• 대한치과교정학회지
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• 제40권6호
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• pp.383-397
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• 2010

본 연구는 상순돌출을 동반한 골격성 III급 부정교합에서 전방분절골절단술(anterior segmental osteotomy, ASO)을 병용한 상행지시상분할골절단술(bilateral sagittal split ramus osteotomy, BSSRO)과 Le Fort I 골절 단술을 병용한 상행지시상분할골절단술(BSSRO) 후 상악의 경 연조직 변화 및 경조직 변화에 대한 연조직 변화율을 비교하였다. A군은 ASO/BSSRO를 시행한 군 14명, B군은 Le Fort I/BSSRO를 시행한 환자 중 상악의 후방부가 상방으로 이동(posterior impaction)된 15명으로 구성되었다. 수술 전 2개월 이내와 수술 후 6개월 이후에 촬영한 측모두부방사선사진을 분석하여 다음과 같은 결과를 얻었다. 두 군 모두 수술 후 상악 전방부 경조직과 연조직이 후방이동되었고, A군에서 더 큰 변화량을 보였다. A point의 후방이동에 따른 superior labial sulcus의 변화율은 A군에서 79%, B군에서 15%를 보였고, supradentale에 대해 labrale superious는 A군에서 80%, B군에서 68%의 비율로 후방이동하였다. 교합평면각은 B군에서 증가한 반면, A군에서는 통계적으로 유의성 있는 변화가 없었다. 이상의 연구결과 골격성 III급 부정교합의 양악수술 시 상악 수술은 상악 전방부와 상순의 돌출이 심한 경우에는 ASO를 시행하고 교합평면각의 증가가 필요한 경우에는 posterior impaction을 동반한 Le Fort I 골절단술을 시행하는 것이 바람직하다.

• Journal of Yeungnam Medical Science
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• 제7권1호
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• pp.203-210
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• 1990

저자들은 영남대학교 영남의료원 치과로 교통 사고후 부정유합으로 인한 부정교합으로 저작 곤란을 호소하며 내원한 환자를 상악골 수평 및 후방 분절 골절단술을 시행해 다음과 같은 결과를 얻었다. 1. 교통 사고후 부정유합된 상악골을 수평 및 후방 분절 골절단술을 이용하여 전방 치열의 반대 교합과 구치부의 개교 및 scissor's bite를 해소했다. 2. 술후 감염등 특기할 만한 합병증은 발생하지 않았으며 술후의 종창은 48시간이 지나면서 서서히 감소했다. 3. 수술후 악간고정은 8주간 시행했으며 악간 고정 제거 1주후 정상적인 개구가 가능했다. 4. 절단된 상악골 고정시 확고한 고정과 회귀성향을 줄이기 위해 miniplates로 고정했다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제31권1호
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• pp.53-60
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• 2009

Maxillary deficiency, anterior cross bite, constriction of maxillary arch, malaligned teeth are frequently observed in patients with cleft lip and palate. Surgery and orthodontics, combined intervention are needed to correct maxillary deficiency. Distraction osteogenesis that currently used has many advantages like less relapse tendency, more advancement of maxilla, capable in growing patients. In case 1, 18 years old girl with BCLP had severe midfacial deficiency and multiple missing of teeth. LeFort I osteotomy, followed by maxillary distraction osteogenesis utilizing rigid external distraction device(RED) system, was performed. After a 6-day latency period, distraction proceeded at a rate of 1mm per day (at 1st week, 1.5mm/day). Total advancement was 19mm. The RED device left in place for the additional 4 weeks for consolidation. After the RED device was removed, face mask was applied with elastic traction for 5 weeks. After achieving acceptable facial appearance and occlusion, orthodontic appliance was removed. The results after 4 years follow-up was sustained pretty well without aggravation of velopharyngeal function. In case 2, 22 years old man with UCLP had severe midfacial deficiency and palatally erupted upper 2nd premolars due to arch length discrepancy, but the anterior segment of maxillary did not show constriction and crowding. patient had no arch width discrepancy, crowding was concentrated on premolar region. Segmental LeFort I osteotomy was performed. After a 6 - day latency period, using internal distraction device, distraction proceeded at a 0.5mm per day(at 1st week, 0.75 - 1 mm/day). Total advancement was 15mm. After internal distraction device was removed, face mask was applied with elastic traction for 4 weeks. After surgical-orthodontic treatment, facial appearance and occlusion was improved pretty good, and after 46 months follow-up the result was retained well.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제46권6호
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• pp.385-392
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• 2020

