• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제36권4호
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• pp.255-261
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• 2010

Introduction: To evaluate the skeletal stability after a bilateral sagittal split osteotomy (BSSO) setback of the mandible fixed with a biodegradable internal fixation device or metal internal fixation device. Materials and Methods: Thirty consecutive patients underwent mandibular setback via BSSO. Fifteen patients were fixed with a biodegradable internal fixation device or metal internal fixation device respectively. Posteroanterior (PA) and lateral cephalograms were taken preoperatively and at two days, 5.5 months and 14.5 months postoperatively. The relevant skeletal points were traced and digitized to evaluate the skeletal changes postoperatively. The relapse rates were analyzed and compared statistically. Results: There was no statistically significant differences in postoperative stability between the two groups.(P<0.05) Conclusion: The biodegradable internal fixation device may make an effective device alternative to a metal internal fixation device for setback BSSO.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제40권1호
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• pp.11-16
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• 2014

Objectives: The aim of this study was to evaluate the pattern of lingual split line when performing a bilateral sagittal split osteotomy (BSSO) for asymmetric prognathism. This was accomplished with the use of cone-beam computed tomography (CBCT) and three-dimensional (3D) software program. Materials and Methods: The study group was comprised of 40 patients (20 males and 20 females) with asymmetric prognathism, who underwent BSSO (80 splits; n=80) from January 2012 through June 2013. We observed the pattern of lingual split line using CBCT data and image analysis program. The deviated side was compared to the contralateral side in each patient. To analyze the contributing factors to the split pattern, we observed the position of the lateral cortical bone cut end and measured the thickness of the ramus that surrounds the mandibular lingula. Results: The lingual split patterns were classified into five types. The true "Hunsuck" line was 60.00% (n=48), and the bad split was 7.50% (n=6). Ramal thickness surrounding the lingual was $5.55{\pm}1.07$ mm (deviated) and $5.66{\pm}1.34$ mm (contralateral) (P =0.409). The position of the lateral cortical bone cut end was classified into three types: A, lingual; B, inferior; C, buccal. Type A comprised 66.25% (n=53), Type B comprised 22.50% (n=18), and Type C comprised 11.25% (n=9). Conclusion: In asymmetric prognathism patients, there were no differences in the ramal thickness between the deviated side and the contralateral side. Furthermore, no differences were found in the lingual split pattern. The lingual split pattern correlated with the position of the lateral cortical bone cut end. In addition, the 3D-CT reformation was a useful tool for evaluating the surgical results of BSSO of the mandible.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제41권
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• pp.35.1-35.7
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• 2019

Background: The purpose of this study was to measure the time of the conventional surgical planning (CSP) and virtual surgical planning (VSP) in orthognathic surgery and to compare them in terms of cost. Material and method: This is a retrospective study of the patients who underwent orthognathic surgery at the Pusan National University Dental Hospital from December 2017 to August 2018. All the patients were analyzed through both CSP and VSP, and all the surgical stents were fabricated through manual and three-dimensional (3D) printing. The predictor variables were the planning method (CSP vs. VSP) and the surgery type (group I: Le Fort I osteotomy + bilateral sagittal split osteotomy [LFI+BSSO] or group II: only bilateral sagittal split osteotomy [BSSO]), and the outcomes were the time and cost. The results were analyzed using the paired t test. Results: Thirty patients (12 females, 18 males) met the inclusion criteria, and 17 patients were excluded from the study due to missing or incomplete data. There were 20 group I patients (LFI+BSSO regardless of genioplasty) and 10 group II patients (BSSO regardless of genioplasty). The average time of CSP for group I was 385 ± 7.8 min, and that for group II was 195 ± 8.33 min. The time reduction rate of VSP compared with CSP was 62.8% in group I and 41.5% in group II. On the other hand, there was no statistically significant cost reduction. Conclusions: The time investment in VSP in this study was significantly smaller than that in CSP, and the difference was greater in group I than in group II.

