• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.29 no.2
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• pp.95-101
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• 2003

The purpose of this study was to evaluate the patterns of skeletal changes of proximal and distal segments after one jaw surgery and two jaw surgery with posterior impaction using SSRO on mandible in order to determine the skeletal origin of relapse and compare the stability of surgical methods in anterior open bite. The points and lines from lateral cephalometrics were measured before, after surgery, and at least 6-month follow up period. And then, the positional change of the proximal and distal segment were evaluated respectively. The results obtained were as follows; In cases of two jaw surgery, the results were stabler because they had less relapse factors. In cases of one jaw surgery, the value of APD were increased but it didn't relapse to the original value. Both of proximal and distal segments were responsible for the relapse tendency. But in one jaw surgery, the rotation of proximal segment was more responsible, and in two jaw surgery, the rotation of distal segment was.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.37
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• pp.9.1-9.7
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• 2015

Background: This study are to identify the symptomatic changes and condylar stability after 2 jaw surgery without preceding treatments for Temporomandibular joints(TMJ) in class III patients with the TMJ symptoms; and to assess therapeutic effect of 2 jaw surgery and the necessity of preceding treatment for alleviation of TMJ symptoms. Methods: 30 prognathic patients with preexisting TMJ symptoms were divided into 2 groups according to presence or absence of preceding treatments before the surgery. We evaluated symptomatic changes on both TMJ by questionnaires and clinical examinations. And we reconstructed 3D cone beam computed tomography images before 2 jaw surgery, immediately after the surgery, and 6 months or more after the surgery with SimPlant software, and analyzed the stability of condylar position on 3D reconstruction model. Significances were assessed by the Wilcoxon signed rank test on SPSS ver. 20.0. Results: Both groups had favorable changes of TMJ symptoms after orthognathic surgery. And postoperative position of condyle had good stability during follow-up period. Conclusion: 2 jaw surgery without preceding treatments for TMD can have therapeutic effect for TMD patients with class III malocclusion.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.23 no.5
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• pp.428-434
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• 2001

Few topics in operative and perioperative patient management generate more controversy than that of appropriate fluid and electrolyte therapy. especially, controversy has swirled around colloid vs crystalloid therapy and the composition of administered fluids, agreement among clinicians as to what fluid therapy is appropriate, and in what amount, is rare. This controversy likely will be enhanced by Arieff' s provocative article. He described 11 adults and 2 pediatric patients. All developed fatal postoperative pulmonary edema, seemingly caused solely by excessive postoperative fluid administration. From January 1999 to December 1999, we investigated 24 patients, which were operated by orthognathic surgery, about the intraoperative fluid therapy and the associated effect in orthognathic surgery, which is regarded as one of the major surgery of oral and maxillofacial surgery. First, They were devided into two groups, that is one-jaw surgery and two-jaw surgery, and each groups were devided by intraoperative fluid volume of 8ml/kg/hr. Subjective assesment was collected through use of a series of 3 questionnaries. In each questionnaire, a 5-point Liekert scale was used far assessment of following parameters of recovery from anesthesia: headache, dizziness, drowsiness, nausea/vomiting, thirst. The patient completed questionnaire 1 at 4 hour after surgery, questionnaire 2 was completed at 24 hours after surgery, and questionnaire 3 was completed at 48 hours after surgery. This study demonstrated that appropriated perioperative rehydration decreases postoperative adverse outcomes and improved the patient's perception of the postoperative period.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.42
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• pp.11.1-11.8
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• 2020

Background: The purpose of this study is to compare the skeletal stability of two-jaw surgery via surgery-first approach with conventional two-jaw surgery in facial asymmetry patients by measuring the skeletal changes after surgery from a three-dimensional analysis. From January 2010 to January 2014, 40 patients with facial asymmetry who underwent two-jaw surgery in Pusan National University Hospital were included in this study. They were classified into experimental group (n = 20) who underwent two-jaw surgery via surgery-first approach and control group (n = 20) who underwent conventional two-jaw surgery. After selection of 24 landmarks and the construction of horizontal and sagittal, coronal reference planes, changes in 10 linear measurements and 2 angular measurements were compared between the surgery-first approach and conventional groups in the preoperative, immediate postoperative, and postoperative periods. The paired t test and Student t test were used for statistical analysis. The mean and standard deviation of the measurement were calculated for the experimental and control groups. Results: The statistical analysis showed that changes in skeletal measurements were similar between the surgery-first approach and conventional groups, according to each period. However, U1-SRP measurement showed statistically significant changes in surgery-first approach groups at postsurgical change (T1 to T2). Also, the mean treatment duration in the treatment group was 15.9 ± 5.48 months whereas that in the control group was 32.9 ± 14.05 months. Conclusion: In facial asymmetry patients, similar results were observed in the postoperative skeletal stability when 2-jaw surgery via surgery-first approach was compared with conventional 2-jaw surgery. However, significant lateral deviation of upper incisor midline was observed. In addition, a shorter average treatment duration was observed. To stabilize the unstable occlusion after surgery, increased wearing of the stent and proactive rubber guidance will be needed.

