• Maxillofacial Plastic and Reconstructive Surgery
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• 제31권6호
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• pp.485-491
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• 2009

Postoperative skeletal stability was evaluated in combination of Le Fort I and U-shaped osteotomies for superior repositioning of maxilla in bi-maxillary surgeries in 30 consecutive patients. The fifteen patients underwent Le Fort I osteotomy alone and the other fifteen patients underwent Le Fort I and U-shaped osteotomies. In all patients, the maxilla was first osteomized and fixed with absorbable plates system. A bilateral sagittal split ramus osteotomy (BSSRO) of the mandible was then carried out and fixation was performed using absorbable plates. Maxillo-mandibular fixation with rubber ring was used for two weeks post-operatively in all patients. Lateral cephalograms were obtained pre-operatively, 1 day post-operatively, 6 months after surgery. The changes in anterior nasal spine (ANS), point A, upper incisior (U1), and point of maxillary tuberosity (PMT) were examined. The maxillas in the fifteen patients of both examination group were repositioned nearly in their planned positions during surgery and no significant post-operative changes in the examined points of the maxilla were found. These results suggest that a combination of a Le Fort I and U-shaped osteotomy is a useful technique for reliable superior repositioning of the maxilla. The post-operative change in the maxilla using this combination osteotomy was comparatively stable.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제25권4호
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• pp.324-329
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• 1999

The facial esthetics are much affected by nasal changes due to especially its central position in relation to facial outline and so appropriately evaluated should be the functional and esthetic aspects of the nose associated with the facial appearance. Generally, a maxillary surgical movement is known to induce the changes of nasolabial morphology secondary to the skeletal repositioning accompanied by muscular retraction. These changes can be desirable or undesirable to individuals according to the direction and amount of maxillary repositioning. We investigated the surgical changes of bony maxilla and its effects to nasal morphology through the analysis of the lateral cephalogram in the Le Fort I osteotomy. Subjects were 10 patients(male 2, female 8, mean age 22.3 years) and cephalograms were obtained 2 weeks before surgery(T1) and 6 months after surgery(T2). The surgical maxillary movement was identified through the horizontal and vertical repositioning of point A. Soft-tissue analysis of the nasal profile was performed employing two angles: nasal tip projection(NTP), columellar angle(CA). Also, alar base width(ABW) was assessed directly on the patients with a slide gauge. The results were as follows; 1. Both anterior and superior movement above 2mm of maxilla rotated up nasal tip above 1mm. Either anterior or superior movement above 2mm of maxilla made prediction of the amount & direction of NTP changes difficult. Especially, a correlation between horizontal movement of maxilla and NTP rotated-up was P<0.01. 2. Both much highly anterior and superior movement of maxilla is accompanied by more CA increase than either highly. Especially, the correlation between horizontal movement of maxilla and CA change was P<0.05. 3. Anterior and/or superior movement of maxilla was accompanied by the unpredictable ABW widening. 4. The amount of changes of NTP, CA, and ABW is not in direct proportion to amout of anterior and/or superior movement of maxilla. 5. Nasal morphologic changes following Le Fort I osteotomy are affacted by not merely bony repositioning but other multiple factors.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제12권2호
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• pp.9-20
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• 1990

A series of 19 cases with maxillary hyperplasia and mandibular retrognathia were operated on by simultaneous superior repositioning of the maxilla after Le Fort I osteotomy and anterior repositioning of the mandible after bilateral sagittal split ramus osteotomies with or without osteotomy of the inferior border of the mandible. These were evaluated by retrospective cephalometric and computer analysis for the longitudinal skeletal and dental changes for an average of 17.1 months after surgery. For stabilization of the osteotomized segments, the authors used wire osteosynthesis by means of bilateral infraorbital and zygomatic buttress suspension wire at the maxilla, and direct interosseous wire at the split segments of the mandibular rami. Results show generally good stability after simultaneous maxillary and mandibular surgery with wire osteosynthesis, and a minimal to moderate tendency toward skeletal and dental relapse. This article is a preliminary study to defy the efficiency of the wire osteosynthesis (wo)compared with rigid internal fixation (RIF) for simultaneous maxillary and mandibular surgery. 1. The vertical relapse rate of the A point after superior repositioning of the maxilla is 2.2%. 2. The horizontal relapse rate of the B point after advancement of the mandible is 18.3%. 3. The condyle is distracted inferiorly and slightly posteriorly at the immediate postoperative period. 4. At the long term follow up examination, the condyle presents tendency of return to the preoperative position. 5. Condylar segment angle is decreased at the immediate postoperative period, and at the long term follow up evaluation, the angle is increased. 6. Gonial angle is increased at the immediate postoperative period, and then is decreased at the long term follow up evaluation. 7. The dentition is satisfactory with acceptable movement at the long term follow up evaluation. 8. At the mandibular free body analysis, genioplasty shows good stability. 9. Wire osteosynthesis provides excellent stabilization for the simultaneous maxillary and mandibular surgery.

