Aesthetic Orthognathic Surgery and Rhinoplasty E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 893

Veröffentlichungsjahr: 2019

Beschreibung

Comprehensive in scope, Aesthetic Orthognathic Surgery and Rhinoplasty presents orthognathic surgery from an aesthetic perspective, encompassing analysis, diagnosis, treatment, 3D virtual planning, and adjunctive procedures. * Easily accessible clinical information presented in a concise and approachable format * Well-illustrated throughout with more than 1,000 clinical photographs * Includes access to a companion website with videos of surgical procedures

Leseprobe

Aesthetic OrthognathicSurgery and Rhinoplasty

Edited by Derek M. Steinbacher

Yale UniversityNew Haven, Connecticut

This edition first published 2019

© 2019 John Wiley & Sons, Inc

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by law. Advice on how to obtain permission to reuse material from this title is available at http://www.wiley.com/go/permissions.

The right of Derek M. Steinbacher to be identified as the author of this work has been asserted in accordance with law.

Registered Office(s)

John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030, USA

Editorial Office

111 River Street, Hoboken, NJ 07030, USA

For details of our global editorial offices, customer services, and more information about Wiley products visit us at www.wiley.com.

Wiley also publishes its books in a variety of electronic formats and by print-on-demand. Some content that appears in standard print versions of this book may not be available in other formats.

Limit of Liability/Disclaimer of Warranty The contents of this work are intended to further general scientific research, understanding, and discussion only and are not intended and should not be relied upon as recommending or promoting scientific method, diagnosis, or treatment by physicians for any particular patient. In view of ongoing research, equipment modifications, changes in governmental regulations, and the constant flow of information relating to the use of medicines, equipment, and devices, the reader is urged to review and evaluate the information provided in the package insert or instructions for each medicine, equipment, or device for, among other things, any changes in the instructions or indication of usage and for added warnings and precautions. While the publisher and authors have used their best efforts in preparing this work, they make no representations or warranties with respect to the accuracy or completeness of the contents of this work and specifically disclaim all warranties, including without limitation any implied warranties of merchantability or fitness for a particular purpose. No warranty may be created or extended by sales representatives, written sales materials or promotional statements for this work. The fact that an organization, website, or product is referred to in this work as a citation and/or potential source of further information does not mean that the publisher and authors endorse the information or services the organization, website, or product may provide or recommendations it may make. This work is sold with the understanding that the publisher is not engaged in rendering professional services. The advice and strategies contained herein may not be suitable for your situation. You should consult with a specialist where appropriate. Further, readers should be aware that websites listed in this work may have changed or disappeared between when this work was written and when it is read. Neither the publisher nor authors shall be liable for any loss of profit or any other commercial damages, including but not limited to special, incidental, consequential, or other damages.

Library of Congress Cataloging-in-Publication Data

Names: Steinbacher, Derek M. (Derek Matthew), editor.

Title: Aesthetic orthognathic surgery and rhinoplasty [electronic resource] /

 [edited by] Derek M. Steinbacher.

Description: Hoboken, NJ : Wiley-Blackwell, 2019. | Includes bibliographical

 references and index. |

Identifiers: LCCN 2018047520 (print) | LCCN 2018048604 (ebook) | ISBN

 9781119187110 (Adobe PDF) | ISBN 9781119186984 (ePub) | ISBN

9781119186977 (hardback)

Subjects: | MESH: Orthognathic Surgical Procedures--methods |

 Rhinoplasty--methods | Esthetics, Dental, Plastic Surgery, Orthodontics, Otolaryngology, Surgery

Classification: LCC RD119.5.N67 (ebook) | LCC RD119.5.N67 (print) | NLM WU

 600 | DDC 617.5/230592--dc23

LC record available at https://lccn.loc.gov/2018047520

Cover image: © Derek Steinbacher

Cover design by Wiley

CONTENTS

Cover

List of Contributors

Foreword I

Foreword II

Foreword III

Foreword IV

Foreword V

Preface

Acknowledgements

About the Companion Website

1 Introduction to Aesthetic Orthognathic Surgery and Rhinoplasty

1.1 Introduction

1.2 Patient Education

1.3 Overview of Orthodontic Considerations

1.4 Growth Evaluation

1.5 Timing

1.6 Nasal and Adjunctive Procedures

1.7 Summary of Goals: Guiding Principles for Aesthetic Orthognathic Surgery

References

2 Assessment and Evaluation in the Aesthetic Orthognathic Patient

2.1 Evaluation (Clinical Exam)

2.2 Evaluation (Records Obtained and Analyzed)

2.3 Overview of Spatial Analysis: Six Planes and Determinants

2.4 Cephalometrics (Radiographs) and Anthropometrics (for Soft Tissue)

2.5 Conclusions – Assessment and Evaluation

References

3 Orthodontic Considerations in Orthognathic Surgery

3.1 Introduction

3.2 Treatment Planning in Orthognathic Surgery

3.3 Anteroposterior Dimension Considerations

3.4 Transverse Dimension Considerations

3.5 Vertical Dimension Considerations

3.6 Asymmetries

3.7 Condylectomies in Orthognathic Surgery

3.8 Postsurgical Orthodontics

3.9 Conclusions

Acknowledgments

References

4 3D Analysis, Planning, and Model Surgery

4.1 Conventional Planning

4.2 3D Planning

4.3 Components and Advantages of 3D Planning

4.4 Steps and Logistics of 3D Planning for Orthognathic Surgery

4.5 3D Planning Steps

4.6 3D Planning, Planes of Space, and Aesthetics (Figure 4.23)

4.7 Types of Splints

4.8 Considerations for Specific Case Types

4.9 Conclusions

References

5 Convex Facial Profiles, Class II Skeletal Problems

5.1 Introduction

5.2 Convex (Class II) Versus Concave (Class III) Profiles

5.3 Convex Profiles and Class II Skeletal Problems

5.4 Goals of Treatment (Convex, Class II Skeletal Patterns)

5.5 Summary

References

6 Concave Facial Profiles, Class III Skeletal Problems

6.1 Introduction

6.2 Etiopathogenesis

6.3 Presentation

6.4 Class III with Vertical Deficiency: Deep Bite

6.5 Class III with Vertical Excess: Open Bite

6.6 Goals of Treatment (Concave, Class III Skeletal Patterns)

6.7 Summary

Case 1 18-yo F with Concave Profile, Poor Upper Lip Support, Lip Incompetence, Class III Malocclusion, Anterior Open Bite

Case 2 20-yo M with Concave Profile, Maxillary Hypoplasia, Mandibular Prognathism, Long Prominent Chin, Class III, Anterior Open Bite

Case 3 28-yo M with Concave Profile, Class III Malocclusion, Prominent Chin

Case 4 17-yo M with Concave Profile, Gummy Smile, Prominent Chin, Long Lower Third, Class III Malocclusion

Case 5 20-yo F with Progressive Change in Occlusion, Chin and Mandible Becomes More Prominent; Right Condylar Hyperplasia (Rotational Type), Macrogenia, Prognathism

References

7 Anterior Open Bite

7.1 Introduction

7.2 Dental Open Bite

7.3 Skeletal Open Bite

7.4 Diagnosis and Etiology

7.5 Short Ramus Condyle Length

7.6 Condylar Resorption

7.7 Other Open Bite Examples – Posterior Open Bite

7.8 Orthodontic Management

7.9 Surgical Management

7.10 Complications/Relapse

7.11 Controversy

7.12 Conclusions

Case 1 24-yo F with Anterior Open Bite, Gummy Smile, Difficulty Closing Lips, no TMJ Symptoms

Case 2 25-yo F with Anterior Open Bite, Gummy Smile; History of TMJ Symptoms; Difficulty Closing Lips

Case 3 24-yo F with Anterior Open Bite, Convex Profile, Mentalis Strain, Prior TMJ Symptoms (Stable)

Case 4 18-yo F with Anterior Open Bite, Lip Incompetence, Mandibular Asymmetry

References

8 Width and Transverse Problems

8.1 Introduction

8.2 Etiopathogenesis

8.3 Evaluation

8.4 Surgical Correction of Transverse Maxillary Hypoplasia

8.5 Surgically Assisted Maxillary Expansion (SAME)

8.6 Segmental Le Fort Osteotomy

8.7 Mandibular Transverse Problems

8.8 Mandibular Arch Width Hyperplasia

8.9 Mandibular Arch Width Hypoplasia

8.10 Mandibular Angle Excess (Bigonial Hyperplasia)

8.11 Mandibular Angle Deficiency

8.12 Conclusions

Case 1 18-yo F with VME, Convex Profile, Transverse Maxillary Discrepancy, Retrognathia, Lip Incompetence

