Current concept of the surgery-first orthognathic approach

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.

Necessity of Education for Emergency Medical Technicians to Improve Awareness of Early Symptoms of Stroke and Assessment of Stroke Patients / 農村醫學 地域保健

OBJECTIVES: The purpose of this study was to reconsider the necessity of stroke-related educational programs by investigating early symptoms of stroke that emergency medical technicians (EMTs) may experience. METHODS: An interview survey was carried out, targeting all EMTs 298 people who were working at 119 fire safety centers and local units in Jeollabuk-do province, from April 1 to 30, 2011. An interviewer administered questionnaire was used to obtain data on ETMs' demographic characteristics, educational level on stroke, and awareness level about early symptoms of stroke and treatment-related characteristics of stroke patients. RESULTS: The results showed that 63.2% of those surveyed had completed the required educational programs on stroke during the past year. The level of awareness about early symptoms of stroke and assessment of stroke patients' condition was relatively high for women, those who were 30 years under, low position people, emergency service practitioners, emergency medical technicians, and people who have completed education, respectively. It was also turned out that 82.8% of those surveyed took stroke patients to the nearest hospitals first so that they could receive appropriate treatment. The level of awareness about early symptoms of stroke and assessment of stroke patients' condition in people who have completed education were higher than non-complete. The level of awareness about early symptoms of stroke was positively correlated with confidence, satisfaction and appropriateness in treatment of stroke patients. CONCLUSIONS: These results strongly suggest that it is necessary to operate specialized educational programs to enhance EMTs' appropriate awareness of the early symptoms of stroke and assessment of stroke patient's condition.

Oral Bisphosphonates Induced Osteonecrosis of the Mandible : a Case Report

Bisphosphonates have been approved for Paget's disease, cancer - related hypercalcemia, bone involvement in multiple myeloma or solid tumors and osteoporosis. Although, underlying pathophysiological mechanisms remain unclear, it seems that bisphosphonates inhibit osteoclast precursor cells, modulate migratory and adhesive characteristics and induce apoptosis of osteoclasts. Furthermore impacts on angiogenesis, microenvironment and signal transduction between osteoclasts and osteoblasts. In this report, we present a case of oral bisphosphonates induced osteonecrosis of the mandible in a 84-year-old patient who received for two years. Two tapered screw vent implants(Zimmer, USA) were placed in the area of first and second molar. Two weeks later after crowns restored, some inflammatory signs and symptoms were observed on the second molar area. Sequestrum was formed and the sequestrum was removed with the implant. Frequent follow-up checks and oral hygiene maintenances were done and the first molar implant was restored. There is insufficient evidence suggests that duration of oral bisphosphonate therapy correlates with the development and severity of osteonecrosis. Therefore, dentists should not overlook the possibility of development of bisphosphonate induced osteonecrosis in patients who have taken oral forms of medication for less than three years.

Posterior Cruciate Ligament Reconstruction Using Hamstring Tendon with Preservation of Posterior Cruciate Ligament Remnant

PURPOSE: The purpose of study is to evaluate the clinical results of posterior cruciate ligament (PCL) reconstruction using the quadruple hamstring tendon with preservation of the PCL remnant. SUBJECTS AND METHODS: Twenty PCL reconstructions have been performed by one surgeon. The average follow-up period were at 31 months. There were 11 isolated injuries and 9 associated injuries. The clinical outcome was assessed by preoperative and postoperative posterior displacement at stress radiograph, Lysholm knee score and complications. RESULTS: At last follow up Lysholm knee scores improved from 60 preoperatively to 92 postoperatively. The average preoperative posterior displacement at stress radiograph was 14 mm and postoperatively it was 3.2 mm. The average postoperative posterior displacement at stress radiograph was 2.6 mm in isolate injury and 3.7 mm in associated injury. The average postoperative posterior displacement at stress radiograph was 2.6 mm in case of reconstruction within three weeks and 3.7 mm in case of reconstruction after three weeks. CONCLUSION: Good stability and function of knee could be obtained by PCL reconstruction using hamstring tendon with preserving the PCL remnant and non-aggressive rehabilitation.

Clinicoradiologic Differential Diagnosis of Odontogenic Keratocyst and Ameloblastoma / 대한구강악안면방사선학회지

PURPOSE: To clarify the clinical and radiologic parameters that can be used to differentiate odontogenic keratocyst and ameloblastoma MATERIALS AND METHODS: The records of 46 patients of ameloblstoma and 48 patients of odontogenic keratocyst at the Yonsei University Dental Hospital during the period of 1979 to 1995 were retrospestively reviewed. As a possible means for differentiating between the odontogenic keratocyst and ameloblastoma, the clinical parameters and the radiologic parameters were evaluated. RESULTS: In the clinical parameters, there was no significant defference in age, sex, and sign and symptoms(p>0.05).In the radiologic parameters, there was significant difference in site, shape of the lesion, and external root resorption of adjacent teeth(p<0.05). CONCLUSION: The site, shape of the lesion, and external root resorption of adjacent teeth can be the parameters to differentiate odontogenic keratocyst and ameloblastoma, but a definite differentiation of these two lesions needs a more specialized imaging modality.

