• 대한치과의사협회지
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• 제37권3호통권358호
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• pp.221-227
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• 1999

The aim of this study was to describe the clinical availability of a variety of facial bone grafts in oral and maxillofacial surgery. Thirty patients with oral and maxillofacial bone defects were treated with mandible, maxilla, and zygoma bone grafts. The ages of the patients ranged from 8 to 64 years, with a mean age of 28.6 years. The follow-up period ranged from 2 to 30 months, with a mean follow-up of 11.7 months. Although postoperative follow-up was of short duration, the recilient sites were favorable to healing and bone consolidation. Healing progressed normally without severe morbidity. The donor site did not present a management problem in any of the patients.Some minor complications developed in 8 patients, of which three were infections and another three were wound dehiscence. There complications were easily managed with incision and drainage, antibiotics and local wound care. We consider that a variety of facial bone grafts can be used for reconsider that a variety of facial bone grafts can be used for reconstruction of small or moderate large bony defects.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제12권2호
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• pp.88-94
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• 1990

Because of it's accessibility and the quantity of bone available, the ilium is a common donor site for autogenous cancellous, cortical, and corticocancellous grafts to the facial skeleton. Especially, the anterior iliac crest has been the traditional source of pelvic bone for autogenous bone grafting in the maxillofacial skeleton. Recently the need for large amounts of bone in some reconstructive procedures of the facial skeleton has led to the evaluation of posterior ilium. The posterior approach to the ilium is superior to the anterior approach when large quantities of cancellous bone are required for facial reconstruction. The posterior approach has the advantages of more available bone, fewer complications, less postoperative pain, less disturbance in ambulation, and a possible reduction in the length of hospitalization. As the posterior approach affords an almost unlimited amount of bone for autogenous grafting in the maxillofacial region, we feel its use is indicated when very large amounts of bone are required.

• Archives of Plastic Surgery
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• 제38권1호
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• pp.15-18
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• 2011

Purpose: The anterior iliac crest is a common source for autologous cancellous bone graft. For patients who have previously received cancellous bone grafts from bilateral anterior iliac crests, there may be concerns of whether a sufficient quantity of autologous cancellous bone remains for additional grafts without harvesting it from other sites, such as the posterior iliac crest. Methods: We experienced 3 cases of reharvesting in 2 patients. The diagnosis of the first patient was bilateral facial cleft number 3. This patient received bilateral side cleft alveoloplasty with corticocancellous bone graft from the both anterior iliac crest respectively by a previous surgeon. This patient then needed reharvesting of the anterior iliac crest cancellous bone to correct an ongoing skeletal problem for the bilateral cleft. The other patient had bilateral incomplete cleft of the primary palate. This patient received left side cleft alveoloplasty with cancellous bone graft from the right anterior iliac crest. Before the patient could receive the alveoloplasty on the other side, a radial head osteotomy and cancellous bone graft was performed by orthopedic surgeons who then used the remaining left iliac crest in order to treat a pulled elbow. For the completion of the right side cleft alveoplasty, the anterior iliac crest cancellous bone needed to be reharvested. Prior to the reharvesting, a preoperative computed tomography scan of the pelvis was obtained to assess the maturity of the donor site regeneration. The grafts were then taken from site where a greater amount of regeneration was evident. Results: Long term follow ups showed that the grafts were successfully taken. This sufficient volume was obtainable 14 months after the first harvest. Conclusion: Satisfactory results were achieved after the reharvesting of iliac cancellous bone. Thus, it appears that the reharvesting of the iliac bone is a possible alternative to multiple site grafting, use of allograft or bone substitute materials.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제12권2호
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• pp.69-81
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• 1990

Classification of facial asymmetry has not been yet well-organized because of their variety on etiologic factors, involved sites and clinical expressions. And surgical treatments are also variable and depend upon their causes and clinical abnormalities. This is a case report on surgical experiences of two patients who had severe facial asymmetry and could not treated pre-surgical orthodontics before surgery. One patient was belong to hemifacial microsomia and another was a very unusual complex type related to unilateral condylar hyperplasia, unilateral macrognathia and unilateral mandibular hypoplasia. The authors used a simultaneous two-jaw surgery, bone shaving and onlay-type bone graft in former case, and a simultaneous two-jaw surgery, condylectomy, bone shaving and only-type bone graft in latter case. In two cases, immediate post-operative results in function and esthetics were excellent, however, progressive resorption of onlay-type bone grafts have been noticed.

• Archives of Plastic Surgery
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• 제45권6호
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• pp.588-592
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• 2018

Harvesting grafts from the anterior iliac bone has been associated with various complications. A 50-year-old woman presented to our department with a chief complaint of right inguinal swelling and pain. Autologous bone grafts had been harvested on two previous occasions from the right anterior iliac crest for use in the reconstruction of multiple facial fractures. Computed tomography and magnetic resonance imaging revealed a full-thickness bone defect in the right anterior iliac crest. A mass was noted in the right gluteus minimus, while a multilocular cystic mass extended from the right iliac crest defect to the right inguinal region. Both the inguinal mass and gluteal mass were removed under general anesthesia. Following histopathological analysis, the gluteal mass was diagnosed as a venous malformation (VM). Based on the patient's clinical course, iliac bone graft harvesting and trauma to the gluteal region triggered hemorrhaging from the VM. Blood components leaked out from the fragile portion of the iliac bone defect, forming a cystic lesion that developed into the inguinal mass. In this case, a coincidental VM resulted in a rare complication of iliac bone graft harvesting. These sequelae could have been avoided by planning for more appropriate ways to collect the grafts.

