1.Psychological effects of the mandibular angle osteotomy on female patients
Antong DU ; Neng DING ; Jie ZHU ; Jianlin ZHANG ; Lie ZHU
Chinese Journal of Medical Aesthetics and Cosmetology 2023;29(5):360-363
Objective:To explore the psychological status of female patients with mandibular angle hypertrophy before and after receiving mandibular angle osteotomy (MAO) using psychological measurement methods.Methods:The study included 36 female patients (age ranged 18-35 years, with mean age of 23 years) who underwent bilateral mandibular angle osteotomy at the Department of Burns and Plastic Surgery, Naval Medical University. Symptom Checklist-90 (SCL-90), Self-Rating Anxiety Scale (SAS), and Self-Rating Depression Scale (SDS) were used to assess the patients′ psychological status before and after surgery. SPSS 18.0 was used to compare the preoperative and postoperative data with the national norms.Results:According to the SCL-90 questionnaire, the scores of the six factors, including obsessive-compulsive symptoms (2.24±0.43 vs. 1.62±0.58, P<0.01), interpersonal sensitivity (1.85±0.46 vs. 1.65±0.61, P=0.02), depression (1.91±0.43 vs. 1.50±0.59, P<0.01), anxiety (1.75±0.42 vs. 1.39±0.43, P<0.01), hostility (1.86±0.45 vs. 1.46±0.55, P<0.01), and paranoia (2.18±0.46 vs. 1.43±0.57, P<0.01) of patients before surgery were significantly higher than the national norms. One month after surgery, there was a significant improvement in SAS and SDS scores compared to preoperative scores ( t=8.0, 10.4, P<0.01). The SAS score decreased from 43.0±9.8 to 37.5±6.8, and the SDS score decreased from 47.1±10.6 to 39.4±7.5. There was no statistically significant difference in the depression and anxiety indices of SCL-90 compared to the national norms ( P>0.05). Conclusions:Mandibular angle osteotomy significantly improves the psychological health of female patients with mandibular angle hypertrophy and can alleviate the symptoms of anxiety and depression.
2.Exploration of three-dimensional aesthetic measurement: its value in the diagnosis and treatment of mandibular angle hypertrophy in Shanghai young female
Antong DU ; Neng DING ; Yingnan GENG ; Jie ZHU ; Jian ZHANG ; Lie ZHU
Chinese Journal of Plastic Surgery 2023;39(7):721-729
Objective:To explore the application of three-dimensional measurement data in the diagnosis and treatment of mandibular angle prominent in Shanghai female youth.Methods:The young females in Shanghai were selected from the Clinical Database of Shanghai Universal Medical Imaging Diagnostic Center in Xuhui and the Second Affiliated Hospital of Naval Medical University from January 2010 to December 2020. Three-dimensional reconstruction of the craniofacial region was performed using computer-aided technology, and the subjects were divided into prominent group, attractive group, and contrast group according to the three-dimensional reconstruction images and doctor’s evaluation results. The mandibular and facial regions of the three groups were measured in three dimensions. The measurement indicators included bone tissue indicators such as mandibular angle (∠Co-Go-Me), mandibular expansion angle (∠Go-Me-Go), mandibular body length/mandibular support height ratio (Go-Me/Co-Go), mandibular angle width/zygomatic width ratio (Go-Go/Zy-Zy), and mandibular width index (Go-Go/Co-Co); and the soft tissue indicators included mandibular angle (∠t-go’-gn), mandibular angle width/midface width ratio (go’-go’/zy’-zy’), and mandibular angle width/mandibular height ratio (go’-go’/s-gn). The data were analyzed using SPSS 18.0 software, with normally distributed metric data expressed as Mean±SD. One-way analysis of variance or Kruskal-Wallis rank sum test was used to compare the three groups, and LSD method was used for comparison among prominent group, contrast group and attractive group. Fisher discriminant analysis was used for indicators with statistical significance. P<0.05 was considered statistically significant. Results:A total of 200 young females in Shanghai were enrolled in this study. 73 cases were included in the prominent group, with an age of (26.1±3.2) years, body weight of (54.3±4.3) kg, and body mass index(BMI) of (21.3±1.9) kg/m 2; 32 cases in the attractive group, with an age of (25.3±3.1) years, body weight of (58.7±3.7) kg, and BMI of (20.0±1.5) kg/m 2; and 95 cases in the contrast group, with an age of (27.2±3.7) years, body weight of (53.3±3.4) kg, and BMI of (20.1±1.3) kg/m 2. There were no significant differences in age, body weight, and BMI among the three groups ( P>0.05). There were significant differences in the measurement values of indicators such as ∠Co-Go-Me, ∠Go-Me-Go, Go-Me/Co-Go, Go-Go/Co-Co, ∠t-go’-gn among the three groups ( P<0.01). The prominent group showed significant outward and posterior protrusion in the mandibular angle area compared with the contrast group in terms of ∠Co-Go-Me (111.69°±4.19° vs. 115.43°±3.01°), ∠Go-Me-Go (66.27°±4.51° vs. 64.19°±3.69°), and ∠t-go’-gn (126.13°±7.51° vs. 130.34°±7.21°) ( P<0.01). The attractive group showed significant differences compared with the contrast group in terms of ∠Co-Go-Me (121.61°±3.22° vs. 115.43°±3.01°), Go-Me/Co-Go (1.67±0.20 vs. 1.58±0.15), and ∠t-go’-gn (137.17°±7.57° vs. 130.34°±7.21°) ( P<0.01). The lower quartile of ∠Co-Go-Me in the prominent