• Maxillofacial Plastic and Reconstructive Surgery
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• 제22권2호
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• pp.191-205
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• 2000

The purpose of this study was undertaken to determine the effects of orthognathic surgery on speech. The hyposis stated herein is that functional behaviors of the dentofacial complex, such as speech production, may be adversely affected by deviations of a structural nature(especially, Class III malocclusion). Twenty adults with Class III malocclusion(13 female and 7 male) were studied preoperative, immediate postoperative and either 6 or 12 months postoperative lateral cephalograms. They had mandibular prognathism and had undergone mandible setback operation. The position of tongue, soft palate(Uvula), hyoid bone, respiratory track width, and pharyngeal depth were assessed on lateral cephalograms with 23 cephalometric variables, ANOVA, Paired t-tests and Pearson's product-moment correlation coefficient tests were used to evalute the operative changes in all cephalometric parameters. A experienced speech and language pathologists performed narrow phonetic transcriptions of tape-recorded words and sentences produced by each of the ninth patients and the recording tapes were analyzed by phonetic computer program(Computerized Speech Lab(CSL) Model 4300BI(U.S.A.)) These judges also recorded their ratings of each patient's overall consonants, hypernasality, hyponasality, and articulation proficiency. The results obtained are as follows; 1. There were significant changes in distance of posterior pharyngeal wall to tongue (TI-TW2, TS-TW3) after the surgery at 6 months postoperatively(each p<0.01 p<0.05). 2. The posterior tongue point(TI, TS, PPT) moved posteriorly after surgery and remained to its changed position at 6 months postoperatively(p<0.05). The displacement of tongue was correlated with the movement of mandibular setback amount(p<0.05). The hyoid bone moved posteriorly superiorly after immediate postoperative period. There was significant changes in hyoid bone movement after immediated postoperative period(p<0.05), but returned to its original position during the follow-up period(p>0.05) 3. The soft palate was displaced posteriorly superiorly after immediated operative period and remained to its changed position at 6 months postoperatively(p<0.05). ANS-PNS-SPT angle increasing, PPU-PPPo distance narrowing was showed after surgery, and remained its appearance 6 months postoperatively(p<0.05). 4. There were significant changes in formant value and squre diagram of vowel sound after the orthognathic surgery and the follow-up period. There were significant changes in /ㅅ/sound and posterior tongue sound. 5. The posterior movement of tongue and the posteriosuperior movement of soft palate was correlated with mandibular setback amount after orthognathic surgery. On the vowel squre diagram, the author found that the place of articulation after operation moved downward, backward, upward. 6. In assessing speech abnormalities, dental occlusion should be considered as a contributing factor. The vast majority of subjects with preoperative misarticulations eliminated or reduced their errors following orthognathic surgery. There was significant difference in speech impovement between pre- and postoperation.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제18권4호
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• pp.607-614
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• 1996

중앙안면골 골절 환자에서 비골 골절과 동반되는 경우가 많으며, 주로 안면골 골절의 정복시 비골도 동시에 정복하지만 여러 가지의 원인에 의하여 이차 비성형술을 시행하여야 하는 경우가 많다. 그러므로 중앙안면골 골절 환자의 초진시 비골 골절에 대한 정확한 진단과 정확한 비골 골절의 정복 그리고 일차 비골 골절의 정복후 이의 적절한 유지와 고정이 중요하지만 이차 비성형술의 가능성에 대비하여야 하며, 일차 비골 골절의 정복시 대칭적인 정복을 시행함으로서 비교적 간단하게 이차 비성형술을 시행할 수 있으리라 생각되었다. 또한 중앙안면골 골절환자에서는 비부의 연조직이나 연골의 이차변형에 의하여 이차 비성형술을 시행할수도 있으므로 일차 수술후 주의깊은 관찰이 요구된다. 이러한 이차 비성형술에는 자가이식재 및 Silicone이나 $Medpore^{(R)}$등이 이용될 수 있으며, 특히 인공이식재의 경우 공여부의 정확한 형성과 적절한 고정이 필수적이며 향후 이러한 인공이식재의 안정성에 대한 더 많은 연구가 이루어져야 할것으로 사료된다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제33권6호
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• pp.490-496
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• 2011

