Orthognathic surgery and temporomandibular joint symptoms / 대한악안면성형재건외과학회지

The aim of this article is to review temporomandibular joint symptoms as well as the effects of orthognathic surgery(OGS) on temporomandibular joint(TMJ). The causes of temporomandibular joint disease(TMD) are multifactorial, and the symptoms of TMD manifest as a limited range of motion of mandible, pain in masticatory muscles and TMJ, Joint noise (clicking, popping, or crepitus), myofascial pain, and other functional limitations. Treatment must be started based on the proper diagnosis, and almost symptoms could be subsided by reversible options. Minimally invasive options and open arthroplasty are also available following reversible treatment when indicated. TMD manifesting in a variety of symptoms, also can apply abnormal stress to mandibular condyles and affect its growth pattern of mandible. Thus, adaptive developmental changes on mandibular condyles and post-developmental degenerative changes of mandibular condyles can create alteration on facial skeleton and occlusion. The changes of facial skeleton in DFD patients following OGS have an impact on TMJ, masticatory musculature, and surrounding soft tissues, and the changes of TMJ symptoms. Maxillofacial surgeons must remind that any surgical procedures involving mandibular osteotomy can directly affect TMJ symptoms, thus pre-existing TMJ symptoms and diagnoses should be considered prior to treatment planning and OGS.

Comparative analysis of the amount of postoperative drainage after intraoral vertical ramus osteotomy and sagittal split ramus osteotomy

OBJECTIVES: The purpose of this retrospective study was to compare the amount of postoperative drainage via closed suction drainage system after intraoral vertical ramus osteotomy (IVRO) and sagittal split ramus osteotomy (SSRO). MATERIALS AND METHODS: We planned a retrospective cohort study of 40 patients selected from a larger group who underwent orthognathic surgery from 2007 to 2013. Mean age (range) was 23.95 (16 to 35) years. Patients who underwent bilateral IVRO or SSRO were categorized into group I or group II, respectively, and each group consisted of 20 patients. Closed suction drainage system was inserted in mandibular osteotomy sites to decrease swelling and dead space, and records of drainage amount were collected. The data were compared and analyzed with independent t-test. RESULTS: The closed suction drainage system was removed at 32 hours postoperatively, and the amount of drainage was recorded every 8 hours. In group I, the mean amount of drainage was 79.42 mL in total, with 31.20 mL, 19.90 mL, 13.90 mL, 9.47 mL, and 4.95 mL measured at 0, 8, 16, 24, and 32 hours postoperatively, respectively. In group II, the mean total amount of drainage was 90.11 mL, with 30.25 mL, 25.75 mL, 19.70 mL, 8.50 mL, and 5.91 mL measured at 0, 8, 16, 24, and 32 hours postoperatively, respectively. Total amount of drainage from group I was less than group II, but there was no statistically significant difference between the two groups (P=0.338). There was a significant difference in drainage between group I and group II only at 16 hours postoperatively (P=0.029). CONCLUSION: IVRO and SSRO have different osteotomy design and different extent of medullary exposure; however, our results reveal that there is no remarkable difference in postoperative drainage of blood and exudate.

Cavernous sinus thrombosis caused by a dental infection: a case report

Cavernous sinus thrombosis not only presents with constitutional symptoms including fever, pain and swelling but also with specific findings such as proptosis, chemosis, periorbital swelling, and cranial nerve palsies. It is known to occur secondary to the spread of paranasal sinus infections in the nose, ethmoidal and sphenoidal sinuses. However, paranasal sinus infection of dental origin is rare. The following is a case of cavernous sinus thrombosis due to the spread of an abscess in the buccal and pterygomandibular spaces via buccal mucosal laceration.

Corrigendum: Cavernous sinus thrombosis caused by a dental infection: a case report

This correction is being published to correct the author's name.

