Soft tissue changes associated with advancement genioplasty in skeletal class III individuals receiving mandibular set-back surgery

골격성 III급 부정교합자에서 전진이부성헝술을 동반한 하악 후퇴술 후 연조직 외형의 변화

  • Kim, Keun-Ryoung (Department of Orthodontics, School of Dentistry, Pusan National University) ;
  • Kim, Seong-Sik (Department of Orthodontics, School of Dentistry, Pusan National University) ;
  • Son, Woo-Sung (Department of Orthodontics, School of Dentistry, Pusan National University) ;
  • Park, Soo-Byung (Department of Orthodontics, School of Dentistry, Pusan National University)
  • 김근령 (부산대학교 치의학전문대학원 치과교정학교실) ;
  • 김성식 (부산대학교 치의학전문대학원 치과교정학교실) ;
  • 손우성 (부산대학교 치의학전문대학원 치과교정학교실) ;
  • 박수병 (부산대학교 치의학전문대학원 치과교정학교실)
  • Published : 2008.04.30

Abstract

Purpose: The purpose of this study was to assess the hard and soft tissue changes associated with mandibular bilateral sagittal split osteotomy and genioplasty. Methods: This is a retrospective study of 40 patients who underwent either bilateral sagittal split osteotomy for mandibular setback (BSSO group, n = 20) or in combination with advancement genioplasty (Genio group, n = 20). Lateral radiographs, were taken before and immediately after surgery, and at least 6 months after surgery. Results: Comparing hard and soft tissue changes between the BSSO group and Genio group, there were significant differences in the lower incisor, soft tissue B point (B'), and soft tissue Pogonion (Pg') (p < 0.5). The mean ratio of hard and soft tissue changes for B/B', Pg/Pg', and Menton/soft tissue Menton after surgery in the BSSO group was 0.997, 0.965, and 1.022 respectively, and 0.824, 0.602, and 0.887 respectively in the genio group. Significant differences were found between the two groups. There were significant differences in lip thickness (B-B', Pg-Pg') in the Genioplasty group between pre and postsurgery, but not in the BSSO group. Pogonion to Labrale inferior and B' had a correlation coefficient of 0.833, 0.922, respectively for the BSSO group, and 0.775, 0.799 for the Genio group. Conclusions: The results indicate that there is a significant difference between bilateral sagittal split osteotomy with or without genioplasty in the lower facial esthetics values. The combination of mandibular setback and genioplasty had a smaller change in soft tissue thickness of the symphysis area after surgery than that of mandibular setback only.

본 연구는 전진이부성형술을 동반한 하악지 시상분할골절단술을 시행한 하악 전돌증을 가진 환자에서 하안면부, 특히 이부의 경조직과 연조직의 변화를 예측하는 데 있어서, 전후관계와 수직적 계측치를 통하여, 경조직의 변화에 따른 연조직의 상대적 변화량에 대해 비교, 분석하여 한국인의 골격성 III급 부정교합자의 악교정 수술시 전진이부성형술이 연조직 외형에 미치는 영향을 알아보고자 시행하였다. 교정치료와 악교정수술을 시행한 골격성 III급 부정교 합자 40명을 전진이부성형술을 시행하지 않고 하악지 시상분할골절단술만 시행한 환자 20명(BSSO group, 남자 10 명, 여자 10명)과 하악지 시상분할골절단술과 동시에 전진이부성형술을 시행한 환자 20명(Genie group, 남자 10명, 여자10명)으로 분류하여 수술직전(T1)과 수술직후(T2), 수술 최소 6개월 후(T3)의 측모 두부 방사선계측사진을 채득하여 계측 항목의 변화량을 분석하였다. BSSO군에서는 수술후 경조직 B점, Pogonion, Menton에 대하여 연조직 B점, Pogonion, Menton이 각각 수평적으로 0.997, 0.965, 1.022의 변화율을 보였으며, Genie군에서는 각각 0.824, 0.602, 0.887의 수평적 변화율을 보여서, Genie 군에서 연조직 B점, 연조직 Pogonion의 연조직 두께의 감소량이 더 크게 나타났다. 경조직 Pogonion(Pg)의 악교정수술 전과 후의 수평적 변화에 따른 하순의 하방점(Li), 연조직 B점 (B')의 변화간의 상관관계계수는 BSSO군에서는 각각 0.833, 0.922인 반면에, Genie 군에서는 각각 0.775, 0.799로 BSSO군에 비해서 상관관계가 다소 작은 것으로 나타났다. 이상의 결과에서 하악지 시상분할골절단술을 시행하는 환자에서 전진이부성형술을 동반할 경우에는 골격의 변화에 대해서 연조직의 두께 변화가 다소 적게 나타나므로 수술시에 이를 고려하여 전진이부성형술을 시행하여야 할 것이다.

