• 제목/요약/키워드: surgery-first

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임상가를 위한 특집 4 - 턱교정수술에서 선수술접근 :적응증과 한계 (Surgery First Approach in Orthognathic Surgery : Indication and limitation)

  • 황대석
    • 대한치과의사협회지
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    • 제50권11호
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    • pp.682-688
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    • 2012
  • Surgery first approach in orthognathic surgery is to proceed the orthognathic surgery without preoperative orthodontic treatment. This approach has many advantages, which include a shorter total treatment period, a high level of patient satisfaction due to immediate post-surgical facial improvement, easy postoperative orthodontic treatment due to early normalization of skeletal muscle, and the rapid tooth movement reflecting the regional accelerated phenomenon. However instability due to transient occlusal interference after surgery make worse of long-term skeletal stability. Especially increasing of vertical occlusion caused by interference of interbicupid and molar happen postsurgical skeletal change. Until now, there is no common consensus about treatment protocol of surgery first approach in orthognathic surgery. The purpose of this paper is to introduce our treatment protocol of the surgery first approach and to evaluate indication and limitation with case analysis.

Skeletal stability after 2-jaw surgery via surgery-first approach in facial asymmetry patients using CBCT

  • Hwang, Dae Seok;Seo, Jeong Seok;Choi, Hong Seok
    • Maxillofacial Plastic and Reconstructive Surgery
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    • 제42권
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    • pp.11.1-11.8
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    • 2020
  • Background: The purpose of this study is to compare the skeletal stability of two-jaw surgery via surgery-first approach with conventional two-jaw surgery in facial asymmetry patients by measuring the skeletal changes after surgery from a three-dimensional analysis. From January 2010 to January 2014, 40 patients with facial asymmetry who underwent two-jaw surgery in Pusan National University Hospital were included in this study. They were classified into experimental group (n = 20) who underwent two-jaw surgery via surgery-first approach and control group (n = 20) who underwent conventional two-jaw surgery. After selection of 24 landmarks and the construction of horizontal and sagittal, coronal reference planes, changes in 10 linear measurements and 2 angular measurements were compared between the surgery-first approach and conventional groups in the preoperative, immediate postoperative, and postoperative periods. The paired t test and Student t test were used for statistical analysis. The mean and standard deviation of the measurement were calculated for the experimental and control groups. Results: The statistical analysis showed that changes in skeletal measurements were similar between the surgery-first approach and conventional groups, according to each period. However, U1-SRP measurement showed statistically significant changes in surgery-first approach groups at postsurgical change (T1 to T2). Also, the mean treatment duration in the treatment group was 15.9 ± 5.48 months whereas that in the control group was 32.9 ± 14.05 months. Conclusion: In facial asymmetry patients, similar results were observed in the postoperative skeletal stability when 2-jaw surgery via surgery-first approach was compared with conventional 2-jaw surgery. However, significant lateral deviation of upper incisor midline was observed. In addition, a shorter average treatment duration was observed. To stabilize the unstable occlusion after surgery, increased wearing of the stent and proactive rubber guidance will be needed.

Distinctions Between Clinicopathological Factors and Prognosis of Alpha-fetoprotein Negative and Positive Hepatocelluar Carcinoma Patients

  • Xu, Jia;Liu, Chang;Zhou, Lei;Tian, Feng;Tai, Ming-Hui;Wei, Ji-Chao;Qu, Kai;Meng, Fan-Di;Zhang, Ling-Qiang;Wang, Zhi-Xin;Zhang, Jing-Yao;Chang, Hu-Lin;Liu, Si-Nan;Xu, Xin-Shen;Song, Yan-Zhou;Liu, Jun;Zhang, Peng
    • Asian Pacific Journal of Cancer Prevention
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    • 제13권2호
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    • pp.559-562
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    • 2012
  • Serum alpha-fetoprotein (AFP) is a significant marker for clinical diagnosis and prognosis evaluation in hepatocellular carcinoma (HCC) patients. However, some proportion of liver cancer patients are AFP-negative (AFP ${\leq}$20ng/ml). In order to study the differences between clinicopathological factors and prognosis of alpha-fetoprotein negative and positive patients, a total of 114 cases (41 AFP-negative and 73 AFP-positive) were selected for our research. By systematically statistical analysis, the results demonstrated that compared with AFP-negative patients, AFP-positive examples were more likely to feature cirrhosis nodules, non-complete neoplasm capsules, and a poor Edmondson-steiner grade. Furthermore, AFP-negative patients demonstrated a favorable long-term prognosis. By univariate analysis and multivariate analysis with Cox's proportional hazards model, multiple tumors were found to be independent risk factors for worse survival of AFP negative patients; however, less tumor-free margins, multiple tumors and Edmondson-steiner grades III/IV, proved to be independent risk factors leading to a poor prognosis of AFP positive cases. Finally, we can infer that high levels of AFP signify a highly malignant tumor and unfavorable prognosis.