• 대한치과교정학회지
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• 제29권5호
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• pp.627-635
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• 1999

하안면의 장경이 길고 웃을 때 치은이 과다 노출되거나 전치부 개방교합을 나타내는 상악골의 수직적 과성장 환자의 치료법으로 상악골의 수술적 상방이동이 고려되어질 수 있다. 이 방법에 의하여 기능적으로 만족스러운 결과를 가져오더라도 심미적 개선이 중요한 부분인 만큼 장기간에 걸친 연조직 변화를 관찰하여 임상적으로 중요하다고 생각되어지는 상악골 상방이동에 대한 상, 하순의 수직적 변화 특히 안정위시의 상악전치와 상순간의 관계의 변화와 상하순간의 이개 거리의 장기간에 걸친 변화를 관찰하는 것이 수술계획 시 치료결과에 대한 심미적 만족도를 높여 줄 수 있다. 따라서 이번연구를 통하여 상악골의 수직적 상방이동 후의 장기간에 걸친 연조직 변화를 관찰하여 상악골의 수술적 상방이동에 의한 치료계획 시 도움을 주고자 하였다. 이를 위해 술 후 최소한 5년이 경과되고 2mm 이상의 수술적 상방이동이 이루어진 49명의 환자의 술 전, 술 후 1년, 술 후 5년의 측모 두부방사선 규격사진을 이용하여 다음과 같은 결론을 얻었다. 1) 코의 하부와 상순의 연조직 계측점의 술 전과 술 후5년의 비교 시 superior labial sulcus의 상방이동과 pronasale의 전방이동만이 유의성있는 변화를 보였다. 2) 술 후 1년까지 하순의 전상방으로의 이동이 그 후 후하방으로 변화되는 경향을 보였으나 술 전과 술 후 5년의 비교시 전상방으로의 전위가 유지되었고 이부성형술을 한 군에서 변화가 더욱 뚜렷하였다. 3)상순의 길이와 홍순(upper vermilion)의 수직적 변화는 술 후 1년까지 감소되었다가 그 후 증가되어 술 전과 비교시 유의성있는 변화가 없었으나 하순의 길이의 증가와 홍순(lower vermilion)의 수직적 감소는 술 후 1년과 5년에서 계속 지속되었다. 4) 안정위시 상악전치의 노출이 지속적으로 유의성있는 감소를 나타냈고, 상하순간의 거리도 지속적 감소를 보였는데 이는 수술에 의한 상악골 상방 이동양보다 큰 감소였다. 5) 술 후 1년 이후에 나타나는 연조직의 하방 이동이 악골의 하방 이동 보다 크게 나타나는 경향을 보였다.

• 대한심미치과학회지
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• 제10권1호
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• pp.8-15
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• 2001

The Class III malocclusion classified in two types of Skeletal Class III and Pseudo Class III. In the case of the maxillary deficiency, the protraction H-G(facemask) with Bonded RPE can be used. For children with A-P and vertical maxillary deficiency, the preferred treatment is to move the maxilla into a more anterior and inferior position, which also increases its size as bone is added at the posterior and superior sutures. Successful forward repositioning of the maxilla can be accomplished before age 8. To resist tooth movement as much as possible, the maxillary teeth should be splinted together as a single unit. The maxillary appliance must have hooks for attachment to the facemask that are located in the canine-primary molar area above the occlusal plane. The facemask usually worn until a positive overjet of 2-5mm is achieved interincisally. Occipital chin cup is successful in those patients who can bring their incisors close to an edge-to-edge position when in centric relation. This treatment is particularly useful in patients who begin treatment with a short lower anterior facial height, as this type of treatment can lead to an increase in lower anterior facial height. If the pull of the chin cup is directed below the condyle, the force of the appliance may lead to a downward and backward rotation of the mandible.