• Maxillofacial Plastic and Reconstructive Surgery
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• 제32권5호
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• pp.488-492
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• 2010

This review evaluates the literature on the relationship between mandibular condylar process fracture and temporomadibular joint (TMJ). The topic of condylar fracture generated more discussion and controversy than any other field of maxillofacial trauma associated with TMJ. Disturbance of occlusal function, devia-tion of mandible, internal derangements of TMJ, and ankylosis of the joint with resultant inability to move the jaw are sequelae of condylar process fracture. Thus it is necessary to understand how the masticatory system adapts to the structural alterations that accompany fractures of the mandibular condyle. Treatment of condylar process fracture include two methods ; closed treatment and open treatment. If one chooses totreat closed, one must understand that adaptations in the musculature, skeleton, and dentition will be necessary. Open treatment of condylar process fractures probably requires fewer adaptations within the masticatory system to provide a favorable functional outcome. However, one must weigh the risk of open surgery against the possible improvement in outcome. The risks are not just surgical risk, but biological risk as well, such as disruption of the blood supply to the condyle. This review presents relevant aspects of change of TMJ associated with condylar process fracture.

• 대한치과의사협회지
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• 제55권10호
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• pp.706-714
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• 2017

Background Synocial chondromatosis(SC), a proliferative disorder of the synovial membrane. The etiology or cause of SC remains unclear. SC usually occurs in large articular joints such as knee, hip, elbow, and ankle. SC of the TMJ is very rare. It is a benign disease that mainly affects unilateral side. It can form cartilagenous and calcified loose bodies of various sizes and cause abnormal function of TMJ. Case Report In this paper, we report two cases of SC in the upper joint space of the left TMJ. One complained that "Sometimes the left jaw joint feels disoriented" and the other had no symptoms. CT scan and MRI showed left TMJ space widening, multiple tiny calcified mass. After clinical and radiographic analysis, we performed surgical removal of the lesion under genereal anesthesia. In the histologic examination, synovial chondromatosis was diagnosed in both patients. Conclusions We report two cases of synovial chondromatosis in the upper joint space of the left TMJ. We performed surgical removal of the lesion. The two patients showed good prognosis without recurrence or pain up to date.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제41권
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• pp.51.1-51.8
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• 2019

Purpose: It has been reported before that the amount of pharyngeal airway space (PAS) significantly decreases following mandibular setback (MS) surgery in patients with mandibular prognathism (MP). Further, MP patients with an anterior open-bite (AOB) presentation may show a larger decrease in PAS compared with those without AOB. However, studies on postoperative PAS changes in MP patients with AOB remain rare. This study sought to evaluate changes in PAS and hyoid bone positioning following MS surgery in MP patients with and without AOB. Patients and methods: Twenty patients who underwent two jaw surgery involving MS movement were included. Patients were divided into a non-AOB group (n = 10; overbite > 2 mm) and an AOB group (n = 10; overbite < - 4 mm). Three-dimensional changes in PAS and hyoid bone positioning were compared and statistically evaluated pre- and postoperatively using computed tomography (CT). Results: The mean magnitude of MS was 6.0 ± 2.8 mm and 5.6 ± 3.2 mm in the non-AOB group and AOB group, respectively. The oropharyngeal volume and upper hypopharyngeal volume were significantly reduced after surgery in both the groups (p = 0.006 and p = 0.003), while the retroglossal cross-sectional area was significantly reduced only in the AOB group (p = 0.028). Although the AOB group showed a larger decrease in PAS, the difference was not statistically significant between the groups. The position of the hyoid bone showed significant posterior and inferior displacement only in the AOB group, while the vertical displacement of the hyoid bone showed a statistically significant difference between the two groups. Conclusion: PAS was significantly decreased after MS in both the groups, while only the AOB group presented a statistically significant reduction in the retroglossal cross-sectional area. Vertical displacement of the hyoid bone showed a statistically significant difference between the groups, while the PAS change was not. Surgeons should be aware of potential postoperative airway problems that may arise when performing MS surgeries.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제33권4호
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• pp.319-322
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• 2011

Purpose: The purpose of this study was to examine the appropriate degree of set-back of the mandible by evaluating the rate of relapse after surgery. Methods: Among the patients who visited our hospital from January 2002 to January 2007 and who underwent orthognathic surgery, of the patients available for follow-up observation, the rate of relapse after surgery was investigated according to the set-back degree. The patients were divided into groups by the degree of set-back, and relapse was evaluated by the radiographs performed the day after surgery, 6 months after surgery, 1 year after surgery, 2 years after surgery and 3 years after surgery. Results: In cases that exceeded the limit of posterior movement of the mandible (13 mm) or that had the wrong position of the condyle, a greater tendency toward relapse was shown. Conclusion: Based on the results of this study, among the cases that required a large amount of posterior movement of the mandible, two jaw surgeries accompanied by bilateral sagittal split ramus osteotomy (BSSRO) and LeFort I osteotomy are recommended.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제38권
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• pp.49.1-49.9
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• 2016

