替牙期单侧完全性唇腭裂患者鼻上颌复合体对称性的锥形束CT研究
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摘要
目的:探讨替牙期单侧完全性唇腭裂(unilateral complete cleft lip and palate, UCLP)患者鼻上颌复合体在三维方向上的对称性。方法:选择20例替牙期UCLP患者颅面部锥形束CT(CBCT)图像,运用Mimics图像分析软件对骨组织进行三维重建,描记鼻根点及鼻上颌复合体健、患侧32个同名标记点,建立三维参考平面、分别测量32个点到三维平面的距离。采用SPSS 22.0软件包对数据进行统计学分析。结果:在水平方向上,与非裂隙侧相比,裂隙侧点INM、SPC处上颌骨的宽度小,点LPA、SPr处上颌骨宽度大,差异具有统计学意义(P<0.05)。在矢状方向上,与非裂隙侧相比,裂隙侧点LPA、Maz、SPr处深度大,点SPM、SPC处深度小,差异具有统计学意义(P<0.05)。在垂直方向上,裂隙侧点LPA、INM、Maz低于非裂隙侧,点SPC、SPr高于非裂隙侧,差异具有统计学意义(P<0.05)。其余各点均无统计学差异(P>0.05)。结论:替牙期UCLP患者鼻上颌复合体在三维方向上均不对称,不对称部位集中在鼻腔和牙槽骨处。眶部及远离裂隙的上颌骨区域未发现明显不对称。
PURPOSE:To investigate the symmetry of nasal maxillary complex in the three-dimensional directions of patients with unilateral complete cleft lip and palate(UCLP) at the stage of mixed dentition.METHODS:Craniofacial cone-beam CT(CBCT) images of 20 UCLP patients at the stage of mixed dentition were selected.Three-dimensional reconstruction of bone tissue was carried out by Mimics software,nasal root point and 32 markers with the same name of the healthy side and the cleft side of the nasal maxillary complex were traced,three-dimensional reference planes were set up,then the distances between the points to the three-dimensional planes were measured respectively.SPSS 22.0 software package was used to analyze the data.RESULTS:In the horizontal direction,compared with the non-cleft side,the width of the cleft side of the maxilla at INM and SPC was smaller,the width of maxilla at LPA and SPr was larger,the differences were statistically significant(P<0.05).In the sagittal direction,compared with the non-cleft side,the depth of LPA,Maz and SPr at the cleft side was larger,the depth of SPM and SPC was smaller,the differences were statistically significant(P<0.05).In the vertical direction,the positions of LPA,INM and Maz at the cleft side was lower than the noncleft side,SPC and SPr were higher,the differences were statistically significant(P<0.05).The remaining points had no significant difference(P>0.05).CONCLUSIONS:The nasal maxillary complex of UCLP patients at the stage of mixed dentition is asymmetric in three directions.The asymmetric locations were mainly located in the nasal cavity and alveolar bone.No obvious asymmetry is found in the orbital region and the maxillary region far from the cleft.
PURPOSE:To investigate the symmetry of nasal maxillary complex in the three-dimensional directions of patients with unilateral complete cleft lip and palate(UCLP) at the stage of mixed dentition.METHODS:Craniofacial cone-beam CT(CBCT) images of 20 UCLP patients at the stage of mixed dentition were selected.Three-dimensional reconstruction of bone tissue was carried out by Mimics software,nasal root point and 32 markers with the same name of the healthy side and the cleft side of the nasal maxillary complex were traced,three-dimensional reference planes were set up,then the distances between the points to the three-dimensional planes were measured respectively.SPSS 22.0 software package was used to analyze the data.RESULTS:In the horizontal direction,compared with the non-cleft side,the width of the cleft side of the maxilla at INM and SPC was smaller,the width of maxilla at LPA and SPr was larger,the differences were statistically significant(P<0.05).In the sagittal direction,compared with the non-cleft side,the depth of LPA,Maz and SPr at the cleft side was larger,the depth of SPM and SPC was smaller,the differences were statistically significant(P<0.05).In the vertical direction,the positions of LPA,INM and Maz at the cleft side was lower than the noncleft side,SPC and SPr were higher,the differences were statistically significant(P<0.05).The remaining points had no significant difference(P>0.05).CONCLUSIONS:The nasal maxillary complex of UCLP patients at the stage of mixed dentition is asymmetric in three directions.The asymmetric locations were mainly located in the nasal cavity and alveolar bone.No obvious asymmetry is found in the orbital region and the maxillary region far from the cleft.
引文
[1]傅民魁.口腔正畸学[M].第6版.北京:人民卫生出版社,2012:272-276.
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[4]Kyrkanides S,Richter L.Mandibular asymmetry and antigonial notching in individuals with unilateral cleft lip and palate[J].Cleft Palate Craniofac J,2002,39(1):30-35.
[5]Suri S,Utreja A,Khandelwal N,et al.Craniofacial computerized tomography analysis of the midface of patients with repaired complete unilateral cleft lip and palate[J].Am J Orthod Dentofacial Orthop,2008,134(3):418-429.