Case 2 18-yo F with VME, Anterior Open Bite, Transverse Narrowing; Convex Profile, Retrognathia

Case 3 26-yo F with VME, Anterior Open Bite, Convex Profile, Narrow Maxillary Arch, Deficient Mandibular Angles; Class II Malocclusion

Case 4 20-yo F with Concave Profile, Over-Widened Maxilla; Midline Discrepancies, Class III Malocclusion

References

9 Facial Asymmetry

9.1 Introduction

9.2 Assessment and Determinants of Facial Asymmetry

9.3 Evaluation and Workup

9.4 Treatment

9.5 Conclusions

Progressive – Growing Patient

Case 1 Condylar Hyperplasia Growing Boy, 6–9 yo M with Progressively Worsening Mandibular and Chin Deviation

Congenital Asymmetry – Manage While Growing Versus Post-Growth Cessation

Case 2 HFM Post-Growth Cessation. 18-yo M with L-Sided HFM

Asymmetric Mandibular Growth History of Condylar Hyperplasia and/or Short RCU

Case 3 16-yo M with Right Mandibular Hyperplasia, Left Mandibular Hypoplasia, (Condylar Change) Class II Presentation, Compensation of Maxilla (Maxillary Cant)

Condylar Hyperplasia – Active (Progressive)

Case 4 54-yo F with History of Prior Orthognathic Surgery, and Recent Mandibular Deviation and Open Bite on Right; Right Condylar Hyperplasia (Vertical Type), Maxillary Hypoplasia, Vertical Deficiency (Hx of Prior Orthognathic Surgery)

Case 5 26-yo F with Worsening Projection and Deviation of Chin (Toward the Left), Right Condylar Hyperplasia (Rotational Type), Class III Malocclusion

Global Facial Asymmetry – Bone/Soft-Tissue

Case 6 18-yo F with History of Progressive Wasting Left Face, with Worsening Asymmetry; Global Left Facial Hypoplasia, Asymmetry, Bony and Soft Tissue (Discoid Lupus)

References

10 Midface and Orbitozygomatic Aesthetics

10.1 Introduction

10.2 Etiology of Midface Deficiency

10.3 Anatomy

10.4 Clinical Evaluation and Assessment

10.5 Management and Techniques

10.6 Global Modification

10.7 Considerations for Orthognathic Planning and Execution for Midface and Malar Deficiencies

10.8 Conclusions

Case 1 26-yo F with History of Left Zygomatico-Orbital Fracture; Leading to a Deformity with Increased Poor Rim Support, and Exopthalmos

Case 2 22-yo F with History of Right Facial GSW (gunshot wound) as Young Girl, Loss of Structure and Physiologic Growth Stimulation Lead to Poor Malar and Orbital Size and Support, Down-Slanting Palpebral Fissure; Malar and Facial Hypoplasia on the Right

Case 3 26-yo F with Concave Profile, Malar and Infraorbital Flattening, Lack of Midfacial Support; Class III Malocclusion (Anterior Crossbite and Open Bite)

Case 4 16-yo F with History of Right Complete Cleft Lip and Palate; Concave Profile, Malar and Infraorbital Flattening, Lack of Midfacial Support; Class III Malocclusion (Anterior Crossbite), Nasal and Lip Deformities

Case 5 18-yo F with Concave Profile, Malar and Infraorbital Flattening, Lack of Midfacial Support; Class III Malocclusion (Anterior Crossbite), Nasal Deformity

Case 6 26-yo F with Concave Profile, Malar and Infraorbital Flattening, Lack of Midfacial Support; Class III Malocclusion (Anterior Crossbite), Mandibular Asymmetry; Nasal Deformity

References

11 Smile Aesthetics

11.1 Introduction

11.2 The Smile in Action

11.3 Smile Classifications

11.4 Components of the Ideal Smile

11.5 Facial and Smile Symmetry

11.6 Ideal Proportions of the Lower Facial Third

11.7 Lip Line

11.8 The Smile Arc

11.9 The Profile Smile

11.10 Lateral Negative Space

11.11 Dental Components

11.12 Gingival Components

11.13 Conclusions

Case 1 Buried/Vertically Deficient and/or Thin Lip Smile Examples

Case 2 Vertical Maxillary Excess – “Gummy” Smile Examples

Case 3 Asymmetric Smile Examples

Case 4 Narrow Smile, Possible Buccal Corridors, and/or Thin Upper Lip

Case 5 Nonconsonant Smile Examples

Case 6 Strained or Incompetent Lip Smiles

References

12 Chin and Submental Aesthetics

12.1 Introduction

12.2 Systematic Evaluation

12.3 Genioplasty: Osseous or Alloplastic Augmentation?

12.4 Conclusion

Case 1 Microgenia, Excess Submental Fat, Nasal Deformity

Case 2 Facial Aging, Excess Submental Skin, Platysmal Banding

Case 3 Convex Profile, with Bimaxillary Labioalveolar Protrusion, Microgenia, Thick Lips

Case 4 Convex Profile, Retrognathia, Microgenia, Excess Submental Tissue, Nasal Deformity

Case 5 Convex Profile, Retrognathia, Microgenia, Excess Submental Tissue

Case 6 Convex Profile, Retrognathia, Microgenia, Jowls, Excess Submental Tissue

References

13 Rhinoplasty: Evaluation and Workup

13.1 Introduction

13.2 Goals of Rhinoplasty

13.3 Nasal Anatomy

13.4 Preoperative Evaluation

13.5 Conclusions

References

14 Rhinoplasty: The Nasal Dorsum, Midvault, Septum, and Osteotomies

14.1 Introduction

14.2 Dorsal Reduction

14.3 Dorsal Augmentation

14.4 Nasal Dorsum

14.5 Radix Grafting

14.6 Midvault

14.7 Nasal Septum

14.8 Osteotomies

14.9 Correction of the Deviated Nose

14.10 Conclusions

Case 1 18-yo M, Complains of Prominent Hump, Asymmetric, Down-Turning Nasal Tip

Case 2 24-yo F, Complains of Prominent Hump, Broad Nasal Tip

Case 3 22-yo F, Complains of Prominent Hump, Infralobular Fullness, Broad Nasal Tip

