We evaluated the role of the clinical path in risk management of orthognathic surgery.
The subjects were 316 patients who underwent LF I+SSRO (49), SSRO (247), or other orthognathic surgery (20) with management by the clinical path.Causes of deviation from the path, outcomes of variance, and results of a questionnaire survey of nurses were analyzed.
As a result, specific problems in each patient could be identified, i. e., the admission period, surgical and anesthetic methods, and postoperative management could be improved by modifying the clinical path.
When a clinical path is applied, specific problems are indicated as deviations and variance.In risk management, measures for specific problems are more effective than evaluation of abstract problems.Therefore, approaching each problem revealed as deviations and variance from the clinical path and modifying the clinical path are considered to lead directly to improvements in risk management.

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A clinical study was carried out on 498 patients who underwent orthognathic surgery between July 1989 and March 2007 in our department.
The results were as follows:
1. The number of orthognathic surgery cases increased annually, exceeding 30 cases a year after 2000.
2. The ratio of female patients was higher than that of males. Among age groups, the number of patients aged between 20 and 29 was the largest.
3.Regarding the clinical diagnosis, the number of mandibular protrusion patients (212 cases) was the largest, accounting for 42.6%.
4. Regarding surgical types, SSRO (361 cases) was the most freauent.accounting for 67.7%. The combineduse of LF-land SSRO was applied in 110 cases, accounting for 20.6%.
5. Administration of anesthetics during surgery, which was performed based on the results of cause and effect analysis, was considered markedly useful for decreasing the amount of bleeding.
6.Smooth treatment of maxillofacial deformity patients and various improvements to decrease complications during and after surgery were performed.Furthermore, due to the introduction of the critical path, effective treatment for patients was achieved, and the quality of care was improved.

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The perioral muscles play an important role in the establishment of natural retention, and their functional assessment is necessary in the treatment of jaw deformities for not only the diagnosis before treatment but also ensuring postoperative stability.
In this study, we measured the maximum upper and lower lip pressures before and after treatment in 3 patients who underwent orthodontic treatment and 2 who underwent surgical orthodontic treatment for malocclu-sion accompanied by skeletal abnormalities. As a result, anterior occlusion remained stable after retention in the 4 patients in whom the balance between the lip pressures was better after than before treatment. However, relapse was noted in the 1 patient in whom no improvement was noted in the balance between the lip pressures after surgical orthodontic treatment.

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A case of acromegaly accompanied by pituitary adenoma in a 35-year-old male is reported. The patient presented with mandibular protrusion, malocclusion and articulate disorder. Prior to oral surgery, a pituitary adenoma was resected at the Department of Neurosurgery. Pre-operative orthodontic treatment was started after growth hormone and insulin-like growth factor I had returned to normal levels. Orthognathic surgery by sagittal split ramus osteotomy (SSRO) was performed, and good occlusion was obtained. Articulate function also improved after orthognathic surgery.

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Distraction osteogenesis has become one of the most widely used methods of correcting craniofacial deformities. In this report we describe a case with Crouzon syndrome treated with Le Fort I distraction osteogenesis using the RED system. The patient was an 11-year 2month-old female with anterior crossbite and maxillary lateral deviation. Her cephalometric radiographs demonstrated craniosynostosis and digital impressions. At the age of 11 years and 6months, a multibracket appliance was used for the presurgical orthodontic treatment of the maxilla. At the age of 13years and 1month, a Le Fort I osteotomy was carried out and the maxilla was distracted using the RED system for 15days. During the distraction, the force vector and the rate of the distraction was adjusted to correct the negative overjet of-5mm and maxillary lateral deviation of 4mm. The external device was left in place for 3weeks for consolidation after the active distraction period, followed by 4months of retention with an orthodontic facial mask. At the age of 13years and 3 months, the multibracket appliance was employed in the mandible. At the age of 15years, 1year and 10 months after distraction, the active orthodontic treatment was finished with acceptable occlusion.

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Coronoid process hyperplasia clinically appears as a progressive reduction in mandibular opening resulting from contact of the enlarged coronoid process with the medial surface of the zygomatic arch.
A case of bilateral coronoid process hyperplasia of the mandible is described. The patient was a 13-year-old male who presented with a chief complaint of limited mandibular movement.
A bilateral coronoidectomy was performed by the intraoral approach under general anesthesia. Immediately thereafter, the patient was able to achieve an interincisal opening of 45mm, however, at 5 years postoperatively he complained of mouth opening pain. Computed tomography showed that both coronoid processes had extended above the zygomatic arch, indicating a bilateral reenlargement of the coronoid processes. A bilateral coronoidectomy was performed by the intraoral approach under general anesthesia again when the patient was 19 years old. Following jaw stretching exercise training, the patient still has an interincisal opening of 50mm at one year postoperatively.
The best treatment for coronoid process hyperplasia is a coronoidectomy with a section through the bases of both coronoids. However, we should exercise caution when recommending a coronoidectomy in young persons.

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