77

Cephalometric Analysis for Orthognathic Surgery

Embed Size (px)

Citation preview

Page 1: Cephalometric Analysis for Orthognathic Surgery
Page 2: Cephalometric Analysis for Orthognathic Surgery

CEPHALOMETRIC ANALYSIS FOR ORTHOGNATHIC SURGERY

Dr. Mohd Ullah KhanDept of Othodontics & Dentofacial OrthopedicsCIDS

Page 3: Cephalometric Analysis for Orthognathic Surgery

CONTENTS

INTRODUCTION CHARACTERISTICS LANDMARKS CHARLES.J.BURSTONE ANALYSIS CONCLUSION REFERENCES

Page 4: Cephalometric Analysis for Orthognathic Surgery

INTRODUCTION

Developed in University of connecticut

The successful t/t of orthognathic surgical pt is dependent of careful diagnosis.

This system describes H and V position of facial bones Size of bone—linear measurement Shape ----angular measurements

Page 5: Cephalometric Analysis for Orthognathic Surgery

CHARACTERISTICS

1. The chosen landmarks and measurements can be altered by various surgical procedures.

2. The comprehensive appraisal includes all of the facial bones and a cranial base reference.

3. Measurements can be readily transferred to a study cast for mock surgery.

4. Critical facial skeletal components are examined.5. For variations in age and sex standards are available.6. Computerized systematic approach to measurement can be

used.

Page 6: Cephalometric Analysis for Orthognathic Surgery

LANDMARKS

Page 7: Cephalometric Analysis for Orthognathic Surgery

Sella (S)

CHARLES J BURSTONE,J ORAL SURGERY...VOL 36,APRIL 1978

Page 8: Cephalometric Analysis for Orthognathic Surgery

Nasion (N) –

CHARLES J BURSTONE,J ORAL SURGERY...VOL 36,APRIL 1978

Page 9: Cephalometric Analysis for Orthognathic Surgery

May 1, 2023CHARLES J BURSTONE,J ORAL SURGERY...VOL 36,APRIL 1978

9Articulare (Ar)

Page 10: Cephalometric Analysis for Orthognathic Surgery

May 1, 2023CHARLES J BURSTONE,J ORAL SURGERY...VOL 36,APRIL 1978

10 Pterygomaxillary fissure (PTM)

Page 11: Cephalometric Analysis for Orthognathic Surgery

May 1, 2023CHARLES J BURSTONE,J ORAL SURGERY...VOL 36,APRIL 1978

11

Subspinale (A) –

Page 12: Cephalometric Analysis for Orthognathic Surgery

May 1, 2023CHARLES J BURSTONE,J ORAL SURGERY...VOL 36,APRIL 1978

12 Pogonion (Pog)

Page 13: Cephalometric Analysis for Orthognathic Surgery

May 1, 2023CHARLES J BURSTONE,J ORAL SURGERY...VOL 36,APRIL 1978

13Supramentale (B)-

Page 14: Cephalometric Analysis for Orthognathic Surgery

May 1, 2023CHARLES J BURSTONE,J ORAL SURGERY...VOL 36,APRIL 1978

14 Anterior nasal spine (ANS) –

Page 15: Cephalometric Analysis for Orthognathic Surgery

May 1, 2023CHARLES J BURSTONE,J ORAL SURGERY...VOL 36,APRIL 1978

15Menton (Me) –

Page 16: Cephalometric Analysis for Orthognathic Surgery

May 1, 2023CHARLES J BURSTONE,J ORAL SURGERY...VOL 36,APRIL 1978

16

Gnathion (Gn)

