• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.34 no.6
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• pp.628-634
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• 2008

The purpose of this study is to examine reproducibility of operation plan and 3-dimentional jaw movement patterns by comparing jaw position of STO with post-operative jaw position. Twenty patients with class III dental and skeletal malocclusion who were treated with Le-Fort I osteotomy and B-SSRO were reviewed. Lateral cephalometric radiographs were taken within two weeks before operation and two days after operation. Cephalometric radiographs were compared and analyzed with orthognathic computer program '$V-Ceph^{TM}$'. Post-operative maxillary advancement was insufficient compared to maxillary advancement through STO. Post-operative setback movement was over compared to mandibular setback movement through STO. But statistically this is not significant. Maxillary vertical location is insignificant on the whole. Especially post-operative maxillary clockwise rotation is significant compared to maxillary rotation through STO. Post-operative maxillary clockwise rotation tendency is generally observed in all patients. So surgeons and staffs must consider this tendency when operation plan is established ans operation is being performed. Using intra or extra oral marking points, face bow, and bite plate will make exact surgery possible.

• The korean journal of orthodontics
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• v.26 no.1 s.54
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• pp.1-16
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• 1996

The purpose of this study was to evaluate the amount and interrelationship of the soft and hard tissue changes after simultaneous maxillary advancement and mandibular setback surgery in skeletal Class III malocclusion. The sample consisted of 25 adult patients(13 males and 12 females) who had severe anteroposterior skeletal discrepancy. These patients had received presurgical orthodontic treatment and surgical treatment which consisted of simultaneous Le Fort I or Le Fort II osteotomy and bilateral sagittal split ramus osteotomy. The presurgical and postsurgical lateral cephalograms were evaluated. The computerized statistical analysis was carried out with SPSS/$PC^+$ program. The results were as follows. 1. The correlation of maxillary hard and soft tissue horizontal changes were high and the ratios for soft tissue to A point were $71\%$ at Sn, $67\%$ at SLS and $37\%$ at LS. 2. The correlation of mandibular hard and soft tissue horizontal changes were very high and the ratios were $84\%$ at LI, $107\%$ at ILS, $96\%$ at Pog' and $97\%$ at Gn'. 3. The correlation of mandibular hard tissue horizontal changes and soft tissue vertical changes were moderate. 4. The upper to lower lip length were increased(P<0.001). 5. The soft tissue thickness were decreased in upper lip and increased in lower lip(P<0.001). The postsurgical changes were reversely correlated with initial thickness in upper lip.

• Korean Journal of Cleft Lip And Palate
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• v.8 no.2
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• pp.71-79
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• 2005

Purpose: Maxillary hypoplasia is a common developmental problem of cleft lip and palate. Fair results with distraction osteogenesis have been reported especially when these patients need a large amount of maxillary advancement, instead of orthognathic surgery. The purpose of this study is to evaluate the clinical results with a relatively new distractor, $TS-MD^{(R)}$ (Trans-sinusoidal maxillary distractor, KLS Martin, Tuttlingen, Germany) which was used for the advancement of the maxilla in the cleft patients. Patients and Method: Distraction osteogenesis using $TS-MD^{(R)}$ was performed for four CLP patients (three males and one female) who had maxillary hypoplasia. All patients were over 16 years old. As three patients showed mandibular prognathism as well, bilateral sagittal split ramus osteotomy for mandibular setback was performed at the same time. After consolidation periods of 4 to 12 weeks, the distraction devices were removed and miniplates were placed for simultaneous internal fixation. Results: Three patients showed a large amount of incisal overbite but one patient did not have sufficient maxillary advancement. Le Fort I osteotomy, maxillary advancement and internal fixation should have been performed for the patient when removing the distraction devices. Different from the $clinician{\box}s$ expectation, the amount of maxillary advancement using $TS-MD^{(R)}$ was not sufficient, although the device has rigid mechanical property. Rotation of maxilla during distraction forward and downward was also observed. Conclusion: Even though the maxillary advancement with $TS-MD^{(R)}$ device could be achieved, the clinical control of some characteristics related with the device was necessary. More clinical studies on $TS-MD^{(R)}$ should be performed.

