대한치과교정학회지 (The korean journal of orthodontics)

  • 제39권1호
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  • Pages.18-27
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  • 2009
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  • 2234-7518(pISSN)
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  • 2005-372X(eISSN)
대한치과교정학회 (The Korean Association Of Orthodontists)
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3차원 전산화 단층 사진을 이용한 안면비대칭 환자의 악교정 수술 전, 후 교근 분석

Analysis of masseter muscle in facial asymmetry before and after orthognathic surgery using 3-dimensional computed tomography

  • 서승아 (연세대학교 치과대학 교정학교실) ;
  • 백형선 (연세대학교 구강과학연구소, 치과대학 교정학교실, 두개안면기형 연구소) ;
  • 황충주 (연세대학교 구강과학연구소, 치과대학 교정학교실, 두개안면기형 연구소) ;
  • 유형석 (연세대학교 구강과학연구소, 치과대학 교정학교실, 두개안면기형 연구소)
  • Seo, Seung-Ah (Department of Orthodontics, College of Dentistry, Yonsei University) ;
  • Baik, Hyoung-Seon (Department of Orthodontics, College of Dentistry, Oral Science Research Institute, The Institute of Cranio-facial Deformity, Yonsei University) ;
  • Hwang, Chung-Ju (Department of Orthodontics, College of Dentistry, Oral Science Research Institute, The Institute of Cranio-facial Deformity, Yonsei University) ;
  • Yu, Hyung-Seog (Department of Orthodontics, College of Dentistry, Oral Science Research Institute, The Institute of Cranio-facial Deformity, Yonsei University)
  • 발행 : 2009.02.28
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초록

안면비대칭 환자에서 하악 우각부위의 연조직 형태에 결정적 영향을 미칠 수 있는 교근의 성상에 대한 평가는 경조직의 분석과 더불어 중요하다. 교근은 수술로 인한 하악의 후방이동 시 가장 많은 영향을 받는 구조 중 하나이며, 수술 후 교근의 상태는 환자의 저작력과 하악 우각부 외형에 영향을 줄 수 있다. 본 연구는 안면비대칭을 가진 골격성 III급 부정교합자의 편위, 비편위측 교근의 형태학적 차이와 하악골 후퇴술 이후 양측 교근의 변화를 비교 분석하고자 하였다. 또한 안면비대칭의 개선 전, 후 교근을 정상교합자와 비교하여 비대칭의 수술이 교근에 미치는 영향을 알아보고자 하였다. 안면비대칭으로 진단된 환자 12명의 양악수술 전후의 3차원 CT 영상과 정상교합자 10명의 3차원 CT 영상에서 하악골과 교근을 계측, 분석하였다. 연구 결과 비대칭군에서 교근의 편위, 비편위측 모두 정상교합군에 비해 부피가 작고, 최대 단면적 부위가 좁은 것을 알 수 있었으며, 편위, 비편위측의 교근의 주행각도 차이와 최대단면적 부위에서의 두께 차이가 정상 교합군보다 크게 나타났다. 양악 수술 전, 후에 교근의 주행각도는 유의성 있게 감소하였고, 편위, 비편위측 각도의 차이도 감소하였으며, 최대 단면적 부위에서의 교근의 두께가 유의성 있게 증가하였다. 비대칭 수술 후 좌우 교근은 너비를 제외하고는 정상 교합자와 유의차 없게 변화하였다. 이상의 연구 결과, 안면비대칭 환자는 교근의 성상이 분명히 정상 교합자와는 다르지만, 적절한 수술 후에 경조직뿐만 아니라 교근도 정상범주로 변화하였음을 알 수 있었다.

Objective: The purpose of this study was to understand the differences in masseter muscle(MM) between the shifted and non-shifted sides in facial asymmetry patients, and the changes shown by MM after mandibular surgery. Methods: Pre- and post-operative CT scans were performed on 12 Class III patients with facial asymmetry who were treated by intraoral vertical ramus osteotomy and 10 subjects with normal occlusion. Using the V-works 4.0 program(Cybermed, Seoul, Korea), 3-dimensional images of the mandible, and MM were reconstructed, and evaluated. Results: In the asymmetry group, the MM angle between the shifted and non-shifted sides was only significantly different(p<0.05). Compared with normal occlusion, the asymmetry group showed a significantly smaller volume and maximum cross-sectional area in both sides of MM(p<0.05). After mandibular surgery, the angle of MM(p<0.01) and differences in angle between the shifted and non-shifted sides of MM(p<0.05) were significantly decreased. The thickness in the maximum cross-sectional area was significantly increased(p<0.01). After surgery, MM in facial asymmetry patients was similarly changed to those in the normal occlusion group except for widths. Conclusions: MM in facial asymmetry was definitely different from those in normal occlusion. However, this study suggests that MM changed symmetrically in conjunction with the mandible after proper mandibular surgery.

키워드

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