骨性Ⅲ类错(牙合)正颌手术前、后面部软、硬组织变化比率的三维研究
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摘要
目的 :研究骨性Ⅲ类错(牙合)畸形患者面部软、硬组织三维方向上变化的相关性,以及手术前、后软、硬组织的变化比率,以期更好地对术后软组织外貌进行预测。方法:对20例骨性Ⅲ类错(牙合)畸形成人患者分别于术前2周及术后3个月进行颅面CT扫描和三维重建及面部软组织3D摄影成像,将采集的数据导入Dolphin软件,转换为三维面像数字化模型,建立三维测量坐标系(轴面、矢状面及冠状面),筛选19个软、硬组织标记点并进行测量、对比和配对,共12对。读取标记点的三维坐标(X、Y、Z),进行手术前、后的定点对比测量,采用SPSS 22.0软件包对测量数据进行统计学分析。结果:12对软、硬组织标志点在X轴即左右方向仅Pn/A、Gn'/Gn及Me'/Me存在相关性,在Y轴即上下方向仅Gn'/Gn存在相关性,在Z轴上所有软、硬组织配对点均存在相关性。除UL'/UI及UL/SPr外,均为高度相关。手术前、后,下颌的软、硬组织测量标志点的变化比率大于上颌。结论:骨性Ⅲ类错(牙合)畸形患者双颌手术前、后软、硬组织的变化主要集中于Z轴即前后向的变化,各软、硬组织配对标志点间呈线性相关关系,且下颌软、硬组织位移比率大于上颌。
PURPOSE: To investigate the change ratios of soft and hard tissue after orthognathic surgery three-dimensionally in osseous Class Ⅲ patients, in order to predict postoperative soft tissue three-dimensionally. METHODS:Twenty adult patients were selected as the experimental group, craniofacial spiral CT and three-dimensional(3 D)stereophotogrammetry were conducted 2 weeks before surgery and 3 months after surgery. Dolphin imaging software was used to establish 3 D image digitizing model and 3 D measurement coordinate system. Nineteen soft and hard tissue land marks were selected and matched into 12 pairs. 3 D coordinate value of these landmarks were read both before and after surgery and were used for statistical analysis with SPSS 22.0 software package. RESULTS: There was a linear relationship only in Pn/A, Gn'/Gn and Me'/Me in X axis, in Gn'/Gn in Y axis and all pairs of landmarks had a close correlation except UL'/UI and UL/SPr in Z axis. Additionally, the change ratio between soft and hard tissue landmarks of mandible was greater than maxilla. CONCLUSIONS: The changes of soft and hard tissue after orthognathic surgery only lie in Z axis(forward and backward), each pair of matched landmarks exhibits a linear relationship, and the change ratio of mandible is greater than the maxilla.
PURPOSE: To investigate the change ratios of soft and hard tissue after orthognathic surgery three-dimensionally in osseous Class Ⅲ patients, in order to predict postoperative soft tissue three-dimensionally. METHODS:Twenty adult patients were selected as the experimental group, craniofacial spiral CT and three-dimensional(3 D)stereophotogrammetry were conducted 2 weeks before surgery and 3 months after surgery. Dolphin imaging software was used to establish 3 D image digitizing model and 3 D measurement coordinate system. Nineteen soft and hard tissue land marks were selected and matched into 12 pairs. 3 D coordinate value of these landmarks were read both before and after surgery and were used for statistical analysis with SPSS 22.0 software package. RESULTS: There was a linear relationship only in Pn/A, Gn'/Gn and Me'/Me in X axis, in Gn'/Gn in Y axis and all pairs of landmarks had a close correlation except UL'/UI and UL/SPr in Z axis. Additionally, the change ratio between soft and hard tissue landmarks of mandible was greater than maxilla. CONCLUSIONS: The changes of soft and hard tissue after orthognathic surgery only lie in Z axis(forward and backward), each pair of matched landmarks exhibits a linear relationship, and the change ratio of mandible is greater than the maxilla.
引文
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[13] Bazina M, Cevidanes L, Ruellas A, et al. Precision and reliability of Dolphin 3-dimensional voxel-based superimposition[J]. Am J Orthod Dentofacial Orthop, 2018, 153(4):599-606.
[14] Schendel SA, Jacobson R, Khalessi S. 3-dimensional facial simulation in orthognathic surgery:is it accurate?[J]. J Oral Maxillofac Surg, 2013, 71(8):1406-1414.
