• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.38 no.3
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• pp.139-144
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• 2012

This study was performed in order to evaluate the occurrence of temporomandibular joint disorder after surgical correction of skeletal class II malocclusion. Materials and Methods: This study included 21 patients who underwent orthognathic surgery for the correction of dentofacial deformities by a single surgeon at Mokdong Hospital, Ewha Womans University from 2000 to 2010. They underwent bilateral sagittal split ramus osteotomy for the treatment of undesirable mandibular advancement. The temporomandibular disorder (TMD) symptoms prior to surgery were recorded and the radiographic evaluation (panorama, bone scan, and magnetic resonance imaging [MRI]) of the post-surgery temporomandibular joint (TMJ) were assessed in order to evaluate condylar resorption, remodeling and disc displacement. The minimum follow-up period, including orthodontic treatment, was 12 months. Orthognathic procedures included 1-jaw surgery (n=8 patients) and 2-jaw surgery (n=13 patients). The monocortical plate was used for bilateral sagittal split ramus osteotomy fixation. Results: Among class II malocclusion patients with TMD symptom, clicking improved in 29.1%, and maximum mouth opening increased from $34.5{\pm}2.1$ mm to $37.2{\pm}3.5$ mm. The differences were not statistically significant, however. Radiographic changes in bone scan improved slightly based on the report by radiologist but not in TMJ dynamic MRI. Conclusion: No particular improvements were found in patients with joint sound only. Patients with limitation of mouth opening showed an increase in the degree of opening, but the difference was not statistically significant (P>0.05).

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.40 no.1
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• pp.11-16
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• 2014

Objectives: The aim of this study was to evaluate the pattern of lingual split line when performing a bilateral sagittal split osteotomy (BSSO) for asymmetric prognathism. This was accomplished with the use of cone-beam computed tomography (CBCT) and three-dimensional (3D) software program. Materials and Methods: The study group was comprised of 40 patients (20 males and 20 females) with asymmetric prognathism, who underwent BSSO (80 splits; n=80) from January 2012 through June 2013. We observed the pattern of lingual split line using CBCT data and image analysis program. The deviated side was compared to the contralateral side in each patient. To analyze the contributing factors to the split pattern, we observed the position of the lateral cortical bone cut end and measured the thickness of the ramus that surrounds the mandibular lingula. Results: The lingual split patterns were classified into five types. The true "Hunsuck" line was 60.00% (n=48), and the bad split was 7.50% (n=6). Ramal thickness surrounding the lingual was $5.55{\pm}1.07$ mm (deviated) and $5.66{\pm}1.34$ mm (contralateral) (P =0.409). The position of the lateral cortical bone cut end was classified into three types: A, lingual; B, inferior; C, buccal. Type A comprised 66.25% (n=53), Type B comprised 22.50% (n=18), and Type C comprised 11.25% (n=9). Conclusion: In asymmetric prognathism patients, there were no differences in the ramal thickness between the deviated side and the contralateral side. Furthermore, no differences were found in the lingual split pattern. The lingual split pattern correlated with the position of the lateral cortical bone cut end. In addition, the 3D-CT reformation was a useful tool for evaluating the surgical results of BSSO of the mandible.

• Journal of The Korean Dental Society of Anesthesiology
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• v.12 no.3
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• pp.173-176
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• 2012

Certain oral procedures require a sedated patient who is responsive to allow for the mouth opening and position change. Dexmedetomidine is a relatively selective alpha2-adrenoceptor agonist with sedative, analgesic, amnestic, and anesthetic-sparing effects. Large dose dexmedetomidine is suitable as a single agent for sedation and anxiolysis for plate removal in a patient with bilateral sagittal split osteotomy and Lefort 1 osteotomy with genioplasty.

• Journal of Dental Anesthesia and Pain Medicine
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• v.21 no.2
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• pp.167-171
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• 2021

We describe the successful insertion of a nasotracheal tube following repeated cuff rupture. The patient was a 55-year-old woman with a history of nasal trauma and multiple rhinoplasties, who underwent elective Lefort I osteotomy and bilateral sagittal split osteotomy for correction of skeletal facial deformity. During fiberoptic bronchoscope-guided nasal intubation after the induction of general anesthesia, the tracheal tube repeatedly ruptured in both nares, despite extensive preparation of the nasal airways. We covered the cuff with a one-inch tape, intubated to the level of the oropharynx, pulled the tracheal tube out through the mouth, and removed the tape. The tracheal tube was then backed out to the level of the uvula, and was successfully advanced.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.22 no.4
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• pp.411-419
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• 2000

Purpose: This study was aimed at analysis of the changes in the condyle position in subjects with mandibular setback osteotomies Method: Twenty patients were evaluated retrospectively for their changes in the condyle position who underwent surgical mandibular setback using bilateral sagittal split osteotomies with a manual condyle repositioning technique and rigid fixation. The cephalometric and panoramic analysis was performed preoperatively, 1 week, 6 months, and 1 year postoperatively. And postoperative noise, temporomandibular joint pain, and mouth opening were clinically examined 2 months, 4 months, 6 months, 8 months, 10 months, and 12 months postoperatively. Result: The condyles rotated posteriorly and laterally immediately after surgery, and they returned to the preoperative position during follow-up period but it is not significant. The statistical analysis (Paired t-test) showed no significant effects in postsurgical stability. The changes in the condyle position didn't have a significant harmful influence on temporomandibular joint disorder. Conclusion: A careful surgical mandibular setback using manual condyle repositioning and fixation technique will move condyle minimally and that will decrease the relapse and temporomandibular joint disorder.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.39 no.5
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• pp.217-223
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• 2013

