• Maxillofacial Plastic and Reconstructive Surgery
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• 제33권5호
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• pp.401-406
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• 2011

Purpose: The purpose of this study was to investigate changes in the position of the hyoid bone and soft palate and the amount of airway space after bilateral sagittal split ramus osteotomy (B-SSRO). Methods: This study is a review of lateral cephalometric tracings of 30 patients who underwent B-SSRO with setbacks at Kyunghee Dental Hospital from 2005 to 2009. Lateral cephalograms were taken before (T0), within one month (T1), and more than six months after the surgery (T2). Results: The hyoid bone at T1 changed significantly towards the inferoposterior position. At T2, it had significantly moved superiorly, but not anteriorly. At T1, the nasopharyngeal space, extending from the posterior nasal spine to the posterior pharyngeal space, decreased significantly, but did not show a significant increase at T2. The nasopharyngeal space, extending from the middle of soft palate to the posterior pharyngeal space, decreased significantly at T1, but did not show a significant decrease at T2. The oropharyngeal airway space decreased significantly at T1 and did not return to its original position at T2. The hypopharyngeal space, extending from the anterior to the posterior pharyngeal space at the level of the most anterior point of the third cervical vertebrae, slightly decreased at T1, but the amount was insignificant; however, the amount of decrease at T2 was significant. The hypopharyngeal space extending from the anterior to the posterior pharyngeal space at the level of the lowest point of the third cervical vertebrae, decreased significantly at T1 but returned to its original position at T2. Conclusion: B-SSRO changes the position of the hyoid bone and muscles inferoposteriorly. These change allows enough space for the tongue and prevent airway obstruction. Airway changes may be related to post-operative edema, posterior movement of the soft palate, anteroposterior movement of the hyoid bone, or compensation for decreased oral cavity volume. The position of the pogonion which measures anterior relapse after surgery did not show significant differences during the follow-up period.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제33권5호
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• pp.413-419
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• 2011

Purpose: Reposition of the maxilla is a common technique for correction of midfacial deformities. To achieve the goal of the surgery, the maxilla should be repositioned based on the precisely planned position during surgery. The internal reference points (IRPs) and the external reference points (ERPs) are usually used to determine vertical dimension of maxilla, which is an important factor for confirming maxillary position. However, the IRPs are known to be inaccurate in determining the vertical dimension. In this study, we investigated the correlation of positional change of the modified IRPs with repositioned maxilla. Methods: The study group consisted of 26 patients with dentofacial deformities. For the simulation of the surgery, patient maxillary CT data and 3-D virtual surgery programs (V-$Works^{(R)}$ and V-$Surgery^{(R)}$) were used. IRPs of this study were set on both the lateral wall of piriform aperture, inferior margin of both infraorbital foramen, and the labial surfaces of the canine and first molar. The distance from the point on lateral wall of the piriform aperture to the point on the buccal surface of the canine was defined as IRP-C, and the distance from the point on the inferior margin of the infraorbital foramen to the point on the buccal surface of the $1^{st}$ molar was defined as IRP-M. After the virtual simulation of Le Fort I osteotomy, the changes in IRP-C and IRP-M were compared with the maxillary movement. All measures were analyzed statistically. Results: With respect to vertical movements, the IRP-C (approximately 98%) and the IRP-M (approximately 96%) represented the movement of the canine and the $1^{st}$ molar. Regarding rotating movement, the IRPs changed according to the movement of the canine and the $1^{st}$ molar. In particular, the IRP-C was changed in accordance with the canine. Conclusion: IRPs could be good indicators for predicting vertical movements of the maxilla during surgery.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제16권3호
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• pp.247-258
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• 1994

