• Maxillofacial Plastic and Reconstructive Surgery
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• 제32권1호
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• pp.72-76
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• 2010

Osteochondroma is the one of the most benign tumors of the axial skeleton, but is rarely found in the facial bones. Typical facial features of condylar osteochondroma include striking facial asymmetry, malocclusion with openbite on the affected side, and prognathic deviation of the chin and crossbite to the contralateral side. In this case, twenty four year-old female showed facial asymmetry, chin deviation, openbite on the affected side but have no symptoms of pain or dysfunction. Concomitantly she had maxillary occlusal cant and hemimandibular hypertrophy. Panoramic radiograph showed radiopaque mass on right mandibular condyle extended along the lateral pterygoid muscle. Computed tomogram demonstrated enlarged condylar head and bony spur on posteromedial side of condyle and 99Tc bone scintigraphy showed a focal hot image. These findings were correspond with osteochondroma. The lesion was treated with condylectomy and residual facial asymmetry was corrected with 2-jaw orthognathic surgery. Herein, we report a case of osteochondroma of the mandibular condyle and accompanying facial asymmetry.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제14권4호
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• pp.255-268
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• 1992

There are various modalities in the treatment of facial asymmetry, but in severe case with TMD by actively growing deformed condyle, the treatment choice is removing the condyle growth center and TMD symptom such as click or muscular discomfort. In our one case, the patient was complain of facial asymmetry. There are severe deformed condyle head with bird-head fashion and enlarged mandibular ramus and body vertically about 18 mm, overgrowthed Rt. mandible body horizontally about 20 mm. She had intermittent Lt. TMJ clicking and muscular discomfort. The author diagnosed it as Lt. hemimandibular hyper-plasia & R, hemimandibular elongation, a combination form with TMD. the condyle was in active growing state in scintigraphic analysis. So we extirpated the deformed condyle by intrasoral sagittal split ramus osteotomy and reshaped the condyle and mandibular distal fragment extraorally. The distal fragment was readapted in glenoid fossa and fixated. In Rt. mandibular body area, autogenous onlay bone graft on the inferior border of mandible was performed to correct the asymmetry. The clicking and facial asymmetry was corrected and we report this results with other literature findings.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제26권2호
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• pp.172-178
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• 2000

When we establish treatment planning of facial asymmetry, we must predict each asymmetrical element that will be changed upon coronal, axial, sagittal plane. At the visual point, prediction of the change of coronal plane is most important. It is important difference between Rt. and Lt. mandibular angle belonging to posterior coronal plane, as well as anterior coronal plane, such as upper and lower incisor, or midline of chin point. Several methods for control bulk of mandibular angle are additional angle shaving after osteotomy, grinding contact area between proximal and distal segment for decrease the volume, or bone graft for increase the volume. But, at the point of bimaxillary surgery, transverse position of posterior maxilla is an important factor for control it. So, we would report transverse movement of posterior maxilla for decrease asymmetry on the posterior coronal plane of face, that is, asymmetry of mandibular angular portion.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제41권2호
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• pp.102-108
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• 2015

In surgery for facial asymmetry, mandibles can be classified into two types, rotational and translational, according to the required mandibular movements for surgery. During surgery for rotational mandibular asymmetry, a bilateral sagittal split ramus osteotomy (BSSRO) may cause a large bone gap between the proximal and distal segments as well as condylar displacement, resulting in a relapse of the temporomandibular joint disorder, especially in severe cases. The intraoral vertical ramus osteotomy has an advantage, in this respect, because it causes less rotational displacement of the proximal segment on the deviated side and even displaced or rotated condylar segments may return to their original physiologic position. Unilateral intraoral vertical ramus osteotomy (UIVRO) on the short side combined with contralateral SSRO was devised as an alternative technique to resolve the spatial problems caused by conventional SSRO in cases of severe rotational asymmetry. A series of three cases were treated with the previously suggested protocol and the follow-up period was analyzed. In serial cases, UIVRO combined with contralateral SSRO may avoid mediolateral flaring of the bone segments and condylar dislocation, and result in improved condition of the temporomandibular joint. UIVRO combined with contralateral SSRO is expected to be a useful technique for the treatment of rotational mandibular asymmetry.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제30권5호
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• pp.359-367
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• 2004

