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Journal of Peking University(Health Sciences) ›› 2020, Vol. 52 ›› Issue (1): 90-96. doi: 10.19723/j.issn.1671-167X.2020.01.014

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Feasibility of Delaire cephalometric analysis to predict the ideal sagittal position of the maxilla and chin for surgery-first patients in orthognathic surgery

Xian-tao SUN,Wei HE,Xiao-jing LIU,Zi-li LI(),Xing WANG   

  1. Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Disease & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
  • Received:2019-10-10 Online:2020-02-18 Published:2020-02-20
  • Contact: Zi-li LI E-mail:kqlzl@sina.com
  • Supported by:
    Supported by the Clinical Research Projects of Beijing Municipal Science & Technology Commission(Z181100001718130)

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Abstract:

Objective: There is no universally accepted method for determining the ideal sagittal position of the maxilla in orthognathic surgery. The purpose of this study was to compare how well the Delaire’s cephalometric analysis correlated with postoperatively findings in patients who underwent orthognathic surgery planned using other cephalometric analyses,as well as to evaluate the feasibility of the Delaire’s cephalometric analysis in predicting the ideal sagittal position of the maxilla and chin. Methods: In the study, 35 patients with skeletal Class Ⅲ malocclusion were involved and met the criteria. Treatment plans were developed using photographs, 3-D photographs,radiographs, and standard cephalometric measurements. The Delaire’s cephalometric analysis data, like the phase measurements (∠C1-L1 and ∠C1-L2) of the sagittal positions of the maxillary and the chin separating the reference line (L1) of NP point and the reference line (L2) of Me point, were analyzed using Dolphin Imaging software. At the same time, the analyses on standard measurements were also performed. Four orthognathic doctors, 4 orthodontic doctors and 4 college students from non-medical majors were selected as aesthetic evaluators to assess the patients’ profile aesthetic by visual analogue scale (VAS). The results through the Delaire’s cephalometric analysis were statistically compared with that through standard methods. Results: The mean of ∠C1-L1 was 83.93°±2.99°and∠C1-L2 was 89.08°±2.48° for males postoperatively, and 85.67°±3.60° and 88.30°±4.20°for females postoperatively. Compared with the reference values of Chinese good-looking people, there was no significant difference of NP point, whereas there was a significant difference of Me point. The postoperative aesthetic scores were: the mean was 6.71±0.25 of upper jaws, 6.81±0.30 of chins and 6.90±0.29 of the overall for males; and 7.19±0.22, 7.26±0.34 and 7.39±0.29 for females. Compared with preoperative scores, there was a significant improvement. Furthermore, the scores of chins and the overall scores were related to the sagittal position of the chins. Conclusion: Compared with standard cephalometric analysis, the Deliare’s cephalometric analysis well unravel the preoperative deformity and the final esthetic sagittal positions of maxillary and chin in the present sample, and could be a useful tool for the planning of surgery-first approach in orthognathic surgery.

Key words: Cephalometric analysis, Orthognathic surgery, Surgery-first

CLC Number: 

  • R782.2

Figure 1

Mark points and lines of the Delaire’s cephalometric analysis Clp, superior top of posterior clinoid process; Cla,superior top of anterior clinoid process; Clm,the midpoint between Clp and Cla;Fm,junction of frontomaxillar sutures;M, junction of maxillary, nasal and frontal sutures;NP, anterior wall of nasopalatine canal; Me,menton;C1,superior cranial base plane;L1,the connection between NP and Fm;L2,the connection between Me and Fm."

Figure 2

Mark points and lines of the standard cephalometric analysis S, sella point;N, nasal point;P, porion; O, orbital;A, subspinale; B, supramental; UI,upper incisor edge;UIa,upper incisor apex;LI,lower incisor edge;LIa, lower incisor apex."

Figure 3

Aesthetic evaluation of the patients preoperatively and postoperatively A,the preoperative lateral cephalometric radiograph; B, the preoperative 3D photograph; C, the preoperative lateral photograph; D, the postoperative lateral cephalometric radiograph; E, the postoperative 3D photograph; F, the postoperative lateral photograph."

Table 1

The SNA and SNB angle values of patients"

Items SNA/(°) SNB/(°) t P
Male 82.00±2.66 84.30±2.87 -2.996 0.030
Female 82.29±3.54 84.16±4.89 -3.319 0.003
t -0.191 0.070
P 0.850 0.945

Table 2

Comparison of the SNA and SNB with normal reference values"

Items SNA/(°) Reference value/(°) t P SNB/(°) Reference value/(°) t P
Male 82.00±2.66 83 -0.922 0.399 84.30±2.87 80 3.675 0.014
Female 82.29±3.54 83 -1.076 0.291 84.16±4.89 80 4.576 <0.001

Table 3

The sagittal positions of patient’s NP point and Me point preoperatively"

Items ∠C1-L1/(°) ∠C1-L2/(°) t P
Male 80.85±3.81 89.37±4.10 -6.776 0.001
Female 82.87±4.25 89.69±4.95 -10.188 <0.001
t -0.625 0.010
P 0.536 0.992

Table 4

Comparative values of∠C1-L1 and ∠C1-L2 with normal reference values"

Items ∠C1-L1/(°) Reference value/(°) t P ∠C1-L2/(°) Reference value/(°) t P
T0 Male 80.85±3.81 85 -2.665 0.045 89.37±4.10 85 2.612 0.048
Female 82.87±4.25 85 -2.700 0.012 89.69±4.95 85 5.095 <0.001
T1 Male 83.93±2.99 85 -0.874 0.422 89.08±2.48 85 4.041 0.010
Female 85.67±3.60 85 1.005 0.324 88.30±4.20 85 4.251 <0.001

Table 5

Comparative values of the incisor angle with the reference values of French normal population"

Items Male Female
U1/L1/(°) French reference t P U1/L1/(°) French reference t P
T0 127.22±7.35 135 2.595 0.049 133.73±8.92 135 -0.766 0.450
T1 128.43±4.20 135 3.833 0.012 129.08±5.64 135 -5.652 <0.001

Table 6

Camprative scores of the patient’s profiles between T0 and T1"

Items Male Female
T0 T1 t P T0 T1 t P
Maxillary 3.52±0.41 6.71±0.25 14.87 <0.001 3.80±0.57 7.19±0.22 24.93 <0.001
Chin 3.35±0.37 6.81±0.30 14.72 <0.001 3.89±0.57 7.26±0.34 25.66 <0.001
Overall 3.39±0.43 6.90±0.29 16.97 <0.001 3.76±0.66 7.39±0.29 24.85 <0.001

Table 7

Correlation between the sagittal positions and the scores of NP, Me points in male patients postoperatively"

Items NP(∠C1-L1-85°) Me(∠C1-L2-85°) NP/Me(L1-L2)
Pearson P Pearson P Pearson P
Maxillary -0.014 0.979 -0.238 0.659 0.394 0.440
Chin 0.492 0.321 -0.754 0.084 0.284 0.586
Overall -0.330 0.524 -0.612 0.196 0.382 0.455

Table 8

Correlation between the sagittal positions and the scores of NP, Me points in female patients postoperatively"

Items NP(∠C1-L1-85°) Me(∠C1-L2-85°) ∠L1-L2
Pearson P Pearson P Pearson P
Maxillary 0.272 0.154 -0.402 0.031 0.287 0.131
Chin 0.462 0.012 -0.550 0.002 0.258 0.176
Overall 0.382 0.041 -0.493 0.007 0.280 0.141
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