• Maxillofacial Plastic and Reconstructive Surgery
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• v.22 no.2
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• pp.254-261
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• 2000

Since callus distraction technique was applied clinically for the correction of dentofacial deformity to the patients with hemifacial dysplasia by McCarthy in 1992, many surgeons have tried to apply this method to the maxillofacial region. But this technique has some drawbacks. One of the disadvantages of this technique is extensive scar formation in the facial area, which is a sequelae of extraoral approach for supraperiosteal dissection of the periosteum overlying the mandible. Recently, we have made an effort to perform this technique through intraoral approaches to prevent scar formation on the submandibular area and modified the design of the osteotomy, that is step osteotomy technique, to increase the raw bone surface on both osteotomized segments. The rationale for the application of this step osteotomy technique is to increase the amount of regenerated bone and the length of distraction, to avoid damage of inferior alveolar neurovascular bundle, and to increase initial stability of the splitted segments. Step osteotomy procedure can be done with fine micro-osteotomy saw through subperiosteal tunneling. Extraoral pins should be inserted before making the osteotomy. Since 1994 we have applied this technique at 8 sites In 5 patients with mandibular deficiencies: 2 cases of hemifacial microsomia, 1 case of developmental facial asymmetry and 2 cases of mandibular bony defect. Mandibular elongation have been achieved from 12 to 20mm in length. 1 out of 8 site, we experienced non-union in the case of mandibular body defect. Some skeletal relapse and growth retardation phenomenon have been observed in some cases with the longest follow-up of 48 months.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.38
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• pp.12.1-12.6
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• 2016

Background: Temporomandibular joint (TMJ) ankylosis can be accompanied by various degrees of functional and esthetic problems. Adequate mouth opening, occlusal stability, and harmonious facial form are the main goals of treatment for ankylosis. Distraction osteogenesis has proven to be an excellent treatment for lengthening the ramus-condyle unit. However, various timings for distraction have been suggested, and there is no consensus on selection criteria for performing the procedure in stages or simultaneously with other treatments. Case presentation: In this case report, concomitant intraoral distraction and gap arthroplasty was planned to treat TMJ ankylosis and associated facial asymmetry. After gap arthroplasty and 23 mm of distraction, the ramus-condyle segment was successfully lengthened and mouth opening range was significantly increased. The resultant interocclusal space was stably maintained with an occlusal splint for 4 months after distraction. Finally, good occlusion was achieved after prosthetic treatment. The remaining mandibular asymmetry was corrected with osseous contouring and augmentation surgery. The mouth-opening range was maintained at 35 mm 24 months after treatment. Conclusion: Gap arthroplasty with intraoral distraction as a one-stage treatment and subsequent contouring surgery can be applied to correct ankylosis with moderate malocclusion and facial asymmetry.

• The Journal of Korean Academy of Prosthodontics
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• v.22 no.1
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• pp.72-78
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• 1984

The notion that the axis of the shaft of the articulator must coincide the patient's mandibular transverse axis tells us the importance of locating the axis precisely. When using kinematic axis to transfer a cast to an articulator, the anatomic asymmetry of the contralateral points will result in certain distortion when the axis transferred to an articulator where the mechanical axis produces symmetry. In this study, after locating the true hinge axis point with Denar hinge axis locator, the discrepancies between true hinge axis point and arbitrary hinge axis point that was 13mm anterior from the posterior margin of center of trangus to the outer canthus of eye were measured. And the discrepancies between left and right true hinge axis point in the superoinferior and anteroposterior directions were measured. For this study, 20 dental students who have no missing teeth and no difficulties of mandibular movement were selected. Upper and lower cast of subjects were mounted on Denar Mark II articulator uisng Denar Slidematic face-bow and centric relation record for the measurement of discrepancies between left and right true hinge axis points. The results obtained as follows. 1. The mean distance from the arbitrary hinge axis point to the true hinge axis point was as follows. Right: horizontal distance; 1.99mm, vertical distance; 2.12mm, linear distance; 3.36 mm. Left: horizontal distance; 1.39mm, vertical distance; 2.06mm, linear distance; 2.09mm. Total: horizontal distance; 1.69mm, vertical distance; 2.09mm linear distance; 3.06 mm. 2. The 87.5% of true hinge axis points were within 5mm of the arbitrary hinge axis point. 3. The mean discrepancies between the right and left hinge axis point were 2.92mm in superoinferior direction and 4.74mm in anteroposterior direction. 4. When transferring the axis to the articulator, anatomic asymmetry between right: and left axis point produces in dislocation of cast on the articulator, and undesirable shift in esthetic tooth position will be resulted.

