• 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.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제21권3호
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• pp.288-297
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• 1999

This study has been carried out in order to measure the thickness of soft-tissue on lateral cephalographs based on body mass index(BMI) and the change in soft-tissue thickness after surgical correction of mandibular protrusion. The control material in cephalometric study comprised students at The Dental College, 38 persons, aged 21~24 years and the patient material comprised 20 women and 12men, aged 19~28 years with mandibular protrusion.The thickness of the soft-tissue based on BMI in control and study groups, the comparison between them, immediate postoperative change in the thickness, 6 months after surgery, ratio of soft-tissue response and correlation was established through various statistical methods. The result were as follows : 1. The groups based on BMI showed significant differences each other as regards the linear measurements. The thickest soft-tissue was measured 13.6mm, 15.47mm, 16.76mm at Ss, the thinnest at G' 6.0mm, 6.7mm, 7.26mm respectively. 2. The differences between control and experimental groups based on BMI showed to be significant. There were no differences at G'. The soft-tissue in prognathic patients was thicker at Ss, Ls and thinner at Li, Ls, Pg', Gn', Me'. Differential gap was greater in overweight groups. 3. The immediate soft-tissue change after surgery showed the increase at Li, Ls, Pg', Gn', Me' except G', Ls in all groups. 4. The postoperative soft-tissue change 6 months after surgery was similar with immediate change. The soft-tissue shows the increase in the thickness at Li, Pg', Gn', Me' and the greatest difference occurred at Li, 1.1mm, 0.98mm, 1.2mm respectively. 5. The patients with lower BMI index showed higher soft-tissue response to bony movement at Pg'. The immediate response ratio was 91%, 87%, 81% in A,B,C groups respectively, the response 6 months after surgery showed 96%, 91%, 84%.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제12권3호
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• pp.49-56
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• 1990

Facial balance is the primary detevminant of good facial esthetics and is expressed externally by the shape of facial soft tissues. Balance of the facial skeleton is most important in prediction of orthognathic surgery, however, it is not alwags coincided to soft tissue balance because the soft tissue drapes overlying hard tissue varies in thickness and tones from case to case. So, soft tissue facial balance and esthetics also should always be considered in prediction of hard tissue changes preoperatively. The chin has a paramount importance in the overall appearance of the face and facial profile because it may express individual charactor or image. Therefore positional change of the chin must be considered in any cases as the last and important option to give an overall soft tissue balance. Two cases were referred from orthodontists only for anterior segmental of teortomuy of the chin. Pre-operative evaluation showed poor soft tissue chin profiles which were not coincided to hard tissue chin balance. We altered surgical plans to fulfill balancing soft tissue profile and then could improve overall esthetics after surgery.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제22권3호
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• pp.319-329
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• 2000

Prediction of the soft tissue changes following hard tissue movement is very important from the esthetic view point for patients who have orthognathic surgery. There are many cephalometric analysis of facial bone and soft tissue on the lower lip and chin region but few soft tissue analysis on the midface after mandibular setback surgery. This study was performed to obtain whether the mandibular posterior movement has influence on the midface and the predictable ratio of post-operative measurement values of the soft tissue changes following mandibular setback surgery. Fifteen patients (8 males and 7 females) who had undergone mandibular setback surgery were selected and analyzed the soft tissue movement on the upper lip and the cheek region. Post-operative changes of the soft tissue measurements after mandibular surgery were examined on pre- and post-operative cephalometrics and the ratio of changes were analyzed after drawing the reference line on the face with the barium sulfate solution. The reference lines were perpendicular to the intercanthal line from infraorbital foramen and lateral canthus. The results obtained were as follows : 1. There were tendancy of anterior movement of soft tissue adjacent the nose after mandibular surgery 2. There were incerased tendancy of the amount of anterior movement from the nasal crease to the cheek region. 3. The amount of anterior movement of the soft tissue was larger below the palatal plane compared with above the palatal plane in the cheek region. 4. The upper lip length was increased and moved posterior direction after mandibular setback surgery 5. The lower lip was moved posterior direction by posterior movement of the mandibular structure 6. Soft tissue of the midface around the nose moved anterior direction after mandibular setback surgery but there was no correlation between the amount of mandibular setback and the amount of the soft tissue changes

• Maxillofacial Plastic and Reconstructive Surgery
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• 제19권3호
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• pp.250-259
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• 1997

The purpose of this study was to evaluate the interrelationship of the soft and hard tissue changes after both maxillary and mandibular anterior segmental surgery in bimaxillary protrusion patients. 11 patients had received both maxillary and mandibular anterior segmental surgery and were investigated radiologically with lateral cephalogram. The results were as follows : 1. The correlation of maxillary hard and soft tissue horizontal changes were relative high. : Coefficient between UIE and Stms was 0.89 (p<0.001). 2. The correlation of mandibular hard and soft tissue horizontal changes were very high, especially at the chin. : Coefficients were over 0.90 (p<0.001) 3. All points were moved superiorly except SLS, LS, Stms. 4. Upper and lower lip convexity to the E-Line were decreased (p<0.001) and postsurgical facial profiles were changed very esthetically.

