• Imaging Science in Dentistry
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• v.36 no.4
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• pp.183-188
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• 2006

Purpose: The purpose of this research was to study bone changes after bilateral sagittal split osteotomy through fractal analysis and measurement of mandibular cortical thickness. Materials and Methods: This study included twenty-two prognathic patients who underwent bilateral sagittal split osteotomy. Panoramic radiographs of these patients were taken immediately before operation and at 1 month, 6 months, and 12 months postoperatively. The fractal dimension was measured by the box-counting method in the region of interest centered on both the basal and interdental bones between the first and second mandibular molars. Measurements of mandibular cortical thickness were taken both in the area between the first and second mandibular molars and at the osteotomy site. Changes of fractal dimension and cortical thickness over four stages were statistically analyzed. Results: The fractal dimension of the mandibular basal bone before surgery and after 1 month, 6 months and 12 months were $1.4099{\pm}0.0657,\;1.382{\pm}0.0595,\;1.2995{\pm}0.0949,\;and\;1.4166{\pm}0.0676$, respectively (Repeated-measures ANOVA, P<0.001). However, no statistically significant differences were noted in interdental fractal dimensions among the four stages. Mandibular cortical thickness between the first and second mandibular molars before operation and after 1 month, 6 months and 12 months was $3.74{\pm}0.48mm,\;3.63{\pm}0.47mm,\;3.41{\pm}0.61mm\;and\;3.55{\pm}0.66mm$ (P<0.01), respectively. Mandibular cortical thickness at the osteotomy site at each of the four stages was $3.22{\pm}0.44mm,\;2.87{\pm}0.59mm,\;2.37{\pm}0.61mm\;and\;2.64{\pm}0.62mm$, respectively (P<0.001). Conclusion: This study suggests that the mandibular tissue continued decreasing for 6 months postoperatively and then increased over the subsequent 6 months.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.31 no.4
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• pp.319-324
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• 2009

Kole's Anterior segmental osteotomy of the mandible is commonly used to close an anterior open bite, to depress an elevated anterior dentoalveolar segment, or to retrude or advance a dentoalveolar segment. The procedure is often combined with an anterior maxillary segmental osteotomy to correct bimaxillary protrusion. We report 53-year-old woman who the extruded state of mandibular anterior alveolar segment was corrected using an mandibular anterior alveolar segmental osteotomy and dental implantation of the anterior maxilla. We planned to remove the old prosthesis, and then perform an anterior mandibular segmental osteotomy and implant restoration of the anterior maxilla. We suggest that anterior segmental osteotomy is very useful for rehabilitating edentulous patients with malaligned alveolar segment.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.22 no.2
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• pp.254-261
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• 2000

Since callus distraction technique was applied clinically for the correction of dentofacial deformity to the patients with hemifacial dysplasia by McCarthy in 1992, many surgeons have tried to apply this method to the maxillofacial region. But this technique has some drawbacks. One of the disadvantages of this technique is extensive scar formation in the facial area, which is a sequelae of extraoral approach for supraperiosteal dissection of the periosteum overlying the mandible. Recently, we have made an effort to perform this technique through intraoral approaches to prevent scar formation on the submandibular area and modified the design of the osteotomy, that is step osteotomy technique, to increase the raw bone surface on both osteotomized segments. The rationale for the application of this step osteotomy technique is to increase the amount of regenerated bone and the length of distraction, to avoid damage of inferior alveolar neurovascular bundle, and to increase initial stability of the splitted segments. Step osteotomy procedure can be done with fine micro-osteotomy saw through subperiosteal tunneling. Extraoral pins should be inserted before making the osteotomy. Since 1994 we have applied this technique at 8 sites In 5 patients with mandibular deficiencies: 2 cases of hemifacial microsomia, 1 case of developmental facial asymmetry and 2 cases of mandibular bony defect. Mandibular elongation have been achieved from 12 to 20mm in length. 1 out of 8 site, we experienced non-union in the case of mandibular body defect. Some skeletal relapse and growth retardation phenomenon have been observed in some cases with the longest follow-up of 48 months.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.29 no.6
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• pp.407-420
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• 2003

