骨性Ⅲ类错▉畸形患者双颌手术后软、硬组织的变化

目的 探讨骨性Ⅲ类错▉畸形患者双颌手术后软、硬组织变化的相关性、软组织厚度与软硬组织变化的相关性及软组织厚度的变化,以更好地预测术后软组织侧貌。方法 对26例骨性Ⅲ类错▉畸形成人患者进行锥形束CT（CBCT）扫描,用InVivo5软件将CBCT转化成头颅侧位片（cephalogram from CBCT, CCB）,导入“几何画板”并建立坐标系,进行定点测量。采用SPSS17.0软件包对所有测量值进行统计学分析。结果 各软、硬组织标志点存在线性相关关系,下颌比上颌相关性强。Sn∶A=0.18∶1,UL∶Ui=0.31∶1,LL∶Li=0.80∶1,Si∶B=0.84∶1,Pg'∶Pg=0.90∶1。鼻底厚度、颏部厚度与相应软、硬组织变化无相关关系。唇部厚度与软、硬组织变化呈负相关关系。术后上唇变薄,下唇变厚。结论 软、硬组织变化呈线性相关关系,下颌软、硬组织位移比率大于上颌。鼻底及颏部软组织受硬组织移动影响小,唇部变化受硬组织影响大;唇部越薄,随硬组织移动性越好。     

双颌正颌手术治疗严重骨性Ⅲ类错牙合 面部硬组织变化的研究

[摘要] 目的：比较严重骨性Ⅲ类错牙合患者双颌正颌手术治疗各阶段硬组织的变化及其术后稳定性。方法：选择30例严重骨性Ⅲ类错牙合患者进行双颌手术,采用SPSS20.0软件包对治疗前（T0）,手术前（T1）,手术后6周（T2）以及治疗结束时（T3）相关硬组织测量项目进行t检验。结果： T0与T1相比,上下切牙的相应测量项目发生了显著变化（P<0.05）;T1与T2相比,上下颌各硬组织标志点分别向前上和后上移位（P<0.05）,SNA角、SNB角、ANB角、Wit值均发生了显著变化(P<0.05),OP-SN增大显著（P<0.05）,牙合平面发生了逆时针方向的旋转,上面高（N-ANS）、下面高（ANS-Me）变化显著（P<0.05）,垂直比例更为协调,均获得了良好咬合关系;T2与T3相比,上下颌各硬组织标志点分别有轻度的后下、前上移位趋势,但其变化无统计学意义（P<0.05）。结论：双颌手术在上颌畸形治疗、面部垂直比例关系改善、牙合平面倾斜度的改变、咬合关系改变方便效果显著,其术后稳定性较好。     

正颌手术对骨性Ⅲ类错畸形患者语音功能的影响

目的: 探讨正颌手术对骨性Ⅲ类错畸形患者术后语音功能的影响。方法: 选择 31例骨性Ⅲ类错畸形成人患者,分别在术前1周、术后 3个月采集颌面 CT 扫描数据、语音数据。将采集的CT数据导入Dolphin软件,对咽部解剖结构进行测量、分析及头颅X线头影测量分析;对语音数据进行主观和客观评价。采用SPSS 24.0软件包进行统计学分析。结果: 正颌手术后,软腭下缘到咽后壁的距离、会厌上缘到咽后壁的距离及其相应的横截面积和口咽、喉咽的体积较术前均有显著差异（P<0.01）。头颅X线片分析显示,术前和术后SNA、SNB、ANB、OJ、OBJ差异具有统计学意义（P<0.05）。正颌患者术后语音情况较术前发生改变,差异具有统计学意义（P<0.05）。正颌手术前、后,元音/a/B2、B3、B4,/i/B1、B2,/u/B1、B2、B4的差异具有统计学意义（P<0.05）,辅音/x/、/zh/、/s/下限频率及/zh/能量值的变化有统计学意义（P<0.05）,辅音/z/的语图形态变化有统计学意义（P<0.05）。上颌骨前移距离与△S1、△VOP、语音变化存在高度相关或显著相关。结论: 正颌手术对上、下颌骨的移动,引起咽腔解剖结构改变,导致术后语音改变。     

