Aesthetic Orthognathic Surgery and Rhinoplasty

622 Pages·2019·49.998 MB·English

by  Steinbacher, Derek M

AestheticOrthognathic
SurgeryandRhinoplasty
Aesthetic Orthognathic
Surgery and Rhinoplasty
EditedbyDerekM.Steinbacher
YaleUniversity
NewHaven,Connecticut
Thiseditionfirstpublished2019
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LibraryofCongressCataloging-in-PublicationData
Names:Steinbacher,DerekM.(DerekMatthew),editor.
Title:Aestheticorthognathicsurgeryandrhinoplasty[electronicresource]/
[editedby]DerekM.Steinbacher.
Description:Hoboken,NJ:Wiley-Blackwell,2019.|Includesbibliographical
referencesandindex.|
Identifiers:LCCN2018047520(print)|LCCN2018048604(ebook)|ISBN
9781119187110(AdobePDF)|ISBN9781119186984(ePub)|ISBN
9781119186977(hardback)
Subjects:|MESH:OrthognathicSurgicalProcedures–methods|
Rhinoplasty–methods|Esthetics,Dental,PlasticSurgery,Orthodontics,Otolaryngology,Surgery
Classification:LCCRD119.5.N67(ebook)|LCCRD119.5.N67(print)|NLMWU
600|DDC617.5/230592–dc23
LCrecordavailableathttps://lccn.loc.gov/2018047520
Coverimage:©DerekSteinbacher
CoverdesignbyWiley
Setin10/12ptWarnockProbyAptaraInc.,NewDelhi,India
10 9 8 7 6 5 4 3 2 1
v
Contents
ListofContributors vii
ForewordI ix
ForewordII xi
ForewordIII xiii
ForewordIV xv
ForewordV xvii
Preface xix
Acknowledgements xxi
AbouttheCompanionWebsite xxiii
1 IntroductiontoAestheticOrthognathicSurgeryandRhinoplasty 1
2 AssessmentandEvaluationintheAestheticOrthognathicPatient 15
3 OrthodonticConsiderationsinOrthognathicSurgery 35
4 3DAnalysis,Planning,andModelSurgery 53
5 ConvexFacialProfiles,ClassIISkeletalProblems 77
6 ConcaveFacialProfiles,ClassIIISkeletalProblems 97
7 AnteriorOpenBite 117
8 WidthandTransverseProblems 145
9 FacialAsymmetry 175
10 MidfaceandOrbitozygomaticAesthetics 213
11 SmileAesthetics 253
12 ChinandSubmentalAesthetics 289
13 Rhinoplasty:EvaluationandWorkup 331
14 RhinoplastyTechniques:TheNasalDorsum,Midvault,Septum,andOsteotomies 349
15 RhinoplastyTechniques:ControlofTip,Ala,andTripodComplex 381
16 NasalConsiderationsandOrthognathicSurgery 421
vi Contents
17 RhinoplastyandOrthognathicSurgery 447
18 RhinoplastyTechnique 489
19 OrthognathicTechnique:LeFortIandBilateralSagittalSplitOsteotomy(BSSO) 505
20 OsseousGenioplasty 517
21 SubmentalLiposuction 535
22 FatGrafting 547
23 AlloplasticFacialAugmentation 559
24 AnesthesiaforOrthognathicSurgeryandRhinoplasty 573
25 OperativePreparationandSetupforAestheticOrthognathicSurgeryandRhinoplasty 587
26 PostoperativeCareandConsiderations 603
Index 613
vii
ListofContributors
DerekM.Steinbacher,MD,DMD,FACS,FAAP SarahPersing,MD
AestheticOrthognathicSurgeryandRhinoplasty SeniorResident,YalePlasticandReconstructiveSurgery
DirectorofCraniofacialSurgery
WilliamRosenblatt,MD
PlasticandReconstructiveSurgery
ProfessorAnesthesiology
ChiefOralandMaxillofacialSurgery
YaleUniversitySchoolofMedicine
YaleSchoolofMedicine
YaleNewHavenHealth YounSagong,DDS
ChiefResident,YaleOralandMaxillofacialSurgery
MatthewAlleman,DMD
ChiefResident,YaleOralandMaxillofacialSurgery RajendraSawh-Martinez,MD
CraniomaxillofacialFellow,YalePlasticSurgery
HeatherAngus,CRNA,MSN,BSN
ChiefResident,YalePlasticandReconstructiveSurgery
MountSinaiMedicalCenter
YaleNewHavenHospital,Anesthesiology AjulShah,MD
ChiefResident,YalePlasticSurgery
KarlBruckman,DDS,MD
CraniomaxillofacialFellow,YalePlasticSurgery AnushaSingh,BS
YaleMedicalStudent
PatriciaVitaglianoBussen,MSN,APRN,FNP-C
Craniofacial,Orthognathic,andRhinoplastyNurse AndrewTimberlake,MD,PhD
Practitioner PlasticSurgeryResident,NYU
YalePlasticandReconstructiveSurgery YaleMedicalStudent
ChrisDeSesa,DMD RobertoTravieso,MD
ChiefResident,YaleOralandMaxillofacialSurgery SeniorResident,YalePlasticandReconstructiveSurgery
CharlesTuggle,MD
LarissaGalante,CRNA,MSN,BSN
