• Journal of Oral Medicine and Pain
• /
• 제38권3호
• /
• pp.255-260
• /
• 2013

양측 하악지 시상 골절단술은 악안면 기형 및 부정교합을 치료하기 위해 흔히 사용되는 필수불가결한 술식이라고 할 수 있다. 하악지 시상 골절단술 후 발생할 수 있는 합병증으로는 하치조 신경 손상, 출혈, 측두하악장애, 부적절한 골면의 유합 및 골절, 재발 등이 있다. 악교정 수술 후 안면신경 마비의 발생 유병율은 최근 0.1 퍼센트로 보고되고 있다. 증상 발생의 원인으로는 안면신경의 압박, 신경의 불완전 또는 완전 손상, 신경의 견인, 마취제에 의한 신경의 허혈 등이 있다. 술 후 발생된 안면 신경의 마비는 환자의 삶의 질을 저해하고 사회활동을 기피하게 함으로써 가장 심각한 합병증 중 하나라고 볼 수 있다. 본 증례에서는 양측 하악지 시상 골전달술을 시행 후 발생한 안면신경 마비에 대하여 보고하고 있다.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• 제42권
• /
• pp.21.1-21.6
• /
• 2020

Background: Fibula free flap mandible reconstruction is the standard procedure after wide resection of the mandible. Establishment and maintenance of normal occlusion are important in mandible reconstruction both intraoperatively and after surgery. However, scar formation on the surgical site can cause severe fibrosis and atrophy of soft tissue in the head and neck region. Case presentation: Here, we report a case of severe soft tissue atrophy that appeared along with scar formation after mandibular reconstruction through the fibular free flap procedure. This led to normal occlusion collapse after it was established, and the midline of the mandible became severely deviated to the affected side that was replaced with the fibula free flap, leading to facial asymmetry. We corrected the malocclusion with a secondary operation: a sagittal split ramus osteotomy on the unaffected side and a sliding osteotomy on the previous fibula graft. After a healing time of 3 months, implants were placed on the fibula graft for additional occlusal stability. Conclusion: We report satisfactory results from the correction of malocclusion after fibula reconstruction using sliding fibula osteotomy and sagittal split ramus osteotomy. The midline of the mandible returned to its original position and the degree of facial asymmetry was reduced. The implants reduced difficulties that the patient experienced with masticatory function.

• 구강회복응용과학지
• /
• 제22권4호
• /
• pp.271-281
• /
• 2006

Long term prediction of surgical result of skeletal class III has not been evaluated adequately because the stability of orthognathic surgery would be affected by not only set back amount of mandible but also many other factors like skeletal pattern, hyoid position, and airway size. The aimof this study is to discriminate the factors which affect the stability of post-treatment result of surgical outcome of sagittal split ramus osteotomy. We have collected 37 patients (male: 17, female: 20) from patients who have been treated at Orthodontic Department in Dankook University. The patients underwent 3 times Cephalometric X-ray taking at pre-, post-orthognathic surgery and after 12 months retention. The subjects were divided into 2 groups (Stable group: 21, Relapse group: 16) according to their relapse amount. We have taken following results from Students t-test and discriminant analysis. The discriminant factors which discern relapse and stable groupe among treatment change variables were BX and Ba-HY. Hyoid bone moved to posterior and inferior position due to surgery and repositioned superiorly and posteriorly during retention period. Skeletal patterns of the relapse group are smaller mandibular plane angle, anterior mandibular position, and greater distance from hyoid bone to cervical bone and mandible respectively.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• 제33권2호
• /
• pp.190-197
• /
• 2011

The management of mandibular prognathism was revolutionized by the advent of the of sagittal split ramus osteotomy (SSRO) technique as described by Obwegesser and Trauner in 1957. Facial nerve palsy following SSRO is a rare but serious problem. In the event of post-operative facial palsy, careful clinical and neurophysiological investigations such as a nerve condunction test for facial function is mandatory. The authors examined patients with facial palsy following SSRO. Patients recovered after 3~4 months and we had performed clinical examinations with electromyography and nerve conduction tests during follow-up period.

• 대한두개안면성형외과학회지
• /
• 제18권1호
• /
• pp.65-70
• /
• 2017

A 25-years-old woman with mandibular prognathism underwent a mandibular setback by way of mandibular sagittal split ramus osteotomy (MSSRO). After 2 days of operation, she developed difficulty of closing her right eye. The blink reflex test and motor nerve conduction study of the right orbicularis oris muscle were revealed right facial neuropathy of unknown origin and House-Brackmann facial nerve grading system (HBFNGS) grade V. For treatment, we initially prescribed oral prednisolone and nimodipine including physical therapy. The samples consisted of 11 facial nerve palsy patients caused by MSSRO and were analysed about onset of facial nerve palsy, postoperative HBFNGS, final HBFNGS, treatment method and recovery time. At 10 weeks of treatment of nimodipine, she had completely regained normal function (HBFNGS grade I) of the right facial nerve. The clinical results lead to assume a fast recovery of facial nerve function by the nimodipine medication, whereas average time of recovery is 16.32 weeks in references. Despite of the limited one patient treated, the result was very promising with respect to a faster recovery of the facial nerve function. Considering the use of nimodipine treatment for peripheral facial nerve palsy following a surgical approach with an anatomically preserved nerve can be recommended.

