Huang Y, Wu Z Y, Zhou X H, Cai Z G, Zhang J
Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & NHC Research Center of Engineering and Technology for Computerized Dentistry & NMPA Key Laboratory for Dental Materials, Beijing 100081, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2023 Aug 18;55(4):708-715. doi: 10.19723/j.issn.1671-167X.2023.04.023.
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.
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.
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 grade Ⅰ was basically symmetrical.The grade Ⅱ was slightly asymmetrical.The grade Ⅲ was obviously asymmetrical.Statistically significant differences were found in the suborbital ( < 0.05) and zygomatic ( < 0.05) areas when comparing all grades of soft-tissue asymmetry, and in the buccal ( < 0.05) and superiolabial ( < 0.05) areas when comparing grades Ⅰ and Ⅲ.The extent of maxillary defect had significant impact on the symmetry of the midface soft-tissue after maxillary reconstruction.
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.
采用立体摄影测量法和主观评估法，初步建立使用股前外侧皮瓣（ALTF）进行上颌骨重建后的面部对称性感知类别。
患者因肿瘤侵犯接受上颌骨切除术，所有上颌骨缺损均采用ALTF进行重建。使用立体摄影相机装置采集患者的三维（3D）照片。在Geomagic软件中，通过沿面部外部的任意平面反射创建镜像。配准后，将原始3D照片上的术后侧分割为6个区域。使用基于表面的颜色图测量面部软组织的3D变化。20名普通民众作为观察者参与研究，要求他们根据自己的审美标准使用5级李克特量表对3D照片进行评分。根据得分对面部软组织不对称进行分级。使用SPSS 24.0软件对收集的数据进行统计分析。
本研究共纳入44名受试者（男21例，女23例，年龄范围19至79岁）。根据主观评分，面部软组织对称性分为三个等级。Ⅰ级基本对称。Ⅱ级轻度不对称。Ⅲ级明显不对称。比较所有等级的软组织不对称时，眶下（<0.05）和颧骨（<0.05）区域存在统计学显著差异；比较Ⅰ级和Ⅲ级时，颊部（<0.05）和上唇（<0.05）区域存在统计学显著差异。上颌骨缺损程度对重建后中面部软组织的对称性有显著影响。
不同程度的上颌骨切除术会导致不同程度的不对称，即使使用ALTF进行了重建，也会导致不同等级的对称性感知。等级越高，面部软组织的对称性越差。眶下和颧骨区域是影响面部对称性感知的重要美学单位，其次是颊部和上唇区域。临床医生在重建上颌骨缺损时，尤其是涉及眶底的大缺损，应注意这些区域的软组织支撑。
