• 대한치과교정학회지
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• 제23권4호
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• pp.707-724
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• 1993

The purpose of the study is to estimate hard and soft tissue changes after orthognathic surgery for the correction of the mandibular prognathism and to describe interrelationship and ratios of soft and hard tissue changes. The presurgical and postsurgical lateral cephalograms of 31 treated patients(17 males and 14 females) was used ; these patients had received combined orthodontic-surgical treatment by means of a bilateral sagittal split ramus osteotomy. Their ages ranged from 16 to 31 years and mean age was 21.4 years. A computerized cephalometric appraisal was developed and used to analyse linear and angular changes of skeletal and soft tissue profile. The statistical elaboration of the data was made by means of $SPSS/PC^+$. The results of the study were as follows : 1. The correlations of soft and hard tissue horizontal changes were significantly high and the ratios were $97\%$ at LI, $107\%$ at ILS, and $93\%$ at Pog'. 2. The correlations of vertical changes at Stm, LI and horizontal changes at Pog were high$(26\%)$ and at the other areas were not statistically high. 3. The correlations of soft ad hard tissue vertical changes were not significantly high in all areas except Gn' $(30\%)$ and Me' $(56\%)$. 4. The soft tissue thickness was significantly decreased in upper lip and increased in lower lip, and the amount of changes after surgery was reversely correlated with initial thickness. 5. The facial convexity was increased and relative protrusion of upper lip was increased and that of lower lip was decreased. 6. The upper to lower facial height(Gl-Sn/Sn-Me') was increased and upper to lower jaw height(Sn-Stms/Stmi-Me') was increased.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제41권5호
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• pp.224-231
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• 2015

Objectives: The purpose of this study was to evaluate changes in the pharyngeal airway space and hyoid bone position after mandibular setback surgery with bilateral sagittal split ramus osteotomy (BSSRO) and to analyze the correlation between the amount of mandibular setback and the amount of change in pharyngeal airway space or hyoid bone position. Materials and Methods: From January 2010 to February 2013, a total of 30 patients who were diagnosed with skeletal class III malocclusion and underwent the same surgery (BSSRO) and fixation method in the Division of Oral and Maxillofacial Surgery, Department of Dentistry at the Ajou University School of Medicine (Suwon, Korea) were included in this study. Lateral cephalograms of the 30 patients were assessed preoperatively (T1), immediately postoperatively (T2), and 6 months postoperatively (T3) to investigate the significance of changes by time and the correlation between the amount of mandibular setback and the amount of change in the airway space and hyoid bone position. Results: Three regions of the nasopharynx, oropharynx, and hypopharynx were measured and only the oropharynx showed a statistically significant decrease (P<0.01). A significant posterior and inferior displacement of the hyoid bone was found 6 months after surgery (P<0.01). Analysis of the correlation between the amount of mandibular setback and the amount of final change in the airway space and hyoid bone position with Pearson's correlation showed no significant correlation. Conclusion: In this study, the oropharynx significantly decreased after mandibular setback surgery, and changes in the surrounding structures were identified through posteroinferior movement of the hyoid bone during long-term follow-up. Therefore, postoperative obstructive sleep apnea should be considered in patients who plan to undergo mandibular setback surgery, and necessary modifications to the treatment plan should also be considered.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제31권2호
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• pp.158-166
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• 2009

The application of CT with basis on 3 dimensional-reconstruction is getting more widely practiced. With the data obtained from cone-beam computed tomography(CBCT), not only the diagnosis of the patient with skeletal abnormality but also the virtual simulation of the orthognathic surgery were performed and its application would be popular in orthodontic field. We reported a case, a 19-year old man who was diagnosed mandibular prognathism and required orthognatic surgery. In this case, the virtual orthognathic surgery was simulated and surgical wafer was fabricated by using CBCT data. That wafer was applied the actual orthognathic surgery. After preoperative orthodontic treatment, we prepared surgery as follows. : (l)Acquisition of 3D image data, (2)Reconstruction of 3-dimensional virtual model, (3)Virtual model surgery, (4)Extraction of stere-olithographic image, (5)Check-up for occlusal interference, (6)Fabrication of surgical stent by stereolithography. Bilateral sagittal split ramus osteotomy was operated and used stereolithographic surgical stent. 1 month later, we superimposed CBCT datas of virtual surgery and that of actual surgery, and then compared the result. CT data's application for othognathic surgery yielded satisfactory outcomes.

• Journal of Yeungnam Medical Science
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• 제12권2호
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• pp.393-399
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• 1995

심한 하악 후퇴증은 교정치료만으로 성공적인 결과를 얻을 수 없으며 골절단술, 이부성형술등 외과적 교정이 고려되어야 한다. 설골상근의 장력에 의한 회귀현상을 최소화하기 위해 수술시 하악 체부를 전방회전시킴과 동시에 가능한 전방으로 overcorrection한다. 저자등은 구미인에 비해 발생빈도가 적은 하악 후퇴증을 주소로 내원한 환자를 양측성 하악골 시상절단술과 이부 성형술을 통하여 만족할만한 안모개선 및 교합관계 개선을 이루었기에 이에 보고하는 바이다.

