Peterson’s Principles of Oral and Maxillofacial Surgery

Preface
Contents
Contributors
I: Medicine, Surgery, and Anesthesia
	1: Wound Healing
		1.1	 Introduction
		1.2	 The Healing Process
		1.3	 Wound Healing Response
			1.3.1	 Inflammatory Phase
			1.3.2	 Proliferative Phase
			1.3.3	 Remodeling Phase
		1.4	 Specialized Healing
			1.4.1	 Nerve
			1.4.2	 Bone
			1.4.3	 Extraction Wounds
			1.4.4	 Skin Grafts
		1.5	 Wound Healing Complications
			1.5.1	 Wound Infection
			1.5.2	 Wound Dehiscence
			1.5.3	 Proliferative Scarring
		1.6	 Optimizing Wound Healing
			1.6.1	 Tissue Trauma
			1.6.2	 Hemostasis and Wound Debridement
			1.6.3	 Tissue Perfusion
			1.6.4	 Diabetes
			1.6.5	 Immunocompromise
			1.6.6	 Radiation Injury
			1.6.7	 Hyperbaric Oxygen (HBO) Therapy
			1.6.8	 Age
			1.6.9	 Nutrition
		1.7	 Advances in Wound Healing
			1.7.1	 Growth Factors
			1.7.2	 Gene Therapy
			1.7.3	 Dermal and Mucosal Substitutes
			Conclusion
		References
	2: Medical Management and Preoperative Patient Assessment
		2.1	 Introduction
		2.2	 Cardiovascular Assessment and Disease
			2.2.1	 Coronary Artery Disease
			2.2.2	 Congestive Heart Failure
			2.2.3	 Valvular Heart Disease
			2.2.4	 Prosthetic Valve Replacement
			2.2.5	 Arrhythmias
			2.2.6	 Hypertension
			2.2.7	 Automatic Implantable Cardioverter Defibrillators and Pacemakers
		2.3	 Respiratory Disease
			2.3.1	 Asthma
			2.3.2	 Chronic Obstructive Pulmonary Disease
			2.3.3	 Pneumonia
			2.3.4	 Pulmonary Embolus
			2.3.5	 Atelectasis
			2.3.6	 Pulmonary Edema
			2.3.7	 Airway
		2.4	 Renal Disease
		2.5	 Liver Disease
		2.6	 Blood Disorders
			2.6.1	 Anemia
			2.6.2	 Myeloproliferative Disease
			2.6.3	 Leukemia
			2.6.4	 Lymphoma and Multiple Myeloma
			2.6.5	 Thrombocytopenia
			2.6.6	 Coagulopathy
			2.6.7	 Hemophilia A and B
			2.6.8	 Warfarin Therapy
			2.6.9	 Hypercoagulable Diseases
		2.7	 Endocrinology
			2.7.1	 Diabetes Mellitus
				2.7.1.1	 Preoperative
			2.7.2	 Thyroid
			2.7.3	 Adrenal
			2.7.4	 Pituitary Disease
		2.8	 Neurologic Disease
			2.8.1	 Trauma
			2.8.2	 Seizures
			2.8.3	 Cerebrovascular Accident
			2.8.4	 Myasthenia Gravis
		2.9	 Other Conditions
			2.9.1	 Malignant Hyperthermia
			2.9.2	 Autoimmune Disease
			2.9.3	 Immunodeficiencies
			2.9.4	 Substance Abuse
			2.9.5	 Obesity
			2.9.6	 Geriatric Patients
			2.9.7	 Pediatric Patients
			2.9.8	 Pregnancy
			Conclusion
		References
	3: Pharmacology of Outpatient Anesthesia Medications
		3.1	 Pharmacodynamics and Pharmacokinetics
			3.1.1	 Pharmacodynamics
			3.1.2	 Pharmacokinetics
		3.2	 Benzodiazepines and Opioids
			3.2.1	 Benzodiazepines
				3.2.1.1	 Diazepam
				3.2.1.2	 Midazolam
				3.2.1.3	 Lorazepam
				3.2.1.4	 Triazolam
				3.2.1.5	 Remimazolam
				3.2.1.6	 Flumazenil
			3.2.2	 Opioids
				3.2.2.1	 Morphine
				3.2.2.2	 Hydromorphone
				3.2.2.3	 Meperidine
				3.2.2.4	 Fentanyl
				3.2.2.5	 Remifentanil, Sufentanil, and Alfentanil
				3.2.2.6	 Nalbuphine
				3.2.2.7	 Naloxone
		3.3	 Sedative Medications Intended for General Anesthesia
			3.3.1	 Propofol
			3.3.2	 Etomidate
			3.3.3	 Ketamine
			3.3.4	 Barbiturates
				3.3.4.1	 Thiopental
				3.3.4.2	 Methohexital
				3.3.4.3	 Pentobarbital
		3.4	 Inhalation Anesthetics
			3.4.1	 Nitrous Oxide
			3.4.2	 Potent Inhalation Agents
				3.4.2.1	 Isoflurane
				3.4.2.2	 Sevoflurane
				3.4.2.3	 Desflurane
				3.4.2.4	 Halothane
		3.5	 Neuromuscular Blocking Medications
			3.5.1	 Succinylcholine
			3.5.2	 Nondepolarizing Agents
		3.6	 Reversal of Nondepolarizing Agents
			3.6.1	 Anticholinesterases
			3.6.2	 Anticholinergics
			3.6.3	 Sugammadex
		3.7	 Adjunct Medications
			3.7.1	 NSAIDs (Nonsteroidal Anti-Inflammatory Drugs)
			3.7.2	 Acetaminophen
			3.7.3	 Alpha-2 Agonists
			3.7.4	 Local Anesthetics
		3.8	 Antiemetic Medications
		Conclusion
		References
	4: Outpatient Anesthesia
		4.1	 Introduction
		4.2	 Level of Sedation
		4.3	 Goals of Sedation
			4.3.1	 Patient Safety
		4.4	 Patient Assessment
			4.4.1	 Airway Assessment
			4.4.2	 Airway Preparation
			4.4.3	 Smoking
			4.4.4	 Obesity
			4.4.5	 Nil Per Os (NPO)
				4.4.5.1	 Emergency Treatment: Full Stomach
			4.4.6	 Pregnancy Testing
			4.4.7	 Substances
				4.4.7.1	 Opioids
				4.4.7.2	 Anesthesia for Addicted Patients [20]
				4.4.7.3	 Marijuana
				4.4.7.4	 Alcohol
				4.4.7.5	 Amphetamine
				4.4.7.6	 Cocaine
				4.4.7.7	 “Ecstasy”
				4.4.7.8	 Inhalational Substances
				4.4.7.9	 Lysergic Acid Diethylamide (LSD)
				4.4.7.10	 PCP
		4.5	 Patient Assessment: Understanding the Changes with Age
			4.5.1	 The Pediatric Patient
			4.5.2	 Anatomic Considerations in the Pediatric Patient
				4.5.2.1	 Pediatric Respiratory System
					Endotracheal Intubation
					Upper Respiratory Infection
				4.5.2.2	 Pediatric Cardiovascular System
					Cardiac Output
					Neural Innervation
					Blood Pressure
				4.5.2.3	 Psychological Assessment
			4.5.3	 The Geriatric Patient
				4.5.3.1	 Cardiovascular
				4.5.3.2	 Pulmonary
				4.5.3.3	 Urinary and Hepatic System
		4.6	 Anesthetic Concepts
			4.6.1	 Monitoring
				4.6.1.1	 Respiratory Monitoring
			4.6.2	 Fluids
			4.6.3	 Patient Positioning
		4.7	 Sedative Techniques: Considerations Based on Age
			4.7.1	 Sedative Techniques in the Pediatric Patient
				4.7.1.1	 Routes of Administration
				4.7.1.2	 Pharmacologic Agents for the Pediatric Patient
					Ketamine
					Midazolam
					Induction Agents
					Inhalational Agents
					Other Medications
		4.8	 Pharmacology of Intravenous Drugs in the Geriatric Patient
		4.9	 Perioperative Complications
			4.9.1	 Airway Distress
			4.9.2	 Bronchospasm
			4.9.3	 Pulmonary Aspiration
			4.9.4	 Laryngospasm
				4.9.4.1	 Succinylcholine
			4.9.5	 Nausea and Vomiting
				4.9.5.1	 Phenothiazines
				4.9.5.2	 Benzamides
				4.9.5.3	 Histamine Antagonists
				4.9.5.4	 Muscarinic Receptor Antagonists
				4.9.5.5	 Serotonin Receptor Antagonists
				4.9.5.6	 Glucocorticoids
		4.10	 Postoperative Recovery and Discharge
		4.11	 Postoperative Analgesia
		4.12	 Special Considerations
			4.12.1	 Attention-Deficit/Hyperactivity Disorder
			4.12.2	 Autism
			4.12.3	 Cerebral Palsy
			4.12.4	 Down Syndrome
			4.12.5	 Muscular Dystrophy
		4.13	 Quality Assurance Protocols for Office-Based Anesthesia
		Box 4.1 Goals of Simulation
		Summary
		References
II: Dentoalveolar and Implant Surgery
	5: Impacted Teeth
		5.1	 Incidence and Etiology
			5.1.1	 Impactions Other than Third Molars
			5.1.2	 Impacted Third Molars
		5.2	 Clinical Evaluation
		5.3	 Treatment of an Impacted Tooth
			5.3.1	 Indications for Removal of Impacted Third Molars
				5.3.1.1	 Periodontitis
				5.3.1.2	 Pericoronitis
				5.3.1.3	 Orthodontic Considerations
				5.3.1.4	 Prevention of Odontogenic Cysts and Tumors
				5.3.1.5	 Root Resorption of Adjacent Teeth
				5.3.1.6	 Teeth Under Dental Prostheses
				5.3.1.7	 Prevention of Jaw Fracture
				5.3.1.8	 Management of Unexplained Pain
			5.3.2	 Contradictions to Treatment of Impacted Teeth
				5.3.2.1	 Extremes of Age
				5.3.2.2	 Compromised Medical Status
				5.3.2.3	 Surgical Damage to Adjacent Structures
		5.4	 Surgery and Perioperative Care for Impactions Other than Third Molars
			5.4.1	 Exposure Versus Exposure and Bonding
			5.4.2	 Surgical Technique
				5.4.2.1	 Exposure and Bonding
				5.4.2.2	 Surgical Uprighting
				5.4.2.3	 Transplantation
				5.4.2.4	 Removal
		5.5	 Surgery and Perioperative Care for Impacted Third Molars
			5.5.1	 Determining Surgical Difficulty
			5.5.2	 Technique for Removal
			5.5.3	 Technique for Coronectomy
			5.5.4	 Use of Perioperative Systemic Antibiotics
			5.5.5	 Use of Perioperative Steroids
		5.6	 Expected Postoperative Course
			5.6.1	 Bleeding
			5.6.2	 Swelling
			5.6.3	 Stiffness
			5.6.4	 Pain
		5.7	 Complications Following Third Molar Surgery
			5.7.1	 Infection
			5.7.2	 Tooth Fracture
			5.7.3	 Alveolar Osteitis
			5.7.4	 Nerve Disturbances
			5.7.5	 Rare Complications
		5.8	 Periodontal Healing After Third Molar Surgery
		Conclusion
		References
	6: Pre-Prosthetic Surgery
		6.1	 Introduction
			6.1.1	 Workup and Evaluation
		6.2	 Alveoloplasty (. Figs. 6.4, 6.5, 6.6, 6.7, 6.8, 6.9, 6.10, and 6.11)
			6.2.1	 Genial Tubercle Reduction
			6.2.2	 Vestibuloplasty Procedures and Floor of Mouth Lowering
			6.2.3	 Mylohyoid Ridge Reduction
			6.2.4	 Mandibular and Maxillary Tori Reduction
			6.2.5	 Maxillary Labial Frenectomy (. Figs. 6.34, 6.35, 6.36, 6.37, and 6.38)
			6.2.6	 Epulis Removal
		Conclusion
		References
	7: Pediatric Dentoalveolar Surgery
		7.1	 Introduction
		7.2	 Impacted Teeth
		7.3	 Impacted Maxillary Canines
			7.3.1	 Maxillary Canine Exposure
			7.3.2	 Palatally Impacted Canines: Technique (. Fig. 7.5)
			7.3.3	 Labially Impacted Canines: Technique (. Fig. 7.6)
			7.3.4	 Maxillary Canine Autotransplantation
		7.4	 Impacted Mandibular and  Maxillary Premolars
			7.4.1	 Impacted Premolar Exposure: Technique
		7.5	 Impacted Maxillary Incisors
			7.5.1	 Maxillary Incisor Exposure: Technique
		7.6	 Impacted First and Second Molars
			7.6.1	 Impacted Molar Exposition: Technique
		7.7	 Supernumerary Teeth
		7.8	 Hypodontia
		7.9	 Transplantation of Teeth
			7.9.1	 Molar Tooth Transplantation: Technique (. Fig. 7.11)