Sander Ⅲ矫治器治疗早期骨性Ⅲ类错(牙合)后软、硬组织变化及垂直向相关性

目的：探讨SanderⅢ矫治器矫治早期骨性Ⅲ类错后软、硬组织变化和垂直向相关性。方法：选择32例拟行SanderⅢ矫治器矫治的早期骨性Ⅲ类错患者,观察矫治前、矫治12个月后软、硬组织变化,分析软组织与垂直向的相关性。采用SPSS 25.0软件包对数据进行统计学分析。结果：矫治12个月后SNB缩小（P<0.05）,ANB、 A-PTV、Go-Me增加（P<0.05）,软组织指标LL-LI增加（P<0.05）,LL-EP减少（P<0.05）,矫治后L1/MP缩小（P<0.05）,U1E-PTV增加（P<0.05）。相关性分析显示,UL-UI与倾斜角、U1E-PP、U6E-PP呈正相关（P<0.05）,LL-LI与倾斜角、U1E-PP、U6E-PP呈负相关（P<0.05）,Sn-UL/FH与U6E-PP呈正相关（P<0.05）。结论：SanderⅢ矫治器可有效矫正早期骨性Ⅲ类错患者软、硬组织畸形,唇部形态随硬组织骨性关系改善而趋于协调,软组织指标与硬组织垂直向关系密切。     

T4K矫治器治疗替牙早期安氏Ⅱ类1分类错的软、硬组织改变及稳定性

目的 探讨T4K矫治器治疗替牙早期安氏Ⅱ类1分类错畸形后患者软、硬组织改变及稳定性。方法 选择20例安氏II类1分类错畸形患者,男11例,女9例;年龄9~14岁,平均11.05岁。所有患者均行T4K矫治器治疗12个月。观察矫治前、矫治后12个月、36个月软、硬组织变化,评价T4K矫治器治疗安氏Ⅱ类1分类错畸形的稳定性。采用SPSS 25.0软件包对数据进行统计学分析。结果 矫治后12个月,硬组织指标U1-NA、U1-NA、L1-NB、L1-NB 显著减小（P<0.05）,U1-L1显著增大（P<0.05）;软组织指标UL-U1、LL-L1显著增大（P<0.05）,覆盖、覆、上唇突点至E 线的垂直距离、下唇突点至E 线的垂直距离显著减小（P<0.05）,鼻唇角、颏沟倾角、颏软组织厚度显著增加（P<0.05）。矫治后36个月,上述指标与术后12个月相比无统计学差异（P>0.0.5）。结论 T4K矫治器治疗替牙早期安氏Ⅱ类1分类错畸形可纠正患者不良口腔习惯,改善口颌以及面部软、硬组织关系,远期效果好,疗效稳定。     

Twin-block矫治器治疗安氏Ⅱ类骨性错后的软、硬组织变化

目的:探讨Twin-block矫治器早期矫治对安氏Ⅱ类骨性错患者软、硬组织的影响。方法:前瞻性选择60例安氏Ⅱ类骨性错患者为研究对象,应用随机数字表法将患者分为2组,每组各30例。实验组采用Twin-block联合直丝矫治器治疗,对照组采用直丝矫治器治疗。观察2组矫治前、矫治后12个月、36个月硬组织指标（SNA、SNB、ANB、U1-NA夹角、U1-NA距离、L1-NB距离、L1-NB夹角、U1-L1夹角）和软组织测量指标[UL-U1、LL-L1、覆盖（over jet）、覆（overbite）、上唇突点至E 线的垂直距离（E-upper-lip）、下唇突点至E 线的垂直距离（E-lower-lip）、颏沟倾角、颏软组织厚度]的变化。采用SPSS 25.0软件包对数据进行统计学分析。结果:实验组矫治后12个月、36个月U1-NA、U1-NA、L1-NB、L1-NB、覆盖、覆、E-upper-lip、E-lower-lip显著小于对照组（P<0.05）,U1-L1、鼻唇角、颏沟倾角、颏软组织厚度显著大于对照组（P<0.05）。结论:Twin-block联合直丝矫治器可显著改善安氏Ⅱ类骨性错患者口颌以及面部软、硬组织关系,远期效果良好。     

