전방 분절골 절단술과 임프란트 식립을 이용한 구강악기능의 재건 : 증례보고

문철웅,김수관,김학균,문성용,유재식,Moon, Chul-Woong,Kim, Su-Gwan,Kim, Hak-Kyun,Moon, Seong-Yong,You, Jae-Seek 대한악안면성형재건외과학회 2009 Maxillofacial Plastic Reconstructive Surgery Vol.31 No.4

Kole's Anterior segmental osteotomy of the mandible is commonly used to close an anterior open bite, to depress an elevated anterior dentoalveolar segment, or to retrude or advance a dentoalveolar segment. The procedure is often combined with an anterior maxillary segmental osteotomy to correct bimaxillary protrusion. We report 53-year-old woman who the extruded state of mandibular anterior alveolar segment was corrected using an mandibular anterior alveolar segmental osteotomy and dental implantation of the anterior maxilla. We planned to remove the old prosthesis, and then perform an anterior mandibular segmental osteotomy and implant restoration of the anterior maxilla. We suggest that anterior segmental osteotomy is very useful for rehabilitating edentulous patients with malaligned alveolar segment.

변형 구개 유경 판막을 이용한 상하악 전방골 분절 성형술

박영주(Young Ju Park),남정훈(Jeong Hun Nam),연병무(Byoung Moo Yeon),송준호(Jun Ho Song),노경록(Kyung Lok Noh),방은오(Eun O Pang),김다영(Da Young Kim),김준현(Jun Hyeon Kim),안장훈(Jang Hun Ahn),강태인(Tae In Gang) 대한치과의사협회 2009 대한치과의사협회지 Vol.47 No.6

This article presents a modified palatal pedicled incision design in anterior segmental maxillary osteotomy. This method includes the circumcrevicular incisions and two vertical relaxing incisions. Then, it is different from the Couper’s method with vestibular horizontal incision and other anterior segmental osteotomy techniques. The main advantages of this method are an improved visibility of surgical field and favorable preservation of palatal pedicle. A patient who had been operated by anterior segmental maxillary and mandibular osteotomy without pre operative orthodontic treatment was analyzed for advantages and complications during the intraoperative and early post operative period. There are no specific major complications such as infection, gingival recession and dehiscence. And the patient had a pleasing esthetic facial appearance.

A comparison of fixation methods using three-dimensional finite element analysis following anterior segmental osteotomy

Kyoung In Yun,Min-Kyu Park,Myung-Kyun Park,Je Uk Park 대한구강악안면외과학회 2012 대한구강악안면외과학회지 Vol.38 No.6

Objectives: This study sought to evaluate fixation methods and determine the best method for the postoperative stabilization of maxillary osteotomy. For our analysis we performed a three-dimensional finite element analysis of stress distribution on the plate, screw, and surrounding bone, as well as displacement onto the plate. Materials and Methods: We generated a model using synthetic skull scan data; an initital surface model was changed to a solid model using software. Modified anterior segmental osteotomy (using Park’s method) was made using the program, and four different types of fixation methods were used. An anterior load of 100 N was applied on the palatal surface of two central incisors. Results: The Type 1 (L-shaped) fixation method gave stresses of 187.8 MPa at the plate, 45.8 MPa at the screw, and 15.4 MPa at the bone around the plate. The Type 2 (I-shaped) fixation method gave stresses of 186.6 MPa at the plate, 75.7 MPa at the screw, and 13.8 MPa at the bone around the plate. The Type 3 (inverted L-shaped) fixation method gave stresses of 28.6 MPa at the plate, 29.9 MPa at the screw, and 15.3 MPa at the bone around the plate. The Type 4 (I-shaped) fixation method gave stresses of 34.8 MPa at the plate, 36.9 MPa at the screw, and 14.9 MPa at the bone around the plate. The deflection of the plates for the four fixation methods was 0.014 mm, 0.022 mm, 0.017 mm, and 0.018 mm, respectively. Conclusion: The Type 3 (inverted L-shaped) fixation method offers more stability than the other fixation methods. We therefore recommend this method for the postoperative stabilization of maxillary osteotomy.