		7.10	 Dental Implants in the Growing Child
		7.11	 Prominent Maxillary Labial Frenum
		7.12	 Techniques
			7.12.1	 Standard Frenectomy
			7.12.2	 Laser Frenectomy
		7.13	 Mandibular Labial Frenum
		7.14	 Techniques
			7.14.1	 Standard Technique
			7.14.2	 Z-Plasty Technique
			7.14.3	 Laser Frenectomy
		7.15	 Lingual Frenum
		Conclusion
		References
	8: Utilization of Three-Dimensional Imaging Technology to Enhance Maxillofacial Surgical Applications
		8.1	 Introduction
		Case One: CBCT Diagnostics for a Horizontally Impacted Maxillary Canine and More
		Case Two: CBCT Diagnostics for a Mandibular Implant Evaluation and More
		Case Three: CBCT Diagnostics to Assess Potential Graft Augmentation
		Case Four: CBCT Diagnostics in the Mandible—Implants and More
		Conclusion
		Suggested Readings
	9: Dynamic Navigation for Dental Implants
		9.1	 Introduction
		9.2	 Principles of Dynamic Navigation
			9.2.1	 Fundamentals of DN
			9.2.2	 Image Processing, Analysis
			9.2.3	 Diagnosis
			9.2.4	 Planning
			9.2.5	 Surgical Simulation
		9.3	 Accuracy and Precision of Dynamic Navigation
		9.4	 Components of Dynamic Navigation
			9.4.1	 Important Definitions
			9.4.2	 Computer
			9.4.3	 Monitor
			9.4.4	 Cameras
			9.4.5	 Digital-Analog Interface
			9.4.6	 Patient Tracking Arrays
			9.4.7	 Instrument Tracking Array
			9.4.8	 Planning Software
			9.4.9	 Tracking Software
			9.4.10	 Surgical Handpiece Chuck and Drill Extension
		9.5	 Basic Workflow of Dynamic Navigation
			9.5.1	 Workflow Overview
		9.6	 Dentate Patient Work Flow
			9.6.1	 Fiducial Clip Considerations
			9.6.2	 Fiducial Clip Preparations
			9.6.3	 Fiducial Clip Impressions
			9.6.4	 Fiducial Clip Placement
			9.6.5	 Dual Arch Considerations
			9.6.6	 Multiple Fiducial Clips on the Same Arch
		9.7	 Edentulous Patient Workflow
			9.7.1	 Location of Edentulous Fiducials
			9.7.2	 CT Acquisition
			9.7.3	 Dual Scan Technique
			9.7.4	 Dual Scan Procedure Overview
			9.7.5	 Detailed Steps
			9.7.6	 CT Scan for All Patients
			9.7.7	 Planning Workflow
			9.7.8	 Creating the Panoramic Curve Step by Step:
			9.7.9	 Marking Nerve
			9.7.10	 Deleting Nerves
				9.7.10.1	 Intra-Oral Scan Registration
				9.7.10.2	 Import Intra-Oral Scan
			9.7.11	 Marking Points on STL File (Intra-Oral Scan) and DICOM File (Bone Surface)
				9.7.11.1	 Removing Points
				9.7.11.2	 Planning Virtually Waxed-Up Crowns
			9.7.12	 Adjusting Crown to Preferred Position
			9.7.13	 Crown Rx Panel
				9.7.13.1	 Planning Implant
			9.7.14	 Planning Implant in 2D Views
			9.7.15	 Adjusting Implant to  Preferred Position
			9.7.16	 Mark Edentulous Fiducials (Edentulous Patients Only)
			9.7.17	 Surgical Instruments Preparation Overview
			9.7.18	 Surgical Instruments Selection
			9.7.19	 Calibrate Contra-Angle Handpiece
				9.7.19.1	 Contra-Angle Handpiece Body Calibration
				9.7.19.2	 Contra-Angle Handpiece Chuck Calibration
				9.7.19.3	 Calibrate Probe (. Fig. 9.28)
			9.7.20	 Probe Pivot Calibration
				9.7.20.1	 Surgery Preparation Procedure Overview
			9.7.21	 Choosing the Appropriate Patient Tracker Arm (. Fig. 9.29)
				9.7.21.1	 Patient Tracker Calibration
			9.7.22	 Patient Tracker and Fiducial Clip Calibration
			9.7.23	 Drill Bit Confirmation
			9.7.24	 Calibration Check
			9.7.25	 Calibration Check Failure
				9.7.25.1	 Implant Surgery with Dynamic Navigation System: Dentate
				9.7.25.2	 Performing Navigation Surgery in Dentate Patient
				9.7.25.3	 Understanding the 3D Target View
				9.7.25.4	 Surgery Preparation Procedure Overview for Edentulous Patients
				9.7.25.5	 Patient Tracker and Edentulous Plate Assembly
				9.7.25.6	 Performing Navigation Surgery in Edentulous Patient
				9.7.25.7	 Postsurgery for All Patients
		Conclusion
		References
	10: Implant Prosthodontics
		10.1	 Introduction
		10.2	 Biomechanical Considerations
		10.3	 Radiographic Evaluation
		10.4	 Implant Surgical Guides
		10.5	 Implant Site Selection
		10.6	 Crown-to-Implant Ratio
		10.7	 Occlusion
		10.8	 Full-Arch Restorations
		10.9	 Implant Selection
		10.10	 Single-Tooth Replacement
		10.11	 Restorations for the Partially Edentulous Patient: Fixed Partial Dentures (FPDs)
		10.12	 Restorations for the Edentulous Patient
		10.13	 Contemporary Techniques
		10.14	 Maxillofacial Prostheses
		10.15	 Complications
		10.16	 Maintenance
		10.17	 Success Criteria
		Conclusion
		References
	11: The Science of Osseointegrated Implant Reconstruction
		11.1	 Introduction
		11.2	 Diagnosis and Treatment Planning
			11.2.1	 Radiographic Imaging
			11.2.2	 Specific Evaluation of the Potential Implant Sites
				11.2.2.1	 Posterior Mandible
				11.2.2.2	 Anterior Mandible
				11.2.2.3	 Posterior Maxilla
				11.2.2.4	 Anterior Maxilla
		11.3	 Implants in Regional Sites
			11.3.1	 The Single Tooth in the Esthetic Zone
				11.3.1.1	 Establishing the Goals
				11.3.1.2	 Determination of Bone Height and Width
				11.3.1.3	 Relating the Cone Beam to  Clinical Situation
				11.3.1.4	 Thin Gingiva and Its Conversion to Thick Gingiva
				11.3.1.5	 When to Use Soft Tissue Grafts
				11.3.1.6	 Labial Bone Loss in the  Esthetic Zone
				11.3.1.7	 Specific Algorithms for Treatment
			11.3.2	 Grafting Material Characteristics
				11.3.2.1	 Xenograft
				11.3.2.2	 Surface Characteristics
		11.4	 Restoration of Bone Volume After Tooth Removal
			11.4.1	 Vertical Height Restoration for Placement of Implants in the Posterior Maxilla by Grafting the Inferior Aspect of the Sinus Floor
			11.4.2	 Restoration of Bone Width for a Narrow Alveolar Ridge
		11.5	 Grafting the Extraction Site
			11.5.1	 Mineralized Bone Allograft
		11.6	 Concave Bone Deformities: Tunneling Versus Open Approaches
			11.6.1	 Treatment of Concave Congenitally Missing Lateral Incisors
			11.6.2	 The Tunnel Approach
			11.6.3	 Surgical Technique
		11.7	 The Mandibular First Molar
			11.7.1	 Grafting the Molar Site
			11.7.2	 Immediate Implant Placement in the Mandibular Molar Site
		11.8	 Quadrant Multiunit Restorations on Implants
			11.8.1	 Surgical Method
		11.9	 The Edentulous Jaw
			11.9.1	 Surgery of the Anterior Mandible
				11.9.1.1	 Placement of Two to Five Implants in the Anterior Mandible (. Figs. 11.13 and 11.14)
			11.9.2	 Evaluation of Anatomy: Physical Examination of the Patient Without Teeth
			11.9.3	 Evaluation of Anatomy: Radiologic Examination of the Patient Without Teeth
			11.9.4	 Surgical Treatment for Placing Implants in the Mandible
			11.9.5	 Placement of Two Implants
			11.9.6	 Placement of Four or More Implants
			11.9.7	 Immediate Loading of the Edentulous Mandible
			11.9.8	 Use of Computed Tomography Guide Stent for Fabrication of a Fixed Provisional
			11.9.9	 Preoperative Preparation for Full-Arch Immediate Provisional Cases
			11.9.10	 Preoperative Laboratory Procedures
			11.9.11	 Surgical Procedure for Computed Tomography-Guided Implant Placement in an Edentulous Mandible
			11.9.12	 Placement of the Temporary Cylinders
			11.9.13	 Connecting the Temporary Cylinders to the Denture
		11.10	 The Flangeless Maxillary Restoration
			11.10.1	 Preoperative Evaluation: Esthetic Evaluation
			11.10.2	 Laboratory Workup
			11.10.3	 Provisional Prosthesis Fabrication
			11.10.4	 Surgical Treatment Considerations
			11.10.5	 Patient Follow-Up
		11.11	 Single Molars in the Maxilla
			11.11.1	 Treatment Strategies
			11.11.2	 Radiographic Evaluation
			11.11.3	 Presence of Greater Than 9 mm of Bone Within the Furcation
			11.11.4	 Insufficient Bone Height Within the Furcation for Primary Implant Stability (. Fig. 11.20)
			11.11.5	 Surgical Procedure
		11.12	 Crestal Approach for Sinus Augmentation
		11.13	 Anatomic Considerations for Material and Method for Sinus Augmentation
			11.13.1	 Bone Thickness
			11.13.2	 Bone Height 9 mm or Greater
			11.13.3	 Bone Height 5 mm or Greater
			11.13.4	 Bone Height 3–5 mm
			11.13.5	 Bone Height 2 mm or Less
		11.14	 The Crestal Window Approach
			11.14.1	 Surgical Technique: Creation of an Island of Bone to Avoid Removal of Bone at the Time of Elevation of the Sinus Floor (. Figs. 11.21 and 11.22)
		11.15	 The Use of Navigation to Guide Implant Placement
			11.15.1	 Static Guides
			11.15.2	 Dynamic Navigation (. Fig. 11.23)
			11.15.3	 Accuracy Considerations
			11.15.4	 Indications for Each Method
		References
	12: Comprehensive Implant Site Preparation: Mandible
		12.1	 Single Missing Teeth
			12.1.1	 Mandibular Incisor Sites
			12.1.2	 Canine-Bicuspid
			12.1.3	 Single-Molar Sites
		12.2	 Segmental Mandibular Defects
			12.2.1	 Anterior Segmental
			12.2.2	 Mandibular Posterior Segment
		12.3	 Full Arch
			12.3.1	 Discussion
		Summary
		References
	13: A Graft-less Approach for Treatment of the Edentulous Maxilla: Contemporary Considerations for Treatment Planning, Biomechanical Principles, and Surgical Protocol
		13.1 Introduction
		13.2 Patient Selection
			13.2.1	 Screw Access Canals: The “Black and Red Dotted Lines”
		13.3 Radiographic Evaluation
			13.3.1	 Zones of the Maxilla
			13.3.2	 Zygoma Anatomy-Guided Approach (ZAGA)
		13.4 Preoperative Considerations
		13.5 Biomechanical Considerations
			13.5.1	 Primary Load-Bearing Bone Under Function
		13.6 Surgical Protocol
			13.6.1	 “Rescue Concept”
