Maxillofacial Plastic and Reconstructive Surgery

Korean Association of Maxillofacial Plastic and Reconstructive Surgeons (대한악안면성형재건외과학회)
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Cone Beam Computed Tomography Analysis of Mandibular Anatomical Variation in a Patient with Facial Asymmetry

안면 비대칭 환자에서 Cone Beam Computed Tomography를 이용한 하악골 해부학적 변이의 분석

  • Park, Seong-Won (Department Oral and Maxillofacial Surgery, College of Dentistry, Wonkwang University) ;
  • Oh, Sung-Hwan (Department Oral and Maxillofacial Surgery, College of Dentistry, Wonkwang University) ;
  • Lee, Jae-In (Department of Prosthodontics, College of Dentistry, Wonkwang University)
  • 박성원 (원광대학교 치과대학 구강악안면외과학교실) ;
  • 오승환 (원광대학교 치과대학 구강악안면외과학교실) ;
  • 이재인 (원광대학교 치과대학 치과보철학교실)
  • Received : 2011.09.05
  • Accepted : 2011.11.22
  • Published : 2012.01.30
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Abstract

Purpose: The study was performed to compare patients with anatomical variations in facial asymmetry with patients in the normal range using cone-beam computed tomography (CBCT) and to take the preoperative condition into consideration in the case of a sagittal split ramus osteotomy (SSRO). Methods: The study was conducted on 46 adult patients composed of 2 subdivided groups, an asymmetry group (n=26) and a symmetry group (n=20). The asymmetry group was divided between patients with hemimandibular hyperplasia (HH, n=8) and hemimandibular elongation (HE, n=18). Using cross-sectional computed tomography images, the thickness of cancelleous bone in the buccal area of the mandible, thickness of buccal cortex in the buccal aspect of the mandible, thickness of cancellous bone in the inferior aspect of the mandible, thickness of buccal cortex in the inferior aspect of the mandible, and cross-sectional surface area of the mandible were measured. Results: In the asymmetry group, the cross-sectional area of the mandible including the inferior alveolar nerve positioned on the affected side was significantly different from the symmetry group. Thickness of cancelleous bone in the buccal aspect of the mandible, thickness of cancelleous bone in the inferior aspect of the mandible, and cross-sectional surface area of the mandible in the affected site of hemimandibular hyperplasia was significantly smaller than in the symmetry group. Conclusion: The inferior alveolar nerve runs lower and in a more buccal direction and shows a smaller cross-sectional surface of the mandible in the hemimandibular hyperplasia patients with asymmetry.

