• 대한치과교정학회지
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• 제35권3호
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• pp.163-173
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• 2005

본 연구는 안면비대칭 환자에서 경조직의 비대칭 정도와 연조직 비대칭 정도의 차이를 3차원적으로 밝히고자 시행되었다. 안면비대칭으로 보이는 성인 남녀 34명을 대상으로 두경부 전산단층사진을 촬영하고 3차원 입체영상으로 재구성한 후 기준평면에 대해 비대칭을 나타내는 5개의 계측항목을 경조직에 설정하고, 이에 대응하는 연조직 계측항목을 각각 설정한 후 3차원 계측을 시행하고 경조직과 연조직의 계측항목간 차이를 비교하였다. 이부편위측과 반대측간의 계측치 차이를 비교한 결과, 경조직과 연조직 모두에서 좌우측 계측치간에 통계적으로 유의한 차이가 관찰되었으며 경조직과 연조직의 비대칭 계측항목을 비교한 결과, 6개의 계측항목 모두에서 통계적으로 유의한 차이를 나타내었다. 이부편위를 나타내는 chin deviation, 하악지와 하악골체를 나타내는 frontal ramal inclination difference, frontal corpus inclination difference 항목은 경조직의 비대칭 정도에 비하여 연조직 비대칭 정도가 작게 나타난 반면, 입술경사를 나타내는 lip cheilion height difference, lip canting은 maxillary height difference, occlusal plane canting보다 크게 나타나 입술부위의 비대칭 정도는 하부 경조직의 비대칭 정도보다 큰 것으로 나타났다. 안면비대칭자에서 경조직과 연조직간 비대칭 정도 차이를 규명한 본 연구 결과는 안면비대칭 평가 시 경조직 외에 연조직 계측항목을 이용한 비대칭 분석도 필요함을 시사하였다.

• 대한치과교정학회지
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• 제53권6호
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• pp.402-419
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• 2023

Objective: This study assessed the differences in soft tissue deviations of the nose, lips, and chin between different mandibular asymmetry types in Class III patients. Methods: Cone-beam computed tomography data from 90 Class III patients with moderate-to-severe facial asymmetry were investigated. The sample was divided into three groups based on the extent of mandibular rolling, yawing, and translation. Soft tissue landmarks on the nose, lips, and chin were investigated vertically, transversely, and anteroposteriorly. A paired t test was performed to compare variables between the deviated (Dv) and nondeviated (NDv) sides, and one-way analysis of variance with Tukey's post-hoc test was performed for intergroup comparisons. Pearson's correlation coefficient was calculated to assess the relationship between the soft and hard tissue deviations. Results: The roll-dominant group showed significantly greater differences in the vertical positions of the soft tissue landmarks between the Dv and NDv than other groups (P < 0.05), whereas the yaw-dominant group exhibited larger differences in the transverse and anteroposterior directions (P < 0.05). Moreover, transverse lip cant was correlated with the menton (Me) deviation and mandibular rolling in the roll-dominant group (P < 0.001); the angulation of the nasal bridge or philtrum was correlated with the Me deviation and mandibular yawing in the yaw-dominant group (P < 0.01). Conclusions: The three-dimensional deviations of facial soft tissue differed based on the mandibular asymmetry types in Class III patients with similar amounts of Me deviation. A precise understanding of soft tissue deviation in each asymmetry type would help achieve satisfactory facial esthetics.

• 대한치과교정학회지
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• 제38권4호
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• pp.252-264
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• 2008

본 연구는 안면비대칭 환자의 악교정수술 시 경조직 이동에 따른 연조직 변화를 정면에서 평가함으로써 정면 얼굴 이미지 시뮬레이션 프로그램 개발에 도움이 되고자 시행되었다. 안면비대칭이 동반된 하악골 수술 예정 환자 45명을 대상으로 정모 두부방사선규격사진과 얼굴사진(photo)을 술전 및 술후에 각각 같은 각도로 촬영한 후, 술전 및 술후의 방사선사진을 이용하여 경조직 계측점의 변화를, 얼굴사진을 이용하여 연조직 계측점의 변화를 수평 및 수직으로 구분하여 각각 측정한 후 경조직 변화에 따른 연조직 변화를 비교 분석하였다. 연조직 변화와 경조직 변화의 상관성을 살펴본 결과 수평 방향, 수직 방향 모두에서 전반적으로 낮은 상관성을 보였으며, 1 : 1 mean ratio 산출을 위하여 서로 상관성이 가장 높은 경조직 계측점을 연조직 계측점별로 선택한 결과 직하방에 있는 경조직보다는 다소 멀리 떨어져 있는 경조직 계측점이 선택되는 경우가 많이 나타났다. 경조직 변화를 이용하여 연조직 변화를 예측할 수 있는 회귀방정식을 연조직 계측점별로 산출한 결과 연조직 수평변화 예측에 경조직 수직변화도 사용되고 연조직 수직변화 예측에 경조직 수평변화도 사용되었으며, 수평과 수직변화 모두에서 가장 설명력이 높은 방정식은 연조직 menton에서 나타났다. 이상의 연구결과 하부 경조직 계측점과 상부 연조직 계측점의 비율을 이용하는 1 : 1 mean ratio 방법은 불가능한 것으로 나타난 반면 회귀분석을 이용한 연조직 변화 예측은 임상에 도움이 될 수 있는 것으로 나타나 정면 이미지의 경우 컴퓨터를 이용한 시뮬레이션 프로그램이 반드시 필요함을 시사하였다.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제31권3호
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• pp.266-273
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• 2005

