• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.26 no.6
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• pp.644-651
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• 2000

In cases of severe alveolar bony resorption in the edentulous posterior maxillae, implant placement is limited anatomically due to maxillary sinus. If the ridge is atrophic, the various bone grafting methods are required for the ridge augmentation. But the result of the onlay grafting procedure is not always promising. On the posterior maxilla, maxillary sinus mucosa lifting and bone grafting into the sinus floor, subantral augmentation(SA) technique are recommended. Various SA procedures have been developed for implant installation. We perfer to simultaneous block bone graft and implant installation through the residual alveolar ridge into the grafted block bone to fix the grafted bone and to gain the primary stability of the installed fixture. When a sagittal skeletal discrepancy in present due to the severe alveolar bony resorption of the maxilla, the advancement of the maxilla by Le Fort I osteotomy simultaneously with installation of implant fixtures combined with sinus lifting and interpositional bone graft procedure can be indicated. We applied various SA techniques for implant installtion to the 46 edentulous posterior maxillae, and total 154 implants were installed at our department from 1992 to 1999. Various SA techniques were classified in detail and the indications of each techniques were discussed. The changes of residual bony height following SA procedure were studied. The results were as follows. 1. The SA procedure combined with bone graft and simultaneous fixture installation were performed in 41 cases, 126 fixtures were installed and 5 fixtures were removed out of them. Le Fort I osteotomy procedure combined with sinus lifting and interpositional bone graft simultaneous with fixture installation were performed in 5 cases. Total 28 fixtures were installed and 2 fixtures were removed so far. 2. Autogenous block bone graft into sinus floor were performed in 35 cases, autogenous particulated marrow cancellous bone(PMCB) graft in 9 cases, and demineralized human bone powder in 2 cases. The donor site for bone graft were anterior iliac bone in 39 cases, posterior iliac bone in 3 cases and mandibular symphysis in 1 case and mandibular ramus in 1 case. 3. In 9 cases with which SA procedure had been performed with the block bone graft, the change of pre- and postoperative residual bony height were measured using MPR(multiplanar reformatted)-CT. The mean residual bony height was 8.0mm preoperatively, 20.2mm at 6 months following up operation and we gained average 12.2mm alveolar bony height. So, we can recommend this one-stage subantral augmentation and fixture installation technique as a time conserving, safe and useful method for compromised posterior edentulous maxilla.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.28 no.4
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• pp.320-328
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• 2006

Purpose: The aim of this study was to evaluate the effects of pterygomaxillary separation on dimensional changes of dental arch following surgically-assisted rapid maxillary expansion (SARME). Patients and Methods: Eighteen adults who had been treated by SARME for transverse maxillary deficiency from May 2000 to August 2005 were evaluated. Thirteen patients (Group 1) were treated with subtotal Le Fort I osteotomy including pterygomaxillary separation and anterior midpalatal osteotomy. The same operation was performed in five patients (Group 2) except pterygomaxillary separation. Dental study casts were taken before operation and after removal of expansion device. And then, skeletal and dental parameters were measured pre- and post-operatively. Results: 1. Changes of mean interdental width 1) In group 1, mean maxillary interdental width was increased 70%($47{\sim}99%$), 95%($84{\sim}115%$), and 77%($57{\sim}94%$) of total expansion on canine, first premolar, and first molar region, respectively after retention. 2) In group 2, mean maxillary interdental width was increased 77%($59{\sim}100%$), 78%($45{\sim}107%$), and 86%($57{\sim}116%$) of total expansion on canine, first premolar, and first molar region, respectively after retention. 3) There was a statistical difference between the change of interdental width of group 1 and group 2 at first premolar(p<0.05). 2. Changes of mean interalveolar width 1) In group 1, mean maxillary alveolar bone width was increased 66%($42{\sim}84%$), 74%($42{\sim}104%$), and 57%($31{\sim}78%$) of total expansion on canine, first premolar, and first molar region, respectively after retention. 2) In Group 2, mean maxillary alveolar bone width was increased 73%($55{\sim}98%$), 67%($36{\sim}89%$), and 59%($48{\sim}73%$) of total expansion on canine, first premolar, and first molar region, respectively after retention. 3) There were no statistical differences between group 1 and group 2 at each teeth area. Conclusion: These results suggest that SARME without pterygomaxillary separation may allow the relatively equal expansion at both anterior and posterior teeth area and most amounts of maxillary interdental expansions were acquired with the expansion of the maxilla by SARME.

