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Ortognatik cerrahi tedavinin burun üzerine etkilerinin 3 boyutlu fotografik yöntemle incelenmesi

Amaç: Bu çalışmanın amacı maksiller ilerletme ile birlikte gömme cerrahisi uygulanan hastalarda, burun yumuşak dokularında meydana gelen değişimin stereofotogrametrik yöntemle incelenmesidir. Gereç ve Yöntem: Çalışmamıza, Erciyes Üniversitesi Diş Hekimliği Fakültesi Ortodonti Anabilim Dalı’nda sabit ortodontik tedavileri yapılmış ve maksiller ilerletme ile birlikte total gömme cerrahisi uygulanmış, yaşları 18-24 arasında değişen (ortalama 20,1±2,2 yaş) 15 kadın 15 erkek toplam 30 birey dahil edilmiştir. Üst çenenin ortalama ilerletme miktarı 4,4±1,3 mm iken; gömme miktarı 2,1±1,1 mm’dir. 3 boyutlu stereofotogrametrik görüntüler operasyondan hemen önce ve operasyondan en az 6 ay sonra alınmıştır. Çalışmamızda burun alanı ile birlikte 6 noktasal, 4 doğrusal, 1 açısal ölçüm yapılmıştır. Veriler, cinsiyetler arasında farklılık gözlenmediği için tek grup olarak değerlendirilmiştir. İstatistiksel analiz için ‘paired t testi’ ve ‘Wilcoxon Rank’ testi kullanılmıştır. Maksiller gömme ve ilerletme miktarları ile burun yumuşak dokularında meydana gelen korelasyon ‘Pearson ve Spearman analizleri’ ile değerlendirilmiştir. Bulgular: Alare (al) ve alare curvature (ac) noktaları ameliyattan sonra vertikal yönde daha yukarda, horizontal yönde daha lateralde, anteroposterior yönde daha önde konumlanmıştır. Pronasale (prn) ve subnasale (sn) noktalarında horizontal yönde anlamlı bir hareket izlenmezken diğer yönlerde al ve ac noktalarına benzer şekilde hareket ettikleri gözlemlenmiştir. Burun genişliği ve burun tabanı mesafesi artarken; burun alanında, burun uzunluğu, kolumellar uzunluk ve burun ucu protrüzyonunda bir değişiklik izlenmemiştir. Maksiller ilerletme ile Prn ve Sn’nin öne hareketi, maksiller gömme ile bilateral Al ve Ac’nin öne hareketi arasında anlamlı bir ilişki tespit edilmiştir. Sonuç: Burun yumuşak dokularının, uzayın 3 boyutunda, maksillanın hareketlerinden etkilendiği görülmüş olup, bu değerlendirmede stereofotogrametrinin kullanımı kolay ve yararlı bir aygıt olduğu düşünülmektedir.

Evaluation of nasal soft tissue changes in orthognathic surgery patients with 3-Dimensional (3D) photographic method

Aim: The purpose of this study is to assess the changes in nasal soft tissues with stereophotogrammetric method in patients who have treated with maxillary advancement and impaction. Materials and Method: In this study, fixed orthodontic treatments were performed in Erciyes University, Faculty of Dentistry, Department of Orthodontics. 15 female and 15 male patients between 18-24 ages (mean 20,1 ± 2,2 years) was included. The mean amount of maxillary advancement was 4,4±1,3 mm; the mean amount of impaction was 2,1 ± 1,1 mm. 3D record were taken just before and at least 6 months post-surgery. Data were combined as a single group because there was no difference between the sexes. 'Paired t test' and Wilcoxon Rank' tests was used for the statistical analysis. Correlation between soft and hard tissue changes were assessed with ‘Pearson and Spearman correlation analyses’. RESULTS: Alare (al) and alare curvature (ac) were located higher, moved lateral and forward post-surgery. While there was no change in the horizontal positions of the pronasale (prn) and subnasale (sn); in other directions they moved in the same way as the al and ac. While nasal ala and alar base width increased; no changes were found in the nasal area, nasal bridge and columellar length and nasal tip protrusion. A significant relationship was found between maxillary advancement and anterior movement of prn and sn’; maxillary impaction and anterior movement of bilateral al and ac. Conclusion: Nasal soft tissues were affected from surgical movement of maxilla and stereophotogrammetry is easy to use and useful device in 3D evaluation.

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