EFFICACY OF ENaP(ESTHETIC NaP)-LINE FOR ORTHOGNATHIC SURGERY OF KOREAN MANDIBULAR PROGNATHISM

한국인 하악골 전돌증 환자의 악교정수술을 위한 ENaP(Esthetic NaP)선의 유효성에 관한 연구

  • Kim, Jong-Kook (Dept. of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University) ;
  • Park, Hyung-Sik (Dept. of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University)
  • 김종국 (연세대학교 치과대학 구강악안면외과학 교실) ;
  • 박형식 (연세대학교 치과대학 구강악안면외과학 교실)
  • Published : 2002.10.30

Abstract

As the most of dentofacial deformity patients indicated to orthognathic surgery have strong desire for esthetic improvement as well as functional improvement, ideal esthetic evaluation should be made at surgical prediction. Lateral cephalographs has been commonly used for surgical prediction, however, remarkable discrepancy between esthetic viewpoint by simple looking and analysis on lateral cephalographs often found on evaluation of sagittal position of the upper and lower jaws especially in cases of mandibular prognathism of Koreans. In these cases, we have been employed Esthetic NaP(ENaP)-line for corrective evaluation and ideal surgical prediction on lateral cephalographs, but the efficacy of ENaP-line has not been evaluated. This is a study on efficacy of ENaP-line for orthognathic surgery of Korean mandibular prognathism. 170 Korean patients who had been diagnosed as mandibular prognathism and planned for orthognathic surgery at Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University during last 10 years are studied. The obtained results are as followings; among 170 patients of mandibular prognathism, 132 patients(77.6%) had not discrepancy in evaluation of sagittal position of the maxilla between cephalometric and esthetic evaluation(they are classified as Group I), however, 38 patients(22.4%) had definite discrepancy(they are classified as Group II). ENaP-line was employed in all cephalometric analysis of Group II. The proportions of male and female were similar in both Groups. Sixteen vertical reference lines perpendicular to 16 horizontal reference lines were obtained as followings; Each of the representative degree of ${\angle}SN/AFH$, ${\angle}SN/CFH$ and ${\angle}AFH/CFH$ obtained at Group I was applied to SN plane, AFH plane and CFH plane of Group II each other, and so 16 horizontal reference lines could be obtained individually according to each of the applied degree to each plane. And then their reliability to coincide with ENaP-line of Group II was evaluated. A vertical reference line perpendicular to a horizontal line made by application of the representative degree of ${\angle}$AFH/CFH in Group I to AFH line in Group II had the most highest coincidence with ENaP-line of Group II, however, its agreement was 42% in male and 47% in female. From this results, the rest of them should be determined their corrective jaw position definitely depend on

Keywords

References

  1. Fromm B, Lundberg M. The soft tissue facial profile before and after surgical correction of mandibular protrusion. Acta. Odontol Scan. 28 : 157-177, 1972
  2. Hershey HC, Smith LH. Soft-tissue profile change associated with surgical correction of the prognathic mandible. Am. J. Orthod. 65 : 483-502, 1974
  3. Lines PA, Steinhauser EW. Soft tissue in changes in relation to movement of hard structure in orthognathic surgery. J. Oral Surg. 32 : 891-896, 1974
  4. Moore JW. Variation of the sella nasion plane and its effect on SNA and SNB. J. Oral Surg. 34 : 24-26, 1976
  5. Robinson, S.W., Speidel, T.M. Isaagson, R.J. and Worms, F.W. : Soft tissue profile change produced by reduction of mandibular prognathism. Angle Orthod., 42 : 227- 235, 1972
  6. Broadbent, B.H. : A new X-ray technigue and its applicatin to orthodontia. Angle Orthod. 1: 45-66, 1931
  7. Harradine, N.W.T., Bimei L.J. : Computerized prediction of the results of ortho-gnathic surgery. J. Maxillofac. Surg., 13 : 245-249, 1985
  8. Sarver, D.M., matukas, V.J., Widssman. S.M. : Incorporation of facial plastic surgery in the planning and treatment of orthognathic surgical cases. Int. J.orthod. orthognathic, Surg., 6 : 227-239, 1991
  9. Sinclair, P.M., et al. : The accuracy of videoimaging in orthognatic surgery. Am. J. Orthod. 107 : 177-185, 1995
  10. Burstone CJ. James RB. Legan H. et al. Cephalometrics for orthognathic surgery. J. Oral Surg. 44 : 125, 1978
  11. Bell, W.H., and Dann, J.J. : Correction of dentofacial deformities by surgery in the anteriorpart of the jaws. Am. J. Orthod. 64 : 1-62, Aug. 1973
  12. Ellis E. III. McNamara JA Jr. Cephalometric reference Planes sella nasion vs Frankfort horizontal. Int. J. Adult Orthod. Orthognath. Surg. 3 : 81-87, 1988
  13. Bjerin R : A comparison between the Frankfort horizontal and the sella turcica nasion reference planes in cephalometric ananlysis. Acta Odont. Scand. 15 : 1-12, 1957
  14. Proffit WR. White BP Jr. Surgical orthodonic treatment. St. Louis 1991. Mosby Year Book. Inc
  15. Riedel Ra. The relation of maxillary sturctures to cranium in malocclusion and in normal occlusion. Angle Orthod. 22 : 142-145, 1952
  16. Wuerpel, E.H. : On facial balance and harmony. angle Orthod., 7 : 81-89, 1937
  17. Burstone, C.J. : Lip posture and its significance in treatment planning. Am. J. Orthod. 53: 262-284, 1967
  18. Macintosh, R.B. : Orthognatic surgery: coments on diagnostic modalities. J. Oral Surgery, 28 : 249-259, 1970
  19. Scheideman, G.B., Legan, H.L. and Bell, W.H. : Soft tissue changes with combined mandibular set back and advancement genioplasty. J. Oral Surgery, 39 : 505-509, 1981
  20. 기화영, 이충국 : 하악골 전돌증의 악교정 수술후 안면 연조직 변화에 관한 연구. 대한구강악안면외과학회, 10 : 2 : 229-239, 1984
  21. 김여갑 : 악교정 수술시 경조직 변화에 따른 연조직 변화에 관한 연구. 대한치과의사협회지, 25 : 1 : 81-91, 1987
  22. 이형식, 박영철 : 하악골 전돌증 환자의 악교정 수술 후 안면 측모변화에 관한 두부방사선 계측학적 연구. 대학치과교정학회지, 17 : 2 : 299-309, 1987
  23. Downs W.B. : Variations in facial relationship : Their significance in treatment and prognosis. Am. J. Orthod. 34 : 812-840, 1948
  24. Bjork N Eliasson S. Wictorin L. Changes of facial profile after surgical treatment of mandibular protrusion. San. J. Plast. Reconstr. Surg. 5 : 41-46, 1971
  25. Holdaway RA. A soft tissue cephalometric analysis and its use in orthodontic treatment planning. Part I Am. J. Orthod. Dentofac. Orthop. 85 : 279-293, 1994
  26. Holdaway, R.A. : Changes in relationship of point A and B during Orthodontic treatment. Am. J. Orthod. 42 : 176-193, 1952