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PRINCIPLES OF
ORAL AND
MAXILLOFACIAL
SURGERY Second Edition
Michael Miloro
Editor
G. E. Ghali • Peter E. Larsen • Peter D. Waite
Associate Editors
2004
BC Decker Inc
EXIT Hamilton • London
BC Decker Inc
P.O. Box 620, L.C.D. 1
Hamilton, Ontario L8N 3K7
Tel: 905-522-7017; 800-568-7281
Fax: 905-522-7839; 888-311-4987
E-mail: [email protected]
www.bcdecker.com
© 2004 BC Decker 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, without prior written permission from the publisher.
04 05 06 07 / FP / 9 8 7 6 5 4 3 2 1
ISBN 1-55009-234-0
Printed in Canada
Illustrations by Paulette Dennis, Andrée Jenks, and Kevin Millar.
Notice: The authors and publisher have made every effort to ensure that the patient care recommended herein, including choice of drugs and drug dosages, is in accord
with the accepted standard and practice at the time of publication. However, since research and regulation constantly change clinical standards, the reader is urged to
check the product information sheet included in the package of each drug, which includes recommended doses, warnings, and contraindications. This is particularly
important with new or infrequently used drugs. Any treatment regimen, particularly one involving medication, involves inherent risk that must be weighed on a case-
by-case basis against the benefits anticipated. The reader is cautioned that the purpose of this book is to inform and enlighten; the information contained herein is not
intended as, and should not be employed as, a substitute for individual diagnosis and treatment.
DEDICATIONS
To Beth and Macy, my two reasons for being, for your love and support. To Pete, my teacher, for
making me a better surgeon and person.
Michael Miloro
To my wife, Hope, for being my best friend and the love of my life. To my parents, Elias and Linda,
and my brother Fred, for their support, inspiration, devotion, and love.
G. E. Ghali
To my wife, Patty, and my sons, Michael, Matthew, and Mark. You are the most important people in
my life, yet always understand and are patient with my absence. To my father who inspired me to
enter medicine. Lastly, to my former and current residents who teach me every day.
Peter Larsen
To my wife, Sallie, and my children, Allison, Eric, and Jon. To my father who inspired my interest in
oral and maxillofacial surgery and to my residents who have continued to teach me.
Peter Waite
CONTENTS
†
Deceased
v
vi Contents
54. Database Acquisition and Treatment Planning 63. Surgical and Nonsurgical Management of
Marc B. Ackerman, DMD; David M. Sarver, DMD, MS. . . . . 1087 Obstructive Sleep Apnea
B. D. Tiner, DDS, MD; Peter D. Waite, MPH, DDS, MD . . . . 1297
55. Orthodontics for Orthognathic Surgery
Larry M. Wolford, DMD; Eber L. L. Stevao, DDS, PhD; PART 9: FACIAL ESTHETIC SURGERY
C. Moody Alexander, DDS, MS;
Section Editor: Peter D. Waite, MPH, DDS, MD
Joao Roberto Goncalves, DDS, PhD. . . . . . . . . . . . . . . . . . . . . 1111
64. Blepharoplasty
56. Principles of Mandibular Orthognathic Surgery
Heidi L. Jarecki, MD; Mark J. Lucarelli, MD,
Dale S. Bloomquist, DDS, MS; Jessica J. Lee, DDS . . . . . . . . . 1135
Bradley N. Lemke, MD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1317
57. Maxillary Orthognathic Surgery
65. Basic Principles of Rhinoplasty
Vincent J. Perciaccante, DDS; Robert A. Bays, DDS . . . . . . . . 1179
James Koehler, DDS, MD; Peter D. Waite, MPH, DDS, MD. . . . 1345
58. Management of Facial Asymmetry
66. Rhytidectomy
Peter D. Waite, MPH, DDS, MD;
G. E. Ghali, DDS, MD; T. William Evans, DDS, MD . . . . . . . 1365
Scott D. Urban, DMD, MD . . . . . . . . . . . . . . . . . . . . . . . . . . . 1205
67. Forehead and Brow Procedures
59. Soft Tissue Changes Associated with Orthognathic Surgery
Angelo Cuzalina, MD, DDS . . . . . . . . . . . . . . . . . . . . . . . . . . 1383
Norman J. Betts, DDS, MS;
Sean P. Edwards, DDS, MD. . . . . . . . . . . . . . . . . . . . . . . . . . . 1221 68. Liposculpting Procedures
Milan J. Jugan, DMD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1407
60. Prevention and Management of Complications in
Orthognathic Surgery 69. Skin Rejuvenation Procedures
Joseph E. Van Sickels, DDS . . . . . . . . . . . . . . . . . . . . . . . . . . . 1247 Gary D. Monheit, MD. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1419
61. Orthognathic Surgery in the Patient with Cleft Palate 70. Alloplastic Esthetic Facial Augmentation
