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Shin, Kim, and Park: Soft tissue changes in skeletal class II patients treated with bilateral sagittal split osteotomy advancement surgery
Original Article

J Korean Assoc Oral Maxillofac Surg 2010;36(2):94-99.

Published online: 10 January 2010

DOI: https://doi.org/10.5125/jkaoms.2010.36.2.94

Soft tissue changes in skeletal class II patients treated with bilateral sagittal split osteotomy advancement surgery

Hee-Jin Shin1, Jin-Wook Kim2, Je-Uk Park1

1Department of Oral and Maxillofacial Surgery, Seoul St. Mary's Dental Hospital, Seoul, Korea

2Graduate school of clinical dental science, the Catholic University, Seoul, Korea

Je-Uk Park Department of Oral and Maxillofacial Surgery, College of Medicine, The Catholic University 505 Banpo-dong, Seocho-gu, Seoul, 137-044, Korea TEL: +82-2-2258-6291 FAX: +82-2-537-2374 E-mail: jupark@catholic.ac.kr

Received 18 February 2010       Revised 11 March 2010       Accepted 30 March 2010

Copyright © 2010 Korean Association of Oral and Maxillofacial Surgeons

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The purpose of this study was to examine the soft tissue changes in skeletal class II patients after mandibular advancement by bilateral sagittal split ramus osteotomy (BSSRO). In Asian population, the incidence of skeletal class II malocclusion is lower than that of skeletal class III malocclusion unlike the caucasians. This study was conducted to figure out the ratio at which hard tissue and soft tissue changes after mandibular advancement by analyzing cephalograms of 13 patients that have undergone the mandibular advancement surgery. As a result, change ratios of Li, B′, Pog′ according to the movement of li, B, Pog were found to be 0.59, 1.06, 0.82. Also, vertical height of vermilion zone (Si-Vb) and lower lip and chin (Si-Me′) were measured to evaluate vertical changes. Vermilion zone showed tendency to decrease by 1.02 mm on the average postoperatively, whereas vertical length of lower lip and chin showed tendency to increase by 3.57 mm on the average.

Keywords: Mandibular advancement surgery, Bilateral sagittal split ramus osteotomy (BSSRO), Soft tissue changes

References

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Fig. 1.
Reference lines and points in cephalometric measurements. (NSL: nasion-sella line)
jkaoms-36-94f1.tif
Table 1.
Cephalometric landmarks and measurement definitions
Landmark Definition
Sella turcica (S) Center of sella turcica
Nasion (N) Most anterior point of frontonasal suture
B point (B) Innermost point on contour of mandible between incisor tooth and bony chin
Pogonion (Pog) Most anterior point on osseous contour of chin
Lower incisor tip (li) Most anterior point of lower lip
Stomion inferius (Si) Uppermost point on vermilion of lower lip
Labrale inferius (Li) Most anterior point of lower lip
Soft tissue B point (B′) Point of greatest concavity in midline of lower lip between labrale inferius and soft tissue pogonion
Soft tissue Pogonion (Pog′) Most prominent or anterior point on chin in midsagittal plane
Soft tissue Menton (Me′) Lowest point on contour of soft tissue chin
Vermillion border (Vb) Tangent point in lower lip profile to line connecting Li and B′
Lower lip height (Si-Vb) Vertical length from stomion inferior to Vb.
Height of mental area (Si-Me′) Vertical length from stomion inferior to soft tissue menton
Table 2.
Postoperative change of the soft and hard tissue
  Patient Age/sex li B Pog Li B′ Pog′ Si-Vb Si-Me′
Group 1 1 20/F 2.99 4.66 14.33 1.4 7.77 11.73 −3.6 8.88
2 30/F 1.16 1.92 3.09 0.49 1.27 3.05 −1.93 2.27
3 26/M 2.75 3.8 7.39 0.02 2.61 8.72 −0.5 0.41
4 24/M 3.37 2.12 8.93 0.86 4.72 7.51 −2.13 1.77
5 33/F 1.45 2.99 9.5 0.84 2.77 7.04 0.89 2.3
6 20/F 5.23 7.19 14.73 6.98 8.75 12.53 −1.4 5.74
7 23/F 8 4.1 11.5 3.38 5.66 9.97 −0.51 3.62
Group 2 8 32/F 2.73 4.95 11.47 1.73 4.87 9.57 1.18 5.15
9 22/F 2.96 5.12 5.1 3.12 4.19 3.72 0.46 5.39
10 22/F 1.26 2.7 9.96 2.28 2.46 4.89 −1.84 3.95
11 20/F 2.42 2.27 5.3 0.08 0.31 3.75 0.23 1.42
12 20/F 2.15 2.98 13.25 0.7 5.68 9.76 −4.26 1.24
13 28/F 0.09 2.26 4.55 0.03 1.71 3.81 0.17 4.32
Table 3.
The amount of anterior movement in Group 1 and Group 2 (T2-T1)
Group 1 Group 2
Landmark Mean SD Mean SD Group difference (Group 1-Group 2)
li 3.561 2.37 1.941 1.08 .11
B point 4.11 1.99 3.381 1.31 .46
Pog 9.921 4.07 8.271 3.76 .46
Li 2 2.45 1.321 1.26 .55
B′ point 4.79 2.79 3.2 2.05 .27
Pog′ 8.65 3.2 5.92 2.94 .14

(1: T2-T1 change significant at P<0.05)

Table 4.
Ratio of the soft tissue changes in relation to the hard tissue changes
Landmark Group 1 Group 2 Group 1+Group 2
Mean SD Mean SD Group difference Mean SD
Li/li 0.50 0.41 0.70 0.65 0.51 0.59 0.52
B′ / B 1.19 0.57 0.92 0.57 0.41 1.06 0.57
Pog′ / Pog 0.90 0.14 0.72 0.13 0.04 0.82 0.16
Table 5.
The amount of the vertical change of the lower lip in Group 1 and Group 2 (T2-T1)
Group 1 Group 2 Group 1+Group 2
Vertical height Mean SD Mean SD Group difference Mean SD
Si-Vb −1.31 1.44 −0.68 2.02 .52 −1.021 1.69
Si-Me′ 3.571 2.87 3.581 1.82 .99 3.571 2.35

(1: T2-T1 change significant at P<0.05)

Table 6.
Simple regression analysis of the soft tissue change
Dependent variables (Y) R (C) Constant coefficient Regression variables Independent P value
Li 0.4 −0.03 0.61 li 0.021
B′ 0.58 −0.24 1.14 B 0.002
Pog′ 0.84 0.26 0.78 Pog 0.0001
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