• Archives of Craniofacial Surgery
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• v.17 no.1
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• pp.9-13
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• 2016

Background: Position of the facial foramina is important for regional block and for various maxillofacial surgical procedures. In this study, we report on anthropometry and morphology of these foramina using three-dimensional computed tomography (3D-CT) data. Methods: A retrospective review was performed for all patients who have undergone 3D-CT scan of the facial skeleton for reasons other than fracture or deformity of the facial skeleton. Anthropometry of the supraorbital, infraorbital, and mental foramina (SOF, IOF, MF) were described in relation to facial midline, inferior orbital margin, and inferior mandibular margin (FM, IOM, IMM). This data was analyzed according to sex and age. Additionally, infraorbital and mental foramen were classified into 5 positions based on the anatomic relationships to the nearest perpendicular dentition. Results: The review identified 137 patients meeting study criteria. Supraorbital foramina was more often in the shape of a foramen (62%) than that of a notch (38%). The supraorbital, infraorbital, and mental foramina were located 33.7 mm, 37.1 mm, and 33.7 mm away from the midline. The mean vertical distance between IOF and IOM was 13.4 mm. The mean distance between MF and IMM was 21.0 mm. The IOF and MF most commonly coincided with upper and lower second premolar dentition, respectively. Between the sex, the distance between MF and IMM was significantly higher for males than for female. In a correlation analysis, SOF-FM, IOF-FM and MF-FM values were significantly increased with age, but IOF-IOM values were significantly decreased with age. Conclusion: In the current study, we have reported anthropometric data concerning facial foramina in the Korean population, using a large-scale data analysis of three-dimensional computed tomography of facial skeletons. The correlations made respect to patient sex and age will provide help to operating surgeons when considering nerve blocks and periosteal dissections around the facial foramina.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.42
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• pp.32.1-32.4
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• 2020

Background: Le Fort I osteotomy is a highly effective treatment for skeletal jaw deformities and is commonly performed. High Le Fort I osteotomy is a modified surgical procedure performed for improving the depression of the cheeks by setting the osteotomy higher than the conventional Le Fort I osteotomy. Developments in three-dimensional (3D) technology have popularized the use of 3D printers in various institutions, especially in orthognathic surgeries. In this study, we report a safe and inexpensive method of performing a high Le Fort I osteotomy using a novel 3D device and piezosurgery, which prevent tooth root injury without disturbing the operation field for patients with a short midface and long tooth roots. Results: A 17-year-old woman presented with facial asymmetry, mandibular protrusion, a short midface, and long tooth roots. We planned high Le Fort I osteotomy and bilateral sagittal split ramus osteotomy. Prevention of damage to the roots of the teeth and the infraorbital nerve and accurate determination of the posterior osteotomy line were crucial for clinical success. Le Fort I osteotomy using 3D devices has been reported previously but were particularly large in size for this case. Additionally, setting the fixing screw of the device was difficult, because of the risk of damage to the roots of the teeth. Therefore, a different surgical technique, other than the conventional Le Fort I osteotomy and 3D device, was required. The left and right parts of the 3D device were fabricated separately, to prevent any interference in the surgical field. Further, the 3D device was designed to accurately cover the bone surface from the piriform aperture to the infra-zygomatic crest with two fixation points (the anterior nasal spine and the piriform aperture), which ensured stabilization of the 3D device. The device is thin and does not interfere with the surgical field. Safe and accurate surgical performance is possible using this device and piezosurgery. The roots of the teeth and the infraorbital nerve were unharmed during the surgery. Conclusions: This device is considerably smaller than conventional devices and is a simple, low-cost, and efficient method for performing accurate high Le Fort I osteotomy.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.35 no.4
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• pp.260-264
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• 2013

Calcium hydroxide root canal filing paste (vitapex) is widely used as canal filling paste for infected canal. However, chemical burn is possible because of the high alkali base of calcium hydroxide. A 57-year old woman was admitted to our clinic for consistent dull pain and paresthesia in the left upper lip, zygoma and buccal cheek area, which developed during an endodontic treatment of the left lateral incisor. Radiographic finding showed radiopaque material, which exits from the left incisor root apex, and was within the left canine and first premolar buccal soft tissue. The overfilled Vitapex extended to the soft tissue was surgically curetted. The result of the surgical curettage was favorable. Though slight hypoesthesia on the upper lip was still remained, paresthesia on zygomatic and buccal cheek area was completely recovered. As far as we know, this is the first case report of infraorbital nerve damage from overfilled Vitapex material.

