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上顎前突手術による上下唇・顎領域の軟部組織の変化を評価するためのセファロメトリ解析
A Cephalometric Analysis for Evaluation of Changes in Soft Tissues in the Regions of the Upper and Lower Lips and Chin due to Orthognathic Maxillary Advancement Surgery.
PMID: 25992065 PMCID: PMC4296950. DOI: 10.1055/s-0033-1361082.
抄録
はじめに矯正手術における硬組織の改変による軟部組織の変化を予測するための最良の方法については、現在のところコンセンサスが得られていない。目的上顎前転手術による硬組織の変化による上唇、下唇、顎部の軟部組織の変化をセファロ法を用いて測定する。方法上顎矯正手術を受けた歯骨格・顔面変形患者35名を対象に研究を行った。術前と術後1年後の2枚のテレラジオグラフを撮影し、セファロメトリックトレースを行った。結果上顎前湾の最深部に位置するハードA(Ah)点と上顎前転のソフトA(As)点との間には強い相関関係(r=0.747)が認められ、Ah点の1%の変化ごとにAsの平均変化率は0.859%であった。上顎軟性前突点（上顎硬性前突点の軟組織上の対応点までの延長）では、上顎硬性前突点（上顎歯槽突起と上顎切歯の歯冠との接合部に位置する骨点）の1%の変動ごとに0.698%の平均変動が発生した。結論本研究で適用したセファロメトリ法により、上顎前進時の硬組織の動きの7～8割は上唇の軟組織が伴っており、下唇の軟組織は変化しないか、または有意な変化を示さないことが明らかになった。
Introduction There is currently no consensus regarding the best method for predicting the changes in soft tissues due to the modification of hard tissues in orthognathic surgery. Objective To measure the changes in soft tissues of the upper lip, lower lip, and chin regions due to the modifications of hard tissues caused by orthognathic maxillary advancement surgery using a cephalometric methodology. Methods The study was conducted on 35 patients with dentoskeletal and facial deformities submitted to orthognathic maxillary advancement surgery. Two teleradiographs were taken: one during the preoperative period and the other 1 year after the surgery, on which the cephalometric tracing was drawn. Results A strong correlation (r = 0.747) was demonstrated in the horizontal analysis between the hard A (Ah) point (located in the deepest point of the anterior curvature of the maxilla) and the soft A (As) point in the advancement of the maxilla, with a mean variation of 0.859% occurring in As with each 1% variation of the Ah point. A mean variation of 0.698% occurred in the superior soft prostion point (prolongation of the superior hard prostion point to its corresponding point on soft tissue) for each 1% variation in the superior hard prostion point (bone point located at the junction of the alveolar process with the crown of the upper incisors). Conclusion The cephalometric methodology applied here revealed that the soft tissues of the upper lip accompanied 70 to 80% of the movement of hard tissues in maxillary advancement and that the soft tissues of the lower lip did not change or showed no significant changes.