Page 17: Cephalometric Analysis for Orthognathic Surgery

May 1, 2023CHARLES J BURSTONE,J ORAL SURGERY...VOL 36,APRIL 1978

17 Posterior Nasal Spine (PNS)

Page 18: Cephalometric Analysis for Orthognathic Surgery

May 1, 2023CHARLES J BURSTONE,J ORAL SURGERY...VOL 36,APRIL 1978

18 Mandibular plane (MP) –

Page 19: Cephalometric Analysis for Orthognathic Surgery

May 1, 2023CHARLES J BURSTONE,J ORAL SURGERY...VOL 36,APRIL 1978

19 Nasal Floor (NF)

Page 20: Cephalometric Analysis for Orthognathic Surgery

May 1, 2023CHARLES J BURSTONE,J ORAL SURGERY...VOL 36,APRIL 1978

20 Gonion (Go)

Page 21: Cephalometric Analysis for Orthognathic Surgery

7HP

Horizontal plane

CHARLES J BURSTONE,J ORAL SURGERY...VOL 36,APRIL 1978

Page 22: Cephalometric Analysis for Orthognathic Surgery

Hard tissue analysis Cranial base Horizontal profile Vertical height - dental & skeletal Maxilla & mandible Dental

Page 23: Cephalometric Analysis for Orthognathic Surgery

Cranial base

1. Ar-N (||HP)

2. Ar-Ptm (||

HP)

Page 24: Cephalometric Analysis for Orthognathic Surgery

Ar-PTM

Ar-N

Ar-N(||HP)(in mm) (F) 50 +3(M) 52.8 + 4.1

Ar-Ptm(||HP)(in mm) (F) 32.8 +1.9(M) 37.1 + 2.8

Ar-PTM is measured to determine horizontal distance b/w post aspect of maxilla and mand.. Greater the distance bt Ar-ptm mandible placed post to maxilla

Page 25: Cephalometric Analysis for Orthognathic Surgery

HORIZONTAL PROFILE

1.N-A-Pog(Angle)2. N-A(|| HP)3. N-B(|| HP)4. N-Pog(|| HP)

CHARLES J BURSTONE,J ORAL SURGERY...VOL 36,APRIL 1978

Page 26: Cephalometric Analysis for Orthognathic Surgery

May 1, 2023CHARLES J BURSTONE,J ORAL SURGERY...VOL 36,APRIL 1978

26

N-A-Pog (F)2.6° + 5.1° (M)3.9° + 6.4°

N

A

Pog

• Degree of skeletal convexity.

Page 27: Cephalometric Analysis for Orthognathic Surgery

.

N-A(||HP) (in mm)(F) -2 + 3.7(M) 0 + 3.7

Page 28: Cephalometric Analysis for Orthognathic Surgery

.

N-B(||HP) (in mm) (F) -6.9 + 4.3 (M) -5.3 + 6.7

Page 29: Cephalometric Analysis for Orthognathic Surgery

..

