가토에서 편측 삼각봉합선 조기유합이 두개 안면골 성장에 미치는 영향

이두형,이안나,허승호,양원용 大韓成形外科學會 1998 Archives of Plastic Surgery Vol.25 No.3

Immobilization of unilateral(right) lambdoid suture was produced in 9-day-old rabbits to determine its effect on subsequent craniofacial growth. The suture was immobilized by the topical application of methyl-2-cyanoacrylate adhesive, subsequent growth effects on the cranial vault, cranial base and facial skeleton were assessed by serial radiographic cephalometry. The statistically significant result(p < 0.05) were: 1. The growth of immobilized lambdoid suture was decreased accompanying compensatory growth at coronal suture bilaterally. 2. The length of anterior and posterior cranial base was increased. 3. Anterior midfacial height was increased. 4. Lower midfacial angle(angular relationship of cranial base to lower midface) was decreased. With the view of above findings, it is clear that restricted growth was seen at unilateral lambdoid suture accompanying compensatory growth at coronal suture and resulted in altered cranial base and facial growth.

가토의 두개 삼각봉합선 조기유합이 두개안면골 성장에 미치는 영향

김영석,양원용 大韓成形外科學會 1996 Archives of Plastic Surgery Vol.23 No.5

Immobilization of the lambdoid suture was produced in 9-day-old rabbits to determine its effect on subsequent craniofacial growth. The suture was immobilized by the topical application of methyl-2-cyanoacrylate adhesive, subsequent growth effects on the cranial vault, cranial base and facial skeleton were assessed by serial radiographic cephalometry. The results statistically significant(P<0.05) are: 1. Reduction in growth at lambdoid suture accompanying compensatory growth at coronal suture. 2. Increased length of anterior and posterior cranial base. 3. Increased anterior midfacial height. 4. Reduction of lower midfacial angle(Angular relatioship of cranial base to lower midface). In the view of above findings, it is clear that restricted growth was seen at lambdoid suture accompanying compensatory growth at coronal suture and resulted in altered cranial base and facial growth.

Effect of Soft Diets on Craniofacial Growth in Mice

KIM, Joon-Hee 朝鮮奬學會 1988 學術論文集 Vol.17 No.-

The 300 C3H/He strain male mice were divided into 3 groups; solid, kneaded, and liquid diet groups. Each group was consisted of 5 cross-sectional subgroups, i.e. 3, 5, 7, 12 and 20 weeks sub-groups. X-ray pictures of their craniofacial complex were measured to investigate the extent and time that growth retardation can be recognized in the cranium. As the results, soft diets could retard craniofacial growth, although it accerelated body growth. Increase of height and depth of distal part of mandihle and all 3 dimensions of craniofacial complex were affected by taking soft diets through the growing period. Some of them were apparent even in weaning period. As the distal areas of both craniofacial complex and mandible are closelv related to jaw function, growth retardation of this area could be explained as the skeletal adaptation to the soft diets.

병인론에 근거한 성인 골격성 Ⅲ급 부정교합자의 분류와 그 prototype 제시를 위한 연구

홍순재,이충국 대한악안면성형재건외과학회 2000 Maxillofacial Plastic Reconstructive Surgery Vol.22 No.4