• Journal of Korean Academy of Oral and Maxillofacial Radiology
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• v.22 no.2
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• pp.375-385
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• 1992

This is a report of adenoid cystic carcinoma occurred in the palate in 30-year-old patient with a complaint of exophytic mass. The authors diagnosed it as adenoid cystic carcinoma by the clinical examination, radiographic findings and histopathological findings. The obtained results are as follows: 1. In clinical examination, asymptomatic exophytic mass of palate was observed. 2. In radiographic findings, soft tissue mass infiltrated the left maxillary sinus, nasal cavity, infraorbital fossa, hard palate, pterygopalatine fossa and pterygoid plate, and enhanced soft tissue mass was also observed in CT. 3. In histopathological findings, tubular and solid patterns of glandular structures were observed and the infiltration of tumor cells into the nerve fibers was also observed. 4. Two years after radical surgery, radiation therapy and chemotherapy, the perineural spread to orbital area was observed. 5. Much longer follow-up than 5 years is needed for early diagnosis of recurrence and distant metastasis.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.29 no.3
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• pp.250-254
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• 2007

Dentigerous cysts are the most common type of developmental odontogenic cysts. They form as a result of a separation of the follicle from around the crown of an unerupted tooth. Usually this lesion can be asymptomatic. Such cysts are often discovered accidently on inspection of x-rays. In other advanced cases, cortical bone expansion, displacement of teeth, secondary infection can be observed. The treatment of dentigerous cyst is enucleation. And according to size, location of lesion and environmental structure marsupialization can be considered. However, Marsupialization takes long treatment time and, cystic tissues are remained so secondary surgery may be needed for total removal., Risks of oroantral fistula, damage on maxillary sinus wall and infraorbital nerve can be considered as complications of conventional surgical treatment of cysts located in maxillary sinus. We treated third molar origin dentogerous cyst located in maxillary sinus removing endoscopically both the tooth and an associated dentigerous cyst. We report our clinical experience with literature review.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.31 no.1
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• pp.74-81
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• 2005

In 1974, Casson et. al. reported midfacial degloving approach to repair the midfacial bone fracture. After then, this approach has been used frequently to treat the lesions on nasal cavity, nasopharynx, facial plastic surgery and midfacial trauma. Midfacial degloving approach consists of 1) bilateral sublabial incision 2) complete transfixion incision/ septocolumellar incision 3) bilateral intercartilaginous incision 4) bilateral pyriform aperature incision. This approach provides proper access for midfacial bone structure without facial scar but has post-operative complications such as transient epistaxis, infraorbital nerve paresthesia and nasal crust. We treated three patients using midfacial degloving approach to correct traumatic deformity in midface area. In two patients, rhinoplasty with autogenous rib graft was done simultaneously. So we report these cases with review of literatures.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.45 no.4
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• pp.192-198
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• 2019

Objectives: Oral and maxillofacial surgeons must gain mastery of various approaches to the midface due to the increasing incidence, complexity, and severity of presenting midfacial fractures. Unlike in the case of other body parts, the need to preserve facial aesthetics makes it more difficult for the surgeon to select an approach for managing the facial injuries. The midfacial degloving (MFD) approach is a combination of intraoral and intranasal incisions made to access the midface without any external incision. The aim of the present study was to evaluate the efficacy of MFD in maxillofacial surgery and to assess its advantages and complications. Materials and Methods: The MFD approach was used in five cases, with three cases treated with open reduction and internal fixation and two cases operated on for posttraumatic deformity. Nasal dorsum augmentation was completed in three cases and nasal osteotomy was performed in one case. The bicoronal flap technique was combined with MFD for frontal bone augmentation in one case. The intraoperative time required for flap completion and the ease of performing the planned procedures were noted. Postoperative evaluation was done for reduction, aesthetics, function, and complications. Results: Access was excellent for performing all planned procedures. Average time spent for flap elevation and exposure of the midface was 63 minutes. Complications like postoperative swelling, infraorbital nerve paresthesia, and intranasal crusting were all transient. No long-term complications like stenosis of the nose, sneer deformity, or weakness of the facial muscles were noticed. Additionally, no complications were noted when MFD was combined with bicoronal flap. Conclusion: Though the MFD approach is technically demanding and takes more time than other facial approaches, it should be learned and applied by maxillofacial surgeons in selective cases, as it provides complete exposure of the midface without facial scarring.