심한 상하악 치열궁 부조화 환자의 수술적 해결: 증례보고

유경선,이백수,김여갑,권용대,최병준,오주영,Ryu, Kyung-Sun,Lee, Baek-Soo,Kim, Yeo-Gab,Kwon, Yong-Dae,Choi, Byung-Joon,Ohe, Joo-Young 대한악안면성형재건외과학회 2013 Maxillofacial Plastic Reconstructive Surgery Vol.35 No.2

Multiple segment osteotomy orthognathic surgery serves to combine the total or segmental maxillary and mandibular correction of the dentofacial deformities with concurrent procedures to provide immediate repositioning to the dento-osseous elements. In addition, splitting the palate may often be necessary to correct a functionally poor relationship of the maxilla to the mandible or the facial skeleton by realigning the maxillary arch. In this case, the discrepancy in a bimaxillary horizontal relationship and the space between the 2nd premolar and 2nd molar was retained after lengthy preoperative orthodontic treatment. However, we could correct these dento-osseous discrepancies immediately by performing midpalatal expansion, anterior segmental osteotomy and symphyseal osteotomy with bimaxillary osteotomies. If the blood supply to each segment segments was maintained and primary closure of the operation site was feasible, multiple segment osteotomy was considered as a very effective technique for treating dentofacial deformities in vertical, transverse, and sagittal dimensions with differential repositioning of all segments.

골격성 III급 부정교합 환자의 양악 Anterior Segmental Osteotomy를 동반한 양악 수술교정 치험례

임근오,박지훈,안정섭 대한치과교정학회 2020 대한치과교정학회 임상저널 Vol.10 No.1

The purpose of this case report is to describe the considerations in surgical orthodontic treatment of a patient with skeletal Class III malocclusion and potential airway problem. A 30-year-old female patient showed skeletal Class III malocclusion and a narrow airway space. After presurgical orthodontic treatment, the bimaxillary orthognathic surgery with bimaxillary anterior segmental osteotomy was done to move the posterior segment of the maxilla forward and reduce the amount of mandibular setback. The remaining extraction space was closed during the postoperative orthodontic treatment. After the orthodontic treatment, proper overjet and overbite were obtained and the protruded mandible was corrected. The airway space increased postoperatively compared to the preoperative condition. In patients with Class III malocclusion who have predisposing factors or present symptoms of obstructive sleep apnea (OSA) or who have been diagnosed with OSA, consideration to minimize reduction of the airway space is necessary in treatment planning.

정면에서 평가한 한국인 여성 입술의 심미성과 전방 분절 골절단술 후 입술의 평가

이범석(Beom-Suk Lee),강윤구(Yoon-Goo Kang),윤태호(Tae-Ho Yoon),국윤아(Yoon-Ah Kook) 대한치과교정학회 2007 대한치과교정학회지 Vol.37 No.1

이 연구는 한국인 여자 유명 모델과 일반인의 정면입술의 차이점을 비교하여 아름다운 입술의 특징을 규명하며 양악 전방 분절골절단술을 시행한 환자에서 정면입술의 변화를 측정하고 그 수술 결과를 한국인 모델과 비교하여 차이점을 알아보고자 하였다. 한국인 유명 모델 30명, 일반인 26명과 양악 전방 분절골절단술을 받은 환자의 10명을 대상으로 정면입술 부위의 12개의 선 길이, 홍순의 5개의 각도와 둘레 및 면적을 측정하였고, 통계분석은 unpaired & paired t-test를 이용하였다. 한국인 유명 모델 군과 일반인 군의 비교에서 하안면 얼굴 폭경, 하안면 수직 길이, 상홍순의 높이, 하순의 길이, 상홍순의 구각부 각도와 central bow의 각도는 의미 있는 차이로 일반인 군보다 유명 모델 군에서 작았다. 그러나, 입술의 폭, 하홍순의 높이, Cupid’s bow tip간 거리와 하홍순의 구각부 각도는 유명 모델 군에서 컸고 입술의 둘레와 전체 면적에서도 일반인 군보다 쳐다 양악 전방 분절골절단술을 받은 환자의 정면입술에서는 하안면 얼굴 폭경, 상홍순의 높이, Cupid’s bow tip에서 구각부까지의 길이와 상홍순의 면적이 통계적으로 의미 있는 변화를 보였고 한국인 유명 모델과의 비교에서 비슷한 수치를 나타내었지만 상순의 길이는 반대로 증가하였다. 연구의 결과는 교정치료 혹은 양악 전방 분절골절단술을 계획할 때 정면 입술 심미성을 평가하는데 도움이 될 것으로 생각된다. Objective:The aim of this study was to determine firstly the characteristics of esthetic lips in Korean females and secondly to measure the changes of the lips before and after anterior segmental osteotomy in bimaxillary protruded patients.<br> Methods: Samples consisted of 30 models and 26 nonmodels, and 10 patients who had received anterior segmental osteotomy. Twelve linear measurements, 5 angular measurements, and the lip perimeter and area were measured. These results were compared for each group using unpaired and paired t-tests.<br> Results: Full face width, nose to chin, upper vermilion height and angle, lateral heights at the point of the tips of Cupid’s bow, central bow angle, and the lower lip to chin lengths were significantly greater in nonmodels than in models. However, overall lip width, lower vermilion height and angle, tip-to-tip of Cupid’s bow lip perimeter, and lower vermilion area were greater in models than in nonmodels. Comparison of before and after anterior segmental osteotomy revealed that the values for the upper vermilion and lateral heights, the angle to Cupid’s bow tip lengths, and upper vermilion area of post-operative patients had become similar to those of Korean female models. Our findings demonstrated that Korean female models have a fuller lower vermilion & thinner upper vermilion compared with nonmodel controls, as determined by the vermilion heights, angles, and areas.<br> Conclusion: It will be helpful for clinicians to use these measurements as guidelines for improving patients’ facial esthetics.

