• Maxillofacial Plastic and Reconstructive Surgery
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• 제16권1호
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• pp.12-20
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• 1994

Generally, the totally paralyzed face can never be made normal by any of the current methods of reconstruction. Careful selection of patients based on sound judgment of what can and cannot be achieved by the proposed surgical technique is paramount to a successful operation and a satisfied patient. The results are related to time of delayed between injury and repair ; the shorter the delay the better are the results. The objectives in correcting facial paralysis are to achieve normal appearance at rest ; symmetry with voluntary motion ; control of the ocular, oral, and nasal sphincter ; symmetry with involuntary emotion and controlled balance when expressing when expressing emotion ; and no significant functional deficit secondary to the reconstructive surgery. It must be employed a number of concepts, for treatment of the paralyzed face by surgeon, depending on the cause, time interval, and wound characteristics, as well as the availability of and necessity for neuromuscular substitution. Nerve grafts, crossovers, muscle transfers, free muscle and nerve-muscle grafts, micronuerovascular muscle transfers, and regional muscle transposition are the principal methods being developed. We applied the temporal musle transposition for reanimation of unilatrally paralyzed faces for long times on two patients. The results of muscle transposition can be enhanced by the patient's learning to activate the transposed muscle by voluntary effort, and are best in patients who are motivated to learn the necessary motor-sensory coordination techniques.

• 대한한의학회지
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• 제30권3호
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• pp.15-27
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• 2009

Objective : This study was carried to identify the anatomical component of BMM (Foot Taeyang Meridian Muscle in the human truncus), and further to help the accurate application to real acupunctuation. Methods: The human truncus was stripped off in order to demonstrate muscles, nerves and other components, and to display the internal structure of the BMM, dividing into outer, middle, and inner parts. Results: The BMM in the human truncus is composed of muscles, nerves, ligaments etc. The internal composition of the BMM in the human truncus is as follows: 1. Muscle A. Outer layer: medial palpebral ligament, orbicularis oculi, frontalis, galea aponeurotica, occipitalis, trapezius, latissimus dorsi, thoracolumbar fascia, gluteus maximus. B. Middle layer: frontalis, semispinalis capitis, rhomboideus minor, serratus posterior superior, splenius cervicis, rhomboideus major, latissimus dorsi, serratus posterior inferior, levator ani. C. Inner layer: medial rectus, superior oblique, rectus capitis, spinalis, rotatores thoracis, longissimus, longissimus muscle tendon, longissimus muscle tendon, multifidus, rotatores lumbaris, lateral intertransversi, iliolumbaris, posterior sacroiliac ligament, iliocostalis, sacrotuberous ligament, sacrospinous ligament. 2. Nerve A. Outer layer: infratrochlear nerve, supraorbital n., supratrochlear n., temporal branch of facial n., auriculotemporal n., branch of greater occipital n., 3rd occipital n., dorsal ramus of 1st, 2nd, 3rd, 4th, 5th, 6th, 7th, 8th, 9th, 10th, 11th, 12th thoracic n., dorsal ramus of 1st, 2nd, 3rd, 4th, 5th lumbar n., dorsal ramus of 1st, 2nd, 3rd, 4th, 5th sacral n. B. Middle layer: accessory nerve, anicoccygeal n. C. Inner layer: branch of ophthalmic nerve, trochlear n., greater occipital n., coccygeal n., Conclusions : This study shows that BMM is composed of the muscle and the related nerves and there are some differences from already established studies from the viewpoint of constituent elements of BMM at the truncus, and also in aspect of substantial assay method. In human anatomy, there are some conceptional differences between terms (that is, nerves which control muscles of BMM and those which pass near by BMM).

