• 대한치과교정학회지
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• 제49권1호
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• pp.59-69
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• 2019

In this report, we describe a case involving a 34-year-old woman who showed good treatment outcomes with long-term stability after multidisciplinary treatment for unilateral cleft lip and palate (CLP), maxillary hypoplasia, severe maxillary arch constriction, severe occlusal collapse, and gingival recession. A comprehensive treatment approach was developed with maximum consideration of strong scar constriction and gingival recession; it included minimum maxillary arch expansion, maxillary advancement by distraction osteogenesis using an internal distraction device, and mandibular setback using sagittal split ramus osteotomy. Her post-treatment records demonstrated a balanced facial profile and occlusion with improved facial symmetry. The patient's profile was dramatically improved, with reduced upper lip retrusion and lower lip protrusion as a result of the maxillary advancement and mandibular setback, respectively. Although gingival recession showed a slight increase, tooth mobility was within the normal physiological range. No tooth hyperesthesia was observed after treatment. There was negligible osseous relapse, and the occlusion remained stable after 5 years of post-treatment retention. Our findings suggest that such multidisciplinary approaches for the treatment of CLP with gingival recession and occlusal collapse help in improving occlusion and facial esthetics without the need for prostheses such as dental implants or bridges; in addition, the results show long-term post-treatment stability.

• 대한치과교정학회지
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• 제42권2호
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• pp.73-79
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• 2012

Objective: The purpose of this study was to investigate the effects of a newly developed rapid maxillary expansion screw-the memory screw-over 6 months. Methods: Five subjects, aged between 11.7 and 13.75 years, were enrolled in this study. All subjects underwent placement of a maxillary expansion appliance containing superelastic nickel-titanium open-coil springs in its screw bed. The parents of the patients and/or the patients themselves were instructed to activate the expansion screw by 2 quarter-turns 3 times a day (morning, midday, and evening; 6 quarter-turns a day). The mean expansion period was $7.52{\pm}1.04$ days. Dentoskeletal effects of the procedure, including dentoalveolar inclination, were evaluated. Measurements of all the parameters were repeated after 6 months of retention in order to check for relapse. Results: Sella-Nasion-A point (SNA) and Sella-Nasion/Gonion-Menton angles increased, and Sella-Nasion-B point (SNB) angle decreased in all the subjects during the expansion phase. However, they approximated to the initial values at the end of 6 months. On the other hand, the increments in maxillary apical base (Mxr-Mxl) and intermolar widths was quite stable. As expected, some amount of dentoalveolar tipping was observed. Conclusions: The newly developed memory expansion screw offers advantages of both rapid and slow expansion procedures. It widens the midpalatal suture and expands the maxilla with relatively lighter forces and within a short time. In addition, the resultant increments in the maxillary apical base and intermolar width remained quite stable even aft er 6 months of retention.

• 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 Yeungnam Medical Science
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• 제5권1호
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• pp.127-133
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• 1988

저자들은 영남대학교 의과대학 부속병원 치과에 상하악 치조전돌을 주소로 내원한 2명의 환자에게 상하악의 전치부 분절골절단술과 교정치료를 병행하여 심미적으로 좋은 결과를 얻었기에 치료결과를 아래와 같이 요약했다. 1. 전치부를 후방 위치시키는 외과적 술식으로 제 1소구치 발치 공간을 이용해 Wunderer, Kole방법을 사용했다. 2. crowding이 있었던 증례 2에서는 술전 교정으로 이를 해소했고 intrusion시키는 단계에서 외과적 시술을 시행하였다. 3. 술전 paper surgery, cast surgery에 의해 술후 결과를 어느 정도 예상할 수 있었다. 4. cast상에서 resin splint를 제작하여 6주 동안 악내고정하였고 이에 따라 악간고정은 필요치 않았다. 5. 증례 2에서 수술후 남아있는 deep bite를 개선하기 위해 술후교정을 시행했다. 6. 각각 3개월, 5개월 관찰하였는 바 아직까지는 relapse와 합병증이 나타나지 않았으며 심미적인 면에서 개선된 양상을 보였다.