Objectives: Buccal fracture of the mandibular proximal bone segment during bilateral sagittal split ramus osteotomy (SSRO) reduces the postoperative stability. The primary aim of this study is to evaluate the effect of this type of fracture on bone healing and postoperative stability after mandibular setback surgery. Materials and Methods: Ten patients who experienced buccal fracture during SSRO for mandibular setback movement were evaluated. We measured the amount of bone generation on a computed tomography scan, using an image analysis program, and compared the buccal fracture side to the opposite side in each patient. To investigate the effect on postoperative stability, we measured the postoperative relapse in lateral cephalograms, immediately following and six months after the surgery. The control group consisted of ten randomly-selected patients having a similar amount of set-back without buccal fracture. Results: Less bone generation was observed on the buccal fracture side compared with the opposite side (P<0.05). However, there was no significant difference in anterior-posterior postoperative relapse between the group with buccal fracture and the control group. The increased mandibular plane angle and anterior facial height after the surgery in the group with buccal fracture manifested as a postoperative clockwise rotation of the mandible. Conclusion: Bone generation was delayed compared to the opposite side. However, postoperative stability in the anterior-posterior direction could be maintained with rigid fixation.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.40
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• pp.36.1-36.5
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• 2018

Background: Botulinum toxin-A (BTX-A) injection into muscle reduces muscular power and may prevent post-operative complication after orthognathic surgery. The purpose of this study was (1) to evaluate BTX-A injection into the masseter muscle on the prevention of plate fracture and (2) to compare post-operative relapse between the BTX-A injection group and the no injection group. Methods: Sixteen patients were included in this study. Eight patients received BTX-A injection bilaterally, and eight patients served as control. All patients received bilateral sagittal split ramus osteotomy for the mandibular setback and additional surgery, such as LeFort I osteotomy or genioplasty. Post-operative plate fracture was recorded. SNB angle, mandibular plane angle, and gonial angle were used for post-operative relapse. Results: Total number of fractured plates in patients was 2 out of 16 plates in the BTX-A injection group and that was 8 out of 16 plates in the no treatment group (P = 0.031). However, there were no significant differences in post-operative changes in SNB angle, mandibular plane angle, and gonial angle between groups (P > 0.05). Conclusions: BTX-A injection into the masseter muscle could reduce the incidence of plate fracture.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.33 no.3
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• pp.276-280
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• 2011

BSSRO (bilateral sagittal split ramus osteotomy) is an effective surgical method for maxillofacial deformities. Rigid fixation using a plate and screws can stabilize bony segments and induce early mouth opening. Though this procedure has a low complication rate, normal function and esthetic recovery is achieved through proper and early management of the complications. Complications consisting of temporomandibular disorders, sensory disturbances due to inferior alveolar nerve damage, open bite, malunion or nonunion, and facial nerve palsy occur, but these rarely develop. Facial nerve palsy causes the muscles involved in facial expression to depress, which results in ocular dryness or retinal damage. When facial nerve palsy develops, early management involving steroid medication and physical therapy is effective. In the case of severe damage, surgical intervention should be considered. A 20-year-male patient came to the oral and maxillofacial surgery department for orthognathic surgery. The mandible was set back by BSSRO under general anesthesia. Facial nerve palsy was observed on the left side of the face: steroid and vitamins were administered early and physical therapy was performed daily. These forms of management can aid in function and allow for gradual esthetic recovery. Presumed causes were excessive soft tissue retraction or soft tissue injury by the osteotome at the horizontal osteotomy of the ramus. Careful dissection, retraction and a precise osteotomy are needed for protection of the facial nerve. If nerve damage is observed, early management can help in the recovery of facial nerve function and esthetics.

• Journal of Dental Anesthesia and Pain Medicine
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• v.15 no.2
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• pp.101-103
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• 2015

In oral and maxillofacial surgery, many complications associated with nasotracheal tube can be caused. In this case, we reported ballooning tube damage of nasotracheal tube during orthognathic double-jaw surgery and replacement of tube through cut down of tube and tube exchange using airway exchange catheter. The patient scheduled for high Le Fort I osteotomy and bilateral sagittal split osteotomy was intubated nasotracheally with nasal endotracheal tube. During maxilla osteotomy, air bubble was detected in the oral blood. In spite of our repeated ballooning, the results were the same so we changed damaged tube using airway exchange catheter aseptically. Tiny and superficial cutting site was detected in the middle of pilot tube. As we know in our case, tiny injury impeded a normal airway management and prevention is important.

• The Journal of Advanced Prosthodontics
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• v.3 no.1
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• pp.51-55
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• 2011

BACKGROUND. Mandibular displacement is a common complication of condylar fracture. In the mandibular displacement due to condylar fracture, it is difficult to restore both esthetics and function without using orthognathic surgery. CASE DESCRIPTION. This clinical report described a full mouth rehabilitation in the patient with bilateral condylar fractures and displaced mandible using bilateral sagittal split ramus osteotomy (BSSRO) and simultaneous dental implant surgery. Mandibular position was determined by model surgery through the diagnostic wax up and restoration of fractured teeth. The precise amount of the mandibular shift can be obtained from the ideal intercuspation of remaining teeth. CLINICAL IMPLICATION. Mandibular displacement by both condylar fractures can be successfully treated by orthognathic surgery. Determination of occlusal plane and visualization from diagnostic wax up are mandatory for mandibular repositioning of model surgery. Stable occlusion and regular recall check up are needed for long-term outcome.