The most common complication associated withlower lid blepharoplasty is lid malposition/retraction.Clinical postoperative presentation may range from in-creased scleral show to lateral canthal rounding or ec-tropion. Any of these complications can exacerbateother ocular problems, such as dry eye syndrome, re-quiring more extensive oculoplastic correction.

Transconjunctival lower lid blepharoplasty has beenproven to produce a lower incidence of postoperativelid malposition versus open excision techniques. Cou-pled with surgical lid tightening and skin resurfacing,transconjuctival blepharoplasty is a safe and effectivemethod for improving lower lid contour and reducingrhytids while producing minimal complications.

Keys to predictable clinical success are understandingnormal lower lid anatomy and its relation to structure/support of the lid complex, recognizing changes associ-ated with the aging eyelid complex, assessment andplanning for surgery to restore structure, and avoidingoperative techniques with a high probability of compli-cations in patients with preexisting eyelid or ocularproblems.

References

Popp JC: Complications of blepharoplasty and their management.Dermatol Surg Oncol 992:1122, 1992

Shorr N, Enzer YR: Considerations in aesthetic eyelid surgery. Der-matol Surg Oncol 992:1081, 1992

Zarem HA, Resnick JI: Operative technique for transconjunctivallower blepharoplasty. Clin Plast Surg 19:351, 1992

S219Scientific Basis and Clinical Applicationof Myocutaneous Island Flaps in Headand Neck ReconstructionUwe Frohberg, DMD, MD, Dallas, TX

Myocutaneous island flaps represent the workhorse ofhead and neck reconstruction because they offer de-pendable, well-vascularized tissue, especially for preirra-diated areas. Soft tissue defects following either ablativetumor surgery or facial trauma can be replaced ade-quately and reliably, thus providing effective and aesthet-ically pleasant results.

A variety of myocutaneous flaps have been described.The most useful and versatile flaps are the pectoralismajor flap, the latissimus dorsi flap, the trapezius flap,and the sternocleido-mastoid flap. The anatomical basisof these flaps will be outlined followed by a detailedpresentation of important technical aspects with specialreference to donor site location and morbidity, flap de-sign, elevation technique, preparation of recipient area,and flap inset. Advantages and disadvantages of the var-ious flaps will be discussed.

The clinic will present differential indication, prefera-

ble choice of flap, and management techniques in headand neck reconstruction using these major myocutane-ous flaps. Selected case reports will demonstrate chal-lenging situations including closure of perforating le-sions, tongue reconstruction after glossectomy, and cra-nial base reconstruction. A variety of cases as well assurgical alternatives to island flaps will be presented fordiscussion.

References

Ariyan S: The pectoralis major myocutaneous flap. A versatile flap forreconstruction in the head and neck. Plast Reconstr Surg 63:73, 1979

Quillen CG, Shearin JC, Georgiade NG: Use of the latissimus dorsimyocutaneous island flap for reconstruction in the head and neck area.A case report. Plast Reconstr Surg 62:113, 1978

Demergasso F, Piazza MV: Trapezius myocutaneous flap in recon-structive surgery for head and neck cancer: An original technique. Am JSurg 138:533, 1979

S220Contemporary Treatment of Snoring,Nasal Congestion and ObstructiveTonsils: What System to Choose, Timingof Surgery, Risks, Benefits, andComplications of Each ProcedureMansoor Madani, DMD, Bala Cynwyd, PA

Snoring affects over 70 million Americans and is oneof the signs of sleep apnea. Oral and maxillofacial sur-geons are positioned on the front line of diagnosis andtreatment of this condition. There are more patientssuffering from this illness than dental implant patients ororthognathic surgery cases. An up to 6-year follow-upreview of over 4,000 cases treated with laser, somno-plasty, coblation, and orthognathic surgery will be dis-cussed. Advantages, disadvantages, complications, andoutcomes of each type of surgery will be reviewed indetail. Case selection, clinical examination, and surgicaltechniques will be analyzed. Somnoplasty and coblationare the latest surgical techniques, using radiofrequencyto reduce tissue volume, with many new and easy appli-cations for the treatment of snoring, chronic nasal con-gestion, and obstructive tonsils. The presenter of thecourse has extensive experience in using these devices inhundreds of cases and will review his findings in detail.

S221Mini Dental Implants: An Alternative toConventional FixturesSteven Sullivan, DDS, Oklahoma City, OK

Conventional endosseous fixtures serve a vital role inthe stabilization of prostheses in the edentulous patient.