Purpose: Dr. Marquardt made the facial 'phi' mask using golden ratio. Most class III patients have bulky faces and want a smaller face. Using a facial golden mask, this study estimated and compared frontal photographs before and after operation for soft tissue measurement. The golden mask can be considered as a reference tool for facial esthetic analyses especially in lower face. Methods: Forty patients who had undergone orthognathic surgery at Samsung Medical Center from January 2006 to December 2009 were included in this study. These patients had Class III malocclusion. Lateral cephalometric radiographs, frontal clinical photos of pre-op and 8~12 month later post-op, and the facial 'phi' mask using golden ratio, were used for analysis. Reduction of the lower face area, occlusal plane changes, amounts of mandible setback and amounts of maxilla posterior impaction were estimated. Results: Lower facial reduction ratio and mandibular setback amounts were significantly different between 1-jaw and 2-jaw groups. Average postoperative changes in the area of lower face between bilateral sagittal split ramus osteotomy (BSSRO) and BSSRO combined maxilla posterior impaction were compared by using an independent simple t-test and $P$ value was 0.016. Therefore, the lower facial reduction ratio and mandibular setback amount were significantly different in maxilla posterior impaction. Conclusion: The two-jaw surgery group showed more reduction of the lower facial area than the 1-jaw surgery group. The amount of lower facial reduction was more related with the amount of mandibular setback. There was no significant relation in lower facial reduction with amount of maxilla posterior impaction, pre-op occlusal plane, post-op occlusal plane and the mandibular angle. A relationship between the change in the lower facial area and the amount of maxilla posterior impaction or the change of mandibular angle occlusal plane at pre-op could not be found because of the difference in the amount of setback between two groups.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제34권5호
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• pp.311-319
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• 2012

Purpose: The aim of this study is to evaluate the vertical changes of the lip and perioral soft tissue, following orthognathic surgery in skeletal class III patients by a cephalometric analysis of a cone beam computed tomography (CBCT). Methods: A total of 20 skeletal class III patients, who had bimaxillary surgery with Le Fort 1 osteotomy and bilateral sagittal split ramus osteotomy, were included in this study. The surgical plan for maxilla was posterosuperior impaction with the anterior nasal spine, as the rotation center. Further, the surgical plan for mandible was also posterosuperior movement. The soft tissue changes between lateral cephalogram and CBCT were compared. And the correlations between independent variables and dependent variables were evaluated. Results: There were no significant differences of the soft tissues changes between lateral cephalogram and CBCT. Upper lip philtrum length (SnLs), nasolabial angle increased and upper lip vermilion length (LsStms), lower lip length (StmiB'), lower lip vermilion length (StmiLi), lower lip philtrum length (LiB') and soft tissue lower facial height (SnMe') decreased after surgery. Change of SnLs (${\Delta}$SnLs) was influenced by vertical change of menton (${\Delta}$MeV), and change of LsStms (${\Delta}$LsStms) was influenced by upper lip thickness (ULT). Change of StmiLi' (${\Delta}$StmiLi') were influenced by preoperative overjet. Change of StmiB' (${\Delta}$StmiB') were influenced by preoperative overjet, vertical change of lower incisor (${\Delta}$L1V) and horizontal change of posterior nasal spine (${\Delta}$PNSH). Change of LiB' (${\Delta}$LiB') was influenced by ${\Delta}$L1V and ${\Delta}$PNSH. Change of SnMe' (${\Delta}$SnMe') was influenced by ${\Delta}$MeV, horizontal change of upper incisor (${\Delta}$U1H) and horizontal change of lower incisor (${\Delta}$L1H). ${\Delta}$Nasolabial angle was influenced by change of ULT (${\Delta}$ULT). Conclusion: Both soft tissues and hard tissues can be evaluated by CBCT. Posterosuperior rotation of maxillomandibular complex resulted in increase of upper lip philtrum length and nasolabial angle, while the upper lip vermilion length, lower lip philtrum length, lower lip vermilion length, and soft tissue lower facial height showed a decrease.

