Mandibuler Setback Cerrahisi Sonrası Sagittal Split Osteotomi Hattında Meydana Gelen Değişikliklerin Üç Boyutlu Olarak İncelenmesi

Amaç: Bu çalışmadaki amacımız çift çene ortognatik cerrahi operasyonu geçiren Sınıf III hastalarda sagittal split osteotomi (SSO) hattında meydana gelen değişimlerin üç boyutlu olarak incelenmesi ve maksiller gömme olup olmamasına bağlı olarak oluşan değişikliklerin belirlenmesidir. Yöntemler: Bu çalışmada ortognatik çene ameliyatı geçirmiş olan 21 Sınıf III hastadan cerrahi öncesi ve sonrası 3-6 aylık dönemde alınmış olan konik ışınlı bilgisayarlı tomografi verileri kullanılmıştır. Yirmi bir hasta iki gruba ayrılmıştır: maksiller ilerletme-gömme ve mandibuler setback uygulanan olgular (10 hasta) “Grup I”, maksiller ilerletme ve mandibuler setback uygulanan olgular (11 hasta) “Grup II” olarak tanımlanmıştır. Üç boyutlu konik ışınlı bilgisayarlı tomografi görüntüleri kafa kaidesi üzerinde çakıştırılmış, sagittal split osteotomi hattında ameliyata bağlı olarak meydana gelen değişimler üç boyutlu imaj rekonstrüksiyonları kullanılarak tespit edilmiştir. Bulgular: Grup II’de SSO hattı noktalarının aksiyel düzlemde medial yönlü değişim miktarı, istatistiksel olarak anlamlıdır (p<0,05). Grup I ve Grup II arasındaki farklar karşılaştırıldığında, aksiyal düzlemde SSO hattı ölçümlerinde meydana gelen değişimin Grup II’de Grup I’den istatistiksel olarak anlamlı derecede yüksek olduğu belirlenmiştir (p<0,05). Sonuç: Maksiller ilerletme ve mandibuler setback uygulanan olgularda SSO hattında x ekseninde istatistiksel olarak anlamlı medial yönlü yer değiştirme meydana geldiği, maksiller ilerletme, gömme ve mandibuler setback uygulanan olgularda ise SSO hattında anlamlı bir değişim meydana gelmediği belirlenmiştir.

Anahtar Kelimeler:

Sagittal split osteotomisi, mandibuler setback, konik ışınlı bilgisayarlı tomografi

Three-Dimensional Evaluation of the Changes at the Sagittal Split Osteotomy Line after Mandibular Setback Surgery

Objective: The aim of this study was to evaluate three-dimensional positional changes at the sagittal split osteotomy (SSO) line after double jaw surgery for class III patients and determine the effect of maxillary impaction at the SSO line. Methods: In this study, cone-beam computed tomography scans of 21 Class III patients taken before and 3–6 months after orthognathic surgery were used. Twenty-one patients were divided into two groups: “Group I” consisted of 10 patients who had combined maxillary advancement, maxillary impaction, and mandibular setback surgery, and “Group II” consisted of 11 patients who had combined maxillary advancement and mandibular setback surgery. Three-dimensional cone-beam computed tomography images were registered using cranial base superimposition and the changes of the SSO line were examined based on the three-dimensional reconstructed images. Results: Medial displacement of the SSO line was statistically significant on the axial plane in Group II (p<0.05). Comparison of the changes between Groups I and II showed that the amount of displacement of the SSO line in the axial plane in Group II was significantly greater than that in Group I (p<0.05). Conclusion: In cases that have maxillary advancement and mandibular setback surgery, significant medial displacement of the SSO line was observed. There was no significant change in patients who had combined maxillary advancement, impaction, and mandibular setback surgery.

