Craniofacial Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, Taipei, Taiwan; Graduate Institute of Dental and Craniofacial Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Craniofacial Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, Taipei, Taiwan; DMD Student, Rutgers School of Dental Medicine, Newark, NJ.
J Oral Maxillofac Surg. 2023 Dec;81(12):1466-1475. doi: 10.1016/j.joms.2023.08.226. Epub 2023 Sep 5.
Facial aesthetics may be optimized based on a deeper understanding of soft tissue changes after orthognathic surgery.
The purpose of the study was to delineate facial soft tissue changes after clockwise rotation (CWR) of the maxillomandibular complex (MMC) to correct mandibular prognathism using the surgery-first approach.
STUDY DESIGN, SETTING, SAMPLE: This prospective cohort study enrolled patients over 18 years of age with skeletal Class III malocclusion in the craniofacial center. The patients were excluded with previous history of craniofacial syndrome, orthognathic surgery trauma, infection at surgical sites, chin deviation (menton deviation ≥4 mm), 2 or more missing data points after surgery, or without informed consent. This study compared significant facial changes before (T0) and after orthodontic debonding (T1) in the CWR and control groups.
The patients were divided in accordance with maxillary occlusal plane change (OPC) after surgery into CWR (OPC >4°) and control (OPC ≤4°) groups.
The primary outcome variable was frontal lip curvature (FLC: Right Cheilion-Stomion-Left Cheilion, degree) with or without upper lip curving upward at T1, where upper lip curving upward was considered more favorable.
The covariates included age, sex, and various cephalometric measurements.
The Mann-Whitney U test, paired, and independent t-test were implemented to compare the intragroup and intergroup differences. Statistical significance was indicated by P value <.05.
The study comprised 34 patients (21 women) in the control group and 37 (29 women) in the CWR group; their mean ages were 23.64 ± 4.38 and 24.21 ± 3.84 years, respectively (P value = .562). At T1, the CWR group had significant increased FLC (P value = .001), alar width (P value = .034), and lower vermilion height (P value = .018), and decreased lower lip length (P value = .004). The high FLC group had significant decreased upper lip projection (P value = .002) and increased nasolabial angle (P value = .013). The significant relationship between CWR and high FLC was supported by the χ test (P value = .018) and multiple logistic regression (P value = .017).
Greater CWR of the MMC increased FLC and lower vermilion height and reduced lower lip length. High FLC resulting from the CWR of the MMC improved facial appearance by moving the upper lip curve upward.
对面部美学的深入了解可以优化软组织变化，进而优化正颌手术后的效果。
本研究的目的是通过手术先行法描绘顺时针旋转（CWR）上颌下颌复合体（MMC）以矫正下颌前突后面部软组织的变化。
研究设计、地点和样本：本前瞻性队列研究纳入了颅面中心的 18 岁以上骨骼 III 类错颌患者。排除标准为颅面综合征史、正颌手术外伤史、手术部位感染史、颏偏斜（颏偏距≥4mm）、术后 2 个或更多缺失数据点或无知情同意书。本研究比较了 CWR 组和对照组在正畸去粘接（T1）前后的显著面部变化。
根据术后上颌牙合平面变化（OPC）将患者分为 CWR（OPC>4°）和对照组（OPC≤4°）。
主要观察指标为 T1 时的正面唇曲度（FLC：右唇珠-人中-左唇珠，度数）和上唇是否向上弯曲，上唇向上弯曲被认为更有利。
协变量包括年龄、性别和各种头影测量。
采用 Mann-Whitney U 检验、配对和独立 t 检验比较组内和组间差异。P 值<.05 表示具有统计学意义。
对照组包括 34 例患者（21 例女性），CWR 组包括 37 例患者（29 例女性）；平均年龄分别为 23.64±4.38 岁和 24.21±3.84 岁（P 值=.562）。在 T1 时，CWR 组的 FLC（P 值=.001）、鼻翼宽度（P 值=.034）和下唇红高度（P 值=.018）显著增加，而下唇长度（P 值=.004）显著减少。FLC 高的患者上唇突度明显降低（P 值=.002），鼻唇角增大（P 值=.013）。χ检验（P 值=.018）和多因素逻辑回归（P 值=.017）支持 CWR 与高 FLC 之间的显著关系。
MMC 的较大 CWR 增加了 FLC 和下唇红高度，减少了下唇长度。MMC 的 CWR 导致的高 FLC 通过使上唇曲线向上移动来改善面部外观。