• Archives of Reconstructive Microsurgery
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• 제14권1호
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• pp.1-13
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• 2005

Purpose: The purpose of this study is to present extended indications for the use of arterialized venous flaps in reconstructing soft tissue, tendon, nerve, blood vessel, and composite tissue defects of the hand of various sizes based on researches and clinical experiences of the authors. Moreover, procedures to achieve complete flap survival and postoperative results are presented. Materials & methods: This study is based on 154 cases of arterialized venous flaps performed to reconstruct the hand during the past 11 years. The most common cause of injury was industrial accidents with 125 cases. One hundred thirty patients or 84% of the cases had emergency operation within 2 weeks of the injury. The flaps were categorized depending on the size of the flap. Flaps smaller than $10\;cm^2$ were classified as small (n=48), those larger than $25\;cm^2$ classified large (n=42) and those in between medium (n=64). Classified according to composition, there were 88 cases (57.1 %) of venous skin flaps, 28 cases of innervated venous flaps, 15 cases of tendocutaneous venous flaps, which incorporated the palmaris longus tendon, for repair of extensor tendons of the fingers, and 17 cases of conduit venous flaps to repair arterial defect. There were 37 cases where multiple injuries to multiple digits were reconstructed. Moreover, there were 6 cases of composite tissue effects that involved soft tissue, blood vessels and tendons. The donor sites were ipsilateral forearm, wrist and thenar area, foot dorsum, and medial calf. The recipient sites were single digit, multiple digits, first web space, dorsum and palm of hand, and wrist. Results: There were seven cases (4.5%) of emergent re-exploration due to vascular crisis, and 3 cases of flap failure characterized by more than 50% necrosis of the flap. The survival rate was 98.1 % (151/154). In small flaps, an average of 1.01 afferent arteries and 1.05 efferent veins were microanastomosed, and in large flaps, an average of 1.88 afferent arteries and 2.19 efferent veins were anastomosed. In 8 cases where innervated flaps were used for reconstructing the palm of the hand, the average static two-point discrimination was $10\;(8{\sim}15)\;mm$. In 12 cases where tenocutaneous flaps were used, active range of motion at the proximal interphalangeal joint was 60 degrees, 20 degrees at the distal interphalangeal joint, and 75 degrees at the metacarpophalangeal joint. Conclusion: We conclude that the arterialized venous flap is a valuable and effective tool in the reconstruction of hand injuries, and could have a more comprehensive set of indications.

• Archives of Reconstructive Microsurgery
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• 제19권1호
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• pp.37-45
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• 2010

Purpose: First introduced by Buncke and Rose in 1979, the neurovascular partial $2^{nd}$ toe pulp free tissue transfer has been attempted to reconstruct posttraumatic finger tip injuries. Although some surgeons prefer other reconstructive methods such as skin graft and local flap, we chose the partial $2^{nd}$ toe pulp flap owing to its many advantages. We report three successful surgical cases in which the patients had undergone this particular method of reconstruction. Methods: We retrospectively examined three cases of fingertip injury patients due to mechanical injury. Bone exposure was seen in all three cases, All had undergone partial toe pulp free flap for soft tissue defect coverage. Results: All flaps survived without any complications such as partial necrosis, hematoma or dehiscence. Although tingling sensation has returned in both cases, two-point discrimination has not returned yet. Currently no patient is complaining of any pain which gradually improved during their course of recuperation. All stitches were removed on postoperative 2 weeks. Patients are satisfied with the final surgical result and there are no signs of any edema or hematoma. Conclusion: The homodigital reconstruction of finger tip injury using the partial $2^{nd}$ toe pulp flap has numerous advantages compared to other reconstructive modalities such as its resistance to wear and tear and in that it provides a non-slip palmar digital surface. However it requires microsurgery which may not be preferred by surgeons. Advanced age of the patient can be a relative contraindication to this approach since atheromatous plaque from the donor toe can compromise flap circulation after surgery. We report three successful cases which patient age was considered appropriate. Further investigation with a larger number of cases and long term follow-up is deemed necessary.

