基于解剖标志的鼻翼基底缩窄缝合术对正颌患者术后鼻唇部形态的影响

doi:10.19723/j.issn.1671-167X.2023.04.027

摘要/Abstract

摘要：

目的: 评价基于鼻肌肉解剖结构行鼻翼基底缩窄缝合术(alar base cinch suture, ABCS)对于骨性Ⅲ类牙颌面畸形患者行上颌Le Fort Ⅰ型截骨术后鼻唇部三维形态的影响。方法: 选取2019年8月至2020年1月于北京大学口腔医院颌面外科行正颌外科手术的骨性Ⅲ类牙颌面畸形患者30例, 其中男性11例, 女性19例, 平均年龄(23.23±2.98)岁, 上颌骨前徙量≤4 mm, 依随机数字表法分成试验组和对照组, 试验组采用鼻底肌群标记、对位缝合法, 对照组采用鼻底肌群拉拢悬吊缝合法。使用3dMD face系统分别在术前及术后至少6个月拍摄患者面部三维照片, 在3dMD patient软件上手工标记鼻唇部软组织特征点, 分别测量特征点的直线距离、曲线距离、角度、鼻深-鼻翼宽指数等14个指标。使用SPSS 22.0软件进行手术前后数据的分析与对比。结果: 两组患者术后上唇皮肤高度、鼻深-鼻翼宽指数变化率之间差异有统计学意义(P=0.023, P=0.012), 对照组患者术后上唇皮肤高度增加率、鼻深-鼻翼宽指数减小率均大于试验组, 试验组与对照组患者术后鼻翼宽度、鼻翼基底宽度均增大, 差异均有统计学意义(P < 0.05), 对照组患者术后鼻唇角较正常值偏大(P=0.036), 试验组患者术后鼻唇角与正常值相比差异无统计学意义。结论: 基于解剖标志的ABCS与传统缝合方式相比, 对于上颌骨轻至中度前徙时患者术后的鼻部协调性及鼻唇部形态更有利, 其在可操作性及客观准确性上亦有一定优势, 可成为更优化、精确的ABCS术式在临床中推广应用。

关键词: 鼻翼基底缩窄缝合术, 三维成像, 解剖标志, Le Fort Ⅰ型截骨术, 正颌外科手术

Abstract:

Objective: To study the effect of a modified alar base cinch suture (ABCS) based on nasal musculature anatomy on the three-dimensional morphology of nasolabial region in patients after Le Fort Ⅰ osteotomy. Methods: In the study, 30 patients[11 males and 19 females, with an average age of (23.23±2.98) years]with skeletal Class Ⅲ malocclusion underwent orthognathic surgery between August, 2019 and January, 2020 to have the maxilla advanced no more than 4 mm in the Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology were involved and were divided into the test and control groups based on the random number table.In the test group, the nasal musculature was identified and labeled before dissection and the ABCS was according to the label, while in the control group, the nasal musculature was directly sutured and knotted in the midline of nose without prepend labeling.All the patients underwent three-dimensional facial photos preoperatively and 6 months postoperatively by using 3dMD face system.On the three dimensional image, soft tissue landmarks of nasolabial region was identified by the same examiner.Fourteen measurements including straight distance, curve distance, angle and ratio were measured.Statistical analysis was done by using SPSS 22.0. Results: There were significant differences between the two groups in cutaneous height of upper lip (P=0.023) and in nasal tip protrusion-alar width (P=0.012).The increase rate of cutaneous height of upper lip and the decrease rate of nasal tip protrusion-alar width in the control group were significantly higher than that in the test group.The alar width and alar base width of the both groups were significantly increased compared with the preoperative level (P < 0.05).The nasolabial angle in the control group was significantly higher compared with the normal value, while there was no significant difference between the test group and the normal value. Conclusion: Compared with the conventional suture method, this modified alar base cinch suture is more favorable for the postoperative nasal coordination and nasolabial morphology in patients who need mild to moderate maxillary advancement, and it has certain advantages in operability and objective accuracy.So it could become a modified and accurate method of alar base cinch suture and be widely applied in clinical practice.

