计算机辅助测量唇腭裂继发颌骨畸形患者手术前后口腔及气道容积的变化

Computer-assisted measurement of changes in oral and airway volume in patients with jaw deformity secondary to cleft lip and palate before and after surgery

目的采用计算机辅助三维重建技术,测量并比较单侧完全性唇腭裂继发颌骨畸形患者双颌手术前后固有口腔(oral cavity proper)及上气道容积的变化,评估数字外科引导下正颌手术对于患者气道及语音的影响。方法获取2015年7月至2019年12月收治的5例单侧完全性唇腭裂继发颌骨畸形患者接受双颌手术前后口腔CBCT及口扫数据,在Mimics 20.0软件中模拟出三维模型并划分固有口腔及上气道的界限,建立口腔容积及气道模型,测量其手术前、术后1个月及3个月的固有口腔与上气道的容积及相关指标并进行分析,并随访患者手术前后通气及语音状况。结果5例患者双颌手术术前、术后1个月及术后3个月的固有口腔总容积、上气道容积的测量数值均无显著差别(P>0.05)。术后固有口腔的下部容积、正中矢状面积、长度、宽度、下颌骨长度较术前明显减小(P<0.05),上部容积和高度明显增加(P<0.05)。鼻咽段与腭咽段的上气道容积术后较术前明显增大(P<0.05),舌咽段及最小横截面积明显减小(P<0.05)。1例患者术后有轻微打鼾症状,术后3个月下颌骨略有前移,语音均未见明显改变。结论单侧完全性唇腭裂继发颌骨畸形患者的固有口腔总容积及上气道总容积在正颌手术前后变化无显著差异,该参数可个性化微调整数字外科的设计过程,可有效地辅助唇腭裂继发颌骨畸形患者正颌手术的实施。

Objective Using computer-assisted three-dimensional reconstruction technology,to measure and compare changes of oral cavity proper and upper airway volume in patients with jaw deformity secondary to unilateral complete cleft lip and palate(UCLP)before and after bimaxillary surgery,and to evaluate the effect of digital surgery guided orthognathic surgery on airway and speech.Method 3D reconstruction of maxillofacial CBCT and oral scan data before and after bimaxillary surgery was operated for 5 patients with jaw deformity secondary to UCLP admitted from July 2015 to December 2019.Mimics 20.0 software was used to divide boundaries of the oral cavity proper and upper airway on 3D model to measure and analyze the oral cavity proper and upper airway volume and related indicators before the surgery as well as one month and three months after the surgery,and patients’ventilation and voice status was followed up before and after the surgery.Results In these 5 patients,there was no significant difference in measurement values of total oral cavity proper volume and upper airway volume before,1 month and 3 months after bimaxillary surgery(P>0.05).The lower volume,median sagittal area,length,width and length of the mandible of oral cavity proper were significantly reduced(P<0.05),and the upper volume and height were significantly increased(P<0.05).The upper airway volume of the nasopharyngeal segment and velopharyngeal segment was significantly increased after surgery(P<0.05),and the glossopharyngeal segment and the minimum cross-sectional area were significantly reduced(P<0.05).One patient had slight snoring symptoms after operation,and the mandible moved slightly forward 3 months after operation.There was no significant change in speech of 5 patients.Conclusion There is no significant difference in the total volume of oral cavity proper and the total volume of upper airway in patients with jaw deformity secondary to UCLP before and after orthognathic surgery.This parameter can be personalized and slightly adjust the design process of digital surgery,and can effectively assist the implementation of orthognathic surgery in patients with jaw deformity secondary to cleft lip and palate.