N-Pog(||HP) (in mm)(F) -6.5 + 5.1(M) -4.3 + 8.5

Page 30: Cephalometric Analysis for Orthognathic Surgery

VERTICAL HEIGHT - SKELETAL

Vertical Skeletal &

Dental

Anterior

N-ANS ANS-Gn

posterior

PNS-N MP-HP

Page 31: Cephalometric Analysis for Orthognathic Surgery

May 1, 2023CHARLES J BURSTONE,J ORAL SURGERY...VOL 36,APRIL 1978

31

HP

ANS

NN-ANS ( in mm) (F) 50 + 2.4 (M) 54.7 + 3.2

Page 32: Cephalometric Analysis for Orthognathic Surgery

May 1, 2023CHARLES J BURSTONE,J ORAL SURGERY...VOL 36,APRIL 1978

32

HP

Gn

ANS

ANS-Gn (in mm) (F) 61.3 + 3.3 (M) 68.6 + 3.8

Page 33: Cephalometric Analysis for Orthognathic Surgery

May 1, 2023CHARLES J BURSTONE,J ORAL SURGERY...VOL 36,APRIL 1978

33

HP

PNS

N PNS-N (F) 50.6 + 2.2 (M) 53.9 + 1.7

Page 34: Cephalometric Analysis for Orthognathic Surgery

May 1, 2023CHARLES J BURSTONE,J ORAL SURGERY...VOL 36,APRIL 1978

34

HP NMP-HP angle (F) 24.2° + 5° (M) 23.0° + 5.9°

Page 35: Cephalometric Analysis for Orthognathic Surgery

May 1, 2023CHARLES J BURSTONE,J ORAL SURGERY...VOL 36,APRIL 1978

35 VERTICAL HEIGHT - DENTAL

Vertical dental

dysplasia

Ant

U1-NF L1-MP

post

U6-NF L6-MP

Page 36: Cephalometric Analysis for Orthognathic Surgery

May 1, 2023CHARLES J BURSTONE,J ORAL SURGERY...VOL 36,APRIL 1978

36

HP N U1-NF (in mm) (F) 27.5 + 1.7 (M) 30.5 + 2.1

Page 37: Cephalometric Analysis for Orthognathic Surgery

May 1, 2023CHARLES J BURSTONE,J ORAL SURGERY...VOL 36,APRIL 1978

37

HP N l1-MP (in mm) (F) 40.8 + 1.8 (M) 45.0 + 2.1

Page 38: Cephalometric Analysis for Orthognathic Surgery

May 1, 2023CHARLES J BURSTONE,J ORAL SURGERY...VOL 36,APRIL 1978

38

HP N U6-NF (in mm) (F) 23.0 + 1.3 (M) 26.2 + 2.0

Page 39: Cephalometric Analysis for Orthognathic Surgery

May 1, 2023CHARLES J BURSTONE,J ORAL SURGERY...VOL 36,APRIL 1978

39

HP N L6-MP (in mm) (F) 32.1 + 1.9 (M)35.8 + 2.6

Page 40: Cephalometric Analysis for Orthognathic Surgery

May 1, 2023CHARLES J BURSTONE,J ORAL SURGERY...VOL 36,APRIL 1978

40 MAXILLA & MANDIBLE

PNS-ANS (||HP) Ar-Go Go-Pog B-Pog (||MP) Ar-Go-Gn (°)

Page 41: Cephalometric Analysis for Orthognathic Surgery

May 1, 2023CHARLES J BURSTONE,J ORAL SURGERY...VOL 36,APRIL 1978

41

HP N PNS-ANS(in mm) (F)52.6 + 3.5 (M)57.7 + 2.5

Page 42: Cephalometric Analysis for Orthognathic Surgery

May 1, 2023CHARLES J BURSTONE,J ORAL SURGERY...VOL 36,APRIL 1978

42

Ar-Go (in mm) (F) 46.8 + 2.5 (M) 52.0 + 4.2

Page 43: Cephalometric Analysis for Orthognathic Surgery

May 1, 2023CHARLES J BURSTONE,J ORAL SURGERY...VOL 36,APRIL 1978

43

B-Pog (in mm) (F) 7.2 + 1.9 (M) 8.9 + 1.7

Page 44: Cephalometric Analysis for Orthognathic Surgery

May 1, 2023CHARLES J BURSTONE,J ORAL SURGERY...VOL 36,APRIL 1978

44

Ar-Go-Gn (in °) (F) 122°+ 6.9° (M) 119.1° + 6.5°

Page 45: Cephalometric Analysis for Orthognathic Surgery

May 1, 2023CHARLES J BURSTONE,J ORAL SURGERY...VOL 36,APRIL 1978

45 DENTAL

OP-HP (angle) A-B(||0P) U1-NF (angle) L1-MP (angle)