Key words: Alar base cinch suture, Three-dimensional imaging, Anatomic landmarks, Le Fort Ⅰ osteotomy, Orthognathic surgical procedures

中图分类号:

R782.2

张雯,刘筱菁,李自力,张益. 基于解剖标志的鼻翼基底缩窄缝合术对正颌患者术后鼻唇部形态的影响[J]. 北京大学学报（医学版）, 2023, 55(4): 736-742.

Wen ZHANG,Xiao-jing LIU,Zi-li LI,Yi ZHANG. Effect of alar base cinch suture based on anatomic landmarks on the morphology of nasolabial region in patients after orthognathic surgery[J]. Journal of Peking University (Health Sciences), 2023, 55(4): 736-742.

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参考文献 22

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Parameter	Anthropometric landmarks
(1) inter-canthal distance	R en-L en
(2) nasal height	n-sn
(3) nasal length	n-prn
(4) nasal tip protrusion	prn-sn
(5) alar width	R al-L al
(6) alar base width	R alB-L alB
(7) columellar length	sn-c
(8) cutaneous height of upper lip	sn-ls
(9) upper lip height	sn-sto
(10) crista philtri width	R cph-L cph
(11) nasolabial angle	c-sn-ls
(12) nasal tip angle	n-prn-sn
(13) facial prominence	n-prn-pg
(14) nasal tip protrusion-alar width ratio	prn-sn/R al-L al

Items	Test group		Control group
Items	T1-T0, $\bar x \pm s$	P value	T1-T0, $\bar x \pm s$	P value
(1) inter-canthal distance/mm	0.36±1.19	0.260	-0.36±0.86	0.124
(2) nasal height/mm	-0.10±1.65	0.820	-0.72±1.67	0.119
(3) nasal length/mm	-0.73±1.24	0.039^*	-1.01±1.56	0.025^*
(4) nasal tip protrusion/mm	0.15±2.21	0.791	-0.78±1.26	0.031^*
(5) alar width/mm	1.00±1.19	0.006^*	1.23±1.59	0.010^*
(6) alar base width/mm	0.73±1.29	0.045^*	1.44±1.62	0.004^*
(7) columellar length/mm	-0.45±1.09	0.134	-0.14±1.15	0.646
(8) cutaneous height of upper lip/mm	0.46±1.07	0.121	0.96±0.82	0.001^*
(9) upper lip height/mm	1.23±2.10	0.091	1.27±2.66	0.085
(10) crista philtri width/mm	0.16±1.79	0.701	0.39±1.04	0.731
(11) nasolabial angle/(°)	6.21±8.50	0.013^*	3.79±7.90	0.085
(12) nasal tip angle/(°)	2.09±4.98	0.126	2.36±3.36	0.057
(13) facial prominence/(°)	-4.71±3.05	< 0.001^*	-6.05±3.10	< 0.001^*
(14) nasal tip protrusion-alar width ratio	0.018±0.053	0.218	-0.028±0.041	0.020^*

Items	Test group change rate/%, $\bar x \pm s$	Control group change rate/%, $\bar x \pm s$	P value
(1) inter-canthal distance	1.007±3.331	-1.010±2.360	0.066
(3) nasal length	-1.547±2.746	-2.194±3.636	0.587
(5) alar width	2.594±3.149	3.534±4.595	0.519
(6) alar base width	3.239±6.875	7.283±8.984	0.177
(8) cutaneous height of upper lip	2.275±5.968	7.420±5.716	0.023^*
(10) crista philtri width	2.927±14.393	9.236±8.647	0.157
(14) nasal tip protrusion-alar width ratio	4.313±11.404	-5.793±8.898	0.012^*

Items	Normal, $\bar x \pm s$	Test group		Control group
Items	Normal, $\bar x \pm s$	T1, $\bar x \pm s$	P value	T1, $\bar x \pm s$	P value
Nasal tip angle/(°)	105.70±9.78	103.71±8.12	0.358	106.78±5.81	0.483
Nasolabial angle/(°)	100.10±10.03	101.82±9.02	0.101	105.07±8.28	0.036^*

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