Oral foregut cyst in the ventral tongue: a case report

An oral foregut cyst is a rare congenital choristoma lined by the respiratory and/or gastrointestinal epithelium. The exact etiology has not been fully identified, but it is thought to arise from misplaced primitive foregut. This lesion develops asymptomatically but sometimes causes difficulty in swallowing and pronunciation depending on its size. Thus, the first choice of treatment is surgical excision. Surgeons associated with head and neck pathology should include the oral foregut cyst in the differential diagnosis for ranula, dermoid cyst, thyroglossal duct cyst and lymphangioma in cases of pediatric head and neck lesions.

Comparative Analysis of the Reference Lines on McNamara's and Delaires Analyses for the Anterior and Posterior Facial Relationship of Maxillofacial Deformity

Postoperative recurrences of odontogenic keratocyst: The behavior and proposal of critical follow-up period

Post-operative recurrence of cystic lesion is a great concern for clinician, patients, and their family, especially in case of odontogenic keratocyst, which has aggressive behavior and high recurrence rate. The purpose of this study was to evaluation clinical characters of OKC, focusing of the recurrence rate and proposed critical follow-up period. 58 cases (aged 9 to 66, 33 males and 25 females) of OKC were reviewed for sex of patients, location, size, operative procedure type, radiographic findings, histopathologic findings, post-operative recurrence time, from 2000 to 2005 at Yonsei Medical Center, were selected. The computerized statistical analysis was carried out with SAS system. 18 of 58 cases (31.03%) were recurred and this study revealed no statistically significant difference in recurrence rate for sex, location, size, radiographic findings, histopatologic findings, operative procedure type, recurrence timing. 3 out of 18 cases (16.7%) showed one or more recurrence. This was statistically significant difference (P=.0264). In this study, 15 of 18 cases (83.3%) were observed recurrence during 4 years after removal of the OKCs, we suggest critical follow-up period during 4 years after operation.

Changes of transverse mandibular width after intraoral vertical ramus osteotomy

PURPOSE: In order to clarify the correlation of mandibular setback using bilateral intraoral vertical ramus osteotomy (BIVRO) and post-surgical transverse mandibular width (TMW), this study examined the pre- and postsurgical changes in hard and soft tissues of TMW and the relationship of TMW and the amount of mandibular setback. PATIENTS AND METHODS: One-hundred seven patients who had undergone BIVRO were evaluated radiographically and clinically. A comparison study of the changes in hard and soft tissue after surgery in all 107 patients was performed with preoperative, 1 month, 3 month, 6 month and 1 year postoperative posteroanterio cephalograms and clinical photographs by tracing. And this changes were evaluated in parts to amounts of mandibular setback. RESULTS: Statistically significant increases of TMW in hard and soft tissue from preoperative to postoperative 1 month were seen. TMW in hard tissue from 1 month to 1 year postopertive were gradually decreased. TMW in soft tissue was not changed uniformly but almost equal to pre-operative width. And there was no significant correlation between TMW and amount of mandibular setback. CONCLUSIONS: The results show that mandibular setback using BIVRO did not significantly influence increasing of TMW in soft tissue.

Long-term results of vertical height augmentation genioplasty using autogenous iliac bone graft

PURPOSE: In order to clarify the clinical utility of the vertical height augmentation (VHA) genioplasty using autogenous iliac bone graft (IBG), this study examined the postsurgical changes in hard and soft tissues of the chin and the stability of the grafted bone. PATIENTS AND METHODS: Twenty-three patients who had undergone VHA genioplasty using autogenous IBG were evaluated radiographically and clinically. A comparison study of the changes in hard to soft tissues after surgery in all 23 patients was performed with preoperative, 1-month, 3-months, 6-months, and/or 1-year postoperative lateral cephalograms by tracing. Stability, bone healing, and complication of the grafted bone was evaluated by follow-up roentgenograms and clinical observation. RESULTS: Between the preoperative and 6-month postoperative tracings, an average vertical augmentation of the osseous segment was 4.2 mm at menton and that of the soft tissue menton was 4.0 mm. There was a high predictability of 1: 0.94 between the amounts of hard versus soft tissue changes with surgery in the vertical plane. The position of the genial bone segment was stable immediately after surgery and soft tissue was not changed significantly from 1 month to 1 year after operation. Clinical and radiological follow-up results of the iliac bone graft showed normal bony union and were generally stable. CONCLUSIONS: VHA genioplasty using IBG is a reliable method for predicting hard and soft tissue changes and for maintaining postoperative soft tissue of the chin after surgery.

