日本顎変形症学会雑誌
Online ISSN : 1884-5045
Print ISSN : 0916-7048
ISSN-L : 0916-7048
25 巻, 1 号
選択された号の論文の6件中1~6を表示しています
総説
  • —Prediction of Soft Tissue Profile of Mandibular Prognathism Patients after Orthognathic Surgery—
    石川 博之, 梶井 貴史, 玉置 幸雄
    2015 年 25 巻 1 号 p. 1-9
    発行日: 2015/04/15
    公開日: 2015/04/27
    ジャーナル フリー
    In surgical orthodontic treatment, it is necessary to evaluate the relationship between changes of hard tissue and those of soft tissue in order to predict the post-treatment soft tissue profiles of jaw deformity patients. Individual differences of patients influence the relationship between changes of hard and soft tissue. This review compares the influence of sagittal split ramus osteotomy (SSRO) with combined maxillary and mandibular ramus surgery in changes of post-treatment soft tissue profiles of skeletal mandibular prognathism. The review also compares the influence of different profile patterns in changes of post-treatment soft tissue profiles of mandibular prognathism.
    Skeletal changes of SSRO influence soft tissue changes more than those of combined maxillary and mandibular ramus surgery because of differences in the postoperative tension generated in muscles and soft tissue attached to the mandible.
    The post-treatment soft tissue B point was located more backwardly than the predicted point in the facial patterns with a high mandibular plane angle and a long lower anterior facial height. In the facial patterns with a low mandibular plane angle, the post-treatment line of the lower lip was positioned more inferiorly and backwardly than the predicted lower lip line.
    The influence on the predictability of post-treatment soft tissue profiles might differ depending on the surgical methods and profile patterns in mandibular prognathism.
原著
  • 植木 亮和, 野嶋 邦彦, 西井 康, 末石 研二, 神尾 崇, 高木 多加志, 高野 伸夫
    2015 年 25 巻 1 号 p. 10-16
    発行日: 2015/04/15
    公開日: 2015/04/27
    ジャーナル フリー
    With the exception of congenital anomalies, facial asymmetry is regarded as being caused by mandibular growth abnormalities in many cases. Conventionally, two-dimensional analysis using cephalometric X-rays is carried out to design the plan for orthognathic surgery. To improve the treatment outcome, however, it may be necessary to elucidate the factors responsible for asymmetry by performing three-dimensional analysis of the craniofacial morphology.
    The objective of the present study was to perform three-dimensional measurements of the mandible using three-dimensional computed tomography (3D-CT) in patients with facial asymmetry requiring orthognathic surgery, and to identify the morphological characteristics of the mandible by comparing the deviated and non-deviated sides.
    3D-CT images of 36 patients with facial asymmetry (≥ 4mm deviation of the mandibular midline) were analyzed using 3D planning software for orthognathic surgery. A total of 10 items were measured, including five angle measurements and five linear measurements with reference to the entire mandible, the mandibular body, or the mandibular ramus.
    The deviated and non-deviated sides were measured, and values were compared using the paired Student's t-test. Multi-regression analysis (step-wise selection) was also performed to evaluate the deviation of the mandibular midline and the items measured.
    In patients with facial asymmetry, a comparatively large mandibular ramus, mandibular body, and condylar process length were observed on the non-deviated side compared with the deviated side, with the mandibular ramus rotated anteromedially along the superior-inferior, left-right, and anterior-posterior axes. These differences between the deviated and non-deviated sides in the morphological characteristics of the mandible resulted in mandibular deviation and rotation. However, no left-right differences were observed in mandibular body height, mandibular body roll, or gonial angle. Our findings also suggested that deviation of the mandibular midline was significantly affected by mandibular ramus length, mandibular body length, and mandibular ramus pitch.
  • 三上 智彦, 福岡 裕樹, 東堀 紀尚, 川元 龍夫, 森山 啓司
    2015 年 25 巻 1 号 p. 17-31
    発行日: 2015/04/15
    公開日: 2015/04/27
    ジャーナル フリー
    The purpose of this study was to evaluate the changes of soft tissue profile following anterior segmental maxillary osteotomy (ASMO) in mandibular retrognathia patients. A total of 20 patients were enrolled in this study. All the patients had undergone only ASMO to correct excess overjet due to skeletal discrepancy. The subjects were divided into two groups: mandibular retrognathia group (MR group: SNB < -1 S.D., 7 females and 3 males, mean age 24.4 years) and maxillary protrusion with no mandibular retrognathia group (NMR group: SNB > -1 S.D., 9 females and 1 male, mean age 24.6 years). Lateral cephalograms at first visit (T0) and just after active treatment (T1) were traced and superimposed. As for the x-y coordinate system, the x-axis parallel to the Frankfurt horizontal (FH) plane passing through the sella turcica was used as the horizontal reference. Linear and angular measurements were statistically evaluated between the changes of the hard and soft tissues in each group.
