• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.27 no.2
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• pp.184-188
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• 2001

Horner's syndrome as a complication of orthognathic surgery is given little attention of head and neck surgery and is a relatively benign and transient condition. A 18-year-old male referred to our department with long and anteriorly projected chin. The cephalometric evaluation revealed a skeletal Class III relationship. A 10-mm setback of the mandible to eliminate Class III relationship and 4-mm vertical reduction genioplasty were performed. Three weeks after operation, the patient was recognized anhidrosis in left face and the head, and ptosis of left eye. The trauma to cervical sympathetic nerve during left sagittal split ramus osteotomy was thought to be the cause of Horner's syndrome. Patient was treated by dermatologic and opthalmologic care. Follow-up examination 8 months later, he was recovery of horner's symptom.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.13 no.3
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• pp.319-323
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• 1991

This is a case report and review of literature that deal with a surgical correction of mandibular deficiency. Patient, 38 years old male, had visited to treat mandibular deficiency. On the basis of clinical and radiographic examination, he was diagnosed as a micrognathia. Surgical method. 1. Intraoral Bilateral sagittal split osteotomy 2. Augmentation of genioplasty - double step. Patient was satisfied with final esthetics by gnathosurgery.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.34 no.3
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• pp.370-375
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• 2008

Sagittal split ramus osteotomy (SSRO) is widely used in treatment of dentofacial deformities. But, many complications can occur including unfavorable fractures during osteotomy. To prevent these complications, it is necessary to understand comprehensively the anatomy of the mandiular ramus. The purpose of this study was to evaluate the morphology of the madibular ramus in manibular prognathism patients by computed tomography comparing with normal control group. The study group consisted of 33 skeletal class III patients (20 males, 13 females) and the control group consisted of the 52 patients without dentofacial deformities (32 males, 20 females). The mean age of study group was 22.0-year old, and that of control group was 37.1-year. For the CT examination, following scan parameters was used: 1mm slice thickness, 0.5 second scan time, 120kV and 100mA/s. The axial scans of the head were made parallel to the mandibular occlusal plane. The anteroposterior length of the ramus, the distance from anterior border of the ramus to lingula, the relative distance from the anterior border of the ramus to lingula compared to the anteroposterior length of the ramus, the thickness of anterior and posterior cortical plate, the thickness of medial cortical plate of the ramus at lingula level, the thickness of cancellous bone of the ramus at lingula level were measured. The skeletal class III mandibular prognathism patients exhibited shorter anteroposterior length of the ramus, thicker anterior and posterior cortical plate, thinner mediolateral cancellous bone thickness. The lingula has a relative stable anteroposterior position in ramus in all groups. There was higher possibility of fusion of medial and lateral cortical plate at lingula level in the mandibular prognathism group. In conclusion, the mandibular prognathism patients have narrow rami with scanty cancellous bone, which means that careful preoperative examination including CT scan can prevent undesirable fractures during osteotomy.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.17 no.1
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• pp.10-19
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• 1995

As a society develops and a standard of living raises, the orthoganthic operation, the purpose of which is the harmony of oral and surrounding tissue, the improvement of the basal bony relations for stable tooth-support, and the improvement of facial appearance, generalized in our society. This is a clinical study on 135 patients who underwent orthognathic operation at the Dept. of Oral and Maxillofacial surgery, College of Dentistry, Kyung-Hee University during the last 5 years. The results were as follows. 1. The ratio of female to male was 1.4 : 1. 2. The age distribution of most patients was the period of 20 years through 24 years. 3. The major reasons for seeking orthagnathic surgery were ethetic complanints(94.8%), and additional reason was functional complaints such as masticatory disturbances, phonetic disturbances, and TMJ discomfort. 4. In order to consult about orthognathic surgery, the patients first visited to the Dept. of oral and maxillofacial surgery at the ratio of 24.0%. 5. The ratio of the patients who underwent the presurgical orthodontic treatment was 79.5%, and the treatment usually required the period from 7 months to 18 months. 6. The setback amount was less than 10mm at the ratio of 85.8%. 7. The orthognathic operations which were practiced were usually composed of ramus osteotomy such as sagittal split ramus osteotomy and vertical ramus osteotomy and additional surgery on mandible at the ratio of 86.7%, and SSRO was done at the ratio of 62.5%, and EVRO was done at the ratio of 37.5%.

