• 대한구순구개열학회지
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• 제15권1호
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• pp.1-10
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• 2012

Parry-Romberg syndrome(PRS) is a degenerative disease characterized by progressive hemifacial atrophy. A 10-year-old girl who had been treated for linear scleroderma at the dermatologic department visited the orthodontic department. The frontal facial photograph showed mild facial asymmetry. On the left side, mild atrophy of soft tissue, enophthalmos, cheek depression, and dry skin with dark pigmentation were observed. The radiograph showed the hypoplasia of both the maxilla and mandible on the left side. This case report describes the treatment of a patient with PRS for 7 years. To minimize the effect of progressive atrophy on the facial growth, a hybrid appliance was used. The facial photos and radiographic records were periodically taken to analyze the progression of PRS. Although it is impossible to prevent the progression of facial asymmetry, it appears to be possible to limit the atrophic effect. After the stabilization of PRS, the orthodontic treatment by the fixed appliance was performed. Additionally, autologous fat graft was performed three times at 6 month intervals. After the treatment, the patient had a confident smile and facial asymmetry was improved.

• Archives of Plastic Surgery
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• 제38권2호
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• pp.161-165
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• 2011

Purpose: Zygomaticomaxillary complex (ZMC) fracture is one of the most common facial injuries after facial trauma. As ZMC composes major facial buttress, it is a key element of the facial contour. So, when we treat these fractures, the operator should have a concern with the symmetry to restore normal appearance and function. But sometimes, unfavorable results may occur. The aim of this study is to analyze the unsatisfied midfacial contour after ZMC fractures reduction retrospectively and to point out the notandum. Methods: 369 patients, treated for fractures of the ZMC were included in the study. After the operation, such as open reduction and internal fixation (ORIF with titanium or absorbable materials), open reduction, and closed reduction, midfacial contour was evaluated with plain films and 3-dimensional computed tomography. And unfavorable asymmetric midfacial contours were correcterd by secondary correction and re-evaluated. Gross photographs were obtained at outpatient clinic. Results: Total of 38 patients had got a facial asymmetry and among of them 24 patients were treated secondary revisional ORIF operations for correction of unfavorable result of after primary reduction. Two of them had received tertiary operations, three patients had got osteotomy more than after one year and six patients had got minor procedures. The etiology of asymmetry were lateral displaced simple fracture of arch (n=2), lateral displaced comminuted fracture of arch (n=6), comminuted arch fracture combined posterior root fracture (n=9), and communited arch and body fracture (n=12), severely contused soft tissue (n=9). After the manipulations outcomes were acceptable. Conclusion: To prevent the asymmetry in ZMC fracture reduction, complete analysis of fracture, choice of appropriate operation technique, consider soft tissue, and secure of zygoma position are important. Especially, we should be more careful about communited fracture of zygomatic body and lateral displacement, root fracture of zygomatic arch. Because they are commom causes that make facial asymmetry. To get optimal result, ensure the definite bony reduction.

• Korean Journal of Acupuncture
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• 제34권3호
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• pp.179-184
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• 2017

목적 : 안면 비대칭에 대한 한의학적 치료의 적용가능성에도 불구하고, 아직까지 관련 연구는 보고되지 않고 있다. 이 증례보고에서 저자들은 하악골 측방변위로 인한 안면 비대칭에 대하여 한의학적 치료의 효과와 안전성을 보고하였다. 방법 : 3명의 안면 비대칭 환자가 동작침법, 기능적 뇌척주요법의 음양균형장치, 연부조직이완술로 구성된 한의학적 치료를 12회 받았다. 치료 전후에 환자의 사진이 촬영되었다. 치료 전후의 4개의 주요 기준선의 변화가 평가되었다. 결과: 모든 환자들은 사진상의 호전을 보였다. 하지만 통계적으로 유의한 차이는 없었다. 결론 : 이 증례보고는 안면 비대칭에 대해 한의학적 치료의 효과를 보고하는 첫 번째 보고이다. 추후 이러한 결과를 확인하기 위한 더 잘 설계된, 무작위화, 플라세보 대조 연구가 필요하다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제42권
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• pp.21.1-21.6
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• 2020

