个性化上颌非对称旋转矫治上颌[牙合]平面偏斜畸形

Individualized maxillary asymmetry rotation in correction of occlusal plane cant deformity

目的评估上颌非对称旋转在矫正平面偏斜不对称畸形患者中的应用。总结治疗面部不对称畸形患者的经验,为临床治疗面部不对称畸形提供参考。方法选取32例平面偏斜的面部不对称畸形患者,拍摄术前螺旋CT及术前、术后头颅正位片,术前在计算机辅助下模拟手术,设计个性化手术方案,不对称旋转上颌平面,并将模拟数据用于手术中。采用配对t检验进行统计学分析比较术前、术后面部外形差异。结果 32例患者面部形态及功能均取得了良好的治疗效果,无术中及术后并发症发生,软硬组织取得良好对称性,面部外形协调美观。术后双侧上颌骨高度差异[(0.6±0.5)mm]小于术前上颌骨高度差异[(4.7±1.5)mm],差异有统计学意义(t=15.172,P<0.001)。术后平面偏斜度[(0.5±0.5)°]小于术前平面偏斜度[(4.4±1.7)°],差异有统计学意义(t=12.934,P<0.001)。术后非对称率[(0.7±0.6)%]小于术前非对称率[(5.5±1.7)%],差异有统计学意义(t=15.640,P<0.001)。结论 (1)数字化计算机辅助外科技术能够模拟手术过程,设计手术方案,重建术后软硬组织形态并指导正颌手术的准确截骨;(2)上颌非对称旋转能够矫正上颌平面偏斜畸形,达到面部软硬组织对称协调,改善面部不对称畸形。

Objective To evaluate the application of maxillary asymmetry rotation in the correction of occlusal plane cant and facial asymmetry deformity,to summarize the treating experience of patients with facial asymmetrical deformity and to provide a reference for clinical treatment. Methods An analysis of 32 patients with maxillary occlusal plane cant and facial asymmetry deformity with spiral CT before operation and radiography of the skull before and after operation. The CT data was used to simulate operation,and to design individualized scheme and asymmetric rotation of the maxillary plane with the assistance of computer. The preoperative and postoperative data were statistically analyzed with the paired t test. Results All the patients obtained satisfactory results both in face morphology and function. Facial deformities were corrected successfully without serious complications. The postoperative height difference of the left side and the right side（0.6 ± 0.5）mm was less than that preoperative height difference（4.7 ±1.5）mm,which was statistically different（t = 15.172,P〈0.001）. The postoperative angle of maxillary plane（0.5 ± 0.5）° was less than the preoperative data（4.4 ± 1.7）°,which was statistically different（t =12.934,P〈0.001）. The postoperative asymmetric rate of jaw bone（0.7 ± 0.6）% was less than preoperative data（5.5 ± 1.7）% which was statistically different（t = 15.640,P〈0.001）. Conclusions（1）Digital computer assisted surgical techniques can help simulate surgical procedures,design individual surgical scheme,rebuild postoperative soft and hard tissues and guide the accurate osteotomy of orthognathic surgery.（2）The asymmetric rotation of the maxillary plane can correct the deformity of the maxillary plane canting,achieve the symmetrical coordination of the facial soft and hard tissue and rectify the asymmetric deformity of the face.