Page 46: Cephalometric Analysis for Orthognathic Surgery

OP-HP angle

Page 47: Cephalometric Analysis for Orthognathic Surgery

May 1, 2023CHARLES J BURSTONE,J ORAL SURGERY...VOL 36,APRIL 1978

47

HP NOP-HP angle (F) 7.1 + 2.5 (M) 6.2 + 5.1

Page 48: Cephalometric Analysis for Orthognathic Surgery

May 1, 2023CHARLES J BURSTONE,J ORAL SURGERY...VOL 36,APRIL 1978

48

HP N A-B(||0P) (in mm) (F) -0.4 + 2.5 (M) -1.1 + 2

Page 49: Cephalometric Analysis for Orthognathic Surgery

May 1, 2023CHARLES J BURSTONE,J ORAL SURGERY...VOL 36,APRIL 1978

49

HP NU1-NF angle (F) 112° + 5.3 (M) 111° + 4.7

Page 50: Cephalometric Analysis for Orthognathic Surgery

May 1, 2023CHARLES J BURSTONE,J ORAL SURGERY...VOL 36,APRIL 1978

50

HP N L1-MP angle (F) 95.9° + 9.7 (M) 95.9° + 5.2

Page 51: Cephalometric Analysis for Orthognathic Surgery

SOFT TISSUE Landmarks used for the analysis

Page 52: Cephalometric Analysis for Orthognathic Surgery

GLABELLA

GLABELLA

Page 53: Cephalometric Analysis for Orthognathic Surgery

COLUMELLA POINT

COLUMELLA POINT

Page 54: Cephalometric Analysis for Orthognathic Surgery

SUBNASALE

Page 55: Cephalometric Analysis for Orthognathic Surgery

LABRALE SUPERIUS

Page 56: Cephalometric Analysis for Orthognathic Surgery

STOMION SUPERIUS

Page 57: Cephalometric Analysis for Orthognathic Surgery

LABRALE INFERIUS

Page 58: Cephalometric Analysis for Orthognathic Surgery

STOMION INFERIUS

Page 59: Cephalometric Analysis for Orthognathic Surgery

SOFT TISSUE POGONION

Page 60: Cephalometric Analysis for Orthognathic Surgery

SOFT TISSUE MENTON

Page 61: Cephalometric Analysis for Orthognathic Surgery

CERVICAL POINT

Page 62: Cephalometric Analysis for Orthognathic Surgery

SOFT TISSUE GNATHION

Page 63: Cephalometric Analysis for Orthognathic Surgery

Horizontal analysis of the soft tissue profile

Page 64: Cephalometric Analysis for Orthognathic Surgery

Facial Form Angle of convexity G to Sn and Sn to Pog Mean Value is 12 degree with a

standard deviation of 4 degree

Page 65: Cephalometric Analysis for Orthognathic Surgery
Page 66: Cephalometric Analysis for Orthognathic Surgery

So to define the anterior posterior position of the jaws two soft tissue measures are taken.

Sn point to G perp : 6 +/- 3 mm

Pog’ point to G perp : 0 +/- 4 mmm

Page 67: Cephalometric Analysis for Orthognathic Surgery

Lower cervicofacial angle Formed by the

intersection of Sn – Gn’ and Gn’ – C lines.

Mean Value is 100 degree with a SD of 7 degree.

.

Page 68: Cephalometric Analysis for Orthognathic Surgery

1. Height of the mid third of the face/ height of the lower third ( A / B)

Page 69: Cephalometric Analysis for Orthognathic Surgery

Height of the lower third of the face increases in : a) Maxillary vertical over growth b) Class 3 patients with vertical height increase c) Skeletal open bites Height of the lower third of the face decreases in : a) Maxillary Vertical undergrowth b) Mandibular retrusion with deep bite c) Vertical undergrowth of the chin

Page 70: Cephalometric Analysis for Orthognathic Surgery

Nasolabial Angle

Formed by the intersection of lines Cl-Sn and Sn-Ls.

Mean Value is 102 degree with a standard deviation of 8 degree.

Page 71: Cephalometric Analysis for Orthognathic Surgery

A-P Lip PositionLine drawn from Subnasale to soft tissue Pog to Ls 3mm

Line drawn from Subnasale to soft tissue Pog to Li 2mm

Page 72: Cephalometric Analysis for Orthognathic Surgery

Labiomental sulcus

Sulcus perp to Li-Pog

4 mm normal

Page 73: Cephalometric Analysis for Orthognathic Surgery

MAXILLARY INCISORS EXPOSURE

2mm is desirable.

Page 74: Cephalometric Analysis for Orthognathic Surgery

INTERLABIAL GAP

Lightly touching to approximately 2mm apart.

Page 75: Cephalometric Analysis for Orthognathic Surgery

CONCLUSION

• A simplified and relevant ceph analysis has been developed that is applicable to planning tt for pt requiring orthognathic surgeries.

• This analysis evaluates both hard tissue and soft tissue with both vertical as well as horizontal aspects of the face.

• If a prime pbjective of orthognathic surgery is facial improvement, soft tissue analysis becomes paramount in treatment planning

Page 76: Cephalometric Analysis for Orthognathic Surgery

REFERENCES

Page 77: Cephalometric Analysis for Orthognathic Surgery