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한국인의 악교정수술후 상악골 이동에 따른 연조직 변화에 관한 연구

Issue Date
1992
Description
치의학과/석사
Abstract
[한글] 악안면 기형환자의 진단 및 치료계획 수립에 있어서 저작, 발음등의 기능적인 측면의 개선 못지않게 안모형태의 개선도 중요한 관점으로 고려되어야 하는데 상악골 교정수술에 의한 경조직의 이동은 안면 중부 연조직의 절대적인 심미적 변화뿐 만 아니라 이 부위 연조직의 계측점을 이용한 전체 안모의 상대적인 심미분석에 결정적인 영향을 주므로 술전 계측에 있어서 경조직의 변화에 따라 이동되는 연조직 계측점을 정확히 예견하여 위치를 선정해 주는 것이 매우 중요하다. 저자는 한국인에서 악교정수술후 상악골의 위치적 이동에 따른 안면 중부 연조직의 변화양상을 연구하기 위해 연세대학교 치과대학 구강악안면외과에서 Le Fort-I 型 골절단술을 이용해 상악골 교정수술을 시행받았던 50명의 환자를 대상으로 상악골 이동방법에 따 라 후구치상방이동(제 1군) 13례, 후구치상방이동 및 전방이동의 복합(제 2군) 18례, 전방이동(제 3군) 9례, 전·후 상방이동(제 4군) 10례로 대별하여 수술 전·후의 두부방사선 계측사진상에서 각군별로 경조직 계측점들의 이동에 따른 연조직 계측점들의 변화율과 상순의 두께, 길이 및 면적의 변화율을 조사하고 이들을 비교 연구한바 다음과 같은 결론을 얻었다. 1. 각 경조직점 계측점들에 대한 연조직 계측점의 수평변화율은 높은 상관관계를 보였으나 수직변화율은 상관관계가 낮았다. 2. 후구치상방이동술식을 위한 술전 계측에서 연조직 계측점의 설정은 경조직 계측점의 수평이동에 따라 Pn은 ANS의 약 30%로, Cm은 ANS의 약 40%로, Sn은 ANS의 약50%로, Ls는 Pr의 약 40%로, Stm은 I의 약 60% 수준으로 설정하는 것이 좋을 것으로 사료된다 3. 후구치상방이동과 전방이동이 동시 적용되는 경우의 술전 계측에서 연조직 계측점의 설정은 경조직 계측점의 수평이동에 따라 Pn은 ANS와 A의 평균치의 약 45%로, Cm은 ANS와 A의 평균치의 약 55%로. Sn은 ANS와 A의 평균치의 약 65%로, Ls는 A와 I의 평균치의 약 60%로, Stm은 I의 약 70% 수준으로 설정하는 것이 좋을것으로 사료된다. 4. 전방이동술식을 위한 술전 계측에서 연조직 계측점의 설정은 경조직 계측점의 수평이동에 따라 Pn은 A의 약 50%로. Stm은 Pr의 약 20% 수준으로 설정하는 것이 좋을것으로 사료되며 Sn은 ANS의 약 60%의 변화율을 보였으나 통계적 유의성은 없었다. 5. 전후구치상방이동군에서는 전 계측점의 변화에서 통계적 유의성을 보이지 않았다. 6. 상악골이동에 따른 입술의 두께, 길이, 면적의 변화량은 제 2 군의 경우에 가장 큰 변화를 보였으나 술전예측에 의미를 두기에는 그 변화량이 미미하였다. SOFT TISSUE CHANGES WITH MAXILLARY MOVEMENTS IN KOREANS FOLLOWING ORTHOGNATHIC SURGERY Jin Ho Choi Dept. of Dental Science, Graduate School, Yonsei University (Directed by Associated Professor Hyung-Sik Park, D.D.S., M.S.D., Ph.D.) Prediction of the soft tissue changes following hard tissue movement is very important from the aesthetic view point for patients who have orthognathic surgery. This study was performed to obtain the predictable ratio of post-operative soft tissue changes of the midfacial measurement values following maxillarry movement according to various type of Le Fort-I osteotomy for orthognathic purposes. Fifty patients(36 males and 14 females) of Koreans who had undergone surgical alterations of the maxilla were selected and classified into four groups depending upon the type of maxillary movements by means of the Le Fort-I osteotomy : Group Ⅰ(13 patients) was moved by posterior impaction, Group Ⅱ(18 patients ) was moved by posterior impaction and advancement simultaneously, Group Ⅲ(9 patients) was moved by advancement only, and Group Ⅳ(10 patients) was moved by superior repositioning both anteriorly and posteriorly. Post-operative changes of the soft tissue measurements according to changes of the hard tissue measurements were examined on pre- and post-operative cephalometrics and the ratio of changes were analyzed. The results obtained were as follows : 1. Soft tissue measures were closely correlated to changes of the maxillary skeleton in the horizontal plane, but soft tissue measures in the vertical plane did not correlate to maxi1lary movement. 2. In the posterior impaction type. the predictable ratio of the Pn was 30% of the ANS, the Cm was 40% of the ANS, the Sn was 50% of the ANS, the Ls was 40% of the Pr, and the Stm was 60% of the I in the horizontal plane. 