• 대한치과교정학회지
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• 제29권1호
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• pp.113-127
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• 1999

악골의 골격적 부조화를 가진 환자의 교정치료는 악교정 수술을 필요로 하고, 악교정 수술에 의해 교합평면각은 변화된다. 특히 전치부 개교를 동반한 III급 부정교합 환자에서 치아안면 기형을 치료하기 위한 교합평면각의 변화에 대하여 많은 논란이 있어 왔다. 교합평면각을 증가시키는 하악골의 시계 방향 회전(clockwise rotation)은 전치부 개교에 대한 적절한 치료법으로 추천되어 왔고 하악골의 반시계 방향의 회전(counterclockwise rotation)은 하악지 고경을 증가시키는 방향으로 하악골을 회전시킨다는 개념으로 인해 재발(relapse)을 유발하는 불안정한 수술 방법으로 인식되어 왔다. 본 연구는 전치부 개교를 동반한 골격성 III 부정교합 환자에서 교합평면의 반시계 방향 회전을 동반한 하악지 시상분할 골절단술 시행 후 교합평면각의 변화와 술후 안정성과의 관계를 평가 하고자 하였다. 하악지 시상분할 골절 단술과 rigid fixation으로 치료받은 환자 25 명 (평균연령 20.6세)을 대상으로 하여 수술 직전(T1), 술후 2주내(T2), 그리고 술후 6 개월 이후(T3)에 촬영한 측모 두부계측 방사선 사진을 통계분석한 결과(Paired t-test, Pearson correlation analysis), 다음의 결론을 얻었다. 1. 악교정 수술 후(T2) 하악평면각은 $2.9^{\circ}$ 감소하였고 SN 평면에 대한 하악 교합평면의 각도는 $2.7^{\circ}$ 감소하였다. 술후 6 개월경과 후(T3) 후안면 고경의 감소로 인해(P<0.01) 하악 평면각은 $1.0^{\circ}$ 증가하였으나 하악 교합평면의 경사도는 변화되지 않았다. 2. 악교정 수술 후 시간 경과(T3)에 의해 발생한 수평적 재발은 하악골의 전방 이동량이 B점에서 1.6 mm로 수술시 전체 후방 이동량의 약$22\%$였다. 전안면 고경에서는 수직적 재발이 발생하지 않았으나,후안면 고경은 감소하였다. (P<0.01). 3. 수평적 재발과 상관관계를 보이는 항목은 하악평면각 이었고(P<0.01) 수술 6 개월경과 후 후안면 고경의 감소와 상관관계가 있는 요소로는 수술시 하악골의 후방 이동량(P<0.01), 하악지 고경의 증가량(P<0.01), 그리고 하악평면각의 감소량(P<0.01) 등이 있었다. 4. 수술시 하악 교합평면 경사도의 변화량과 술후 재발과는 상관관계가 없었다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제37권
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• pp.6.1-6.9
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• 2015

Orthognathic surgery requires stable fixation for uneventful healing of osteotomized bony segments and optimal remodeling. Titanium plates and screws have been accepted as the gold standard for rigid fixation in orthognathic surgery. Although titanium osteofixation is the most widely used approach, the use of bioabsorbable devices has been increasing recently. Biodegradation of bioabsorbable devices eliminates the need for a second operation to remove metal plates and screws. However, long-term stability and relapse frequency in bioabsorbable osteofixation are still insufficiently studied, especially in cases of segmental movements of great magnitude or segmental movements to a position where bony resistance exists. This paper reviews the background, techniques, and complications of bioabsorbable osteofixation and compares bioabsorbable and titanium osteofixation in orthognathic surgery in terms of skeletal stability.

• 대한치과교정학회지
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• 제28권2호
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• pp.175-187
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• 1998

본 연구는 치료후 빈번한 재발로 인해 치료에 어려움을 겪는 III급 부정교합의 치료후 예후를 예측하는 데 도움을 주고자, 교정치료후 관찰기간동안 측모와 교합이 양호한 상태로 유지된 안정군(Stable group, n=12)과 그렇지 않고 재발의 경향을 보인 재발군(Relapse group, n=13)으로 나누고, 초진시 계측항목을 이용한 t-test, 상관분석 그리고 판별분석을 시행한 결과 다음과 같은 결론을 얻었다. 1. 상하악골의 전후방적인 위치와 관계를 나타내는 항목인 SNA, SNB, ANB, Angle of convexity 그리고 APDI에서 두 군간 통계학적으로 유의성 있는 차이를 보여주지 않아(p>0.05) 두 군간 전후방적 인 골격 형태에 있어서는 차이가 나지 않음을 알 수 있었다. 2. 교합평면의 경사도와 관련된 항목인 Wits, AB to Occlusal plane angle 그리고 Occlusal plane to Mandibular Plane angle에서 두 군간 통계학적으로 유의성 있는 차이를 보여(p<0.05)재발군의 교합평면이 안정군에 비해 전하방으로 많이 경사져 있음을 알 수 있었다. 3. 상하치열관계를 나타내는 항목인 Overjet에서 안정군이 재발군에 비해 절대치로 더 커(p<0.01) 전후방 골격부조화에 의한 것이 아닐 경우 치열의 전후방부조화가 클수록 치료후 예후가 좋음을 알 수 있었다. 4. 상관분석결과 Overjet과 Occlusal plane to Mandibular plane angle만이 통계학적으로 유의성 있는 상관관계를 보여 주었다(p<0.001, p<0.01). 5. 판별에 기여도가 높은 3항목 즉 Overjet, AB to Occlusal paine angle 그리고 Articular angle을 이용한 판별식을 도출하였으며, 이를 이용할 때 본 연구에 사용한 표본의 88%를 올바르게 판별할 수 있었다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제13권4호
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• pp.476-490
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• 1991