• Archives of Plastic Surgery
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• 제34권1호
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• pp.123-127
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• 2007

Purpose: Rigid external distraction(RED) is a highly effective technique for correction of maxillary hypoplasia in patients with cleft or syndromic craniosynostosis. Despite many advantages of RED, it also has the problem of relapse as the conventional advancement surgery. Bicoronal approach, that is the common approach to gain access to the craniofacial skeleton, had some morbidity, such as hair loss, sensory loss, wide scar and temporal hollowing. We present our clinical experience of RED distraction with minimal invasive approach and early rigid fixation to overcome these disadvantages. Methods: A 27-year-old female patient with Crouzon's disease underwent Le Fort III osteotomy and RED device application through the minimal invasive direct skin incisions. After the latent period of 5 days, distraction was undertaken until proper convexity and advancement were obtained. During the rigid retention period, inflammation occurred on the right cheek, and proper conservative managements were done including continuous irrigation. To maintain the stability of distraction, early rigid fixation was undertaken on the osteotomy sites through another skin incisions. Preoperative and postoperative orthodontic treatments were performed. Serial photographs and cephalometric radiographs were obtained preoperatively, after distraction and 6 months after distraction. Results: The cephalometric analysis demonstrated postoperatively significant advancement of the maxilla and improvement of facial convexity. After 6-month follow-up period, the maxilla was stable in the sagittal plane and no relapse was found. Facial scars were not noticeable and other deformity and morbidity did not occur. Conclusion: This effective and stable technique will be a good alternative for the patients who need large amount of distraction and for adult patients with severe maxillary hypoplasia or syndromic craniosynostosis.

• 대한치과교정학회지
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• 제27권3호
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• pp.373-389
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• 1997

본 연구는 성장기 아동 중 골격성 III급 부정교합 환자에서 구외력을 이용한 상악골 전방견인시에 발생하는 경조직과 연조직의 변화와 상악골 전방견인 장치의 제거 후 관찰되는 경조직과 연조직의 재발 양상 및 이들의 상관성을 알아 보고자 하였다. 부산대학교병원 치과교정과에 내원하여 상악골 열성장을 동반하는 골격성 III급 부정교합으로 진단받은 아동 중 안면 비대칭과 순구개열이 없고 상악골 전방견인 치료 전이나 후에 상하악에서 고정성 또는 가철성 장치를 사용하지 않은 29명 (남자 10명, 여자 19명 )을 대상으로 상악골 전방견인 전,후와 장치제거 후 1-3개월때 채득한 측모두부 방사선 규격사진을 계측,분석하여 다음과 같은 결과를 얻었다. 1. 상악골 전방견인에 의하여 상순부 연조직은 그 하방 경조직과 함께 전하방 이동되었고 하순부 연조직은 경조직의 변화에도 불구하고 수평적으로는 비교적 안정적이었다. 2. 상악골 전방견인 장치제거 후 상하 전치의 재발양상에도 불구하고 상하순 모두 수평방향으로는 비교적 안정적이었으며 수직방향으로는 전방견인 후보다 더 하방이동 하였다. 3. 상악골 전방견인에 의하여 상악골과 상악치열이 전방 이동되었고 구개평면은 전상방 회전되었으며 하악골과 하악치열은 하후방 회전되었다. 4. 상악골 전방견인 장치제거 후 악골의 위치는 비교적 안정적이었으나 상하 전치의 치축과 전상방 회전되었던 구개평면이 치료 전 위치로 재발되었다. 5. 경조직과 연조직의 상관성 검정에서 입술의 위치는 그 하방 경조직과 밀접한 상관성을 보였다.

• 대한소아치과학회지
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• 제32권4호
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• pp.709-716
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• 2005

