• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.23 no.1
• /
• pp.31-39
• /
• 2001

The purpose of this study is to reveal the factors leading to the problem of unilateral condylar fractures and suggest a treatment guideline of treatment for good prognosis in surgical treatment. The factors can be age, sex, fracture site, degree of displacement, posterior occlusion loss, post-operative alteration of condylar head position, post-operative condylar head resorption, and maxillomandibular fixation period. One hundred and eleven patients with unilateral condylar fractures, who were treated by surgical method from 1990 Feb. to 2000 Feb., were studied. Minimum follow-up period was 6 months. The results were as follows ; 1. In the age group of $41{\sim}60$, females had significantly higher complication rate than males, therefore we must be careful about treatment of female in this age group 2. In level I fractures of the mandibular condyle, because there were abundant complications when the patients were treated with fragment removal, conservative treatment is recommended over the surgical approach. 3. There were no differences in the complication rate, in the level II, III fractures. but were severe complications in the cases of patients treated by Dr.Nam's method or fragment removal. Therefore, open reduction and internal fixation is recommended over Dr.Nam's method or fragment removal. 4. In level IV fractures, open reduction and internal fixation is recommended 5. Although there was a higher complication rate depending on the degree of deviation, there was no correlation between the degree of deviation and development of complications in each level of fracture 6. Because the complication rate was higher in cases of condylar resorption, vertical dimension loss, and alteration of condylar head position, we must make an effort to prevent such complications during treatment

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.33 no.6
• /
• pp.497-504
• /
• 2011

Purpose: Patients who had a subcondylar fracture with a displaced or deviated condylar segment were treated with a retromandibular approach (RMA) or an endoscope-assisted transoral approach (EATA) in our department of oral and maxillofacial surgery. The clinical results of the approaches were compared. A comparative study of specific approaches for subcondylar fractures has not been published before in Korea. Methods: Twenty-one patients with subcondylar fractures of the mandible were included. Ten patients were treated with the retromandibular approach and 11 were treated with an endoscope-assisted transoral approach. We examined patient age, gender, fracture sites, classifications, period of maxillomandibular fixation, facial nerve (FN) or greater auricular nerve (GAN) injuries, maximal mouth opening, deflection, occlusal changes, number of plates, follow-up period, and other complications. Preoperative computed tomography and pre-operative, post-operative, and follow-up panoramic views were taken of each patient. Results: Mean maximal mouth openings were similar between the two approaches. FN and GAN injuries were more frequent in the RMA group but the deflective rate with mouth opening was higher in the EATA than that in RMA group. Two cases of post-operative infection occurred in the EATA group, and occlusal changes were observed in one case for both approaches. Conclusion: The RMA offers more direct access and visualization of the surgical field but it can cause scars and retractive injuries of the FN and GAN. But, EATA did not result in consequent nerve injuries or scars postoperatively, but unfavorable fractures such as $medial$ $override$ condyles were more difficult to reduce endoscopically. Except cases of an expected difficult reduction, the treatment of choice for a displaced subcondylar fracture may be an EATA.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.31 no.6
• /
• pp.544-549
• /
• 2009

Failure to use effective methods of reduction, fixation and immobilization may lead to osteomyelitis with the exposed necrotic bone, as the overzealous use of transosseous wires & plates that devascularizes bone segments in the compound comminuted fractures of mandible. Once osteomyelitis secondary to fractures has become established, intermaxillary fixation should be instituted as early as possible. Fixation enhances patient comfort and hinders ingress of microorganisms and debris by movement of bone fragments. Teeth and foreign materials that are in the line of fracture should be removed and initial debridement performed at the earliest possible time. Grossly necrotic bone should be excised as early as possible ; no attempt should be made to create soft tissue flaps to achieve closure over exposed bone. The key to treatment of chronic osteomyelitis of the mandible is adequate and prolonged soft tissue drainage. If good soft tissue drainage is provided over a long period, sequestration of infected bone followed by regeneration or fibrous tissue replacement will occur so that appearance and function are not seriously altered. Localization and sequestration of infected mandible are far better performed by natural mechanism of homeostasis than by cutting across involved bone with a cosmetic or functional defect. As natural host defenses and conservative therapy begin to be effective, the process may become chronic, inflammation regresses, granulation tissue is formed, and new blood vessels cause lysis of bone, thus separating fragments of necrotic bone(sequestra) from viable bone. The sequestra may be isolated by a bed of granulation tissue, encased in a sheath of new bone(involucrum), and removed easily with pincettes. This is a case report of the long-term conservative drainage care in osteomyelitis associated with mandibular fractures.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• v.36 no.4
• /
• pp.320-324
• /
• 2010

