• Archives of Plastic Surgery
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• v.45 no.1
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• pp.23-28
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• 2018

Background Condylar process fractures account for one-third of all mandibular fractures, and the distal fragment is prone to dislocate to the medial side due to the pulling of the lateral pterygoid muscle. Retromandibular approaches are commonly used, but the intraoperative view becomes limited in medially dislocated fractures. This study summarized a series of cases of retromandibular reduction for medially dislocated condylar process fractures and described our supplementary procedure to realign the dislocated condylar process. Methods Nine patients with medially dislocated condylar process fractures underwent surgical correction from January 2012 to December 2016. In 6 of them, it was possible to realign the fractures with a conventional retromandibular approach, but for 3 cases of severe dislocation to the middle cranial fossa, a supplementary transoral procedure was carried out. The angle difference between the ramus and condyle, ramus height, and maximal mouth opening (MMO) were evaluated. Results All 9 cases were restored to the proper anatomical alignment without any major complications, and postoperative images revealed successful union. The angle difference was $8.94^{\circ}{\pm}4.11^{\circ}$ preoperatively, and $0.99{\pm}0.49^{\circ}$ at the 6-month follow-up. The pretreatment ramus height difference was $6.12{\pm}6.09mm$, and the postoperative difference was $0.18{\pm}0.10mm$. These changes after surgery were statistically significant. The MMO before surgery was $11.44{\pm}3.0mm$, and the postoperative MMO was $37.2{\pm}2.9mm$, reflecting a significant increase after reduction. Conclusions Retromandibular reduction is a useful method in medially dislocated condylar process fractures, and additional transoral assistance should be considered to realign condylar processes that severely dislocate to the middle cranial fossa.

• Archives of Craniofacial Surgery
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• v.23 no.3
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• pp.119-124
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• 2022

Background: Many severe nasal bone fractures present with septal fractures, causing postoperative septal deviation and negatively affecting the patients' quality of life. However, when a septal fracture is absent, it is difficult to predict whether surgical correction can help minimize nasal septal deviation postoperatively. This study determined whether performing closed reduction on even mildly displaced nasal bone fracture could deter the outcome of septal deviation. Methods: We retrospectively reviewed the data of 116 patients aged 21-72 years who presented at the outpatient clinic and emergency room with fractures of nasal bones only without any involvement of the septum from January 2014 to December 2020. Patients were classified into three fracture type groups: A (unilateral), B (bilateral), and C (comminuted with depression). The degree of septal deviation was calculated by measuring the angle between the apex of the most prominent point and the crista galli in the coronal view on computed tomography images. The difference between the angles of the initial septal deviation and that of the follow-up was calculated and expressed as delta (Δ). Results: Closed reduction tended to decrease the postoperative septal deviation in all fracture types, but the values were significantly meaningful only in type A and B fractures. In the surgical group, with type A as the baseline, type B showed a significantly larger Δ value, but type C was not significantly different, although type C showed a smaller Δ value. In the conservative group, with type A as the baseline, the other fracture types presented significantly lower Δ values. Conclusion: For all fracture types, closed reduction significantly decreased the extent to which the nasal septum likely deviated. Therefore, when a patient is reluctant to undergo closed reduction, physicians should address the possible outcomes and prognosis of untreated nasal bone fractures.

• Journal of Yeungnam Medical Science
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• v.13 no.1
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• pp.22-31
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• 1996

It is difficult to get a satisfactory result for the correction of malunited fracture of zygoma. Triple osteotomy and reposition of malunited zygoma is accepted as the better surgical method than camouflage surgery by means of onlays, if the orbital floor is to be reconstructed. The surgical approach can be divided into bicoronal, periorbital, intraoral and old scar. In 7 patients with malunited fracture of zygoma, the authors used a limited approach through extension of periorbital incision and intraoral incision instead of wide exposure including bicoronal incision. And we performed triple osteotomy and advancement of zygoma complex. The patients were followed for 4.5 months with acceptable result, and this approach was an effective method for the relatively simple tripod type-malunited fracture of zygoma. The authors obtained following conclusions: 1. Preoperative evaluation through thorough measurement of X-rays, investigation of photographs and detail communication with the patients was an important process. 2. Through lateral extension of subciliary incision, lateral eyebrow and intraoral incision, we could obtain adequate exposure for triple osteotomy and advancement of zygoma. 3. The zygoma should be reduced and fixed in an overcorrected superior and medial direction. 4. Return of zygoma to its anatomical position was possible only when it is completely freed from the surrounding soft tissue including masseter. 5. We could not find any different results between autogenous calvareal bone graft and $Medpor^{(R)}$ insertion on the floor of orbit.