The Odontogenic Keratocysts: A Consideration of the Clinical and Radiologic Features / 대한구강악안면방사선학회지

PURPOSE: To determine whether the significant relationship exists between radiographic appearance, whether it is unilocular or multilocular, and its corresponding clinical and histologic features by examining the odontogenic keratocyst clinically, radiologically and histologically. MATERIALS AND METHODS: This study was conducted on 48 cases of odontogenic keratocyst from the files of Dental Hospital, Yonsei University for the years 1982 through 1995. RESULTS AND CONCLUSIONS: The mean age of patients was 30.5 years in the unilocular group and 35.5 years in the multilocular group. The male to female ratio was 1:1.06 in the unilocular group and 1:1.75 in the multilocular group. The chief complaint was swelling in both groups(unilocular 35.1%, multilocular 54.5%). In the occurrence site, the border of the lesion, the displacement and external root resorption of the adjacent teeth, there were no statistically significant difference between the unilocular group and multilocular group, but in the border type, there was statistically significant difference( x2-test, p<0.05). Two recurred cases were observed among 11 cases of odontogenic keratocyst. One was unilocular case and the other was multilocular case.

A study on the distributions and trends in malocclusion patients from department of orthodontics, college of dentistry, Yonsei university / 대한치과교정학회지

Distributions trends were examined in 9159 malocclusion patients had been examined and diagnosed at Department of Orthodontics, College of Dentistry, Yonsei University over a 6 year-period from 1992 to 1997. The results were as follows: 1. The total number of orthodontic patients in 1997 increased in comparing with that of 1992(86%)and after 1995, the number of annual patients showed an increase. 2. Age distribution had shown over-19 year-old group being the largest(39.9%) but percentages of pre-adolescent patients had been decreasing while that of adult patient had gradually increased. 3. Distributions in the types of malocclusion, the Angle's Classification had shown : 33. 3% for Class I, 28.6% for ClassII and the largest 38.1% for Class III. 4. Among Class I patients, crowding showed the largest(32.6%) and protrusion group had gradually increased to 33.9% in 1996. Otherwise openbite and groups tend to decrease, annually. 5. Geographic distribution showed a majority of patients from Seoul(above 70%). Among the patients from Seoul, group within the distance 3-6km from Yonsei dental hospital was the largest(32.3%) and group within 9km showed 69% of total patients.

A study on skeletal relapse patterns following orthognathic surgery of Class III patients : comparison between SSRO and IVRO / 대한치과교정학회지

To evaluate the relapse pattern and long-term stabilities depanding on surgical methods following orthognathic surgery of Cl III patients, the author selected 24 subjects(10 male, 14 female) operated by SSRO and 26 subjects(10 male, 16 female) operated by IVRO. Each subject took four lateral cephalograms: just before surgery(Tl), within 48hrs after surgery(T2), 4-8 wks after surgery(T3), 6 month or more after surgery(T4), and the landmarks were digitized. The differences of relapse patterns in each interval between two groups were compared and the significance of correlation among the variables of each group was tested The obtained results are as follows; 1. Horizontal early relapse was forward movement of mandible in SSRO group, as compared to the backward movement in IVRO group, and there was a statistical significance between the two groups. 2. Vertical early and late relapses were decreases in anterior facial height in both groups and there was no statistical significance between the two groups. 3. There was a statistical significance in negative correlation between mandibular hornontal late relapse and surgical change of articular angle in SSRO group. 4, There was a statistical significance in negative correlation between amount of mandibular set-back and mandibular horizontal early relapse in both groups.

Semi-longitudinal study on growth and development of children aged 6 to 17 Part II : Growth change of craniofacial soft tissue / 대한치과교정학회지

Along with traditional goal of 'straightening teeth', today's orthodontics put more and more emphasis on facial esthetics. Naturally, the importance of soft tissue, which dictates one's facial form, is noticed. There have been many cephalometric studies on growth of hard tissue; however, only a few on that of soft tissue. In Korea, various methods of sampling, measuring and analysing were used to study soft tissue changes, and yet, soft tissue changes along with process of normal growth have not been studied. The author carried out this study as a part of semi-longitudinal study on craniofacial growth and development of Korean children from ages of six to seventeen. 409 boys and 436 girls who'd had no systemic disease for the last three years and shown normal developmental and occlusal status were chosen as subjects. Cephalometric X -rays were taken of each subject, and facial form, lip position & form, nose form, and lip thickness were measured, Mean values and standard deviations were calculated according to age and gender, and figures and tables were drawn accordingly. The following results were obtained: 1. In respect to facial form, boys showed growth for longer period compared to girls. Also, lower face showed higher growth rate than upper face. 2. There was not much change in thickness of upper and lower lips with age; however , they appeared more prominent compared to caucasian children. 3. Nose grew horizontally with age. 4. Horizontal thickness of lower face increased with age, and upper lip thickness at nose base[A-Sn(FH)] showed more growth than anywhere else.