Contents Welcome ...... 1 Agenda...... 3
SESSION I: CRANIOMAXILLOFACIAL GROWTH & DEVELOPMENT ...... 10 Dental anatomy ...... 11 Dental notation ...... 16 Sequence of eruption ...... 18 Curves of the occlusal plane ...... 19 Dental nerve supply ...... 20 CMF & Dental Radiology...... 21 Occlusion ...... 25 Oral Health ...... 30 Mandibular Biomechanics ...... 31 Dental embryology ...... 34 Ectodermal dysplasia ...... 39 Jaw cysts and tumours...... 40 Cranio-Maxillofacial embryology ...... 48 Dermoid cysts ...... 52 Nasal dermoid sinus cysts ...... 53 Holoprosencephaly ...... 55 Concepts in craniofacial development ...... 56 Cranial vault development...... 57 Brain growth ...... 59 Skullbase development ...... 63 Mandibular development...... 67 Mandibular hypoplasia ...... 70 Sinus development...... 71 Pneumosinus dilatans ...... 72 Palatal development...... 73 Auricular Development...... 74 Cranial Bifidum...... 76 Parietalia Foramina Magna ...... 77
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Cranio-Maxillofacial 2012, Snow Workshop Queenstown
Cutis Aplasia ...... 78 SESSION II: ORTHOGNATHIC SURGERY...... 79 Aesthetic facial analysis...... 80 Cephalometric analysis...... 84 Orthognathic surgery workup...... 89 Dental impressions ...... 90 Wax bites ...... 90 Facebow transfer ...... 91 Articulators ...... 92 Wafers/ Occlusal splints...... 93 Orthognathic Surgery...... 97 Sagittal split osteotomy ...... 100 Genioplasty ...... 103 Le Fort I osteotomy ...... 106 Complications of orthognathic surgery...... 110 Orbital compartment syndrome...... 112 Obstructive sleep apnoea ...... 114
SESSION III: CLEFT LIP AND PALATE...... 116 Embryology of cleft lip and palate ...... 117 Anatomy of cleft lip and palate...... 122 Epidemiology of clefts ...... 133 Cleft aetiology ...... 134 Prenatal diagnosis ...... 138 Presurgical orthodontics ...... 139 Cleft lip repair...... 141 Cleft palate repair...... 144 Cleft lip and palate speech assessment ...... 153 Alveolar bone grafting in cleft lip ...... 157 Cleft rhinoplasty ...... 159
SESSION IV: CRANIOORBITAL CONDITIONS...... 162 Craniofacial clefts...... 163 Hypertelorism...... 166 6
Cranio-Maxillofacial 2012, Snow Workshop Queenstown
Vertical Orbital dystopia ...... 170 Encephalocoeles...... 172 Graves Opthalmopathy ...... 174 Fibrous dysplasia ...... 178 Radiation induced craniofacial hypoplasia ...... 181
SESSION V: CMF SURGERY - PRINCIPLES AND TECHNOLOGIES .....183 Skull base access ...... 184 Bone healing and bone grafting ...... 188 Wires, Rigid fixation, Absorbable plates...... 191 Transnasal canthopexy ...... 195 Submental intubation ...... 197 Orbital tissue expansion...... 198 Osseointegration and implantology...... 200 Distraction osteogenesis ...... 202 Cranial springs ...... 210 Cranioplasty alloplasts ...... 214 Endotracheal tube fixation to maxilla in burns...... 220
SESSION V: CRANIOSYNOSTOSIS ...... 221 Cranial Suture Biology ...... 222 Craniosynostosis classifications...... 225 Aetiology of craniosynostosis...... 228 Consequences of Craniosynostosis...... 230 Intracranial Volume ...... 230 Intracranial Pressure ...... 231 CSF flow dynamics and hydrocephalus ...... 234 Cerebellar tonsil herniation ...... 235 Dandy-Walker malformations...... 235 Visual impairment in craniosynostosis ...... 236 Obstructive sleep apnoea in craniosynostosis ...... 238 Sagittal synostosis ...... 239 Metopic synostosis...... 242 Bicoronal synostosis ...... 244 7
Cranio-Maxillofacial 2012, Snow Workshop Queenstown
Unicoronal synostosis ...... 245 Lambdoid synostosis...... 246 Fronto-sphenoid synostosis ...... 247 Apert syndrome...... 248 Crouzon syndrome...... 251 Pfeiffer syndrome...... 253 Saethre Chotzen syndrome ...... 254 Craniofrontonasal dysplasia...... 255 Cleidocranial dysostosis ...... 257 Oxycephaly ...... 259 Kleeblattschadel...... 260 Other craniosynostosis syndromes...... 261 Deformational plagiocephaly...... 262 Ventricular shunt deformities ...... 264 Surgical treatment of craniosynostosis ...... 265 Craniofacial Osteotomies...... 266 Posterior fossa decompression...... 274 Le Fort III advancement ...... 276
SESSION VII: CRANIOFACIAL CONDITIONS I ...... 278 Hemifacial microsomia...... 279 Binder syndrome...... 287 Robin Sequence ...... 290 TMJ ankylosis ...... 293 Treacher Collins Syndrome ...... 295 Nager Syndrome...... 298
SESSION VIII: CRANIOMAXILLOFACIAL TRAUMA ...... 299 Assessment and emergency management...... 300 Ocular/lacrimal injuries...... 301 Dental injury ...... 302 Zygomatic fractures ...... 303 Mandible fractures ...... 304 Orbital fractures ...... 306 8
Cranio-Maxillofacial 2012, Snow Workshop Queenstown
Craniofacial dysjunction (Le Fort style fractures)...... 307 Nasoethmoid fractures...... 309 Frontal sinus fractures ...... 310 Cranial fractures...... 312 Orbital apex syndrome/superior fissure syndrome ...... 314 Paediatric trauma...... 315
SESSION IX: CMF CONDITIONS II ...... 316 Microtia & ear reconstruction ...... 317 Moebius syndrome...... 325 Chin deformities ...... 327 Neurofibromatosis ...... 332 Rombergs progressive hemifacial atrophy...... 337 Proteus syndrome ...... 339 Macroglossia ...... 340 Beckwith Weidemann syndrome...... 342 Craniopagus...... 343 Craniometaphyseal dysplasia ...... 344 Thanatophoric dysplasia ...... 344 Vascular anomalies - update...... 345
APPENDIX: +2 CMF Training ...... 347
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Cranio-Maxillofacial 2012, Snow Workshop Queenstown