• Archives of Plastic Surgery
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• v.42 no.4
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• pp.419-423
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• 2015

Background Orthognathic surgery is required in 25% to 35% of patients with a cleft lip and palate, for whom functional recovery and aesthetic improvement after surgery are important. The aim of this study was to examine maxillary and mandibular changes, along with concomitant soft tissue changes, in cleft patients who underwent LeFort I osteotomy and sagittal split ramus osteotomy (two-jaw surgery). Methods Twenty-eight cleft patients who underwent two-jaw surgery between August 2008 and November 2013 were included. Cephalometric analysis was conducted before and after surgery. Preoperative and postoperative measurements of the bone and soft tissue were compared. Results The mean horizontal advancement of the maxilla (point A) was 6.12 mm, while that of the mandible (point B) was -5.19 mm. The mean point A-nasion-point B angle was $-4.1^{\circ}$ before surgery, and increased to $2.5^{\circ}$ after surgery. The mean nasolabial angle was $72.7^{\circ}$ before surgery, and increased to $88.7^{\circ}$ after surgery. The mean minimal distance between Rickett's E-line and the upper lip was 6.52 mm before surgery and 1.81 mm after surgery. The ratio of soft tissue change to bone change was 0.55 between point A and point A' and 0.93 between point B and point B'. Conclusions Patients with cleft lip and palate who underwent two-jaw surgery showed optimal soft tissue changes. The position of the soft tissue (point A') was shifted by a distance equal to 55% of the change in the maxillary bone. Therefore, bone surgery without soft tissue correction can achieve good aesthetic results.

• Archives of Plastic Surgery
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• v.36 no.2
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• pp.127-134
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• 2009

Purpose: Adipose tissue injection as a free graft for the correction of soft - tissue deficiency or depression deformity is a widespread procedure in plastic surgery. This study is to analyze the changes and viability of cryopreserved adipose tissue and to find out efficient long - term storage period. Methods: After centrifugation of aspirated abdominal tissues, $10m{\ell}$ of packed Adipose tissue were freezed at $-20^{\circ}C$. For 2, 4, 6, 8 months, each frozen samples were taken and injected into scalp of SCID mice. After 15 weeks, injected Adipose tissue were sampled and analyzed at 2 months interval. We compared and analyzed each group about the weight of the injected fat, histologic impressions, activity of mitochondria, size of a fat cell and rate of survival. Results: Significant weight changes were observed in cryopreservation for 2 months(p<0.05). Histologic changes were observed, independent of the freezing period with H - E stain. Among cryopreservations for 2, 4, 6 months, no significant change were observed. The reduction of mitochondrial enzymatic activity was observed independent of time interval but activity of mitochondrial dehydrogenase was reduced less than 50% in MTT assay. Conclusion: Freezing in $-20^{\circ}C$ for 6 months has no adverse effect to Adipose tissue, but fragile adipocytes, damaged cell membrane during harvesting procedure, were disrupted within 1 - 2 month and the maximum volume reduction were followed less than 2 months. These results demonstrate that tissue preparation cells without membrane damage have the greatest viability level and cryopreservation less than 2 months has great volume effect and cryopreservation for 6 months has stable volume effect.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.19 no.2
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• pp.130-134
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• 1997

The sagittal split ramus osteotomy(SSRO) of the mandible has used one of the most popula methods for the correction of various dentofacial deformities, especially mandibular prognathism. In SSRO, there are produced bony gap following mandible setback because of mandibular flaring. For this reason, the condylar axis may be changed due to bony approximation both segment in three dimension more mesio-laterally. According to change of condylar position, the condition of TMJ structure are changed and change of TMJ symptoms are suggested theoretically, and the correction of malocclusion by SSRO may improve the TMJ symptoms by improvement of feeding difficulties. The pupose of this study was to determine relationship between expected alterations in condylar position and suggested TMJ symptoms produced by change of condylar position. TMJ symptoms of 15patients who had operated SSRO are checked at about postoperative 6 month ranging $5{\sim}11$ month. Anterior-posterior position of condyle which was comparison preoperative with postoperative position, was classified 5 groups. The author tried to identify relationship between positional change of condyle and TMJ discomfort.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.15 no.4
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• pp.329-337
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• 1993

Improvement of orthognathic surgical techniques make it possible to design esthetic surgical correction for total esthetic face. In order to find the esthetic line which guide esthetic surgical correction in patients of orthognathic surgery, cephalometric soft tissue analysis of esthetic faces were performed. In esthetic Korean young adults, 25 males and 25 females who were within 1 S.D. of E-line, ANB, P/A facial height ratio, were analyzed in natural position keeping their face eye level. 1. Sn position is constant in males and females. The Sn-N'-N' Vertical plane angle is $5.3^{\circ}$ in both sexes. Sn is positioned in front of 5 mm in female 7 mm in male from the N' vertical plane. 2. The Sn-Ls line make constant angle to horizontal plane with $72.5^{\circ}$ in both sexes, which is called "upper esthetic line". The Ls-Pg' line makes constant angle to $72.4^{\circ}$ (range $72.2^{\circ}$ in female to $72.6^{\circ}$ in male), which is called "lower esthetic line". 3. When inter-esthetic line angle (the Sn-Ls line to Ls-Pg' line) has $144.9^{\circ}$, lower third face has esthetic upper and lower lip. 4. In treatment planning, Sn is first corrected in proper position, and then upper and lower esthetic line are established with the angle of 144.9. The maxilla is moved to tangent Ls to the upper esthetic line, and mandible is moved to tangent Li and Pg' to the lower esthetic line, according to the "y"-shaped esthetic lines, then lower third face showes esthetics.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.33 no.3
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• pp.218-224
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• 2011