Timothy A. Turvey, DDS; Ramon L. Ruiz, DMD, MD; Bruce N. Epker, DDS, MSD, PhD . . . . . . . . . . . . . . . . . . . . . . 1435
Katherine W. L. Vig, BDS, MS, D. Orth.;
71. Otoplastic Surgery for the Protruding Ear
Bernard J. Costello, DMD, MD . . . . . . . . . . . . . . . . . . . . . . . . 1267
Todd G. Owsley, DDS, MD . . . . . . . . . . . . . . . . . . . . . . . . . . . 1449
62. Distraction Osteogenesis
Suzanne U. Stucki-McCormick, MS, DDS. . . . . . . . . . . . . . . . 1277 Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1461
PREFACE
ix
ENCOMIUM
Dr. Larry J. (“Pete”) Peterson is easily the smartest person I have ever known, and I do not mean with regard to medicine
and surgery alone. Pete certainly forgot more information in his life than most people ever know. He made everyone around
him want to be better than they were, and he helped them to reach their potential. Peterson’s Principles of Oral and Maxillo-
facial Surgery, Second Edition, is dedicated to this man. Unfortunately, the majority of readers will never have had the
opportunity to meet him and to experience his imposing presence. The fact that this book will continue to educate many
surgeons for years to come would have pleased him very much since his greatest passion in life was, perhaps, teaching.
Pete obtained his doctor of dental surgery degree at the University of Missouri, Kansas City, in 1968. He completed his
training in oral and maxillofacial surgery at Georgetown University, where he also received his masters of science degree.
Pete served on the faculty at the Medical College of Georgia and, subsequently, at the University of Connecticut as the direc-
tor of Oral and Maxillofacial Surgery Residency Training. However, he is best known for his academic accomplishments at
Ohio State University, where he served as chairman of Oral and Maxillofacial Surgery, Pathology, and Anesthesiology from
1982 through 1999. To experience the full range of our specialty, Pete entered private practice in 1999 and continued in that
area until his death on August 7, 2002.
Pete’s professional and personal accomplishments and his contributions to our specialty are innumerable. In 1993 Pete
assumed the role of editor-in-chief of Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontics, upon
the retirement of Dr. Robert Shira. Pete demanded excellence in the manuscript submissions and maintained high standards
for this journal during his tenure. Pete also edited Contemporary Oral and Maxillofacial Surgery, which, like its predecessor
from his mentor Dr. Gustav O. Kruger, defined dental undergraduate education in oral and maxillofacial surgery nation-
wide. Pete’s dedication to education was further demonstrated in his role as chair of the American Association of Oral and
Maxillofacial Surgeons Committee on Residency Education and Training. He lectured and published extensively both
nationally and internationally, with a particular emphasis on the topics of odontogenic infections and dental implantology,
and his contributions to the literature are many and varied.
Pete was a loving husband and father and enjoyed life to the fullest at each and every opportunity. To Pete, life was a
journey. The answer to any problem was inconsequential; the long arduous path from question to answer was the only pur-
pose for the question in the first place. Dr. Peter Larsen and I had the privilege of working closely with Pete and experienc-
ing his talents and benefiting from his wisdom and guidance at Ohio State University for several years. We had the unique
opportunity to observe Pete in and out of the hospital—the phrase “work hard, play hard” epitomizes the Peterson philos-
ophy. Peter Larsen remembered Pete at his funeral; here is a portion of that eulogy:
x
Encomium xi
When I tried to decide what to say about this amazing man, I started by making a list. What I discovered was a man of what I like to call
“wonderful contradiction.”
Pete was perhaps one of the most successful men I have known, yet he would have listed his Eagle Scout Award as being more important than
many of the prestigious professional honors he received.
He was our most vigorous critic and yet our strongest advocate.
He was the teacher of teachers but also the perpetual student.
He was not an OSU alumnus but bled scarlet and gray.
He demanded hard work but taught me that it isn’t really work if you love what you do.
