• Korean Journal of Cleft Lip And Palate
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• v.8 no.2
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• pp.87-94
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• 2005

Patients with unilateral cleft lip and palate (UCLP) generally demonstrate the asymmetries in the lip, nose and the naso-maxillary complex. And their skeletal asymmetries are known to be derived from the displacement of nasal septum, anterior nasal spine (ANS) and the pre-maxilla toward the non-affected side during the developmental and growth period. Due to the interruption of the important facial muscles, which are critical for the symmetric growth of premaxilla, functional matrix system fails to develop and results in the displacement of the ANS toward the non-affected side and nasal asymmetry. Therefore the rhinoplasty for CLP patients is required to have inter-skeletal and muscular rearrangement in the naso-maxillary complex in order to let them recover from esthetic and physiologic imbalances. And functional cheilorhinoplasty (FCR) has been a representative treatment of choice for this concept of treatment modality. The outcome and prognosis of primary or repair FCR have been known to be definitely affected by timing of the operation as well as adequate reconstruction of naso-labial muscles. However, sometimes FCR has an ineffective treatment results for patients after the facial growth period, and the limited rhinoplasty around the nose often fails to bring satisfying results. In order to circumvent this limitation, we performed ANS osteotomy for patients with unilateral CLP showing asymmetric nose, as an alternative way for corrective rhinoplasty. We could observe that the nose was rearranged along the facial mid-line by this osteotomy design and asymmetries were evidently improved postoperatively. Here we present this osteotomy method in CLP patients.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.31 no.6
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• pp.485-491
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• 2009

Postoperative skeletal stability was evaluated in combination of Le Fort I and U-shaped osteotomies for superior repositioning of maxilla in bi-maxillary surgeries in 30 consecutive patients. The fifteen patients underwent Le Fort I osteotomy alone and the other fifteen patients underwent Le Fort I and U-shaped osteotomies. In all patients, the maxilla was first osteomized and fixed with absorbable plates system. A bilateral sagittal split ramus osteotomy (BSSRO) of the mandible was then carried out and fixation was performed using absorbable plates. Maxillo-mandibular fixation with rubber ring was used for two weeks post-operatively in all patients. Lateral cephalograms were obtained pre-operatively, 1 day post-operatively, 6 months after surgery. The changes in anterior nasal spine (ANS), point A, upper incisior (U1), and point of maxillary tuberosity (PMT) were examined. The maxillas in the fifteen patients of both examination group were repositioned nearly in their planned positions during surgery and no significant post-operative changes in the examined points of the maxilla were found. These results suggest that a combination of a Le Fort I and U-shaped osteotomy is a useful technique for reliable superior repositioning of the maxilla. The post-operative change in the maxilla using this combination osteotomy was comparatively stable.

• The korean journal of orthodontics
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• v.39 no.6
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• pp.362-371
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• 2009

Objective: The purpose of this study was to compare the longitudinal treatment effects of facemask with rapid maxillary expansion (FM/RME) and chincup (CC) therapy followed by fixed orthodontic treatment (FOT) in Class III malocclusion (CIII) patients. Methods: The samples consisted of twenty-one CIII patients who had similar skeletal and dental characteristics before FM/RME or CC therapy and good retention results (Class I molar/canine relationship and positive overbite/overjet) after FOT (Group 1, FM/RME, n = 11; Group 2, CC, n = 10). Lateral cephalograms were taken before (T0) and after FM/RME or CC therapy (T1), and after FOT and retention (T2). Skeletal and dental variables were measured. Mann-Whitney U-test and Wilcoxon signed-rank test were used for statistical analysis. Results: During T0-T1, FM/RME therapy induced forward movement of point A, and labioversion of the upper incisors. Both groups showed posterior repositioning of the mandible. FM/RME resulted in increase of the vertical dimension; however, CC caused an increase in articular angle and decrease in gonial angle. During T1-T2, both groups exhibited forward growth of point A. Group 1 showed forward growth and counterclockwise rotation of the mandible and increase of IMPA; however, Group 2, showed increase of ANS-Me/N-Me and decrease of overbite. Conclusions: The key factor for successful FM/RME and CC therapy and good retention results might be a harmonized forward growth of the maxilla that could keep pace with the growth and rotation of the mandible.