• Maxillofacial Plastic and Reconstructive Surgery
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• 제32권2호
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• pp.141-148
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• 2010

The bilateral sagittal split ramus osteotomy (BSSRO) is preferred method of surgical correction for mandibular prognathism, retrognathism and asymmetry. This technique performed from primarily an intraoral incision to avoid a scar. After forward movement of the distal segment of the mandible, healing of bone by primary or secondary intention is easily accomplished through large areas of cancellous bony overlap. When rigid fixation is used for the BSSRO, it is possible to open the mouth during the immediate post-operative period because it promotes the healing process. Although this surgical procedure has been well-documented, the incidence of postoperative trigeminal neurosensory disorder in the region of the inferior alveolar nerve and the mental nerve remains one of the major complication. However, evaluation of objective methods for sensory recovery patterns is insufficient although most patients find their sensory return. Neurometer electrodiagnostic device performs automated neuroselective sensory nerve conduction threshold evaluation by determining current perception threshold (CPT) measures. The purpose of this study was to evaluate the sensory recovery patterns of inferior alveolar and mental nerve over time. Nerve examination with a neurometer was performed in 30 patients undergoing the BSSRO at pre-operative, post-operative 1-, 2-, 4- week, and 2-, 3-, 4-, 5-, 6- month follow-up visits after the osteotomy to compare the differences of nerve injury and recovery patterns after the BSSRO with or without genioplasty and sensory recovery patterns associated with the kind of nerve fiber.

• 대한치과교정학회지
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• 제29권3호
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• pp.285-301
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• 1999

악교정 수술의 계획에 있어서 수술 후 경조직의 이동에 따른 연조직 변화 양상을 보다 정확히 예측하는 것은 매우 중요하다. 최근에는 측모 두부 규격 방사선 사진과 실제 측모 사진을 병합하여 수술 후 측모 변화에 대한 가시성을 높인 여러 종류의 video imaging 프로그램들이 개발되어 널리 사용되고 있다. 그러나 이들 프로그램의 정확도를 판단하는 연구는 아직 미비한 실정이며 특히 국내에서 많이 시행되고 있는 골격성 III급 부정교합 환자의 수술 후 변화 양상에 대한 연구가 임상적인 활용에 앞서 선행되는 것이 필요하다. 이에 저자는 video imaging프로그램의 하나인 Power $Ceph^{\circledR}$ (Power Soft Co. Ver 3.3)을 이용하여 국내에서 양악수술을 시행 받은 골격성 III급 부정교합 환자 30명(남 14명, 여 16명)을 대상으로 예측도와 실제 술후의 측모를 비교하여 정확도를 평가하였으며 정확도에 영향을 미치는 요인을 분석하기 위해 이동량 및 술식별로 분류 비교하여 다음과 같은 결론을 얻었다. 1. 예측치와 실제 계측치의 비교에서 24개의 계측항목 중 14개 항목에서 유의성 있는 차이를 보였다. 2. 계측항목 중 유의성 있는 차이를 보이는 항목은 대부분 상악에 관련된 연조직으로 하악에 관련된 연조직에 비해 다양한 차이를 나타내었다. 3.상악 및 하악의 이동량에 따른 비교에서 이동량이 적은 군이 이동량이 많은 군에 비하여 예측치와 실제 계측치 비교에서 유의성 있는 차이를 보인 항목이 적게 나타났다. 4. 이부 성형술 여부에 따른 비교에서 이부 성형술을 시행하지 않은 군에서 이부 성형술을 시행한 군에 비하여 예측치와 실제 계측치 비교에서 유의성 있는 차이를 보인 항목이 적게 나타났다. Video imaging(Power $Ceph^{\circledR}$ Ver 3.3)프로그램에 의한 예측치와 실제 계측치 비교시 그 차이는 대부분 2mm 이내로써 임상적으로 수용할 수 있는 수준이었다.

• 대한치과교정학회지
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• 제30권3호
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• pp.355-365
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• 2000

악교정수술에 관한 치료계획은 치료결과에 관한 정확한 예측을 바탕으로 수립되는 것이 바람직하며 이는 심미적인 결과를 얻기 위한 가장 중요한 요소 중에 하나이다. 성인에서 골격성 하악전돌증의 치료는 하악골후퇴술을 이용한 악교정수술법이 주로 이용되는데, 술후 턱끝의 돌출도가 과도하게 감소되어 하악전진이부성형술을 추가로 시행해야 하는 경우 하악골과 턱 부위의 연조직 변화방향이 상이하게 나타나므로 술후 연조직 변화를 정확히 예측하는데 한계가 있다. 본 연구에서는 골격성 하악전돌증을 주소로 악교정수술을 시행한 성인을 대상으로, 상행지시상분할골절단술(BSSRO)만을 시행한 경우(A군) 11명 과 하악전진이부성형술(advancement genioplasty)도 같이 시행한 경우(B군) 9명의 경조직과 연조직 변화의 상관관계를 알아보기 위하여, 수술 8개월 이후에 채득된 측모두부계측방사선사진을 비교하여 다음과 같은 결과를 얻었다. 1. E-line에 대하여 상순은 더 돌출되고 하순은 더 후퇴되어 입술의 형태가 개선되었으며, 하악전진이부성형술을 병행한 경우 하순의 돌출도는 더 개선되었다. 2. 두 군 모두에서 상순은 후방이동하고 비순각은 증가하였다. 3. 술후 B점에 대한 연조직 POGs점의 변화율은 A군에서 $84\%$, B군에서 $66\%$로 나타났으며 두 군간에 통계적 유의성이 있었다. 4. 경조직과 계측점의 수직변화량은 A군에서 감소하였다.

