The correlation study on mandibular deviation and cervical vertebrae posture in patients with mandibular asymmetry

doi:10.21203/rs.3.rs-467365/v1

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The correlation study on mandibular deviation and cervical vertebrae posture in patients with mandibular asymmetry

https://doi.org/10.21203/rs.3.rs-467365/v1

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Background: To explore the degree of skeletal mandibular deviation and the change of mandible position in patients with mandibular deformity and its correlation with cervical posture in patients with jaw deformity using CBCT and to provide the reference for clinical diagnosis and treatment planning.

Methods: CBCT images from 30 adult patients with skeletal mandibular deviation and 30 adult individuals with facial symmetry were analyzed and imported in Invivo 5 to reconstruct a 3D hard-tissue surface model. A reference frame was set up and 20 measurements of the mandible and cervical vertebrae were performed to calculated. The difference between the three-dimensional position of the mandible and the posture of cervical spine were analyzed in patients with mandibular asymmetry and normal people.

Results: Compared with the normal maxillofacial symmetry groups, there were significant differences in the degree of skeletal mandibular asymmetry and cervical deviation in the mandibular deviation groups(P ＜ 0.05). A strong positive, linear correlation was found in patients with mandibular deviation between the deviation of the mandible and cervical vertebrae posture.

Conclusion: There is an inherent correlation between the occurrence of mandibular deviation and the deflection of cervical posture, and they interact on each other. The deformity of mandible affects the three-dimensional posture of the cervical vertebra and can cause different degrees of cervical deflection. The degree of mandible deviation and cervical vertebrae posture in patients with mandibular asymmetry are greater than those in individuals with facial symmetry. Compared with the patients with normal jaw, the deformity among the patients with skeletal mandibular asymmetry has a tendency to tilt forward and bend forward. The abnormal posture of the cervical spine will also affect the three-dimensional position of the mandible, causing the lower 1/3 of the face to appear facial asymmetry with the deflection of the head and neck posture.

Orthopedics

Mandibular deviation

Cervical vertebrae posture

CBCT

Table 1. Demographic characteristics of the sample

Characteristics	Total	Mandibular deviation group	Facial symmetry group
Patients(n)	60	30	30
Male(n)	29	13	16
Female(n)	31	17	14
Age(y), mean±SD	20.73±8.55	22.55±9.38	24.25±6.37
Age(y), range	18-40	18-40	18-31
Me deviation(mm), mean±SD	2.63±2.07	3.87±1.73	0.73±0.52
Me deviation(mm), range	0.07-9.03	2.03-9.03	0.07-1.87

SD standard deviation

Table 2. Description of points used in this study

Point	Description
OrL	The lowest point of the left inferior orbital margin
OrR	The lowest point of the right inferior orbital margin
PoR	The uppermost point of the right external auditory canal
N	The midpoint of the frontonasal structure-the intersection of the internasal and frontonasal suture in the midsagittal plane
Ba	The midpoint of the anterior margin of the foramen magnum
CoL	The most superior articulation point of left condyle
CoR	The most superior articulation point of right condyle
GoL	The most posterior inferior point at left gonial angle of mandible
GoR	The most posterior inferior point at right gonial angle of mandible
Me	Point located on the midpoint of the chin ridge
C2	Point located on the midpoint of the lower margin of the 2th cervical vertebra
C3	Point located on the midpoint of the lower margin of the 3th cervical vertebra
C4	Point located on the midpoint of the lower margin of the 4th cervical vertebra
C2S	Point located on the topmost point of the odontoid process
C2M	Point located on the midpoint of the lower margin of the odontoid process
C2I	Point located on the last point of the lower margin of the odontoid process
C2P C4P	Point located on the most salient point of the posterior margin of the odontoid process Point located on the last point at the posterior margin of the 4th cervical vertebra

Table 3. Planes in three-dimensional cephalometric analysis

Plane	Definition
HP (horizontal plane)	Plane defined by OrL, OrR, PoR
MSP(median sagittal plane)	Plane through N,Ba and perpendicular to horizontal plane
CP (coronal plane)	Plane through N and perpendicular to horizontal plane and median sagittal plane
MHP	Plane through Me and parallel to horizontal plane
Cp (Cervical plane) CSP(Cervical vertebra tangent) OPP(Odontoid tangent)	Plane through C2Sand C2M The line between C2P and C4P The line between C2P and C2I

