The korean journal of orthodontics (대한치과교정학회지)

The Korean Association Of Orthodontists (대한치과교정학회)
권호 표지

A comparative study of soft tissue changes with mandibular one jaw surgery and double jaw surgery in Class III malocclusion

III급 부정교합자의 양악 수술과 하악 편악 수술 시 연조직 변화에 관한 비교 연구

  • Chang, In-Hee (Department of Orthodontics, School of Dentistry, Kyung Hee University) ;
  • Lee, Young-Jun (Department of Orthodontics, School of Dentistry, Kyung Hee University) ;
  • Park, Young-Guk (Department of Orthodontics, School of Dentistry, Kyung Hee University)
  • 장인희 (경희대학교 치과대학 교정학교실) ;
  • 이영준 (경희대학교 치과대학 교정학교실) ;
  • 박영국 (경희대학교 치과대학 교정학교실)
  • Published : 2006.02.28
Download PDF
⟨ Previous Next ⟩

Abstract

Numbers of postulations lie on the difference of integumental changes with two major surgical remedies of one jaw vs. two jaw surgery in skeletal Class III malocclusion. Accordingly it was the aim of the study to elucidate the skeletal profile changes with an accompanying disposition of soft tissues, consequently to yield the correlation and ratio of soft tissue changes with two types of surgical procedures, which in turn make it possible to predict the soft tissue outcomes by means of assembled regression equations. Cephalometric headfilms of fifty two adult skeletal Class III comprised of 26 maxillary advancement by Le Fort I osteotomy and mandibular setback by sagittal split ramus osteotomy simultaneously (double jaw surgery, group A), 26 mandibular setback alone (one jaw surgery, group B) were statistically analyzed. Group A manifested 72.4% soft tissue advancement to skeletal changes in the upper lip area, while group B appeared to have no statistically significant changes. The nasolabial angle showed more increment in group A than in group B, whereas the mentolabial angle illustrated more reduction in group B. The backward movement of soft tissue pogonion to skeletal change revealed 98% in group A, and 109% in group B. The double jaw surgery group characteristically revealed remarkable integ umental change in the upper lip area, while the one jaw surgery had major effects in the lower lip and soft tissue pogonion areas.

악교정 수술 시행 시 연조직 변화에 대한 대부분의 연구는 II급 부정교합을 대상으로 하였다. 또한 수술 방법에 따른 연조직 변화에 대한 비교 연구가 부족하였다. 따라서 이 연구는 골격성 III급 부정교합자에서 상악골 전진술과 하악골 후퇴술을 동시에 시행한 양악 수술과 하악골 편악 수술 시행 시, 경조직과 연조직 측모 및 연조직 두께의 변화를 관찰하고, 수술 전후 변화의 상관성을 산출하며, 경조직 변화에 수반하는 연조직 변화의 비율을 산출하여 교정-악교정 수술 복합 치료 계획 수립과 결과의 예측에 이용하고자 시행되었다. 경희대학교 치과병원 교정과에 내원하여 골격성 III급 부정교합자로 진단받은 환자 52명을 대상으로 하여, Le Fort I osteotomy를 이용한 상악골 전방이동술과 시상분할골절단술을 이용한 하악골 후퇴술을 시행한 양악 수술군 26명과 하악골 후퇴술만을 시행한 편악 수술군 26명으로 구분하여, 수술 전후 측모두부방사선규격사진을 계측, 분석하여 다음과 같은 결과를 얻었다. 양악 수술군은 골격 변화량의 72.4% 비율로 상순 부위 연조직의 전방 이동을 보였으며, 편악 수술군은 통계적으로 유의한 변화를 보이지 않았다. 비순각은 양악 수술군에서 편악 수술군에 비해 더 크게 증가하였다. 이순각은 편악 수술군에서 더 크게 감소하였다. 하악골의 후방 이동에 따른 연조직 pogonion의 후방 이동은 양악 수술군에서 98%, 편악 수술군에서 109%로 편악 수술군에서 더 크게 나타났다. 양악 수술군에서는 편악 수술군에 비하여 경조직의 변화에 수반하는 상순에서의 큰 변화가 나타났다. 편악 수술군에서는 상순의 변화는 미약하였으며, 하순 및 이부의 변화가 양악 수술군에 비해 두드러지게 나타났다.

