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系統識別號 U0026-2607201508513800
論文名稱(中文) 臉部不對稱的三維診斷系統
論文名稱(英文) Three-dimensional diagnosis of facial asymmetry with a new system
校院名稱 成功大學
系所名稱(中) 口腔醫學研究所
系所名稱(英) Institute of Oral Medicine
學年度 103
學期 2
出版年 104
研究生(中文) 郭子彥
研究生(英文) Tzu-Yen Kuo
學號 T46021067
學位類別 碩士
語文別 英文
論文頁數 83頁
口試委員 指導教授-王東堯
指導教授-劉佳觀
口試委員-方晶晶
召集委員-李正喆
中文關鍵字 臉部不對稱  最優化對稱面分析 
英文關鍵字 Facial asymmetry  OSP analysis 
學科別分類
中文摘要 本研究的目的是希望建立一套新的診斷系統,包含臉部不對稱的量化並進行分類。臉部不對稱在臨床上是尋求正顎手術的病人常見的主訴。然而目前用來評估臉部不對稱的工具仍無法全面以及有效的量化臉部不對稱的程度,這大大的影響了臨床醫師在進行臉部不對稱的診斷以及手術計畫的制訂。過去的診斷大多是在定義造成病人臉部不對稱的原因。這種從病理學所下的診斷,往往只能讓手術醫師知道病人有臉部不對稱的情況,然而對於臉部不對稱的嚴重程度並沒有詳細地描述。目前已有許多工具使用2D側顱攝影或是3D電腦斷層掃描的影像,以標點來測量並評估臉部不對稱的情況,且近年來隨著醫學影像以及電腦輔助技術的進步,都提高了測量及影像的準確度。但是如下顎骨如此複雜的立體結構,只利用2D 工具來評估其在空間中的對稱性必定是有所限制的。OSP分析軟體是我們自行研發的一套系統,是在空間中分別建立中臉部以及下顎骨的對稱面,並以此來進行臉部不對稱的分析。本研究分成三個部分,第一部分中病患的OSP分析結果有任一參數大於4mm或是4∘時才被選入,共選入有35位病人並比較病人使用傳統2D側顱影像分析及OSP分析的結果,發現傳統側顱分析有低估臉部不對稱的趨勢。第二部分研究中選入49位病人,探討了兩側下顎髁突尺寸的差異和OSP分析結果的相關性,結果表明兩側下顎髁突尺寸的差異和OSP分析結果有顯著正相關。第三部分我們蒐集了51位病人正面照片,並請5位評分者對6項臉部不對稱特徵進行評分,由無到嚴重臉部不對稱分別為1到5分。接著計算相關係數以及回歸分析來探討臉部不對稱特徵和OSP分析結果的相關性。結果表明多數比較的組別為顯著正相關。只有HDA和Lip canting這組沒有顯著相關性。另外我們也對臉部不對稱特徵和OSP分析結果進行回歸分析,並以回歸方程式來預測病人臉部不對稱的嚴重程度。當病人的臉部不對稱特徵被評大於三分時,被認為有明顯的臉部不對稱的情形。因此三分被訂為臨界值。依照回歸方程式,我們可以得到評分三分時OSP分析的預測值分別為:3DDA為 3.35, FDA為 2.1∘, ADD為4.7mm以及PDD為2.04mm。這預測結果可以協助手術醫師針對臉部不對稱的病人制訂手術計畫。
英文摘要 The aim of this study was to establish a new system to diagnose, classify, and quantify facial asymmetry. In clinical, facial asymmetry is one of the most common chief complaints. However, diagnosis of asymmetry was usually by the etiologies. These pathologic diagnoses just provide clinicians an impression of the facial asymmetry, without further information about the facial features and severity of the deformities. Currently, some CT-based 3D analysis methods are developed in which landmarks are used. These methods lack proper reference plane and are inappropriate or inefficient in characterizing the asymmetry. The OSP analysis is a self-developed system to examine symmetry, in which optimal symmetry planes (OSP) are established for midface and mandible for reference in 3D. The present study was divided in three parts. In part I study, we enrolled 35 patients to compare 2D postoanterior cephalometry (PAC) and OSP analysis. In part II, 49 patients were enrolled and the relation between condyle dimension and OSP analysis was examined. In part III, 51 patients were enrolled and conventional frontal facial photographs of 51 patients in natural head position were taken. Then, five raters who were residents from our oral surgery and orthodontic department were instructed to evaluate each picture for six facial asymmetry features on a scale from 1 to 5. Correlation coefficient and regression analysis were calculated to study the relation between rating of facial asymmetry feature and OSP analysis. In part I, we found the conventional 2D PAC analysis was significantly different from the OSP analysis, and was usually under-estimated. Part II study indicated association between condyle dimensional discrepancies and OSP analysis were positive and statistically significance. In part III study, the result showed that OSP analysis and objective rating of symmetry were correlated significantly (P < .05) except for horizontal deviation angle and lip canting. Regression analysis of OSP analysis and soft tissue features were calculated and the regression function could be used to predict severity of facial asymmetry. When the rating of 3 (observable asymmetry) was used as the cutting point for asymmetry, the correspondingly predicted OSP data, as followings: 3.35∘for 3DDA, 2.1∘for FDA, 4.7mm for ADD and 2.04mm for PDD. The predicted values could help surgeon to determine the plan of surgery.
論文目次 CONTENTS
ABSTRACT II
ACKNOWLEDGMENT III
LISTS OF TABLE VI
LISTS OF FIGURE VII
ABBREVIATION X
CHAPTER 1 INTRODUCTION 1
1.1 Background 1
1.2 Literature review 3
1.2.1 Definition, prevalence and etiology of facial asymmetry 3
1.2.2 Diagnosis of facial asymmetry 4
1.3 Motivation 17
1.4 Purposes 17
1.5 The organization of the thesis 18
CHAPTER 2 MATHEMATICAL BACKGROUND 19
2.1 The mathematics of optimal symmetry plane (OSP) 19
2.2 Creation of optimal symmetry plane 20
CHAPTER 3 MATERIALS AND METHODS 22
3.1 Part I: Comparing PAC analysis with OSP analysis in facial symmetry patients 22
3.1.1 Sample selection 22
3.1.2 Posteroanterior cephalometric analysis collection 23
3.1.3 OSP analysis data collection 24
3.1.4 Statistical analysis 24
3.2 Part II: Relation between OSP analyses and condyle dimension 26
3.2.1 Sample selection 26
3.2.2 Measurement of condylar dimension 26
3.2.3 OSP analysis data collection 27
3.2.4 Statistical analysis 27
3.3 Part III: Relation between OSP analysis and the rating of the facial asymmetry features 27
3.3.1 Photography 27
3.3.2 Rating 28
3.3.3 OSP analysis data collection 28
3.3.4 Statistical analysis 29
CHAPTER 4 RESULTS 30
4.1 Part I: Comparing PAC analysis with OSP analysis in facial symmetry patients 30
4.1.1 Discrepancy between PAC analysis and OSP analysis 30
4.1.2 Mismatch trend 30
4.2 Part II: Relation between condyle dimension and OSP analysis 32
4.3 Part III: Relation between OSP analysis and the rating of the facial asymmetry features 32
CHAPTER 5 DISCUSSION 34
CHAPTER 6 CONCLUSION AND PROSPECT 40
REFERENCES 41
APPENDIX 50
VITA 83

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