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|dc.contributor.author||Monica Illescas Ralda||en|
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結果：以二維技術分析軟、硬組織移動關係，發現下唇平均往後移4.425 mm、往下1.975 mm，軟硬組織移動比值是Li:L1=1.13、B’:B=0.99；上唇平均往前移1.025 mm、往下3 mm，Ls:U1=0.89；頦部軟硬組織移動比Pog’:Pog=0.86、Men’:Men=1.16。
超音波分析結果，總體而言，術後軟組織之灰值下降、厚度及分形維度增加；以下區域之厚度改變顯著：上唇皮膚（0.080 cm, P<0.05）、下唇肌肉及全層（分別為0.121及0.365 cm, P<0.05）、頦部肌肉、皮下組織及全層（分別為0.153、0.057及0.367 cm, P<0.05）；下唇皮膚及全層之灰值有顯著差異（分別為18.768及26.221, P<0.05），此外，頦部肌肉之術後灰值變化於是否接受頦成型術病患間有顯著差異。術前在有明顯頦偏移之病患中，發現頦偏移側之咬肌厚度比非偏移側大（
1.961 cm相對1.408 cm），而其硬度及回音性則較低，術後兩側組織特性則趨近相同。術後，頦部及下唇顯示出Type II-III之內部纖維結構，且真皮與下方組織交界不規則，上唇則具Type I纖維結構，且真皮與其下組織交界規則。
|dc.description.abstract||Purpose: Prospectively examine the composition and changes of soft tissues in orthognathic patients with Class III malocclusion.
Methods: This preliminary clinical study recruited four patients with skeletal Class III malocclusion who underwent bimaxillary orthognathic surgery at the Department of Oral and Maxillofacial Surgery, from July to December 2018. Complete medical records were obtained at two time points: pre-surgery (T0: within 4 weeks prior to surgery) and post-surgery (T1:at least 6 months after surgery). Changes in soft tissue position and composition were analyzed through the use of conventional two-dimensional analysis, three-dimensional Per-Vertex animation technique and ultrasound analysis, with the concomitant application of elastography and fractal box dimension for soft tissue characterization.
Results: Regarding soft tissue to hard tissue movement by two-dimensional analysis, the lower lip moved on average 4.425 mm posteriorly and 1.975 mm inferiorly, reporting soft to hard tissue ratios of Li:L1= 1.13 and B’:B = 0.99. The upper lip moved an average of 1.025 mm forward and 3mm downward, with Ls:U1=0.89. The mental soft tissue reported ratios of 0.86 at Pog’:Pog and 1.16 at Men’:Men.
For three-dimensional analysis, we found that the idea is feasible of building a base model for both pre and post operation morphing and then analyzing the location changes after surgery at every point given in the mesh. However, higher computing power is required for the construction of models with high resolution and optimized geometry.
Concerning ultrasound study, in general, decrease of grey value, and increase in soft tissue thickness and fractal dimension were observed postoperatively. Changes in thickness were significant at the upper lip skin (0.80 mm, P <0.05); muscle and total lower lip area (1.21 and 3.65 mm, respectively, P <0.05); muscle, subcutaneous tissue and total mental area (1.53, 0.57 and 3.67mm, respectively, P <0.05). The differences in grey value were significant at the skin and total area of the lower lip (18.768 and 26.221, respectively, P <0.05). Moreover, significant difference in grey value changes was observed at the mental muscle area between patients with and without genioplasty.
Before surgery, in patients with significant chin deviation, the masseter muscle on the chin-deviated side showed higher thickness when compared with the non-deviated side (1.961 cm vs. 1.408 cm), but lower stiffness and echogenicity. Post-operatively, these characteristics changed to almost equal between the two sides. After surgery, the mental and lower lip area presented Type II-III internal fibrillar structure with an irregular junction of the dermis to the hypodermis; the upper lip, showed Type I structure, with a smooth junction.
Conclusions: The three-dimensional diagnosis, treatment planning and prediction of surgery outcomes are of great importance for the correct management of dentofacial deformity. The idea of applying morphing technique for the evaluation of soft tissue changes is feasible, but further studies with the use of higher computing power are needed. The dynamic and complex behavior of soft tissue could be observed by ultrasound analysis, stating the multifactorial character that influence its composition and position change at the different facial areas. Concluding that a simplistic hard to soft tissue relationship for the creation of software should be avoided and research that could apply this individual and regional variability should be encouraged.
Key words: Soft tissue, three-dimensional analysis, facial ultrasound, elastography, fractal dimension, orthognathic surgery.
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Previous issue date: 2019
1. Review of the literature 1
1.1. Dentofacial Deformity and Class III malocclusion 1
1.2 Diagnosis and Treatment Planning 1
1.3 Facial Soft tissue and its composition 3
1.4 Healing process after orthognathic surgery 7
1.5 Facial soft tissue: Symmetric vs. Asymmetric cases 9
1.6 Facial soft tissue and facial morphology 11
1.7 The effect of age, sex, weight and race on soft tissue characteristics 11
1.8 Facial Soft tissue and Orthognathic surgery 12
1.9 Three-dimensional imaging systems in the study of soft tissue 14
1.9.1 Cone beam computer tomography 15
1.9.2 Three-dimensional surface imaging systems 16
1.9.3 Intraoral Scanners 17
1.10 Three dimensional systems and orthognathic surgery
1.11 Ultrasound 20
2. Research Objectives 24
2.1 Primary Aims 24
2.2. Secondary Aims 24
3. Materials and Methods 25
3.1 Inclusion Criteria 25
3.2 Exclusion Criteria 25
3.3 Data Collection 26
3.4 Data Analysis 30
3.4.1 Definition of Regions of Interests 30
3.4.2 Two-Dimensional Data evaluation 30
3.4.3 Three-Dimensional Data Evaluation 31
3.4.4 Sonographic Analysis 34
4. Statistical Analysis 36
4.1 Errors of Method 36
5. Results 37
5.1 Evaluation of Intraobserver variability and reliability 37
5.2 Evaluation of current procedures 37
5.2 Three- Dimensional results 37
5.3 Two-Dimensional Analysis 38
5.3 Ultrasound Results 39
6. Discussion 43
7. Clinical Relevance 49
8. Conclusions 50
9. Limitations and Recommendations 51
10. Tables 52
11. Figures 68
12. References 76
Appendix A 83
Appendix B 89
|dc.title||Evaluation of soft tissue changes in bimaxillary orthognathic surgery: A three-dimensional approach and ultrasound analysis.||en|
|dc.contributor.coadvisor||王成平(Cheng-ping Wang),(Edward K. Hsieh)|
|dc.contributor.oralexamcommittee||姚宗珍(Jane Chung-Chen Yao)|
|dc.subject.keyword||Soft tissue,three-dimensional analysis,facial ultrasound,elastography,fractal dimension,orthognathic surgery.,||en|
|Appears in Collections:||臨床牙醫學研究所|
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