• 대한골관절종양학회지
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• 제1권1호
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• pp.105-112
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• 1995

Soft tissue sarcomas are malignant tumors that arise in the extraskeletal connective tissues of the body. And the clinical behavior of soft tissue sarcomas is characterized by a tendency to extensively invade surrounding soft tissues as well as early metastatic dissemination. Difficulties were encounted when soft tissue sarcomas invade the major vessels. There are a few reprots about the reconstruction of the major vessels after resection of soft tissue sarcomas. We have treated 3 cases of the soft tissue sarcomas involving the major artery. After marginal excision of the tumor mass, the involved major artery was reconstructed with Gortex artificial vessel graft and we could salvage the patient's extremity.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제34권6호
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• pp.413-420
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• 2012

Purpose: The purpose of this setback genioplasty study is to develop a prediction method for the calculated osteotomy angle using horizontal and vertical changes as well as to evaluate the proportion of hard and soft tissue changes. Methods: Twelve patients who had received setback genioplasty with other maxillofacial surgery were examined. Three lateral cephalograms were taken just before surgery, immediately after surgery, and 3 months later surgery. A reference line was established to the reference point of the inner most point of the lingual symphysis cortex, incisor tip, and 2nd molar cusp tip. Measuring was conducted from pogonion (Pg), menton (Me), labrale inferius (Li), Mentolabial fold, soft tissue pogonion (Pg'), and soft tissue menton (Me') to the reference lines. Results: In setback genioplasty, the skeletal Pg moved posteriorly 5.07 mm. The ratios of soft tissue to hard tissue movement were 36% posteriorly and 62% inferiorly at Pg', 67% posteriorly and 104% inferiorly at Me', and 34% anteriorly and 164% posteriorly at Li. In reduction & setback genioplasty, skeletal Pg moved posteriorly 4.63 mm and skeletal Me moved superiorly 3.63 mm. The ratios of soft tissue to hard tissue movement were 76% posteriorly and 18% superiorly at Pg', 68% posteriorly and 42% superiorly at Me', and 44% anteriorly, 124% posteriorly at Li. The calculated mean slope angle, based on ${\Delta}H/{\Delta}V$ ratio, was 61.25 and the measured mean slope angle was 60.17. Thus, the calculated and measured slope angles have a similarity. Conclusion: In setback genioplasty, soft tissue moves posteriorly and inferiorly. In particular, at the Me' and Pg', the inferior movement of the soft tissue is greater than the posterior movement. Also, the predictable results (measured slope angle) after operation can be achieved by the calculated slope angle. Thus, the relationship of soft and hard tissue changes must be considered as the results are predictable.

• Archives of Plastic Surgery
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• 제36권3호
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• pp.344-347
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• 2009

Purpose: Malignant soft tissue tumors, known as sarcomas, are well known to be locally aggressive, frequently metastatic, and highly recurrent. In other hands, intermediate soft tissue tumors often recur locally with adjacent tissue infiltration so the clinical management is difficult as sarcoma. In the present study, we evaluate the clinical course of the intermediate soft tissue tumors and consider the management plan for those. Methods: From March, 1998 to April 2008, total 3 patients of intermediate soft tissue tumors underwent operations. A patient with fibrohistiocytic neoplasm, a free flap reconstruction was performed, and he underwent several more operations because of recurrences. Other patients with desmoids - type fibromatosis showed local invasion and adhesion, and one of them underwent reoperation due to local recurrence. Results: 2 of 3 patients underwent recurrences of tumors and reoperations were performed. In another patient with no recurrence, follow-up period was just 5 months, so there may be recurrence of tumor in long term follow-up. Conclusion: The clinical course of intermediate soft tissue tumors shows high recurrence rate. So clinically, intermediate soft tissue tumors should be considered as sarcomas. The successful management requires wide resection, carefully planned reconstruction, and close follow up with radiologic evaluation.

• 대한두개안면성형외과학회지
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• 제22권5호
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• pp.276-279
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• 2021

A 65-year-old woman presented with a solid mass on the right temporal area. The mass had grown for over 2 years without any initiating event of trauma or inflammation. Before excision, the patient went through a computed tomography scan, revealing a calcified mass without bony connection. Under general anesthesia, an excisional biopsy was performed. Microscopic examination confirmed a diagnosis of soft tissue osteoma. Soft tissue osteoma is rare, especially in the head and neck region. Osteomas in the temporal region have not been reported yet. Due to its rarity, osteoma might be misdiagnosed as another soft tissue or bone origin tumor. Its treatment of choice is simple excision. In this review, we present an unusual clinical form of soft tissue osteoma.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제22권1호
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• pp.63-69
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• 2000

Le fort II osteotomy is much useful technique to correct the midfacial hypoplasia including nasomaxillary complex especilly in patient with dish face appearance. Not in simple orthognathic surgery but in Le Fort II osteotomy, the standardization of prognostic value is essential in treatment planning to achieve satisfactory postoperative results. According to pervious reports, the ratio of soft tissue change to hard tissue movements varies as to different surgical methods and different facial regions. But there are few report about the ratio of soft tissue change to hard tissue movement following Le Fort II osteotomy. So we tried to develop standarized soft tissue surgical treatment objective. We have followed up 16 patients, who had received Le Fort II osteotomy by one operator from 1990 to 1996, one year postoperatively. In cephalometrics, we used Frankfort line as horizontal reference line, and vertical reference line as one drawn from Sella to horizontal line perpendicularly. The landmarks are G to soft tissue G, N on reference line to soft tissue N, ANS to Pn and A to Sn. The results are as follows. 1. The value of soft tissue change to hard tissue movement showed positive correlation, having statistical significancy at G, N2, N3 point. 2. At G, N2, N3 point, the ratio of soft tissue change to hard tissue movement was 0.51, 0.98 and 0.80 respectively and showed statistical significancy, while at N1, ANS, A point, that was 0.72, 0.49 and 0.26 but didn't showed statistical significance. 3. This result shows much the same change of the soft tissue change to hard tissue movement on the upper nasomaxilla, and less the same change on the lower maxilla and so the Le Fort II osteotomy can be recommended as a reliable effective operation method for correction of nasomaxillary retrusion.