    The following results were obtained:
    The changes of all hard tissue measurement values were not significantly different between the two groups. In respect of soft tissue changes, protrusive upper and lower lip and retrusive chin were corrected in both groups. Namely, soft tissue landmarks in the subnasal, upper and lower lip, and chin regions were significantly moved backward in both groups. In addition, the landmarks in the mental region (SPog, SGn) were more significantly moved downward in the MR group than in the NMR group.
    The present study suggests that a distinct skeletal pattern at the initial stage gives a different soft tissue profile in the mental region after surgery. The improvement of protrusive upper and lower lip and retrusive chin in both groups implies that ASMO is a useful technique for treating mandibular retrognathia patients.
  • 大塚 雄一郎, 藤田 昌樹, 江川 広人, 三條 恵介, 藤本 舞, 龍田 恒靖, 松井 成幸, 嶋田 淳, 須田 直人
    2015 年 25 巻 1 号 p. 32-41
    発行日: 2015/04/15
    公開日: 2015/04/27
    ジャーナル フリー
    The osteotomy line in sagittal split ramus osteotomy (SSRO) has a wide variation among surgeons. Recently, short lingual osteotomy (SL), in which the lingual split is limited up to the area near the mandibular foramen, is performed in many facilities. The reason for this is that SL can reduce the amount of interference between the proximal and distal segments, and shorten the operation time compared with Obwegeser osteotomy (Ob). However, since medial pterygoid muscles (MPM) are included in the proximal segments, SL is prone to induce backward rotation and distal positioning of the mandibular ramus due to the interference between MPM and distal segments when mandibular setback is performed.
    The purpose of this study was to compare the postoperative outcome of SL and Ob for mandibular prognathism. Twenty-two skeletal Class III cases without lateral deviation treated by SSRO in Meikai University Hospital, were examined. Among the 22 cases, 15 and 7 cases underwent SL and Ob, respectively. The postoperative changes of the proximal and distal segments were evaluated in lateral and postero-anterior cephalograms taken immediately before the surgery (T1), immediately after the surgery (T2), and one year after the surgery (T3). At T1, there was no significant difference in SNB, FMA, or gonial angle between the SL and Ob groups. No significant difference in the amount of mandibular setback was found between the two groups. Comparing values at T1 and T2, the proximal segments tended to rotate backward in the SL group, but there was no significant difference in the anterio-posterior position of proximal segments between the two groups. Comparing values at T2 and T3, counter-clockwise rotation of proximal segments was seen in the SL group but not in the Ob group. It is likely that this rotation of proximal segments in the SL group was caused by the muscular strength of MPM attached mainly to the proximal segments. Moreover, a significant negative correlation in the amount of rotation of proximal segments was detected between T1-T2 and T2-T3 in the Ob group, but not in the SL group.
    These findings indicate that special attention to the rotation in SL cases is important since a wider variation in the rotation of proximal segments may occur compared with the Obwegeser method.
症例
  • 南里 篤太郎, 小原 悠, 大場 誠悟, 梯 裕恵, 吉田 教明, 朝比奈 泉
    2015 年 25 巻 1 号 p. 42-48
    発行日: 2015/04/15
    公開日: 2015/04/27
    ジャーナル フリー
    In cases of jaw deformity, bimaxillary surgery combining Le Fort I osteotomy and sagittal split ramus osteotomy (SSRO) is one of the standard operations. However, this operation can be difficult to use in cases of severe mandibular prognathism because of the large amount of setback. We report herein a case of severe mandibular prognathism treated with a two-stage surgical procedure. At the first stage, we performed mandibular body ostectomy, followed at the second stage by maxillary advancement by Le Fort I osteotomy and mandibular set-back by sagittal split ramus osteotomy. This unique two-stage surgical treatment improved and kept the patient's overall facial aesthetics and occlusion for one year postoperatively.
  • 君塚 幸子, 福山 英治, 米満 郁男, 島崎 一夫, 大村 進, 濱田 良樹, 藤内 祝
    2015 年 25 巻 1 号 p. 49-55
    発行日: 2015/04/15
    公開日: 2015/04/27
    ジャーナル フリー
    A 19-year-old male with Marfan syndrome (MFS) was referred to our hospital for improvement of his facial asymmetry. Orthognathic surgery was planned because the cardiovascular and thoracic abnormalities were relatively mild. The patient initially underwent pre-operative orthodontic treatment, and then the surgery was performed under careful control of the cardiovascular and pulmonary function. After a combination of Le Fort I osteotomy and bilateral sagittal splitting ramus osteotomy, a distractor was placed on the hypoplastic side of the maxilla. The activation of the distractor resulted in gradual rotation of the maxillomandibular complex using intermaxillary fixation. This allowed decanting of the occlusal plane with displacement of the chin position to the opposite side, leading to an improvement in the facial asymmetry. The postoperative course was uneventful. Over a follow-up period of 11 years, the facial symmetry and the occlusion have been stable.
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