Mandibular advancement of anterior segmental osteotomy for aesthetic correction of mandibular retrusion.

PURPOSE: Advancement genioplasty to achieve aesthetic improvement was performed; however, the more genioplasty was advanced, the worse the depth of the labiomental fold became. Therefore, our hospital applied not only advancement of genioplasty but also rotational advancement of anterior segmental osteotomy (ASO) for satisfactory aesthetic lines. MATERIALS AND METHODS: From January 2008 to March 2010, our hospital operated on 10 patients who showed not only convexity profile with posterior divergent but also small SNB and microgenia in the cephalometric analysis. Their mean age was 24.8 years, and we had them followed up for at least 6 months. The surgical technique was contrary to the ASO setback, which means a rotational advancement and an average 5-mm advancement of the ASO segment, adding an average of 6- to 7-mm advancement of genioplasty. RESULTS: Postoperative results in the cephalometric analysis showed a good balance of the lower part of the face. Average SNB was increased from 69.96 to 72.88 degrees. The pogonion of the soft tissue came forward on an average of 7.18 mm and superiorly on an average of 1.93 mm. The inclination of L(1)MP was decreased from 100.00 to 91.99 degrees, but it was within the reference range. The labiomental fold was not deeper. We checked that spaces created by the anterior segmental osteotomy and advancement of genioplasty were filled with new bone through follow-up x-ray density images. CONCLUSIONS: If balance of the lower part of the face with mandibular retrusion is insufficient using advancement of genioplasty, our hospital also applied rotational advancement of ASO. This operative technique not only was relatively simple and applied less pressure but also made a new B point.

Modified temporalis tendon transfer extended with periosteum for facial paralysis patients.

BACKGROUND: We have devised a novel surgical method, termed as temporalis muscle tendonperiosteum (T-P) compound surgical method, by modifying pre-existing techniques. Our method is characterized by elevation of temporalis muscle tendon and the periosteum of the mandibular ramus as a single compound. Here, we describe the concept and clinical outcomes of our method. METHODS: We conducted both a cadaveric study and a clinical study. First, we used four human cadavers (two males and two females) to confirm the anatomy of the temporalis muscle tendon and availability of sufficient length extension through the elevation of the T-P compound. Moreover, we obtained measurements of the mouth angle and the philtrum angle from a total of six patients (two males and four females) and compared them between preoperatively and postoperatively. RESULTS: The mean length of the periosteal portion was measured as 2.43± 0.15 cm (range, 2.2-2.6 cm). There was an improvement in the mouth angle postoperatively as compared with preoperatively (7.2°± 3.0° vs. 14.5°± 4.7°, respectively). Moreover, there was also an improvement in the philtrum angle postoperatively as compared with preoperatively (7.2°± 3.4° vs. 17.2°± 6.5°, respectively). CONCLUSION: Our method is a simple, minimally-invasive modality that is effective in achieving good clinical outcomes. Its advantages include an ability to achieve a firm extension of the temporalis muscle tendon as well as a lack of requirement for a donor site that may cause complications.

Cephalometric Angular Measurements of the Mandible Using Three-Dimensional Computed Tomography Scans in Koreans.

BACKGROUND: We conducted this study to analyze the values of the key cephalometric angular measurements of the mandible using 3-dimensional (3D) computed tomography scans. METHODS: In the 106 enrolled patients, a 3D cephalometric analysis was performed to measure the angular variables of the mandible. These values were compared between the two sides and between the two sexes. RESULTS: The frontal measurements revealed that the mandibular body curve angle was larger on the left (Lt) side (right [Rt], 141.24±7.54; Lt, 142.68±6.94; P=0.002) and the gonial angle was larger on the right side (Rt, 134.37±8.44; Lt, 131.54±7.14; P<0.001). The sagittal measurements showed that the gonial angle was larger on the right side (Rt, 134.37±8.44; Lt, 131.54±7.14; P>0.05). Further, the transverse measurements revealed that the mandibular body curve angle was larger on the right side (Rt, 140.28±7.05; Lt, 137.56±6.23; P<0.001). CONCLUSIONS: These results provide an average of the mandibular angular measurements for the Korean population, establishing a standard for determining surgical patient groups and outcome evaluations in the field of mandible contour surgery.

Stafne Bone Cavity of the Mandible.

Stafne bone cavity is a rare mandibular defect that was first reported by Edward C. Stafne in 1942. It commonly presents with a well-demarcated, asymptomatic, unilateral radiolucency that indicates lingual invagination of the cortical bone. A 52-year-old female patient who with nasal bone fracture, visited the hospital. During facial bone computed tomography (CT) for facial area evaluation, a well-shaped cystic lesion was accidentally detected on the right side of the mandible. Compared to the left side, no swelling or deformity was observed in the right side of the oral lesion, and no signs of deformity caused by mucosal inflammation. 3D CT scans, and mandible series x-rays were performed, which showed a well-ossified radiolucent oval lesion. Axial CT image revealed a cortical defect containing soft tissue lesion, which has similar density as the submandibular gland on the lingual surface of the mandible. The fact that Stafne cavity is completely surrounded by the bone is the evidence to support the hypothesis that embryonic salivary gland is entrapped by the bone. In most cases, Stafne bone cavity does not require surgical treatment. We believe that the mechanical pressure from the salivary gland could have caused the defect.

New nasal fracture classification for patients with silicone implants.

Aesthetic nasal augmentation has increased in popularity among Asian populations, and nasal bone fracture is the most common type of facial bone fracture. In Asia, the frequency of nasal bone fractures is also increasing among patients who have undergone silicone augmentation rhinoplasty. The increasing prevalence of this injury presents a challenge to the surgeon. Thirty-six patients who had previously undergone augmentation rhinoplasty with silicone implant presented with nasal bone fracture from June 2007 through December 2011. The patients were grouped into three categories: patients with fractures in the high level (type I), patients with fractures in the low level (type II), and patients with fractures throughout the entire nasal bone, from base to top (type III). The largest group comprised patients with type I fractures (n = 24, 67%), followed by type II (n = 4, 11%), and Type III (n = 8, 22%) fractures. Symptoms and surgical outcomes for nasal bone fractures may be different in patients with silicone implants. A novel classification system for nasal bone fractures is required, as is a new approach to diagnosis and treatment.