Turkiye Klinikleri Journal of Dental Sciences

.: ORIGINAL RESEARCH
Farklı İskeletsel Sınıflamaya Sahip Hastaların Mandibulalarındaki Sagittal Split Osteotomisi Bölgelerinin Morfolojik Analizi
Morphometric Analysis of Mandibles Regarding to Osteotomy Sites of Sagittal Split Ramus Osteotomy with Different Skeletal Classifications
Nurettin DİKERa, Nur ALTIPARMAKb, Burak BAYRAMb
aBezmialem Vakıf Üniversitesi Diş Hekimliği Fakültesi, Ağız, Diş ve Çene Cerrahisi ABD, İstanbul, TÜRKİYE
bBaşkent Üniversitesi Diş Hekimliği Fakültesi, Ağız, Diş ve Çene Cerrahisi ABD, Ankara, TÜRKİYE
Turkiye Klinikleri J Dental Sci. 2021;27(2):159-67
doi: 10.5336/dentalsci.2020-74789
Article Language: TR
Full Text
ÖZET
 Amaç: Bu çalışmada farklı iskeletsel sınıflamaya sahip hastaların sagittal split ramus osteotomisi (SSRO) bölgelerindeki morfolojik farklılıklarının konik ışınlı bilgisayarlı tomografi (KIBT) ile değerlendirilmesi amaçlanmıştır. Gereç ve Yöntemler: Hastalar iskeletselsınıflamasına göre gruplandırılmıştır. Hastaların KIBT görüntüleri geriye dönük olarak incelenmiştir. Bu çalışmaya sınıf I iskeletsel yapıya sahip (n:12), sınıf II iskeletsel yapıya sahip (n:12) ve sınıf III iskeletsel yapıya sahip (n:12) toplamda 36 hasta dahil edilmiştir. SSRO'nun ramus alt kenarı, vertikal ve horizontal osteotomi alanlarıyla ilişkili toplamda 16 morfolojik parametrenin ölçümleri farklı iskeletsel sınıflar arasında karşılaştırılmıştır. İnferior alveolar sinirle ilişkili morfolojik parametreler birinci ve ikinci büyük azı diş bölgelerinde ölçülerek her iskeletsel sınıflama içerisinde karşılaştırılmıştır. Bulgular: İkinci mandibular büyük azının en distalinden mandibular foramene olan mesafe, sınıf III iskeletsel yapıya sahip hastalarda sınıf I iskeletsel yapıya sahip hastalardan daha uzundur (p<0,001). İkinci büyük azı hizasında mandibular kanalın bukkalindeki kortikal kemik kalınlığı, sınıf II iskeletsel yapıya sahip hastalarda sınıf I iskeletsel yapıya sahip hastalarla karşılaştırıldığında daha incedir (p=0.002). İkinci büyük azı hizasında mandibulanın inferior kortikal kemiği ile mandibular kanal arasındaki süngerimsi kemik miktarı, sınıf III iskeletsel yapıya sahip hastalarda sınıf I iskeletsel yapıya sahip hastalarla karşılaştırıldığında daha kalındır (p=0,010). Sonuç: Çalışmanın yazarları hastalar arası anatomik farklılıklar nedeniyle SSRO öncesinde KIBT alınmasını önermektedir. İntraoperatif komplikasyonların önlenmesi için SSRO sırasında hastaların morfolojik farklılıkları göz önünde bulundurulmalıdır.

