• 구강회복응용과학지
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• 제26권3호
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• pp.359-371
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• 2010

안면 비대칭 중 가장 흔히 나타나는 하악 비대칭은 성장 중 골격성장의 비대칭을 유발하는 다양한 원인에 의해 발생한다. 안면 비대칭이 있을 경우 외모 뿐 아니라 저작과 기능에 지장을 줄 수 있다. 심한 골격성 악간관계 부조화가 있는 경우 보철치료만으로는 이상적인 교합관계를 형성하기 어려우며, 힘의 분산이 적절히 이루어지지 않아 자연치와 수복물의 수명이 단축될 수 있다. 악간관계 부조화로 인한 부정교합이 존재하여 치아의 수복 시 예후가 불량할 것으로 예상되는 경우 먼저 교정치료를 통한 악간관계의 개선을 위한 교합안정이 우선되어야 한다. 부조화가 심한 경우 기능적 및 심미적인 치료 결과를 위해 악교정 수술이 필요하며, 진단결과에 따라 편악 또는 양악수술이 시행된다. 상 하악 또는 안면 비대칭증의 악교정 수술시 이부 성형술이 동반될 수 있으며, 이는 하악골의 이부의 수직적, 횡적, 전후방적 위치를 외과적으로 변화시킴으로써 더욱 심미적인 안모개선을 얻기 위해 시행된다. 본 증례의 환자는 안모의 비대칭과 돌출된 하악 및 불량 보철물을 개선하고자 술전 교정을 시행한 뒤 상악 Le-Fort I 골절단술, 하악 시상분할골절단술, 이부 성형술(전방 4 mm), 우측 하악각 증대술을 시행하였다. 술후 교정치료를 진행하고 치관연장술 및 완전구강회복을 진행하였다. 보철 수복 완료 후, 환자의 평가와 객관적 결과로 만족할만한 결과를 얻었기에 이를 보고하고자 한다.

• 대한치과교정학회지
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• 제30권5호
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• pp.657-668
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• 2000

본 연구는 골격성 III급 부정교합 환자에서 상악골 전방이동 수술 후 야기되는 코의 형태변화에 대해 연구하고 이를 예측할 수 있는 요소를 찾아 교정-악교정 수술 복합 치료계획의 수립과 결과의 예측에 이용하고자 시행되었다. 부산대학교병원 치과진료처 교정과에 내원하여 골격성 III급 부정교합으로 진단되어 술전 교정치료를 받고 Le Fort I 골절단술로 상악골의 전방 이동시키는 동시에 하악골을 후방 이동시킨 남녀 성인 환자 25명을 대상으로 하였다. 이들의 수술전, 후 측모두부규격방사선사진과 정모 및 측모 안면사진을 계측, 분석하여 다음과 같은 결과를 얻었다. 1. 상악골 전방이동에 따른 비첨의 수직적 위치 변화는 상관성이 높았으며 ANt, SNt에서 A point의 전방이동에 의해 ${\beta}_0$는 각각 0.228, 0.257로 나타났다. 2. 상악골 전방이동에 따른 비첨의 수평적 위치변화는 상관성이 높았으며 ANt, SNt, Sn point에서 A point의 전방이류에 의해 ${\beta}_0$는 각각 0.484, 0.431, 0.806으로 나타났다. 3. 상악골의 전방이동에 따른 비익부의 확장정도는A point의 전방이동에 의해 0.002의 ${\beta}_0$를 나타내었으나, 임상적으로 유의한 변화는 없었다. 4. 수술 후 비첨의 수직적 및 전후방적 위치변화를 예측하는 지표로 사용된 ADV, DRI, Prominence of nose, Pre-Op CA 중 ADV 만이 설명변수로서 유의성이 있었다.

