• 대한치과교정학회지
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• 제30권5호
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• pp.535-542
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• 2000

본 연구는 안면비대칭 환자의 natural head position(NHP)시 정면에서의 두부 또는 경추의 경사 정도를 알아봄으로써 교정환자의 임상검사시 비대칭의 진단에 도움이 되고자 시행되었다. 두드러진 전후방 골격 이상은 없으나 뚜렷한 좌우 안면비대칭을 보이는 성인 20명을 비대칭군으로, 좌우 대칭적인 외모와 비교적 정상교합을 보이는 성인 21명 을 대칭군으로 선정 한 다음 물방울 수평계를 이용하여 NHP 상태의 정모두부방사선사진을 촬영하고 투사도를 작성하였다. Crista galli와 anterior nasal spine을 연결한 선과 crista galli와 menton을 연결한 선이 이루는 각을 menton의 변위 정도로 정하고, 좌우 supra-orbital margin의 최상방점을 지나는 supra-orbital line과, 제1경추와 제4경추의 중심을 연결한 cervical line이 각각 true vertical line과 이루는 각을 계측한 다음 이들간의 상관관계를 비교 분석하여 다음과 같은 결과를 얻었다. 1. Supra-orbital line이 true vortical line과 이루는 각이 직각에서 벗어난 정도가 대칭군에 비하여 비대칭군에서 통계적으로 유의하게 크게 나타났다. 2. Cervical line이 true vertical line과 이루는 각은 통계적 유의차는 없었으나 비대칭군에서 더 큰 경향을 보였다. 3. 비대칭군에서 supra-orbital line이 true vortical line과 이루는 각이 직각에서 벗어난 정도는 menton의 변위 정도와 통계적으로 유의한 순상관관계를 보였다. 이상의 결과로 안면비대칭 환자는 menton의 변위를 보상하려는 방향으로 기울어진 NHP를 가지는 경향이 있음을 알 수 있었다.

• 대한구순구개열학회지
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• 제15권1호
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• pp.1-10
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• 2012

Parry-Romberg syndrome(PRS) is a degenerative disease characterized by progressive hemifacial atrophy. A 10-year-old girl who had been treated for linear scleroderma at the dermatologic department visited the orthodontic department. The frontal facial photograph showed mild facial asymmetry. On the left side, mild atrophy of soft tissue, enophthalmos, cheek depression, and dry skin with dark pigmentation were observed. The radiograph showed the hypoplasia of both the maxilla and mandible on the left side. This case report describes the treatment of a patient with PRS for 7 years. To minimize the effect of progressive atrophy on the facial growth, a hybrid appliance was used. The facial photos and radiographic records were periodically taken to analyze the progression of PRS. Although it is impossible to prevent the progression of facial asymmetry, it appears to be possible to limit the atrophic effect. After the stabilization of PRS, the orthodontic treatment by the fixed appliance was performed. Additionally, autologous fat graft was performed three times at 6 month intervals. After the treatment, the patient had a confident smile and facial asymmetry was improved.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제32권4호
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• pp.351-358
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• 2010

A 31-year-old woman with hemifacial microsomia presented to the Department of Oral and Maxillofacial Surgery, Seoul National University Dental Hospital. The patient was previously treated with distraction osteogenesis device to elongate right maxilla and mandibular ramus. But, the result was not satisfactory, to correct residual facial asymmetry due to hemifacial microsomia we planned costochondral graft for reconstruction of ramus and condyle, Le Fort I osteotomy and sagittal split ramus osteotomy for facial asymmetry. The right mandibular condyle and ramus was reconstructed with right eleventh costochondral graft via submandibular approach. Using costochondral graft and orthognathic surgery the facial asymmetry in hemifacial microsomia patient was corrected. 1-stage treatment consists of costochondral graft and orthognathic surgery can achieve function and esthetics at the same time, is timesaving to both patient and surgeon.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제30권6호
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• pp.546-553
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• 2008

Purpose: The purpose of this study was to estimate validity of posterior anterior cephalometric and 3D-CT for orbital canting analysis. Materials and methods: Three trained observers classified two patients group using standardized frontal photographs of facial asymmetry patients. Group A consisted of patients with facial asymmetry and orbital canting(n=19), and group B consisted of patients with only facial asymmetry(n=43). Orbital canting was measured with line of bilateral inferior orbitale. Orbital canting measurement was done with posterior anterior cephalometric and 3D-CT. Each horizontal reference line was established by bilateral GWSO(cephalometric), FZS(3D-CT). Maxillary canting and mandibular deviation angle were also measured and analyzed with orbital canting. Results: The mean orbital canting was $3.03{\pm}1.00^{\circ}$ in Group A and $1.11{\pm}0.76^{\circ}$ in Group B in frontal photograph. The mean orbital canting was $1.20{\pm}0.74^{\circ}$ in group A and $1.22{\pm}0.65^{\circ}$ in group B by cephalometric analysis(p>0.05). In 3D-CT, orbital canting was almost paralleled with horizontal reference line. The orbital canting, maxillay canting and mandibular deviation between two groups showed no significant differences except madibular deviation in 3D-CT. Conclusion: Common analysis of posterior anterior cephalometric and 3D-CT is not valide method to evaluate orbital canting for facial asymmetry patients with orbital canting.

