lected appropriately the majority of them can be suc-cessfully managed without significant complications.

Finally, total joint reconstruction with alloplastic TMJprosthesis will be briefly discussed.

References

Dimitroulis G. The role of surgery in the management of disorders ofthe temporomandibular joint: a critical review of the literature. Part 1Int J Oral Maxillofac Surg 34(2): 107-113, 2005

Dimitroulis G. The role of surgery in the management of disorders ofthe temporomandibular joint: a critical review of the literature. Part 2Int J Oral Maxillofac Surg 34(3): 231-237, 2005

Al-Belasy, FA, Dolwick, MF. Arthrocentesis for the treatment oftemporomandibular closed lock: a review article. Int J Oral MaxillofacSurg 36: 773-782, 2007

S421The Microvascular Fibula: Applicationsfor Maxillofacial ReconstructionJason Potter, DDS, MD, Portland, ORDavid L. Hirsch, DDS, MD, New York, NY

Purpose: Since its first description in the late 1980’sthe free fibula flap has been the “work horse” flap forbony maxillofacial defects. The combination of ease ofharvest, minimal donor sight morbidity, composite tis-sue transfer, and reliability make it the flap of choice forboth mandibular and maxillary reconstruction. This sur-gical clinic will cover harvest, microvascular techniqueand reconstruction of specific maxillofacial sites. Theclinic will also cover the challenging pre-operative, peri-operative and post-operative management principles as-sociated with this microvascular free flap.

Patient and Methods: The two presenters will presentclinical cases to illustrate technical aspects relating to fibulaharvest and considerations in maxillofacial reconstruction.A variety of clinical cases will be presented for benign,malignant, congenital, and osteomyelitic processes. In ad-dition, site specific reconstruction will be discussed.

Results: Long term results including cosmetic and den-tal rehabilitation will be presented. In addition, compli-cations and donor site morbidity will be addressed.

Conclusions: The free fibula flap is a viable option toreplace composite tissue defects in the MaxillofacialSkeleton. The survival rates of this flap have been welldocumented for all maxillofacial sites.

References

Choi S. Schwartz DL. Farwell DG. Austin-Seymour M. Futran N.Radiation therapy does not impact local complication rates after freeflap reconstruction for head and neck cancer. [Journal Article] Ar-chives of Otolaryngology -- Head & Neck Surgery. 130(11):1308-12,2004 Nov

Hidalgo DA. Pusic AL. Free-flap mandibular reconstruction: a 10-yearfollow-up study. [Journal Article] Plastic & Reconstructive Surgery.110(2):438-49; discussion 450-1, 2002 Aug

Urken ML. Buchbinder D. Costantino PD. Sinha U. Okay D. LawsonW. Biller HF. Oromandibular reconstruction using microvascular com-

posite flaps: report of 210 cases. [Journal Article] Archives of Otolar-yngology -- Head & Neck Surgery. 124(1):46-55, 1998 Jan

S422Cleft Lip and Palate: ComprehensiveReconstruction From Infancy ThroughAdolescenceBernard J. Costello, DMD, MD, Pittsburgh, PARamon L. Ruiz, DDS, MD, Orlando, FL

Surgeons caring for children with cleft lip and palatedeformities must proceed with a firm cognitive under-standing of three-dimensional regional anatomy, the ex-tent of the hard and soft tissue defects, and the complexinterplay between surgery and subsequent maxillofacialgrowth. This allows the clinician to appropriately formu-late and sequence the staged surgical treatment of pa-tients with cleft lip and palate deformities from the initialconsultation in infancy through adulthood.

Thoughtful, interdisciplinary planning of the recon-struction saves the patient family unnecessary therapiesand operative procedures. As such, appropriate planningavoids needlessly burdening the patient and/or healthcare system with inefficacious or unproven modalities.

This clinic will provide a comprehensive review of thetreatment rationale, diagnostic approach, and operativetechniques (primary lip repair, primary and secondarypalatal reconstruction, orthognathic surgery, and rhino-plasty) involved in the staged management of oro-facialclefts.

References

Strauss RP: Health policy and craniofacial care: Issues in resourceallocation. Cleft Palate Craniofac J 31: 78, 1994

American Cleft Palate-Craniofacial Association: Parameters for theevaluation and treatment of patients with cleft lip/palate or othercraniofacial anomalies. Cleft Palate Craniofac J 30 (suppl 1): 4, 1993

Koop CE: Surgeon General’s Report: Children with Special HealthCare Needs. Washington, D.C. Government Printing Office, June 1987

S423Lip Augmentation and RejuvenationLikith Reddy, DDS, MD, Cincinnati, OHErik W. Evans, DDS, MD, Cincinnati, OH

Esthetic changes in the aging upper lip constitute atroublesome problem for modern society. During theprocess of aging, the following alterations appear in theupper lip: vertical wrinkles, reduction in height of thevermilion border along with lengthening of the skin areaof the lip, and disappearance of the Cupid’s bow. Carefulanalysis of this area and appropriate treatment can har-monize these areas and produce a globally esthetic re-sult. The pertinent anatomy and esthetics of the preop-erative evaluation will be discussed in detail.

Surgical Clinics

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