The purposes of this study were to investigate the relationship between occlusion and lingual articulation of skeletal Class III asymmetry cases and to evaluate the effect of orthognathic surgery on lingual articulation.
The subjects used in this study were three adult patients, two males and one female, who required orthognathic surgery. These patients did not have any complaints about speech and tongue position both preoperatively and postoperatively. Lingual articulation was observed by static palatography. In addition, occlusion, shape of the palate and maxillo-facial morphology were analyzed by using occlusograms, Moire topographies and cephalometric radiographs, respectively. Materials were obtained at preoperative and postoperative intervals of 3, 6, 18, and 30 to 42 months.
The results of this study revealed that the patterns of postoperative palatograms had a tendency similar to those of normal occlusion in spite of differences in patients and/or in consonants.
In conclusion, the patients had a natural tendency to adapt postoperative lingual articulation to the reestablished craniofacial morphology corrected by orthognathic surgery.

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The purpose of this study was to investigate long-term dentofacial stability after two-jaw orthognathic surgery in skeletal Class III malocclusion. Fourteen subjects, 12 females and 2 males, who had undergone two-jaw surgery at Tohoku University Dental Hospital were used in this study. Each patient had at least a five-year of post operative observation period. The frontal and lateral cephalometric radiographs were used for quantitative evaluation of dentofacial stability. The materials were taken seven times from the initial examination for 5 years postoperatively.
The results of this study were as follows:
1. Excellent postoperative stability was observed at the maxilla three-dimentionally.
2. Although antero-posterior displacement of the manbible after debonding was minimal, moderate relapse tendencies were observed vertically. Especially, significant reduction of lower facial height and Go to Or distance caused relapse in some patients.
3. Appropriate overjet has been maintained in most of the cases. But there was a tendency to decrease in overbite during the long-term observation period. However, none of the patients showed reversed occlusion or openbite at the latest examinations.
In conclusion, the results of this study indicated the following conditions to maintain long-term dentofacial stadibility after two-jaw surgery; 1) to establish a treatment planning to prevent vertical relapse of the mandible, 2) if necessary, to reconstruct the physiological occlusion by prosthetic treatment, and 3) to activate organs and tissues associated with the masticatory system by means of functional therapy and training.

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Changes in soft tissue profile following mandibular set back were investigated with lateral cephalograms of 40 patients initially having mandibular prognathism. Soft tissue profiles were evaluated using the analysis methods reported by Legan and Burstone, Ricketts, and Merrifield. Differences of the measurements before and after surgery were calculated as changes in profile produced by surgery, and following studies were made.
1. The average changes in profile were analysed and the results were as follows: 1) Facial convexity improved, 2) Mandibular prognathism decreased, 3) No change in maxillary prognathism, 4) Posterior displacement of the upper lip with elongation and increase in upper lip protrusion, 5) Nasolabial angle increased, 6) Decrease in lower lip protrusion, 7) Lower facial height decreased, 8) Vertical lip-chin ratio improved, 9) Labiomental sulcus depth increased.
2. The principal component analysis was employed in order to qualify the changes in profile as composition of several patterns.
The analysis resulted in four principal components having 85% of accumulated contribution ratio.
1) The first component (37.9%) is indicative of over-all quantitative change in profile by surgery.
2) The second (23%) is indicative of displacement of the upper lip and change in lower lip protrusion.
3) The third (14%) is indicative of changes in height of the lower lip and lower facial height and in the nasolabial angle.
4) The fourth (10%) is indicative of change in the depth of the labiomental sulcus.
Since there is no correlation among components in a principal component analysis, the second and third components in this study suggest the qualitative patterns of profile change. Therefore, changes in profile vary in the height of the lips and lower face and lower lip protrusion, based upon the averaged over-all changes.

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The purpose of this study was to evaluate the appropriateness and problems of “The classification in the maxillofacial deformity (three-dimensional diagnostic description) by Hashimoto”
With this classification, twelve oral surgeons evaluated and classified fifty patients with maxillofacial deformities who had been treated at the Department of Dentistry and Oral and Maxillofacial Surgery, Hospital of Hamamatsu University School of Medicine.
First, the face was divided into three parts (“U”: Upper part of the face, “M”: Middle part of the face, “L”: Lower part of the face) vertically and five parts (I-V from the right side of the face) horizontally to express the abnormal region.
The profile was divided into three parts (“U”, “M”, “L”).
Then the regional relation of the each section was expressed using three numerals (“0”, “1”, “2”).
“0”: normal condition (symmetry or balanced)
“1”: left eccentric or increased condition.
“2”: right eccentric or decreased condition.
And then “A”(Asymmetry of the face), “H”(Height of the face), “W”(W idth of the face) and “P”(Profile of the face) were inspected and given a corresponding description for each of them using the regional expression and the numerals in the following formula.
A (UML) H (UML) W (UML) P (UML)
The agreement rate of the most popular description was checked for A, H, W, and P respectively. Only “W” was significantly low. And it was lower than the others in cases with facial asymmetry, while it was higher than the others in cases with normal face. The aggreement rate was 59.5% on the average for A, H, W, and P.
We presented the plan that the face was divided into three parts (“r”: right side of the face, “m”: middle part of the face, “1”: left side of the face) horizontally on the basis of bilateral pupils (center of the eyelid).
It was thought that this improvement would make up for shortcomings of the conventional method and increase the accuracy of diagnosis and classification and wide utilization in the clinic and research institute.

