• Maxillofacial Plastic and Reconstructive Surgery
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• 제21권4호
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• pp.376-381
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• 1999

A variety of materials and procedures such as sinus floor elevation, sinus-lift graft, inlay bone graft using Le Fort I osteotomy, and onlay graft have been used to create adequate bone volume in the maxillary sinus for placement of endosseous implants in the posterior atrophic maxilla. Because of the frequent lack of bone in the posterior maxilla, sinus lift procedure has become a commonly practiced treatment modality. The 138 endosseous implants of 36 patients with sinus augmentation procedures performed in Korea University Hospital from January 1991 to December 1998 were summarized and analysed. The result of this study were as follows: 1. Age ranged from 39 to 57, with a mean of 50.7. 2. The mean survival rate for 138 implants with maxillary sinus lift procedure was 80.4%. 3. There was no corelationship between the fixture length, width and the survival rate. 4. The result showed that the healing period for 8-12 months was necessary if the residual alveolar bone height was less than 5mm. 5. Autogenous iliac corticocancellous block graft showed the most favorable survival rate(95%).

• 대한두개안면성형외과학회지
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• 제12권2호
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• pp.102-106
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• 2011

Purpose: It is accepted universally that correction of the cleft lip nasal deformity requires multiple stages of surgery. Following primary lip repair in infancy or early childhood, secondary surgery to improve the deformity of the lip and nose is frequently necessary. A suitable surgical procedure to correct the accompanying deformity, such as cleft palate and alveolus, must be carried out at an appropriate age. In developing countries, it is common for patients with cleft lip nasal deformity to present severe secondary deformities in adolescence, because of poor follow-up and inappropriate surgery. Methods: The first patient was a 12 year old Mongolian boy. He presented prominent lip scar, short lip, wide columella, asymmetric nostril, palatal fistula, cleft alveolus, and velopharyngeal incompetence. He underwent cheilorhinoplasty, transpositional flap, alveoloplasty by iliac bone graft, and sphincter pharyngoplasty. On follow-up, a bilateral maxillary hypoplasia and a class III malocclusion developed. He underwent LeFort I osteotomy and maxillary advancement at the age of 16 years. The second patient was an 18 year old Eastern Russian girl. She presented with a deviated nose, right alar base depression, short lip, protrusion on vermilion, large palatal fistula, and severe VPI due to short palate. She underwent the combined procedure of cheilorhinoplasty, corrective rhinoplasty, tongue flap for palatal fistula, and superiorly based pharyngeal flap. And the tongue flap was detached at postoperative 3 weeks. Results: The overall results have been extremely pleasing and satisfactory to patients. There were no postoperative complications. Conclusion: We discovered the one stage operation for radical correction was sufficient procedure to provide excellent clinical outcomes in patients with severe cleft lip nose deformity.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제26권6호
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• pp.644-651
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• 2000

In cases of severe alveolar bony resorption in the edentulous posterior maxillae, implant placement is limited anatomically due to maxillary sinus. If the ridge is atrophic, the various bone grafting methods are required for the ridge augmentation. But the result of the onlay grafting procedure is not always promising. On the posterior maxilla, maxillary sinus mucosa lifting and bone grafting into the sinus floor, subantral augmentation(SA) technique are recommended. Various SA procedures have been developed for implant installation. We perfer to simultaneous block bone graft and implant installation through the residual alveolar ridge into the grafted block bone to fix the grafted bone and to gain the primary stability of the installed fixture. When a sagittal skeletal discrepancy in present due to the severe alveolar bony resorption of the maxilla, the advancement of the maxilla by Le Fort I osteotomy simultaneously with installation of implant fixtures combined with sinus lifting and interpositional bone graft procedure can be indicated. We applied various SA techniques for implant installtion to the 46 edentulous posterior maxillae, and total 154 implants were installed at our department from 1992 to 1999. Various SA techniques were classified in detail and the indications of each techniques were discussed. The changes of residual bony height following SA procedure were studied. The results were as follows. 1. The SA procedure combined with bone graft and simultaneous fixture installation were performed in 41 cases, 126 fixtures were installed and 5 fixtures were removed out of them. Le Fort I osteotomy procedure combined with sinus lifting and interpositional bone graft simultaneous with fixture installation were performed in 5 cases. Total 28 fixtures were installed and 2 fixtures were removed so far. 2. Autogenous block bone graft into sinus floor were performed in 35 cases, autogenous particulated marrow cancellous bone(PMCB) graft in 9 cases, and demineralized human bone powder in 2 cases. The donor site for bone graft were anterior iliac bone in 39 cases, posterior iliac bone in 3 cases and mandibular symphysis in 1 case and mandibular ramus in 1 case. 3. In 9 cases with which SA procedure had been performed with the block bone graft, the change of pre- and postoperative residual bony height were measured using MPR(multiplanar reformatted)-CT. The mean residual bony height was 8.0mm preoperatively, 20.2mm at 6 months following up operation and we gained average 12.2mm alveolar bony height. So, we can recommend this one-stage subantral augmentation and fixture installation technique as a time conserving, safe and useful method for compromised posterior edentulous maxilla.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제28권4호
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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.

