• Korean Journal of Cleft Lip And Palate
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• v.4 no.1
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• pp.13-26
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• 2001

Cleft lip and/or palate is the congenital orofacial malformation most commonly occurred in humans, The disease is multifactorial and is probably caused by genetic and/or environmental factors, So, there are many problems in research concerning etiology and in treatment of the disease, Even the most practiced and sophisticated methods of surgical repair are necessarily followed by scar contraction and fibrosis, which result in skeletal defects, dental abnormalities, cosmetic disfigurement, and speech impairment, As a result, Fetal surgery can be considered but practiced rarely when the deformity is not fatal to life, And treatment of cleft palate is performed in the form of medicine projection into uterus in animal experiments, Many studies show that growth factor and its receptor emerge from the developing palate; and the epidermal growth factor receptors have a important role in craniofacial development and in palatal fusion, The palatal morphogenesis of the avine is different from the mammal's; it takes the form of physiologic cleft palate, Recently, cleft palate fusion experiment was performed when the avine were in the period of palate formation through the exogenous TGF-β3 addition, and it showed that the exogenous TGF-β3 makes fusion of divided palate through certain process when cleft palate is occurred in palatal formation, In this study, I had the conformation of the fusion of cleft palate through the addition of TGF-β in case of chicken embryo, and observed the effect of TGF-β in EGF receptor distribution, And the following is the results of this study, 1. In case of the TGF-βl and β3 addition group, there was the decrease of EGFR(Epidermal Growth Factor Receptor) immunoreactivity in mesenchymal cells beneath the medial edge epithelium and also in epithelial mesenchymal interface which is between medial edge epithelium and nasal septum in 72 hours, 2, The immunoreactivity of the control group resembles that of normal chicken embryo palate in development, 3. In the view through fluorescence confocal microscopy, there was confluence in TGF-β3 addition group, This shows that the confluence induced by exogenous TGF-β3 is related to EGFR expression in palate of chicken embryo, which is a physiologic cleft palate model.

• Korean Journal of Cleft Lip And Palate
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• v.6 no.1
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• pp.1-15
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• 2003

Cleft lip and palate deformity have unknown patterns of maxillofacial growth and development. The maxillofacial growth can be affected either by congenital or environmental factors such as infection and trauma. Surgical repair of cleft lip and palate may interfere the subsequent growth and development of maxillofacial region. The purpose of this study is to evaluate the characteristics of development of maxillofacial region in adult cleft lip and palate patients and to compare post-treat-ment craniofacial morphology between cleft lip and palate patients with secondary alveolar bone graft group and normal group. The material for this study consisted of 20 adult male patients with cleft lip and palate(mean 22.5, range 18-31) visited in Yeungnam University medical center. Cephalometric tracing and measurements were done by one investigator. Results were followed: The values of Na. perpendicular to point A, SNA angle and Pogonion to Na. perpendicualrwere -4.93±5.70, 76.45±4.69, and -6.38±6.73. The values of effective maxillary length, effective mandibular length, mandibular plane angle and facial axis angle were 85.6±4. 42, 123.88±7.10, 29.9±5.09 and 5.53±2.03. The value of upper incisors to point A was 3.95±2.74.

• Journal of Korean Academy of Oral and Maxillofacial Radiology
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• v.28 no.2
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• pp.363-385
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• 1998