He was a teacher who, when honored, thanked his students for teaching him.
Although surrounded by personal success, he found the greatest satisfaction in the success of others.
He was our boss but was more comfortable as our partner in a raft on the New River.
He would argue with you, not to get you to agree, but to get you to disagree and defend.
He trained many to reach great financial success but placed the reward gained by teaching higher than any financial reward.
He had much of which to boast and be proud, but instead practiced humility.
He was perhaps the smartest man I have ever known but was always first to admit when you had a good idea, and was gracious enough not
to point out that he had thought of it himself, perhaps even years prior.
I never heard him speak on a topic when I was not totally impressed with the insight and knowledge he seemed to have, but he was often
more content listening to what others had to say.
He was more interested in finding the truth than about being right himself.
He was 15 years older than me but looked younger.
He would often tell residents, much to their dismay, I might add, that it is not the answer that is important, but the question.
Many of his accomplishments could easily be ranked on a 1-to-10 scale as a “10.” Yet, I can still hear him say, “There is no such thing as a ‘10.’”
He had the same enthusiasm for a giant rope swing as he did for a new operation.
He knew more than many of the speakers at the lectures he attended, but he always took notes.
He built what is perhaps the best Oral and Maxillofacial Surgery Department in the country, but, for me, his finest hour as our leader was
when he tenderly took care of Vicki, Arden Hegtvedt’s wife, when Arden died.
He was a man most deserving of a long and wonderful life, yet we are here today because this wonderful life has been tragically cut short.
If, as said by William James, “the greatest use of life is to spend it for something that will outlast it,” then Pete spent his life well. For, as I look
around, I see scores of us who owe so much of what we are to this one life well spent.
Pete died too young, and he will be missed, but through this textbook his teachings will continue.
Ronald M. Achong, DMD, MD Norman J. Betts, DDS, MS Larry L. Cunningham Jr, DDS, MD
Department of Oral and Maxillofacial Surgery Department of Oral and Maxillofacial Surgery Department of Oral Health Science
Louisiana State University School of Dentistry University of Michigan School of Dentistry University of Kentucky, College of Dentistry
New Orleans, Louisiana Ann Arbor, Michigan Lexington, Kentucky
Marc B. Ackerman, DMD Remy H. Blanchaert Jr, MD, DDS Angelo Cuzalina, MD, DDS
Private Practice Department of Oral and Maxillofacial Surgery Department of Oral and Maxillofacial Surgery
Orthodontics Kansas City Schools of Dentistry and Medicine University of Oklahoma Health Science Center
Bryn Mawr, Pennsylvania University of Missouri Oklahoma City, Oklahoma
Kansas City, Missouri
C. Moody Alexander, DDS, MS Jeffrey B. Dembo, DDS, MS
Department of Orthodontics Michael S. Block, DMD Department of Oral Health Science
Baylor College of Dentistry, Texas A&M Department of Oral and Maxillofacial Surgery University of Kentucky College of Dentistry
University System Louisiana State University School of Dentistry Lexington, Kentucky
Dallas, Texas New Orleans, Louisiana
Eric J. Dierks, DMD, MD
Carl M. Allen, DDS, MSD Dale S. Bloomquist, DDS, MS Department of Oral and Maxillofacial Surgery
Section of Oral and Maxillofacial Surgery, Department of Oral and Maxillofacial Surgery Oregon Health Sciences University
Pathology, and Dental Anesthesiology University of Washington School of Dentistry Portland, Oregon