Case 4 28-yo F, Complains of Prominent Nose, Hump and Tip

Case 5 19-yo F, Complains of Deviated Nose, Prominent Hump, Asymmetric Nasal Tip

References

15 Rhinoplasty: Control of Tip, Ala, and Tripod Complex

15.1 Introduction

15.2 Nasal Tip

15.3 Normal Tip Morphology: Relationship of the Tip and Alar Lobules

15.4 Tip Definition: Management of the Bifid, Bulbous, and Boxy Tip

15.5 Increasing and Decreasing Tip Projection

15.6 Rotating and Derotating the Nasal Tip

15.7 Alar–Columellar Discrepancies

15.8 Conclusions

References

16 Nasal Considerations and Orthognathic Surgery

16.1 Introduction

16.2 Anatomy and Aesthetics

16.3 Nasal Function and Dentofacial Abnormalities

16.4 Goals of Treatment: Orthognathic and Nasal Surgery

16.5 Nasal Changes Depending on Type of Le Fort Movement

16.6 Adjunctive Procedures During Le Fort I to Alter Nasal Function and Aesthetics

16.7 Examples Where Le Fort Improves the Nasal Appearance

16.8 Conclusions

References

17 Rhinoplasty and Orthognathic Surgery

17.1 Introduction

17.2 Nasal Deformities in the Orthognathic/Dentofacial Setting

17.3 Rhinoplasty Techniques to Address Specific Nasal Deformities Created from Orthognathic Surgery

17.4 Decision on Rhinoplasty Timing: Simultaneous Versus Staged

17.5 Conclusions

References

18 Rhinoplasty Technique

18.1 Introduction

18.2 Anesthesia and Preparation

18.3 Incision and Exposures

18.4 Cephalic Trim and Access to the Septum

18.5 Dorsal Reduction (if Indicated)

18.6 Septoplasty

18.7 Spreader Graft Placement

18.8 Osteotomies

18.9 Turbinates

18.10 Tip and Base (Posterior Septal Angle) Modification

18.11 Medial/Intermediate Crural Tripod Leg

18.12 Domal Suturing

18.13 Creation of Tip Projection (Deprojection) and Rotation (Derotation)

18.14 Tip Grafting

18.15 Alar or Lateral Crural Grafting

18.16 Closure

18.17 External Base and/or Sill Modification

18.18 Splints and Dressing

18.19 Postoperative Care

18.20 Conclusions

References

19 Orthognathic Technique: Le Fort I and Bilateral Sagittal Split Osteotomy (BSSO)

19.1 Introduction

19.2 Operative Sequence

19.3 Maxillary Orthognathic Surgery: Le Fort I Osteotomy

19.4 Mandibular Orthognathic Surgery: Bilateral Sagittal Split Osteotomy

References

20 Osseous Genioplasty

20.1 Introduction

20.2 Evaluation and Workup

20.3 Diagnosis

20.4 Planning

20.5 Relevant Anatomy

20.6 Preoperative Discussion

20.7 Operative Technique

20.8 Outcomes

20.9 Complications

20.10 Conclusions

References

21 Submental Liposuction

21.1 Introduction

21.2 History

21.3 Relevant Anatomy

21.4 Technique

21.5 Considerations for Submental Liposuction in Orthognathic Surgery

21.6 Conclusions

References

22 Fat Grafting

22.1 Introduction and Clinical Usage

22.2 Underlying Biology

22.3 Practical Considerations

22.4 Technique

22.5 Processing

22.6 Injection

22.7 Conclusions

References

23 Alloplastic Facial Augmentation

23.1 Introduction

23.2 Indications

23.3 Materials

23.4 Malar

23.5 Mandibular Angle

23.6 Chin

23.7 Conclusions

References

24 Anesthesia for Orthognathic Surgery and Rhinoplasty

24.1 Introduction

24.2 Airway Assessment

24.3 Airway Management

24.4 Intraoperative Concerns

24.5 Local Anesthetics

24.6 Nausea and Vomiting

24.7 End of Case Care

24.8 Conclusions

References

25 Operative Preparation and Setup for Aesthetic Orthognathic Surgery and Rhinoplasty

25.1 Preoperative Workup

25.2 Laboratory Studies

25.3 Preparing the Operating Room

25.4 Positioning

25.5 Medications

25.6 Intraoperative Precautions

25.7 Instruments

25.8 Immediate Postoperative Care

25.9 Conclusions

References

26 Postoperative Care and Considerations

26.1 Introduction

26.2 Procedure Length and Hospital Course

26.3 Splints and Dressings

26.4 Edema, Bruising, Swelling, and Leakage

26.5 Bleeding

26.6 Nausea and Vomiting

26.7 Diet

26.8 Medications

26.9 Wound Care

26.10 Activity

26.11 Follow-Up

26.12 Conclusions

References

Index

End User License Agreement

List of Tables

Chapter 5

Table 5.1

Table 5.2

Table 5.3

Table 5.4

Table 5.5

Chapter 6

Table 6.1

Table 6.2

Table 6.3

Table 6.4

Chapter 7

Table 7.1

Chapter 8

Table 8.1

Table 8.2

Chapter 9

Table 9.1

Table 9.2

Table 9.3

Table 9.4

Table 9.5

Table 9.6

Table 9.7

Table 9.8

Table 9.9

Table 9.10

Table 9.11

Table 9.12

Table 9.13

Table 9.14

Table 9.15

Table 9.16

Table 9.17

Table 9.18

Table 9.19

Table 9.20

Chapter 10

Table 10.1

Table 10.2

Table 10.3

Table 10.4

Table 10.5

Chapter 11

Table 11.1

Table 11.2

Table 11.3

Chapter 12

Table 12.1

Table 12.2

Table 12.3

Table 12.4

Chapter 16

Table 16.1

Table 16.2

Table 16.3

Table 16.4

Table 16.5

Table 16.6

Table 16.7

Table 16.8

Table 16.9

Chapter 17

Table 17.1

Table 17.2

Table 17.3

Table 17.4

Table 17.5

Table 17.6

Chapter 20

Table 20.1

Chapter 21

Table 21.1

Table 21.2

Chapter 22

Table 22.1

Table 22.2

Chapter 23

Table 23.1

Table 23.2

Table 23.3

Table 23.4

Chapter 24

Table 24.1

Table 24.2

Table 24.3

Table 24.4

Table 24.5

Table 24.6

Table 24.7

Table 24.8

Table 24.9

Chapter 25

Table 25.1

Table 25.2

Table 25.3

Chapter 26

Table 26.1

Table 26.2

Table 26.3

Table 26.4

Table 26.5

List of Illustrations

Chapter 1

Figure 1.1 Form and function addressed in an aesthetically minded manner.

Figure 1.2 3D soft-tissue prediction used as part of patient education.

Figure 1.3 Example, pre and post- of orthognathic, rhinoplasty patient; addressing bone, s...

Figure 1.4 (a and b) Facial appearance and overjet (occlusion) worsened with decompensatio...

Figure 1.5 Angle classification of occlusion. (a) Overview of Angle classification; (b) cl...

Figure 1.6 Example of Class I canine and Class III molar following extractions and mandibu...

Figure 1.7 Compensated occlusion in the presence of a class II convex facial appearance. (...

Figure 1.8 Apertognathia with two planes of occlusion. (a) Lateral 3D CT view with discrep...

Figure 1.9 Hand–wrist film can be used as a guide to skeletal growth completion; bone scan...

Figure 1.10 Class II v. III and when to proceed with treatment based on growth and deformit...

Figure 1.11 Example of orthognathic, rhinoplasty and facial aesthetic optimization. (a) Rig...

Figure 1.12 Pre- and postoperative comparisons of aesthetic and orthognathic procedures, wh...

Chapter 2

Figure 2.1 Balanced (a) versus unbalanced (b, c) faces.

Figure 2.2 (a) Horizontal thirds and (b) vertical fifths.

Figure 2.3 (a) Anterior divergence and (b) posterior divergence.

Figure 2.4 (a) E line; (b) chin projection and lip projection.

Figure 2.5 (a) Profile and nasal analysis and (b) prominent nose, small lower third.

Figure 2.6 (a) Global frontal aesthetics; (b) additional frontal regions; (c) submental; a...

Figure 2.7 (a) Smile with midline discrepancies; (b) maxillary tooth show at rest; (c) app...

Figure 2.8 Top row, right to left: (a) normal tooth/gingival contour, scalloping on smile;...

Figure 2.9 Sequence of photos. Top row: (a) frontal repose; (b) frontal smiling; (c) subme...

Figure 2.10 3D images, same patient; (a) frontal; (b) oblique right; (c) lateral right; can...

Figure 2.11 (a) Top row: Count teeth, missing teeth; Crowding and rotations of teeth. Botto...

Figure 2.12 Asymmetries. Top row: Cant up to right; asymmetry, midlines off, posterior cros...

Figure 2.13 Images of hand-articulated models; (Right) Submental view, appreciate midlines ...

Figure 2.14 Curve of Spee (left, on lateral view); curve of Wilson (Right, on frontal view)...

Figure 2.15 Conventional radiographs. Panorex; PA cephalogram; lateral cephalogram.

Figure 2.16 CBCT frontal and right lateral.

Figure 2.17 (a) TMJ assessment/series on CBCT; (b) airway assessment using CBCT.

Figure 2.18 Determinants and five variables in space; (a) Composite image of all movements;...

Figure 2.19 Bone and soft-tissue cephalometric points/landmarks.

Figure 2.20 Horizontal and vertical reference planes on lateral; including: SN, FH [24]; al...

Figure 2.21 Sagittal relationships Steiner; Harvold; Wits [23,25,26].

Figure 2.22 Vertical relationships; Soft-tissue vertical dimensions [27] upper and lower fa...

Figure 2.23 (a) Normal soft-tissue facial heights [27]; (b) Sagittal view maxillary incisor...

Figure 2.24 Transverse relationships; Transverse, width measures on a PA ceph – bony (to us...

Figure 2.25 E plane, S-line, Chin to throat (cervicomental) distance; and cervicomental ang...

Figure 2.26 Facial soft-tissue angles.

Chapter 3

Figure 3.1 Cartoon depicting a patient with concave profile. (a) Significant maxillary inc...

Figure 3.2 Alternative to correct the mandibular incisor inclination in a patient with mil...

Figure 3.3 Patient with concave facial profile and lingually tipped mandibular incisors an...

Figure 3.4 Patient with significant facial convexity treated with extraction of the lower ...

Figure 3.5 Counterclockwise rotation of the occlusal plane to maximize chin projection in ...

Figure 3.6 Patient with a discrepancy between the skeletal and occlusal relationship. Soft...

Figure 3.7 Patient with dentoalveolar protrusion treated orthodontically without premolar ...

Figure 3.8 Patient congenitally missing lateral incisors and first premolars. (a) Temporar...

Figure 3.9 Patient with adequate anteroposterior maxillary incisor axial inclination and m...