Anahtar Kelimeler: Osteotomi; sagittal split ramus; komplikasyon; intraoperatif; morfoloji
ABSTRACT
 Objective: The present study aims to evaluate the morphological differences of mandibles with the different skeletal patterns at sagittal split ramus osteotomy (SSRO) sites using cone-beam computed tomography (CBCT). Material and Methods: Patients were grouped according to their skeletal classification. CBCT images of patients were retrospectively evaluated. The present study involved 36 CBCT images of patients having Class I skeletal pattern (n:12), Class II skeletal pattern (n:12) and Class III skeletal pattern (n:12). 16 different morphological parameters regarding the inferior border, horizontal and vertical osteotomy sites of SSRO were compared between different skeletal patterns. Morphometric parameters regarding the inferior alveolar nerve were measured at both first and second molar regions and they were compared for each skeletal pattern. Results: The distance from the most distal point of the second mandibular molar to the mandibular foramen was significantly longer in Class III patients than Class I patients (p<0.001). The cortical bone thickness in the second mandibular molar area was thinner in Class II patients when compared with Class I patients (p=0.002). The bone marrow between the mandibular canal and inferior cortical bone was thicker in Class III patients than Class I patients (p=0.010). Conclusion: The authors recommend the preoperative CBCT examination before SSRO due to anatomical variations between patients. Morphological differences of mandibles should be considered during the SSRO of the patients to prevent intraoperative complications.

Keywords: Osteotomy; sagittal split ramus; complication; intraoperative; morphology
REFERENCES:
  1. Trauner R, Obwegeser H. The surgical correction of mandibular prognathism and retrognathia with consideration of genioplasty. II. Operating methods for microgenia and distoclusion. Oral Surg Oral Med Oral Pathol. 1957;10(9):899-909. [Crossref] [PubMed] 
  2. Sant'Ana E, Souza DPE, Temprano AB, Shinohara EH, Faria PEP. Lingual short split: a bilateral sagittal split osteotomy technique modification. J Craniofac Surg. 2017;28(7):1852-4. [Crossref] [PubMed] 
  3. Watzke IM. Sagittal split osteotomy. In: Anderson L, Kahnberg K, Pogrel A, eds. Oral and Maxillofacial Surgery. Vol. III. 2nd ed. St. Louis: Elsevier Inc; 2009. p.87-118.
  4. Friscia M, Sbordone C, Petrocelli M, Vaira LA, Attanasi F, Cassandro FM, et al. Complications after orthognathic surgery: our experience on 423 cases. Oral Maxillofac Surg. 2017;21(2):171-7. [Crossref] [PubMed] 
  5. Muto T, Shigeo K, Yamamoto K, Kawakami J. Computed tomography morphology of the mandibular ramus in prognathism: effect on the medial osteotomy of the sagittal split ramus osteotomy. J Oral Maxillofac Surg. 2003;61(1):89-93. [Crossref] [PubMed] 
  6. Gasperini G, de Siqueira IC, Costa LR. Lower-level laser therapy improves neurosensory disorders resulting from bilateral mandibular sagittal split osteotomy: a randomized crossover clinical trial. J Craniomaxillofac Surg. 2014;42(5):e130-3. [Crossref] [PubMed] 
  7. Aarabi M, Tabrizi R, Hekmat M, Shahidi S, Puzesh A. Relationship between mandibular anatomy and the occurrence of a bad split upon sagittal split osteotomy. J Oral Maxillofac Surg. 2014;72(12):2508-13. [Crossref] [PubMed] 
  8. Arakeri G, Brennan PA. A guiding oblique osteotomy cut to prevent bad split in sagittal split ramus osteotomy: a technical note. Plast Aesthet Res. 2015;2(3):127-9. [Crossref] 
  9. Chortrakarnkij P, Lonic D, Lin HH, Yamaguchi K, Kim SG, Lo LJ. A modified technique of mandibular ramus sagittal split osteotomy for prevention of inferior alveolar nerve injury: a prospective cohort study and outcome assessment. Ann Plast Surg. 2017;78(3 Suppl 2):S108-16. [Crossref] [PubMed] 
