The korean journal of orthodontics (대한치과교정학회지)

The Korean Association Of Orthodontists (대한치과교정학회)
권호 표지

Comparison of asymmetric degree between maxillofacial hard and soft tissue in facial asymmetric subjects using three-dimensional computed tomography

안면비대칭자의 3차원 전산단층사진 분석에서 경$\cdot$연조직간 비대칭 정도 차이

  • Kim, Wang-Sik (Department of Orthodontics, School of Dentistry, Chonnam National University) ;
  • Lee, Ki-Heon (Department of Orthodontics, School of Dentistry, Dental Science Research Institute, Chonnam National University) ;
  • Hwang, Hyeon-Shik (Department of Orthodontics, School of Dentistry, Dental Science Research Institute, Chonnam National University)
  • 김왕식 (전남대학교 치과대학 교정학교실) ;
  • 이기헌 (전남대학교 치의학연구소, 전남대학교 치과대학 교정학교실) ;
  • 황현식 (전남대학교 치의학연구소, 전남대학교 치과대학 교정학교실)
  • Published : 2005.06.01
Download PDF
⟨ Previous Next ⟩

Abstract

The purpose of this study was to compare the asymmetric degree between maxillofacial hard and soft tissues in individuals with facial asymmetry. Computerized tomographies (CT) of 34 adults (17 male, 17 female) who had facial asymmetry were taken. The CT images were transmitted to personal computers and then reconstructed into three-dimensional (3D) images through the use of computer software. In order to evaluate the degree of facial asymmetry, 6 measurements were constructed as the hard tissue measurements while 6 counterpart measurements were taken as the soft tissue measurements. The means and standard deviations were obtained for each measurement using 3D measure, then t-test was used to investigate the differences between each hard tissue measurement and the corresponding soft tissue measurement All measurements used in the present study showed statistically significant differences between the hard and soft tissues. The degree of soft tissue asymmetry was smaller than that of corresponding hard tissue asymmetry in case of chin deviation, frontal ramal inclination difference, and frontal corpus inclination difference. On the other hand, the degree of soft tissue asymmetry was greater than that of underlying hard tissue asymmetry in the measurement of lip canting and lip cheilion height difference The present study suggests that asymmetric differences of hard and soft tissue is observed nu facial asymmetric subjects and thus soft tissue analysis is needed in addition to hard tissue analysis when making an evaluation of facial asymmetry.

본 연구는 안면비대칭 환자에서 경조직의 비대칭 정도와 연조직 비대칭 정도의 차이를 3차원적으로 밝히고자 시행되었다. 안면비대칭으로 보이는 성인 남녀 34명을 대상으로 두경부 전산단층사진을 촬영하고 3차원 입체영상으로 재구성한 후 기준평면에 대해 비대칭을 나타내는 5개의 계측항목을 경조직에 설정하고, 이에 대응하는 연조직 계측항목을 각각 설정한 후 3차원 계측을 시행하고 경조직과 연조직의 계측항목간 차이를 비교하였다. 이부편위측과 반대측간의 계측치 차이를 비교한 결과, 경조직과 연조직 모두에서 좌우측 계측치간에 통계적으로 유의한 차이가 관찰되었으며 경조직과 연조직의 비대칭 계측항목을 비교한 결과, 6개의 계측항목 모두에서 통계적으로 유의한 차이를 나타내었다. 이부편위를 나타내는 chin deviation, 하악지와 하악골체를 나타내는 frontal ramal inclination difference, frontal corpus inclination difference 항목은 경조직의 비대칭 정도에 비하여 연조직 비대칭 정도가 작게 나타난 반면, 입술경사를 나타내는 lip cheilion height difference, lip canting은 maxillary height difference, occlusal plane canting보다 크게 나타나 입술부위의 비대칭 정도는 하부 경조직의 비대칭 정도보다 큰 것으로 나타났다. 안면비대칭자에서 경조직과 연조직간 비대칭 정도 차이를 규명한 본 연구 결과는 안면비대칭 평가 시 경조직 외에 연조직 계측항목을 이용한 비대칭 분석도 필요함을 시사하였다.