Background: Fibula free flap mandible reconstruction is the standard procedure after wide resection of the mandible. Establishment and maintenance of normal occlusion are important in mandible reconstruction both intraoperatively and after surgery. However, scar formation on the surgical site can cause severe fibrosis and atrophy of soft tissue in the head and neck region. Case presentation: Here, we report a case of severe soft tissue atrophy that appeared along with scar formation after mandibular reconstruction through the fibular free flap procedure. This led to normal occlusion collapse after it was established, and the midline of the mandible became severely deviated to the affected side that was replaced with the fibula free flap, leading to facial asymmetry. We corrected the malocclusion with a secondary operation: a sagittal split ramus osteotomy on the unaffected side and a sliding osteotomy on the previous fibula graft. After a healing time of 3 months, implants were placed on the fibula graft for additional occlusal stability. Conclusion: We report satisfactory results from the correction of malocclusion after fibula reconstruction using sliding fibula osteotomy and sagittal split ramus osteotomy. The midline of the mandible returned to its original position and the degree of facial asymmetry was reduced. The implants reduced difficulties that the patient experienced with masticatory function.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제47권4호
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• pp.286-290
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• 2021

Objectives: The use of fat grafts in maxillofacial sculpturing is currently a common technique. Unlike fillers, autologous fats unite with facial tissues, but long-term results may still be unsatisfactory. Sharing long-term follow-ups can be helpful in making outcomes more predictable. Materials and Methods: The data from patients who were admitted from 2014 to 2016 for fat augmentation were collected. In all cases, fat grafts were injected by blunt cannula using a tunneling technique in different planes. A fan shape order for the malar, periorbital, nasolabial fold, mandibular angle and body, and perioral area was established. Results: Autologous fat was used for different sites of the maxillofacial regions. Of 15 patients, two patients were not satisfied due to fat graft resorption. For this, further injections were performed six months after the first injection using preserved fat grafts. One patient continued to be dissatisfied. There were no other complications related to fat transplants. Conclusion: Fat transplantation is a safe, reliable, and non-invasive method for facial contour and facial soft tissue defect restoration. Additional methods such as mesenchymal stem cells along with fat injection increase the survival rate of transferred fat.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제13권1호
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• pp.82-87
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• 1991

반안면왜소증이란 제1및 제2새궁에서 유래되는 기관에 결손이 옴으로써 초래되는 안면기형을 일컫는 것으로 선천성 악안면기형 중 순열 및 구개파열 다음으로 빈발하는 질환이다. 결손부는 하악골을 포함한 안면골의 여러 부위와 안면근 및 저작근, 뇌신경, 이개등여러 부위에 다양하게 나타나며, 그 기형의 발현 정도도 아주 다양하다. 본 교실에서는 안면비대칭과 교합부전을 주소로 내원한 20 세된 남자환자에 있어서 먼저 경조직을 바로잡기 위하여 상${\cdot}$하악골에 대한 악교정수술과 onlay골이식을 시행한 후, 남아있는 연조직 결손부에 대하여 진피-지방이식을 시행하여 심미적으로 만족할만한 결과를 얻었기에 보고하는 바이다.

• Archives of Plastic Surgery
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• 제38권3호
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• pp.257-262
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• 2011

Purpose: In neurofibromatosis patients, complete surgical excision of the mass is almost impossible and surgical treatment usually consists of multiple serial excisions that only result in a debulking effect. Remnant tumor mass has a gravitational effect on facial soft tissues that leads to sagging of skin and soft tissue, and eventually, facial disfigurement and asymmetry. The purpose of our surgical method is to perform soft tissue lifting with longer lasting effect with less surgical risk of damaging facial nerve and vessels. With external fixation using K-wire or surgical screw, the procedure only called for a short incision length and had additional adhesive properties that enabled anchoring of soft tissue in a lifted position for a longer postoperative period. Methods: A total of 5 neurofibromatosis patients (NF-1) visited our clinic for mass reduction and face lifting. The age of patients ranged from 13 to 42 (mean 28.8 years), and most patients had a long history of multiple excisions in the past. Face lifting was performed in 2 different areas, the periorbital area in 3 patients, and the midface in 2 patients. The materials used in fixation of retaining ligament were K-wire (n=3) and titanium screw (n=2). Results: Follow up period was from 5 month to 3 years and 1 month (mean=2 years and 1 month). All patients conveyed satisfaction with the results and no major complications were reported. The lifting effect lasted for as long as 3 years, and there were no complaints of relapse of soft tissue depression or sagging within the operated area. 1 patient (M/13) needed secondary k-wire insertion and additional mass excision in 1 year and 10 months postoperatively due to tumor growth. In two patients with K-wire fixation, mild dimpling and tenderness were observed in the follow up period, but in about 2 months postoperatively, dimpling was relieved and there was no need for removal of fixating material. Conclusion: Surgical lifting in neurofibromatosis patients can be challenging, for mass excision cannot be done completely and gravitational effect by residual mass can be persistent. External fixation of the retaining ligament in patients with neurofibromatosis can give satisfactory results-for incision length is relatively shorter, and the lifting effect can last longer compared to other various face lifting techniques.

