Skeletne promene kod bolesnika sa mandibularnim prognatizmom nakon mandibularne i bimaksilarne hirurgije – komparativna rendgenkraniometrijska studija
Sažetak
Uvod/Cilj. Maksilarna i bimaksilarna hirurgija dobila je nedavno primat u hirurškim korekcijama deformiteta klase III. Cilj ovog istraživanja je bio da se uporede promene u skeletnim odnosima kod bolesnika sa mandibularnim prognatizmom posle bimaksilarne operacije. Metode. Ispitivanjem je obuhvaćeno 70 ispitanika podeljenih u tri grupe. Dvadeset ispitanika klase III eksperimentalne grupe 1 podvrgnuto je bilateralnoj sagitalnoj ramus osteotomiji, a dvadeset ispitanika eksperimentalne grupe 2 podvrgnuto je bimaksilarnoj operaciji. Kontrolnu grupu činilo je 30 ispitanika sa skeletnom klasom I i fiziološkom okluzijom. Rendgen-kraniometrijsko istraživanje obavljeno je na 110 bočnih telerendgen snimaka urađenih kod ispitanika u eksperimentalnim grupama 1 i 2 pre i posle operacije i ispitanika kontrolne grupe. Koristeći kompjuterski program „Dr.Ceph”, na svakom telerendgenu analizirano je 30 linearnih i ugaonih skeletnih varijabli. Rezultati. Bimaksilarna osteotomija promenila je većinu varijabli koje karakterišu mandibularni prognatizam. Promene u sagitalnoj ravni uključuju značajan porast ugla maksilarnog prognatizma (SNA) (od 4º u proseku) i ugla gagitalnog odnosa tela gornje i donje vilice (ANB) ugla (6°), značajno smanjenje uglova ugao mandibularnog prognatizma (SNB) (3º), ganialnog ugla (ArGoMe) (8°), donjeg gonialnog ugla (NGoMe) (6,2º), i Bjorkovog poligona (7°). Vertikalni odnosi su normalizovani značajnim smanjenjem ukupne prednje visine lica N-Me (od 5 mm u proseku), prednje donje visine lica (ANB-Me) (4 mm), povećanjem ukupne zadnje visine lica M-Go (2,5–3 mm), zadnje donje visine lice PNS-Go (4 mm), i značajnim smanjenjem mandibularnih uglova. Zaključak. U poređenju sa izolovanom mandibularnom operacijom bimaksilarna hirurgija menja efikasnije sagitalne i vertikalne skeletne odnose kod bolesnik sa deformitetima klase III i uspešnije harmonizuje ceo skeletni profil lica.
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