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A CASE REPORT OF SURGICAL CORRECTION OF MANDIBULAR PROGNATHISM WITH MIDFACIAL DEFICIENCY USING LE FORT III OSTEOTOMY (Le Fort III 골절단술을 이용한 중안면성장부전을 동반한 하악전돌증의 치험례)

  • Lee, Baek-Soo;Ryu, Dong-Mok;Lee, Sang-Chull;Kim, Yeo-Gab;Hwang, Hye-Wook;Cho, Se-Jong
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • v.26 no.1
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    • pp.1-4
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    • 2000
  • True midfacial deficiency is defined as a hypoplasia of various components of midface such as maxilla, orbit, zygoma and nasal bone. For treatment of these anomalies Le Fort III osteotomy and its modifications have been used traditionally. Le Fort III osteotomy is the method which advances maxilla with nasal bone and zygomatic bone at a time. At first midfacial osteotomy was introduced by Gillies to treatment of dentofacial deformity in 1950. In 1967 Tessier designed Le Fort III osteotomy according to Le Fort III midfacial fracture line and popularized to treat midfacial deficiency using coronal incision to appoach osteotomy sites. This is a case of patient who had mandibular prognathism with midfacial deficiency with severe discrepancy in maxillomandibular interrelation. First we performed Le Fort III osteomomy for zygomaticomaxillary advancement, and then carried out simultaneous two jaw surgery with Le Fort I osteotomy and BSSRO three months after first surgery.

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A New Method of Intraoral Le Fort II Osteotomy for Correction of Midface in Cleft Patients (구순 구개열 환자에서의 새로운 구강내 접근 Le Fort II 골절단술)

  • Choung Pill-Hoon;Kim Kwang-Ho
    • Korean Journal of Cleft Lip And Palate
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    • v.4 no.2
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    • pp.29-35
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    • 2001
  • Midfacial retrusion is one of characteristics of cleft patients due to underdevelopment of the midface. In this case, Le Fort II advancement is indicated. But there has not been reported on intraoral approach to Le Fort II osteotomy for correction of midface, which traditional technique resulted in facial scar. To overcome the problems, Le Fort II osteotomy via only intraoral approach named 'Intraoral Le Fort IT osteotomy' was developed by Choung in 1994, this technique was applied to cleft patients. A new technique of Intraoral Le Fort IT osteotomy for correction of midface in cleft patients was successfully carried out with good results. This technique showed no noticeable relapse nor complications, which is reported.

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Soft tissue changes associated with ASO/BSSRO and Le Fort I/BSSRO in skeletal Class III malocclusion with upper lip protrusion (상순돌출을 동반한 골격성 III급 부정교합에서 수술방법에 따른 치료 후 상악 연조직 변화 - ASO/BSSRO와 Le Fort I/BSSRO 비교)

  • Kang, Ju-Man;Kim, Yoon-Ji;Park, Je-Uk;Kook, Yoon-Ah
    • The korean journal of orthodontics
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    • v.40 no.6
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    • pp.383-397
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    • 2010
  • Objective: The objective of this study was to compare maxillary soft tissue changes and their relative ratios to hard tissue changes after anterior segmental osteotomy (ASO)/bilateral sagittal split ramus osteotomy (BSSRO) and Le Fort I/BSSRO in skeletal Class III malocclusion with upper lip protrusion. Methods: The study sample comprised the ASO/BSSRO group (n = 14) and the Le Fort I/BSSRO group (n = 15). The Le Fort I/BSSRO group included cases of maxillary posterior impaction only. Lateral cephalograms were taken 2 months before and 6 months after surgery. Linear and angular measurements were performed. Results: The anterior maxilla moved backward in both groups after surgery, however the amount of change was significantly larger in the ASO/BSSRO group (p < 0.01). The ratios of hard to soft tissue change were 79% (SLS to A point), 80% (LS to A point) in the ASO/BSSRO group, and 15% (SLS to A point), 68% (LS to A point) in the Le fort I/BSSRO group. In addition, there was a $3.23^{\circ}$ increase of the occlusal plane in the Le Fort I/BSSRO group. Conclusions: When two-jaw surgery is indicated in skeletal Class III patients with protrusive lips, ASO may be a treatment of choice for cases with more severe upper lip protrusion, while Le Fort I with posterior impaction may be considered if an increase of occlusal plane angle is required.