• 대한소아치과학회지
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• 제37권3호
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• pp.359-366
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• 2010

전치부 교환기의 반대교합 아동에서는 골격적 특성이 강할수록 상하 치아의 성숙도에 현격한 차이가 있음을 쉽게 관찰할수 있다. 파노라마 방사선 사진으로 평가가 가능한 상하 치령의 차이가 III급 부정교합의 조기 징후로 개연성이 있다면, 이것은 조기 감별진단의 한 도구로써 가치가 있을 것으로 판단되었다. 부산대학교치과병원 소아치과에 내원한 Hellman 치령 IIA, IIC의 환자를 대상으로, 측두방사선사진, 파노라마 방사선사진, 석고 모형과 임상사진을 조사하여 정상교합군과 전치부 반대교합군 각 50명을 선택하였다. 이들의 파노라마 방사선사진을 이용하여 Demirjian법으로 각 군의 상하 치령 및 제1대구치 맹출율을 구하고 그 차이를 비교, 분석하여 다음과 같은 결과를 얻었다. 1. 정상교합군과 반대교합군 모두에서 역령에 비해 치령이 높게 나타났으며 성차는 보이지 않았다(p>0.05). 2. 정상교합군과 반대교합군의 상하 치령의 차이는 각각 0.22세와 0.69세로 반대교합군에서 더 큰 차이를 보였다(p<0.05). 3. 정상교합군에 비해 반대교합군에서 상하 제1대구치 맹출율의 차이가 크게 나타났다(p<0.05).

• 대한치과교정학회지
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• 제33권1호
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• pp.1-9
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• 2003

본 연구에서는, 술전 교정전 예측치와 교정 후 실측치 사이에 나타나는 오차의 크기와 정확성 및 어떠한 요소가 그러한 결과에 영향을 미치는지에 대해 평가하고자 하였다. 연세대학교 치과병원 교정과에서 골격성 III급 부정교합으로 진단되어 술전 교정치료 및 양악수술을 받은 환자 가운데 조건에 부합되는 45명(남자 17명, 여자 28명)을 선별하여, 초진 상태를 T1, 교정 치료전 예측치를 T2, 술전 교정후를 T3로 정의하고 각각의 계측치를 수평과 수직좌표로 나누어 측정하였다. 또한 환자의 어떠한 진단적 요소가 술전교정의 예측치와 실측치 사이의 차이에 영향을 미치는지 알아보기 위해 연구대상을 arch length discrepancy (ALD), 상$\cdot$하악 전치의 치축(U1 to SN, IMPA), curve of Spee(COS), 발치 여부, 발치한 치아의 종류 등에 의해 여러 군으로 분류하여 유의성을 평가하였으며 다음과 같은 결과를 얻었다. 1. U6mbc, L1x의 수평 좌표와 U1i, U1x, W6me, U6mbc, L6mbc의 수직 좌표에서 예측한 위치와 수술직전의 실제 위치의 차이가 유의성(p<0.05) 있게 나타났다. 2. 예측의 정확성은 수평적인 차이의 예측에 있어서 수직적인 차이의 예측에 비해 상대적으로 높게 나타났다. 3. 하악에서보다 상악의 많은 계측점에서 예측치와 실측치 사이의 유의한 차이(p<0.05)가 관찰되었다. 4. 상악의 경우 발치 여부 및 발치한 치아의 종류, ALD의 양에 따라 상악 전치와 제1대구치 위치의 예측에 유의한 차이(p<0.05)를 보였으며, 하악의 경우에는 ALD의 양과 IMPA에 따라 하악 전치와 제1대구치의 위치의 예측에 유의한 차이(p<0.05)를 나타냈다. 이번 연구에서 얻은 결과를 통하여 술전 교정전 예측치와 실측치 사이의 오차의 정도와 그것에 영향을 미치는 요소들을 분석하고 회귀 계수를 구함으로써, 악교정 수술을 동반한 교정 환자의 치료 계획 시 예측의 정확성을 높일 수 있을 것으로 생각된다. 또한 수직적인 예측에 있어서는 앞으로 더 많은 연구가 이루어져야 할 것으로 생각된다.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제34권6호
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• pp.628-634
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• 2008

