofacial region, 210–219for diagnosis of craniomaxillofacial bone

infections, 78in mandibular grafting, 407in maxillary sinus grafting, 175–176of osteomyelitis of the maxilla, 84See also Computed tomography

Radiographynarrow-beam, detailed, 210panoramic, 210–211

Radiologyfor evaluation of the mandibular

condylar prosthesis, 378for evaluation of the temporomandibular

joint, 343–345for examination before orthognathic

surgery, 512–518for follow-up of bone grafts, case

reports, 220–231for observation of condylar prosthesis,

375Radionuclide imaging

in craniomaxillofacial bone infections,78–79

in osteomyelitisof the frontal bone, 85suppurative, 81

Ramus osteotomycombination with midline split, 648vertical, 614–615

Recipient sitepreparation of, in calvarial bone grafting,

703–704in surgery for cleft lip and palate, 543

Reconstructioncomplications of, in irradiated fields,

290head and neck, for the oncologic patient,

289–294mandibular

after surgery for oral cancer, 71–72timing of, 335

orbital, technique for, 479–480Reconstruction plate

for bridging bony defects, 317, 320,336–337

development of, 1for double barrel graft fixation, 331–332for extensive anterior mandibular defect

repair, 414after oral surgery for cancer, 73permanence of, 395–397three-dimensional, for mandibular angle

defect reconstruction, 389Record keeping, radiologic examination as

part of, in orthognathic surgery, 513Rectus abdominis free flap, for mandibular

reconstruction, 338Rectus abdominis musculocutaneous flaps,

361–364Relapse

in genioplasty, 652in intraoral vertical ramus osteotomy,

after bone screw fixation, 646in the Le Fort I maxillary osteotomy,

654–656midface, 657

in mandibular sagittal split ramusosteotomy, 643–645

in subapical osteotomy, 651Remodeling, in osteotomy, 639Research

animalon the effects of plate and screw

fixation, 693–699experimental grafting of iliac crests,

128current, on prefabrication of

vascularized bones flaps, 313experimental studies of grafts and

implants, 127–128human experimentation, on the stability

of maxillofacial implants, 135studies of radiation, effects on grafting

with use of reconstruction plates,420–422

See also Clinical studiesReserpine, nasal deformities due to in

utero exposure to, 50Resin, for dental implant restoration, 241Resorbable Fixation System, 458–459Resorbable materials

for microplate fixation, in surgery formetopic suture release, 675

780 Index

plates and screws, in craniosynostosisreconstruction, 673

Resorptionof bone after extraction of all teeth, 236condylar

in late relapse after osteotomy, 639,643–645

positioning to prevent, 614with rigid internal fixation, 617

of grafts, 462effect of screw fixation on, 484reconstruction of the ascending ramus

and condyle, 464maxillary, significance of patterns in, 243

Respiratory problems, accompanying Apertsyndrome, 752

Restoration, single-tooth, 250–253. Seealso Reconstruction

Retinoic acid syndrome (RAS), earmalformations in, 728

Retrognathia, in skeletal malocclusion, 39Retromolar region, donor site for free bone

grafts, 296Revascularization, of cortical bone grafts,

126Rhabdomyosarcoma, soft-tissue grafts in

children, 365Rhesus monkeys (Macaca mulatta),

research using, 695–699Rheumatic ankylosis (RA), complications

in treating, 379–381Rheumatoid arthritis

bilateral alloarthroplasty for, 383bilateral temporomandibular joint

arthroplasty for, 384Rhinion (Rh), for evaluation of

craniomaxillofacial deformity, 7Rib as donor site

for free bone grafts, 298for nasal reconstruction, 483for pedicled bone grafts, 300

Rickett analysis of the head and face, useof, in planning orthognathicsurgery, 515–518

Ridge augmentation, localized, usingguided bone regeneration, 155–163

Ridge fracture, in maxillary sinus grafting,194

Rifle injuries, craniomaxillofacial, 47Rigid fixation

in craniomaxillofacial calvarial bonegraft harvesting, 700–712

in osteotomies for Apert syndromereconstructions, 753–754

Rigid internal fixation (RIF)for bimaxillary surgery, 522–538in the growing facial skeleton,

disadvantages of, 693in horizontal osteotomy of the

symphysis, 612

in mandibular osteotomy, 606–622in maxillary osteotomy, 581–605in maxillary surgery, 527–528for nasal reconstruction, 483–488in posttraumatic osteomyelitis treatment,

