J Korean Assoc Oral Maxillofac Surg.  2021 Aug;47(4):249-256. 10.5125/jkaoms.2021.47.4.249.

Sagittal split ramus osteotomy, intraoral vertical ramus osteotomy, and lateral corticectomy for asymmetric mandibular prognathism

• Lee JY
• Han SJ

• KMID: 2519822
• DOI: http://doi.org/10.5125/jkaoms.2021.47.4.249

Abstract

Objectives
The purpose of this study was to evaluate the postoperative anteroposterior stability and improvements in facial asymmetry after performing LeFort I osteotomy in the maxilla, sagittal split ramus osteotomy (SSRO) and intraoral vertical ramus osteotomy (IVRO) in the mandible, and lateral corticectomy on the IVRO side.
Materials and Methods
From July 2009 to October 2018, a retrospective analysis was performed on 11 subjects. Lateral cephalometric radiograph was performed preoperatively (T0), postoperatively (T1), and at 12 months of follow-up (T2), and the B point distance was measured. Posteroanterior cephalometric radiograph was performed preoperatively (S0) and at 12 months of follow-up (S1) and was used to measure five indicators (Ag angle, M-Ag, Co-Ag, Co-Me, and Ag-Me) of facial asymmetry.
Results
The B point distances for T0 and T1 were significantly different (P=0.007), whereas those for T1 and T2 were not significantly different (P=0.1). In addition, there was a significant difference between the B point distances of T2 and T0 (P=0.026). Comparison of the facial asymmetry indicators before and after surgery showed a significant difference for all indicators between S0 and S1: the P-values of Ag angle, M-Ag, Co-Ag, Co-Me, and Ag-Me were 0.003, 0.003, 0.008, 0.006, and 0.004, respectively. The Z value was based on negative ranks.
Conclusion
There was no significant difference in the B point distances from postoperation to the 12-month follow-up. However, there were significant differences in all five indicators related to facial asymmetry before and after surgery. The values for the five indicators of facial asymmetry all increased postoperatively.

Keyword

Prognathism; Facial asymmetry; Sagittal split ramus osteotomy

Figure

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  Fig. 1 A. Several holes are made by using bur on the oblique ride line of mandible. B. Adequate cortical bones are removed by lateral corticectomy procedure.

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  Fig. 2 A. Preoperative posteroanterior (PA) cephalometric. B. Preoperative lateral cephalometric. C. Postoperative PA cephalometric. D. Postoperative lateral cephalometric.

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  Fig. 3 A. Preoperative frontal facial photo. B. Preoperative lateral facial photo. C. Postoperative frontal facial photo. D. Postoperative lateral facial photo.

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  Fig. 4 A. Preoperative frontal facial photo. B. Preoperative lateral facial photo. C. Postoperative frontal facial photo. D. Postoperative lateral facial photo.

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  Fig. 5 Reference points and axes on lateral cephalometric radiograph. (S: sella turcica, Or: orbitale, Po: porion, B: B point, X-axis: Frankfort line, Y-axis: The line which is through the sella turcica and perpendicular to the Frankfort line)

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  Fig. 6 Reference points and lines on posteroanterior cephalometric radiograph. (Co: condylion, Ag: antegonion, Me: menton, MSR: mid-sagittal reference line)

Reference

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