구내수직시상하악지 골절단술 후 삼차원 컴퓨터 단층촬영술을 이용한 하악과두의 위치변화 연구

학위논문 (석사)-- 서울대학교 대학원 : 치의과학과, 2012. 2. 서병무.Purpose Improperly positioned condyles are considered one of the major etiologic factors of temporomandibular disorder (TMD) after orthognathic surgery. One of the surgical objectives in orthognathic surgery is to produce minimal changes in condylar position to ensure normal mandibular movement and function of the temporomandibular joint (TMJ) in asymptomatic patients. However, postoperative changes in condylar position and adjacent tissues, including the TMJ disk, can be occurred after orthognathic surgery. Conventionally, two-dimensional cephalometric radiographs have been used for the evaluation of dentofacial deformity and for surgical planning. Recently, the use of three-dimensional computed tomography (3D CT) has enhanced the accuracy of assessing postoperative changes in anatomic structures. This study was designed to use 3D CT to examine the association between TMJ positional changes and TMJ symptoms after orthognathic surgery, particularly in patients with mandibular prognathism who underwent intraoral vertico-sagittal ramus osteotomy (IVSRO). Patients and Methods The study population consisted of 50 patients with mandibular prognathism (100 TMJs) who underwent IVSRO with or without Le Fort I osteotomy between 2006 and 2010. One surgeon performed all of the operations in this study, which avoided surgeon-dependent bias. Among the 50 patients, 38 had facial asymmetry in conjunction with mandibular prognathism, and 12 had mandibular prognathism without facial asymmetry. There were 19 males and 31 females, and the average age was 22.5 ± 3.9 years. We reviewed 3D CT images taken before the surgery and at 3 months after surgery as a part of the routine clinical evaluation protocol. The pre- and postoperative images were superimposed and evaluated in the axial, sagittal, and coronal planes. The amount of condylar linear displacement and the angular changes of the condylar axis were measured in these planes. In addition, we used clinical documents to evaluate postoperative changes in TMJ pain and joint sounds. The association between clinical signs and symptoms with respect to postoperative condylar changes were investigated. Results Upon evaluation of 100 TMJs, postoperative pain developed in 10, whereas pain disappeared in 7 within 3 months after the surgery. However, 5 TMJs had persistent pain. TMJ sounds developed in 6 TMJs postoperatively. However, preexisting TMJ sounds disappeared in 18. Ten TMJs continued to have joint sounds even after surgery. Most condyles showed postoperative displacement in the anterior, medial, and downward directions. The average displacement was 0.42 ± 0.56 mm in the anterior direction, 0.29 ± 0.24 mm in the posterior direction, 0.67 ± 0.71 mm in the medial direction, 0.26 ± 0.24 mm in the lateral direction, 0.55 ± 0.61 mm in the downward direction, and 0.28 ± 0.19 mm in the upward direction. In the axial plane, most condyles (83%) were displaced less than 1 mm. With respect to changes the condylar axis, inward rotation in the axial plane and posterior rotation in the sagittal plane were predominantly detected. The average degree of change in the condylar axis was 3.43 ± 2.9° inward and 2.71 ± 1.97° outward in the axial plane; 4.39 ± 5.88° anteriorly and 3.59 ± 2.27° posteriorly in the sagittal plane; and 2.7 ± 1.78° medially and 2.41 ± 2.02° laterally in the coronal plane. There were no statistically significant differences in condylar displacements or condylar axis changes between patient groups according to TMJ pain. No significant difference was found in condylar displacements or condylar axis changes between patient groups according to joint sounds. In patients with facial asymmetry, inward rotation was more frequent on the deviated side than on the non-deviated side. Also, the degree of inward rotation was higher on the deviated side than on the non-deviated side in the same plane (P < 0.05). Conclusion The dominant directions of condylar displacement after IVSRO are the anterior, medial, and inferior directions, whereas the dominant direction of condylar rotation is inward in the axial plane and posterior in the sagittal plane. After IVSRO, most condyles showed minimal positional changes (< 1 mm). There were no statistically significant differences in the changes of condylar position and axis according to changes in TMJ signs and symptoms. In patients with facial asymmetry, there was a higher frequency and degree of inward rotation on the deviated side than on the non-deviated side.연구 목적 악교정수술 후 정상적인 하악운동과 기능을 회복하기 위해서 수술 후 하악과두 위치의 변화가 최소화 되도록 추구한다. 그러나 많은 경우에 악교정수술 이후 하악과두를 비롯하여 관절원판 및 관절 주위 조직의 위치 변화가 나타나며, 부적절한 위치에 놓인 하악과두는 술 후 발생하는 측두하악관절장애의 주요 요인으로 지목되고 있다. 현재까지 기존의 이차원적인 방사선사진을 통한 술 후 하악과두의 변화에 대해 시행된 많은 연구들은 한계점을 보여 왔으며, 최근에는 컴퓨터 단층 촬영술을 이용한 삼차원적인 연구를 통해 그 한계점을 극복하려는 노력이 지속되고 있다. 본 연구는 구내수직시상하악지 골절단술 후 변화된 하악과두위치와 환자가 느끼는 악관절부위의 증상(통증 및 관절잡음)의 상관관계를 삼차원 컴퓨터 단층촬영술을 이용하여 알아보았다. 연구대상 및 방법 2006년부터 2010년까지 서울대학교 치과병원 구강악안면외과에서 동일 술자가 시행한 구내수직시상하악지 골절단술을 시행 받은 하악골 전돌증 환자 12명, 안면비대칭을 동반한 하악골 전돌증 환자 38명, 총 50명 환자(100개의 측두하악관절)를 대상으로 연구를 시행하였다. 남자 19명, 여자 31명으로 평균연령은 22.5± 3.9세 이다. 술 전 및 술 후 3개월에 삼차원 컴퓨터 단층촬영술을 시행하였으며, 술 전 및 술 후 영상을 중첩하여 3가지 평면(수평면, 시상면, 관상면)에서의 하악과두의 이동량 및 축의 각도변화를 측정하였다. 또한 술 후 통증 및 관절잡음 변화를 술 전과 술 후 3개월, 6개월 및 1년째에 평가하였으며, 술 후 하악과두 위치의 변화와의 상관관계를 비교하였다. 연구 결과 100개의 측두하악관절을 평가한 결과 10개(10%)의 측두하악관절에서 술 후 3개월째 추적 검사 시 통증이 발생되어 있었으며, 7개(7%)의 관절에서 통증이 사라졌음이 확인되었다. 술 후 관절잡음이 발생한 경우는 6개(6%), 사라진 경우가 18개(18%)였다. 술 후 전방, 내방, 하방으로의 하악과두 위치이동이 우세하게 나타났다. 평균 이동량은 전방 0.42±0.56mm, 후방 0.29±0.24mm, 내방 0.67±0.71mm, 외방 0.26±0.24mm, 하방 0.55±0.61mm, 상방 0.28±0.19mm를 보였다. 하악과두 축의 변화는 수평면에서 내방, 시상면에서 후방, 관상면에서 내방으로의 회전변화가 우세하게 나타났다. 평균 회전량은 수평면에서 내방 3.43±2.9°, 외방 2.71±1.97°, 시상면에서 전방 4.39±5.88°, 후방 3.59±2.27°, 관상면에서 내방 2.7±1.78°, 외방 2.41±2.02°의 각도 변화를 보였다. 수평면에서의 전후방 및 내외방으로의 하악과두의 변화는 대부분이 1 mm 미만의 이동을 보였다(83%). 통증 변화에 따른 하악과두위치의 이동량 및 축의 각도변화량은 유의할만한 차이를 보이지 않았다. 관절잡음 변화에 따른 하악과두 위치의 이동량 및 축의 각도변화량 또한 유의할만한 차이를 보이지 않았다. 안면비대칭을 동반한 경우 수평면에서 관찰한 하악과두 축의 변화는 변위측에서 대부분 내방회전변화가 나타났다. 같은 평면에서 측정한 회전변위량도 비변위측에 비해 변위측에서 많은 것으로 나타났다(P < 0.05). 이를 제외한 다른 변화의 경우 변위측과 비변위측에서 유의할만한 수준의 차이를 보이지 않았다. 결론 구내수직시상하악지 골절단술이후 하악과두의 이동은 전방, 내방, 하방으로, 하악과두 축의 변화는 수평면에서 내방, 시상면에서 후방으로의 회전변화가 우세하다. 비대칭이 존재하는 경우 변위측에서 내방회전이 주로 나타난다. 환자의 통증 및 관절잡음 변화에 따른 하악과두의 위치 및 축의 각도 변화량은 유의할만한 차이를 보이지 않았다.Maste