Facial asymmetry with mandibular prognathism: A new trial of classification and interpretation

OBJECT: Patients with facial asymmetry accompanying mandibular prognathism have various causes and clinical features. So, it is difficult to find a satisfactory treatment method functionally and esthetically. Every traditional classification and interpretation to find etiopathogenesis and/or to establish ideal surgical modality has many limitations because it can't be applied simply to various conditions of patients with facial asymmetry accompanying mandibular prognathism. Therefore, we employ a new classification to interpret more details of the morphologic change of mandible and the spatial change of mandible and maxilla. MATERIALS AND METHODS: Using panoramic X-ray films, PA cephalograms and submentovertex films of 126 patients diagnosed with facial asymmetry accompanying mandibular prognathism as resources, the following results were gathered after analyzing each characteristics through distributing the patterns according to the morphological mandibular asymmetry and mandibular and maxillary spatial asymmetry. RESULTS: Almost frequency of morphological mandibular asymmetry was shown. In case of condyle-ramus elongation and body elongation group, it's frequency was the highest. Higher frequency of compensating vertical growth was shown on the side of over growing maxilla in case of vertical length difference between left and right condyle-ramus. On the other hand, higher frequency of no compensating vertical growth difference between left and right side was shown in case of no vertical length difference in condyleramus. Spatial mandibular asymmetry generally occurred when there was no morphological mandibular asymmetry. Correlation between condyle length difference and condyle-ramus length difference between left and right side was very high, but correlation between condyle length difference and body length difference, and correlation between condyle length difference and body vertical length difference was low. CONCLUSION: In case of patients with facial asymmetry accompanying mandibular prognathism, it is suggested that various pattern of facial asymmetry is occurred by the independent growth of each unit rather than dependent growth of other unit by major growth unit abnormality. Due to the untypical pattern and the various asymmetry occurring according to the changes of each mandibular growth unit, it is considered that an appropriate surgical method should be searched based on the accurate recognition of the each pattern for patients with facial asymmetry accompanying mandibular prognathism.

A comparative clinical study on decompression and enucleation to treat cystic lesions of the jaws

PURPOSE: Among the various surgical methods used for the effective treatment of cystic lesion in the jaws historically, decompression procedure has some of superior prognosis compare to direct enucleation. In order to propose the efficacy of decompression we performed this retrospective study to compare decompression procedure with one-stage enucleation in clinical results and prognosis. PATIENTS AND METHODS: We reviewed 175 patients who had been histopathologically diagnosed cystic lesions from 1996 to 2000 in our department. Patients who had been received decompression alone or secondary enucleation after decompression were 31 cases, and enucleation alone were 144 cases. The age and sex of the patients, the area, size, and histological type of the lesions, and detailed operation and complications including recurrence were investigated. The minimal follow-up period was 2 years. RESULTS: In 31cases of decompression, male patients were 22cases(71%) similar to male predilection(62.3%) in total 175 cases. Cystic lesions were developed evenly in all age groups totally. Decompression was mainly performed in teenagers but enucleation was used in elder decades. In decompression cases the lesions were located in mandibular posterior, maxillary posterior, mandibular anterior, and maxillary anterior in order, which had some differences in total and enucleation cases. In enucleation cases, less than 3cm in size was 77.1% but larger than 3cm was 93.5% in decompression cases. Histopathologically, dentigerous cysts(54.8%), unicystic ameloblastomas(16.1%), and odontogenic keratocysts(12.9%) were seen in decompression cases and no recurrence or metaplasia and infection was observed. On the other hand, permanent tooth loss, numbness, recurrence, and so on were accompanied after enucleation. CONCLUSION: Although decompression procedure has disadvantages such as many of visiting times and slow recovery of the surgical defect, decompression is the best choice of treatment for large cystic lesions of the jaws, because it prevents functional and cosmetic defect, allows bone regeneration, and makes easy secondary enucleation.