Introduction: The placement of a single miniplate is not sufficient to achieve rigid fixation in mandibular angle fractures. It often causes difficulties in reducing the intermaxillary fixation (IMF) period. Consequently, the placement of 2 miniplates is preferable. The intraoral approach in an open reduction and internal fixation (ORIF) of a mandibular angle fracture with 2 miniplates is often challenging. Accordingly, an alternative of transbuccal approach is performed. However, this method leaves a scar on the face and can result in facial nerve injury. This clinical study suggests a protocol that can maintain rigid fixation without a transbuccal approach in mandibular angle fractures. Materials and Methods: The subjects were 7 patients who sustained fractures of the mandibular angle and treated at Department of Oral and maxillofacial surgery, Sacred Heart Hospital, Hallym University. ORIF under general anesthesia was done using the intraoral approach. One miniplate was inserted on external oblique ridge of the mandible, and the other was placed on lateral surface of the mandibular body with contra-angle drill and driver. A radiographic assessment and occlusal contact point examination was carried out before surgery, and 2, 4 and 6 weeks after surgery. Results: The mean operation time was 80 minutes. Regarding the occlusion state, the number of contact points increased after surgery. Paresthesia and infection were reported to be complications before surgery. Conclusion: The placement of 2 miniplates using contra-angle drill for ORIF of mandibular angle fractures allows early movement of the mandible without IMF. We propose this approach to reduce the patients’discomfort and simplify the surgical procedure.

• The korean journal of orthodontics
• /
• v.38 no.2
• /
• pp.121-132
• /
• 2008

Objective: The purpose of this study was to evaluate the upper airway dimensional change according to maxillary superior movement after orthognathic surgery and to identify the relationship between the amount of maxillary movement and upper airway dimensional changes. Methods: The samples consisted of 24 adult patients (9 males and 15 females) who had a skeletal discrepancy and had received presurgical orthodontic treatment. They underwent Le Fort I superior impaction osteotomy and mandibular setback surgery. Cephalometric x-rays were taken at 3 stages - T0 (before orthognathic surgery), T1 (just or within 2 weeks after orthognathic surgery), T2 (6 months after surgery) Results: 1, Pharyngeal airway space (PAS (R)-nasopharynx) was decreased after surgery (T1) but recovered at 6 months after surgery; 2, Pharyngeal airway space (PAS (NL)-palatal plane) was increased after surgery and at 6 months after surgery; 3, Pharyngeal airway space (PAS (OL)-occlusal plane) was increased at T1 and was decreased at T2; 4, Soft palate thickness was increased at T1 but it became the same or thinner at T2; 5, There is no statistically significant relation between the amount of maxillary superior movement and pharyngeal airway space. Conclusions: These findings suggested that the maxillary superior movement of about an average of $4.40{\pm}1.14 mm$ did not affect upper pharyngeal airway space changes.

