中国修复重建外科杂志

中国修复重建外科杂志

骨性Ⅲ类错畸形患者双颌手术前后面部软组织变化的三维研究

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目的探讨骨性 Ⅲ 类错畸形患者双颌手术前后面部软组织变化规律。方法选择 2016 年 8 月—2017 年 4 月,接受上颌骨 LeFortⅠ型截骨前徙+下颌骨矢状劈开截骨后退术治疗的 30 例骨性Ⅲ类错畸形患者为研究对象。其中,男 11 例,女 19 例;年龄 18~35 岁,平均 22.6 岁。于术前 2 周内任一时间点及术后 6 个月行全头颅 CT 扫描和面部软组织三维面像扫描,采用 Artec Studio11.0、CMF Proplan3.0 软件建立三维面像模型,分析手术前后面部软组织变化区域,测量面部各区域软组织解剖标志点,并比较手术前后差异。结果双颌手术后面部软组织变化区域为上颌鼻旁至下颌颏下区域,两侧不超过外眦垂线界限。手术前后比较,水平方向左右侧鼻翼基点以及左右侧颊点发生显著变化(P<0.05)。矢状方向鼻下点、鼻尖点、左右鼻翼基点、上唇缘点显著前移(P<0.05),左右口角点、下唇缘点、颏唇沟中点、颏前点、颏下点显著后退(P<0.05)。垂直方向上唇缘点、双侧口角点、下唇缘点、左右侧颊点、左右侧内眦点显著下降(P<0.05),颏下点显著上抬(P<0.05)。术后鼻小柱显著变短、上唇变长、鼻翼基底变宽(P<0.05)。结论骨性 Ⅲ 类错畸形患者双颌手术后面部整体变短且更饱满,面部软组织变化范围下颌大于上颌,提示手术设计时需考虑患者术后面型变化。

ObjectiveTo investigate the changes of facial soft tissue before and after orthognathic surgery in patients with skeletal Class Ⅲ malocclusion.MethodsBetween August 2016 and April 2017, 30 patients with skeletal Class Ⅲ malocclusion who underwent maxillary LeFort Ⅰ osteotomy and sagittal split mandible osteotomy were selected as study subjects. Among them, 11 were male and 19 were female with an average age of 22.6 years (range, 18-35 years). Full head CT scan and facial soft tissue three-dimensional image scan were performed within 2 weeks before surgery and at 6 months after surgery. A three-dimensional facial image model was established using Artec Studio 11.0 and CMF Proplan 3.0 software to analyze the facial soft tissue changes before and after surgery. The soft tissue anatomical landmarks in each area of the face were measured and compared before and after surgery.ResultsThe area of facial soft tissue change after surgery was the maxillary nose and the lower jaw area, and the two sides did not exceed the vertical boundary of the outer canthus. After surgery, the horizontal points of bilateral alar bases and bilateral cheeks changed significantly (P<0.05). The sagittal points of subnasale, pronasale, bilateral alar bases, upper lip margin significantly forwarded (P<0.05); the sagittal points of the bilateral cheilions, lower lip margin, midpoint of chin-lip groove, pogonion, and menton significantly backwarded (P<0.05). The vertical points of the upper lip margin, bilateral cheilions, lower lip margin, bilateral cheeks, and bilateral inner canthus points significantly descended (P<0.05), and the vertical point of the menton significantly elevated (P<0.05). After surgery, the nasal column was significantly shortened, the upper lip got longer and the alar base widened when compared with those before surgery (P<0.05).ConclusionThe overall change of face after double jaw surgery is shorter and fuller, and the mandible of facial soft tissue change is larger than that of maxillary, which suggests that the postoperative facial changes should be taken into account in the surgical design.

关键词: 正颌手术; 软组织变化; 三维研究

Key words: Orthognathic surgery; soft tissue change; three-dimensional study

引用本文: 史雨林, 商洪涛, 田磊, 白石柱, 刘文静, 刘彦普. 骨性Ⅲ类错畸形患者双颌手术前后面部软组织变化的三维研究. 中国修复重建外科杂志, 2018, 32(5): 612-616. doi: 10.7507/1002-1892.201801051 复制

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