[15] Mommaerts MY, Lippens F, Abeloos JV, et al. Nasal profile changes after maxillary impaction and advancement surgery[J]. J Oral Maxillofac Surg, 2000, 58(5):470-475.
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[21] Hui E, Hagg EU, Tideman H. Soft tissue changes following maxillary osteotomies in cleft lip and palate and non-cleft patients[J]. J Craniomaxillofac Surg, 1994, 22(3):182-186.
[22]梁立卿,孙健,李亚莉,等.正颌外科二维头影测量与三维面颅重建测量的比较[J].现代口腔医学杂志, 2016, 30(6):342-345.
[23] Rossini G, Cavallini C, Cassetta M, et al.3D cephalometric analysis obtained from computed tomography[J]. Ann Stomatol(Roma), 2011, 2(3-4):31-39.
[24] Jung PK, Lee GC, Moon CH. Comparison of cone-beam computed tomography cephalometric measurements using a midsagittal projection and conventional two-dimensional cephalometric measurements[J]. Korean J Orthod, 2015, 45(6):282-288.
[25]王瑞晨,李桂珍,柳春明,等.三维头影测量分析法在正颌外科术前测量中的应用[J].中国修复重建外科杂志, 2014, 28(7):873-878.
[26] Enacar A, Taner T, Toroglu S. Analysis of soft tissue profile changes associated with mandibular setback and double-jaw surgeries[J]. Int J Adult Orthodon Orthognath Surg, 1999, 14(1):27-35.
[27] Coleta KE, Wolford LM, Gon觭alves JR, et al. Maxillo-mandibular counter-clockwise rotation and mandibular advancement with TMJ Concepts total joint prostheses:part IV-soft tissue response[J]. Int J Oral Maxillofac Surg, 2009, 38(6):637-646.
[28] Lu CH, Ko EW, Huang CS. The accuracy of video imaging prediction in soft tissue outcome after bimaxillary orthognathic surgery[J]. J Oral Maxillofac Surg, 2003, 61(3):333-342.
[29] Lee DY, Bailey LJ, Proffit WR. Soft tissue changes after superior repositioning of the maxilla with Le Fort I osteotomy:5-year follow-up[J]. Int J Adult Orthodon Orthognath Surg, 1996, 11(4):301-311.
[30] Jensen AC, Sinclair PM, Wolford LM. Soft tissue changes associated with double jaw surgery[J]. Am J Orthod Dentofacial Orthop, 1992, 101(3):266-275.
[31] Aydemir H, Efendiyeva R, Karasu H, et al. Evaluation of longterm soft tissue changes after bimaxillary orthognathic surgery in ClassⅢpatients[J]. Angle Orthod, 2015, 85(4):631-637.
[32] Conley RS, Boyd SB. Facial soft tissue changes following maxillomandibular advancement for treatment of obstructive sleep apnea[J]. J Oral Maxillofac Surg, 2007, 65(7):1332-1340.
[33] Lin SS, Kerr WJ. Soft and hard tissue changes in ClassⅢpatients treated by bimaxillary surgery[J]. Eur J Orthod, 1998, 20(1):25-33.
[34] Chew MT. Soft and hard tissue changes after bimaxillary surgery in Chinese ClassⅢpatients[J]. Angle Orthod, 2005, 75(6):959-963.
[35] Chew MT, Sandham A, Wong HB. Evaluation of the linearity of soft-to hard-tissue movement after orthognathic surgery[J]. Am J Orthod Dentofacial Orthop, 2008, 134(5):665-670.
[36] Altug-Atac AT, Bolatoglu H, Memikoglu UT. Facial soft tissue profile following bimaxillary orthognathic surgery[J]. Angle Orthod, 2008, 78(1):50-57.
[37] Aydil B,魻zer N, Marsan G. Bimaxillary surgery in ClassⅢmalocclusion:soft and hard tissue changes[J]. J Craniomaxillofac Surg, 2013, 41(3):254-257.
[38] Kuvat SV, Güven E, Hocaoglu E, et al. Body fat composition and weight changes after double-jaw osteotomy[J]. J Craniofac Surg,2010, 21(5):1516-1518.
[39] Worrall SF. Changes in weight and body composition after orthognathic surgery and jaw fractures:a comparison of miniplates and intermaxillary fixation[J]. Br J Oral Maxillofac Surg, 1994, 32(5):289-292.
[40] Kau CH, Cronin AJ, Richmond S. A three-dimensional evaluation of postoperative swelling following orthognathic surgery at 6 months[J]. Plast Reconstr Surg, 2007,119(7):2192-2199.
