A study on the correlations between facial biotype, submentovertex cephalometric measurements and surface EMG activity in patients with facial asymmetry

안면 비대칭 환자의 수직 안모 유형과 이하두정 두부방사선 규격사진 계측치 및 표면 근전도의 상관성에 대한 연구

  • Kim, Seong-Soo (Department of Dentistry, School of Dentisty, Kangnung National University) ;
  • Lee, Nam-Ki (Department of Dentistry, School of Dentisty, Kangnung National University) ;
  • Cha, Bong-Kuen (Department of Dentistry, School of Dentisty, Kangnung National University)
  • 김성수 (강릉대학교 치과대학 교정학교실) ;
  • 이남기 (강릉대학교 치과대학 교정학교실) ;
  • 차봉근 (강릉대학교 치과대학 교정학교실)
  • Published : 2006.06.30

Abstract

Although the submentovertex radiograph and surface EMG are not often used due to the difficulty of interpretation, they are accepted as useful diagnostic and analytic aids for skeletal asymmetry. There have been reports which state that they were also useful for the evaluation of vertical skeletal relations. The purpose of this study was to evaluate the correlations between EMG data, measurements from submentovertex radiographs, facial types and facial asymmetry following examination of 60 asymmetric patients. The radiographic corpus length were greater in the nonaffected sides (p<0.001), gonion to interspinosum axis were greater in the affected sides and the mandibular condyle and gonion were located more anteriorly in the non-affected sides than in the affected sides but not significant (p=0.07). The activity of the anterior temporal muscle in rest position was higher in the affected sides than in the non-affected sides (p<0.01). The activity of the masseter muscle at maximum clenching was found to be nonsignificant but it was higher in the affected sides than in the non-affected sides (p=0.09). There was positive correlation between facial index and the intercondylar axes angle (p<0.01). There was positive correlation between masseter muscle activity in maximum occlusion and facial index in the affected and non-affected sides (p<0.05). The results demonstrate that the submentovertex radiograph and EMG can provide useful information for the evaluation of horizontal and vertical skeletal relations.

안면 비대칭 환자의 진단분석에 이용할 수 있는 이하두정 두부방사선 규격사진과 표면 근전도 검사 자료는 통용화된 진단분석법 부재 등의 이유로 제한적으로 사용되고 있다. 그러나 여타 진단분석법과 비교할 때, 수직 안모 유형의 평가 등 차별적인 정보를 얻을 수 있어 이에 대한 연구가 필요하리라 보인다. 본 연구의 목적은 안면 비대칭을 보이는 60명을 대상으로 이하두정 두부방사선 규격사진 및 저작근의 표면 근전도를 측정하여 수직 안모 유형과의 연관성 및 안면 비대칭과의 연관성을 평가하고자 함이다. 이하두정 두부방사선 규격사진 계측치 중 radiographic corpus length는 비편위측이 큰 값을 보였고 (p<0.001), 유의성은 없었으나 gonion to interspinosum axis는 편위측이 크고, gonion과 하악과두의 위치는 비편위측이 편위측에 비해 전방에 위치하였다 (p=0.07). 안정시 편위측 전측 두근의 근활성은 비편위측보다 높은 것으로 나타났다 (p<0.01). 또한 최대 폐구 시 교근의 활성은 유의성이 없었으나 비편위측에 비해 편위측이 큰 값을 보였다 (p<0.09). Facial index와 intercondylar axes angle은 양의 상관관계를 보였다 (p<0.01). 최대 폐구 시 편위측 및 비편위측의 교근의 활성은 facial index와 양의 상관관계를 보였다 (p<0.05). 이상의 결과를 통해 골격성 안면 비대칭을 보이는 환자에서 이하두정 두부방사선 규격사진과 표면 근전도 검사를 통해 비대칭 양상의 평가와 더불어 수직 안모 유형의 평가 또한 가능한 것으로 생각된다.