Fracture patterns and causes in the craniofacial region: an 8-year review of 2076 patients

Abstract Background For proper recovery from craniofacial fracture, it is necessary to establish guidelines based on trends. This study aimed to analyze the patterns and causes of craniofacial fractures. Methods This retrospective study analyzed patients who underwent surgery for craniofacial fractures between 2010 and 2017 at a single center. Several parameters, including time of injury, region and cause of fracture, alcohol intoxication, time from injury to surgery, hospitalization period, and postoperative complications, were evaluated. Results This study analyzed 2708 fracture lesions of 2076 patients, among whom males aged 10 to 39 years were the most numerous. The number of patients was significantly higher in the middle of a month. The most common fractures were a nasal bone fracture. The most common causes of fracture were ground accidents and personal assault, which tended to frequently cause more nasal bone fracture than other fractures. Traffic accidents and high falls tended to cause zygomatic arch and maxillary wall fractures more frequently. Postoperative complications—observed in 126 patients—had a significant relationship with the end of a month, mandible or panfacial fracture, and traffic accidents. Conclusions The present findings on long-term craniofacial fracture trends should be considered by clinicians dealing with fractures and could be useful for policy decisions

Association between dental health and obstructive coronary artery disease: an observational study

Abstract Background The association between dental health and coronary artery disease (CAD) remains a topic of debate. This study aimed to investigate the association between dental health and obstructive CAD using multiple dental indices. Methods Eighty-eight patients (mean age: 65 years, 86% male) were prospectively enrolled before undergoing coronary CT angiography (n = 52) or invasive coronary angiography (n = 36). Obstructive CAD was defined as luminal stenosis of ≥50% for the left main coronary artery or ≥ 70% for the other epicardial coronary arteries. All patients underwent thorough dental examinations to evaluate 7 dental health indices, including the sum of decayed and filled teeth, the ratio of no restoration, the community periodontal index of treatment needs, clinical attachment loss, the total dental index, the panoramic topography index, and number of lost teeth. Results Forty patients (45.4%) had obstructive CAD. Among the 7 dental health indices, only the number of lost teeth was significantly associated with obstructive CAD, with patients who had obstructive CAD having significantly more lost teeth than patients without obstructive CAD (13.08 ± 10.4 vs. 5.44 ± 5.74, p < 0.001). The number of lost teeth was correlated with the number of obstructed coronary arteries (p < 0.001). Multiple binary logistic regression analysis revealed that having ≥10 lost teeth was independently associated with the presence of obstructive CAD (odds ratio: 8.02, 95% confidence interval: 1.80–35.64; p = 0.006). Conclusions Tooth loss was associated with the presence of obstructive CAD in patients undergoing coronary evaluation. Larger longitudinal studies are needed to determine whether there is a causal relationship between tooth loss and CAD