Keywords

References

  1. Stricker G, Clifford E, Cohen LK, Giddon DB, Meskin LH, Evans CA. Psychosocial aspects of craniofacial disfigurement. Am J Orthod 1979;76:410-22 https://doi.org/10.1016/0002-9416(79)90226-4
  2. Ewing M, Ross RB. Soft tissue response to mandibular advancement and genioplasty. Am J Orthod Dentofacial Orthop 1992; 101:550-5 https://doi.org/10.1016/0889-5406(92)70130-3
  3. Ellis E 3rd, Dechow PC, McNamara JA Jr, Carlson DS, Liskiewicz WE. Advancement genioplasty with and without soft tissue pedicle; An experimental investigation. J Oral Maxillofac Surg 1984;42:637-45 https://doi.org/10.1016/0278-2391(84)90205-2
  4. Heiple KG, Chase SW, Herndon CH. A comparative study of the healing process following different types of bone transplantation. J Bone Joint Surg Am 1963;45:1593-616 https://doi.org/10.2106/00004623-196345080-00003
  5. Thompson N, Casson J. Experimental onlay bone grafts to the jaws. A preliminary study in dogs. Plast Reconstr Surg 1970;46;341-9 https://doi.org/10.1097/00006534-197010000-00003
  6. Dann JJ, Epker BN. Proplast genioplasty; a retrospective study with treatment recommendations. Angle Orthod 1977;47:173-85
  7. Friedland JA, Coccaro PJ, Converse JM. Retrospective cephalometric analysis of mandibular bone absorption under silicone rubber chin implants. Plast Reconstr Surg 1976;57:144-51 https://doi.org/10.1097/00006534-197602000-00002
  8. Robinson M, Shuken R. Bone resorption under plastic chin implants. J Oral Surg 1969;27:116-8
  9. Peled IJ, Wexler MR, Ticher S, Lax EE. Mandibular resorption from silicone chin implants in children. J Oral Maxillofac Surg 1986;44:346-8 https://doi.org/10.1016/S0278-2391(86)80028-3
  10. Park HS, Ellis E 3rd, Fonseca RJ, Reynolds ST, Mayo KH. A retrospective study of advancement genioplasty. Oral Surg Oral Med Oral Pathol 1989;67:481-9 https://doi.org/10.1016/0030-4220(89)90261-2
  11. Bjork N Eliasson S, Wictorin L. Changes of facial profile after surgical treatment of mandibular protrusion. Scand J Plast Reconstr Surg 1971;5:41-6 https://doi.org/10.3109/02844317109042935
  12. Fromm B, Lundberg M. 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
  13. Robinson SW, Spiedel TM, Isaacson RJ, Worms FW. Soft tissue profile change produced by reduction of mandibular prognathism. Angle Orthod. 1972;42:227-35
  14. Hershey HG, Smith LH. Soft tissue profile change associated with surgical correction of prognathic mandible. Am J Orthod 1974;65:483-502 https://doi.org/10.1016/0002-9416(74)90031-1
  15. Busquets CJ, Sassouni V. Changes in the integumental profile of the chin and lower lip after genioplasty. J Oral Surg 1981;39:499-504
  16. Wittbjer J, Rune B. Changes of the profile after advancement genioplasty. Scand J Plast Reconstr Surg Hand Surg 1989;23:65-70 https://doi.org/10.3109/02844318909067512
  17. Polido WD, Bell WH. Long-term osseous and soft tissue changes after large chin advancements. J Craniomaxillofac Surg 1993;21:54-9 https://doi.org/10.1016/S1010-5182(05)80148-9
  18. Van Sickels JE, Smith CV, Tiner BD, Jones DL. Hard and soft tissue predictability with advancement genioplasties. Oral Surg Oral Med Oral Pathol 1994;77:218-25 https://doi.org/10.1016/0030-4220(94)90288-7
  19. Lines PA, Steinhauser EW. Diagnosis and treatment planning in surgical orthodontic therapy. Am J Orthod 1974;66:378-97 https://doi.org/10.1016/0002-9416(74)90048-7
  20. Wolford LM, Hilliard FW, Dugan DJ. Surgical treatment objective; a systematic approach to the prediction tracing. St. Louis: Mosby; 1984. p. 54-74
  21. Talbot WR. Soft-tissue glass impaction. Oral Surg Oral Med Oral Pathol 1974 ;38:161-2 https://doi.org/10.1016/0030-4220(74)90328-4
  22. Quast DC, Biggerstaff RH, Haley JV. The short-term and long-term soft-tissue profile changes accompanying mandibular advancement surgery. Am J Orthod 1983;84:29-36 https://doi.org/10.1016/0002-9416(83)90145-8
