Monobloc and facial bipartition osteotomies 1st
edition by Ramon Ruiz, Timothy Turvey, Paul
Tiwana pdf download
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Atlas of Oral and Maxillofacial Surgery 1st Edition by Deepak
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Manual of Internal Fixation in the Cranio Facial Skeleton 1st Edition
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, Atlas Oral Maxillofacial Surg Clin N Am 10 (2002) 131–148
Monobloc and facial bipartition osteotomies
Ramon L. Ruiz, DMD, MDa,b,c,d,*, Timothy A. Turvey, DDSa,c,
Paul S. Tiwana, DDS, MDa
a
Department of Oral and Maxillofacial Surgery, University of North Carolina at Chapel Hill, Brauer Hall,
CB# 7450, Chapel Hill, NC 27599-7450, USA
b
Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
c
Children’s Hospital of North Carolina, Chapel Hill, NC 27599, USA
d
University of North Carolina Craniofacial Center, Chapel Hill, NC 27599, USA
Maxillofacial surgery underwent a dramatic evolution as a direct result of the experience
gained by surgeons who managed the facial injuries seen during the trench warfare of World
War I [1]. The surgical techniques pioneered for the repair of injuries that involved the maxil-
lofacial structures often were applied to the craniofacial skeleton and subsequently provided
the foundation for newer procedures used in the reconstruction of congenital deformities. In
the strictest sense, craniofacial surgical procedures are defined as those in which a transcranial
approach is used for access to the upper facial skeleton. Despite this distinction, however, most
craniofacial procedures represent an extension of the original scientific principles and traditional
techniques of maxillofacial surgery.
Tessier was the first to describe an approach for the correction of the craniofacial anomalies
associated with Crouzon and Apert syndromes using a Le Fort III osteotomy, which included a
combined extracranial/transcranial approach, access via a coronal scalp flap, interpositional
bone grafts for stabilization at the osteotomy sites, and an external fixation device [2–4]. Sub-
sequent modifications [5–7] resulted in the development of the monobloc and facial bipartition
procedures. More recently, the work of Posnick provides the most comprehensive description of
the specific surgical techniques, additional technical refinements, and clinical examples of ideal
functional and esthetic results in the correction of total midface deficiency associated with con-
genital deformities [8–13]. In North America, Posnick’s numerous publications have established
the role of the monobloc and facial bipartition procedures as viable reconstructive maneuvers in
the craniofacial surgeon’s armamentarium.
The purpose of this article is to provide the surgeon with an overview of the monobloc and
facial bipartition procedures. The operative steps are described, with attention given to the in-
dications for surgery and specific intraoperative, technical considerations.
Indications
The craniofacial dysostosis syndromes (Crouzon, Apert, Pfeiffer, Saethre-Chotzen, and Car-
penter) are inherited forms of craniosynostosis in which there is also extensive involvement of
the sutures of the midfacial skeleton. In addition to the cranial vault dysmorphology that results
from craniosynostosis (usually bilateral coronal), affected patients exhibit a characteristic total
midface deficiency that involves the orbits and maxilla.
The surgical correction of the craniofacial anomalies of the craniofacial dysostosis syndromes
requires at least three carefully sequenced stages of reconstruction [14,15]. Initially, release of
the bilateral coronal synostosis with reshaping of the cranial vault is undertaken. The surgical
* Corresponding author.
E-mail address: (R.L. Ruiz).
1061-3315/02/$ - see front matter Ó 2002, Elsevier Science (USA). All rights reserved.
PII: S 1 0 6 1 - 3 3 1 5 ( 0 1 ) 0 0 0 0 8 - 7
edition by Ramon Ruiz, Timothy Turvey, Paul
Tiwana pdf download
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, Get Your Digital Files Instantly: PDF, ePub, MOBI and More
Quick Digital Downloads: PDF, ePub, MOBI and Other Formats
Atlas of Oral and Maxillofacial Surgery 1st Edition by Deepak
Kademani, Paul Tiwana ISBN 1455753284 9781455753284
https://ebookball.com/product/atlas-of-oral-and-maxillofacial-
surgery-1st-edition-by-deepak-kademani-paul-tiwana-
isbn-1455753284-9781455753284-5546/
Rhinology and Facial Plastic Surgery 1st Edition by Fred Stucker,
Chris de Souza, Guy Kenyon, Timothy Lian, Wolfgang Draf, Bernhard
Schick ISBN 9783540743804
https://ebookball.com/product/rhinology-and-facial-plastic-
surgery-1st-edition-by-fred-stucker-chris-de-souza-guy-kenyon-
timothy-lian-wolfgang-draf-bernhard-schick-
isbn-9783540743804-7698/
Forensic Criminology 1st edition by Wayne Petherick, Brent Turvey,
Claire Ferguson ISBN 0123750717‎ 978-0123750716
https://ebookball.com/product/forensic-criminology-1st-edition-
by-wayne-petherick-brent-turvey-claire-ferguson-
isbn-0123750717aeurz-978-0123750716-16752/
Manual of Internal Fixation in the Cranio Facial Skeleton 1st Edition
by Leon Assael, Douglas Klotch, Paul Manson, Joachim Prein, Berton
Rahn, Wilfried Schilli ISBN 9783642587894