Although various technical details of the surgical procedures have been improved, Skeletal relapse is the most noteworthy complication of orthognathic surgery. It seems to be an imbalance of the perioral muscular groups resulting from changes in the cavitas oris propria after surgery. Among other factors, it is widely known with the changes of tongue posture, as indicated by the hyoid position. Ten patients that had undergone mandibular setbacks by way of Modified Obwegeser method were evaluated retrospectively. The serial cephalometric films were taken preoperatively, immediately postoperatively, after removal of IMF, and at a subsequent long-term follow-up period. The cephalometric evaluation of tongue posture were based on stable craniofacial landmarks. The relation between the 2-dimensional changes of tongue posture and hyoid position and the relapse of mandibular setback are discussed. Anatomic changes that were found to accompany such setback are as follows. 1.There are 2 cases of relapse in 10 patients at long-term follow-up(20%) 2.The tongue was moved posteriorly and its size was reduced anteriorly and posteriorly at immediate postoperative change and then the mandible shifted slightly toward the preoperative position, but the long was adapted to its new environment due to changing the position of its posterior part, and also the hyoid that moved posterioly and inferiorly was stabilized sightly posteriorly than its original position. 3.On the distance change of the suprahyoid muscle, the distance of P-H, ST-H was increased at immediate postoperative change(p<0.01) and decreased at IMF period(p<0.001), but the distance of H-Me, H-Ge was slightly decreased at IMF and long-term period(p<0.05). 4.On the width change of the pharyngeal air way, the width of the upper part of the pharyngeal space was lightly contracted at IMF and long-term period(p<0.05). 5.On the relation between mandibular setback and tongue posture and hyoid position, the significant correlation was found between the changes of some parts of mandibular setback and those of tongue posture, and not found those of hyoid position.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제33권5호
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• pp.407-412
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• 2011

Purpose: The purpose of the present study was to evaluate the postoperative skeletal stability of two-jaw surgery (Le Fort I osteotomy and bilateral sagittal split ramus osteotomy) via surgery first orthodontic treatment (SFOT) in class III malocclusion. Methods: Thirty-two patients who had two-jaw surgery via SFOT were included in this study. Serial lateral cephalograms were obtained before (T0), immediately after (T1), and six months after (T2) surgery. Twelve variables were measured for horizontal and vertical skeletal stability as well as for dental change. All measurements were evaluated statistically by a paired t-test ($P$ <0.05). Results: The mean skeletal changes were $0.1{\pm}2.5$ mm at point A and $-12.0{\pm}7.4$ mm at the pogonion. The mean horizontal relapse was 11.6% at the pogonion, and the mean vertical surgical changes included an upward displacement of $2.1{\pm}7.1$ mm and a forward displacement of $1.4{\pm}4.6$ mm at the pogonion. Upper incisor inclination decreased after surgery and was maintained at T2, and lower incisors were proclined from T1 to T2 by postsurgical orthodontic treatment. Conclusion: Postoperative skeletal stability of two-jaw surgery via surgery first orthodontic treatment in class III malocclusion was clinically acceptable.

• Journal of Korean Dental Science
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• 제14권2호
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• pp.110-117
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• 2021

Purpose: The purpose of this article is to study the relationship of unintentionally extended split in the distal segment during the bilateral sagittal split ramus osteotomy (BSSRO) and skeletal relapse. Materials and Methods: Twenty patients with mandibular prognathism were divided into two groups according to whether or not unintentionally extended split had occurred. Cone-beam computed tomography images were taken before surgery (T0), immediately after surgery (T1), and postoperatively at 6 months (T2). The stability was evaluated by measuring the change of Nasion perpendicular-Pogonion (N-Pog) distance. Result: Both groups showed mild advancement of Pog during follow-up. In both groups, the condyle head rotated inward and moved posterioinferiorly after surgery, but tended to return to their original position during follow-up. Conclusion: There was no statistically significant difference between the two groups in mandible position. Moreover, the condylar position was stable. If it is difficult to proceed reduction of the unintentionally extended split, careful inspection should be performed to prevent subsequent complications during follow-up.