• 대한치과교정학회지
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• 제24권4호
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• pp.787-798
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• 1994

The purpose of this study was three-fold: i) to investigate the degree of asymmetry in Angle's Class III malocclusion patients and normal adults; ii) to determine the nature of difference existed between two groups; and iii) to investigate the correlationship between the degree of asymmetry and ANB and overbite in Angle's Class III malocclusion patients. The subjects consisted of 25 Angle's Class III malocclusion patients and 25 normal adults and the mean ages were 22.0 and 24.5 years, respectively. Their posteroanterior and lateral cephalograms were traced and analysed with three-dimensional approach. The results were as follows: 1. Asymmetry of Angle's Class III malocclusion group was significant in all regions except cranial base. Their horizontal asymmetry was seen in mandibular angle, maxillary and mandibular 1st molar, mandibular midline and menton. Vertical asymmetry was observed in maxillary 1st molar and mandibular shape and anteroposterior asymmetry in mandibular angle. 2. Nine variables indicating asymmetry were selected and each variable had similar discriminant score. 3. There was a little correlationship between An and asymmetric variable(MSR-B6) and its correlation coefficients was 0.3564. 4. There was no significant correlationship between overbite and asymmetric variables.

• 구강회복응용과학지
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• 제27권1호
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• pp.63-71
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• 2011

안면비대칭은 안면골의 기형으로 인한 경우가 대부이므로 대개의 경우 수술을 동반한 치료가 이루어지고 있으며 이에 따라 3차원적인 기형인 비대칭을 진단하기 위해서는 안면 구조의 대칭성을 비교 측량하기 위한 시상기준면의 설정이 매우 중요하다. 이 연구의 목적은 이미 사용되고 있는 이러한 골격적 대칭을 비교하기 위한 시상기준면이 안면의 표층에 존재하는 연조직 중심점들과도 일치하는 지를 알아보기 위한 것이다. 총 연구대상은 비대칭군 25명(남 15명, 여 10명), 정상교합군 19명(남 11명, 여 8명)이었다. 실험군과 정상군간의 차이는 단지 Gnathion 부위에서와 Stomion에서만 존재하였으며 3가지 시상중심기준면과의 계측에서 대부분의 연조직 시상기준면은 1mm 내외의 변위를 보였다. 시상중심기준점들과 3가지 시상중심면간의 비교에서 Sa1은 나머지 중심선에 비해 Pronasale에서 변위가 크게 나타났다. 턱(Gnathion)의 변위가 시상중심기준선에서 벗어날수록 크게 영향을 받는 시상중심기준점은 3가지 시상중심기준면 모두에서 stomion 이었다. 3가지 모두의 시상기준면에서 대부분의 연조직의 시상기준점들이 적절한 변위내에 있었으나 Sa1의 경우는 Pronasale의 시상위치에 영향을 줄 수 있었다.

• 대한소아치과학회지
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• 제45권3호
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• pp.378-385
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• 2018

하악의 골절은 아이들의 악안면 영역 골절 중 높은 빈도로 발생하며, 성장기의 환자에서 악골의 골절은 성인의 골절과 구별된 처치가 필요하다. 골편의 변위가 심하지 않다면 비관혈적 정복술과 추가적인 악간 고정을 시행할 수 있으며 악관절 강직을 예방하기 위한 기능적 운동이 필요하다. 하악의 골절 이후 여러 합병증이 발생할 수 있다. 특히 과두 골절의 경우, 골절 이환 측에서 성장장애를 일으켜 부정교합과 안면비대칭을 야기할 수 있다. 하악의 골절 이후 성장 장애가 발생한 경우, 환자에 따라 catch-up growth가 일어날 수 있으므로 주기적인 관찰이 필요하다. 성장장애가 지속되는 경우엔 안면 비대칭이 심해지는 것을 방지하기 위해 기능성 장치의 사용을 고려할 수 있다. 본 증례에서는 하악의 골절 이후 안면비대칭을 보이는 2명의 환자를 장기적으로 관찰하고 의미 있는 결과를 나타내고 있기에 이를 보고하는 바이다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제41권
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• pp.48.1-48.7
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• 2019

