骨性Ⅲ类偏颌患者正颌术后面部软组织的三维变化  

A three-dimensional facial soft tissue analysis of skeletal ClassⅢasymmetric mandibular deformities following bimaxillary orthognathic surgery

作　　者：庞久绅 厉松[2] Pang Jiushen;Li Song(School of Stomatology,Capital Medical Unversity,Beijing 100050,China;Departmentof Orthodontics,Capital Medical Unversity,Beijing 100050,China)

机构地区：[1]首都医科大学口腔医学院,北京100050 [2]首都医科大学附属北京市口腔医院正畸科,北京100050

出　　处：《中华口腔正畸学杂志》2024年第3期126-131,共6页Chinese Journal of Orthodontics

摘　　要：目的探讨骨性Ⅲ类偏颌患者正颌术前和术后不同时期面部不同区域软组织的变化。方法回顾性选择2016年10月至2019年12月于首都医科大学附属口腔医院创伤整形科接受LeFortⅠ型截骨术、下颌骨矢状劈开术和颏成形术治疗的23例骨性Ⅲ类偏颌成人患者,其中男性9例.女性14例,年龄23~30岁。所有患者分别于术前1周、术后3个月、术后6个月和术后12个月拍摄三维面像和锥形束CT。将所采集患者的面部软硬组织三维数据导入Mimics Medical和3-matic Medical软件并将其划分为27个区域,将软组织图像与硬组织根据额部进行三维重叠,软件根据重叠信息自动计算各区域的软组织体积,并分析术后不同时期各区域软组织的体积变化。通过SPSS统计软件对不同时期不同部位软组织的体积变化数据进行单因素重复测量方差分析。结果骨性Ⅲ类偏颌患者偏斜侧鼻翼旁区、上口角旁区、鼻区、上唇区、下颊部区、下[牙合]体区以及非偏斜侧颧骨区、鼻翼旁区、上颊部区、上下口角旁区软组织体积术前1周到术后3个月、6个月和12个月软组织体积均呈增加趋势(P<0.05)。术后12个月患者下唇及颏区软组织和偏斜侧下口角旁区体积均减小(P<<0.01)。术后左右侧上下口角旁区软组织的对称性变化在不同时期存在统计学差异(P<0.05)。结论骨性Ⅲ类偏颌患者双颌手术和颏成形术后面部偏斜明显改善。面下三分之一软组织术后变化明显,偏斜侧下口角旁区和下唇及颏区软组织术后变得凹陷.而偏斜侧和非偏斜侧上下口角旁、下颌体区、上唇区软组织均较术前凸出。术后左右侧上下口角旁区软组织的不同变化利于改善口周软组织的对称性。骨性Ⅲ类偏颌患者术后鼻翼旁区、鼻区软组织均发生变化,术前应告知骨Ⅲ类偏颌患者上颌骨前徙术后可能会影响鼻部外观。Objective To investigate soft tissue changes after orthognathic surgery in patients with skeletal ClassⅢmalocclusion and facial asymmetry using three-dimensional facial scanning images.Methodss This study included 23 patients with skeletal classⅢmalocclusion and facial asymmetry.Three-dimensional facial stereography and cone-beam CT were performed 1 week before surgery,1 week after surgery,3 months after surgery and 12 months after surgery.Twenty-seven soft tissue areas were screened to analyze the soft tissue changes in each facial area.Three-dimensional facial stereography data collected from 27 facial regions and hard tissue data were imported into Mimics Medical and 3-matic Medical software for partitioning,and the 3D changes of soft tissue in different areas were analyzed at different periods after surgery.SPSS 26.O statistical software was used to analyze the three-dimensional data of soft tissue in different areas at different periods using one-way repeated measures analysis of variance,and P<0.05 was considered statistically significant.Results The soft tissue volume of the skewed side of the lateral nasal,the upper corner of the mouth,the nasal,the upper lip,the lower buccal area,the mandibular area and the non-skewed side of the zygomatic bone,the lateral nasal,the upper and lower buccal area and the upper and lower corner of the mouth area in the patients with skeletal ClassⅢmalocclusion and facial asymmetry was positively changed from 1 week before surgery to 3 months,6 months and 12 months after surgery(P<0.05).The soft tissue volume of the lower lip and chin area on the skewed side negatively changed after operation(P<0.01).There were statistically significant differences in the soft tissue changes in the left and right corner of the mouth area(P<0.05).Conclusions The patients with skeletal ClassⅢmalocclusion and facial asymmetry significantly improved following orthognathic surgery and mentoplasty,resulting in high patient satisfaction.Significant changes were observed in the soft tissues o

关 键 词：骨性Ⅲ类错[牙合] 偏颌 正颌手术 面部软组织三维变化 

分 类 号：R783.5[医药卫生—口腔医学]