正颌手术对成人骨性Ⅲ类颜面部不对称三维特征改变锥形束CT观察  

Observation with cone-beam computed tomography in orthognathic surgery to improve adult patients with skeletal class Ⅲ facial asymmetry

作　　者：刘可[1] 赵宏 荣亮 孙伯阳[1] 赵春洋[3] LIU Ke;ZHAO Hong;RONG Liang;SUN Bo-yang;ZHAO Chun-yang(Department of Stomatology,Nanjing General Hospital of Nanjing Military Region,PLA,Nanjing 210002,Jiangsu,China;Department of Orthodontics,Stomatology Hospital of Hefeng,Kunshan 215300,Jiangsu,China;Department of Orthodontics,Institute of Stomatology,Nanjing Medical University,Nanjing 210002,Jiangsu,China)

机构地区：[1]南京军区南京总医院口腔科,南京210002 [2]昆山市禾丰口腔医院正畸科,昆山215300 [3]南京医科大学附属口腔医院正畸科,南京210002

出　　处：《东南国防医药》2018年第6期580-585,共6页Military Medical Journal of Southeast China

基　　金：南京军区南京总医院院管课题(2015018)

摘　　要：目的通过锥形束CT(CBCT)研究成人骨性Ⅲ类错牙合伴下颌偏斜患者正颌手术前后颌面部的三维特征。方法回顾性分析正畸成人骨性Ⅲ类错牙合伴下颌偏斜患者20例患者临床资料,作为颜面部不对称组,另选取同期成人骨性Ⅰ类无下颌偏斜患者20例为颜面部对称组,对不对称组采用正畸-正颌联合治疗的方法,在正畸治疗前和正颌手术后12个月后使用CBCT分别对2组患者进行三维扫描获得颅面部DICOM数据,采用Dolphin 11.2对颌骨进行三维重建,选择描述颌骨骨性结构特征的28个点进行描记,对上下颌骨共60个变量进行分析统计。结果不对称组手术后,牙合平面的倾斜度、上颌骨下部宽度、下颌总长度及下颌支倾斜的对称性得到了明显的纠正,但与对称组比较,在术后上颌骨的上部及双侧髁突的位置仍存在明显不对称性。结论正颌手术对成人骨性Ⅲ类错牙合患者颌面部硬组织对称性的改善主要是对牙合平面的倾斜度、上颌骨下部宽度及下颌体长度不协调的纠正,而上颌骨上部及髁突的不对称仍未有效改善。Objective To study the three-dimensional characteristics of the maxillofacial before and after orthognathic surgery in patients with skeletal classⅢmalocclusion and mandibular deviation. Methods 20 patients with skeletal classⅢmalocclusion and mandibular deviation were selected as facial asymmetry group,and other 20 adult skeletal class I patients with no mandibular deviation were symmetry facial group.Facial asymmetry was treated with orthodontic-orthognathic therapy.CBCT was used to perform 3D scanning on patients to obtain DICOM data before orthognathic operation and twelve months after the orthognathic operation.Dolphin 11.2 was utilized to rebuild the jaws in 3D.28 points concerning maxillofacial feature were chosen,60 variables of maxillofacial measurements were analyzed. Results In the asymmetry group,the inclination of occlusal plane,the width of lower maxilla,the total length of mandible,and the symmetry of mandibular branch were significantly corrected,but relative to the symmetry group,the upper of maxilla and the position of condyle still has obvious asymmetry after surgery. Concluion The improvement of symmetry of maxillofacial hard tissue in orthodontic treatment of adult skeletal classⅢmalocclusion is mainly due to the inconsistent correction of occlusal plane inclination,maxillary lower width,and the length of mandibular.The asymmetry of upper maxilla and condylar still has not been effectively improved,Accurate 3D measurement analysis before surgery is crucial for the determination of surgical protocol and the judgment of prognosis.

关 键 词：下颌偏斜 骨性Ⅲ类错牙合 正颌 锥形束CT 测量 

分 类 号：R783.5[医药卫生—口腔医学]