• 대한치과교정학회지
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• 제29권1호
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• pp.113-127
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• 1999

악골의 골격적 부조화를 가진 환자의 교정치료는 악교정 수술을 필요로 하고, 악교정 수술에 의해 교합평면각은 변화된다. 특히 전치부 개교를 동반한 III급 부정교합 환자에서 치아안면 기형을 치료하기 위한 교합평면각의 변화에 대하여 많은 논란이 있어 왔다. 교합평면각을 증가시키는 하악골의 시계 방향 회전(clockwise rotation)은 전치부 개교에 대한 적절한 치료법으로 추천되어 왔고 하악골의 반시계 방향의 회전(counterclockwise rotation)은 하악지 고경을 증가시키는 방향으로 하악골을 회전시킨다는 개념으로 인해 재발(relapse)을 유발하는 불안정한 수술 방법으로 인식되어 왔다. 본 연구는 전치부 개교를 동반한 골격성 III 부정교합 환자에서 교합평면의 반시계 방향 회전을 동반한 하악지 시상분할 골절단술 시행 후 교합평면각의 변화와 술후 안정성과의 관계를 평가 하고자 하였다. 하악지 시상분할 골절 단술과 rigid fixation으로 치료받은 환자 25 명 (평균연령 20.6세)을 대상으로 하여 수술 직전(T1), 술후 2주내(T2), 그리고 술후 6 개월 이후(T3)에 촬영한 측모 두부계측 방사선 사진을 통계분석한 결과(Paired t-test, Pearson correlation analysis), 다음의 결론을 얻었다. 1. 악교정 수술 후(T2) 하악평면각은 $2.9^{\circ}$ 감소하였고 SN 평면에 대한 하악 교합평면의 각도는 $2.7^{\circ}$ 감소하였다. 술후 6 개월경과 후(T3) 후안면 고경의 감소로 인해(P<0.01) 하악 평면각은 $1.0^{\circ}$ 증가하였으나 하악 교합평면의 경사도는 변화되지 않았다. 2. 악교정 수술 후 시간 경과(T3)에 의해 발생한 수평적 재발은 하악골의 전방 이동량이 B점에서 1.6 mm로 수술시 전체 후방 이동량의 약$22\%$였다. 전안면 고경에서는 수직적 재발이 발생하지 않았으나,후안면 고경은 감소하였다. (P<0.01). 3. 수평적 재발과 상관관계를 보이는 항목은 하악평면각 이었고(P<0.01) 수술 6 개월경과 후 후안면 고경의 감소와 상관관계가 있는 요소로는 수술시 하악골의 후방 이동량(P<0.01), 하악지 고경의 증가량(P<0.01), 그리고 하악평면각의 감소량(P<0.01) 등이 있었다. 4. 수술시 하악 교합평면 경사도의 변화량과 술후 재발과는 상관관계가 없었다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제35권6호
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• pp.360-367
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• 2013

Purpose: The purpose of this study was to perform three-dimensional (3D) assessment of facial soft tissue in patients with skeletal Class III and mandibular asymmetry after orthognathic surgery. Methods: Samples consisted of 3D facial images obtained from five patients with A point-nasion-B point angle less than 2 degrees, and more than 5 mm of menton deviation. All patients had been treated at Gangneung-Wonju National University Dental Hospital from 2009 to 2012. They had undergone orthognathic surgery of Lefort I, and sagittal split osteotomy for correction of skeletal deformity, and orthodontic treatment. Facial scanning was performed before treatment (T1) and post-surgical orthodontic treatment (T2). Linear and angle variables of soft tissue landmarks, antero-posterior facial depth, and facial volume were measured. Results: No significant differences in width of the alar base, mouth width, and nasal canting were observed between T1 and T2. However, lip deviation, menton deviation, alar canting, lip canting, and menton deviation angle were significantly reduced at T2. Antero-posterior facial depth on the axial plane parallel to the left cheilion was significantly reduced on the deviated side and significantly increased on the non-deviated side at T2. Volume of the lower lateral and lower medial parts of the face was reduced on the deviated side, and volume of upper lateral and lower lateral parts on the non-deviated side was significantly increased at T2. Conclusion: After orthognathic surgery, facial asymmetry of soft tissue was improved following skeletal changes, especially the mandibular region. Although the length of the alar base and mouth width did not change, lip and soft tissue menton were displaced to the medial side after treatment. Facial depth also became symmetric after treatment. Facial volume showed a decrease on the lower part of the deviated side and that on lateral parts of the non-deviated side showed an increase after treatment.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제33권5호
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• pp.401-406
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• 2011

