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      하악전돌자에서 3차원영상을 이용한 하악지시상분할골절단술과 관련된 하악골의 해부학적 연구 = MORPHOLOGIC STUDY FOR SAGITTAL SPLIT RAMUS OSTEOTOMY USING 3-D IMAGE IN MANDIBULAR PROGNATHISM

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      https://www.riss.kr/link?id=A105667463

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      다국어 초록 (Multilingual Abstract)

      Sagittal split ramus osteotomy(SSRO) has been commonly performed in the mandibular prognathism. The previous studies of the mandibular anatomy for SSRO have mostly been used in dry skull without consideration of age, sex or jaw relationship of patients. This study was performed to evaluate the location of mandibular canal and the anatomy of ramus, such as the location of mandibular lingula and the ramal bone marrow, which were associated with SSRO procedures, in the patients with mandibular prognathism and normal young adults by using computerized tomographs(CT) and 3D images. The young adults at their twenties, who were considered to complete their skeletal growth, and seen in the Department of Orthodontics and Oral and Maxillofacial Surgery in Chonnam National University Hospital between March 2000 and May 2003, were selected. This study was performed in 30 patients (15men, 15women) who were diagnosed as skeletal class I normal relationship, and another 30 patients (15men, 15women) who were diagnosed as skeletal class III relationship upon clinical examination and lateral cephalometric radiographs. The patients were divided into 2 groups : Class I group, the patients who had skeletal class Ⅰ normal relationship(n=30, 15men, 15women), and Class III group, the patients who had skeletal class III relationship(n=30, 15men, 15women). Facial CT was taken in all patients, and pure 3D mandibular model was constructed by V-works version 4.0. The occlusal plane was designed by three points, such as the mesiobuccal cusp of both mandibular 1st molar and the incisal edge of the right mandibular central incisor, and used as a reference plane. Distances between the tip of mandibular lingula and the occlusal plane, the sigmoid notch, the anterior and the posterior borders of ramus were measured. The height of ramal bone marrow from the occlusal plane and the distance between mid-point of mandibular canal and the buccal or lingual cortex of the mandible in the 1st and 2nd molars were measured by V-works version 4.0. Distance(Li-OP) between the occlusal plane and the tip of mandibular lingula of Class III Group was longer than that of Class I Group in men(p<0.01), but there was no significant difference in women between both groups. Distance(Li-SN) between the sigmoid notch and the tip of mandibular ligula of Class III group was longer than that of Class I Group in men(p<0.05), but there was no significant difference in women between both groups. Distance(Li-RA) between the anterior border of ramus and the tip of mandibular lingula of Class III Group was shorter than that of Class I Group in men and women(p<0.01). Distance(Li-RP) between the posterior border of ramus and the tip of mandibular lingula of Class III Group was slightly shorter than that of Class I Group in men(p<0.05), but there was no significant difference in women between both groups. Distance(RA-RP) between the anterior and the posterior borders of ramus of Class III Group was shorter than that of Class I Group in men and women(p<0.01). Longer the distance(SN-AN) between the sigmoid notch and the antegonial notch was, longer the vertical ramal length above occlusal plane, higher the location of mandibular lingula, and shorter the antero-posterior ramal length were observed(p<0.01). Height of ramal bone marrow of Class III Group was higher than that of Class I Group in men and women(p<0.01). Distance between mandibular canal and buccal cortex of Class III Group in 1st and 2nd lower molars was shorter than that of Class I Group in men and women (p<0.05 in 1st lower molar in men, p<0.01 in others). These results indicate that there are some anatomical differences between the normal occlusal patients and the mandibular prognathic patients, such as the anterior-posterior length of ramus, the height of ramal bone marrow, and the location of mandibular canal.
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      Sagittal split ramus osteotomy(SSRO) has been commonly performed in the mandibular prognathism. The previous studies of the mandibular anatomy for SSRO have mostly been used in dry skull without consideration of age, sex or jaw relationship of patient...

