骨性安氏Ⅲ类错正颌术后侧貌预测及评价

The prediction and assessment of facial profile on postoperative orthognathic surgery in skeletal Class Ⅲ malocclusion

目的预测骨性安氏Ⅲ类错患者正颌外科手术术后的面部软组织侧貌,分析侧貌美观评价的差异,为正畸治疗和正颌外科手术方案的设计提供参考。方法选择中国医科大学口腔医学院正畸科2005年2月收治的骨性安氏Ⅲ类错患者1例。模拟正颌外科手术的设计方案,对术前正畸去代偿后的侧貌照片及头颅定位侧位片进行图片叠合处理,上颌硬组织以术前影像为基准,分别前移0、2、4、6、8mm,软组织按相应比例移动,下颌后退至正常覆、覆盖关系,生成5张面部侧貌图片。选择3组评分者:医生组(正畸及正颌外科医生,41名)、口腔本科生组(中国医科大学口腔医学专业本科生,44名)和患者组(骨性Ⅲ类错畸形患者,20例)。对术前及预测的共6张图片(图2a、2b、2c、2d、2e、2f)进行随机排序,由高到低评分,比较所有图片的评分差异以及评分者性别对评分结果的影响。结果 6张图片的得分差异均具有统计学意义(P<0.05),评分由高到低的顺序为:图2c、2d、2a、2f、2b、2e。3组间及不同性别评分者的评分结果比较,差异均无统计学意义(P>0.05)。结论比较评分者对术后预测图片的评价结果,直面型满意度最高,凸面型其次,凹面型最低;评价结果不受性别影响。

Objective To predict the facial profile on postoperative orthognathic surgery,and determine the facial profile on facial profile esthetics.Methods One case of pre-orthognathic surgery of the patient with skeletal Class Ⅲ malocclusion was selected.Simulate orthognathic surgery design proposal,composite processing the facial profile photography after decompensate preoperative orthodontic and photography of lateral cephalometric radiograph,maxillary hard tissue base on preoperative benchmark which should be moved forward 0、2、4、6、8mm,and soft tissue also moved by the same proportion until mandibular was back to the normal occlusion position,generate five facial profile photography.Three groups of raters was chosen：specialists（orthodontists and orthopaedists,41）,undergraduates（China Medical University undergraduates,44）,patients（patients in skeletal Class Ⅲ malocclusion,20）.The subjects were asked to rank the six random profile photography in descending order,compare the difference of the score of all six photos and the effect of gender on the ratings.Results The differences in rank scores among all the profile types were statistically significant（P 0.05）.The rank was as follows：C、D、A、F、B、E.Comparing the score among the three groups and different gender,the difference was not statistically significant（P 0.05）.Conclusions The participants give different comments on the postoperative prediction pictures of orthognathic surgery from the traditional standard of orthodontic treatment,but closer to the facial profile which has been recognized by the majority of the public.The rating is not affected by gender.