• 대한치과교정학회지
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• 제30권5호
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• pp.657-668
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• 2000

본 연구는 골격성 III급 부정교합 환자에서 상악골 전방이동 수술 후 야기되는 코의 형태변화에 대해 연구하고 이를 예측할 수 있는 요소를 찾아 교정-악교정 수술 복합 치료계획의 수립과 결과의 예측에 이용하고자 시행되었다. 부산대학교병원 치과진료처 교정과에 내원하여 골격성 III급 부정교합으로 진단되어 술전 교정치료를 받고 Le Fort I 골절단술로 상악골의 전방 이동시키는 동시에 하악골을 후방 이동시킨 남녀 성인 환자 25명을 대상으로 하였다. 이들의 수술전, 후 측모두부규격방사선사진과 정모 및 측모 안면사진을 계측, 분석하여 다음과 같은 결과를 얻었다. 1. 상악골 전방이동에 따른 비첨의 수직적 위치 변화는 상관성이 높았으며 ANt, SNt에서 A point의 전방이동에 의해 ${\beta}_0$는 각각 0.228, 0.257로 나타났다. 2. 상악골 전방이동에 따른 비첨의 수평적 위치변화는 상관성이 높았으며 ANt, SNt, Sn point에서 A point의 전방이류에 의해 ${\beta}_0$는 각각 0.484, 0.431, 0.806으로 나타났다. 3. 상악골의 전방이동에 따른 비익부의 확장정도는A point의 전방이동에 의해 0.002의 ${\beta}_0$를 나타내었으나, 임상적으로 유의한 변화는 없었다. 4. 수술 후 비첨의 수직적 및 전후방적 위치변화를 예측하는 지표로 사용된 ADV, DRI, Prominence of nose, Pre-Op CA 중 ADV 만이 설명변수로서 유의성이 있었다.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제34권6호
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• pp.628-634
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• 2008

The purpose of this study is to examine reproducibility of operation plan and 3-dimentional jaw movement patterns by comparing jaw position of STO with post-operative jaw position. Twenty patients with class III dental and skeletal malocclusion who were treated with Le-Fort I osteotomy and B-SSRO were reviewed. Lateral cephalometric radiographs were taken within two weeks before operation and two days after operation. Cephalometric radiographs were compared and analyzed with orthognathic computer program '$V-Ceph^{TM}$'. Post-operative maxillary advancement was insufficient compared to maxillary advancement through STO. Post-operative setback movement was over compared to mandibular setback movement through STO. But statistically this is not significant. Maxillary vertical location is insignificant on the whole. Especially post-operative maxillary clockwise rotation is significant compared to maxillary rotation through STO. Post-operative maxillary clockwise rotation tendency is generally observed in all patients. So surgeons and staffs must consider this tendency when operation plan is established ans operation is being performed. Using intra or extra oral marking points, face bow, and bite plate will make exact surgery possible.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제30권1호
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• pp.92-99
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• 2008

The purpose of this study was to evaluate maxillay distraction for the cleft and other patients who were treated with RED $system^{(R)}$(Martin, Tuttlingen Germany). Eleven patients with severe maxillary hypoplasia who were treated between 2002 and 2007 in the Department of Oral and Maxillofacial surgery, Pusan National University Hospital, are reviewed for this study. Their age at the time of surgery ranged from 7 to 22 years(mean age=15.36 years). Distraction was started at 5 days after Le Fort I or III osteotomy at a rate of 1mm per day for 10 to 20days. All patients used the Rigid External Distraction II system. After distraction was completed, a 2 to 3 months period of consolidation was undertaken. The follow-up period ranged from 1 to 6 years. The mean amount of advancement of the maxilla was 14.2mm(A-point). Relapse, VPI, and local infection around the halo pin were the most common complications. In adult patients, the relapse of maxilla ranged from 21% to 35%. In the growing child, postoperative stability of the maxilla was unstable and unpredictable.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제29권2호
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• pp.141-147
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• 2007

