• The korean journal of orthodontics
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• v.15 no.1
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• pp.123-140
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• 1985

Variation in the facial pattern and effect of the rotational jaw growth on the facial proportion were studied in serial cephalometric radiographs of 40 Korean children (25 boys, 15 girls) ranging in age from 6 to 13 years. According to Y-axis (N-S-Gn) growth change during the 7 years of period, the subject who had exhibited 'wave-like' manner of Y-axis growth change within ${\pm}\;2^{\circ}$ was classified to the Parallelwise group and the subject who had exhibited Y-axis increase more than $+2^{\circ}$ was classified to the Clockwise rotation group and the subject who had exhibited Y-axis decrease more than $-2^{\circ}$ was classified to the Counterclockwise rotation group. For the comparison of each group, a total of 22 morphologic variables were employed and the data were analyzed by means of computer morphometrics and statistical methods. On the basis of the finding of this study, the following trends were established. 1. The Parallelwise group was $75\%$, the Clockwise rotation group was $12.5\%$ and the Counter-clockwise rotation group was $12.5\%$. 2. The growth pattern of cranial base was related to the rotation of mandible. 9. Maxillary prognathism was occured in the Counterclockwise rotation group and the rotation of palatal plane was occured in the Clockwise rotation group. 4. Mandibular prognathism was occured in the Parallelwise and the Counterclockwise rotation groups, especially in the Counterclockwise rotation group. 5. The degree of maxillo-mandibular divergency was constant in the Clockwise rotation group but decreased in the Counterclockwise rotation and the Parallelwise groups, especially in the Counterclockwise group. 6. There were no differences in the size of the anterior upper facial height (N-ANS) and the posterior lower facial height ((Go-Me)-PNS) but there were differences in the size of the anterior lower facial height (ANS-Me) and the posterior upper facial height ((S-N)-PNS) between each group. 7. The growth increment and the size of the facial depth was not related to the growth pattern of the face but the growth increment and the size of the facial height was related to the growth pattern of the face. 8. Proportional change due to the facial growth rotation was concentrated in the anterior lower face. 9. The most apparent difference between each group was happened in the size of the posterior cranial base (S-Ba) and the facial length (S-Gn).

• Maxillofacial Plastic and Reconstructive Surgery
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• v.27 no.4
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• pp.334-345
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• 2005

The purpose of this study was to compare the postoperative stability and relapse according to 2 different fixation methods after bilateral sagittal split ramus osteotomies in mandibular prognathic patients. Tweenty one patients with Class III dental and skeletal malocclusion who were treated with bilateral sagittal split ramus osteotomy were selected for this retrospective study. We classfied the patients into two groups according to the fixation methods of bony segments after osteotomies. Group W (n = 10) had the bone segments fixed with nonrigid wire and Group S (n = 11) had bicortical screws inserted in the gonial area through a transcutaneous approach. Cephalometric radiographs were taken preoperatively, immediate postoperatively and more than six months postoperatively in each patient. After tracing the cephalometric radiographs, various parameters were measured. Before surgery, both groups were balanced with respect to linear and angular measurements of craniofacial morphology. Mean posterior sagittal setback amounts of the mandibular symphysis was 8.6 mm in the wire group and 6.79 mm in the rigid group, Six months postoperatively, the wire group had 33.1% relapse of the mandibular symphysis and 22.8% in the rigid group relapse. Both groups experienced changes in the orientation and configuration of the mandible. It is thought that Rigid screw fixation is a more stable method than nonrigid wire fixation for maintaining mandibular setback after sagittal split ramus osteotomy.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.36 no.5
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• pp.185-191
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• 2014

