• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.35 no.2
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• pp.94-100
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• 2009

Purpose: As the interest and demand for esthetics grow up with medical development, the number of patients who want to correct dentofacial deformities by orthognathic surgery has increased. And the success of orthognathic surgery is dependent upon satisfaction of patients in great measure. Therefore the purpose of this study is to examine functional disability, sensory disturbance and esthetic satisfaction of the patients after orthognathic surgery. Material and methods: Among 89 patients who orthognathic surgery was performed at Seoul National University Bundang Hospital during the period from July 2003 to July 2008, 46 patients were considered in the study. Patients were surveyed with questionnaires and visual analogue scale(VAS) which author has designed. The analysis and comparison were performed according to gender, follow up span, and type of surgery based on answer of questionnaires. Results and conclusions: Total satisfaction rate was 76%. And there was statistical significant difference between subjective evaluation of facial esthetics before the surgery and that of after surgery(p<0.05). Differences in occurrence of functional disability, sensory disturbance between groups were not observed. In conclusion, the operator should understand the postoperative self-satisfaction of the patients and complications. If we can communicate with the patients before operation. patients' satisfaction rate will increase after operation.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.29 no.2
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• pp.157-166
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• 2007

Moderns have desire likely to be further good-looking concomitant with a qulitative advancement of the life. Orthognathic surgery for the correction of dentofacial deformities is a common elective procedure. It's possible to occur many complication during the operations and especially, an excessive bleeding of those may be fatal and so a tranfusion is performing for the prevention and management of that. The most notable of these for reduction of blood loss is the utilization of induced hypotensive anesthetic technique to reduce the mean arterial pressure between 55 and 60 mmHb. Another method for dealing with blood loss following orthognathic surgery is the transfusion of blood obtained as an autologous tranfusion or from banked blood. Some of the disadvantage of banked blood are overcome with the use of predeposited autologous transfusion. But currently, surgeons try so that even autologous transfusion may not transfuse the patients. We made a comparative study of hematologic change and transfusion requirement based on a series of 200 patients who had an orthognathic surgical procedure at Chonbuk National University during the period 2001-2005. This study is to make a comparative analysis of an post-operative hematologic (Hemoglobin, Hematocrit, Red blood cell) change and duration of the procedure under induced hypotensive anesthesia in healthy orthognathic patients.

• Imaging Science in Dentistry
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• v.44 no.1
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• pp.15-20
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• 2014

Purpose: This study aimed to assess the three-dimensional (3D) facial changes after orthognathic surgery by evaluating the spherical coordinates of facial lines using 3D computed tomography (CT). Materials and Methods: A 19-year-old girl was diagnosed with class III malocclusion and facial asymmetry. Orthognathic surgery was performed after orthodontic treatment. Facial CT scans were taken before and after orthognathic surgery. The patient had a menton deviation of 12.72 mm before surgery and 0.83 mm after surgery. The spherical coordinates of four bilateral facial lines (ramal height, ramal lateral, ramal posterior and mandibular body) were estimated from CT scans before and after surgery on the deviated and opposite side. Results: The spherical coordinates of all facial lines changed after orthognathic surgery. Moreover, the bilateral differences of all facial lines changed after surgery, and no bilateral differences were zero. Conclusion: The spherical coordinate system was useful to compare differences between the presurgical and postsurgical changes to facial lines.

• Journal of The Korean Dental Society of Anesthesiology
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• v.13 no.3
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• pp.133-137
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• 2013

Three patients who underwent orthognathic surgery under general anesthesia complained about difficulty in vocalization and hoarseness after surgery. Intubation granuloma was diagnosed by the department of otorhinolaryngology in our hospital and the masses were excised by laryngoscopy assisted surgery. Chief complaints and symptoms of patients were relieved after surgery. These cases report with review of articles is presented, and the etiology, diagnosis, treatment and prognosis of intubation granuloma after orthognathic surgery are evaluated.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.27 no.4
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• pp.344-348
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• 2001

Isoflurane and enflurane are currently used on orthognathic surgery in Korea. Since starting to use enflurane and isoflurane in orthognathic surgery, we have questioned their effect on liver function. Many studies have reported liver function after enflurane and isoflurane anesthesia. Although both enflurane and isoflurane are less hepatotoxic than halothane, some cases of liver dysfunction have been reported after enflurane and isoflurane anesthesia. And, we know that isoflurane is less hepatotoxic than its predecessors, enflurane. But, fulminant liver failure and necrosis were also reported after isoflurane anesthesia. The purpose of this study was to compare immediate liver function in healthy orthognathic surgical patients receiving enflurane or isoflurane anesthesia. To assess the effect of enflurane and isoflurane on liver function, we measured pre-and post-operative serum concentrations of aspartate aminotransferase(AST), and alanine aminotransferase(ALT), alkaline phosphatase(ALP), total bilirubin(Tbil).

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.36 no.1
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• pp.28-38
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• 2010

The factors influencing the relapse and recurrence of skeletal deformity after the orthognathic surgery include various factors such as condylar deviation, the amount of mandibular set-back, stretching force by the soft tissues and muscles around the facial skeleton. The purpose of this report is to recognize and analyze the possible factors of reoperation after orthognathic surgery, due to early relapses. Six patients underwent reoperation after the orthognathic surgeries out of 110 patients from 2006 to 2009 were included in this study. In most cases, clincal signs of the insufficient occlusal stability, anterior open bite, and unilateral shifting of the mandible were founded within 2 weeks postoperatively. Although elastic traction was initiated in every case, inadequate correction made reoperation for these cases inevitable. The chief complaints of five cases were the protruded mandible combined with some degree of asymmetric face and in the other one case, it was asymmetric face only. Various factors were considered as a major cause of post-operative instability such as condylar sagging, counter-clockwise rotation of the mandibular segment, soft tissue tension related with asymmetrical mandibular set-back, preoperatively existing temporomandibular disorder (TMD), poor fabrication of the final wafer, and dual bite tendency of the patients.