Skeletal class Ⅲ had been classified by the position of the maxilla, the mandible, the maxillary alveolus, the mandibular alveolus and vertical development. This morphologic approach is simple and useful for clinical use, but it is insufficient to permit understanding of the pathophysiology of dysmorphoses. The author hypothesizes that there are different patterns of mutual relation of the skeletal components which have contributed pathologic equilibrium of skeletal class Ⅲ. The purpose of this study are threefold: 1) to classify skeletal class Ⅲ in subgroups, which can show the architectural characteristics of the deformity, 2) to analyse the craniofacial architecture of each subgroup on etio-pathogenic basis, and 3) to characterize and visualize the pattern as a prototype. Materials used in this study were lateral cephalograms of 106 skeletal class Ⅲ adults, which were analysed with modified Delaire's architectural and structural analysis. Linear and angular measurements of the individual subject were obtained and cluster analysis was used for the subgrouping. Data were evaluated for verification of the statistical significances. The following results were obtained. 1.By the modified Delaire's architectural and structural analysis and cluster analysis, skeletal class Ⅲ adults were classified into 7 clusters and presented as prototypes, which could show the pathophysiology of the skeletal architecture 2.There was significant relationship in measurement variables of each cluster, which could reflect characteristics of the skeletal pattern of growth. 3.The flexure of cranial base had a close relationship to the anterior rotational growth of the maxilla and contributes to understand the etio-pathology of skeletal class Ⅲ. 4.The proportion of craniospinal area in cranial depth, craniocervical angle and vertical position of point Om had a close relationship to rotational growth of the mandible and direction of condylar growth. They contribute to understand the etio-pathology of skeletal class Ⅲ. In summary, the cranium and the craniocervical area must be considered in diagnosis and treatment planning of dentofacial deformity. And the occlusal plane can be considered as a representative which shows the mutual relationships of the skeletal components.

병인론에 근거한 성인 골격성 III급 부정교합자의 분류와 그 prototype 제시를 위한 연구

홍순재,이충국,Hong, Soon-Xae,Yi, Choong-Kook 대한악안면성형재건외과학회 2000 Maxillofacial Plastic Reconstructive Surgery Vol.22 No.4

Skeletal class III had been classified by the position of the maxilla, the mandible, the maxillary alveolus, the mandibular alveolus and vertical development. This morphologic approach is simple and useful for clinical use, but it is insufficient to permit understanding of the pathophysiology of dysmorphoses. The author hypothesizes that there are different patterns of mutual relation of the skeletal components which have contributed pathologic equilibrium of skeletal class III. The purpose of this study are threefold: 1) to classify skeletal class III in subgroups, which can show the architectural characteristics of the deformity, 2) to analyse the craniofacial architecture of each subgroup on etio-pathogenic basis, and 3) to characterize and visualize the pattern as a prototype. Materials used in this study were lateral cephalograms of 106 skeletal class III adults, which were analysed with modified Delaire's architectural and structural analysis. Linear and angular measurements of the individual subject were obtained and cluster analysis was used for the subgrouping. Data were evaluated for verification of the statistical significances. The following results were obtained. 1. By the modified Delaire's architectural and structural analysis and cluster analysis, skeletal class III adults were classified into 7 clusters and presented as prototypes, which could show the pathophysiology of the skeletal architecture 2. There was significant relationship in measurement variables of each cluster, which could reflect characteristics of the skeletal pattern of growth. 3. The flexure of cranial base had a close relationship to the anterior rotational growth of the maxilla and contributes to understand the etio-pathology of skeletal class III. 4. The proportion of craniospinal area in cranial depth, craniocervical angle and vertical position of point Om had a close relationship to rotational growth of the mandible and direction of condylar growth. They contribute to understand the etio-pathology of skeletal class III. In summary, the cranium and the craniocervical area must be considered in diagnosis and treatment planning of dentofacial deformity. And the occlusal plane can be considered as a representative which shows the mutual relationships of the skeletal components.