Purpose: The purpose of this study was to investigate changes in the position of the hyoid bone and soft palate and the amount of airway space after bilateral sagittal split ramus osteotomy (B-SSRO). Methods: This study is a review of lateral cephalometric tracings of 30 patients who underwent B-SSRO with setbacks at Kyunghee Dental Hospital from 2005 to 2009. Lateral cephalograms were taken before (T0), within one month (T1), and more than six months after the surgery (T2). Results: The hyoid bone at T1 changed significantly towards the inferoposterior position. At T2, it had significantly moved superiorly, but not anteriorly. At T1, the nasopharyngeal space, extending from the posterior nasal spine to the posterior pharyngeal space, decreased significantly, but did not show a significant increase at T2. The nasopharyngeal space, extending from the middle of soft palate to the posterior pharyngeal space, decreased significantly at T1, but did not show a significant decrease at T2. The oropharyngeal airway space decreased significantly at T1 and did not return to its original position at T2. The hypopharyngeal space, extending from the anterior to the posterior pharyngeal space at the level of the most anterior point of the third cervical vertebrae, slightly decreased at T1, but the amount was insignificant; however, the amount of decrease at T2 was significant. The hypopharyngeal space extending from the anterior to the posterior pharyngeal space at the level of the lowest point of the third cervical vertebrae, decreased significantly at T1 but returned to its original position at T2. Conclusion: B-SSRO changes the position of the hyoid bone and muscles inferoposteriorly. These change allows enough space for the tongue and prevent airway obstruction. Airway changes may be related to post-operative edema, posterior movement of the soft palate, anteroposterior movement of the hyoid bone, or compensation for decreased oral cavity volume. The position of the pogonion which measures anterior relapse after surgery did not show significant differences during the follow-up period.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제33권1호
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• pp.36-43
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• 2011

Purpose: This study evaluated the pharyngeal airway space changes in CT images in patients receiving bilateral sagittal split osteotomy (BSSRO) for the surgical correction of mandibular prognathism. Methods: A total of 22 patients with mandibular prognathism were treated using BSSRO. Computed tomography was performed 1 month (T0) before surgery and, 1 month after surgery (T1). The anteroposterior length (AP), lateral width (LAT) and cross-sectional area (AREA) at the level of soft palate (C2) and base of the tongue (C3) were measured using CT images. Results: The mean amount of mandibular setback was 7.41 mm (${\pm}$3.46 mm). All the AP, LAT and AREA at the C2 and C3 level were decreased significantly 1 month after surgery (P<0.001). As the amount of mandibular setback was increased, the AP, LAT and AREA levels at the level of C2 and C3 had decreased. In addition, the reduction of the AREA at the C3 level was associated with the amount of mandibular setback (P<0.05). Conclusion: A significant decrease in pharyngeal airway space was observed 1 month after the operation. The cross-sectional area at the level of base of tongue was decreased with increasing amount of mandibular setback.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제33권6호
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• pp.490-496
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• 2011

Purpose: Dr. Marquardt made the facial 'phi' mask using golden ratio. Most class III patients have bulky faces and want a smaller face. Using a facial golden mask, this study estimated and compared frontal photographs before and after operation for soft tissue measurement. The golden mask can be considered as a reference tool for facial esthetic analyses especially in lower face. Methods: Forty patients who had undergone orthognathic surgery at Samsung Medical Center from January 2006 to December 2009 were included in this study. These patients had Class III malocclusion. Lateral cephalometric radiographs, frontal clinical photos of pre-op and 8~12 month later post-op, and the facial 'phi' mask using golden ratio, were used for analysis. Reduction of the lower face area, occlusal plane changes, amounts of mandible setback and amounts of maxilla posterior impaction were estimated. Results: Lower facial reduction ratio and mandibular setback amounts were significantly different between 1-jaw and 2-jaw groups. Average postoperative changes in the area of lower face between bilateral sagittal split ramus osteotomy (BSSRO) and BSSRO combined maxilla posterior impaction were compared by using an independent simple t-test and $P$ value was 0.016. Therefore, the lower facial reduction ratio and mandibular setback amount were significantly different in maxilla posterior impaction. Conclusion: The two-jaw surgery group showed more reduction of the lower facial area than the 1-jaw surgery group. The amount of lower facial reduction was more related with the amount of mandibular setback. There was no significant relation in lower facial reduction with amount of maxilla posterior impaction, pre-op occlusal plane, post-op occlusal plane and the mandibular angle. A relationship between the change in the lower facial area and the amount of maxilla posterior impaction or the change of mandibular angle occlusal plane at pre-op could not be found because of the difference in the amount of setback between two groups.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제36권4호
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• pp.154-160
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• 2014

