• Maxillofacial Plastic and Reconstructive Surgery
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• 제37권
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• pp.3.1-3.7
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• 2015

Hemifacial microsomia (HFM) is the most common craniofacial anomaly after cleft lip and cleft palate; this deformity primarily involves the facial skeleton and ear, with either underdevelopment or absence of both components. In patients with HFM, the management of the asymmetries requires a series of treatment phases that focus on their interception and correction, such as distraction osteogenesis or functional appliance treatment during growth and presurgical orthodontic treatment followed by mandibular and maxillary surgery. Satisfactory results were obtained in a 9-year-old girl with HFM who was treated with distraction osteogenesis. At the age of 19, genioplasty and mandible body augmentation with a porous polyethylene implant (PPE, $Medpor^{(R)}$, Porex) was sequentially performed for the functional and esthetic reconstruction of the face. We report a case of HFM with a review of the literature.

• Archives of Plastic Surgery
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• 제36권6호
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• pp.788-791
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• 2009

Purpose: Reconstruction of full - thickness defects of the nasal ala has always been a challenge. Local flaps can be used easily, and good result can be achieved when it is indicated. But local flaps often result in facial scars and bulky ala that require secondary revisions. Composite auricular chondrocutaneous graft may matches nasal alae well in terms of contour, color and texture, however, the size of composite graft is limited. We performed free vascularized helical root flaps for reconstruction of nasal ala. Methods: Bilateral ala were excised and the defects were reconstructed with a chondrocutaneous free helical root flap. Each side of ala was reconstructed in 3 months interval. Superficial temporal vessels of vascularized helical root flap were anastomosed to facial vessels. Great saphenous vein was used for interpositional vascular graft. Results: Flaps were survived successfully. The contour, texture and color match were satisfactory. Functional problem of nasal obstruction caused by scar stenosis of nostrils was also resolved. Conclusion: The free vascularized helical root flap is a reliable method in reconstruction of nasal alar defects. The donor deformity was minimal.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제31권1호
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• pp.74-81
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• 2005

Midfacial degloving approach는 중안면부에 대한 접근시 비교적 광범위한 수술시야의 확보가 가능하고, 술 후 중안모에 반흔을 남기지 않는 심미적 장점이 있다. 특히 중안면부의 광범 위한 골절과 비골 복합 골절을 동반한 중안면부 골절 수복에 이용되어 골절부에 대한 적절한 시야 확보로 정확한 관혈적 정복술이 가능하며 필요시에는 자가 늑골 등을 이용한 비 성형술이 가능하다는 장점이 있다. 이에 저자 등은 중안면부 복합골절의 치료시 midfacial degloving approach을 통해 중안면골의 관혈적 정복술 및 비 재건술을 시행한 증례에 대하여 문헌 고찰과 함께 보고하는 바이다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제40권
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• pp.37.1-37.7
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• 2018

Background: Fibrous dysplasia (FD) is characterized by the replacement of normal bone by abnormal fibro-osseous connective tissue and typically treated with surgical contouring of the dysplastic bone. When dysplastic lesions involve occlusion, not only is surgical debulking needed, orthognathic surgery for correction of dentofacial deformity is mandatory. However, the long-term stability of osteotomized, dysplastic bone segments is a major concern because of insufficient screw-to-bone engagement during surgery and the risk of FD lesion re-growth. Case presentation: This case report reviewed two patients with non-syndromic FD that presented with maxillary occlusal canting and facial asymmetry. Le Fort I osteotomy with recontouring of the dysplastic zygomaticomaxillary region had been performed. The stability of osseous segments were favorable. However, dysplastic, newly formed bone covered the previous plate fixation site and mild bony expansion was observed, which did not influence the facial profile. Including the current cases, 15 cases of orthognathic surgery for FD with dentition have been reported in the literature. Conclusion: The results showed that osteotomy did not appear to significantly reduce the long-term stability of the initial fixation insufficiency of the screw to the dysplastic bone. However, based on our results and those of the others, long-term follow-up and monitoring are needed, even in cases where the osteotomized segment shows stable results.

• Archives of Plastic Surgery
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• 제34권4호
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• pp.461-465
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• 2007

Purpose: Nasal bone fracture may be the most common fracture among facial trauma. However, diagnosis and treatment tend to be overlooked while the reduction and maintenance of fragments remain complicated. Thus, the results are plagued with high rate of nasal deformity which leads cosmetic and functional discomfort. We took advantage of the fact that the nasal bone is one of the thinnest facial bone while at the same time being located close to the skin and utilized ultrasound in performing reduction of nasal bone. Methods:This method was performed on 25 patients with nasal bone fracture. The CL 15-7 linear array transducer (10-15MHz) ultrasound which provides a total of 7 views (3 axial views and 4 transverse views) of the elevator under the bony fragments was enough for the surgeon to accurately perform the reduction. Results: In our class, an accurate and precise reduction has been made possible by real time images before, during, and after the procedure with the help of ultrasound while reducing the exposure to radiation. Conclusion: Compared to previous methods, satisfaction of patients has increased in the nasal tip, minimal fracture of the side wall and secondary reduction cases. Therefore, the incorporation of ultrasound in the closed reduction of nasal bone may prove to be a useful method.