• The korean journal of orthodontics
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• v.43 no.1
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• pp.42-52
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• 2013

The aim of this paper was to propose a new method of bimaxillary orthognathic surgery planning and model surgery based on the concept of 6 degrees of freedom (DOF). A 22-year-old man with Class III malocclusion was referred to our clinic with complaints of facial deformity and chewing difficulty. To correct a prognathic mandible, facial asymmetry, flat occlusal plane angle, labioversion of the maxillary central incisors, and concavity of the facial profile, bimaxillary orthognathic surgery was planned. After preoperative orthodontic treatment, surgical planning based on the concept of 6 DOF was performed on a surgical treatment objective drawing, and a Jeon's model surgery chart (JMSC) was prepared. Model surgery was performed with Jeon's orthognathic surgery simulator (JOSS) using the JMSC, and an interim wafer was fabricated. Le Fort I osteotomy, bilateral sagittal split ramus osteotomy, and malar augmentation were performed. The patient received lateral cephalometric and posteroanterior cephalometric analysis in postretention for 1 year. The follow-up results were determined to be satisfactory, and skeletal relapse did not occur after 1.5 years of surgery. When maxillary and mandibular models are considered as rigid bodies, and their state of motion is described in a quantitative manner based on 6 DOF, sharing of exact information on locational movement in 3-dimensional space is possible. The use of JMSC and JOSS will actualize accurate communication and performance of model surgery among clinicians based on objective measurements.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.28 no.4
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• pp.320-328
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• 2006

Purpose: The aim of this study was to evaluate the effects of pterygomaxillary separation on dimensional changes of dental arch following surgically-assisted rapid maxillary expansion (SARME). Patients and Methods: Eighteen adults who had been treated by SARME for transverse maxillary deficiency from May 2000 to August 2005 were evaluated. Thirteen patients (Group 1) were treated with subtotal Le Fort I osteotomy including pterygomaxillary separation and anterior midpalatal osteotomy. The same operation was performed in five patients (Group 2) except pterygomaxillary separation. Dental study casts were taken before operation and after removal of expansion device. And then, skeletal and dental parameters were measured pre- and post-operatively. Results: 1. Changes of mean interdental width 1) In group 1, mean maxillary interdental width was increased 70%($47{\sim}99%$), 95%($84{\sim}115%$), and 77%($57{\sim}94%$) of total expansion on canine, first premolar, and first molar region, respectively after retention. 2) In group 2, mean maxillary interdental width was increased 77%($59{\sim}100%$), 78%($45{\sim}107%$), and 86%($57{\sim}116%$) of total expansion on canine, first premolar, and first molar region, respectively after retention. 3) There was a statistical difference between the change of interdental width of group 1 and group 2 at first premolar(p<0.05). 2. Changes of mean interalveolar width 1) In group 1, mean maxillary alveolar bone width was increased 66%($42{\sim}84%$), 74%($42{\sim}104%$), and 57%($31{\sim}78%$) of total expansion on canine, first premolar, and first molar region, respectively after retention. 2) In Group 2, mean maxillary alveolar bone width was increased 73%($55{\sim}98%$), 67%($36{\sim}89%$), and 59%($48{\sim}73%$) of total expansion on canine, first premolar, and first molar region, respectively after retention. 3) There were no statistical differences between group 1 and group 2 at each teeth area. Conclusion: These results suggest that SARME without pterygomaxillary separation may allow the relatively equal expansion at both anterior and posterior teeth area and most amounts of maxillary interdental expansions were acquired with the expansion of the maxilla by SARME.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.31 no.5
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• pp.390-398
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• 2005

Purpose: The aim of this study was to evaluate the skeletal and dentoalveolar dimensional changes following surgically-assisted rapid maxillary expansion (SARME). Patients & methods: Thirteen adults who had been treated by SARME for transverse maxillary deficiency from May 2000 to December 2003 were evaluated. The SARME procedure was the subtotal Le Fort I osteotomy combined with pterygomaxillary separation and anterior midpalatal osteotomy. Dental study casts and posteroanterior cephalometric radiographs were taken before operation, after removal of expansion device, and follow up period. Nasal cavity width, skeletal and dentoalveolar parameters were measured pre- and post-operatively. Results: 1. Mean nasal cavity width was increased 12%$(0{\sim}21%)$ of total expansion after retention. 2. Mean maxillary interdental width was increased 70%$(47{\sim}99%)$, 95%$(84{\sim}115%)$, and 77%$(57{\sim}94%)$ of total expansion in the canine, the first premolar, and the first molar region, respectively after retention. 3. Mean maxillary alveolar bone width was increased 66%$(42{\sim}84%)$, 74%$(42{\sim}94%)$, and 57%$(31{\sim}78%)$ of total expansion in the canine, the first premolar, and the first molar region, respectively after retention. 4. Mean palatal vault depth was decreased 1.3 mm ($0.5{\sim}2.0$ mm) after retention. 5. Mean interdental and alveolar bone width of the mandibular canine and intermolar width of mandible were slight increased as maxilla was expanded after retention. 6. There were statistical differences between preoperative and postoperative values of nasal cavity, all maxillary interdental and interalveolar widths, palatal vault depth, mandibular interdental and interalveolar width of canine(paired t-test, p<0.05). 7. The maxillary interdental and alveolar bone width were decreased approximately 25% of total expansion by relapse at follow up period. Conclusion: In conclusion, most amounts of maxillary interdental expansions were acquired with the expansion of the maxilla by SARME. For preventing the relapse, approximately 25% of the overexpansion was needed.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.26 no.4
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• pp.407-413
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• 2000