• 대한구순구개열학회지
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• 제3권2호
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• pp.41-50
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• 2000

The alar base on the cleft side in unilateral complete cleft lip, alveolus and palate is markedly displaced laterally, caudally and dorsally, By incising the pyriform margin from the cleft margin of the alveolar process, including mucosa of the anterior part of the inferior turbinate, to the upper end of the postnasal vestibular fold, the alar base is released from the maxilla, A physiological correction of nasal deformity can be accomplished by careful reconstruction of nasolabial muscle integrity, functional repair of the orbicular muscle, raising and rotating the displaced alar cartilage, and finally by lining the lateral nasal vestibule, The inferior maxillary head of the nasal muscle complex is identified as the deeper muscle just below the web of the nostril, The muscle is repositioned inframedially, so that it is sutured to the periosteum that overlies the facial aspect of the premaxilla in the region of the developing lateral incisor tooth, And then, the deep superior part of the orbicular muscle is sutured to the periosteum and the fibrous tissue at the base of the septum, just in front of the anterior nasal spine, The nasal floor is surgically created by insertions of the nasal muscle complex in deep plane and of the orbicular muscle in superficial one, The upper part of the lateral nasal vestibular defect is sutured by shifting the alar flap cephalically, The middle and lower parts of this defect are closed by use of cleft margin flaps of the philtral and lateral segments, respectively, Authors stress the importance of nasal floor reconstruction at primary surgery and report the technique and postoperative results.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제37권6호
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• pp.539-544
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• 2011

Maxillary canting and vertical shortening of the unilateral mandibular ramus height is common in cases of severe facial asymmetry. Normally, mandibular distraction osteogenesis (DO) with horizontal osteotomy at the ascending ramus is used for vertical lengthening of the mandibular ramus to correct facial asymmetry with an absolute shortened ascending ramus. In this case report, vertical lengthening of the ascending ramus was performed successfully with unilateral DO and sagittal split ramus osteotomy (SSRO), where the posterior part of the distal segment can be distracted simultaneously in an inferior direction with maxillary DO, resulting in a lengthening of the medial pterygoid muscle. This case describes the acquired unilateral mandibular hypoplasia caused by a condylar fracture at an early age, which resulted in abnormal mandibular development that ultimately caused severe facial trismus. The treatment of this case included two-stage surgery consisting of bimaxillary distraction osteogenesis for gradual lengthening of the unilateral facial height followed by secondary orthognathic surgery to correct the transverse asymmetry. At the one year follow-up after SSRO, the vertical length was maintained without complications.

• Archives of Plastic Surgery
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• 제42권6호
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• pp.735-740
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• 2015

Background Botulinum toxin (BT) chemodenervation and anterior belly of digastric muscle (ABD) transfer are both treatment options in the management of an isolated marginal mandibular branch of the facial nerve (MMB) palsy. We compare the patient satisfaction following either BT injections or ABD transfer in the management of their isolated MMB palsy. Methods Patients in the ABD-arm of the study were identified retrospectively from September 2007 to July 2014. The patients in the BT-arm of the study were identified prospectively from those attending the clinic. Both groups of patients completed a validated patient satisfaction survey. Statistical analysis was performed and a P-value <0.05 was considered statistically significant. Results Seven patients were in the ABD-arm and 11 patients in the BT-arm of the study. The patient satisfaction in both groups was high with 45% of ABD-arm patients and 40% of BT-arm patients rating their overall outcome as 'better' or 'much better', which was significantly more than the proportion rating their outcome as 'worse' or 'much worse' (P<0.001), although there was a significant trend towards those in the ABD-arm being more likely to be dissatisfied with their outcome (P=0.01). Conclusions BT therapy is a good first-line intervention in the management of isolated MMB palsy. We have, however, shown that the overall satisfaction in both groups is high. Therefore, in patients who would prefer a more permanent solution to manage their facial asymmetry, ABD transfer remains a satisfactory treatment option with a good level of patient satisfaction.

• 대한두개안면성형외과학회지
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• 제25권1호
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• pp.22-26
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• 2024

