Wagner Florian, Figl Michael, Cede Julia, Schicho Kurt, Sinko Klaus, Klug Clemens
Resident, University Clinic of Cranio- and Maxillofacial Surgery, Medical University of Vienna, Vienna, Austria.
Professor and Physicist, Centre for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria.
J Oral Maxillofac Surg. 2018 Feb;76(2):416-425. doi: 10.1016/j.joms.2017.07.158. Epub 2017 Jul 25.
The aim of this study was to evaluate soft tissue changes after intraoral quadrangular Le Fort II osteotomy (IOQLFII) and correlate those changes to underlying osseous changes.
Twenty-six non-growing patients with midfacial deficiency and Class III malocclusion were analyzed. A study group of 13 patients who underwent IOQLFII was compared with 13 patients who underwent conventional Le Fort I osteotomy (LFI). After fusion of pre- and postoperative computed tomograms, each patient's hard and corresponding soft tissue changes were measured. Measurement points were defined at 3 levels in the IOQLFII group (infraorbital rim [IR], sinus floor [SF], and lateral incisor tip [LI]) and at 2 levels in the LFI group (SF and LI). Linear models were created to test for correlations between hard and soft tissues.
The slope (a coefficient) between anteroposterior hard and soft tissue changes was found to be highly significant at each measurement point for all groups. In the IOQLFII group, soft tissue advancement was 69% (confidence interval [CI], 62 to 77%) of the hard tissue advancement at the IR, 90% (CI, 84 to 96%) at the SF, and 73% (CI, 64 to 82%) at the LI. In the LFI group, the corresponding percentages were 90% (83 to 97%) at SF and 84% (77 to 90%) at LI.
IOQLFII results in predictable correction of midfacial deficiency. At the IR, bony advancement always resulted in markedly less soft tissue advancement than at the SF level. These results indicate that the planned infraorbital advancement should not be too conservative because soft tissue changes are smaller in this region.
本研究旨在评估口内四边形Le Fort II截骨术（IOQLFII）后软组织的变化，并将这些变化与潜在的骨组织变化相关联。
分析26例非生长发育期的面中部凹陷和III类错牙合患者。将13例行IOQLFII的患者组成的研究组与13例行传统Le Fort I截骨术（LFI）的患者进行比较。在术前和术后计算机断层扫描融合后，测量每位患者的硬组织和相应的软组织变化。在IOQLFII组的3个水平（眶下缘[IR]、窦底[SF]和侧切牙尖[LI]）以及LFI组的2个水平（SF和LI）定义测量点。建立线性模型以测试硬组织和软组织之间的相关性。
在所有组的每个测量点，前后硬组织和软组织变化之间的斜率（系数）均具有高度显著性。在IOQLFII组中，眶下缘处软组织前移量为硬组织前移量的69%（置信区间[CI]，62%至77%），窦底处为90%（CI，84%至96%），侧切牙尖处为73%（CI，64%至82%）。在LFI组中，相应的百分比在窦底处为90%（83%至97%），在侧切牙尖处为84%（77%至90%）。
IOQLFII可对面中部凹陷进行可预测的矫正。在眶下缘处，骨组织前移导致的软组织前移明显少于窦底水平。这些结果表明，计划的眶下前移不应过于保守，因为该区域的软组织变化较小。