Background: Soft tissue asymmetry such as lip canting or deviation of the philtrum is an important influencing factor for unbalanced facial appearance. Lip canting could be improved by the correction of the occlusal canting or positional change of the mentum. Although there are many studies about changes of lip canting, however, postoperative changes of philtrum deviation have not been yet reported. In this study, we investigate the positional change of the philtrum after orthognathic surgery and influencing factors. Methods: Positional change of the philtrum was evaluated in 41 patients with facial asymmetry who underwent bimaxillary surgery, in relation to other anatomical soft tissue landmarks using a frontal clinical photo. The surgical movement of the maxillary and mandibular dental midline and canting were measured in postero-anterior cephalogram before and 1 day after surgery. The same procedure was repeated in patients with more than 1.5 mm perioperative change of the mandibular dental midline after bimaxillary surgery. Results: Maxillary dental midline shifting and canting correction did not have a significant correlation with lateral movement of the philtrum midline. However, the mandibular shift had a statistically significant correlation with a lateral movement of the philtrum (p < 0.05) as well as other linear parameters and angle values. Conclusion: The horizontal change of the philtrum is influenced by lateral mandibular movement in patients with facial asymmetry, rather than maxillary lateral movement.

• 대한치과교정학회지
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• 제47권4호
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• pp.256-267
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• 2017

Objective: To evaluate transverse skeletal and dental changes, including those in the buccolingual dental axis, between patients with skeletal Class III malocclusion and facial asymmetry after bilateral intraoral vertical ramus osteotomy with and without presurgical orthodontic treatment. Methods: This retrospective study included 29 patients with skeletal Class III malocclusion and facial asymmetry including menton deviation > 4 mm from the midsagittal plane. To evaluate changes in transverse skeletal and dental variables (i.e., buccolingual inclination of the upper and lower canines and first molars), the data for 16 patients who underwent conventional orthognathic surgery (CS) were compared with those for 13 patients who underwent preorthodontic orthognathic surgery (POGS), using three-dimensional computed tomography at initial examination, 1 month before surgery, and at 7 days and 1 year after surgery. Results: The 1-year postsurgical examination revealed no significant changes in the postoperative transverse dental axis in the CS group. In the POGS group, the upper first molar inclined lingually on both sides (deviated side, $-1.8^{\circ}{\pm}2.8^{\circ}$, p = 0.044; nondeviated side, $-3.7^{\circ}{\pm}3.3^{\circ}$, p = 0.001) and the lower canine inclined lingually on the nondeviated side ($4.0^{\circ}{\pm}5.4^{\circ}$, p = 0.022) during postsurgical orthodontic treatment. There were no significant differences in the skeletal and dental variables between the two groups at 1 year after surgery. Conclusions: POGS may be a clinically acceptable alternative to CS as a treatment to achieve stable transverse axes of the dentition in both arches in patients with skeletal Class III malocclusion and facial asymmetry.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제42권
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• pp.11.1-11.8
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• 2020

Background: The purpose of this study is to compare the skeletal stability of two-jaw surgery via surgery-first approach with conventional two-jaw surgery in facial asymmetry patients by measuring the skeletal changes after surgery from a three-dimensional analysis. From January 2010 to January 2014, 40 patients with facial asymmetry who underwent two-jaw surgery in Pusan National University Hospital were included in this study. They were classified into experimental group (n = 20) who underwent two-jaw surgery via surgery-first approach and control group (n = 20) who underwent conventional two-jaw surgery. After selection of 24 landmarks and the construction of horizontal and sagittal, coronal reference planes, changes in 10 linear measurements and 2 angular measurements were compared between the surgery-first approach and conventional groups in the preoperative, immediate postoperative, and postoperative periods. The paired t test and Student t test were used for statistical analysis. The mean and standard deviation of the measurement were calculated for the experimental and control groups. Results: The statistical analysis showed that changes in skeletal measurements were similar between the surgery-first approach and conventional groups, according to each period. However, U1-SRP measurement showed statistically significant changes in surgery-first approach groups at postsurgical change (T1 to T2). Also, the mean treatment duration in the treatment group was 15.9 ± 5.48 months whereas that in the control group was 32.9 ± 14.05 months. Conclusion: In facial asymmetry patients, similar results were observed in the postoperative skeletal stability when 2-jaw surgery via surgery-first approach was compared with conventional 2-jaw surgery. However, significant lateral deviation of upper incisor midline was observed. In addition, a shorter average treatment duration was observed. To stabilize the unstable occlusion after surgery, increased wearing of the stent and proactive rubber guidance will be needed.