			13.6.2	 Prosthetic Conversion Technique
			13.6.3	 Postoperative Care
			13.6.4	 Discussion
		References
	14: Soft Tissue Management in Implant Therapy
		14.1	 Soft Tissue Integration
		14.2	 Flap Management Considerations
			14.2.1	 Introduction
			14.2.2	 Design for Submerged Implant Placement
			14.2.3	 Design for Abutment Connection and Nonsubmerged Implant Placement
			14.2.4	 Surgical Maneuvers for Management of Peri-implant Soft Tissues
				14.2.4.1	 Resective Contouring
				14.2.4.2	 Papilla Regeneration
				14.2.4.3	 Lateral Flap Advancement
		14.3	 Rationale for Soft Tissue Grafting with Implants
		14.4	 Clinical Guidelines for Soft Tissue Augmentation
		14.5	 Principles of Oral Soft Tissue Grafting
		14.6	 Epithelialized Palatal Graft Technique for Dental Implants
			14.6.1	 General Considerations
			14.6.2	 Contemporary Surgical Technique
		14.7	 Subepithelial Connective Tissue Grafting for Dental Implants
			14.7.1	 General Considerations
			14.7.2	 Surgical Technique: Donor-Site Surgery
			14.7.3	 Surgical Technique: Recipient-Site Surgery
				14.7.3.1	 Closed Technique
				14.7.3.2	 Open Technique
		14.8	 Vascularized Interpositional Periosteal Connective Tissue Flap
			14.8.1	 General Considerations
			14.8.2	 Surgical Technique
		14.9	 Oral Soft Tissue Grafting with Acellular Dermal Matrix
			14.9.1	 General Considerations
			14.9.2	 Surgical Technique
		Conclusion
		References
	15: Craniofacial Implant Surgery
		15.1	 Introduction
		15.2	 Prosthetic Reconstruction
		15.3	 Autogenous Reconstruction
		15.4	 Technical Considerations
			15.4.1	 Temporal Implants
			15.4.2	 Orbital Implants
			15.4.3	 Nasal Implants
		15.5	 Surgical Technique
			15.5.1	 Pretreatment Criteria
			15.5.2	 Pre-resection Collaboration
			15.5.3	 Residual Bony Volume
			15.5.4	 Computer-Guided Treatment Planning
			15.5.5	 Overlying Soft Tissues
			15.5.6	 Transition Line
			15.5.7	 Surgical Considerations
				15.5.7.1	 Extraoral Implants
				15.5.7.2	 Intraoral and Intranasal Implants
			15.5.8	 Preparing the Osteotomy
			15.5.9	 Orbital Defects
			15.5.10	 Nasal Defects
			15.5.11	 Complex Maxillofacial Defects
			15.5.12	 Unusual Maxillofacial Defects
		15.6	 Healing Period
			15.6.1	 Abutment Connection and Impression Taking
			15.6.2	 Soft Tissue Reactions and Infections
		15.7	 Longevity of Cranial Implants
		15.8	 Radiation in Cranial Implantation
		15.9	 Prosthetic Considerations
			15.9.1	 Preoperative Planning
				15.9.1.1	 Options without Cranial Implant Surgery
				15.9.1.2	 Options with Cranial Implant Surgery
			15.9.2	 Prosthetic Surgical Considerations
				15.9.2.1	 Auricular Considerations
			15.9.3	 Templates
				15.9.3.1	 Auricular Templates
			15.9.4	 Construction of the Prosthesis
				15.9.4.1	 Nasal Prostheses
				15.9.4.2	 Color and Tinting of the Prosthesis
		15.10	 Discussion
			15.10.1	 Retention Components
			15.10.2	 Management of the Skin Tissues Around the Extraoral Abutments
			15.10.3	 Long-Term Maintenance
		Conclusion
		References
			Suggested Reading
III: Maxillofacial Trauma
	16: Initial Management of the Trauma Patient
		16.1	 Introduction
		16.2	 Assessment of the Severity of Injury
			16.2.1	 Glasgow Coma Scale
			16.2.2	 Trauma Score and Revised Trauma Score
			16.2.3	 Injury Severity Score
			16.2.4	 Other Scoring Systems
		16.3	 Primary Survey: ABCs
			16.3.1	 Airway Maintenance with Cervical Spine Control
			16.3.2	 Breathing
			16.3.3	 Circulation
			16.3.4	 Neurologic Examination
			16.3.5	 Exposure of the Patient
		16.4	 Secondary Assessment
			16.4.1	 Head and Skull
			16.4.2	 Chest
			16.4.3	 Maxillofacial Area and Neck
			16.4.4	 Spinal Cord
			16.4.5	 Abdomen
			16.4.6	 Focused Assessment with Sonography for Trauma (FAST) Exam
			16.4.7	 Genitourinary Tract
			16.4.8	 Extremities
			16.4.9	 Opioids
		Conclusion
		References
	17: Soft Tissue Injuries
		17.1	 Introduction
		17.2	 Principles of Management
		17.3	 Anatomic Evaluation
		17.4	 Sequence of Repair and Basic Technique
		17.5	 Types of Injuries
			17.5.1	 Abrasions
			17.5.2	 Contusions
			17.5.3	 Lacerations
			17.5.4	 Avulsive Injuries
			17.5.5	 Animal and Human Bites
			17.5.6	 Gunshot Wounds to the Face
		17.6	 Regional Considerations
			17.6.1	 Scalp and Forehead
			17.6.2	 Eyelid and Nasolacrimal Apparatus
			17.6.3	 Nose
			17.6.4	 Ear
			17.6.5	 Lip
			17.6.6	 Neck
			17.6.7	 Cheek
		17.7	 Postoperative Wound Care
		Conclusion
		References
	18: Rigid Versus Nonrigid Fixation
		18.1	 Rigid Internal Fixation
		18.2	 Nonrigid Internal Fixation
		18.3	 Selection of Fixation Schemes: How Much Fixation (Rigidity) Is Enough?
		18.4	 Biomechanic Studies Versus Clinical Outcomes
		18.5	 Load-Bearing Versus Load-Sharing Fixation
		18.6	 Regional Dynamic Forces
		18.7	 One-Point Versus Two-Point Fixation
		18.8	 Compression Versus Noncompression Plate Osteosynthesis
		18.9	 Locking Plate-Screw Systems
		18.10	 Lag Screw Fixation
		18.11	 Plate Fatigue
		18.12	 Single Versus Multiple Mandibular Fractures
		Summary
		References
	19: Dentoalveolar and Intraoral Soft Tissue Trauma
		19.1	 Introduction
		19.2	 Etiology and Demographics
			19.2.1	 Epidemiology
		19.3	 History and Physical Examination
		19.4	 Imaging
		19.5	 Classification of Dentoalveolar Fractures
			19.5.1	 Dental Tissues and Pulp
		19.6	 Treatment of Injuries to the Hard Tissues and Pulp
			19.6.1	 Enamel Fractures Crown Infractions
			19.6.2	 Crown Fracture Without Pulp Involvement
			19.6.3	 Crown Fracture with Pulp Involvement
			19.6.4	 Crown-Root Fracture
			19.6.5	 Root Fracture
			19.6.6	 Periodontal Tissue Injury and Treatment
			19.6.7	 Exarticulations (Avulsions)
			19.6.8	 Treatment
			Box 19.1 Treatment Summary for Avulsed Teeth
			Box 19.2 Treatment Summary for Teeth Avulsed >2 ha
			Box 19.3 Splint Requirements
			Box 19.4 Sequence of Acid-Etch Splinting Techniquea
			19.6.9	 Treatment of Fractures of the Alveolar Process
			19.6.10	 Treatment of Trauma to the Gingiva and Alveolar Mucosa
			19.6.11	 Pediatric Dentoalveolar Trauma Treatment
			19.6.12	 Thermal Injuries
		Conclusion
		References
	20: Contemporary Management of Mandibular Fractures
		20.1	 Introduction
		20.2	 World War and Influential Surgeons of Maxillofacial Trauma Surgery
		20.3	 Classification
		20.4	 Biomechanics
		20.5	 Treatment: Historical Perspectives
			20.5.1	 The Splint Age, 1866–1918
			20.5.2	 The Wire Age, 1918–1968
			20.5.3	 The Metal Plate Age and the Evolution of Modern Systems of Internal Fixation, 1968–Present
				20.5.3.1	 Rigid Internal Fixation and the AO/ASIF: “The German School”
				20.5.3.2	 Functional Fixation, Michelet and Champy: “The French School”
		20.6	 Diagnosis
		20.7	 Perioperative Management
		20.8	 Operative Management
		20.9	 Closed Treatment with Maxillo-mandibular Fixation vs. Open Reduction and Internal Fixation
		20.10	 Interdental Wire Fixation as an  Aid to Open Reduction and  Internal Fixation
		20.11	 Surgical Approach
		20.12	 Hardware Selection
			20.12.1	 Principles of Rigid Internal Fixation
		20.13	 Teeth in the Line of Fracture
			20.13.1	 Isolated Mandibular Symphysis, Parasymphysis, and Body Fractures
			20.13.2	 Use of Bone Reduction Forceps
			20.13.3	 Mandibular Angle Fractures
			20.13.4	 Bilateral Mandible Fractures
			20.13.5	 Comminuted Mandibular Fractures
			20.13.6	 Edentulous Atrophic Mandibular Fractures
			20.13.7	 Pediatric Mandibular Fractures
		20.14	 Intraoperative Imaging and Virtual Surgical Planning
		20.15	 Intraoperative 3D Imaging
		20.16	 Intraoperative Navigation/ Surgical Navigation (SN)
		20.17	 Virtual Surgical Planning
		20.18	 Complications
			20.18.1	 Infection
			20.18.2	 Malunion
			20.18.3	 Nonunion
		Conclusions
		References
	21: Fractures of the Mandibular Condyle
		21.1 Introduction
		21.2 Etiology
		21.3 Anatomy
		21.4 Fracture Patterns
			21.4.1	 Biomechanics
			21.4.2	 Classification
		21.5 Diagnosis and Assessment
			21.5.1	 Clinical Findings
			21.5.2	 Radiographic Evaluation
		21.6 Treatment
			21.6.1	 General Principles
			21.6.2	 Closed
			21.6.3	 Open
			21.6.4	 Submandibular
			21.6.5	 Retromandibular
			21.6.6	 Preauricular/Endaural
			21.6.7	 Retroauricular
			21.6.8	 Transoral
			21.6.9	 Reduction and Fixation
			21.6.10	 Endoscopy-Assisted Reduction
			21.6.11	 Virtual Surgical Planning
		21.7 Postoperative Treatment
		21.8 Complications
			21.8.1	 Malocclusion
			21.8.2	 Mandibular Hypomobility
			21.8.3	 Ankylosis
			21.8.4	 Asymmetry
			21.8.5	 Dysfunction/Degeneration
			21.8.6	 Chronic Pain
		21.9 Pediatric Condylar Fractures
			21.9.1	 Craniofacial Growth
			21.9.2	 Diagnosis
			21.9.3	 Treatment Options
			21.9.4	 Posttreatment Management and Complications
		Conclusion
		References
	22: Management of Maxillary Fractures
		22.1 Introduction
		22.2 History
		22.3 Le Fort Classification System
			22.3.1	 Le Fort I Level
			22.3.2	 Le Fort II Level
			22.3.3	 Le Fort III Level
		22.4 Anatomy
		22.5 Diagnosis
			22.5.1	 Clinical Examination
			22.5.2	 Imaging
		22.6 Treatment
			22.6.1	 Surgical Splints
			22.6.2	 Special Considerations
			22.6.3	 Complications
			Box 22.1 Complications Associated with Maxillary Fractures
		Conclusion
		References
	23: Management of Zygomatic Complex Fractures
		23.1 Introduction
		23.2 Surgical Anatomy
		23.3 Diagnosis
			23.3.1	 Radiographic Evaluation
		23.4 Treatment
			23.4.1	 Zygomatic Arch Fractures
			23.4.2	 Zygomatic Complex Fractures
			23.4.3	 Internal Fixation
		23.5 Complications
		Conclusion
		References
	24: Orbital and Ocular Trauma
		24.1	 Introduction
		24.2	 Orbital Fractures
			24.2.1	 Anatomy
				Box 24.1 Eyelid layers: cutaneous (anterior) to conjunctival (posterior)
		24.3	 Fracture Configurations
		24.4	 Clinical Examination
		24.5	 Imaging
		24.6	 Ocular Injuries and Disturbances
			24.6.1	 Visual Impairment
			24.6.2	 Diplopia
			24.6.3	 Posttraumatic Enophthalmos
			24.6.4	 Oculocardiac Reflex
			24.6.5	 Eyelid Lacerations
			24.6.6	 Lacrimal Injuries
			24.6.7	 Telecanthus
		24.7	 Nonoperative Management of Orbital Fractures
		24.8	 Operative Management of Orbital Fractures
			24.8.1	 Indications
			24.8.2	 Surgical Approaches
			24.8.3	 Lateral Tarsal Approaches
			24.8.4	 Acute Repair
			24.8.5	 Virtual Surgical Planning and Mirror Imaging Overlay(MIO)
			24.8.6	 Navigation-Guided Implant Placement
			24.8.7	 Intraoperative Imaging
				Conclusion
		References
	25: Management of Frontal Sinus and Naso-orbitoethmoid Complex Fractures
		25.1	 Introduction
		25.2	 Anatomy and Physiology
			25.2.1	 Embryology of the Sinus
			25.2.2	 Physiology of the Sinus
			25.2.3	 Osteology
			25.2.4	 Neurovascular Structures
			25.2.5	 Interorbital Space
			25.2.6	 Medial Canthal Tendon
			25.2.7	 Lacrimal Apparatus
		25.3	 Patient Evaluation
			25.3.1	 Clinical Findings
			25.3.2	 Imaging
			25.3.3	 Patency of the NFOT
			25.3.4	 Classification of NOE Fractures
			25.3.5	 Classification of Frontal Sinus Fractures
		25.4	 Treatment
			25.4.1	 Treatment Goals
			25.4.2	 Surgical Access
			25.4.3	 Osseous Recovery and Access
			25.4.4	 Intraoperative Evaluation of the NFOT
			25.4.5	 Anterior Table Fractures
			25.4.6	 Posterior Table Fractures
			25.4.7	 Orbital Roof and Supraorbital Bar Reconstruction
			25.4.8	 Nasofrontal Outflow Tract (NFOT) Obstruction
			25.4.9	 Sinus Obliteration
			25.4.10	 Endoscopy in the Management of Frontal Fractures
			25.4.11	 NOE Reconstruction
			25.4.12	 Medical Therapy of the Sinus Postoperatively
		25.5	 Complications
			25.5.1	 Dacryocystorhinostomy
		25.6	 Correction of Posttraumatic Deformity
			Conclusion
		References
	26: Nasal Fractures
		26.1	 Introduction
		26.2	 Surgical Anatomy
		26.3	 Clinical and Radiographic Diagnostic Tools
		26.4	 Surgical Management
		26.5	 Postoperative Care and Complications
			Conclusion
		Reference and Further Reading
	27: Maxillofacial Firearm Injuries
		27.1	 Introduction
		27.2	 Epidemiology
			27.2.1	 Fatal and Nonfatal Firearm Injuries
			27.2.2	 Risk Factors for Firearm Injuries
				27.2.2.1	 Unintended Firearm Injuries
				27.2.2.2	 Pediatric Firearm Injuries
				27.2.2.3	 Alcohol and Drug Abuse
				27.2.2.4	 Other Risk Factors
		27.3	 Characteristics of Maxillofacial Ballistic and Missile Injuries
			27.3.1	 Categorizations of Gunshot Injuries
			27.3.2	 Injury Patterns and Associated Injuries
		27.4	 Acute Care Considerations
			27.4.1	 Airway Management
			27.4.2	 Hemorrhage Management
