The korean journal of orthodontics (대한치과교정학회지)

The Korean Association Of Orthodontists (대한치과교정학회)
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Soft tissue changes associated with ASO/BSSRO and Le Fort I/BSSRO in skeletal Class III malocclusion with upper lip protrusion

상순돌출을 동반한 골격성 III급 부정교합에서 수술방법에 따른 치료 후 상악 연조직 변화 - ASO/BSSRO와 Le Fort I/BSSRO 비교

  • Kang, Ju-Man (Department of Orthodontics, Graduate School of Clinical Dental Science, The Catholic University of Korea) ;
  • Kim, Yoon-Ji (Department of Orthodontics, Graduate School of Clinical Dental Science, The Catholic University of Korea) ;
  • Park, Je-Uk (Department of Maxillofacial Surgery, Graduate School of Clinical Dental Science, The Catholic University of Korea) ;
  • Kook, Yoon-Ah (Department of Orthodontics, Graduate School of Clinical Dental Science, The Catholic University of Korea)
  • 강주만 (가톨릭대학교 임상치과학대학원 교정과) ;
  • 김윤지 (가톨릭대학교 임상치과학대학원 교정과) ;
  • 박재억 (가톨릭대학교 임상치과학대학원 구강악안면외과) ;
  • 국윤아 (가톨릭대학교 임상치과학대학원 교정과)
  • Received : 2009.09.29
  • Accepted : 2010.06.01
  • Published : 2010.12.31
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Abstract

Objective: The objective of this study was to compare maxillary soft tissue changes and their relative ratios to hard tissue changes after anterior segmental osteotomy (ASO)/bilateral sagittal split ramus osteotomy (BSSRO) and Le Fort I/BSSRO in skeletal Class III malocclusion with upper lip protrusion. Methods: The study sample comprised the ASO/BSSRO group (n = 14) and the Le Fort I/BSSRO group (n = 15). The Le Fort I/BSSRO group included cases of maxillary posterior impaction only. Lateral cephalograms were taken 2 months before and 6 months after surgery. Linear and angular measurements were performed. Results: The anterior maxilla moved backward in both groups after surgery, however the amount of change was significantly larger in the ASO/BSSRO group (p < 0.01). The ratios of hard to soft tissue change were 79% (SLS to A point), 80% (LS to A point) in the ASO/BSSRO group, and 15% (SLS to A point), 68% (LS to A point) in the Le fort I/BSSRO group. In addition, there was a $3.23^{\circ}$ increase of the occlusal plane in the Le Fort I/BSSRO group. Conclusions: When two-jaw surgery is indicated in skeletal Class III patients with protrusive lips, ASO may be a treatment of choice for cases with more severe upper lip protrusion, while Le Fort I with posterior impaction may be considered if an increase of occlusal plane angle is required.

본 연구는 상순돌출을 동반한 골격성 III급 부정교합에서 전방분절골절단술(anterior segmental osteotomy, ASO)을 병용한 상행지시상분할골절단술(bilateral sagittal split ramus osteotomy, BSSRO)과 Le Fort I 골절 단술을 병용한 상행지시상분할골절단술(BSSRO) 후 상악의 경 연조직 변화 및 경조직 변화에 대한 연조직 변화율을 비교하였다. A군은 ASO/BSSRO를 시행한 군 14명, B군은 Le Fort I/BSSRO를 시행한 환자 중 상악의 후방부가 상방으로 이동(posterior impaction)된 15명으로 구성되었다. 수술 전 2개월 이내와 수술 후 6개월 이후에 촬영한 측모두부방사선사진을 분석하여 다음과 같은 결과를 얻었다. 두 군 모두 수술 후 상악 전방부 경조직과 연조직이 후방이동되었고, A군에서 더 큰 변화량을 보였다. A point의 후방이동에 따른 superior labial sulcus의 변화율은 A군에서 79%, B군에서 15%를 보였고, supradentale에 대해 labrale superious는 A군에서 80%, B군에서 68%의 비율로 후방이동하였다. 교합평면각은 B군에서 증가한 반면, A군에서는 통계적으로 유의성 있는 변화가 없었다. 이상의 연구결과 골격성 III급 부정교합의 양악수술 시 상악 수술은 상악 전방부와 상순의 돌출이 심한 경우에는 ASO를 시행하고 교합평면각의 증가가 필요한 경우에는 posterior impaction을 동반한 Le Fort I 골절단술을 시행하는 것이 바람직하다.

Keywords

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