[41] Joss CU, Joss-Vassalli IM, Kiliaridis S, et al. Soft tissue profile changes after bilateral sagittal split osteotomy for mandibular advancement:a systematic review[J]. J Oral Maxillofac Surg,2010, 68(6):1260-1269.
[2] San Miguel Moragas J, Van Cauteren W, Mommaerts MY. A systematic review on soft-to-hard tissue ratios in orthognathic surgery part I:maxillary repositioning osteotomy[J]. J Craniomaxillofac Surg, 2014, 42(7):1341-1351.
[3] San Miguel Moragas J, Oth O, Büttner M, et al. A systematic review on soft-to-hard tissue ratios in orthognathic surgery partⅡ:Chin procedures[J]. J Craniomaxillofac Surg, 2015, 43(8):1530-1540.
[4] Olate S, Zaror C, Blythe JN, et al. A systematic review of soft-tohard tissue ratios in orthognathic surgery. PartⅢ:Double jaw surgery procedures[J]. J Craniomaxillofac Surg, 2016, 44(10):1599-1606.
[5] Swennen GR, Schutyser F, Barth EL, et al. A new method of 3-D cephalometry Part I:the anatomic Cartesian 3-D reference system[J]. J Craniofac Surg, 2006, 17(2):314-325.
[6] Shafi MI, Ayoub A, Ju X, et al. The accuracy of threedimensional prediction planning for the surgical correction of facial deformities using Maxilim[J]. Int J Oral Maxillofac Surg,2013, 42(7):801-806.
[7]史雨林,商洪涛,田磊,等.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[J].中国修复重建外科杂志,2018, 32(5):612-616.
[8] Olate S, Zaror C, Mommaerts MY. A systematic review of softto-hard tissue ratios in orthognathic surgery. Part IV:3D analysis-Is there evidence?[J]. J Craniomaxillofac Surg, 2017, 45(8):1278-1286.
[9] Schendel SA, Jacobson R, Khalessi S. 3-Dimensional facial simulation in orthognathic surgery:is it accurate?[J]. J Oral Maxillofac Surg, 2013, 71(8):1406-1414.
[10] Aboul-Hosn Centenero S, Hernández-Alfaro F. 3D planning in orthognathic surgery:CAD/CAM surgical splints and prediction of the soft and hard tissues results-our experience in 16 cases[J].J Craniomaxillofac Surg, 2012, 40(2):162-168.
[11] Van Hemelen G, Van Genechten M, Renier L, et al. Threedimensional virtual planning in orthognathic surgery enhances the accuracy of soft tissue prediction[J]. J Craniomaxillofac Surg,2015, 43(6):918-925.
[12] Liebregts J, Xi T, Timmermans M, et al. Accuracy of threedimensional soft tissue simulation in bimaxillary osteotomies[J]. J Craniomaxillofac Surg, 2015, 43(3):329-335.
[13] Bazina M, Cevidanes L, Ruellas A, et al. Precision and reliability of Dolphin 3-dimensional voxel-based superimposition[J]. Am J Orthod Dentofacial Orthop, 2018, 153(4):599-606.
[14] Schendel SA, Jacobson R, Khalessi S. 3-dimensional facial simulation in orthognathic surgery:is it accurate?[J]. J Oral Maxillofac Surg, 2013, 71(8):1406-1414.
[15] Mommaerts MY, Lippens F, Abeloos JV, et al. Nasal profile changes after maxillary impaction and advancement surgery[J]. J Oral Maxillofac Surg, 2000, 58(5):470-475.
[16] Freihofer HP Jr. Changes in nasal profile after maxillary advancement in cleft and non-cleft patients[J]. J Maxillofac Surg,1977, 5(1):20-27.
[17] Engel GA, Quan RE, Chaconas SJ. Soft-tissue change as a result of maxillary surgery. A preliminary study[J]. Am J Orthod, 1979,75(3):291-300.
[18] Mansour S, Burstone C, Legan H, An evaluation of soft-tissue changes resulting from Le FortⅠmaxillary surgery[J]. Am J Orthod, 1983, 84(1):37-47.
[19] Rosen HM. Lip-nasal aesthetics following Le FortⅠosteotomy[J].Plast Reconstr Surg, 1988, 81(2):171-182.
[20] Hack GA, de Mol van Otterloo JJ, et al. Long-term stability and prediction of soft tissue changes after Le FortⅠsurgery[J]. Am J Orthod Dentofacial Orthop, 1993,104(6):544-555.
