• Maxillofacial Plastic and Reconstructive Surgery
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• 제13권2호
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• pp.191-198
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• 1991

안모비대칭은 심미적 정서적으로 영향을 줄 뿐만 아니라 기능적인 장애를 초래하는 경우도 있다. 안모비대칭은 안면골 중에서 특히 하악골과 관련된 경우가 많은데 이는 하악골이 안면하부의 연조직을 지지하므로 작은 위치, 형태 변화에도 두드러지게 나타나기 때문이다. 비대칭안모를 초래하는 하악과두의 거대증은 Hyperplasia, Hypertrophy, 골증, 외골증, 골연골증, 연골육종 등을 들 수 있다. 비대칭안모 분류는 여러 학자에 의해 다양하게 분류되지만 Bruce와 Hayward는 Deviation prognathism, Unilateral macroganthia, Unilateral condylar hyperpiasia로 분류한 바 있다. 과증식된 하악과두의 절제술은 1856년 Humphry에 의해 최초로 시행된 후 여러 학자들에 의해 성공적으로 시행되고 있다. 본 증례에서는 Unilateral condylar hyperlpasia와 골연골종으로 인한 안모비대칭 환자로써 Condylectomy, Le Fort I osteotomy, Vertical ramus osteotomy, Mandibular inferior border ostectomy, Genioplasty 등을 시행하여 심미적 기능적으로 양호한 결과를 얻었기에 이를 보고하는 바이다.

• 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.

• Journal of Korean Dental Science
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• 제11권2호
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• pp.86-91
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• 2018

Ameloblastomaa are odontogenic benign tumors with epithelial origin, which are characterized by slow, aggressive, and invasive growth. Most ameloblastomas occur in the mandible, and their prevalence in the maxilla is low. A 27-year-old male visited our clinic with a chief complaint of the left side nasal airway obstruction. Three-dimensional computed tomography showed left maxillary sinus filled with a mass. Except for the perforated maxillary left edentulous area, no invaded or destructed bone was noted. The tumor was excised via Le Fort I osteotomy. The main mass was then sent for biopsy and it revealed acanthomatous ameloblastoma. The lesion in the left maxillary sinus reached the ethmoidal sinus through the nasal cavity but did not invade the orbit and skull base. The tumor was accessed through a Le Fort I downfracture in consideration of the growth pattern and range of invasion. The operation site healed without aesthetic appearances and functional impairments. However, further long-term clinical observation is necessary in the future for the recurrence of ameloblastoma. Conservative surgical treatment could be the first choice considering fast recovery after surgery and the patient's life quality.

• 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.

• Archives of Plastic Surgery
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• 제48권1호
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• pp.61-68
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• 2021

Background This study evaluated changes in nasal airway function following Le Fort I osteotomy with maxillary impaction according to the Nasal Obstruction Symptom Evaluation (NOSE) scale. Methods This cohort study included 13 patients who underwent Le Fort I osteotomy with maxillary impaction. Nasal airway function was evaluated based on the NOSE scale preoperatively and at 3 months postoperatively. The change in the NOSE score was calculated as the preoperative score minus the postoperative score. If the normality assumptions for changes in the NOSE score were not met, a nonparametric test (the Wilcoxon signed-rank test) was used. Differences in NOSE score changes according to patient characteristics and surgical factors were evaluated using the Kruskal-Wallis test and the Mann-Whitney test. Results Patients ranged in age from 18 to 29 years (mean ±standard deviation [SD], 23.00±3.87 years). Three were men and 10 were women. Eleven patients (84%) had an acquired dentofacial deformity with skeletal class III malocclusion. The preoperative NOSE scores ranged from 40 to 90 (mean±SD, 68.92±16.68), and the postoperative NOSE scores ranged from 25 to 80 (53.84±18.83). The cohort as a whole showed significant improvement in nasal airway function following maxillary impaction (P=0.028). Eleven patients (84%) had either improved (n=8) or unchanged (n=3) postoperative NOSE scores. However, nasal airway function deteriorated in two patients. Patient characteristics and surgical factors were not correlated with preoperative or postoperative NOSE scores. Conclusions Nasal airway function as evaluated using the NOSE scale improved after maxillary impaction.