정면에서 평가한 한국인 여성 입술의 심미성과 전방 분절 골절단술 후 입술의 평가

이범석,강윤구,윤태호,국윤아 대한치과교정학회 2007 대한치과교정학회지 Vol.37 No.5

이 연구는 한국인 여자 유명 모델과 일반인의 정면입술의 차이점을 비교하여 아름다운 입술의 특징을 규명하며 양악 전방 분절골절단술을 시행한 환자에서 정면입술의 변화를 측정하고 그 수술 결과를 한국인 모델과 비교하여 차이점을 알아보고자 하였다. 한국인 유명 모델 30명, 일반인 26명과 양악 전방 분절골절단술을 받은 환자의 10명을 대상으로 정면입술 부위의 12개의 선 길이, 홍순의 5개의 각도와 둘레 및 면적을 측정하였고, 통계분석은 unpaired & paired t-test를 이용하였다. 한국인 유명 모델 군과 일반인 군의 비교에서 하안면 얼굴 폭경, 하안면 수직길이, 상홍순의 높이, 하순의 길이, 상홍순의 구각부 각도와 central bow의 각도는 의미 있는 차이로 일반인 군보다 유명 모델 군에서 작았다. 그러나, 입술의 폭, 하홍순의 높이, Cupid's bow tip간 거리와 하홍순의 구각부 각도는 유명 모델 군에서 컸고 입술의 둘레와 전체 면적에서도 일반인 군보다 컸다. 양악 전방 분절골절단술을 받은 환자의 정면입술에서는 하안면 얼굴 폭경, 상홍순의 높이, Cupid's bow tip에서 구각부까지의 길이와 상홍순의 면적이 통계적으로 의미 있는 변화를 보였고 한국인 유명 모델과의 비교에서 비슷한 수치를 나타내었지만 상순의 길이는 반대로 증가하였다. 연구의 결과는 교정치료 혹은 양악 전방 분절골절단술을 계획할 때 정면 입술 심미성을 평가하는 데 도움이 될 것으로 생각된다. Objective: The aim of this study was to determine firstly the characteristics of esthetic lips in Korean females and secondly to measure the changes of the lips before and after anterior segmental osteotomy in bimaxillary protruded patients. Methods: Samples consisted of 30 models and 26 nonmodels, and 10 patients who had received anterior segmental osteotomy. Twelve linear measurements, 5 angular measurements, and the lip perimeter and area were measured. These results were compared for each group using unpaired and paired t-tests. Results: Full face width, nose to chin, upper vermilion height and angle, lateral heights at the point of the tips of Cupid's bow, central bow angle, and the lower lip to chin lengths were significantly greater in nonmodels than in models. However, overall lip width, lower vermilion height and angle, tip-to-tip of Cupid's bow lip perimeter, and lower vermilion area were greater in models than in nonmodels. Comparison of before and after anterior segmental osteotomy revealed that the values for the upper vermilion and lateral heights, the angle to Cupid's bow tip lengths, and upper vermilion area of post-operative patients had become similar to those of Korean female models. Our findings demonstrated that Korean female models have a fuller lower vermilion & thinner upper vermilion compared with nonmodel controls, as determined by the vermilion heights, angles, and areas. Conclusions: It will be helpful for clinicians to use these measurements as guidelines for improving patients' facial esthetics.

