CASE REPORT 김택우 1 김복주 1 전영미 2 김동우 3 김철훈 1 1 동아대학교의과대학구강악안면외과학교실 2 동아대학교의과대학치과교정학교실 3 김동우이루미치과 초록.. LeFort 1 osteotomy,. LeFort 1 osteotomy (bilateral sagittal split ramus osteotomy). Dr. 김택우 Dr. 김복주 Dr. 전영미 Dr. 김동우 Dr. 김철훈 김택우 1 김복주 1 전영미 2 김동우 3 김철훈 1 1 동아대학교의과대학구강악안면외과학교실 2 동아대학교의과대학치과교정학교실 3 김동우이루미치과교신저자 : 김철훈 Department of Oral and Maxillofacial Surgery, Dong-A University medical center, Dongdeasin 3Ga, Soe-Gu, Busan, Korea Tel: +82-51-240-5475 Fax: +82-51-241-5475 E-mail: bbp2000@hanmail.net 40 CASE REPORT 1
김택우 김복주 전영미 김동우 김철훈 서론., 1,2. 3,,.,,. total setback, impaction/rotation, canting. 3,.. 증례 I 29 2012 1.,, cephalometry analysis ( 1, 2). SNA 85.37, U1 to SN 104.74. Gummy smile, 1 그림 1. 초진시구강내사진 대한치과교정학회임상저널 41
그림 2. 초진시안모사진, 측모두부계측방사선사진과파노라마방사선사진 3mm canting,.. 2012 1. 2012 12, A point 4mm total setback. ANS 3mm, 1 7.5mm, 4.5mm 3mm occlusal canting Gummy smile., 1mm. BSSRO Rt. 9mm, Lt. 7mm setback lat. angle reduction advancing genioplasty. 7 microimplant 그림 3. 수술 9 개월후구강내사진 42 CASE REPORT 1
김택우 김복주 전영미 김동우 김철훈, Interproximal reduction. SNA: 81.37, SNB:78.24, ANB: 3.12,. ( 3-6, 1). 그림 4. 수술 9 개월후안모사진, 측모두부계측방사선사진과파노라마방사선사진 그림 5. 수술전후측모두부계측방사선사진과중첩사진 표 1. 치료전후측모두부계측방사선사진의계측치 그림 6. 수술전후안모사진 Measurements Norm Pretreatment Posttreatment ( 술후 9 개월 ) SNA( ) 82.0 85.37 81.37 SNB( ) 79.10 81.31 78.24 ANB( ) 2.40 4.07 3.12 FMA( ) 24.20 30.88 31.83 U1 to SN( ) 107.0 104.74 107.43 IMPA( ) 95.90 94.28 87.37 대한치과교정학회임상저널 43
증례 II 24 2010 9 Gummy smile.,,.,, cephalometry analysis ( 7, 8). SNA: 87.99, SNB: 82.86,. Gummy smile., total setback/total impaction LeFort I osteotomy, BSSRO setback advancing genioplasty. 2010 9. 그림 7. 초진시구강내사진 그림 8. 초진시안모사진, 측모두부계측방사선사진과파노라마방사선사진 44 CASE REPORT 1
김택우 김복주 전영미 김동우 김철훈 2011 1, A point total setback 5mm. ANS 3mm, 1 4mm. BSSRO 8mm setback, lat. angle reduction advancing genioplasty. II. 2011 8, 11 ( 9-12, 2)., Gummy smile ( 13),. Rotation surgery. 그림 9. 교정치료종료후 ( 수술 9 개월후 ) 구강내사진 그림 10. 교정치료종료후 ( 수술 9 개월후 ) 안모사진, 측모두부계측방사선사진과파노라마방사선사진 대한치과교정학회임상저널 45
그림 11. 수술전후측모두부계측방사선사진과중첩사진 표 2. 치료전후측모두부계측방사선사진의계측치 그림 12. 수술전후안모사진 Measurements Norm Pretreatment Posttreatment ( 술후 9 개월 ) SNA( ) 82.0 87.99 83.12 SNB( ) 79.10 82.86 78.70 ANB( ) 2.40 4.89 4.42 FMA( ) 24.20 26.74 29.68 U1 to SN( ) 107.0 108.72 105.57 IMPA( ) 95.90 89.78 98.61 그림 13. 수술전후 smile 사진 46 CASE REPORT 1
김택우 김복주 전영미 김동우 김철훈 고찰 (bimaxillary protrusion) (dentoalveolar deformity). 4 (convex profile). 4., 4. 5,6, 24~30., (anterior segmental osteotomy) LeFort I osteotomy (bilateral sagittal split ramus osteotomy). 3 SNA: 85.37, U1 to SN 104.74,,, gummy smile., gummy smile, (concave lower profile).,, gummy smile. SNA: 87.99, SNB: 82.86, gummy smile,. LeFort 1 osteotomy LeFort(1901) Wassmund(1927). 1960 obwegeser LeFort 1. 7 Lefort 1 setback total setback, clockwise rotation. 8,, canting total impaction/elongation impaction/elongation, rotation, impaction/ elongation. (pterygoid process) (maxillary tuberosity), 3 (palatine bone) 3. 2, bony interference,, descending palatine artery sphenopalatine artery. 9, (infraorbital nerve) (great palatal nerve) dysesthesia paraesthesia.. 대한치과교정학회임상저널 47
,. 10,,,.,,, canting,,,. 7 LeFort 1 osteotomy total setback LeFort 1 osteotomy. 참고문헌 1. Proffit WR, Hall DJ. [Combined orthodonticsurgical treatment of bimaxillary protrusion]. InfOrthodKedferorthop 1978;10(4):439-60. 2. Bills DA, Handelman CS, BeGole EA. Bimaxillarydentoalveolar protrusion: traits and orthodontic correction. Angle Orthod 2005;75(3):333-9. 3. Chu YM, Bergeron L, Chen YR. Bimaxillary protrusion: an overview of the surgical-orthodontic treatment. SeminPlastSurg 2009;23(1):32-9. 4. Redlich M, Mazor Z, Brezniak N: Severe high angle class II division 1 malocclusion with vertical maxillary excess and gummy smile: a case report, Am J OrthodDentofacialOrth op1999;116:317-320. 5. Bell WH, Condit CL. Surgical-orthodontic correction of adult bimaxillary protrusion. J Oral Surg 1970;28(8):578-90. 6. Kent JN, Hinds E. Management of dental facial deformities by anterior alveolar surgery. J Oral Surg 1971;29(1):13-26. 7. Yang EB. The Comparison of Anterior Segmental Osteotomy and Le Fort 1 Osteotomy Setback as a Treatment of Bimaxillary Protrusion. Master's thesis,department of dentistry, The Graduate School, Seoul National University, 2012. 8. Chu YM, Po-Hsun Chen R, Morris DE, Wen-ChingKo E, Chen YR. Surgical approach to the patient with bimaxillary protrusion. ClinPlastSurg 2007;34(3)535-46. 9. Turvey TA, Fonseca RJ. The anatomy of the internal maxillary artery in the pterygopalatine fossa: its relationship to maxillary surgery. J Oral Surg 1980;38:92-5. 10. Lee JY, An Evaluation of Initial Stability after Maxillary Posterior Impaction. J Korean AssocMaxillofacplastRecons trsurg 2012;34(5):320-325. 48 CASE REPORT 1