• Archives of Plastic Surgery
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• 제40권4호
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• pp.433-439
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• 2013

Background Facial beauty depends on the form, proportion, and position of various units of the face. In terms of the frontal view and facial profile, the chin is the most prominent aesthetic element of the lower third of the face. Many methods have been implemented to obtain good proportions of the lower face. In this study, we applied the T-shaped genioplasty method to correcting chin deformities. Methods All of the procedures in 9 cases were performed under general anesthesia. For genioplasty, a horizontal cutting line and 1 or 2 vertical cutting lines were drawn 5 mm below the mental foramen. Osteotomed bone segments of the chin were used for horizontal widening using bone grafts or for horizontal shortening. Likewise, they were used as bone grafts for vertical lengthening or vertical shortening. The bone segments were approximated in the midline and held in place using miniplates. Results The postoperative appearance of the 9 cases showed that the lower third of the face had been naturally changed. At the same time, vertical lengthening or shortening, and horizontal widening or shortening could be implemented during the operation. Satisfactory results were obtained based on reviews of the patients' preoperative and postoperative photographs. The patients were also satisfied with the outcomes. Conclusions Using T-shaped genioplasty, we efficiently adjusted the shape and position of the chin to obtain good proportions of the lower face and change its contour to obtain an aesthetically appealing oval face in accordance with East Asians' aesthetic preferences.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제37권
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• pp.29.1-29.7
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• 2015

Facial asymmetry is found in patients with or without cosmetic facial alterations. Some patients have facial asymmetry that manifests underlying skeletal problems, while others have only limited soft-tissue facial asymmetry. Orthognathic surgery brings about a dermatic change, as soft tissue covers underlying bones. Limited soft-tissue asymmetry, meanwhile, is difficult to correct. The treatment modalities for the creation or restoration of an esthetically pleasing appearance were autogenous fat grafts, cartilage graft, and silicon injections. A young female patient had right-side facial asymmetry. The clinical assessment involved visual inspection of the face and palpation to differentiate soft tissue and bone. Although the extra-oral examination found facial asymmetry with skin atrophy, the radiographic findings revealed no mandibular atrophy or deviation. She was diagnosed as localized scleroderma with muscle spasm. In conclusion, facial asymmetry patients with skeletal asymmetry can be esthetically satisfied by orthognathic surgery; however, facial atrophy patients with skin or subdermal tissue contraction need treatment by cosmetic dermatological surgery and orthodontic correction.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제17권4호
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• pp.337-349
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• 1995

Periosteum in general is described as a specialized fibrous membrane of mesenchymal origin consisting of two basis layers : outer fibrous layer consists of irregularly arranged dense connective-tissue with fibroblasts, and inner osteogenic or cambial layer is composed of more loosely arranged fibers, greater vascularity and flatted spindle-shaped pre-osteoblasts. This periosteum may serve in controlling bone growth, especially mandibular growth has been emphasized. But, the periosteum enwrapping the facial skeleton have been studied for many years leaving a controversy in opinion regarding the function of these structures. We evaluated the bone formation activity of te periosteum in allogeneic bone grafts which bones are made of freeze-dried preparation preoperatively. We made the calvarial bone defects, 5 ${\times}$ 7mm sized, amd grafted with allogeneic bone in rats, which a half of specimens has dissected the overlying periosteum and a rest intacted. After bone grafting, we evaluated the capacity ofbone formation of periosteum, 1, 2, 4, 6, 8 weeks postoperatively. There are subtle differences of bone formation during early healing period after demineralized allogeneic bone grafting between control groups with periosteum and experimental groups without periosteum.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제18권4호
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• pp.546-554
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• 1996

전두골 결손과 다발성 안면골 골절의 비유합 및 부정유합으로 인해 심한 안모변형이 초래된 62세의 남자 환자와, 좌측 상악골에 발생한 점액종의 치료를 위해 상악골 전척출술후 안모변형이 예상되는 66세 남자환자에서 동측의 혈관화 두개골 외층골피판으로 재건해 주었다. 이 골피판은 수술부위와 가깝고 막성골이며 흡수가 적어 두개 안면골의 결손이나 변형시에 유용하게 사용될 수 있을 것으로 생각된다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제38권
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• pp.2.1-2.9
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• 2016

Background: We reviewed the biological and mechanical properties of porous hydroxyapatite (HA) compared to other synthetic materials. Computer-aided design/computer-aided manufacturing (CAD/CAM) was also evaluated to estimate its efficacy with clinical and radiological assessments. Method: A systematic search of the electronic literature database of the National Library of Medicine (PubMed-MEDLINE) was performed for articles published in English between January 1985 and September 2013. The inclusion criteria were (1) histological evaluation of the biocompatibility and osteoconductivity of porous HA in vivo and in vitro, (2) evaluation of the mechanical properties of HA in relation to its porosity, (3) comparison of the biological and mechanical properties between several biomaterials, and (4) clinical and radiological evaluation of the precision of CAD/CAM techniques. Results: HA had excellent osteoconductivity and biocompatibility in vitro and in vivo compared to other biomaterials. HA grafts are suitable for milling and finishing, depending on the design. In computed tomography, porous HA is a more resorbable and more osteoconductive material than dense HA; however, its strength decreases exponentially with an increase in porosity. Conclusions: Mechanical tests showed that HA scaffolds with pore diameters ranging from 400 to $1200{\mu}m$ had compressive moduli and strength within the range of the human craniofacial trabecular bone. In conclusion, using CAD/CAM techniques for preparing HA scaffolds may increase graft stability and reduce surgical operating time.