구순구개열 환자에서는 이른 시기에 시행된 수술로 인한 구순이나 구개부의 반흔 형성으로 섭식장애나 발음장애를 동반한 상악의 열성장이 나타나게 된다. 때로는 집중적인 교정치료 후에도 심한 상악골 저형성증을 보이며 이러한 경우성장이 완료 된 후에 골이식을 동반한 악교정 수술로 상악골을 전방이동시켜 안모의 개선을 도모하기도 한다. 그러나 이러한 상악골의 전방이동은 연조직의 과도한 신장으로 인한 술후회귀현상, 추가적인 골이식이 필요하다는 한계를 가지고 있다. 골신장술은 이러한 한계점을 극복하는 최신 치료방법으로 구순구개열 환자, 두개골 융합증을 나타내는 환자 등에서 상악골을 포함한 두개 안면골의 개선에 많이 이용되고 있다. 특히 구외장치를 이용하는 골신장술은 골신장기간 중에 견인 방향의 조절이 보다 쉬우며, 충분한 양의 골신장이 가능하여 보다 좋은 결과를 얻을 수 있다. 본 증례는 상악 열성장을 보이는 구순구개열 6세 7개월의 여자 환아로, 변형된 구내 르포씨 1형 골절단술(modified Le Fort I osteotomy) 후 두개골을 고정원으로 이용하는 견고 구외 골신장술을 통해 상악골을 전진시켜 양호한 결과를 얻었기에 이를 보고하는 바이다.

• 대한치과교정학회지
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• 제17권2호
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• pp.299-310
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• 1987

The purpose of this study was to examine soft tissue and hardtissue changes following orthognathic surgery in patients with mandibular prognathism lateral cephalometric films were obtained immediate before surgery, 48 hours following surgery, and 6 months following surgery. 18 patients were selected (10 men, and 6 women) for this study, who had received orthognathic surgery. Statistical analysis for the each time interval differences were performed with the SPSS package The results were as follows, *In the cases of mandibular sagittal split osteotomy 1 LI point was moved backward (average 7.55mm) 48 hours following surgery. 6 months later, it was returned forward (average 1.1mm) Relapse rate was 14.6% 2 Pog was moved backward (average 8.3mm) 48 hours following surgery The ratio of horizontal change of soft tissue to hard tissue at pog is 0.95 1 *In the cases of maxillary Le-Fort I osteotomy & mandibular sagittal split osteotomy. 3. A point was moved forward (average 3.31mm) 48 hours following surgery. 6 months later, it was returned backward (average 0.31) Relapse rate was 9 4% 4 6 months later, the ratio of facial convexity angle change of soft tissue to hard tissue is 0.63 1.

• 대한치과교정학회지
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• 제42권3호
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• pp.100-109
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• 2012

Objective: A national survey was conducted to assess orthodontic residents' current concepts and knowledge of cleft lip and palate (CLP) management in Korea. Methods: A questionnaire consisting of 7 categories and 36 question items was distributed to 16 senior chief residents of orthodontic department at 11 dental university hospitals and 5 medical university hospitals in Korea. All respondents completed the questionnaires and returned them. Results: All of the respondents reported that they belonged to an interdisciplinary team. Nineteen percent indicated that they use presurgical infant orthopedic (PSIO) appliances. The percentage of respondents who reported they were 'unsure' about the methods about for cleft repair operation method was relatively high. Eighty-six percent reported that the orthodontic treatment was started at the deciduous or mixed dentition. Various answers were given regarding the amount of maxillary expansion for alveolar bone graft and the estimates of spontaneous or forced eruption of the upper canine. Sixty-seven percent reported use of a rapid maxillary expansion appliance as an anchorage device for maxillary protraction with a facemask. There was consensus among respondents regarding daily wearing time, duration of treatment, and amount of orthopedic force. Various estimates were given for the relapse percentage after maxillary advancement distraction osteogenesis (MADO). Most respondents did not have sufficient experience with MADO. Conclusions: These findings suggest that education about the concepts and methods of PSIO and surgical repair, consensus regarding orthodontic management protocols, and additional MADO experience are needed in order to improve the quality of CLP management in Korean orthodontic residents.

• 대한구순구개열학회지
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• 제8권1호
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• pp.11-22
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• 2005

상악골의 열성장과 횡적 부조화, 그리고 광범위한 치조열 및 구강상악동 누공의 치료에 있어서 기존의 방법에 비해 골신장술을 사용하였을 경우, 본 증례들과 관련 문헌 고찰을 통하여, 견인량의 충분한 확보 및 회귀율의 최소화를 얻을 수 있으며, 또한 입원가료기간의 감소와 연조직 부조화의 해결을 볼 수 있어 구순구개열에 관련된 상악골 변형의 치료에 골신장술이 유용한 치료법이라 생각되어 보고한다.