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研究生:陳柏勳
研究生(外文):Po-Hsun Chen
論文名稱:顏面不對稱患者接受正顎手術先後之三度空間顏面影像評估
論文名稱(外文):Three-Dimensional Evaluation of Facial Asymmetry Corrected by Orthognathic Surgery
指導教授:黃烱興
指導教授(外文):Chiung-Sing Huang
學位類別:碩士
校院名稱:長庚大學
系所名稱:顱顏口腔醫學研究所
學門:醫藥衛生學門
學類:牙醫學類
論文種類:學術論文
論文出版年:2007
畢業學年度:95
語文別:中文
論文頁數:98
中文關鍵詞:顏面不對稱三度空間正顎手術
外文關鍵詞:facial asymmetrythree dimensionalOrthognathic surgery
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顏面顱顏之三度空間測量、模擬與重建在顱顏矯正與整型醫學領域越來越受到人們的重視,它不但使的手術醫師可以更完整的獲得病人的訊息,更使的病人可獲得和以往不同的療程感受。斷層掃瞄與核磁共振(MRI)在醫學上是非常有用的診斷工具,但是受到本身輻射、費用以及掃瞄時間的限制,侷限了這樣侵略性的診斷方式在臨床的應用。因此其他較不具侵入性的影像工具如表面雷射掃瞄技術應醞而生,這些技術具有容易使用、快速以及無放射線等優點。
(一)研究目的:本研究利用表面雷射掃瞄技術來測量顏面不對稱患者在正顎手術前後之三度空間顏面變化,並將顏面兩側不對稱之程度加以量化,以其作為臨床診斷與術後評估之應用。
(二)研究對象:包括二十位在長庚醫院接受下顎正顎手術之顏面不對稱的患者為實驗組與由長庚醫院顱顏中心團隊所任意選出之三十位成年人為對照組。
(三)研究方法:利用雷射掃瞄設備所取得之三度空間顏面影像,在以眼角中點垂直面作為參考平面下,分析十五個顏面界標在三度空間座標之對稱性,並利用左右側顏面投影向量的不對稱差異值(不對稱向量指數,asymmetry vector),來分析左右側臉在六個顏面區域之不對稱程度。
(四)研究結果:不論是在界標對稱性或是不對稱向量指數方面,在對照組可分析出少量之不對稱。在實驗組方面,術前顏面界標的不對稱性差異,雖然在術後得到統計上有意義之改善,但是與對照組比較於嘴角在x軸(p <0.001)與y軸(p <0.05)仍有差異。在不對稱向量指數方面,實驗組於術後在下唇、下巴與中下側臉部皆顯示統計上和對照組有意義的差異(p < 0.05)。
(五)結論:即使是在外觀看似正常的對照組,以三度空間測量仍可發現輕微的不對稱。而在實驗組術後顏面對稱性雖有明顯的改善,但在兩側嘴角界標與下唇、下巴與側臉的向量差異於手術後,仍無法達到對照組之對稱範圍內。
1. Objectives: Three-dimensional evaluation and quantification of facial asymmetry after orthognathic surgery by laser surface scanning.
2. Materials and Methods: 30 normal subjects and 20 facial asymmetry patients were included in this retrospective study. The images of 3D laser surface scanning were taken on 30 normal subjects as the control group and the images of orthognathic patients were taken before and after 6 months of surgery. These images were measured and analyzed by customized software ( Beauty 3D ) to analysis the symmetry of facial landmarks in x, y and z coordinates, difference of bilateral surface vectors as “asymmetry vectors” in six facial areas were also compared.
3. Results: The result of the study shows acceptable but not absolute symmetry in control group. In study group, significant improvement was noted after surgery on both symmetry of landmarks and asymmetry vectors. When compared to control group, significant difference of mouth angle was noted in x (p <0.001) and y (p <0.05) coordinate while asymmetry vectors on lower lip , chin , middle and lower lateral surface are lager than that on control group with statistical significance (p <0.05).
4. Conclusion: Mild facial asymmetry can be observed in control group by three-dimensional laser surface scanner .Even residual facial asymmetry remained after orthognathic surgery, it improves facial symmetry of patients and the three-dimensional technique can help us quantify facial asymmetry.
指導教授推薦書………………………………………………………………… i
口試委員會審定書……………………………………………………………… ii
授權書…………………………………………………………………………… iii
誌謝………………………………………………………………………………… iv
中文摘要…………………………………………………………………………… v
英文摘要…………………………………………………………………………. vii
目錄………………………………………………………………………………. ix
第一章 前言………………………………………………………………1
第二章 三度空間影像技術…………………………………………………5
2.1 三度空間影像技術簡介…………………………………………………5
2.2 三度空間顏面資料之不對稱分析…………………………………………9
第三章 顱顏面對稱性之相關文獻回顧…………………………………………12
3.1人體測量學……………………………………………………………12
3.2相片分析法……………………………………………………………12
3.3環口X光片分析…………………………………………………………13
3.4 正面測顱X光分析………………………………………………………14
3.5顱頂下頦X光分析………………………………………………16
3.6三度空間顏面對稱性分析……………………………………………… 17
3.7三度空間立體影像界標之誤差估計……………………………………21
第四章 研究目的……………………………………………………………25
第五章 實驗對象與研究方法……………………………………………………26
5.1實驗對象…………………………………………………………26
5.2三度空間顏面資料的取得……………………………………27
5.3測量軟體 Beauty 3D………………………………………………………29
5.4手術方式…………………………………………………………………30
5.5臉部界標的定義…………………………………………………………31
5.6實驗誤差估計……………………………………………………………34
5.7實驗流程…………………………………………………………………35
5.8預期目標及工作進度……………………………………………………36
第六章 實驗結果…………………………………………………………………37
6.1對照組之實驗結果………………………………………………………37
6.2實驗組在術前之實驗結果……………………………………………38
6.3 實驗組在術後之實驗結果與術前比較………………………………39
第七章 討論………………………………………………………………………44
7.1 三度空間影像在顏面不對稱研究之重要性與趨勢 ……………………44
7.2 顏面於三度空間對稱平面之選擇………………………………………44
7.3 顏面不對稱指數的原理與應用…………………………………………46
7.4 正顎手術前後顏面不對稱之變化與分析………………………………47
7.5 術前術後嘴角對稱性與寬度之變化……………………………………51
7.6 正顎手術對顏面不對稱患者的改善結果………………………………51
第八章 結論………………………………………………………………………53
第九章 未來發展的方向與目標…………………………………………………54
參考文獻……………………………………………………………………………56
表……………………………………………………………………………………69
附圖…………………………………………………………………………………85
附錄 I………………………………………………………………………………94
附錄 II……………………………………………………………………………95
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