https://ebookball.com/product/manual-of-internal-fixation-in-the-
cranio-facial-skeleton-1st-edition-by-leon-assael-douglas-klotch-
paul-manson-joachim-prein-berton-rahn-wilfried-schilli-
isbn-9783642587894-7748/
,Intel Galileo and Intel Galileo Gen 2 API Features and Arduino
Projects for Linux Programmers 1st edition by Manoel Ramon ISBN
1430268395 978-1430268390
https://ebookball.com/product/intel-galileo-and-intel-galileo-
gen-2-api-features-and-arduino-projects-for-linux-
programmers-1st-edition-by-manoel-ramon-
isbn-1430268395-978-1430268390-20336/
Verified Computer Algebra in ACL2 1st Edition by Medina Bulo, Palomo
Lozano, Alonso Jiménez, Ruiz Reina 9783540232124
https://ebookball.com/product/verified-computer-algebra-in-
acl2-1st-edition-by-medina-bulo-palomo-lozano-alonso-jima-c-nez-
ruiz-reina-9783540232124-9170/
Big Data Marketing Strategies for Superior Customer Experience 1st
edition by Jose Ramon Saura ISBN 1668464551 978-1668464557
https://ebookball.com/product/big-data-marketing-strategies-for-
superior-customer-experience-1st-edition-by-jose-ramon-saura-
isbn-1668464551-978-1668464557-24568/
Facial Aesthetics Concepts and Clinical Diagnosis 1st Edition by
Farhad Naini 9781444391022 144439102X
https://ebookball.com/product/facial-aesthetics-concepts-and-
clinical-diagnosis-1st-edition-by-farhad-
naini-9781444391022-144439102x-7602/
Encyclopedia of Artificial Intelligence 1st edition by Juan Ramon
Rabunal Dopico, Julian Dorado De La Calle, Alejandro Pazos Sierra
1599048507 9781599048505
https://ebookball.com/product/encyclopedia-of-artificial-
intelligence-1st-edition-by-juan-ramon-rabunal-dopico-julian-
dorado-de-la-calle-alejandro-pazos-
sierra-1599048507-9781599048505-19464/
, Atlas Oral Maxillofacial Surg Clin N Am 10 (2002) 131–148
Monobloc and facial bipartition osteotomies
Ramon L. Ruiz, DMD, MDa,b,c,d,*, Timothy A. Turvey, DDSa,c,
Paul S. Tiwana, DDS, MDa
a
Department of Oral and Maxillofacial Surgery, University of North Carolina at Chapel Hill, Brauer Hall,
CB# 7450, Chapel Hill, NC 27599-7450, USA
b
Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
c
Children’s Hospital of North Carolina, Chapel Hill, NC 27599, USA
d
University of North Carolina Craniofacial Center, Chapel Hill, NC 27599, USA
Maxillofacial surgery underwent a dramatic evolution as a direct result of the experience
gained by surgeons who managed the facial injuries seen during the trench warfare of World
War I [1]. The surgical techniques pioneered for the repair of injuries that involved the maxil-
lofacial structures often were applied to the craniofacial skeleton and subsequently provided
the foundation for newer procedures used in the reconstruction of congenital deformities. In
the strictest sense, craniofacial surgical procedures are defined as those in which a transcranial
approach is used for access to the upper facial skeleton. Despite this distinction, however, most
craniofacial procedures represent an extension of the original scientific principles and traditional
techniques of maxillofacial surgery.
Tessier was the first to describe an approach for the correction of the craniofacial anomalies
associated with Crouzon and Apert syndromes using a Le Fort III osteotomy, which included a
combined extracranial/transcranial approach, access via a coronal scalp flap, interpositional
bone grafts for stabilization at the osteotomy sites, and an external fixation device [2–4]. Sub-
sequent modifications [5–7] resulted in the development of the monobloc and facial bipartition
procedures. More recently, the work of Posnick provides the most comprehensive description of
the specific surgical techniques, additional technical refinements, and clinical examples of ideal
functional and esthetic results in the correction of total midface deficiency associated with con-
genital deformities [8–13]. In North America, Posnick’s numerous publications have established
the role of the monobloc and facial bipartition procedures as viable reconstructive maneuvers in
the craniofacial surgeon’s armamentarium.
The purpose of this article is to provide the surgeon with an overview of the monobloc and
facial bipartition procedures. The operative steps are described, with attention given to the in-
dications for surgery and specific intraoperative, technical considerations.
Indications
The craniofacial dysostosis syndromes (Crouzon, Apert, Pfeiffer, Saethre-Chotzen, and Car-
penter) are inherited forms of craniosynostosis in which there is also extensive involvement of
the sutures of the midfacial skeleton. In addition to the cranial vault dysmorphology that results
from craniosynostosis (usually bilateral coronal), affected patients exhibit a characteristic total
midface deficiency that involves the orbits and maxilla.
The surgical correction of the craniofacial anomalies of the craniofacial dysostosis syndromes
requires at least three carefully sequenced stages of reconstruction [14,15]. Initially, release of
the bilateral coronal synostosis with reshaping of the cranial vault is undertaken. The surgical
* Corresponding author.
E-mail address: (R.L. Ruiz).
1061-3315/02/$ - see front matter Ó 2002, Elsevier Science (USA). All rights reserved.
PII: S 1 0 6 1 - 3 3 1 5 ( 0 1 ) 0 0 0 0 8 - 7