Keywords

References

  1. Vasir NS, Thompson RT, Davies TM Dental and skeletal changes following sagittal split osteotomy for correction of mandibular prognathism. Eur J Orthod 1991;13:134-42 https://doi.org/10.1093/ejo/13.2.134
  2. Subtelny JD. A longitudinal study of soft tissue facial structure and their profile characteristics defined in relation to underlying skeletal structures. Am J Orthod 1959:45:481-507 https://doi.org/10.1016/0002-9416(59)90014-4
  3. Burstone CJ, James RB, Legan H, Murphy GA, Norton LA. Cephalometries for orthognathic surgery. J Oral Surg 1978;36:269-77
  4. Robinson SW, Speidel TM, Isaacson RJ, Worms FW. Soft tissue profile change produced by reduction of mandibular prognathism. Angle Orthod 1972:42:227-35
  5. Hershey HG, Smith LH. Soft tissue profile change associated with surgical correction of the prognathic mandible. Am J Orthod 1974;65: 483-502 https://doi.org/10.1016/0002-9416(74)90031-1
  6. Enacar A, Taner T, Toroglu S. Analysis of soft tissue profile changes associated with mandibular setback and double jaw surgeries. Int J Adult Orthodon Orthognath Surg 1999;14:27-35
  7. Gaggl A, Schultes G, Karcher H. Changes in soft tissue profile after sagittal split ramus osteotomy and retropositioning of the mandible. J Oral Maxillofac Surg 1999;57:542-6 https://doi.org/10.1016/S0278-2391(99)90072-1
  8. Bell WH, Dann JJ. 3rd. President's Page. Am J Orthod 1973;64:162-87 https://doi.org/10.1016/S0002-9416(73)90308-4
  9. Kajikawa Y. Changes in soft tissue profile after surgical correction of skeletal Class III malocclusion. J Oral Surg 1979;37:167-74
  10. Lines PA, Steinhauser EW. Soft tissue profile changes in relationship to movement of hard structures in orthognathic surgery: a preliminary report. J Oral Surg 1974;32:891-6 https://doi.org/10.1016/0030-4220(71)90175-7
  11. Scheideman GB, Legan HL, Bell WH. Soft tissue changes with combined mandibular setback and advancement genioplasty. J Oral Surg 1981;39:505-9
  12. Hohl TH, Epker BN. Macrogenia; a study of treatment results with surgical recommendation. Oral Surg Oral Med Oral Pathol 1976;41:545-67 https://doi.org/10.1016/0030-4220(76)90307-8
  13. Jensen AC, Sinclair PM, Wolford LM. Soft tissue changes associated with double jaw surgery. Am J Orthod Dentofacial Orthop 1992;101:266-75 https://doi.org/10.1016/0889-5406(92)70096-S
  14. Hu J, Wang D, Luo S, Chen Y. Differences in soft tissue profile changes following mandibular setback in Chinese men and women. J Oral Maxillofac Surg 1999;57:1182-6 https://doi.org/10.1016/S0278-2391(99)90481-0
  15. 조은정, 양원식. 골격성 3급 부정교합자의 양악수술후 연조직 변화의 평가. 대치교정지 1996;26:1-16
  16. 성정옥, 경희문, 권오원, 성재현. 외과적 악교정술을 위한 두부방사선 계측 기준치. 대치교정지 1989;19:169-85
  17. 최유경, 서정훈. 하악전돌증환자의 악교정 수술 후 경조직과 연조직 변화에 관한 두부방사선계측학적 연구. 대치교정지 1993;23:707-24
  18. Gjorup H, Athanasiou AE. Soft tissue and dentoskeletal profile changes associated with mandibular setback osteotomy. Am J Orthod Dentofacial Orthop 1991;100:312-23 https://doi.org/10.1016/0889-5406(91)70068-8
  19. Betts NJ, Vig KW, Vig P, Spalding P, Fonseca RJ, Changes in the nasal and labial soft tissues after surgical repositioning of the maxilla. lnt J Adult Orthodon Orthognath Surg 1993;8:7-23
  20. Willmot DR. Soft tissue profile changes following correction of Class Ill malocclusions by mandibular surgery. Br J Orthod 1981;8:175-81 https://doi.org/10.1179/bjo.8.4.175
  21. Suckiel JM, Kohn MW. Soft tissue changes related to the surgical management of mandibular prognathism. Am J Orthod 1978;73:676-80 https://doi.org/10.1016/0002-9416(78)90228-2
  22. Carlotti. Facial changes associated with surgical advancement of the lip and maxilla. J Oral Maxillofac Surg 1986:44:593-6 https://doi.org/10.1016/S0278-2391(86)80068-4
  23. Rosen HM. Lip nasal aesthetics following Le Fort I osteotomy. Plast Reconstr Surg 1988;81:171-82 https://doi.org/10.1097/00006534-198802000-00005
  24. Bjork N, Eliason S, Wictorin L. Changes in the facial profile after surgical treatment of mandibular protrusion. A cephalometric study, 1 and 11 years after treatment. Scand J Plast Reconstr Surg 1971;5:41-6 https://doi.org/10.3109/02844317109042935
  25. Fromm B. The soft tissue facial profile before and after surgical correction of mandibular protrusion. Acta Odontol Scand 1970;28:157-77 https://doi.org/10.3109/00016357009032025
  26. MacIntosh RB. Orthodontic surgery: comments on diagnostic modalities. J Oral Surg 1970;28:249-59
  27. Lin SS, Kerr WJ, Soft and hard tissue changes in Class ill patients treated by bimaxillary surgery. Eur J Orthod 1998;20:25-33 https://doi.org/10.1093/ejo/20.1.25
  28. 김여갑. 악교정 수술시 경조직 변화에 따른 연조직 변화에 관한 연구. 대치협회지 1987;25:81-91
  29. 이형식, 박영철. 하악전돌증환자의 악교정 수술 후 안면 측모 변화에 관한 두부방사선 계측학적 연구. 대치교정지 1987:17:299-309
  30. Stella JP, Streater MR, Epker BN, Sinn DP. Predictability of upper lip soft tissue changes with maxillary advancement. J Oral Maxillifac Surg 1989;47:697-703 https://doi.org/10.1016/S0278-2391(89)80008-4