POSTOPERATIVE POSITIONAL CHANGE OF CONDYLE AFTER BILATERAL SAGITTAL SPLIT RAMUS OSTEOTOMY ASSOCIATED WITH MANDIBULAR ASYMMETRY

하악골 비대칭 환자의 양측성 하악골 시상분할 골절단술 후 하악과두의 위치 변화

  • Lee, Sung-Keun (Department of Oral & Maxillofacial Surgery, College of Dentistry, Dankook University) ;
  • Kim, Kyung-Wook (Department of Oral & Maxillofacial Surgery, College of Dentistry, Dankook University) ;
  • Kim, Chul-Hwan (Department of Oral & Maxillofacial Surgery, College of Dentistry, Dankook University)
  • 이성근 (단국대학교 치과대학 구강악안면외과학교실) ;
  • 김경욱 (단국대학교 치과대학 구강악안면외과학교실) ;
  • 김철환 (단국대학교 치과대학 구강악안면외과학교실)
  • Published : 2004.10.30

Abstract

Purpose: After the surgical correction with sagittal split ramus osteotomy, the position of the mandibular condyle in the glenoid fossa and the proximal segment of the mandible change because of bony gap between proximal and distal segment, especially in case of mandibular setback asymmetrically. In this study, positional changes in the condyle and proximal segment after BSSRO were estimated in the mandibular asymmetry patient by analyzing the in submentovertex view and P-A cephalogram for identification of ideal condylar position during surgery. Patients and Methods: The 20 patients were selected randomly who visit Dankook Dental Hospital for mandibular asymmetry. Bilateral sagittal split ramus osteotomy with rigid fixation was performed and P-A cephalogram and submentovertex view was taken at the time of preoperative, immediate postoperative, 3 month postoperative period. Results: Intercondylar length and transverse condylar angle was increased due to inward rotation of proximal segment and anteromedial rotation of lateral pole of condyle head. The condylar position had a tendency to return to the preoperative state and after 3 months return up to about half of the immediate post-operative changes, and all the results showed more changes in asymmetry patient and deviated part of the mandible. Conclusion: Based on all these results above, surgeon should make efforts to have a precise preoperative analysis and to have a ideal condylar position during rigid fixation after BSSRO.