강직내고정이 성장기 가토의 두개안면골 성장에 미치는 영향

이종건,조문제 大韓成形外科學會 1994 Archives of Plastic Surgery Vol.21 No.2

Craniofacial surgery includes those surgical procedures to correct complex congenital and acquired deformities of cranial an facial bones. Miniplate and screw fixation has had a profound deffect on the recent development of craniofacial surgery. In recent years, craniofacial surgeons have extended the applicaion of rigid fixation on growth of the craniofacial skeleton is not entirely known and has not been qualified in infancy and childhood. This study is to determine which of the following theoretical possibilities : (1) craniofacial growth could continue unhindered by the rigid fixation, (2) growth could be limited either locally where the plate is applied or in an adjacent region, and (3) local growth restriction may be associated with a compensatory growth in an adjacent region. Thirty-one male New Zealand white rabbits weighing 500g to 600g were obtained immediately after weaning at the age of 6 to 7 weeks and were divided into 4 surgical groups. All rabbits in group Ⅰ,Ⅱ,Ⅲ, and Ⅳ were anesthetized with intramuscular ketamine 20 mg/kg. Identical midline sagittal skin incision was made in all operative groups. Periosteal elevation was performed with a periosteal elevator to the left of the midline over the nasal and frontal bone. In group I, a rotary saw was used to complete aosteotomy across the left frontonasal wuture with saline irrigtion. In group Ⅱ, 4 hole miniplates and self-tapping screws were used across the osteotomy lines. The plates and screws were removed after 4 weeks postoperatively under ketamine anesthesia. In rigid internal fixations were kept until sacrifice. In groupⅣ, interosseous wire techniques were used with 0.018 inch wires across the osteotomy lines. Skin and periosteum were closed with a running 4-0 chromic catgut sutures. All animals were housed and fed under identical conditions postoperatively for 12 weeks Dry skulls were made through the several steps. All dry skulls were taken photographs simultaneously with identical focal length and photographer. The 11 topographic landmarks made on each skull, and each landmarks were recorded using the image analysis system(Vidas, Kontron, Germany) interfaced with a personal computer. All digitizings were made by a single investigator. The results were as follows ; 1. Int group Ⅰand group Ⅳ,a significant growith restriction on the operated sides(P<0.05,P<0.05) was observed in nasoincisive suture length. However, no such changes were observed in nasal and cranial bone. 2. In group Ⅱ and group Ⅲ, more significant growth restriction on the operated side was observed in nasoincisive suture length(<0.0001,P<0.001), total length of lateral rim of nasal bone(P<0.001, )<0.0001), and nasal bone extent(P<0.005, P<0.001). But no such changes were observed in cranial bone. 3. A significant difference of mean length in nasal bone was observed on the operated side between group,Ⅰ,Ⅳand group Ⅱ,Ⅲ(P<0.05), but mean extent between group Ⅰand group Ⅲ only. The results showed that osteotomy and either plate or removal after union of growing craniofacial skeleton resulted in a statistically significant growth restriction on the operated side, with a statistically insignificant change on the osteotomy and wire fixation groups, when compared with unoperated sides. In conclusion, rigid internal fixation results in growth disturbance on growing craniofacial skeleton. It is recommended that the plates and screws are removed as early as possible after bony union.

