摘要
目的探讨女性上颌前突患者正颌术后鼻唇区软组织的三维变化特点。方法北京大学口腔医院收治88例女性上颌前突畸形患者,年龄18~42岁,平均28.2岁。所有患者上颌均行Le FortⅠ型分块截骨术,通过拔除2颗上颌第一前磨牙创造间隙后退上颌骨。上颌前突并下颌后缩患者,下颌行双侧升支矢状劈开截骨术移动下颌体部,双颌前突患者下颌行根尖下截骨术。分别在术前1~3 d及术后至少6个月拍摄3dMD照片,获取面部三维图像,使用Geomagic Studio 2013软件测量手术前、后软组织三维标志点坐标以及线距、角度的变化,并进行三维偏差分析。测量结果进行配对t检验,P<0.05为差异具有统计学意义。结果上颌前突患者鼻下点在矢状向的距离术前为(-10.90±18.60)mm,术后为(-10.05±18.62)mm(t=-7.66,P<0.001),后退了(0.85±1.00)mm;上唇缘点术前为(-15.18±18.67)mm,术后为(-11.92±18.90)mm(t=-21.97,P<0.001),后退了(3.26±1.40)mm。鼻翼宽度术前为(37.32±2.32)mm,术后为(38.08±2.32)mm(t=-4.85,P<0.001),增加了(0.76±1.47)mm;口角宽度术前为(49.17±3.54)mm,术后为(47.68±3.74)mm(t=5.77,P<0.001),减小了(1.49±2.42)mm;人中长度术前为(15.20±2.32)mm,术后为(15.78±2.17)mm(t=-4.70,P<0.001),增加了(0.58±1.16)mm;鼻唇角术前为101.98°±9.34°,术后为109.05°±8.59°(t=-12.36,P<0.001),增大了6.99°±5.35°。三维偏差分析显示,术后鼻旁区软组织前移了(1.54±0.73)mm。结论正颌术后女性患者鼻底及上唇均显著后退,鼻旁区出现前移,并伴随鼻翼变宽、口角宽度减小、人中变长、唇红变薄、鼻唇角增大等改变。
Objective To evaluate the three-dimensional soft tissue changes at nasolabial region of female patients with maxillary protrusion after orthognathic surgery with maxillary setback.Methods Peking University School and Hospital of Stomatology admitted 88 female patients with maxillary protrusion,aged 18-42 years old,with an average age of 28.2 years old.The segmental Le FortⅠosteotomies were performed in all patients with extraction of maxillary first premolars to create space for maxillary setback.The patients with maxillary protrusion and mandibular retraction received bilateral sagittal split ramus osteotomy(BSSRO)to move mandibular body,while the patients with bimaxillary protrusion received subapical osteotomy.3dMD photos were taken preoperative 1-3 days and at least 6 months after operation to obtain three-dimensional facial images.The postoperative soft tissue changes of three-dimensional landmarks,line space and angles were measured with the use of Geomagic Studio 2013,and three-dimensional deviation analysis was applied.Paired t test was performed on the measured results.P<0.05 was considered statistically significant.Results The distance of the subnasale in sagittal direction in patients with maxillary protrusion was(-10.90±18.60)mm preoperatively,(-10.05±18.62)mm(t=-7.66,P<0.001)postoperatively,and setback of(0.85±1.00)mm;Labrale superius was(-15.18±18.67)mm preoperatively,(-11.92±18.9)mm postoperatively,and setback of(3.26±1.40)mm.Preoperative nasal width was(37.32±2.32)mm,postoperative for(38.08±2.32)mm(t=-4.85,P<0.001)and increased by(0.76±1.47)mm.The lip width was(49.17±3.54)mm before surgery and(47.68±3.74)mm(t=5.77,P<0.001)after surgery(t=5.77,P<0.001),decreased by(1.49±2.42)mm.Philtrum length was(15.20±2.32)mm preoperatively and(15.78±2.17)mm(t=-4.70,P<0.001)postoperatively,increased by(0.58±1.16)mm;The nasolabial angle was 101.98°±9.34°before surgery and 109.05°±8.59°(t=-12.36,P<0.001)after surgery,increased by 6.99°±5.35°.The three-dimensional deviation analysis result showed that the soft tissue in the parasnasal area was moved forward(1.54±0.73)mm.Conclusions 3dMD can reflect the three-dimensional soft tissues changes after orthognathic surgery directly and accurately.After maxillary setback,the nasal base and upper lip of patients were significantly retrograded,and the paranasal area appeared forward,accompanied by increase in the nasolabial angle,lengthening of the philtrum length,vermillion length decrease,increase in nasal width and decrease in lip width.
作者
李虎
王兴
李自力
伊彪
梁成
王晓霞
Li Hu;Wang Xing;Li Zili;Yi Biao;Liang Cheng;Wang Xiaoxia(Department of Oral and Maxillofacial Surgery,Peking University School and Hospital of Stomatology,Beijing 100081,China)
出处
《中华整形外科杂志》
CAS
CSCD
北大核心
2020年第2期113-120,共8页
Chinese Journal of Plastic Surgery
关键词
正颌外科
上颌前突
软组织
变化
三维
偏差
鼻唇区
Orthodontic surgery
Maxillary protrusion
Soft tissue
Changes
three-dimensional
Deviation
Nasolabial region