• Archives of Plastic Surgery
• /
• v.36 no.4
• /
• pp.469-474
• /
• 2009

Purpose: A lower facial contouring surgery has become a commonly performed procedure in Asia. Currently, mandibular angle sagittal ostectomy and botulinum toxin type A treatment are main procedures for aesthetic correction of a broad lower face. There are a few date to show the differences in the mandibular contouring changes between mandibular angle splitting ostectomy and botulinum toxin type A treatment. Facial golden mask is easy to apply, inexpensive, and relatively objective for evaluation of facial contour analysis. This study was designed specifically to compare the changes in lower face width after two different forms of lower facial contouring procedure using facial golden mask. Methods: Seventeen patients, aged 18 to 55 years (mean, 28.6 years), 15 women and 2 men, consented to the study and receive a contouring procedure of lower face. The patients were classified in to 2 groups. In group A, the sample consisted of 10 patients with a prominent squared mandibular angle and mandibular angle splitting ostectomy was performed. In group B, the sample consisted of 7 patients with masseteric hypertrophy and botulinum toxin type A treatment was performed. Photographs of the face were taken to record the facial change at preoperative and postoperative. The postoperative photographs were taken to considered maximal effect at 2 years after surgery in group A and 4.8 months after treatment in group B. The authors applied the facial golden mask to preoperative and postoperative photographs and horizontal ratio, which compares facial width with golden mask width, were calculated. We made an analysis of the result of horizontal ratio using SPSS. Results: Overall average horizontal ratio of pre- and postoperative photos of group A were 1.24 and 1.11, whereas overall average horizontal ratio of pre- and postoperative photos of group B were 1.19 and 1.12. The horizontal ratio decreased 10.24% in group A and 5.93% in group B. There was a statistically significant change in before and after treatment, but there was no significant change in comparing the group A and group B. Conclusions: The result from this study suggest that mandibular angle sagittal ostectomy and botulinum toxin type A treatment showed relatively satisfactory clinical effects on lower facial contouring treatment. There was no statistical significant difference within two lower facial contouring treatment. Facial golden mask is easy to apply, inexpensive, and relatively objective, so we think that facial golden mask is a good method for evaluation of lower facial contouring treatment.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• v.27 no.5
• /
• pp.428-434
• /
• 2001

After miniplate fixation of mandibular angle fractures, fracture line stability during functional loading was evaluated. Using panoramic radiographs, 15 mandibular angle fracture patients who were treated by open reduction and one miniplate fixation along the external oblique ridge, were evaluated at postoperative 1, 4 and 8 weeks. At each time, 2 radiographs were taken: one taken during maximum biting of hardened silicone sheet on the affected side molar area and the other on the non-affected side. The distraction gap of inferior border of mandible at each time and each side was measured and these data were analysed statistically with clinical findings. The differences of inferior border distraction gap during hardened silicone sheet biting on the affected side molar area and on the non-affected side molar area at 4 week radiographs were smaller than those of 1 week's except one case. At 8 week's radiographs, the fracture lines were so stabilized that it was almost impossible to find the gap differences except one case and there were increased radiopacity along the entire fracture lines. Clinically, bony union was confirmed in all cases during plate removal performed at postoperative 6 month. By statistical analysis(paired t-test), the inferior border distraction gap during biting of hardened silicone sheet on the affected side was significantly reduced during 1 and 4 week interval(p<0.01). The differences of inferior border distraction gap during biting on the affected side molar area and on the non-affected side molar area were also significantly reduced at 1 and 4 week interval(p<0.01). But the inferior border distraction(compression) gap during non-affected side biting was not significantly changed. From these findings, it could be concluded that fracture line stability during functional loading after one miniplate fixation of mandibular angle fractures stems mainly from reduction of inferior border distraction gap during affected side biting on time interval. According to these radiographic and clinical findings, the clinical superiority of one miniplate fixation technique in mandibular angle fracture treatment could be confirmed.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• v.28 no.3
• /
• pp.196-204
• /
• 2002