Keywords

References

  1. Akiyuki Nishimura, Shigeyo Sakurada, Masayasu Iwase, et al: Positional changes in the mandibular condyle and amount of mouth opening after sagittal split ramus osteotomy with rigid or nonrigid osteosynthesis. J Oral Maxillofac Surg 1997;55;672-676
  2. Timothy G. Stroster, Valmy Pangrazio-Kulbersh: Assessment of condylar position following bilateral sagittal ramus osteotomy with wire fixation or rigid fixation. Int J Adult Orthognath Surg 1994;9:55-62
  3. Freihofer HP Jr.: Late results after advancing the mandible by sagittal splitting of the rami. J Maxillofac Surg 1975;3:250
  4. Schendel SA, Epker BN: Results after mandibular advancement surgery : An analysis of 87 cases. J Oral Surg 1980;38:268
  5. Samuel L. Lake, R. William McNeill, Robert M. Little, et al: Surgical mandibular advancement : A cephalometric analysis of treatment response. Am J Orthod 1981;80:376-394
  6. 오정환, 김여갑: 하악전돌증 환자의 악교정 수술 후 하악과두의 위치 변화와 안정성에 관한 연구. 대한구강악안면외과학회지 1996;22:322-331
  7. Kenneth S. Rotskoff, Eugenio G. Herbosa, Peter Villa: Maintenance of condyle-proximal segment position in orthognathic surgery. J Oral Maxillofac Surg 1991;49:2-7
  8. Martin Kundert, Orestis Hadjianghelou: Condylar displacement after sagittal splitting of the mandibular rami. J Maxillofac Surg 1980;8:278-287 https://doi.org/10.1016/S0301-0503(80)80115-9
  9. Fred L. Hackney, Joseph E. Van Sickels, Pirkka V. Nummikoski: Condylar displacement and temporomandibular joint dysfunction following bilateral sagittal split osteotomy and rigid fixation. J Oral Maxillofac Surg 1989;47:223-227
  10. 정재형, 박형식, 황충주: 하악골 전돌증 환자의 구내 하악골상행지 수직골절단술 후 이하두정 계측방사선사진상에서의 근심골편의 형태 및 위치 변화. 대한구강악안면외과학회지 2003;29:26-34
  11. 이창선: 하악 과두골절의 진단 및 치료 후 예후 측정을 위한 이하두정 X-선 계측사진에서의 정상 계측치. 대한구강악안면외과학회지 1998;24:83-90
  12. Duane C. Grummons, Martin A. Kappeyne: A frontal asymmetry analysis. JCO 1987;21:448
  13. Berger H: Problems and promises of basilar view cephalograms. Angle Orthod 1961;31:237-245
  14. Gilbert K, Woo TL: Further investigation of morphologic characters of the individual bones of the human skull. Biometrika 1935;2:423-465
  15. Marmary, Y. Zilbergman, Y. Mirsky: Use of foramina spinosa to determine skull midlines. Angle Orthod 1979;49:263
  16. Philip C. Williamson, Paul W. Major, Brian Nebbe, et al: Landmark identification error in submentovertex cephalometrics. : A computerized method for determining the condylar long axis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998;86:360-369 https://doi.org/10.1016/S1079-2104(98)90186-X
  17. 남동석, 서정훈, 양원식, et al: 한국 성인에서 이하두정 방사선 계측 사진 분석. 대한치과교정학회지 2000;30:1-7
  18. 최은영, 박태원: 안면 비대칭 환자 진단에 있어서 후전방두부 방사선사진과 이하두정 방사선사진 및 파노라마 방사선사진의 임상적 효용성. 대한구강악안면방사선학회지 1994;24:427-437
  19. Westesson P-L, Liedberg J: Horizontal condylar angle in relation to internal derangement of the temporomandibular joint. Oral Surg Oral Med Oral Pathol 1987;64:391-394 https://doi.org/10.1016/0030-4220(87)90137-X
  20. Christiansen EL, Thompson JR, Kopp SF, et al: Radiographic signs of temporomandibular joint disease : An investigation utilizing x-ray computed tomography. Dentomaxillofac Radiol 1985;14:83-91 https://doi.org/10.1259/dmfr.1985.0011
  21. Philip C. Williamson, Paul W. Major, Brian Nebbe, et al: Horizontal condylar angulation and condyle position associated with adolescent TMJ disk status. J Craniomandib Pract 1999;17:101-108
  22. 유준영: 하악지 시상분할술에 있어 술 후 하악과두의 위치와 측두하 악관절 장애. 대한악안면성형재건외과학회지 1997;19:130-133
  23. 박재억: 악교정수술학. 서울; 군자출판사 2003, 364-365
  24. James W. Nickerson: Stabilization of the proximal segment in sagittal split osteotomy : A new technique. J Oral Maxillofac Surg 1983;41:683-685
  25. L. Heffez, J. Marsik, J. Bressman: A simple means of maintaining the condyle-fossa relationship. J Oral Maxillofac Surg 1987;45:288-290
  26. W. R. Hiatt, P. Michael Schelkun, David L. Moore: Condylar Positioning in orthognathic surgery. J Oral Maxillofac Surg 1988;46:1110-1112
  27. Bruce N. Epker, G. Alistair Wylie: Control of the condylar-proximal mandibular segments after sagittal split osteotomies to advance the mandible. Oral Surg Oral Med Oral Pathol 1986;62:613-617
  28. Hans-Georg Luhr: The significance of condylar position using rigid fixation in orthognathic surgery. Clin Plast Surg 1989;16:147
  29. Clifton T. Forsberg, Charles J. Burstone, Kevin J. Hanley: Diagnosis and treatment planning of skeletal asymmetry with the submentalvertical radiograph. Am J Orthod 1984;85:224-237