骨性Ⅲ类错牙合患者正畸正颌联合治疗前后面部软组织变化的研究

目的探讨骨性Ⅲ类错牙合患者正畸正颌联合治疗前后面部软组织变化的特征。方法选择在江苏省口腔医院正畸科就诊的14例骨性Ⅲ类错牙合畸形的患者为研究对象,分别于正畸正颌联合治疗前、后拍摄3dMD,利用3dMD vultus软件对颌面部软组织进行重建,然后选取面部软组织有代表性的17个三维标志点并测量线距和角度,比较骨性Ⅲ类错牙合患者正畸正颌联合治疗前后的差异。结果面凸角、鼻唇角、颏唇角、上唇长度,鼻翼宽度及鼻基底宽度有统计学差异,P<0.05。结论①3dMD提供了三维测量软组织的一种方法。②骨性Ⅲ类错牙合患者正畸正颌联合治疗前后面型改善。     

正颌术后硬组织位置变化预测的准确性评价

目的　探讨牙颌面畸形患者行正颌外科手术术后硬组织位置变化与术前预测误差的影响因素。方法　对 15例牙颌面畸形患者正颌外科手术后 1个星期拍头颅定位侧位片进行头影测量 ,并和术前正畸后头颅定位侧位片模拟手术后所得预测值进行 15项硬组织测量指标统计分析。结果　术后测量值和术前预测值在水平向量变化上存在着绝对值差异 ,但无显著性差异 ,而在一些垂直向量变化中存在着显著性差异 ,分析差异引起的原因 :术前头影测量和模型外科的差异 ,牙合板制作不准确的影响 ,颞颌关节的影响及术中因素的影响。结论　术前精确的头影测量和模型外科 ,牙合板的精确制作 ,术中选用合适的口外标记点并仔细行手术操作是取得完善疗效的关键     

骨性Ⅲ类错(牙合)正颌术后颊部宽度变化的三维研究

目的 探讨骨性Ⅲ类错(牙合)患者正颌术后颊部宽度变化的规律.方法 20例完成正颌手术的骨性Ⅲ类错(牙合)患者,男性9例,女性11例,平均年龄(25.06±5.33)岁,其中9例接受双侧下颌升支矢状劈开截骨(Bilateral sagittal split ramus osteotomy,BSSRO)后退术,11例接受Lefort-Ⅰ型截前移骨术和BSSRO后退术,分别在术前2周(T1)、术后6个月(T2)进行面部激光扫描检查,手术前后软组织面型的三维图像在同一坐标系中完成测量,分析颊部宽度的变化.结果 在经过外眦连线中点的冠状截面上,20例患者术后单侧颊部软组织宽度增加(3.58±2.21) mm,不同性别之间无显著性差异;下颌后退组单侧颊部增宽(1.74±0.76) mm,双颌手术组单侧颊部增宽(5.00±1.86) mm,两组之间存在显著性差异(P=0.001).结论 骨性Ⅲ类错(牙合)接受单纯下颌后退或者双颌手术后,颊部宽度均有增加的趋势.     

骨性Ⅲ类错[牙合]患者双颌手术前后软硬组织的三维测量分析

目的：通过研究骨性安氏Ⅲ类错[牙合]患者双颌手术结果,评估Ⅲ类错[牙合]患者软硬组织之间的变化关系。方法：骨性安氏Ⅲ类错[牙合]畸形患者41例,采用上颌骨LeFortI型截骨和双侧下颌支矢状劈开术。分别在术前和术后6个月时进行三维CT重建测量,并对手术前、后的软硬组织变化以SPSS11.0软件包进行Pearson相关分析。结果：术后软硬组织变化有一定规律。下颌骨软硬组织移动在水平方向上高度相关（r〉0.9）,而在垂直方向上呈中度相关（0.82〉r〉0.63）。上颌骨软硬组织移动则在2个方向上均呈中度相关（0.78〉r〉0.56）到弱相关（r〈0.6）。结论：与上颌骨相比,下颌骨的软硬组织移动变化呈现强相关性;而在水平方向上的相关性也高于垂直方向。本研究得到的软硬组织移动比率对术前预测有一定帮助。     

Comprehensive analysis of soft tissue changes in response to orthognathic surgery: mandibular versus bimaxillary advancement