• 대한치과교정학회지
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• 제25권5호
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• pp.613-625
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• 1995

본 연구는 골격성 III급 부정교합 환자에서 술전 상태와 수술방법 사이의 관계 및 악교정 수술후 재발경향을 조사하기 위하여 시행하였다. 연구 대상으로는 악교정수술을 받은 31명(남자 17명, 여자 14명)을 선택하였고, 이중 20명은 편악수술, 11명은 양악수술을 시행하였으며, 평균연령은 22.5세였다. 각 대상에서 술전, 수술직후, 1년 이상 경과 후의 측모두부방사선 규격사진을 채득하여, 투사도를 작성하고, 분석하여 다음과 같은 결과를 얻었다. 1. 하악만을 수술한 군보다 양악 동시수술군에서 하악체의 길이가 4.24mm, 하안모 고경의 길이가4.64mn, 하순의 길이가 4.13mm 더 길게 나타났으며, 반면 수평피개도는 3.13mm 더 작게 나타났다. 2. 하악만을 수술한 군에서 $8.95\pm4.45mm$ 하악이 후방이동되었으며, 양악 동시수술군에서 상악은 $5.15\pm3.46mm$ 전방이동되었고, 하악은 $7.24\pm9.11mm$ 후방이동되었다. 3. 최소 1년 이상 경과 후와 수술직후의 변화에 있어서 양악 동시수술군에서 A point는 $1.02\pm2.14mm$, Pn에서는 $1.05\pm1.48mm$, Sn에서는 $1.55\pm1.37mm$ 후방이동되었다. 4. 최소 1년 이상 경과 후와 수술직후의 변화에 있어서 B point에서 하악만을 수술한 군은 $28\%$ 양악 동시수술군은 $8\%$, B' point에서 하악만을 수술한 군은 $24\%$, 양악 동시수술군은 $3\%$ 전방이동되었다.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제36권1호
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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.

• Archives of Plastic Surgery
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• 제32권5호
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• pp.547-554
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• 2005

Orthognathic surgery for Class III malocclusion requires an elaborate preoperative planning using cephalometries or Mock surgery models which enable the surgeon to anticipate postoperative skeletal changes of maxilla and mandible as well as dentition. After surgery, patient's satisfaction is greatly influenced by appearance of soft tissue change. Therefore, it is imperative to predict a relatively accurate soft tissue change prior to surgery. A 5 year retrospective study was designed to evaluate the soft tissue change after sagittal split osteotomy of ramus(SSRO) for class III malocclusion. Analyses of preoperative and postoperative anthropometric measurements were performed. Patients who were treated only by SSRO for class III malocclusion and could follow up for 6 months were studied. Among them, the patients who had history of cleft palate and lip or hemifacial microsomia were excluded. Soft tissue changes were estimated by using the frontal and lateral photographs. Skeletal changes were observed by measuring amount of set back and angular changes of mandible to the reference line by using cephalometries. Relapses were also measured 6 months after the operation. We could observe skeletal changes were more profound than soft tissue changes concerning amount of set back, but soft tissue changes were also profound in angle. Relapse was more profound in skeleton than soft tissue but the amount was not significant. In spite of the variables which may affect proper assessment of the soft tissue change after skeletal relocation, this study can serve as a guide for exact prediction of the postoperative change of soft tissue and skeleton.

• Archives of Plastic Surgery
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• 제50권3호
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• pp.254-263
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• 2023

Background The three-dimensional (3D) evaluation of skeletal stability after orthognathic surgery is a time-consuming and complex procedure. The complexity increases further when evaluating the surgery-first orthognathic approach (SFOA). Herein, we propose and validate a simple time-saving method of 3D analysis using a single software, demonstrating high accuracy and repeatability. Methods This retrospective cohort study included 12 patients with skeletal class 3 malocclusion who underwent bimaxillary surgery without any presurgical orthodontics. Computed tomography (CT)/cone-beam CT images of each patient were obtained at three different time points (preoperation [T0], immediately postoperation [T1], and 1 year after surgery [T2]) and reconstructed into 3D images. After automatic surface-based alignment of the three models based on the anterior cranial base, five easily located anatomical landmarks were defined to each model. A set of angular and linear measurements were automatically calculated and used to define the amount of movement (T1-T0) and the amount of relapse (T2-T1). To evaluate the reproducibility, two independent observers processed all the cases, One of them repeated the steps after 2 weeks to assess intraobserver variability. Intraclass correlation coefficients (ICCs) were calculated at a 95% confidence interval. Time required for evaluating each case was recorded. Results Both the intra- and interobserver variability showed high ICC values (more than 0.95) with low measurement variations (mean linear variations: 0.18 mm; mean angular variations: 0.25 degree). Time needed for the evaluation process ranged from 3 to 5 minutes. Conclusion This approach is time-saving, semiautomatic, and easy to learn and can be used to effectively evaluate stability after SFOA.