• 대한치과교정학회지
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• 제29권3호
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• pp.285-301
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• 1999

악교정 수술의 계획에 있어서 수술 후 경조직의 이동에 따른 연조직 변화 양상을 보다 정확히 예측하는 것은 매우 중요하다. 최근에는 측모 두부 규격 방사선 사진과 실제 측모 사진을 병합하여 수술 후 측모 변화에 대한 가시성을 높인 여러 종류의 video imaging 프로그램들이 개발되어 널리 사용되고 있다. 그러나 이들 프로그램의 정확도를 판단하는 연구는 아직 미비한 실정이며 특히 국내에서 많이 시행되고 있는 골격성 III급 부정교합 환자의 수술 후 변화 양상에 대한 연구가 임상적인 활용에 앞서 선행되는 것이 필요하다. 이에 저자는 video imaging프로그램의 하나인 Power $Ceph^{\circledR}$ (Power Soft Co. Ver 3.3)을 이용하여 국내에서 양악수술을 시행 받은 골격성 III급 부정교합 환자 30명(남 14명, 여 16명)을 대상으로 예측도와 실제 술후의 측모를 비교하여 정확도를 평가하였으며 정확도에 영향을 미치는 요인을 분석하기 위해 이동량 및 술식별로 분류 비교하여 다음과 같은 결론을 얻었다. 1. 예측치와 실제 계측치의 비교에서 24개의 계측항목 중 14개 항목에서 유의성 있는 차이를 보였다. 2. 계측항목 중 유의성 있는 차이를 보이는 항목은 대부분 상악에 관련된 연조직으로 하악에 관련된 연조직에 비해 다양한 차이를 나타내었다. 3.상악 및 하악의 이동량에 따른 비교에서 이동량이 적은 군이 이동량이 많은 군에 비하여 예측치와 실제 계측치 비교에서 유의성 있는 차이를 보인 항목이 적게 나타났다. 4. 이부 성형술 여부에 따른 비교에서 이부 성형술을 시행하지 않은 군에서 이부 성형술을 시행한 군에 비하여 예측치와 실제 계측치 비교에서 유의성 있는 차이를 보인 항목이 적게 나타났다. Video imaging(Power $Ceph^{\circledR}$ Ver 3.3)프로그램에 의한 예측치와 실제 계측치 비교시 그 차이는 대부분 2mm 이내로써 임상적으로 수용할 수 있는 수준이었다.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제31권5호
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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.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제34권5호
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• pp.311-319
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• 2012

