• International Journal of Oral Biology
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• v.37 no.1
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• pp.25-29
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• 2012

During maxillofacial surgery, the infraorbital and mental nerves are blocked at eac foramen to induce local anesthesia. This study examined the relative locations of the infraorbital foramen (IOF) and mental foramen (MF) based on softtissue landmarks. Twenty-eight hemifacial cadavers were dissected to expose the IOF and MF. The distances between the bilateral IOFs, the bilateral MFs, the alae of the nose (alares), and the corners of the mouth (cheilions) were measured directly on cadavers by using a digital vernier caliper. The vertical and horizontal distances of the IOF and MF relative to the alare and cheilion were measured indirectly on digital photographs using Adobe Photoshop (Adobe, CA, USA). The distance between the bilateral IOFs ($58.09{\pm}4.04mm$) was longer than the distance between the bilateral MFs ($50.32{\pm}1.93mm$). The distances between the bilateral alares and cheilions were $41.22{\pm}3.44mm$ and $58.43{\pm}6.62mm$, respectively. The IOF was located $12.92{\pm}3.75mm$ superior and $7.88{\pm}2.56mm$ lateral to the alare, and the vertical angle (Angle 1) between these structures was $31.67{\pm}13.36^{\circ}$ superolaterally. The MF was located $21.83{\pm}3.26mm$ inferior and $5.56{\pm}3.37mm$ medial to the cheilion, and the vertical angle (Angle 2) between these structures was $14.05{\pm}10.12^{\circ}$ inferomedially. In conclusion, these results provide more detailed information about the locations of the IOF and MF relative to soft-tissue landmarks.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.38
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• pp.38.1-38.10
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• 2016

Background: The aims of this study are to evaluate the lip morphology and change of lip commissure after mandibular setback surgery (MSS) for class III patients and analyze association between the amount of mandibular setback and change of lip morphology. Methods: The samples consisted of 14 class III patients treated with MSS using bilateral sagittal split ramus osteotomy. Lateral cephalogram and cone-beam CT were taken before and about 6 months after MSS. Changes in landmarks and variables were measured with 3D software program $Ondemand^{TM}$. Paired and independent t tests were performed for statistical analysis. Results: Landmarks in the mouth corner (cheilion, Ch) moved backward and downward (p < .005, p < .01). However, cheilion width was not statistically significantly changed. Landmark in labrale superius (Ls) was not altered significantly. Upper lip prominence angle (ChRt-Ls-$ChLt^{\circ}$) became acute. Landmarks in stomion (Stm), labrale inferius (Li) moved backward (p < .005, p < .001). Lower lip prominence angle (ChRt-Li-$ChLt^{\circ}$) became obtuse (p < .001). Height of the upper and lower lips was not altered significantly. Length of the upper lip vermilion was increased (p =< 0.01), and length of the lower lip vermilion was decreased (p < .05). Lip area on frontal view was not statistically significantly changed, but the upper lip area on lateral view was increased and change of the lower lip area decreased (p > .05, p < .005). On lateral view, upper lip prominent point (UP) moved downward and stomion moved backward and upward and the angle of Ls-UP-Stm ($^{\circ}$) was decreased. Lower lip prominent point (LP) moved backward and downward, and the angle of Stm-LP-Li ($^{\circ}$) was increased. Li moved backward. Finally, landmarks in the lower incisor tip (L1) moved backward and upward, but stomion moved downward. After surgery, lower incisor tip (L1) was positioned more superiorly than stomion (p < .05). There were significant associations between horizontal soft tissue and corresponding hard tissue. The posterior movement of L1 was related to statistically significantly about backward and downward movement of cheilion. Conclusions: The lip morphology of patients with dento-skeletal class III malocclusion shows a significant improvement after orthognathic surgery. Three-dimensional lip morphology changes in class III patients after MSS exhibited that cheilion moved backward and downward, upper lip projection angle became acute, lower lip projection angle became obtuse, change of upper lip area on lateral view was increased, change of lower lip area decreased, and morphology of lower lip was protruding. L1 was concerned with the lip tissue change in statistically significant way.

