• Journal of International Society for Simulation Surgery
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• 제3권1호
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• pp.12-15
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• 2016

Functional and esthetic reconstruction after segmental mandibulectomy is one of the most challenging surgeries in microsurgical reconstruction field. Simulation surgery before free flap reconstruction has been performed for efficient surgery and successful results. Fibula free flap is the flap of the choice for reconstruction of the segmental mandibular defect. Straight nature of the fibula bone requires multiple segmentations to fit into mandible. 3D rapid prototype (RP) model gives a lot of information for mandibular reconstruction. The purpose of this study was to report mandibular reconstruction with free fibular flap using simulation surgery. A total of 30 consecutive patients were included for functional and esthetic evaluation. Among 30 patients, two flaps showed necrosis after radiotherapy. The other flaps were all survived and showed successful reconstruction in both function and esthetics.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제41권
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• pp.14.1-14.10
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• 2019

Background: Condylar dislocation can arise as a complication in patients who required mandibular and/or condylar reconstruction and were operated on with fibula free flap (FFF) using surgical guides designed using simulation surgery. Surgeons should be aware of the complications in these present cases when planning and performing reconstructions as well as predicting prognoses. Cases presentation: Two cases showed condylar dislocation in mandibular reconstruction using a FFF fixed with a reconstruction plate. Three cases showed condylar dislocation in mandibular reconstruction using a fibula free flap fixed with a mini-plate. Conclusion: Despite the lack of clinical symptoms in these cases following mandibular reconstruction using an FFF, the mandibular condyle was severely displaced away from the glenoid fossa. A surgeon must have sufficient time to consider the use of a long flap with thickness similar to that of the mandible, ways to minimize span and bending, and methods of fixation. The patient, moreover, should be educated on condylar dislocation. Customized CAD/CAM-prototyped temporomandibular condyle-connected plates may be a good alternative even if virtual simulation surgery is to be performed before surgery. These considerations may help reduce the incidence of complications after mandibular reconstruction.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제32권2호
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• pp.129-137
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• 2006

The treatment plan for orthognathic surgery must be based on accurate predictions, and this can be produced the most esthetic, functional and stable results. The purpose of this study was aimed to evaluate the amount and interrelationship of the gonial angle and the mandibular width change after the mandibular setback surgery in the mandibular prognathic patients. Twenty patients were selected who received orthognathic surgery after presurgical orthodontic treatment. The patients with skeletal and dental Class III malocclusion were operated upon with bilateral sagittal split ramus osteotomy and mandibular setback. The lateral and posteroanterior cephalometric radiographs were taken preoperatively, postoperative 1 day and 12 months later after the orthognathic surgery, and then the gonial angle and mandibular width were measured. The computerized statistical analysis was carried out with SPSS/PC program. The gonial angle at postoperative 1 day was decreased about $5.3^{\circ}$ than preoperative value and the gonial angle at postoperative 12 months was increased about $1.4^{\circ}$ than postoperative 1 day. So the gonial angle at postoperative 12 months was decreased about $3.9^{\circ}$ than preoperative value. The mean preoperative gonial angle was $125.35^{\circ}{\pm}7.36$, showing significantly high value than normal and mean gonial angle at postoperative 12 months was $121.45^{\circ}{\pm}6.81$, showing value near to normal. The mandibular width at postoperative 1 day was decreased about 1.1 mm than preoperative value and the mandibular width at postoperative 12 months was more decreased about 1.7 mm than postoperative 1 day. So the mandibular width at postoperative 12 months was decreased about 2.8 mm than preoperative value. These results indicate that sagittal split ramus osteotomy in mandibular prognathic patients with high gonial angle is effective to improvement of gonial angle. It is considered to be helpful for maintenance of postoperative stable gonial angle area that detailed postoperative care and follow-up.