  23. Mommaerts MY, Marxer H. A cephalometric analysis of the long-term, soft tissue profile changes which accompany the advancement of the mandible by sagittal split ramus osteotomies. J Craniomaxillofac Surg 1987;15:127-31 https://doi.org/10.1016/S1010-5182(87)80036-7
  24. Gonzalez-Ulloa M. Quantitative principles in co ,smetic surgery of the face (profileplasty). Plast Reconstr Surg Transplant Bull 1962;29;186-98 https://doi.org/10.1097/00006534-196202000-00006
  25. Steiner CC. The use of cephalometrics as an aid to planning and assessing orthodontic treatment. Am J Orthod 1960;46:721-35 https://doi.org/10.1016/0002-9416(60)90145-7
  26. Burstone CJ. Lip posture and its significance in treatment planning. Am J Orthod 1967;53:262-84 https://doi.org/10.1016/0002-9416(67)90022-X
  27. Garn SM, Lewis AB, Vicinus JH. The inheritance of symphyseal size during growth. Angle Orthod 1963;33:222-31
  28. Rosenstein SW. A longitudinal study of anteroposterior growth of the mandibular symphysis. Angle Orthod 1964;34:155-67
  29. Buschang PH, Julien K, Sachdeva R, Demirjian A. Childhood and pubertal growth changes of the human symphysis. Angle Orthod 1992;62:203-10
  30. Cha BK, Suhr CH. A study on the morphology of chin in relation to vertical dysplasia of craniofacial complex. Korean J Orthod 1990;20:135-56
  31. Shim WS, Chung KR, Lee KS. A Longitudinal study of growth change on the mandibular symphysis and lower incisors. Korean J Orthod 1987;17:73-83
  32. Yang WS. Morphology of mandibular symphysis and positioning of lower incisors in the skeletal Class III malocclusions. Korean J Orthod 1985;15:149-53
  33. Kim SD, Kwon OW, Sung JH. The relationship between the morphology of mandibular symphysis and the craniofacial morphology in Class III malocclusion. Korean J Orthod 1996;26:509-22
  34. Handelman CS. The anterior alveolus: its importance in limiting orthodontic treatment and its influence on the occurrence of iatrogenic sequelae. Angle Orthod 1996;66:95-109
  35. Wehrbein H, Bauer W, Diedrich P. Mandibular incisors, alveolar bone, and symphysis after orthodontic treatment. A retrospective study. Am J Orthod Dentofacial Orthop 1996;110:239-46 https://doi.org/10.1016/S0889-5406(96)80006-0
  36. Bell WH, Proffit WR, White RP. Surgical correction of dentofacial deformities. Philadelphia: WB Saunders; 1980
  37. Fanibunda KB. Changes in the facial profile following correction for mandibular prognathism. Br J Oral Maxillofac Surg 1989;27:277-86 https://doi.org/10.1016/0266-4356(89)90038-7
  38. Scheideman GB, Legan HL, Bell WH. Soft tissue changes with combined mandibular setback and advancement genioplasty. J Oral Surg 1981;39:505-9
  39. 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
  40. Lee HS, Park YC. A cephalometric study of profile changes following orthognathic surgery in patients with mandibular prognathism. Korean J Orthod 1987;17:299-310
  41. Kajikawa Y. Changes in soft tissue profile after surgical correction of skeletal class III malocclusion. J Oral Surg 1979;37:167-74
  42. Bell WH, Dann JJ. Correction of dentofacial deformities by surgery in the anterior part of the jaws. A study of stability and soft-tissue changes. Am J Orthod 1973;64:162-87 https://doi.org/10.1016/S0002-9416(73)90308-4
  43. Veltkamp T, Buschang PH, English JD, Bates J, Schow SR. Predicting lower lip and chin response to mandibular advancement and genioplasty. Am J Orthod Dentofacial Orthop 2002;122:627-34 https://doi.org/10.1067/mod.2002.128864
  44. Bell WH, Brammer JA, McBride KL, Finn RA. Reduction genioplasty: surgical techniques and soft-tissue changes. Oral Surg Oral Med Oral Pathol 1981;51:471-7 https://doi.org/10.1016/0030-4220(81)90003-7