The purpose of this study was to evaluate the effects of maxillary occlusal plane angle to postoperative skeletal stability by comparative analysis after two-jaw surgery of patients with skeletal CIII malocclusion. This study was made with lateral cephalometric radiography of 52 patients with skeletal class III malocclusion that were performed to Le Fort I osteotomy and BSSRO. And 52 patients were divided to Group A(n=30) and B(n=22). Maxillary posterior impaction was not conducted in Group A, which the pre-operative maxillary occlusal plane angle was in a normal range, and for Group B, which the pre-operative maxillary occlusal plane was low, the maxillary posterior impaction was conducted. The results were obtained as follows : 1. The relapse rate of Group A, which the pre-operative maxillary occlusal plane angle was in a normal range, was relatively stable compared to Group B, which the pre-operative maxillary occlusal plane was low. 2. The relapse rate of each measurement of Group B, which had the maxillary occlusal plane altered during the operation, was somewhat high, and of those, the post-operative relapse rate of overjet, overbite, mandibular plane angle appeared to be significantly high in the statistics. The analyzed results above, was thought to be indicating that the pre-operative maxillary occlusal plane angle was closely related to the post-operative skeletal stability, and that obtaining post-operative skeletal stability only through operative normalization of occlusal plane angle may meet limitations.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제28권2호
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• pp.178-182
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• 2006

폐부종은 구강악안면외과 영역의 수술 도중에 발생할 가능성이 있다. 따라서 전신마취하에 수술중인 외과의와 마취의는 환자의 상태를 주의깊게 관찰하여야 하며 수술 중 폐부종이 발생할 가능성에 항상 대비하여야 한다. 폐부종 증세가 발견되는 즉시, 즉각적이고도 적절한 처치를 시행한 경우 예후가 좋으며, 근본적인 원인치료 및 타장기의 합병증 및 후유증에 대하여 검사가 필요하다.

• 대한구순구개열학회지
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• 제12권2호
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• pp.85-94
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• 2009

Cleft lip and palate patients show midface hypoplasia, maxillary hypoplasia due to scar of previous surgery, and manifest as a class III malocclusion, retruded midface and shallow palate. These deformities have been treated with traditional orthognathic surgery. Although conventional Le Fort I osteotomy was performed on most cleft patinets with midface hypoplasia, it showed limited amount of maxillary advancement and high relapse tendency. Recently, when great amount of advancement are required in severe maxillary hypoplasia, distraction osteogenesis using RED system is widely used. But, several months of consolidation period is needed after distraction osteogenesis, occlusal relationship is not stable until mandibular setback surgery has done in mandibular hyperplasia cases and during these period, patients may feel discomfort. We present clinical cases of immediate rigid internal fixation after completion of maxillary distraction using RED system and simultaneous mandibular setback procedure in adult cleft and lip patients who show both maxillary hypoplasia and mandibular prognathism.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제43권4호
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• pp.239-246
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• 2017

Objectives: This paper proposes Han's ratio as an objective and quantitative comparative result obtained from pre and postoperative data in patients with a mandibular angle reduction. Materials and Methods: Thirty patients, 12 men and 18 women, who visited the Department of Oral and Maxillofacial Surgery with the chief complaints of skeletal mandibular prognathism and prominent mandibular angle were selected. The subjects were classified into 3 groups according to the types of surgical procedures involved. Group A consisted of patients who underwent mandibular angle resection and mandibular setback. Group B was comprised of patients with mandibular angle resection, mandibular setback and genioplasty. Group C consisted of patients with mandibular angle resection, mandibular setback, Le Fort I osteotomy, and genioplasty. The landmarks placed in pre and postoperative frontal photographs were used to obtain the Han's ratio in each group. The Han's ratios were compared pre- and postoperation and according to the surgical techniques applied. Results: Of the 3 groups who had undergone a mandibular angle resection, all showed a statistically significant increase in Han's ratio. On the other hand, there was no statistically significant difference based on the surgical techniques used. Conclusion: The ratio of the lateral lower face proposed in this study is a potential indicator of postoperative esthetic enhancement in mandibular angle reduction surgery.