• Journal of Yeungnam Medical Science
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• v.21 no.2
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• pp.242-250
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• 2004

In general, the skeletal class III has the characteristics of mandibular overgrowth with a normal maxillary growth or maxillary undergrowth with a normal mandibular growth And clinical and radiographic evaluations of the patient are needed. However, the treatment plan is not dependent on these evaluations alone, because patient's general condition and hope for aesthetics varies. The aim of this report is to consider the treatment of a medically compromised patient with an anterior open bite and skeletal class III, which showed a severe mandibular overgrowth. In 2003, a 17-year-old boy with epilepsy, mental retardation presented at our clinic complaining of concave profile. A clinical examination showed severe mandibular prognathism with an anterior open bite. The radiographic examination revealed a short cranial base, a moderate maxillary overgrowth, severe mandibular overgrowth and skeletal open bite tendency. In 2004, he was verified to have no potential of growth by hand-and-wrist radiographs and an endocrine examination. He completed the preoperative orthodontic treatment and orthognathic surgery (sagittal split ramus osteotomy, genioplasty). He was evaluated on the first visit, the preoperative period and the postoperative period with a clinical and radiographic examination. At the first visit, the patient showed moderate overgrowth of the maxilla, severe overgrowth of the mandible, and a subsequential skeletal open bite. After the preoperative orthodontic treatment (preoperative period), the patient showed the same skeletal problem as before and a decompensated dentition for orthognathic surgery. After orthognathic surgery, his profile had improved, but he had still a skeletal openbite tendency because the maxillary orthognathic surgery was not performed. Severe mandibular prognathism with a maxillary overgrowth and anterior open bite should be treated by bimaxillary orthognathic surgery. However, one-jaw orthognathic surgery on the remaining the skeletal open bite tendency was performed for his medical problem and facial esthetics. This subsequential open bite should be resolved with a postoperative orthodontic treatment.

• Journal of International Society for Simulation Surgery
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• v.2 no.2
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• pp.71-75
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• 2015

To overcome limitations of conventional diagnosis and planning for orthognathic surgery, surgeons have begun to use 3-dimensional (3D) virtual simulation to plan complex orthognathic surgery. In many literatures, it has shown that better surgical outcome achieved with 3D virtual simulation than that with conventional methods. But, there is still lack of data about accuracy of maxillary segmental surgery with 3D virtual simulation. The purpose of this paper was to report the case of maxillary segmental orthognathic surgery with 3D virtual simulation and to assess the actual surgical outcome. Though the result was clinically acceptable, discrepancy between 3D simulation and actual surgery was not superior compared with conventional method. The accuracy of 3D simulation surgery and intermediate wafer fabrication for maxillary segmental surgery needs to be improved. Advancement in 3D software program and careful surgical technique will make it more precise and reliable method.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.21 no.4
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• pp.382-387
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• 1999

The concept of PCA(Patient Controlled Analgesia) was first described in 1968, by Sechzer. The earliest descriptions of actual self-administered PCA machines were by Forrest et al. In gastric bypass surgery, cesarian section, orthopedic surgery etc, PCA is widely used in the control of postoperative pain. Previous Studies have shown that PCA provides effective pain-control for the postoperative patient. The postoperative pain-control is a problem that should be solved in surgery. Especially in orthognathic surgery, it is not same as in the case of maxillofacial trauma surgery or of tumor surgery: most orthognathic surgery patients are under operation not accustomed to pains, and difficulties in pain-complaint due to IMF(Intermaxillary fixation), postoperative nausea, and vomiting are additional problem. In this study, we have compared PCA and IM analgesics with respect not only to time request but also to the quality of postoperative pain control.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.34 no.3
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• pp.180-185
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• 2012

Purpose: An accurate preoperative analysis of the patient is essential in orthognathic surgery in order to acquire superior results. In profile, the location of the chin's position may change according to the neck's inclination. This may ultimately affect the amount of surgical movement. During acquisition of cephalometric radiographs, or in supine position, there is a discrepancy in the neck's inclination. This means that there are also various discrepancies between the actual profile and the various preoperative profile images. In the clinical situation, the decision in performing genioplasty usually lies in the analysis of the patient's profile on the operating table at the final stages of orthognathic surgery. This study aims to analyze the different preoperative profile images and to compare their discrepancies. Methods: Fifty eight patients undergoing orthognathic surgery were chosen. These patients were divided into three groups according to angle's classification of malocclusion, as class I, II or III. The right profile of these patients in centric occlusion was taken in natural head position (NHP). This was set as the 'actual profile image.' Another right profile image was taken on the operating table after insertion of the nasotracheal intubation and with muscle relaxants in effect. This was also taken in centric occlusion. The angle (denoted 'A') between the soft tissue glabella-pognion and the true vertical plane was found in the above-mentioned profile images and in the cephalometric radiographs. The differences of these values were analyzed. Results: There were differences in Angle 'A' in all of the preoperative images. These values were however, not statistically significant. Conclusion: In order to gain an esthetic profile during orthognathic surgery, the NHP is shown to be the most reliable position. Images reproducing such head positions should be used in the treatment planning process.