전산화단층촬영 방사선영상을 이용한 이공과 하악관 전방고리의 형태학적 분석
Morphological Analysis of the Mental Foramen and Anterior Loop of the Mandibular Canal using Computed Tomography
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이공과 하악관 전방고리는 악골의 외과적 술식에서 중요한 기준점이 된다. 이번 연구의 목적은 전산화단층촬영를 이용해 이공과 하악관 전방고리의 형태를 분석하고, 이를 임상에 적용하기 위함이다. 외과적 수술이 계획된 96명(남성 33명, 여성 63명, 연령범위 17 ~ 43세, 평균연령 24.6 ± 4.99세)의 환자를 대상으로 전산화단층촬영을 시행하였다. 전산화단층촬영 방사선영상에서 이공의 수평적, 수직적 위치, 치근첨과의 거리를 측정하였고, 하악관 전방고리는 치근첨에서의 거리, 협측 측방각도를 측정하였다. 이공의 위치는 하악 제2소구치 하방이 81례(46.0%)로 가장 많았으며, 하악 제1소구치와 제2소구치사이에 존재하는 경우는 67례(38.0%)로, 하악 제2소구치와 제1대구치 사이에 존재하는 경우는 19례(10.2%)로 나타났다. 이공과 하악골 하연과의 평균거리는 12.20 ± 1.77 ㎜, 이공과 치근첨과의 평균거리는 5.16 ± 0.98 ㎜. 하악관 전방고리의 평균 길이는 5.80 ± 2.00 ㎜로 나타났다. 하악관 전방고리에 대한 협측 각도는 47.7 ± 9.07˚로 나타났다. 치근첨과 이공과의 거리는 파노라마 영상에서는 5.16 ± 0.98 ㎜로 나타났고, 전산화단층촬영영상에서는 6.2 ± 3.07 ㎜로 나타났다. 이공과 하악관의 평균거리는 5.39 ± 1.62 ㎜로 나타났다. 임플란트를 포함한 악골의 외과적 술식에서 이신경의 손상 및 외과적 외상의 위험을 최소화하고 최적의 수술결과를 얻기 위해서는 이공과 하악관 전방고리의 형태와 위치에 대한 정확한 평가가 이뤄져야 한다. 전산화단층촬영 영상은 이러한 해부학적 구조를 찾는데 유용할 것으로 생각된다.
Abstract
The mental foramen and anterior loop of the mandibular canal are important landmarks for mandibular surgical procedures. The purpose of this study was to analyze the shape and position of the mental foramen and anterior loop of the mandibular canal on the computed tomography (CT) images, and apply the results clinically. CT images of 96 patients (33 male, 36 female, age range 17~43 years, mean 24.6 ± 4.99 years) were enrolled. The horizontal and vertical position of the mental foramen, as well as the distance from the root apices were measured. The distance of the anterior loop of the mandibular canal to the root apices, and the buccal angle were measured. The mental foramen was found mostly below the second premolar observed in 81 cases (46.0%), between the first and second premolars in 67 cases (38.0%), and between the second premolar and first molar in 19 cases (10.2%). The mean distance between the mental foramen and the lower border of the mandible was 12.20 ± 1.77 ㎜, the mean distance between the mental foramen and root apex was 5.16 ± 0.98 ㎜. The mean distance of the anterior loop of the mandibular canal was 5.80 ± 2.00 ㎜. The buccal angle measured at 47.7 ± 9.07˚. The distance between the root apex and mental foramen measured as 5.16±0.98 ㎜ on panoramic radiography, and 6.2 ± 3.07 ㎜ on CT. The mean distance between the mental foramen and mandibular canal was 5.39 ± 1.62 ㎜. When performing surgical procedures such as installing dental implants, it is important to minimize surgical trauma, especially the risk of damage to the mental nerve. To optimize the surgical outcome, a careful assessment of the shape and position of the mental foramen and the anterior loop of the mandibular canal must be made. CT images are useful for finding such anatomic structures.
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