• 대한치과교정학회지
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• 제49권1호
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• pp.3-11
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• 2019

Objective: The purpose of this study was to investigate the influence of heritability on the craniofacial soft tissue cephalometric characteristics of monozygotic (MZ) twins, dizygotic (DZ) twins, and their siblings (SIB). Methods: The samples comprised Korean adult twins and their siblings (mean age, 39.8 years; MZ group, n = 36 pairs; DZ group, n = 13 pairs of the same gender; and SIB group, n = 26 pairs of the same gender). Thirty cephalometric variables were measured to characterize facial profile, facial height, soft-tissue thickness, and projection of nose and lip. Falconer's method was used to calculate heritability (low heritability, $h^2$ < 0.2; high heritability, $h^2$ > 0.9). After principal components analysis (PCA) was performed to extract the models, we calculated the intraclass correlation coefficient (ICC) value and heritability of each component. Results: The MZ group exhibited higher ICC values for all cephalometric variables than DZ and SIB groups. Among cephalometric variables, the highest ${h^2}_{(MZ-DZ)}$ and ${h^2}_{(MZ-SIB)}$ values were observed for the nasolabial angle (NLA, 1.544 and 2.036), chin angle (1.342 and 1.112), soft tissue chin thickness (2.872 and 1.226), and upper lip thickness ratio (1.592 and 1.026). PCA derived eight components with 84.5% of a cumulative explanation. The components that exhibited higher values of ${h^2}_{(MZ-DZ)}$ and ${h^2}_{(MZ-SIB)}$ were PCA2, which includes facial convexity, NLA, and nose projection (1.026 and 0.972), and PCA7, which includes chin angle and soft tissue chin thickness (2.107 and 1.169). Conclusions: The nose and soft tissue chin were more influenced by genetic factors than other soft tissues.

• Journal of Korean Dental Science
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• 제13권1호
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• pp.11-20
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• 2020

Purpose: This study sought to identify differences in hard and soft tissue chin profile changes in skeletal Class III patients after bimaxillary surgery, with or without advancement genioplasty. Materials and Methods: The retrospective study was conducted based on cephalometric analysis of skeletal and soft tissue variables. Lateral cephalograms taken at 3 different time points were utilized: pre-operation (T0), immediately post-operation (T1), and at least 6 months (11.0±2.6 months) post-operation (T2). The 2 groups were matched for sample size (n=20 each). Data were analyzed using independent t-tests with Bonferroni correction. Result: Group N (bimaxillary surgery alone) and Group G (bimaxillary surgery with an advancement genioplasty by horizontal sliding osteotomy) did not differ significantly in terms of demographic characteristics. The soft tissue chin thickness of Group G increased more after surgery, followed by a greater decrease during the postoperative period, and was eventually not significantly different from Group N at T2. On the other hand, the mentolabial sulcus depth of Group G (5.5±1.3 mm) was significantly greater than that of Group N (4.4±0.9 mm) (P=0.006) at T2. Conclusion: Although Group G showed a statistically significantly greater decrease in soft tissue chin thickness during the postoperative period, there were no significant intergroup differences in the chin profile for at least 6 months after the surgery, except for the mentolabial sulcus depth, which was greater in Group G than in Group N.

• 대한두개안면성형외과학회지
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• 제22권4호
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• pp.183-192
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• 2021

Background: The purse-string suture (PSS) is a simple and rapid wound closure method that results in minimal scarring. It has been used to treat circular or oval skin defects caused by tumor excision or trauma. However, due to obscurity, it is not widely used, especially for the head and neck. This study aimed to modify the PSS to obtain predictable and acceptable results. Methods: A total of 45 sites in 39 patients with various types of skin and soft tissue defects in the head and neck were treated with PSS. We used PDS II (2-0 to 5-0), which is an absorbable suture. Minimal dissection of the subcutaneous layer was performed. The suture knot was hidden by placing it in the dissection layer. Depending on the characteristics of the skin and soft tissue defects, additional surgical interventions such as side-to-side advancement sutures, double PSS, or split-thickness skin graft were applied. Results: All wounds healed completely without any serious complications. Large defects up to 45 mm in diameter were successfully reconstructed using only PSS. Postoperative radiating folds were almost flattened after approximately 1-2 months. Conclusion: PSS is simple, rapid, and relatively free from surgical design. Owing to the circumferential advancement of the surrounding tissue, PSS always results in a smaller scar than the initial lesion and less distortion of the body structures around the wound in the completely healed defect. If the operator can predict the process of healing and immediate radiating folds, PSS could be a favorable option for round skin defects in the head and neck.

