• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제26권1호
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• pp.1-4
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• 2000

저자 등은 경희대학교 구강악안면외과에 내원한 중안면성장 부전을 동반한 하악전돌증 환자의 치료에 있어 관상절개를 통한 Le Fort III 골절단술 및 Le Fort I 골절단술과 양측 하악지시상분 할골절단술을 2회법으로 시행하여 기능적 심미적으로 만족할만한 결과를 얻었기에 보고하는 바이다.

• 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.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제22권3호
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• pp.310-318
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• 2000

The purpose of this study was to assess the soft tissue changes of upper lip & nose using 38 patients who treated with Le Fort I osteotomy for the correction of dentofacial deformities. Patients were devided into three groups. One was advancement group of maxilla(Group I, N=14), another was impaction group of maxilla(Group II, N=12) and the other was combination group(advancement & impaction)(Group III, N=12). Preop. and 1 month postop. (T1), preop. and 6 months postop.(T2) were analyzed and compared. The results obtained were as follows : 1. The upper lip thickness(UL-VP) moved anteriorly approximately 62% of the horizontal maxillary change and this was significant in the advancement group(Group I) 2. The upper lip length(Stm-Sn) and the lower border of upper lip(Stm) moved superiorly 25%, 40% of the maxillary impaction group(Group II) (P<0.05) 3. There was significancy in the upper lip thicness(UL-VP) approximately 56% of the combination group(Group III) (P<0.05) 4. The nasolabial angle decreased in all groups, but there were no significancy.

• 대한구순구개열학회지
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• 제2권1_2호
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• pp.15-22
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• 1999

It is well known that the postoperative skeletal instability after Le Fort I osteotomy for advancement of maxilla in the cleft patients is one of the major surgical problems. So we had tried to compare the amount of relapse after Le Fort I advancement surgery in the horizontal and vertical positional change, angular change of reference points between cleft patients and non-cleft patients. Longitudinal records of 10 consecutive cleft patients (test group) and 20 non-cleft patients (control group) were analyzed. Lateral cephalograms were taken preoperatively, immediately postoperatively, and 2, 6, 12 months postoperatively. We measured horizontal and vertical changes (ANS, PNS, AI) and angular change (SNA) of the reference points and lines. In the test group, horizontal relapse of ANS, PNS, AI point are 36.4%, 37.5%, 32.0% respectively at 12 months postoperatively. The vertical relapse of ANS, PNS, AI are 25.3%, 32.3%, 39.1% respectively at 12 months postoperatively. The angular change of SNA is 33.6% at 12 months postoperatively. In the control group, horizontal relapse of ANS, PNS, AI point are 23.8%, 30.2%, 21.7% respectively at 12 months postoperatively. The vertical relapse of ANS, PNS, AI are 22.7%, 27.3%, 25.1% respectively at 12 months postoperatively. The angular change of SNA is 22.2% at 12 months postoperatively. The cleft patients have a larger tendency of skeletal and dental relapse compared with non-cleft patients after Le Fort I surgery. So the oral and maxillofacial surgeons must keep in mind these facts in order to minimize the relapse phenomenon from the beginning of surgical planning to postoperative care.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제32권2호
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• pp.149-153
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• 2010

The purpose of this retrospective study was to evaluate relapse, comparing large and small maxillary advancements with four-plate rigid fixation and without bone grafting. All patients had skeletal class III malocclusion, and underwent bimaxillary surgery. Standardized cephalometric analysis by one examiner was performed on serial radiographs of 14 patients immediately before surgery, and within 1 week and at least 6 months postoperatively (mean 10 months). The group was divided into two subsets to determine whether the magnitude of relapse. In group 1 ($\leq$ 5 mm, n = 8), the average advancement was $4.0{\pm}0.9\;mm$, with a mean relapse of $0.1{\pm}0.5\;mm$. In group 2 (6-8 mm, n = 4), the average advancement was $6.8{\pm}0.9\;mm$, with a mean relapse of $0.7{\pm}0.4\;mm$. There was no statistical difference in the measured relapse among the groups. Maxillary advancement with a 1-piece Le Fort I osteotomy is a relatively stable procedure.

• 대한치과의사협회지
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• 제53권7호
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• pp.468-475
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• 2015

Cleft 상악수술은 근본적으로 재발 성향을 가지며 Lefort I 후에 대부분 횡적으로 완전하게 안정되어 있지않고 움직임이 존재하므로 악간 고정기간을 통상적인 수술에서보다도 좀 더 충분히 두는 것이 좋다. 수술과 동시에, 추가적으로 비대칭적인 piriform aperture 나 alar base를 correction하기 위하여 골이식이 고려될 수 있으며 경우에 따라서는 조심스럽게 반흔조직을 절개해 주어야 하는 경우도 있다. Cleft 환자의 경우 상순이 얇고 수술에 의한 전방이동효과가 적기때문에 상악 수술시 이를 적극 고려하는 것이 필요하다. 또한 cleft 환자의 pterygomaxilla 부위의 해부학적 구조가 일반인과 차이가 있다는 것을 숙지하여 상악 수술에 임하는 것이 필요하다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제22권2호
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• pp.243-248
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• 2000