Purpose: To assess the relationship between soft tissue reference line and hard tissue reference line using the standardized photographs and the posteroanterior cephalometric radiographs(P-A)in facial asymmetric patients and to compare the differences of angular measurement between normal group and asymmetry group. Methods: Normal group consisted of 44 persons with normal occlusion and normal facial morphology. Asymmetry group consisted of 90 patients with facial asymmetry. Standardized facial photographs and P-A were taken in all subjects. The horizontal reference lines were bipupillary line in photographs and latero-orbitale line in P-A respectively. The vertical reference line were the line from the midpoint of horizontal reference line perpendicularly. Angular measurement of otobasion canting, lip canting, nose deviation, chin deviation, and maxillary deviation were compared and analyzed in photographs. And angular measurement of mastoid canting, mandibular canting, nose deviation, chin deviation, and maxillary deviation were compared and analyzed in P-A. Results: 1. The variables of photographs and P-A were significantly related in the asymmetry group. 2. Significant differences between all variables except for PT2 and PA2 were shown in the asymmetry group and between PT1 and PA1, PT3 and PA3 in the normal group respectively. 3. Comparison measurement scores of angular difference between control group and experimental group concerning each variable showed significant difference except for PA1. Conclusions: Soft tissue components may not compensate for underlying skeletal imbalance in nose deviation and chin deviation. The horizontal reference lines in photographs were significant related with the P-A, but angular variables between the two studies show significant differences. Therefore, we do not recommend use photography in the assessment the facial asymmetry as complemented in the P-A.

• 대한치과교정학회지
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• 제54권2호
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• pp.89-107
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• 2024

Objective: This systematic review aimed to provide a comparative analysis of the treatment outcomes, including hard and soft tissues, postoperative stability, temporomandibular disorders (TMD), and quality of life (QoL), in patients with facial asymmetry who underwent orthognathic surgery. Methods: The primary objective was to address the question, "How do different factors related to surgery affect the outcomes and stability of orthognathic surgery in the correction of facial asymmetry?" A meta-analysis was conducted on the outcome parameters, such as skeletal, dental, and soft tissue symmetry, TMD, QoL, and relapse, using the Hartung-Knapp-Sidik-Jonkman method for random-effects models. Subgroup analyses were conducted considering surgery-related factors such as surgical techniques (one-jaw vs. two-jaw), use of the surgery-first approach, utilization of computer simulation, and analytical methods employed to evaluate asymmetry (2D vs. 3D). Results: Forty-nine articles met the inclusion criteria. The metaanalysis demonstrated a significant improvement in the symmetry of hard and soft tissues. The subgroup analysis indicated that the treatment outcomes showed significant improvement, regardless of the factors related to surgery. Changes in TMD signs and symptoms varied according to the surgical technique used. Quality of life improved in the facial, oral, and social domains. Skeletal relapse was observed during the follow-up. Conclusions: Our findings support the positive outcomes of orthognathic surgery in the treatment of facial asymmetry in terms of skeletal and soft tissue improvements, stability, relief of TMD symptoms, and enhancement of QoL. However, most of the included studies showed a low certainty of evidence and high heterogeneity.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제27권2호
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• pp.151-159
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• 2005

The purpose of this study was to evaluate the nasal deviation in mandibular prognathism with mandibulo-facial asymmetry. There were 40 patients whose mandibular prognathism with/without facial asymmetry were treated with orthognathic surgery from March 2002 to October 2003. The Group A(n=20) had a mandibulo-facial asymmetry over 6mm menton deviation in cephalogram PA and the Group B(n=20) had a mandibular prognathism. The preoperative frontal photograph, cephalogram PA and three dimensionalcomputed tomography(divided in hard tissuse image and soft tissue image) of two group was evaluated NDA(nasal deviation angle) and MDA(mandibular deviation angle). The NDA was statistical difference between asymmetry Group A and symmetry Group B(p<0.01), and was deviated in affected side of asymmetry. The MDA were also statistical difference between Group A and Group B(p<0.01), however the measurements of MDA between the frontal photograph, 3D-CT and cephalogram PA were similar to each others. The low correlation of NDA between frontal photograph and cephalogram PA in Group A and B demonstrate that we couldn't assess nasal deviation in cephalogram PA. It could be concluded that patients with mandibulo-facial asymmetry have a nasal deviation and clinician must remember this fact when they assess and treat patients.