Figure 3.10 (a) Soft-tissue profile of a patient with facial convexity, reduced lower facia...

Figure 3.11 Patient with significant open bite treated nonsurgically with TADs for posterio...

Figure 3.12 (a) Patient with a lever arm placed from a miniplate on the left labial molar r...

Figure 3.13 Patient with hemimandibular hyperplasia showing a maxillary cant and asymmetry ...

Figure 3.14 Condylectomy in a patient with significant mandibular asymmetry. (a) Pretreatme...

Chapter 4

Figure 4.1 Images for Dolphin 2D planning and conventional model surgery.

Figure 4.2 3D Planning integrates parameters onto one platform.

Figure 4.3 (a) Normal overlay mandible; (b) Plan a v. plan b.

Figure 4.4 (a) Complex asymmetry; (b) Assess malar and infraorbit, normal overlay.

Figure 4.5 (a) Nerve position, BSSO (bilateral sagittal split osteotomy) gap; (b) Nerve po...

Figure 4.6 3D splints.

Figure 4.7 3D model and plate bent to fit (for BSSO).

Figure 4.8 Compare plan to actual result. (a) CT scans and plan; (b) 3D images of result.

Figure 4.9 Ensure 3D printed splints fit on casts (and then in mouth).

Figure 4.10 Analysis – measurements from all 3D vantage points, and comparison with other a...

Figure 4.11 Compare to other anatomical structures – orbital rims, sinuses, nasal floor.

Figure 4.12 Check condylar positions.

Figure 4.13 Check yaw, bodily, pitch.

Figure 4.14 Tooth–lip position requiring impaction and disimpaction, respectively.

Figure 4.15 Check pre- and postcephalometrics.

Figure 4.16 Virtually perform surgery and allow to translate to actual.

Figure 4.17 (a, b) Soft-tissue simulation and bone to soft-tissue algorithms.

Figure 4.18 (a) Setting the bite – holding casts in occlusion; (b) Holding segmental cast i...

Figure 4.19 Sequence (See video at www.wiley.com/go/Steinbacher/Aesthetic OrthognathicSurge...

Figure 4.20 (a) Correction of maxillary cant; (b) Midline correction; (c) Yaw correction; (...

Figure 4.21 (a, b) Mandibular checks and positioning.

Figure 4.22 Genio repositioning.

Figure 4.23 Movements translate into an aesthetic result.

Figure 4.24 Intermediate and final splints (maxilla first).

Figure 4.25 Mandible-first conventional model surgery – need transfers (top); versus digita...

Figure 4.26 Asymmetry correction (frontal).

Figure 4.27 Segmental double jaws – (a) sandwich splint (conventional); and (b) 3D printed ...

Figure 4.28 (a) Intermediate splint – mandible first. (b) Intermediate (and final splints) ...

Figure 4.29 Comparison of maxilla-first and mandible-first intermediate splint position in ...

Figure 4.30 Example of surgery-first case – frequently needs segmentation as in this case.

Figure 4.31 Example of sequence in redo orthognathic surgery.

Chapter 5

Figure 5.1 Planes of space in orthognathic surgery.

Figure 5.2 Class II dental relationships; Class II division 1 (a) Class II division 2 (b)....

Figure 5.3 Class II facial profile with compensation – no excess overjet; (a) Frontal view...

Figure 5.4 Class II with compensation. Frontal findings – diminutive chin; Lateral with a ...

Figure 5.5 Class II deep bite; Frontal (see small chin, and rolled out lower lip), Oblique...

Figure 5.6 Class II deep bite; Frontal; Smile (see short vertical dimensions); Lateral wit...

Figure 5.7 Class II open bite; mentalis strain; Frontal with lip incompetence; Oblique wit...

Figure 5.8 Class II open bite; condylar resorptive process; Convex profile, strained labio...

Figure 5.9 Class II open bite and VME; VME with gummy smile and lip incompetence, convex p...

Chapter 6

Figure 6.1 (a) Frontal: poor cheek and perialar support, scleral show. (b) Lateral: concav...

Figure 6.2 Class III molar and canine (dental) relationships.

Figure 6.3 Influence of sagittal position on transverse relationships (relative versus abs...

Figure 6.4 Binder or Binderoid examples – nasomaxillary deficiency. (a−c) Examples photo a...

Figure 6.5 Converging facial profile: flat occlusal plane, lower incisors overlapping uppe...

Figure 6.6 Mamelons on mandibular incisors.

Figure 6.7 Increased gingival show on smile (vertical maxillary excess [VME]), open bite, ...

Figure 6.8 Class III with a long lower third pattern and open bite; Mandibular prognathism...

Figure 6.9 Long lower third, diverging occlusal planes, steep mandibular plane angle with ...

Chapter 7

Figure 7.1 (a, b) Anterior open bite; note the presence of mamelons. There is contact on p...

Figure 7.2 (a) Facial appearance with a class II open bite. Vertical maxillary excess is a...

Figure 7.3 (a) Lateral cephalogram of a class II with anterior open bite. This image is th...

Figure 7.4 (a) Acquired anterior open bite that occurred after the eruption and function o...

Figure 7.5 Skeletal causes of anterior open bite. (a) Vertical maxillary excess (posterior...

Figure 7.6 Example of unilateral posterior open bite from condylar hyperplasia. (a) Fronta...

Figure 7.7 Posterior open bites. (a) Lateral ceph showing bilateral symmetric posterior op...

Figure 7.8 Class III Open bite; Frontal photo, see lip incompetence, strain, due to open b...

Figure 7.9 Anterior open bite, class III tendency, but more appropriate AP maxillomandibul...

Figure 7.10 Convex profile with progressively worsening anterior open bite, history of TMJ ...

Figure 7.11 Convex profile with mandibular retrognathia, long lower facial third, mentalis ...

Figure 7.12 Convex profile, poor mandibular projection with loss of support; prior history ...

Chapter 8

Figure 8.1 Crossbites.

Figure 8.2 Models hand articulated into the appropriate AP position; notice increase maxil...

Figure 8.3 (a, b) Case with transverse maxillary discrepancy, posterior crossbites, anteri...

Figure 8.4 Examples of narrow, normal, and wide buccal corridors. The ill-aesthetics of tr...

Figure 8.5 (a–f) Class III and posterior crossbite; need to confirm if a true transverse d...

Figure 8.6 (a–e) Class II and posterior crossbite, is by definition a true transverse disc...

Figure 8.7 (a, b) Cast analysis; demonstrating narrowed canine and molar widths (transvers...

Figure 8.8 Crossbite from dental tip versus true alveolar and maxillary skeletal narrowing...

Figure 8.9 J-point analysis scheme. .

Figure 8.10 Actual J-point analysis performed on PA rendering; pre- and post-treatment show...

Figure 8.11 (a, b) Demonstrates CBCT – transverse dimension; the crossbite is observed on t...

Figure 8.12 Facial height preop v. post SAME v. post orthognathic.

Figure 8.13 Determine SAME v. segmental Le Fort I.

Figure 8.14 (A, B) Vault height, area of constriction, and dual occlusal plane, determines ...

Figure 8.15 (a, b) Typical tooth-borne palatal expander.

Figure 8.16 (a, b) Bone-borne palatal expander.

Figure 8.17 (a, b) Intraoperative performance of a SAME, (a) osteotomy in place at the midl...

Figure 8.18 (a, b) Patients should be counseled that a period of an unaesthetic diastema wi...

Figure 8.19 (a) Intraop image showing midline splint; (b) diastema develops after a period ...

Figure 8.20 Segmental – middle v. unilateral (2 : 3) v. bilateral (2 : 3) v. bilateral (3 :...

Figure 8.21 (a, b) Segment to correct dual occlusal plane (model and side view 3D plan).

Figure 8.22 (a, b) Splint within a splint.

Figure 8.23 Technical aspects of segmental Le Fort osteotomies. (a) Drawn horseshoe along t...

Figure 8.24 (a–d) Segment to narrow (a) ct plan; (b) ct axial cut; (c) drawn hemi-horseshoe...

Figure 8.25 Anterior symphyseal mandibular exposure, for vertical osteotomy or transverse m...

Figure 8.26 Mandibular arch narrowing procedure, osteotomies enable two halves of distal se...

Figure 8.27 Mandibular arch widening, same osteotomies, with the two halves of the distal s...

Figure 8.28 Mid symphyseal distraction for widening; see the widened mandibular incisors an...

Figure 8.29 Mandibular angle ostectomy – to decrease width and/or bigonial prominence.

Figure 8.30 Example of bigonial narrowing – ostectomy and botox for masseteric hyperplasia ...