      Sagittal split ramus osteotomy(SSRO) has been commonly performed in the mandibular prognathism. The previous studies of the mandibular anatomy for SSRO have mostly been used in dry skull without consideration of age, sex or jaw relationship of patients. This study was performed to evaluate the location of mandibular canal and the anatomy of ramus, such as the location of mandibular lingula and the ramal bone marrow, which were associated with SSRO procedures, in the patients with mandibular prognathism and normal young adults by using computerized tomographs(CT) and 3D images. The young adults at their twenties, who were considered to complete their skeletal growth, and seen in the Department of Orthodontics and Oral and Maxillofacial Surgery in Chonnam National University Hospital between March 2000 and May 2003, were selected. This study was performed in 30 patients (15men, 15women) who were diagnosed as skeletal class I normal relationship, and another 30 patients (15men, 15women) who were diagnosed as skeletal class III relationship upon clinical examination and lateral cephalometric radiographs. The patients were divided into 2 groups : Class I group, the patients who had skeletal class Ⅰ normal relationship(n=30, 15men, 15women), and Class III group, the patients who had skeletal class III relationship(n=30, 15men, 15women). Facial CT was taken in all patients, and pure 3D mandibular model was constructed by V-works version 4.0. The occlusal plane was designed by three points, such as the mesiobuccal cusp of both mandibular 1st molar and the incisal edge of the right mandibular central incisor, and used as a reference plane. Distances between the tip of mandibular lingula and the occlusal plane, the sigmoid notch, the anterior and the posterior borders of ramus were measured. The height of ramal bone marrow from the occlusal plane and the distance between mid-point of mandibular canal and the buccal or lingual cortex of the mandible in the 1st and 2nd molars were measured by V-works version 4.0. Distance(Li-OP) between the occlusal plane and the tip of mandibular lingula of Class III Group was longer than that of Class I Group in men(p<0.01), but there was no significant difference in women between both groups. Distance(Li-SN) between the sigmoid notch and the tip of mandibular ligula of Class III group was longer than that of Class I Group in men(p<0.05), but there was no significant difference in women between both groups. Distance(Li-RA) between the anterior border of ramus and the tip of mandibular lingula of Class III Group was shorter than that of Class I Group in men and women(p<0.01). Distance(Li-RP) between the posterior border of ramus and the tip of mandibular lingula of Class III Group was slightly shorter than that of Class I Group in men(p<0.05), but there was no significant difference in women between both groups. Distance(RA-RP) between the anterior and the posterior borders of ramus of Class III Group was shorter than that of Class I Group in men and women(p<0.01). Longer the distance(SN-AN) between the sigmoid notch and the antegonial notch was, longer the vertical ramal length above occlusal plane, higher the location of mandibular lingula, and shorter the antero-posterior ramal length were observed(p<0.01). Height of ramal bone marrow of Class III Group was higher than that of Class I Group in men and women(p<0.01). Distance between mandibular canal and buccal cortex of Class III Group in 1st and 2nd lower molars was shorter than that of Class I Group in men and women (p<0.05 in 1st lower molar in men, p<0.01 in others). These results indicate that there are some anatomical differences between the normal occlusal patients and the mandibular prognathic patients, such as the anterior-posterior length of ramus, the height of ramal bone marrow, and the location of mandibular canal.

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      참고문헌 (Reference)

      1 "Variations in the normal anatomy of the inferior dental canal:a retrospective study of panoramic radiographs from 3612 routine dental patients" 55-, 151977

      2 "The surgical correction of mandibular prognathism and retrognathia with consideration of genioplasty Surgical procedure to correct mandibular prognathism and reshaping of the chin" 677-681, 1957

      3 "The intramandibular course of the inferior dental nerve" 65 : 319-, 1931

      4 "The intramandibular course of the inferior alveolar nerve" 108 : 433-, 1971

      5 "The inferior dental canal and its nerve in the adult" 49 : 356-, 1928

      6 "The anatomical location of the mandiblurar canal:its relationship to the sagittal ramus osteotomy" 37-47, 1986