Keywords

References

  1. Peck H, Peck S. A concept of facial esthetics. Angle Orthod 1970;40:284-318
  2. Ricketts RM, Bench RW, Hilgers JJ, Schulhof R. An overview of computerized cephalometrics. Am J Orthod 1972;61:1-28 https://doi.org/10.1016/0002-9416(72)90172-8
  3. Svanholt P, Solow B. Assessment of midline discrepancies on the postero-anterior cephalometric radiograph, Tran. Eur Orthod Soc 1977;25:261-8
  4. Solow B. The pattern of craniofacial associations. Acta Odont Scand 1966;24:24
  5. Nakasima A, Ichinose M. Size of the cranium in parents and their children with cleft lip. Cleft Palate J 1984;21:193-203
  6. Vig PS, Hewitt AB. Asymmetry of the human facial skeleton. Angle Orthod 1975;45:125-9
  7. Michaels LYF, Tourne LPM. Nasion true vertical: a proposed method for testing the clinical validity of cephalometric measurements applied to a new cephalometric reference line. Int J Adult Orthodon Orthognath Surg 1990;5:43-52
  8. Yogosawa F. Predicting soft tissue profile changes concurrent with orthodontic treatment. Angle Orthod 1990;60:199-200
  9. Peck S, Peck L, Kataja M. Skeletal asymmetry in esthetically pleasing faces. Angle Orthod 1991;61:43-8
  10. Haraguchi S, Takada K, Yasuda Y. Facial asymmetry in subjects with skeletal class Ill deformity. Angle Orthod 2002;72:28-35
  11. Baumrind S, Frantz RC. The reliability of head film measurements: 1. Landmark identification. Am J Orthod 1971;60:111-27 https://doi.org/10.1016/0002-9416(71)90028-5
  12. Baumrind S, Frantz RC. The reliability of head film measurements: 2. Conventional angular and linear measures. Am J Orthod 1971;60: 505-17 https://doi.org/10.1016/0002-9416(71)90116-3
  13. Eliasson S, Welander U, Ahlqvist J. The cephalographic projection: Part I. General considerations. Dentomaxillofac Radiol 1982;11:117-22 https://doi.org/10.1259/dmfr.1982.0015
  14. Ahlqvist J, Eliasson S, Welander U. The cephalometric projection: Part II. Principles of image distortion in cephalography. Dentomaxillofac Radiol 1983;12:101-8 https://doi.org/10.1259/dmfr.1983.0017
  15. Phillips C, Greer J, Vig P, Matteson S. Photocephalometry: errors of projection and landmark location. Am J Orthod 1984;86:233-43 https://doi.org/10.1016/0002-9416(84)90375-0
  16. Grayson B, Cutting C, Bookstein FL, Kim H, McCarthy JG. The three-dimensional cephalogram: theory, technique, and clinical application. Am J Orthod Dentofacial Orthop 1988;94:327-37 https://doi.org/10.1016/0889-5406(88)90058-3
  17. Kusnoto B, Evans CA, BeGole EA, de Rijk W. Assessment of 3-dimensional computer-generated cephalometric measurements. Am J Orthod Dentofacial Orthop 1999;116:390-9 https://doi.org/10.1016/S0889-5406(99)70223-4
  18. Ferrario VF, Sforza C, Miani A, Serrao G. A three-dimensional evaluation of human facial asymmetry. J Anat 1995;186:103-10
  19. Ferrario VF, Sforza C, Poggio CE, Serrao G. Facial three-dimensional morphometry. Am J Orthod Dentofacial Orthop 1996;109:86-9 https://doi.org/10.1016/S0889-5406(96)70167-1
  20. Ferrario VF, Sforza C, Schmitz JH, Miani A, Serrao G. A three-dimensional computerized mesh diagram analysis and its application in soft tissue facial morphometry. Am J Orthod Dentofacial Orthop 1998;114:404-13 https://doi.org/10.1016/S0889-5406(98)70185-4