Background: This study analyzed the demographic characteristics of patients with facial palsy who were treated using either dynamic or static procedures. This study aimed to compare the frequency of procedure implementation and age distribution between the two groups. Methods: This study retrospectively analyzed the medical records of patients treated for facial palsy at a single institution from 2014 to 2022. Among cases included in our study, dynamic procedures involved cross-facial nerve graft and latissimus dorsi or gracilis muscle flap transfer. Static procedures included gold weight insertion, canthopexy, browlift, and thread lift/static slings. Results: Among the 31 patients included in our study, eight (25.8%) incorporated dynamic techniques, and the average age of patients was 44.75 years (range, 24-68 years) with a male to female ratio of 1:4. The remaining 23 patients (74.2%) underwent a static procedure, of which the average age was 59.17 years (range, 23-81 years) which was statistically significantly higher than the average age of 44.75 of dynamic patients (p= 0.013). Regarding the timing of treatment after diagnosis, no patient underwent dynamic procedures more than 20 years after initial diagnosis. A greater diversity in the timing of treatment was observed in the static group. All patients who underwent dynamic procedures were treated using static procedures during the study period. Conclusion: Because aesthetics-based static techniques are typically quick outpatient procedures that can be performed under local anesthesia, our study shows that these are often preferred treatments for all age groups, especially for debilitated or older patients. Further research is required to investigate the long-term functional outcomes of these surgical techniques in a wider population of patients.

• Anatomy and Cell Biology
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• 제56권3호
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• pp.308-312
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• 2023

The bony notch on the inferior border of the mandible, anterior to the attachment of the masseter muscle, where the facial vessels commonly pass, has been called different names in the literature, e.g., premasseteric notch, antegonial notch, and notch for the facial vessels. Interestingly, various disciplines have leaned toward different names for this notch. Therefore, to aid in consistent communication among professionals, the present study aimed to analyze usage of these varied terms and make recommendations for the best terminology. Based on the adjacent anatomical structures used to name this notch, three groups were analyzed in this study, a group using masseter in the term, a group using gonion in the term, and a group using facial vessels in the term. A literature search found that the group using gonion in the term was found most in the literature. The orthodontics field used gonion in the term the most (29.0%: 31/107) followed by the oral and maxillofacial surgery field (14.0%: 15/107), the plastic surgery field (4.7%: 5/107), and the anatomy field (3.7%: 4/107). The dental field used gonion in this term the most (43.9%: 47/107) and the medical field used facial vessels in the term the most (33.3%: 6/18). Based on these results, the use of gonial terms for this notch seems to be preferred.

• 대한기관식도과학회:학술대회논문집
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• 대한기관식도과학회 1982년도 제16차 학술대회연제순서 및 초록
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• pp.16.1-16
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• 1982

구순은 음식이 구강을 통과하는데 뿐만 아니라 음절을 구성 하는데도 중요한 역할을 한다. 구순을 이루고 있는 Orbicularis oris 근육이 괄약근으로 작용하여 강한 수축을 하여야 구순의 완전한 폐쇄를 이룰수 있고 구순의 모양을 형성할 수 있게 된다. 또 이 Orbicularis oris근육이 유지되기 위해서는 Orbicularis oris 근육주위의 여러 근육들이 서로 길항 혹은 협력할수 있어야만 한다. 구순재건술의 관점에서 가장 중요한 것은 안면신경과 혈관은 보존하면서도 괄약작용에 손실없이 주위근육으로부터 Orbicularis oris 근육을 분리할 수 있어야 한다는 것이다. 저자들은 교상으로 인하여 하구순 결손 환자에서 구순재건술을 시행하여 그 기능과 미용에 있어서 좋은 결과를 얻었으므로 문헌과 함께 보고하는 바이다.

• Journal of Oral Medicine and Pain
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• 제36권1호
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• pp.39-51
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• 2011

