臺灣博碩士論文加值系統

研究背景及目的：顏面不對稱是齒顎顏面異常患者關注的主要問題之一。本研究之目的為（1）評估骨性二級異常合併顏面不對稱患者在雙顎手術後顏面不對稱程度的變化，（2）將二級異常咬合患者術前及術後的顏面不對稱程度與正常控制組做比較。
方法：本研究蒐集30位連續接受雙顎手術的骨性二級異常合併顏面不對稱成年患者，利用術前及術後至少六個月以上的錐形線束電腦斷層掃描計算出臉部每個標記點的不對稱指數，並與30位骨性一級關係的正常控制組做比較。
結果：術後，下臉部與全臉的不對稱指數顯著減少（分別為17.8 ± 29.4及16.6 ± 29.5公厘，p < 0.01），但是中臉部的不對稱指數卻顯著增加（1.2 ± 2.2公厘，p < 0.01）。百分之五十三的二級異常咬合患者術後尚有殘餘的頦部不對稱。術後全臉的不對稱指數與其術前不對稱指數有顯著正相關（相關係數為0.37，p < 0.05)。
結論：骨性二級異常合併顏面不對稱患者的下臉部不對稱程度在雙顎手術後雖有顯著改善，但還是約有一半的患者有殘餘的頦部不對稱。術後全臉不對稱程度與其術前不對稱程度有關。

Background and Purpose: Facial asymmetry is one of the main concerns in patients with dentofacial deformity. The aims of the study were (1) to evaluate the changes in facial asymmetry after bimaxillary surgery for asymmetric skeletal Class II deformity, and (2) to compare preoperative and postoperative facial asymmetry of Class II patients with normal controls.
Methods: The facial asymmetry of 30 adults who consecutively underwent bimaxillary surgery for asymmetric skeletal Class II deformity were assessed on cone-beam computed tomography before and at least 6 months after surgery. The asymmetry index of each landmark of face was calculated. Results were compared with those of 30 normal control subjects with skeletal Class I structure.
Results: After surgery, the asymmetric index of the lower face and total face decreased significantly (17.8m ± 29.4 mm and 16.6 ± 29.5 mm, respectively, both p < 0.01), whereas the asymmetric index of the middle face increased significantly (1.2 ± 2.2 mm, p < 0.01). Postoperatively, 53 percent of the Class II patients had residual chin asymmetry. The postoperative total face asymmetric index was positively correlated with the preoperative asymmetric index (r = 0.37, p < 0.05).
Conclusions: In patients with asymmetric Class II deformity after bimaxillary surgery, lower face asymmetry improved significantly. However, around 50 percent of the patients still had residual chin asymmetry. The postoperative asymmetry of total face was related to the initial severity of asymmetry.

長庚大學碩士學位論文指導教授推薦書
長庚大學碩士學位論文口試委員會審定書
誌謝 iii
摘要 iv
ABSTRACT vi
CONTENTS viii
LIST OF TABLES xi
LIST OF FIGURES xii
CHAPTER 1 INTRODUCTION 1
CHAPTER 2 SYSTEMATIC REVIEW 3
2.1 Introduction 3
2.2 Methods 4
2.2.1 Search strategy 4
2.2.2 Selection criteria 4
2.2.3 Data extraction 5
2.3 Results 5
2.3.1 Asymmetry outcome for Class II deformity 7
2.3.2 Asymmetry outcome for a mixed sample of various types of malocclusion 7
2.3.3 Lip cant 7
2.3.4 Soft tissue chin deviation 8
2.3.5 Overall facial asymmetry 8
2.4 Discussion 8
2.5 Conclusions 9
CHAPTER 3 AIMS AND HYPOTHESES 11
3.1 Aims 11
3.2 Hypotheses 11
CHAPTER 4 METHODS 12
4.1 Patients with Asymmetric Class II Deformity 12
4.2 Control Subjects 12
4.3 Surgical Technique 13
4.4 CBCT 13
4.5 Asymmetry Index (AI) 14
4.6 Reliability 15
4.7 Statistical Analysis 16
CHAPTER 5 RESULTS 17
5.1 Subject Characteristics 17
5.2 Postsurgical Changes in Class II Patients 17
5.3 Frequency of Residual Asymmetry in Class II Patients 17
5.4 Correlation between Postoperative AI and Preoperative AI 18
CHAPTER 6 DISCUSSION 19
CHAPTER 7 CONCLUSIONS 24
REFERENCES 25
TABLES 2.1 through 5.4 32
FIGURES 2.1 through 4.2 52


LIST of TABLES
Table 2.1 Details of included studies regarding outcome of orthognathic surgery for asymmetric skeletal Class II deformity 32
Table 2.2 Assessment and results of included studies regarding outcome of orthognathic surgery for asymmetric skeletal Class II deformity 35
Table 2.3 Quality analysis of the included studies 38
Table 4.1 Definitions of skeletal landmarks and reference planes 40
Table 4.2 Definitions of landmarks used for asymmetry index calculation 41
Table 4.3 Definitions of regional and total face asymmetry index (AI) 44
Table 5.1 Patients characteristics before treatment 45
Table 5.2 Asymmetry index (AI) before and after surgery in Class II patients 46
Table 5.3 Landmark asymmetry index (AI) before and after surgery in Class II patients 48
Table 5.4 Correlation coefficients between postoperative asymmetric index (AI) and preoperative AI 51


LIST of FIGURES
Figure 2.1 Study flow diagram 52
Figure 4.1 Reference planes for the 3D coordinate system 53
Figure 4.2 Study landmarks 54

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