group was 110°, and the upper quartile of ∠GO-Me-Go was 72°, with a small overlap in the mode region compared with the other two groups. Three indicators, ∠Co-Go-Me ( D1), ∠Go-Me-Go ( D2), and Go-Me/Co-Go ( D3), were selected to establish Fisher discriminant functions. The Fisher discriminant function for prominent group was Z=0.237 D2-0.084 D1-5.813, with a discriminant rate of 60.3%, and for the attractive group was Z=0.257 D1-0.015 D3-28.610, with a Fisher discriminant rate of 85.3%. Conclusion:The ∠Co-Go-Me, ∠Go-Me-Go, ∠t-go’-gn, and other data in Shanghai female youth can be used to evaluate their mandibular contour morphology, providing a reference for the diagnosis and treatment of mandibular angle prominent. The ∠Co-Go-Me of the mandibular aesthetic group should approach 122°, and ∠Co-Go-Me<110° and ∠Go-Me-Go>72° can be used as preliminary indicators for the diagnosis of mandibular angle prominent in prominent group, guiding clinical practice.
3.Application of curve fitting based on least square method in mandibular osteotomy
Antong DU ; Neng DING ; Yingnan GENG ; Jie ZHU ; Jian ZHANG ; Lie ZHU
Chinese Journal of Plastic Surgery 2023;39(9):974-983
Objective:To use the least square method to curve fit the mandibular contours of Chinese women, obtain an ideal fitting function model, and explore the effectiveness of using mathematical curves for bone cutting line design in mandibular osteotomy.Methods:(1) Female cranial CT data were selected from the Second Affiliated Hospital of Naval Medical University and Shanghai Universal Medical Imaging Diagnostic Center. The mandibular morphology of the CT reconstructed images was evaluated using the Likert scale, and samples were selected from individuals with mandibular angle hypertrophy, aesthetically pleasing mandibular morphology, and aesthetically pleasing appearance after osteotomy as references. The Python platform Spyder module was used to analyze the curve fitting of mandibular contour morphology and the goodness of fitting was measured by the coefficient of determination R2( R2 ≥ 0.800 was considered acceptable for the fitted function, while R2≥ 0.900 was deemed sufficient to meet clinical application requirements). The fitting degree of polynomial functions, logarithmic functions, and other mathematical curves in the facial contours of individuals with aesthetically pleasing mandibular morphology were analyzed to obtain an ideal mandibular contour curve fitting function model. (2) Patients with mandibular angle hypertrophy who underwent intraoral mandibular osteotomy from March 2020 to March 2021 at the Department of Plastic and Reconstructive Surgery of Second Affiliated Hospital of Naval Medical University were divided into a mathematical template group (guided by a mathematical curve-based bone cutting plan), a traditional template group (guided by traditional bone cutting templates), and a manual osteotomy group. Three-dimensional reconstruction technology was used to evaluate the efficacy postoperatively. Preoperative preparation time, bone cutting time, surgical time, and postoperative complications were compared among the three groups. Patient self-evaluation of surgical outcomes was assessed using the jawline component of the Face-Q questionnaire. Results:(1) A total of 205 female cranial CT data were selected, including 73 cases of mandibular angle hypertrophy, 32 cases of aesthetically pleasing mandibular morphology, and 5 cases of aesthetically pleasing appearance after osteotomy as reference samples for mandibular contour curve fitting. The result showed that the third-degree polynomial function ( R2=0.918±0.027) and logarithmic function ( R2=0.930±0.039) could be used to simulate the mandibular contour morphology in individuals with aesthetically pleasing mandibular morphology. (2) The mathematical template group (using logarithmic function for bone cutting design), traditional template group, and manual osteotomy group included 28, 14, and 11 patients with mandibular angle hypertrophy, respectively. All patients were satisfied with the postoperative mandibular contour morphology and no complications such as deformity or significant asymmetry were observed. The mathematical template group outperformed the manual osteotomy group in terms of the total score of the jawline questionnaire, surgical time, and bone cutting time(all P<0.01). The preoperative preparation time in the mathematical template group was shorter than that in the traditional template group [(82.39±9.77) min vs. (97.07±17.49) min, P<0.01], and the jawline questionnaire evaluation showed that the patients in the mathematical template group had higher scores in evaluating the lateral view of the mandible and the smoothness of the lower facial contour compared to the traditional template group [3.75±0.44 vs. 3.14±0.36, 3.71±0.46 vs. 3.36±0.50, both P<0.05]. Conclusion:Curve fitting based on the least square method can be used to simulate mandibular angle osteotomy. Models such as logarithmic functions can be used for preoperative design of mandibular osteotomy and have advantages in terms of contour smoothness and symmetry after surgery. Bone cutting design based on mathematical curves can meet patient demands and aesthetic standards, providing precise and individualized solutions for surgery.