• Archives of Plastic Surgery
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• v.50 no.4
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• pp.370-376
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• 2023

Background The posterior ledge (PL) is a vital structure that supports the implant posteriorly during orbital floor reconstruction. This study describes a technique for mapping the PL in relation to the infraorbital margin (IM) in patients with orbital floor blowout fractures. This study establishes the location of the optic foramen in relation to the PL. Methods Facial computed tomography (FCT) scans of 67 consecutive patients with isolated orbital floor blowout fractures were analyzed using Osirix. Planes of reference for orbital fractures, a standardized technique for performing measurements on FCT, was used. Viewed coronally, the orbit was divided into seven equal sagittal slices (L1 laterally to L7 medially) with reference to the midorbital plane. The distances of PL from IM and location of optic foramen were determined. Results The greatest distance to PL is found at L5 (median: 30.1 mm, range: 13.5-37.1 mm). The median and ranges for each slice are as follows: L1 (median: 0.0 mm, range: 0.0-19.9 mm), L2 (median: 0.0 mm, range: 0.0-21.5 mm), L3 (median: 15.8 mm, range: 0.0-31.7 mm), L4 (median: 26.1 mm, range: 0.0-34.0 mm), L5 (median: 30.1 mm, range: 13.5-37.1 mm), L6 (median: 29.0 mm, range: 0.0-36.3 mm), L7 (median: 20.8 mm, range: 0.0-39.2 mm). The median distance of the optic foramen from IM is 43.7 mm (range: 37.0- 49.1) at L7.

• Korean Journal of Radiology
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• v.23 no.10
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• pp.976-985
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• 2022

Objective: To compare the clinical and radiological features of various etiologies of chronic diffuse lacrimal gland enlargement. Materials and Methods: We retrospectively reviewed 91 consecutive patients who underwent surgical biopsy for chronic diffuse lacrimal gland enlargement and were diagnosed with non-specific dacryoadenitis (DA) (n = 42), immunoglobulin G4-related dacryoadenitis (IgG4-RD) (n = 33), and lymphoma (n = 16). Data on patient demographics, clinical presentation, and CT imaging findings (n = 73) and MRI (n = 43) were collected. The following radiologic features of lacrimal gland enlargement were evaluated: size, unilaterality, wedge sign, angle with the orbital wall, heterogeneity, signal intensity, degree of enhancement, patterns of dynamic contrast-enhanced, and apparent diffusion coefficient value. Radiological features outside the lacrimal glands, such as extra-lacrimal orbital involvement and extra-orbital head and neck involvement, were also evaluated. The clinical and radiological findings were compared among the three diseases. Results: Compared to the DA and IgG4-RD groups, the lymphoma group was significantly older (mean 59.9 vs. 46.0 and 49.4 years, respectively; p = 0.001) and had a higher frequency of unilateral involvement (62.5% vs. 31.0% and 15.2%, respectively; p = 0.004). Compared to the IgG4-RD and lymphoma groups, the DA group had significantly smaller lacrimal glands (2.3 vs. 2.8 and 3.3 cm, respectively; p < 0.001) and a lower proportion of cases with a wedge sign (54.8% vs. 84.8% and 87.5%, respectively; p = 0.005). The IgG4-RD group showed more frequent involvement of the extra-orbital head and neck structures, including the infraorbital nerve (36.4%), paranasal sinus (72.7%), and salivary gland (58.6%) compared to the DA and lymphoma groups (4.8%-28.6%) (all p < 0.005). Conclusion: Patient age, unilaterality, lacrimal gland size, wedge sign, and extra-orbital head and neck involvement differed significantly different between lymphoma, DA, and IgG4-RD. Our results will be useful for the differential diagnosis and proper management of chronic lacrimal gland enlargement.