• The korean journal of orthodontics
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• v.29 no.3 s.74
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• pp.285-301
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• 1999

There is a need for more accurate prediction in surgical orthodontic treatment. Video imaging is an important technology in planning orthognathic surgery and educating patients about the esthetic results after treatment. Preoperative and postoperative lateral cephalogram of 30 patients who had one piece Le Fort I osteotomy advancement and mandibular set back by bilateral intraoral vertical ramal osteotomy with or without genioplasty were used in this study. The computer generated soft tissue line drawing prediction were compared with the actual postoperative cephalograms .The results are as follows. 1. 14 variables showed Statistically significant differences from 24 variables between computer predicted profile and post operative profile 2. Most of the differences were found in the maxilla-related soft tissue landmarks. 3. The predicted results were more accurate in the groups who had small amount of mandibular set back. 4. The predicted results were more accurate in the groups who had no genioplasty. Most of these differences were within 2mm ranges. Therefore profile change prediction by video imaging could be considered clinically acceptable.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.31 no.5
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• pp.390-398
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• 2005

Purpose: The aim of this study was to evaluate the skeletal and dentoalveolar dimensional changes following surgically-assisted rapid maxillary expansion (SARME). Patients & methods: Thirteen adults who had been treated by SARME for transverse maxillary deficiency from May 2000 to December 2003 were evaluated. The SARME procedure was the subtotal Le Fort I osteotomy combined with pterygomaxillary separation and anterior midpalatal osteotomy. Dental study casts and posteroanterior cephalometric radiographs were taken before operation, after removal of expansion device, and follow up period. Nasal cavity width, skeletal and dentoalveolar parameters were measured pre- and post-operatively. Results: 1. Mean nasal cavity width was increased 12%$(0{\sim}21%)$ of total expansion after retention. 2. Mean maxillary interdental width was increased 70%$(47{\sim}99%)$, 95%$(84{\sim}115%)$, and 77%$(57{\sim}94%)$ of total expansion in the canine, the first premolar, and the first molar region, respectively after retention. 3. Mean maxillary alveolar bone width was increased 66%$(42{\sim}84%)$, 74%$(42{\sim}94%)$, and 57%$(31{\sim}78%)$ of total expansion in the canine, the first premolar, and the first molar region, respectively after retention. 4. Mean palatal vault depth was decreased 1.3 mm ($0.5{\sim}2.0$ mm) after retention. 5. Mean interdental and alveolar bone width of the mandibular canine and intermolar width of mandible were slight increased as maxilla was expanded after retention. 6. There were statistical differences between preoperative and postoperative values of nasal cavity, all maxillary interdental and interalveolar widths, palatal vault depth, mandibular interdental and interalveolar width of canine(paired t-test, p<0.05). 7. The maxillary interdental and alveolar bone width were decreased approximately 25% of total expansion by relapse at follow up period. Conclusion: In conclusion, most amounts of maxillary interdental expansions were acquired with the expansion of the maxilla by SARME. For preventing the relapse, approximately 25% of the overexpansion was needed.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.34 no.5
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• pp.311-319
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• 2012

Purpose: The aim of this study is to evaluate the vertical changes of the lip and perioral soft tissue, following orthognathic surgery in skeletal class III patients by a cephalometric analysis of a cone beam computed tomography (CBCT). Methods: A total of 20 skeletal class III patients, who had bimaxillary surgery with Le Fort 1 osteotomy and bilateral sagittal split ramus osteotomy, were included in this study. The surgical plan for maxilla was posterosuperior impaction with the anterior nasal spine, as the rotation center. Further, the surgical plan for mandible was also posterosuperior movement. The soft tissue changes between lateral cephalogram and CBCT were compared. And the correlations between independent variables and dependent variables were evaluated. Results: There were no significant differences of the soft tissues changes between lateral cephalogram and CBCT. Upper lip philtrum length (SnLs), nasolabial angle increased and upper lip vermilion length (LsStms), lower lip length (StmiB'), lower lip vermilion length (StmiLi), lower lip philtrum length (LiB') and soft tissue lower facial height (SnMe') decreased after surgery. Change of SnLs (${\Delta}$SnLs) was influenced by vertical change of menton (${\Delta}$MeV), and change of LsStms (${\Delta}$LsStms) was influenced by upper lip thickness (ULT). Change of StmiLi' (${\Delta}$StmiLi') were influenced by preoperative overjet. Change of StmiB' (${\Delta}$StmiB') were influenced by preoperative overjet, vertical change of lower incisor (${\Delta}$L1V) and horizontal change of posterior nasal spine (${\Delta}$PNSH). Change of LiB' (${\Delta}$LiB') was influenced by ${\Delta}$L1V and ${\Delta}$PNSH. Change of SnMe' (${\Delta}$SnMe') was influenced by ${\Delta}$MeV, horizontal change of upper incisor (${\Delta}$U1H) and horizontal change of lower incisor (${\Delta}$L1H). ${\Delta}$Nasolabial angle was influenced by change of ULT (${\Delta}$ULT). Conclusion: Both soft tissues and hard tissues can be evaluated by CBCT. Posterosuperior rotation of maxillomandibular complex resulted in increase of upper lip philtrum length and nasolabial angle, while the upper lip vermilion length, lower lip philtrum length, lower lip vermilion length, and soft tissue lower facial height showed a decrease.