In orthodontics and orthognathic surgery. cephalogram has been routine practice in diagnosis and treatment evaluation of craniofacial deformity. But its inherent distortion of actual length and angles during projecting three dimensional object to two dimensional plane might cause errors in quantitative analysis of shape and size. Therefore, it is desirable that three dimensional object is diagnosed and evaluated three dimensionally and three dimensional CT image is best for three dimensional analysis. Development of clinic necessitates evaluation of result of treatment and comparison before and after surgery. It is desirable that patient that was diagnosed and planned by three dimensional computed tomography before surgery is evaluated by three dimensional computed tomography after surgery. too. But Because there is no standardized normal values in three dimension now and three dimensional Computed Tomography needs expensive equipments and because of its expenses and amount of exposure to radiation. limitations still remain to be solved in its application to routine practice. If postoperative three dimensional image is constructed by pre and postoperative lateral and postero-anterior cephalograms and preoperative three dimensional computed tomogram. pre and postoperative image will be compared and evaluated three dimensionally without three dimensional computed tomography after surgery and that will contribute to standardize normal values in three dimension. This study introduced new method that computer-simulated three dimensional image was constructed by preoperative three dimensional computed tomogram and pre and postoperative lateral and postero-anterior cephalograms. and for validation of new method. in four cases of dry skull that position of mandible was displaced and four patients of orthognathic surgery. computer-simulated three dimensional image and actual postoperative three dimensional image were compared. The results were as follows. 1. In four cases of dry skull that position of mandible was displaced. range of displacement between computer-simulated three dimensional images and actual postoperative three dimensional images in co-ordinates values was from -1.8 mm to 1.8 mm and 94％ in displacement of all co-ordinates values was from -1.0 mm to 1.0 mm and no significant difference between computer-simulated three dimensional images and actual postoperative three dimensional images was noticed(p>0.05). 2. In four cases of orthognathic surgery patients, range of displacement between computer­simulated three dimensional images and actual postoperative three dimensional images in coordinates values was from -6.7 mm to 7.7 mm and 90％ in displacement of all co-ordinates values was from -4.0 to 4.0 mm and no significant difference between computer-simulated three dimensional images and actual postoperative three dimensional images was noticed(p>0.05). Conclusively. computer-simulated three dimensional image was constructed by preoperative three dimensional computed tomogram and pre and postoperative lateral and postero-anterior cephalograms. Therefore. potentiality that can construct postoperative three dimensional image without three dimensional computed tomography after surgery was presented.

• Journal of the korean academy of Pediatric Dentistry
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• v.38 no.3
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• pp.270-275
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• 2011

Fibrous dysplasia is a developmental tumor-like condition that is characterized by replacement of normal bone by an excessive proliferation of cellular fibrous connective tissue intermixed with irregular bony trabeculae. Craniofacial lesions may cause facial pain, headache, cranial asymmetry, facial deformity, tooth displacement and visual or auditory impairment. In this case, a 2-year-9-month old boy who was diagnosed as the fibrous dysplasia showed delayed eruption on affected area. Teeth of left lateral dentition group have erupted completely but teeth of right lateral dentition group are erupting slowly. Eruption and maturation of affected teeth are in progress, so continuous observation is required presently. If the eruption state stops, surgical opening or forced eruption of the impacted teeth will be considered.

• The korean journal of orthodontics
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• v.41 no.6
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• pp.384-398
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• 2011

Objective: The purpose of this study was to analyze the stress distribution and the displacement pattern of mandibular anterior teeth under various intrusive force vectors according to the position of orthodontic miniscrews and hooks, using three-dimensional finite element analysis. Methods: A three-dimensional finite element model was constructed to simulate mandibular teeth, periodontal ligament, and alveolar bone. The displacement of individual tooth on three-dimensional planes and the von Mises stress distribution were compared when various intrusion force vectors were applied. Results: Intrusive forces applied to 4 mandibular anterior teeth largely resulted in remarkable labial tipping of the segment according to the miniscrew position. All 6 mandibular anterior teeth were labially tipped and the stress concentrated on the labiogingival area by intrusive force from miniscrews placed mesial to the canine. The distointrusive force vector led to pure intrusion and the stress was evenly distributed in the whole periodontal ligament when the hook was placed between the central and lateral incisors and the miniscrew was placed distal to the canine. Conclusions: Within the limits of this study, it can be concluded that predictable pure intrusion of the 6 anterior teeth segment may be accomplished using miniscrews placed distal to the canine and hooks located between the central and lateral incisors.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.26 no.2
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• pp.115-131
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• 2000

