臺灣博碩士論文加值系統

BACKGROUND &; PURPOSEThe aims of the present study were to assess the alteration of mandibular proximal segments in patients with skeletal Class III mandible deviation after orthognathic surgery (OGS), and to investigate the six months post-surgical outcome of jaw motion analysis in relation with the changes of mandibular proximal segments.
METHODSTwenty-one adult patients with skeletal Class III mandible deviation were assessed. All the patients underwent two-jaw OGS. The records included cone-bean computerized tomography (CBCT) before (T1) and within one month after OGS (T2), jaw motion analysis (JMA) data and tempromandibular joint TMJ examination were obtained six months after OGS.Three-dimensional (3D) CBCT skull images were constructed and further measured with the software Simplant®. The differences in morphology between the deviated and non-deviated sides, and the surgical changes at ipsilateral sides were tested with paired-t test.
The Pearson correlation test was performed to assess the relationship between the surgical changes and outcome of JMA.
RESULTSThe differences in the morphology showed that the deviated side had smaller gonial angle(116.94º for the deviated side, and 121.30º for the non-deviated side),smaller ramus axis to coronal plane (21.62º for the deviated side, and 23.80º for the non-deviated side), and shorter ramus height (56.60 mm for the deviated side, and 61.31 mm for the
non-deviated side)compared with the non-deviated side.The skeletal changes demonstrated decrease in the mandibular body at both sides after OGS(from 91.68 mm to 87.94 mm on the non-deviated side and from 89.82 mm to 86.43 mm on the deviated side). The ramus axis to the coronal plane became more upright bilaterally (decreased from 23.80º to 15.24º on the non-deviated side, and decreased from 21.62º to 15.86º on the deviated side), while the gonial angle on the deviated side showed remarkable increase after the OGS(from 116.94º to 119.77º)by moving into a symmetrical angulation (P=0.028). The ramus height also became
more balanced as it decreased on the non-deviated sidefrom 61.31 mm to 60.72 mm), and increased on the deviated side(increased from 56.60 mm to 57.91 mm). For the JMA, the incisal range of motion in laterotrusion to the deviated side increases when the ramus axis to coronal plane decreases (P=0.04), and the condylar range of motion in opening at the deviated side improved when the Gonion to midsagittal plane decreased (P=0.03),the angle of horizontal condylar movement in lateral movement at the deviated side increased by increasing the ramus axis tomidsagittal plane (P=0.037), while the condylar range of motion in retrusion at the deviated and the non-deviated sides decreased when the condyle to midsagittal plan (p=0.046 for the deviated side, and P=0.009 for the non-deviated side) and the ramus axis to midsagittal plane increased (P=0.019 for the deviated side , and P=0.024 for the non-deviated side).
CONCLUSIONThe visualization of 3D model clearly detected the amount of changes in the proximal segment after the OGS. The condylar range of motion did show relationship with the skeletal changes of the proximal segments in Class III patients; the improvement ppeared mainly at the deviated side.