Purpose: The aim of this study is to evaluate the vertical changes of the lip and perioral soft tissue, following orthognathic surgery in skeletal class III patients by a cephalometric analysis of a cone beam computed tomography (CBCT). Methods: A total of 20 skeletal class III patients, who had bimaxillary surgery with Le Fort 1 osteotomy and bilateral sagittal split ramus osteotomy, were included in this study. The surgical plan for maxilla was posterosuperior impaction with the anterior nasal spine, as the rotation center. Further, the surgical plan for mandible was also posterosuperior movement. The soft tissue changes between lateral cephalogram and CBCT were compared. And the correlations between independent variables and dependent variables were evaluated. Results: There were no significant differences of the soft tissues changes between lateral cephalogram and CBCT. Upper lip philtrum length (SnLs), nasolabial angle increased and upper lip vermilion length (LsStms), lower lip length (StmiB'), lower lip vermilion length (StmiLi), lower lip philtrum length (LiB') and soft tissue lower facial height (SnMe') decreased after surgery. Change of SnLs (${\Delta}$SnLs) was influenced by vertical change of menton (${\Delta}$MeV), and change of LsStms (${\Delta}$LsStms) was influenced by upper lip thickness (ULT). Change of StmiLi' (${\Delta}$StmiLi') were influenced by preoperative overjet. Change of StmiB' (${\Delta}$StmiB') were influenced by preoperative overjet, vertical change of lower incisor (${\Delta}$L1V) and horizontal change of posterior nasal spine (${\Delta}$PNSH). Change of LiB' (${\Delta}$LiB') was influenced by ${\Delta}$L1V and ${\Delta}$PNSH. Change of SnMe' (${\Delta}$SnMe') was influenced by ${\Delta}$MeV, horizontal change of upper incisor (${\Delta}$U1H) and horizontal change of lower incisor (${\Delta}$L1H). ${\Delta}$Nasolabial angle was influenced by change of ULT (${\Delta}$ULT). Conclusion: Both soft tissues and hard tissues can be evaluated by CBCT. Posterosuperior rotation of maxillomandibular complex resulted in increase of upper lip philtrum length and nasolabial angle, while the upper lip vermilion length, lower lip philtrum length, lower lip vermilion length, and soft tissue lower facial height showed a decrease.

• 대한치과교정학회지
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• 제50권5호
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• pp.336-345
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• 2020

Objective: To investigate the treatment modalities (Tx-Mods) for patients with unilateral hemifacial microsomia (UHFM) according to Pruzansky-Kaban types and growth stages. Methods: The samples consisted of 82 Korean UHFM patients. Tx-Mods were defined as follows: Tx-Mod-1, growth observation due to mild facial asymmetry; Tx-Mod-2, unilateral functional appliance; Tx-Mod-3, fixed orthodontic treatment; Tx-Mod-4, growth observation due to a definite need for surgical intervention; Tx-Mod-5, unilateral mandibular or bimaxillary distraction osteogenesis (DO); Tx-Mod-6, maxillary fixation using LeFort I osteotomy and mandibular DO/sagittal split ramus osteotomy; Tx-Mod-7, orthognathic surgery; and Tx-Mod-8, costochondral grafting. The type and frequency of Tx-Mod, the number of patients who underwent surgical procedures, and the number of surgeries that each patient underwent, were investigated. Results: The degree of invasiveness and complexity of Tx-Mod increased, with an increase in treatment stage and Pruzansky-Kaban type (initial < final; [I, IIa] < [IIb, III], all p < 0.001). The percentage of patients who underwent surgical procedures increased up to 4.2 times, with an increase in the Pruzansky-Kaban type (I, 24.1%; IIa, 47.1%; IIb, 84.4%; III, 100%; p < 0.001). However, the mean number of surgical procedures that each patient underwent showed a tendency of increase according to the Pruzansky-Kaban types (I, n = 1.1; IIa, n = 1.5; IIb, n = 1.6; III, n = 2.3; p > 0.05). Conclusions: These findings might be used as basic guidelines for successful treatment planning and prognosis prediction in UHFM patients.