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We developed the convenient measuring device of spine curvature from a lateral aspect to evaluate general symptoms of mandibular prognathism patients who apparently need surgical correction.
The device enabled convenient measurement of the spine curvature of patients from a lateral aspect without affections the patients.

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Forty-five patients underwent orthognathic surgery from 1981 to 1993 at the Department of Oral and Maxillofacial Surgery, Nara Medical University during the past 11 years and 7 months. There were 17 male and 28 female patients whose ages ranged from16to30years with an average of 21 years and 3 months.
Thirty-three patients (73.4%) had mandibular prognathism including asymmetry, open bite and/or maxillary retrognathism. The other diagnoses were facial asymmetry in 4, skeletal open bite in 3, mandibular micrognathia in 2, maxillary prognathism in 2, and skeletal open bite with asymmetry in one.
Thirty-nine patients (86.7%) were operated on with ramus sagittal splitting osteotomy (Obwegeser-Dal Pont's method). Four patients in the early stage underwent wire osteosynthesis, considering the influence of rigid fixation on the condylar position. Because wire osteosynthesis resulted in dislocation of bone fragments, long-term intermaxillay fixation and relapse, miniplate osteosynthesis has been employed since then. Miniplate osteosynthesis had simplicity and minimal complications as compared with wire osteosynthesis, and produced better results when combined with tongue reduction and/or suprahyoid myotomy.
Four patients underwent two-jaw surgery (three had mandibular prognathism with maxillary microgn-athia, and one had skeletal open bite). Fixation of bone fragments was accomplished by a double -splint technique. After the maxilla was secured to the cranium, the mandible was sectioned and fixed to the maxilla. In these cases, it was very useful to employ autopreserved blood reinfusion and hypoten-sion anesthesia for preventing complications of transfusion.

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In recent years, there has been an increase in number of patients with maxillofacial trauma due to traffic accident. If the patient has had the fracture of the maxilla with severely complicated trauma, generally, he is immediately transported to the emergency hospital and primary treatment may be done there. Consequently, some of them result in incomplete healing of the fracture.
Two cases, in this report, had open bite as a complication after treatment for maxillary fracture and were treated with Le Fort I osteotomy and mini-plate fixation. Following this secod operation, their occlusions have been recovered properly.
The main reason for their malocclusions was due to little consideration of the occlusions in primary treatment. These cases indicated the necessity of cooperation between the OMF surgeon and allied department faculty in primary treatment of maxillary fracture.

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Orthognathic surgery for skeletal open bite is considered to be one of the most operations with relapse. To prevent postoperative relapse of the mandibular position, we tried to make intermaxillary skeletal fixation (IMSF) after sagittal splitting osteotomy of the mandibular rami, and compared it with a usual method of intermaxillary dental fixation (IMDF). IMSF was applied in 3 cases, and IHDF was applied in2cases. Lateral cephalograms were compared between the2groups before surgery, immediately, 6months, and one year after surgery.
The later relapse of the mandibular position was significantly smaller in the IMSF group than in the IMDF group. IMSF was considered to be a useful method for postoperative fixation in the case of skeletal open bite.

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Thirty-eight patients with jaw deformity were operated on in our hospital from January to October in 1993. Thirty-five of them (male: 13, female: 22, mean age: 21.5) had received autotransfusion.
A total of 400ml of blood from each patient was collected into a “quadruple-bag ACD-MAP” 5 weeks before surgery, and the red-cells and the plasma were separated.
In this study, the relation between the recovery of anemia after 400ml phlebotomy and the administration of sodium ferrous citrate were investigated.
(1) After the administration of sodium ferrous citrate, the amemic levels of hemoglobin, serum iron and serum ferritin after 400ml phlebotomy recovered within 5 weeks.
(2) Decrease of the levels of serum iron and serum ferritin were prevented.
(3) In patients with controlled serum ferritin levels under 30ng/ml, increase of the levels of controlled serum ferritin was confirmed before phlebotomy by the administration of the sodium ferrous citrate.

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Orthognathic surgery has been performed on 180 patients from 1980 to 1992 in our clinic.
Male to female ratio of the total patients was 1: 2.2. The average age of male patients was 20.9 y. o. and 21.0 y. o. for females. Eighty percent of 180 patients were diagnosed as mandibular prognathism with open bite or facial asymmetries. Sagittal splitting ramus osteotomy was carried out on 70.4% of the patients.
The average time of operation was recorded as follows: 3hr. and45min for sagittal splitting ramus osteotomy, 7hr. and 45 min for-two jaw surgery, 5hr. and45min for the combination of sagittal splitting ramus osteotomy and upper alveolar segmental osteotomy.
The average blood loss during operation was as follows: 366.4ml in sagittal splitting ramus osteotomy, 666.7ml in two-jaw surgery, 575.3ml in combination of sagittal splitting ramus osteotomy and upper alveolar segmental osteotomy. Five patients received allogeneic blood transfusions, and one patient received autologous blood.
Fixation of bone fragments was done as follows: 130 patients with circumferential wiring and 17 patients with bicortical screw fixation.
The average period of intermaxillary fixation was 28.6 days in the case of circumferential wiring, 12.6 days with lag screws, 28.0 days with miniplates and 27.9 days with interosseous wiring.

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