• Imaging Science in Dentistry
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• v.32 no.4
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• pp.201-206
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• 2002

Purpose : To evaluate the radiographic change of operation sites after orthognathic surgery using the digital image processing and fractal analysis. Materials and Methods : A series of panoramic radiographs of thirty-five randomly selected patients who had undergone mandibular orthognathic surgery (bilateral sagittal split ramus osteotomy) without clinical complication for osseous healing, were taken. The panoramic radiographs of each selected patient were taken at pre-operation (stage 0), 1 or 2 days after operation (stage 1), 1 month after operation (stage 2), 6 months after operation (stage 3), and 12 months after operation (stage 4). The radiographs were digitized at 600 dpi, 8 bit, and 256 gray levels. The region of interest, centered on the bony gap area of the operation site, was selected and the fractal dimension was calculated by using the tile-counting method. The mean values and standard deviations of fractal dimension for each stage were calculated and the differences among stage 0, 1, 2, 3, and 4 were evaluated through repeated measures of the ANOVA and paired t-test. Results : The mean values and standard deviations of the fractal dimensions obtained from stage 0, 1, 2, 3, and 4 were 1.658±0.048, 1.580±0.050, 1.607±0.046, 1.624±0.049, and 1.641 ±0.061, respectively. The fractal dimensions from stage 1 to stage 4 were shown to have a tendency to increase (p < 0.05). Conclusion: The tendency of the fractal dimesion to increase relative to healing time may be a useful means of evaluating post-operative bony healing of the osteotomy site.

• The korean journal of orthodontics
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• v.38 no.2
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• pp.104-120
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• 2008

Purpose: The purpose of this study was to assess the hard and soft tissue changes associated with mandibular bilateral sagittal split osteotomy and genioplasty. Methods: This is a retrospective study of 40 patients who underwent either bilateral sagittal split osteotomy for mandibular setback (BSSO group, n = 20) or in combination with advancement genioplasty (Genio group, n = 20). Lateral radiographs, were taken before and immediately after surgery, and at least 6 months after surgery. Results: Comparing hard and soft tissue changes between the BSSO group and Genio group, there were significant differences in the lower incisor, soft tissue B point (B'), and soft tissue Pogonion (Pg') (p < 0.5). The mean ratio of hard and soft tissue changes for B/B', Pg/Pg', and Menton/soft tissue Menton after surgery in the BSSO group was 0.997, 0.965, and 1.022 respectively, and 0.824, 0.602, and 0.887 respectively in the genio group. Significant differences were found between the two groups. There were significant differences in lip thickness (B-B', Pg-Pg') in the Genioplasty group between pre and postsurgery, but not in the BSSO group. Pogonion to Labrale inferior and B' had a correlation coefficient of 0.833, 0.922, respectively for the BSSO group, and 0.775, 0.799 for the Genio group. Conclusions: The results indicate that there is a significant difference between bilateral sagittal split osteotomy with or without genioplasty in the lower facial esthetics values. The combination of mandibular setback and genioplasty had a smaller change in soft tissue thickness of the symphysis area after surgery than that of mandibular setback only.

• The Journal of Korean Academy of Prosthodontics
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• v.61 no.3
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• pp.204-214
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• 2023

The occlusal treatment including prosthetic treatment should be considered when the pathologic symptom was observed with the excessive discrepancy between the centric relation occlusion (CRO) and the maximum intercuspal position (MIP). Through careful diagnosis, the malocclusion and interarch relationship can be analyzed, and occlusal adjustment, restorative treatment, orthodontic therapy, or orthognathic surgery can be performed depending on the degree of disharmony. The patient in this case report complained the unstable occlusion and loss of masticatory function that had been occurring for several years. At the time of the visit, the patient showed severe occlusal disharmony, with only the upper right second molar contacting the lower jaw at the maximum intercuspal position. Based on the analysis of the occlusion, it was difficult to solve the problem with just occlusal adjustment or restorative treatment. In addition, the patient had the skeletal class II malocclusion between the upper and lower jaws. Therefore, for resolving the severe skeletal class II malocclusion, pre- and post-orthodontic treatment, bilateral sagittal split ramus osteotomy (BSSRO) was performed. After that, the occlusal adjustment was performed for stable occlusion, and the missing teeth area was restored with dental implants. During the follow-up period, a periodic follow-up visits and additional occlusal adjustments were performed to achieve a stable centric occlusion and harmonious anterior and lateral guidance. As a result, the final prosthodontic treatment was completed, and the patient's masticatory function was restored.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.30 no.3
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• pp.232-240
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• 2008

