Division of Maxillofacial Surgery, Città Della Salute e Della Scienza Hospital, University of Torino, Italy.
Division of Maxillofacial Surgery, Città Della Salute e Della Scienza Hospital, University of Torino, Italy.
J Craniomaxillofac Surg. 2021 Mar;49(3):223-230. doi: 10.1016/j.jcms.2021.01.008. Epub 2021 Jan 19.
The aim of this prospective study is to objectively assess 3D soft tissue and bone changes of the malar region by using the malar valgization osteotomy in concomitant association with orthognatic surgery.
From January 2015 to January 2018, 10 patients who underwent single stage bilateral malar valgization osteotomy in conjunction with maxillo-mandibular orthognatic procedures for aesthetic and functional correction were evaluated. Clinical and surgical reports were collected and patient satisfaction was evaluated with a VAS score. For each patient, maxillofacial CT-scans were collected 1 month preoperatively (T0) and 6 months after the operation (T1). DICOM data were imported and elaborated in the software MatLab, which creates a 3D soft tissue model of the face. 3D Bone changes were assessed importing DICOM data into iPlan (BrainLAB 3.0) software and the superimposition process was achieved using autofusion. Descriptive statistical analyses were obtained for soft tissue and bone changes.
Considering bone assessment the comparison by superimposition between T0 and T1 showed an increase of the distance between bilateral malar prominence (Pr - Pl) and a slight forward movement (87,65 ± 1,55 to 97,60 ± 5,91); p-value 0.007. All of the patients had improvement of α angle, ranging from 36,30 ± 1,70 to 38,45 ± 0,55, p-value 0,04 (αr) and 36,75 ± 1,58 to 38,45 ± 0,35; p-value 0,04 (αl). The distance S increased from 78,05 ± 2,48 to 84,2 ± 1,20; p-value 0,04 (Sr) and 78,65 ± 2,16 to 82,60 ± 0,90 (Sl); p-value 0,03. Considering the soft tissue, the comparison by superimposition between T0 and T1 showed an antero-lateral movement (p-value 0.008 NVL; p-value 0.001 NVR) of the malar bone projection together with an increase in width measurements (p-value 0,05 VL; p-value 0,01 VR). Angular measurement confirmed the pattern of the bony changes (p-value 0.034 αL; p-value 0,05 αR).
The malar valgization osteotomy in conjunction with orthognatic surgery is effective in improving zygomatic projection contributing to a balanced facial correction in midface hypoplasia.3D geometrical based volume and surface analysis demonstrate an increase in transversal and forward direction. The osteotomy can be safely performed in conjunction with orthognatic procedures.
本前瞻性研究旨在通过颧骨外扩截骨术联合正颌手术，客观评估颧骨区域的 3D 软组织和骨变化。
自 2015 年 1 月至 2018 年 1 月，10 例患者接受了单侧颧骨外扩截骨术联合上下颌正颌手术，以实现美容和功能矫正。收集临床和手术报告，并使用视觉模拟评分（VAS）评估患者满意度。每位患者在术前 1 个月（T0）和术后 6 个月（T1）均采集颌面 CT 扫描。将 DICOM 数据导入 MatLab 软件中进行处理，该软件可创建面部的 3D 软组织模型。将 DICOM 数据导入 iPlan（BrainLAB 3.0）软件中评估 3D 骨变化，并通过自动融合实现叠加过程。对软组织和骨变化进行描述性统计分析。
考虑到骨骼评估，通过 T0 和 T1 之间的叠加比较显示双侧颧骨突出（Pr-Pl）之间的距离增加，且有轻微的向前移动（87.65±1.55 至 97.60±5.91；p 值 0.007）。所有患者的 α 角均得到改善，范围从 36.30±1.70 至 38.45±0.55，p 值 0.04（αr）和 36.75±1.58 至 38.45±0.35，p 值 0.04（αl）。S 距离从 78.05±2.48 增加到 84.2±1.20，p 值 0.04（Sr）和 78.65±2.16 增加到 82.60±0.90，p 值 0.03（Sl）。在软组织方面，通过 T0 和 T1 之间的叠加比较显示颧骨突出的前外侧移动（p 值 0.008，NVL；p 值 0.001，NVR），同时宽度测量增加（p 值 0.05，VL；p 值 0.01，VR）。角度测量证实了骨骼变化的模式（p 值 0.034，αL；p 值 0.05，αR）。
颧骨外扩截骨术联合正颌手术可有效改善颧骨突出，有助于中面部发育不全的面部平衡矫正。基于 3D 几何的体积和表面分析显示在横向和前向方向上有增加。该截骨术可与正颌手术安全联合进行。