Figure 8.31 (a–f) Examples of mandibular angle implant – the technique of placing the impla...

Figure 8.32 (a, b) Due to the parabolic shape of the mandibular arch, advancement and setba...

Chapter 9

Figure 9.1 Facial asymmetry; (a–c) The facial asymmetry is due to a combination of skeleta...

Figure 9.2 Two halves of face – every face is asymmetric.

Figure 9.3 3D tools enable us to assess for bone, soft-tissue, or combination asymmetry.

Figure 9.4 (a) Congenital facial asymmetry (soft-tissue and bone, in hemifacial microsomia...

Figure 9.5 Acquired facial asymmetry; Right-sided condylar hyperplasia.

Figure 9.6 Soft-tissue asymmetry (Examples of Romberg).

Figure 9.7 Soft-tissue asymmetry – automimmune; (a) scleroderma, (b) lupus.

Figure 9.8 Predominantly skeletal – Fibrous dysplasia.

Figure 9.9 History of Unicoronal synostosis. Nasal radix to right, chin to left.

Figure 9.10 (a) L lambdoid synostosis, L ear down, (b) CT scan with Lambdoidal synostosis.

Figure 9.11 Combination facial asymmetry. (a) Hemifacial hyperplasia; (b) hemifacial micros...

Figure 9.12 Is one side under-developed or one side over-developed?

Figure 9.13 Type I HH. Frontal pic, CT, PA ceph.

Figure 9.14 Type I HH: Lateral ceph, panorex, midline.

Figure 9.15 Type II, Condylar hyperplasia; (a) early peak (age 4–7); (b) later peak (early ...

Figure 9.16 Condylar hyperplasia; age 7.

Figure 9.17 Vertical type CH.

Figure 9.18 Rotational type CH.

Figure 9.19 Anthropomentric facial measurements.

Figure 9.20 Cant and bite stick.

Figure 9.21 Occlusion look for cant/level and midlines.

Figure 9.22 PA ceph, lateral ceph, panorex – traditionally have been used for asymmetry ass...

Figure 9.23 CT scan demonstrating global osseous asymmetry.

Figure 9.24 Using CT scan to assess the proximal ramus, condyle, and TMJ.

Figure 9.25 MRI TMJ.

Figure 9.26 Serial volumetric condyle and condylar neck assessment. Greater volume and leng...

Figure 9.27 Bone scan showing increased uptake (Right condylar hyperplasia).

Figure 9.28 Level cant with VSP.

Figure 9.29 Leveling all three levels, VSP.

Figure 9.30 Lateral repositioning pre and post.

Figure 9.31 High condylectomy.

Figure 9.32 Mandibular angle augmentation to address asymmetry.

Figure 9.33 Before and after malar implant to the right cheek, in addition to fat grafting ...

Figure 9.34 Fat grafting – use for augmentation. See chapter on fat grafting.

Chapter 10

Figure 10.1 Example of midfacial and lower lip correction. Pre- and post-3D images. See the...

Figure 10.2 (Top) Facial plane – frontal medial and lateral aspects of midface; Skeletal co...

Figure 10.3 (Top) Lid, periorbital anatomy, including the medial and lateral canthal tendon...

Figure 10.4 Orbital sagittal–globe relationship. Clinical face showing these relationships;...

Figure 10.5 Youthful versus aged face. The midfacial form differs in a youthful, appealing ...

Figure 10.6 (Right to left): Powell's; Hinderer's; Wilkinson's; Pendergast and Schoenrock; ...

Figure 10.7 (Top) Clinical example of global midfacial hypoplasia in Crouzon syndrome. (Bot...

Figure 10.8 Left enopthalmous; Note the deepened supratarsal crease, the dilated pupil, the...

Figure 10.9 Examples of dystopia. (Top) (right) Vertical dystopia (post-traumatic) on the r...

Figure 10.10 (Top) Vertical dystopia and exopthalmous (Left orbit higher/superior; right orb...

Figure 10.11 Right malar flattening, post-traumatic; (Left) yellow arrow shows flattening; (...

Figure 10.12 Left-sided fibrous dysplasia, an example of unilateral malar overgrowth or hype...

Figure 10.14 Example of prominent buccal fat, and reversed malar–midcheek relationship; (a, ...

Figure 10.15 (Left) Example of buccal descent and excess, due both to aging, and off-label i...

Figure 10.16 Examples of soft-tissue cheek hypoplasia, wasting, or hollow; (Top) Unilateral ...

Figure 10.17 Example of hard- and soft-tissue hypoplasia (malar, cheek), from scleroderma; S...

Figure 10.18 Example of patient with nasomaxillary hypoplasia (Binder), where the ANS and pi...

Figure 10.19 History of multiple prior orthognathic procedures, where the ANS was resected, ...

Figure 10.20 For global midfacial deficiency, in Crouzon, a Le Fort III is used (especially ...

Figure 10.21 For midfacial following and a shallow radix, a Le Fort II or a Le Fort I, malar...

Figure 10.22 Example of significant maxillary and malar hypoplasia, treated by Le Fort I and...

Figure 10.23 Improvement of maxillary, nasolabial, and cheek support, with Le Fort I and mal...

Figure 10.24 Soft-tissue repositioning, including face lift with SMAS flap, fat grafting, wi...

Figure 10.25 Facelift, malar soft-tissue repositioning, 3D camera showing shadowing with imp...

Figure 10.26 Soft-tissue and bony deficiency and asymmetry in HFM; Frontal view; Submental v...

Figure 10.27 Midfacial, orbitozygomatic deficiency and asymmetry due to discoid lupus; (Top)...

Figure 10.28 19-year-old Asian male with flat malar and midface (yet wide bizygomatic distan...

Figure 10.29 Flat long midface, with malar and cheek flattening, class III malocclusion; (To...

Chapter 11

Figure 11.1 (a) Examples of “commissure” smile; (b) Wide, “canine” smile – exacerbates the ...

Figure 11.2 Examples of smile asymmetry due to unequal muscle pull or facial nerve dysfunct...

Figure 11.3 Asymmetric smile due largely to skeletal disharmony. (a) Maxillary cant down on...

Figure 11.4 Maxillary midline off from the facial midline. (a) Oblique midline and to the r...

Figure 11.5 (a) Lip line may be short in cleft example (as shown here), with deficient prem...

Figure 11.6 Vertical skeletal position and lip line interface. (a) Gummy smile due to VME, ...

Figure 11.7 (a, b) Lip incompetence at rest but appropriate maxillary tooth show. This hype...

Figure 11.8 Mentalis strain due to long lower face (and open bite), but appropriate maxilla...

Figure 11.9 Mentalis strain due to long lower face, and VME (with open bite); (a) strain at...

Figure 11.10 Nonconsonant smile; regardless of tooth and skeletal location, the smile arch i...

Figure 11.11 Open bite smile. Anterior open bite, of any variety (class II, III, asymmetry) ...

Figure 11.12 Smile on profile. (a) ¾ view with soft smile; (b) Lateral view with beginning o...

Figure 11.13 Example of pre versus post, and the profile influence on the smile. The overall...

Figure 11.15 Buccal corridors. In the setting of transverse maxillary arch narrowing and/or ...

Figure 11.16 Smile is affected because of dental issues, including crowding, spacing, tooth ...

Figure 11.17 Gingival issues, inflammation, overgrowth, can influence treatment, outcome, an...

Chapter 12

Figure 12.1 Examples of alteration of the chin and submental region. (a) Face and necklift ...

Figure 12.2 Mentalis strain in both convex and concave examples; (a, b) convex profile, cla...

Figure 12.3 Lip incompetence in both convex and concave examples. (a) Class II and lip inco...

Figure 12.4 Deep LM crease – usually seen in class II, convex, short lower third (overclose...

Figure 12.5 Short versus long lower face height. (a) Short lower face, with deep bite, deep...

Figure 12.6 Gonzalez-Ulloa and Steven's “Zero Meridian” Line. A line perpendicular to the F...

Figure 12.7 Y-axis (growth axis). The angle made by FH and the line sella–gonion. 60 ± 5° i...

Figure 12.8 Rickett's “E” line [14]. Line from pronasion to soft tissue pogonion. Upper lip...

Figure 12.9 Steiner's “S” line [15]. Line drawn from soft tissue pogonion to midpoint on co...

Figure 12.10 Burstone's line [16,17]. A line drawn from subnasale–soft tissue pogonion. Uppe...

Figure 12.11 Holdaway ratio. The NB line is drawn and then the mandibular incisor position i...