디지털 기술을 이용한 선수술 악교정치료 (Application of CAD-CAM technology to surgery-first orthognathic approach)

  • 김윤지;길병규;류재준
    • 대한치과의사협회지
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    • 제56권11호
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    • pp.622-630
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    • 2018
  • For successful surgery-first approach, accurate prediction of skeletal and dental changes following orthognathic surgery is essential. With recent development of digital technology using computer-aided design/computer-aided manufacturing (CAD/CAM) technology, attempts to provide more predictable orthodontic/orthognathic treatment have been made through 3D virtual surgery and digital tooth setup. A clinical protocol for the surgery-first orthognathic approach using virtual surgery is proposed. A case of skeletal Class III patient with facial asymmetry treated by the surgery-first approach using digital setup and virtual surgery is presented. Advantages and limitations of applying CAD/CAM technology to orthognathic surgery are discussed.

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Current status of the surgery-first approach (part I): concepts and orthodontic protocols

  • Choi, Dong-Soon;Garagiola, Umberto;Kim, Seong-Gon
    • Maxillofacial Plastic and Reconstructive Surgery
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    • 제41권
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    • pp.10.1-10.8
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    • 2019
  • The "surgery-first" approach, defined as a team approach between surgeons and orthodontists for orthognathic surgery without preoperative orthodontic treatment, is aimed at dental decompensation. A brief historical background and indications for the surgery-first approach are reviewed. Considering the complicated mechanism of postoperative orthodontic treatment, the proper selection of patients is a vital component of successful surgery-first approach.

Current concept of the surgery-first orthognathic approach

  • Choi, Jong-Woo;Lee, Jang-Yeol
    • Archives of Plastic Surgery
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    • 제48권2호
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    • pp.199-207
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    • 2021
  • Traditional orthognathic surgery has long been performed after presurgical orthodontic treatment. Despite some concerns, the surgery-first orthognathic approach (SFOA) or surgery-first approach (SFA) without presurgical orthodontic treatment has gradually gained popularity. In recent years, several articles dealing with the concepts of the SFA have been published worldwide. However, the SFA has not yet been standardized, and many surgeons use slightly different protocols and concepts. This review article discusses the beginning and evolution of the SFA and its current concepts, including some opinions based on the authors' clinical experiences over the last 15 years. According to recent investigations, the SFA could be applied effectively in several situations including class III malocclusion, class II malocclusion, and facial asymmetry. However, debate on the SFA continues and many issues remain to be resolved. This review article addresses the current issues regarding the SFOA, including its advantages and disadvantages, as well as its indications and contraindications. The authors summarize various aspects of the SFA and expect that this review article will help surgeons and orthodontists better understand the current status of the SFA.

Overexpression of Long Non-Coding RNA HOTAIR Promotes Tumor Growth and Metastasis in Human Osteosarcoma

  • Wang, Bo;Su, Yun;Yang, Qun;Lv, Decheng;Zhang, Weiguo;Tang, Kai;Wang, Hong;Zhang, Rui;Liu, Yang
    • Molecules and Cells
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    • 제38권5호
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    • pp.432-440
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    • 2015
  • Human osteosarcoma usually presented a high tendency to metastatic spread and caused poor outcomes, however, the underlying mechanism was still largely unknown. In the present study, using a series of in vitro experiments and an animal model, we investigated the roles of HOX antisense intergenic RNA (HOTAIR) during the proliferation and invasion of osteosarcoma. According with our results, HOTAIR was commonly overexpressed in osteosarcoma, which significantly correlated with advanced tumor stage, highly histological grade and poor prognosis. In vitro and in vivo experiments demonstrated that knockdown of HOTAIR could notably suppress cellular proliferation, inhibit invasion and decrease the secretion of MMP2 and MMP9 in osteosarcoma. Collectively, our results suggested that HOTAIR might be a potent therapeutic target for osteosarcoma.

무지 외반증 수술 후 발생하는 제 1중족지관절 신전제한에 대한 족저근막 유리술의 유용성 (The Effectiveness of Plantar Aponeurosis Release for the Limitation in First Metatarsophalangeal Joint Extension after Hallux Valgus Surgery)

  • 최홍준;김대욱;강영훈;박종호;손찬모
    • 대한족부족관절학회지
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    • 제21권2호
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    • pp.55-60
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    • 2017
  • Purpose: Stiffness in the first metatarsophalangeal joint after surgery for hallux valgus has been reported. The goal of this study was to test the efficacy of releasing plantar aponeurosis for improving the range of extension in the first metatarsophalangeal joint that was limited after hallux valgus surgery. Materials and Methods: Thirteen patients (1 man, 12 women [17 feet]; median age, 54.4 years; range, 44~69 years) with limited first metatarsophalangeal joint extension after hallux valgus surgery, who underwent an additional procedure of plantar aponeurosis release between March 2015 and August 2015, were included. Subsequently, the passive range of extension in the first metatarsophalangeal joint was evaluated via knee extension and flexion positions. Hallux valgus angle, inter-metatarsal angle, distal metatarsal articular angle, and talo-first metatarsal angle were measured on weightbearing dorsoplantar and lateral radiographs of the foot preoperatively. Results: The mean range of extension for the first metatarsophalangeal joint improved significantly, from $2.5^{\circ}$ to $40.9^{\circ}$ in the knee extension position (p<0.00). The mean extension range for the first metatarsophalangeal joint also improved, from $18.2^{\circ}$ to $43.2^{\circ}$ in the knee flexion position (p<0.00). In all patients, congruence of the first metatarsophalangeal joint was recovered. Conclusion: Plantar aponeurosis release is an effective additional procedure for improving the extension range of the first metatarsophalangeal joint after hallux valgus surgery.