• Archives of Plastic Surgery
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• 제48권1호
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• pp.69-74
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• 2021

Background In inferomedially rotated zygomatic fractures sticking in the maxillary sinus, it is often difficult to achieve complete reduction only by conventional intraoral reduction. We present a new intraoral reduction technique using a Kirschner wire and its clinical outcome. Methods Among 39 inferomedially impacted zygomatic fractures incompletely reduced by a simple intraoral reduction trial with a bone elevator, a Kirschner wire (1.5 mm) was vertically inserted from the zygomatic body to the lateral orbital rim in 17 inferior-dominant rotation fractures and horizontally inserted to the zygomatic arch in nine medial-dominant and 13 bidirectional rotation fractures. A Kirschner wire was held with a wire holder and lifted in the superolateral or anterolateral direction for reduction. Following reduction of the zygomaticomaxillary fracture, internal fixation was performed. Results Fractures were completely reduced using only an intraoral approach with Kirschner wire reduction in 33 cases and through an additional lower lid or transconjunctival incision in six cases. There were no surgical complications except in one patient with undercorrection. Postoperative 6-month computed tomography scans showed complete bone union and excellent bone alignment. Four patients experienced difficulty with upper lip elevation; however, these problems spontaneously resolved after manual tissue lump massage and intralesional steroid (Triamcinolone) injection. Conclusions We completely reduced infraorbital rim fractures, zygomaticomaxillary buttresses, and zygomaticofrontal suture fractures in 84% of patients through an intraoral approach alone. Intraoral Kirschner wire reduction may be a useful option by which to obtain effective and powerful reduction motion of an inferomedially rotated zygomatic body.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제23권3호
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• pp.270-276
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• 2001

The treatment of mandibular subcondylar fractures is a matter of controversy. The majority of mandibular subcondylar fracture are treated by closed reduction, but the displaced or dislocated mandibular subcondylar fractures may be treated by open reduction. The characteristics of open reduction are the anatomical reduction, the functional restoration, the rapid function, the maintenance of vertical ramus dimension, the better appearance and the less resultant TMJ problem etc. When an open reduction is considered, the wire, miniplate, lag screw and Kirschner wire are available with internal fixation. Of these, Kirschner wire is a simple method relatively and correct positioning of the wire achieves rigid fixation. But many open reduction methods for mandibular subcondylar fractures require extraoral approach. The extraoral approach has some problems, the facial scar and the risk of facial nerve injury. On the other hand, the intraoral approach eliminates the potency of the facial scar and the facial nerve injury, but is difficult to access the operation site. Since the intraoral approach was first described by Silverman (1925), the intraoral approach to the mandibular condyle has been developed with modifications. The purpose of this article is to describe the intraoral technique with the Kirschner wire on mandibular subcondylar fractures. Conclusion : The intraoral reduction with Kirschner wire on mandubular subcondylar fractures avoids the facial scar and facial nerve injury and is simple method to the extraoral approach. And it has minimal morbidity and better esthetics.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제30권1호
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• pp.72-82
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• 2008

Various surgical approaches in the mandibular condyle fracture have been reported and many advantages of intraoral reduction were also introduced. But there are still controversies about surgical method of condylar fractures up to date. To establish the surgical approach protocol of condylar fracture, from May 2001 to December 2004, total 65 patients with 74 fractures of the mandibular condyle were reviewed during 2 years, retrospectively. All cases were classified according to the treatment considering factors, such as the level of fracture, degree and direction of displacement of fractured segment, patient’s age and gender, surgical approach methods, and their complications. Especially, advantages and surgical limitations of extraoral surgical approach, such as direct reduction and fixation via submandibular approach, Nam’s method, and endaural approach, were compared with those of intraoral surgical approach, such as direct intraoral reduction with transbuccal fixation or right angle driver system, and intraoral reinsertional approach after extraoral fixation of fractured fragment. The guidelines of surgical approach of condylar fracture based on our clilnical retrospective experiences and literature reviews can be suggested.