저신장 소아에서 성장호르몬 치료가 두개안면필 성장에 미치는 영향

정성호,김진욱,박용훈,황충주,이희경 대한치과교정학회 2010 대한치과교정학회지 Vol.40 No.4

Objective: The purpose of this study was to analyze the effect of growth hormone treatment (GHT) on craniofacial growth in children of short stature. Methods: Nineteen untreated children of short stature were referred from the Pediatric Department, Yeungnam University Hospital as a subject group. All subjects had lateral cephalograms taken before, after 1 year and after 2 years of growth hormone treatment. As a reference group, we selected 19 normal children with paired sampling who matched the subjects' age and sex, from the Department of Orthodontics, Kyungpook National University Hospital. Results: Before GHT, anterior cranial base length and upper posterior facial height, posterior total facial height, mandibular ramus length, and mandibular corpus length were significantly smaller in the reference group. In angular craniofacial measurements, saddle angle and mandibular plane angle were larger. SNA and SNB were smaller in the reference group. After two years of GHT, growth hormone accelerated growth in several craniofacial components. The posterior total facial height, the anterior, posterior cranial base length, and the mandibular ramus length were increased. And the difference in mandibular plane angle and ANB values compared with the reference group was decreased. Conclusions: GHT over 2 years leads to a craniofacial catch-up growth tendency, which is pronounced in interstitial cartilage and condylar cartilage. 저신장이란 같은 연령 및 성별 소아들의 표준 신장 평균치에서 -2.0 SD 이하인 경우를 말한다. 본 연구의 목적은 저신장 소아의 두개안면골격의 특성을 분석하고, 성장호르몬 치료가 신장을 성장시킴과 동시에 두개안면골격에 어떤 영향을 주는지 알아보고자 함이다. 영남대학교 의과대학 부속병원 소아청소년과에서 저신장으로 진단받은 소아를 대상으로 성장 호르몬 치료 전 그리고 치료 후 1년, 2년 후 총 3회 측모 두부 방사선 규격 사진의 촬영을 시행하였다. 대조군은 경북대학교 치의학전문대학원 교정과에 소장된 한국인 평균 신장의 2 표준오차 내의 아동들을 대상으로 측모 두부 방사선 규격사진을 2년마다 10년간 촬영한 자료를 이용하여 저신장 소아의 연령과 성별을 기준으로 짝진 표집(paired sampling)을 하였다. 성장 호르몬 치료 전 저신장 소아는 작고 후퇴된 하악골과 편평한 두개저를 가지는 것으로 나타났다. 성장 호르몬 치료 후 anterior, posterior cranial base length, upper posterior facial height, lower anterior facial height, posterior total facial height, mandibular ramus length, mandibular corpus length와 overall mandibular length 성장량이 정상군에서의 2년 성장량과 비교했을 때 유의하게 큰 것으로 나타났으며 각도 계측에서는 saddle angle, mandibular plane angle과 ANB변화량이 정상군에서의 2년 성장량과 비교했을 때 큰 변화를 보이며 정상군의 평균치를 따라잡는 경향을 보였다. 성장 호르몬 치료는 불균형적인 성장의 징후 없이 정상화를 향한 성장(따라잡기 성장)을 나타내었으며 이는 특히 하악과두의 성장과 후안면고경의 성장을 촉진시켜 저신장 소아의 convex 한 profile을 완화하는 것으로 판단된다.

악안면 성장양상에 따른 하악이부 형태에 관한 연구

남현진,유영규 대한치과교정학회 1996 대한치과교정학회지 Vol.26 No.5

교정치료에 있어서 악안면 성장의 양상은 진단과 치료계획 수립에 있어서 매우 유용한 자료이며 교합의 달성 및 안모의 형태, 발육에 많은 영향을 미친다. 따라서 성장유형의 분류에 대한 많은 연구가 있었으며 성장예측을 위한 많은 시도가 있었다. 이에 본 연구에서는 성인 120명을 대상으로 치료전 측모두부계측 방사선사진을 이용하여 전안면고경에 대한 후안면고경의 비를 측정하여 56%-62%는 시계방향 성장군(36명), 65%-80%는 반시계방향 성장군(43명)으로, 그리고 62%-65%는 정상군(41명)으로 분류하고 이에 따른 하악이부의 형태와 돌출정도 평가를 시행한 결과 다음과 같은 결과를 얻었다. 1. 남녀 하악이부 형태비교에 있어서는 남자가 여자보다 이부의 높이와 돌출정도가 크게 나타났다. 2. 시계방향 성장군이 반시계방향 성장군에 비해 하악이부의 Height, H/D ratio, Actual length는 크게 나타났고, Depth, Angle, Effective length, E/A ratio는 작은 값을 나타냈다. 3. 악안면 성장양상에 있어 이부의 돌출정도가 작을수록 시계방향성장 경향을 나타내며, 돌출정도가 클수록 반시계방향성장 경향을 나타냈다. Craniofacial growth pattern is an important diagnostic data in the course of orthodontic diagnosis and treatment planning ; it also has great influence in the establishment of occlusion as well as shaping and development of face. There have been many studies to classify different craniofacial growth patterns and attempts to predict growth patterns. This study aimed to correlate craniofacial growth pattern and symphysis morphology. 120 adult patients with age from 19 to 39 (mean age :231) were chosen as subjects ; using lateral cephalometric films their anterior to posterior facial height ratios were calculated. They were divided into 3 groups - clockwise growth pattern with 56%-62%(36subjects), counter-clockwise growth pattern group with 65%-80%(43subjects) and normal growth pattern group with 62%-65%(41subjects). Symphysis morphology and prominence evaluation in each subject were studied and the following conclusions were drawn : 1. In comparison of symphysis morphology between the sex groups, men showed large symphysis height and prominence. 2. Concerning the symphysis morphology, the clockwise growth pattern group showed larger height, H/D ratio and actual length but smaller depth, angle, effective length and E/A ratio compared to the counter - clockwise growth pattern group. 3. Those with smaller prominance of symphysis showed clockwise growth tendency and those with larger prominance showed counter-clockwise growth tendency.

