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골격성 III급 부정교합 환자의 IVRO (Intraoral Vertical Ramus Osteotomy) 후 안면폭경 변화

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 Facial width changes after IVRO (Intraoral Vertical Ramus Osteotomy) in skeletal class III patients 
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[한글]골격성 III급 부정교합 환자에서 구내 하악골 상행지 수직 골절단술 (Intraoral vertical ramus osteotomy:IVRO)을 받은 후 일어나는 안면폭경 변화를 알아보고자 연세대학교 영동세브란스 치과병원에서 IVRO를 통해 하악골을 후방 위치시킨 환자 56명을 대상으로 술전 (T1), 수술 직후 (T2), 수술 후 6개월 (T3)에 정모두부방사선사진을 촬영하였으며 그중 42명은 술전 (T1)과 수술 후 1개월 (T2), 수술 후 6개월 (T3)에 얼굴정면사진을 촬영하였다. 계측항목을 설정하여 안면폭경을 측정, 각 T2-T1, T3-T2, T3-T1 에서의 안면폭경 변화량을 조사하였다. 또한 성별, 하악평면각, gonial angle, 하악후퇴량에 따라 수술 후 안면폭경 변화에 차이가 있는지를 조사하였다.가. 정모두부방사선사진에서 intermastoid width와 intergonial width는 T2-T1에서 각각 4.1±3.13 mm, 7.0±6.04 mm 증가하였고, T3-T2에서 2.8±2.66 mm, 3.2±4.30 mm 감소하였으며, T3-T1에서 1.3±2.84 mm, 3.8±4.33 mm 증가하였다 (P<.001).나. 정모두부방사선사진에서 intercondylar width와 interantegonial width는 T2-T1, T3-T2, T3-T1 모두에서 유의성있는 변화를 보이지 않았다 (P>.05).다. 정모두부방사선사진에서 안면폭경 변화는 성별, 하악평면각, gonial angle, 하악후퇴량에 따른 차이가 없었다 (P>.05).라. 얼굴정면사진에서 intercheilion width는 T2-T1에서 1.3±4.60 mm 감소, T3-T2에서 1.2±5.45 mm 감소하였고 (P>.05), T3-T1에서는 2.5±5.61 mm 감소하였다 (P<.05).마. 얼굴정면사진에서 interULA (upper lobule of auricle) width와 interLLA (lower lobule of auricle) width는 T2-T1, T3-T2, T3-T1 모두에서 유의성있는 변화를 보이지 않았다 (P>.05).바. 얼굴정면사진에서 안면폭경 변화는 하악평면각, gonial angle, 하악후퇴량에 따른 차이가 없었으나 (P>.05), intercheilion width는 남성이 여성보다 4.6 mm 더 감소하였다 (P<.01).IVRO 후 정모두부방사선사진에서 측정한 골격적 안면폭경은 수술 직후부터 6개월 동안 감소하였지만 수술에 의한 증가량이 더 많아 술전보다 증가하였다. 반면에 얼굴정면사진에서 측정한 연조직 하안면폭경은 수술 후 지속적으로 감소하였다.
[영문]In order to study the facial width changes of skeletal Class III patients that had undergone IVRO (intraoral vertical ramus osteotomy), posteroanterior cephalographs were taken preoperatively (T1), immediately postoperatively (T2), 6 months postoperatively (T3) of 56 patients that had mandibular posterior repositioning through IVRO at Yonsei University, Yondong Severance Dental Hospital. Frontofacial photographs were also taken preoperatively (T1), 1 month postoperatively (T2), and 6 months postoperatively (T3) of 42 patients out of the initial study group. Measurement categories were established and changes of facial width were researched at T2-T1, T3-T2, and T3-T1 respectively. Differences in facial width change according to sex, mandibular plane angle, gonial angle, and amount of mandibular setback were also researched.1. Intermastoid width and intergonial width in posteroanterior cephalographs were increased in period T2-T1 by 4.1±3.13 mm and 7.0±6.04 mm, decreased in period T3-T2 by 2.8±2.66 mm and 3.2±4.30 mm, and increased in period T3-T1 by 1.3±2.84 mm and 3,8±4.33 mm, respectively (P<.001).2. Intercondylar width and interantegonial width in periods T2-T1, T3-T2, and T3-T1 did not show any significant change in posteroanterior cephalographs (P>.05).3. Facial width changes in posteroanterior cephalographs did not show difference in relation to sex, mandibular plane angle, gonial angle, and amount of mandibular setback (P>.05).4. Intercheilion width in frontofacial photographs decreased by 1.3±4.60 mm at T2-T1 and 1.2±5.45 mm at T3-T2 (P>.05), and 2.5±5.61 mm at T3-T1 (P<.05).5. InterULA (upper lobule of auricle) width and interLLA (lower lobule of auricle) width in periods T2-T1, T3-T2, and T3-T1 did not show significant change in frontofacial photographs (P>.05).6. There was no difference in facial width change in frontofacial photographs in relation to mandibular plane angle, gonial angle, and amount of mandibular setback (P>.05), but intercheilion width decreased in males by 4.6 mm compared to females (P<.01).Skeletal facial width changes after IVRO in posteroanterior cephalographs decreased through out the post-operative 6 months, however increased conclusively due to the overall amount of increase from surgery. On the contrast, lower facial width changes of soft tissue decreased steadily in frontofacial photographs.
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