안면비대칭의 외과적 교정
Facial asymmetry: Critical element of clinical successful treatment
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안면비대칭의 빈도는 21~85%이며, 상당수는 상안모 보다는 하안모의 비대칭이 나타난다. ‘대칭’이라는 용어는 사물의 좌측과 우측이 거울상(mirrorimage)과 같이 수학적으로 동일한 것이다. 그렇지만, 인간의 두개안면부에서 이러한 수학적인 대칭은거의 찾아보기 힘들다. Ferrario 등5)은 디지털 사진을 이용하여 건강한 정상인의 교합면 경사를 측정한결과, 2.15°에서 2.90°정도의 기울기가 관찰되었다. 비대칭이 있다고 해서 일반인이 곧바로 인식하기는 어려울 수 있으며, Haraguchi 등의 menton의 변이(deviation) 연구에서 두부규격 방사선사진과 비교할 때 사진으로 판단 시에는 55.6%만 검출되었다. 직관적인 판단에 의해 인식되는 안면비대칭은 치아의 부정교합과 연조직의 보상적 부피 변화 및 두부 자세 등으로도 가려질 수 있으며, 궁극적으로는 사람의 비대칭에 대한 인식역이 존재하여 어느 정도의 범위를 벗어나야‘비대칭’을 인식할 수 있다. 교합면의 경사에대해서는 3°가 기울면 관찰자의 50%정도가 비대칭을인식하고, 4°가 기울었을 때, 90% 정도가 비대칭을인식한다고 한다.
Abstract
The facial asymmetries include maxillary, mandibular, and chin asymmetries, although the most common deformity is primarily in the mandible. Common causes of this type of asymmetry can include asymmetric growth of the condyle or the mandible. In these patients, the location of the Me would be deviated to the shorter side because of the asymmetric growth of the mandible, and, commonly, the maxillary occlusal plane would be tilted toward the deviated side because the maxilla likely grows asymmetrically according to the pattern of asymmetric mandibular growth. Three-dimensional CT images are ideal for evaluating the size and location of anatomic structures, and such reconstructed images allow the use of software that can show anatomic structures from numerous angles, allowing actual measurements of distances and angles without problems of magnification, distortion, or superimposition caused by 2-dimensional imaging. In the present study using 3D-CT imaging, the 8 parameters, including measurements of the upper midline deviation, maxillary canting in the canine and first molar regions, width of the upper arch, width of the mandible at the Go, vertical length of the ramus, inclination of the ramus, and deviation of the Me were easily measured. The dentition should be orthodontically decompensated and dental midline should ensure incisor midlines positioned in the midline of each jaw before surgical correction. Surgical correction could be considered such as canting or yawing correction in the frontal or horizontal aspect, respectively.
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