The purpose of this study is to examine reproducibility of operation plan and 3-dimentional jaw movement patterns by comparing jaw position of STO with post-operative jaw position. Twenty patients with class III dental and skeletal malocclusion who were treated with Le-Fort I osteotomy and B-SSRO were reviewed. Lateral cephalometric radiographs were taken within two weeks before operation and two days after operation. Cephalometric radiographs were compared and analyzed with orthognathic computer program '$V-Ceph^{TM}$'. Post-operative maxillary advancement was insufficient compared to maxillary advancement through STO. Post-operative setback movement was over compared to mandibular setback movement through STO. But statistically this is not significant. Maxillary vertical location is insignificant on the whole. Especially post-operative maxillary clockwise rotation is significant compared to maxillary rotation through STO. Post-operative maxillary clockwise rotation tendency is generally observed in all patients. So surgeons and staffs must consider this tendency when operation plan is established ans operation is being performed. Using intra or extra oral marking points, face bow, and bite plate will make exact surgery possible.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제27권4호
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• pp.334-345
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• 2005

The purpose of this study was to compare the postoperative stability and relapse according to 2 different fixation methods after bilateral sagittal split ramus osteotomies in mandibular prognathic patients. Tweenty one patients with Class III dental and skeletal malocclusion who were treated with bilateral sagittal split ramus osteotomy were selected for this retrospective study. We classfied the patients into two groups according to the fixation methods of bony segments after osteotomies. Group W (n = 10) had the bone segments fixed with nonrigid wire and Group S (n = 11) had bicortical screws inserted in the gonial area through a transcutaneous approach. Cephalometric radiographs were taken preoperatively, immediate postoperatively and more than six months postoperatively in each patient. After tracing the cephalometric radiographs, various parameters were measured. Before surgery, both groups were balanced with respect to linear and angular measurements of craniofacial morphology. Mean posterior sagittal setback amounts of the mandibular symphysis was 8.6 mm in the wire group and 6.79 mm in the rigid group, Six months postoperatively, the wire group had 33.1% relapse of the mandibular symphysis and 22.8% in the rigid group relapse. Both groups experienced changes in the orientation and configuration of the mandible. It is thought that Rigid screw fixation is a more stable method than nonrigid wire fixation for maintaining mandibular setback after sagittal split ramus osteotomy.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제41권5호
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• pp.224-231
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• 2015

Objectives: The purpose of this study was to evaluate changes in the pharyngeal airway space and hyoid bone position after mandibular setback surgery with bilateral sagittal split ramus osteotomy (BSSRO) and to analyze the correlation between the amount of mandibular setback and the amount of change in pharyngeal airway space or hyoid bone position. Materials and Methods: From January 2010 to February 2013, a total of 30 patients who were diagnosed with skeletal class III malocclusion and underwent the same surgery (BSSRO) and fixation method in the Division of Oral and Maxillofacial Surgery, Department of Dentistry at the Ajou University School of Medicine (Suwon, Korea) were included in this study. Lateral cephalograms of the 30 patients were assessed preoperatively (T1), immediately postoperatively (T2), and 6 months postoperatively (T3) to investigate the significance of changes by time and the correlation between the amount of mandibular setback and the amount of change in the airway space and hyoid bone position. Results: Three regions of the nasopharynx, oropharynx, and hypopharynx were measured and only the oropharynx showed a statistically significant decrease (P<0.01). A significant posterior and inferior displacement of the hyoid bone was found 6 months after surgery (P<0.01). Analysis of the correlation between the amount of mandibular setback and the amount of final change in the airway space and hyoid bone position with Pearson's correlation showed no significant correlation. Conclusion: In this study, the oropharynx significantly decreased after mandibular setback surgery, and changes in the surrounding structures were identified through posteroinferior movement of the hyoid bone during long-term follow-up. Therefore, postoperative obstructive sleep apnea should be considered in patients who plan to undergo mandibular setback surgery, and necessary modifications to the treatment plan should also be considered.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제32권2호
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• pp.129-137
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• 2006