Management of Le Fort I fracture

  • Kim, Hak Su;Kim, Seong Eun;Lee, Hyun Tae
    • Archives of Craniofacial Surgery
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    • v.18 no.1
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    • pp.5-8
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    • 2017
  • Among the classification of maxillary fracture, the Le Fort classification is the best-known categorization. Le Fort (1901) completed experiments that determined the maxilla areas of structural weakness which he designated as the "lines of weakness". According to these results, there are three basic fracture line patterns (transverse, pyramidal and craniofacial disjunction). A transverse fracture is a Le Fort I fracture that is above the level of the apices of the maxillary teeth section, including the entire alveolar process of the maxilla, vault of the palate and inferior ends of the pterygoid processes in a single block from the upper craniofacial skeleton. Le Fort fractures result in both a cosmetic and a functional deficit if treated inappropriately. In this article, authors review the management of a Le Fort I fracture with a case-based discussion.

A COMPARATIVE STUDY OF RADIOGRAPHIC IMAGINGS IN PATIENTS WITH MAXILLOFACIAL FRACTURES (상안면부 골절에 관한 방사선학적 비교 연구)

  • Hong Seong-Woo;Koh Kawng-Joon
    • Journal of Korean Academy of Oral and Maxillofacial Radiology
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    • v.25 no.2
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    • pp.545-553
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    • 1995
  • The subjects of this study consisted of 58 patients with Le Fort fractures, who were admitted to Chonbuk National University Hospital from Jan. 1988 to Oct. 1995. The author classified the maxillofacial fractures by Le Fort classification and examined the. incidence of Le Fort fractures by age, sex and etiology. The purpose of this study was to compare the imagings of conventional radiograms with those of computed tomograms and to aid in the diagnosis of patients with Le Fort fractures. The obtained results were as follows: 1. The Le Fort fractures occured mainly in 3rd and 4th decades, but there was no significant difference between decades. A ratio of men to women was 5.5 : 1. The major etiologic factors were traffic accident(69%), assault(14%) and fall-down(12%). 2. The most common type of Le Fort fracture was type I(49.3%). The numbers of Le Fort II, ill fractures were 41.3%, 9.4% respectively. And 8.6% were midsagittal splitting fractures. 3. The discontinuity and haziness of the maxillary sinus were easily detected by Waters' view. In skull PI A view, it was difficult to observe fractures due to overlapping of the other structures, but the haziness of the maxillary sinus was sometimes observed. 4. In Le Fort fracture, the fracture pattern of orbit, the wall of maxillary sinus, nasal bone and pterygoid plate were more easily detected in computed tomograms than in conventional radiograms.

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THE AMOUNT OF SOFT TISSUE CHANGE TO HARD TISSUE MOVEMENT FOLLOWING LE FORT II OSTEOTOMY (Le Fort II 골절단술을 이용한 비중안모 개선 효과에 대한 임상적 연구;경조직 이동에 따른 연조직 변화율에 대한 연구)

  • Kim, Myung-Jin;Yi, An-Na
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.22 no.1
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    • pp.63-69
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    • 2000
  • Le fort II osteotomy is much useful technique to correct the midfacial hypoplasia including nasomaxillary complex especilly in patient with dish face appearance. Not in simple orthognathic surgery but in Le Fort II osteotomy, the standardization of prognostic value is essential in treatment planning to achieve satisfactory postoperative results. According to pervious reports, the ratio of soft tissue change to hard tissue movements varies as to different surgical methods and different facial regions. But there are few report about the ratio of soft tissue change to hard tissue movement following Le Fort II osteotomy. So we tried to develop standarized soft tissue surgical treatment objective. We have followed up 16 patients, who had received Le Fort II osteotomy by one operator from 1990 to 1996, one year postoperatively. In cephalometrics, we used Frankfort line as horizontal reference line, and vertical reference line as one drawn from Sella to horizontal line perpendicularly. The landmarks are G to soft tissue G, N on reference line to soft tissue N, ANS to Pn and A to Sn. The results are as follows. 1. The value of soft tissue change to hard tissue movement showed positive correlation, having statistical significancy at G, N2, N3 point. 2. At G, N2, N3 point, the ratio of soft tissue change to hard tissue movement was 0.51, 0.98 and 0.80 respectively and showed statistical significancy, while at N1, ANS, A point, that was 0.72, 0.49 and 0.26 but didn't showed statistical significance. 3. This result shows much the same change of the soft tissue change to hard tissue movement on the upper nasomaxilla, and less the same change on the lower maxilla and so the Le Fort II osteotomy can be recommended as a reliable effective operation method for correction of nasomaxillary retrusion.