Purpose : The purpose of this study was to analyse the facial changes and factors contributing to then after bilateral sagittal split ramus osteotomy of mandibular prognathism. Materials and Methods : Forty patients with Class III dental and skeletal malocclusion who were treated with bilateral sagittal split ramus osteotomy were reviewed. Frontal and lateral 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. Results : 1. Gonial angle at postoperative two days was decreased about $10.4^{\circ}$ than preoperatively and gonial angle at postoperative six months was increased about $6.8^{\circ}$ than postoperative two days. So, gonial angle at postoperative six months was decreased about $3.6^{\circ}$ than preoperative gonial angle. 2. Facial height postoperative two days was decreased about 0.8mm than preoperatively and facial height at postoperative six months was decreased about 0.7mm than postoperative two days. So, facial height at postoperative six months was decreased about 1.5mm than preoperative facial height. 3. Mandibular width postoperative two days was decreased about 1.0mm than preoperatively and mandibular width at postoperative six months was increased about 1.8mm than postoperative two days. So, mandibular width at postoperative six months was decreased about 2.8mm than preoperative mandibular width. 4. Amount of set back and mandibular plane angle were not influencing on relapse degree. Conclusion : It is thought that bilateral sagittal split ramus osteotomy in mandibular prognathic patients is effective to improve long face and steep gonial angle. More prudent operation and careful postoperative management is required to maintain stable face postoperatively. Further research for soft tissue changes and factors which are related with relapse is needed.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.23 no.2
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• pp.169-173
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• 2001

Maxillary-malar deficiency is the most frequently occurring midface dentofacial deformity. Clinicaly patients with maxillary-malar deficiency exhibit malar and infraorbital rim deficiency and class III malocclusion. For treatment of these deformities, modified LeFort III osteotomy have been used. Modified LeFort III osteotomy advances maxilla with orbital rims and zygomatic bone anteroposteriorly. This is a case of patient who had severe mandibular prognthism with midface deformity. We performed modified LeFort III osteotomy for maxillary-malar advancement and simultaneous bilateral sagittal split ramus osteotomy for mandibular prognathism and autogenous iliac bone graft.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.11 no.1
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• pp.249-254
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• 1989

Transverse mandibular deficiency is rare maxillomandibular malrelationship. Most of this malrelationship is considered to be caused by loss of bone substances. This can be corrected by subapical osteotomy, midsagittal vertical osteotomy, midline horizontal L sliding osteotomy, etc., case by case. In these cases, malrelationship after malunion of mandibular fracture, combination of vertical osteotomy and sliding autogenous cortical bone graft was used and favorable results were obtained. Advantages over previous traditional surgical methods were as follows : 1. This method provided easy access and good visibility. 2. It provided broad bone contact area, thus no other operation to obtain bone graft was needed. 3. There were little circumstances to extract teeth. 4. There were no difficulty in tongue movement after operation.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.23 no.1
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• pp.21-30
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• 2001

The purpose of this study was to evaluate the skeletal relapse pattern of the mandibular prognathic patients after mandibular set back surgery by sagittal split ramus osteotomy. The horizontal and vertical position of the cephalometric points were measured before, after surgery and after one-year follow up period. The next, the positional change of the proximal and distal mandibular segment were evaluated respectively. The obtained results were as follows; 1. The horizontal and vertical position of Cd was not changed before and after surgery, and it was maintained its original position during the observation periods. 2. As the mandibular prognathism of the patients was severe before surgery, the more skeletal relapse tendency was observed during follow-up period(p<0.05). 3. As the horizontal positional change of the mandible which was obtained by mandibular set-back surgery was large, the more horizontal relapse tendency was observed during follow-up period(p<0.05). 4. The corpus axis angle decreased by sagittal split ramus osteotomy(p<0.01), but it was kept its reoriented position during follow-up period. 5. During the follow-up period after mandibular set-back by sagittal split ramus osteotomy, the forward relapse of mandible correlated with not only the forward rotation of the proximal segment but also the forward movement of the distal segment(p<0.05).

