Morphologic study for sagittal split ramus osteotomy using 3-D image in mandibular prognathism

ABSTRACT

Sagittal split ramus osteotomy(SSRO) has been commonly performed in the mandibular prognathism. The previous studies of the mandibular anatomy for SSRO have mostly been used in dry skull without consideration of age, sex or jaw relationship of patients. This study was performed to evaluate the location of mandibular canal and the anatomy of ramus, such as the location of mandibular lingula and the ramal bone marrow, which were associated with SSRO procedures, in the patients with mandibular prognathism and normal young adults by using computerized tomographs(CT) and 3D images. The young adults at their twenties, who were considered to complete their skeletal growth, and seen in the Department of Orthodontics and Oral and Maxillofacial Surgery in Chonnam National University Hospital between March 2000 and May 2003, were selected. This study was performed in 30 patients (15men, 15women) who were diagnosed as skeletal class I normal relationship, and another 30 patients (15men, 15women) who were diagnosed as skeletal class III relationship upon clinical examination and lateral cephalometric radiographs. The patients were divided into 2 groups Class I group, the patients who had skeletal class I normal relationship(n=30, 15men, 15women), and Class III group, the patients who had skeletal class III relationship(n=30, 15men, 15women). Facial CT was taken in all patients, and pure 3D mandibular model was constructed by V-works version 4.0. The occlusal plane was designed by three points, such as the mesiobuccal cusp of both mandibular 1st molar and the incisal edge of the right mandibular central incisor, and used as a reference plane. Distances between the tip of mandibular lingula and the occlusal plane, the sigmoid notch, the anterior and the posterior borders of ramus were measured. The height of ramal bone marrow from the occlusal plane and the distance between mid-point of mandibular canal and the buccal or lingual cortex of the mandible in the 1st and 2nd molars were measured by Vworks version 4.0. Distance(Li-OP) between the occlusal plane and the tip of mandibular lingula of Class III Group was longer than that of Class I Group in men(p<0.01), but there was no significant difference in women between both groups. Distance(Li-SN) between the sigmoid notch and the tip of mandibular ligula of Class III group was longer than that of Class I Group in men(p<0.05), but there was no significant difference in women between both groups. Distance(Li-RA) between the anterior border of ramus and the tip of mandibular lingula of Class III Group was shorter than that of Class I Group in men and women(p<0.01). Distance(Li-RP) between the posterior border of ramus and the tip of mandibular lingula of Class III Group was slightly shorter than that of Class I Group in men(p<0.05), but there was no significant difference in women between both groups. Distance(RA-RP) between the anterior and the posterior borders of ramus of Class III Group was shorter than that of Class I Group in men and women(p<0.01). Longer the distance(SN-AN) between the sigmoid notch and the antegonial notch was, longer the vertical ramal length above occlusal plane, higher the location of mandibular lingula, and shorter the antero-posterior ramal length were observed(p<0.01). Height of ramal bone marrow of Class III Group was higher than that of Class I Group in men and women(p<0.01). Distance between mandibular canal and buccal cortex of Class III Group in 1st and 2nd lower molars was shorter than that of Class I Group in men and women (p<0.05 in 1st lower molar in men, p<0.01 in others). These results indicate that there are some anatomical differences between the normal occlusal patients and the mandibular prognathic patients, such as the anterior-posterior length of ramus, the height of ramal bone marrow, and the location of mandibular canal.