  10. Teltzrow T, Kramer FJ, Schulze A, Baethge C, Brachvogel P. Perioperative complications following sagittal split osteotomy of the mandible. J Craniomaxillofac Surg. 2005;33(5):307-13. [Crossref] [PubMed] 
  11. Kaji M, Ohashi Y, Mutoh Y. Study of late sensory paralysis in the lower lip after sagittal split osteotomy. Part 2. Investigation of location of mandibular canal by computed tomography. Niigata Dent J. 1998;28:7-11. [Link] 
  12. Politis C, Lambrichts I, Agbaje JO. Neuropathic pain after orthognathic surgery. Oral Surg Oral Med Oral Pathol Oral Radiol. 2014;117(2):e102-7. [Crossref] [PubMed] 
  13. Steenen SA, van Wijk AJ, Becking AG. Bad splits in bilateral sagittal split osteotomy: systematic review and meta-analysis of reported risk factors. Int J Oral Maxillofac Surg. 2016;45(8):971-9. [Crossref] [PubMed] 
  14. Wang T, Han JJ, Oh HK, Park HJ, Jung S, Park YJ, et al. Evaluation of mandibular anatomy associated with bad splits in sagittal split ramus osteotomy of mandible. J Craniofac Surg. 2016;27(5):e500-4. [Crossref] [PubMed] 
  15. Ylikontiola L, Moberg K, Huumonen S, Soikkonen K, Oikarinen K. Comparison of three radiographic methods used to locate the mandibular canal in the buccolingual direction before bilateral sagittal split osteotomy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002;93(6):736-42. [Crossref] [PubMed] 
  16. Yang J, Cavalcanti MG, Ruprecht A, Vannier MW. 2-D and 3-D reconstructions of spiral computed tomography in localization of the inferior alveolar canal for dental implants. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1999;87(3):369-74. [Crossref] [PubMed] 
  17. Stratis A, Zhang G, Lopez-Rendon X, Politis C, Hermans R, Jacobs R, et al. Two examples of indication specific radiation dose calculations in dental CBCT and Multidetector CT scanners. Phys Med. 2017;41:71-7. [Crossref] [PubMed] 
  18. Wittwer G, Adeyemo WL, Beinemann J, Juergens P. Evaluation of risk of injury to the inferior alveolar nerve with classical sagittal split osteotomy technique and proposed alternative surgical techniques using computer-assisted surgery. Int J Oral Maxillofac Surg. 2012;41(1):79-86. [Crossref] [PubMed] 
  19. Tengku Shaeran TA, Shaari R, Abdul Rahman S, Alam MK, Muhamad Husin A. Morphometric analysis of prognathic and non-prognathic mandibles in relation to BSSO sites using CBCT. J Oral Biol Craniofac Res. 2017;7(1):7-12. [Crossref] [PubMed] [PMC] 
  20. Yeh AYE, Finn BP, Jones RHB, Goss AN. The variable position of the inferior alveolar nerve (IAN) in the mandibular ramus: a computed tomography (CT) study. Surg Radiol Anat. 2018;40(6):653-65. [Crossref] [PubMed] 
  21. Yamamoto R, Nakamura A, Ohno K, Michi KI. Relationship of the mandibular canal to the lateral cortex of the mandibular ramus as a factor in the development of neurosensory disturbance after bilateral sagittal split osteotomy. J Oral Maxillofac Surg. 2002;60(5):490-5. [Crossref] [PubMed] 
  22. Pavlíková G, Foltán R, Horká M, Hanzelka T, Borunská H, Sedý J. Piezosurgery in oral and maxillofacial surgery. Int J Oral Maxillofac Surg. 2011;40(5):451-7. [Crossref] [PubMed] 
  23. Schaeren S, Jaquiéry C, Heberer M, Tolnay M, Vercellotti T, Martin I. Assessment of nerve damage using a novel ultrasonic device for bone cutting. J Oral Maxillofac Surg. 2008;66(3):593-6. [Crossref] [PubMed] 
  24. Landes CA, Stübinger S, Ballon A, Sader R. Piezoosteotomy in orthognathic surgery versus conventional saw and chisel osteotomy. Oral Maxillofac Surg. 2008;12(3):139-47. [Crossref] [PubMed] 
  25. Ma J, Lu L. Computed tomography morphology of the mandibular ramus at the lingual plane in patients with mandibular hyperplasia. Int J Oral Maxillofac Surg. 2009;38(8):823-6. [Crossref] [PubMed] 

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