• Archives of Plastic Surgery
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• v.34 no.1
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• pp.137-139
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• 2007

Purpose: The mandibular ramus sagittal split osteotomy is a common procedure in cosmetic surgery. A late complication of this procedure, pseudoaneurysm rarely happens. The purpose of this case is to present our experience that is rare late vascular complication after mandibular ramus sagittal split osteotomy. Methods: A 21-year-old male was operated by local plastic surgeon for treatment of mandibular prognathism. After 9 days, the man was transferred to our hospital with persistent bleeding and swelling on the mandibular area. We operated the man three times and failed to control hemorrhage. Therefore, we did angiography and found the pseudoaneurysm on the buccal and pterygoid branches of internal maxillary artery. Then we did selective embolization for removal of the pseudoaneurysm. Results: The man was operated using the therapeutic embolization, and the pseudoaneurysm was removed. The results were successful, and we couldn't find any bleeding and the pseudoaneurysm during the follow-up of 12 months. Conclusion: The selective embolization is the good therapeutic method of late vascular complication after mandibular ramus sagittal split osteotomy.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.21 no.4
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• pp.345-352
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• 1999

This study was conducted for the purpose of suggestion of the new technique of sagittal split ramus osteotomy pararell to the true sagittal plane. This pararellism is the important concept of the sagittal split ramus osteotomy to reduce the condylar sagging including mandibular hypomobility, temporomandibular disorder, occlusal relapse and other complications. We used 26 adult dry manibles(52 rami), and obtained the computed tomographs through the sagittal, horizontal and coronal sections. The results were obtained as follows. 1. On sagittal section, mean area of S1 was $8.63{\pm}2.10cm^2$, S2 was $8.93{\pm}1.94cm^2$, S3 was $9.49{\pm}2.15cm^2$, S6 was $10.72{\pm}2.22cm^2$. The wider area of sagittal section, the more lateral section, But, no significant differency between the areas of the sagittal sections(P>0.05). 2. On horizontal section, The distance between the inferior alveolar canal and the lateral cortical plate of the mandibular ramus were $6.73{\pm}1.24mm$ minum, $7.70{\pm}1.44mm$ maximum. 3. On coronal section, Outer mandibular angle were $4.84{\pm}2.37^{\circ}$ right side, $4.93{\pm}2.12^{\circ}$ left side. 4. The design of the ideal true sagittal split ramus osteotomy is that posterior border of osteotomy must be limited vertically, at the right posterior point of lingula mandibularis and anterior of osteotomy must be extended to mandibular body, anteroinferiorly.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.14 no.1_2
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• pp.65-76
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• 1992

This study was designed to observe the adaptive changes of mandibular condyles to displacement of mandibular condyle in adult animals. In this study, 16 rabbits weighting about 3.5 kg was selected. Four rabbits were preserved for control group and 8 animals were divided into 3 groups, 2 weeks, 4 weeks and 8 weeks. The experimental animals were performed oblique osteotomy on both mandibular ramus and internal wiring at mandibular border. The experimental animals were sacrificed consecutively on the 2 weeks, 4 weeks and 8 weeks after oblique osteotomy and mandibular condyles were dissected out carefully to produced tissue specimen. The specimens were fixed with 10% N formaline solution for 24 hours and rinsed with phosphate buffer solution. It was decalcified with 5% nitric acid for 15 days. Thereafter the specimens were dehydrated in alcohol series and embedded paraffin as usual manner. The mebedded specimen were sectioned in $4-6{\mu}m$ microtome, stained with hematoxylin-eosin and azan stain and observed through light microscope. The following results were observed from this experiment. When there was postional change of condyle head after mandibular ramus oblique osteotomy in adult rabbit, 1. The density of chondrocyte was generally increased at condylar cartilage and the thickness of condylar cartilage was increased posterosuperior aspect of the mandibular condyle slightly. 2. The density of chondrocyte was increased at proliferative zone so fibrous articular zone, porliferative zone and hypertrophic zone was clearly distinguished. 3. Active endochondral bone formation was occurred at mandibular condyle.