• Maxillofacial Plastic and Reconstructive Surgery
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• v.13 no.3
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• pp.324-331
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• 1991

Ocular injuries often accompany midfacial trauma Blindness related to indirect optic nerve injury in midfacial fractures is an uncommon and usually permanent complication. Opic nerve blindness is secondary to an indirect optic nerve injury due to the skeletal distortion that occurs in a facial fracture and almost all are caused by frontal, nasoethmoido-frontal or Le Fort III type fractures. When the loss of vision following midfacial fractures is complete and immediate, the prognosis is poor in spite of treatment. Computed tomography revealed compressin of the optic nerve by bony fragments. And so if injury to the optic nerve is suspected, a CT-scan must be performed and massive steroid therapy must be started as soon as possible. Surgery must be performed if there are hematoma or bony fragments injuring the nerve. The following report concerns two patients who suffered immediate and total loss of vision due to a midfacial fracture with no improvement after massive steroid therapy and surgial decompression.

• Journal of Korean Dental Science
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• v.10 no.2
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• pp.82-86
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• 2017

Oral and maxillofacial surgery (OMFS) trauma cases are commonly treated under general anesthesia. The purpose of this case report is to introduce an alternative method of anesthesia in patients who refuse general anesthesia. A combination of dexmedetomidine and ketamine for sedation anesthesia in 3 frequent fracture types in the field of OMFS-Le Fort I fracture, mandibular fracture, and alveolar bone fracture-was used. Dexmedetomidine as the single agent has not shown stable success rates for invasive procedures. To overcome some of the pitfalls with dexmedetomidine, combination sedation using ketamine was performed. Visual analogue scale scores were recorded postoperatively. Dexmedetomidine combined with ketamine administration provided safe and effective sedation and anxiolysis for surgical reduction and internal fixation of OMFS fractures. It showed advantages of decreased admission time, reduced expenses, minimal pain, and reduced anesthetic burden for the patient thus ultimately increasing overall satisfaction.

• Journal of Korean Dental Science
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• v.16 no.1
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• pp.87-98
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• 2023

This report presents a case of successful treatment of skeletal Class III malocclusion with transverse discrepancy in adult by surgery-first approach. Traditionally dental decompensation is necessary prior to surgery in 2-jaw surgery to correct transverse and rotational discrepancy. However, the hyrax-type palatal expansion appliance was used to improve maxillary expansion accuracy and postoperative stability in this surgery-first approach (segmental Le Fort I osteotomy and mandibular setback surgery). It was established to be an effective means of precisely predicting postoperative occlusion and achieving stable retention after surgery of skeletal Class III malocclusion with maxillary transverse discrepancy.

• The korean journal of orthodontics
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• v.30 no.5 s.82
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• pp.657-668
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• 2000

The purpose of this study was to evaluate the amount and interrelationship of the soft tissue of nose and maxillary changes and to identify the nasal morphologic features that indicate susceptibility to nasal deflection in such a manner that they would be useful in presurgical prediction of nasal changes after maxillary advancement surgery in skeletal Class III malocclusion. The sample consisted of 25 adult patients (13 males and 12 females) who had severe anteroposterior skeletal discrepancy. The patients had received presurgical orthodontic treatment. They underwent a Le Fort I advancement osteotomy, rigid internal fixation, alar cinch suture and V-Y advancement lip closure. The presurgical and postsurgical lateral cephalograms and lateral and frontal facial photographs were evaluated. The computerized statistical analysis was carried out. Soft tissue of nose change to h point change ratios were calculated by regression equations. The results were as follows 1. The correlation of maxillary hard tissue horizontal changes and nasal soft tissue vortical changes were high and the ${\beta}_0$ for soft tissue to ADV were 0.228 at ANt, 0.257 at SNt. 2. The correlation of maxillary hard tissue and nasal soft tissue horizontal changes were high and the ${\beta}_0$ for soft tissue to ADV were 0.484 at ANt, 0.431 at SNt, 0.806 at Sn. 3. The correlation of maxillary hard tissue horizontal changes and width changes of ala of nose were high and the ${\beta}_0$ lot alar base width ratio to ADV were 0.002. 4. The DRI, Prominence of nose, Pre-Op CA is not a quantitative measure that can be used clinically to improve the predictability of vertical and horizontal nasal tip deflection. In this study, increases in nasal tip projection and anterosuperior rotation occur when there is an anterior vector of maxillary movement. These nasal changes were Quantitatively correlated to magnitude of maxillary(A point) movement.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.33 no.5
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• pp.413-419
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• 2011

