Postoperative Evaluation on SSRO performed by Short Lingual Osteotomy and IVRO

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1 140 J Meikai Dent Med 43 2, , 2014 Short Lingual Osteotomy SSRO IVRO SSRO SSRO IVRO SSRO short lingual osteotomy SL SL IVRO SL 4 6 IVRO SL IVRO SL 1 IVRO SL short lingual osteotomy Postoperative Evaluation on SSRO performed by Short Lingual Osteotomy and IVRO Masaki FUJITA 1, Yuichiro OTSUKA 1, Hiroto NISHINO 1, Norikazu ENDO 1, Keisuke SANJO 1, Mai FUJIMOTO 1, Syumei YOSHIKAWA 2, Tsuneyasu TATSUTA 2, Shigeyuki MATSUI 1, Jun SHIMADA 2 and Naoto SUDA 1 1 Division of Orthodontics, Department of Human Development and Fostering, Meikai University School of Dentistry 2 Division 1 of Oral and Maxillofacial Surgery, Department of Diagnostic & Therapeutic Sciences, Meikai University School of Dentistry Abstract : When applying sagittal split ramus osteotomy SSRO to facial asymmetry cases, distal segments tend to contact proximal segments and cause lateral deviation of proximal segments. In these cases, vertical ramus osteotomy IVRO is applied to correct facial asymmetry. Alternatively, when SSRO is applied, short lingual osteotomy SL in which the lingual cut is limited up to the area near the mandibular foramen, is also performed. Short lingual osteotomy is known to reduce the risk of lateral deviation of proximal segments in treating facial asymmetry cases, but little is known about the postoperative outcome. To evaluate the outcome of cases treated in Meikai University Hospital, four and six cases undergone IVRO and SL, respectively, were examined. After IVRO and SL, proximal segments showed a clockwise rotation in many cases. Examined laterally, proximal segments showed a wide deviation to both inner and outer directions immediately after IVRO, but a slight deviation only to the outer direction immediately after SL. From immediately after to one year after surgeries, postoperative relapse of proximal and distal segments were hardly seen in cases. These findings demonstrate SL as well as IVRO as an useful surgical technique in correcting facial asymmetry cases. Key words : facial asymmetry, short lingual osteotomy, postoperative stability

2 SL IVRO SSRO IVRO SSRO IVRO Traunar 2 Obwegeser 3 SSRO Obwegeser SSRO Obwegeser Obwegeser 7 Obwegeser IVRO 8, 9 IVRO 7, 10 6, 11 IVRO 10, 12 IVRO Epker 13 SSRO short lingual osteotomy SL SL 4 Obwegeser SL SL SL IVRO mm IVRO SL 4 6 Obwegeser SL 6 2 Le Fort IVRO 4 T1 4 1 T T T1-T2 T1 T2 T2-T3 T2 T3 2 IVRO Fig 1

3 Fig 1 Osteotomy lines in IVRO Black lines denote osteotomy lines in buccal and lingual views. Fig 3 Cephalometric measures for anterior-posterior evaluation in lateral cephalogram. SN plane : Line connecting N and S, FH plane : Line connecting Po and Or, Ramus plane : Tangential line to the posterior border of ramus from Ar, S-vertical plane : Line perpendicular to FH plane through S, SNB angle : Angle between S-N plane and the line connecting N and B, SNP angle : Angle between S-N plane and the line connecting N and P, Ramus inclination : The angle between FH plane and ramus plane denoted by a, b : Distance from the posterior edge of the mandibular second molar to S-vertical plane. Fig 2 Osteotomy lines in SL Black lines denote osteotomy lines in buccal and lingual views. SL SSRO Fig Fig 3 10 T1- T2 2 SNB SNP T1-T2 2 Fig 3 3 T1, T2, T3 SL SL IVRO IVRO Ar Articulare FH SL IVRO SL IVRO S FH S-vertical plane 3 Fig 4 3 T1, T2, T3