Factors Affecting Postoperative Sagittal Alignment after Lateral Lumbar Interbody Fusion in Adult Spinal Deformity: Posterior Osteotomy, Anterior Longitudinal Ligament Rupture, and Endplate Injury

Hiroaki Nakashima,Tokumi Kanemura,Kotaro Satake,Yoshimoto Ishikawa,Jun Ouchida,Naoki Segi,Hidetoshi Yamaguchi,Shiro Imagama 대한척추외과학회 2019 Asian Spine Journal Vol.13 No.5

Study Design: Prospective cohort study. Purpose: To identify factors that affect sagittal alignment correction in lateral lumbar interbody fusion (LIF) surgery for adult spinal deformity (ASD) and to investigate the degree of correction in each condition. Overview of Literature: LIF is a useful procedure for ASD, but the degree of correction can be affected by posterior osteotomy, intraoperative endplate injury, or anterior longitudinal ligament (ALL) rupture. Methods: Radiographical data for 30 patients who underwent LIF for ASD were examined prospectively. All underwent two-stage surgery (LIF followed by posterior fixation). Radiographical parameters were measured preoperatively, after LIF, and after posterior fixation; these included the segmental lordotic angle, lumbar lordosis (LL), and other sagittal alignment factors. Results: LL was corrected from 16.5°±16.7° preoperatively to 33.4°±13.8° after LIF (p<0.001) and then to 52.1°±7.9° following posterior fixation (p<0.001). At levels where Schwab grade 2 osteotomy was performed, the acquired segmental lordotic angles from the preoperative value to after posterior fixation and from after LIF to after posterior fixation were 19.5°±9.2° and 9.9°±3.9°, respectively. On average, 12.4° more was added than in cases without osteotomy. Endplate injury was identified at 21 levels (19.4%) after LIF, with a mean loss of 3.4° in the acquired segmental lordotic angle (5.3°±8.4° and 1.9°±5.9° without and with endplate injury, respectively). ALL rupture was identified at seven levels (6.5%), and on average 19.3° more was added in these cases between the preoperative and postoperative values than in cases without ALL rupture. Conclusions: LIF provides adequate sagittal alignment restoration for ASD, but the degree of correction is affected by grade 2 osteotomy, intraoperative endplate injury, and ALL rupture.

상악골 전방부 골절단술후 발생된 개방형 열개 : 증례보고 A CASE REPORT

김훈,김수관,이준길,정태영 大韓顎顔面成形再建外科學會 2003 Maxillofacial Plastic Reconstructive Surgery Vol.25 No.3

An anterior segmental osteotomy may be complicated by malpositioning,bleeding, perfusion deficiencies, periodontal defects(dehiscence), devitalized teeth, oronasal fistula, and nonunion(delayed union).If preiodontal defects occur after surgery, though hygiene and good nutrition are all that can be recommended until primary healing has occurred. However, a soft tussue graft might be needed at the defect site when the preiodontal defects do not heal properly. We reported a patient who showed an excellent prognosis after undergoing a palatal mucosa graft accompanied by laterally positioned flap as a result of a dehiscence that occurred after anterior segmental osteotomy.

전치부 분절골절단술과 통상적인 교정 치료의 치근 흡수에 대한 비교 및 고찰

오주영 ( Joo-young Ohe ) 경희대학교 경희의료원 2018 慶熙醫學 Vol.33 No.1

Patients undergoing orthodontic treatment are more likely to have apical root shortening. Many literatures showed the etiologic factors were complex and multifactorial. It appears that external apical root resorption results from a combination of patient-related risk factors such as previous history of root resorption, genetic influences and systemic factors and orthodontic treatment-related factors like treatment duration, magnitude of applied force, direction of tooth movement, amount of apical displacement, method of force application, type of appliance, treatment technique and so on. We could encounter the patients having the short teeth root and the poor periosteum in a case that much maxillary setback be needed, such as bimaxillary protrusion or skeletal class II. The anterior segmental osteotomy (ASO) has been known that this could complement the possibility of external apical root resorption and buffer the periodontal problems, so it could be the choice of treatment. But the studies about the efficacy of ASO in aspects of preserving the root are deficient. So in this study, we compared the amount of root resorption after orthodontic procedure between patients group who had been taken a conventional orthodontic and patients group in whom ASO had been included in orthodontic treatment procedure.