• Archives of Plastic Surgery
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• v.42 no.6
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• pp.735-740
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• 2015

Background Botulinum toxin (BT) chemodenervation and anterior belly of digastric muscle (ABD) transfer are both treatment options in the management of an isolated marginal mandibular branch of the facial nerve (MMB) palsy. We compare the patient satisfaction following either BT injections or ABD transfer in the management of their isolated MMB palsy. Methods Patients in the ABD-arm of the study were identified retrospectively from September 2007 to July 2014. The patients in the BT-arm of the study were identified prospectively from those attending the clinic. Both groups of patients completed a validated patient satisfaction survey. Statistical analysis was performed and a P-value <0.05 was considered statistically significant. Results Seven patients were in the ABD-arm and 11 patients in the BT-arm of the study. The patient satisfaction in both groups was high with 45% of ABD-arm patients and 40% of BT-arm patients rating their overall outcome as 'better' or 'much better', which was significantly more than the proportion rating their outcome as 'worse' or 'much worse' (P<0.001), although there was a significant trend towards those in the ABD-arm being more likely to be dissatisfied with their outcome (P=0.01). Conclusions BT therapy is a good first-line intervention in the management of isolated MMB palsy. We have, however, shown that the overall satisfaction in both groups is high. Therefore, in patients who would prefer a more permanent solution to manage their facial asymmetry, ABD transfer remains a satisfactory treatment option with a good level of patient satisfaction.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.35 no.3
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• pp.189-194
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• 2013

Osteochondroma is a benign neoplasm, osseous projection surrounded with cartilage, 35.8% of benign osseous tumor, 8.5% of whole osseous tumor and usually arises from the skeletal bone. Osteochondroma is a cartilaginous derivation and relatively uncommon in the craniofacial bone. Osteochondroma of the mandible has slow growth rates which mainly affect women around forty years of age and it can appear through the coronoid process and mandibular condyle, especially in the medial half. Clinical finding associated with osteochondroma of condyle are primarily a palpable, painless temporomandibular area mass with facial asymmetry, malocclusion and midline deviations. Sometimes pain and dysfunction like trismus often accompany the anatomic derangement. Other features include malocclusion with open-bite on the affected side and cross-bite on the contralateral side. In this study, a 45-years old female patient exhibits pain on the left temporo-mandibular joint area and malocclusion due to loss of the molar region with osteochondroma on the top left of her mandibular condyle head. The patient is able to recover gradually from the symptom through treatments on manipulation, stabilization splint, arthroscopic lavage and surgical excision, thus, this is reported as a clinical case.

• The korean journal of orthodontics
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• v.30 no.1 s.78
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• pp.43-52
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• 2000

Hemifacial microsomia ( HFM ) is the second most common craniofacial abnormalies. HFM represnted a spectrum of clinical findings such as hypoplasia of the mandibular ramus and condyle, confinement of maxilla growth, external and/or middle ear defects, involvement of some cranial suture, buccal soft tissue, facial nerve, and muscles in the affected side. HFM often showed progressive facial asymmetry and occlusal plane slanting to the affected side with growth. There were several reports about asymmetry of tooth maturation, hypodontia, delayed eruption, enamel hypoplasia in HFM. Since teeth develope in close association with size and morphology of the maxillary and the mandible, it is highly likely that dental changes will be present in HFM. So the Purpose of this study was to investigate the differences of the primary and the permanent teeth dimensions in the maxillary and the mandibular dentition between the affected and the non-affected side of HFM.. The sample of this study consisted of 34 unilateral HFM Patients (18 males and 16 females, average age : 5 year 11 months old). The authors examined the mesiodistal and the faciolingual dimensions of the primary and the permanent teeth and performed statistical study by using paired t-test. The results were as follows 1. The mesiodistal dimensions of the mandibular second primary molar and the mandibular first permanent molar in the affected side of HFM were significantly smaller than those of non-affected side. But there were no significant differences in the anterior teeth and the mandibular first primary molar. It means that a gradient of severity from anterior teeth to posterior teeth was found in the mandibular dentition. 2. Although there were no significant differences in the faciolingual dimensions of the primary and the permanent teeth in the maxillary and the mandibular dentition between the affected and non-affected side of HFM, there were general trend of compensatory increase in faciolingual dimension of the mandibular primary and the permanent teeth in the affected side Therefore these results showed that HFM might affect on the abnormality of tooth dimension, especially the most posterior teeth, in the affected side of the mandible.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.35 no.4
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• pp.256-259
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• 2013

Botulinum toxin type A (BTX-A) inhibits muscle contraction, which leads to reversible muscle atrophy and paralysis. Therefore, BTX-A injection can be an effective treatment of facial asymmetry that originated from the uncoordinated muscle movement. A 52-year-old patient was referred from another hospital for the correction of post-traumatic sequelae. The patient had prominent scar in the mandibular symphysis area with asymmetric lower lip movement. The reason for this asymmetric lower lip movement was due to damage in the lower lip depressor muscle. After the injection of BTX-A on the lower lip depressors, asymmetric lip movement has been improved.

