Niikura Yoichiro, Ishii Takenobu, Sakamoto Yoshiaki, Ariizumi Dai, Sakamoto Teruo, Sueishi Kenji
From the Department of Orthodontics, Tokyo Dental College, Tokyo, Japan.
Department of Orthodontics, Tokyo Dental College Chiba Dental Centre, Chiba, Japan.
Plast Reconstr Surg Glob Open. 2024 Jun 10;12(6):e5877. doi: 10.1097/GOX.0000000000005877. eCollection 2024 Jun.
Surgical planning for hemifacial microsomia (HFM) patients often involves planning the amount of maxillary movement and mandibular bone distraction from three-dimensional (3D) volumetric images constructed from computed tomography scans. By representing anatomical indicators for facial symmetry in X, Y, and Z coordinates, we identified the more challenging areas in correcting facial asymmetry.
The study included five HFM patients with a mean age of 22.2 years, all diagnosed with HFM (type IIB). We established measurement points with high reproducible 3D coordinates on the 3D volumetric images obtained from computed tomography scans for before surgery, treatment objectives, and after surgery. We assessed the symmetry of measurement points between the affected side and nonaffected side at each time point.
In the before-surgery group, significant differences were observed between the affected side and nonaffected side in X,Y (excluding Palatine foramen, upper molar, canine) and Z coordinates for measurement items. In the treatment objectives group, no differences were observed between the affected side and nonaffected side in X, Y, and Z coordinates, resulting in facial symmetry. In the after-surgery group, significant differences were observed in Y coordinates in the mental foramen area, and significant differences were observed in z axis measurement items in the canine and mental foramen areas.
It is evident that relying solely on a front view assessment is insufficient to achieve facial symmetry. Particularly, both anterior-posterior and vertical improvements in the area near the mental foramen on the affected side are necessary.
半侧颜面短小畸形（HFM）患者的手术规划通常涉及根据计算机断层扫描构建的三维（3D）容积图像来规划上颌移动量和下颌骨牵张。通过在X、Y和Z坐标中表示面部对称性的解剖学指标，我们确定了在纠正面部不对称方面更具挑战性的区域。
该研究纳入了5例平均年龄为22.2岁的HFM患者，均诊断为HFM（IIB型）。我们在术前、治疗目标和术后从计算机断层扫描获得的3D容积图像上建立了具有高可重复性3D坐标的测量点。我们评估了每个时间点患侧和非患侧测量点的对称性。
在术前组中，测量项目的X、Y（不包括腭孔、上颌磨牙、犬齿）和Z坐标在患侧和非患侧之间观察到显著差异。在治疗目标组中，X、Y和Z坐标在患侧和非患侧之间未观察到差异，从而实现了面部对称。在术后组中，颏孔区的Y坐标观察到显著差异，犬齿和颏孔区的z轴测量项目观察到显著差异。
显然，仅依靠正面评估不足以实现面部对称。特别是，患侧颏孔附近区域的前后和垂直方向的改善都是必要的。
