하악 이부 확장술 시 나타나는 합병증의 치험례 (A case report of complications during mandibular transverse symphysis widening)

서지정보

· 발행기관 : 대한악안면성형재건외과학회
· 수록지 정보 : Maxillofacial Plastic Reconstructive Surgery / 30권 / 5호 / 480 ~ 488페이지
· 저자명 : 서충환, 강경화, 최문기

초록

Orthodontists often treat cases which are difficult to treat with conventional orthodontics. In such cases,
it could be treated with surgical procedures with the help of an oral surgeon. Especially, transverse deficiency
of the mandible can be corrected by widening the transverse width of mandibular symphysis, using
distraction osteogenesis. Transverse widening of mandibular sympysis is known as a safe treatment but
still complications could occur during the treatment.
We are reporting some complications of cases that mandibular symphysis transverse widening were
applied.
Some cases showed complications because of the inappropriate osteotomy line. Since straight vertical
osteotomy line was inclined to the left, only the left bony segment was likely to expand. According to biomechanical
considerations, it will be better to perform a step osteotomy, cutting the eccentric area of the
alveolar crest and the centric area of the basal symphyseal area.
Complications could also occur by the failure of the distraction device. The tooth borne distraction device
was attached on the lingual side of the tooth with composite resin. During the distraction period, it was
impossible to obtain appropriate distraction speed and rhythm because of frequent fall off of the distraction
device. Therefore, distraction device should be attached firmly with orthodontic band or bone screw, etc.
Tooth mobility increasement could also occur as a complication‘. Walking teeth phenomenon’was
observed during the distraction period, showing severe teeth mobility and pain during mastication. These
symptoms fade out during the consolidation period. Since the patient could feel insecure and uncomfortable,
it should be notified to the patient before the procedure.
Finally, alveolar crestal bone loss could occur. Alveolar crestal bone loss occurred because of lack of distraction
device firmness and teeth trauma caused by lower lip biting habit. Therefore, adequate firmness of
the distraction device and habit control will be needed.

영어초록

Orthodontists often treat cases which are difficult to treat with conventional orthodontics. In such cases,
it could be treated with surgical procedures with the help of an oral surgeon. Especially, transverse deficiency
of the mandible can be corrected by widening the transverse width of mandibular symphysis, using
distraction osteogenesis. Transverse widening of mandibular sympysis is known as a safe treatment but
still complications could occur during the treatment.
We are reporting some complications of cases that mandibular symphysis transverse widening were
applied.
Some cases showed complications because of the inappropriate osteotomy line. Since straight vertical
osteotomy line was inclined to the left, only the left bony segment was likely to expand. According to biomechanical
considerations, it will be better to perform a step osteotomy, cutting the eccentric area of the
alveolar crest and the centric area of the basal symphyseal area.
Complications could also occur by the failure of the distraction device. The tooth borne distraction device
was attached on the lingual side of the tooth with composite resin. During the distraction period, it was
impossible to obtain appropriate distraction speed and rhythm because of frequent fall off of the distraction
device. Therefore, distraction device should be attached firmly with orthodontic band or bone screw, etc.
Tooth mobility increasement could also occur as a complication‘. Walking teeth phenomenon’was
observed during the distraction period, showing severe teeth mobility and pain during mastication. These
symptoms fade out during the consolidation period. Since the patient could feel insecure and uncomfortable,
it should be notified to the patient before the procedure.
Finally, alveolar crestal bone loss could occur. Alveolar crestal bone loss occurred because of lack of distraction
device firmness and teeth trauma caused by lower lip biting habit. Therefore, adequate firmness of
the distraction device and habit control will be needed.

참고자료

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