• 대한구순구개열학회지
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• 제8권2호
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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.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제27권3호
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• pp.239-249
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• 2001

저자는 1999년 6월부터 2000년 4월까지 경북대학교병원 구강악안면외과에서 하악골 후퇴를 위해 SSRO 혹은 LeFort I 골 절단술을 동반한 SSRO를 시행받은 환자 42명을 대상으로 술전, 술후 1개월, 술후 6개월에 각각 MKG를 이용하여 하악운동량 및 양상을 조사하고 이를 몇 가지 요소에 따라 군으로 나누어 계측치를 측정, 연구한 바 아래와 같은 결과를 얻었다. 1. 남녀 성별에 따른 두 군 사이에서, 좌측운동량의 변화 및 최대 개구속도의 변화량은 유의한 차이가 있었으며(p<0.05), 그 외의 항목은 차이가 없었다. 2. SSRO만을 시행 받거나 혹은 LeFort I을 동반하여 SSRO를 시행받을 경우, 수술방법에 따른 하악운동량의 변화는 유의성이 없었다.(p>0.05) 3. 하악골이동량에 따른 세 군에서 각 군사이의 하악운동량의 변화는 좌측 측방운동량에서는 $6{\sim}10mm$의 이동군이 가장 우수하였으며(p<0.05), 그 외의 항목은 통계적 유의성이 없었다. 4. 하악골의 개폐구 양상은 전두면 상에서 술전이 복잡편향형, 단순편향형, 복잡편위형, 단순편위형, 직선형 순이었고 술후 1개월에서는 단순편향형, 단순편위형, 복잡편위형, 직선형, 복잡편향형 순이며, 술후 6개월에서는 술전과 같은 순서였다. 또한 시상면상에서는 술전에 비일치형이, 술후 1개월에서는 일치형이 술후 6개월에서는 다시 비일치형이 우세하였다. 5. 술전 관절증의 증상유무에 따른 두 군사이의 하악운동량의 변화에는 통계적 유의성이 없었다(p>0.05). 6. 과두재위치장치를 적용한 군과 적용하지 않은 군에서, 두 군사이의 하악운동량의 변화에는 유의성이 없었다(p>0.05). 7. 술전 관절증이 있었던 환자중 술후 관절증의 완화가 나타난 경우가 63% 였으며, 과두재위치장치를 적용하지 않은 군에서 술후 관절증의 완화가 더 유의성있게 나타났다(p<0.05).를 보였으며 복합 레진은 유의차가 없었다. 상악 견치 (8%), 하악 제 1소구치 (5%) 순이었다. 10. I군에서 추정되는 낭의 발생 원인으로는 치수절단술을 받은 유치가 59.2%로 가장 많았고 이외에 심한 우식 및 치료 받지 않은 외상 병력등 기타 가능한 원인들이 있었다. 11.함치성 낭의 치료법으로는 I군의 경우 61.2%에서 조대술이 시행되었고, II군과 III군의 경우 61.1%, 80.0%에서 적출술이 시행되었다.mH I처치시 SM1과 SM2는 4조각의 절편으로 절단되어 같은 양상을 보였고, GS톤의 경우는 3조각의 절편으로 절단되었다. Kpn I, Sma I, Xho I 그리고 Pst I에는 절단되지 않았다.s subsp. salicinius와 유전자 유사치가 99.60%, 99.73%를 보여 Lactobacillus salivarius subsp. salicinius로 동정되었다. 이상의 결과를 종합하면 치아우식증이 없는 소아의 타액에서 분리된 유산균 중 과산화수소를 분비하여 인공치태 형성과 휘발성 유황화합물 생성을 억제하는 분리균주는 Lactobacillus salivarius subsp. salicinius로 동정되었다.적으로 낮은 수축률과 우수한 물성을 보였으며, 나노필러를 사용한 복합레진의 경우, 기존의 hybrid 필러를 이용한 레진에 비하여 수축응력을 감소시키지는 못하였다. 나노필러를 이용한 복합레진은 개발의 초기단계이며, 물성의 증가를 위한 연구가 필요할 것으로 사료된다.또 다른 약물인 glycyrrhetinic acid($100{\mu}M$)도 CCh 자극으로 인한 타액분비를 억제하였다. 이상의 결과로 미루어 gap junction은 흰쥐 악하선 세포로부터의 타액분비 조절에 중요한 역할을 하는데, 이는 gap junction이 세포막 $Ca^{2+}$ 통로를 조절함으로써 수용체 자극으로 유발된 세포내