• Maxillofacial Plastic and Reconstructive Surgery
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• v.37
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• pp.26.1-26.4
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• 2015

We experienced a patient of subcondylar fracture who had a squared contour of the lower face with prominent angle of the mandible and masseter hypertrophy. Our patient was increasingly seeking esthetic improvement of the lower third of the face. But she did not want multi-stage operations. Thus, we decided and performed a one-stage mandibular angle ostectomy with fracture management. We have a stable and esthetic result simultaneously despite fractures of the fixation plates during follow-up period, so report a case.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.33 no.3
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• pp.218-224
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• 2011

Purpose: The purpose of this study is to evaluate the post-operative skeletal stability after surgical correction of patients with mandibular prognathism by bilateral sagittal split ramus osteotomy (BSSRO) and to evaluate the horizontal relapse tendency after the surgery. Methods: Twenty-six patients with Class III dental and skeletal malocclusion were selected for this retrospective study. Fifteen of them underwent BSSRO for mandibular setback and eleven of them underwent two-jaw surgery (Lefort I and BSSRO). In each patient, lateral cephalometric radiographs were taken pre-operatively, post-operatively within 1 week, and post-operatively after eight months. After tracing of the cephalometric radiographs, various parameters were measured. The analyses were done by linear measurement to evaluate the change in position of hard tissue B point, pogonion and mandibular plan angle by examination on lateral cephalograms. Results: The horizontal relapse rate was 27.1% at B point and 31.6% at pogonion in patients who underwent BSSRO. The horizontal relapse rate of the group where the amount of correction exceeded 10 mm was 25.69% at B point. Conclusion: There were no statistical differences on the magnitude of setback and direction of rotation of the mandible in mandibular stability. There were also no statistical differences between single mandibular surgery and two-jaw surgery for mandibular stability.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.32 no.1
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• pp.43-48
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• 2010

The mandibular condyle fracture occurs at 15-30% frequency of whole mandibular fracture. The treatment of choice is open reduction or closed reduction. In many cases, closed reduction is preferred for treatment of condylar fracture because it is hard to approach to condyle and there is risk of surgical complications, such as nerve damage in open reduction. Open reduction, however, has some advantages like possibility of anatomical reduction, occlusal stability and rapid functional recovery. Furthermore, it is possible to retain original ramal heights and to decrease deviation during mouth opening. There are many surgical approaches for open reduction of subcondyle fracture. At present, transoral approach using trochar device is tried for effective and minimally invasive method for open reduction of subcondyle fracture. And the authors report the cases of reduction of subcondyle fracture with transoral approach using trochar device.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.40
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• pp.35.1-35.7
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• 2018

Background: After the resection at the mandibular site involving oral cancer, free vascularized fibular graft, a type of vascularized autograft, is often used for the mandibular reconstruction. Titanium mesh (T-mesh) and particulate cancellous bone and marrow (PCBM), however, a type of non-vascularized autograft, can also be used for the reconstruction. With the T-mesh applied even in the chin and angle areas, an aesthetic contour with adequate strength and stable fixation can be achieved, and the pores of the mesh will allow the rapid revascularization of the bone graft site. Especially, this technique does not require microvascular training; as such, the surgery time can be shortened. This advantage allows older patients to undergo the reconstructive surgery. Case presentation: Reported in this article are two cases of mandibular reconstruction using the ready-made type and custom-made type T-mesh, respectively, after mandibular resection. We had operated double blind peer-review process. A 79-year-old female patient visited the authors' clinic with gingival swelling and pain on the left mandibular region. After wide excision and segmental mandibulectomy, a pectoralis major myocutaneous flap was used to cover the intraoral defect. Fourteen months postoperatively, reconstruction using a ready-made type T-mesh (Striker-Leibinger, Freibrug, Germany) and iliac PCBM was done to repair the mandible left body defect. Another 62-year-old female patient visited the authors' clinic with pain on the right mandibular region. After wide excision and segmental mandibulectomy on the mandibular squamous cell carcinoma (SCC), reconstruction was done with a reconstruction plate and a right fibula free flap. Sixteen months postoperatively, reconstruction using a custom-made type T-mesh and iliac PCBM was done to repair the mandibular defect after the failure of the fibula free flap. The CAD-CAM T-mesh was made prior to the operation. Conclusions: In both cases, sufficient new-bone formation was observed in terms of volume and strength. In the CAD-CAM custom-made type T-mesh case, especially, it was much easier to fix screws onto the adjacent mandible, and after the removal of the mesh, the appearance of both patients improved, and the neo-mandibular body showed adequate bony volume for implant or prosthetic restoration.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.15 no.3
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• pp.178-181
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• 1993

Sixty four patients were followed-up for over 6 months following the orthognathic surgeries and were examined for the Temporo-mandibular joint dysfunction. The results are as follows: 1. Of 64 patients, 9(14.1%) had been suffered from TMD preoperatively : 4.7% in the prognathism and 46.2% in the laterognathism. 2. Following the orthognathic surgeries, 7 of 64 patients(10.9%) complained TMD, and 55.6% of the TMD patients resulted in significant improvement. 3. By the type of deformities, laterognathism with TMD could be expected to be improved in 30.8%, while 7.7% in the prognathism. 4. Non-rigid fixation resulted in higher incidence of TMD than the Rigid fixation after the SSRO ; 4 of 15(26.5%) and 2 of 25(8.0%) respectively.