This study was performed to compare soft tissue changes in response to mandibular and bimaxillary advancement osteotomy. Preoperative and postoperative cone beam computed tomography scans of 24 cases were analysed: 12 underwent bimaxillary advancement and 12 underwent mandibular advancement. The skeletal surgical movements were measured and soft tissue changes were displayed on a three-dimensional colour map. The intensity and shade of the colour indicated the magnitude and direction of the changes. In the bimaxillary advancement group, maxillary advancement was 5.5 ± 2.7 mm with anterior vertical impaction of 2.7 ± 2.5 mm; mandibular advancement was 4.6 ± 3.2 mm. Most of the mediolateral soft tissue changes were limited to the anatomical boundaries of the paranasal region – the columella together with the alar bases of the nose; these showed clear forward movement, which extended to involve most of the cheeks. In the mandibular surgery group, the mean advancement was 3.5 ± 2.6 mm. The chin region, lower lip, and inferior parts of the cheek showed forward shift with minimal changes at the vermilion border, which was only displaced in an upward direction. In conclusion, dense anatomical correspondence is a clinically meaningful method of producing a visual comprehensive analysis of the changes in response to orthognathic surgery.     

Differences in three-dimensional soft tissue changes after upper,lower, or both jaw orthognathic surgery in skeletal class III patients

The decision is not always straightforward as to which orthognathic procedure is best for a good aesthetic result; three-dimensional imaging has brought new insight into this topic. The aim of this prospective study was to verify objectively whether postoperative changes occur within those regions not directly affected by surgical movements of the underlying jaw bones. The study included 83 young adults with skeletal class III deformities. They were classified into three groups according to the type of surgery: bilateral sagittal split osteotomy set-back of the mandible (BSSO), Le Fort I advancement of the maxilla, or a combination of both. Pre- and postoperative optical scans were registered as regional best-fits on the areas of the foreheads and both orbits. The shell to shell differences were measured and the average distances between the observed regions were calculated. As expected, changes were greatest in the regions where the underlying bones had been moved, but regardless of the operation performed, changes were found over the whole face. Changes in the nose, cheek, and upper lip regions in the BSSO group and in the lower lip and chin region in the Le Fort I group confirmed the concept of the facial soft tissue mask acting as one unit.     

立体摄影颌面部软组织三维重建与测量的研究进展

颌面部软组织三维重建及其在此基础上的测量，在口腔颌面外科学、口腔正畸学、整形外科学、法医学、人类学及美学等领域有着很重要的意义。在面部软组织重建与测量方面，出现了激光扫描、立体摄影、莫尔云纹、结构光技术、CT、MRI等方法，但各有利弊。面部软组织三维立体摄影测量（stereopho-togrammetry）在20世纪90年代初即开始出现。     

Predicting soft tissue changes after orthognathic surgery: The sparse partial least squares method

Objectives:To develop a prediction algorithm for soft tissue changes after orthognathic surgery that would result in accurate predictions (1) regardless of types or complexity of operations and (2) with a minimum number of input variables.Materials and Methods:The subjects consisted of 318 patients who had undergone the surgical correction of Class II or Class III malocclusions. Two multivariate methods—the partial least squares (PLS) and the sparse partial least squares (SPLS) methods—were used to construct prediction equations. While the PLS prediction model included 232 input variables, the SPLS method included a reduced number of variables generated by a handicapping algorithm via the sparsity control. The accuracy between the PLS and SPLS models was compared.Results:There were no significant differences in prediction accuracy depending on surgical movements, the sex of the subjects, or additional surgeries. The predictive performance with a reduced set of 34 input variables chosen using the SPLS method was statistically indistinguishable from the full set of variables with the original PLS prediction model.Conclusions:The prediction method proposed in the present study was accurate for a wide range of orthognathic surgeries. A reduced set of input variables could be selected through the SPLS method while simultaneously maintaining a prediction level that was as accurate as that of the original PLS prediction model.     

Accuracy of soft tissue prediction in surgery-first treatment concept in orthognathic surgery: A prospective study

Purpose

The purpose of this study was to provide a quantitative accuracy assessment of soft tissue predictions generated by a computer-aided maxillofacial planning system in patients undergoing orthognathic surgery following the “surgery-first” treatment.

