正顎手術後之鼻外型側顱放射影像分析

三級異常咬合關係在亞洲地區盛行率相較於白種人高，亞洲人種三級異常 咬合發生率在 9%~18%，白種人則只有 0.8%~4.2%。而此異常咬合關係的原因可 能為齒列性因素或骨性因素，其中骨性因素又有上顎骨後縮或下顎骨前突抑或 兩者合併之情況。三級骨性異常咬合關係對於顏面外觀的影響主要在於鼻、唇 與下巴軟組織相對關係因骨性關係不理想而造成不和諧之表現。正顎手術合併 矯正治療為治療三級骨性異常咬合關係的主要手段之一，藉由切開下顎骨上升 支、上顎骨截斷術與根尖下截骨術等方式游離骨塊並移動至牙齒、顎骨、顱底 三者彼此理想相對關係之位置。 本研究藉由回溯完成治療後之三級骨性異常咬合患者，比較矯正合併手術治療前後的側顱放射影像，分析鼻子之外型變化以及與其他解剖構造之相對關係變化並同時比較不同性別之間的差異。研究中發現在鼻唇角、鼻顏角、鼻頦角、鼻尖與上唇、門牙切端、下巴頦 前點的距離以及 H angle 等數值在手術治療前後具有明顯差異，此外 E line、S line、H line、B line 等美觀線也有顯著變化;此外不同性別間在鼻額角與鼻子的 長度、高度、突出度以及與組織厚度相關的數值都有明顯差異。

The prevalence of Angle’s Class III malocclusion was higher in asian than caucasian, which is 9%~18% among Asia people and 0.8%~4.2% in caucasian. This kind of malocclusions could be contributed to dental factors or skeletal factors. And skeletal factors include maxillary rretrognathism, mandibular prognathism or both. The main influence of skeletal class III malocclusion on appearance is the relationship among nose, lips and soft tissue of chin, that can cause facial disharmony due to the disproportionate bony structures underlying these soft tissue. Orthognathic surgery combined with orthodontic treatment is one of the main strategies for skeletal class III malocclusion. By vertical ramus osteotomy or sagittal split osteotomy of mandible, Le fort I osteotomy of maxilla and subapical osteotomy, we can move maxilla, mandible and dentition into ideal position and better relationship among each other.This retrospective study is going to analyze the skeletal class III patients after orthognathic surgery and orthodontic treatment. Compare the changes of nasal morphology and the relationship between the nose and other anatomic structures.In our study, we found there were significant difference in nasolabial angle, nasofacial angle, nasomental angle, distance between pronasale and labrale superius, incisioin superius and soft tissue pogonion before and after treatment. H angle and other soft tissue esthetic lines such as E line, S line, H line and B line also were significantly different after treatment. The nasofrontal angle and length, height and depth of nose and value about soft tissue thickness had significance between male and female.