한국인 정상아동 6세~16세 악안면 성장에 관한 준종단적 연구

정미,황충주 대한치과교정학회 1999 대한치과교정학회지 Vol.29 No.1

교정치료의 대부분은 성장기 아동들이며 성장양태가 진단 및 치료목표와 계획, 교정치료 후 나타나는 효과등에 상당한 영향을 준다. 교정학 분야에서는 성장기 아동에서부터 성인에 이르기까지 폭넓은 연령층을 대상으로 정상적인 성장과 발육상태 여부를 판별하고 이를 근거로 비정상적인 성장변이를 치료하기 위해서 정상적인 아동들의 폭넓은 자료수집이 요구되며 그에 따른 기초연구가 필요하다. 본 연구는 6~16세아동의 악안면성장에 관한 자료를 수집하고 평가하기 위해 기초연구로 연령에 따른 한국인의 성장변화의 추이를 연구하였다. 성장자료의 수집방법중 각기 다른 연령층의 소표본에서 계측되고 동일기간 동안 관찰되는 많은 소표본으로 구성되는 준종단적인 방법을 택하였다. 본 연구는 전신적으로 특기할 만한 질환이 없고 성장발육상의 장애가 없으며 교정치료를 받은 경험이 없는 총 393명(남자 223명, 여자 170명)을 준종단적인 방법으로 만 3년간 두부방사선 사진을 채득하였고, McNamara분석 및 Ricketts분석법을 이용하여 두 개저, 두 개저와 상 · 하악골 관계, 하악골, 상 · 하악 치열관계의 5부분에 대하여 각 연령의 성장량, 각 연령군 간의 성장증감관계, 남녀비교 유의성검정을 연구한 바 다음과 같은 결론을 얻었다. 1. 두 개저에서는 Anterior Cranial Base항목에서 14, 15세군에서 남녀별 유의차를 보여 주었다. 2. 성장변화량 비교에서 Posterior Facial Height는 10~11세, 12~13세, 14~15세사이군에서 연령군간 유의차(P<0.01)를 보였고 연령증가에 따라 증가하였다. 3. Na perpendicular to A 항목에서 여자는 11~12세, 남자는 12~13세로 여자에서 남자보다 급성장시기가 더 빨리나타났으며, 상악 `A`점과 하악`Pg`점의 수평계측 비교시 상악보다 하악성장이 더 크게 나타났다. 4. 두 개저및 하악골에서 최대 급성장시기는 여자 11~12세, 남자 13~14세로 여자가 더 일찍 일어났다. 5. 상악 중절치는 연령이 증가함에 따라 더욱 순측경사되었고 하악 중절치와 A-Pg line거리, 하악중절치 경사도가 증가되었고 10세군에서 남녀 유의한 차를 보였다(P<0.05). In orthodontic field, it is very important to understand the normal growth, Such an understanding can be derived from observation of normal growth in various samples from children to adulthood, and this builds a foundation from which growth abnormally or variation can be defined. Thus, a broad data collection of normal children, as well as basic study reviewing such data become necessary. The relationship between the mean values of cephalometric measurements in Growth and Development was studied among the groups(boys and girls) of Korean children from the ages 6-years to 16-years. 220 by 170 girls were chosen as subjects : Cephalometric X-ray were taken for 3 years and hard tissue analysis on McNamara and Ricketts Analysis which was divided into measurements of 5 parts(Cranial base, Cranial base and Maxilla & Mandible, Maxilla and Mandible, Mandible, Dental measurements). The relationship of craniofacial growth was studied. The following conclusions were obtained: 1. There were statistically significant differences in anterior cranial base between the two sexes of 14 and 15-year groups. 2. In comparison of growth amounts among different age groups, statistically singificant difference in Posterior facial height exhisted among 10~11, 12~13 and 14~15 year-old interval groups. This pattern increased with aging. 3. Na perpendicular to A showed earlier growth peak in females(11~12years) than males(12-13years). When horizontal measurements of point A and Pogonion are compared, mandibular growth appeared to be greater. 4. Maximum growth peak of cranial base and mandible was earlier in females(11-12years) than males(13-14years). 5. Upper central incisor flared out with aging, and there were increases in lower incisor to A-Pg, and lower incisor inclination There was significant difference between the two sexes 10-year-old group.