Purpose: This study was performed to evaluate transverse changes of proximal segment after bilateral sagittal split ramus osteotomy (BSSRO) using 3-D CT in mandibular prognathism. Patients and methods: Twenty-two patients who underwent BSSRO for mandibular set-back in class III malocclusion without facial asymmetry were examined. Miniplates were used for the fixation after BSSRO. Facial CT was taken before and after BSSRO within 3 months. Frontal-ramal inclination (FRI), inter-gonial width (IGW) and intercondylar width (ICW) were measured in 3-D CT images using V-works $4.0^{TM}$ program. Student t-test was used to compare the changes between pre- and post-operative measurements using SPSS 10.0 program. Results: 1. Mean peroperative FRI value ($12.87{\pm}3.43^{\circ}$) was slightly increased to postoperative value ($14.13{\pm}3.72^{\circ}$) (p < 0.05). The average FRI increased 10.42% and the range was from $-2.46^{\circ}$ to $3.34^{\circ}$. 2. Mean peroperative IGW ($99.01{\pm}5.36$) was slightly decreased to postoperative IGW ($96.51{\pm}5.88mm$) (p < 0.05). The average IGW decreased 2.52 % and the range was from $-6.61^{\circ}$ to 0.91 mm. 3. Mean preoperative ICW ($125.01{\pm}5.30mm$) was slightly decreased to postoperative ICW ($125.40{\pm}5.45mm$) (p < 0.05). There is no significant difference between pre- and post-operative ICW. 4. There was significant correlationship between FRI difference and IGW difference (p < 0.05). Conclusions: These results indicate that the lower ramus of the proximal segment is moved inward after BSSRO procedure for mandibular set-back.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.38
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• pp.25.1-25.4
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• 2016

Background: Bilateral sagittal split ramus osteotomy (BSSRO) is the most widely used mandibular surgical technique in orthognathic surgery and is easy to relocate the distal segments, accelerating bone repair by the large surface of bone contact. However, it can cause neurosensory dysfunction (NSD) or sensory loss by injury of the inferior alveolar nerve. The purpose of the present study was to evaluate NSD after BSSRO and modifiers at NSD recovery. Methods: In this study, NSD characteristics after BSSRO from 2009 to 2014 at the Kyung Hee University Dental Hospital were evaluated. The pattern of sensory recovery over time was also evaluated based on factors such as field of sensory dysfunction, surgical procedure, presence of pre-operative facial asymmetry, and postoperative medications. Results: Most of the patients had shown NSD immediately after orthognathic surgery. Among the 1192 sides of 596 patients, NSD was observed in 953 sides and 544 patients. Sexual predilection was shown in males (p value = 0.0062). In the asymmetric group of 132 patients, NSD was observed in 128 patients (96.97 %). In the symmetric group of 464 patients, NSD was observed in 416 patients (89.45 %); on the other hand, NSD was observed significantly higher in the asymmetric group (p = 0.025). NSD-associated factors were analyzed, and vitamin B12 may be beneficial for NSD recovery. Conclusions: There was a difference between the symmetric group and the asymmetric group in NSD recovery. Vitamin B12 can be regarded as an effective method to nerve recovery. However, a further prospective study is needed.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.43 no.1
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• pp.23-28
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• 2017

Objectives: The purpose of this study is to compare the postoperative stability of conventional orthognathic surgery to a surgery-first orthognathic approach after bilateral sagittal split ramus osteotomy (BSSRO). Materials and Methods: The study included 20 patients who underwent BSSRO for skeletal class III conventional orthognathic surgery and 20 patients who underwent a surgery-first orthognathic approach. Serial lateral cephalograms were analyzed to identify skeletal changes before surgery (T0), immediately after surgery (T1), and after surgery (T2, after 1 year or at debonding). Results: The amount of relapse of the mandible in the conventional orthognathic surgery group from T1 to T2 was $2.23{\pm}0.92mm$ (P<0.01) forward movement and $-0.87{\pm}0.57mm$ (non-significant, NS) upward movement on the basis of point B and $2.54{\pm}1.37mm$ (P<0.01) forward movement and $-1.18{\pm}0.79mm$ (NS) upward movement on the basis of the pogonion (Pog) point. The relapse amount of the mandible in the surgery-first orthognathic approach group from T1 to T2 was $3.49{\pm}1.71mm$ (P<0.01) forward movement and $-1.78{\pm}0.81mm$ (P<0.01) upward movement on the basis of the point B and $4.11{\pm}1.93mm$ (P<0.01) forward movement and $-2.40{\pm}0.98mm$ (P<0.01) upward movement on the basis of the Pog. Conclusion: The greater horizontal and vertical relapse may appear because of counter-clockwise rotation of the mandible in surgery-first orthognathic approach. Therefore, careful planning and skeletal stability should be considered in orthognathic surgery.