• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.46 no.6
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• pp.409-416
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• 2020

Objectives: The goal of this retrospective study was to determine the significance and impact of several factors on the alveolar cleft bone grafting procedure. Materials and Methods: The medical records were reviewed. In addition, x-rays were checked. The size of every cleft was measured in this retrospective study. The analyzed factors included sex, age, type of cleft, size of the cleft, and the type of flap used in surgery. The patients were characterized into group A (no complications, Bergland scale 1 or 2), group B (complications or Bergland scale 3), or group C (failure cases). Statistical analysis was performed with a P-value set at 0.05. Results: There were 32 cases in group A, 26 in group B, and 9 in group C. Multinomial logistic regression showed an association between the type of the cleft and the size of the cleft, with the presence of complications, or achieving type 3 on the Bergland scale, with odds ratios of 5.118 and 6.000, respectively. The type of cleft was related to failure with an odds ratio of 4.833. Given a small sample, statistical analysis could not be performed to evaluate the relationship between the size of the cleft and group C. Age, sex, and the type of the flap were not significant factors. Conclusion: The cleft size of more than 10 mm and bilateral clefts were listed regarding their effect on the procedure. Clinicians should not overlook these factors. In addition, patients must be informed of any risks that are present.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.46 no.6
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• pp.379-384
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• 2020

Objectives: We sought to identify a clinically useful method of analyzing orbital dystopia to aid in diagnosis and treatment planning and to quantify vertical discrepancies in eye level and variations in canthal tilt in Koreans. Patients and Methods: In 76 Korean patients with a mean age of 23.12 years, mean differences in the level of the pupils, lateral canthi, medial canthi, and canthal tilt were measured. The difference in pupil level was calculated from the perpendicular lines drawn from the midpupil area of each eye to the midline of the face to determine the amount of skeletal discrepancy of the eye. Soft tissue discrepancies were determined according to the vertical difference between the lines drawn from the lateral or medial canthus of each eye perpendicular to the midline of the face. The canthal tilt was determined from the inclination of a line connecting the lateral and medial canthi, then classified as class I, II, or III. Results: Mean differences in pupil level, medial canthi, and lateral canthi were 1.57±1.10 mm, 1.14±1.07 mm, and 2.03±1.64 mm, respectively. The mean degree of canthal tilt were 8.45°±3.53° for the right side and 8.42°±3.81° for the left side. No study participants presented with class III canthal tilt. The mean canthal tilt values for those with class I tilt were 3.21°±1.68° for the right side and 3.18°±1.63° for the left side, while, for those who had class II tilt, the values were 9.60°±3.66° for the right side and 9.54°±2.99° for the left side. Conclusion: The presented diagnostic method of orbital dystopia can be used to effectively establish a treatment plan that takes into consideration the patient's skeletal and soft-tissue discrepancies.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.47 no.3
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• pp.197-208
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• 2021

Objectives: The purpose of this retrospective study was to evaluate the variables associated with length of stay (LOS), hospital costs, intensive care unit (ICU) use, and treatment outcomes in patients hospitalized for maxillofacial infections at a tertiary medical center in South Korea. Materials and Methods: A retrospective chart review was conducted for patients admitted for treatment of maxillofacial infections at Dankook University Hospital from January 1, 2011 through September 30, 2020. A total of 390 patient charts were reviewed and included in the final statistical analyses. Results: Average LOS and hospital bill per patient of this study was 11.47 days, and ₩4,710,017.25 ($4,216.67), respectively. Of the 390 subjects, 97.3% were discharged routinely following complete recovery, 1.0% expired following treatment, and 0.8% were transferred to another hospital. In multivariate linear regression analyses to determine variables associated with LOS, admission year, infection side, Flynn score, deep neck infection, cardiovascular disease, admission C-reactive protein (CRP) and glucose levels, number and length of surgical interventions, tracheostomy, time elapsed from admission to first surgery, and length of ICU stay accounted for 85.8% of the variation. With regard to the total hospital bill, significantly associated variables were age, type of insurance, Flynn score, number of comorbidities, admission CRP, white blood cell, and glucose levels, admission temperature, peak temperature, surgical intervention, the length, type, and location of surgery, tracheostomy, time elapsed from admission to first surgery, and length of ICU use, which accounted for 90.4% of the variation. Age and ICU use were the only variables significantly associated with unfavorable discharge outcomes in multivariate logistic regression analysis. Conclusion: For successful and cost-effective management of maxillofacial infections, clinicians to be vigilant about the decision to admit patients with maxillofacial infections, perform appropriate surgery at an adequate time, and admit them to the ICU.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.47 no.1
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• pp.20-24
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• 2021