Figure 12.12 Vertical facial divisions. The lower facial third itself if often divided into ...

Figure 12.13 Bizygomatic and bigonial widths. Go–Go should be 30% less Za–Za.

Figure 12.14 Facial contour (convexity) angle. Formed by connecting soft tissue glabella, su...

Figure 12.15 Classification of neck (dedo) (see Table 12.1 – to correspond with images).

Figure 12.16 Macrogenia (left); Microgenia (right).

Figure 12.17 Macrogenia (left); Microgenia (right).

Figure 12.18 Combined; (a) AP macrogenia, with vertical microgenia; (b) AP microgenia with v...

Figure 12.19 Chin asymmetry.

Figure 12.20 Lateral cephalograms showing different labioalveolar positions; (a) Ceph of cla...

Figure 12.21 Chin projection is determined by placement of pogonion. In some cases a properl...

Figure 12.22 Cervicomental definition is impacted by skeletal support, but also the intrinsi...

Figure 12.23 Examples of deficient chin or lower third projection and definition, requiring ...

Figure 12.24 Examples with prominent lower third, conducive to setback and/or shortening; (a...

Figure 12.25 Examples of face and necklift to improve jawline and submental definition; (a) ...

Figure 12.26 Alloplastic genioplasty; (a) silicone chin implant ex vivo; (b) porous polyethy...

Figure 12.27 Examples of osseous genioplasty; osseous technique is more versatile (compared ...

Figure 12.28 The LM crease, lips, prejowl spaces, can be augmented using autologous fat (see...

Chapter 13

Figure 13.1 Goals of rhinoplasty.

Figure 13.2 Nasal osteocartilaginous anatomy from Gray's Anatomy.

Figure 13.3 Nasal lining/Concha from Gray's.

Figure 13.4 Nasal blood supply.

Figure 13.5 Nasal innervation.

Figure 13.6 Nasal airway.

Figure 13.7 Nasal valves and clinical examples of valve collapse.

Figure 13.8 (a) NOSE Survey; (b) Epworth Sleepiness Scale.

Figure 13.9 Patient images (frontal, ¾, lateral, worm's eye, bird's eye).

Figure 13.10 (a, b) Lateral and frontal nasofacial analysis (c) On frontal view, can appreci...

Figure 13.11 (a, b) Midline and dorsal aesthetic lines; (c–f) Divergent lateral crus; see pa...

Figure 13.12 (a) Nasal projection; (b) Angles (c–f) Demonstration of alar columellar disprop...

Figure 13.13 Basilar view.

Figure 13.14 (a–d) Coronal CT scans showing crowding of the nasal cavity due to septal devia...

Chapter 14

Figure 14.1 (a) Dorsum (bone and cartilage); (b) dorsal proportions; (c–e) dorsal hump on l...

Figure 14.2 (a) Dorsal reduction (Larabee); (b) dorsal reduction osteotomy; (c) composite d...

Figure 14.3 (a) Rasp and (b) open-roof deformity (Springer).

Figure 14.4 Examples of dorsal reduction (nine images).

Figure 14.5 (a) Saddle nose deformity; (b) dorsal augmentation framework; (c) septal cartil...

Figure 14.6 (a) Infected silicone augment; (b) capsule around implant; (c) removal of infec...

Figure 14.7 (a–h) Examples of dorsal augmentation.

Figure 14.8 (a–f) Spreader flaps and grafts.

Figure 14.9 (a–g) Midvault alteration.

Figure 14.10 (a) Septal deviation and external valve collapse; (b) anterior septal angle; (c...

Figure 14.11 (a) Osteotomies, (b) HLH osteotomies, (c) osteotomies – springer, (d) Webster's...

Figure 14.12 (a–m) Deviated nose.

Chapter 15

Figure 15.1 Ideal tip (frontal, lateral, basilar).

Figure 15.2 Tripod theory.

Figure 15.3 Normal tip morphology (Toriumi).

Figure 15.4 (a, b) Tip irregularity. (c–h) Bifid tip.

Figure 15.4a

Figure 15.5 Bulbous tip.

Figure 15.6 Bulbous ball tip.

Figure 15.7 Cephalic malposition.

Figure 15.8 Boxy tip.

Figure 15.9 Boxy tip classification from Rohrich article.

Figure 15.10 Cephalic trim.

Figure 15.11 (a) Tip suturing (Rohrich); (b–e) Domal irregularity; (h–i) Tip sutures example...

Figure 15.11a

Figure 15.12 (a) Increasing/decreasing tip projection; (b) Rotation and projection.

Figure 15.13 Clinical examples of columellar strut.

Figure 15.14 (a) CSEG cartoon (Source: Apaydin 2016); (b–e) CSEG placed, and domes brought u...

Figure 15.15 Lateral crural steal (Source: Apaydin).

Figure 15.16 Tongue in groove (Source: Apaydin).

Figure 15.17 Tip graft cartoons.

Figure 15.18 Clinical images tip grafts.

Figure 15.19 Visible tip grafts.

Figure 15.20 Stepoff to create supratip break.

Figure 15.21 (a) Overprojected tip basilar view; (b) Lateral crural overlay; (c) Deprojectio...

Figure 15.22 Increase rotation.

Figure 15.23 Examples of derotation/nasal lengthening.

Figure 15.24 Classification of AC disproportion (Source: Rohrich).

Figure 15.25 AC difference; if excess columellar show trim caudal septum, free edge of MC (o...

Figure 15.26 Reduce nostril show via caudal septal trim and/or MC trim and/or TIG.

Figure 15.27 Alar support grafts; Batten grafts (Rohrich), Lateral crural strut grafts to br...

Figure 15.28 Excise and bring up hanging ala.

Chapter 16

Figure 16.1 (a) Nasolabial positions; (b) anthropometry and angles.

Figure 16.2 (a) Changes to nose and lip before and after orthognathic (as seen on soft-tiss...

Figure 16.3 (a) Normal, esthetically pleasing nasal and lip contours and proportions in a f...

Figure 16.4 Image of skull maxilla with nose – showing piriform, nasal floor, septum, turbi...

Figure 16.5 Examples of interplay between nasal obstruction and dentofacial deformities. Ex...

Figure 16.6 Example of Le Fort-induced nasal deformity; (a) Pre-jaw surgery, no nasal defor...

Figure 16.7 Examples of nasal morphology improving post-Le Fort. (a, c) Pre-jaw surgery; (b...

Figure 16.8 Example of pre-existing nasal deformity that remains or worsens as a nasal defo...

Figure 16.9 Examples of overall changes; (a) Increase in NL angle (tip rotation); decrease ...

Figure 16.10 Submental view of NL regions and areas measured for change following segmental ...

Figure 16.11 Lateral view of NL changes following segmental Le Fort I with advancement and w...

Figure 16.12 “Buckling” phenomenon of the columella leading to an absolute decrease in nasal...

Figure 16.13 Summary of nasal changes depending on movement. (a) NL angle usually increases,...

Figure 16.14 Images showing the piriform, anterior nasal spline, nasal floor. (a, b) On down...

Figure 16.15 (a) Deviated septum where the base is deflected off the ANS; (b) Turbinates on ...

Figure 16.16 (a) See the elongated caudal and posterior septum (posterior septal angle) (yel...

Figure 16.17 (a) Caudal and dorsal septal deviation, possibly caused by prior Le Fort I, as ...

Figure 16.18 Turbinates during Le Fort; Turbinates are located just underneath the nasal muc...

Figure 16.19 Schematic of alar cinch.

Chapter 17

Figure 17.1 (a). The nasolabial angle increases (tip rotation increases), while the tip pro...

Figure 17.2 (a, b). Alar base widens unaesthetically.

Figure 17.3 (a, b). Already underprojected tip becomes even less projected.

Figure 17.4 (a, b). Wide nostrils are made wider and more horizontal.

Figure 17.5 (a, b). Over-rotated tip increases in rotation (shortened nose appearance).

Figure 17.6 (a, b, c). Normal or deep supratip break becomes more accentuated. (d). Arrows ...

Figure 17.7 Low dorsum and/or radix becomes even less prominent (disappears behind globe in...

Figure 17.8 Narrow midvault on frontal appears more narrow.

Figure 17.9 Examples of Convex facial profile – prominent nose, possible dorsal hump, and r...

Figure 17.10 Concave profile, with a prominent chin with prognathic or overclosed mandible, ...

Figure 17.11 Asymmetric or deviated nose, due to osteocartilaginous intrinsic deformities.

Figure 17.12 Preop v. Orthognathic (further loss tip support) v. post-rhinoplasty. Tip proje...

Figure 17.13 With increasing tip projection the alar base will narrow. In some cases Weir an...