To evaluate the stability after orthognathic surgery in cleft lip and palate patients using rigid fixation, 20 patients underwent primary repair in childhood and later developed a jaw deformity and malocclusion that required orthognathic surgery were reviewed. Two groups, one of 10 patients performed Le Fort I osteotomy with sagittal split ramus osteotomy and one of 10 patients with sagittal split ramus osteotomy of the mandible, were evaluated. Each group had unilateral cleft only and all alveolar cleft sites had been grafted with autogeneous bone before the orthognathic surgery. The amount of surgical movement and relapse were compared in both horizontal and vertical dimensions. Two-jaw surgery group was more stable than mandibular surgery only group in mandibular position (p< 0.05). Statistically significant relapse was observed in mandibular skeletal point in mandibular surgery group (p<0.05). There was no statistically significant relapse in the skeletal point of two-jaw surgery group. However, the correlation between the horizontal surgical movement and relapse was detected (r = 0.88). This correlation indicates the need of overcorrection. The presence of scar tissues and relatively deficient maxillary bone could be attributed to this close relation between the surgical change and relapse.

• The Journal of Advanced Prosthodontics
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• v.3 no.2
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• pp.96-100
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• 2011

An 18-year-old male presented severe hypodontia due to hypohidrotic ectodermal dysplasia was treated with Le Fort I maxillary osteotomy with simultaneous sinus floor augmentation using the mixture of cortical autogenous bone graft harvested from iliac crest and organic Bio-Oss to position the maxilla in a right occlusal plane with respect to the mandible, and to construct adequate bone volume at posterior maxilla allowing proper implant placement. Due to the poor bone quality at other sites, ridge augmentation with onlay graft was done to construct adequate bone volume allowing proper implant placement, using tissue harvested from the iliac bone. Seven implants were placed in the maxilla and 7 implants were inserted in the mandible and screw-retained metal ceramic FPDs were fabricated. The two year follow up data showed that dental implants should be considered as a good treatment modality for patients with ectodermal dysplasia.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.48 no.1
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• pp.13-20
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• 2022

The lifetime incidence of epistaxis in dental and maxillofacial practice has been reported to be as high as 60% and can be caused by dental implant placement, Le Fort I osteotomy, intranasal supernumerary tooth, odontogenic tumors, blood disorders and maxillofacial trauma. Most epistaxis cases are minor and easily managed with direct compression on the nares for 10 minutes. For more significant or recurrent epistaxis, other techniques might include electrocautery, anterior or posterior nasal packing, or Foley catheter balloon. For patients with refractory epistaxis, cauterization of the sphenopalatine artery under endonasal endoscopy or embolization of the internal maxillary artery should be performed. Epistaxis control is required in patients diagnosed with inherited or acquired bleeding disorders or with drug-induced coagulopathies during dental procedures. In these cases, hemostatic system adjustment and hemostasis achieved by local and adjunctive methods are required. Dentists and maxillofacial surgeons must be aware that the nasal cavity is a potential source of perioperative hemorrhage. Depending on the invasiveness of the dental intervention, preoperative involvement of the hematologist and cardiologist is usually necessary to reverse anticoagulation or to cease anticoagulant therapy.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.32 no.5
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• pp.447-453
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• 2010

The hemifacial microsomia is characterized by variable underdevelopment of the craniofacial skeleton, external ear, and facial soft tissues. So, patients with hemifacial microsomia have an occlusal plane canting and malocclusion with facial asymmetry. Distraction osteogenesis (DO) with an intraoral or extraoral device is a technique using tension to generate new bone with gradual bone movement and remodeling. DO has especially been used to correct craniofacial deformities such as a hemifacial microsomia, facial asymmetry, and mandible defect that could not adequately be treated by conventional reconstruction with osteotomies. It has a significant advantage to lengthen soft and hard tissue of underdeveloped site without bone graft and a few complication such as nerve injury or muscle contracture. A 13-years old girl visited our clinic for the chief complaint of facial asymmetry. She had a left hypoplastic maxilla and mandible, occlusal plane canting and malocclusion. We diagnosed hemifacial microsomia and lanned DO to lengthen the affected side. Le Fort I osteotomy, left mandibular ramus and symphysis osteotomy were performed. The internal distraction devices fixed with screw on maxillary and mandibular ramus osteotomy sites. External devices were adapted to lower jaw for DO on symphysis osteotomy site and to upper jaw for rapid maxillary expansion (RME). At 7days after surgery, distraction was started at the rate of 1mm per day for 13days, and after 4months consolidation periods, distraction devices were removed. Simultaneous multiple maxillo-mandibular distraction osteogenesis with RME resulted in a satisfactory success in correcting facial asymmetry as well as occlusal plane canting for our hemifacial microsomia.