The Journal of the Korean dental association (대한치과의사협회지)

The Korean Dental Association (대한치과의사협회)
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Facial asymmetry: Critical element of clinical successful treatment

임상가를 위한 특집 4 - 안면비대칭의 외과적 교정

  • Hong, Jongrak (Department of Oral & Maxillofacial Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • 홍종락 (성균관의대 삼성서울병원 구강악안면외과분과)
  • Received : 2014.08.14
  • Accepted : 2014.09.29
  • Published : 2014.10.01
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Abstract

The facial asymmetries include maxillary, mandibular, and chin asymmetries, although the most common deformity is primarily in the mandible. Common causes of this type of asymmetry can include asymmetric growth of the condyle or the mandible. In these patients, the location of the Me would be deviated to the shorter side because of the asymmetric growth of the mandible, and, commonly, the maxillary occlusal plane would be tilted toward the deviated side because the maxilla likely grows asymmetrically according to the pattern of asymmetric mandibular growth. Three-dimensional CT images are ideal for evaluating the size and location of anatomic structures, and such reconstructed images allow the use of software that can show anatomic structures from numerous angles, allowing actual measurements of distances and angles without problems of magnification, distortion, or superimposition caused by 2-dimensional imaging. In the present study using 3D-CT imaging, the 8 parameters, including measurements of the upper midline deviation, maxillary canting in the canine and first molar regions, width of the upper arch, width of the mandible at the Go, vertical length of the ramus, inclination of the ramus, and deviation of the Me were easily measured. The dentition should be orthodontically decompensated and dental midline should ensure incisor midlines positioned in the midline of each jaw before surgical correction. Surgical correction could be considered such as canting or yawing correction in the frontal or horizontal aspect, respectively.

안면비대칭의 주원인은 하악골이며, 하악골의 비대칭 성장에 대한 상악골의 보상성장에 따라 교합면 경사 등이 초래된다. 디지털 사진과 삼차원 CT 등 다양한 방법으로 정확한 진단을 하고 수술을 포함한 치료계획을 세운다. 술전 교정 치료는 상악골과 하악골 치열의 치성 보상(dental compensation)을 제거하면서 상악 치열의 중심은 상악골의 정중선에, 하악 치열의 중심은 하악골 정중선에 맞게 이동하여 술후 상하악 치열궁이 일치하면서 동시에 안모 정중선에 일치하게 맞추어야 한다. 악교정 수술은 일반적으로 상하악 동시 수술을 하게 되며 우각부 풍융도 교정과 이부 성형술(genioplasty) 등을 부가적으로 할 수 있으며, 교합면 경사 교정과 수평 회전 등의 이동이 상하악 위치에 서로 영향을 주면서 수술 후 안모 변화에 대한 예측을 어렵게 만들기 때문에, 다양한 분석을 통해 정확한 예측으로 최선의 결과를 얻는 것이 가장 중요하다.

Keywords

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