• 대한치과교정학회지
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• 제38권2호
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• pp.104-120
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• 2008

본 연구는 전진이부성형술을 동반한 하악지 시상분할골절단술을 시행한 하악 전돌증을 가진 환자에서 하안면부, 특히 이부의 경조직과 연조직의 변화를 예측하는 데 있어서, 전후관계와 수직적 계측치를 통하여, 경조직의 변화에 따른 연조직의 상대적 변화량에 대해 비교, 분석하여 한국인의 골격성 III급 부정교합자의 악교정 수술시 전진이부성형술이 연조직 외형에 미치는 영향을 알아보고자 시행하였다. 교정치료와 악교정수술을 시행한 골격성 III급 부정교 합자 40명을 전진이부성형술을 시행하지 않고 하악지 시상분할골절단술만 시행한 환자 20명(BSSO group, 남자 10 명, 여자 10명)과 하악지 시상분할골절단술과 동시에 전진이부성형술을 시행한 환자 20명(Genie group, 남자 10명, 여자10명)으로 분류하여 수술직전(T1)과 수술직후(T2), 수술 최소 6개월 후(T3)의 측모 두부 방사선계측사진을 채득하여 계측 항목의 변화량을 분석하였다. BSSO군에서는 수술후 경조직 B점, Pogonion, Menton에 대하여 연조직 B점, Pogonion, Menton이 각각 수평적으로 0.997, 0.965, 1.022의 변화율을 보였으며, Genie군에서는 각각 0.824, 0.602, 0.887의 수평적 변화율을 보여서, Genie 군에서 연조직 B점, 연조직 Pogonion의 연조직 두께의 감소량이 더 크게 나타났다. 경조직 Pogonion(Pg)의 악교정수술 전과 후의 수평적 변화에 따른 하순의 하방점(Li), 연조직 B점 (B')의 변화간의 상관관계계수는 BSSO군에서는 각각 0.833, 0.922인 반면에, Genie 군에서는 각각 0.775, 0.799로 BSSO군에 비해서 상관관계가 다소 작은 것으로 나타났다. 이상의 결과에서 하악지 시상분할골절단술을 시행하는 환자에서 전진이부성형술을 동반할 경우에는 골격의 변화에 대해서 연조직의 두께 변화가 다소 적게 나타나므로 수술시에 이를 고려하여 전진이부성형술을 시행하여야 할 것이다.

• Journal of Dental Anesthesia and Pain Medicine
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• 제18권5호
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• pp.295-300
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• 2018

Background: Removal of the plate following Le Fort I osteotomy and BSSO (bilateral sagittal split osteotomy) is a common procedure. However, patients who undergo plate removal experience intense pain and discomfort. This study investigated the half-maximal effective concentration ($Ce_{50}$) of remifentanil in the prevention of plate removal pain under sedation using dexmedetomidine. Methods: The study evaluated 18 patients, between 18 and 35 years of age, scheduled for elective surgery. Remifentanil infusion was initiated after sedation using dexmedetomidine, and started at a dose of 1.5 ng/mL on the first patient via target-controlled infusion (TCI). Patients received a loading dose of $1.0{\mu}g/kg$ dexmedetomidine over 10 min, followed by a maintenance dose of $0.7{\mu}g/kg/h$. When the surgeon removed the plate, the patient Modified Observer's Assessment of Alertness/Sedation (MOAA/S) score was observed. Results: The Ce of remifentanil ranged from 0.9 to 2.1 ng/mL for the patients evaluated. The estimated effect-site concentrations of remifentanil associated with a 50% and 95% probability of reaching MOAA/S score of 3 were 1.28 and 2.51 ng/mL, respectively. Conclusion: Plate removal of maxilla can be successfully performed without any pain or adverse effects by using the optimal remifentanil effect-site concentration ($Ce_{50}$, 1.28 ng/mL; $Ce_{95}$, 2.51 ng/mL) combined with sedation using dexmedetomidine.