• Journal of Korean Academy of Oral and Maxillofacial Radiology
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• v.25 no.2
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• pp.569-578
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• 1995

Condylar hyperplasia is a self-limiting condition characterized by a slowly progressing, enlargement of the mandible that results in facial asymmetry and a crossbite malocclusion. The facial asymmetry, open bite or crossbite, and radiographic evidence of an enlarged condyle confirm the diagnosis of condylar hyperplasia. The etiology of the condition is unknown. This condition usually first becomes apparent during the second decade of life, when one condyle continues to grow while the other is no longer active. Radiographically, the condyle may appear enlarged or the neck of the condyle maybe elongated or both may occur, Sometimes, however, no radiographically demonstrable condylar abnormality will be noted. Surgical correction with subcondylar osteotomy is the treatment of choice. We have observed two cases of condylar hyperplasia occurred in the left mandibular condyle of 24-year-old and 35-year-old women. We obtained that two cases were shown the followed results; 1. Clinically, both cases was unilaterally developed on C/C area, with temporomandibular disorders and pain, facial asymetry and malocclusion. 2. Radiographically, hyperplastic mass confined to the condyle. 3. Histopathologically, these cases shown increased hypertrophic region in parts, and lamellated bone with irregular trabeculae.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.33 no.5
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• pp.518-523
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• 2007

Purpose: The purpose of this study is to prove that orthognatic surgery on asymmetric prognathism patients improve the temporomandibular dysfunction. Materials and methods: All 30 patients underwent mandibular setback with B-SSRO including 22 patients Le Fort I surgery in KyungHee medical center. Preoperative and postoperative PA cephalograms & transcranial radiographs were measured midline deviation in Mx and Mn, occlusal canting change, condyle position, the temporomandibular dysfunction were checked before surgery, within 1 month after surgery, $3{\sim}6$ months, 12-24 months after surgery respectively. Results: The temporomandibular dysfunction were relieved after surgery in 17 patients of 25 patients. Conclusion: Orthognatic surgery may benefit the temporomandibular joint dysfunction in facial asymmetry patients by obtaining a postoperative stable occlusion and better physiologic neuromuscular function. Specially impovement of occlusal canting may reduce condyle displacement of midline deviation side and the temporomandibular joint dysfunction.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.33 no.5
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• pp.559-566
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• 2007

Distraction osteogenesis(DO) is a surgical method of bone formation that involves an osteotomy and sequential stretching of the healing callus by gradual movement and subsequent remodeling. DO is used to correct facial asymmetry, such as in patients with hemifacial microsomia, maxillary or mandibular retrusion, cleft lip and palate, alveolar defects, and craniofacial deficiency. It is accomplished with the aid of a distraction device, which is secured with screws placed directly into bone, for a predetermined length of time. Hemifacial microsomia is characterized by unilateral facial hypoplasia, often with unilateral shortening of the mandible and subsequent malocclusion. Patients with hemifacial microsomia and facial asymmetry have a vertically short maxilla, tilted occlusal plane, and short mandible. Early treatment is necessary to avoid subsequent impaired midfacial growth. The standard treatment of these malformations consists of the application of bone grafts, which can lead to unpredictable growth. The new bone-lengthening procedure represents a limited surgical intervention and opens up a new perspective for treatment, especially in younger children with severe deformities. This report describes a case of hemifacial microsomia(Type-II left-sided hemifacial microsomia). The patient, a 10-year-old child, visited our clinic for facial asymmetry correction. He had a hypoplastic mandible, displaced ear lobe, 10 mm canting on the right side, and malocclusion. We planned DO to lengthen the left mandible in conjunction with a Le Fort I osteotomy for decanting and then perform a right intraoral vertical ramus osteotomy(IVRO). Progressive distraction at a rate of 0.5 mm/12 hours was initiated 7 days postoperatively. The duration of DO was 17 days. The consolidation period was 3 months. Satisfactory results were obtained in our case, indicating that DO can be used successfully for functional, aesthetic reconstruction of the mandible. We report a case involving DO in conjunction with orthognathic surgery for correcting mandibular hypoplasia with a review of the literature.