[6]Yang L,Chen Z,Zhang X.A cone-beam computed tomography evaluation of facial asymmetry in unilateral cleft lip and palate individuals[J].J Oral Sci,2015,58(1):109-115.
[7]Li H,Yang Y,Chen Y,et al.Three-dimensional reconstruction of maxillae using spiral computed tomography and its application in postoperative adult patients with unilateral complete cleft lip and palate[J].J Oral Maxillofac Surg,2011,69(12):e549-557.
[8]Lin HH,Chuang YF,Weng JL,et al.Comparative validity and reproducibility study of various landmark-oriented reference planes in 3-dimensional computed tomographic analysis for patients receiving orthognathic surgery[J].PLoS One,2015,10(2):e0117604.
[9]李巍然,周恒,林久祥.单侧完全性唇腭裂术后患者颅面结构的后前位X线头影测量研究[J].中华口腔正畸学杂志,1998,5(2):10-12.
[10]Zemann W,Santler G,K覿rcher H.Analysis of midface asymmetry in patients with cleft lip,alveolus and palate at the age of 3months using 3D-COSMOS measuring system[J].J Craniomaxillofac Surg,2002,30(3):148-152.
[11]Nagasao T,Miyamoto J,Konno E,et al.Dynamic analysis of the effects of upper lip pressure on the asymmetry of the facial skeleton in patients with unilateral complete cleft lip and palate[J].Cleft Palate Craniofac J,2009,46(2):154-160.
[12]Kim YI,Kim JR,Park SB.Three-dimensional analysis of midfacial soft tissue changes according to maxillary superior movement after horizontal osteotomy of the maxilla[J].J Craniofac Surg,2010,21(5):1587-1590.
[13]M覬lsted K,Dahl E,Brattstr觟m V,et al.A six-center international study of treatment outcome in patients with clefts of the lip and palate:evaluation of maxillary asymmetry[J].Cleft Palate Craniofac J,1993,30(1):22-28.
[14]李巍然,林久祥,傅民魁.唇腭裂术后反与颞下颌关节紊乱综合征[J].中华口腔医学杂志,1996,44(6):354-356.
[2]Liao YF,Mars M.Long-term effects of clefts on craniofacial morphology in patients with unilateral cleft lip and palate[J].Cleft Palate Craniofac J,2005,42(6):601-609.
[3]Kurt G,Bayram M,Uysal T,et al.Mandibular asymmetry in cleft lip and palate patients[J].Eur J Orthod,2010,32(1):19-23.
[4]Kyrkanides S,Richter L.Mandibular asymmetry and antigonial notching in individuals with unilateral cleft lip and palate[J].Cleft Palate Craniofac J,2002,39(1):30-35.
[5]Suri S,Utreja A,Khandelwal N,et al.Craniofacial computerized tomography analysis of the midface of patients with repaired complete unilateral cleft lip and palate[J].Am J Orthod Dentofacial Orthop,2008,134(3):418-429.
[6]Yang L,Chen Z,Zhang X.A cone-beam computed tomography evaluation of facial asymmetry in unilateral cleft lip and palate individuals[J].J Oral Sci,2015,58(1):109-115.
[7]Li H,Yang Y,Chen Y,et al.Three-dimensional reconstruction of maxillae using spiral computed tomography and its application in postoperative adult patients with unilateral complete cleft lip and palate[J].J Oral Maxillofac Surg,2011,69(12):e549-557.
[8]Lin HH,Chuang YF,Weng JL,et al.Comparative validity and reproducibility study of various landmark-oriented reference planes in 3-dimensional computed tomographic analysis for patients receiving orthognathic surgery[J].PLoS One,2015,10(2):e0117604.
[9]李巍然,周恒,林久祥.单侧完全性唇腭裂术后患者颅面结构的后前位X线头影测量研究[J].中华口腔正畸学杂志,1998,5(2):10-12.
[10]Zemann W,Santler G,K覿rcher H.Analysis of midface asymmetry in patients with cleft lip,alveolus and palate at the age of 3months using 3D-COSMOS measuring system[J].J Craniomaxillofac Surg,2002,30(3):148-152.
[11]Nagasao T,Miyamoto J,Konno E,et al.Dynamic analysis of the effects of upper lip pressure on the asymmetry of the facial skeleton in patients with unilateral complete cleft lip and palate[J].Cleft Palate Craniofac J,2009,46(2):154-160.
[12]Kim YI,Kim JR,Park SB.Three-dimensional analysis of midfacial soft tissue changes according to maxillary superior movement after horizontal osteotomy of the maxilla[J].J Craniofac Surg,2010,21(5):1587-1590.
[13]M覬lsted K,Dahl E,Brattstr觟m V,et al.A six-center international study of treatment outcome in patients with clefts of the lip and palate:evaluation of maxillary asymmetry[J].Cleft Palate Craniofac J,1993,30(1):22-28.
[14]李巍然,林久祥,傅民魁.唇腭裂术后反与颞下颌关节紊乱综合征[J].中华口腔医学杂志,1996,44(6):354-356.
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