Purpose: After the surgical correction with sagittal split ramus osteotomy, the position of the mandibular condyle in the glenoid fossa and the proximal segment of the mandible change because of bony gap between proximal and distal segment, especially in case of mandibular setback asymmetrically. In this study, positional changes in the condyle and proximal segment after BSSRO were estimated in the mandibular asymmetry patient by analyzing the in submentovertex view and P-A cephalogram for identification of ideal condylar position during surgery. Patients and Methods: The 20 patients were selected randomly who visit Dankook Dental Hospital for mandibular asymmetry. Bilateral sagittal split ramus osteotomy with rigid fixation was performed and P-A cephalogram and submentovertex view was taken at the time of preoperative, immediate postoperative, 3 month postoperative period. Results: Intercondylar length and transverse condylar angle was increased due to inward rotation of proximal segment and anteromedial rotation of lateral pole of condyle head. The condylar position had a tendency to return to the preoperative state and after 3 months return up to about half of the immediate post-operative changes, and all the results showed more changes in asymmetry patient and deviated part of the mandible. Conclusion: Based on all these results above, surgeon should make efforts to have a precise preoperative analysis and to have a ideal condylar position during rigid fixation after BSSRO.

• 대한치과교정학회지
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• 제48권2호
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• pp.73-80
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• 2018

Objective: This retrospective study compared the three-dimensional (3D) structure of mandibular condyles between adults with and without facial asymmetry, and whether it influences menton deviation. Methods: Sixty adult patients were classified into symmetry and asymmetry groups based on the menton deviation on postero-anterior radiographs. The right/left differences of 3D measurements were compared between the two groups, and measurements were compared separately on the right and left sides. The correlations between menton deviation and the right/left differences were analyzed. Results: The mediolateral dimension, neck length, condylar angles to the anteroposterior reference (PO) and midsagittal reference planes, and neck and head volumes showed significantly larger right/left differences in the asymmetry group compared to the symmetry group. Separate comparisons of the right and left sides between the two groups showed that the neck was significantly shorter and neck and head volumes were significantly smaller on the left side, which was deviated side in the asymmetry group. Pearson's correlation analysis showed significant positive correlations of menton deviation with right/left differences in neck length, condylar angle to the PO plane, and neck and head volumes in the asymmetry group. Conclusions: In individuals with facial asymmetry, menton deviation is associated with the right/left differences caused by a smaller condyle on the deviated side, particularly in neck length and neck and head volumes.

• Imaging Science in Dentistry
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• 제33권4호
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• pp.207-209
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• 2003

Purpose: To evaluate the clinical and radiographic features of unilateral hyperplastic mandibular condyles for some useful preliminary diagnostic recommendations. Materials and Methods : Clinical records, radiographs and histologic diagnoses of 35 cases with asymmetric mandibular condyles due to apparent unilateral condylar hyperplasia were evaluated retrospectively. Results: Among 35 cases, 28 were true hyperplastic conditions of condyles whereas the remaining 7 were unilateral internal derangement occurring on the short side. 17 of the 28 hyperplastic condyles showed a mass or irregular radiographic shadow with histologic diagnosis including osteochondroma and osteoma. Only 5 of these cases showed facial asymmetry. 2 out of the 17 cases showed hyperplastic round shaped irregular condyles consistent with ankylosis and their histologic diagnoses were osteochondromas. 11 of the 28 cases showed smooth enlargement of condylar head with elongation of the neck causing facial asymmetry, but histologic diagnoses were not available because the surgical operation conserved the condyles. Conclusion: The hyperplastic conditions of the mandibular condyles include not only true hyperplasia, osteochondroma, osteoma, and ankylosis, but also unilateral internal derangement occurring on the short side.

