• Maxillofacial Plastic and Reconstructive Surgery
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• v.23 no.1
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• pp.21-30
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• 2001

The purpose of this study was to evaluate the skeletal relapse pattern of the mandibular prognathic patients after mandibular set back surgery by sagittal split ramus osteotomy. The horizontal and vertical position of the cephalometric points were measured before, after surgery and after one-year follow up period. The next, the positional change of the proximal and distal mandibular segment were evaluated respectively. The obtained results were as follows; 1. The horizontal and vertical position of Cd was not changed before and after surgery, and it was maintained its original position during the observation periods. 2. As the mandibular prognathism of the patients was severe before surgery, the more skeletal relapse tendency was observed during follow-up period(p<0.05). 3. As the horizontal positional change of the mandible which was obtained by mandibular set-back surgery was large, the more horizontal relapse tendency was observed during follow-up period(p<0.05). 4. The corpus axis angle decreased by sagittal split ramus osteotomy(p<0.01), but it was kept its reoriented position during follow-up period. 5. During the follow-up period after mandibular set-back by sagittal split ramus osteotomy, the forward relapse of mandible correlated with not only the forward rotation of the proximal segment but also the forward movement of the distal segment(p<0.05).

• Maxillofacial Plastic and Reconstructive Surgery
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• v.28 no.2
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• pp.136-142
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• 2006

Temporomandibular joint(TMJ) disorders have characteristic clinical findings such as pain, joint sound, and abnormal jaw function. With the rapid progress in TMJ imaging techniques, magnetic resonance imaging(MRI) especially provides the clinician and researcher with the ability to evaluate TMJ disorders(effusion, anterior disk displacement) and the hard and soft tissue of the TMJ. In order to manage the internal derangement of TMJ such as anterior disk displacement, the so-called appliance therapy is commonly used. This technique became the treatment of choice before surgical intervention by many practitioners. The purpose of the present study was to evaluate and determine the efficacy of anterior repositioning splint by means of the change of the position of the disk through pre- and post-treatment MRI. MRI and clinical symptom were carefully recorded in TMJ disorder patients. The relationship between TMJ symptoms such as pain, clicking sound, and disk displacement and effusion in MRI were analyzed. Then, splint therapy was applied for 3 months according to our protocol; at day 1, patients should wear 24 hours, in order to accomodate the splint and then, wearing time is reduced to 12 hours per day for one month. During next 2 months, it is tapered to 8 hours per day according to the evaluation of the clinical symptoms. Post-treatment MRI was obtained after 3 month protocol. This treatment strategy improved the clinical symptoms of TMJ disorder, and effusion and articular disk position showed a significant change. In conclusion, a treatment modality using an anterior repositioning splint therapy is an appropriate method for temporomandibular disorder patients.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.17 no.1
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• pp.32-45
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• 1995

This study was intended to evaluate condyle position and the relationship of condyle position change and post surgical relapse following the sagittal split ramus osteotomy for mandible setback in 25 patients by paired t-test and multiple regression analysis. We used oblique transcranial and cephalometric radiographs taken before operation, immediate after operation, and at least 6 months post operatively. 1. In oblique transcranial view, posterior joint space was decreased immediate after operation and increased 6 months after operation. To compare the measurement before and 6 months after operation, there was no statistically significant change in over all joint spaces(P>0.05). 2. The joint spaces changed under the 0.2mm were 30%, 0.2mm to 1.0mm were 60.7%, above 1.0mm were 9.3%. This result reveals that condyle position was relatively reproduced to pre-operative state. 3. Statistically, the amount of mandible set back didn't influence the post operative relapse(P>0.05). 4. Statistically, the amount of mandible set back didn't influence the condylar displacement(P>0.05), and the amount of joint space change didn't influence the post operative relapse.(P>0.05) The changes in joint space is in the standard tracing error or within the adaptive capacity of the individual, it was too small to influence the stability of surgery.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.17 no.1
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• pp.1-9
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• 1995

We observed 117 orthognathic surgery cases with dentofacial deformity for 8 years from Jan. 1986 to Dec. 1993. The ratio of male female was 1 : 1.4 and the mean age was 23.0 years ranged from 16 to 35 years. The most dominant group was related to mandibular prognathism (75.0%). Surgery method were divided into 88 cases of mandible surgery, 6 cases of maxilla surgery and 23 cases of two jaw surgery. Sagittal split osteotomy were performed on 84 cases (71.8%). Rigid fixation was increased after 1989 and total percent of rigid fixation was 66%. We used autotransfusion method from 1992 to all orthognathic surgery patient. Lower lip numbness caused by Inferior alveolar nerve injury is the most common problem after operation, and it was 63 cases (53.8%) of total operation cases. In our clinic, we performed 5 cases of re-operation because of segment malalignment, condylar sag, and fixation instability.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.30 no.5
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• pp.480-488
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• 2008