• 대한두개안면성형외과학회지
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• 제20권6호
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• pp.397-400
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• 2019

Frontonasal dysplasia is an uncommon congenital anomaly with diverse clinical phenotypes and highly variable clinical characteristics, including hypertelorism, a broad nasal root, median facial cleft, a missing or underdeveloped nasal tip, and a widow's peak hairline. Frontonasal dysplasia is mostly inherited and caused by the ALX genes (ALX1, ALX3, and ALX4). We report a rare case of a frontonasal dysplasia patient with mild hypertelorism, a broad nasal root, an underdeveloped nasal tip, an accessory nasal tag, and a widow's peak. We used soft tissue re-draping to achieve aesthetic improvements.

• 치과방사선
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• 제23권1호
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• pp.103-114
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• 1993

The purpose of this study was to determine whether any difference existed in craniofacial morphology between parents of children with cleft lip and/or palate and parents of children without cleft lip and/or palate as well as the characteristics of craniofacial morphology in parents of children with cleft lip and/or palate. Thirty three measurements of the various regions of cranium and face were obtained from lateral cephalometric radiograms in parents of 28 children with cleft lip and palate, 18 children with cleft lip, and 22 children with cleft palate. There were 28 couples and 40 single parents in this sample. There were 92 individuals including 41 males and 51 females. The measurements were compared with those in control subjects, including 40 adult males and 40 adult females, who had no history of craniofacial abnormalities. The total sample was compared for the sex independently. The obtained results were as follows. 1. In the cranium, both parents of cleft children had significantly shorter posterior cranial base length(S-Ba). 2. In the upper face, a significantly shorter anteroposterior length of maxilla(A'-Ptm'), particularly in the anterior region (A'-K), anterior facial depth(A-SBaL), posterior facia! height(Ptm'-SNL) and relation of subnasale to the cranial base (∠BaN'Sn) were noted in fathers of cleft children. But, all measurements were not found to be significantly different between experimental group and control group in all mothers. 3. In the lower face, both parents of cleft children showed a significantly greater Y axis angle(∠NSGn) and ramal plane angle(∠SNL-RP) in fathers of cleft children. Thus both patents showed a posteriorly rotation of mandible. The thickness of the lower lip(B-B') was significantly thicker in fathers of cleft children. 4. In the facial profile, a significantly shorter posterior facial height(S-Go) and greater angle of soft tissue facial convexity (∠BaN'Pog') were noted in the fathers of cleft children. But, all measurements were not found to be significantly different between experimental group and control group in all mothers.

• 대한두개안면성형외과학회지
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• 제20권2호
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• pp.139-143
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• 2019

Here we report a case of a focal atypical proliferative nodule (PN) arising from a congenital melanocytic nevus (CMN). Diagnosis was challenging because it had both benign and malignant clinical features. Unusual histopathology, immunohistochemistry, and intraoperative findings of this atypical PN are discussed. A 5-year-old girl was admitted for a congenital $5{\times}5cm$ sized scalp mass. This hemangioma-like soft mass showed biphasic characteristics such as a slow, gradual, and benign increase in size but worrisome dural invasion with cranial bone defect. We removed the scalp mass with clear resection margins. Interoperatively, we found that the cranial bone defect had already filled. Histopathologic examination showed CMN with focal atypical PN. The nodule showed sharp demarcation and cellular pleomorphism. However, in immunohistochemical study, Ki-67 proliferation index and expression levels of protein S-100 and Melan-A were very low. These were unusual findings of atypical PNs. Despite her worrisome preoperative radiologic features, she showed an indolent clinical course compatible with previously reported biologic behavior. The patient underwent follow-up inspection with magnetic resonance imaging every 6 months for up to 3 years. The nodule appeared to be stationary at the last visit.

• Archives of Plastic Surgery
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• 제48권5호
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• pp.503-510
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• 2021

Facial feminization surgery (FFS) incorporates aesthetic and craniofacial surgical principles and techniques to feminize masculine facial features and facilitate gender transitioning. A detailed understanding of the defining male and female facial characteristics is essential for success. In this first part of a two-part series, we discuss key aspects of the general preoperative consultation that should be considered when evaluating the prospective facial feminization patient. Assessment of the forehead, orbits, hairline, eyebrows, eyes, and nose and the associated procedures, including scalp advancement, supraorbital rim reduction, setback of the anterior table of the frontal sinus, rhinoplasty, and soft tissue modifications of the upper and midface are discussed. In the second part of this series, bony manipulation of the midface, mandible, and chin, as well as soft tissue modification of the nasolabial complex and chondrolaryngoplasty are discussed. Finally, a review of the literature on patient-reported outcomes in this population following FFS is provided.