Figure 17.14 Definition of alar base width and alar flare.

Figure 17.15 Wedge and sill excisions enable more aggressive narrowing of the alar base (and...

Figure 17.16 Examples of alar base appearance before and after narrowing via excisions.

Figure 17.17 Shadow overlay using the 3D camera demonstrates the change in tip and alar base...

Figure 17.18 Sequence showing 1. Before orthognathic v. 2. Postorthognathic v. 3. Post-rhino...

Figure 17.19 Nasal length is increased via tip deroration using a CSEG, infralobular graftin...

Figure 17.20 Another example of tip derotation. A CSEG is used to caudally rotate the tip co...

Figure 17.21 Improvement of alar–columellar relationship, using some combination of tongue-i...

Figure 17.22 Placement of spreader grafts on either side of the dorsal septum. This aids in ...

Figure 17.23 To address the narrow midvault, bilateral spreader grafts are placed. The absol...

Figure 17.24 Supratip depression (and scooped out appearance of the dorsum) can be accentuat...

Figure 17.25 Frequent maneuvers to address supratip and dorsal depression include: proper ti...

Figure 17.26 Examples to treat a low radix and saddle-nose (depressed dorsum) using costal c...

Figure 17.27 Treating an excessive (accentuated) supratip deformity, which developed post Le...

Figure 17.28 Peri- and intraoperative sequence of simultaneous orthognathic surgery (BSSO, g...

Figure 17.29 (a–d). Postoperative results of simultaneous orthognathic surgery and rhinoplas...

Figure 17.30 Patient underwent simultaneous orthognathic surgery and rhinoplasty. Orthognath...

Chapter 18

Figure 18.1 (a, b) Patient with oral RAE in preparation for rhinoplasty.

Figure 18.2 Image of prep table.

Figure 18.3 Planned incision (a stairstep, inverted V, or V-shaped incision can be employed...

Figure 18.4 (a–c) Cephalic trim.

Figure 18.5 (a, b) Anterior septal angle and caudal septum.

Figure 18.6 (a) Component dorsal takedown; (b) Bony cap with dorsal septum and ULCs (hump t...

Figure 18.7 (a) Septoplasty leaving an L-strut; (b) Septal harvest; and (c) Septal cartilag...

Figure 18.8 (a) Carved spreaders from septal harvest; (b) Schematic diagram showing spreade...

Figure 18.9 Schematic of high-low-high osteotomies (extending from the piriform, up the nas...

Figure 18.10 Turbinates on coronal computed tomography (CT). Typically managed by coblation ...

Figure 18.11 Stabilize the base. (a) Visualization of the septum at the ANS interface (poste...

Figure 18.12 Tripod theory. (a–c) Stabilizing paired medial crus with a columellar strut. (d...

Figure 18.13 (a) Blue pen marks planned location for domal creation sutures; (b) Domes creat...

Figure 18.14 (a–b) Suturing of the medial crus and domal elements to the medial limb of the ...

Figure 18.15 (a–d) Examples of tip grafts, typically infralobular location.

Figure 18.16 (a) Example of lateral crural strut grafts; (b–d) In situ repositioning to eith...

Figure 18.17 Closure images.

Figure 18.18 Alar base (Weir) and or Sill excisions; (a) Schematic of the variation of alar ...

Figure 18.19 (a–c) Splints and dressings shown.

Figure 18.20 Case example. (a) Preoperative images with dorsal hump, broad tip; (b) Rhinopla...

Figure 18.20b

Figure 18.20c

Chapter 19

Figure 19.1 (a) Assess positions of chin, lip drape, incisal positions on frontal view; (b)...

Figure 19.2 (a) Incision marked in vestibule; (b) Subperiosteal dissection, exposing landma...

Figure 19.3 (a) Planned osteotomy drawn using pencil; it is cut with reciprocating saw, and...

Figure 19.4 (a) Smith spreaders are used to initiate the downfracture; (b) Smith spreaders ...

Figure 19.5 (a) The nasal floor can be modified following downfracture; in cases of segment...

Figure 19.6 (a) Intermediate splint in place; (b) Splint within a splint if a segmental, ma...

Figure 19.7 Fixation examples; (a) At piriform; (b) Piriform plates; (c) Left maxillary pla...

Figure 19.8 BSSO incision and exposure; (a) BSSO incision drawn; (b) Initial subperiosteal ...

Figure 19.9 Osteotomies made; (a) Drawn with pencil; (b) After cut made with reciprocating ...

Figure 19.10 Initiation of the split; (a) A 3D model shows the planned segments and nerve po...

Figure 19.11 Splint is put in place prior to fixation; (a) Final splint in an Invisalign cas...

Figure 19.12 Fixation of proximal and distal segments; (a, b) For plate fixation the proxima...

Figure 19.13 Dressing at end of case – face bra and chin dressing.

Figure 19.14 Case of orthognathic surgery (BSSO, Le Fort, genioplasty) (and later, interval ...

Chapter 20

Figure 20.1 Frontal and ¾ views assessing the lower facial third (the Golden ratio).

Figure 20.2 (a) Cervicomental distance and vertical plumb line. (b) S-line assessment, (c) ...

Figure 20.3 Panorex and CBCT (cone beam computerized tomography) (frontal).

Figure 20.4 Lateral cephalogram and lateral view CBCT.

Figure 20.5 (a) Microgenia (horizontal, vertical), (b) Macrogenia (horizontal, vertical), (...

Figure 20.6 (a) Advance and lengthening genioplasty for vertical and sagittal microgenia. (...

Figure 20.7 (a) Advance and shorten genioplasty (vertically long, sagittally deficient); (b...

Figure 20.8 (a) Shortening genioplasty (see requisite anatomy; and planned wedge); (b) Fixa...

Figure 20.9 (a) Lengthening genioplasty, vertical gap created; (b) Clinical example showing...

Figure 20.10 (a) Asymmetry correction with a rotation and wedge type movement; (b) Clinical ...

Figure 20.11 (a) Intraoperative image showing the mental nerve exiting foramen, and the oste...

Figure 20.12 (a) Planned incision (>8–10 mm from mucogingival line), (b) Incision and dissec...

Figure 20.13 (a) Shortening genioplasty; (b) Advancement genioplasty; (c) Lengthening geniop...

Figure 20.14 Fixation options.

Figure 20.15 (a) Chin dressing using Elastoplast; (b) Chin dressing with facial support.

Figure 20.16 Convex profile; (a) Preop with microgenia, vertical and AP; (b) Following treat...

Figure 20.17 (a) 3D shadow view of microgenia, treated using vertical lengthening and advanc...

Figure 20.18 (a) Short recessive chin with deep labiomental crease; (b) Following treatment ...

Figure 20.19 Pre and post lateral 3D views to improve vertical and sagittal projection; see ...

Figure 20.20 (a) Microgenia, lip/mentalis strain preop; (b) Chin and submental morphology po...

Figure 20.21 (a) Preop retrognathia, deep labiomental crease; microgenia; (b) Post advanceme...

Figure 20.21a

Figure 20.22 (a) Preop frontal and chin asymmetry; chin is rotated and canted to the left; (...

Figure 20.22a

Figure 20.23 Vertically long and rotated/asymmetric chin; pre versus post correction (which ...

Figure 20.24 (a) Vertically long and asymmetric chin; (b) Following correction, in part usin...

Chapter 21

Figure 21.1 Examples of submental skin and fat excess; (a) Submental fat, with retognathia;...

Figure 21.2 Face and necklift; for significant facial aging, skin laxity, fat pad repositio...

Figure 21.3 Dedo classification of the neck [6].

Figure 21.4 Anatomy of the submental region; for submental liposuction the goal is to stay ...

Figure 21.5 Images after instillation of tumescent fluid; (a) Early 20s female; (b) Early 6...

Figure 21.6 Technical aspects. Following instillation of tumescent fluid (50–100 cc), we us...

Figure 21.7 (a) Intraop markings, submental region and jowls; (b) Pre and post SML (and rhi...

Figure 21.8 Pre and post SML (and orthognathic).

Figure 21.9 (a, b) Pre and post SML (and orthognathic).

Figure 21.10 (a, b) Pre and post SML (and orthognathic).

Figure 21.11 (a, b) Pre and post SML (and orthognathic).

Chapter 22

Figure 22.1 Histopathologic and stem cell analyses showing higher concentrations of stem ce...

Figure 22.2 (a) Previous work showing a higher concentration of mesenchymal stem cells; (b)...

Figure 22.3 (a) The abdomen is our preferred donor site for fat grafting; (b) although the ...