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Neighborhood Park (Fort Wayne) : A Study For Better Environment (Fort Wayne시 근린공원에 관한 연구)

  • Kwon, Hong-Sung
    • Journal of the Korean Institute of Landscape Architecture
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    • v.14 no.1
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    • pp.61-79
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    • 1986
  • This study was an effort to identify the reasons for use or underuse of neighborhood parks in Fort Wayne, Indiana and to suggest the solutions for the problems found. The significant differences between under and heavily used parks were found by the quantity and quality of each park's facilities and by the racial characteristics of residents around the each park. Environmental and social factors, and user satisfaction with their neighborhood park are suggested to be the solutions.

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MODIFIED LEFORT III OSTEOTOMY FOR MANDIBULAR PROGNATHISM WITH MAXILLARY-MALAR DEFICIENCY : A CASE REPORT (변형 LeFort III 골절단술을 이용한 중안면 성장부전을 동반한 하악전돌증의 치험례)

  • Kim, Moon-Soo;Kim, Su-Gwan;Ryu, Chong-Hoy
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.23 no.2
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    • pp.169-173
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    • 2001
  • Maxillary-malar deficiency is the most frequently occurring midface dentofacial deformity. Clinicaly patients with maxillary-malar deficiency exhibit malar and infraorbital rim deficiency and class III malocclusion. For treatment of these deformities, modified LeFort III osteotomy have been used. Modified LeFort III osteotomy advances maxilla with orbital rims and zygomatic bone anteroposteriorly. This is a case of patient who had severe mandibular prognthism with midface deformity. We performed modified LeFort III osteotomy for maxillary-malar advancement and simultaneous bilateral sagittal split ramus osteotomy for mandibular prognathism and autogenous iliac bone graft.

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A safe, stable, and convenient three-dimensional device for high Le Fort I osteotomy

  • Sugahara, Keisuke;Koyachi, Masahide;Odaka, Kento;Matsunaga, Satoru;Katakura, Akira
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.42
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    • pp.32.1-32.4
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    • 2020
  • Background: Le Fort I osteotomy is a highly effective treatment for skeletal jaw deformities and is commonly performed. High Le Fort I osteotomy is a modified surgical procedure performed for improving the depression of the cheeks by setting the osteotomy higher than the conventional Le Fort I osteotomy. Developments in three-dimensional (3D) technology have popularized the use of 3D printers in various institutions, especially in orthognathic surgeries. In this study, we report a safe and inexpensive method of performing a high Le Fort I osteotomy using a novel 3D device and piezosurgery, which prevent tooth root injury without disturbing the operation field for patients with a short midface and long tooth roots. Results: A 17-year-old woman presented with facial asymmetry, mandibular protrusion, a short midface, and long tooth roots. We planned high Le Fort I osteotomy and bilateral sagittal split ramus osteotomy. Prevention of damage to the roots of the teeth and the infraorbital nerve and accurate determination of the posterior osteotomy line were crucial for clinical success. Le Fort I osteotomy using 3D devices has been reported previously but were particularly large in size for this case. Additionally, setting the fixing screw of the device was difficult, because of the risk of damage to the roots of the teeth. Therefore, a different surgical technique, other than the conventional Le Fort I osteotomy and 3D device, was required. The left and right parts of the 3D device were fabricated separately, to prevent any interference in the surgical field. Further, the 3D device was designed to accurately cover the bone surface from the piriform aperture to the infra-zygomatic crest with two fixation points (the anterior nasal spine and the piriform aperture), which ensured stabilization of the 3D device. The device is thin and does not interfere with the surgical field. Safe and accurate surgical performance is possible using this device and piezosurgery. The roots of the teeth and the infraorbital nerve were unharmed during the surgery. Conclusions: This device is considerably smaller than conventional devices and is a simple, low-cost, and efficient method for performing accurate high Le Fort I osteotomy.