上颌Le FortⅠ前徙术与前份根尖下截骨后退术术后软组织变化的比较研究

Soft tissue changes of the maxillary region in patients after anterior maxillary osteotomy setback and Le FortⅠosteotomy advancement

目的测量不同上颌骨正颌术式前后鼻唇区域软组织变化,分析可能导致变化的因素。方法2017—2021年于四川大学华西口腔医院正颌及关节外科住院行正颌手术的患者37例,其中因上颌后缩行上颌骨Le FortⅠ型骨切开前徙术(LFIA)的患者18例,因上颌前突行上颌骨前份根尖下截骨后退术(AMOS)的患者19例。收集其术前即刻和术后6~12个月的螺旋CT影像,通过Mimics和3-Matic软件进行三维重建和匹配,测量软硬组织标志点变化。使用GraphPad Prism软件进行统计学分析,显著性水平α=0.05。结果2种术式术后最主要的软组织变化均发生在上唇区域且改变方向与骨组织移动方向相同。在前后向软组织改变上,LFIA组软硬组织改变的比例为0.628,而AMOS组为0.465。颊部和鼻尖软组织在2种术式后均发生了前移,其中AMDS组中颊部软组织前移的量与软组织厚度的改变具有显著正相关性。在垂直向软组织变化上,LFIA组鼻尖点发生上抬且其距离与颌骨前徙距离具有显著正相关性,AMOS组上唇缘点发生下降且其距离与颌骨后退距离具有显著正相关性。在水平向软组织变化上,鼻翼宽度在行2种术式后均出现增宽,但在AMOS组中鼻翼宽度增宽量与后退距离呈显著负相关。结论AMOS和LFIA术后的鼻唇区域软组织改变与颌骨移动量及方向具有显著相关性。上唇前后向改变与颌骨移动距离具有显著正相关性,鼻翼宽度改变与上颌骨后退距离具有相关性。以上相关性的发现可能帮助临床医生更准确地判断鼻唇区域的软硬组织改变。

Objective This work aimed to analyze nasolabial soft tissue changes in patients with maxillary advancement and setback via different maxillary orthognathic procedures.Methods A retrospective,observational,and analytical study was carried out for a period of 4 years involving 37 patients.A total of 18 patients diagnosed with maxillary retrusion were treated by Le FortⅠosteotomy advancement(LFIA),and 19 patients diagnosed with maxillary protrusion were treated by anterior maxillary osteotomy setback(AMOS).Similarity and distinction of soft tissue changes in these two groups(AMOS and LFIA)were investigated and compared.Spiral computed tomography was conducted immediately before surgery and 6-12 months after surgery.The hard and soft tissue landmarks were measured in a 3D coordinate system after CT reconstruction.The differences between pre-and postoperative images were recorded as surgical changes.The appropriate statistical test was carried using GraphPad Prism,and the level of significance wasα=0.05.Results Both LFIA and AMOS brought greater soft tissue changes in the lip region compared with those in the nose and cheek regions.In the anteroposterior direction,the hard/soft tissue change ratio after LFIA(0.628)was higher than that after AMOS(0.465).Cheek and nose tips protruded after both surgical processes.Ck advancement was significantly correlated with soft tissue thickness change in the AMOS group.In the vertical direction,Prn presented uplift movement that was correlated with the maxilla advancement distance in the LFIA group,whereas Ls showed downward movement that was correlated with the maxilla setback distance in the AMOS group.Postoperative alar width increased in both groups.Interestingly,the degree of alar widening was negatively correlated with the maxilla setback distance in the AMOS group.Conclusion Postoperative nasolabial soft tissue changes in both LFIA and AMOS patients could be predicted through the direction and amount of maxilla movement to a large extent,especially in the lip region.Further investigations to illustrate the precise correlations between soft tissue changes and maxillary movement in the future could be beneficial for the prediction of postoperative appearance.