• Archives of Plastic Surgery
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• 제34권1호
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• pp.123-127
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• 2007

Purpose: Rigid external distraction(RED) is a highly effective technique for correction of maxillary hypoplasia in patients with cleft or syndromic craniosynostosis. Despite many advantages of RED, it also has the problem of relapse as the conventional advancement surgery. Bicoronal approach, that is the common approach to gain access to the craniofacial skeleton, had some morbidity, such as hair loss, sensory loss, wide scar and temporal hollowing. We present our clinical experience of RED distraction with minimal invasive approach and early rigid fixation to overcome these disadvantages. Methods: A 27-year-old female patient with Crouzon's disease underwent Le Fort III osteotomy and RED device application through the minimal invasive direct skin incisions. After the latent period of 5 days, distraction was undertaken until proper convexity and advancement were obtained. During the rigid retention period, inflammation occurred on the right cheek, and proper conservative managements were done including continuous irrigation. To maintain the stability of distraction, early rigid fixation was undertaken on the osteotomy sites through another skin incisions. Preoperative and postoperative orthodontic treatments were performed. Serial photographs and cephalometric radiographs were obtained preoperatively, after distraction and 6 months after distraction. Results: The cephalometric analysis demonstrated postoperatively significant advancement of the maxilla and improvement of facial convexity. After 6-month follow-up period, the maxilla was stable in the sagittal plane and no relapse was found. Facial scars were not noticeable and other deformity and morbidity did not occur. Conclusion: This effective and stable technique will be a good alternative for the patients who need large amount of distraction and for adult patients with severe maxillary hypoplasia or syndromic craniosynostosis.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제47권5호
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• pp.382-387
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• 2021

Objectives: Zygomatic complex (ZMC) fractures comprise up to 40% of all facial fractures. Misaligned bone fragments and misplaced fixation hardware traditionally detected postoperatively on plain radiographs of the skull might require re-operation. The intraoperative O-Arm (Medtronic, USA) is a three-dimensional (3D) computed tomographic imaging system. Materials and Methods: This retrospective single-center study evaluated the utility of O-Arm scanning during corrective surgeries for ZMC and zygomatic arch (ZA) fractures from 2018 to 2020. Three females and 16 males (mean age, 31.52 years; range, 22-48 years) were included. Fracture instability (n=6) and facial deformity (n=15) were the most frequent indications for intraoperative 3D O-Arm scan. Results: The images demonstrated that all fracture lines were properly reduced and fixed. Another scan performed at the end of the fixation or reduction stage, however, revealed suboptimal results in five of the 19 cases, and further reduction and fixation of the fracture lines were required. Conclusion: Implementation of an intraoperative O-Arm system in ZMC and ZA fracture surgeries assists in obtaining predictable and accurate results and obviates the need for revision surgeries. The device should be considered for precise operations such as ZMC fracture repairs.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제50권4호
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• pp.235-240
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• 2024

Lipomas, the most common soft-tissue mesenchymal neoplasms in adults, are characterized by the proliferation of mature white adipocytes without cytologic atypia. Lipomas are rarely observed in the head and neck region. We present a case of resection and orthognathic surgical removal of an intramuscular lipoma of the mandible with involvement of the mandibular ramus and condylar head and neck. An 18-year-old female patient was referred to our hospital for orthognathic surgery for the management of facial asymmetry and mandibular prognathism. The patient did not present with facial swelling, pain, or temporomandibular dysfunction; however, on radiographic examination, including cone-beam computed tomography and magnetic resonance imaging, an infiltrative fatty lesion was observed in the masticator space inside the right mandible, and the adjacent mandible exhibited bone thinning and deformity. Resection of the lipoma was performed along with orthognathic surgery, including a Le Fort I osteotomy for the maxilla and bilateral sagittal split ramus osteotomy (BSSRO). In this case, because the ramus was split using BSSRO, accessing the lipoma intraorally was easy. Consequently, aesthetic scarring was avoided, and no complications, such as unfavorable splitting or pathologic fracture, occurred. Although recurrence has not been observed about 1 year, long-term follow-up should be performed.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제21권3호
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• pp.317-323
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• 1999

TMJ ankylosis is defined as a mobile disorder of jaw such as mouth opening limitation, limitation of anterior or/and lateral movement of TMJ. Kazanjian published first clinical report about classification of TMJ ankylosis dividing with intracapsular ankylosis and extracapsular ankylosis. TMJ ankylosis is resulted from trauma, infection, metastatic tumor, irradiation, burn and etc. When TMJ ankylosis is manifested in growing period, it affects to functional disorder and development and position of mandible, so it can result in maxillofacial deformity such as facial asymmetry, micrognathia, malocclusion. For treatment of TMJ ankylosis, various surgical interventions were devised ; condylectomy, gap arthroplasty, interpositional arthroplasty and TMJ reconstruction. So, we report our results with documental study and cases of true ankylosis in our department.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제21권3호
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• pp.284-287
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• 1999

The nose, a striking features of the human face, is regarded by many clinicians as the keystone of facial esthetics. Clinically, as the treatment of a dentofacial deformity, the soft tissue changes that occurred normally with movement of the skeletal bases. Changes of the soft tissue in the maxillary orthognathic surgery are widening of alar base, elevated nasal tip and flattening of upper lip. In addition, soft tissue change is difficult to predict, it has considerable variability in the response of soft tissue. We reviewed patients who received Le Fort I advancement osteotomy in our department and analysed preoperative and postoperative alar base width, nasal height in clinical measurement and cephalometry and patient's satisfaction of postoperative nasal appearance.