434–435, 436–437stability of maxillary and mandibular

osteotomies with, 639–659Rods, polylactide, for mandible fixation,

116Rotation, nasal, 14

SSaethre-Chotzen syndrome, facial features

of, 36Sagittal interrelationships, in skeletal

malocclusion, 38–39Sagittal osteotomy, fixation with

biodegradable self-reinforcingpolymer screws, 119, 121

Sagittal split ramus osteotomy (SSRO),606

bilateral, 639–645condylar torquing in, 618mandibular, 612–614morbidity in, 523

Sagittal suture synostosis, 675–676Sarcomas

ameloblastic fibrosarcomas orodontosarcomas, 61, 70

mandibular fibrosarcomas,reconstruction after removal of, 386

Scanning, of bone in oral malignancies,68–69

Scaphocephalydefined, 10, 675deformity in, 31lateral and superior views, 679

Scapuladonor site for ascending ramus and

condyle grafts, 465–466with flaps

for mandibular continuity defectrepair, 321

for maxillofacial reconstruction,304–306

myocutaneous flaps from, advantage inanterior defects of the mandible, 414

vascularized bone grafts from, formaxillofacial reconstruction, 313,359–361, 472

Scapular flap, for mandibularreconstruction, 389–390

Scar tissue, fibrous, in bone healing, 125Schneiderian membrane, tearing of, in the

sinus lift procedure, 189, 193–194Schuchardt procedure, posterior maxillary

osteotomy, 586–587Schwannoma, suprasellar, transfacial

access to, 493

Sclerosing osteomyelitis, chronic, 81–82Screw and drill bit chart, craniofacial

modular fixation system, 449Screws

for craniomaxillofacial bone healing,102–103

in dental implants, loose or fractured,254

effect of fixation with, on boneresorption, 484

failure of, comparison of conventionaland THORP plates, 402–403

polylactide copolymer, for mandiblefixation, 116

technique of fixation with, 532–534Secluded space, creation and maintenance

of, in guided bone regeneration,156–157

Secondary bone grafting, delay of, afterirradiation, 429

Segmental osteotomies, periodontal defectsresulting from, 523

Segment control, during surgery, with atransbuccal trocar, 534–535

Self-reinforcing technique, polymers forfracture fixation, 114

Septal hematoma, septal abscess from, 54Serratus anterior muscle (SAM), for

oromandibular defect repair, 338Sex

and cleft lip and palate incidence, 22and Garre sclerosing osteomyelitis

incidence, 82and hemifacial microsomia incidence,

727Sheep, experimental grafting of iliac crests,

127–128Shotgun injuries, craniomaxillofacial, 47Shotgun wound, repair of, 416Silver-palladium, for dental substructure

fabrication, 239Simmons-Peyton classification

of craniofacial deformities, 36of facial clefting, 30

Single-tooth osteotomy, 606Sinus, cranialization for management of,

495Sinus lift graft procedure, 174

smoking, 178–179Skeletal malocclusion, etiology of, 38–42Skull, donor site for free bone grafts,

296–297Skull base

reconstruction of, after cancer surgery,292

transfacial access osteotomies to,489–496

Smokingassociation with mandibular

osteomyelitis, 435

Index 781

Smoking (Continued)as a contraindication to fibula donation,

414as a contraindication to sinus lift in,

178–179Soft tissue

alterations ofin cleft and noncleft patients, 561in orbital hypertelorism, 744

closure in genioplasty, 631effects on, of irradiation, 427–429for evaluation of craniomaxillofacial

deformity, 7flaps for coverage of craniomaxillofacial

osseous continuity defects, 335–342healing of

delayed, as a complication ofmaxillary sinus surgery, 194

in the presence of a membrane, 156isolated grafts of, 359–361local flaps for reconstruction of, in

maxillary midface defects, 356–359

macrostomia in hemifacial microsomia,730

malformation ofassociation with cleft, 28in hemifacial microsomia, 683

prevention of growth into grafts, andsuccess of incorporation, 127

for reconstruction in craniomaxillofacialdeformity, 90

restoration after surgery, 310, 337–338for oral cancer, 72

surgical access viaLe Fort II osteotomy, 660Le Fort III osteotomy, 664–665

Spark erosion prosthesis, maxillary, 245Speech

effect onof cleft lip and palate, 556of dental implant restoration, 237

patterns of, evaluating in cleft lip andpalate, 551

problems with, in cleft infants, 541Sphenoid bone, locating targets for skull

base surgery relative to, 489–490Spiessl technique, for mandibular sagittal

split ramus osteotomy, 616Squamous cell cancer

bilateral total maxillectomy for, 439–444involving the jaw joint, 291mandibulectomy for, 411–413oral, 65–70patterns of spread, and margins of safety

in resection, 336repair of deformity after surgery for, 415

Stabilityof grafts, 127

long-term, of maxillary and mandibularosteotomies with rigid internalfixation, 639–659

of maxillary osteotomies, 587segmental, 603

of midfacial advancement osteotomies incleft patients, 574, 577

of rigid fixation versus wireosteosynthesis, in the Le Fort Imaxillary osteotomy, 655–656

