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.


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?

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