The Ohio State University, College of Dentistry Seattle, Washington
Columbus, Ohio David N. Duddleston, MD
Kevin J. Butterfield, DDS, MD Department of Medicine
Brian Alpert, DDS, FACD Department of Oral and Maxillofacial Surgery University of Mississippi Medical Center
Department of Surgical and Hospital Dentistry University of Connecticut Jackson, Mississippi
University of Louisville School of Dentistry Farmington, Connecticut
Louisville, Kentucky Sean P. Edwards, DDS, MD
Eric R. Carlson, DMD, MD Department of Oral and Maxillofacial Surgery
Meredith August, DMD, MD Department of Oral and Maxillofacial Surgery University of Michigan School of Dentistry
Department of Oral and Maxillofacial Surgery University of Tennessee Graduate School of Ann Arbor, Michigan
Harvard University Medicine
Boston, Massachusetts Knoxville, Tennessee Edward Ellis III, DDS, MS
Department of Surgery
Jonathan S. Bailey, DMD, MD Guillermo E. Chacon, DDS University of Texas Southwestern Medical
Department of Surgery Department of Oral and Maxillofacial Surgery Center
University of Illinois College of Medicine at The Ohio State University Medical Center Dallas, Texas
Urbana-Champaign Columbus, Ohio
Urbana, Illinois Bruce N. Epker, DDS, MSD, PhD
Rakesh K. Chandra, MD Aesthetic Facial Surgery Center
Robert A. Bays, DDS Department of Otolaryngology-Head and Weatherford, Texas
Department of Surgery Neck Surgery
Emory University School of Medicine University of Tennessee Health Science Center T. William Evans, DDS, MD, FACS
Atlanta, Georgia Memphis, Tennessee Department of Oral and Maxillofacial Surgery
The Ohio State University
Jeffrey D. Bennett, DMD M. Scott Connor, DDS, MD Columbus, Ohio;
Department of Oral Surgery and Hospital Department of Oral and Maxillofacial Surgery Department of Oral and Maxillofacial Surgery
Dentistry Louisiana State University Health Sciences University of Michigan
Indiana University School of Dentistry Center Ann Arbor, Michigan
Indianapolis, Indiana Shreveport, Louisiana
Michael W. Finkelstein, DDS, MS
Charles N. Bertolami, DDS, D.Med.Sc. Bernard J. Costello, DMD, MD Department of Oral Pathology, Radiology, and
Department of Oral and Maxillofacial Surgery Department of Oral and Maxillofacial Surgery Medicine
University of California University of Pittsburgh University of Iowa, College of Dentistry
San Francisco, California Pittsburgh, Pennsylvania Iowa City, Iowa
xiii
xiv Contributors
Stephen B. Milam, DDS, PhD, FACD Vincent J. Perciaccante, DDS Michael S. Scherer, DDS, MD
Department of Oral and Maxillofacial Surgery Department of Surgery Department of Oral and Maxillofacial Surgery
University of Texas Health Science Center Emory University School of Medicine Case Western Reserve University School of
San Antonio, Texas Atlanta, Georgia Dental Medicine
Cleveland, Ohio
Michael Miloro, DMD, MD Larry J. Peterson, DDS, MS†
Department of Oral and Maxillofacial Surgery Department of Oral and Maxillofacial Surgery Sterling R. Schow, DMD
The Nebraska Medical Center The Ohio State University, College of Dentistry Department of Oral and Maxillofacial Surgery
Omaha, Nebraska Columbus, Ohio Baylor College of Dentistry, Texas A&M
University System
Dale J. Misiek, DMD Joseph F. Piecuch, DMD, MD Dallas, Texas
Department of Oral and Maxillofacial Surgery Department of Oral and Maxillofacial Surgery
Louisiana State University Health Sciences University of Connecticut School of Dental Anthony G. Sclar, DMD
Center Medicine Department of Surgery
New Orleans, Louisiana Farmington, Connecticut University of Miami School of Medicine
Miami, Florida
Gary D. Monheit, MD Michael A. Pikos, DDS
Departments of Dermatology and Ophthalmology Department of Oral and Maxillofacial Surgery Vivek Shetty, DDS, Dr.Med.Dent.