• The korean journal of orthodontics
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• v.54 no.2
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• pp.89-107
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• 2024

Objective: This systematic review aimed to provide a comparative analysis of the treatment outcomes, including hard and soft tissues, postoperative stability, temporomandibular disorders (TMD), and quality of life (QoL), in patients with facial asymmetry who underwent orthognathic surgery. Methods: The primary objective was to address the question, "How do different factors related to surgery affect the outcomes and stability of orthognathic surgery in the correction of facial asymmetry?" A meta-analysis was conducted on the outcome parameters, such as skeletal, dental, and soft tissue symmetry, TMD, QoL, and relapse, using the Hartung-Knapp-Sidik-Jonkman method for random-effects models. Subgroup analyses were conducted considering surgery-related factors such as surgical techniques (one-jaw vs. two-jaw), use of the surgery-first approach, utilization of computer simulation, and analytical methods employed to evaluate asymmetry (2D vs. 3D). Results: Forty-nine articles met the inclusion criteria. The metaanalysis demonstrated a significant improvement in the symmetry of hard and soft tissues. The subgroup analysis indicated that the treatment outcomes showed significant improvement, regardless of the factors related to surgery. Changes in TMD signs and symptoms varied according to the surgical technique used. Quality of life improved in the facial, oral, and social domains. Skeletal relapse was observed during the follow-up. Conclusions: Our findings support the positive outcomes of orthognathic surgery in the treatment of facial asymmetry in terms of skeletal and soft tissue improvements, stability, relief of TMD symptoms, and enhancement of QoL. However, most of the included studies showed a low certainty of evidence and high heterogeneity.

• The korean journal of orthodontics
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• v.50 no.3
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• pp.157-169
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• 2020

Objective: The aim of this retrospective study was to evaluate the pre- and postsurgical bone densities at alveolar and extra-alveolar sites following two-jaw orthognathic surgery. Methods: The sample consisted of 10 patients (mean age, 23.2 years; range, 18.0-27.8 years; 8 males, 2 females) who underwent two-jaw orthognathic surgery. A three-dimensional imaging program (Invivo 5) was used with multidetector computed tomography images taken pre- and postoperatively (obtained 32.3 ± 6.0 days before surgery and 5.8 ± 2.6 days after surgery, respectively) for the measurement of bone densities at the following sites: (1) alveolar bone in the maxilla and mandible, (2) extra-alveolar sites, such as the top of the head, menton (Me), condyle, and the fourth cervical vertebrae (C4). Results: When pre- and postsurgical bone densities were compared, an overall tendency of decrease in bone density was noted. Statistically significant reductions were observed in the densities of cancellous bone at several areas of the maxillary alveolar bone; cortical and cancellous bone in most areas of the mandibular alveolar bone; cortical bone in Me; and cancellous bone in C4. There was no statistically significant difference in bone density in relation to the depth of the alveolar bone. In a comparison of the bone densities between groups with and without genioplasty, there was almost no statistically significant difference. Conclusions: Accelerated tooth movement following orthognathic surgery may be confirmed with reduced bone density. In addition, this study could offer insights into bone metabolism changes following orthognathic surgery, providing direction for further investigations in this field.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.33 no.2
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• pp.137-143
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• 2011

