• Maxillofacial Plastic and Reconstructive Surgery
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• v.38
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• pp.47.1-47.8
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• 2016

Background: The paradigm of tonsillectomy has shifted from a treatment of recurrent throat infection to one of multi-discipline management modalities of sleep-disordered breathing (SDB). While tonsillectomy as a treatment for throat problems has been performed almost exclusively by otorhinolaryngologists, tonsillectomy as a part of the armamentarium for the multifactorial, multidisciplinary therapy of sleep-disordered breathing needs a new introduction to those involved in treating SDB patients. This study has its purpose in sharing a series of tonsillectomies performed at the Seoul National University Dental Hospital for the treatment and prevention of SDB in adult patients. Methods: Total of 78 patients underwent tonsillectomy at the Seoul National University Dental Hospital from 1996 to 2015, and 23 of them who were operated by a single surgeon (Prof. Jin-Young Choi) were included in the study. Through retrospective chart review, the purpose of tonsillectomy, concomitant procedures, grade of tonsillar hypertrophy, surgical outcome, and complications were evaluated. Results: Twenty-one patients diagnosed with SDB received multiple surgical procedures (uvulopalatal flap, uvulopalatopharyngoplasty, genioglossus advancement genioplasty, tongue base reduction, etc.) along with tonsillectomy. Two patients received mandibular setback orthognathic surgery with concomitant tonsillectomy in anticipation of postoperative airway compromise. All patients showed improvement in symptoms such as snoring and apneic events during sleep. Conclusions: When only throat infections were considered, tonsillectomy was a procedure rather unfamiliar to oral and maxillofacial surgeons. With a shift of primary indication from recurrent throat infections to SDB and emerging technological and procedural breakthroughs, simpler and safer tonsillectomy has become a major tool in the multidisciplinary treatment modality for SDB.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.35 no.4
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• pp.211-220
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• 2013

Purpose: The purpose of this study was to compare the changes in the pharyngeal airway space, tongue and hyoid bone positions according to the orthognathic surgical methods of mandibular prognathism. Methods: The subjects included 30 patients (16 males, 14 females) with the skeletal class III malocclusion. Group 1 (10 patients) underwent bilateral sagittal split ramus osteotomy (BSSRO) only; group 2 (10 patients) underwent BSSRO with genioplasty; and group 3 (10 patients) underwent BSSRO, Le Fort I osteotomy. We measured the lines between the selected upper air way, hyoid bone and tongue landmarks on the lateral cephalometric x-ray films of skeletal class III. The measurements were made preoperation, within 1 week after the operation, 3~6 months after the operation and 1 year after the operation. We compared and analyzed the measurements with matched paired t-test and independent samples t-test. Results: There were no postoperative changes in the nasopharyngeal airway space in group 3. The measurements of group 3 also increased during the follow-up period as compared to the preoperative measurements. In group 1, 2 and 3, the immediate postoperative oropharyngeal and hypopharyngeal airway spaces were decreased. In the following period, the hypopharyngeal airway space returned to the preoperative positions, but the oropharyngeal airway space was not significantly changed. The upper and lower tongue was posteriorly repositioned immediately after the surgery. During the follow-up period, the lower tongue position returned to the preoperative position, and the upper tongue position was not significantly changed. Immediately after the surgery, the B point was moved to the posterior position, and a slight anterior advancement was found in the follow-up period. Conclusion: Patients who received the mandibular setback surgery showed a decrease in the posterior airway space, and those who underwent maxillary advancement showed a significant increase of the nasopharyngeal airway space, which remained stable during the evaluation period. The change of the airway space, position of the hyoid bone and tongue did not differ according to the presence or absence of genioplasty.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.19 no.1
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• pp.25-34
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• 1997

This study was made with lateral cephalometric radiography of 28 skeletal class III malocclusion patients that were performed to setback surgery of mandible. The 28 patients were selected by four standards as follows. 1) Set-back amount of mandible is below 10 mm 2) No extrusion and intrusion of posterior tooth or alteration of interincisial angle at period of postoperative orthodontic treatment. 3) Change of mesial segment location of mandible on lateral cephalometrics 4) No genioplasty And 28 patients were divided to three group(1,2,3 group) by degree of preoperative occlusal plane angle to Burstone's horizontal plane. The preoperative occlusal plane angle, which of 1 group was smaller than $7^{\circ}$ and 2 group was between $7^{\circ}$ to $15^{\circ}$ and 3 group was larger than $15^{\circ}$. The results were as follows : 1. As the preoperative occlusal plane angle was larger, the degree of mandibular prognathism was not severe. 2. On comparsion of preoperative and immediate postoperative cephalometric analysis, specific relationship of occlusal plane angle and set-back amount of mandible was not present. 3. As the preoperative occlusal plane angle was smaller, the alteration of postoperative occlusal plane angle was increased tendency. As the preoperative occlusal plane angle was larger, the alteration of postoperative occlusal plane angle was decreased tendency. 4. The relapsed degree of B point distance to Vertical plane was not relationship to the degree of preoperative occlusal plane angle.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.21 no.1
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• pp.35-40
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• 1999

Recently, sagittal split ramus oseotomy and intraoral vertical ramus osteotomy have been commonly performed for the correction of mandibular prognathism, occurred to abundant oriental people. Many authors have studied the soft tissue change after orthognathic surgery, especially between mandibular hard tissues and soft tissue of lower lip, but the study of upper lip change is comparatively little. Therefore, we studied the 12 patients, operated only sagittal split ramus osteotomy without genioplasty or maxillary osteotomy in department of oral and maxillofacial surgery, Hanyang university hospital from 1996. 1. 1. to 1998. 7. 20. Preoperative and postoperative cephalometric view was measured to know the change of upper lip position and shape after mandibular setback. The result were obtained as follows. 1. The ratio of upper lip change amount to lower incisor horizontal movement was 15.1%. 2. The ratio of lower facial profile between Sn-Stm and Stm-Mes was changed from 1 : 2.352 to 1 : 2.069 after operation. 3. Post-operative upper lip was flattened 72.4% compared with pre-operative one. 4. The vermilion zone of the upper lip increased 56 % horizontally, 5.8% vertically after operation. 5. The vermilion zone ratio of the lower lip to the upper lip was changed from 1 : 1.253 to 1 : 1.348. 6. The distance between esthetic line and Ls was changed from -3.958mm to -1.15mm.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.40
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• pp.36.1-36.5
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• 2018

Background: Botulinum toxin-A (BTX-A) injection into muscle reduces muscular power and may prevent post-operative complication after orthognathic surgery. The purpose of this study was (1) to evaluate BTX-A injection into the masseter muscle on the prevention of plate fracture and (2) to compare post-operative relapse between the BTX-A injection group and the no injection group. Methods: Sixteen patients were included in this study. Eight patients received BTX-A injection bilaterally, and eight patients served as control. All patients received bilateral sagittal split ramus osteotomy for the mandibular setback and additional surgery, such as LeFort I osteotomy or genioplasty. Post-operative plate fracture was recorded. SNB angle, mandibular plane angle, and gonial angle were used for post-operative relapse. Results: Total number of fractured plates in patients was 2 out of 16 plates in the BTX-A injection group and that was 8 out of 16 plates in the no treatment group (P = 0.031). However, there were no significant differences in post-operative changes in SNB angle, mandibular plane angle, and gonial angle between groups (P > 0.05). Conclusions: BTX-A injection into the masseter muscle could reduce the incidence of plate fracture.