Objectives: The aim of this study was to evaluate the profile of patients on antiresorptive therapies for cancer treatment and assess presence of oral lesions, oral hygiene status, and knowledge regarding medication-related osteonecrosis of the jaw (MRONJ). Materials and Methods: This was an observational cross-sectional study that evaluated patients treated with antiresorptive medication at a single cancer hospital. Clinical data were collected and oral examination was performed to assess patient oral health. Results: From July 2017 to December 2018, 90 patients were assessed; 64 were female and 26 were male, and the mean age was 61 years. The most common drug was an intravenous bisphosphonate, zoledronic acid. Among the 90 patients, 47 presented with some type of oral disease, isolated or associated. Among these 47 patients, 9 patients (10%) developed osteonecrosis. Oral hygiene was evaluated, and most patients, with or without MRONJ, presented with regular to poor condition. Regarding patient knowledge of the risks of MRONJ and the risks associated with dental surgery, 60% stated that they were not aware of the risks. Conclusion: Identifying the profile of patients and their needs facilitates not only the preventive process, but also the emergence of new therapeutic options. Our study shows that most patients are weakened both by metastatic disease and antineoplastic treatment as well as by issues associated with aging because most were over 60 years of age. Collectively, this information should be considered for management of preventive and therapeutic measures.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.47 no.1
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• pp.25-33
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• 2021

Objectives: Many conditions of the oral and maxillofacial region require hospitalization and in-patient care. The average length of stay (LOS) of these patients varies and is usually affected by multiple confounding variables. However, even with an increasing number of hospital admissions, published evidence on the factors that affect the LOS of oral and maxillofacial patients is lacking. Therefore, this study assessed the LOS of in-patients at the oral and maxillofacial surgery department of a government-funded, multi-specialty hospital in Malaysia, based on their reasons for admission and other factors. Materials and Methods: Our samples were collected retrospectively over a 5-year period and included patients with maxillofacial infections, post-trauma stabilization, facial bone fracture surgery, benign and malignant lesion surgery, dentoalveolar surgery, and other maxillofacial surgeries as reasons for admission. Factors potentially affecting LOS were also recorded, and their significance was determined using multiple logistic regression analyses. A P-value of less than 0.05 was considered to be statistically significant. Results: A total of 1,380 patients were included in this study. Most (84.5%) of our in-patients were of Malay ethnicity, and males outnumbered females in our sample by 502 subjects. The median LOS of our in-patients was 3 days. Sex, ethnicity, age, reason for admission, and American Society of Anesthesiology (ASA) classification were factors that significantly affected LOS. Conclusion: The median LOS reported in this study was 3 days. LOS was significantly affected by sex, ethnicity, age, reason of admission and ASA classification.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.47 no.1
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• pp.34-39
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• 2021

Objectives: The purpose of the study was to assess the occurrence, location, and dimensions of the intraosseous vascular canal in the lateral wall of the maxillary antrum using cone-beam computed tomography (CBCT). Materials and Methods: In this retrospective study, we examined 400 CBCT scans from our archive of patients who had earlier reported to a dental teaching hospital in the United Arab Emirates. The prevalence, location, and dimensions of the lateral antral intraosseous canal (LAIC) in the maxillary antrum were evaluated by 2 examiners using standardised methods. A third examiner was consulted in cases of disagreement. Results: The prevalence of LAIC was 62.3% (249 maxillary antra) among the study population. The mean distance between the most inferior point of the alveolar bone and the inferior border of the LAIC in the posterior maxillary region was 19.83±3.12 mm. There was a significant difference (P=0.05) between the maxillary molar and premolar regions in mean distance from the most inferior point of the alveolar bone and the inferior border of the LAIC. There was no statistically significant difference in mean distance between the most inferior point of the alveolar bone and the inferior border of the LAIC between dentulous and edentulous areas (P=0.1). The G3-intrasinusal type canal less than 1mm in diameter was the most common type of LAIC. Conclusion: This study established the approximate location of the LAIC in a United Arab Emirates cohort, which will assist the oral surgeon in selecting the appropriate site for sinus lift procedures with reduced risk of surgical hemorrhage.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.47 no.1
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• pp.40-46
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• 2021

Marsupialization is widely used as a primary treatment modality for reducing size of large cysts. However, there is no recommendation for specific duration of marsupialization. In addition, Carnoy's solution usually is applied at the time of enucleation as a fixative agent. In this report, we present an appropriate marsupialization duration of ameloblastoma involving two unerupted teeth. In this present study, marsupialization using a Foley catheter was performed in two cases of ameloblastoma of the mandible involving two adjacent impacted teeth. Carnoy's solution was applied for 3-5 minutes after enucleation in both patients. Periodically during marsupialization, the size of the radiolucency was measured in panoramic view, and clinical examination was performed. No remarkable paresthesia or soft tissue injury was observed after application of Carnoy's solution or during follow-up. We recommend 12 to 16 weeks as an adequate marsupialization duration for a large ameloblastoma involving two impacted teeth based on increased radiopacity along the margins of the lesions. Poor oral hygiene was an issue after 12 weeks of marsupialization in one case. There were no remarkable complications with Carnoy's solution in either case. The Foley tube has a two-way system that is more effective for irrigating the cavity than is the conventional one-way system.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.47 no.3
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• pp.216-223
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• 2021

