骨性Ⅲ类错正颌术后侧貌预测及评价

Prediction and assessment of facial profile after bimaxillary orthognathic surgery in skeletal Class Ⅲ malocclusion

目的:预测骨性Ⅲ类错患者双颌术后侧貌,经审美评分,确定侧貌美观度,为手术方案设计提供参考。方法 :选择重庆医科大学口腔医院正畸科骨性Ⅲ类错患者1例,以Photoshop CS4模拟患者术后侧貌,以Andrews美学理论二要素设计上颌硬组织前徙位置,以中国人软组织面型角设计下颌骨后退位置,预测出侧貌标准图P1。在P1上分别矢状向移动B’点及Pog’点±1、±2、±3、±5、±7 mm,获得20幅面型图,随机排列,由专业组、非专业组共128人评分;采用SPSS13.0软件包中的Wilcoxon秩和检验比较21幅预测图得分及2个评价组是否有差异。结果:21幅侧貌图得分具有显著差异(P<0.05)。被认为美观的侧貌得分由高至低:分别为图D3、D2、D1、B1、A1、P1、C1、A2、B2;被认为不能接受的侧貌图依次为:图C5、B5、C4、A5。专业组及非专业组的审美评分无显著差异(P>0.05)。结论:人们对侧貌美观度的认知不同,直面型最美观,其次是下颌或颏部稍后缩的面型,而下颌或颏部严重前突或后缩被认为是很不美观且不能为人接受。

PURPOSE： To predict and assess the facial profile after bimaxillary orthognathic surgery in a patient model. METHODS： One patient with skeletal Class Ⅲ malocclusion was selected.The orthognathic surgery design was simulated through Photoshop CS4 software.Preoperative photograph and lateral cephalometric radiograph were processed to produce the first standard facial profile photography P1.The maxillary hard tissue was moved forward according to Andrews theory Ⅱ,and soft tissue also moved in proportion until the mandible recessed to the Chinese G-Sn-Pog＇angle.Then the mandible was moved forward and back ±1,±2,±3,±5,±7 mm,generating 20 facial profile photographs.Two groups of reviewer were chosen for evaluation：specialists（40 orthodontists）,undergraduates（68 undergraduates from Chongqing Medical University）.They were asked to rank the 21 random profiles in descending order.The difference of the score of 21 photographs given by two groups of reviewer was compared using Wilcoxon rank sum test with SPSS13.0 software package. RESULTS： The scores of 21 profile photographs were significantly different（P0.05）.Profile D3 was considered to be the most beautiful,followed by D2,D1,B1,A1,P1,C1,A2 and B2.C4、A5、B5 and C5 were not acceptable.The scores for each photograph given by the two groups of reviewer were not significantly different（P0.05）.CONCLUSIONS： The reviewers give different scores for 21 profiles.Straight profile is most beautiful,followed by profile with minor mandibular or chin retraction.Profiles with severe protrusion or retrusion is not acceptable.