4.Exploration of three-dimensional aesthetic measurement: its value in the diagnosis and treatment of mandibular angle hypertrophy in Shanghai young female
Antong DU ; Neng DING ; Yingnan GENG ; Jie ZHU ; Jian ZHANG ; Lie ZHU
Chinese Journal of Plastic Surgery 2023;39(7):721-729
Objective:To explore the application of three-dimensional measurement data in the diagnosis and treatment of mandibular angle prominent in Shanghai female youth.Methods:The young females in Shanghai were selected from the Clinical Database of Shanghai Universal Medical Imaging Diagnostic Center in Xuhui and the Second Affiliated Hospital of Naval Medical University from January 2010 to December 2020. Three-dimensional reconstruction of the craniofacial region was performed using computer-aided technology, and the subjects were divided into prominent group, attractive group, and contrast group according to the three-dimensional reconstruction images and doctor’s evaluation results. The mandibular and facial regions of the three groups were measured in three dimensions. The measurement indicators included bone tissue indicators such as mandibular angle (∠Co-Go-Me), mandibular expansion angle (∠Go-Me-Go), mandibular body length/mandibular support height ratio (Go-Me/Co-Go), mandibular angle width/zygomatic width ratio (Go-Go/Zy-Zy), and mandibular width index (Go-Go/Co-Co); and the soft tissue indicators included mandibular angle (∠t-go’-gn), mandibular angle width/midface width ratio (go’-go’/zy’-zy’), and mandibular angle width/mandibular height ratio (go’-go’/s-gn). The data were analyzed using SPSS 18.0 software, with normally distributed metric data expressed as Mean±SD. One-way analysis of variance or Kruskal-Wallis rank sum test was used to compare the three groups, and LSD method was used for comparison among prominent group, contrast group and attractive group. Fisher discriminant analysis was used for indicators with statistical significance. P<0.05 was considered statistically significant. Results:A total of 200 young females in Shanghai were enrolled in this study. 73 cases were included in the prominent group, with an age of (26.1±3.2) years, body weight of (54.3±4.3) kg, and body mass index(BMI) of (21.3±1.9) kg/m 2; 32 cases in the attractive group, with an age of (25.3±3.1) years, body weight of (58.7±3.7) kg, and BMI of (20.0±1.5) kg/m 2; and 95 cases in the contrast group, with an age of (27.2±3.7) years, body weight of (53.3±3.4) kg, and BMI of (20.1±1.3) kg/m 2. There were no significant differences in age, body weight, and BMI among the three groups ( P>0.05). There were significant differences in the measurement values of indicators such as ∠Co-Go-Me, ∠Go-Me-Go, Go-Me/Co-Go, Go-Go/Co-Co, ∠t-go’-gn among the three groups ( P<0.01). The prominent group showed significant outward and posterior protrusion in the mandibular angle area compared with the contrast group in terms of ∠Co-Go-Me (111.69°±4.19° vs. 115.43°±3.01°), ∠Go-Me-Go (66.27°±4.51° vs. 64.19°±3.69°), and ∠t-go’-gn (126.13°±7.51° vs. 130.34°±7.21°) ( P<0.01). The attractive group showed significant differences compared with the contrast group in terms of ∠Co-Go-Me (121.61°±3.22° vs. 115.43°±3.01°), Go-Me/Co-Go (1.67±0.20 vs. 1.58±0.15), and ∠t-go’-gn (137.17°±7.57° vs. 130.34°±7.21°) ( P<0.01). The lower quartile of ∠Co-Go-Me in the prominent group was 110°, and the upper quartile of ∠GO-Me-Go was 72°, with a small overlap in the mode region compared with the other two groups. Three indicators, ∠Co-Go-Me ( D1), ∠Go-Me-Go ( D2), and Go-Me/Co-Go ( D3), were selected to establish Fisher discriminant functions. The Fisher discriminant function for prominent group was Z=0.237 D2-0.084 D1-5.813, with a discriminant rate of 60.3%, and for the attractive group was Z=0.257 D1-0.015 D3-28.610, with a Fisher discriminant rate of 85.3%. Conclusion:The ∠Co-Go-Me, ∠Go-Me-Go, ∠t-go’-gn, and other data in Shanghai female youth can be used to evaluate their mandibular contour morphology, providing a reference for the diagnosis and treatment of mandibular angle prominent. The ∠Co-Go-Me of the mandibular aesthetic group should approach 122°, and ∠Co-Go-Me<110° and ∠Go-Me-Go>72° can be used as preliminary indicators for the diagnosis of mandibular angle prominent in prominent group, guiding clinical practice.