We got this conclusion from an investigation about complications from 144 cases of 130 patients who were to be searched their personal records, admission chart, clinical laboratory sheet, anesthetic record, consult sheet and radiographic opinion. They had orthognathic surgery for maxillofacial deformity treatment at the department of oral and maxillofacial surgery in dental school of Kyung Hee university for 4 years and 10 months, from March 1989 to December 1993. 1. In the intraoperative phase, by the frequency of complication, blood vessel injury was found the most-22%, and then soft tissue injury, unfavorable osteotomy split, and there were some cases of tooth injury and inappropriate osteotomy. In the mandibular segmental osteotomy, blood vessel injury was found the most frequently-20 cases (27%), soft tissue injury, unfavorable osteotomy split were the second frequent cases, and then unfavorable fragment position was found. In the extraoral vertical ramus osteotomy and Le Fort I osteotomy also, blood vessel injury and nerve injury were found the most. 2. In the postoperative hospitalization phase, by the frequency of complication, hematoma (23%) was happened the most, except for that, lkie the complication that can be happened by adverse reaction of medicine or long hospital life. In the case of SSRO, there were 21 cases (20%) of hematoma, and this wal the most frequently case. In the case of EVRO, hematoma wasn't happened that much-2 case (4%). 3. In the follow up phase, relaps, numbness and TMJ dysfunction were happened. In mandibular surgery, the forward relapse percentage of point B, was 27% when used wire fixation on SSRO, was 15% by miniplate fixation on SSRO and was 7% on EVRO. In the case of SSRO, numbness was kind of high, comparing to ordinary surgery-12 cases(16 There were many difficulties in analyzing this data accurately, Although orthognathic surgery is done many times, only available date is from the "success" stories and data is not consistently recorded for the cases with complications. In this manner, much essential informantion is lost and overlooked. When data is charted including those cases that are seemingly insignificalt, we can have a much clearer understanding and more accurate guide on treatment protocols.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제11권1호
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• pp.297-308
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• 1989

저자동은 약 1년전 모 병원에서 하악과 상악에 각기 안모변형과 골팽창을 동반한 병소에 대해 수술을 재발한 치주인대에서 기인한 양성 섬유골성 병소를 치험하였으며 다음과 같은 결과를 얻었다. 1. 본증례 1은 32세 남자의 우측 하악 골체부에서 술후 약 1년만에 재발된 백악질골섬유종이었고 증례 2는 72세 여자의 상악 전치부에서 술후 약 5개월만에 재발소견을 보인 골섬유종이었다. 2. 방사선학적 소견에서 증례 1은 방사선 투과상의 병소내에 방사선불투과상의 석회화 물질이 함유된 혼합기의 상태였고 증례 2는 비교적 불명확한 경계를 가졌으나 방사선 투명대에 의해 치밀한 방사선 불투과상의 병소가 둘러싸여 있는 성숙기의 상태였다. 3. 조직병리학적 소견으로 두 증례 모두 조골세포의 부연이나 규칙적인 골소주 구조 및 기절내 세포성분의 증가를 관찰할 수 있었으나 증례 1에서는 골성분외에 백악질소적과 같은 석회화물질이 관찰되었고 증례 2에서는 층판골만이 관찰되어 증례 1은 백악질골섬유종, 증례 2는 골섬유종의 특징을 지닌 양성 섬유 골성 병소였다. 4. 재발된 병소이므로 증례 1은 하악 우측 제 1소구치부터 우각부까지 하악골 절제술과 장골 및 하치조신경 이식술을, 증례 2는 정상 인접골을 포함한 종물의 적출술을 시행하였다. 5. 술후 1년이 경과한 현재까지 정기적인 임상 및 방사선 검사결과 재발증상 없이 양호한 치유 경과를 보여주고 있다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제33권3호
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• pp.233-240
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• 2011

Purpose: To apply a computer assisted navigation system to orthognathic surgery, a simple and efficient measuring algorithm calculation based on affine transformation was designed. A method of improving accuracy and reducing errors in orthognathic surgery by use of an optical tracking camera was studied. Methods: A total of 5 points on one surgical splint were measured and tracked by the Polaris $Vicra^{(R)}$ (Northern Digital Inc Co., Ontario, Canada) optical tracking system in two cases. The first case was to apply the transformation matrix at pre- and postoperative situations, and the second case was to apply an affine transformation only after the postoperative situation. In each situation, the predictive measuring value was changed to the final measuring value via an affine transformation algorithm and the expected coordinates calculated from the model were compared with those of the patient in the operation room. Results: The mean measuring error was $1.027{\pm}0.587$ using the affine transformation at pre- and postoperative situations and the average value after the postoperative situation was $0.928{\pm}0.549$. The farther a coordinate region was from the reference coordinates which constitutes the transform matrixes, the bigger the measuring error was found which was calculated from an affine transformation algorithm. Conclusion: Most difference errors were brought from mainly measuring process and lack of reproducibility, the affine transformation algorithm formula from postoperative measuring values by using of optic tracking system between those of model surgery and those of patient surgery can be selected as minimizing the difference error. To reduce coordinate calculation errors, minimum transformation matrices must be used and reference points which determine an affine transformation must be close to the area where coordinates are measured and calculated, as well as the reference points need to be scattered.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제35권4호
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• pp.211-220
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• 2013