Orthodontists often treat cases which are difficult to treat with conventional orthodontics. In such cases, it could be treated with surgical procedures with the help of an oral surgeon. Especially, transverse deficiency of the mandible can be corrected by widening the transverse width of mandibular symphysis, using distraction osteogenesis. Transverse widening of mandibular sympysis is known as a safe treatment but still complications could occur during the treatment. We are reporting some complications of cases that mandibular symphysis transverse widening were applied. Some cases showed complications because of the inappropriate osteotomy line. Since straight vertical osteotomy line was inclined to the left, only the left bony segment was likely to expand. According to bio-mechanical considerations, it will be better to perform a step osteotomy, cutting the eccentric area of the alveolar crest and the centric area of the basal symphyseal area. Complications could also occur by the failure of the distraction device. The tooth borne distraction device was attached on the lingual side of the tooth with composite resin. During the distraction period, it was impossible to obtain appropriate distraction speed and rhythm because of frequent fall off of the distraction device. Therefore, distraction device should be attached firmly with orthodontic band or bone screw, etc. Tooth mobility increasement could also occur as a complication. 'Walking teeth phenomenon' was observed during the distraction period, showing severe teeth mobility and pain during mastication. These symptoms fade out during the consolidation period. Since the patient could feel insecure and uncomfortable, it should be notified to the patient before the procedure. Finally, alveolar crestal bone loss could occur. Alveolar crestal bone loss occurred because of lack of distraction device firmness and teeth trauma caused by lower lip biting habit. Therefore, adequate firmness of the distraction device and habit control will be needed.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.32 no.4
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• pp.368-372
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• 2010

Botryoid odontogenic cyst (BOC) is considered a rare multilocular variant of the lateral periodontal cyst. In this report, a 67-year-old male visited with chief complaint of severe mobility on mandibular incisors. Multilocular radiolucent lesion was seen from the right premolar to the left premolar area, involving almost the whole mandible. Histologically, the botryoid odontogenic cyst showed focal nodular thickening of the lining epithelium. These thickening often showed swirling appearance of the cells. Cyst enucleation and bone graft on mandible anterior and both body area were performed under general anesthesia, and postoperative healing was favorable without recurrence.

• Archives of Craniofacial Surgery
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• v.9 no.2
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• pp.105-109
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• 2008

Temporomandibular joint(TMJ) and dental occlusion are important in functional aspect as well as in cosmetic aspect for craniofacial surgery such as orthognathic and traumatic surgery. During these operations, appropriate maxillomandibular fixation(MMF) is especially necessary to conserve or reconstruct, dynamic TMJ and functional occlusion. Arch bar is one of the most popular method to gain proper MMF. Seventeen patients including 5 patients with mandibular fracture, 12 patients with orthognathic surgery(6 patients had relatively normal occlusion, however 6 patients had facial anomalies such as hemifacial microsomia with irregular occlusal plane.) were joined in this study. Arch bar was contoured on the dental cast, which was prepared for model surgery, prior to apply it on the facial anomaly patient. On using pre-contoured arch bar, patients felt better during the procedure and surgeons saved time. Moreover, well-contoured arch bar promises precise transmission of force on the bone, which implies surgeons do not need to worry about the occlusion while fixing bony structures. Authors suggest how to apply arch bar to satisfy basic theories about dental row and occlusion based on the experience. In addition, it is proposed to contour arch bar on the dental impression prior to apply it on the patient who has irregular and complex occlusal plane.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.13 no.2
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• pp.160-166
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• 1991

In 1977, Robinson & Martinez described a distinct varient of ameloblastomas in which the response to curettage was found to be favorable, with a recurrence rate of 25%. They referred to this varient as unicystic ameloblastoma. Unicystic ameloblastoma occur most commonly in the second and third decades of life, which is considerablly younger than the average age of discovery for the classical ameloblastoma. For the accurate histopathological diagnosis of the unicystic ameloblastoma, the specimen obtained the excisional biopsy, complete enucleation or incisional biopsy from the multiple site of the lesion. The purpose of this report is to review of the literature and to present three cases in which an unicystic ameloblastoma appear to be arising in the wall of a dentigerous cyst.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.13 no.2
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• pp.167-176
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• 1991

This is three case-reports of pleomorphic adenomas arising from one parotid gland and two minor salivary glands treated by total parotidectomy and complete enucleation. We conclude as follows : 1. During the parotidectomy, we tried to preserve the facial nerve by retrograde approach to the trunk from the mandibular branch where it passes over the posterior facial vein. Although the paresis of the lower lip following the operation was seen, it disappeared in about 3 months. 2. Microscopically, the tumor of the first patient (case 1) contained equally myxoid and cellular components and showed well encapsulation. 3. In the second patient (case 2), the tumor revealed large areas of hemorrhage, cystic change, dystrophic calcification and stromal hyalinization, but no definite evidence of carcinoma, therefore we labeled this tumer as "atypical mixed tumor". 4. In the third patient (case 3), the tumor showed principally myxoid component and incomplete capsule, but the tumor was well demarcated.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.28 no.1
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• pp.73-79
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• 2006

The management of mandibular prognathism and retrognathism was revoluted by the advent of the technique of bilateral sagittal split ramus osteotomy(BSSRO) as described by Obwegeser and Trauner in 1957. The BSSRO of the mandible has been used for nearly 50 years and has undergone numerous modifications and improvements. Most patients, treated by this surgical operation, express their satisfaction with improved facial esthetics, masticatory function and others. But several complications associated with BSSRO may appear. Especially among them, facial nerve palsy following BSSRO is rare but serious problem. We treated for facial nerve palsy following BSSRO by physical therapy, steroid therapy and surgical intervention and then the result was favorable. Therefore we would like to report a case about a patient with facial nerve palsy after BSSRO with a review of the literatures.