ChiefResident,YalePlasticandReconstructiveSurgery
MemorialSloanKetteringCancerCenter
YaleNewHavenHospital,Anesthesiology FlavioUribe,DDS,MDentSc
Dr.CharlesJ.BurstoneProfessorinOrthodontics
GrahamGrabowski,DMD,FRCD(C)
DivisionofOrthodontics,CraniofacialSciences
UniversityofBritishColumbia,FacultyofDentistry
UniversityofConnecticutSchoolofDentalMedicine
ChiefResident,YaleOralandMaxillofacialSurgery
AnamikaVeeramani,BS
KatrinaKontaxis,DMD
ResearchFellow,YaleUniversity
ChiefResident,YaleOralandMaxillofacialSurgery
MarcE.Walker,MD,MBA
JeremyMay,DDS
ChiefResident,YalePlasticandReconstructiveSurgery
ChiefResident,YaleOralandMaxillofacialSurgery
ElizabethZellner,MD
LillianPagoni,RN,BSN
Fellow,HospitalforSickChildren
Craniofacial,Orthognathic,RhinoplastyNurse
ChiefResident,YalePlasticSurgery
Coordinator
YaleNewHavenHealth
SabrinaPavri,MD
ChiefResident,YalePlasticandReconstructiveSurgery
ix
ForewordI
This book, Aesthetic Orthognathic Surgery and Rhino- augmentation and reduction, nasal changes incumbent
plasty by Dr. Derek Steinbacher, masterfully considers on maxillary movements, and all relevant rhinoplasty
the interface between the dentofacial, soft-tissue, and aspects.Therhinoplastyperspectiveiscriticaltoseehow
nasal elements of the face. The relationship between thenasalformandfunctioncanbeoptimized,andhowa
structure,osteocartilaginousvaults,andoverallappear- well-performedrhinoplastyisessentialtoachieveover-
anceandfunctionisconsideredfirst-hand.Thecontent all facial balance. The most aesthetic face incorporates
of this book enables the reader and surgeon to under- well-balancedfacialbuttressesalongwithnasalformand
stand,diagnose,andarchitecturallymanipulateanatom- function,togetherinharmonywiththeoverlyingsofttis-
icalstructurestooptimizefacialbalanceandaesthetics. sues. The chapters take a unique bend and show how
When performed properly, repositioning and alteration the entirety of the face is greater than the sum of its
of the facial skeleton and nasal anatomy can very pos- parts.Thisbookisessential,andanecessaryadditionto
itively benefit nasal form and function. Orthognathic thelibraryofallproviders,surgeons,andorthodontists
manipulation improves not only the occlusion, but can whoexhibitaninterestinfacialaesthetic,reconstructive,
optimizebreathing,andincorporatecompleteaesthetic craniofacial,facialplastic,andrhinoplastysurgery.
optimization.
Thecontentcoversallcriticalaspectsofthesetopics, JoachimA.Obwegeser
including analysis and planning, new concepts in treat- M.D.,D.M.D.,FEBOMS
mentsequenceandapproach,andproperexecutionand Professor(UniversityZurich)
techniquetomanipulatefacialstructurestoachievethe Cleft-andCraniofacialSurgeon
best results. Importantly,adjunctiveconsiderationsand (UniversityChildrenHospitalZurich)
procedurestocomplementthejawmovementsarecon- LimmatCleftandCraniofacialCentreZurich
sidered in depth. These include fat grafting, soft-tissue (FounderandOwner)
xi
ForewordII
Therehasbeenagreatneedforatrustedreferencesource a definition that is so well stated and well done. Tradi-
regarding orthognathic surgery and rhinoplasty. This tionally, it has been that orthognathic surgery is done
truly is what this text, Aesthetic Orthognathic Surgery first, and a separate, staged rhinoplasty later. But there
and Rhinoplasty, by Dr. Derek Steinbacher establishes. arereasonswhenonecanandshouldperformbothpro-
Dr. Steinbacher is uniquely qualified and experienced ceduressimultaneously,suchasinthesettingofasignif-
as a plastic and reconstructive, oral and maxillofacial, icant nasal deformity and osseous nasal pyramid defor-
craniofacial,andrhinoplastysurgeon.Hebringstogether mity.Dr.Steinbacheraddressesthisconcomitantlywith
the state-of-the-art in the scientific foundations, and aestheticcorrectionofthechinandneckarea.