• 대한치과교정학회지
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• 제29권4호
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• pp.457-466
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• 1999

하악 후퇴술 후의 골격성 재발과 치열 변화는 악간고정(intermaxillary fixation, IMF)제거 후 뿐만 아니라 악간고정기간 중에도 일어난다고 보고되고 있다. 악간고정기간 중에 일어나는 골격성 재발에 따른 골편간 견고한 융합의 방해, 보상성 치아이동, 전치부 개방교합 등과 같은 여러 가지 부작용은 술후 교정치료에 많은 영향을 미칠 수 있으므로 임상적으로 중요한 의미를 갖는다. 본 연구는 악간고정기간 중에 일어나는 골격성 재발과 치열의 변화를 알아보고자 시행하였으며, 하악전돌증의 치료를 위해서 양측성 하악지 시상분할골절단술(bilateral sagittal split ramus osteotomy, BSSRO)과 강선고정 (wire fixation), 악간고정을 시행한 28명을 대상으로 하였다. 본 연구에서는 측모 두부 방사선 사진을 통하여 수술에 의한 골편들의 이동량과 방향, 악간고정기간 중의 골격성 재발과 치열 변화의 양과 방향을 측정하였다. 또한 수술에 의한 골편들의 이동과 골격성 재발과의 상관관계, 골격성 재발과 치열 변화간의 상관관계를 평가하였다. 본 연구를 통하여 다음과 같은 결론을 얻었다. 1. 수술에 의한 골편의 이동방향은 원심골편은 후상방으로, 근심골편은 시계방향으로 회전하였다. 2. 악간고정기간 중에 원심골편의 전방부는 후방 변위, 후방부는 상방 변위하였으며 근심골편은 상방 변위와 함께 근심골편의 gonion(p-Go)부위는 전방 변위를 하였다. 악간고정기간중에 근심골편의 gonion(p-Go)의 전방 변위는 수술에 의한 근심골편의 gonion (p-Go)의 후방으로의 이동량과 유의한 상관관계를 보였다. 즉, 수술에 의한 근심골편의 gonion(p-Go)의 후방으로의 이동이 많을수록 악간고정기간 중의 근심골편의 gonion(p-Go)의 전방 변위는 증가하였다. 3. 악간고정기간 중에 수평피개, 수직피개는 변화가 없었다. 상악 전치부는 후방경사(retroclination), 하악 전치부는 후방경사, 정출이 일어났으며, 이러한 보상성 치아이동은 악간고정기간 중의 근심골편의 gonion(p-Go)의 상방 변위와 유의한 상관관계를 보였다. 즉, 악간고정기간 중의 근심골편의 gonion(p-Go)의 상방 변위가 클수록 보상성 치아 이동량도 증가하였다.

• 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.

• 대한구순구개열학회지
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• 제8권2호
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• pp.71-79
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• 2005

Purpose: Maxillary hypoplasia is a common developmental problem of cleft lip and palate. Fair results with distraction osteogenesis have been reported especially when these patients need a large amount of maxillary advancement, instead of orthognathic surgery. The purpose of this study is to evaluate the clinical results with a relatively new distractor, $TS-MD^{(R)}$ (Trans-sinusoidal maxillary distractor, KLS Martin, Tuttlingen, Germany) which was used for the advancement of the maxilla in the cleft patients. Patients and Method: Distraction osteogenesis using $TS-MD^{(R)}$ was performed for four CLP patients (three males and one female) who had maxillary hypoplasia. All patients were over 16 years old. As three patients showed mandibular prognathism as well, bilateral sagittal split ramus osteotomy for mandibular setback was performed at the same time. After consolidation periods of 4 to 12 weeks, the distraction devices were removed and miniplates were placed for simultaneous internal fixation. Results: Three patients showed a large amount of incisal overbite but one patient did not have sufficient maxillary advancement. Le Fort I osteotomy, maxillary advancement and internal fixation should have been performed for the patient when removing the distraction devices. Different from the $clinician{\box}s$ expectation, the amount of maxillary advancement using $TS-MD^{(R)}$ was not sufficient, although the device has rigid mechanical property. Rotation of maxilla during distraction forward and downward was also observed. Conclusion: Even though the maxillary advancement with $TS-MD^{(R)}$ device could be achieved, the clinical control of some characteristics related with the device was necessary. More clinical studies on $TS-MD^{(R)}$ should be performed.

