骨性安氏Ⅲ类错患者正颌术后的面部软组织侧貌预测分析

Prediction and analysis of facial soft tissue profile in patients with skeletal Class Ⅲ malocclusion after orthognathic treatment

目的研究骨性安氏Ⅲ类错患者正畸正颌联合治疗对面部软组织侧貌的影响。方法回顾分析2009年10月~2014年10月于本院口腔科实施正畸正颌治疗的32例骨性安氏Ⅲ类错患者临床资料,均予术前正畸、Le FortⅠ型上颌截骨+矢状劈开下颌升支截骨+颏成形术、术后正畸治疗,观察矫治前、正颌术后3月、术后1年软组织角度的改变情况。结果术后3月与鼻尖部软组织侧貌有关的E angle、NS-Prn-Pos与矫治前对比,明显降低(P<0.05)。鼻小柱软组织侧貌有关的Cm-Sn-UL与矫治前对比,明显增大(P<0.05)。鼻下点软组织侧貌有关的G-Sn-Pos、NS-Sn-Pos与矫治前对比,明显增大(P<0.05)。FH-Sn Pos与矫治前对比,明显减小(P<0.05)。上下唇软组织侧貌有关的FH-A~丿UL与矫治前对比,明显增大(P<0.05),FH-B~丿LL、Z角UL、Z角LL、LL-B~丿Pos与矫治前对比,明显减小(P<0.05),H角(硬)、H角(软)与矫治前对比,明显增大(P<0.05)。与面部突度有关的SN~丿Sn与矫治前对比,明显增大(P<0.05),FH-B~丿LL、SN~丿B~丿与矫治前对比,明显减小(P<0.05),A~丿UL-B~丿LL与矫治前对比,无明显变化(P>0.05)。术后1年下唇SN~丿B~丿与术后3月对比,明显增大(P<0.05),G-SnPos、NS-Sn-Pos与术后3月对比,明显减小(P<0.05),FH-Sn Pos、Z角UL较术后3月增大,但无统计学意义(P>0.05)。结论应用术前正畸—正颌手术—术后正畸治疗骨性安氏Ⅲ类错,术后1年软组织侧貌向垂直向、水平向改变,呈现出更为自然的软组织侧貌,整体美观效果改变显著。

Objective To investigate the effect of orthodontic treatment combined with orthognathic surgery on patients with skeletal Class Ⅲ malocclusion. Methods Thirty-two patients with skeletal Class m malocclusion undergoing orthodontic treatment combined with orthognathic surgery in the Department of Stomatology in our 2014 were retrospectively analyzed. The patients hospital between October 2009 and October were treated with preoperative orthodontic treatment, LeFort I maxillary osteotomy ＋ intraoral sagittal split ramus osteotomy ＋ genioplasty, and postoperative orthodontic treatment. Changes in soft tissue angle were observed before orthodontic treatment, 3 months and 1 year after orthognathic surgery. Results Three months after orthognathic surgery, soft tissue profile of the nasal tip-related E angle and NS-Prn-Pos re- duced significantly, soft tissue profile of the nasal columella-related Cm-Sn-UL increased ap- parently, soft tissue profile of the subnasal point-related G-Sn-Pos and NS-Sn-Pos increased evidently, FH-SnPos reduced obviously, soft tissue profile of upper and lower lip-related FH-A丿 UL increased significantly, FH-B丿 LL, Z angle UL, Z angle LL and LL-B丿 Pos decreased markedly, H angle （hard） and H angle （soft） increased evidently, facial prominence-related SN丿 Sn increased obviously, and FH-B丿 LL and SN丿 B丿 decreased apparently compared with those before orthodontic treatment （ all P 〈 0. 05 ）. A 丿 UL-B 丿 LL 3 months after orthognathic surgery showed no obvious change compared with that before orthodontic treatment （P 〉 0.05）. One year after orthognathic surgery, lower lip-related SN丿 B丿 increased significantly, and G-Sn-Pos and NS-Sn-Pos reduced evidently compared with those 3 months after orthognathic surgery （ all P 〈 0. 05 ）. FH-SnPos and Z angle UL 1 year after orthognathic surgery increased compared with those 3 months after orthognathic surgery, without statistical significance （P 〉0. 05）. Conclusion Application of preoperative orthodontic treatment-orthognathic surgery-postoperative orthodontic treatment in the treatment of skeletal Class Ⅲ malocclusion can change soft tissue profile in the vertical direction and horizontal direction, presenting more natural soft tissue profile, with overall aesthetic effect changed significantly.