• Archives of Plastic Surgery
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• 제34권6호
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• pp.777-784
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• 2007

Purpose: For a minor degree of mandibular prognathism, mandibular anterior segmental osteotomy (ASO), usually extracting the bilateral premolars, has been performed frequently to correct malocclusion of the anterior teeth. Preoperative planning using cephalometry and a dental model is very important for such a orthognathic surgery. Depending on the specific preoperative mock surgery with the dental model, ASO, with ipsilateral unitooth extraction, is defined to be feasible and performed for ten patients. The comparisons of its preoperative and postoperative analysis of clinical photographs, dental casts, and lateral cephalograms, for soft tissue profiles, skeletal and dental relationships are described in the following, and its clinical applications are noted. Methods: From March 1, 2004, to March 31, 2006, We performed 10 mandibular ASO by extraction of ipsilateral unitooth to improve their lower facial profiles and the lip relationships. Patient age ranged from 19 to 33 years, with a mean age of 25.6 years. Two were males and eight were females. Results: All patients were satisfied with aesthetic and occlusal changes postoperatively. Significant and persistent decrease in the SNB and interincisal angle were observed in the postoperative cephalometries. The soft tissue profiles also were improved and near Ricketts's esthetic line. Other combined procedures include nine genioplasties, two rhinoplasties, and one blepharoplasty. One patient complained of transient unilateral inferior mental nerve paresthesia. There were no other significant complications or relapses throughout the follow-up period(6-20 months). Conclusion: Mandibular ASO, extracting the ipsilateral unitooth, was performed for ten patients to correct mild mandibular prognathism. The amount of setback of the mandibular anterior portion was 2 to 3 mm, and satisfactory results were obtained combined with genioplasties.

• 대한치과의사협회지
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• 제58권2호
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• pp.114-122
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• 2020

Aesthetic facial profile is mainly determined by cultural background. In some countries, prominent mandibular angle is considered as characteristics, whereas it is considered as unattractive in East Asian countries. Therefore, reduction surgery for prominent mandibular angle is one of the popular cosmetic surgery in theses countries. The anatomical component of the mandibular angle consists of masseter muscle and the angular part of the mandibular ramus. Thus, the mandibular angle reduction can be performed by myotomy or bone reduction or both.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제23권4호
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• pp.348-356
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• 2001

The factors related to relapse in 20 skeletal class III patients who performed two-jaw surgery with Le Fort I maxillary osteotomy and bilateral sagittal split ramus osteotomy was investigated. All patients were fixed with miniplate on the maxilla and three screws at each mandible. Cephalograms taken at preoperative, immediate postoperative and 8 months postoperative after surgery were traced and digitized. 1.The horizontal and vertical relapse of maxilla and mandibular chin points was within 1mm postoperatively. Compare to the preceding report concerning the mandibular set-back surgery only group, this reveals two-jaw surgery for mandibular prognathism using rigid fixation is more stable. 2.Although there was no significant relapse tendancy was observed at chin points, the screw tip land-marks moves anterio-superiorly and each side of the screws moved as a one unit. The screw tip points moved similar direction to the masticatory force and this movements might be influenced by the muscular tension to the distal segment of the mandible. 3.According to the regression analysis, the amount of horizontal and vertical movement of mandibular set-back influenced the mandibular relapse. However, direction and amount of maxillary surgical movement did not inf1uenced the maxillary and mandibular relapse.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제28권1호
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• pp.49-57
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• 2006

Mandibular fractures have higher incidence rate compared to facial bone fractures because of relatively prominent form. Specially, mandibular angle fractures were known as common fracture site because of morphological anatomic structure. The mandibular third molar appears to be the most frequent impacted tooth. The mandibular third molar have influence on mandibular angle fractures according to it's eruption state. Also, the mandibular angle fracture including the third molar may influence on post operative infection whether the third molar is in impacted or extracted state when reduction of fracture site is operated. The presence or absence and degree of impaction of the mandibular third molar were assessed for each patient and were related to the occurrence of the mandibular angle fracture. The extraction or non extraction of the mandibular third molar were related to the occurrence of the post operative infection in the reduction of mandibular angle fractures. In the presence of mandibular third molar, the possibility of mandibular angle fractures were relatively common. When viewing the mandibular third molar at occlusal plane, the possibility of mandibular angle fractures were high in the class C group. The possibility of mandibular angle fractures were high in the mesial angulation and partial impaction. There was a statistically significant difference(P<0.05). In complete erupted mandibular third molar, the possibility of post operative infection occurs quite often, but there was no statistical significant difference(P>0.05). In the extracted or non extracted of mandibular third molar, the post operative infection showed no statistical significant difference(P>0.05). With the results mentioned above, mandibular third molar was significantly more susceptible to mandibular angle fracture. In the reduction of mandibular angle fracture, it was recommended that mandibular third molar should be extracted especially in case of pericoronitis, periodontitis and other infections.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제31권6호
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• pp.492-498
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• 2009