• 대한치과의사협회지
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• 제47권11호
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• pp.750-757
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• 2009

Purpose : The purpose of this study is to evaluate the clinical availability of submentoplasty for esthethic improvement of the cervico-facial region of patients with obtuse chin-neck angle. Materials and methods : Case 1. We evaluate the changes of submental line length and chin-neck angle of 35-year-old woman with skeletal Class III and mandibular excess with excessive submental fat before and after surgery: Bilateral sagittal split ramus osteotomy(BSSRO) setback(5mm), Mandibular Angle Reduction, Reduction Malarplasty and Submentoplasty. In this case, It was done simultaneously with orthognathic surgery. Case 2. The changes of submental line length and chin-neck angle of 20-year-old man with skeletal class III and maxillary defiency were evaluated before surgery, at first surgery : Lefort I osteotomy(6mm posterior Impaction), BSSRO setback(9mm), Paranasal Augmentation and at second surgery: genioplasty(6mm advanced) with submentoplasty. In this case, submentoplasty and advancement genioplasty were done after 2 months post-operative periods. Results : Case 1. In case of the Skeletal Class III mandibular excess with submental fat deposit, It showed the improvement of submental angle and length of submental line after simultaneous submentoplasty. Submental angle is changed from $177^{\circ}$ (pre-op) to $151^{\circ}$ (post-op) and submental line length is changed from 8mm(pre-op) to 36mm(post-op). Case 2. The improvement of submental angle and length of submental line after delayed submentoplasty was aquired in case of the skeletal class III maxillary defiency. Submental angle is changed from $154^{\circ}$ (pre-op) to $161^{\circ}$ (first surgery) and to $153^{\circ}$ (second surgery) and submental line length is changed from 25mm(pre-op) to 19mm(first surgery) and to 23mm(second surgery). Conclusion : The results suggest that Submentoplasty is useful surgical procedure for esthethic improvement of the cervicofacial region of patients with obtuse chin-neck angle.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제23권1호
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• pp.48-58
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• 2001

After performing mandibular setback surgery, we found some changes in patterns and organs of speech. This investigation was undertaken to investigate the aspect and degree of speech patterns according to the amount of surgical setback in mandibular prognathic patients. Thirteen patients with skeletal Class III malocclusion were studied preoperative and postoperative over 6 months. They had undergone the mandible setback operation via bilateral sagittal split ramus osteotomy(BSSRO). We split the patients into two groups. Group 1 included patients whose degree of mandibular setback was 6mm or less, and Group 2 above 6mm. Control group was two adults wish normal speech patterns. A phonetician performed narrow phonetic transcriptions of tape-recorded words and sentences produced by each of the patients and the acoustic characteristics of the plosives, fricatives, and flaps were analyzed with a phonetic computer program (Computerized Speech Lab(CSL) Model 4300B(USA)). The results are as follows: 1. Generally, Patients showed longer closure duration of plosives, shorter VOT(voice onset time) and higher ratio of closure duration against VOT. 2. Patients showed more frequent diffuse distribution than the control group in frication noise energy of fricatives. 3. In fricatives, frequency of compact from were higher in group 1 than in group 2. 4. Generally, a short duration of closure for /ㄹ/ was not realized in the patient's flaps. Instead, it was realized as fricatives, sonorant with a vowel-like formant structure, or trill type consonant. 5. Abnormality of the patient's articulation was reduced, but adaptation of their articulation after surgery was not perfect and the degree of adaptation was different according to the degree of surgical setback.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제35권2호
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• pp.82-87
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• 2013

Purpose: This study evaluated postoperative maxillary stabilities in patients with skeletal Class III malocclusion who were taken both maxillary advancement surgery and mandibular retrusive surgery, using Le Fort I osteotomy, through three-dimensional computed tomography. Methods: We selected 14 patients who were taken postoperative three-dimensional computerized tomography at the time before surgery, immediately after surgery, six months after surgery among the patients undergone both maxillary advancement surgery using Le Fort I osteotomy and mandibular retrusive surgery using bilateral sagittal split ramus osteotomy. We measured and compared the vertical distance of A-point and posterior nasal spine (PNS), the horizontal distance of A-point and PNS in transverse plane and coronal plane of the three-dimensional reconstructed images, respectively. Results: In transverse plane, the distance difference between immediately after surgery ($S_1$) and immediately before surgery ($S_0$) of A-point was $-0.04{\pm}1.80$ mm, $S_2$ and $S_0$ was $-0.15{\pm}1.69$ mm, and between $S_1$ and $S_2$ was $0.11{\pm}0.58$ mm. There were no significant differences between these data (P>0.05). In transverse plane, the distance between $S_1-S_0$ of PNS was $-3.87{\pm}2.37$ mm, $S_2-S_0$ of PNS was $-3.79{\pm}2.39$ mm, and $S_1-S_2$ of PNS was $-0.08{\pm}0.18$ mm. There were significant differences between these data (P<0.05). In coronal plane, the distance between $S_1-S_0$ of A-point was $3.99{\pm}0.86$ mm, $S_2-S_0$ was $3.57{\pm}1.09$ mm, and $S_1-S_2$ was $0.42{\pm}0.42$ mm. There were significant differences between these data (P<0.05). In coronal plane, the distance between $S_1-S_0$ of PNS was $3.82{\pm}0.96$ mm, $S_2-S_0$ was $3.43{\pm}0.91$ mm, and $S_1S_2$ was $0.39{\pm}0.49$ mm. There were significant differences between these data (P<0.05). In transverse plane, it was estimated that PNS has no statistical postoperative stability in the same direction. In coronal plane, it was estimated that both A-point and PNS had no statistical postoperative stability (P<0.05). Conclusion: Clinically, the operation plan needs to take into account of the maxillary relapse.