Background: The aim of this report is to present a new reference for aesthetic mandible surgery using three-dimensional cone-beam computed tomography-based treatment planning for orthognathic surgery which can be implemented in surgical planning and perioperative procedure. Methods: To make an objective standard for evaluating aesthetic mandibular outline, we make an aesthetic scoring criteria with consideration of asymmetry, broad mandibular border line, and prominent mandibular angle. Two maxillofacial surgeons and two orthodontists rated their aesthetical evaluation from 1 to 5. Experimental group consisting of 47 female and 38 male patients who had rotational orthognathic two-jaw surgery from 2010 to 2011 were chosen according to aesthetic scoring done by two maxillofacial surgeons and two orthodontists. A high aesthetic score (${\geq}16$) means the facial contour is symmetric, with no broad and narrow aesthetic mandible frontal profiles. Control A group consisted of ten female and ten male patients who had no orthognathic surgery experience and low aesthetic score (${\geq}10$). Control B group consisted of ten female and ten male patients who had no orthognathic surgery experience and had anaesthetic mandibular frontal profile and a high aesthetic score (${\geq}16$). The three-dimensional image of the patient was taken from dental cone-beam CT (DCT) scanning (experimental group and control A group: 6 months DCT after surgery, control B group: 1st visit DCT). Each DCT was reformatted to reorient the 3D image using 3D analyzing program (OnDemand3D, cybermed Inc, CA, USA). After selection of 12 landmarks and the construction of reoriented horizontal, vertical, and coronal reference lines, 15 measurements were taken in 3D analysis of frontal mandibular morphology. Afterwards, horizontal and vertical linear measurements and angular measurements, linear ratio were obtained. Results: Mean $Go^{\prime}_{Rt}-Me^{\prime}-Go^{\prime}_{Lt}$ angular measurement was $100.74{\pm}2.14$ in female patients and $105.37{\pm}3.62$ in male patients. These showed significant difference with control A group in both genders. Ratio of $Go^{\prime}_{Rt}-Go^{\prime}_{Lt}-Me^{\prime}$ length to some linear measurements (ratio of $Me^{\prime}-Cd^{\prime}_{Rt}Cd^{\prime}_{Lt}$ to $Me^{\prime}-Go^{\prime}_{Rt}Go^{\prime}_{Lt}$, ratio of $Me^{\prime}-Go^{\prime}$ to $Me^{\prime}-Go^{\prime}_{Rt}Go^{\prime}_{Lt}$, ratio of $Go^{\prime}_{Rt}-Go^{\prime}_{Lt}$ to $Me^{\prime}-Go^{\prime}_{Rt}Go^{\prime}_{Lt}$) showed significant difference with control A group in both genders. Conclusion: This study was intended to find some standard measurement of mandible frontal view in 3D analysis of aesthetic patient. So, these potential measurement value may be helpful for orthognathic treatment planning to have more aesthetic and perspective outcomes.

• 대한두개안면성형외과학회지
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• 제19권4호
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• pp.291-295
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• 2018

Dental origins are a common cause of facial cutaneous sinus tracts. However, it can be easily overlooked or misdiagnosed if not suspected by a surgeon who is not familiar with dental origins. Cutaneous odontogenic sinuses are typically nodulocystic lesions with discharge and are most frequently located on the chin or jaw. This article presents two cases of unusual cutaneous odontogenic sinus presentations, as deep dimpling at the middle of the cheek. The patients were undergone surgical excision of sinus tract and dimpling immediate before and after treatment of causal teeth and the lesions resolved without recurrence. Surgeons should consider dental origins of facial dimpling lesions with discharge and provide appropriate treatment.

• 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.