• The korean journal of orthodontics
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• v.50 no.5
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• pp.336-345
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• 2020

Objective: To investigate the treatment modalities (Tx-Mods) for patients with unilateral hemifacial microsomia (UHFM) according to Pruzansky-Kaban types and growth stages. Methods: The samples consisted of 82 Korean UHFM patients. Tx-Mods were defined as follows: Tx-Mod-1, growth observation due to mild facial asymmetry; Tx-Mod-2, unilateral functional appliance; Tx-Mod-3, fixed orthodontic treatment; Tx-Mod-4, growth observation due to a definite need for surgical intervention; Tx-Mod-5, unilateral mandibular or bimaxillary distraction osteogenesis (DO); Tx-Mod-6, maxillary fixation using LeFort I osteotomy and mandibular DO/sagittal split ramus osteotomy; Tx-Mod-7, orthognathic surgery; and Tx-Mod-8, costochondral grafting. The type and frequency of Tx-Mod, the number of patients who underwent surgical procedures, and the number of surgeries that each patient underwent, were investigated. Results: The degree of invasiveness and complexity of Tx-Mod increased, with an increase in treatment stage and Pruzansky-Kaban type (initial < final; [I, IIa] < [IIb, III], all p < 0.001). The percentage of patients who underwent surgical procedures increased up to 4.2 times, with an increase in the Pruzansky-Kaban type (I, 24.1%; IIa, 47.1%; IIb, 84.4%; III, 100%; p < 0.001). However, the mean number of surgical procedures that each patient underwent showed a tendency of increase according to the Pruzansky-Kaban types (I, n = 1.1; IIa, n = 1.5; IIb, n = 1.6; III, n = 2.3; p > 0.05). Conclusions: These findings might be used as basic guidelines for successful treatment planning and prognosis prediction in UHFM patients.

• Korean Journal of Cleft Lip And Palate
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• v.8 no.2
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• pp.71-79
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• 2005

Purpose: Maxillary hypoplasia is a common developmental problem of cleft lip and palate. Fair results with distraction osteogenesis have been reported especially when these patients need a large amount of maxillary advancement, instead of orthognathic surgery. The purpose of this study is to evaluate the clinical results with a relatively new distractor, $TS-MD^{(R)}$ (Trans-sinusoidal maxillary distractor, KLS Martin, Tuttlingen, Germany) which was used for the advancement of the maxilla in the cleft patients. Patients and Method: Distraction osteogenesis using $TS-MD^{(R)}$ was performed for four CLP patients (three males and one female) who had maxillary hypoplasia. All patients were over 16 years old. As three patients showed mandibular prognathism as well, bilateral sagittal split ramus osteotomy for mandibular setback was performed at the same time. After consolidation periods of 4 to 12 weeks, the distraction devices were removed and miniplates were placed for simultaneous internal fixation. Results: Three patients showed a large amount of incisal overbite but one patient did not have sufficient maxillary advancement. Le Fort I osteotomy, maxillary advancement and internal fixation should have been performed for the patient when removing the distraction devices. Different from the $clinician{\box}s$ expectation, the amount of maxillary advancement using $TS-MD^{(R)}$ was not sufficient, although the device has rigid mechanical property. Rotation of maxilla during distraction forward and downward was also observed. Conclusion: Even though the maxillary advancement with $TS-MD^{(R)}$ device could be achieved, the clinical control of some characteristics related with the device was necessary. More clinical studies on $TS-MD^{(R)}$ should be performed.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.27 no.3
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• pp.239-249
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• 2001