Preoperative patient analysis for oral cancer involves multiple considerations that are based on multiple factors; these include TNM stages, histopathologic findings, and adjacent anatomical structures. Once the decision is made to excise the lesion, the margin of dissection and its extent should be considered along with the best form of reconstruction and airway management. Treatment methods include surgical resection, radiotherapy, and chemotherapy. Although the combined method of treatment is controversial, surgical resection is considered predominantly, and immediate reconstruction after surgical resection follows. The choice of treatment is dictated by the anticipated functional and esthetic results of treatment and also by the availability of a surgeon with the required expertise. Segmental mandibulectomy with primary reconstruction has been shown to have advantages in both functional and esthetic results. A 52-year-old male patient with basaloid squamous cell carcinoma of the floor of the mouth, and the anterior portion of the mandible was treated with surgical procedures that included segmental mandibulectomy with both supraomohyoid neck dissection (SOHND) at Levels I-III and mandible reconstruction with a left fibula free flap. A 55-year-old male patient with clear cell odontogenic carcinoma of the oral cavity underwent segmental mandibulectomy with both SOHND at Levels I-III and mandible reconstruction with a left fibula free flap. The purpose of this study was to review the anatomic and functional results of patients after immediate reconstruction with a fibula free flap following resection of carcinoma in the anterior portion of the mandible and floor of the mouth.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.47 no.4
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• pp.249-256
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• 2021

Objectives: The purpose of this study was to evaluate the postoperative anteroposterior stability and improvements in facial asymmetry after performing LeFort I osteotomy in the maxilla, sagittal split ramus osteotomy (SSRO) and intraoral vertical ramus osteotomy (IVRO) in the mandible, and lateral corticectomy on the IVRO side. Materials and Methods: From July 2009 to October 2018, a retrospective analysis was performed on 11 subjects. Lateral cephalometric radiograph was performed preoperatively (T0), postoperatively (T1), and at 12 months of follow-up (T2), and the B point distance was measured. Posteroanterior cephalometric radiograph was performed preoperatively (S0) and at 12 months of follow-up (S1) and was used to measure five indicators (Ag angle, M-Ag, Co-Ag, Co-Me, and Ag-Me) of facial asymmetry. Results: The B point distances for T0 and T1 were significantly different (P=0.007), whereas those for T1 and T2 were not significantly different (P=0.1). In addition, there was a significant difference between the B point distances of T2 and T0 (P=0.026). Comparison of the facial asymmetry indicators before and after surgery showed a significant difference for all indicators between S0 and S1: the P-values of Ag angle, M-Ag, Co-Ag, Co-Me, and Ag-Me were 0.003, 0.003, 0.008, 0.006, and 0.004, respectively. The Z value was based on negative ranks. Conclusion: There was no significant difference in the B point distances from postoperation to the 12-month follow-up. However, there were significant differences in all five indicators related to facial asymmetry before and after surgery. The values for the five indicators of facial asymmetry all increased postoperatively.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.47 no.4
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• pp.239-248
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• 2021

The paper reviews various classifications and surgical techniques for the treatment of temporomandibular joint ankylosis. PubMed, EBSCO, Web of Science, and Google Scholar were searched using a combination of keywords. Articles related to classification, resection-reconstruction of the temporomandibular joint, and management of airway obstruction were considered and categorized based on the objectives. Seventy-nine articles were selected, which included randomized clinical trials, non-randomized controlled cohort studies, and case series. Though several classifications exist, most classifications are centered on the radiographic extent of the ankylotic mass and do not include the clinical and functional parameters. Hence there is a need for a comprehensive staging system that takes into consideration the age of the patient, severity of the disease, clinical, functional, and radiographic findings. Staging the disease will help the clinician to adopt a holistic approach in treating these patients. Interpositional arthroplasty (IA) results in better maximal incisal opening compared with gap arthroplasty, with no significant difference in recurrent rates. Distraction osteogenesis (DO) is emerging as a popular technique for the restoration of symmetry and function as well as for relieving airway obstruction. IA, with a costochondral graft, is recommended in growing patients and may be combined with or preceded by DO in cases of severe airway obstruction. Alloplastic total joint replacement combined with fat grafts and simultaneous osteotomy procedures are gaining popularity. A custom-made total joint prosthesis using CAD/CAM can efficiently overcome the shortcomings of stock prostheses.