• 대한두개안면성형외과학회지
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• 제16권1호
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• pp.1-10
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• 2015

Facial symmetry is an important component of attractiveness. However, functional symmetry is favorable to aesthetic symmetry. In addition, fluctuating asymmetry is more natural and common, even if patients find such asymmetry to be noticeable. However, fluctuating asymmetry remains difficult to define. Several studies have shown that a certain level of asymmetry could generate an unfavorable image. A natural profile is favorable to perfect mirror-image profile, and images with canting and differences less than $3^{\circ}-4^{\circ}$ and 3-4 mm, respectively, are generally not recognized as asymmetry. In this study, a questionnaire survey among 434 medical students was used to evaluate photos of Asian women. The students preferred original images over mirror images. Facial asymmetry was noticed when the canting and difference were more than $3^{\circ}$ and 3 mm, respectively. When a certain level of asymmetry is recognizable, correcting it can help to improve social life and human relationships. Prior to any operation, the anatomical component for noticeable asymmetry should be understood, which can be divided into hard tissues and soft tissue. For diagnosis, two-and three-dimensional (3D) photogrammetry and radiometry are used, including photography, laser scanner, cephalometry, and 3D computed tomography.

• 대한치과교정학회지
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• 제52권2호
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• pp.85-101
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• 2022

Objective: To classify facial asymmetry (FA) phenotypes in adult patients with skeletal Class III (C-III) malocclusion. Methods: A total of 120 C-III patients who underwent orthognathic surgery (OGS) and whose three-dimensional computed tomography images were taken one month prior to OGS were evaluated. Thirty hard tissue landmarks were identified. After measurement of 22 variables, including cant (°, mm), shift (mm), and yaw (°) of the maxilla, maxillary dentition (Max-dent), mandibular dentition, mandible, and mandibular border (Man-border) and differences in the frontal ramus angle (FRA, °) and ramus height (RH, mm), K-means cluster analysis was conducted using three variables (cant in the Max-dent [mm] and shift [mm] and yaw [°] in the Manborder). Statistical analyses were conducted to characterize the differences in the FA variables among the clusters. Results: The FA phenotypes were classified into five types: 1) non-asymmetry type (35.8%); 2) maxillary-cant type (14.2%; severe cant of the Max-dent, mild shift of the Man-border); 3) mandibular-shift and yaw type (16.7%; moderate shift and yaw of the Man-border, mild RH-difference); 4) complex type (9.2%; severe cant of the Max-dent, moderate cant, severe shift, and severe yaw of the Man-border, moderate differences in FRA and RH); and 5) maxillary reverse-cant type (24.2%; reverse-cant of the Max-dent). Strategic decompensation by pre-surgical orthodontic treatment and considerations for OGS planning were proposed according to the FA phenotypes. Conclusions: This FA phenotype classification may be an effective tool for differential diagnosis and surgical planning for Class III patients with FA.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제20권2호
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• pp.91-96
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• 1998

Surgical resection of tumors in the maxillofacial region sometimes results in extended defects of soft and hard tissue that frequently causes aesthetic, functional and especially mental damages. It is essential for patients with such facial defects to reduce the scar and maxillofacial asymmetry. To attain esthetic facial appearance after hemimaxillectomy, we devise a new design, so called 'IOIO Incision' (InfraOrbital-IntraOral incision). The new approach is established on infraorbital region to expose maxillofacial skeleton in aspect of face. And the other incision is designed on intraoral region. The IOIO incision provide excellent aesthetic result after hemimaxillectomy, because of reduced minimal facial scar contraction. Maxillofacial surgeons are used to designing Weber-Fergusson incision in resection of maxillofacial tumors, but disadvantages of the incision were large scar and asymmetry of face. To improve theses problem, we attempted IOIO Incision.. For correct osteotomy of posterolateral wall of maxillary sinus, 1. Fenestra formation on zygomatic body for easily access of reciprocating saw to posterolateral wall of maxillary sinus. 2. To achieve better visual field in posterolateral aspect of maxilla, fat tissue is removed from infratemporal fossa. This new, versatile procedure can be used for benign and malignant lesions of the maxillary area. We introduce cases with review of literatures.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제13권1호
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• pp.82-87
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• 1991

반안면왜소증이란 제1및 제2새궁에서 유래되는 기관에 결손이 옴으로써 초래되는 안면기형을 일컫는 것으로 선천성 악안면기형 중 순열 및 구개파열 다음으로 빈발하는 질환이다. 결손부는 하악골을 포함한 안면골의 여러 부위와 안면근 및 저작근, 뇌신경, 이개등여러 부위에 다양하게 나타나며, 그 기형의 발현 정도도 아주 다양하다. 본 교실에서는 안면비대칭과 교합부전을 주소로 내원한 20 세된 남자환자에 있어서 먼저 경조직을 바로잡기 위하여 상${\cdot}$하악골에 대한 악교정수술과 onlay골이식을 시행한 후, 남아있는 연조직 결손부에 대하여 진피-지방이식을 시행하여 심미적으로 만족할만한 결과를 얻었기에 보고하는 바이다.