가토의 두개안면골봉합선의 견고한 고정이 골성장에 미치는 영향

하성윤,한기환,강진성 大韓成形外科學會 1998 Archives of Plastic Surgery Vol.25 No.7

Plate and screw fixation has had a profound effect on the recent development of craniofacial surgery. Rigid fixation of the facial skeleton by using plate and screw has become routine in adults, many craniofacial surgeons have expanded its use to the pediatric patient. The effects of microplate and screw fixation on subsequent craniofacial growth, however, have not been qualified in infancy and childhood. Sixty white male rabbits, 4 weeks old and weighing 400 gm, were divided into 5 groups. Each group contains 12 rabbits. Group 1 was control and group 2 was sham. They operated periosteal elevation to the right of the midline over the nasal and frontal bone. Group 3: 2-hole microplate and screws were placed in the right nasofrontal suture. Group 4: 2-hole microplate and screws were placed in the right nasomaxillary suture. Group 5: microplates and screws were placed in the right nasofrontal and nasomaxillary suture. All rabbits were killed at 18 weeks postoperatively. We analyzed the changes in morphology to the result of differences in growth between the operated and unoperated group by direct osteometry on dry skull preparations, and the structures of the constrained suture were analysed under light microscopy. Periosteal elevation alone (sham group) showed no discenible change in the shape of craniofacial bone except localized periosteal thickening. Nasofrontal suture plating showed periosteal thickening and bony resorption around the plate, nasal flattening of plated side, an increase in the width of the nasal bone on the plated side, a slight nasal deviation (mean 2.0 degrees) to the plated side, and frontal displacement of microplate and screws. Nasomaxillary suture plating showed periosteal thickening and bony resorption around the plate, nasal flattening of plated side, a decrease in the width of the nasal bone on the plated side, and nasal displacement of microplate and screws. Nasofrontal and nasomaxillary suture plating showed periosteal thickening and bony resorption around the plate, nasal depression of plated side, a decrease in the width of the nasal bone on the plated side, a significant nasal deviation (mean 5.2 degrees) to the plated side, and frontal and nasal displacement of microplates and screws. The findings of this study show that the use of microplate and screw fixation of the growing craniofacial skeleton in the rabbit model leads to little evidence of localized growth retardation. But their use in the pediatric population should be viewed cautiously, because secondary growth disturbances can be produced with the use of these fixation devices. Careful observation of early and late growth is mandatory when microplates are used in the pediatric patient. It is recommended that the plates and screws are removed as soon as possible their bony union.