University of Alabama University of Miami School of Medicine Department of Oral and Maxillofacial Surgery
Birmingham, Alabama Miami, Florida University of California
Los Angeles, California
Jeffrey J. Moses, DDS, FACD, FICD, FAACS M. Anthony Pogrel, DDS, MD, FRCS, FACS
Department of Dentistry Department of Oral and Maxillofacial Surgery James W. Sikes Jr, DMD, MD
University of California University of California Department of Oral and Maxillofacial Surgery
Los Angeles, California San Francisco, California Louisiana State University Health Sciences
Center
Gregory M. Ness, DDS Jeffrey C. Posnick, DMD, MD, FRCS(C), FACS Shreveport, Louisiana
Department of Oral and Maxillofacial Surgery Departments of Surgery and Pediatrics
The Ohio State University, College of Dentistry Georgetown University Medical Center Massimo Simion, DDS
Columbus, Ohio Washington, District of Columbia Department of Periodontology
University of Milan
Mark W. Ochs, DMD, MD Michael P. Powers, DDS, MS Milan, Italy
Department of Oral and Maxillofacial Surgery Department of Oral and Maxillofacial Surgery
University of Pittsburgh School of Dental Case Western Reserve University School of Douglas P. Sinn, DDS
Medicine Dental Medicine Department of Surgery
Pittsburgh, Pennsylvania Cleveland, Ohio University of Texas Southwestern Medical
Center
Robert. A. Ord, MD, DDS, MS, FRCS, FACS Ramon L. Ruiz, DMD, MD Dallas, Texas
Department of Oral and Maxillofacial Surgery Departments of Oral and Maxillofacial Surgery
University of Maryland and Pediatrics Daniel B. Spagnoli, DDS, PhD
Baltimore, Maryland University of North Carolina Department of Oral and Maxillofacial Surgery
Chapel Hill, North Carolina Louisiana State University Health Sciences
Todd G. Owsley, DDS, MD Center
Carolina Surgical Arts, PA Thomas J. Salinas, DDS New Orleans, Louisiana
Greensboro, North Carolina Department of Otolaryngology
University of Nebraska Medical Center Peter M. Spalding, DDS, MS, MS
Stephen M. Parel, DDS, FACD, FICD Omaha, Nebraska Department of Growth and Development
Department of Oral and Maxillofacial Surgery University of Nebraska Medical Center College
Baylor College of Dentistry, Texas A&M Noah A. Sandler, DMD, MD of Dentistry
University System Department of Diagnostic and Surgical Sciences Lincoln, Nebraska
Dallas, Texas University of Minnesota
Minneapolis, Minnesota Eber L. L. Stevao, DDS, PhD
Alex E. Pazoki, MD, DDS Department of Oral and Maxillofacial Surgery
Department of Oral and Maxillofacial Surgery David M. Sarver, DMD, MS Baylor College of Dentistry, Texas A&M Univer-
University of Maryland Department of Orthodontics sity System
Baltimore, Maryland University of North Carolina Dallas, Texas
Chapel Hill, North Carolina
†
Deceased
xvi Contributors
Suzanne U. Stucki-McCormick, MS, DDS Scott D. Urban, DMD, MD Joel M. Weaver, DDS, PhD, FACD, FICD
Pacific Center for Jaw and Facial Surgery Department of Oral and Maxillofacial Surgery Department of Anesthesiology
Encinitas, California University of Alabama College of Medicine and Public Health
Birmingham, Alabama The Ohio State University
B. D. Tiner, DDS, MD Columbus, Ohio
Department of Oral and Maxillofacial Surgery Joseph E. Van Sickels, DDS
University of Texas Health Science Center Department of Oral Health Science Randall M. Wilk, DDS, PhD, MD
San Antonio, Texas University of Kentucky Department of Oral and Maxillofacial Surgery
Lexington, Kentucky Louisiana State University Health Sciences Center
Paul S. Tiwana, DDS, MD, MS New Orleans, Louisiana
Department of Oral and Maxillofacial Surgery Tomaso Vercellotti, MD, DDS
University of North Carolina Department of Ear, Nose, and Throat Larry M. Wolford, DMD
Chapel Hill, North Carolina University of Studies of Genova (Italy) Department of Oral and Maxillofacial Surgery
Genova, Italy Baylor College of Dentistry, Texas A&M
Yan Trokel, MD, DDS University System
Department of Oral and Maxillofacial Surgery Katherine W. L. Vig, BDS, MS, D. Orth, FDS(RCS) Dallas, Texas
University of Texas Southwestern Medical Center Department of Orthodontics
Dallas, Texas The Ohio State University, College of Dentistry Deborah L. Zeitler, DDS, MS
Columbus, Ohio Department of Oral and Maxillofacial Surgery
Maria J. Troulis, DDS, MSc University of Iowa College of Dentistry
Department of Oral and Maxillofacial Surgery Steven D. Vincent, DDS, MS Iowa City, Iowa
Harvard University Department of Oral Pathology, Radiology, and
Boston, Massachusetts Medicine Michael F. Zide, DMD
University of Iowa, College of Dentistry Department of Oral and Maxillofacial Surgery
Timothy A. Turvey, DDS Iowa City, Iowa University of Texas Southwestern Medical
Department of Oral and Maxillofacial Surgery School
University of North Carolina Peter D. Waite, MPH, DDS, MD, FACD Dallas, Texas
Chapel Hill, North Carolina Department of Oral and Maxillofacial Surgery
University of Alabama School of Dentistry
Birmingham, Alabama