Table 4. Measurements in three-dimensional cephalometric analysis

Measurement	Definition
CoL-MSP	The vertical distance from the left condyle to the median sagittal plane
CoR-MSP	The vertical distance from the right condyle to the median sagittal plane
GoL-MSP	The vertical distance from the left gonion to the median sagittal plane
GoR-MSP	The vertical distance from the right gonion to the median sagittal plane
CoL-MHP	The vertical distance from CoL to MHP
CoR-MHP	The vertical distance from CoR to MHP
GoL-MHP	The vertical distance from GoL to MHP
GoR-MHP CoL-CP CoR-CP GoL-CP GoR-CP Me-MSP	The vertical distance from GoR to MHP The vertical distance from CoL to CP The vertical distance from CoR to CP The vertical distance from GoL to CP The vertical distance from GoR to CP The vertical distance from the menton to the median sagittal plane
C2-MSP	The vertical distance from C2 to the median sagittal plane
C3-MSP	The vertical distance from C3 to the median sagittal plane
C4-MSP	The vertical distance from C4 to the median sagittal plane
Cp-HP (Cervical inclination) CSP-HP OPP-HP	The crossing angle between Cp and HP The crossing angle between CSP and HP The crossing angle between OPP and HP
CSP-OPP (Cervical curvature)	The crossing angle between CSP and OPP

Table 5. Analysis of symmetry of the mandibular position in facial symmetry groups(mm)

Measurement

Right

Left

Co-MSP

51.16±3.92

49.89±4.82

Go-MSP

Co-MHP

Go-MHP

Co-CP

Go-CP

45.38±2.47

85.94±7.95

28.84±8.70

65.22±3.24

55.03±3.06

44.89±3.72

86.53±7.80

28.35±8.97

64.67±4.21

56.14±3.82

Table 6. Analysis of symmetry of the mandibular position in mandibular deviation groups(mm)

Measurement

Right

Left

Co-MSP

50.17±4.55

52.57±5.01^＃

Go-MSP

Co-MHP

Go-MHP

Co-CP

Go-CP

45.78±3.62

87.28±6.17

29.38±5.77

65.57±6.34

57.14±4.83

47.92±4.96^＃

90.55±7.04^＃

33.27±9.03^＃

70.06±4.87^＃

62.04±6.29^＃

^＃P＜0.05

Table 7. Comparison of the degree of mandible and cervical vertebra deviation between mandibular deviation groups and facial symmetry groups

Measurement	Right	Left
Me-MSP	0.73±0.52	3.87±1.73^a
C2-MSP	1.14±0.98	2.20±1.24 ^a
C3-MSP C4-MSP Cp-HP CSP-HP OPP-HP CDP-OPP	1.62±1.14 1.89±1.33 83.79±4.22 96.08±3.62 92.80±3.55 2.02±1.59	3.21±1.21^a 3.41±1.18^a 80.76±3.77^a 89.08±4.43^a 84.75±7.29^a 3.07±1.75 ^a

^a P＜0.05

Table 8. Comparison of mandibular position symmetry between mandibular deviation groups and facial symmetry groups(mm)

Measurement	facial symmetry groups	mandibular deviation groups
CoR-MSP	51.16±3.92	50.17±4.55^※
CoL-MSP	49.89±4.82	52.57±5.01^※
GoR-MSP GoL -MSP CoR -MHP CoL -MHP GoR -MHP GoL -MHP CoR -CP CoL -CP GoR -CP GoL -CP	45.38±2.47 44.89±3.72 85.94±7.95 86.53±7.80 28.84±8.70 28.35±8.97 65.22±3.24 64.67±4.21 55.03±3.06 56.14±3.82	45.78±3.62^※ 47.92±4.96^※ 87.28±6.17^※ 90.55±7.04^※ 29.38±5.77^※ 33.27±9.03^※ 65.57±6.34^※ 70.06±4.87^※ 57.14±4.83^※ 62.04±6.29^※

^※P＜0.05

Table 9. Correlation between the mandibular deviation and cervical posture

The degree of mandibular deflection

Pearson Correlation Coefficient

0.512

0.504

0.477

P value

0.004

0.005

0.009

No competing interests reported.

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Editorial decision: Major revision
10 Jul, 2021
Reviews received at journal
30 May, 2021
Reviewers agreed at journal
13 May, 2021
Reviewers agreed at journal
05 May, 2021
Reviewers invited by journal
02 May, 2021
Editor assigned by journal
02 May, 2021
Editor invited by journal
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Submission checks completed at journal
02 May, 2021
First submitted to journal
27 Apr, 2021

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The correlation study on mandibular deviation and cervical vertebrae posture in patients with mandibular asymmetry

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