		27.5	 Management of Gunshot Wounds to the Face
			27.5.1	 Soft and Hard Tissue Involvement
			27.5.2	 Bone and Soft Tissue Reconstruction
		27.6	 Postoperative Complications
			Conclusion
		References
	28: Pediatric Facial Trauma
		28.1 Introduction
		28.2 History
			28.2.1	 Child Maltreatment
		28.3 Physical Evaluation
			28.3.1	 Airway
			28.3.2	 Breathing
			28.3.3	 Circulation
			28.3.4	 Cervical Spine
			28.3.5	 Disability
			28.3.6	 Exposure
		28.4 Head Injuries
		28.5 Concussions
		28.6 Neck and Airway
		28.7 Cervical Spine
			28.7.1	 Pediatric Perioperative Management
		28.8 Soft Tissue Injuries
		28.9 Regional Soft Tissue Wounds
			28.9.1	 The Ear
		28.10 The Eyelid and Lacrimal System
		28.11 Lacrimal Apparatus
		28.12 The Nose
		28.13 Epistaxis
		28.14 The Scalp
		28.15 The Cheek
		28.16 The Lip and Oral Cavity
			28.16.1	 Wound Care Adjuncts
				28.16.1.1	 Wound Support
				28.16.1.2	 Antibiotic Ointments
				28.16.1.3	 Silicone Agents
				28.16.1.4	 Dog Bites
		28.17 Hard Tissue Injuries—Facial Bone Fractures
		28.18 Diagnosis of Facial Fractures
		28.19 Fixation—Absorbable Versus Titanium
		28.20 Anterior Cranial Fractures
			28.20.1	 Frontal Sinus
			28.20.2	 Orbital Roof
			28.20.3	 Upper Facial Fractures
				28.20.3.1	 Naso-Orbital–Ethmoid (NOE) Complex
				28.20.3.2	 Nasal Complex
			28.20.4	 Orbital Floor
		28.21 Zygomaticomaxillary Complex (ZMC)
		28.22 Lower Facial Fractures
			28.22.1	 Maxillary Fractures
			28.22.2	 Mandible Fractures
		28.23 Condyle
		28.24 Body and Symphysis
		28.25 Dentoalveolar Injuries
		28.26 Growth Disturbance
		References
	29: Management of Panfacial Fractures
		29.1 Introduction
		29.2 Historic Perspective
			29.2.1	 Etiology
		29.3 Anatomic Considerations
			29.3.1	 Facial Buttresses
			29.3.2	 Key Landmarks
			29.3.3	 Dental Arches
			29.3.4	 The Mandible
			29.3.5	 Sphenozygomatic Suture
			29.3.6	 Intercanthal Region
		29.4 Imaging
		29.5 Surgical Approaches
		29.6 Bone Grafting and Soft Tissue Resuspension
			29.6.1	 Bone Grafting
			29.6.2	 Soft Tissue Resuspension
		29.7 Sequence of Treatment
			29.7.1	 Airway Management
			29.7.2	 Fracture Management
		Box 29.1 Bottom-Up and Inside-Out
		Box 29.2 Top-Down and Outside-In
		29.8 Complications
		29.9 Computer-Assisted Surgery
			29.9.1	 Virtual Surgical Planning
			29.9.2	 Intraoperative Navigation
			29.9.3	 Intraoperative Imaging
			29.9.4	 Onsite 3D Printing
			29.9.5	 Future Considerations
		Conclusion
		References
IV: Maxillofacial Pathology/Infections
	30: Differential Diagnosis of Oral Disease
		30.1	 Introduction
		30.2	 The Diagnostic Process
			Case Study: From Differential Diagnosis to Final Diagnosis
			30.2.1	 History
			30.2.2	 Clinical Examination
		30.3	 Developing the Differential Diagnosis (DDx)
			Case Study: Neophyte Versus Expert Clinician
		30.4	 Determining the Final Diagnosis: Adjunctive Diagnostic Methods
			30.4.1	 Diagnostic Imaging
			30.4.2	 Analysis of Lesional Tissue: Histologic, Immunohistochemical, and Molecular Evaluation
		30.5	 Patient Follow-Up
		Box 30.1 Follow-up of oral pathology
		Conclusion
		References
	31: Odontogenic Cysts and Tumors
		31.1	 Introduction
		31.2	 Odontogenic Cysts
			Box 31.1 World Health Organization (WHO) 2017 Classification of Odontogenic Cysts [4]
			31.2.1	 Dentigerous Cyst
			31.2.2	 Odontogenic Keratocyst
				Box 31.2 Clinical Features of the Nevoid Basal Cell Carcinoma Syndrome
				31.2.2.1	 Nevoid Basal Cell Carcinoma Syndrome
			31.2.3	 Glandular Odontogenic Cyst
			31.2.4	 Calcifying Odontogenic Cyst
		31.3	 Odontogenic Tumors
			Box 31.3 World Health Organization (WHO) 2017 Classification of Benign Odontogenic Tumors [4]
			31.3.1	 Ameloblastoma
				31.3.1.1	 Ameloblastoma
				31.3.1.2	 Unicystic Ameloblastoma
				31.3.1.3	 Extraosseous/Peripheral Ameloblastoma
				31.3.1.4	 Metastasizing Ameloblastoma
			31.3.2	 Malignant Odontogenic Tumors
				Box 31.4 World Health Organization (WHO) 2017 Classification of Malignant Odontogenic Tumors [4]
				31.3.2.1	 Ameloblastic Carcinoma
				31.3.2.2	 Primary Intraosseous Carcinoma
				31.3.2.3	 Clear Cell Odontogenic Carcinoma
			31.3.3	 Ameloblastic Fibroma
			31.3.4	 Ameloblastic Fibro-Odontoma
			31.3.5	 Odontoma
			31.3.6	 Odontogenic Myxoma
			31.3.7	 Calcifying Epithelial Odontogenic Tumor
			31.3.8	 Adenomatoid Odontogenic Tumor
		31.4	 Conclusion
		References
	32: Benign Nonodontogenic Lesions of the Jaws
		32.1	 Benign Fibro-Osseous Disease
			32.1.1	 Fibrous Dysplasia
			32.1.2	 Cemento-Osseous Dysplasia
				32.1.2.1	 Periapical Cemento-Osseous Dysplasia
				32.1.2.2	 Focal Cemento-Osseous Dysplasia
				32.1.2.3	 Florid Cemento-Osseous Dysplasia
			32.1.3	 Familial Gigantiform Cementoma
			32.1.4	 Fibro-Osseous Neoplasms
				32.1.4.1	 Ossifying Fibroma
				32.1.4.2	 Juvenile Aggressive Ossifying Fibroma
		32.2	 Osteoblastoma and Osteoid Osteoma
		32.3	 Chondroma
		32.4	 Osteoma
		32.5	 Synovial Chondromatosis and Osteochondroma
		32.6	 Aggressive Mesenchymal: Tumors of Childhood
		32.7	 Lesions Containing Giant Cells
			32.7.1	 Central Giant Cell Granuloma
			32.7.2	 Giant Cell Tumor
			32.7.3	 Hyperparathyroidism
			32.7.4	 Cherubism
			32.7.5	 Aneurysmal Bone Cyst
		32.8	 Vascular Malformations
			32.8.1	 Langerhans’ Cell Histiocytosis
		32.9	 Nonodontogenic Cysts of the Jaws
			32.9.1	 Globulomaxillary Lesion
			32.9.2	 Nasolabial Cysts
			32.9.3	 Median Mandibular Cyst
			32.9.4	 Nasopalatine Duct Cyst
			32.9.5	 Traumatic Bone Cyst
			32.9.6	 Stafne’s Bone Defect
		32.10	 Neurogenic Tumors
			32.10.1	 Schwannoma
			32.10.2	 Neurofibroma
			32.10.3	 Traumatic Neuroma
		32.11	 Paget’s Disease
		32.12	 Gorham’s Disease (Gorham-Stout Syndrome)
		32.13	 Tori
			32.13.1	 Torus Palatinus
			32.13.2	 Torus Mandibularis
		References
	33: Oral Cancer: Classification, Diagnosis, and Staging
		33.1	 Introduction
		33.2	 Epidemiology
			33.2.1	 Projections
			33.2.2	 Survival
		33.3	 Risk Factors
			33.3.1	 Tobacco
			33.3.2	 Alcohol
			33.3.3	 Oncogenic Viruses
				33.3.3.1	 Human Papillomavirus (HPV)
				33.3.3.2	 Genetic Factors
		33.4	 Race
			33.4.1	 Other Risk Factors
		33.5	 Oral Potentially Malignant Disorders
			33.5.1	 Red, White, and Mixed Lesions
			33.5.2	 Oral Lichen Planus
			33.5.3	 Oral Submucous Fibrosis
		33.6	 Subsites of the Oral Cavity
			33.6.1	 Mucosal Lip
			33.6.2	 Buccal Mucosa
			33.6.3	 Floor of Mouth
			33.6.4	 Oral Tongue
			33.6.5	 Mandibular Gingiva and Alveolar Ridge
			33.6.6	 Maxillary Gingiva, Alveolar Ridge, and Hard Palate
			33.6.7	 Retromolar Trigone
		33.7	 Regional Lymphatics
		33.8	 Diagnosis and Workup: NCCN Guidelines
			33.8.1	 Assessment for Bone Invasion
			33.8.2	 Biopsy
			33.8.3	 Histological Features and Grading
			33.8.4	 Adverse Histologic Features
				33.8.4.1	 Perineural Invasion
			33.8.5	 Lymphovascular Invasion
				33.8.5.1	 Brandwein–Gensler Risk Model
				33.8.5.2	 Assessment of Regional Lymphatics
				33.8.5.3	 CT
				33.8.5.4	 MRI
				33.8.5.5	 Ultrasound
				33.8.5.6	 PET/CT to Diagnose “Regional” Lymphatics
				33.8.5.7	 Sentinel Node Biopsy
			33.8.6	 Distant Metastasis Workup
		33.9	 Staging: AJCC
		Conclusion
		References
	34: Oral Cancer Management
		34.1	 Introduction
		34.2	 Histology
		34.3	 Management of Premalignant Lesions
		34.4	 Role of Panendoscopy in Treatment Planning
		34.5	 Choosing a Treatment
		34.6	 Surgery
			34.6.1	 Perioperative Issues in Oral Cavity Cancer Treatment
			34.6.2	 Airway
			34.6.3	 Perioperative Antibiotics
			34.6.4	 Alcohol Withdrawal
			34.6.5	 Deep Venous Thrombosis
			34.6.6	 Fluid Management
			34.6.7	 Transfusion
			34.6.8	 Nutrition
			34.6.9	 Complications of Surgery
		34.7	 Radiation
		34.8	 Chemotherapy
		34.9	 Immunotherapy
		34.10	 Chemoprevention
		34.11	 Special Treatment Considerations by Site
			34.11.1	 Lip
			34.11.2	 Buccal Mucosa
			34.11.3	 Retromolar Trigone
			34.11.4	 Tongue
			34.11.5	 Floor of Mouth
			34.11.6	 Alveolus and Gingiva
			34.11.7	 Palate
		34.12	 Management of the Mandible in Oral Cavity Cancer
		34.13	 Management of the Cervical Lymph Nodes in Oral Cavity Squamous Cancer
		34.14	 Neck Dissection in Oral Cavity Squamous Cell Cancer
		34.15	 Sentinel Node Biopsy
		34.16	 Therapeutic Neck Dissection
		34.17	 Recurrence and Follow-Up Surveillance
		34.18	 Future Treatments
		Conclusion
		References
	35: Lip Cancer
		35.1	 Introduction
		35.2	 Epidemiology and Etiology
		35.3	 Anatomic Considerations
		35.4	 Management
			35.4.1	 Evaluation
			35.4.2	 Surgical Treatment
			35.4.3	 Lip Reconstruction
			35.4.4	 Cervical Lymphadenectomy
		35.5	 Treatment Results
		Conclusions
		References
	36: Head and Neck Skin Cancer
		36.1 Introduction
		36.2 Background
		36.3 Epidemiology
			36.3.1	 Basal Cell Carcinoma
			36.3.2	 Squamous Cell Carcinoma
			36.3.3	 Melanoma
		36.4 Etiology
			36.4.1	 Host Factors
			36.4.2	 Syndromes
			36.4.3	 Predisposing Lesions
			36.4.4	 Immunologic Factors
			36.4.5	 Environmental Factors
		36.5 Prevention
		36.6 Diagnosis
			36.6.1	 Biopsy
			36.6.2	 Basal Cell Carcinoma
			36.6.3	 Squamous Cell Carcinoma
			36.6.4	 Melanoma
		36.7 Treatment
			36.7.1	 Standard Excision
			36.7.2	 Mohs’ Micrographic Surgery (MMS)
			36.7.3	 Radiation Therapy
			36.7.4	 Cryosurgery
			36.7.5	 Curettage and Electrodesiccation (C&E)
			36.7.6	 Topical Chemotherapy
			36.7.7	 Lasers
			36.7.8	 Photodynamic Therapy
			36.7.9	 Interferons
			36.7.10	 Retinoids
			36.7.11	 Targeted Therapy
			36.7.12	 Follow-Up
		36.8 Reconstructive Surgery
			36.8.1	 Flaps, Grafts, and Healing by Secondary Intention
			36.8.2	 Skin Biomechanics
			36.8.3	 Flap Undermining
		36.9 Flap Designs
			36.9.1	 Advancement Flaps
			36.9.2	 Rotational Flaps
			36.9.3	 Transposition Flaps
			36.9.4	 Axial Pattern Flaps
			36.9.5	 Skin Grafts
			36.9.6	 Full-Thickness Skin Grafts
			36.9.7	 Split-Thickness Skin Grafts
			36.9.8	 Composite Grafts
			36.9.9	 Free Tissue Transfer
		36.10 Complications
			36.10.1	 Smoking
			36.10.2	 Infection
			36.10.3	 Bleeding
			36.10.4	 Poor Cosmetic Results
		Conclusion
		References
	37: Salivary Gland Disease
		37.1	 Introduction
		37.2	 Diagnostic Modalities
		37.3	 Nonneoplastic Salivary Gland Disorders
			37.3.1	 Obstructive Disease: Sialolithiasis
			37.3.2	 Cystic Conditions: Mucous Extravasation and Retention Phenomena, Ranulas, Sialoceles, Parotid Gland Cysts
			37.3.3	 Inflammatory
			37.3.4	 Noninflammatory/Autoimmune Conditions
		37.4	 Neoplastic Salivary Gland Disorders
			37.4.1	 General Considerations
			37.4.2	 Benign Salivary Gland Tumors
			37.4.3	 Malignant Salivary Gland Tumors
			Box 37.1 Biologic Classification of Salivary Gland Malignant Tumors
		37.5	 Selective Complications of Salivary Gland Surgery
		Conclusions
		References
	38: Mucosal and Related Dermatologic Diseases
		38.1	 Introduction
		38.2	 Infectious Stomatitis
			38.2.1	 Bacterial Infections
				38.2.1.1	 Tuberculosis
				38.2.1.2	 Syphilis
				38.2.1.3	 Gonorrhea
			38.2.2	 Viral Infections
			38.2.3	 Fungal Infections
				38.2.3.1	 Candidosis
				38.2.3.2	 Deep Fungal Infections
		38.3	 Noninfectious Stomatitis
			38.3.1	 Recurrent Aphthous Stomatitis (Recurrent Aphthous Ulcerations; Canker Sores)
			38.3.2	 Erythema Migrans (Geographic Tongue; Benign Migratory Glossitis: Wandering Rash of the Tongue: Erythema Areata Migrans: Stomatitis Areata Migrans)
			38.3.3	 Oral Lichen Planus
			38.3.4	 Oral Lichenoid Drug Reaction and Oral Lichenoid Contact Hypersensitivity Reaction
			38.3.5	 Lupus Erythematosus
			38.3.6	 Graft Versus Host Disease
			38.3.7	 Chronic Ulcerative Stomatitis
				38.3.7.1	 Pemphigus Vulgaris
				38.3.7.2	 Paraneoplastic Pemphigus
				38.3.7.3	 Mucous Membrane Pemphigoid (Cicatricial Pemphigoid)
				38.3.7.4	 Bullous Pemphigoid
				38.3.7.5	 Lichen Planus Pemphigoides
			38.3.8	 Erythema Multiforme and Related Disorders
		38.4	 Pigmented Lesions of Oral Mucosa and Skin
			38.4.1	 Localized Pigmented Lesions
				38.4.1.1	 Ephelis (Freckle)
				38.4.1.2	 Lentigo
				38.4.1.3	 Melanotic Macule
				38.4.1.4	 Post-inflammatory Melanosis
				38.4.1.5	 Oral Melanoacanthoma
				38.4.1.6	 Melanocytic Nevi
				38.4.1.7	 Seborrheic Keratosis
				38.4.1.8	 Melanoma
			38.4.2	 Vascular Lesions
				38.4.2.1	 Telangiectasia and Varix
				38.4.2.2	 Hemangioma
				38.4.2.3	 Angiosarcoma and Kaposi Sarcoma
			38.4.3	 Lesions Produced by Extravasated Blood
				38.4.3.1	 Hematoma
				38.4.3.2	 Tattoos
			38.4.4	 Generalized Pigmented Lesions