본 연구는 측두하악장애의 연구 진단 기준(Research Diagnostic Criteria for Temporomandibular Disorder; RDC/TMD)을 이용하여 구분된 측두하악장애(Temporomandibular Disorder; TMD) 환자를 대상으로 안면의 골격적 양상과 TMD 사이의 연관성을 규명하고 교정 환자의 진단과 치료에 있어 RDC/TMD의 활용 가능성을 제시하고자 하였다. 서울대학교 치과병원 구강내과에 측두하악장애의 진단과 치료를 위해 내원한 여성 환자들의 의무 기록 및 방사선사진을 검토하였으며 환자의 연령이 18세 미만이거나 전신 질환, 골격적 기형 또는 측두하악관절 부위의 외상 병력이 있는 경우는 제외되었다. 총 96명의 여성 환자로부터 얻은 RDC/TMD Axis I 을 포함한 임상 검사 결과와 측방 두부규격방사선사진 (lateral cephalogram), 파노라마 방사선사진(panoramic radiograph) 및 횡두개 방사선사진(transcranial radiograph)을 이용한 방사선적 검사 결과를 분석하였다. RDC/TMD를 이용하여 집단을 분류한 후 측방 두부규격방사선사진의 각도 및 길이 요소들을 계측하여 안면의 골격 관계, 상하악 관계 및 치열 관계를 분석하였다. 통계적 분석법으로는 독립표본 t-검정(independent t-test), 일원분산분석(one-way Analysis of Variance; one-way ANOVA) 및 카이제곱 검정(chi-square test)을 이용하였고 다음과 같은 결과를 얻었다. 1. 근육 문제를 진단하는 RDC/TMD Axis I 의 제 1 군 측두 두부방사선적 특징에서 통계적 유의성이 인정되지 않았다. 2. 관절원판 변위를 임상적으로 진단하는 제 2 군에서는 개구 장애를 동반하지 않는 비정복성 관절원판 변위가 있는 경우 관절원판 변위가 없는 정상 집단에 비하여 articular angle이 큰 것으로 나타났다. 3. 관절통, 관절염 및 관절증을 진단하는 제 3 군에서는 articular angle, FMA, Bjork sum, posterior facial height 및 facial height ratio에서 유의한 차이가 있는 것으로 분석되었다. 4. TMD 진단군과 골격적 양상 사이의 관계를 단순화하기 위하여 RDC/TMD Axis I 각 군을 양분법적으로 분류한 뒤 동일 한 방식으로 분석을 시행하였다. 그 결과 제 1 군에서는 overjet, 제 2 군에서는 articular angle, facial height ratio 및 IMPA, 마지막으로 제 3 군에서는 articular angle, gonial angle, facial convexity, FMA, Bjork sum, posterior facial height, facial height ratio 및 ANB angle에서 유의한 차이를 보였다. 이상의 RDC/TMD Axis I 을 이용하여 진단된 측두하악장애 환자를 대상으로 안면의 골격적 양상과 TMD 사이의 연관성 을 분석한 결과로부터 RDC/TMD Axis I 임상 진단에 따라 진단한 측두하악장애 환자 중 제 2 군과 제 3 군의 환자들에서 측두하악장애와 관련된 것으로 알려진 하악골의 후하방 회전으로 인한 골격적 차이가 존재함을 확인하였다. RDC/TMD Axis I은 교정 전 혹은 교정 치료 진행 중에 임상 검사 및 일반 방사선사진으로부터의 제한된 정보를 바탕으로 교정 치료 중 고려하여야 할 TMD 환자를 감별하는데 유용한 정보를 제공할 수 있을 것이다.

• Archives of Plastic Surgery
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• 제37권2호
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• pp.161-168
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• 2010

Purpose: Surgical approaches to the condylar neck and subcondyle area can cause some morbidity such as, facial nerve injury, time-consuming nature and external scar etc. So many surgeons hesitate using open reduction and internal fixation for the treatment of subcondylar fractures. We report open reduction and internal fixation of subcondylar fractures in 13 adult patients via transmasseteric approach. Methods: From 2007 to 2009, 13 adults with subcondylar fracture of mandible were treated with open reduction and internal fixation via transmasseteric approach. A preauricular incision was extended downwards in a curvilinear fashion in the cervicomastoid skin crease. Skin flap was elevated above the SMAS layer. Masseter muscle was splitted at the anteroinferior edge of the parotid gland. After the fracture was reduced, fixed with appropriate plates and screws. All operation were performed under general anesthesia. Results: Mean follow-up period was 13.3 months. There were no signs and symptoms of facial nerve injury, difficulty in mouth opening, or malocclusion. Dissection time was roughly within 30 minutes. Conclusion: Transmasseteric open reduction and internal fixation of mandible subcondylar fracture can be performed with excellent visualization, and inconspicuous scar. It also offers swift access to the subcondylar area while substatially reducing the risk to the facial nerve and eliminating the complications associated with transparotid approaches.