잇몸과다노출미소의 새로운 교정 방법: 상순거근봉양술

Abstract

For decades, many surgical techniques have been devised for correction of the gummy smile including mucosal resection, myectomy, the implant spacer technique, and osseous shortening of the alveolar-maxillary complex in case of vertical maxillary excess. However there are several problems in those techniques: the mucosal resection and the myectomy tends to recur, there would be the morbidity of the implant in the implant spacer technique, and the osseous shortening of the alveolar-maxillary complex is a procedure for the long face syndrome. Our technique is freeing the levator labii suprioris muscles and cinching them to the anteroinferior nasal septal cartilage for loss of muscle action. Seventeen patients(14 females and 3 males; mean age, 24 years) underwent operations. Preoperative photogrammetric analysis indicated the range of gum exposure when smiling was 2.0 - 9.0 mm(mean, 3.8 mm) and the maxillary lip length in repose was 17.0 - 29.0 mm(mean, 23.1 mm). Three to 31 months(mean, 12 months) after the operation, the results were analysed using the Wilcoxon signed ranks test. The postoperative gum exposure was ranged 0.0 - 4.0 mm(mean, 0.4 mm) (-3.4 mm, p< 0.05). And the maxillary lip length was elongated about 4%(+1.0 mm, p< 0.05). Results were also analyzed clinically by the ordinary scale method. The gum exposure when smiling was excellent and the nature of the smile was good. Upper lip stiffness developed in all patients, but resolved completely within 1 month after the operatio. Hypesthesia of the upper lip was noted in 8 cases, but also disappeared within 2 months. Additionally, this technique resulted in narrowing of the interalar distance. Our technique is effective in correcting a gummy smile, but would not be recommended for patients with an abnormally narrow interalar distance.

저자들은 양쪽 상순거근을 골막하박리하여 종지부인 구륜근으로부터 유리시킨 다음 이를 상대방으로 당겨 서로 묶어주는 봉양술을 이용함으로써 잇몸과다노출미소를 효과적으로 교정할 수 있었다. 이 방법은 부수적으로 비익간격을 좁히는 효과도 있으므로 비익간격도 넓으면서 잇몸과다노출미소가 있는 환자에서 동시 교정이 가능하다.