Purpose: The purpose of this study was to compare the changes in the pharyngeal airway space, tongue and hyoid bone positions according to the orthognathic surgical methods of mandibular prognathism. Methods: The subjects included 30 patients (16 males, 14 females) with the skeletal class III malocclusion. Group 1 (10 patients) underwent bilateral sagittal split ramus osteotomy (BSSRO) only; group 2 (10 patients) underwent BSSRO with genioplasty; and group 3 (10 patients) underwent BSSRO, Le Fort I osteotomy. We measured the lines between the selected upper air way, hyoid bone and tongue landmarks on the lateral cephalometric x-ray films of skeletal class III. The measurements were made preoperation, within 1 week after the operation, 3~6 months after the operation and 1 year after the operation. We compared and analyzed the measurements with matched paired t-test and independent samples t-test. Results: There were no postoperative changes in the nasopharyngeal airway space in group 3. The measurements of group 3 also increased during the follow-up period as compared to the preoperative measurements. In group 1, 2 and 3, the immediate postoperative oropharyngeal and hypopharyngeal airway spaces were decreased. In the following period, the hypopharyngeal airway space returned to the preoperative positions, but the oropharyngeal airway space was not significantly changed. The upper and lower tongue was posteriorly repositioned immediately after the surgery. During the follow-up period, the lower tongue position returned to the preoperative position, and the upper tongue position was not significantly changed. Immediately after the surgery, the B point was moved to the posterior position, and a slight anterior advancement was found in the follow-up period. Conclusion: Patients who received the mandibular setback surgery showed a decrease in the posterior airway space, and those who underwent maxillary advancement showed a significant increase of the nasopharyngeal airway space, which remained stable during the evaluation period. The change of the airway space, position of the hyoid bone and tongue did not differ according to the presence or absence of genioplasty.

• 대한치과교정학회지
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• 제25권1호
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• pp.13-18
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• 1995

편측성 순구개열자의 교합과 안모의 비대칭이 연령 증가에 따라 변화하는 양상을 파악하여 비성형술의 시행시기 결정, 교정치료 도중의 안모 변화 예측 등에 이용하고자 구순과 구개의 수술을 시행받은 편측성 순구개열자 39명을 8세 이하, 9세에서 12세, 13세 이상의 3군으로 나누어 정모두부방사선 규격사진을 채득하여 투사도를 작성하였다. 좌, 우측 전두협골봉합의 내면을 잇는 선을 수평 기준선(HR)으로 하고, HR을 수직 이등분하는 선을 정중시상 기준선(MSR)으로 정하여 상악골, 상하악 치열, 하악골의 좌우 비대칭을 판단하기 위한 17 항목을 선정, 계측하였다. 안모 비대칭의 정도를 파악하기 위하여 student t-test를, 성장에 따른 비대칭의 변화를 알아 보기 위하여 one-way ANOVA를 시행하여 다음과 같은 결과를 얻었다. 1. 편측성 순구개열자에서 비대칭은 다양하게(1.22-3.47$mm/^{\circ}$) 나타났다. 특히 정중선에 대한 상악 제1대구치와 중절치까지의 거리, 하악지의 길이에서 비대칭이 크게 나타났다. 2. 편측성 순구개열자에서 비대칭은 몇 항목에서 뚜렷한 특징을 보였다. 비중격은 모두 파열측으로 변위되었고 비강의 하연은 대부분이 파열측에서 더 하방에 위치하였다. ANS는 주로 비파열측으로, 상악 중절치는 주로 파열측으로 변위되었다. 3. 성장에 따른 비대칭의 변화양상이 가장 뚜렷한 항목은 비중격으로 9세에서 14세까지도 비대칭의 양이 증가하였다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제33권1호
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• pp.36-43
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• 2011