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ACKNOWLEDGMENT ................................................................... iii
ABSTRACT.......................................................................... iv
CONTENTS............................................................................... vi
LIST of TABLES............................................................ ix
LIST of FIGURES ...............................................................x
CHAPTER 1 INTRODUCTION..................................................1
1.1 Background.................................................................1
CHAPTER 2 SYSTEMATIC REVIEW....................................5
2.1 Introduction.................................................5
2.2 Search strategy......................................................9
2.3 Selection criteria ...................................................9
2.4 Data collection and assessment................................10
2.5 Results.................................................................10
2.5.1 Changes in the proximal segment with orthognathic surgery.....................11
2.5.2 Effectiveness of condylar positioning devices (CPD) .........................12
2.5.3 Methodology assessment .....................................13
2.6 Relationship between OGS and jaw motion ............................14
2.7 Discussion.................................................................16
CHAPTER 3 PURPOSE AND HYPOTHESIS........................................18
3.1 Purpose..............................................................18
3.2 Null hypothesis .......................................................18
3.3 Research hypothesis.................................................19
CHAPTER 4 MATERIALS AND METHODS........................................20
4.1 Experimental materials ................................................20
4.1.1 Sample and selection criteria ........................................20
4.1.2 Sample description.....................................................21
4.2 Data collection and measurement .........................................22
4.2.1 Cone Beam Computed Tomography (CBCT)..............................22
4.2.2 Mandibular Motion Analysis ............................................22
4.2.3 3D model construction.......................................................23
4.2.4 TMD Examination .............................................................25
4.3 Measurement methods .......................................................26
4.4 Statistical analysis............................................................26
CHAPTER 5 RESULTS ................................................28
5.1 The skeletal relationship between the deviated and non-deviated sides..28
5.1.1 Comparing the non-deviated side with the deviated side before OGS .......28
5.1.2 Comparing the non-deviated side with the deviated side after OGS..........29
5.1.3 Comparing the non-deviated side before and after OGS............................29
5.1.4 Comparing the deviated side before and after OGS ................30
5.2 The relationship between the 3D measurements and mandibular
movements ......................................................................30
5.2.1 The result of the OGS changes deviated side and six months outcomes of
JMA 30
5.2.2 The result of the OGS changes in the non-deviated side and six month
outcomes of JMA......................................................31
5.3 Screening examination of the condyle and the surrounded muscles 6
months after OGS .................................................................32
viii
5.3.1 Clicking sound ................................................................32
5.3.2 Condylar pain...............................................................32
5.3.3 Tenderness...............................................................32
5.3.4 Muscle pain................................................................32
5.4Chi-square test. .....................................................................32
CHAPTER 6 DISCUSSION.....................................................................33
6.1 Changes in the Proximal segment before and after OGS ........................33
6.2 The effect of OGS outcome on jaw motion .............................................35
6.3 The changes in the proximal segment in relation to the JMA and TMJ
symptoms............................................................................36
6.4 Clinical implications ...........................................................37
6.5 Limitation.......................................................................38
CHAPTER 7 CONCLUSION ..................................................................39
REFERENCES .......................................................41
ix
LIST of TABLES
Table2.1 Details of included studies.........................................................51
Table2.2 Methodology assessment of the reviewed articles.....................54
Table4.1 Definition of mandibular movement measurements. ................55
Table4.2 Anatomical landmarks that were taken in this study. ................56
Table4.3 Measurements for study variables and its abbreviations. ..........57
Table5.1 Comparing the non-deviated side with the deviated side
pre-surgery. .......................................................................58
Table5.2 Comparing the non-deviated side with the deviated side
post-surgery...............................................59
Table5.3 Comparing the non-deviated side pre-surgery with the
non-deviated side post-surgery. ................................................................60
Table5.4 Comparing the deviated side pre-surgery with the deviated side
post-surgery..................................................61
Table5.5 Mean and SD of jaw motion analysis (JMA) data.....................62
Table5.6Result of OGS changes in the deviated side and six months
outcomes of JMA...................................................63
Table5.7Result of OGS changes in the non-deviated side and six months
outcomes of JMA.................................................................65
Table5.8 Summery of tables 5.6, 5.7 ..........................................67
LIST of FIGURES
Figure 4.1 Initial diagnosis of facial asymmetry on PA cephalograms. ...68
Figure 4.2 Motion data obtained by mandibular movement—maximal
mouth opening then retrusion and forward closing. .................................68
Figure 4.3, 4.4 Maximum bilateral lateral excursive movement..............69
Figure 4.5Maximal mandible opening (MMO) then closing. ..................69
Figure 4.6 Illustration of the deviated and the non-deviated sides……..70
Figure 4.7 Ramus height......................................70
Figure 4.8 Body length ........................................71
Figure 4.9 Gonion to midsagittal .......................................
figure 4.10 Gonial angle ..........................................................................72
Figure 4.11 Condyle to midsagittal plane.................................................72
Figure 4.12Condyle to the FH plane.........................................................73
Figure 4.13 Condyle to the coronal plane.................................................73
Figure 4.14 Condyle head axis to the midsagittal plane...........................74
Figure 4.15 Ramus axis to the midsagittal plane......................................74
Figure 4.16 Ramus axis to coronal plane..................................................75
Figure 4.17 Three-dimensional planes (3D).............................................75
Figure 5.1 Screening examination of the condyle for clicking sound......76

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