Phylogenetic Analysis and Rapid Detection of Genus Phellinus using the Nucleotide Sequences of 18S Ribosomal RNA

Analysis of phylogenetic relationship was performed among Phellinus species based on 18S ribosomal subunit sequence data. Twenty-five strains of 19 Phellinus species including P. linteus were examined in this study. Regions of 18S ribosomal subunit were very conserved, but some variable regions between Phellinus species were observed. The species-specific detection primers, modified by 2 or 3 nucleotides in sense primer were designed based on 18S ribosomal DNA (rDNA) sequence data. The 210 bp PCR bands were detected with annealing temperature 48degrees C. The 18S 2F-18S 4R detection primer set distinguished P. linteus from various Phellinus species but some species like P. baumii, P. weirianius, P. rhabarberinus and P. pomaceus also had weak reactivity on this primer set. The 18S 3F-18S 4R primer set distinguished only P. linteus from various Phellinus species, although sensitivity with this primer set was lower than that of 18S 2F-18 4R primer set. These primer sets would be useful for the detection of only P. linteus among unknown Phellinus species rapidly.

Morphologic and positional change of the proximal segments after intraoralvertical ramus osteotomy of the mandibular prognathism on submentovertex cephalogram

Intraoral Vertical Ramus Osteotomy,along with Sagittal Split Ramus Osteotomy,is an popular surgical technique performed on mandibular prognathism. However Intraoral Vertical Ramus Osteotomy has been suspected for an initial mobilization at the healing phase of segment because it does not employ the rigid fixation between segments. To execute a study on the healing phase of seg-ment after Intraoral Vertical Ramus Osteotomy on the horizontal plane, 102 patients (204 parts) who were diagnosed mandibular prog-nathism and took Intraoral Vertical Ramus Osteotomy at the Yonsei University dental hospital were observed during the period of before operation, immediately postoperation, 1 month, 3 months, 6 months, and 12 months. The change in the width of segment and horizontal angle of proximal segment and condylar head on the Submentovertex Cephalogram taken from those patients represented following results. 1. The width of proximal and distal segment decreased with the lapse of time. It decreased into 84.5% between immediate postoperative and 6M and even continued to decrease till 12M. 2. The horizontal angle of the proximal segment did medial rotation according as the lapse of time and rigorously continued till 3M.The rotation angle of condylar head indicated its tendency of recurrence to the original position but the entire recurrence was not allowed. The bigger an initial angle was, the higher was the tendency of recurrence after the operation while the rotation angle remained still bigger. 3. After grouping into group 1, group 2,and group 3 based on the extent of the variation of rotation angle of condylar head at immediate postoperative, the variation of rotation angle was measures in each group. The result presented that the initial rotation angle of condylar head had correlation with that of proximal segment but had no relation with the extent of setback of the mandible. However a quantitative analysis alone is not a sufficient method for analyzing the healing phase of segment on the horizontal plane.Therefore a multilateral analysis using 3 dimensional data such as CT is recommendable for the future study.

Efficacy of ENaP(ESTHETIC NaP)-line for orthognathic surgery of korean mandibular prognathism