• 대한치과교정학회지
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• 제28권2호
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• pp.219-229
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• 1998

심한 골격성 III급 부정교합을 가진 성인환자는 많은 경우 심미성증진과 기능증진을 위해 악교정수술과 교정치료를 병행하여 치료하게 된다. 이러한 경우 진단과 치료계획 수립시 중요한 의미를 가지는 경조직 및 연조직 측모윤곽선의 형태를 정상교합자와 비교 분석하고, 두개악안면구조의 특성을 파악하여 부조화의 소재를 규명하고자 이 연구가 시행되었다. 골격성 III급 부정교합으로 진단된 환자 중 ANB각의 차이가 -2이하인 18세 이상의 성인남녀 환자 112명의 측모두부 규격 엑스선 사진을 연구자료로 이용하였으며 평균연령은 23.1세였다. 대조군으로는 성인 정상교합자 50명의 측모 두부 규격 엑스선 사진을 대상으로 하였으며 남, 녀 각 25명씩이었다. 전후방기준으로는 Nasion perpendicular to FH line을 사용하였으며, 수평 기준선으로는 FH line을 사용하였다. 이 연구에서 정상교합자와 비교한 심한 III급 부정교합자 안면골격의 특징을 다음과 같다. 1. 나지온점에서 프랑크프르트 수평선에 내린 수선을 기준선으로 III급 부정교합자의 경조직 측모 윤곽을 평가하였을 때, III급 부정교합자의 전두부, 상악의 전방돌출도는 정상과 유사하였으나, 하악은 정상에 비하여 심하게 돌출되어 있었다. 2. III급 부정교합자의 연조직 측모윤곽은 오목하였다. III급 부정교합자의 연조직 두께는 전두부에서는 정상과 차이가 없었으나, 상순은 두껍고 비상순각은 작았으며, 하순과 하순구부위의 연조직은 얇고 하순의 외번도는 작았다. 3. III급 부정교합자의 두개저(전방두개저의 길이, 후방두개저의 길이 및 안상각)는 정상에 비하여 작았다. 4. III급 부정교합자에서 두개저에 대한 중안면부(안와하연점)의 전후관계는 정상과 유사하였으나,중안면부의 길이는 짧았다. 5. III급 부정교합자에서 두개저에 대한 상악의 전후방관계는 정상과 유사하였으나 상악골의 길이는 짧았다. 6. III급 부정교합자에서 두개저에 대한 하악의 전후관계는 전방돌출되어 있었으며, 하악지 및 하악체 길이는 크고, 하악각이 크며, 이부각(Chin angle)이 작았다. 7. III급 부정교합자의 상악 절치는 전방경사되어 있었으며, 하악 절치는 설측경사되어 있었다.

• 대한두개안면성형외과학회지
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• 제21권4호
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• pp.237-243
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• 2020

Background: The scalp is an important functional and aesthetic structure that protects the cranial bone. Due to its inelastic characteristics, soft-tissue defects of the scalp make reconstruction surgery difficult. This study aims to provide an improved scalp reconstruction decision making algorithm for surgeons. Methods: This study examined patients who underwent scalp reconstruction within the last 10 years. The study evaluated several factors that surgeons use to select a given reconstruction method such as etiology, defect location, size, depth, and complications. An algorithmic approach was then suggested based on an analysis of these factors. Results: Ninety-four patients were selected in total and 98 cases, including revision surgery, were performed for scalp reconstruction. Scalp reconstruction was performed by primary closure (36.73%), skin graft (27.55%), local flap (17.34%), pedicled regional flap (15.30%), and free flap (3.06%). The ratio of primary closure to more complex procedure on loose scalps (51.11%) was significantly higher than on tight scalps (24.52%) (p=0.011). The choice of scalp reconstruction method was affected significantly by the defect size (R=0.479, p<0.001) and depth (p<0.001). There were five major complications which were three cases of flap necrosis and two cases of skin necrosis. Hematoma was the most common of the 29 minor complications reported, followed by skin necrosis. Conclusion: There are multiple factors affecting the choice of scalp reconstruction method. We suggest an algorithm based on 10 years of experience that will help surgeons establish successful surgical management for their patients.

• 대한치과교정학회지
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• 제23권3호
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• pp.341-358
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• 1993

This study was investigated to evaluate the morphologic characteristics of deepbite tendency as multiple factors. The subjects consisted of 60 control subjects(male 25, female 35) and 137 deephite patients(68 male, 69 female). The deepbite group was composed of 4 subgroups(Class I 44, Class II div. 1 40, Class II div. 2 13, Class III 40). The mean age was 21.57 year for the control group 21 year for deepbite group lateral cephalograph in centric occlusion were taken, traced, and digitized for each subject. The statistically computerized analysis was carried out with SAS program. The results were as follows ; 1. In deepbite group, saddle angle is lesser than that of normal group. 2. The vertical dysplasia is prominent on anterior lower face and is closely related with mandibular form and inclination. 3. Without consideration of sagittal relationship, the dental factors such as curve of Spee, interincisal angle, U1 to upper lip length were prominent in the deepbite group. 4. Although there were individual variances in the perioral soft tissue profile, the lip presented more protruded pattern. 5. There was no significant difference in hyoid bone position and inclination between normal and deepbite group. 6. The multivariate discriminant analysis between normal and Class I deepbite group showed that curve of Spee, AB-MP angle, interincisal angle, articular agnle were critical in the determination of deepbite as multiple factors.