• 대한치과의사협회지
• /
• 제55권8호
• /
• pp.537-540
• /
• 2017

BSSRO (bilateral sagittal split ramus osteotomy) is frequently performed to correct dentofacial deformity and malocclusion. Among its complications the incidence of post-operative facial nerve palsy is very rare, but it is one of the most serious complications. The case of a 21-year-old male patient who underwent facial nerve palsy after BSSRO is described. After surgical intervention and conservative therapy, the patient recovered his facial nerve function successfully.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• 제36권5호
• /
• pp.185-191
• /
• 2014

Purpose: Although there have been several studies of reduced airway space after mandibular setback surgery using the sagittal split ramus osteotomy technique, research on the risk factors for changes of the airway space is lacking. Therefore, this study was performed to examine airway changes and the position of the hyoid bone after orthognathic surgery, and to assess possible risk factors. Methods: In this retrospective study, 50 patients who underwent posterior displacement of the mandible by the bilateral sagittal split ramus osteotomy technique were included. Changes of the position of the hyoid bone and the airway space were analyzed over various follow-up periods, using cephalometric radiography taken preoperatively, immediately after surgery, eight weeks after surgery, six months after surgery, and one year after surgery. To identify risk factors, multiple regression analysis of age, gender, body mass index (BMI), posterior mandibular movement, and the presence of genioplasty was performed. Results: Inferor and posterior movement of the hyoid bone was observed postoperatively, but subsequent observations showed regression towards the anterosuperior aspect. The airway space also significantly decreased after surgery (P<0.05), and increased slightly up until six months after surgery. The airway space significantly decreased (${\beta}=0.47$, P<0.01) as the amount of mandibular setback increased. However, age, sex, BMI, and presence of genioplasty were not associated with airway reduction. Conclusion: The amount of mandibular set back was significantly associated with postoperative reduction of airway space. It is necessary to establish a treatment plan considering this factor.

• Journal of Korean Dental Science
• /
• 제14권2호
• /
• pp.110-117
• /
• 2021

Purpose: The purpose of this article is to study the relationship of unintentionally extended split in the distal segment during the bilateral sagittal split ramus osteotomy (BSSRO) and skeletal relapse. Materials and Methods: Twenty patients with mandibular prognathism were divided into two groups according to whether or not unintentionally extended split had occurred. Cone-beam computed tomography images were taken before surgery (T0), immediately after surgery (T1), and postoperatively at 6 months (T2). The stability was evaluated by measuring the change of Nasion perpendicular-Pogonion (N-Pog) distance. Result: Both groups showed mild advancement of Pog during follow-up. In both groups, the condyle head rotated inward and moved posterioinferiorly after surgery, but tended to return to their original position during follow-up. Conclusion: There was no statistically significant difference between the two groups in mandible position. Moreover, the condylar position was stable. If it is difficult to proceed reduction of the unintentionally extended split, careful inspection should be performed to prevent subsequent complications during follow-up.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• 제47권4호
• /
• pp.249-256
• /
• 2021

Objectives: The purpose of this study was to evaluate the postoperative anteroposterior stability and improvements in facial asymmetry after performing LeFort I osteotomy in the maxilla, sagittal split ramus osteotomy (SSRO) and intraoral vertical ramus osteotomy (IVRO) in the mandible, and lateral corticectomy on the IVRO side. Materials and Methods: From July 2009 to October 2018, a retrospective analysis was performed on 11 subjects. Lateral cephalometric radiograph was performed preoperatively (T0), postoperatively (T1), and at 12 months of follow-up (T2), and the B point distance was measured. Posteroanterior cephalometric radiograph was performed preoperatively (S0) and at 12 months of follow-up (S1) and was used to measure five indicators (Ag angle, M-Ag, Co-Ag, Co-Me, and Ag-Me) of facial asymmetry. Results: The B point distances for T0 and T1 were significantly different (P=0.007), whereas those for T1 and T2 were not significantly different (P=0.1). In addition, there was a significant difference between the B point distances of T2 and T0 (P=0.026). Comparison of the facial asymmetry indicators before and after surgery showed a significant difference for all indicators between S0 and S1: the P-values of Ag angle, M-Ag, Co-Ag, Co-Me, and Ag-Me were 0.003, 0.003, 0.008, 0.006, and 0.004, respectively. The Z value was based on negative ranks. Conclusion: There was no significant difference in the B point distances from postoperation to the 12-month follow-up. However, there were significant differences in all five indicators related to facial asymmetry before and after surgery. The values for the five indicators of facial asymmetry all increased postoperatively.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• 제33권5호
• /
• pp.524-529
• /
• 2007

Objective: Autologous transfusion is frequently used with orthognathic surgery. The necessity of autologous transfusion has begun to question alone in bilateral sagittal split ramus osteotomy. The aim of this study was to evaluate the availability of autologous transfusion. Methods: The chart reviews of sixty patients who had undergone bilateral sagittal ramus osteotomy were done. The subjects were divided into two groups: In experimental group, 30 patients who autodonated 320ml in the preoperative 3 weeks actually received a transfusion in the postoperative 6 hours were included. In control group, 30 patients who underwent the same operation without preoperative donation and any other transfusion were included. Hemoglobin, hematocrit, and changes of these values in both groups were evaluated. Results: 1. From postoperative 3 hours to postoperative 1 day, the increases of hemoglobin(0.8g/dL in experimental group, 0.2g/dL in control group) and hematocrit(0.3% in experimental group, 0.6% in control group) were not statistically significant between both groups. 2. From postoperative 1 day to postoperative 1 week, the increase of hemoglobin(0.6g/dL in experimental group, 0.3g/dL in control group) was not statistically significant between both groups. But the increase of hematocrit(2.5% in experimental group, 1.0% in control group) was statistically significant between both groups over the same period(hematocrit p=0.043). 3. On postoperative 1 week, the values of hemoglobin(12.3% in both groups) and hematocrit(35.6% in experimental group, 36.8% in control group) were not statistically significant between both groups. Conclusion: The autologous transfusion in surgery of just a little blood loss was not effective. The most results show that there is little availability of autologous transfusion according to changes of hemoglobin and hematocrit in bilateral sagittal split ramus osteotomy.