We sought to evaluate the relationship between the mandibular canal and impacted mandibular third molars by using dental cone beam computed tomograph(CBCT) for third molar surgery. A total of 111 patients(177 teeth) offered the images through CBCT and panoramic radiography for the extraction of the mandibular third molars. In CBCT, the accurate relationship between the third molar and the mandibular canal were evaluated. In panoramic radiographies, we evaluated the impacted level and superimposition sign of the mandibular third molar with the mandibular canal, and also, the radiopacity of the white line in the canal. Data were statistically analyzed and estimated by $X^2$-test. In CBCT finding, high prevalence of contact between the mandibular canal and roots occured in the deep impacted third molars, narrowing mandibular canals, bending mandibular canals and cases where the radiopacity of white line of canals were "absence" on panoramic images. It showed statistical significance (P<0.05). When evaluating the mandibular canal and the roots through the panoramic radiography for third molar extraction, it could be difficult to diagnosis accurately. Thus, it is required to have an accurate diagnostic approach through CBCT that could evaluated the location between mandibular canal and root.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제36권1호
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• pp.30-36
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• 2014

There are many treatment options in management of mandibular condylar neck fractures. Closed reduction is the most conservative treatment; however, achievement of anatomic reduction is difficult, and there are some risks of mandibular functional impairment. Open anatomic reduction and internal fixation have some advantages; therefore, many oral and maxillofacial surgeons have attempted to achieve anatomic reduction through the open approach and extracorporeal reduction and fixation. However, when using this method, there is some risk of resorption of the fractured mandibular condylar head. Therefore, we designed a modified extracorporeal reduction technique, without detaching the lateral pterygoid muscle in order to maintain the blood supply to the fractured mandibular condylar head. We believe that this minor modification may minimize the risk of resorption of the fractured mandibular condylar head. In this article, we introduce this technique in detail, and report on two cases.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제22권3호
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• pp.319-329
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• 2000

Prediction of the soft tissue changes following hard tissue movement is very important from the esthetic view point for patients who have orthognathic surgery. There are many cephalometric analysis of facial bone and soft tissue on the lower lip and chin region but few soft tissue analysis on the midface after mandibular setback surgery. This study was performed to obtain whether the mandibular posterior movement has influence on the midface and the predictable ratio of post-operative measurement values of the soft tissue changes following mandibular setback surgery. Fifteen patients (8 males and 7 females) who had undergone mandibular setback surgery were selected and analyzed the soft tissue movement on the upper lip and the cheek region. Post-operative changes of the soft tissue measurements after mandibular surgery were examined on pre- and post-operative cephalometrics and the ratio of changes were analyzed after drawing the reference line on the face with the barium sulfate solution. The reference lines were perpendicular to the intercanthal line from infraorbital foramen and lateral canthus. The results obtained were as follows : 1. There were tendancy of anterior movement of soft tissue adjacent the nose after mandibular surgery 2. There were incerased tendancy of the amount of anterior movement from the nasal crease to the cheek region. 3. The amount of anterior movement of the soft tissue was larger below the palatal plane compared with above the palatal plane in the cheek region. 4. The upper lip length was increased and moved posterior direction after mandibular setback surgery 5. The lower lip was moved posterior direction by posterior movement of the mandibular structure 6. Soft tissue of the midface around the nose moved anterior direction after mandibular setback surgery but there was no correlation between the amount of mandibular setback and the amount of the soft tissue changes