- 學位論文
骨性三級異常咬合之顏面不對稱手術矯正治療結果分析
Surgical-orthodontic Treatment Outcome of Facial Asymmetry in Patients with Skeletal Class III Malocclusion
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摘要
目的： 探討骨性三級異常咬合患者在接受正顎手術合併矯正治療後，顏面軟硬組織不對稱性的改善情形，以及下顎骨遠心骨塊移動對於近心骨塊移動的影響及其相關性。 材料與方法： 本回溯性研究包括30位完成勒弗氏一型手術與下顎矢狀分裂骨切開術合併矯正治療的骨性三級異常咬合患者 (男性：13位，女性：17位，平均年齡：22.43 ± 4.71歲) ，其正顎手術規劃皆藉助數位手術模擬完成設計。研究方法: 將治療前後的全頭顱錐狀射束電腦斷層掃描 (cone-beam computed tomography, CBCT)影像，匯入Amira® 3D Pro Amira進行三維影像重組及資料分析，利用Voxel-based Registration將之手術前及整體治療完成後的CBCT影像疊合，利用虛擬三角形來代表不同骨塊，以分析各骨塊在治療前後的位置變化，包括在X, Y, Z軸向的平移量以及Pitch, Roll, Yaw旋轉角度，並依本院正顎手術及矯正研究團隊過去所提出的顏面不對稱分類架構進行探討。分類架構定義如下：Group 1為下頷點歪斜與下頷枝較寬側同方向且大於下頷枝寬度差異；Group 2為下頷點歪斜與下頷枝較寬側同方向且小於下頷枝寬度差異；Group 3為下頷點歪斜與下頷枝較寬側方向相反。 結果與結論： 本研究的測量值具有高度的觀察者內信度，所有測量項目的組內相關係數皆在0.9以上。三個組別的下頷點偏斜治療後皆有顯著改善；下顎枝寬度的對稱性在Group 1以及 Group 2中也有顯著改善，而在Group 3中並沒有更加惡化。 骨塊的移動分析顯示，Group 1上顎呈現Non-deviated side roll upward及咬合平面偏斜的改善；Group 2 下顎遠心骨塊移動與Group 1相似，多以往非偏斜側、往後、往上移動為主；Group 3 下顎遠心骨塊有明顯Yaw rotation及Deviated side roll upward，偏斜側近心骨塊有較多的Pitch upward 以及較少的Roll inward，非偏斜側近心骨塊有較多Yaw inward，上述變化有助於維持術後下顎枝寬度的對稱性。 至於相關性分析的結果顯示Group 1與Group 2 的下顎骨遠心骨塊平移與下頷點偏斜及下頷枝對稱性的改善有關。Group 3的下顎骨遠心骨塊Yaw 旋轉及Deviated-side roll upward 皆與非偏斜側近心骨塊未更向外側Roll outward存在顯著相關性。 總結而言，骨性三級異常咬合患者的正顎手術及矯正治療可根據顏面不對稱特徵適當給予相對應的數位手術模擬規劃以達成良好的治療成果。
並列摘要
Purpose: The study aimed to investigate the improvement of soft and hard tissue facial asymmetry in patients with skeletal Class III malocclusion after surgical-orthodontic treatment, as well as the impact of the translation and rotation of the mandibular distal segment on the movement of the proximal segment. Materials and Methods: This retrospective study analyzed the outcomes of orthodontic treatment combined with double-jaw surgery aid by digital surgical simulation in 30 patients with skeletal class III malocclusion (13 males, 17 females; mean age: 22.43 ± 4.71 years). Cone-beam computed tomography (CBCT) scans were taken before surgery and after orthodontic treatment, then the scans were superimposed using voxel-based registration and analyzed with Amira® 3D Pro Amira software. A total of 4 virtual triangles were used to represent the bone segments of LeFort I osteotomy and bilateral sagittal split osteotomy. Afterwards, the positional change of the virtual triangles were analyzed to assess the movement of jaw bones, including translation in the x, y, and z axes, as well as pitch, roll, and yaw rotations. Movement of the bone segments were further delineated for the different pattern of facial asymmetry based on our classification system described previously. Patients in Group 1 and 2 showed menton and ramus deviation to the same side. Group 1 patients exhibited a larger shift of the menton but smaller ramus deviation. For the group 2 patients, gonion asymmetry is more evident than menton deviation. As for the group 3 patients, the direction of menton deviation is opposite to the prominent gonial region. Results: All intraclass correlation coefficients of the measured values were above 0.9, indicating a high level of intra-observer reliability. After treatment, a notable improvement was observed in chin deviation in all three groups. Moreover, Group 1 and Group 2 showed a significant correction in the asymmetry of mandibular ramus width, whereas Group 3 did not experience any further deterioration. In Group 1, the maxilla segment presented a roll upward at non-deviated side, contributing to the correction of canted occlusal plane. In Group 2, the movement of the mandibular distal segment was similar to that in Group 1, resulting in a position change toward the non-deviated side, posterior and upward translation. In Group 3, the mandibular distal segment exhibited a significant yaw rotation and upward roll on the deviated side, while the proximal segment at the deviated side showed more pitch upward and less inward roll. The proximal segment at the non-deviated side showed more inward yaw rotation. These changes might contribute to the correction of asymmetry in mandibular ramus width. The results of the correlation analysis showed that the mandibular distal segment translation in Group 1 and Group 2 improved the menton deviation and also enhanced the symmetry of the mandibular ramus width. In Group 3, both the yaw rotation and deviated side upward roll of the distal segment have a significant correlation with a less roll outward of the non-deviated side. Conclusions: In this study, all the Class III subjects diagnosed as skeletal Class III, who were divided into three groups based on their facial features and given corresponding digital surgical planning for jaw movement, could improve their facial asymmetry after orthodontic and orthognathic treatment.
參考文獻
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