5.Application of curve fitting based on least square method in mandibular osteotomy
Antong DU ; Neng DING ; Yingnan GENG ; Jie ZHU ; Jian ZHANG ; Lie ZHU
Chinese Journal of Plastic Surgery 2023;39(9):974-983
Objective:To use the least square method to curve fit the mandibular contours of Chinese women, obtain an ideal fitting function model, and explore the effectiveness of using mathematical curves for bone cutting line design in mandibular osteotomy.Methods:(1) Female cranial CT data were selected from the Second Affiliated Hospital of Naval Medical University and Shanghai Universal Medical Imaging Diagnostic Center. The mandibular morphology of the CT reconstructed images was evaluated using the Likert scale, and samples were selected from individuals with mandibular angle hypertrophy, aesthetically pleasing mandibular morphology, and aesthetically pleasing appearance after osteotomy as references. The Python platform Spyder module was used to analyze the curve fitting of mandibular contour morphology and the goodness of fitting was measured by the coefficient of determination R2( R2 ≥ 0.800 was considered acceptable for the fitted function, while R2≥ 0.900 was deemed sufficient to meet clinical application requirements). The fitting degree of polynomial functions, logarithmic functions, and other mathematical curves in the facial contours of individuals with aesthetically pleasing mandibular morphology were analyzed to obtain an ideal mandibular contour curve fitting function model. (2) Patients with mandibular angle hypertrophy who underwent intraoral mandibular osteotomy from March 2020 to March 2021 at the Department of Plastic and Reconstructive Surgery of Second Affiliated Hospital of Naval Medical University were divided into a mathematical template group (guided by a mathematical curve-based bone cutting plan), a traditional template group (guided by traditional bone cutting templates), and a manual osteotomy group. Three-dimensional reconstruction technology was used to evaluate the efficacy postoperatively. Preoperative preparation time, bone cutting time, surgical time, and postoperative complications were compared among the three groups. Patient self-evaluation of surgical outcomes was assessed using the jawline component of the Face-Q questionnaire. Results:(1) A total of 205 female cranial CT data were selected, including 73 cases of mandibular angle hypertrophy, 32 cases of aesthetically pleasing mandibular morphology, and 5 cases of aesthetically pleasing appearance after osteotomy as reference samples for mandibular contour curve fitting. The result showed that the third-degree polynomial function ( R2=0.918±0.027) and logarithmic function ( R2=0.930±0.039) could be used to simulate the mandibular contour morphology in individuals with aesthetically pleasing mandibular morphology. (2) The mathematical template group (using logarithmic function for bone cutting design), traditional template group, and manual osteotomy group included 28, 14, and 11 patients with mandibular angle hypertrophy, respectively. All patients were satisfied with the postoperative mandibular contour morphology and no complications such as deformity or significant asymmetry were observed. The mathematical template group outperformed the manual osteotomy group in terms of the total score of the jawline questionnaire, surgical time, and bone cutting time(all P<0.01). The preoperative preparation time in the mathematical template group was shorter than that in the traditional template group [(82.39±9.77) min vs. (97.07±17.49) min, P<0.01], and the jawline questionnaire evaluation showed that the patients in the mathematical template group had higher scores in evaluating the lateral view of the mandible and the smoothness of the lower facial contour compared to the traditional template group [3.75±0.44 vs. 3.14±0.36, 3.71±0.46 vs. 3.36±0.50, both P<0.05]. Conclusion:Curve fitting based on the least square method can be used to simulate mandibular angle osteotomy. Models such as logarithmic functions can be used for preoperative design of mandibular osteotomy and have advantages in terms of contour smoothness and symmetry after surgery. Bone cutting design based on mathematical curves can meet patient demands and aesthetic standards, providing precise and individualized solutions for surgery.