Shared decision-making (SDM) is a core element of patient-centered care; however, traditional approaches to informed consent and physicians’ duty to explain have often remained procedural and predominantly physician-driven. This review aims to examine how SDM substantively strengthens the physician’s duty to explain and how it may contribute to reducing medical litigation risk while simultaneously improving patient–physician relationships.Current concepts: SDM is a collaborative process in which patients and physicians jointly consider available treatment options, relevant medical evidence, and patients’ individual values and preferences. Evidence from systematic reviews indicates that SDM improves patients’ knowledge, promotes more realistic expectations, reduces decisional conflict, and enhances satisfaction and trust. From a legal perspective, inadequate communication and information asymmetry constitute major contributors to medical disputes. By emphasizing meaningful dialogue, documenting deliberative processes, and incorporating patient decision aids, SDM reframes informed consent from a largely formal requirement into an interactive process that supports patients’ substantive understanding and autonomous decision-making.Discussion and conclusion: Although direct evidence demonstrating that SDM reduces medical errors remains limited, existing findings suggest that SDM may mitigate structural causes of medical disputes by addressing communication failures and unmet patient expectations. By reinforcing the physician’s duty to explain in a substantive and patient-centered manner and by fostering a trust-based therapeutic alliance, SDM has the potential to reduce medical litigation risk. Integrating SDM into routine clinical practice through education, institutional support, and supportive legal frameworks may represent an emerging standard for fulfilling physicians’ duty to explain and for promoting sustainable patient–physician relationships.

The aim of this study was to analyze the changes and improvements in symptoms of sleep-disordered breathing (SDB) using semi-rapid maxillary expansion (SRME) in children with narrow maxilla and SDB symptoms. Subjects were 15 patients with sleep disorder (apnea-hypopnea index, AHI ≥ 1) and narrow maxillary arch between 7 and 9 years of age. Before the SRME was applied, all subjects underwent pediatric sleep questionnaires (PSQ), lateral cephalometry, and portable sleep monitoring before expansion (T0). All subjects were treated with SRME for 2 months, followed by maintenance for the next 3 months. All subjects had undergone PSQ, lateral cephalometry, and portable sleep monitoring after expansion (T1). Adenoidal-nasopharyngeal ratio (ANR), upper airway width and hyoid bone position were measured by lateral cephalometry. The data before and after SRME were statistically analyzed with frequency analysis and Wilcoxon signed rank test. As reported by PSQ, the total PSQ scale was declined significantly from 0.45 (T0) to 0.18 (T1) (p = 0.001). Particularly, snoring, breathing, and inattention hyperactivity were significantly improved (p = 0.001). ANR significantly decreased from 0.63 (T0) to 0.51 (T1) (p = 0.003). After maxillary expansion, only palatopharyngeal airway width was significantly increased (p = 0.035). There was no statistically significant difference in position of hyoid bone after expansion (p = 0.333). From analysis of portable sleep monitoring, changes in sleep characteristics showed a statistically significant decrease in AHI and ODI, and the lowest oxygen desaturation was significantly increased after SRME (p = 0.001, 0.004, 0.023).In conclusion, early diagnosis with questionnaires and portable sleep monitoring is important. Treatment using SRME will improve breathing of children with SDB.
Cephalometry ; Child ; Diagnosis ; Early Diagnosis ; Humans ; Hyoid Bone ; Maxilla ; Oxygen ; Palatal Expansion Technique ; Polysomnography ; Respiration ; Sleep Apnea Syndromes ; Sleep Wake Disorders ; Snoring

Abnormal orofacial functions such as lip incompetency in the period of growth and development can cause morphological anomalies of the craniofacial complex. Therefore, it is crucial to make an early diagnosis based on the evaluation of the myofunctional conditions, and to make appropriate treatment plans.The objectives of this study were to quantitatively evaluate the standard lip closing force (LCF) of each age in the elementary school children, and to evaluate the relationships between LCF and affecting factors.The sample consisted of 765 children who were 7 – 12 years old in Jeonju city. Clinical examination about occlusal conditions and lip competency, and LCF measurement were performed by a single examiner. LCF was measured three times for each children with the LCF measuring device.The LCF was correlated positively with age in both sexes. The distribution of LCF groups was correlated significantly with Angle's classes and lip competency (p = 0.016, 0.004). The proportion of children with high LCFs was greater in the “competent lip” group, whereas the proportion of those with low LCFs was greater in the “incompetent lip” group.
Child ; Early Diagnosis ; Growth and Development ; Humans ; Jeollabuk-do ; Lip

True midfacial deficiency is defined as a hypoplasia of various components of midface such as maxilla, orbit, zygoma and nasal bone. For treatment of these anomalies Le Fort III osteotomy and its modifications have been used traditionally. Le Fort III osteotomy is the method which advances maxilla with nasal bone and zygomatic bone at a time. At first midfacial osteotomy was introduced by Gillies to treatment of dentofacial deformity in 1950. In 1967 Tessier designed Le Fort III osteotomy according to Le Fort III midfacial fracture line and popularized to treat midfacial deficiency using coronal incision to appoach osteotomy sites. This is a case of patient who had mandibular prognathism with midfacial deficiency with severe discrepancy in maxillomandibular interrelation. First we performed Le Fort III osteomomy for zygomaticomaxillary advancement, and then carried out simultaneous two jaw surgery with Le Fort I osteotomy and BSSRO three months after first surgery.
Dentofacial Deformities ; Humans ; Maxilla ; Nasal Bone ; Orbit ; Orthognathic Surgery ; Osteotomy* ; Prognathism* ; Zygoma