Figure 22.4 (a) Harvesting fat from the abdomen using the non-dominant hand in a “banana-ro...

Figure 22.5 (a) Telfa rolling processing of fat prior to rolling; (b) during; (c) and follo...

Figure 22.6 The fat is then scooped into a 10 cc syringe and transferred to individual 1 cc...

Figure 22.7 Common sites for injection include (a) the tear trough, nasolabial folds and la...

Figure 22.8 (a) Injection of fat is at different tissue planes depending on the desired eff...

Figure 22.9 Pre- and post-operative 3D photographs of a patient before and after orthognath...

Figure 22.10 3D photographs of a patient pre- and at various time points postoperatively, fo...

Figure 22.11 Pre-, intra- and postoperative images of orthognathic procedure, with fat graft...

Figure 22.12 Pre and postoperative 2D and 3D photographs, following orthognathic surgery, cl...

Figure 22.13 Pre and post orthognathic, fat grafting, rhinoplasty.

Figure 22.14 Pre and post orthognathic and fat grafting.

Figure 22.14a

Figure 22.15 Pre and post BSSO and fat grafting; including white shadow image.

Chapter 23

Figure 23.1 (a–f) Scleroderma pt with B malar, B mandibular angle; chin porous polyethylene...

Figure 23.2 (a) Porous polyethylene mandibular angle implant; (b) Silicone chin implant; (c...

Figure 23.3 (a, b) Shows removed silicone nasal dorsal implant.

Figure 23.4 (a–d) Examples of malar/infraorbital porous polyethylene.

Figure 23.5 (a–d) Place via unilateral vestibular approach; not with orthognathic; (b–d) Pl...

Figure 23.6 (a, b) Examples of 3D photo with malar implant.

Figure 23.7 (a, b) Malar unilateral images.

Figure 23.8 Mandibular angle deficiency – frontal – bigonial width.

Figure 23.9 Mandibular angle deficiency/loss; especially vertically.

Figure 23.10 Plan for mandibular angle implant – can do normal overlays to show the vertical...

Figure 23.11 (a, b, c) Mandibular angle implant; – alone, underside; and showing fit.

Figure 23.12 (a, b) Placement of mandibular angle implant at the time of orthognathic; proxi...

Figure 23.13 (a, b, c) Case example with mandibular angle implants.

Figure 23.14 (a) Before and after example of mandibular angle implant, filling in the hollow...

Figure 23.15 Silicone chin implant requiring removal (a–d).

Figure 23.16 Exposure for porous polyethylene implant (a; b) (b shows the mental nerve).

Figure 23.17 (a, b) Genioplasty example.

Figure 23.18 (a, b) Genioplasty example.

Chapter 24

Figure 24.1 Mallampati Test [2].

Figure 24.2 Difficult Airway Algorithm. SOURCE: Apfelbaum, J.L, Hagberg, C.A., Caplan, R.A,...

Chapter 25

Figure 25.1 Images and plan within the OR; (a) Setup with prep table, models splints, medic...

Figure 25.2 Nasal RAE tube for orthognathic; (a) Placement of tube by anesthesia; (b) Nasal...

Figure 25.3 Oral RaAE tube for rhinoplasty. (a) Oral tube in place, lateral view; (b) Oral ...

Figure 25.4 Orthognathic prep table.

Figure 25.5 Rhinoplasty prep table.

Figure 25.6 Fat-grafting donor site, prepped.

Figure 25.7 (a) Site marked for planned SML; (b) Frontal view; (c) After tumescent instille...

Figure 25.8 Image of palpating; visualizing before starting.

Figure 25.9 (a–b) Images of orthognathic instrument trays; in aggregate.

Figure 25.10 Retractors. (a) Toe-in retractor, for ease of access and retraction for the ora...

Figure 25.11 Large osteotomes. (a) Metal handle osteotome for use in both Le Fort and BSSO; ...

Figure 25.12 Forceps, and spreader; (a) Rowe disimpaction forcep to help, in some cases, for...

Figure 25.13 Tools for mobilization; (a) Bone hook, to aid in downfracture (Le Fort); (b) Pt...

Figure 25.15 (a) Aufricht retractor schematic; (b) Neivert retractor in action exposing the ...

Figure 25.16 (a) Cottle speculum; (b) Cottle elevator.

Figure 25.17 Skin hooks; (a) Single; (b) Double skin hooks, various widths used.

Figure 25.18 Scissors for dissection; (a) Converse; (b) Stevens.

Figure 25.19 (a) Bayonette forceps; (b) Pituitary (Takahashi) forcep.

Figure 25.20 (a) Double guard osteotome; (b) Double-ended rasp.

Chapter 26

Figure 26.1 (a) Chin dressing; (b, c) Face bra, overtop chin dressing.

Figure 26.2 (a) Interdental splint (usuallyremoved at end of case, unless segmental, then l...

Figure 26.3 (a, b) Rhinoplasty splint at end of case, affixed with glue and steri-strips; r...

Figure 26.4 (a, b) Images of one-week postop orthognathic; see edema and bruising.

Figure 26.5 3D images of orthognathic swelling change over time; (a) Frontal; (b) Oblique; ...

Figure 26.6 3D images showing edema decrements with time, over a one-year period (following...

Figure 26.7 (a, b) Rhinoplasty image at one-week postop, just before splint removal.

Figure 26.8 (a, b) Rhinoplasty at one week (before left, after right at one week); less ede...

Figure 26.9 3D images depicting decrease in rhinoplasty edema with time; from one-week post...

Figure 26.10 (a, b) Red rubber catheter and Luer-Lok syringe – will aid in taking per os liq...

Guide

Cover

Table of Contents

Preface

Pages

iii

iv

vii

ix

xi

xiii

xv

xvii

xix

xx

xxi

xxiii

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

31

32

33

35

36

37

38

39

40

41

42

43

44

45

46

47

48

49

50

51

52

53

54

55

56

57

58

59

60

61

62

63

64

65

66

67

68

69

70

71

72

73

74

75

77

78

79

80

81

82

83

84

85

86

87

88

89

90

91

92

93

94

95

96

97

98

99

100

101

102

103

104

105

106

107

108

109

110

111

112

113

114

115

116

117

118

119

120

121

122

123

124

125

126

127

128

129

130

131

132

133

134

135

136

137

138

139

140

141

142

143

145

146

147

148

149

150

151

152

153

154

155

156

157

158

159

160

161

162

163

164

165

166

167

168

169

170

171

172

173

175

176

177

178

179

180

181

182

183

184

185

186

187

188

189

190

191

192

193

194

195

196

197

198

199

200

201

202

203

204

205

206

207

208

209

210

211

213

214

215

216

217

218

219

220

221

222

223

224

225

226

227

228

229

230

231

232

233

234

235

236

237

238

239

240

241

242

243

244

245

246

247

248

249

250

251

252

253

254

255

256

257

258

259

260

261

262

263

264

265

266

267

268

269

270

271

272

273

274

275

276

277

278

279

280

281

282

283

284

285

286

287

289

290

291

292

293

294

295

296

297

298

299

300

301

302

303

304

305

306

307

308

309

310

311

312

313

314

315

316

317

318

319

320

321

322

323

324

325

326

327

328

329

331

332

333

334

335

336

337

338

339

340

341

342

343

344

345

346

347

349

350

351

352

353

354

355

356

357

358

359

360

361

362

363

364

365

366

367

368

369

370

371

372

373

374

375

376

377

378

379

381

382

383

384

385

386

387

388

389

390

391

392

393

394

395

396

397

398

399

400

401

402

403

404

405

406

407

408

409

410

411

412

413

414

415

416

417

418

419

421

422

423

424

425

426

427

428

429

430

431

432

433

434

435

436

437

438

439

440

441

442

443

444

445

447

448

449

450

451

452

453

454

455

456

457

458

459

460

461

462

463

464

465

466

467

468

469

470

471

472

473

474

475

476

477

478

479

480

481

482

483

484

485

486

487

489

490

491

492

493

494

495

496

497

498

499

500

501

502

503

505

506

507

508

509

510

511

512

513

514

515

517

518

519

520

521

522

523

524

525

526

527

528

529

530

531

532

533

535

536

537

538

539

540

541

542

543

544

545

546

547

548

549

550

551

552

553

554

555

556

557

559

560

561

562

563

564

565

566

567

568

569

570

571

572

573

574

575

576

577

578

579

580

581

582

583

584

585

587

588

589

590

591

592

593

594

595

596

597

598

599

600

601

602

603

604

605

606

607

608

609

610

611

612

613

614

615

616

617

618

619

620

621

622

E1