Purpose: The efficiency of an anchor plate placed during orthognathic surgery via minimal presurgical orthodontic treatment was evaluated by analyzing the mandibular relapse rate and dental changes. Methods: The subjects included nine patients with Class III malocclusion who had bilateral sagittal split osteotomy at the Division of Oral and Maxillofacial Surgery, Department of Dentistry in Ajou University Hospital, after minimal presurgical orthodontic treatment. During orthognathic surgery, anchor plates were placed at both maxillary buttresses. The anchor plates were used to move maxillary teeth backward and for maximum anchorage of Class III elastics to minimize mandibular relapse during the postoperative orthodontic treatment. The lateral cephalometric X-ray was taken preoperatively (T0), postoperatively (T1), and one year after the surgery (T2). Seven measurements (distance from Pogonion to line Nasion-Nasion perpendicular [Pog-N Per.], angle of line B point-Nasion and Nasion-Sella [SNB], angle of line maxilla 1 root-maxilla 1 crown and Nasion-Sella [U1 to SN], distance from maxilla 1 crown to line A point-Nasion [U1 to NA], overbite, overjet, and interincisal angle) were taken. Measurements at T0 to T1 and T1 to T2 were compared and differences tested by standard statistical methods. Results: The mean skeletal change was posterior movement by $13.87{\pm}4.95mm$ based on pogonion from T0 to T1, and anterior movement by $1.54{\pm}2.18mm$ from T1 to T2, showing relapse of about 10.2%. There were significant changes from T0 to T1 for both Pog-N Per. and SNB (P<0.05). However, there were no statistically significant changes from T1 to T2 for both Pog-N Per. and SNB. U1 to NA that represents the anterior-posterior changes of maxillary incisor did not differ from T0 to T1, yet there was a significant change from T1 to T2 (P<0.05). Conclusion: This study found that the anchor plate minimizes mandibular relapse and moves the maxillary teeth backward during the postoperative orthodontic treatment. Thus, we conclude that the anchor plate is clinically very useful.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제26권2호
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• pp.115-131
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• 2000

In the study of craniofacial deformity, it is very important that identifying the factor which can affect the morphology and which is closely related to the morphology, because it can not only improve the comprehension of growth and developmental process but also be applied in growth prediction and treatment modality. Several investigators have already mentioned the characterstics of head posture and airway space in relations to morphologic difference. But it is very meaningful work in clarifying the correlation between morphology, head posture and airway space that observing the change of head posture after morplologic change caused by operation and the change of airway space after same procedure. To investigate above correlation, I selected normal group which is consisted of 43 adults and mandibular prognathism group which is consisted of 47 adults who had been operated by sagittal split ramus osteotomy and were followed up more than 1 year. With their lateral skull radiograghs, reference lines which can evaluate each measuring points and areas without effect of postural change were first determined. And using above reference lines, change of airway space, positional change of tongue and hyoid, change of cranial and cervical angulations were measured. The results obtained from the study were as follows 1. In the change of head posture, the position of tongue and hyoid neighboring to pharynx is more closely related to the reference line of cervical column than to reference line of cranium. 2. After mandibular setback operation, the airway dimension was decreased to 81.6% of preoperative state at 1 month postoperatively and was slightly increased to 89.7% at 1 year postoperatively. 3. Posterior movement of tongue plays important role in decrease of airway dimension and inferior movement of hyoid was closely correlated with posterior movement of tongue. 4. Postoperative anterior movement of mandible, namely, morphologic relapse had correlation with relapse phenomenon of airway dimension. 5. Craniocervical angulation increased postoperatively. Especially in the postoperative early state, there was increased foreward inclination of cervical angulation rather than increase of cranial angulation. But at postoperative 1 year it was observed that cervical inclination was returned to preoperative state and cranial angulation was increased gradually. 6. Increase rate of airway dimension was correlated with the increase of cranial angulation from postoperative 1 month to 1 year. In conclusion, relapse tendency of airway dimension following increase of cranial angulation was found after mandibular setback operation and it is considered that increase of cranial angulation is one of compensatory mechanism in airway maintenance.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제40권
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• pp.4.1-4.4
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• 2018

Background: Along with the advances in technology of three-dimensional (3D) printer, it became a possible to make more precise patient-specific 3D model in the various fields including oral and maxillofacial surgery. When creating 3D models of the mandible and maxilla, it is easier to make a single unit with a fused temporomandibular joint, though this results in poor operability of the model. However, while models created with a separate mandible and maxilla have operability, it can be difficult to fully restore the position of the condylar after simulation. The purpose of this study is to introduce and asses the novel condylar repositioning method in 3D model preoperational simulation. Methods: Our novel condylar repositioning method is simple to apply two irregularities in 3D models. Three oral surgeons measured and evaluated one linear distance and two angles in 3D models. Results: This study included two patients who underwent sagittal split ramus osteotomy (SSRO) and two benign tumor patients who underwent segmental mandibulectomy and immediate reconstruction. For each SSRO case, the mandibular condyles were designed to be convex and the glenoid cavities were designed to be concave. For the benign tumor cases, the margins on the resection side, including the joint portions, were designed to be convex, and the resection margin was designed to be concave. The distance from the mandibular ramus to the tip of the maxillary canine, the angle created by joining the inferior edge of the orbit to the tip of the maxillary canine and the ramus, the angle created by the lines from the base of the mentum to the endpoint of the condyle, and the angle between the most lateral point of the condyle and the most medial point of the condyle were measured before and after simulations. Near-complete matches were observed for all items measured before and after model simulations of surgery in all jaw deformity and reconstruction cases. Conclusions: We demonstrated that 3D models manufactured using our method can be applied to simulations and fully restore the position of the condyle without the need for special devices.