		Conclusion
		References
	39: Pediatric Maxillofacial Pathology
		39.1	 Introduction
		39.2	 Odontogenic Pathology
			39.2.1	 Odontogenic Cysts
			39.2.2	 Epithelial Odontogenic Tumors
			39.2.3	 Mesenchymal Odontogenic Tumors
			39.2.4	 Mixed Odontogenic Tumors
		39.3	 Non-odontogenic Pathology
			39.3.1	 Benign Mesenchymal Tumors
				39.3.1.1	 Giant Cell Lesions
				39.3.1.2	 Fibro-osseous Lesions
			39.3.2	 Hematopoietic Reticuloendothelial Tumors
			39.3.3	 Neurogenic Tumors
			39.3.4	 Vascular Pathology
			39.3.5	 Congenital Head and Neck Masses and Cysts
			39.3.6	 Epithelial Neoplasms
			39.3.7	 Mesenchymal Neoplasms
		39.4	 Salivary Gland Pathology
			39.4.1	 Inflammatory Salivary Gland Disease
			39.4.2	 Cystic Conditions of the Salivary Glands
		39.5	 Salivary Gland Neoplasms
			39.5.1	 Benign Salivary Gland Tumors
			39.5.2	 Malignant Salivary Gland Tumors
		Conclusions
		References
	40: Odontogenic Infections
		40.1 Introduction
		40.2 Principles of Surgical Management of Odontogenic Infections
		40.3 Principles of Modern Antibiotic Therapy
		40.4 Step 1: Determine the Severity of Infection
			40.4.1	 Anatomic Location
			40.4.2	 Rate of Progression
			40.4.3	 Airway Compromise
		40.5 Step 2: Evaluate Host Defenses
			40.5.1	 Immune System Compromise
			Box 40.1 Factors Associated with Immune System Compromise
			40.5.2	 Systemic Reserve
		40.6 Step 3: Decide on the Setting of Care
			Box 40.2 Indications for Hospital Admission
		40.7 Step 4: Treat Surgically
			40.7.1	 Airway Security
			Box 40.3 When to Go to the Operating Room
			40.7.2	 Surgical Drainage
			40.7.3	 Timing of Incision and Drainage
			40.7.4	 Culture and Sensitivity Testing
		40.8 Step 5: Support Medically
		40.9 Step 6: Choose and Prescribe Antibiotic Therapy
			40.9.1	 Surgery to Remove the Cause and Establish Drainage is Primary; Antibiotics are Adjunctive Treatment
			40.9.2	 Use Therapeutic Antibiotics Only When Clinically Indicated
			Box 40.4 Indications for Antibiotics in Odontogenic Infections
			40.9.3	 Use Specific Antibiotic Therapy as Soon as Possible, Based on Culture and Sensitivity Testing
			40.9.4	 Use the Narrowest Spectrum Empiric Antibiotic Effective Against the Most Likely Pathogens
			40.9.5	 Avoid the Use of Combination Antibiotics, Except in Specific Situations Where They are Shown to be Necessary
			40.9.6	 Use the Least Toxic Indicated Antibiotic, Considering Interaction with Concurrent Medications
			40.9.7	 Minimize the Duration of Antibiotic Therapy, as Appropriate to the Presenting Type of Infection
			40.9.8	 Use the Most Cost-effective Appropriate Antibiotic
		40.10 Step 7: Administer the Antibiotic Properly
		40.11 Step 8: Evaluate the Patient Frequently
			Box 40.5 Causes of Treatment Failure
			Box 40.6 Criteria for Changing Antibiotics
		Summary
		References
	41: Osteomyelitis, Osteoradionecrosis (ORN), and Medication-Related Osteonecrosis of the Jaws (MRONJ)
		41.1	 Osteomyelitis
			41.1.1	 Pathogenesis
			41.1.2	 Microbiology
			41.1.3	 Classification
			41.1.4	 Clinical Presentation
			41.1.5	 Treatment
			41.1.6	 Surgical Options
		41.2	 Osteoradionecrosis
		41.3	 Medication-Related Osteonecrosis of the Jaws
			41.3.1	 List of Bisphosphonates
			41.3.2	 Medications Linked to Osteonecrosis of the Jaws and their Clinical Indication
			41.3.3	 Patients About to Initiate Bisphosphonate Therapy
			41.3.4	 Patients Receiving Intravenous Bisphosphonates
			41.3.5	 Patients Receiving Oral Bisphosphonates
			41.3.6	 Staging of MRONJ
		Conclusion
		References
V: Maxillofacial Reconstruction
	42: Local and Regional Flaps
		42.1	 Introduction
		42.2	 Flap Principles
		42.3	 Flap Nomenclature
			42.3.1	 Blood Supply
			42.3.2	 Location
			42.3.3	 Configuration
			42.3.4	 Tissue Content
			42.3.5	 Method of Transfer
		42.4	 Designing the Flap
		42.5	 Types of Flaps
			42.5.1	 Local Flaps
				42.5.1.1	 Advancement Flaps
				42.5.1.2	 Rotation Flaps
				42.5.1.3	 Transposition Flaps
				42.5.1.4	 Interpolation Flaps
			42.5.2	 Regional Flaps
				42.5.2.1	 Pectoralis Major Myocutaneous Flap
				42.5.2.2	 Deltopectoral Flap
				42.5.2.3	 Temporalis Flap
				42.5.2.4	 Sternocleidomastoid Flap
				42.5.2.5	 Trapezius Myocutaneous Flap
				42.5.2.6	 Latissimus Dorsi Myocutaneous Flap
		42.6	 Complications
		Conclusion
		References
	43: Nonvascularized Reconstruction
		43.1	 Introduction
		43.2	 Anatomic Considerations
		43.3	 Defects of the Mandible
		43.4	 Defects of the Maxilla
		43.5	 Limitation of Bony Reconstruction
		43.6	 Bone Biology
		43.7	 Bone Grafting Biology
		43.8	 Bone Morphogenic Protein
		43.9	 Platelet-Rich Plasma (PRP)
		43.10	 Bone Marrow Aspirate
		43.11	 Autogenous Sites
		43.12	 Intraoral
		43.13	 Cranial
		43.14	 Costochondral Graft
		43.15	 Iliac Crest
			43.15.1	 Anterior Iliac Crest
			43.15.2	 Posterior Iliac Crest
		43.16	 Tibial Plateau
		43.17	 Hyperbaric Oxygen
		Conclusion
			• Reconstruction of Mandible
			• Reconstruction of Maxilla
		References
	44: Vascularized Reconstruction
		44.1	 Introduction
			44.1.1	 Microvascular Techniques and Setup
		44.2	 Microvascular Soft Tissue Flaps
			44.2.1	 Radial Artery Fasciocutaneous Flap
				44.2.1.1	 Flap Harvesting
				44.2.1.2	 Applications
			44.2.2	 Anterolateral Thigh Flap
				44.2.2.1	 Flap Harvesting
				44.2.2.2	 Applications
			44.2.3	 Rectus Abdominus Myocutaneous Flap
				44.2.3.1	 Flap Harvesting
				44.2.3.2	 Applications
			44.2.4	 Latissimus Myocutaneous Free Flap
				44.2.4.1	 Flap Harvesting
				44.2.4.2	 Applications
			44.2.5	 Lateral Arm Free Flap
				44.2.5.1	 Flap Harvesting
				44.2.5.2	 Applications
		44.3	 Microvascular Composite Bone Flaps
			44.3.1	 Osteocutaneous Radial Forearm Flap
				44.3.1.1	 Flap Harvesting
				44.3.1.2	 Applications
			44.3.2	 Osteocutaneous Fibula Flap
				44.3.2.1	 Flap Harvesting
				44.3.2.2	 Applications
			44.3.3	 Scapula Free Flap
				44.3.3.1	 Flap Harvesting
				44.3.3.2	 Applications
			44.3.4	 Iliac Crest Free Flap
				44.3.4.1	 Flap Harvest
				44.3.4.2	 Applications
		Conclusion
		References
	45: Microneurosurgery
		45.1	 Introduction
		45.2	 Demographics
			Box 45.1 Risk Factors for Nerve Injury During Third Molar Removal
			Box 45.2 Rood’s Radiographic Predictors of Potential Tooth Proximity to the Inferior Alveolar Canal
		45.3	 Trigeminal Nerve Anatomy and Physiology
		45.4	 Nerve Injury Classification
			45.4.1	 Clinical Neurosensory Testing
			Box 45.3 Clinical Neurosensory Testing
			Box 45.4 Systemic Pharmacologic Agents
		45.5	 Nonsurgical Treatment
		45.6	 Trigeminal Neuralgia
		45.7	 Treatment Algorithms
		45.8	 Surgical Treatment
			45.8.1	 Exposure
			45.8.2	 External Neurolysis
			45.8.3	 Internal Neurolysis
			45.8.4	 Nerve Stump Preparation
			45.8.5	 Approximation
			45.8.6	 Coaptation
			45.8.7	 Neurorrhaphy
			45.8.8	 Nerve Grafts
			45.8.9	 Entubulation Techniques
			45.8.10	 Immediate IAN Reconstruction with Mandibular Resection
		45.9	 Postsurgical Management
		45.10	 Medicolegal Issues
		Conclusions
		References/Additional Resources
			Further Readings
	46: Comprehensive Management of Facial Clefts
		46.1	 Introduction
		46.2	 History of Cleft Lip and Palate Repair
		46.3	 Embryology
		46.4	 Genetics and Etiology
		46.5	 Classification
		46.6	 Prenatal Counseling
		46.7	 Feeding the Child with a Cleft Palate
		46.8	 Surgical Treatment Planning and Timing
		46.9	 Technical Considerations for Cleft Lip and Palate Repair
		46.10	 Presurgical Taping and Presurgical Orthopedics
		46.11	 Lip Adhesion
		46.12	 Primary Unilateral Cleft Lip Repair
		46.13	 Primary Bilateral Lip Repair
		46.14	 Cleft Palate Repair
		46.15	 Complex Facial Clefting
		46.16	 Outcome Assessment
		Conclusion
		References
	47: Alveolar Cleft Reconstruction
		47.1	 Introduction
		47.2	 Rationale for Grafting
		47.3	 Measuring Outcomes
		47.4	 Timing of the Graft
		Box 47.1 Timing of Alveolar Bone Grafting
		Box 47.2 Factors Contributing to Timing of  Grafting during the Mixed Dentition
		47.5	 Source of Bone Graft
		47.6	 Pre- Versus Postsurgical Orthodontics
		47.7	 Surgical Technique for Grafting the Cleft Alveolus
		47.8	 Stepwise Approach to the Comprehensive Management of the Alveolar Cleft Patient
		Conclusion
		References
	48: Nonsyndromic Craniosynostosis
		48.1	 Introduction
		48.2	 Functional Considerations
			48.2.1	 Intracranial Hypertension
			48.2.2	 Visual Impairment
				48.2.2.1	 Visual Acuity
				48.2.2.2	 Ocular Motor Disturbances
			48.2.3	 Limitation of Brain Growth
			48.2.4	 Neuropsychiatric Disorders
		48.3	 Diagnosis/Preoperative Data Collection
			48.3.1	 Physical Examination
			48.3.2	 Laboratory and Radiological Studies
		48.4	 Classification
			48.4.1	 Sagittal Synostosis/Scaphocephaly
			48.4.2	 Unilateral Coronal Synostosis/Anterior Plagiocephaly
			48.4.3	 Metopic Synostosis/Trigonocephaly
			48.4.4	 Bilateral Coronal Synostosis/Brachycephaly
			48.4.5	 Unilateral Lambdoid Synostosis/Posterior Plagiocephaly
		48.5	 Principles of Management
			48.5.1	 Multidisciplinary Team Approach
			48.5.2	 Virtual Surgical Planning
			48.5.3	 Airway Management
			48.5.4	 Intravenous Access
			48.5.5	 Monitoring
			48.5.6	 Patient Positioning and Eye Protection
			48.5.7	 Transfusion Protocol
			48.5.8	 Current Surgical Approach
		48.6	 Surgical Considerations
			48.6.1	 Sagittal Synostosis
			48.6.2	 Unilateral Coronal Synostosis
			48.6.3	 Metopic Synostosis
			48.6.4	 Bilateral Coronal Synostosis
			48.6.5	 Unilateral Lambdoid Synostosis
			48.6.6	 Complications
		48.7	 Summary
		References
	49: Craniofacial Dysostosis Syndromes: Evaluation and Treatment of the Skeletal Deformities
		49.1	 Introduction
		49.2	 Genetic Aspects
		49.3	 Functional Considerations
			49.3.1	 Brain Growth and Intracranial Pressure
			49.3.2	 Vision
			49.3.3	 Hydrocephalus
			49.3.4	 Effects of Midface Deficiency on Airway
			49.3.5	 Dentition and Occlusion
			49.3.6	 Hearing
			49.3.7	 Extremity Anomalies
		49.4	 Morphologic Considerations
			49.4.1	 Frontoforehead Aesthetic Unit
			49.4.2	 Posterior Cranial Vault Aesthetic Unit
			49.4.3	 Orbitonasozygomatic Aesthetic Unit
			49.4.4	 Maxillary–Nasal Base Aesthetic Unit
			49.4.5	 Quantitative Assessment
			49.4.6	 CT Scan Analysis
			49.4.7	 Anthropometric Surface Measurements
			49.4.8	 Cephalometric Analysis
		49.5	 Surgical Management
			49.5.1	 Historical Perspectives
			49.5.2	 Philosophy Regarding Timing of Intervention
			49.5.3	 Incision Placement
			49.5.4	 Management of Cranial Vault Dead Space
			49.5.5	 Soft Tissue Management
		49.6	 Crouzon Syndrome
			49.6.1	 Primary Cranio-orbital Decompression: Reshaping in Infancy
			49.6.2	 Repeat Craniotomy for Additional Cranial Vault Expansion and Reshaping in Young Children
			49.6.3	 Management of “Total Midface” Deformity in Childhood
			49.6.4	 Orthognathic Procedures for Definitive Occlusal and Lower Facial Aesthetic Reconstruction
			49.6.5	 Assessment of Results in the Crouzon Patient
			49.6.6	 Quantitative Assessment of Presenting Crouzon’s Deformity and Surgical Results Based on CT Scan Analysis After First-Stage Cranio-orbital Reconstruction
			49.6.7	 Quantitative Intracranial Volume Measurements Before and After Cranio-orbital Reshaping in Children with Crouzon Syndrome
			49.6.8	 Quantitative Assessment of Presenting Deformity in Children with Crouzon Syndrome and Surgical Results After Monobloc Osteotomy Based on CT Scan Analysis
		49.7	 Apert Syndrome
			49.7.1	 Primary Cranio-orbital Decompression: Reshaping in Infancy
			49.7.2	 Further Craniotomy for Additional Cranial Vault Expansion and Reshaping in Young Children
			49.7.3	 Management of the “Total Midface” Deformity in Childhood
			49.7.4	 Orthognathic Procedures for Definitive Occlusal and Lower Facial Aesthetic Reconstruction
			49.7.5	 Assessment of Results in the Apert Patient
				49.7.5.1	 Quantitative Assessment of Presenting Apert’s Deformity and Surgical Results Based on CT Scan Analysis After First-Stage Cranio-orbital Reconstruction
				49.7.5.2	 Quantitative Intracranial Volume Measurements Before and After Cranio-orbital Reshaping in Children with Apert Syndrome
				49.7.5.3	 Quantitative Assessment of Presenting Deformity in Children with Apert Syndrome and Surgical Results After Facial Bipartition Osteotomy Based on CT Scan Analysis
		49.8	 Pfeiffer Syndrome
		49.9	 Carpenter Syndrome
		49.10	 Saethre-Chotzen Syndrome
		49.11	 Cloverleaf Skull Anomaly