blends the complex analytics of orthognathic surgery The beauty of this book is that it truly balances the
with the art of rhinoplasty. Not only has Dr. Stein- art, technique, and experience of an oral and maxillo-
bacher done a unique job in defining these deformi- facial and plastic/rhinoplasty surgeon to provide uni-
ties and their inter-relationships, but he has done so formlysuperbresults.Themanagementofthesecomplex
with clear images/depictions, state-of-the art 3D plan- orthognathic and craniofacial deformities, especially in
ning, and assessment of results. The management of the setting of significant nasal deformities, is challeng-
skeletofacial deformities: Class II–III, mid- and lower- ing.Dr.Steinbacherandhisauthorsshould becongrat-
face discrepancies, and significant asymmetries, is ele- ulated for this magnificent book which is a must read
gantlyillustrated.Dr.Steinbacherhasuniquelybeenable for all rhinoplasty surgeons, especially those who deal
tobringboththecraniofacialandtheplasticsurgeryvan- with significant craniofacial and orthognathic deformi-
tagepointstoorthognathicsurgerytoprovideforstable ties.Clearlytheapplicationofbothorthognathicsurgery
reconstructionofthefaceinanaestheticmanner. andrhinoplastyisoneofthemostpowerfulcombinations
Furthermore, because of his talent, experience, and toachieveoptimalfacialaestheticsandform.
background, as an orthognathic and maxillofacial sur-
geonandasanaestheticplasticsurgeon,hehasbeenable RodJ.Rohrich,MD,FACS
toeffectivelyblendthemanagementofnasaldeformities. ClinicalProfessorandFoundingChairman
Cosmeticrhinoplasty,togetherwithfunctionalimprove- DistinguishedTeachingProfessor
ment,isconsideredineitherasimultaneousorastaged DepartmentofPlasticSurgery
fashion.Oneofthemostimportantaspectsofthisbook UTSouthwesternMedicalCenter
is the chapter in which he addresses when to perform FoundingPartner
combinationorthognathicsurgerywithrhinoplastyand DallasPlasticSurgeryInstitute
whentoadheretoastagedsequence.Ihaveneverseen Dallas,Texas
xiii
ForewordIII
As the field of aesthetic and functional surgery of the doorways–andisfollowedinsequencebyfloor cover-
face has evolved, it has been increasingly recognized ings,framingofdoorsandwindows,theadditionofelec-
that the face is more than just the sum of its parts. In tricityandplumbing,etc.Onlywhentheseelementsare
the ideal functional and aesthetic state there exists a inplaceistheinteriordecoratorinvitedintoaddcolor,
harmonious balance between not only the different fabric, and furniture. This is the recipe for a success-
facial regions, but between the hard and soft tissues. It fulrenovation.Stepwise,andbeginningatthebeginning,
is this dynamic interaction that is an absolute requisite withthefoundation.Toooftenthisisforgotten.Wehave
forcreatingsomethingthatismaximallyfunctionaland allprobablybeeninhomeswhereadefinedspaceorroom
aesthetically pleasing. Too often surgeons have focused asastandalonestructureiselegantbutjustdoesnotfit
regionally,ignoringthevariousotherpartsand,although withtheremainderofthespace.
the result in isolation may be acceptable, the overall Themanagementofappearance-relatedandfunctional
improvementislessthanideal.Thesameistrueforthe deformities of the face is no different, especially those
hardandsofttissues:thosewithprimarytraininginthe centeredaroundthejaw,thenose,andthemouth.First
hard tissues have been guilty of paying little attention you define what you like and do not like, then estab-
to the soft-tissue mantle, while those with primary lishanormalorsupranormal(aesthetic)skeletalfounda-
traininginthesofttissuesoftenignoreorminimizethe tionwhichtakesintoconsiderationtheeffectitmayhave
contributionoftheunderlyingbonyframework. on the related soft tissues, and finally you modify and
Consider if you would the rehabilitation of an older adaptthosesofttissuesforthebestpossiblefit,bothaes-
home,somethingmanyreadersmightidentifywith.One thetically and functionally. You treat both the hard and
canseethepromiseofthespace,buttorealizethatpoten- the soft tissues and you do so in a logical and stepwise
tial a series of organizational steps are necessary. First, fashion.
itstartswithwhatonelikesaboutthespace,suchasan WhobetterthanDr.DerekSteinbachertobringthese
ornatefireplaceorgrandentryway,butthenthosethings principlestogether?Trainedinboththehardandsofttis-
that are disagreeable must be addressed: small rooms, suesofthefacewithresidenciesinOralandMaxillofacial
narrow passageways, limited windows, and the like, to Surgery,PlasticSurgery,andafellowshipinCraniofacial
name just a few. So an architect is hired, and working Surgery,henotonlyunderstandstheseconceptsbutputs
withyouheputstogetherasetofplansandblueprints, themtopractice,asthiswell-writtenandpracticalguide
both 2D and 3D, for the entire project that will include demonstrates.
thingssuchascombiningsmallroomstomakeagrander Enjoythisbook;youareinforaninformativeandprac-
spaceandopeningupthewindows,walls,andpassage- ticaljourney.
waystoletinmorelight.Buthealsoretainsthatwhich
isattractiveandfunctional,suchastheornatemantle,a ScottP.Bartlett,M.D.
handmadedoor,oragrandstairway.Thelistisendless. PeterRandallEndowedChairin
Construction follows, during which small modifica- PediatricPlasticSurgery,
tions inevitably are added, but everything is done in a TheChildren’sHospitalofPhiladelphia
stepwisefashionbeginningwiththefoundationandthe ProfessorofSurgery,PerelmanSchool
“bones”ofthestructure–thewalls,floors,windows,and ofMedicine,UniversityofPennsylvania