• 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.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제32권1호
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• pp.49-56
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• 2010

Objective: To evaluate nasal and upper lip changes after Le Fort I surgery by means of images taken with a three-dimensional computed tomography (3D-CT). Methods: Fifteen patients (9 female and 6 male, mean age 21.9 years) with preoperative and postoperative 3D-CT were studied. The patients underwent maxillary movement with impaction or elongation, and advancement or setback. With the 3D-CT which presents reconstructive soft tissue images, preoperative and postoperative measurement and analysis were performed for nasal tip projection angle, columellar angle, supratip break angle, nasolabial angle, interalar width, internostril width, columella length and nasal tip projection. Results: Postoperative interalar and internostril widening was significant for all categories of maxillary movement. However, there was little significant relation in all parameters between the amount and direction of maxillary movement. Interestingly, movement of the maxilla with upward did show a little decrease in the columellar angle, supra tip break angle and nasolabial angle. Also movement of the maxilla with forward did show a little advancement in the upper lip position. Conclusion: Changes to the nose clearly occur after orthognathic surgery. There was a significant increase in postoperative interalar width and internostril width with maxillary movement. However, no clear correlation could be determined between amount of change and maxillary movement. Interestingly, maxillary impaction did show a little decrease in the columellar angle, supra tip break angle and nasolabial angle. In addition, we used 3D-CT for more precise analysis as a useful tool.

• 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.

• 대한구순구개열학회지
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• 제15권2호
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• pp.89-96
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• 2012

Le Fort 1 osteotomy or maxillary advancement with distraction osteogenesis (DO) is main treatment strategy for cleft palate patients with maxillary hypoplasia. Maxillary DO allows greater maxillary advancement within physiological limit than Le Fort 1 osteotomy. Moreover, it is better for velopharyngeal function. However, there is a greater tendency for an increase in nasal sound when maxilla is advanced excessively. Therefore, the advancement of anterior maxillary segment using DO has been utilized. It offers advantages such as an increase in the length of the palate, a prevention of the change in palatopharyngeal depth, and a preservation of the velopharyngeal function. Moreover, it will obliterate the necessity of bone graft, and it prevents the occurrence of oronasal or oroantral fistula. Finally, it stimulates the regeneration of the soft and hard tissue of alveolus, and subsequently makes possible to place implant.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제35권5호
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• pp.329-334
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• 2009

Objective: To evaluate the ratio between bone-contact length and inter-segmental length of the rigid fixation screw used in bilateral sagittal split ramus osteotomy (BSSRO) for mandibular setback. Material and Methods: Records of 40 patients with Class III malocclusion were selected. 20 of them had BSSRO, while the other 20 had BSSRO with maxillary LeFort I osteotomy. All of the patients had three noncompressive bicortical screws inserted at the gonial angle through transcutaneous approach. Two screws were inserted antero-posteriorly above inferior alveolar nerve and one screw was inserted below. The lengths of bone-contact and that of inter-segmental part were measured using cone-beam computed tomography. Ratio between these two measured lengths was calculated. Results: Both bone-contact and inter-segmental lengths were longer in BSSRO group than in BSSRO with maxillary LeFort I osteotomy group. Ratio of bone-contact to inter-segmental length was lower in BSSRO group than in BSSRO with Lefort I group. Both bone-contact and inter-segmental lengths were longer at the antero-superior position than at the inferior position. However, their ratio showed little difference. Conclusion: This study suggest that stability of screws in BSSRO group was greater than in BSSRO with Lefort I group. Stability of screws at the antero-superior position was greater than at the inferior position. Ratio of bone-contact to inter-segmental lengths was 0.2 in average.