[21] Hui E, Hagg EU, Tideman H. Soft tissue changes following maxillary osteotomies in cleft lip and palate and non-cleft patients[J]. J Craniomaxillofac Surg, 1994, 22(3):182-186.
[22]梁立卿,孙健,李亚莉,等.正颌外科二维头影测量与三维面颅重建测量的比较[J].现代口腔医学杂志, 2016, 30(6):342-345.
[23] Rossini G, Cavallini C, Cassetta M, et al.3D cephalometric analysis obtained from computed tomography[J]. Ann Stomatol(Roma), 2011, 2(3-4):31-39.
[24] Jung PK, Lee GC, Moon CH. Comparison of cone-beam computed tomography cephalometric measurements using a midsagittal projection and conventional two-dimensional cephalometric measurements[J]. Korean J Orthod, 2015, 45(6):282-288.
[25]王瑞晨,李桂珍,柳春明,等.三维头影测量分析法在正颌外科术前测量中的应用[J].中国修复重建外科杂志, 2014, 28(7):873-878.
[26] Enacar A, Taner T, Toroglu S. Analysis of soft tissue profile changes associated with mandibular setback and double-jaw surgeries[J]. Int J Adult Orthodon Orthognath Surg, 1999, 14(1):27-35.
[27] Coleta KE, Wolford LM, Gon觭alves JR, et al. Maxillo-mandibular counter-clockwise rotation and mandibular advancement with TMJ Concepts total joint prostheses:part IV-soft tissue response[J]. Int J Oral Maxillofac Surg, 2009, 38(6):637-646.
[28] Lu CH, Ko EW, Huang CS. The accuracy of video imaging prediction in soft tissue outcome after bimaxillary orthognathic surgery[J]. J Oral Maxillofac Surg, 2003, 61(3):333-342.
[29] Lee DY, Bailey LJ, Proffit WR. Soft tissue changes after superior repositioning of the maxilla with Le Fort I osteotomy:5-year follow-up[J]. Int J Adult Orthodon Orthognath Surg, 1996, 11(4):301-311.
[30] Jensen AC, Sinclair PM, Wolford LM. Soft tissue changes associated with double jaw surgery[J]. Am J Orthod Dentofacial Orthop, 1992, 101(3):266-275.
[31] Aydemir H, Efendiyeva R, Karasu H, et al. Evaluation of longterm soft tissue changes after bimaxillary orthognathic surgery in ClassⅢpatients[J]. Angle Orthod, 2015, 85(4):631-637.
[32] Conley RS, Boyd SB. Facial soft tissue changes following maxillomandibular advancement for treatment of obstructive sleep apnea[J]. J Oral Maxillofac Surg, 2007, 65(7):1332-1340.
[33] Lin SS, Kerr WJ. Soft and hard tissue changes in ClassⅢpatients treated by bimaxillary surgery[J]. Eur J Orthod, 1998, 20(1):25-33.
[34] Chew MT. Soft and hard tissue changes after bimaxillary surgery in Chinese ClassⅢpatients[J]. Angle Orthod, 2005, 75(6):959-963.
[35] Chew MT, Sandham A, Wong HB. Evaluation of the linearity of soft-to hard-tissue movement after orthognathic surgery[J]. Am J Orthod Dentofacial Orthop, 2008, 134(5):665-670.
[36] Altug-Atac AT, Bolatoglu H, Memikoglu UT. Facial soft tissue profile following bimaxillary orthognathic surgery[J]. Angle Orthod, 2008, 78(1):50-57.
[37] Aydil B,魻zer N, Marsan G. Bimaxillary surgery in ClassⅢmalocclusion:soft and hard tissue changes[J]. J Craniomaxillofac Surg, 2013, 41(3):254-257.
[38] Kuvat SV, Güven E, Hocaoglu E, et al. Body fat composition and weight changes after double-jaw osteotomy[J]. J Craniofac Surg,2010, 21(5):1516-1518.
[39] Worrall SF. Changes in weight and body composition after orthognathic surgery and jaw fractures:a comparison of miniplates and intermaxillary fixation[J]. Br J Oral Maxillofac Surg, 1994, 32(5):289-292.
[40] Kau CH, Cronin AJ, Richmond S. A three-dimensional evaluation of postoperative swelling following orthognathic surgery at 6 months[J]. Plast Reconstr Surg, 2007,119(7):2192-2199.
[41] Joss CU, Joss-Vassalli IM, Kiliaridis S, et al. Soft tissue profile changes after bilateral sagittal split osteotomy for mandibular advancement:a systematic review[J]. J Oral Maxillofac Surg,2010, 68(6):1260-1269.