Carotid cavernous sinus fistula(CCSF) is an abnormal communication at the base of the skull between the internal carotid artery and the cavernous sinus. Fistula is almost associated with extensive facial trauma as a result of direct or indirect forces. Most fistulas of traumatic origin develop as a result of fractures through the base of the skull, which cause the laceration of the internal carotid artery near the cavernous sinus. The signs and symptoms of CCSF are pulsating exophthalmosis, orbital headache, pain, orbital or frontal bruit, loss of visual acuity, diplopia and ophthalmoplegia. Angiography reveals a definite CCSF and a detachable balloon embolization is known to be the treatment of choice. Even though carotid cavernous sinus fistula is an uncommon complication after orthognathic surgery, several cases of CCSF due to congenital anomalies, pre-existing aneurysms and abnormally thickened maxillary posterior wall have been reported in the literature. We have experienced a case of CCSF after Le Fort I osteotomy for maxillary advancement in skeletal class III patient and the cause, pathogenesis, diagnosis and treatment of this case.

• 대한치과교정학회지
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• 제46권6호
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• pp.395-408
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• 2016

We report a case involving a young female patient with severe mandibular retrognathism accompanied by mandibular condylar deformity that was effectively treated with Le Fort I osteotomy and two genioplasty procedures. At 9 years and 9 months of age, she was diagnosed with Angle Class III malocclusion, a skeletal Class II jaw relationship, an anterior crossbite, congenital absence of some teeth, and a left-sided cleft lip and palate. Although the anterior crossbite and narrow maxillary arch were corrected by interceptive orthodontic treatment, severe mandibular hypogrowth resulted in unexpectedly severe mandibular retrognathism after growth completion. Moreover, bilateral condylar deformities were observed, and we suspected progressive condylar resorption (PCR). There was a high risk of further condylar resorption with mandibular advancement surgery; therefore, Le Fort I osteotomy with two genioplasty procedures was performed to achieve counterclockwise rotation of the mandible and avoid ingravescence of the condylar deformities. The total duration of active treatment was 42 months. The maxilla was impacted by 7.0 mm and 5.0 mm in the incisor and molar regions, respectively, while the pogonion was advanced by 18.0 mm. This significantly resolved both skeletal disharmony and malocclusion. Furthermore, the hyoid bone was advanced, the pharyngeal airway space was increased, and the morphology of the mandibular condyle was maintained. At the 30-month follow-up examination, the patient exhibited a satisfactory facial profile. The findings from our case suggest that severe mandibular retrognathism with condylar deformities can be effectively treated without surgical mandibular advancement, thus decreasing the risk of PCR.

• 대한치과교정학회지
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• 제50권4호
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• pp.249-257
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• 2020

Objective: To evaluate the changes in the nose in three dimensions after Le Fort I osteotomy in patients with skeletal Class III malocclusion. Methods: The subjects were 40 adult patients (20 females and 20 males; mean age, 20.3 ± 3.0 years; range, 17.0 to 31.1 years) who underwent one-piece Le Fort I osteotomy with maxillary advancement and impaction treatment for maxillary hypoplasia. The mean maxillary advancement was 4.56 ± 1.34 mm, and the mean maxillary impaction was 2.03 ± 1.04 mm. Stereophotogrammetry was used to acquire three-dimensional images before and at least 6 months after surgery. Results: Alare (Al) and alare curvature (Ac) points had moved vertically and anterolaterally postoperatively. A significant increase was observed in the nasal ala width and alar base width, and no changes were noted in the columellar length, nasolabial angle, and nasal area. There was a significant relationship between maxillary impaction and nasal ala width and horizontal and sagittal positions of the bilateral Al and Ac. The only relationship found was between maxillary advancement and postoperative sagittal location of the subnasale and pronasale. Conclusions: Nasal soft tissues were highly affected by the vertical movement of the maxilla; however, the soft tissue responses were individual-dependent.

• Journal of Yeungnam Medical Science
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• 제9권1호
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• pp.189-196
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• 1992

유아기에 구순성형술 및 구개성형술 등에 의한 중 안면부의 성장장애를 동반한 성인환자에서 만기 이차성 골이식술(Late secondary bone graft)을 동반한 Le Fort I osteotomy를 시행한 결과 기능적, 심미적으로 양호한 개선 효과를 얻었다. 1. 증례에서는 골지지가 거의 없는 우측 상악 중절치 및 측절치 부위의 치아를 발거하고, 술전 교정치료로 변위된 치아의 배열과 소실된 공간을 회복한 후 장골이식을 동반한 상악골 전진술을 시행하였다. 2. 파열 변연부위에 골점막 절개를 시행한 후 순측 구개측 봉합 및 비점막을 거상하여 구비강 누공을 폐쇄한 후 장골능에서 얻은 골수-망상골을 이식하였다. 3. 수술후 구비강 폐쇄로 비음이 개선되었고, 술후 8개월된 방사선 사진상 파열부위의 골 재생을 확인한 후 보철치료를 시행하였다. 4. 표준 두부방사선 계측상 상악골의 전진에 의한 측모의 현저한 개선을 관찰할 수 있었다.