Purpose: Reposition of the maxilla is a common technique for correction of midfacial deformities. To achieve the goal of the surgery, the maxilla should be repositioned based on the precisely planned position during surgery. The internal reference points (IRPs) and the external reference points (ERPs) are usually used to determine vertical dimension of maxilla, which is an important factor for confirming maxillary position. However, the IRPs are known to be inaccurate in determining the vertical dimension. In this study, we investigated the correlation of positional change of the modified IRPs with repositioned maxilla. Methods: The study group consisted of 26 patients with dentofacial deformities. For the simulation of the surgery, patient maxillary CT data and 3-D virtual surgery programs (V-$Works^{(R)}$ and V-$Surgery^{(R)}$) were used. IRPs of this study were set on both the lateral wall of piriform aperture, inferior margin of both infraorbital foramen, and the labial surfaces of the canine and first molar. The distance from the point on lateral wall of the piriform aperture to the point on the buccal surface of the canine was defined as IRP-C, and the distance from the point on the inferior margin of the infraorbital foramen to the point on the buccal surface of the $1^{st}$ molar was defined as IRP-M. After the virtual simulation of Le Fort I osteotomy, the changes in IRP-C and IRP-M were compared with the maxillary movement. All measures were analyzed statistically. Results: With respect to vertical movements, the IRP-C (approximately 98%) and the IRP-M (approximately 96%) represented the movement of the canine and the $1^{st}$ molar. Regarding rotating movement, the IRPs changed according to the movement of the canine and the $1^{st}$ molar. In particular, the IRP-C was changed in accordance with the canine. Conclusion: IRPs could be good indicators for predicting vertical movements of the maxilla during surgery.

• The korean journal of orthodontics
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• v.36 no.1 s.114
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• pp.63-73
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• 2006

Numbers of postulations lie on the difference of integumental changes with two major surgical remedies of one jaw vs. two jaw surgery in skeletal Class III malocclusion. Accordingly it was the aim of the study to elucidate the skeletal profile changes with an accompanying disposition of soft tissues, consequently to yield the correlation and ratio of soft tissue changes with two types of surgical procedures, which in turn make it possible to predict the soft tissue outcomes by means of assembled regression equations. Cephalometric headfilms of fifty two adult skeletal Class III comprised of 26 maxillary advancement by Le Fort I osteotomy and mandibular setback by sagittal split ramus osteotomy simultaneously (double jaw surgery, group A), 26 mandibular setback alone (one jaw surgery, group B) were statistically analyzed. Group A manifested 72.4% soft tissue advancement to skeletal changes in the upper lip area, while group B appeared to have no statistically significant changes. The nasolabial angle showed more increment in group A than in group B, whereas the mentolabial angle illustrated more reduction in group B. The backward movement of soft tissue pogonion to skeletal change revealed 98% in group A, and 109% in group B. The double jaw surgery group characteristically revealed remarkable integ umental change in the upper lip area, while the one jaw surgery had major effects in the lower lip and soft tissue pogonion areas.

• Archives of Plastic Surgery
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• v.42 no.4
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• pp.419-423
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• 2015

Background Orthognathic surgery is required in 25% to 35% of patients with a cleft lip and palate, for whom functional recovery and aesthetic improvement after surgery are important. The aim of this study was to examine maxillary and mandibular changes, along with concomitant soft tissue changes, in cleft patients who underwent LeFort I osteotomy and sagittal split ramus osteotomy (two-jaw surgery). Methods Twenty-eight cleft patients who underwent two-jaw surgery between August 2008 and November 2013 were included. Cephalometric analysis was conducted before and after surgery. Preoperative and postoperative measurements of the bone and soft tissue were compared. Results The mean horizontal advancement of the maxilla (point A) was 6.12 mm, while that of the mandible (point B) was -5.19 mm. The mean point A-nasion-point B angle was $-4.1^{\circ}$ before surgery, and increased to $2.5^{\circ}$ after surgery. The mean nasolabial angle was $72.7^{\circ}$ before surgery, and increased to $88.7^{\circ}$ after surgery. The mean minimal distance between Rickett's E-line and the upper lip was 6.52 mm before surgery and 1.81 mm after surgery. The ratio of soft tissue change to bone change was 0.55 between point A and point A' and 0.93 between point B and point B'. Conclusions Patients with cleft lip and palate who underwent two-jaw surgery showed optimal soft tissue changes. The position of the soft tissue (point A') was shifted by a distance equal to 55% of the change in the maxillary bone. Therefore, bone surgery without soft tissue correction can achieve good aesthetic results.