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There are factors associated with conventional fixtures,including a more complicated surgical procedure, a rec-ommended period of osseointegration prior to loadingand expense, which may limit availability to some pa-tients.

The MDI system, which has been recently approved asan ongoing minidental implant, avoids some of theselimitations by permitting the clinician to insert and, inmany instances, immediately load with predictable re-sults. Mini dental implants are finding their way intoimplant dentistry in that they offer a less expensive formof treatment that can be used as a transitional device inconjunction with conventional fixtures or as a stand-alone ongoing implant.

This presentation will describe the use of mini dentalimplants, patient selection, limitations, and insertionprotocol for use in the edentulous mandible and maxilla.A hands-on exercise will be provided.

References

el Attar MS, el Shazly D, Osman S, et al: Study of the effect of usingmini-transitional implants as temporary abutments in implant overden-ture cases. Implant Dent 8:152, 1999

Sendax VI: Mini-implants as adjuncts for transitional prostheses.Dent Implantol Update 7:12, 1996

Froum S, Emtiaz S, Bloom MJ, et al: The use of transitional implantsfor immediate fixed temporary prostheses in cases of implant restora-tions. Pract Periodont Aesthet Dent 10, 1998

S222A Rational and Predictable Approach toSite Development and Implant PlacementRobert Emery, DDS, Washington, DC

Many surgical techniques and materials are available tothe implant surgeon. The myriad of options, reportedoutcomes, and complications can lead to confusion andpoor outcomes if inappropriate treatment plans are un-dertaken.

This presentation will provide the surgeon and theirteam a rational and predictable approach to implant sitedevelopment. The program will begin with a practicaldiagnostic approach, reviewing and categorizing ana-tomic deficiencies and prosthetic options. This will befollowed by surgical treatment options and the specifictechniques directed by this diagnostic approach. Finally,the materials and instrumentation needed to perform thesurgery will be reviewed.

The presenters approach is a result of a thoroughreview of the literature and his clinical experiences in ademanding fee for service private practice. Techniquesdiscussed will include minimal incision grafting ap-proaches, sinus lifting procedures, ridge expansion, andnerve lateralization procedures. Various grafting materi-als will be reviewed and soft tissue considerations dis-cussed.

At the conclusion of this program the participants:1. Will be able to categorize bone and soft tissue

defects prior to implant site development.2. Choose appropriate procedures to address these

defects.3. Choose appropriate materials for these proce-

dures.

References

Emery RW, Guttenberg SA: Nerve Repositioning for Implant Place-ment. Implant News & Views, Vol. 4, No.3, May/June 2002

Engelmann M: Clinical Decision Making and Treatment PlanningOsseointegration, Illinois, Quintessence Publishing, 1996

Misch C: Contemporary Implant Dentisty. New York, Mosby YearBook, 2001

S301Management of Pediatric MaxillofacialTraumaBruce Horswell, DDS, MD, MS, Charleston, WVJames Henderson, MD, DDS, Charleston, WV

Over 22 million children are injured annually, com-prising 12% of all trauma patients. Children are uniquelysusceptible to craniomaxillofacial injury due to theircranial mass-to-body ratio. Soft-tissue injuries are rela-tively common, and include contusions, abrasions, lac-erations, and electrical and chemical burns. Childrensustain a small but increasing portion of reported facialfractures as age increases, peaking in adolescence.

Triage and evaluation of the pediatric trauma patientrequire consideration of differences in anatomy andphysiology, concomitant injuries, and the stage ingrowth and development at the time of injury. Immedi-ate intervention and treatment are important, with goalsof treatment being prevention of infection, early func-tion, and measures to minimize scarring. The cliniciantreating the pediatric maxillofacial trauma patient shouldbe aware of the potential for late adverse sequelae in thehead and neck region.

Individual clinicians may not manage sufficient volumesof pediatric trauma cases to formulate systematic and con-sistent treatment plans, particularly as it relates to signifi-cant soft tissue facial injuries and midfacial trauma. Consid-eration should be given for referral to dedicated pediatricinstitutions and practitioners with greater pediatric experi-ence, as evidenced by improved clinical outcomes.

Finally, prevention of injury is paramount as a publichealth measure in the care of children. Clinicians can,and should, be involved with their local, state, and na-tional organizations to help raise public awareness ofpediatric facial trauma and implementation of preventa-tive measures.

This clinic will concentrate on triage and initial treat-ment of the injured child patient, evaluation and man-

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