• Archives of Craniofacial Surgery
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• v.24 no.6
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• pp.266-272
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• 2023

Background: In recent years, there has been an increase in reports of perioral vascular complications resulting from filler injections, such as necrosis of the lip or alar rim, occlusion, and in severe cases, blindness. Conversely, the use of perioral arterial flaps is becoming more prevalent in the treatment of cleft lips, cancer, and trauma. A thorough understanding of perioral arteries is essential to minimize complications and maximize the success of these flaps. However, the course of the facial artery (FA) in the perioral region remains incompletely understood. The aim of this study was to describe the variations of the FA in the perioral region. Methods: We dissected 52 embalmed and formaldehyde-fixed Vietnamese cadavers. We then studied the size and distribution of perioral arteries in 102 specimens. Results: The superior labial artery (SLA) was the most common branch, occurring in 87.25% of cadavers, followed by the inferior labial artery (ILA) at 78.43%. The SLA primarily originated above the mouth corner (cheilion), accounting for 91.01% of cases, and predominantly exhibited a tortuous course within the submucosa (78.65%). The ILA's branching pattern varied, but it was primarily located below the cheilion (91.25%). The ILA also followed a twisted path, generally within the submucosa. The ILA exhibited two patterns: the typical pattern, distributed at the vermilion border of the lower lip (8.82%), and the horizontal labiomental artery pattern, which ran horizontally in the middle of the lower lip area (69.61%). At their origin, the SLA and ILA had average external diameters of 1.29 mm and 1.28 mm, respectively. Conclusion: Numerous anatomical variations in the FA in the perioral region were found. A detailed anatomic description, suggested landmarks, and angiography before the procedure will be useful to help doctors avoid complications.

• The korean journal of orthodontics
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• v.35 no.3 s.110
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• pp.163-173
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• 2005

The purpose of this study was to compare the asymmetric degree between maxillofacial hard and soft tissues in individuals with facial asymmetry. Computerized tomographies (CT) of 34 adults (17 male, 17 female) who had facial asymmetry were taken. The CT images were transmitted to personal computers and then reconstructed into three-dimensional (3D) images through the use of computer software. In order to evaluate the degree of facial asymmetry, 6 measurements were constructed as the hard tissue measurements while 6 counterpart measurements were taken as the soft tissue measurements. The means and standard deviations were obtained for each measurement using 3D measure, then t-test was used to investigate the differences between each hard tissue measurement and the corresponding soft tissue measurement All measurements used in the present study showed statistically significant differences between the hard and soft tissues. The degree of soft tissue asymmetry was smaller than that of corresponding hard tissue asymmetry in case of chin deviation, frontal ramal inclination difference, and frontal corpus inclination difference. On the other hand, the degree of soft tissue asymmetry was greater than that of underlying hard tissue asymmetry in the measurement of lip canting and lip cheilion height difference The present study suggests that asymmetric differences of hard and soft tissue is observed nu facial asymmetric subjects and thus soft tissue analysis is needed in addition to hard tissue analysis when making an evaluation of facial asymmetry.

• The Journal of the Korean dental association
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• v.54 no.3
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• pp.217-229
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• 2016

Purpose: The aim of this study was to evaluate the soft-tissue change after the maxillary protraction therapy using threedimensional (3D) facial images. Materials and Methods: This study used pretreatment (T1) and posttreatment (T2) 3D facial images from thirteen Class III malocclusion patients (6 boys and 7 girls; mean age, $8.9{\pm}2.2years$) who received maxillary protraction therapy. The facial images were taken using the optical scanner (Rexcan III 3D scanner), and T1 and T2 images were superimposed using forehead area as a reference. The soft-tissue changes after the treatment (T2-T1) were three-dimensionally calculated using 15 soft-tissue landmarks and 3 reference planes. Results: Anterior movements of the soft-tissue were observed on the pronasale, subnasale, nasal ala, soft-tissue zygoma, and upper lip area. Posterior movements were observed on the lower lip, soft-tissue B-point, and soft-tissue gnathion area. Vertically, most soft-tissue landmarks moved downward at T2. In transverse direction, bilateral landmarks, i.e. exocanthion, zygomatic point, nasal ala, and cheilion moved more laterally at T2. Conclusion: Facial soft-tissue of Class III malocclusion patients was changed three-dimensionally after maxillary protraction therapy. Especially, the facial profile was improved by forward movement of midface and downward and backward movement of lower face.