In the study of craniofacial deformity, it is very important that identifying the factor which can affect the morphology and which is closely related to the morphology, because it can not only improve the comprehension of growth and developmental process but also be applied in growth prediction and treatment modality. Several investigators have already mentioned the characterstics of head posture and airway space in relations to morphologic difference. But it is very meaningful work in clarifying the correlation between morphology, head posture and airway space that observing the change of head posture after morplologic change caused by operation and the change of airway space after same procedure. To investigate above correlation, I selected normal group which is consisted of 43 adults and mandibular prognathism group which is consisted of 47 adults who had been operated by sagittal split ramus osteotomy and were followed up more than 1 year. With their lateral skull radiograghs, reference lines which can evaluate each measuring points and areas without effect of postural change were first determined. And using above reference lines, change of airway space, positional change of tongue and hyoid, change of cranial and cervical angulations were measured. The results obtained from the study were as follows 1. In the change of head posture, the position of tongue and hyoid neighboring to pharynx is more closely related to the reference line of cervical column than to reference line of cranium. 2. After mandibular setback operation, the airway dimension was decreased to 81.6% of preoperative state at 1 month postoperatively and was slightly increased to 89.7% at 1 year postoperatively. 3. Posterior movement of tongue plays important role in decrease of airway dimension and inferior movement of hyoid was closely correlated with posterior movement of tongue. 4. Postoperative anterior movement of mandible, namely, morphologic relapse had correlation with relapse phenomenon of airway dimension. 5. Craniocervical angulation increased postoperatively. Especially in the postoperative early state, there was increased foreward inclination of cervical angulation rather than increase of cranial angulation. But at postoperative 1 year it was observed that cervical inclination was returned to preoperative state and cranial angulation was increased gradually. 6. Increase rate of airway dimension was correlated with the increase of cranial angulation from postoperative 1 month to 1 year. In conclusion, relapse tendency of airway dimension following increase of cranial angulation was found after mandibular setback operation and it is considered that increase of cranial angulation is one of compensatory mechanism in airway maintenance.

• The korean journal of orthodontics
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• v.36 no.4
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• pp.284-294
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• 2006

Objective: Activating mutations in the fibroblast growth factor receptor-2 (FGFR2) have been shown to cause syndromic craniosynostosis such as Apert and Crouzon syndromes. The purpose of this pilot study was to investigate the resultant phenotypes induced by the two distinctive bone-targeted gene constructs of FGFR2, Pro253Arg and Cys278Phe, corresponding to human Apert and Crouzon syndromes respectively. Methods: Wild type and a transgenic mouse model with normal FGFR2 were used as controls to examine the validity of the microinjection. Micro-CT and morphometric analysis on the skull revealed the following results. Results: Both Apert and Crouzon mutants of FGFR2 induced fusion of calvarial sutures and anteroposteriorly constricted facial dimension, with anterior crossbite present only in Apert mice. Apert mice differed from Crouzon mice and transgenic mice with normal FGFR2 in the anterior cranial base flexure and calvarial flexure angle which implies a possible difference in the pathogenesis of the two mutations. In contrast, the transgenic mice with normal FGFR2 displayed normal craniofacial phenotype. Conclusion: Apert and Crouzon mutations appear to lead to genotype-specific phenotypes, possibly causing the distinctive sites and sequence of synostosis in the calvaria and cranial base. The exact function of the altered FGFR2 at each suture needs further investigation.

• The korean journal of orthodontics
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• v.27 no.4 s.63
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• pp.643-659
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• 1997

For the total treatment of skeletal malocclusions, 3-dimensional evaluation and diagnosis are essential. Although anteroposterior discrepancies can be evaluated through various methods, the satisfactory methods for evaluations of facial asymmetry and transverse discrepancies are yet to be found. The adequate diagnosis and treatment of transverse discrepancies may be more important in the maintenance of functional occlusion as well as for the stability of results obtained from orthognathic surgery than the anteroposterior or vertical discrepancies. Since the soft tissue effects from the transverse discrepancies may not be pronounced, especially when combined with anteroposterior or vertical discrepancies which have prominent characteristics, the differentiation of their effects may be difficult from visual inspection alone. Therefore it is essential that the normal facial proportions would be established from the posteroanterior cephalometry as a reference for the accurate diagnosis and treatment. The present study evaluates 76 subjects from Yonsei University freshmen with normal facial symmetry and occlusion. Posteroanterior cephalograms were taken from the subjects and the normal values and facial proportions are obtained. The results are as follows. 1. The transverse and vortical values from posteroanterior cephalometry and their ratio, with means and standard deviations are calculated. 2. The ratio of vertical values to transverse values is 0.837 (male 0.836, female 0.841). 3. The Proportion of maxillary and mandibular widths is 0.747 (male 0.745, female 0.752), with statistically significant correlation. 4. Various degree of significant correlations are observed in the following craniofacial widths; (Cranial width, Bizygomaticofrontal suture width, Facial width, Maxillary width, Upper & Lower Intermolar width, Mandibular width). 5. Although the facial height as well as other line measurements increase as the facial widths increase, angle measurement ($Bj\ddot{o}rk$ Sum, Mandibular Plane Angle, Gonial Angle), decreases and posterior to anterior facial height ratio increases, therefore indicating the tendency for a brachycephalic facial type. These results may be used as references for the treatment planning in orthognathic and orthodontic treatments for the dentofacial deformity patients.