• The korean journal of orthodontics
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• v.38 no.2
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• pp.121-132
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• 2008

Objective: The purpose of this study was to evaluate the upper airway dimensional change according to maxillary superior movement after orthognathic surgery and to identify the relationship between the amount of maxillary movement and upper airway dimensional changes. Methods: The samples consisted of 24 adult patients (9 males and 15 females) who had a skeletal discrepancy and had received presurgical orthodontic treatment. They underwent Le Fort I superior impaction osteotomy and mandibular setback surgery. Cephalometric x-rays were taken at 3 stages - T0 (before orthognathic surgery), T1 (just or within 2 weeks after orthognathic surgery), T2 (6 months after surgery) Results: 1, Pharyngeal airway space (PAS (R)-nasopharynx) was decreased after surgery (T1) but recovered at 6 months after surgery; 2, Pharyngeal airway space (PAS (NL)-palatal plane) was increased after surgery and at 6 months after surgery; 3, Pharyngeal airway space (PAS (OL)-occlusal plane) was increased at T1 and was decreased at T2; 4, Soft palate thickness was increased at T1 but it became the same or thinner at T2; 5, There is no statistically significant relation between the amount of maxillary superior movement and pharyngeal airway space. Conclusions: These findings suggested that the maxillary superior movement of about an average of $4.40{\pm}1.14 mm$ did not affect upper pharyngeal airway space changes.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.13 no.1
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• pp.44-52
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• 1991

Internal measurement technique has been commonly and classically used to guide down-fractured maxilla by Le Fort I osteotomy into its new position during intraoperative procedure for correlating preoperative model works with surgery. However, It has been challenged now by several authors due to some problems as its inaccuracy in three-dimensional changes at surgery, difficulty to measure during surgery and impossibility of rechecking at the end of surgery etc. The purpose of this study was to evaluate the accuracy of maxillary movement by external measuring technique and to determine its accuracy between the prediction tracing and a new maxillary position. The results indicate that the external measuring technique was predictable in the vertical, horizontal and transverse change of the maxilla as its prediction, however, it has a tendency to shift the maxilla more anterior and inferior in overall direction than prediction. Post-operative canting difference were mimic, however Ehange of the maxillary dental midline was large and had a right-shifting tendency.1 The precise methods to keep maxillary dental midline as same as prediction and the avoidance of uneven force applied to the mandible for autorotation should be necessary during surgery in use of external measurement technique.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.13 no.1
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• pp.63-68
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• 1991

The author has arrived at the following result after having carried out multilateral study based on a total of 282 maxillofacial fracture patients who have receive treatment at the Euijeongbu general hospital and Shinchun general hospital in the northern district of Kyunggido from march 1988 to august 1990. 1. Sex distribution of Mx. facial fx. patient was higher in male by 4.6:1 and was predominant in the 3rd decade with 40.4% followed in decreasing order by the 2nd decade and the 4th. 2. A majority were in the Mn. with 40.2% followed in decreasing order by zygoma. nasal bone and maxilla. 3. For the sex distribution according to anatomy, make to female ratio was 6.2:1 in the mandible, followed in decreasing order by zygoma, and nasal bone with predominance in male. 4. Car accident with 42.8% was the most common cause of fx. followed in decreasing order by violence, workmen's accident, and fall down. 5. The involvement of other trauma areas are head. 79.0%, abdomen-thorax, and the extremities in decreasing order. 6. In the mandibular fx. a majority were in the symphysis with 73.9% followed in decreasing order by angle, Condyle, and body. 7. Maxillary fx. of the type LeFort II was estimated to be 41.2% 8. Fracture in the zygoma including zygomatic arch was estimated to be 72.5%