		Summary
		References
	50: Technology in Oral and Maxillofacial Reconstruction
		50.1	 Introduction
			50.1.1	 Data Acquisition
			50.1.2	 Preoperative Planning
			50.1.3	 Manufacturing
				50.1.3.1	 Patient-Specific Implants
			50.1.4	 Surgery
				50.1.4.1	 Intraoperative Navigation
			50.1.5	 Intra- and Postoperative Assessment
		50.2	 Craniomaxillofacial Trauma and Reconstruction
			50.2.1	 Zygoma Reconstruction
			50.2.2	 Orbital Reconstruction
			50.2.3	 Mandibular Reconstruction in the Setting of Trauma
		50.3	 Craniomaxillofacial Surgery
			50.3.1	 Orthognathic Surgery
			50.3.2	 Craniofacial Surgery
			50.3.3	 Custom Cranial Implants
		50.4	 Head and Neck Surgery and Craniomaxillofacial Reconstruction
		50.5	 Robotic Surgery
		Conclusion
		References
VI: Temporomandibular Joint Disease
	51: Anatomy and Pathophysiology of the Temporomandibular Joint
		51.1	 Introduction
		51.2	 Overall Anatomy
		51.3	 Osseous Structures
		51.4	 Cartilage and Synovium
		51.5	 Articular Disk and Retrodiskal Tissue
		51.6	 Ligaments
		51.7	 Vascular Supply and Innervation
		51.8	 Musculature
			51.8.1 Supramandibular Muscle Group
			51.8.2 Inframandibular Muscle Group
		51.9	 Biomechanics of TMJ Movement
		51.10	 Pathology of the TMJ and Associated Structures
			51.10.1 Epidemiology
			51.10.2 Types of TMJ Pathology
			Box 51.1 Taxonomy of temporomandibular disorders (adapted from Peck et al., 2014 [18])
			51.10.3 Joint Pain
			51.10.4 Joint Disorders
				51.10.4.1	 Disk Displacement (Internal Derangement)
				51.10.4.2	 Hypomobility Disorders (Other Than Disk Disorders)
				51.10.4.3	 Hypermobility Disorders
			51.10.5 Joint Diseases
				51.10.5.1	 Degenerative Joint Disease
			51.10.6 Neoplasms
			51.10.7 Infection
		Conclusion
		References
	52: Nonsurgical Management of Temporomandibular Disorders
		52.1	 Introduction
		52.2	 Treatment Considerations
		Box 52.1 Goals of Nonsurgical Therapy for  Temporomandibular Disorders
		52.3	 Nonsurgical Therapy Diet
			Box 52.2 Soft Diet
			52.3.1	 Pharmacotherapy
		52.4	 Analgesics
		52.5	 Anti-Inflammatory Medications
			52.5.1	 NSAIDs
			Box 52.3 Nonsteroidal Anti-inflammatory Drugs: Ideal Properties
			52.5.2	 Corticosteroids
		52.6	 Anxiolytics
		Box 52.4 Antianxiety Medications: Benzodiazepines
		52.7	 Antidepressants
		Box 52.5 Antidepressant Medications
		52.8	 Muscle Relaxants
		Box 52.6 Central Muscle Relaxants and Their Effects
		Box 52.7 Peripheral Muscle Relaxants
		52.9	 Botulinum Toxin
		52.10	 Local Anesthetics
			Box 52.8 Local Anesthetics
			52.10.1	 Physical Therapy
		Box 52.9 Physical Therapy
		52.11	 Exercise Therapy
		Box 52.10 Manual Therapy
		52.12	 Thermal Agents
		52.13	 Ultrasonography and Phonophoresis
		52.14	 Electrical Stimulation Transcutaneous Electrical Nerve Stimulation
			52.14.1	 High-Voltage Stimulation
			52.14.2	 Iontophoresis
		Box 52.11 Electrical Stimulation
		52.15	 Trigger Points and Muscle Injections
			52.15.1	 Stress-Reduction Techniques
				52.15.1.1	 Relaxation and Biofeedback
		Box 52.12 Behavioral Therapy
		52.16	 Acupressure and Acupuncture
		52.17	 Psychotherapy
			52.17.1	 Occlusal Appliance Therapy
		52.18	 Stabilization (Flat Plane) Appliance
		Box 52.13 Stabilization Appliance
		52.19	 Anterior Repositioning Appliance
		Box 52.14 Repositioning Appliance
		52.20	 Occlusal Adjustment
		52.21	 Causes of Failure
		Summary
		References
	53: Arthroscopy and Arthrocentesis of the Temporomandibular Joint
		53.1	 History
		53.2	 Goals
		53.3	 Indications
		Box 53.1 General Indications for Arthroscopy
		Box 53.2 Wilkes Classification
		53.4	 Contraindications
		53.5	 Advantages
		53.6	 Patient Evaluation
			53.6.1 McCain TMJ Assessment Standardized Forms
			53.6.2 Anamnesis
				53.6.2.1	 Chief Complaint
				53.6.2.2	 Parafunction and Associated Causes
			53.6.3 Analog Scales
			53.6.4 History
			53.6.5 Diet
			53.6.6 Treatment
		53.7	 Physical Examination
			53.7.1	 Mouth Opening and Range of Motion
			53.7.2 Joint Noise
			53.7.3 Pain Assessment of the Joint and Adjacent Musculature
			53.7.4 Joint Locking or Dislocation
				53.7.4.1	 Mahan’s Sign
			53.7.5 Head, Eyes, Ears, Nose, and Throat
			53.7.6 Panoramic Radiograph
			53.7.7 Magnetic Resonance Imaging
			53.7.8 Etiology
			53.7.9 Diagnosis
			53.7.10 Discussion
			53.7.11 Rapid TMJ Assessment
		53.8	 Arthrocentesis
			53.8.1 The Arthroscope
			53.8.2 Technology of Video Arthroscopy
			53.8.3 Armamentarium
				53.8.3.1	 Hand Instrumentation
					Cannulas
					Probes
					Biopsy Forceps/Tissue Graspers
					Meniscus Mender
				53.8.3.2	 Other Hand Instruments
				53.8.3.3	 Motorized Instruments
					Shavers
					Whisker Shaver
					Full-Radius Shaver
					Abraders
			53.8.4 Coblation
			53.8.5 Laser
				53.8.5.1	 Holmium:Yttrium-Aluminum- Garnet Laser
			53.8.6 Portals of Entry and Danger Zones
				53.8.6.1	 Fossa Portal
				53.8.6.2	 Anterior Eminence Portal
				53.8.6.3	 Danger Zones
			53.8.7 Internal Arthroscopic Anatomy
				53.8.7.1	 Posterior Pouch
				53.8.7.2	 Intermediate Zone
				53.8.7.3	 Anterior Recess
				53.8.7.4	 Inferior Joint Space Anatomy
				53.8.7.5	 Posterior Recess
				53.8.7.6	 Intermediate Zone
				53.8.7.7	 Anterior Recess
			53.8.8 TMJ Arthroscopic Technique
				53.8.8.1	 Immediate Preoperative Steps
					Examination Under Anesthesia
					Ear Examination
					Palpation of TMJ Anatomy
					Marking the Fossa Portal Puncture Site
					Insufflation
				53.8.8.2	 Operative Steps
					Fossa Puncture
					Technique Pearls and Pitfalls
					Outflow Needle Puncture
				53.8.8.3	 Diagnostic Sweep (Seven Points of Interest of TMJ Arthroscopic Examination)
				53.8.8.4	 Intra-Articular Pathology
					Synovitis
					Fibrosis
					Villonodular Synovitis
					Synovial Chondromatosis
					Rheumatoid Arthritis
					Pseudogout/Chondrocalcinosis
					Joint Stenosis
					Articular Dysfunction
					Osteoarthritis
			53.8.9 Chondromalacia Grading
				53.8.9.1	 Grade I: Softening of Cartilage
				53.8.9.2	 Grade II: Furrowing
				53.8.9.3	 Grade III: Fibrillation and Ulceration
				53.8.9.4	 Grade IV: Crater Formation and Subchondral Bone Exposure
				53.8.9.5	 Arthrofibrosis
		53.9	 Arthroscopic Operative Procedures
			53.9.1	 Second Puncture
			53.9.2 Lysis and Lavage
				53.9.2.1	 Anterior and Posterior Recess Adhesions
				53.9.2.2	 Lateral Recess Adhesions
			53.9.3 Intra-Articular Medications
				53.9.3.1	 Steroids
				53.9.3.2	 Botulinum Toxin A
				53.9.3.3	 Hyaluronic Acid
			53.9.4 Débridement
			53.9.5 Synovectomy
			53.9.6 Anterior Release
			53.9.7 Disc Reduction
			53.9.8 Posterior Scarification/Cauterization
			53.9.9 Disc Function
				53.9.9.1	 Arthroscopic Discopexy
				53.9.9.2	 Discopexy Technique
					Placement of the Suture Passing Needle
					Placement of the Suture Catching Needle
					Retrograde Passing of the Anterior Suture End
					Arthroscopic Rigid Disc Fixation
		53.10	 Postoperative Patient Management
			53.10.1 General Anesthesia Considerations
			53.10.2 Analgesia/Pain Management
			53.10.3 Anti-Inflammatory Management
			53.10.4 Antibiotics
			53.10.5 Diet
		53.11	 Postoperative Rehabilitation
			53.11.1 Stage I Physiotherapy
			53.11.2 Stage II Physiotherapy
			53.11.3 Stage III Physiotherapy
			53.11.4 Stage IV Physiotherapy
		53.12	 Complications of TMJ Arthroscopic Surgery
			53.12.1	 Damage to Cranial Nerve VII and Facial Palsy/Atony
			53.12.2 Damage to the Collaterals of Cranial Nerve V (Auriculotemporal [ATN], Lingual, or Inferior Alveolar Paresthesia)
			53.12.3 Damage to Cranial Nerve VIII and Vestibulocochlear Dysfunction
			53.12.4 Scuffing of Fibrocartilage
			53.12.5 Damage to the Maxillary Artery/Collaterals with or without Formation of Arteriovenous Fistula
			53.12.6 Damage to the Superficial Temporal Vessels with or Without Formation of AVF
			53.12.7 Perforation of the Glenoid Fossa
			53.12.8 Damage to the Disc
			53.12.9 Hemarthrosis
			53.12.10 Infection
			53.12.11 Non-infectious Postoperative Effusions
			53.12.12 Instrument Failure/Loose Bodies
		Conclusion
		References
			Suggested Reading
	54: Internal Derangement of the Temporomandibular Joint
		54.1	 Introduction
		54.2	 Pathophysiology
			54.2.1	 Clinical Course
			54.2.2	 Etiologic Factors
				54.2.2.1	 Trauma
				54.2.2.2	 Joint Laxity
				54.2.2.3	 Bruxism
				54.2.2.4	 Changes in the Joint Lubrication System
		54.3	 Diagnosis
			54.3.1	 Clinical Diagnosis
				54.3.1.1	 Joint Incoordination
				54.3.1.2	 Disc Displacement with Reduction
				54.3.1.3	 Disc Displacement Without Reduction
				54.3.1.4	 Anchored Disc Phenomenon
				54.3.1.5	 Other Conditions
			54.3.2	 Imaging Diagnosis
		54.4	 Indications, Goals, and Outcomes Assessment
			54.4.1	 Indications
			54.4.2	 Goals
			54.4.3	 Outcomes Assessment
		54.5	 Nonsurgical and Minimally Invasive Surgery
		54.6	 Open Joint Surgery
			54.6.1	 Surgical Anatomy
				54.6.1.1	 Fascial Layers
				54.6.1.2	 Facial Nerve (Main Trunk and Frontal Branch)
				54.6.1.3	 Auriculotemporal Nerve
				54.6.1.4	 Superficial Temporal Vessels
				54.6.1.5	 Internal Maxillary Artery
			54.6.2	 Surgical Approaches
				54.6.2.1	 Preauricular Approach
				54.6.2.2	 Endaural Approach
				54.6.2.3	 Postauricular Approach
				54.6.2.4	 Capsular Incisions
				54.6.2.5	 Horizontal Incision Over the Lateral Rim of the Glenoid Fossa
					Horizontal Incision Below the Lateral Rim of the Glenoid Fossa
					Horizontal Incisions Above and Below the Disc
					T-Shaped Incision
			54.6.3	 Wound Closure
		54.7	 Surgical Procedures
			54.7.1	 Disc Repositioning
			54.7.2	 Disc Repositioning and Discoplasty
			54.7.3	 Disc Repositioning and Arthroplasty
			54.7.4	 Disc Repair
			54.7.5	 Discectomy
				54.7.5.1	 Disc Replacements
					Temporalis Muscle/Fascia Flap
					Ear Cartilage
					Dermal Fat Graft
					Abdominal Dermis Fat Graft
					Tissue-Engineered TMJ Disc
			54.7.6	 Modified Mandibular Condylotomy
		54.8	 Postoperative Management
		54.9	 Complications
			54.9.1	 Perioperative Complications
				54.9.1.1	 Vascular Injury and Hemorrhage
				54.9.1.2	 Neurologic Injury
				54.9.1.3	 Infection
				54.9.1.4	 Otologic Complications
			54.9.2	 Long-Term Complications
				54.9.2.1	 Malocclusion
				54.9.2.2	 Ankylosis
				54.9.2.3	 Reoperations
		Conclusions
		References
	55: Hypomobility and Hypermobility Disorders of the Temporomandibular Joint
		55.1 Introduction
		55.2 Hypomobility
			55.2.1	 Classification
			55.2.2	 Etiology
			55.2.3	 Clinical Presentation
			55.2.4	 Imaging Assessment
			55.2.5	 Post-Traumatic Hypomobility
			55.2.6	 Postinfectious Hypomobility
			55.2.7	 Hypomobility After Radiation Therapy
			55.2.8	 Post-Craniotomy Hypomobility
			55.2.9	 Inflammatory and Rheumatologic Causes
			55.2.10	 Hypomobility After Orthognathic Surgery
			55.2.11	 General Treatment Considerations
			55.2.12	 Complications Associated with Treatment
			55.2.13	 Postoperative Physical Therapy
		55.3 Hypermobility
			55.3.1	 Classification
			55.3.2	 Etiology
			Box 55.1 Causes of Hypermobility
			55.3.3	 Treatment
				55.3.3.1	 Acute Dislocation
				55.3.3.2	 Chronic Dislocation
				55.3.3.3	 Sclerotherapy/Prolotherapy
				55.3.3.4	 Autologous Blood Injection
				55.3.3.5	 Botulinum Toxin Injection
			55.3.4	 Surgical Techniques
				55.3.4.1	 Temporomandibular Joint Arthroscopy
				55.3.4.2	 Eminectomy
				55.3.4.3	 LeClerc/Dautrey Procedure
		Conclusion
		References
	56: Pediatric Temporomandibular Disorders: Juvenile Idiopathic Arthritis
		56.1	 Introduction
		56.2	 Diagnosis
		56.3	 Management of Arthritis
		56.4	 Management of TMJ Symptoms
		56.5	 Development of Dentofacial Deformity
		56.6	 Management of Dentofacial Deformity
			56.6.1	 Interceptive Treatment in Growing Patients
			56.6.2	 Correction of the End-Stage Deformity
		Conclusion
		References
	57: End-Stage Temporomandibular Joint Disease
		57.1	 Introduction
		57.2	 Autogenous Bone Grafting
		57.3	 Transport Distraction Osteogenesis
		57.4	 Bioengineered Tissue for Total Joint Reconstruction
		57.5	 Alloplastic Total Joint Reconstruction
		57.6	 History of Alloplastic TMJ Reconstruction
			Box 57.1 Indications for Total Joint Replacement
			Box 57.2 Goals of TMJ Reconstruction
			Box 57.3 Autogenous Bone Grafting TMJR Options
			Box 57.4 History of Autogenous TMJR
			Box 57.5 Comparison of Advantages of Autogenous and Alloplastic TMJR
			Box 57.6 Comparison of Disadvantages of Autogenous and Alloplastic TMJR
			Box 57.7 History of Alloplastic TMJR.