• Journal of the korean academy of Pediatric Dentistry
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• v.34 no.1
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• pp.140-149
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• 2007

Cleft lip and palate are congenital craniofacial malformation. Reconstruction of dental arch in patient with alveolo-palatal clefts is very important, because they have many problems in functions and esthetics. Malnutrition, poor oral hygiene, respiratory infections, speech malfunctions, maxillofacial deformity, and psychological problems may be occured without proper treatment during the long period of management of the cleft lip and palate. So the treatment should be managed with a multidisciplinary approach. Bone grafting is a consequential step in the dental rehabilitation of the cleft lip and palate patient A complete alveolar arch should be achieyed of the teeth to erupt in and to form a stable dentition. And the presence of the cleft complicate the orthodontic treatment. Therefore bone grafting in patients with cleft lip and palate is a widely adopted surgical procedure. Grafted bone stabilizes the alveolar process and allows the canine or incisor to move into the graft site. After the bone grafting, orthodontic closure of the maxillary arch has become a common practice for achieving dental reconstruction without any prosthodontic treatment. Various grafting materials have been used in alveolar clefts. Iliac bone is most widely fovoured, but tibia, rib, cranial bone, mandible have also been used. And according to its time of occurrence, the bone graft may be divided into primary, early secondary, secondary, late secondary. Bone grafting is called secondary when performed later, at the end of the mixed dentition. It is the most accepted procedure and has become part of treatment of protocol A secondary bone graft is performed preferably before the eruption of the permanent canine in order to provide adequate periodontal support for the eruption and preservation of the teeth adjacent to the cleft. In this report, we report here on a patient with unilateral cleft lip and palate, who underwent iliac bone graft. The cleft was fully obliterated by grafted bone in the region of the alveolar process. The presence of bone permitted physiologic tooth movement and the orthodontic movement of adjacent tooth into the former cleft area. Satisfactory arch alignment could be achieved in by subsequent orthodontic treatment.

• The korean journal of orthodontics
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• v.31 no.1 s.84
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• pp.63-69
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• 2001

Cleft lip and/or palate(CLP) is the most common congenital deformity in the craniofacial region. For a practical public health system for these patients it is necessary to have an understanding on the prevalence of CLP. However, it was difficult to estimate the exact number of CLP patients due to problems in sample selection, higher miscarriage and still birth rate, difficulty in classification, and adoptions to foreign countries. Therefore this study was to estimate the prevalence of CLP and the rate of orthodontic treatment, which is usually necessary in cleft lip and/or palate patients. The samples consisted of 218,322 Korean male adults from Seoul, Kwangju, Taegu and Pusan, all born in 1979. The screening method for recognizing the CLP patients was proceeded in steps and the results are as follows. 1. The prevalence of cleft lip and/or palate in Korean male adults born in 1979 was 0.65 out of the 1000 samples. 2. In the anteroposterior aspect of the 1000 samples, the prevalence of cleft lip, cleft lip and palate, and cleft palate was 0.26, 0.36 and 0.03 respectively. 3. In the transverse aspect of the 1000 samples, the prevalence of left, right and bilateral cleft was 0.35, 0.16, 0.12 respectively. The cleft in the left showed a much higher prevalence than in the rirht, while bilateral cleft showed a lower prevalence than unilateral cleft. 4. The orthodontic treatment rate of Korean male adults among cleft lip and/or palate Patients was $35\%$, and it was in the order of cleft lip and Palate, cleft lip, and cleft Palate, being $67\%,\;29\%\;and\;29\%$ respectively. The orthodontic treatment rate in patients with the more severe cleft lip and palate was higher than in patients solely having cleft lip or cleft palate.