• The Journal of the Korean dental association
• /
• v.50 no.2
• /
• pp.64-71
• /
• 2012

Recently, the presurgical orthodontic duration tends to be shortened by virtue of the advancement of surgical and orthodontic techniques in class III orthognathic surgery cases. But the predictability of the surgical results should be secured by removing several uncertain factors in presurgical orthodontic treatment. The purpose of this study is to investigate the influence of immediate postsurgical occlusal stability on postsurgical mandibular change. The study includes 40 patients who underwent orthognathic surgery to correct skeletal class III malocclusion. The patients were divided into two groups based on the numbers of occlusal contact in surgical setup occlusion: group 1 (stable surgical occlusion, n=24) and group 2(unstable surgical occlusion, n=16). Changes of horizontal and vertical mandibular measurements during postsurgical follow up period(from 1 week postsurgery to 12month after debonding) were compared to examine the differences between two groups. The stability of surgical occlusion is one of the factors influencing postsurgical mandibular changes in class III malocclusion. The various class III malocclusion cases have specific prerequisites for the orthognathic surgery according to the skeletal patterns. The prerequisites should be obtained by minimum presurgical orthodontics to increase the predictability of the surgical results.

• The korean journal of orthodontics
• /
• v.27 no.1
• /
• pp.21-33
• /
• 1997

The purpose of this study was to investigate the factors affecting the postsurgical mandibular stability for both one- and two jaw surgery. 18 for one-jaw surgerys and 24 for two-jaw surgerys among skeletal class III malocclusion patients who experienced orthodontic treatment and orthognathic surgery at Pusan National University Hospital were selected. Lateral cephalograms taken at the first visit, after presurgical orthodontic treatment, immediately after surgery and follow-up over 6 months, were traced. Based ANOVA, multiple linear regression analysis was completed for one-jaw surgery with postsurgical stability as the criterion and the magnitude of mandibular setback, the change of mandibular incisor height during surgery, the changes of mandibular plane angle and mandibular incisor angle during presurgical orthodontic treatment as affecting factors. Same analysis was completed for two-jaw surgery with postsurgical stability as the criterion and the magnitude of mandibular setback as affecting factor. The results were as follows : 1. In the one-jaw surgery cases, the magnitude of mandibular setback, the change of mandibular incisor height during surgery, the changes of mandibular plane angle and mandibular incisor angle during presurgical orthodontic treatment explained the variability in postsurgical stability with a significant $R^2$ value of 0.84. 2. In the two-jaw surgery cases, the magnitude of mandibular setback explained the variability in postsurgical stability with a significant $R^2$ value of 0,28.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.41
• /
• pp.23.1-23.10
• /
• 2019

The choice of surgical technique in orthognathic surgery is based primarily on the surgical treatment objectives (STO), which is a fundamental component of the orthognathic treatment process. In the conventional orthodontics-first approach, presurgical planning can be performed twice, during the preorthodontic (initial STO) and presurgical phases (final STO). Recently, a surgery-first orthognathic approach (SFA) without presurgical orthodontic treatment has been introduced and combined initial and final STO at the same time. In contrast to the conventional surgical-orthodontic treatment protocol that includes preoperative orthodontics for dental decompensations to maximize stable postoperative occlusion, the SFA potentially shortens the treatment period and minimizes esthetic concerns during the decompensation period because skeletal problems are corrected from the beginning. The indications for the SFA have been proposed in the literature, but no consensus exists. Moreover, because dental occlusion of the pre-orthodontic arches cannot be used as a guide for establishing the surgical treatment plan, there are fundamental limitations in accurate prediction of postsurgical results in the SFA. Recently, the concepts of postsurgical orthodontic treatment are continuously changing and evolving to overcome this inherent limitation of the SFA. The elimination of presurgical orthodontics can change the paradigm of orthognathic surgery but still requires cautious case selection and thorough discussion and collaboration between orthodontists and surgeons regarding the goals and postoperative management of the orthognathic procedure.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• v.31 no.6
• /
• pp.509-514
• /
• 2005