  21. Ferrario VF, Sforza C, Serrao G. Colombo A, Ciusa V. Soft tissue facial growth and development as assessed by the three-dimensional computerized mesh diagram analysis. Am J Orthod Dentofacial Orthop 1999;116:215-28 https://doi.org/10.1016/S0889-5406(99)70220-9
  22. Ferrario VF, Sforza C, Schmitz JH, Santoro F. Three-dimensional facial morphometric assessment of soft tissue changes after orthognathic surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;88:549-56 https://doi.org/10.1016/S1079-2104(99)70084-3
  23. Carls FR, Schuknecht B, Sailer HF. Value of three-dimensional computed tomography in craniomaxillofacial surgery. J Cranio-Maxillofac Surg 1994;5:282-8 https://doi.org/10.1097/00001665-199411000-00003
  24. Santler G, Karcher H, Ruda C. Indications and limitations of three-dimensional models in cranio-maxillofacial surgery. J Cranio-Maxillofac Surg 1998;26:11-6 https://doi.org/10.1016/S1010-5182(98)80029-2
  25. 황현식. 안변비대칭 진단을 위한 악안면 3차원 영상 분석, 대치협회지 2004;42:76-83
  26. 이병도. 치과학에서 3차원 CT 영상의 적용, 대치협회지 2002;40:853-9
  27. 김기덕, 유선국. 치과영역에서 개인용 컴퓨터를 이용한 3차원 CT 영상의 활용. 대치협회지 2004;42:197-208
  28. Shah SM, Joshi MR. An assessment of asymmetry in the normal craniofacial complex. Angle Orthod 1978;48:141-8
  29. Ferrario VF, Sforza C, Miani A, Tartaglia G. Craniofacial morphometry by photographic evaluations. Am J Orthod Dentofacial Orthop 1993;103:327-37 https://doi.org/10.1016/0889-5406(93)70013-E
  30. Ferrario VF, Sforza C, Poggio CE, Tartaglia G. Distance from symmetry: a three-dimensional evaluation of facial asymmetry. J Oral Maxillofac Surg 1994;52:1126-32 https://doi.org/10.1016/0278-2391(94)90528-2
  31. Ferrario VF, Sforza C, Ciusa V, Dellavia C, Tartaglia G. The effect of sex and age on facial asymmetry in healthy subjects: a cross-sectional study from adolescence to mid-adulthood. J Oral Maxillofac Surg 2001:59:382-8 https://doi.org/10.1053/joms.2001.21872
  32. Baumrind S, Moffitt FH, Curry S. Three-dimensional x-ray stereometry from paired coplanar images: a progress report. Am J Orthod 1983;84:292-312 https://doi.org/10.1016/S0002-9416(83)90346-9
  33. Baumrind S, Moffitt FH, Curry S. The geometry of three-dimensional measurement from paired coplanar x-ray images. Am J Orthod 1983;84:313-22 https://doi.org/10.1016/S0002-9416(83)90347-0
  34. 이계형, 조홍규, 황현식, 김종철. 얼굴 비대칭 인지도와 정면 머리방사선 사진 계측항목간의 관련성 연구. 대체인류지 1998;11:41-8
  35. 안정순, 황현식. 안면비대칭에 대한 주관적 인지도와 정모두부방사선사진 분석치의 연관성. 대치교정지 2001;31:489-98
  36. Severt TR, Proffit WR. The prevalence of facial asymmetry in the dentofacial deformities population at the University of North Carolina.Int J Adult Orthodon Orthognath Surg 1997;12:171-6
  37. Enlow DH. Handbook of Facial Growth. 3rd ed. Phladelphia: W.B. Saunders; 1991. p. 58-163
  38. 장혜숙, 백형선. 3차원 CT 영상을 이용한 두개악안면 분석을 위한 계측점의 제안. 대치교정지 2002;32:313-25
  39. 김고운. 전산화단층사진을 이용한 하악골 3차원 영상에서 비대챙진단 계측 항목의 재현도에관한 연구. 석사학위논문, 전남대학교 대학원, 광주, 2004
  40. 윤일선, 이기헌, 황현식. 군집분석법에 의한 안면비대칭의 분류. 대치협회지 2001:39:765-73
  41. 이설미. 방사선사진과 안모사진을 이용한 하악 비대칭의 평가. 대구악안방사선지 2001;31:199-204
  42. 김희진, 강민규, 허경석, 김창헌, 정인혁. 한국인 얼굴 연조직의 두께. 대법의지 1999;23:117-21
  43. Kim EJ, Hwang HS, Park BJ, Cho KH. Correlations of frontal lip line canting with craniofacial morphology and muscular activity. J Dent Science 2002;14:284-96