The treatment plan for orthognathic surgery must be based on accurate predictions, and this can be produced the most esthetic, functional and stable results. The purpose of this study was aimed to evaluate the amount and interrelationship of the gonial angle and the mandibular width change after the mandibular setback surgery in the mandibular prognathic patients. Twenty patients were selected who received orthognathic surgery after presurgical orthodontic treatment. The patients with skeletal and dental Class III malocclusion were operated upon with bilateral sagittal split ramus osteotomy and mandibular setback. The lateral and posteroanterior cephalometric radiographs were taken preoperatively, postoperative 1 day and 12 months later after the orthognathic surgery, and then the gonial angle and mandibular width were measured. The computerized statistical analysis was carried out with SPSS/PC program. The gonial angle at postoperative 1 day was decreased about $5.3^{\circ}$ than preoperative value and the gonial angle at postoperative 12 months was increased about $1.4^{\circ}$ than postoperative 1 day. So the gonial angle at postoperative 12 months was decreased about $3.9^{\circ}$ than preoperative value. The mean preoperative gonial angle was $125.35^{\circ}{\pm}7.36$, showing significantly high value than normal and mean gonial angle at postoperative 12 months was $121.45^{\circ}{\pm}6.81$, showing value near to normal. The mandibular width at postoperative 1 day was decreased about 1.1 mm than preoperative value and the mandibular width at postoperative 12 months was more decreased about 1.7 mm than postoperative 1 day. So the mandibular width at postoperative 12 months was decreased about 2.8 mm than preoperative value. These results indicate that sagittal split ramus osteotomy in mandibular prognathic patients with high gonial angle is effective to improvement of gonial angle. It is considered to be helpful for maintenance of postoperative stable gonial angle area that detailed postoperative care and follow-up.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제29권6호
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• pp.407-420
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• 2003

Purpose : The purpose of this study was to analyse the facial changes and factors contributing to then after bilateral sagittal split ramus osteotomy of mandibular prognathism. Materials and Methods : Forty patients with Class III dental and skeletal malocclusion who were treated with bilateral sagittal split ramus osteotomy were reviewed. Frontal and lateral cephalometric radiographs were taken preoperatively, immediate postoperatively and more than six months postoperatively in each patient. After tracing the cephalometric radiographs, various parameters were measured. Results : 1. Gonial angle at postoperative two days was decreased about $10.4^{\circ}$ than preoperatively and gonial angle at postoperative six months was increased about $6.8^{\circ}$ than postoperative two days. So, gonial angle at postoperative six months was decreased about $3.6^{\circ}$ than preoperative gonial angle. 2. Facial height postoperative two days was decreased about 0.8mm than preoperatively and facial height at postoperative six months was decreased about 0.7mm than postoperative two days. So, facial height at postoperative six months was decreased about 1.5mm than preoperative facial height. 3. Mandibular width postoperative two days was decreased about 1.0mm than preoperatively and mandibular width at postoperative six months was increased about 1.8mm than postoperative two days. So, mandibular width at postoperative six months was decreased about 2.8mm than preoperative mandibular width. 4. Amount of set back and mandibular plane angle were not influencing on relapse degree. Conclusion : It is thought that bilateral sagittal split ramus osteotomy in mandibular prognathic patients is effective to improve long face and steep gonial angle. More prudent operation and careful postoperative management is required to maintain stable face postoperatively. Further research for soft tissue changes and factors which are related with relapse is needed.

• 대한치과교정학회지
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• 제50권3호
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• pp.206-215
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• 2020

Osteochondroma is a common benign tumor of bones, but it is rare in the mandibular condyle. With its outgrowth it manifests clinically as deviation of the mandible limitation of mouth opening, and facial asymmetry. After the tumor is diagnosed on the basis of clinical symptoms and radiographic examination including cone-beam computed tomography (CBCT) analysis, an appropriate surgery and treatment plan should be formulated. Herein, we present the case of a 44-year-old female patient who visited our dental hospital because her chin point had been deviating to the left side slowly but progressively over the last 3 years and she had difficulty masticating. Based on CBCT, she was diagnosed with skeletal Class III malocclusion accompanied by osteochondroma of the right mandibular condyle. Maxillary occlusal cant with the right side down was observed, but it was confirmed to be an extrusion of the molars associated with dental compensation. Therefore, after intrusion of the right molars with the use of temporary anchorage devices, sagittal split ramus osteotomy was used to remove the tumor and perform orthognathic surgery simultaneously. During 6 months after the surgery, continuous bone resorption and remodeling were observed in the condyle of the affected side, which led to a change in occlusion. During the postoperative orthodontic treatment, intrusive force and buccal torque were applied to the molars on the affected side, and a proper buccal overjet was created. After 18 months, CBCT revealed that the rate of bone absorption was continuously reduced, bone corticalization appeared, and good occlusion and a satisfying facial profile were achieved.