Purpose: The purpose of this study is to evaluate the post-operative skeletal stability after surgical correction of patients with mandibular prognathism by bilateral sagittal split ramus osteotomy (BSSRO) and to evaluate the horizontal relapse tendency after the surgery. Methods: Twenty-six patients with Class III dental and skeletal malocclusion were selected for this retrospective study. Fifteen of them underwent BSSRO for mandibular setback and eleven of them underwent two-jaw surgery (Lefort I and BSSRO). In each patient, lateral cephalometric radiographs were taken pre-operatively, post-operatively within 1 week, and post-operatively after eight months. After tracing of the cephalometric radiographs, various parameters were measured. The analyses were done by linear measurement to evaluate the change in position of hard tissue B point, pogonion and mandibular plan angle by examination on lateral cephalograms. Results: The horizontal relapse rate was 27.1% at B point and 31.6% at pogonion in patients who underwent BSSRO. The horizontal relapse rate of the group where the amount of correction exceeded 10 mm was 25.69% at B point. Conclusion: There were no statistical differences on the magnitude of setback and direction of rotation of the mandible in mandibular stability. There were also no statistical differences between single mandibular surgery and two-jaw surgery for mandibular stability.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.38
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• pp.13.1-13.12
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• 2016

Background: Mandibular motion tracking system (ManMoS) has been developed for orthognathic surgery. This article aimed to introduce the ManMoS and to examine the accuracy of this system. Methods: Skeletal and dental models are reconstructed in a virtual space from the DICOM data of three-dimensional computed tomography (3D-CT) recording and the STL data of 3D scanning, respectively. The ManMoS uniquely integrates the virtual dento-skeletal model with the real motion of the dental cast mounted on the simulator, using the reference splint. Positional change of the dental cast is tracked by using the 3D motion tracking equipment and reflects on the jaw position of the virtual model in real time, generating the mixed-reality surgical simulation. ManMoS was applied for two clinical cases having a facial asymmetry. In order to assess the accuracy of the ManMoS, the positional change of the lower dental arch was compared between the virtual and real models. Results: With the measurement data of the real lower dental cast as a reference, measurement error for the whole simulation system was less than 0.32 mm. In ManMoS, the skeletal and dental asymmetries were adequately diagnosed in three dimensions. Jaw repositioning was simulated with priority given to the skeletal correction rather than the occlusal correction. In two cases, facial asymmetry was successfully improved while a normal occlusal relationship was reconstructed. Positional change measured in the virtual model did not differ significantly from that in the real model. Conclusions: It was suggested that the accuracy of the ManMoS was good enough for a clinical use. This surgical simulation system appears to meet clinical demands well and is an important facilitator of communication between orthodontists and surgeons.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.17 no.1
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• pp.20-31
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• 1995

The need to assess preoperative psychological characteristics of orthognathic surgery patients has recently been recognized. Fifty six patients were involved in this study, they were investigated in the preoperative psychosocial aspects. Korean Version Eysenk Personality Questionaire and Korean Version Tennessee Self-Concept Scale were used for psychological test. The results were as follows : 1. There was no significant difference of sex and age in the personality dimension, the selfconcept scale, and the preoperative tests(P>0.05). 2. 37% of subjects showed phonetic problem, 60% masticatory problem and 56% social problem for facial deformity. The first choice was the face in the order of correction for mastication, phonation and face. And 83% of the subjects forecasted the change in their face after surgical correction, The answer was generally vague. 64% of the subjects expected their personality to become more lively as a result of their operation. 3. Total positive self score and personal self score were less improved in the groups with high scores of toughmindness and neuroticism(P<0.05), degree of suffering was increased in the group with high scores of neuroticism(P<0.05). 4. Degree of subjective deformity, self-consciousness, and degree of dissimilarity were more improved in the group of intraversion, there was a significant correlation with degree of dissimilarity in the group with high score of toughmindness(r=-.64, P<0.05). 5. There was a significant correlation with the forecast of change in the groups with high score in extraversion(r=.59, P<0.01) and with low score in neuroticism(r=-.39, P<0.05).