As the most of dentofacial deformity patients indicated to orthognathic surgery have strong desire for esthetic improvement as well as functional improvement, ideal esthetic evaluation should be made at surgical prediction. Lateral cephalographs has been commonly used for surgical prediction, however, remarkable discrepancy between esthetic viewpoint by simple looking and analysis on lateral cephalographs often found on evaluation of sagittal position of the upper and lower jaws especially in cases of mandibular prognathism of Koreans. In these cases, we have been employed Esthetic NaP(ENaP)-line for corrective evaluation and ideal surgical pre-diction on lateral cephalographs, but the efficacy of ENaP-line has not been evaluated. This is a study on efficacy of ENaP-line for orthognathic surgery of Korean mandibular prognathism. 170 Korean patients who had been diagnosed as mandibular prognathism and planned for orthognathic surgery at Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University during last 10 years are studied. The obtained results are as followings; among 170 patients of mandibular prognathism, 132 patients(77.6%) had not discrepancy in evaluation of sagittal position of the maxilla between cephalometric and esthetic evaluation(they are classified as Group I), however, 38 patients(22.4%) had definite discrepancy(they are classified as Group II). ENaP-line was employed in all cephalometric analysis of Group II. The proportions of male and female were similar in both Groups. Sixteen vertical reference lines perpendicular to 16 horizontal reference lines were obtained as followings; Each of the representative degree of SN/AFH, SN/CFH and AFH/CFH obtained at Group I was applied to SN plane, AFH plane and CFH plane of Group II each other, and so 16 horizontal reference lines could be obtained individually according to each of the applied degree to each plane. And then their reliability to coincide with ENaP-line of Group II was evaluated. A vertical reference line perpendicular to a horizontal line made by application of the representative degree of AFH/CFH in Group I to AFH line in Group II had the most highest coincidence with ENaP-line of Group II, however, its agreement was 42% in male and 47% in female. From this results, the rest of them should be determined their corrective jaw position definitely depend on

Molecular Detection of Phellinus linteus and P. baumii by PCR Specific Primer

Specific primer sets based on ribosomal DNA (rDNA) internal transcribed specer (ITS) sequences were designed for rapid detection of Phellinus linteus and P. baumii. Polymerase chain reaction (PCR) with these primers produced unique bands for each Phellinus species. The annealing temperature range is from 40degrees C to 55degrees C. The length of PCR products (P. linteus and P. baumii) using designed combinative primer sets of PL1F, PL2R, PB1F, PB2R, ITS5F and ITS4R, were from 520 bp to 730 bp. Fifteen strains of Phellinus species including P. linteus, P. baumii, P. weirianus, P. johnsonianus, P. rhabarberinus, P. pini, P. gilvus, P. igniarius, P. nigricans and P. laevigatus were examined in this study. Five strains, including two isolated strains of P. linteus (MPNU 7001 and MPNU 7002), and two isolated strains of P. baumii (MPNU 7004 and MPNU 7005) were shown to have about 520 bp (PL1F-PL2R), 700 bp (ITS5F-PL2R) and 600 bp (PB1F-ITS4R)-sized PCR single bands respectively. This molecular genetic technique provided a useful method for rapid detection and identification of P. linteus and P. baumii.

The Determination of the Partial 28S Ribosomal DNA Sequences and Rapid Detection of Phellinus linteus and Related species

Species of Phellinus were known to harmful fungi causing white pocket rot and severe plant disease such as canker or heart-rot in living trees in the West, but some species have been used to traditional medicines in the Orient for a long time. In this study the partial D1-D2 nucleotide sequences of 28S ribosomal DNA from 13 Phellinus strains were determined and compared with the sequences of 21 strains obtained from GenBank database. According to the neighbor-joining (NJ) method comparing the sequence data the phylogenetic tree was constructed. The phylogenetic tree displayed the presence of four groups. Group I includes P. ferreus, P. gilvus and P. johnsonianus, Group II contains P. laevigatus, P. conchatus and P. tremulae, Group III possesses P. linteus, P. weirianus, P. baumii, P. rhabarbarinus and P. igniarius, and Group IV comprises P. pini, P. chrysoloma. P. linteus and P. baumii, which were used mainly in traditional medicine, belong to the same group, but exactly speaking both were split into two different subgroups. To detect P. linteus only, we developed the PCR primer, D12HR. The primer showed the specific amplification of P. linteus, which is permitted to medicinal mushroom in the East. The results make a potential to be incorporated in a PCR identification system that could be used for the rapid identification of this species from its related species, P. linteus especially.