Keywords

References

  1. Peck H, Peck S. A concept of facial esthetics. Angle Orthod 1970;40:284-318.
  2. Maeda M, Katsumata A, Ariji Y, et al. 3D-CT evaluation of facial asymmetry in patients with maxillofacial deformities. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;102:382-90. https://doi.org/10.1016/j.tripleo.2005.10.057
  3. Baek SH, Cho IS, Chang YI, Kim MJ. Skeletodental factors affecting chin point deviation in female patients with class III malocclusion and facial asymmetry: a three-dimensional analysis using computed tomography. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;104:628-39. https://doi.org/10.1016/j.tripleo.2007.03.002
  4. Sakurai A, Hirabayashi S, Sugawara Y, Harii K. Skeletal analysis of craniofacial asymmetries in plagiocephaly (unilateral coronal synostosis). Scand J Plast Reconstr Surg Hand Surg 1998;32:81-9. https://doi.org/10.1080/02844319850158967
  5. Haraguchi S, Takada K, Yasuda Y. Facial asymmetry in subjects with skeletal Class III deformity. Angle Orthod 2002;72:28-35.
  6. Sassouni V. Diagnosis and treatment planning via roentgenographic cephalometry. Am J Orthodontics 1958;44:433-63. https://doi.org/10.1016/0002-9416(58)90003-4
  7. Ricketts RM. Cephalometric synthesis. Am J Orthodontics 1960;46:647-73. https://doi.org/10.1016/0002-9416(60)90172-X
  8. Mulick JF. Clinical use of the frontal headfilm. Angle Orthod 1965;35:299-304.
  9. Graber TM. New horizons in case analysis-clinical cephalometrics. Am J Orthodont 1952;38:603-24. https://doi.org/10.1016/0002-9416(52)90027-4
  10. Graber TM. A critical review of clinical cephalometric radiography. Am J Orthodont 1954;40:1-26. https://doi.org/10.1016/0002-9416(54)90166-9
  11. 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
  12. 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
  13. Lee JY, Kim YI, Hwang DS, et al. Cross-sectional study of the mandibular body in patients with facial asymmetry. J Korean Assoc Oral Maxillofac Surg 2011;37:109-113. https://doi.org/10.5125/jkaoms.2011.37.2.109
  14. Obwegeser HL, Makek MS. Hemimandibular hyperplasia-hemimandibular elongation. J Maxillofac Surg 1986;14:183-208. https://doi.org/10.1016/S0301-0503(86)80290-9
  15. Bishara SE, Burkey PS, Kharouf JG. Dental and facial asymmetries: a review. Angle Orthod 1994;64:89-98.
  16. Ahn JS, Hwang HS. Relationship between perception of facial asymmetry and posteroanterior cephalometric measurements. Korean J Orthod 2001;31:489-98.
  17. Bruneteau RJ, Mulliken JB. Frontal plagiocephaly: synostotic, compensational, or deformational. Plast Reconstr Surg 1992;89:21-31. https://doi.org/10.1097/00006534-199289010-00005
  18. Trauner R, Obwegeser H. The surgical correction of mandibular prognathism and retrognathia with consideration of genioplasty. I. Surgical procedures to correct mandibular prognathism and reshaping of the chin. Oral Surg Oral Med Oral Pathol 1957;10:677-89. https://doi.org/10.1016/S0030-4220(57)80063-2
  19. Wyatt WM. Sagittal ramus split osteotomy: literature review and suggested modification of technique. Br J Oral Maxillofac Surg 1997;35:137-41. https://doi.org/10.1016/S0266-4356(97)90691-4
  20. White RP Jr, Peters PB, Costich ER, Page HL Jr. Evaluation of sagittal split-ramus osteotomy in 17 patients. J Oral Surg 1969;27:851-5.
  21. Guernsey LH, DeChamplain RW. Sequelae and complications of the intraoral sagittal osteotomy in the mandibular rami. Oral Surg Oral Med Oral Pathol 1971;32:176-92. https://doi.org/10.1016/0030-4220(71)90221-0
  22. Behrman SJ. Complications of sagittal osteotomy of the mandibular ramus. J Oral Surg 1972;30:554-61.
  23. Freihofer HP Jr, Petresevic D. Late results after advancing the mandible by sagittal splitting of the rami. J Maxillofac Surg 1975;3:250-7. https://doi.org/10.1016/S0301-0503(75)80051-8
  24. Broadbent TR, Woolf RM. Our experience with sagittal split osteotomy for retrognathia. Plast Reconstr Surg 1977;60:860-7. https://doi.org/10.1097/00006534-197712000-00003
  25. Westermark A, Bystedt H, von Konow L. Inferior alveolar nerve function after mandibular osteotomies. Br J Oral Maxillofac Surg 1998;36:425-8. https://doi.org/10.1016/S0266-4356(98)90457-0
  26. Kane AA, Lo LJ, Chen YR, Hsu KH, Noordhoff MS. The course of the inferior alveolar nerve in the normal human mandibular ramus and in patients presenting for cosmetic reduction of the mandibular angles. Plast Reconstr Surg 2000;106:1162-74. https://doi.org/10.1097/00006534-200010000-00029
  27. Ylikontiola L, Moberg K, Huumonen S, Soikkonen K, Oikarinen K. Comparison of three radiographic methods used to locate the mandibular canal in the buccolingual direction before bilateral sagittal split osteotomy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002;93:736-42. https://doi.org/10.1067/moe.2002.122639
  28. Yamamoto R, Nakamura A, Ohno K, Michi KI. Relationship of the mandibular canal to the lateral cortex of the mandibular ramus as a factor in the development of neurosensory disturbance after bilateral sagittal split osteotomy. J Oral Maxillofac Surg 2002;60:490-5. https://doi.org/10.1053/joms.2002.31843
  29. Yoshioka I, Tanaka T, Khanal A, et al. Relationship between inferior alveolar nerve canal position at mandibular second molar in patients with prognathism and possible occurrence of neurosensory disturbance after sagittal split ramus osteotomy. J Oral Maxillofac Surg 2010;68:3022-7. https://doi.org/10.1016/j.joms.2009.09.046
  30. Tamas F. Position of the mandibular canal. Int J Oral Maxillofac Surg 1987;16:65-9. https://doi.org/10.1016/S0901-5027(87)80032-2
  31. Gowgiel JM. The position and course of the mandibular canal. J Oral Implantol 1992;18:383-5.