• The korean journal of orthodontics
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• v.36 no.1 s.114
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• pp.1-13
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• 2006

Three-dimensional (3-D) laser scans can provide a 3-D image of the face and it is efficient in examining specific structures of the craniofacial soft tissues. Due to the increasing concerns with the soft tissues and expansion of the treatment range, a need for 3-D soft tissue analysis has become urgent. Therefore, the purpose of this study was to evaluate the scanning error of the Vivid 900 (Minolta, Tokyo, Japan) 3-D laser scanner and Rapidform program (Inus Technology Inc., Seoul, Korea) and to evaluate the mean error and the magnification percentage of the image obtained from 3-D laser scans. In addition, soft tissue landmarks that are easy to designate and reproduce in 3-D images of normal, Class II and Class III malocclusion patients were obtained. The conclusions are as follows; scanning errors of the Vivid 900 3-D laser scanner using a manikin were 0.16 mm in the X axis, 0.15 mm in the Y axis, and 0.15 mm in the Z axis. In the comparison of actual measurements from the manikin and the 3-D image obtained from the Rapidform program, the mean error was 0.37 mm and the magnification was 0.66%. Except for the right soft tissue gonion from the 3-D image, errors of all soft tissue landmarks were within 2.0 mm. Glabella, soft tissue nasion, endocanthion, exocanthion, pronasale, subnasale, nasal alare, upper lip point, cheilion, lower lip point, soft tissue B point, soft tissue pogonion, soft tissue menton and preaurale had especially small errors. Therefore, the Rapidform program can be considered a clinically efficient tool to produce and measure 3-D images. The soft tissue landmarks proposed above are mostly anatomically important points which are also easily reproducible. These landmarks can be beneficial in 3-D diagnosis and analysis.

• The korean journal of orthodontics
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• v.35 no.6 s.113
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• pp.409-419
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• 2005

Studies for diagnostic analysis using three-dimensional (3D) CT images are recently in progress and needs for 3D craniofacial analysis are increasing in the fields of orthodontics. It is especially essential to analyze the facial soft tissue after orthodontic treatment and orthognathic surgery. In this study 3D CT images of adults with normal occlusion were taken to analyze the facial soft tissue. Norms were obtained from CT images of adults with normal occlusion (12 males, 11 females) using a computer program named V works 4.0 program. 3D coordinate planes were established using soft tissue Nasion as the reference point and a total of 20 reproducible landmarks of facial soft tissue were obtained using the multiple reconstructive sectional images (axial, sagittal and coronal images) of the V works 4.0 program: soft tissue Nasion, Pronasale, Subnasale, Upper lip center, Lower lip center, soft tissue B, soft tissue Pogonion, soft tissue Menton, Endocanthion (Rt/Lt), Alare lateralis (Rt/Lt), Cheilion (Rt/Lt), soft tissue Gonion (Rt/Lt), Tragus (Rt/Lt), and Zygomatic point (Rt/Lt). According to the established landmarks and measuring method, the 3D CT images of adults with normal occlusion were measured and the normal positional measurements and their Net (${\delta}=\sqrt{{X^2}+{Y^2}+{Z^2}}$) values were obtained using V surgery program, In the linear measurement between landmarks, there was a significant difference between males and females except Na' -Sn and En(Rt)-En(Lt). The normal ranges of Na'-Zy, Na'-Ch and Na'-Go' (facial depth) were obtained, which was difficult to measure by two-dimensional (2D) cephalometric analysis and facial photographs. These data may be used as references for 3D diagnosis and treatment planning for patients with malocclusion and dentofacial deformity.