Three-dimensional evaluation of soft-tissue response to osseous movement after orthognathic surgery in patients with facial asymmetry: A systematic review

To systematically assess the current literature on soft-tissue response associated with osseous movement following orthognathic surgery in patients with facial asymmetry.Six electronic databases (PubMed, EMBASE (via Ovid), Medline (via Ovid), Cochrane Library, Scopus, and Web of Science) and gray literature were searched for studies evaluating hard- and soft-tissue responses three-dimensionally after orthognathic surgery, using MeSH terms and keywords. The methodological quality and level of evidence of the included studies were analyzed using EPHPP and GRADE, respectively.The primary search yielded 125 articles, and 10 articles that satisfied the predefined inclusion criteria were finally included. All the included articles evaluated soft-tissue response, with six of them additionally investigating the magnitude of this response. Soft tissues move with hard tissues horizontally and anteroposteriorly; however, soft-tissue movement is less than hard tissue movement. In addition, soft tissue movement is more pronounced in the lower central facial region. Six articles were judged as having ‘strong’ methodological quality, while the evidence was found to be of ‘low’ quality for the soft-tissue response and the magnitude of this response.Despite a low level of evidence, the review substantiates a favorable three-dimensional soft-tissue response following osseous surgery. The soft-tissue response is more pronounced horizontally, anteroposteriorly, and in the lower central facial region. Nevertheless, well-designed prospective studies with a higher level of evidence are needed.     

应用有限元法预测正颌术后三维软组织形变的初步探讨

目的:基于锥形束CT(CBCT)资料建立有限元模型,预测正颌术后三维软组织形变,探讨该方法的可行性与准确性。方法:选取下颌前突患者2例,于术前行颅颌面CBCT扫描,导入Mimics10.01软件,进行软、硬组织三维重建。采用Geomagic Studio11软件进行模型处理,并按实际情况进行手术模拟截骨,导入有限元分析软件AnsysWorkbench 11.0,建立线弹性有限元模型,加载位移后,经分析得出术后软组织三维模样,将其与术后6个月及以上的软组织三维重建图像对比,并进行定性及定量评价。结果:2例患者CBCT资料顺利进行有限元建模及预测,临床定性评价显示2例患者预测结果总体观察相似度高,但在口周及颊部相似度欠佳;Geomagic Qualify11定量检测显示,病例1误差小于2mm的区域为94.98%,病例2误差小于2mm的区域为90.71%。结论:采用线弹性有限元模型预测下颌前突正颌术后的软组织形态是可行的,可为临床提供较为可靠的参考。     

应用核磁共振(MRI)采集及三维重建面部表面软组织形态的研究

目的:对MRI在面部软组织的三维扫描与重建图像效果进行研究,以判断其在颌面重建领域中的应用价值。方法:对2名健康志愿者头部进行MRI扫描,扫描数据以DICOM格式储存。在诊断工作站上以SSD法对图像进行重建。结果:在扫描层厚较小的情况下,MRI能完成面部大部分软组织的三维扫描与重建,但图像质量较粗糙。结论:MRI能完成面部软组织的三维扫描与重建,但不应作为颌面重建首选的重建方式。     

测量牙齿及口腔软组织表面积的临床试验

目的测量牙齿及口腔软组织的表面积。方法选择全身及口腔健康、至少有28颗自然牙,且无严重牙列拥挤的成年志愿者62名,男性、女性各31名。用红胶及藻酸盐取上下颌模型,灌注石膏模型后,使用铝箔纸压在模型每个区域,使铝箔与模型表面成相应的形状,经裁剪后计算出牙齿、硬腭、颊舌牙槽粘膜和牙龈粘膜、颊唇前庭粘膜、舌背、口底及舌腹六个区域的面积。结果62名志愿者平均年龄26.6岁,平均牙数29.3颗,口腔总面积为228.4cm^2,牙齿、硬腭、颊舌牙槽粘膜和牙龈粘膜、颊唇前庭粘膜、舌背、口底及舌腹表面积均值分别为49.5cm^2、25.6cm^2、40.6cm^2、53.1cm^2、34.9cm^2和24.7cm^2。结论本试验报道了国人口腔六个区域的面积,为口腔专业的相关研究提供了数据基础。