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http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/70863
標題: | 顏面不對稱之軟組織及硬組織評估:
應用錐狀射束電腦斷層掃描之三維分析 Hard and soft tissue evaluation of facial asymmetry: 3D analysis using CBCT. |
作者: | Kai-Jing Yeh 葉凱菁 |
指導教授: | 陳羿貞 |
關鍵字: | 顏面不對稱, facial asymmetry, |
出版年 : | 2018 |
學位: | 碩士 |
摘要: | 目的:
安格氏第三類異常咬合的盛行率在亞洲人大幅高出其他族群,並且常伴有臉部不對稱。本研究的目標為利用錐束射束斷層掃描(CBCT),分析骨性三級異常之正顎手術患者的中臉部與下臉部不對稱特徵,並探討硬軟組織之間表現的關聯性。本研究先分析下頦點偏斜與下顎枝寬度關係,再根據下顎骨不對稱形態差異,將患者分為三個組別,進一步分析比較 各組內偏斜側與非偏斜側不對稱特徵,以及三個組別間不對稱特徵之差異。 研究程序及方法: 本研究蒐集採行正顎手術治療的安格氏三級骨性咬合患者共計70位。患者於治療前拍攝錐狀射束斷層掃描並進行3D影像重組。在患者3D影像的臉部硬軟組織選取21個界標點,以評估顏面形態不對稱。根據左右下顎枝寬度差異(Ramus width difference)與下頷點偏斜(Menton deviation)的量及方向將患者分成三組,Group1與Group2的偏斜側下顎枝寬度比非偏斜側較寬,Group 1的下頦點偏斜量大於下顎枝寬度差異,而group 2的下頦點偏斜量小於下顎枝寬度差異,Group 3則是偏斜側的下顎枝寬度反而比非偏斜側較小。 結果: Group 1 (n=33)患者有最大的下頦點歪斜,不對稱特徵包含:上下顎骨皆為偏斜側較寬,上顎非偏斜側會往下傾斜(downward canting),上顎非偏斜側位於較前方,偏斜側下顎枝往頰側傾斜。齒性部分上顎後牙適應下顎偏斜,發生代償現象,咬合平面非偏斜側較往下傾斜,偏斜側後牙較往頰側傾斜(buccal tipping)。軟組織的表現則與骨骼表現同向,皆為偏斜側較寬。Group 1的不對稱形態為:(1)從正面觀為下顎roll rotation的不對稱形態,(2)從axial view看,上顎及下顎往偏斜側做yaw rotation。 Group 2 (n=18)患者的下頦點歪斜量為三組之中最小,不對稱特徵包括:上下顎骨偏斜側比較寬,上顎齒性代償現象只有在左右橫向上有所表現,垂直向度上則否。軟組織與骨骼表現同向,皆為偏斜側較寬,Group 2的不對稱形態為類似下顎平移(sideshift)所造成的不對稱。 Group 3 (n=19)患者的不對稱特徵包括:上顎骨非偏斜側較為前方,下顎骨非偏移側比較寬,齒性部分沒有明顯橫向及垂直向代償現象,至於軟組織則與骨骼表現反向,偏斜側軟組織較厚。Group 3的不對稱形態從axial view看,上下顎骨皆往偏斜側做yaw rotation,旋轉中心可視為位於下頦點與兩側下顎枝連線之間的下顎骨體中央區域。 三組間不對稱分析,上顎部分Jugular point與冠狀平面之距離 (Jugular-C) 的測量值有顯著差異,從axial view看,group 1及group 3上顎往偏斜側做yaw rotation,非偏移側mandibular foramen以及mental foramen 較偏移側前方。下顎骨骼的測量值大部份都有顯著差異。Group 3下顎骨兩側橫向差異 (discrepancy)較小。從frontal view看,Group 1的偏斜側下顎枝較往頰側傾斜。三組間達到顯著差異的齒性測量項目有:Maxilla U6 canting,Maxilla U6 dimension difference。其中group 1有最大的咬合平面傾斜,且為非偏移側較往下傾斜。Group 1的上顎arch form discrepancy為3組中最大,偏斜側後牙寬度較寬。軟組織測量項目,包括嘴唇傾斜、左右軟組織寬度差異、左右軟組織厚度差異等項目,在3組間皆達到顯著差異。Group 1的lip canting的程度顯著大於其他兩組,且與上顎骨傾斜,上顎後牙咬合平面傾斜的方向皆相同。 結論 本篇研究根據下頦點偏斜及左右下顎枝寬度差異之相對量及方向,將患者分成三組,結果顯示下顎偏斜型態不同的顏面不對稱,在上顎及齒槽區亦存在相異的不對稱特徵。顏面不對稱程度最嚴重的Group 1患者,上顎臼齒的頰舌角度及垂直高度伴隨下顎不對稱而有橫向及垂直向齒性代償現象,Group 3軟組織與骨骼不對稱為反向表現,偏斜側的軟組織較厚。 Objective: The purpose of this study is to evaluate facial asymmetry 3 dimensionally using cone-beam computed tomography (CBCT) in skeletal Class III patients. Material and methods: The patients were classified into 3 groups based on the relationship of direction and amount of menton deviation relative to the transverse ramus width asymmetry. In groups 1 and 2, menton deviation was accompanied by a larger transverse ramus distance on the deviated side. While in group 1 the amount of menton deviation was greater than that of ramus asymmetry, group 2 patients showed a smaller menton deviation in comparison to ramus asymmetry. Patients in group 3 exhibited an atypical asymmetry of larger ramus distance contralateral to the side of menton deviation. Statistical analysis was run to compare hard/ soft tissue characteristics between the deviation side and non-deviation side in each group. Difference of the structural characteristics among 3 groups were also delineated by using one-way ANOVA and posy-hoc tests. Results: Group 1 showed the greatest amount of menton deviation. Significant