Accurate and safe orthognathic surgery

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Accurate and safe orthognathic surgery
All the specialists at SNUDH OSC are doing their best to provide patients with optimum treatment under the policy of accurate and safe orthognathic surgery.
In order to fulfill this policy, diagnosis and surgical planning are being carried out through interdisciplinary cooperation between various. The participating departments are as follows: the department of oral and maxillofacial surgery; the department of orthodontics; the department of oral medicine for TMJ physical therapy before and after surgery; the department of oral and maxillofacial radiology for taking and reading radiographs; the department of dental anesthesiology for providing safe general anesthesia; the department of nuclear medicine for the patient's growth potential and TMJ inflammation; and the blood bank for managing blood for intraoperative autotransfusion.
Furthermore, if the patient has any underlying medical conditions that can increase the risk of complications during orthognathic surgery under general anesthesia, an efficient patient referral system is available to allow close interdisciplinary care with the related departments at the Seoul National University Hospital for more accurate and safe operation.

턱교정수술센터는 구강악안면외과(진단, 수술)와 치과 교정과(진단, 교정치료)로 구분되어 있으며, 구강내과(턱관절 물리치료), 치과마치과(전신마취 및 기도관리), 영상의학과(방사선촬영 및 판독, CT촬영 및 판독), 핵의학과(잔존성장 평가, 턱관절염 평가), 혈액은행(자가수혈, 일반수혈)으로 구성되어 있습니다.

3D virtual surgical planning and simulation for orthognathic surgery
At SNUDH, surgical plans are made based on not only diagnostic method using two-dimensional radiographs, but also using a three-dimensional images as well.
3D facial images captured by a 3D face scanner along with 3D CT images can be used to predict the final outcome by performing precise 3D diagnosis and virtual surgery simulation.

3차원 가상 모의 수술 - 하악전돌중 환자의 턱교정수술, 턱교정수술 전후 기도공간 및 연조직 변화 예측


  • (1) It is possible to evaluate the functional and esthetic outcomes of the surgery by confirming the post-operative locations of the upper and lower jaws three-dimensionally, according to the surgical plan can be modified for the better outcome.

수술계획대로시행한 가상 모의수술 - 상악골이 좌측으로 틀어짐, 좌측 하악골이 더 풍융해 보이는 잔존 비대칭 발생 / 3차원적 수술계획 변경 - 추가적인 회전 이동으로 대칭 적인 상악골 형성, 하악골이 상악골에 따라 함께 회전되므로 더욱 대칭적인 골격 형태가 가능해짐

  • (2) It is possible to figure out in advance the areas of the face which may need facial bone contouring surgery or bone graft after virtual movement of the upper and lower jaws.

턱교정 수술을 통해 상, 하악골 재위치 후 모습 - 피질골절제술이 고려되는 부위 / 골이식이 고려되는 부위

The department of dental anesthesiology with sufficient experience and expertise in orthognathic surgery
Orthognathic surgery is an operation that takes place in the oral cavity which is an important component of the airway and is accompanied by severe facial swelling that requires professional airway management skills.
Evaluation of the patient's condition before general anesthesia, anesthetic management during surgery, and airway management after surgery are carried out by dental anesthesiologists who have sufficient professional experience and expertise in head and neck surgery.
Management of complications related to orthognathic surgery
(1) Nerve Damage - The infraorbital nerve responsible for sensation to the upper lip and midface and the inferior alveolar nerve responsible for sensation to the lower lip, chin, lower teeth and gingiva, are located close to where the bone is cut, so paresthesia may occur after the surgery.
Some efforts which are made to minimize complications include precisely identifying the three-dimensional location of the nerves in the pre-operative radiographs and CT images; using ultrasonic bone cutting device, or modifying surgical method when there is high risk of nerve damage.
(2) Post-operative infection - After the surgery, examinations are done continuously throughout the hospital stay and regular follow-up visits so that any signs of infection can be detected early and treated properly.
(3) Relapse - Post-surgical relapse occurs mostly due to the forces of muscles attached to the jaw and the change in TMJ position.
Surgical overcorrection is planned in consideration of possible relapse after the operation and factors that may cause relapse are detected and minimized before the surgery. After the surgery, any signs of relapse are detected early through regular follow-up visits.
As soon as relapse is detected, further treatment decision is made with the department of orthodontics.

상, 하악골의 신경 주행 - 안와하신경 / 하치조신경

Emergency Management
Orthognathic surgery is an operation that accompanies cutting with the risk of breathing difficulty caused by post-operative swelling and delayed bleeding. Therefore, intensive patient care is necessary for 1-2 days after the surgery. Prompt action is required in case of an emergency situation.
Orthognathic surgery is an operation that accompanies cutting with the risk of breathing difficulty caused by post-operative swelling and delayed bleeding. Therefore, intensive patient care is necessary for 1-2 days after the surgery. Prompt action is required in case of an emergency situation.
Orthognathic surgery is an operation that accompanies cutting with the risk of breathing difficulty caused by post-operative swelling and delayed bleeding. Therefore, intensive patient care is necessary for 1-2 days after the surgery. Prompt action is required in case of an emergency situation.
In case of any emergencies, the emergency team from the department of oral and maxillofacial surgery, the medical staff from the department of dental anesthesiology, and the emergency resuscitation team from Seoul National University Hospital are always on standby to provide professional emergency treatment as promptly and efficiently as possible.