Journal List > J Korean Assoc Oral Maxillofac Surg > v.37(4) > 1032476

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Kim, Lee, Kim, Song, Hwang, and Chung: A comparative study on the change of postoperative facial hard tissue profile after maxillary rotational surgery
Original Article

J Korean Assoc Oral Maxillofac Surg 2011;37(4):264-271.

Published online: 7 January 2011

DOI: https://doi.org/10.5125/jkaoms.2011.37.4.264

A comparative study on the change of postoperative facial hard tissue profile after maxillary rotational surgery

Uk-Kyu Kim, Sung-Tak Lee, Tae-Hoon Kim, Jae-Min Song, Dae-Seok Hwang, In-Kyo Chung

Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University, Yangsan, Korea

In-Kyo Chung Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University Beomeo-ri, Mulgeum-eup, Yangsan, 626-770, Korea TEL: +82-55-360-5100 FAX: +82-55-360-5104 E-mail: inkchung@pusan.ac.kr

Received 14 April 201122 July 2011       Accepted 25 July 2011

Copyright © 2011 Korean Association of Oral and Maxillofacial Surgeons

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This study evaluated retrospectively the postsurgical facial hard tissue profile of a Le Fort I osteotomy with/without posterior impaction and rigid internal fixation to correct mandibular prognathism. After observing a difference between the two groups, this measurement was used to prepare a treatment plan for 2-jaw surgery.

Patients and Methods

Thirty patients who had undergone orthognathic surgery in Pusan National University Dental Hospital were enrolled in this study. Fifteen patients were treated using a Le Fort I osteotomy with posterior impaction and mandibular setback bilateral sagittal split ramus osteotomy, and the other fifteen patients were treated without posterior impaction. The preoperative (T0), immediate postoperative (T1) and six-month followup period (T2) cephalograms were taken and difference between T1-T0 and T2-T2 was analyzed.

Results

Both groups was FH-ABp, SNB and ANB showed significant changes in the measurement, whereas only the posterior impaction group showed a change in the SN-U1, occlusal plane, posterior facial height, surgical movement difference from the L1 and B-point. There was no significant statistical change between the immediate postoperative (T1) and six-month followup (T2) hard tissue analysis in the two groups.

Conclusion

A Le Fort I osteotomy with posterior impaction is considerable for patients with a flat occlusal plane angle, large posterior facial height, prominent B-point, pogonion and labioversed incisal inclination if the indications are well chosen.

Keywords: Hard tissue, Rotational orthognathic surgery, Posterior impaction

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Fig. 1.
Annual trend of the surgical treatment modality of orthognathic surgery since 2008 in Department of Oral and Maxillofacial Sugery, Pusan National University Dental Hospital.
jkaoms-37-264f1.tif
Fig. 2.
Anatomic landmark used in this study.
jkaoms-37-264f2.tif
Fig. 3.
Reference line.
jkaoms-37-264f3.tif
Table 1.
Sex and age distribution of study
  Age (yr) Male (n) Female (n)
Posterior impaction group ≤19 2 4
20–25 2 3
≤26 2 2
Total 6 9
Non-posterior impaction group ≤19 5 1
20–25 1 3
≤26 1 4
Total 7 8
Table 2.
Posterior impaction vs non-posterior impaction
  Posterior impaction Non-posterior impaction
Mean age (yr) 22.6 24.2
M:F ratio 6:09 7:08
Table 3.
Inclusion criteria

  • - Non growing patient

  • - Maxilla surgery: Le Fort I osteotomy Mandibular surgery: bilateral sagittal split ramus osteotomy

  • - No history of congenital defects or syndromes

  • - No previous orthognathic or cosmetic surgery involving the middle and/or lower face

  • - No surgery-first orthognathic approach

  • - Use of rigid internal fixation
Table 4.
Measurements and it's mean value

  1. Angular measurements (°)

    1. FH-ABp: Angle between FH plane and A-B plane

    2. Mx. depth: Angle between FH plane and N-A plane

    3. SNA: Angle between SN line and A point

    4. SNB: Angle between SN line and B point

    5. ANB: SNA-SNB

    6. Occlusal plane angle: Angle between FH plane and occlusal plane

    7. U1-SN°: Angle between SN line and Is-Ir line

  2. Horizontal measurements (mm)

    1. Nper-A: Distance from N perpenticular line to A-point

    2. VRP to U1: Distance from VRP to upper incisor tip

    3. VRP to L1: Distance from VRP to lower incisor tip

    4. VRP to A: Distance from VRP to A-point

    5. VRP to B: Distance from VRP to B-point

    6. VRP to PNS: Distance from VRP to PNS

    7. VRP to Pg: Distance from VRP to pogonion

  3. Vertical measurements (mm)

    1. AFH: Distance from Nasion (N) to Mentom (Me)

    2. PFH: Diatnace from Sella (S) to Gonion (Go)

    3. HRP to U1: Distance from HRP to upper incisor tip

    4. HRP to L1: Distance from HRP to lower incisor tip

    5. HRP to A: Distance from HRP to A-point

    6. HRP to B: Distance from HRP to B-point

    7. HRP to PNS: Distance from HRP to PNS

    8. HRP to Pg: Distance from HRP to pogonion

(FH: frankfort horizontal, VRP: vertical referance plane, HRP: horizontal referance plane, AFH: anterior facial height, PFH: posterior facial height)

Table 5.
Descriptive statistics for non-posterior impaction group
Measurement T0 T1 T2
FH-ABp 90.11±13.5 80.57±6.3 80.69±5.98
Mx. depth 84.02±11 87.78±3.55 87.94±3.56
U1-SN 105.61±5.22 103.68±4.73 104.73±5.54
Nper-A 4.43±5.7 2.12±3.45 −2.01±3.56
SNA 77.62±10.4 81.25±2.88 81.07±3.21
SNB 80.65±3.98 77.54±3.36 77.70±3.66
ANB difference −1.49±6.17 3.56±1.96 3.14±2.2
Anterior facial height 132.43±9.39 130.22±7.23 130.58±7.44
Posterior facial height 85.17±6.19 82.93±6.08 82.63±5.75
Occlusal plane 12.38±4.71 12.59±4.65 12.77±4.58

Data is presented by means±SD.