• Archives of Plastic Surgery
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• 제38권6호
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• pp.845-850
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• 2011

Purpose: In general, orientals including Korean, have a mesocephalic face whereas Caucasians, among the western, have a dolichocephalic face. Unlike the western, in orientals including Korean, prominent malar bones are recognized as stubborn and unattractive appearance. That is why reduction malarplasty is one of the most popular aesthetic surgical procedure in Korea. Many surgical methods to reposition prominent malar bones have been performed by means of a coronal incision or a combined incisions, using both the intraoral and the external incision. Bicoronal approach has advantage such as wide operative field, easy to maintain symmetry and possibility of combining facial lift but has shortcoming, such as external scars, long operative time, and the possibility of facial nerve or artery injury. Intraoral approach has advantages of short operative time, simplicity of procedure and no external scar. But this approach is associated with problems of cheek drooping, limited exposure and difficulty in making symmetry. Methods: During 8 years, we performed a reduction malarplasty without internal fixation through an minimal intraoral incision and dissection in 39 patients. Results: The patients were followed for 46 months, with satisfactory results and no cheek drooping. There was no patient who want to revise the inappropriate operative result such as asymmetry and incomplete correction. Conclusion: We conclude that minimal intraoral incision and dissection could acquire satisfactory result of reduction malarplasty along with prevention of cheek drooping.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제15권3호
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• pp.171-177
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• 1993

The prominent malar region has been recognized a sign of youth and beauty in caucasian who generally have a dolichocephalic and long face. But in the orients, especially Koreans who generally have a mesocephalic or brachycephalic face, it is considered an agressive, unesthetic facial appearance. So many patients require the shaving of prominent malar eminence and arch, and many methods of its reduction have been devised. For the exposure of malar complex, infraorbital skin incision, intraoral approach, preauricular approach, supraauricular scalp incision, and coronal approach have been used. And for the reduction of bony structure, direct shaving, contouring and repositioning of the malar complex after extirpation, and medially fracture of zygomatic arch have been used with its own merits. We performed the reduction malarplasty through intraoral approach. After two parallel oeteotomy at medial part of the zygomatic bone, the midsegment is removed. The posterior arch of zygoma was bended or green stick fractured. When more correction was required, the posterior arch was fractured medially through the step incision at skin. This method has a some advantages. Compared with the method for extirpation of malar complex, the infection rate is diminished, the resorption is small because of no free bone graft. And cheek drooping is prevented. Compared with the method of coronal approach, the surgical trauma is minimal. Now we report some cases of reduction malarplasty performed through intraoral approach and disscus the surgical technique and results.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제34권6호
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• pp.644-648
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• 2008

Purpose: The aim of this study was to investigate the clinical cases of subcondylar fracture with intraoral approach. Material and Method: Fifteen patients with unilateral subcondylar fracture were treated in the department of oral and maxillofacial surgery, Kangdong Sacred Heart Hospital, College of Medicine, Hallym University between 2006 and 2007. Each patients was examined by computed tomography(CT) and panorama. 3D-CT taken when fractured segment was displaced and comminuted. Patients was done intermaxillary fixation to occlusal stability and prevent displacement of fractured segment before general operation. Open reduction and internal fixation(ORIF) accomplished under general anesthesia and used to intraoral approach. We examinated the state of occlusion, maximum opening. Evaluation of the state of occlusion was divided in patient`s subjective evaluation that compare pre-traumatic occlusion with postoperative occlusion, and estimator`s objective evaluation that use articulating paper. Examination was done at 2 weeks, 1, 3, 6 month postoperative by follow up. Result: The ORIF through intraoral approach was good in all patients. In the state of occlusion, all patients recovered pre-traumatic occlusion in 6 month postoperation. Maximum opening was gradually increased. In 3 month postoperative, maximum opening was excessed 40mm. Conclusion: Our study indicate that the intraoral approach is a good technique for subcondylar fracture. Intraoral approach prevent complication that facial nerve damage, scar formation caused by extraoral approach. So, we recommend intraoral approach when subcondylar fracture.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제22권1호
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• pp.105-109
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• 2000

