대한치과의사협회지 (The Journal of the Korean dental association)

  • 제53권7호
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  • Pages.468-475
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  • 2015
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  • 0376-4672(pISSN)
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  • 2713-7961(eISSN)
대한치과의사협회 (The Korean Dental Association)
권호 표지

구순구개열 환자를 위한 상악 악교정 수술

Le Fort I maxillary osteotomy for cleft lip and palate patients

  • 신영민 (경북대학교 치의학전문대학원 구강악안면외과학교실) ;
  • 권대근 (경북대학교 치의학전문대학원 구강악안면외과학교실)
  • Shin, Young-Min (Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyungpook National University) ;
  • KWON, Tae-Geon (Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyungpook National University)
  • 투고 : 2015.06.16
  • 심사 : 2015.06.25
  • 발행 : 2015.07.01
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초록

Cleft 상악수술은 근본적으로 재발 성향을 가지며 Lefort I 후에 대부분 횡적으로 완전하게 안정되어 있지않고 움직임이 존재하므로 악간 고정기간을 통상적인 수술에서보다도 좀 더 충분히 두는 것이 좋다. 수술과 동시에, 추가적으로 비대칭적인 piriform aperture 나 alar base를 correction하기 위하여 골이식이 고려될 수 있으며 경우에 따라서는 조심스럽게 반흔조직을 절개해 주어야 하는 경우도 있다. Cleft 환자의 경우 상순이 얇고 수술에 의한 전방이동효과가 적기때문에 상악 수술시 이를 적극 고려하는 것이 필요하다. 또한 cleft 환자의 pterygomaxilla 부위의 해부학적 구조가 일반인과 차이가 있다는 것을 숙지하여 상악 수술에 임하는 것이 필요하다.

In cleft lip and palate (CLP) patients, there are various degree of residual maxillofacial deformities in adolescent period. Usually, orthoganthic surgery for the cleft patients needs Le Fort I osteotomy and/or mandibular set-back surgery. Previous report from other institute had been shown that there is significant relapse after maxillary movement after Le Fort I osteotomy when the surgical advancement of the maxilla was over than 5 or 7mm in average. Recent comphrehensive report showed that most of the relapse was happened within 1 year and the total horizontal relapse of the maxilla was as high as 30% in average. Therefore, overcorrection is needed in maxillary surgery for cleft patients. Another concerns for cleft orthognathic surgery is the anatomical variation in pterygomaxillary region in cleft patients compared to control patients. Patients with CLP had larger and thicker pterygomaxillary dimensions, and the results imply that careful attention to pterygomaxillary anatomy is needed in patients with CLP undergoing Le Fort I surgery. This article reviews the pre and postoperative considering factors for orthognathic surgery for CLP patients.

키워드

참고문헌

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