• 대한두개안면성형외과학회지
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• 제13권1호
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• pp.4-10
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• 2012

Purpose: The objective of this retrospective study was to assess the skeletal stability after orthognathic surgery for patients with cleft lip and palate. The soft tissue changes in relation to the skeletal movement were also evaluated. Methods: Thirty one patients with cleft received orthognathic surgery by one surgeon at the Craniofacial Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan. Osseous and soft tissue landmarks were localized on lateral cephalograms taken at preoperative (T0), postoperative (T1), and after completion of orthodontic treatment (T2) stages. Surgical movement (T0.T1) and relapse (T1.T2) were measured and compared. Results: Mean anteroposterior horizontal advancement of maxilla at point A was 5.5 mm, and the mean horizontal relapse was 0.5 mm (9.1%). The degree of horizontal relapse was found to be correlated to the extent of maxillary advancement. Mean vertical lengthening of maxilla at point A was 3.2 mm, and the mean vertical relapse was 0.6 mm (18.8%). All cases had maxillary clockwise rotation with a mean of 4.4 degrees. The ratio for horizontal advancement of nasal tip/anterior nasal spine was 0.54/1, and the ratio of A' point/A point was 0.68/1 and 0.69/1 for the upper vermilion/upper incisor tip. Conclusion: Satisfactory skeletal stability with an acceptable relapse rate was obtained from this study. High soft tissue to skeletal tissue ratios were obtained. Two-jaw surgery, clockwise rotation, rigid fixation, and alar cinch suture appeared to be the contributing factors for favorable results.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제21권4호
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• pp.376-381
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• 1999

A variety of materials and procedures such as sinus floor elevation, sinus-lift graft, inlay bone graft using Le Fort I osteotomy, and onlay graft have been used to create adequate bone volume in the maxillary sinus for placement of endosseous implants in the posterior atrophic maxilla. Because of the frequent lack of bone in the posterior maxilla, sinus lift procedure has become a commonly practiced treatment modality. The 138 endosseous implants of 36 patients with sinus augmentation procedures performed in Korea University Hospital from January 1991 to December 1998 were summarized and analysed. The result of this study were as follows: 1. Age ranged from 39 to 57, with a mean of 50.7. 2. The mean survival rate for 138 implants with maxillary sinus lift procedure was 80.4%. 3. There was no corelationship between the fixture length, width and the survival rate. 4. The result showed that the healing period for 8-12 months was necessary if the residual alveolar bone height was less than 5mm. 5. Autogenous iliac corticocancellous block graft showed the most favorable survival rate(95%).

• 대한두개안면성형외과학회지
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• 제12권2호
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• pp.102-106
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• 2011

Purpose: It is accepted universally that correction of the cleft lip nasal deformity requires multiple stages of surgery. Following primary lip repair in infancy or early childhood, secondary surgery to improve the deformity of the lip and nose is frequently necessary. A suitable surgical procedure to correct the accompanying deformity, such as cleft palate and alveolus, must be carried out at an appropriate age. In developing countries, it is common for patients with cleft lip nasal deformity to present severe secondary deformities in adolescence, because of poor follow-up and inappropriate surgery. Methods: The first patient was a 12 year old Mongolian boy. He presented prominent lip scar, short lip, wide columella, asymmetric nostril, palatal fistula, cleft alveolus, and velopharyngeal incompetence. He underwent cheilorhinoplasty, transpositional flap, alveoloplasty by iliac bone graft, and sphincter pharyngoplasty. On follow-up, a bilateral maxillary hypoplasia and a class III malocclusion developed. He underwent LeFort I osteotomy and maxillary advancement at the age of 16 years. The second patient was an 18 year old Eastern Russian girl. She presented with a deviated nose, right alar base depression, short lip, protrusion on vermilion, large palatal fistula, and severe VPI due to short palate. She underwent the combined procedure of cheilorhinoplasty, corrective rhinoplasty, tongue flap for palatal fistula, and superiorly based pharyngeal flap. And the tongue flap was detached at postoperative 3 weeks. Results: The overall results have been extremely pleasing and satisfactory to patients. There were no postoperative complications. Conclusion: We discovered the one stage operation for radical correction was sufficient procedure to provide excellent clinical outcomes in patients with severe cleft lip nose deformity.