• Archives of Reconstructive Microsurgery
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• 제7권2호
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• pp.135-145
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• 1998

In 1980 Morrison and O'Brien reported their experiences about the reconstruction of amputated thumb using wrap-around neurovascular free flap from the great toe with a nonvascularized iliac bone graft. From then it has been considered to be a good reconstructive procedure for the amputated thumb, but it's indication has been limited distal to the metacarpophalangeal(MP) joint. We have performed 37 cases of wrap-around free flap from the great toe for the reconstruction of thumb amputated at distal or proximal to the MP joint and investigated their functional results according to the level of amputation. Level of amputation was distal to the MP joint in 25 cases and proximal to it in 12 cases. Pinching and grasping power, two point discrimination and the amount of opposition to the other fingers were compared to the uninjured hand. Pinching and grasping power were not significantly different according to the level of amputation but the amount of two point discrimination was significantly high in the cases amputated proximal to the MP joint. The opposition of reconstructed thumb to the other fingers was completely possible in all cases amputated distal to the MP joint. In 12 cases amputated proximal to the MP joint of the thumb, opposition was completely possible in 6 cases in which the iliac bone block was fixated in the position of $30^{\circ}$ flexion and $45^{\circ}$ internal rotation but in 6 cases in the fixation of $30^{\circ}$ flexion and $30^{\circ}$ internal rotation, the opposition of reconstructed thumb to the ring and little fingers were impossible in 5 cases and only to the little finger in 1 case. In this study, we concluded that even if amputation proximal to the MP joint, it is no more contraindication of the wrap-around free flap procedure for thumb reconstruction, however in these cases we recommend iliac bone block fixation in the position of $30^{\circ}$ flexion and $45^{\circ}$ infernal rotation for the better functional outcome.

• Archives of Reconstructive Microsurgery
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• 제15권1호
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• pp.17-25
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• 2006

Twelve cases in eleven patients with segmental bone defects were treated with contralateral fibula free flap and ipsilateral island fibula flap in an antegrade, retrograde or bidirectional flow fashion. Five cases were managed with free flaps and seven were with ipsilateral fibula island transfer. Among seven cases, antegrade fashion was three, retrograde was three, and bidirectional was one. All patients were related with open tibial fractures and its sequelae except one who had open foot bone fracture. According to Gustilo's classification, ten patients were type IIIb and one was type IIIc. Basically, antegrade-flow flaps based on the peroneal vessels as in the conventional free flap were used for the proximal or middle one-third tibial defects. On the contrary, retrograde-flow flaps based on the communicating branch between the peroneal and posterior tibial vessels were used for the middle or distal one-third of the tibia. Bidirection-flow flap based on intact peroneal vessels were used for the middle portion of the tibia. The patients who have undergone ipsilateral fibula island flap had one of the following problems: a previously failed free flap, below-knee amputation of the opposite leg because of open tibial fracture, refusal to use the contralateral sound leg, or poor general condition to stand a lengthy operation. Six of the patients who have got ipsilateral fibula island flap also had an associated fibula fracture on the same leg, which was ultimately used as one of the osteotomy sites. The follow-up period was from 1 to 10 years. Two cases of free flap were failed: one patient had below-knee amputation and the other patient had ipsilateral fibula transfer. Other cases were successful and excellent hypertophy of the transferred fibula was achieved. Time to bone union ranged from 4 to 11 months. Time to full weight bearing was from 5 to 13 months after surgery. All of the transferred fibulas showed hypertrophy after weight bearing. In one case, stress fracture was developed during ambulation, which was healed conservatively. Nonunion occurred in two cases, which were treated with a long leg cast and cancellous bone graft, respectively. Length discrepancy of the legs was noted. The limb was shorter by an average 0.5 cm in three cases, longer by 1.1 cm in one case. In the case of island fibula transfer, limited arc of rotation was not a problem. Other disabling complications were not seen. We believe that these diverse modalities using a vascularized fibula will make us more comfortable to handle major bone defects.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제20권4호
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• pp.284-290
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• 1998