Objectives: This study evaluates soft tissue changes of the upper lip and nose after maxillary setback with orthognathic surgery such as Le Fort I or anterior segmental osteotomy. Materials and Methods: All 50 patients with bimaxillary protrusion and skeletal Class II malocclusion underwent Le Fort I or anterior segmental osteotomy with backward movement. Soft and hard tissue changes were analyzed using cephalograms collected preoperatively and 6 months postoperatively. Results: Cluster analysis on the ratios shows that 2 lines intersected at 4 mm point. Based on this point, we divided the subjects into 2 groups: Group A (less than 4 mm, 27 subjects) and Group B (more than 4 mm, 23 subjects). Also, each group was divided according to changes of upper incisor angle (≥4°=A1, B1 or <4°=A2, B2). The correlation between A and B groups for A'/ANS and Ls/Is (P<0.001) was significant; A'/A (P=0.002), PRN/A (P=0.043), PRN/ANS (P=0.032), and St/Is (P=0.010). Variation of nasolabial angle between the two groups was not significant. There was no significant correlation of vertical movement and angle variation. Conclusion: The ratio of soft tissue to hard tissue movement depends on the amount of posterior movement in the maxilla, showing approximately two times higher rates in most of the midface when posterior movement was greater than 4 mm. The soft tissue changes caused by posterior movement of the maxilla were little affected by angular changes of upper incisors. Interestingly, nasolabial angle showed a different tendency between A and B groups and was more affected by incisal angular changes when horizontal posterior movement was less than 4 mm.

• 대한치과교정학회지
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• 제28권3호
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• pp.479-486
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• 1998

양악 전돌은 흔히 접하는 부정교합 증례로서, 대부분 상하순의 전돌에 의한 안모 심미성의 손상을 주소로 내원한다. 이러한 증례는 제 1소구치를 발거하고 그 공간을 이용하여 전치부를 견인하여 치료하는 경우가 많으며, 성공적인 치료 결과를 얻을 수 있다. 그러나, 성인 환자의 경우에는 환자의 협조도 불량으로 인한 악외 고정원 사용의 불량, 치료기간의 장기화, 치조골이 충분하지 못한 경우등에 있어서의 치근 흡수량의 증가, 구외 장치 사용으로 인한 환자의 사회심리적 부담감등의 부작용이 있다. 이의 해결방안의 하나인 근첨하 분절 골절단술은 고정원의 절대 보존, 치료기간의 단축, 구외 고정원 사용 필요성 제거 및 이를 통한 환자의 협조도 증가 등의 장점을 가지고 있다. 이에, 제 1소구치 발거 및 이 부위를 이용한 근첨하 분절 골절단술을 병행하여 치료한 치아치조 전돌의 증례를 치료 전후의 두부 방사선 계측 사진및 연구 모형을 통해 비교분석하여 변화를 살펴보고, 이의 장단점을 고찰해 보도록 하고자 한다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제28권3호
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• pp.242-246
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• 2006

Objective : This is to report the criteria of success of intraoral distraction osteogenesis for alveolar augmentation in the severely atrophied alveolar defects through clinical result of 2 cases. Subjects and Methods : Anterior segmental osteotomy was performed and alveolar distractors (Martin and Leibinger, Germany) were applied each in 2 patients with severely defected anterior maxillary area. The osteomized alveolar segments were distracted by 1mm a day after latency period. After the consolidation period implants were installed with removal of distractor. The implants were evaluated clinically and radiographically. Results : In Case I, the distracted bone was directed to the palatal side, and another augmentation treatment - block bone graft, guided bone regeneration - was needed. In Case II, the successful alveolar bone augmentation was achieved. Dental implant was placed on distracted alveolar bone, and showed good osseointegration and good function without any complication. Conclusion : Distraction osteogenesis can be a good choice for alveolar ridge augmentation of severely atrophied ridges. However, the anterior esthetic prosthetics relies on the control of the vector, the kind of distractor, the healing capacity of patient and the etiology of atrophy. Therefore another study of each category would be needed.