			Box 57.8 Relative Contraindications to Alloplastic TMJR
		References
VII: Orthognathic Surgery
	58: Craniofacial Growth and Development
		58.1	 Introduction
		58.2	 Prenatal Craniofacial Development
			58.2.1	 Facial Prominences and Formation of Face
			58.2.2	 Formation of the Craniofacial Bones
			58.2.3	 The Growth of the Craniofacial Complex During Fetal Period
		58.3	 Postnatal Craniofacial Development
			58.3.1	 Cranial Vault
			58.3.2	 Cranial Base
			58.3.3	 Nasomaxilla
			58.3.4	 Mandible
			58.3.5	 Dental Development
			58.3.6	 Facial Development
			58.3.7	 Growth and Facial Changes During Adulthood
		58.4	 Orthodontic, Orthopedic, and Orthognathic Clinical Considerations
			58.4.1	 Craniofacial Growth Assessment
			58.4.2	 Orthopedic Treatment for Growth Modification
			58.4.3	 Transverse Orthopedic Treatment
			58.4.4	 Anteroposterior Orthopedic Treatment: Class II
			58.4.5	 Anteroposterior Orthopedic Treatment: Class III
			58.4.6	 Vertical Orthopedic Treatment
			58.4.7	 Orthodontic Camouflage: Orthopedic Consequence Versus Surgical Preparation
		Conclusion
		References
	59: Digital Data Acquisition and Treatment Planning in Orthognathic Surgery
		59.1	 Introduction
		59.2	 Initial Consultation
			59.2.1	 Patient History
				59.2.1.1	 Chief Complaint, Expectations
				59.2.1.2	 Orthodontic History
				59.2.1.3	 Age, Growth, Recognition of Anomalies
			59.2.2	 Clinical Exam
				59.2.2.1	 Maxillofacial
				59.2.2.2	 Airway
				59.2.2.3	 Dental
				59.2.2.4	 Esthetic
			59.2.3	 Digital Data Acquisition
				59.2.3.1	 Photography
				59.2.3.2	 Intraoral Scanners
				59.2.3.3	 Radiography and Other Imaging
				59.2.3.4	 Polysomnography, Drug-Induced Sleep Endoscopy
				59.2.3.5	 Cervical Vertebral/Hand Wrist Maturation and Other Imaging
			59.2.4	 Determining a Diagnosis and Generate a Problem List
			59.2.5	 Visual Treatment Predictions/ Surgical-Orthodontic Treatment Options and Communication with the Orthodontist
		59.3	 Peri-Orthodontic Mid-Treatment Review
			59.3.1	 Evaluation of Growth and Orthodontic Progress for Surgery
			59.3.2	 Review of History, Chief Complaint, and Clinical Examination
			59.3.3	 Establishment of an Orthognathic Surgery Digital Planning Timeline
		59.4	 Digital Surgical Workup: Preoperative Preparation
			59.4.1	 Database Gathering
				59.4.1.1	 Minimum Digital Hardware and Software Requirements
			59.4.2	 Software Requirements for Cephalometric Analysis and Predictive Software
			59.4.3	 Quality Guidelines: Imaging/Digital Scans, CBCT/CT Acquisition, and Communication Tools
				59.4.3.1	 Secure Data Sharing
				59.4.3.2	 Video Conferencing
				59.4.3.3	 Digital Conferencing Steps
			59.4.4	 Final Digital Treatment Plan
			59.4.5	 Recognition of Potential Errors in Digital Planning
			59.4.6	 Surgery-First Approach
			59.4.7	 Role of Clear Aligners in Digital Planning
			Case I
			Case II
			Conclusions
		References
	60: Orthodontics for Orthognathic Surgery
		60.1	 Introduction
			60.1.1	 Sequencing
		60.2	 Orthodontic Goals
			60.2.1	 Incisor Position
			60.2.2	 Occlusal Plane Angle (OPA) Surgical Alteration
			60.2.3	 Dental and Periodontal Treatment
		60.3	 Treatment Options for Specific Orthodontic Problems
			60.3.1	 Adjustment for Tooth-Size Discrepancy (TSD)
			60.3.2	 Correct Over-Angulated (Proclined) and/or Crowded Maxillary or Mandibular Anterior Teeth
			60.3.3	 Correct Under-Angulated (Retro-Inclined) Maxillary or Mandibular Incisors
			60.3.4	 Correct Excess Curve of Spee: Maxillary Arch
			60.3.5	 Correct Accentuated Curve of Spee: Mandibular Arch
			60.3.6	 Correct Reverse Curve of Spee: Maxillary Arch
			60.3.7	 Correct Reverse Curve of Spee: Mandibular Arch
			60.3.8	 Anteroposterior Arch Asymmetry (Maxilla or Mandible)
			60.3.9	 Divergence of Roots Adjacent to Interdental Surgical Sites
			60.3.10	 Coordination of Maxillary and Mandibular Arch Widths
			60.3.11	 Additional Orthodontic Issues
			60.3.12	 Corticotomies to Accelerate Orthodontic Movement
			60.3.13	 Final Presurgical Preparation
		60.4	 Postsurgical Orthodontics
			60.4.1	 Surgical Stabilizing Devices (Splints)
			60.4.2	 Postsurgical Orthodontic Management
			60.4.3	 Orthodontic Instability
			Conclusion
		References
	61: Model Surgery and Computer-Aided Surgical Simulation for Orthognathic Surgery
		61.1	 Introduction
		61.2	 Traditional Immediate Preoperative Analytical Model Surgery
			61.2.1	 Presurgical Clinical Database
			61.2.2	 Presurgical Records
				61.2.2.1	 Dental Impressions
				61.2.2.2	 Facebow Transfer
				61.2.2.3	 CR Bite Registration
		61.3	 Mounting Dental Models for Simulated Surgery
		61.4	 Marking and Measuring the Final Models and Simulating Surgery
			61.4.1	 Mandibular Surgery
				61.4.1.1	 Isolated Mandibular Surgery (Sagittal Split Osteotomy or Vertical Ramus Osteotomy Only)
			61.4.2	 Maxillary Surgery
				61.4.2.1	 Isolated Maxillary Surgery
				61.4.2.2	 Vertical Measurements in Maxillary Surgery
				61.4.2.3	 Segmental Maxillary Surgery
				61.4.2.4	 Combined Maxillary and Mandibular Surgery
					Sequence of Bimaxillary Orthognathic Surgery
					Splint Fabrication
		61.5	 Three-Dimensional Virtual Model Surgical Simulation
			61.5.1	 Introduction
			61.5.2	 History
			61.5.3	 Sequence of Data Acquisition Prior to Computer-Assisted 3D Surgical Simulation (CASS)
			61.5.4	 Computer-Assisted 3D Surgical Simulation Session
		61.6	 Other Virtual Surgery Customizations
			61.6.1	 Custom Plates and Cutting Guides
			61.6.2	 Limitations of CASS
		Conclusion
		References
			Suggested Reading
			Traditional Analytical Model Surgery
			Virtual Simulated Orthognathic Surgery
	62: Mandibular Orthognathic Surgery
		62.1	 History
		62.2	 Anatomic and Physiologic Considerations of Mandibular Surgeries
			62.2.1	 Vascular Supply
			62.2.2	 Nerves
			62.2.3	 Muscles
		62.3	 Mandibular Osteotomy Techniques
			62.3.1	 Mandibular Ramus Osteotomies
			62.3.2	 Vertical Ramus Osteotomy (VRO)
				62.3.2.1	 Indications
				62.3.2.2	 Technique
				62.3.2.3	 Alternative Techniques
				62.3.2.4	 Complications
					Stability
					Nerve Damage
					TMJ Dysfunction
					Other Complications
			62.3.3	 Inverted-L and C Ramus Osteotomies
				62.3.3.1	 Indications
				62.3.3.2	 Techniques
				62.3.3.3	 Alternative Techniques
				62.3.3.4	 Complications
			62.3.4	 Bilateral Sagittal Split Osteotomy
				62.3.4.1	 Indications
				62.3.4.2	 Technique
				62.3.4.3	 Alternative Techniques
				62.3.4.4	 Complications
					Stability
					Nerve Damage
					TMJ Dysfunction
				62.3.4.5	 Condylar Malposition
					Miscellaneous Complications
			62.3.5	 Horizontal Ramus Osteotomies
				62.3.5.1	 Indications
				62.3.5.2	 Technique
				62.3.5.3	 Alternative Techniques
				62.3.5.4	 Complications
					Relapse
					Neural Complications
			62.3.6	 Subapical Osteotomies
				62.3.6.1	 Anterior Subapical Osteotomy
					Indications
					Procedure
				62.3.6.2	 Posterior Subapical Osteotomy
					Indications
					Technique
					Alternative Techniques
			62.3.7	 Total Mandibular Subapical Alveolar Osteotomy
				62.3.7.1	 Indications
				62.3.7.2	 Technique
				62.3.7.3	 Technique Variations
				62.3.7.4	 Complications
			62.3.8	 Horizontal Osteotomy of the Symphysis (Genioplasty)
				62.3.8.1	 Indications
				62.3.8.2	 Technique
				62.3.8.3	 Alternative Techniques
				62.3.8.4	 Complications
		References
	63: Maxillary Orthognathic Surgery
		63.1	 Introduction
			63.1.1	 Basic Principles of Maxillary Surgery
			63.1.2	 Computer-Assisted 3D Surgical Simulation and Traditional Model Surgery
		63.2	 Surgical Anatomy
			63.2.1	 Osseous Structures
			63.2.2	 Vascular Structures
		63.3	 The Soft Tissue Envelope of the Maxilla
		63.4	 Surgical Techniques
			63.4.1	 Incisions, Dissection, and Exposure of the Maxilla
			63.4.2	 Osseous Surgery
			63.4.3	 Segmental Maxillary Procedures
				63.4.3.1	 Superior Maxillary Repositioning
				63.4.3.2	 Anterior Maxillary Repositioning
				63.4.3.3	 Inferior Maxillary Repositioning
				63.4.3.4	 Posterior Maxillary Repositioning
		63.5	 Rigid Internal Fixation for Maxillary Osteotomy
		63.6	 Specific Procedures
			63.6.1	 Anterior Maxillary Osteotomy
				63.6.1.1	 Posterior Maxillary Osteotomy
				63.6.1.2	 Total Maxillary Alveolar Osteotomy
		63.7	 Surgically Assisted Rapid Palatal Expansion (SARPE)
			63.7.1	 History
			63.7.2	 SARPE Versus Multiple-Piece Maxillary Osteotomy
			63.7.3	 SARPE Surgical Technique
			63.7.4	 Zygomatic Osteotomy and Modified Le Fort Osteotomies
			Conclusion
		References
	64: Sequencing in Orthognathic Surgery
		64.1	 Introduction
		64.2	 Presurgical Planning of Bimaxillary Surgery
			64.2.1	 Conventional Model Surgery
			64.2.2	 Maxilla-First Model Surgery
			64.2.3	 Mandible-First Model Surgery
		64.3	 Maxilla-First Sequencing
			64.3.1	 Maxilla-First Surgical Sequence
			64.3.2	 Scenarios in Which Maxilla-First Sequencing Is Advantageous
				64.3.2.1	 Clockwise Rotation of the Maxillomandibular Complex
				64.3.2.2	 Mandibular Osteotomy Is Not Stable
		64.4	 Mandible-First Sequencing
			64.4.1	 Mandible-First Surgical Sequence
			64.4.2	 Scenarios in Which Mandible-First Sequencing Is Advantageous
				64.4.2.1	 Inaccurate Bite Registration or Discrepancy in Centric Relation and Centric Occlusion
				64.4.2.2	 Segmented Maxillae
				64.4.2.3	 Counterclockwise Rotation and Downgrafting of the Posterior Maxilla
				64.4.2.4	 Large Maxillomandibular Advancements
				64.4.2.5	 Anterior Open Bite Correction
				64.4.2.6	 Rigid Fixation of the Maxilla Versus Mandible
		64.5	 Concomitant TMJ Surgery Staging
		64.6	 Virtual Surgical Planning
			64.6.1	 Patient-Specific Implants
			Conclusion
		References
	65: Concomitant Orthognathic and Temporomandibular Joint Surgery
		65.1	 Introduction
		65.2	 Indications
			65.2.1	 Idiopathic Condylar Resorption
			65.2.2	 Condylar Hyperplasia
			65.2.3	 Osteochondroma of the Mandibular Condyle
			65.2.4	 Autoimmune/Connective Tissue (CT) TMJ Diseases
			65.2.5	 Craniofacial Syndromes
			65.2.6	 TMJ Ankylosis
		65.3	 Clinical Scenarios Benefiting from Concomitant Surgery Procedures
			65.3.1	 TMJ Disk Repositioning Causing Malocclusion
			65.3.2	 Patient with TMJ Internal Derangement and a Coexisting Dentofacial Deformity
			65.3.3	 TMJ Arthroplasty (Osseous Condylar Procedures) and Concomitant Orthognathic Surgery
		65.4	 Expected Outcomes of Concomitant TMJ Disk Surgery and Orthognathic Surgery
		65.5	 Autogenous Versus Alloplastic TMJ Reconstruction in Concomitant Surgery
		65.6	 Diagnosis and Treatment Planning
			65.6.1	 General Patient Evaluation