• The korean journal of orthodontics
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• v.32 no.5 s.94
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• pp.313-325
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• 2002

Three-dimensional CT imaging is efficient in examining specific structures in the craniofacial area by reproducing actual measurements through minimization of errors from patient movement and image magnification. Due to the rapid development of digital image technology and the expansion of treatment range a need for developing three -dimensional analysis has become urgent. Therefore the purpose of this study was to evaluate the percentage of error and magnification of three-dimensional CT using a dried skull and Vworks $program^{TM}$ (Cybermed Inc., Seoul, Korea) and also to obtain landmarks that are easy to designate and reproduce in three-dimensional images using the Vmorph-proto $program^{TM}$ (Cybermed Inc., Seoul, Korea). The following conclusions were obtained, 1. In the comparison of actual measurements from the dried skull and the three-dimensional image obtained from the Vworks program, the mean error was 0.99mm and the magnification was 1.04%. 2. Clinically useful hard tissue landmarks from three-dimensional images were Supraorbitale, Lateral orbital margin, Infraorbitale, Nasion, ANS, A point, Zygomaticomaxilla, Upper incisor, Lower incisor, B point, pogonion, Menton, PNS, Condylar inner margin, Condylar outer margin, Porion, Condylion, Gonionl, Gonion2, Gonion3, Sigmoid notch and Basion. 3. Clinically useful soft tissue landmarks from three-dimensional images were Endocanthion, Exocanthion, Soft tissue Nasion, Pronasale, Alare lateralis, Upper nostril point, Lower nostril point, Subnasale, Upper lip point, Cheilion, Stomion, Lower lip center, Soft tissue B, Pogonion, Menton and Preaurale. The Vworks program can be considered a clinically efficient tool to produce and measure three-dimensional images. Most of the hard and soft tissue landmarks proposed above are anatomically important points which are also easily reproducible and designated. These landmarks can be beneficial in three-dimensional diagnosis and the prediction of changes before and after surgery.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.35 no.6
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• pp.360-367
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• 2013

Purpose: The purpose of this study was to perform three-dimensional (3D) assessment of facial soft tissue in patients with skeletal Class III and mandibular asymmetry after orthognathic surgery. Methods: Samples consisted of 3D facial images obtained from five patients with A point-nasion-B point angle less than 2 degrees, and more than 5 mm of menton deviation. All patients had been treated at Gangneung-Wonju National University Dental Hospital from 2009 to 2012. They had undergone orthognathic surgery of Lefort I, and sagittal split osteotomy for correction of skeletal deformity, and orthodontic treatment. Facial scanning was performed before treatment (T1) and post-surgical orthodontic treatment (T2). Linear and angle variables of soft tissue landmarks, antero-posterior facial depth, and facial volume were measured. Results: No significant differences in width of the alar base, mouth width, and nasal canting were observed between T1 and T2. However, lip deviation, menton deviation, alar canting, lip canting, and menton deviation angle were significantly reduced at T2. Antero-posterior facial depth on the axial plane parallel to the left cheilion was significantly reduced on the deviated side and significantly increased on the non-deviated side at T2. Volume of the lower lateral and lower medial parts of the face was reduced on the deviated side, and volume of upper lateral and lower lateral parts on the non-deviated side was significantly increased at T2. Conclusion: After orthognathic surgery, facial asymmetry of soft tissue was improved following skeletal changes, especially the mandibular region. Although the length of the alar base and mouth width did not change, lip and soft tissue menton were displaced to the medial side after treatment. Facial depth also became symmetric after treatment. Facial volume showed a decrease on the lower part of the deviated side and that on lateral parts of the non-deviated side showed an increase after treatment.

• The korean journal of orthodontics
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• v.41 no.6
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• pp.411-422
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• 2011

Objective: The aim of this study was to evaluate the lip and perioral soft tissue changes after bracket bonding. Methods: The soft tissue changes in 45 adult patients (age greater than 18 years and less than 29 years) without severe skeletal discrepancy were evaluated using three-dimensional images acquired with a laser scanner before and after bracket bonding was performed using 4 types of labial orthodontic brackets. Results: Among the statistically significant changes in distance observed for the landmarks, the biggest change was observed in forward movement. The landmarks on the lateral sides also showed significant changes. While the landmarks on the upper lip showed significant upward movement, those on the lower lip showed significant downward movement. However, the changes were smaller for the landmarks on the upper lip (average, 0.87 mm) than for the landmarks on the lower lip (average, 1.21 mm). The type of bracket used did not significantly affect the soft tissue changes. Conclusions: These findings will help predict soft tissue changes after bracket bonding for orthodontic treatment.