For the study of its stability when the screw has been fixed after sagittal split ramus osteotomy(SSRO) of the mandible, the methods of screw arrangement are classified into two types, triangular and straight. The angles of screws to the bone surface are classified as perpendicular arrangements, the $60^{\circ}$ anterioinferior screw, known as triangular, and the most posterior screw, called straight arrangement, thus there are four types. The finite element method model has been made by using a three dimensional calculator and a supercomputer. The load directions are to the anterior teeth, premolar region, and molar region, and the bite force is 1 Kgf to each region. The distribution of stress, the von-Mises yield strength, and safety of margin refer to the total sum of transformed energy have been studied by comparison with each other. The following conclusion has been researched : 1. When shear stress is compared, in the triangular arrangement in the form of "ㄱ", the anterosuperior screw is seen at contributing to the support of the bone fragment. In the straight arrangement, substantial stress is seen to be concentrated on the most posterior angled screw. 2. When the von-Mises yield strength is compared, it seemed that the stress concentration on the angled anteroinferior screw is higher, it shows a higher possibility of fracture than any other screw. In the straight arrangement, stress appeared to be concentrated on the most posteriorly angled screw. 3. When the safety margins of the transfomed energy are compared, the energy conduction is much greater in the case of the angled screw than in the case of the perpendicular screw. The triangular arrangement in the form of "ㄱ" shows a superior clinical sign to that of the straight arrangement. Judging from the above results, when the screw fixation is made after SSRO in practical clinical cases, two screws should be inserted in the superior border of mandibular ramus and a third screw of mandibular inferior border should be inserted in the form of triangular. All screws on the bony surface should be placed perpendicularly-$90^{\circ}$ angles apparently best promote bony support and stability.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.34 no.2
• /
• pp.100-105
• /
• 2012

Purpose: In general, the surgical treatment for mandibular retrognathism is represented by two methods, distraction osteogenesis (DO) and mandibular osteotomy surgery. The DO is mostly preferred when the degree of advancement of mandible is large. However, the postoperative stability of mandibular advancement using DO have not been actively investigated. Therefore, in the present study we have compared the postoperative stability between DO and bilateral sagittal split ramus osteotomy (BSSRO) in mandibular retrognathism. Methods: Seven patients who had been treated by DO and thirteen patients with BSSRO were included in this study. Serial lateral cephalograms were analyzed by manual tracing and the amount of the mandibular elongation was measured. To evaluate the postoperative stability, positional changes of the condylar position and B point were analyzed. Results: Mean amount of mandibular advancement was $6.51{\pm}3.57mm$ for BSSRO group and $12.43{\pm}4.35mm$ for DO group, respectively. There was no significant difference in age between the two groups (P>0.05). Mean follow up periods were 10.77 months for BSSRO group and 11.28 months for DO group, respectively. After mandibular advancement, mean positional changes in the condyle were $0.56{\pm}1.43mm$ horizontally and $0.72{\pm}1.61mm$ vertically for BSSRO group and $0.53{\pm}1.56mm$ horizontally and $0.56{\pm}1.75mm$ vertically for DO group, respectively. Mean change of distance from B point to Y-axis was $-1.76{\pm}0.83mm$ for BSSRO group and $-2.14{\pm}1.82mm$ for DO group, respectively. According to the condylar position and B point, there were no significant differences in postoperative stability between the two groups (P>0.05). Conclusion: There was no significant difference in postoperative stability between DO and BSSRO group according to condylar position and B point. Based on the results of the present study, it is hypothesized that DO would be a good treatment choice for severe mandibular retrognathism because DO could achieve more mandibular advancement and concurrent soft tissue elongation.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.31 no.5
• /
• pp.408-413
• /
• 2009

Odontogenic keratocyst (OKC) is a epithelial developmental cyst which were first described by Phillipsen in 1956. The frequency of OKC has been reported to vary from 3% to 11% of odontogenic cysts. The most characteristic clinical aspect of OKC is the high frequency of recurrence. The mechanism of recurrence is thought to be related to residues of cyst epithelium and an intrinsic growth potential following excision. And since the lining of the OKC is thin and friable, removal of the cyst in one piece may sometimes be difficult. Complete removal of the cyst lining without leaving behind remnants attached to the soft tissue or bone is necessary to avoid recurrence. Therapeutic approaches vary in different studies from marsupialization and enucleation, which may be combined with adjuvant therapy such as cryotherapy or Carnoy's solution, to marginal or radical resection. The recurrent rate varies from approximately 20% to 62%. And OKC in the angle-ramus region of the mandible had a higher tendency to recur, because of the difficulty in accessing and removing OKC from the ramus. By employing a sagittal splitting of the mandible a good surgical access was provided and cyst could be removed completely. We present an illustrative case of a small, lobulated OKC that involved ramus on mandible, and a review of the contemporary literature.