Fiberoptic Nasotracheal Intubation in Pediatric Patients with Difficult Mouth Opening: A case report / 대한마취과학회지

We present two pediatric patients, one with Pierre Robin syndrome and one with temporomandibular joint ankylosis with limited mouth opening. They had historical and physical evidence of airway obstruction, difficult feeding, and sleep disturbance. They were scheduled for oromaxillofacial surgery. In each case, two different-sized fiberoptic bronchoscopes were used for nasotracheal intubation. After loss of consciousness following an IV injection of ketamine or inhalation of sevoflurane while maintaining spontaneous respiration, 10% lidocaine was sprayed into one nostril. Following insertion of a 60 cm Olympus LF-2 fiberoptic bronchoscope (OD: 3.8 mm) through the same nostril without tube placement, the vocal cords were visualized and topical anesthesia of the larynx was achieved by spraying 2% lidocaine through the biopsy channel. Thirty seconds later, the bronchoscope was passed into the trachea and 2% lidocaine was sprayed intratracheally. Then, the bronchoscope was withdrawn. An endotracheal tube was advanced through the same nostril and positioned in the nasopharynx and the ultrathin fiberoptic bronchoscope (OD: 2.2 mm) was threaded through the tube. There was neither a cough nor laryngeal spasm during advancement of the tube into the trachea. Extubation was performed without compromise in the operating room. The patients were discharged uneventfully.

Phylogenetic Analysis of Caterpillar Fungi by Comparing ITS 1-5.8S-ITS 2 Ribosomal DNA Sequences

This study was carried out to identify the phylogenetic relationships among several caterpillar fungi by comparing the sequences of internal transcribed spacer regions (ITS1 and ITS2) and 5.8S ribosomal DNA (rDNA) repeat unit. The sequences of ITS1, ITS2, and the 5.8S rDNA from 10 strains of Cordyceps species, 12 strains of Paecilomyces, 3 strains of Beauveria, 2 strains of Metarhizium and 1 strains of Hirsutella were amplified, determined and compared with the previously known Cordyceps species. The sequences of 5.8S rDNA were more conserved in length and variation than those of ITS regions. Although the variable ITS sequences were often ambiguously aligned, the conserved sites could be found. In the phylogenetic tree, the species generally divided into three clusters, supported by their morphology and/or host ranges. The 5.8S rDNA and ITS1 sequences among 10 species of Cordyceps militaris were identical and only one base pair in ITS2 sequence was different. Cordyceps sinensis and Cordyceps ophioglossoides were also clearly different, although they belonged to the same cluster. The GenBank database search of species revealed sister taxa of an entomogenous fungus. Metarhizium was used as an outgroup in all taxa.

Availability of Sikhae Factory Wastewater as a Submerged Culture Medium for Lentinula edodes

Sikhae is a Korean traditional beverage of saccharified rice. Its factory waste (SFW) is usually thrown away instead of being used. We developed a cheap substrate of SFW for use in liquid spawn that is known for its higher fruit body yields than grain spawn in sawdust cultivation. Mycelia of Lentinula edodes ASI 3046, which is regarded as the most suitable strain for sawdust cultivation, were cultured on six kinds of previous known media and SFW. As the seven kinds of media were applied, a Sikhae Factory Waste (SFW) was most excellent in growth. The dried mycelial weight in SFW was almost four times as much as that in the other media. In the flask culture, optimum culture conditions for the mycelial growth were obtained after 13 days of cultivation at media volume of 100 ml, 100 rpm, initial pH 4.5, and 25degrees C. The best mycelial growth was observed when MgSO4 . 7H2O and D-sucrose were added as a supplement in SFW. SWM must be a remarkable medium for L. edodes because of its simple preparation and low cost.

Cephalometric study of posterior airway space and hyoid bone position in patients affected by class II malocculusion and treated with orthognathic surgery

No abstract available.