Purpose: In order to clarify the clinical utility of the vertical height augmentation (VHA) genioplasty using autogenous iliac bone graft (IBG), this study examined the postsurgical changes in hard and soft tissues of the chin and the stability of the grafted bone. Patients and Methods: Twenty-three patients who had undergone VHA genioplasty using autogenous IBG were evaluated radiographically and clinically. A comparison study of the changes in hard to soft tissues after surgery in all 23 patients was performed with preoperative, 1-month, 3-months, 6-months, and/or 1-year postoperative lateral cephalograms by tracing. Stability, bone healing, and complication of the grafted bone was evaluated by follow-up roentgenograms and clinical observation. Results: Between the preoperative and 6-month postoperative tracings, an average vertical augmentation of the osseous segment was 4.2 mm at menton and that of the soft tissue menton was 4.0 mm. There was a high predictability of 1: 0.94 between the amounts of hard versus soft tissue changes with surgery in the vertical plane. The position of the genial bone segment was stable immediately after surgery and soft tissue was not changed significantly from 1 month to 1 year after operation. Clinical and radiological follow-up results of the iliac bone graft showed normal bony union and were generally stable. Conclusions: VHA genioplasty using IBG is a reliable method for predicting hard and soft tissue changes and for maintaining postoperative soft tissue of the chin after surgery.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• v.33 no.5
• /
• pp.499-503
• /
• 2007

Introduction: In orthognathic surgery, internal fixation has been usually done with titanium plates and screws. Recently, Biodegradable plates and screws have been frequently used but the reports of long term results of postoperative stability are rare, especially after maxillary reposition in orthognathic surgery. Objective: In order to clarify the clinical utility of self-reinforced bioresorbable poly-70L/30DL-Lactide miniplates & screws in maxillary fixation after LeFort I osteotomy, this study examined the postsurgical changes in maxilla and complications of biodegradable plates and screws. Study design: Nineteen patients who had undergone maxillary internal fixation using biodegradable plates and screws were evaluated radiographically and clinically. A comparison study of the changes in maxilla position after surgery in all 19 patients was performed with 1-week, 1-month, 3-months, 6-months and/or 1-year postoperative lateral cephalograms by tracing. Complication of the biodegradable plates and screws was evaluated by follow-up roentgenograms and clinical observation. And one-way ANOVA test was used for statistical analysis. Results: The position of the maxillary bone was stable after surgery and was not changed significantly from 1 week to 1 year after operation. And we could not find any complication of biodegradable plates and screws. Conclusions: Internal fixation of the maxilla after LeFort I osteotomy using self-reinforced biodegradable plates and screws is a reliable method for maintaining postoperative position of the maxilla after LeFort I osteotomy.

• The Journal of the Korean dental association
• /
• v.50 no.11
• /
• pp.682-688
• /
• 2012

Surgery first approach in orthognathic surgery is to proceed the orthognathic surgery without preoperative orthodontic treatment. This approach has many advantages, which include a shorter total treatment period, a high level of patient satisfaction due to immediate post-surgical facial improvement, easy postoperative orthodontic treatment due to early normalization of skeletal muscle, and the rapid tooth movement reflecting the regional accelerated phenomenon. However instability due to transient occlusal interference after surgery make worse of long-term skeletal stability. Especially increasing of vertical occlusion caused by interference of interbicupid and molar happen postsurgical skeletal change. Until now, there is no common consensus about treatment protocol of surgery first approach in orthognathic surgery. The purpose of this paper is to introduce our treatment protocol of the surgery first approach and to evaluate indication and limitation with case analysis.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• v.29 no.2
• /
• pp.95-101
• /
• 2003

The purpose of this study was to evaluate the patterns of skeletal changes of proximal and distal segments after one jaw surgery and two jaw surgery with posterior impaction using SSRO on mandible in order to determine the skeletal origin of relapse and compare the stability of surgical methods in anterior open bite. The points and lines from lateral cephalometrics were measured before, after surgery, and at least 6-month follow up period. And then, the positional change of the proximal and distal segment were evaluated respectively. The results obtained were as follows; In cases of two jaw surgery, the results were stabler because they had less relapse factors. In cases of one jaw surgery, the value of APD were increased but it didn't relapse to the original value. Both of proximal and distal segments were responsible for the relapse tendency. But in one jaw surgery, the rotation of proximal segment was more responsible, and in two jaw surgery, the rotation of distal segment was.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.33 no.3
• /
• pp.225-232
• /
• 2011