• 대한치과의사협회지
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• 제47권11호
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• pp.750-757
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• 2009

Purpose : The purpose of this study is to evaluate the clinical availability of submentoplasty for esthethic improvement of the cervico-facial region of patients with obtuse chin-neck angle. Materials and methods : Case 1. We evaluate the changes of submental line length and chin-neck angle of 35-year-old woman with skeletal Class III and mandibular excess with excessive submental fat before and after surgery: Bilateral sagittal split ramus osteotomy(BSSRO) setback(5mm), Mandibular Angle Reduction, Reduction Malarplasty and Submentoplasty. In this case, It was done simultaneously with orthognathic surgery. Case 2. The changes of submental line length and chin-neck angle of 20-year-old man with skeletal class III and maxillary defiency were evaluated before surgery, at first surgery : Lefort I osteotomy(6mm posterior Impaction), BSSRO setback(9mm), Paranasal Augmentation and at second surgery: genioplasty(6mm advanced) with submentoplasty. In this case, submentoplasty and advancement genioplasty were done after 2 months post-operative periods. Results : Case 1. In case of the Skeletal Class III mandibular excess with submental fat deposit, It showed the improvement of submental angle and length of submental line after simultaneous submentoplasty. Submental angle is changed from $177^{\circ}$ (pre-op) to $151^{\circ}$ (post-op) and submental line length is changed from 8mm(pre-op) to 36mm(post-op). Case 2. The improvement of submental angle and length of submental line after delayed submentoplasty was aquired in case of the skeletal class III maxillary defiency. Submental angle is changed from $154^{\circ}$ (pre-op) to $161^{\circ}$ (first surgery) and to $153^{\circ}$ (second surgery) and submental line length is changed from 25mm(pre-op) to 19mm(first surgery) and to 23mm(second surgery). Conclusion : The results suggest that Submentoplasty is useful surgical procedure for esthethic improvement of the cervicofacial region of patients with obtuse chin-neck angle.

• Imaging Science in Dentistry
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• 제46권4호
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• pp.279-284
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• 2016

To our knowledge, the imaging features of costochondral grafts (CCGs) on cone-beam computed tomography (CBCT) have not been documented in the literature. We present the case of a CCG in the facial soft tissue to the anterior mandible, with changes mimicking a cartilaginous neoplasm. This is the first report to describe the CBCT imaging features of a long-standing graft in the anterior mandible. Implants or grafts may be incidental findings on radiographic images made for unrelated purposes. Although most are well-defined and radiographically homogeneous, being of relatively inert non-biological material, immune reactions to some grafts may stimulate alterations in the appearance of surrounding tissues. Biological implants may undergo growth and differentiation, causing their appearance to mimic neoplastic lesions. We present the case of a cosmetic autogenous CCG that posed a diagnostic challenge both radiographically and histopathologically.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제14권3호
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• pp.207-216
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• 1992

The congenital condition referred as hemifacial microsomia is characterized by underdevelopment, malformation or abscence of certain soft and hard tissue derivatives of the first and second branchial arches and open also of structures which are not derived from the branchial arches, such as the zygoma, temporal bone. This is a report about a 14 years old male patient with the chief complaint of severe facial asymmetry, who was diagnosed as hemifacial microsomia having agenesis of the right mandibular condyle and zygomatic arch. Deformities and rib bone graft on the affected mandibular condyle and body, and LeFort I osteotomy in the maxilla. To correct contour-deficient chin, we performed the genioplasty, and the zygomatic arch was reconstructed with rib bone graft.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제49권3호
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• pp.107-113
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• 2023

Bimaxillary transverse width discrepancies are commonly encountered among patients with dentofacial deformities. Skeletal discrepancies should be diagnosed and managed appropriately with possible surgical corrections. Transverse width deficiencies can present in varieties of combinations involving the maxilla and mandible. We observed that in a significant proportion of cases, the maxilla is normal, and the mandible showed deficiency in the transverse dimension after pre-surgical orthodontics. We designed novel osteotomy techniques to enhance mandibular transverse width correction, as well as simultaneous genioplasty. Chin repositioning along any plane is applicable concomitant with mandibular midline arch widening. When there is a requirement for larger widening, gonial angle reduction may be necessary. This technical note focuses on key points in management of patients with transversely deficient mandible and the factors affecting the outcome and stability. Further research on the maximum amount of stable widening will be conducted. We believe that developing evidence-based additional modifications to existing conventional surgical procedures can aid precise correction of complex dentofacial deformities.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제43권5호
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• pp.318-323
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• 2017