• 대한치과교정학회지
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• 제32권5호
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• pp.361-373
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• 2002

이번 연구의 목적은 골격성 III급 부정교합자의 악교정 수술 전과 수술 후의 하악전치부 치조골의 형태 변화를 평가하는 것이다 : 하악지 시상골분할절단술만을 시행받은 30명의 성인 골격성 III급 부정교합자를 대상으로 하였다. 초진시와 수술 전과 수술 후 3개월이 경과하였을 때의 측모두부규격방사선 사진을 비교하였다 골격과 하악이부의 계측치를 비교하였으며 이들 사이의 상관성 분석을 시행하여서 다음과 같은 결과를 얻었다. 1. 술전교정후군과 악교정수술후군에서 치료전군에 비해 하악전치부의 순측과 설측의 치조골 높이가 감소하였다. 2. 치조골 기저부의 전후방적인 폭경은 두개안면골격의 수직계측항목과 역상관관계를, IMPA와는 순상관관계를 보였다(P<0.01). 3. 하악이부 계측항목중 하악이부의 장경과 폭경은 두개안면골격과 상관관계를 보이지 않았다. 4. 순측의 치조골 높이와 설측의 치조골 높이는 순상관관계를 나타냈지만(p<0.001), 설측의 치조정의 폭경과는 역상관관계를 보였다(p<0.01). 순측과 설측의 치조정의 폭경은 역상관관계를 보였다(p<0.05). 하악이부의 장경과 폭경은 서로 순상관관계를 보였다(p<0.01). 5. IMPA와 LISA는 순, 설측치조골의 장경과 설측의 치조골 폭경과는 역상관관계를 보였지만, 순측치조골폭경과는 순상관관계를 보였다

• 대한치과교정학회지
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• 제26권1호
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• pp.1-16
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• 1996

본 연구는 골격성 III 급 부정교합 환자에서 상악골 전방이동수술과 하악골 후방이동수술을 동시에 시행하였을 때 경,연조직 측모 및 연조직 후경의 변화를 관찰하고 경,연조직 변화의 상관성과 그 비율을 산출하여 교정-악교정 수술복합 치료 계획의 수립과 결과의 예측에 이용하고자 하였다. 서울대학교병원 치과진료부 교정과에 내원하여 상, 하악골의 수직적 골격 부조화는 경미하고 전후방적 골격 부조화가 심한 골격성 III급 부정교합으로 진단되어 술전 교정치료를 받고 1990년 7월부터 1995년 4월 중에 Le Fort I 골절단술 또는 Le Fort II 골절단술로 상악골을 전방이동시키는 동시에 시상분할 골절단술로 하악골을 후방이동시킨 성인 환자 25명(남자 13명, 여자 12명) 을 대상으로 수술전,후 측모두부방사선사진을 계측, 분석하여 다음과 같은 결과를 얻었다. 1. 상악골의 전방이동에 따른 상순부 연조직의 수평적 변화는 Stms를 제외하면 상관성이 높았으며 A point의 전방이동에 따라 Sn, SLS, LS 는 각각 $71\%,\;67\%,\;37\%$ 의 비율로 전방이동하였다. 2. 하악골의 후방이동에 따른 하순부 연조직의 수평적 변화는 상관성이 상당히 높았으며 ID, B point, Pog, Gn의 후방이동에 따라 LI, ILS, Pog, Gn 은 각각 $84\%,\;107\%,\;96\%,\;97\%$ 의 비율로 후방이동하였다. 3. 하악골의 후방이동에 따라 SLS, LS, Stm, LI 는 중등도의 상관성을 가지며 하방이동하였다. 4. 경조직의 전후안면고경비율과 연조직의 상,하안면고경 은 수술전후 유의한 차이가 없었으나 수술후 Stm 의 하방이동으로 하순고경에 대한 상순고경의 비율은 유의성있게 증가하였다(p<;0.001). 5. 연조직 후경은 수술후 LI-LIH 에서는 증가하고 LS-LSH 에서는 감소하였으며 LS-LSH 의 수술후 변화량과 수술전 후경은 역상관관계를 나타내었다(p<0.001).