greater transverse dimension of maxilla and mandible were noted for the deviation side. In addition, maxilla exhibited downward canting in the non-deviation side, and the ramus of the deviation side was more buccal inclined than that of the non-deviation side. The bucco-lingual axes of maxillary first molars were compensated to transverse skeletal asymmetry, which resulted in canting in the maxillary occlusal plane. In contrast, no significant difference in soft tissue thickness between the deviation side and the non-deviation side was observed. Group 2 showed the lowest amount of menton deviation. Significant greater transverse dimension of maxilla and mandible were observed at the deviation side. No significant difference was noted in the bucco-lingual tooth axis of bilateral maxillary first molars nor dentoalveolar heights was observed between the deviated and non-deviated sides. There was no significant difference in soft tissue thickness between the deviation and non-deviation sides. In group 3, the Jugular point was more anterior positioned in the non-deviation side than the deviation side. The transverse dimension of mandible was significant greater at the non-deviation side. The asymmetry in bucco-lingual inclination of bilateral maxillary first molars was not statistically significant, suggesting that no obvious dental compensation existed. However, the soft tissue thickness was significant greater at the deviation side. The Jugular-C measurement was significant different between the 3 groups. In group 1 and 3, the Jugular point was more anteriorly positioned at the non-deviated side than the deviation side. Most of the measurements representing mandibular structures were significant different among 3 groups. Similarly, in group 1 and 3, the mandibular foramen and mental foramen were more anteriorly positioned at the non-deviation side. Group 1 exhibited more buccally inclined ramus at the deviation side than the other 2 groups. Group 3 showed the smallest amount of transverse width discrepancy between bilateral ramus. There were significant differences in the measurements of maxilla U6 canting and maxilla U6 dimension difference between 3 groups. Group 1 showed greatest maxilla U6 canting and transverse width discrepancy. All the soft tissue measurements were significant different among the 3 groups. The lip canting was of greatest amount in group 1. Group 3 exhibited the greatest difference in the bilateral soft tissue thickness of the lower face. Conclusion Different structural characteristics were found among 3 groups. In Group 1 patients, the maxillomandibular complex exhibited displacement including a roll rotation in frontal view and a yaw rotation in axial view to the deviation side. As to group 2 patients, facial asymmetry was characterized by mandible sideshift to the deviation side. Abruptly, the maxillomandibular complex of group 3 patients exhibited a yaw rotation to the deviation side. |
URI: | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/70863 |
DOI: | 10.6342/NTU201801784 |
全文授權: | 有償授權 |
顯示於系所單位: | 臨床牙醫學研究所 |
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