Purpose: This study evaluated the pharyngeal airway space changes in CT images in patients receiving bilateral sagittal split osteotomy (BSSRO) for the surgical correction of mandibular prognathism. Methods: A total of 22 patients with mandibular prognathism were treated using BSSRO. Computed tomography was performed 1 month (T0) before surgery and, 1 month after surgery (T1). The anteroposterior length (AP), lateral width (LAT) and cross-sectional area (AREA) at the level of soft palate (C2) and base of the tongue (C3) were measured using CT images. Results: The mean amount of mandibular setback was 7.41 mm (${\pm}$3.46 mm). All the AP, LAT and AREA at the C2 and C3 level were decreased significantly 1 month after surgery (P<0.001). As the amount of mandibular setback was increased, the AP, LAT and AREA levels at the level of C2 and C3 had decreased. In addition, the reduction of the AREA at the C3 level was associated with the amount of mandibular setback (P<0.05). Conclusion: A significant decrease in pharyngeal airway space was observed 1 month after the operation. The cross-sectional area at the level of base of tongue was decreased with increasing amount of mandibular setback.

• Journal of Chest Surgery
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• 제35권4호
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• pp.303-306
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• 2002

심한 Ebstein기형이 있으면서 신생아시기에 증상이 있는 경우, 심한 심비대를 보이며 이로인해 폐발달의 장애가 생기고 기능적 폐동맥판폐쇄를 보이며, 동맥관의존 폐혈류를 보인다. 지금까지 이런 경우 양심실성교정은 실망적이었으며 근래에 와서 Fontan술식을 목표로 하는 Stames술식으로 좋은 결과를 보고하고 있다. 본원에서는 생후 4일째 심한 심비대와 함께 해부학적 폐동맥판폐쇄가 동반된 Ebstein기형의 환아에서 심방화된 우심실을 수직적 주름성형술, 삼첨판막륜성형술, 우심실유출로재건, 심방중격결손부분폐쇄, 우심방축소술로 양심실고정술을 시행하였다. 술후 환아는 심홉곽비의 현저한 감소와 심초음파검사상 경도의 삼첨판폐쇄부전을 보이며 10개월째 건강한 상태로 외래추적관찰중이다.

• Archives of Plastic Surgery
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• 제38권6호
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• pp.798-802
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• 2011

Purpose: A wart is caused by epidermal infection with the human papilloma virus. Although wart naturally disappears in some cases, it require treatment because of pain, aesthetic problem, and the possibility of malignant change. Conventional non-surgical treatment cannot be a fundamental solution for the pain and has such disadvantages as frequent recurrence and difficulties in achieving a satisfactory outcome. A surgical procedure was performed on patients with wart and the procedure had a good outcome. Methods: We investigated the gender, age, lesion site, mean treatment duration, and presence or absence of recurrence in 21 patients with a wart within the period of January 2007 to July 2011. For local lesions, primary closure, including subcuticular suture after the excision, was performed. If the defect size was too big to do primary closure, we performed rotation flap. For wide multiple lesions, a split thickness skin graft was performed. Results: Among the 21 patients, 12 patients were male and 9 patients were female, and their mean age was 42 years (SD=17.38, range: 11~75 years). The lesion site was the foot in 10 patients, the hand in 8 patients, the face in 2 patients, and the scalp in 1 patient. The mean treatment duration was 13.5 days (SD=4.36, range: 6~15 days) for the primary closure or rotation flap, and 18.5 days (SD=2.12, range: 17~20 days) for the skin graft. 20 patients were cured without recurrence. No recurrence was observed in the patients who underwent primary closure or rotation flap. One of the two patients who underwent a skin graft of their wart that had covered their entire palm had local recurrence in part of her finger tips. Conclusion: We performed surgical procedure on recalcitrant wart. As a results, we can treat it with short treatment duration, low recurrence rate and less scarring and get high patient satisfaction.