4 SL IVRO 143 Fig 4 Cephalometric measures for lateral evaluation in P-A cephalogram. Facial midline : Line perpendicular to Lo-Lo plane running through the most narrow section of Crista galli, Lateral border of ramus : Tangential line to the lateral border of ramus from the condylar neck, c : Angle between Zyg-Zyg plane and lateral border of ramus, Deviation of Me : Horizontal distance of Me from the facial midline denoted by d, Deviation of L-1 : Horizontal distance of L-1 from the facial midline denoted by e. Lo, Lo SL IVRO Zyg, Zyg : Zygoma Zyg- Zyg lateral border of ramus Zyg-Zyg 2 Me Me mm L-1 L-1 mm 2 1 T1-T2 SNB SL IVRO Fig 5 SNP SL IVRO SL IVRO 2 T1-T2 SL IVRO Fig 6 T2-T3 SL IVRO T1-T2 SL IVRO mm mm Fig mm SL T2-T3 SL IVRO mm mm 3 T1-T2 SL IVRO Fig 8 T2-T3 SL IVRO

5 Fig 5 Change in SNB and SNP in SL and IVRO cases. Fig 6 Change in ramus inclination in SL and IVRO sides. Fig 8 Change in inclination of lateral border of ramus in SL and IVRO sides. Fig 7 Distal movement of the distal edge of the mandibular second molars in SL and IVRO sides. T1-T2 Me mm SL mm, IVRO mm Fig 9 L 1 mm SL mm, IVRO mm T2-T3 Me mm SL mm, IVRO mm L 1 mm SL mm, IVRO mm

6 SL IVRO 145 Fig 9 Change in lateral deviation of Me and L-1 in SL and IVRO cases. 1 T1-T2 SL IVRO SNB SNP SL IVRO SL IVRO T1-T2 IVRO 10 mm IVRO 10 IVRO 14 SSRO 15 Obwegeser 16 Obwegeser SL 4 T1-T2 SL SL IVRO T1-T2 IVRO 17 IVRO 10, CT IVRO T1-T2 T1-T2 SL IVRO IVRO 18 IVRO 1 19 IVRO IVRO SL IVRO SL

7 SL IVRO SL 2 T2-T3 10 T2-T mm Me mm 3.0 mm mm 1 IVRO T1-T2 T2-T3 1.0 mm IVRO SL T2-T3 T1-T2 T2-T Obwegeser mm 1.5 mm 1 T2-T , T2-T3 IVRO SL T1-T2 1 IVRO SL 4 6 IVRO SL IVRO SL 1 IVRO SL IVRO SL , , 2008 Trauner R and Obwegeser H : The surgical correction of mandibular prognathism and retrognathia with consideration of genioplasty. Part 1. Surgical procedures to correct mandibular prognathism and reshaping of the chin, Oral Surg Oral Med Oral Pathol 10, , 1957 Obwegeser H : The indications for surgical correction of mandibular deformity by the sagittal splitting technique. Brit J Oral Surg 1, , 1963 Epker Obwegeser-Dal Pont 7, , , , , , 1992 SSRO IVRO 20, , 2010

8 SL IVRO 147 6, 83 91, 1996 Bell WH, Yamaguchi Y and Poor MR : Treatment of temporomandibular joint dysfunction by intraoral vertical ramus osteotomy. Int J Adult Orthod Orthognath Surg 5, 9 27, , 88 97, , 28 40, 2005 Hall DH : Intraoral vertical ramus osteotomy. In Bell WH, Proffit WR and White RP : Surgical correction of dentofacial deformities WB Saunders, Philadelphia, pp , 1980 Epker BN. : Modification in the sagittal osteotomy of the mandible, J Oral Surg 35, , 1977 Hall DH, Chase DC and Payor LG : Evaluation and refinement of the intraoral vertical subcondylar osteotomy, J Oral Surg 33, , , , 1992 sagittal splitting method parallel method 25, , 1979 Hall DH : Mandibular prognathism, Bell WH : Modern practice in orthognathic and reconstructive surgery. W. B. Saunders Co, Philadelphia, pp , , , 2012 IVRO 1 X 6, 32 40, , , 1989 Two-Jaw Surgery 4, 15 25, , , , 21 31, 1996 IVRO SSRO 7, , , 1 7, 2009 X 4, 77 86,

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