• 대한두경부종양학회지
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• 제7권1호
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• pp.24-34
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• 1991

Lymphangioma is a benign, growth of lymphatic tissue that is present at birth or develops in early childhood, which may cause serious alterations in growth and developmemt. The problems with facial lymphangioma is usually releated directly to their size and to the area of the face which is involved. The lesions themselves may range from small, localized blemishes to huge facial masses involving both soft tissue and underlying bone and causing great distortion and asymmetry. The facial bones are seldom involved, but the natutal evolution of an individual lesion often cannot be accurately predicted when the child is first seen. Any changes in the underlying facial bone could be due either to a direct growth of the lesion into the bone, or secondary to pressure of the lesion growing outside the bone itself. A case of cystic lymphangioma extending from the neck to the tongue is reported. A six-year-old female was admitted because of swelling of the tongue. At that time, the tongue reportedly reached the extraoral size of 7x5x2.5cm and a soft, diffuse swelling of left anterior neck was revealed. The removal of cystic mass including left neck dissection and partial glossectomy were undertaken. The another case of lymphangioma is located on mandibular cheek. A twenty nine-year-old male was admitted because of palpable mass of the left mandibular area and fissure of palate. The radical excision of mass with mandibulectomy of body were undertuken. Thus we reported such a rare case and reviewed the lymphangioma.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제32권5호
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• pp.447-453
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• 2010

The hemifacial microsomia is characterized by variable underdevelopment of the craniofacial skeleton, external ear, and facial soft tissues. So, patients with hemifacial microsomia have an occlusal plane canting and malocclusion with facial asymmetry. Distraction osteogenesis (DO) with an intraoral or extraoral device is a technique using tension to generate new bone with gradual bone movement and remodeling. DO has especially been used to correct craniofacial deformities such as a hemifacial microsomia, facial asymmetry, and mandible defect that could not adequately be treated by conventional reconstruction with osteotomies. It has a significant advantage to lengthen soft and hard tissue of underdeveloped site without bone graft and a few complication such as nerve injury or muscle contracture. A 13-years old girl visited our clinic for the chief complaint of facial asymmetry. She had a left hypoplastic maxilla and mandible, occlusal plane canting and malocclusion. We diagnosed hemifacial microsomia and lanned DO to lengthen the affected side. Le Fort I osteotomy, left mandibular ramus and symphysis osteotomy were performed. The internal distraction devices fixed with screw on maxillary and mandibular ramus osteotomy sites. External devices were adapted to lower jaw for DO on symphysis osteotomy site and to upper jaw for rapid maxillary expansion (RME). At 7days after surgery, distraction was started at the rate of 1mm per day for 13days, and after 4months consolidation periods, distraction devices were removed. Simultaneous multiple maxillo-mandibular distraction osteogenesis with RME resulted in a satisfactory success in correcting facial asymmetry as well as occlusal plane canting for our hemifacial microsomia.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제26권6호
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• pp.636-643
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• 2000

Facial asymmetry is the most frequent disease in craniofacial deformities. And the primary causing area of that is mostly placing in mandible. That is to say, it is known that primarily, mandible grows excessively or deficiently, and other facial region involving maxilla undergoes compensatory growth secondarily, so asymmetric face develops. In facial asymmetry, the surgical correction of undergrowth is more difficult than that of overgrowth and the reason of it is the postoperative relapse caused by stress of surrounding soft tissues. It means the stress of surrounding soft tissues occurring after bone lengthening and reducing above stress is the same meaning with reducing postoperative relapse. Among various areas, mandibular ramus is the most difficult area to lengthen vertically and maintain its length. The reason of it is considered by many authors as the stress of surrounding pterygomasseteric sling which is enveloping lower border of mandible and interrupting elongation of ramal height. So we applied two different surgical procedures in which pterygomasseteric slings have different stress respectively to monkeys which have similar masticatory function and anatomy to human being and compared relapse by radiographic film and observed periodically the histochemical change of masseteric muscle fiber. So we could see the following results. The relapse was less in EVRO group in which we separated pterygomasseric sling in inferior border and didn't approximate muscle sling after vertical lengthening to minimize the stress of soft tissues than IVRO group in which we elongated ramal height preserving pterygomassetric sling. Of course, we could see a problem in EVRO group such as bone resorption in inferior border caused by uncovering the periosteum of inferior border. But we expect that such problem will be solved by developing periosteum substitutes for covering the exposed bone and minimizing the surgical trauma. In histochemical study of masseteric muscle fiber, the fiber constituents of EVRO group in which we minimized soft tissue stress was changed immediately after operation and maintained it for 1 year, whereas that of IVRO group in which we preserved soft tissue stress was changed in more portion after operation and recovered it by 1 year. By the histochemical results, we can see that the recovery of fiber constituents reflect the recovery of muscle stress and it is closely related with relapse phenomenon.