Purpose: This study was designed to retrospectively evaluate the postsurgical initial stability of the Le Fort I osteotomy with posterior impaction and rigid internal fixation for the correction of mandibular prognathism with midface deficiency. Particular attention was paid to the magnitude and direction of the initial postsurgical change. Methods: 20 healthy patients with mandibular prognathism and midface deficiency participated in this study. All patients underwent Le Fort I osteotomy with posterior impaction and mandibular setback BSSO by one surgeon. Preoperative (T0), immediate postoperative (T1) and follow-up period (T2) cephalograms were taken and analyzed. Change between T0~T1 and T1~T2 was measured and analyzed. Results: Between T0~T1, significant differences were observed in all measurements except the ANS point and mandibular plane angle. Between T1~T2, only the occlusal plane angle was significantly changed. No significant changes were found in all other measurements. Conclusion: This study indicates that Le Fort I osteotomy with posterior impaction is stable at initial stages. Although changes in the occlusal plane angle were observed, it was caused by tooth movement after post-operative orthodontic treatment. However, more studies with larger samples are required to form definitive conclusions. Conclusion: This study indicates that Le Fort I osteotomy with posterior impaction is stable at initial stages. Although changes in the occlusal plane angle were observed, it was caused by tooth movement after post-operative orthodontic treatment. However, more studies with larger samples are required to form definitive conclusions.

• Archives of Plastic Surgery
• /
• v.48 no.4
• /
• pp.457-461
• /
• 2021

Background Pedicled perforator flaps can present postoperative complications similar to those encountered in free flap surgery. Beyond a clinical evaluation, there is still no reliable technical aid for the early prediction of vascular issues. The aim of this study was to assess the support of near-infrared spectroscopy technology as an intraoperative tool to anticipate postsurgical flap ischemia. Methods We prospectively enrolled 13 consecutive patients who were referred to our hospital from March 2017 to July 2018 and required a reconstructive procedure with a pedicled fasciocutaneous perforator flap. We measured flap peripheral capillary oxygen saturation (SpO₂) in each patient with a Somanetics INVOS 5100C Cerebral/Somatic Oximeter (Medtronic), both before and after transposition. Patient demographics, operative data, and complications were then recorded during the following 6 months. We analyzed the data using the Wilcoxon signed-rank test and linear regression. Results The mean flap SpO₂ before and after transposition was 92%±3% and 78%±19%, respectively. The mean change in SpO₂ was 14%±17%, with a range of 0% to 55%. The change in saturation and mean saturation ratio were significantly different between patients with and without postoperative flap necrosis. Conclusions An immediate quantitative analysis of flap peripheral capillary SpO₂ after transposition has never before been described. In our experience, an intraoperative drop in SpO₂ equal to or greater than 15%-20% predicted vascular complications in pedicled perforator flaps. Conversely, flap size and rotation angle were not correlated with the risk of flap necrosis.

• The korean journal of orthodontics
• /
• v.35 no.3 s.110
• /
• pp.216-226
• /
• 2005

The purpose of this study was to test and compare the accuracy and reliability of soft tissue profile predictions generated from two computer software programs (Quick Ceph Image $Pro^{TM}$ (ver 3.0) and $V-Ceph^{TM}$(ver 3.5)) for mandibular set-back surgery. The presurgical and postsurgical lateral cephalograms of 40 patients (20 males and 20 females) were traced on the same acetate paper with the reference taken as the cranial base outline. The presurgical skeletal outlines were digitized onto each computer program and the mandible was moved to mimic the expected surgical procedure with reverence to the mandibular anterior border and lower incisor position of the actual postsurgical skeletal outline. The soft tissue profile was generated and the amount and direction of skeletal movement was calculated with each software. The predicted soft tissue profile was compared to the actual postsurgical soft tissue profile. There were differences between the actual and the predicted surgical soft tissue profile charges in the magnitude and direction, especially the upper lip. lower lip and the soft tissue chin (P<0.05). Quick Ceph had more horizontal measurement errors and thickness errors for the upper lip and lower lip, but V-Ceph had more vertical measurement errors of the lower lip (P<0.05). There was a positive correlation between the prediction errors and the amount of mandibular movements in the vertical position of Sn, the horizontal position of Ls and the upper lip thickness for V-Ceph, and there was a negative correlation in the horizontal position and the thickness of the lower lip for Quick Ceph (P<0.05). However all of the Prediction errors of both imaging softwares were ranged within 3mm, and this was considered to be allowable clinically.