Lai Hsin-Chih, Denadai Rafael, Ho Cheng-Ting, Lin Hsiu-Hsia, Lo Lun-Jou
Division of Orthodontics, Department of Dentistry, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan.
Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan.
J Clin Med. 2020 Jan 18;9(1):262. doi: 10.3390/jcm9010262.
Patients with a skeletal Class III deformity may present with a concave contour of the anteromedial cheek region. Le Fort I maxillary advancement and rotational movements correct the problem but information on the impact on the anteromedial cheek soft tissue change has been insufficient to date. This three-dimensional (3D) imaging-assisted study assessed the effect of surgical maxillary advancement and clockwise rotational movements on the anteromedial cheek soft tissue change. Two-week preoperative and 6-month postoperative cone-beam computed tomography scans were obtained from 48 consecutive patients who received 3D-guided two-jaw orthognathic surgery for the correction of Class III malocclusion associated with a midface deficiency and concave facial profile. Postoperative 3D facial bone and soft tissue models were superimposed on the corresponding preoperative models. The region of interest at the anteromedial cheek area was defined. The 3D cheek volumetric change (mm; postoperative minus preoperative models) and the preoperative surface area (mm) were computed to estimate the average sagittal movement (mm). The 3D cheek mass position from orthognathic surgery-treated patients was compared with published 3D normative data. Surgical maxillary advancement (all < 0.001) and maxillary rotation (all < 0.006) had a significant effect on the 3D anteromedial cheek soft tissue change. In total, 78.9%, 78.8%, and 78.8% of the variation in the cheek soft tissue sagittal movement was explained by the variation in the maxillary advancement and rotation movements for the right, left, and total cheek regions, respectively. The multiple linear regression models defined ratio values (relationship) between the 3D cheek soft tissue sagittal movement and maxillary bone advancement and rotational movements of 0.627 and 0.070, respectively. Maxillary advancements of 3-4 mm and >4 mm resulted in a 3D cheek mass position (1.91 ± 0.53 mm and 2.36 ± 0.72 mm, respectively) similar (all > 0.05) to the 3D norm value (2.15 ± 1.2 mm). This study showed that both Le Fort I maxillary advancement and rotational movements affect the anteromedial cheek soft tissue change, with the maxillary advancement movement presenting a larger effect on the cheek soft tissue movement than the maxillary rotational movement. These findings can be applied in future multidisciplinary-based decision-making processes for planning and executing orthognathic surgery.
患有骨性III类错畸形的患者可能表现为前内侧脸颊区域轮廓凹陷。Le Fort I型上颌骨前移和旋转运动可纠正该问题，但迄今为止，关于其对前内侧脸颊软组织变化影响的信息尚不充分。这项三维（3D）成像辅助研究评估了上颌骨手术前移和顺时针旋转运动对前内侧脸颊软组织变化的影响。对48例连续接受3D引导双颌正颌手术以矫正与面中部凹陷和面部轮廓凹陷相关的III类错畸形的患者，分别在术前2周和术后6个月进行锥形束计算机断层扫描。将术后3D面部骨骼和软组织模型与相应的术前模型进行叠加。定义前内侧脸颊区域的感兴趣区域。计算3D脸颊体积变化（mm；术后模型减去术前模型）和术前表面积（mm）以估计平均矢状运动（mm）。将接受正颌手术患者的3D脸颊质量位置与已发表的3D标准数据进行比较。上颌骨手术前移（均P<0.001）和上颌骨旋转（均P<0.006）对3D前内侧脸颊软组织变化有显著影响。总体而言，右侧、左侧和双侧脸颊区域的脸颊软组织矢状运动变化分别有78.9%、78.8%和78.8%可由上颌骨前移和旋转运动的变化来解释。多元线性回归模型定义的3D脸颊软组织矢状运动与上颌骨前移和旋转运动之间的比值分别为0.627和0.070。上颌骨前移3 - 4 mm和>4 mm时，3D脸颊质量位置（分别为1.91±0.53 mm和2.36±0.72 mm）与3D标准值（2.15±1.2 mm）相似（均P>0.05）。本研究表明，Le Fort I型上颌骨前移和旋转运动均会影响前内侧脸颊软组织变化，其中上颌骨前移运动对脸颊软组织运动的影响大于上颌骨旋转运动。这些发现可应用于未来基于多学科的正颌手术规划和实施决策过程中。