• Archives of Craniofacial Surgery
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• v.22 no.2
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• pp.105-109
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• 2021

The use of a fibula osteocutaneous flap is currently the mainstay of segmental mandibular reconstruction. This type of flap is used to treat tumors, trauma, or osteoradionecrosis of the mandible. However, a fibula osteocutaneous flap may also be a good option for reconstructing the mandible to preserve oropharyngeal function and facial appearance in cases of pathological fracture requiring extensive segmental bone resection. Chronic osteomyelitis is one of the various causes of subsequent pathologic mandibular fractures; however, it is rare, and there have been few reports using free flaps in osteomyelitis of the mandible. We share our experience with a 76-year-old patient who presented with a pathologic fracture following osteomyelitis of the mandible that was reconstructed using a fibula osteocutaneous flap after wide segmental resection.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.22 no.1
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• pp.76-82
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• 2000

In general, treatment of the patients with closed lock divides into a conservative and a surgical treatment. Surgical treatment has been often applied in case that occlusal splint therapy was not effective on the patient with closed lock. In recent, some clinicians reported good results with mandibular manipulation. Three patients complained limitation of month opening-(mean mouth opening was 22.3mm) and TMJ pain. Articular discs were displaced anteriorly on MRI. Two patients didn't improve the symptoms with long term occlusal splint therapy. We applied mandibular manipulation after injection with 2% lidocaine into the upper joint space of the affected TMJ and directly inserted occlusal splint to all patients. At the follow-up check, mean mouth opening was 41.7mm. TMJ pain decreased, condyle and disc relationship was improved functionally on MRI.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.27 no.6
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• pp.535-544
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• 2005

The management of mandibular condyle fractures continues to be a subject of much debate. It is suggested that, if not properly managed, these fractures may give rise to serious problems, such as malocclusion, mouth opening limitation, temporomandibular joint disorders. Treatment planing of mandibular condyle fractures is very important. The aim of this present study was to evaluate the long-term results according to treatment methods in condylar fractures. Also, it was to evaluate results of treatment according to condylar fracture level. We conducted a retrospective analysis of 43 mandibular condyle fractures. 43 patients followed for average period of 9.00 years(mini. 7yr, max. 12yr). All patients underwent a clinical and radiologic evaluation focusing on mouth opening, mandibular movements, TMJ function, change of ramal height, condylar remodelling. If the level of fracture was positioned in high, especially in level II, mandibular movement disability and ramus length loss was more prominent. This results were similar to the cases of treatment of fragment removal. In high level fracture and fragment removal cases, It is thought that more intensive and long term management are needed than other treatment cases using different operation methods. Also, direct fixation by each approach showed good results in mandibular movement, ramal height change and condylar shape. Through this results, accurate reduction of the mandibular condyle fractures was a very important factor in postoperative prognosis.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.31 no.6
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• pp.510-518
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• 2009

Purpose: In this study, we analyzed and compared the anatomical position of the mandibular canal in normal occlusion and mandibular prognathism patients. Patients and Methods: Computed tomography image from 58 patients were divided into normal occlusion group and mandibular prognathism group, and each measurement were taken in the each measuring points(2nd premolar, 1st molar, 2nd molar, 3rd molar, ramus). Measurements were statistically analyzed by student's t-test. Results: BC (Thickness of the buccal cortex) value was 2.3~2.7 mm, CB (Distance from the canal to the lingual aspect of the buccal cortex) value was 1.3~4.3 mm, MC (Diameter of the canal) value was 3.2~3.8 mm, LI (Distance from the canal to the lingual aspect of the lingual cortex) value was 2.0~3.7 mm, TM (Thickness of the total mandible) value was 9.5~12.9 mm and CM (Distance from the canal to the inferior border of the mandible) value was 6.9~17.5 mm. Conclusion: In the comparison between two groups, there was statistically significant difference in CB value of 2nd, 3rd molar between normal occlusion and mandibular prognathism, and other value in the rest of the measuring points didn't show statistically significant difference.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.16 no.1
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• pp.63-71
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• 1994

Recently, we have used internal fixation with titanium miniplate which introduced by Champy in 1976 in facial bone fractures. In cases of mandibular fractures, particulary mandibular angle fractures, we usually underwent the open reduction extraorally. But extraoral approaches may leave scars and put the facial nerve at greater risk. So, we had undergone the intraoral approaches in 31 patients of mandibular angle fractures (male : 29, female : 2). These patients visited in Wonkwang university hospital from October 1991 to June 1993. We got easy operation time as average 20 minutes than extraoral approach. And reduced the postoperative nerve injury(14.2%), but postoperative infection is 6.1% nearly as same as extraoral approach. TMJ problems after intraoral open reduction was similar to extraoral approaches.