The purpose of this study was to assess the soft tissue changes using twenty skeletal class III malocclusion patients who treated with bimaxillary surgery for the correction of dentofacial deformities. Patients were divided into two groups. One was impaction and advancement of maxilla with mandibular set-back (Group 1), the other was downward and advancement of maxilla with mandibular set-back (Group 2). Preoperative and postoperative one year cephalometric data were analyzed and compared. Results obtained were as follows: 1. The ratio of horizontal changes of soft tissue to hard tissue at Nt to ANS, Ls to UI, Li to LI, sPog to Pog were 1:0.60, 1:0.79, 1:0.47, 1:0.63 in group 1 respectively, and 1:0.59, 1:0.48, 1:0.83, 1:1.09 in group 2 respectively. Soft tissue changes were highly predictable at the upper lip, lower lip, and chin area. 2. The ratio of vertical changes of soft tissue to hard tissue at Nt to ANS, Li to LI were 1:0.72, 1:0.06 in group 1, and others showed no statistically significant difference. 3. The ratio of horizontal changes of Ls to hard tissue movements at LI(h) was 1:-0.82 in group 1 and at UI(h), LI(h) were 1:0.48, 1:0.01 in group 2. These ratios of group 1 were greater than those of group 2. 4. The direction of horizontal change of Li was the same as that of hard tissue change. The ratio of horizontal changes of Li to LI was 1:0.47 in group 1 and others showed no statistically significant difference. 5. The changes of upper lip thickness and length were -1.6mm, -1.4mm in group 1, and -1mm, -2.7mm in group 2. 6. The ratios of thickness of upper lip to ANS, UI, LI were 1:-0.83, 1:-0.37, 1:0.11 in group 1. There was similar trend in group 2, and there were no statistically significant difference. These results suggest that prediction of changes in soft tissue of upper lip, lower lip, and chin were 79%, 47%, and 63% in group 1, and 48%, 83%, and 109% in group 2. There was a tendency to decrease in thickness and increase in length of the upper lip.

• Journal of Chest Surgery
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• 제39권10호
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• pp.775-778
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• 2006

비후형 심근증은 심근의 부적절한 비대로 유발되며 호흡곤란, 흉통, 실신, 그리고 급사에 이르기까지 다양한 임상 양상을 보인다. 이러한 증상은 주로 좌심실유출로의 협착으로 인해 발생하며 이를 해결하기 위해 심실중격절제술이 고안되었다. 하지만 기존의 고전적인 중격절제슬은 대동맥절개술을 통해 진행되었으며, 이는 심실 중격의 중앙부위에 병변이 존재할 경우 시야 확보의 어려움과 병변으로의 접근이 용이하지 않아 극히 일부분의 심실중격절제술만을 시행할 수밖에 없었다. 따라서 좌심실 유출로의 협착 및 승모판막의 수축기전방운동 등이 완벽하게 해결되지 않는 경우가 흔하였고 이러한 경우 환자의 증상 호전과 생존기간의 연장에도 한계가 있었다. 본 증례에서는 이러한 환아에게서 좌심실 심첨부의 절개를 통해 비후된 유두근과 건삭을 포함한 광범위 중격절제술(extended septal myectomy)을 시행하였다. 수술 후 환아의 증상은 호전되었으며 심초음파 및 방사선학적 소견상 특별한 문제없이 10개월째 외래 경과 관찰 중이다.