The purpose of this study is to evaluate the relationship of the factors which could be influenced by orthognathic surgery especillay SSRO. We measured the amounts of the maximum opening, lateral movements, maximum velocity and pattern of mandibular path during the opening and closing of mandible at the following times ; preoperative, 1 month after operation, 6 months after operation respectively using MKG. And the results were compared according to the categorized subgroups. Following results were obtained : 1. The change of the amounts of mandibular lateral movement and maximum opening velocity were statistically different between male and female (p<0.05), but the others were not. 2. According to the method of operation, there was no difference in the change of the mandibular movements between the group of SSRO and SSRO plus LeFort I osteotomy (p>0.05). 3. According to the amounts of mandibular movement, the recovery of left lateral movement of the group of $6{\sim}10mm$ was better than the other groups (p<0.05). 4. In the frontal pattern of the opening and closing of the mandible, the complex deflected type (F5), simple deflected type (F4), complex deviated type (F3), simple deviated type (F2), straight type (F1) were obtained in order at the time of preoperative, simple deflected type, simple deviated type, complex deviated type, straight type, complex deflected type in order at the time of 1 month after surgery, and the result at the time of 6 months after surgery was the same with that of the time of preoperative. In the sagittal pattern, non-coincident type (S2) was predominant at the time of preoperative, and coincident type (S1) was predominant at the time of 1 month after surgery. After 6 months, the result was also the same with that of the preoperative in sagittal pattern. 5. There was not a statistical difference in the change of the mandibular movement between group of presence of the preoperative TMJ symptoms and non-presence group (p>0.05). 6. There was not a statistical difference in the change of the mandibular movement between repositioning device applied group and non-applied group (p>0.05). 7. Sixty three percents of the patients who had preoperative TMJ symptoms were improved after surgery and preoperative TMJ symptoms were more improved after operation in the repositioning device non-applied group statistically (p<0.05).

• Maxillofacial Plastic and Reconstructive Surgery
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• v.35 no.6
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• pp.368-375
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• 2013

Purpose: This study is to evaluate the location of descending palatine artery, the anatomy of pterygomaxillary junction, and the association between the obtained anatomic values and several variables. Methods: We studied 40 patients who were treated for dentofacial deformites from January 2010 to December 2012 in Ulsan University Hospital, Ulsan, Korea. Cone beam computed tomogram (CBCT) was done for all patients. The reference point was approximately 5 to 7 mm above anterior nasal spine on axial image. We evaluated the location of the greater palatine canal (line a: on the coronal view, the shortest line between the center of greater palatine canal and pterygoid fossa; distance a: the distance of line a). We also measured the thickness (line b: on the coronal view, the shortest line between maxillary posterior sinus wall and pterygoid fossa; distance b: distance of line b), width (line c: on the coronal view, the line perpendicular to the line b and the nearest line from the most concave point of lateral pterygoid plate to the medial pterygoid plate; distance c: distance of line c) and height (line d: on sagittal view, the vertically longest line of pterygoid junction; distance d: the distance of line d) in pterygomaxillary junctions. We evaluated the association between the obtained anatomic values and several variables (sex, age, height and weight). Results: The mean distance a was 4.78 mm, mean distance b was 5.53 mm, mean distance c was 8.01 mm and mean distance d was 13.22 mm. The differences between age and mean distance c and weight and mean distance d in pterygomaxillary junctions are statistically significant. Conclusion: There apparently is anatomic variation of pterygomaxillary junctions by various values, particularly weight and age in a Korean clinical population.

• Journal of Dental Anesthesia and Pain Medicine
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• v.19 no.6
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• pp.353-360
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• 2019

Background: Controlled hypotension (CH) provides a better surgical environment and reduces operative time. However, there are some risks related to organ hypoperfusion. The EV1000/FloTrac system can provide continuous cardiac output monitoring without the insertion of pulmonary arterial catheter. The present study investigated the efficacy of this device in double jaw surgery under CH. Methods: We retrospectively reviewed the medical records of patients who underwent double jaw surgery between 2010 and 2015. Patients were administered conventional general anesthesia with desflurane; CH was performed with remifentanil infusion and monitored with an invasive radial arterial pressure monitor or the EV1000/FloTrac system. We allocated the patients into two groups, namely an A-line group and an EV1000 group, according to the monitoring methods used, and the study variables were compared. Results: Eighty-five patients were reviewed. The A-line group reported a higher number of failed CH (P = 0.005). A significant correlation was found between preoperative hemoglobin and intraoperative packed red blood cell transfusion (r = 0.525; P < 0.001). In the EV1000 group, the mean arterial pressure (MAP) was significantly lower 2 h after CH (P = 0.014), and the cardiac index significantly decreased 1 h after CH (P = 0.001) and 2 h after CH (P = 0.007). Moreover, venous oxygen saturation (ScVO₂) decreased significantly at both 1 h (P = 0.002) and 2 h after CH (P = 0.029); however, these values were within normal limits. Conclusion: The EV1000 group reported a lower failure rate of CH than the A-line group. However, EV1000/FloTrac monitoring did not present with any specific advantage over the conventional arterial line monitoring when CH was performed with the same protocol and same mean blood pressure. Preoperative anemia treatment will be helpful to decrease intraoperative transfusion. Furthermore, ScVO₂ monitoring did not present with sufficient benefits over the risk and cost.