Complete Bimaxillary Surgery - Live Surgical Videos

Course by: Bill Arnett

Duration: 4 Hours 50 min

Dr. Arnett shares 40 years of OR experience to avoid surgical complications and achieve excellent surgical outcomes. The OR surgical video contains both closeup and wide-angle cameras. A clear portrayal of surgery is presented both visually and verbally. Preliminary procedures, BSSO, MS LFI, chin reconstruction, and finishing procedures are demonstrated.

WHAT WE COVER IN THIS COURSE:

1. Preliminary Procedures

When and where is local anesthetic for the sagittal osteotomy placed?
How is the anesthesia tube secured to the patient’s head?
How is the table configured to reduce bleeding?
Which jaw is operated first?
What is a 26 gauge restraining wire?

2. Right Side BSSO Incision /Dissection

Why does the medial ramus dissect so easily?
How is the incisor made to avoid buccal fat pad exposure?
What is the anterior limit of the incision?
What is the superior limit of the incision?

3. Right Side BSSO Osteotomy

What saws/burs are used to make the sagittal osteotomy cuts?
What happens if the inferior border cortex is not completely cut?

4. Left Side BSSO Incision/Dissection

What instruments are used to make the incision?
What method is used for the medial dissection to preserve the nerve?

5. Left Side BSSO Osteotomy

What bur starts the medial ramus osteotomy?
What saw blade is used to make all of the sagittal osteotomy cuts?

6. Right Side BSSO Split

What happens if the split is not done properly?
What is the chisel sequence for splitting?
Where are the osteotomy cuts made to avoid bad splits?

7. Left Side BSSO Split

Should the neurovascular bundle be dissected free?
What causes a bad split?

8. Intermaxillary Fixation

Is an intermediate splint used?
What is skeletal intermaxillary fixation?
Why is a 2×11 screw placed in the mandibular buccal cortex between the first and second molar roots?

9. Upper Lip Reconstruction Planning

Do you really want to do this procedure?
Where is the LFI incision placed to increase lip thickness and vermillion?
Where is the posterior extent of the LFI incision?
When is the local anesthetic placed for the LFI?

10. Left Side BSSO Plating

Why is a fissure bur notch placed in the anterior superior corner of the condylar bearing fragment?
What is bivector seating of the condyle? Why is it used?
What happens if the condyle is misplace in the fossa?
Is a contra-angle handpiece necessary for BSSO plating?
What is the sequence of screw placement for the plates to make life easier?

11. Right Side BSSO Plating

What advantage does the tab on the BSSO plate provide?
How many plates are placed on each BSSO?
What instruments are used to place the plates?
Which plate is place first? The superior or inferior?

12. IMF Release / Bite Check

What is bivector checking of the bite?
If the bite is checked by pushing the chin back what will you see?

13. LIP Reconstruction LFI Incision / Dissection

When is the LFI local anesthetic placed to provide hemostasis?
What is the posterior extent of the LFI incision?
How is the LFI incision dissection produced?

14. Interdental (Segmental) Osteotomy

How is the interdental cut safely accomplished?
What instrument is used to cut between the teeth roots?
What is the 24-gauge wires purpose?

15. LFI Horizontal Osteotomy

What saw is used for the horizontal osteotomy?
How is the nasal mucosa protected?
What is used to separate the pterygoid plates from the maxilla?

16. Initial LFI Mobilization

What is the bone hook used for?
What may happen to the blood pressure and pulse when the LFI is down fractured and stretched?

17. Bone Harvest

Why is bone harvested from the maxilla?
How is the pterygopalatine bone separated from maxilla without causing bleeding?
How is the descending palatine artery preserved?

18. Increasing LFI Mobilization

How are a periosteal elevator and a bone hook used to stretch the posterior maxilla down?
If the maxilla won’t advance, what maneuver allows the maxilla to be advanced?

19. Nasal Floor H Segmental Osteotomy

What is the H nasal floor osteotomy?
What cutting technique is used for the H osteotomy?
Why are two para-midline nasal floor osteotomies used instead of one midline osteotomy?