Purpose: Orthognathic surgery is required in patients with severe skeletal disharmony and facial asymmetry, which results in functional and esthetic improvement. Recently, bimaxillary surgery has become generalized. Establishment of the occlusal plane among several other factors included in the surgery plan is a major consideration for the diagnosis and treatment plan and it is also an important factor for postoperative stability. Methods: In this study, we assessed postoperative stability of occlusal plane, B-point, and pogonion point on 20 patients who underwent two-jaw surgery in the Chosun Dental Hospital from 2000 to 2007. Preoperative and postoperative states and at least a one year postoperative follow-up were compared. Results: The postsurgical relapse volume of the occlusal plane to the SN plane and the FH plane was $-0.26{\pm}2.8^{\circ}$ and $-0.44{\pm}3.29^{\circ}$, respectively and after two-jaw surgery, the stability of occlusal plane was maintained. The horizontal relapse degree was $0.85{\pm}0.46$ mm and $0.76{\pm}0.48$ mm, respectively, and the vertical relapse degree was $1.16{\pm}0.36$ mm and $1.13{\pm}0.71$ mm of the B point and the Pogonion point at the time after minimal 1 year. Conclusion: The vertical relapse amount was shown to be slightly larger than the horizontal relapse amount.

• The korean journal of orthodontics
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• v.27 no.1
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• pp.21-33
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• 1997

The purpose of this study was to investigate the factors affecting the postsurgical mandibular stability for both one- and two jaw surgery. 18 for one-jaw surgerys and 24 for two-jaw surgerys among skeletal class III malocclusion patients who experienced orthodontic treatment and orthognathic surgery at Pusan National University Hospital were selected. Lateral cephalograms taken at the first visit, after presurgical orthodontic treatment, immediately after surgery and follow-up over 6 months, were traced. Based ANOVA, multiple linear regression analysis was completed for one-jaw surgery with postsurgical stability as the criterion and the magnitude of mandibular setback, the change of mandibular incisor height during surgery, the changes of mandibular plane angle and mandibular incisor angle during presurgical orthodontic treatment as affecting factors. Same analysis was completed for two-jaw surgery with postsurgical stability as the criterion and the magnitude of mandibular setback as affecting factor. The results were as follows : 1. In the one-jaw surgery cases, the magnitude of mandibular setback, the change of mandibular incisor height during surgery, the changes of mandibular plane angle and mandibular incisor angle during presurgical orthodontic treatment explained the variability in postsurgical stability with a significant $R^2$ value of 0.84. 2. In the two-jaw surgery cases, the magnitude of mandibular setback explained the variability in postsurgical stability with a significant $R^2$ value of 0,28.

• Journal of The Korean Dental Society of Anesthesiology
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• v.12 no.1
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• pp.25-31
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• 2012

We report a case of 15 year-old Jehovah's Witness patient with mild anemia who underwent a successful orthognathic two-jaw surgery. Jehovah's Witness patients refuse transfusion of blood or blood products even in life threatening situations. The use of recombinant human erythropoietin and iron supplement increased hemoglobin during preoperative period. Intraoperatively, meticulous surgical hemostasis, acute normovolemic hemodilution and induced hypotension enabled the completion of the operation without the use of blood products.

• The korean journal of orthodontics
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• v.49 no.4
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• pp.254-264
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• 2019

Objective: To evaluate the short-term changes in masticatory muscle activity and mandibular movement patterns after orthognathic surgery in skeletal Class III patients with facial asymmetry. Methods: Twenty-seven skeletal Class III adult patients were divided into two groups based on the degree of facial asymmetry: the experimental group (n = 17 [11 male and 6 female]; menton deviation ${\geq}4mm$) and control group (n = 10 [4 male and 6 female]; menton deviation < 1.6 mm). Cephalography, electromyography (EMG) for the anterior temporalis (TA) and masseter muscles (MM), and mandibular movement (range of motion [ROM] and average chewing pattern [ACP]) were evaluated before (T0) and 7 to 8 months (T1) after the surgery. Results: There were no significant postoperative changes in the EMG potentials of the TA and MM in both groups, except in the anterior cotton roll biting test, in which the masticatory muscle activity had changed into an MM-dominant pattern postoperatively in both groups. In the experimental group, the amount of maximum opening, protrusion, and lateral excursion to the non-deviated side were significantly decreased. The turning point tended to be shorter and significantly moved medially during chewing in the non-deviated side in the experimental group. Conclusions: In skeletal Class III patients with facial asymmetry, the EMG activity characteristics recovered to presurgical levels within 7 to 8 months after the surgery. Correction of the asymmetry caused limitation in jaw movement in terms of both ROM and ACP on the non-deviated side.