3. In the posterior impaction and advancement type, the predictable ratio of the Pn was 45% of mean of the ANS and A, the Cm was 55% of mean of the ANS and A, the Sn was 65% of mean of the ANS and A, the Ls was 60% of mean of the A and I, the Stm was 70% of the I in the horizontal plane. 4. In the advancement type only, the predictable ratio of the Pn was 50% of the A, the Stm was 20% of the Pr in the horizontal plane. The ratio of changes in the Sn was 60% of the ANS. but there was no statistically significant difference. 5. In the superior repositioning type, all ratios of soft tissue changes were not predictable. 6. All ratios of changes in the thickness, length and area of upper lip, following maxillary movement, was largest in group Ⅱ, however. the magnitude of this ratio was so little that there was no clinical significance.
[영문] Prediction of the soft tissue changes following hard tissue movement is very important from the aesthetic view point for patients who have orthognathic surgery. This study was performed to obtain the predictable ratio of post-operative soft tissue changes of the midfacial measurement values following maxillarry movement according to various type of Le Fort-I osteotomy for orthognathic purposes. Fifty patients(36 males and 14 females) of Koreans who had undergone surgical alterations of the maxilla were selected and classified into four groups depending upon the type of maxillary movements by means of the Le Fort-I osteotomy : Group Ⅰ(13 patients) was moved by posterior impaction, Group Ⅱ(18 patients ) was moved by posterior impaction and advancement simultaneously, Group Ⅲ(9 patients) was moved by advancement only, and Group Ⅳ(10 patients) was moved by superior repositioning both anteriorly and posteriorly. Post-operative changes of the soft tissue measurements according to changes of the hard tissue measurements were examined on pre- and post-operative cephalometrics and the ratio of changes were analyzed. The results obtained were as follows : 1. Soft tissue measures were closely correlated to changes of the maxillary skeleton in the horizontal plane, but soft tissue measures in the vertical plane did not correlate to maxi1lary movement. 2. In the posterior impaction type. the predictable ratio of the Pn was 30% of the ANS, the Cm was 40% of the ANS, the Sn was 50% of the ANS, the Ls was 40% of the Pr, and the Stm was 60% of the I in the horizontal plane. 3. In the posterior impaction and advancement type, the predictable ratio of the Pn was 45% of mean of the ANS and A, the Cm was 55% of mean of the ANS and A, the Sn was 65% of mean of the ANS and A, the Ls was 60% of mean of the A and I, the Stm was 70% of the I in the horizontal plane. 4. In the advancement type only, the predictable ratio of the Pn was 50% of the A, the Stm was 20% of the Pr in the horizontal plane. The ratio of changes in the Sn was 60% of the ANS. but there was no statistically significant difference. 5. In the superior repositioning type, all ratios of soft tissue changes were not predictable. 6. All ratios of changes in the thickness, length and area of upper lip, following maxillary movement, was largest in group Ⅱ, however. the magnitude of this ratio was so little that there was no clinical significance.
URI
http://ir.ymlib.yonsei.ac.kr/handle/22282913/117257
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2. 학위논문 > 2. College of Dentistry (치과대학) > 석사
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