Keywords

References

  1. Berger H. Problems and promises of basilar view cephalograms. Angle Orthod 1961:31:237-45
  2. Marmary Y, Zilberman Y, Mirsky Y. Use of foramina spinosa to determine skull midlines. Angle Orthod 1979;49:263-8
  3. Moss ML, Salentijn L. Differences between the functional matrices in anterior open bite and in deep overbite. Am J Orthod 1971:60:264-80 https://doi.org/10.1016/0002-9416(71)90135-7
  4. Forsberg CT, Burstone CJ, Hanley KJ, Diagnosis and treatment planning of skeletal asymmetry with the submental-vertical radiograph. Am J Orthod 1984;85:224-37 https://doi.org/10.1016/0002-9416(84)90062-9
  5. Grummons D: Orthodontics for the TMJ.TMD patient. Arizona: Wright & Co; 1997
  6. Lew KK, Tay DK. Submentovertex cephalometric norms in male Chinese subjects. Am J Orthod Dentofacial Orthop 1993;103:247-52 https://doi.org/10.1016/0889-5406(93)70005-9
  7. Maxwell MF, Farman AG, Haskell BS, Yancey JM. Submentovertex radiology: cephalometric considerations in temporomandibular dysfunction. Cranio 1995;13:15-21
  8. Adrian ED, Bronk DW. Discharge of impluses in mortor nerve fibers: frequency of discharge in reflex and voluntary contraction. J Physiol 1929;67:119-51
  9. Moyers RE. Temporomandibular muscle contraction patterns in Angle Class II, division 1 malocclusions: an electromyographic analysis. Am J Orthod 1949;35:837-57 https://doi.org/10.1016/0002-9416(49)90078-0
  10. Ahlgren JG, Ingervall BF, Thilander BL. Muscle activity in normal and postnormal occlusion. Am J Orthod 1973;64:445-56 https://doi.org/10.1016/0002-9416(73)90258-3
  11. Moller E. The chewing apparatus. An electromyographic study of the action of the muscles of mastication and its correlation to facial morphology. Acta Physiol Scand 1966;(Suppl 280):75-139
  12. Troelstrup B, Moller E. Electromyography of the temporalis and masseter muscles in children with unilateral cross-bite. Scand J Dent Res 1970;78:425-30
  13. Ingervall B, Thilander B. Activity of temporal and masseter muscles in children with a lateral forced bite. Angle Orthod 1975;45:249-58
  14. Alarcon JA, Martin C, Palma JC. Effect of unilateral posterior crossbite on the electromyographic activity of human masticatory muscles. Am J Orthod Dentofacial Orthop 2000;118:328-34 https://doi.org/10.1067/mod.2000.103252
  15. Williamson EH, Wilson CW. Use of a submental-vertex analysis for producing quality temporomandibular joint laminagraphs, Am J Orthod 1976;70:200-7 https://doi.org/10.1016/S0002-9416(76)90320-1
  16. Williamson EH, Simmons MD. Mandibular asymmetry and its relation to pain dysfunction. Am J Orthod 1979;76:612-7 https://doi.org/10.1016/0002-9416(79)90207-0
  17. Bakke M, Moller E. Distortion of maximal elevator activity by unilateral premature tooth contact. Scand J Dent Res 1980;88:67-75
  18. Williamson EH. The role of craniomandibular dysfunction in orthodontic diagnosis and treatment planning. Dent Clin North Am 1983;27:541-60
  19. Arnold TG, Anderson GC, Liljemark WF. Cephalometric norms for craniofacial asymmetry using submental-vertical radiographs. Am J Orthod Dentofacial Orthop 1994;106:250-6 https://doi.org/10.1016/S0889-5406(94)70044-3
  20. Yuen SW, Hwang JC, Poon PW. Changes in power spectrum of electromyograms of masseter and anterior temporal muscles during functional appliance therapy in children. Am J Orthod Dentofacial Orthop 1990;97:301-7 https://doi.org/10.1016/0889-5406(90)70102-I
  21. Sato S, Akimoto S, Fushima K, Ishii Y. 악관절 기능을 고려한 부정교합 치료. 서울: 지성출판사; 1997
  22. Pancherz H. Temporal and masseter muscle activity in children and adults with normal occlusion. An electromyographic investigation. Acta Odontol Scand 1980;38:343-8 https://doi.org/10.3109/00016358009033603
  23. Nielsen IL, McNeill C, Danzig W, Goldman S, Levy J, Miller AJ. Adaptation of craniofacial muscles in subjects with craniomandibular disorders. Am J Orthod Dentofacial Orthop 1990;97:20-34 https://doi.org/10.1016/S0889-5406(05)81705-6
  24. Christiansen EL, Roberts D, Kopp S, Thompson JR. CT assisted evaluation of variation in length and angulation of the lateral pterygoid muscle and variation in angulation of the medial pterygoid muscle: mandibular mechanics implications. J Prosthet Dent 1988;60:616-21 https://doi.org/10.1016/0022-3913(88)90225-9
  25. Westesson PL. Double-contrast arthrotomography of the temporo-mandibular joint: introduction of an arthrographic technique for visualization of the disc and articular surfaces. J Oral Maxillofac Surg 1983;41:163-72 https://doi.org/10.1016/0278-2391(83)90074-5
  26. 조재형, 유영규. 이하두정방사선사진과 측모두부방사선사진상에서의 계측치 상호연관성에 관한 연구. 대치교정지 1996;26:413-21
  27. 차봉근, 서정훈. 안모수직 부조화에 따른 하악이부 형태에 관한 연구. 대치교정지 1990;20:135-55
  28. Becker MH, Coccaro PJ, Converse JM. Antegonial notching of the mandible: an often overlooked mandibular deformity in congenital and acquired disorders. Radiology 1976:121:149-51 https://doi.org/10.1148/121.1.149
  29. 이연희, 차봉근, 박인우. 한국인 성인의 교근 두께에 관한 초음파검사적 연구. 대치교정지 2001;31:225-36
  30. Ingervall B, Helkimo E. Masticatory muscle force and facial morphology in man. Arch Oral Biol 1978;23:203-6 https://doi.org/10.1016/0003-9969(78)90217-0
  31. Ingervall B, Thilander B. Relation between facial morphology and activity of the masticatory muscles. J Oral Rehabil 1974;1:131-47 https://doi.org/10.1111/j.1365-2842.1974.tb00771.x
  32. Ueda HM, Miyamoto K, Saifuddin M, Ishizuka Y, Tanne K. Masticatory muscle activity in children and adults with different facial types. Am J Orthod Dentofacial Orthop 2000:118:63-8 https://doi.org/10.1067/mod.2000.99142