股前外侧皮瓣修复上颌骨缺损术后面部软组织对称性感观分级

Category of facial symmetry perception after maxillary reconstruction using anterolateral thigh flap

目的:采用三维立体摄影测量与主观评价相结合的方法初步建立股前外侧皮瓣修复上颌骨缺损术后面部软组织对称性的感观分级系统。方法:患者上颌骨因肿瘤侵犯而被行不同范围的切除,同期行股前外侧皮瓣(anterolateral thigh flap,ALTF)修复。术后采用三维立体摄影技术获取患者三维面相,以任意平面为对称面创建原始三维面相的镜像,重叠配准原始面相与镜像后,将患侧面部分为6个区域,采用基于表面的色谱分析法测量患侧面部软组织三维变化。同时请20名非医学专业人员作为评价者对患者的三维面相进行主观评价,并在Likert 5分量表中进行评分,根据主观评分将面部软组织的对称性进行分级。应用SPSS 24.0统计软件对三维立体摄影测量结果与主观评价分级进行统计学分析。结果:共有44例患者符合入组条件,其中男性21例,女性23例,年龄19~79岁。按照主观评价得分将所有患者面部软组织对称性分为Ⅰ、Ⅱ、Ⅲ级。Ⅰ级患者面部基本对称,Ⅱ级患者面部略不对称,Ⅲ级患者面部明显不对称。Ⅰ、Ⅱ、Ⅲ级患者在眶下区及颧区的差异均有统计学意义(P<0.05),Ⅰ级与Ⅲ级患者相比,除眶下区与颧区外,颊区与上唇区的差异也具有统计学意义(P<0.05)。上颌骨缺损范围越大,ALTF修复后的患者面部对称性越差。结论:不同范围上颌骨切除后经过单纯ALTF修复的患者其面部软组织依然会存在不同程度的不对称,所引起的感观不适可分为三个等级,等级越高表明面部软组织对称性越差;眶下区与颧区是影响面部对称性感知的重要区域,其次为颊区与上唇区,临床医师在进行上颌骨缺损修复尤其是累及眶底的大范围缺损修复时,应当重视这些区域的软组织支撑。

Objective:To preliminarily establish a category of facial symmetry perception after maxillary reconstruction using anterolateral thigh flap(ALTF)by the methods of stereophotogrammetry and subjective assessment.Methods:The patients underwent maxillectomy due to neoplasms invasion,and all the maxillary defects were reconstructed using ALTF.Three-dimensional(3D)photographs were captured from the patients with a stereophotogrammatrical camera set-up.In the Geomagic software,the mirror image was created by reflecting along an arbitrary plane outside of the face.After the registration,the postoperative side on the original 3D photograph was segmented into 6 areas.The 3D change of the facial soft-tissue was measured using surface-based color map.Twenty laypeople took part in the study as observers,and they were asked to rate the 3D photographs using 5 point Likert-type scale according to their own aesthetic standard.The soft tissue asymmetry was graded according to the score.The collected data were subjected to statistical analysis using the SPSS 24.0 software.Results:In the study,44 subjects were recruited(21 males and 23 females,age range from 19 to 79 years).The soft-tissue symmetry was graded into three levels according to the subjective scores.The gradeⅠwas basically symmetrical.The gradeⅡwas slightly asymmetrical.The gradeⅢwas obviously asymmetrical.Statistically significant differences were found in the suborbital(P<0.05)and zygomatic(P<0.05)areas when comparing all grades of soft-tissue asymmetry,and in the buccal(P<0.05)and superiolabial(P<0.05)areas when comparing gradesⅠandⅢ.The extent of maxillary defect had significant impact on the symmetry of the midface soft-tissue after maxillary reconstruction.Conclusion:Varying extent maxillectomy would result in varying degrees of asymmetry,and cause different grades of symmetry perception even if they had been reconstructed using ALTF.The higher the grade,the worse the symmetry of facial soft-tissue.Suborbital and zygomatic areas were important aesthetic units that affected the facial symmetry perception,followed by buccal and superiolabial areas.The clinicians should pay attention to the soft-tissue support in these areas when reconstructing the maxillary defect,especially large defect with orbital floor involved.