Stabilizationof the Le Fort II osteotomy, midface

reconstruction, 662–663of the Le Fort III osteotomy, midface

reconstruction, 666–667in metopic suture release, 675in orbital rim advancement, 675–676

Stainless steel implants, 111Standardized incidence ratio, for oral

cancer, Finnish Cancer Registry,65–66

Staples, for craniomaxillofacial bonehealing, 102

Stent, surgical, for dental implantrestoration, 232–233

Step defects, in Le Fort III osteotomy,723–724

Step osteotomy, 606Von Eiselberg, 609

Stomion (St), for evaluation ofcraniomaxillofacial deformity, 7

Stress, physiologic, and bone density,233–234

Stud-retained overdentures, 242Subantral grafting and implant insertion,

185Subapical osteotomy, 650–651Subcondylar osteotomy, 610

horizontal, 609vertical ramus, 606

Subcranial orbital rotation, 746Substructure fabrication, dental implant

restoration, 239Superior vermilion border (Vs), for

evaluation of craniomaxillofacialdeformity, 7

Supracrestal connective tissue, arounddental implants, plasma-sprayedtitanium, 142–143

Supraorbital contour, reshaping, in Apertsyndrome surgery, 751

Surgical approach/proceduresin angioplasty, 627–628in cleft lip and palate, 543–546condylar prosthesis for replacement of

the mandibular condyle, 372–374in craniosynostosis, staging of

reconstruction, 673in Crouzon syndrome, 715–724

dental implant system, 164and fixation method, for

craniomaxillofacial bone healing,104–105

for genioplasties, 628for mandibular restoration, 390–391for orbital hypertelorism management,

740–748for osteotomies, in cleft lip and palate,

561–574planning of, for oral cancer, 70–73for temporomandibular joint repair,

345–346See also Planning

Surgical techniquefor Le Fort II osteotomy, midface

reconstruction, 660–662for Le Fort III osteotomy, midface

reconstruction, 665–666for maxillary osteotomies, 591–601

segmental, anterior, 601–602for maxillary segmentation, 596for maxillary sinus grafts, 185–187See also Techniques

Suturescraniofacial, closure and fusion of,

40–41polylactide, for mandible fixation,

116Swansea approach, to bone grafting in cleft

lip and palate, 546–548Symphysis

as a donor site for corticocancellousblocks, 181

horizontal osteotomy of, 612rigid fixation in, 617

Syndactylyin Apert syndrome, 36, 679, 682,

749in Pfeiffer syndrome, 680–681

Synostosis, bilateral coronal, 675Synovitis, acne, pustulosis, hyperostosis,

osteitis (SAPHO) syndrome, 82Systemic disorders, observation of, before

orthognathic surgery, 500

TTandem screw fixation, in mandibular

osteotomies, 615–616Tearing injuries, craniomaxillofacial, 48Technetium scan

of bone repair with fibula double-barrelvascularized graft, 332–333

in craniomaxillofacial bone infection,78–79

Techniquesin genioplasty, 651–652in intraoral vertical ramus osteotomy,

645–646

782 Index

in the Le Fort I maxillary osteotomy,654

midface, 656–657in mandibular midline split, 648in mandibular sagittal split ramus

osteotomy, 640in nasal reconstruction, 484–488in subapical osteotomy, 650–651See also Surgical technique

Teethcharacteristics of, in bilateral cleft

patients, 557cleft-adjacent, variations of, 540eruption of, effect of cleft alveolar

osseous defect, 542Telecanthus, in a Tessier No. 12 cleft,

28Temporalis osteomuscular flap, for

maxillofacial reconstruction, 301Temporal region, evaluating in

craniomaxillofacial deformity, 11Temporomandibular joint (TMJ)

ankylosis of, condylar prostheses insurgery for, 377

defective, replacement of, in hemifacialmicrosomia, 734

degenerative changes in, andimmobilization of the mandible,606

dysfunction of, identifying prior toorthognathic surgery, 506

restoration of, 291, 343Tessier classification

of craniofacial clefts, 23–29of craniofacial deformities, 52–53of craniosynostosis syndromes, 35–37

Thalidomide, hemifacial microsomia-likedefects from animal studies with,728

Three-Dimensionally BendableReconstruction Plate system, forfixation of bone grafts, 321, 323

