- 學位論文
骨性三級咬合不正下顎單顎手術後退量的美觀分析
The skeletal class III esthetic analysis on mandibular setback surgery
摘要
本研究蒐集6年中山醫學大學附設醫院接受下頷單顎手術之骨性三級咬合不正的成年患者，藉由手術前、後測顱影像的測量方式，分析患者臉部美觀線的變化並以過五個測量變數（Nasolabial angle、E-line to upper lip、E-line to lower lip、Vertical height change、Occlusal plane change）分析手術前後下顎骨後退量與美學上之間的關係。本研究納入了258例患，根據手術方式、性別以及E-line是否符合標準進行樣本分組，其中手術方式分為bilateral vertical ramus osteotomy、genioplasty以及BVRO plus genioplasty三種，E-line定義在0到2 mm區間內為符合美學標準，區間外為不符合美學標準。經測量（Nasolabial angle、E-line to upper lip、E-line to lower lip、Vertical height change、Occlusal plane change）等五個變數，使用統計方式分析影響下顎後退量的重要因子以及呈現不同條件樣本下的Esthetic line及Wits appraisal切點數值。發現nasolabial.angle、U-lip-E line、L-lip-E line、vertical height change以及occlusal plane change等變量均為美觀上重要的影響因子，在不同的組別中對後退量可達到顯著的影響。根據（Receiver operating characteristic（ROC）分析結果，採用單顎手術並於術以符合美觀線，則術前E-line的threshold區間為0.191~0.473，若術前超出此標準時則手術候美觀結果較不佳。本研究發現骨性三級咬合不正患者在評估手術前，可考慮術前的E-line數值來決定能否僅需進行單顎手術。
並列摘要
Collecting data from adult patients underwent single-jaw surgery for skeletal Class III malocclusion between 6 years. Through measuring cranial imaging changes before and after surgery, we analyzed whether aesthetic standards could be achieved through one-jaw surgery in patients. Additionally, we examined the relationship between the degree of maxillary setback and five measurement variables (Nasolabial angle, E-line to upper lip, E-line to lower lip, Vertical height change, Occlusal plane change). Patients were grouped based on surgical procedure, gender, and whether their E-line fell within the standard range (0 to 2 mm). Surgical procedures included BVRO, genioplasty, and BVRO plus genioplasty. Analysis were employed to determine the significant factors influencing setback and to establish Esthetic line and Wits appraisal cutoff values for assessing surgical outcomes in different conditions. The analysis revealed that five variables were all significant influencing factors, exhibiting substantial effects on setback in various groups. According to ROC results, if one intends to opt for one-jaw surgery and achieve postoperative aesthetic standards, the threshold for preoperative E-line ranged from 0.191 to 0.473. Patients exceeding this standard preoperatively may have poorer surgical outcomes, although this finding may not fully support clinical practice.