Table 6.
Descriptive statistics for Posterior impaction group
Measurement T0 T1 T2
FH-ABp 93.55±7.97 84.9±3.63 84.82±3.90
Mx. depth 90.87±3.69 89.49±2.59 89.67±2.58
U1-SN 113.59±4.74 106.75±5 107.92±4.07
Nper-A 0.84±3.82 −0.11±2.4 −0.11±2.45
SNA 83.30±2.77 82.85±3.11 82.78±3.31
SNB 84.40±4.21 79.14±3.11 80.33±3.35
ANB difference −1.10±3.7 3.77±1.63 2.48±1.85
Anterior facial height 125.49±8.68 123.11±8.36 122.89±8.13
Posterior facial height 82.62±8.11 74.94±7.94 75.12±8.89
Occlusal plane 5.72±4.71 13.05±2.96 13.20±2.92

Data is presented by means±SD.

Table 7.
Paired t tests evaluating surgical and postsurgical change
Measurement Non-posterior impaction group
T1-T0 T2-T1
Difference SD P value Difference SD P value
FH-ABp 9.540 10.600 0.007∗ −0.115 7.880 0.607
Mx. depth 3.770 9.760 0.190 0.162 0.583 0.338
U1-SN −1.930 5.100 0.197 1.049 2.152 0.104
Nper-A 0.998 2.335 0.149 0.115 0.611 0.509
SNA 1.325 2.649 0.096 −0.186 0.878 0.459
SNB −3.109 2.309 0.000∗ 0.162 0.936 0.546
ANB difference 4.590 4.200 0.002∗ −0.422 1.171 0.325
Anterior facial height −2.210 5.700 0.187 0.358 1.068 0.075
Posterior facial height −2.230 5.180 0.146 −0.300 0.509 0.055
Occlusal plane 0.211 0.948 0.438 0.178 0.474 0.199
PNS to HRL −2.372 2.798 0.010∗ 0.221 0.789 0.333
PNS to VRL 0.987 1.103 0.007∗ −0.228 1.147 0.488
A to HRL −0.590 4.590 0.649 0.442 0.567 0.016∗
A to VRL 4.07 12.240 0.253 0.270 0.786 0.2390
U1 to HRL −0.270 5.140 0.850 −0.528 3.355 0.581
U1 to VRL 0.745 3.357 0.439 0.696 2.449 0.326
L1 to HRL −2.940 5.180 0.063 0.341 1.748 0.496
L1 to VRL −7.340 5.050 0.003∗ 1.349 2.314 0.057
B to HRL −3.500 5.150 0.031∗ 0.584 2.097 0.335
B to VRL −6.340 5.640 0.002∗ 0.738 2.467 0.303
Pg to HRL −3.080 7.510 0.164 0.120 1.954 0.829
Pg to VRL −5.530 6.710 0.012∗ 0.209 2.545 0.772

(+) value: anterior or inferior movement, (−) value: posterior or superior movement

∗ P<0.05

Table 8.
Paired t tests evaluating surgical and postsurgical change
Measurement Posterior impaction group
Surgical changes T1-T0 Postsurgical changes T2-T1
Difference SD P value Difference SD P value
FH-ABp 8.650 6.500 0.001∗ 0.077 0.566 0.608
Mx. depth −1.38 2.690 0.067 0.191 0.759 0.329
U1-SN −6.837 3.870 0.001∗ 1.176 1.960 0.036∗
Nper-A −0.948 2.798 0.211 −0.003 0.324 0.975
SNA −0.450 1.537 0.276 −0.068 0.750 0.731
SNB −5.262 2.430 0.001∗ 1.195 0.772 0.001∗
ANB difference 4.878 3.437 0.000∗ −1.297 0.823 0.000∗
Anterior facial height −2.375 3.511 0.020∗ −0.223 1.022 0.412
Posterior facial height −2.683 2.199 0.000∗ 0.185 2.539 0.782
Occlusal plane 6.572 3.032 0.000∗ 0.157 0.444 0.193
PNS to HRL −4.787 1.413 0.000∗ 0.321 0.648 0.076
PNS to VRL 1.510 1.760 0.010∗ 0.025 0.990 0.924
A to HRL 0.740 6.110 0.646 −0.720 4.350 0.531
A to VRL 1.460 6.230 0.380 −1.180 5.870 0.447
U1 to HRL 1.980 8.710 0.393 −0.280 7.310 0.884
U1 to VRL −1.110 5.540 0.449 0.940 6.510 0.584
L1 to HRL −1.720 3.381 0.069 −0.093 3.425 0.917
L1 to VRL −7.620 3.128 0.002∗ 3.507 2.339 0.086
B to HRL −2.078 3.263 0.027∗ −0.423 1.907 0.405
B to VRL −7.620 2.983 0.011∗ 0.550 1.793 0.255
Pg to HRL −2.330 1.544 0.000∗ −0.342 1.662 0.439
Pg to VRL −7.915 3.790 0.000∗ 0.689 1.808 0.162

+) value: anterior or inferior moovement, (−) value: posterior or superior movement

∗ P<0.05

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