20. Final Intermaxillary Fixation

Is a splint used between the teeth to establish final occlusion intermaxillary fixation?
Why is buccal cusp wear bonded prior to surgery?
Why is equilibration of the teeth done during surgery?
Why is the 2×11 screw used for posterior IMF/

21. LFI Osteotomy Bone Removal

What is general anesthesia terminal chin from the chin?
Why is the anterior nasal wall not removed?
How is the 2×17 nasal screw used to control the vertical dimension?
What is bivector seating?

22. Pre-Plating Procedures

What prevents a deviated nasal septum?
What is the pre-plating sequence?
What is used to control bleeding in the posterior maxilla prior to plating?

23. LFI Piriform Rim Plating

Where are the C and L KLS plates used?
What is the advantage of the plate tab?
Why is a drill avoided for screw holes?
Why is a measurement caliper used?
If the plates are not passive what happens to condyle position?
Is bivector or chin condylar seating used during piriform plating?
What happens to the vertical incisor height if the first screw placed above the osteotomy is drilled high?

24. LFI Zygomatic Buttress Plating

What is the plate design used exclusively on the zygomatic buttress?
Why is it important to record the bone to screw interface?
Will the posterior osteotomy heal if the buccal fat pad goes into the sinus?
How are the condyles seated when the buttress plates are attached?
What happens if the first screw across the osteotomy is not in the middle of the plate hole?

25. LFI Graft Placement

What is the material used for grafting the maxilla?
What is local bone?
When is a BMP membrane utilized?
Where is the only anatomical location where a Vitoss 4mm graft helps bone healing?

26. LFI Incision Closure

What is the alar base suture?
What tissue must the alar base suture go through?
Why take small bites on the dental side of the LFI flap (incision) closure?

27. Chin Osteotomy

What factors determine if a chin osteotomy is necessary?
What are the two characteristics of chin esthetics?
How many millimeters is the chin osteotomy place inferior to the mental nerve exit?
What saw and blade are used for the chin osteotomy?
What does a 2mm chin plate produce?

28. Composite Application to the sectioned Maxillary Archwire

Why is composite bonding applied to the sectioned archwire before release of fixation?
What happens when a final splint is used?
What are the factors which create maximum intercuspation of the occlusion?

29. Left BSSO Osteotomy Graft

The 2 by 11 screw is used for posterior IMF, why?
What makes up the graft material placed in the sagittal osteotomy?
Why is resorbable hydroxyapatite mixed with local bone?

30. Left BSSO Osteotomy Closure

What suture material is used for the mucosal closure?
What is my technique for closing the incision?
What happens if a pressure dressing isn’t used for the first 12 hours after surgery?
Why is a skin hook used during closure?
Why are 3 deep mucosal 4-0 vicryl sutures placed?

31. Right BSSO Osteotomy Graft

What causes torque of the condyle when the plates are placed?
Do the condylar bearing and tooth bearing fragment require contact to heal?
Why are 2 plates always placed?
What is anterior skeletal fixation? Why is it used?
What prevents a nonunion?
What may happen when the condylar and tooth bearing fragments contact?

32. Right BSSO Osteotomy Closure

What is the recipe for keeping the incision closed?
What happens if a pressure dressing is not used after closure?

33. Chin Closure

Where is the deep closure placed?
What suture is used for the deep and mucosal level closures?

34. IMF Release Final Bite Check

Why is it an advantage to do the LFI last after the BSSO?
When is condyle seating more difficult, during the LFI or BSSO?
How is the condyle seated during bite check?
What happens if the condyles are seated with chin pushback during the bite check?

35. Finishing Procedures

What constitutes elastic intermaxillary fixation?
What does skeletal traction control?
How is the vertical incisor height checked?
Regarding IMF elastics, what happens if anterior dental elastics are used without anterior skeletal elastics?
What is the recipe for increasing upper vermillion exposure?
Why does a witch’s chin form after surgery?
Why does the sagittal osteotomy incision open up post-surgery?

SCREENSHOTS FROM THE COURSE