      7 "Stability associated with mandibular advancement treated by rigid osseous fixation" 43 : 338-341, 1985

      8 "Sagittal splitting and bicortical screw fixation of the ascending ramus" 6 : 198-203, 1978

      9 "Retromolar osteotomy for the correction of prognathism" 19 : 42-47, 1961

      10 "Retromolar osteotomy for the correction of prognathism" 19 : 42-47, 1961

      1 "Variations in the normal anatomy of the inferior dental canal:a retrospective study of panoramic radiographs from 3612 routine dental patients" 55-, 151977

      2 "The surgical correction of mandibular prognathism and retrognathia with consideration of genioplasty Surgical procedure to correct mandibular prognathism and reshaping of the chin" 677-681, 1957

      3 "The intramandibular course of the inferior dental nerve" 65 : 319-, 1931

      4 "The intramandibular course of the inferior alveolar nerve" 108 : 433-, 1971

      5 "The inferior dental canal and its nerve in the adult" 49 : 356-, 1928

      6 "The anatomical location of the mandiblurar canal:its relationship to the sagittal ramus osteotomy" 37-47, 1986

      7 "Stability associated with mandibular advancement treated by rigid osseous fixation" 43 : 338-341, 1985

      8 "Sagittal splitting and bicortical screw fixation of the ascending ramus" 6 : 198-203, 1978

      9 "Retromolar osteotomy for the correction of prognathism" 19 : 42-47, 1961

      10 "Retromolar osteotomy for the correction of prognathism" 19 : 42-47, 1961

      11 "Problems incountered in the sagittal split operation" 10 : 81-86, 1981

      12 "Perioperative morbidity in maxillofacial orthopaedic surgery:a retrospective study" 263-270, 1996

      13 "Perioperative complications in corrective facial orthopedic surgery:a 5-year retrospective study" 754-760, 2000

      14 "Modified techniques for internal fixation of sagittal ramus osteotomies" 42 : 270-272, 1984

      15 "Modification of the mandibular ramus sagittal split osteotomy" 64 : 146-155, 1987

      16 "Modification in the sagittal osteotomy of the mandible" 35 : 157-159, 1977

      17 "Mandibular ramus anatomy as it relates to the medial osteotomy of the sagittal split ramus osteotomy" 49 : 112-116, 1991

      18 "Mandibular deficiency syndrome.Surgical considerations for mandibular advancement" 349-, 1968

      19 "Mandibular anatomy related to sagittal split ramus osteotomy in Koreans" 38 : 19-25, 1997

      20 "Intraoperative complications of sagittal osteotomy of the mandibular ramus" incidence and management 504-509, 1985

      21 "Facial palsy after sagittal split osteotomy" 21 : 50-53, 1993

      22 "Facial nerve paralysis following a sagittal split osteotomy of the mandible" -422, 1985

      23 "Facial nerve injury as a complication of sagittal split ramus osteotomy" 40 : 309-310, 1982

      24 "Epidemiologic study of the prevalence of malocclusion in Koreans" 14 : 33-37, 1984

      25 "Computed tomography morphology of the mandibular ramus in prognathism:effect on the medial osteotomy of the sagittal split ramus osteotomy" 89-93, 2003

      26 "Complications after mandibular sagittal split osteotomy" 42 : 101-107, 1984

      27 "Bone screws and plates in orthognathic surgery" 11 : 209-216, 1982

      28 "Biologic basis for modification of the sagittal ramus split operation" 35 : 362-369, 1977

      29 "A study on the prevalence of malocclusion of Yonsei University students in 1991" Yonsei University 12-18, 1991

      30 "A study of mandibular ramus anatomy and its significance to sagittal split osteotomy" 26 : 176-178, 1997

      31 "A comparative study of wire osteosynthesis versus bone screws in the treatment of mandiblular prognathism" 54 : 2-6, 1982

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