Purpose: Although there have been several studies of reduced airway space after mandibular setback surgery using the sagittal split ramus osteotomy technique, research on the risk factors for changes of the airway space is lacking. Therefore, this study was performed to examine airway changes and the position of the hyoid bone after orthognathic surgery, and to assess possible risk factors. Methods: In this retrospective study, 50 patients who underwent posterior displacement of the mandible by the bilateral sagittal split ramus osteotomy technique were included. Changes of the position of the hyoid bone and the airway space were analyzed over various follow-up periods, using cephalometric radiography taken preoperatively, immediately after surgery, eight weeks after surgery, six months after surgery, and one year after surgery. To identify risk factors, multiple regression analysis of age, gender, body mass index (BMI), posterior mandibular movement, and the presence of genioplasty was performed. Results: Inferor and posterior movement of the hyoid bone was observed postoperatively, but subsequent observations showed regression towards the anterosuperior aspect. The airway space also significantly decreased after surgery (P<0.05), and increased slightly up until six months after surgery. The airway space significantly decreased (${\beta}=0.47$, P<0.01) as the amount of mandibular setback increased. However, age, sex, BMI, and presence of genioplasty were not associated with airway reduction. Conclusion: The amount of mandibular set back was significantly associated with postoperative reduction of airway space. It is necessary to establish a treatment plan considering this factor.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.29 no.2
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• pp.148-156
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• 2007

Purpose: The aim of this study is the changes of upper respiratory airway space in patients with mandibular prognathism after 2-jaw orthognathic surgery in patients with skeletal classs III malocclusion. Method: We measured the lines between selected upper airway landmarks on lateral cephalometric x-ray films of skeletal class III 64 persons who had not been operated yet, were 6 months after operation. The test subjects were divided into 3 groups according to maxillary movement, as follows; maxillary advancement (MA) group, maxillary posterior impaction (MPI) group, maxillary posterior impaction and superior repositioning (MPI+MSR) group. Result: In this study, nasopharyngeal airway space in MPI+MSR group was significantly increased after operation (p<0.05). Oropharygeal and hypopharyngeal airway space in MA group and MPI group were significantly decreased after operation (p<0.05). From hyoid bone to anterior mandible point distance in MA group and MPI group were significantly decreased after operation (p<0.05). Conclusion: Oropharygeal and hypopharyngeal airway space were influenced more by mandibular set-back than maxillary movement. Maxillary movement surgery as well as mandibular setback surgery should be taken into consideration in order to minimize symptoms related to obstructive sleep apnea syndrome after operation.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.17 no.1
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• pp.1-9
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• 1995

We observed 117 orthognathic surgery cases with dentofacial deformity for 8 years from Jan. 1986 to Dec. 1993. The ratio of male female was 1 : 1.4 and the mean age was 23.0 years ranged from 16 to 35 years. The most dominant group was related to mandibular prognathism (75.0%). Surgery method were divided into 88 cases of mandible surgery, 6 cases of maxilla surgery and 23 cases of two jaw surgery. Sagittal split osteotomy were performed on 84 cases (71.8%). Rigid fixation was increased after 1989 and total percent of rigid fixation was 66%. We used autotransfusion method from 1992 to all orthognathic surgery patient. Lower lip numbness caused by Inferior alveolar nerve injury is the most common problem after operation, and it was 63 cases (53.8%) of total operation cases. In our clinic, we performed 5 cases of re-operation because of segment malalignment, condylar sag, and fixation instability.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.31 no.4
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• pp.294-305
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• 2009

Purpose: This retrospective study evaluated the changes in hyoid bone and tongue positions as well as oral cavity volume after mandibular setback by BSSRO. Materials and Methods: 18 Koreans who underwent BSSRO to correct mandibular prognathism were studied. Lateral cephalograms were taken and traced preoperatively (T0), immediately (T1) and approximately 6 months postoperatively (T2). Submentovertex radiograghs were taken and traced before surgery (T0) and about 6 months after surgery (T2). The area and volume of oral cavity, the vertical and horizontal dimensions of the hyoid bone and tongue dorsum were measured. Results: Mandibular setback surgery resulted in a significant reduction of lower oral cavity volume. The hyoid bone displaced posteroinferiorly immediately after surgery, and it tended to return to its original vertical position at 6 month after mandibular setback by BSSRO. The retropalatal space around tongue was maintained and the retrolingual space around tongue was reduced immediately postoperatively. The readaptation of tongue was not evident for that the follow up period was not long enough. No significant statistical correlations between the amounts of mandibular setback and the changes of oral cavity volume were observed. Conclusion: Mandibular setback surgery resulted in a significant reduction of lower oral cavity volume, which was most likely attributable to the posterior movement of the mandible. More subjects and long-term observations should be performed to assess the changes of oropharyngeal configuration following mandibular setback surgery.