The zygoma is protruded on both sides of the midface and plays an important part in determining the impression of face. There are much different esthetic consideration of zygomatic prominence between the oriental and western. Because slight prominent zygoma is thought to be esthetic in the western, there has been done many augmentation therapy. But, in the oriental, prominent zygoma, especially in the female, is thought to be aggresive and manlike image, there has been done many zygoma reduction therapy. There are two methods to reduce the prominent zygoma, one is shaving method and the other is zygoma repositioning with ostectomy. The approach to zygoma and zygomatic arch without surgical morbidity is very difficult, so this problem has been difficult subject to oral & maxillofacial surgeon in a long period. We report the treatment case of facial asymmetry with the unilateral zygoma reduction & genioplasty using only intraoral approach with the retrospective study.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제16권1호
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• pp.63-71
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• 1994

Recently, we have used internal fixation with titanium miniplate which introduced by Champy in 1976 in facial bone fractures. In cases of mandibular fractures, particulary mandibular angle fractures, we usually underwent the open reduction extraorally. But extraoral approaches may leave scars and put the facial nerve at greater risk. So, we had undergone the intraoral approaches in 31 patients of mandibular angle fractures (male : 29, female : 2). These patients visited in Wonkwang university hospital from October 1991 to June 1993. We got easy operation time as average 20 minutes than extraoral approach. And reduced the postoperative nerve injury(14.2%), but postoperative infection is 6.1% nearly as same as extraoral approach. TMJ problems after intraoral open reduction was similar to extraoral approaches.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제38권
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• pp.36.1-36.6
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• 2016

Background: Fracture of the zygomaticomaxillary complex (ZMC) is one of the most common facial injuries. A previous study has performed 3D analyses of the parallel and rotational displacements that occur in a fractured ZMC. However, few studies have investigated adequate fixation methods according to these displacements. Here, we assessed whether specific approaches and fixation methods for displacement of ZMC fractures produce esthetic results. Methods: Hospital records and pre- and post-surgical computed tomographic scans of patients treated for ZMC fractures at the Department of Oral and Maxillofacial Surgery, College of Dentistry, Wonkwang University, between January 2010 and December 2015, were selected. Data were analyzed according to the direction of displacement and post-reduction prognosis using a 3D software. Results: With ZMC fractures, displacement in the posterior direction occurred most frequently, while displacement in the superior-inferior direction was rare. A reduction using a transconjunctival approach and an intraoral approach was statistically better than that using an intraoral approach, Gillies approach, and lateral canthotomy approach for a posterior displacement (P < 0.05). Conclusions: When posterior displacement of a fractured ZMC occurs, use of an intraoral approach and transconjunctival approach simultaneously is recommended for reducing and fixing the displaced fragment accurately.

• Journal of Oral Medicine and Pain
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• 제18권1호
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• pp.97-105
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• 1993

In order to evaluate the effectiveness of tooth brushing, mouth gargling and gum chewing in reducing halitosis, 84 individuals ranging in age from 22 59 28 years old were examined. These individuals had no gross oral abnormalities, other than mild gingival inflammation, dental caries, nasopharyngeal disorder, or systemic diseases that were associated with halitosis. They were divided into a tooth brushing group, a mouth garging group, a gum chewing group and a control group that did not use any halitosis removing method. Each of the groups included 21 persons, B.B. Checker (Tokuyama Soda Col, LTDl, Japan) was used to measure the concentrations of intraoral volatile methyl mercaptan of each group. The concentrations of intraoral volatile methyl mercaptan were measured before and after lunch, and after removing halitosis by toothe brushing, mouth gargling and gum chewing. The obtained results were as follows : 1. The average concentration of intraoral volatile methyl mercaptan before lunch was 1.79ppm and after lunch it was 2.02ppm, an increase of 12.9%. 2. In the tooth brushing group the average concentration of intraoral volatile methyl mercaptan was 0.61ppm, in the mouth gargling group it was 1.15ppm, in the gum chewing group it was 1.64ppm and in the control group it was 1.92ppm. It decreased 69.5% in the tooth brushing group, 43.8% in the mouth gargling group, 18.4% in the gum chewing group and 5.4% in the control grop (p<0.05). 3. There were significant differences between the tooth brushing and control group, tooth brushing and gum chewing group and between mouth gargling and control group in concentrations of intraoral volatile methyl mercaptan after using the halitosis removing methods (p<0.05). According to the above results, tooth brushig and mouth gargling are effective ways to reduce halitosis.