Yoshikawa Hiroshi, Tanikawa Chihiro, Ito Shinsuke, Tsukiboshi Yosuke, Ishii Hitomi, Kanomi Ryuzo, Yamashiro Takashi
Graduate School of Dentistry, Osaka University, Suita, Osaka, 5650871, Japan.
Graduate School of Dentistry, Osaka University, Suita, Osaka, 5650871, Japan; Center for Advanced Medical Engineering and Informatics, Osaka University, Suita, Osaka, 5650871, Japan.
J Craniomaxillofac Surg. 2022 Apr;50(4):353-363. doi: 10.1016/j.jcms.2022.02.002. Epub 2022 Feb 18.
This study aimed to establish a three-dimensional (3D) cephalometric analysis of craniofacial morphology and discuss its theoretical usefulness in orthognathic patients. Cone-beam computed tomography (CBCT) images of Japanese subjects with skeletal Class I malocclusion before treatment were selected from among 1000 patients so that samples matched a historic 2D cephalometric cohort with normal occlusion using propensity score matching. In each CBCT image, 67 3D measurements were calculated based on manually identified landmarks. The mean and standard deviation of the measurements were calculated and used as the normative range for each sex. To confirm the usefulness of the 3D measurements, pre- and post-treatment CT data of nine jaw deformity patients who underwent orthognathic surgery with two-dimensional planning (2DP) in the past were used. Pre- and post-treatment CT values were evaluated with a paired t-test as well as a Z-score, which was calculated using the aforementioned normative range, and then categorized into five groups ("deteriorated", "no improvement", "over-treatment", "no change", "improvement") with -1 < Z-score < 1 considered normal. Fifty-six patients were matched to normal skeletal 1 subjects. The normative range of 67 items indicating 3D craniofacial morphology of the Japanese was calculated. Postoperatively, the horizontal position of the pogonion to the mid-sagittal plane significantly decreased (p = 0.043) and "improved"; however, the ramus axis on the right side significantly increased (p = 0.005) and "deteriorated". Maxillary yaw and the horizontal position of the gonion also tended to "deteriorated". The normative range for the 3D cephalometric analysis in Japanese has been established. Given findings of deteriorated maxillomandibular yawing after surgery when using conventional 2DP, 3D cephalometric measurements should be used when planning jaw positions after surgery for orthognathic patients.
本研究旨在建立颅面部形态的三维（3D）头影测量分析方法，并探讨其在正颌患者中的理论应用价值。从1000例患者中选取治疗前患有骨骼I类错牙合畸形的日本受试者的锥形束计算机断层扫描（CBCT）图像，通过倾向得分匹配使样本与具有正常牙合的历史二维头影测量队列相匹配。在每张CBCT图像中，基于手动识别的标志点计算67项三维测量值。计算测量值的均值和标准差，并将其用作各性别组的正常范围。为了证实三维测量的实用性，使用了过去接受二维规划（2DP）正颌手术的9例颌骨畸形患者的治疗前和治疗后CT数据。治疗前和治疗后CT值采用配对t检验以及Z评分进行评估，Z评分使用上述正常范围计算，然后分为五组（“恶化”、“无改善”、“过度治疗”、“无变化”、“改善”），Z评分在-1<Z评分<1范围内被视为正常。56例患者与正常骨骼I类受试者匹配。计算出了表示日本人三维颅面部形态的67项指标的正常范围。术后，颏前点至正中矢状面的水平位置显著降低（p = 0.043）且“改善”；然而，右侧下颌升支轴线显著增加（p = 0.005）且“恶化”。上颌偏斜和下颌角的水平位置也有“恶化”趋势。已建立日本人三维头影测量分析的正常范围。鉴于使用传统二维规划术后颌骨偏斜恶化的结果，正颌患者手术规划颌骨位置时应使用三维头影测量。