			65.6.2	 Problem-Focused Specific Evaluation
			65.6.3	 Age for Surgical Intervention
		65.7	 Preoperative Considerations
		65.8	 Surgical Sequencing
		65.9	 Intraoperative Considerations
		65.10	 Postsurgical Management
		65.11	 Complications
		65.12	 Case Presentations
			65.12.1	 Active Condylar Resorption and Dentofacial Deformity (. Figs. 65.9 and 65.10)
			65.12.2	 TMJ Connective Tissue Disease and Dentofacial Deformity (. Fig. 65.11)
			Conclusion
		Bibliography
	66: Facial Asymmetry
		66.1	 Etiology of Facial Asymmetry
		66.2	 Congenital Anomalies
			66.2.1	 Hemifacial Microsomia
		66.3	 Cleft Lip and Cleft Palate
			66.3.1	 Craniosynostosis: Plagiocephaly
			66.3.2	 Congenital Hemifacial Hyperplasia
		66.4	 Developmental Facial Asymmetries
			66.4.1	 Primary Growth Deformities
				66.4.1.1	 Facial Hemiatrophy
				66.4.1.2	 Hemimandibular Hyperplasia
			66.4.2	 Secondary Growth Deformities
		66.5	 Acquired Facial Asymmetries
			66.5.1	 Condylar Trauma
			66.5.2	 Juvenile Idiopathic Arthritis
			66.5.3	 Degenerative Joint Disease
		66.6	 Clinical Patient Assessment
			66.6.1	 Radiographic Assessment
				66.6.1.1	 Panoramic Radiograph
				66.6.1.2	 Posteroanterior Cephalometric Radiograph
				66.6.1.3	 Lateral Cephalometric Radiograph
			66.6.2	 Computed Tomography
			66.6.3	 Stereolithographic Modeling
			66.6.4	 Bone Scans
		66.7	 Surgical Treatment
			66.7.1	 Delayed Treatment
			66.7.2	 Orthodontic Considerations
			66.7.3	 Surgical Options
				66.7.3.1	 Facial Asymmetry Case Examples
					Case 1
					Case 2
					Case 3
					Case 4
			Conclusion
		References
	67: Soft Tissue Changes and Prediction with Orthognathic Surgery
		67.1	 Introduction
		67.2	 General Soft Tissue Effects
		67.3	 Lateral Cephalometric Prediction (Manual and Computer Assisted)
			67.3.1	 Mandibular Surgery
				67.3.1.1	 Mandibular Advancement
				67.3.1.2	 Mandibular Setback
				67.3.1.3	 Genioplasty
			67.3.2	 Maxillary Surgery
				67.3.2.1	 Maxillary Advancement
				67.3.2.2	 Maxillary Impaction
				67.3.2.3	 Maxillary Setback
				67.3.2.4	 Bimaxillar Surgery
		67.4	 Photographic Prediction
			67.4.1	 Computerized Digital Video Imaging
				67.4.1.1	 Mandibular Advancement
				67.4.1.2	 Mandibular Setback
				67.4.1.3	 Bimaxillary Surgery
				67.4.1.4	 Maxillary Impaction
			67.4.2	 Three-Dimensional Computer-Assisted Prediction
				67.4.2.1	 Workup
				67.4.2.2	 Results
			Conclusion
		References
	68: Complications in Orthognathic Surgery
		68.1	 Introduction
		68.2	 Hemorrhage: Acute and Delayed
			68.2.1	 Acute Maxillary Hemorrhage
			68.2.2	 Delayed Maxillary Hemorrhage
			68.2.3	 Mandibular Hemorrhage
			68.2.4	 Hemorrhage with Sagittal Split Osteotomy
			68.2.5	 Hemorrhage with Vertical Ramus Osteotomy
		68.3	 Vascular Compromises: Maxilla and Mandible
			68.3.1	 Vascular Compromise (Avascular Necrosis)
			68.3.2	 Nonunion of the Maxilla
			68.3.3	 Nonunion of the Mandible
		68.4	 Dental and Periodontal Injuries: Maxilla and Mandible
		68.5	 Fistula Formation
		68.6	 Infection
		68.7	 Nerve Injury: Sensory and Motor
			68.7.1	 Maxillary Sensory Injuries
			68.7.2	 Mandibular Sensory Injuries
				68.7.2.1	 Sagittal Split Osteotomy
				68.7.2.2	 VRO and Other Ramus Procedures
				68.7.2.3	 Motor Nerve Injury
		68.8	 Nasal and Paranasal Sinus Considerations
			68.8.1	 Alterations in Nasal Form: Septal Deviation
			68.8.2	 Alterations in Nasal Form: Internal Nasal Valve
			68.8.3	 Alterations in Nasal Form: Alar Base
			68.8.4	 Postoperative Sinus Disease
		68.9	 Unanticipated Mandibular Osteotomy Fractures
			68.9.1	 Management of bad Splits
			68.9.2	 Proximal Segment Buccal Plate Fracture, Partial
			68.9.3	 Proximal Segment Buccal Plate Fracture, Complete
			68.9.4	 Distal Segment Lingual Plate Fracture
		68.10	 Displacement of the Proximal VRO Segment
		68.11	 Proximal Segment Rotation
		68.12	 Unanticipated Maxillary Fractures
		68.13	 Postoperative Occlusal Discrepancies
			68.13.1	 Anterior Open Bite Malocclusions
		68.14	 Miscellaneous Complications
			68.14.1	 Epiphora
			68.14.2	 Auriculotemporal Syndrome
			68.14.3	 Facial Scars
			68.14.4	 Dysphagia
			68.14.5	 Salivary Gland Injuries
			Conclusion
		Reference and Further Reading
	69: Cleft Orthognathic Surgery
		69.1	 Cleft Distraction Osteogenesis
		69.2	 Postsurgical Considerations
			69.2.1	 Velopharyngeal Considerations
		References
	70: Distraction Osteogenesis of the Craniomaxillofacial Skeleton
		70.1	 Introduction
		70.2	 History of DO
		70.3	 Biological Basis of DO
		70.4	 Overview of Risk of DO
		70.5	 Principles of DO
		70.6	 Patient Evaluation and Vector Planning
		70.7	 Orthodontics for Craniomaxillofacial DO
		70.8	 Mandibular Distraction
		70.9	 Maxillary Distraction (Le Fort I Level)
		70.10	 Midface Distraction (Le Fort II, III, Monobloc and Facial Bipartition)
		70.11	 DO for Craniosynostosis
		70.12	 Alveolar Ridge Distraction
		70.13	 The Future of  Craniomaxillofacial DO
			Conclusion
		References
			Suggested Readings
	71: Surgical and Nonsurgical Manssagement of Obstructive Sleep Apnea
		71.1	 History
		71.2	 Normal Sleep Stages
		71.3	 Sleep Apnea Syndrome
			71.3.1	 Classification
			71.3.2	 Differential Diagnosis
			71.3.3	 History of OSA Syndrome
			71.3.4	 Clinical Manifestations
			71.3.5	 Physical Findings
		71.4	 Diagnosis
			71.4.1	 Physical Examination
			71.4.2	 Cephalometric Examination
			71.4.3	 Computed Tomography
			71.4.4	 Polysomnography
			71.4.5	 Site of Obstruction
		71.5	 Medical Treatment
			71.5.1	 Oral Appliances
			71.5.2	 Continuous Positive Airway Pressure
		71.6	 Surgical Treatment
			71.6.1	 Tracheostomy
			71.6.2	 Nasal Surgery
			71.6.3	 Uvulopalatopharyngoplasty
			71.6.4	 Laser-Assisted Uvulopalatoplasty
			71.6.5	 Uvulopalatal Flap
			71.6.6	 Tongue Surgery
			71.6.7	 Orthognathic Surgery Procedures
			71.6.8	 Mandibular Advancement
			71.6.9	 Genial Tubercle Advancement
			71.6.10	 Genial Advancement with Hyoid Myotomy and Suspension
			71.6.11	 Maxillomandibular Advancement
			71.6.12	 Mandibular Setbacks
		71.7	 Complications
		71.8	 Summary
		References
VIII: Facial Esthetic Surgery
	72: Blepharoplasty
		72.1	 Introduction
		72.2	 Nomenclature
		72.3	 Anatomy
			72.3.1	 Anterior Lamella
			72.3.2	 Middle Lamella
			72.3.3	 Posterior Lamella
		72.4	 Innervation and Blood Supply
		72.5	 Lacrimal System
		72.6	 Patient Evaluation
		72.7	 Surgical Procedures
		72.8	 Postoperative Care
		72.9	 Complications and Management
		Conclusion
		References
	73: Basic Principles of Rhinoplasty
		73.1	 Introduction
			73.1.1	 Nasal Anatomy
			73.1.2	 Surface Anatomy
			73.1.3	 Skin and Soft Tissue
				Box 73.1 Surface anatomy of the nose
			73.1.4	 Superficial Musculoaponeurotic System and Nasal Musculature
			73.1.5	 Blood Supply
			73.1.6	 Bone and Cartilage
			73.1.7	 Nerves
			73.1.8	 Nasal Valve
				Box 73.2 Tip support mechanisms
		73.2	 Cosmetic Evaluation
			73.2.1	 Psychiatric Stability
			73.2.2	 General Facial Analysis
			73.2.3	 Nasal Analysis
		73.3	 General Assessment
			73.3.1	 Skin
			73.3.2	 Symmetry
				73.3.2.1	 Lateral View
					Nasofrontal Angle
					Nasal Dorsum
					Nasal Tip Definition
					Nasal Tip Projection
					Nasal Tip Rotation
					Tip Support
				73.3.2.2	 Frontal View
					Width of Nasal Dorsum
					Alar Width
				73.3.2.3	 Basal View
				73.3.2.4	 Oblique View
			73.3.3	 Functional Considerations
			73.3.4	 Photographs
		73.4	 Anesthesia
		73.5	 Incisions/Sequencing
			73.5.1	 Complete Transfixion
			73.5.2	 Partial Transfixion
			73.5.3	 Hemitransfixion
			73.5.4	 Killian Incision
			73.5.5	 Intercartilaginous Incision
			73.5.6	 Intracartilaginous Incision
			73.5.7	 Rim/Marginal Incision
			73.5.8	 Transcolumellar Incision
		73.6	 Septoplasty
			Box 73.3 Surgical sequence for endonasal rhinoplasty
			Box 73.4 Surgical sequence for external rhinoplasty
		73.7	 Turbinectomy
		73.8	 Nasal Dorsum
			73.8.1	 Reduction
			73.8.2	 Augmentation
				73.8.2.1	 Autogenous Augmentation
				73.8.2.2	 Alloplastic Augmentation
			73.8.3	 Osteotomies
		73.9	 Nasal Tip
			73.9.1	 Tip Projection
				73.9.1.1	 Increasing Tip Projection
				73.9.1.2	 Decreasing Tip Projection
			73.9.2	 Tip Rotation
				73.9.2.1	 Increasing Tip Rotation
				73.9.2.2	 Decreasing Tip Rotation
			73.9.3	 Tip Shape
		73.10	 Nasal Base Alar Reduction
		73.11	 Postoperative Management
			Conclusion
		References
	74: Rhytidectomy
		74.1	 Introduction
		74.2	 History
			Box 74.1 Generations of rhytidectomy
		74.3	 Patient Evaluation
		74.4	 Surgical Technique
			74.4.1	 Flap Development
			74.4.2	 Skin Closure
		74.5	 Complications
			Conclusion
		Appendix Postoperative Rhytidectomy Instructions
			Immediately upon Arriving Home
			One Day or More After Surgery
			Please Report Any of the Following to Our Office
		References
	75: Forehead and Brow Procedures
		75.1	 Anatomic and Aesthetic Considerations
		75.2	 Bony Landmarks
		75.3	 Muscle and Fascial Anatomy
		75.4	 Vessel and Nerve Anatomy
			75.4.1	 Forehead Dissection
		75.5	 Preoperative Evaluation and  Surgical Preparation
		75.6	 Coronal Forehead and Brow Lift
		75.7	 Trichophytic or Pretrichial Forehead and Brow Lift
		75.8	 Endoscopic Forehead and Brow Lift
		75.9	 Temporal Lift
		75.10	 Direct Brow Lift
		75.11	 Midforehead and Brow Lift
		75.12	 Transpalpebral and Other Local Brow Procedures
		75.13	 Botulinum Toxin–Assisted Brow Lift
		75.14	 Adjunctive Procedures: Skin Care and Micropigmentation
		75.15	 Postoperative Care
		75.16	 Complications
			Summary and Conclusions
		References
	76: Otoplastic Surgery for the Protruding Ear
		76.1	 Embryology of the Auricle
		76.2	 Surgical Anatomy
		76.3	 Blood Supply
		76.4	 Nerve Supply
		76.5	 Deformities
		76.6	 Protruding Ear
		76.7	 Surgical Correction
		76.8	 Surgical Techniques
		76.9	 Davis Method
		76.10	 Mustarde Method
		76.11	 Correction of the Protruding Earlobe
		76.12	 Complications
		76.13	 Hematoma
		76.14	 Perichondritis
		76.15	 Keloid and Hypertrophic Scar Formation
		76.16	 Aesthetic Complications
		76.17	 Telephone Ear Deformity
		76.18	 Scapha Buckling
		76.19	 Narrowed Meatus
		76.20	 Summary
		References
	77: Adjunctive Facial Cosmetic Procedures
		77.1	 Introduction
		77.2	 Facial Evaluation
		77.3	 Neuromodulators
			77.3.1	 Injectable Facial Fillers
		77.4	 Fat Transfer
		77.5	 Patient Selection
		77.6	 Harvesting
		77.7	 Fat Transfer Procedure
			Case Presentation
		77.8	 Facial Implants
		77.9	 Surgical Lip Lift
		77.10	 Skin Resurfacing
			Conclusion
		References and Further Reading
Index