Objectives: Mandibular angle reduction or reduction genioplasty is a routine well-known facial contouring surgery that reduces the width of the lower face resulting in an oval shaped face. During the intraoral resection of the mandibular angle or chin using an oscillating saw, unexpected peripheral nerve damage including inferior alveolar nerve (IAN) damage could occur. This study analyzed cases of damaged IANs during facial contouring surgery, and asked what the basic standard of care in these medical litigation-involved cases should be. Materials and Methods: We retrospectively reviewed a total of 28 patients with IAN damage after mandibular contouring from August 2008 to July 2015. Most of the patients did not have an antipathy to medical staff because they wanted their faces to be ovoid shaped. We summarized three representative cases according to each patient's perceptions and different operation procedures under the approvement by the Institutional Review Board of Seoul National University. Results: Most of the patients did not want to receive any further operations not due to fear of an operation but because of the changes in their facial appearance. Thus, their fear may be due to a desire for a better perfect outcome, and to avoid unsolicited patient complaints related litigation. Conclusion: This article analyzed representative IAN cutting cases that occurred during mandibular contouring esthetic surgery and evaluated a questionnaire on the standard of care for the desired patient outcomes and the specialized surgeon's position with respect to legal liability.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제34권3호
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• pp.180-185
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• 2012

Purpose: An accurate preoperative analysis of the patient is essential in orthognathic surgery in order to acquire superior results. In profile, the location of the chin's position may change according to the neck's inclination. This may ultimately affect the amount of surgical movement. During acquisition of cephalometric radiographs, or in supine position, there is a discrepancy in the neck's inclination. This means that there are also various discrepancies between the actual profile and the various preoperative profile images. In the clinical situation, the decision in performing genioplasty usually lies in the analysis of the patient's profile on the operating table at the final stages of orthognathic surgery. This study aims to analyze the different preoperative profile images and to compare their discrepancies. Methods: Fifty eight patients undergoing orthognathic surgery were chosen. These patients were divided into three groups according to angle's classification of malocclusion, as class I, II or III. The right profile of these patients in centric occlusion was taken in natural head position (NHP). This was set as the 'actual profile image.' Another right profile image was taken on the operating table after insertion of the nasotracheal intubation and with muscle relaxants in effect. This was also taken in centric occlusion. The angle (denoted 'A') between the soft tissue glabella-pognion and the true vertical plane was found in the above-mentioned profile images and in the cephalometric radiographs. The differences of these values were analyzed. Results: There were differences in Angle 'A' in all of the preoperative images. These values were however, not statistically significant. Conclusion: In order to gain an esthetic profile during orthognathic surgery, the NHP is shown to be the most reliable position. Images reproducing such head positions should be used in the treatment planning process.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제38권
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• pp.47.1-47.8
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• 2016

Background: The paradigm of tonsillectomy has shifted from a treatment of recurrent throat infection to one of multi-discipline management modalities of sleep-disordered breathing (SDB). While tonsillectomy as a treatment for throat problems has been performed almost exclusively by otorhinolaryngologists, tonsillectomy as a part of the armamentarium for the multifactorial, multidisciplinary therapy of sleep-disordered breathing needs a new introduction to those involved in treating SDB patients. This study has its purpose in sharing a series of tonsillectomies performed at the Seoul National University Dental Hospital for the treatment and prevention of SDB in adult patients. Methods: Total of 78 patients underwent tonsillectomy at the Seoul National University Dental Hospital from 1996 to 2015, and 23 of them who were operated by a single surgeon (Prof. Jin-Young Choi) were included in the study. Through retrospective chart review, the purpose of tonsillectomy, concomitant procedures, grade of tonsillar hypertrophy, surgical outcome, and complications were evaluated. Results: Twenty-one patients diagnosed with SDB received multiple surgical procedures (uvulopalatal flap, uvulopalatopharyngoplasty, genioglossus advancement genioplasty, tongue base reduction, etc.) along with tonsillectomy. Two patients received mandibular setback orthognathic surgery with concomitant tonsillectomy in anticipation of postoperative airway compromise. All patients showed improvement in symptoms such as snoring and apneic events during sleep. Conclusions: When only throat infections were considered, tonsillectomy was a procedure rather unfamiliar to oral and maxillofacial surgeons. With a shift of primary indication from recurrent throat infections to SDB and emerging technological and procedural breakthroughs, simpler and safer tonsillectomy has become a major tool in the multidisciplinary treatment modality for SDB.