• 대한치과교정학회지
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• 제47권3호
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• pp.195-206
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• 2017

Facial asymmetry can be classified into the rolling-dominant type (R-type), translation-dominant type (T-type), yawing-dominant type (Y-type), and atypical type (A-type) based on the distorted skeletal components that cause canting, translation, and yawing of the maxilla and/or mandible. Each facial asymmetry type represents dentoalveolar compensations in three dimensions that correspond to the main skeletal discrepancies. To obtain sufficient surgical correction, it is necessary to analyze the main skeletal discrepancies contributing to the facial asymmetry and then the skeletal-dental relationships in the maxilla and mandible separately. Particularly in cases of facial asymmetry accompanied by mandibular yawing, it is not simple to establish pre-surgical goals of tooth movement since chin deviation and posterior gonial prominence can be either aggravated or compromised according to the direction of mandibular yawing. Thus, strategic dentoalveolar decompensations targeting the real basal skeletal discrepancies should be performed during presurgical orthodontic treatment to allow for sufficient skeletal correction with stability. In this report, we document targeted decompensation of two asymmetry patients focusing on more complicated yaw-dependent types than others: Y-type and A-type. This may suggest a clinical guideline on the targeted decompensation in patient with different types of facial asymmetries.

• 대한소아치과학회지
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• 제45권3호
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• pp.378-385
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• 2018

하악의 골절은 아이들의 악안면 영역 골절 중 높은 빈도로 발생하며, 성장기의 환자에서 악골의 골절은 성인의 골절과 구별된 처치가 필요하다. 골편의 변위가 심하지 않다면 비관혈적 정복술과 추가적인 악간 고정을 시행할 수 있으며 악관절 강직을 예방하기 위한 기능적 운동이 필요하다. 하악의 골절 이후 여러 합병증이 발생할 수 있다. 특히 과두 골절의 경우, 골절 이환 측에서 성장장애를 일으켜 부정교합과 안면비대칭을 야기할 수 있다. 하악의 골절 이후 성장 장애가 발생한 경우, 환자에 따라 catch-up growth가 일어날 수 있으므로 주기적인 관찰이 필요하다. 성장장애가 지속되는 경우엔 안면 비대칭이 심해지는 것을 방지하기 위해 기능성 장치의 사용을 고려할 수 있다. 본 증례에서는 하악의 골절 이후 안면비대칭을 보이는 2명의 환자를 장기적으로 관찰하고 의미 있는 결과를 나타내고 있기에 이를 보고하는 바이다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제41권
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• pp.48.1-48.7
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• 2019

Background: Soft tissue asymmetry such as lip canting or deviation of the philtrum is an important influencing factor for unbalanced facial appearance. Lip canting could be improved by the correction of the occlusal canting or positional change of the mentum. Although there are many studies about changes of lip canting, however, postoperative changes of philtrum deviation have not been yet reported. In this study, we investigate the positional change of the philtrum after orthognathic surgery and influencing factors. Methods: Positional change of the philtrum was evaluated in 41 patients with facial asymmetry who underwent bimaxillary surgery, in relation to other anatomical soft tissue landmarks using a frontal clinical photo. The surgical movement of the maxillary and mandibular dental midline and canting were measured in postero-anterior cephalogram before and 1 day after surgery. The same procedure was repeated in patients with more than 1.5 mm perioperative change of the mandibular dental midline after bimaxillary surgery. Results: Maxillary dental midline shifting and canting correction did not have a significant correlation with lateral movement of the philtrum midline. However, the mandibular shift had a statistically significant correlation with a lateral movement of the philtrum (p < 0.05) as well as other linear parameters and angle values. Conclusion: The horizontal change of the philtrum is influenced by lateral mandibular movement in patients with facial asymmetry, rather than maxillary lateral movement.