• 대한치과교정학회지
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• 제29권2호
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• pp.239-249
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• 1999

악안면 부조화를 치료하여 적절한 기능적, 심미적 형태를 얻고자 하는 악교정 수술에 있어서는 정확한 진단과 치료계획의 수립이 필수적이다. 특히 심한 상 하악의 복합적인 문제를 가지고 있는 경우에 시행되는 양악 수술에선 상악골과 하악골이 삼차원적인 공간에서 동시에 재배치되는데, 상악골의 재배치에 따라 하악골은 전후 좌우 위치가 결정되면서 새로운 교합평면이 만들어진다. 따라서 교합평면은 양악 수술에서 중요한 기준이 되어 상악골의 새로운 위치를 결정하게되므로 진단 및 치료계획 수립시에 최적의 기능적, 심미적 결과와 수술 후 안정성을 얻을 수 있게 계획되어져야 한다. 본 연구에서는 양악 수술을 시행받은 골격성 제 III급 부정교합 환자 48명(남자25명 여자23명, 평균 연령 21.5세)을 대상으로 하여 교합평면의 설정에 사용되어지는 몇 가지 진단 기준중, 많이 사용되어지고 있는 Delaire의 구조적, 구성적 분석에 의한 각 개인의 이상적인 교합평면으로 수술되었을 때 경조직의 술후 안정성에 대해서 평가하고자 이상적인 교합평면에 부합되게 수술이 시행된 군(A군-24명)과 이 평면에서 벗어난 군(B군-24명)으로 나누어, 수술 직전($T_1$) 과 수술 직후($T_2$-평균 4.3일), 수술 8개월 이상 경과 후($T_3$-평균 1년 3개월)에 두군의 측모 두부 방사선 사진을 비교하여 다음과 같은 결론을 내렸다. 1. A군과 B군 모두 수술에 의하여 ANS의 수직적 위치보다 PNS의 수직적 위치가 감소되었다. 즉 상하악 복합체가 후상방으로 회전되었다. 2. $T_3$에 $T_2$와 유의차를 보이는 값은 두군 모두에서 수직 계측항목에서 HRP-Me(p<0.01), 각도 계측항목에선 Articular angle(p<0.01), Gonial angle(p<0.01), Mn. plane angle(p<0.05)이 유의차를 보였다. 두 군 모두에서 HRP-Me이 감소하면서 하악평면각은 증가 하였다. 3. A군과 B군사이에서 술후 경조직의 안정성에는 유의성 있는 차이가 없었다. 4. 수술에 의한 B와 Pog.의 수평 이동량은 수술후 B와 Pog.의 수평 재발량과 그리고 PNS의 수직 재발량과 통계적으로 유의성 있는 높은 역상관관계를 보였고, 하악평면각의 수술에 의한 변화량과 gonial angle의 술후 변화량과도 통계적으로 유의성 있는 높은 역상관관계를 보였다.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제30권4호
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• pp.345-348
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• 2004

Cephalic tetanus is a rare subtype of tetanus in which trismus is a charateristic symptom. The paralysis of one or more cranial nerves can occur. The 7th cranial nerve is most frequently involved. It account for 1 to 3% of the tetanus and has a mortality of 15 to 30%. The incubation period is 1 to 14 days, and approximately two thirds of tetanus cases progress to generalized tetanus. Generally, the symptoms of cephalic tetanus can include : facial pain, trismus, dysphagia, muscle twitching spasms of the face and jaw (risus sardonicus), neck stiffness and malaise. We present a case of cephalic tetanus who 54-year male patient had trismus and dysphagia. There was no history of trauma. As there was a delay in diagnosis of cephalic tetanus, respiratory disorder and intermittent general spasm occurred. The patient was treated by injection of antibiotics, muscle relaxant, and human anti-tetanus immunoglobulin. His symptoms were disappeared, and he was discharged ambulatory.

• 대한치과마취과학회지
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• 제10권2호
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• pp.166-171
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• 2010

Background: Controlled hypotension is used to reduce bleeding and improve surgical conditions during surgery. Nicardipine and remifentanil have been used to induce controlled hypotension in healthy patients. This study compared controllability of nicardipine and remifentanil on hemodynamic stability during controlled hypotension. Methods: Forty healthy patients scheduled for orthognathic two jaw surgery were randomly allocated to nicardipine (group N) and remifentanil (group R) group. After induction of anesthesia, group N (n = 20) was infused with nicardipine to induce hypotension and group R (n = 20) was infused with remifentanil. Mean arterial pressure (MAP) and heart rate (HR) were measured over 5 minute interval. Surgical field rating and blood loss were measured after surgery. Results: HR was lower in group R than group N. MAP was maintained at 50-60 mmHg during controlled hypotension but the fluctuation of blood pressure and HR were more frequent in group N than group R. There were no significant differences in the surgical field rating and blood loss between the groups. Conclusions: Nicardipine and remifentanil enabled controlled hypotension and provided good surgical conditions, but the fluctuation of hemodynamic parameters was more frequent in nicardipine group.