Keywords:

Sagittal split osteotomy, mandibular setback, cone-beam computed tomography,

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Lee W, Park JU. Three-dimensional evaluation of positional change of the condyle after mandibular setback by means of bilateral sagittal split ramus osteotomy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002; 94: 305-9. [Crossref ] 2. Cevidanes LHS, Bailey LJ, Tucker SF, Styner MA, Mol A, Phillips CL, et al. Three-dimensional cone-beam computed tomography for assessment of mandibular changes after orthognathic surgery. Am J Orthod Dentofac Orthop 2007; 131: 44-50. [Crossref ] 3. Kim YJ, Oh KM, Hong JS, Lee JH, Kim HM, Reyes M, et al. Do patients treated with bimaxillary surgery have more stable condylar positions than those who have undergone single-jaw surgery? J oral Maxillofac Surg 2012; 70: 2143-52. [Crossref ] 4. Choi HS, Rebellato J, Yoon HJ, Lund AB. Effect of Mandibular Setback via Bilateral Sagittal Split Ramus Osteotomy on Transverse Displacement of the Proximal Segment. J Oral Maxillofac Surg 2005; 63: 908-16. [Crossref] Yoo JY, Kwon YD, Suh JH, Ko SJ, Lee B, Lee JW, et al. Transverse stability of the proximal segment after bilateral sagittal split ramus osteotomy for mandibular setback surgery. Int J Oral Maxillofac Surg 2013; 42: 994- 1000. [Crossref ] 6. Kawamata A, Fujishita M, Nagahara K, Kanematu N, Niwa K, Langlais RP. Three-dimensional computed tomography evaluation of postsurgical condylar displacement after mandibular osteotomy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998; 85: 371-6. [Crossref ] 7. Chirani RA, Jacq JJ, Meriot P, Roux C. Temporomandibular joint: a methodology of magnetic resonance imaging 3-D reconstruction. Oral Surgery Oral Med Oral Pathol Oral Radiol Endodontology 2004; 97: 756-61. [Crossref ] 8. Chen S, Lei J, Wang X, Fu KY, Farzad P, Yi B. Short- and long-term changes of condylar position after bilateral sagittal split ramus osteotomy for mandibular advancement in combination with le fort i osteotomy evaluated by cone-beam computed tomography. J Oral Maxillofac Surg 2013; 71: 1956-66. [Crossref ] 9. Carvalho FAR, Cevidanes LHS, Motta ATS, Almeida MAO, Phillips C. Three-dimensional assessment of mandibular advancement 1 year after surgery. Am J Orthod Dentofac Orthop 2010; 137: S53.e1-12. 10. Mozzo P, Procacci C, Tacconi A, Martini PT, Andreis IA. A new volumetric CT machine for dental imaging based on the cone-beam technique: preliminary results. Eur Radiol 1998; 8: 1558-64. [Crossref ] 11. Mah J, Hatcher D. Three-dimensional craniofacial imaging. Am J Orthod Dentofac Orthop 2004; 126: 308-19. [Crossref ] 12. Hashimoto K, Arai Y, Iwai K, Araki M, Kawashima S, Terakado M. A comparison of a new limited cone beam computed tomography machine for dental use with a multidetector row helical CT machine. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003; 95: 371-7. [Crossref ] 13. Ludlow JB, Davies-Ludlow LE, Brooks SL, Howerton WB. Dosimetry of 3 CBCT devices for oral and maxillofacial radiology: CB Mercuray, NewTom 3G and i-CAT. Dentomaxillofacial Radiol 2006; 35: 219-26. [Crossref ] 14. Hilgers ML, Scarfe WC, Scheetz JP, Farman AG. Accuracy of linear temporomandibular joint measurements with cone beam computed tomography and digital cephalometric radiography. Am J Orthod Dentofac Orthop 2005; 128: 803-11. [Crossref ] 15. Ikeda K, Kawamura A. Assessment of optimal condylar position with limited cone-beam computed tomography. Am J Orthod Dentofacial Orthop 2009; 135: 495-501. [Crossref ] 16. Beycan K, Acar A. Does intergonial distance change after mandibular setback surgery? Case Study and Case Report 2016; 6: 44-8.