Soft tissue change of the midface in skeletal class III orthognathic surgery patients

Jong-Hyun Jung; Seong-Sik Kim; Woo-Sung Son; Soo-Byung Park

doi:10.4041/kjod.2008.38.2.83

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Jung, Kim, Son, and Park: Soft tissue change of the midface in skeletal class III orthognathic surgery patients

Original Article

Korean Journal of Orthodontics

Korean Journal of Orthodontics 2008; 38(2): 83-94.

Published online: 30 April 2008

DOI: https://doi.org/10.4041/kjod.2008.38.2.83

Soft tissue change of the midface in skeletal class III orthognathic surgery patients

Jong-Hyun Jung, DDS, MSD^a, Seong-Sik Kim, DDS, MSD, PhD^b, Woo-Sung Son, DDS, MSD, PhD^c, Soo-Byung Park, DDS, MSD, PhD^c

^aPostgraduate student, Department of Orthodontics, School of Dentistry, Pusan National University, Korea.

^bAssociate Professor, Department of Orthodontics, School of Dentistry, Pusan National University, Korea.

^cProfessor, Department of Orthodontics, School of Dentistry, Pusan National University, Korea.

Corresponding author: Seong-Sik Kim. Department of Orthodontics, School of Dentistry, Pusan National University, Gu-Deok-Ro 305, Seo-Gu, Busan 623-739, Korea. +82 51 240 7443; softid@pusan.ac.kr.

Received 26 December 2007 Revised 24 March 2008 Accepted 26 March 2008

Abstract

Purpose

The first objective of this study was to compare the upper midface morpholgy, focusing on the soft tissues, between skeletal Class III maloccusion patients with midfacial depression and the norm. The second objective was to estimate and analyze the change in the upper midface soft tissues following surgical correction with maxillary advancement by Lefort I osteotomy and mandibular setback by bilateral sagittal split osteotomy (BSSRO).

Methods

The samples consisted of 34 adult patients (15 males and 12 females) with an average age of 21years, who had severe anteroposterior discrepancy with midfacial depression. These patients had received presurgical orthodontic treatment and surgical treatment which consisted of simultaneous Lefort I osteotomy and BSSRO.

Results

The correlation coefficient between changes in maxillary advancement and changes in Or' (soft tissue orbitale) was 0.599 (p < 0.05). Change in maxillary plane angle and vertical change of the maxilla were not correlated with the change in Or' (p < 0.05). The ratio of soft tissue change in Or' to maxillary advancement was 43.57 %, and 81.54 % in Sn. Regression equations between maxillary movement and Or' were devised. The r² value was 0.476.

Conclusions

The majority of measurements in the upper midface in skeletal Class III maloccusions when compared to the norm, showed significant differences. In Class III malocclusion with midfacial depression, maxillary advancement produces soft tissue change in the upper midface.

Keywords: Skeletal class III malocclusion, midface, soft tissue change, orthognathic surgery

Figures and Tables

Fig 1

Landmarks and linear (Left) and angular (Right) measurements. S (Sella); N (Nasion); Or (Orbitale); Or' (Soft tissue Orbitale), the intersection point of the soft tissue on Orbitale and the FH plane; A (Subspinale, point A); Sn (Subnasale); G (Glabella); Nd, the intersection point of the FH plane and the dorsum of nose; S', the perpendicularly projected point from S onto the FH plane; N', the perpendicularly projected point from N onto the FH plane; A', the perpendicularly projected point from the point A onto the FH plane; Sn', the perpendicularly projected point from Sn onto the FH plane; G', the perpendicularly projected point from G onto the FH plane; S'-A'; S-N; S'-Or; S'-Or'; S'-G'; S'-Sn'; N'-Or; G'-Or'; A⊥FH, The distance from A point to FH plane; Or⊥NA, the distance from Or to NA line; Or'⊥GSn, the distance from Or' to GSn line; Sn⊥FH, the distance from Sn to FH plane.

Table 1

Comparison of the mean values of soft tissue and skeletal tissue variables between skeletal Class III patients (T1) and normal occlusion in the previous report by Lee and Chung22 (male)

^*p < 0.05; ^†p < 0.01.

Table 2

Comparison of the mean values of soft tissue and skeletal tissue variables between skeletal Class III patients (T1) and normal occlusion in the previous report by Lee and Chung22 (female)

^*p < 0.05; ^†p < 0.01.

Table 3

Cephalometric measurement of treatment changes

^*p < 0.05; ^†p < 0.01.

Table 4

Correlation between soft tissue and hard tissue movements (Pearson correlation)

^*Significant at p < 0.05; ^†significant at p < 0.01.

Table 5

Soft tissue to hard tissue ratio in sagittal movement of treatment changes (%)

Table 6

Multiple linear regression between skeletal and soft tissue change in Sagittal movement

Regression equation 1, S'-Or' change = 0.67 + 0.287 × S'-A' change + 0.096 × ∠FHPal change; Regression equation 2, S'-Or' change = 0.65 + 0.245 × S'-A' change; ^*significant at p < 0.05; ^†significant at p < 0.01.

Notes

This study was supported by VATECH Research Grant (Year 2008).

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