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Comparison of Relapse Pattern after Two-jaw Surgery in Two Cleft Patients

대한구순구개열학회지 2017년 20권 2호 p.9 ~ 20

박윤희, 백승학,

소속 상세정보

박윤희 ( Park Yoon-Hee ) - 서울대학교 치의학대학원 치과교정학교실
백승학 ( Baek Seung-Hak ) - 서울대학교 치의학대학원 치과교정학교실

KMID : 0952820170200020009

Abstract

This article presents two cleft patients treated with orthognathic surgery, which showed different relapse pattern after two-jaw surgery. The high relapse case was unilateral cleft lip and palate, the low relapse case was bilateral cleft lip and palate. Both cases underwent two-jaw surgery after growth completion. Differences in the surgical movement of the maxilla and mandible in two cases were as follows. First, although both cases showed backward movement (ΔB-H, -12.6 mm vs. -8.9 mm) and clockwise rotation of the mandible, the amount of clockwise rotation was significantly larger in the high relapse case than the low relapse case (ΔFMA, 17.4° vs 3.3°). Second, both cases showed clockwise rotation of the maxilla by forward movement of the maxilla and elongation of the maxillary anterior portion in the high relapse case (ΔA-H, 4.5 mm; ΔA-V, 6.2 mm) and impaction of the maxillary posterior portion without forward movement of the maxilla in the low relapse case (ΔA-H, 0.9 mm; ΔA-V, 2.0 mm). Two cases showed different relapse pattern after two-jaw surgery. First, while the high relapse case exhibited significant advancement of the mandible, the relapse of the mandible was minimal (ΔB-H, 4.4 mm vs. 0.8 mm). Second, the vertical relapse of the maxilla occurred in the high relapse case, but the maxilla of the low relapse case was stable (ΔA-V, -3.6 mm vs. -0.7 mm). Third, although the maxillary incisors of both cases was tipped labially, the amount of labioversion was lager in high relapse case than the low relapse case (ΔU1-SN, 7.1° vs. 4.3°). In order to prevent significant post-surgical relapse of the mandible in cleft patients, several surgical methods that can reduce unnecessary clockwise rotation of the mandible and increase the vertical stability of maxilla are required.