• The korean journal of orthodontics
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• v.22 no.1
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• pp.205-227
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• 1992

This study was aimed to investigate the characteristics & the causative areas of the adult skeletal class III malocclusions with different facial divergency. The lateral cephalograms of 80 subjects with skeletal class III malocclusion from 17 to 29 years of age were classified into 3 groups according to SN-MP angle; hypodivergent group $(21.65{\pm}3.52^{\circ})$, neutrodivergent group $(30.50{\pm}2.29^{\circ})$ and hyperdivergent group $(40.02{\pm}3.98^{\circ})$. The data were gathered by digitizing of the traced cephalograms and were statistically analyzed. The results were as follows: 1. The anterior cranial base of the hyperdivergent group was shortest & tipped upwardly to the FH plane. 2. The maxilla of hyperdivergent group was shortest anteroposteriorly and positioned posteriorly to the anterior cranial base. 3. The degree of the mandibular prognathism in hyperdivergent group was less than the hypodivergent group. The hyperdivergent group showed the downward & backward rotated mandible. 4. The mandibular ramus & body was short & slender in the hyperdivergent group and the gonial angle was greatest in the hyperdivergent group. 5. The temporomandibular joint was positioned more superiorly to the anterior cranial base in the hyperdivergent group. 6. The cranial base, palatal plane, occlusal plane and mandibular plane were diverged in the hyperdivergent group. And this group had a great anterior total facial height, especially anterior lower facial height. 7. The craniofacial characteristics of skeletal class III malocclusion were critical in the vertical structure than the horizontal.

• Journal of Korean Dental Science
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• v.14 no.2
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• pp.110-117
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• 2021

Purpose: The purpose of this article is to study the relationship of unintentionally extended split in the distal segment during the bilateral sagittal split ramus osteotomy (BSSRO) and skeletal relapse. Materials and Methods: Twenty patients with mandibular prognathism were divided into two groups according to whether or not unintentionally extended split had occurred. Cone-beam computed tomography images were taken before surgery (T0), immediately after surgery (T1), and postoperatively at 6 months (T2). The stability was evaluated by measuring the change of Nasion perpendicular-Pogonion (N-Pog) distance. Result: Both groups showed mild advancement of Pog during follow-up. In both groups, the condyle head rotated inward and moved posterioinferiorly after surgery, but tended to return to their original position during follow-up. Conclusion: There was no statistically significant difference between the two groups in mandible position. Moreover, the condylar position was stable. If it is difficult to proceed reduction of the unintentionally extended split, careful inspection should be performed to prevent subsequent complications during follow-up.

• The korean journal of orthodontics
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• v.30 no.2 s.79
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• pp.261-272
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• 2000

Severe skeletal anteroposterior and vertical discrepancy is difficult to obtain satisfactory result by only orthodontic treatment, and much anteroposterior movement and treatment stability require orthodontic treatment with orthognathic surgery. The treatment goal of mandibular prognathic patients is to promote the function of stomatognathic system including mastication and phonetics, to improve the esthetics of facial profile and to maintain stability. Positional changes of hyoid bone, pharynx and tongue were seen with mandibular movement after orthognathic surgery. This study was performed to observe the changes of perimandibular tissues of orthodontic patients with skeletal mandibular prognathism who treated with orthodontic treatment, and the changes of hyoid bone, pharyx and tongue by relapse or recurrance after before and after orthognathic surgery and retention. The 22 patients who had mandibular prognathism were selected. They treated with orthodontic treatment with sagittal split ramus osteotomy as orthognathic surgery. And lateral cephalometric radiographs were taken 3 times : pre-surgery (T1), immediate post-surgery (T2) and 2 years alter retention (T3). The results were as follows : 1. The hyoid bone returned back after clockwise rotation to maxilla and occlusal plane during retention (P<0.01). 2. The hyoid bone moved posterior-inferiorly by mandibular surgery and returned back anterior-superior after retention. (P<0.01) 3. The changes of pharyngeal depth showed a little decrease at upper area in post- surgery, but it was not a significant difference generally through before, after and retention. 4. In relating to tongue base, the angle of tongue base was decreased and the dorsal area of tongue base moved to inferior-posterior direction and to superior direction again after retention (P<0.01). 5. Related to the thickness of upper and lower lip, the thickness of upper lip decreased after surgery, and the soft tissues below lower lip increased after surgery and decreased after retention.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.32 no.2
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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.