Throat point (C), for evaluation ofcraniomaxillofacial deformity, 7

Tibia, donor site for autogenous bonegrafts, 300

Tip-defining point (Tp), for evaluation ofcraniomaxillofacial deformity, 7

Tissue reactionsto ITI material in implants, 140versus polarization resistance of metals

and metal alloys, 107–108to polymers for bone fixation,

114–115See also Soft tissue

Titanium Hollow Screw ReconstructionPlate (THORP)

advantages of, 323–324in condylar reconstruction, 381

for anterior mandibular archreconstruction, after surgery, 290

for bilateral maxillary defectreconstruction, 439–444

combination with adaptable condyles,372

for dental implant restoration, 275–278for reconstruction of mandibular

continuity defects, 321–323, 337,397

Titanium implants, 1, 110–111experimental evaluation of

osseointegration of, 128–129miniplate, in orbital hypertelorism

reconstruction, 744plasma-sprayed, dental, 140reactivity of metal in, 110reconstruction plates, 336–337substructure fabrication, 239

Tobacco use, and mouth cancer, 65. Seealso Smoking

Tomography, multidirectional, of thecraniomaxillofacial region, 211–212

Torquing, with rigid fixation, 639Townes view, of screw fixation of a plate

reconstruction, 401Tragion (Tg), for evaluation of

craniomaxillofacial deformity, 7Transcutaneous suction-irrigation systems,

for managing posttraumaticosteomyelitis, 433

Transfacial access osteotomies, 489–496Transglabellar approach, for transfacial

access osteotomy, 495Transmandibular approach

to the central and anterolateral skullbase, 491–494

Transmaxillary approachto the central and anterolateral skull

base, 491–494to the skull base, 494–495

Transorbitozygomatic approach, to theskull base, 496

Transplant, defined, 124–125Transverse interrelationships, in skeletal

malocclusion, 39–42Trauma

avulsion injuries, 43mandible module for repair in, 269–271nasal injury from, 56

Treacher Collins syndromeaesthetic repair in, 283classification of cranial bone

deformities, 97incomplete form of, Tessier No. 6 cleft,

27–28principles of management of, 685–686,

688–689

Treatmentfor hemifacial microsomia, 684,

733–736for orbital hypertelorism, 740

Treatment planning. See PlanningTrends, in craniomaxillofacial reconstruction,

310–316. See also ResearchTrigonocephaly deformity

in metopic synostosis, 675–677secondary, 34

Tumorsbenign

differentiating, 62maxillofacial, 59–64

lymphatic and hemopoietic, in patientswith steel hip implant, 619

nasal, 55, 57nonodontogenic, within the facial bones,

62–64odontogenic, 59–62resection of, craniomaxillofacial

deformity secondary to, 6suprasellar, 489See also Malignancies

Turricephaly, defined, 10Twins, monozygotic, discordance for

hemifacial microsomia in, 727–728

UUnilateral complete cleft lip and palate

(UCLP), deformities in, 556–557Unilock module, 273–275Universal fracture plates, maintenance of

the blood supply of microvasculargrafts with, 322–324

Upper facial plane (UFP), for evaluation ofcraniomaxillofacial relationships, 8

Vvan der Meulen classification, of clefts, 29Vascularized bone grafts (VGBs), 310–313

for mandibular reconstruction, 389–390for temporomandibular joint

reconstruction, 462Vascularized free-bone grafts, to bridge

mandibular defects, 399Vascular supply

of the anterior maxillary segment, 590in bone grafts, 125–126of the chin bone, preserving in

genioplasty, 623in craniomaxillofacial deformity, 90ensuring in maxillary osteotomies,

595–596of grafts, 127

and outcomes, 132Velopharyngeal incompetence, timing of

evaluation for correctivepharyngoplasty, 551

Index 783

Veneering materials, for dental implantrestoration, 240–241

Virchow classificationof craniofacial deformities, 35of facial clefting, 30

Visionimpairment of, in craniosynostosis, 673improving with surgery, in Apert

syndrome, 750measuring the acuity of, 12

Vitamin D deficiencies, effect ondevelopment, 5

WWaardenburg syndrome, 12Warfarin, nasal deformities due to in utero

exposure to, 50

Wassmund technique, 601inverted “L” osteotomy, 610in labial and palatal anterior segmental

osteotomy, 589, 653–654Water’s view

for assessing maxillary sinus, 175for assessing osteosynthesis plate

location, 212Wegener granulomatosis, nasoseptal

manifestations of, 57Wire fixation, for craniomaxillofacial bone

healing, 101–102Wound dehiscence, in genioplasty,

634Wunderer technique, 601

for anterior maxillary segmentalosteotomy, 590

XXenogeneic grafts, maxillary sinus, 184X-ray, of bone repair with fibula double-

barrel vascularized graft, 332

ZZygoma

biodegradable materials for fixation offractures of, 117

classification of deformities of, 93–94Zygomatic arch

defect of, calvarial bone graft forreconstruction of, 708–709

evaluating, in craniomaxillofacialdeformity, 15

Zygomatic maxillary complex (ZMC),fracture of, aesthetic repair, 281

784 Index